The evaluation of peripheral nerve disorders has traditionally relied on clinical history, physical examination, and electrodiagnostic studies. The electrodiagnostic study is currently most popular procedure. The purpose of this study is to assess the significance of the changes of amplitude and area of compound muscle action potentials(CMAPs) in peripheral nerve injury. After compression of sciatic nerve in 65 Korean house rabbits, the amplitude and the area of CMAPs were compared to each other before and after compression injury. The correlation coefficients between the changes of the parameters, amplitude and area, were obtained at a scheduled interval, and the parameters were also assessed when the evidence of denervation and regeneration was seen. In addition, the relationship between the degree of abonormal spontaneous activities and each parameter was assessed. At preinjury state, there was a significantly high correlationship between two parameters. The correlation coefficients were 0.764 and 0.756 with distal and proximal stimulations respectively in abductor hallucis recordings, and 0.649 in gastrocnemius recording. At postinjury, there was more significant high correlationship between two parameters. The correlation coefficients were 0.955 and 0.962 with distal and proximal stimulations respectively in abductor hallucis recordings, and 0.930 in gastrocnemius recording. Nineteen cases showed denervation activities at postinjury 4th day. Of those cases, the amplitude was decreased earlier in 2 cases and the area in 3 cases at the same day. Of 10 cases regenerated, the amplitude was normalized earlier than the area in 2 cases. There was a significant decrement tendency in both amplitude and area with the degree of abnormal spontaneous activities. Therefore, both the amplitude and the area of CMAPs are good quantitative indices of peripheral neuropathy and useful parameters in long-term follow up study.
Action Potentials* ; Denervation ; Follow-Up Studies ; Peripheral Nerve Injuries* ; Peripheral Nerves* ; Peripheral Nervous System Diseases ; Physical Examination ; Rabbits ; Regeneration ; Sciatic Nerve

Noonan syndrome is a condition involving facial, cardiovascular and skeletal abnormalities that may pose problems to anesthesiologists during surgery. Propofol, which is used as an induction agent for noncardiac surgery, produces little or no change in the heart rate. Remifentanil decreases the sympathetic and somatic responses to noxious stimuli and can be given in high doses without negative inotropic effects. We report successful management of a patient with Noonan syndrome, hypertrophic cardiomyopathy, and atrial fibrillation, undergoing laparoscopic cholecystectomy using the the total intravenous anesthesia with propofol and remifentanil.
Anesthesia, Intravenous* ; Atrial Fibrillation ; Cardiomyopathy, Hypertrophic ; Cholecystectomy, Laparoscopic ; Heart Rate ; Humans ; Noonan Syndrome* ; Propofol

BACKGROUND: Remifentanil requires a long acting agent for postoperative pain control, and Nalbuphine, a long acting agonist-antagonist, causes less respiratory depression than pure mu-agonists. However, Nalbuphine can also cause additional distress when used with a pure mu-agonist. Therefore, we evaluated the effects of nalbuphine during TIVA with remifentanil and propofol. METHODS: 56 ASA class I, II adult patients undergoing minor surgery were included in this study. After maintaining BIS values between 40-60 as well as a relatively similar blood pressure (BP) and heart rate (HR) for 20 minutes without changing the target concentrations of anesthesia during surgical procedures, the subjects received either 0.1 ml/kg of normal saline or nalbuphine intravenously. Hemodynamic and BIS variables were then recorded for 20 minutes, during which time the target concentrations were not modified. The BIS values, heart rate, and mean arterial pressure were then compared between groups using t-tests, with a P < 0.05 being considered statistically significant. RESULTS: The mean BIS and HR measured at each interval in the nalbuphine group were not significantly different from those of the control group. However, 10, 15 and 20 minutes after the administration of nalbuphine, the mean systolic BP and the mean arterial BP of the treatment and control groups were significantly different (P < 0.05). In addition, the mean diastolic BP was also significantly different 10 and 20 minutes after the treatment was administered (P < 0.05). Postoperative pain was well controlled and none of the patients reported intraoperative awareness. CONCLUSIONS: Although nalbuphine seems to cause distress, which appeared as an increase in BP, it may still be used in combination with propofol and remifentanil because it did not cause a significant increase in the HR and BIS values.
Adult ; Anesthesia ; Anesthesia, Intravenous* ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intraoperative Awareness ; Nalbuphine* ; Pain, Postoperative ; Propofol* ; Respiratory Insufficiency ; Surgical Procedures, Minor

