BACKGROUND: To compare the diagnostic value between Phalen's test and reverse Phalen's test using a morphological change of the median nerve and the carpal tunnel in diabetics and normal controls seen by high-resolution ultrasonography and to research on an ultrasonography as an available tool for the screening and follow up aid-test of the carpal tunnel syndrome(CTS). METHODS: A cross-sectional area and a flattening ratio of the median nerve, and a cross-sectional area of the carpal tunnel were measured in neutral, maximally flexed(Phalen's test), and maximally extended (reverse Phalen's test) positions in 59 wrists of 30 normal controls and 60 wrists of 30 diabetics. RESULTS: 1) In controls and diabetics, the mean cross-sectional area of median nerve at the hamatum were 8.8/10.2 mm2, 8.0/9.5 mm2, 8.3/9.4 mm2, the mean flattening ratio were 3.0/3.0 mm2, 2.4/2.0 mm2, 3.2/3.0 mm2, the mean cross-sectional area of carpal tunnel were 176.5/197.7 mm2, 157.9/187.0 mm2, 170.6/192.5 mm2 in neutral, maximal flexion and maximal extension. 2) In controls, the cross-sectional area of median nerve and carpal tunnel were significantly decreased in maximal flexion(p<0.01), and in maximal extension(p<0.01). 3) In controls, the mean flattening ratio of median nerve was revealed significant change in maximal flexion(p<0.01), and in maximal extension(p<0.01). 4) In diabetics, the flattening ratio was significantly decreased in maximal flexion(p<0.01) with com- paring to neutral position. 5) In diabetics, the cross-sectional area of median nerve and carpal tunnel were significantly increased in all positions(p<0.05), and the mean flattening ratio of median nerve was similar to controls. CONCLUSION: In diabetics, increased cross-sectional area of median nerve can be explained by swelling of median nerve, also increased cross-sectional area of carpal tunnel is can be said to have taken place by the decreasing of the useful space in between the median nerve and carpal tunnel, this show that the diabetics have the high risk of the CTS. Phalen's test reveals higher degree of irritation to median nerve, The high-resolution ultrasonography is suggested as an available tool for the screening and follow up aid-test for the CTS
Carpal Tunnel Syndrome ; Follow-Up Studies ; Mass Screening ; Median Nerve* ; Ultrasonography ; Wrist*

BACKGROUND: Exercise testing is a standard noninvasive method used in the evaluation and management of patients with suspected coronary artery disease. However, patients with lower limb impairment are unable to undergo a standard bicycle or treadmill test. Alternative methods of exercise testing are needed for patients with vascular, orthopedic or neurologic conditions who cannot perform leg exercise. This study was aimed to determine the diagnostic accuracy of arm exercise thallium-201 SPECT for evaluating chest pain in patients unable to perform leg exercise. METHOD: Twenty-five anginal patients performed arm ergometry testing in conjunction with thallium-201 SPECT. Thereafter all underwent coronary angiography. RESULT: Significant coronary artery disease (> or =50% stenosis) in at least one vessel was present in 22 (88%) of the 25 patients. The sensitivity of thallium-201 SPECT for detecting coronary artery disease was 91%, which was significantly higher than the 32% sensitivity found with the electrocardiographic response alone (p <0.001). Thallium-201 SPECT yielded a sensitivity of 88, 86 and 100% for one, two, and three vessel diseases, respectively, and an 84% sensitivity and 81% specificity for detecting individual vessel stenosis. CONCLUSION: Arm exercise thallium-201 SPECT is useful for detecting coronary artery disease in patients unable to perform leg exercise. In addition, it provides an information regarding exercise tolerance. Therefore, this test appears to be reliable and useful and should be considered in the detection of coronary artery disease in nonambulatory patients.
Angina Pectoris ; Arm* ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Exercise Test ; Exercise Tolerance ; Humans ; Leg ; Lower Extremity ; Orthopedics ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

Malignant hyperthermia is defined as a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia, skeletal muscle rigidity, tachycardia, respiratory and metabolic acidosis, cyanosis etx. There is no simple noninvasive test to identify the susceptible individuals. A history of hyperpyrexia and/or muscle rigidity during previous general or a family history of such a condition provides the anesthesiologist with valuable information. Avoidance of potent inhalational anesthetic agents and other triggering agenta, and the selective use of regional anesthesia with either a local anesthetic agent or neuroleptic anesthesia, are the usual acceptable guidelines in the anesthetic management of susceptible individuals. Dentrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia in malignant hyperthermia susceptible swine. We gave Dantrolene sodium orally as a part of the prophylaxia for malignant hyperthermia in a 34yearts-old woman who underwent an emergency bilateral salpingectomy and who had a family history of malignant hyperthermia. We report on this patient with a family history of hyperthermia and reviewed the literature concerning malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Conduction ; Anesthetics ; Cyanosis ; Dantrolene ; Emergencies ; Female ; Fever ; Humans ; Malignant Hyperthermia* ; Muscle Rigidity ; Muscle, Skeletal ; Salpingectomy ; Sodium ; Swine ; Tachycardia