Leprosy is an infectious disease caused by Mycobacterium leprae and characterized by dermal and peripheral nerve lesions. The facial nerve is also frequently involved in leprosy. There are a few electrophysiologic studies on the facial nerve involvement in leprosy patients, but there is no electrophysiologic study on the facial nerve involvement in cured leprosy patitents. So we performed facial nerve conduction study and Blink reflex study in 19 cured leprosy patients who have been managed with Dapsone for a long time. Facial motor latencies were prolonged in 11 patients(57.9%).: 10 of 15 patients in lepromatous type; 1 of 4 patients in tuberculoid type. Prolonged latencies were shown in temporal branch, zygomatic branch, buccal branch, and mandibular branch in 9(47.4%), 6(31.6%), 5(26.3%), and 3(15.8%), respectively. Blink reflex study suggests combined facial nerve and trigeminal nerve lesion in 2 patients.
Blinking ; Communicable Diseases ; Dapsone ; Facial Nerve* ; Humans ; Leprosy* ; Mycobacterium leprae ; Peripheral Nerves ; Trigeminal Nerve

OBJECTIVE: To examine the intra-rater, inter-rater, and inter-instrumental reliability of the digitalized pinch muscle strength dynamometer. METHOD: Thirty normal subjects were examined for pinch strength, using both the Preston pinch gauge and the digitalized pinch dynamometer. The participants performed all pinch strength tests in the seated position as recommended by the American Society of Hand Therapists (ASHT). Three successive measurements were taken for each hand. The mean of the three trials was used for data analysis. The pinch strength tests performed used a repeated measure design and measurements were taken by each rater. RESULTS: The relationship between the Preston pinch gauge and the digitalized pinch dynamometer in pinch strength was reliable (the ICC were 0.821 and 0.785 in rater 1 and rater 2 respectively). The relationship between the first session and second session in pinch strength using the digitalized pinch dynamometer was reliable (the ICC were 0.872 and 0.886 in rater A and rater B respectively). The relationship between rater A and rater B in pinch strength using the digitalized pinch dynamometer was reliable (the ICC was 0.754). CONCLUSION: The pinch strength measurement using the digitalized pinch dynamometer is reliable within the rater and between raters. Thus, the Preston pinch gauge and the digitalized dynamometer measure grip strength equivalently, and can be used interchangeably.
Hand ; Hand Strength ; Muscle Strength ; Muscle Strength Dynamometer ; Pinch Strength ; Statistics as Topic

Terson syndrome is a vitreous hemorrhage associated with subarachnoid hemorrhage. This can be caused by spontaneous, aneurysmal rupture or traumatic subarachnoid hemorrhage, but never has been reported as a consequence of hemorrhage due to thrombolysis and thrombectomy treatments of acute ischemic stroke patient. A 48-year-old man presented with left sided weakness was diagnosed as cerebral infarction on right middle cerebral artery territory due to complete occlusion of right distal internal carotid, middle cerebral, and anterior cerebral artery. He underwent thrombolysis and mechanical thrombectomy, and subarachnoid hemorrhage developed. Later, visual disturbance on right eye occurred so he was consulted to ophthalmology. Vitreous hemorrhage was found and surgery was recommended after two weeks of observation. After pars planar vitrectomy, visual acuity improved, along with functional ability. Therefore, possibilities of Terson syndrome in patients with subarachnoid hemorrhage have to be kept in mind to improve not only visual acuity but also rehabilitation outcome.
Aneurysm ; Anterior Cerebral Artery ; Cerebral Infarction ; Hemorrhage ; Humans ; Middle Aged ; Middle Cerebral Artery ; Ophthalmology ; Rupture ; Stroke* ; Subarachnoid Hemorrhage* ; Subarachnoid Hemorrhage, Traumatic ; Thrombectomy* ; Treatment Outcome ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