A congenital ureteral valve is a rare disease, with the first case presented in 1887, since when, only 42 cases have subsequently been reported. From a review of the reported cases, this abnormality was often found to be associated with other urological disorders, such as vesicoureteral reflux, ectopic ureter, complete and incomplete duplication of the kidney, and contralateral renal atrophy. Here, the case of an adult patient with multiple congenital ureteral valves and renal atrophy is reported.
Adult* ; Atrophy ; Constriction, Pathologic ; Humans ; Kidney ; Rare Diseases ; Ureter* ; Vesico-Ureteral Reflux

Arterial blood gas analysis has become an integral part of the clinical evaluation of the patient with known or suspected pulmonary disease. However, when the results of the measurements show arterial hypoxemia which is out of proportion to the clinical and X-ray evidence of lung disease, we may consider potential errors in measurement involving the blood gas analyzer or methods of blood sample storage. We experienced spurious hypoxemia in a patient with extreme leukocytosis (220.0 X 10(3)/mm3) secondary to leukemia. The degree of PaO2 decay was blunted by placing the blood on ice.
Anoxia ; Blood Gas Analysis ; Humans ; Ice ; Leukemia ; Leukocytosis* ; Lung Diseases ; Oxygen*

PURPOSE: The tension-free vaginal tape SECUR(R) (TVT-S) is a new, minimally invasive sling procedure for treating female stress urinary incontinence (SUI). However, results of comparisons of the TVT-S with the transobturator tape (TOT) sling are lacking. Therefore, we investigated outcome and satisfaction of the TVT-S procedure compared with the TOT procedure. MATERIALS AND METHODS: We included 64 patients with SUI who underwent the TVT-S (n=31) or TOT (MONARC(R), n=33) procedure and were followed up for more than 1 year. The preoperative evaluation included history taking, pelvic examination, consecutive 3-day voiding diary, and urodynamic study including Valsalva leak point pressure. Postoperatively, continence status and subjective patient satisfaction were evaluated. Cure was defined as the absence of any episodes of involuntary urine leakage during stressful activities and a stress cough test. RESULTS: The TVT-S group (71.0%) showed a slightly lower cure rate than did the MONARC group (84.8%); however, there was no significant difference between the 2 groups (p=0.179). Nine of the patients who underwent the TVT-S showed incontinence postoperatively. Among them, the H approach was used in 7 patients and the U approach was done in 2 patients. Following TVT-S and MONARC, the patients' reported satisfaction was 80.6% and 78.8%, respectively. Patient satisfaction did not differ significantly between the two groups (p=0.854). CONCLUSIONS: Our results showed that the TVT-S and MONARC procedures may be comparable in terms of cure rate and patient satisfaction after more than 1 year of follow-up.
Cough ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Patient Satisfaction ; Suburethral Slings ; Surgical Procedures, Minimally Invasive ; Treatment Outcome ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urodynamics

OBJECTIVE: To compare the diagnostic value between Phalen's test and reverse Phalen's test using a morphological change of the median nerve and the carpal tunnel seen by high-resolution ultrasonography and to research on an ultrasonography as an available tool for the screening and follow up aid-test of the carpal tunnel syndrome (CTS). METHOD: A cross-sectional area and a flattening ratio of the median nerve, and a cross-sectional area of the carpal tunnel were measured in neutral, maximally flexed (Phalen's test), and maximally extended (reverse Phalen's test) positions in 59 wrists of 30 normal subjects. RESULT: The cross-sectional area of median nerve was significantly decreased in maximal flexion (p<0.01), and in maximal extension (p<0.01). The mean flattening ratio of median nerve was revealed significant change in maximal flexion (p<0.01), and in maximal extension (p<0.01). The mean cross-sectional area of the carpal tunnel was significantly decreased in maximal flexion (p<0.01), and in maximal extension (p<0.01), with comparing to neutral position, respectively. CONCLUSION: Phalen's test reveals higher degree of irritation to median nerve. The high-resolution ultrasonography is suggested as an available tool for the screening and follow up aid-test for the CTS.
Carpal Tunnel Syndrome ; Follow-Up Studies ; Mass Screening ; Median Nerve* ; Ultrasonography ; Wrist*