OBJECTIVE: To determine the prevalence and related characteristics of carpal tunnel syndrome (CTS) in orchardists and to investigate the association between electrodiagnostic severity and physical examinations. METHODS: Between July 2013 and September 2014, 377 subjects (174 men and 203 women) visited the Gyeongsang National University Hospital's Center for Farmer's Safety and Health. All the subjects underwent electrodiagnostic tests and physical examination, including Phalen's test, Tinel's sign, and Durkan's carpal compression test (CCT). The subjects were classified into 2 groups, the normal group and the CTS group, according to electrodiagnostic test results. To determine the related characteristics of CTS, potential variables, including age, sex, drinking, smoking, body mass index, waist circumference, and total work time, were compared between the 2 groups. The association between electrodiagnostic severity and physical examinations was analyzed. RESULTS: CTS was diagnosed in 194 subjects based only on electrodiagnostic test results, corresponding to a prevalence of 51.5%. Among the variables, mean age (p=0.001) and total work time (p=0.007) were significantly correlated with CTS. With respect to the physical examinations, low specificities were observed for Tinel's sign, Phalen's test, and Durkan's CCT (38.4%, 36.1%, and 40.9%, respectively) in the subjects aged ≥65 years. In addition, Phalen's test (p=0.003) and Tinel's sign (p=0.032) in men and Durkan's CCT (p=0.047) in women showed statistically significant differences with increasing CTS severity. The odds ratio was 2.066 for Durkan's CCT in women according to the multivariate logistic regression analysis. CONCLUSION: CTS prevalence among orchardists was high, and Durkan's CCT result was significantly quantitatively correlated with the electrodiagnostic test results. Therefore, Durkan's CCT is another reliable examination method for CTS.
Body Mass Index ; Carpal Tunnel Syndrome* ; Drinking ; Electrodiagnosis ; Female ; Gyeongsangnam-do* ; Humans ; Logistic Models ; Male ; Methods ; Odds Ratio ; Physical Examination ; Prevalence* ; Smoke ; Smoking ; Waist Circumference

OBJECTIVE: To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital. METHODS: A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS). RESULTS: After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident. CONCLUSION: After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization.
Critical Pathways* ; Deglutition Disorders ; Demography ; Heart Valve Diseases ; Hospitalization ; Humans ; Inpatients ; Length of Stay ; Lower Extremity ; Osteoarthritis ; Rehabilitation ; Rehabilitation Centers ; Retrospective Studies* ; Shoulder Pain ; Stroke*

Collet-Sicard syndrome is a rare syndrome that involves paralysis of 9th to 12th cranial nerves. We report an uncommon case of schwannoma of the hypoglossal nerve in a 39-year-old woman presented with slurred speech, hoarse voice, and swallowing difficulty. Physical examination revealed decreased gag reflex on the right side, decreased laryngeal elevation, tongue deviation to the right side, and weakness of right trapezius muscle. MRI revealed a mass lesion in the right parapharyngeal space below the jugular foramen. The tumor was surgically removed. It was confirmed as hypoglossal nerve schwannoma via pathologic examination. Videofluoroscopic swallowing study revealed aspiration of liquid food and severe bolus retention in the vallecula and piriform sinus. Laryngoscopy revealed right vocal cord palsy. Electrodiagnostic study revealed paralysis of the right 11th cranial nerve. In summary, we report an uncommon case of schwannoma of the hypoglossal nerve with 9th to 12th cranial nerve palsy presenting as Collet-Sicard syndrome.
Adult ; Cranial Nerve Diseases ; Cranial Nerves ; Deglutition ; Female ; Humans ; Hypoglossal Nerve* ; Laryngoscopy ; Magnetic Resonance Imaging ; Neurilemmoma* ; Paralysis ; Physical Examination ; Pyriform Sinus ; Reflex ; Superficial Back Muscles ; Tongue ; Vocal Cord Paralysis ; Voice