OBJECTIVES: To introduce a new injection material for vocal fold diseases, which could be readily translated to clinical practice, we investigated the effectiveness of platelet-rich plasma (PRP) injection on the injured vocal fold in terms of histological recovery. METHODS: Blood samples were drawn from New Zealand White rabbits and PRP was isolated through centrifugation and separation of the samples. Using a CO2 laser, we made a linear wound in the 24 vocal fold sides of 12 rabbits and injected each wound with PRP on one vocal fold side and normal saline (NS) on the other. Morphologic analyses were conducted at 2, 4, and 12 weeks after injection, and inflammatory response, collagen deposit, and changes in growth factors were assessed using H&E and masson trichrome (MT) staining and western blot assay. RESULTS: PRP was prepared in approximately 40 minutes. The mean platelet concentration was 1,315,000 platelets/mm3. In morphological analyses, decreased granulation was observed in the PRP-injected vocal folds (P<0.05). However, the irregular surface and atrophic change were not difference. Histological findings revealed significant inflammation and collagen deposition in NS-injected vocal folds, whereas the PRP-injected vocal folds exhibited less (P<0.05). However, the inflammatory reaction and fibrosis were not difference. In western blot assay, increased amounts of growth factors were observed in PRP-injected vocal folds. CONCLUSION: Injection of injured rabbit vocal folds with PRP led to improved wound healing and fewer signs of scarring as demonstrated by decreased inflammation and collagen deposition. The increased vocal fold regeneration may be due to the growth factors associated with PRP.
Blood Platelets ; Blotting, Western ; Centrifugation ; Cicatrix ; Collagen ; Fibrosis ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Lasers, Gas ; Platelet-Rich Plasma* ; Rabbits ; Regeneration ; Vocal Cords* ; Wound Healing* ; Wounds and Injuries*

Moyamoya disease is characterized by progressive stenosis of the distal portion of the internal carotid arteries and fragile collateral vessels in the brain. The precise pathogenesis is still not known. Although extracranial vessel involvement is very rare, coronary arterial involvement has recently been reported. Here, we report a case of diffuse, multivessel coronary spasm leading to cardiac arrest and myocardial infarction in a 47-year-old man with moyamoya disease with no underlying emotional or physical stress.
Brain ; Carotid Artery, Internal ; Constriction, Pathologic ; Death, Sudden, Cardiac ; Heart Arrest* ; Humans ; Middle Aged ; Moyamoya Disease* ; Myocardial Infarction ; Spasm*

BACKGROUND/AIMS: In patients with coronary artery stents, the cost of clopidogrel has been cited as a factor in the premature discontinuation of therapy. Thus, the introduction of lower-cost generic clopidogrel may increase patient compliance. However, platelet inhibition by generic clopidogrel has not been compared to the original clopidogrel formulation in patients with coronary artery stents. METHODS: We prospectively enrolled 20 patients receiving chronic therapy with the original clopidogrel bisulfate (Plavix(R)). After assessing patient compliance with Plavix(R), maintenance therapy was switched to generic clopidogrel bisulfate (Plavitor(R)). Platelet reactivity was assessed at baseline and 30-day after the switch using conventional aggregometry and the VerifyNow P2Y12 assay. RESULTS: All patients completed maintenance therapy with Plavitor(R). Before and after switching therapy maximal (36.5 +/- 7.9% vs. 39.8 +/- 16.2%, p = 0.280) and late platelet aggregation (23.5 +/- 10.9% vs. 29.1 +/- 18.3%, p = 0.156) with 5 micromol/L adenosine diphosphate (ADP) stimulus did not differ. Likewise, 20 micromol/L ADP-induced platelet aggregation and P2Y12 reaction unit in patients on Plavitor(R) therapy was comparable to that in patients on Plavix(R) therapy. However, Bland-Altman analysis showed wide limits of agreement between measured platelet reactivity on Plavix(R) vs. Plavitor(R) therapies. CONCLUSIONS: Among patients on Plavix(R) maintenance therapy with coronary stents, replacement with Plavitor(R) shows a comparable inhibition of ADP-induced platelet aggregation. However, due to poor inter-therapy agreement, between two regimens, physicians may be cautious when introducing generic clopidogrel bisulfate.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Combined Modality Therapy ; Coronary Artery Disease/*drug therapy/therapy ; *Drug-Eluting Stents ; Drugs, Generic/*administration & dosage/adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Compliance ; Platelet Aggregation/drug effects ; Platelet Aggregation Inhibitors/*administration & dosage/adverse effects ; Prospective Studies ; Receptors, Purinergic P2/metabolism ; Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives