NERVE ENTRAPMENT AT THE ELBOW IN RHEUMATOID ARTHRITIS

Although there was some delay in the posterior interosseousbranch of the radial nerve conduction time in six of the 152rheumatoid elbows, in no case were there clinical signs attributableto entrapment of this nerve. Some delay in ulnar nerve conductionwas recorded in 27 of the 152 elbows; this was marked in 12.These patients tended to be older and to have more severe diseaseof the elbow. ^*Paper read at the Annual Meeting of the British Associationfor Rheumatology and Rehabilitation, London, April 1975.     

Anterior dislocation of the shoulders with bilateral brachial plexus injury

A case of bilateral anterior shoulder dislocation accompanied by bilateral brachial plexus injuries is presented. A 53-year-old man fell and landed on his chest and arms flexed at the elbows. The dislocations were satisfactorily reduced using the forward elevation, flexion maneuver. Electromyography and nerve conduction studies confirmed bilateral brachial plexus lesions. Arthrogram of the right shoulder demonstrated a rotator cuff tear. The patient is undergoing physical therapy and making a slow recovery.     

Postoperative results and complications of total elbow arthroplasty in patients with rheumatoid arthritis: three types of nonconstrained arthroplasty

Postoperative results and complications of total elbow arthroplasty (TEA) conducted for rheumatoid arthritis (RA) patients at our institute were studied. Primary TEAs were performed in 72 patients. The mean follow-up period was 3.5 years. Three types of prostheses were implanted: JACE prosthesis in 34 elbows, STABLE prosthesis in 13 elbows, and KUDO prosthesis (type 5) in 32 elbows. The outcome was evaluated by the change in the range of motion and the Japanese Orthopaedic Association functional evaluation score for the elbow joint (JOA score). The arc of motion and the JOA score at discharge and at final examination significantly improved in patients with the three types of prosthesis. The loosening rates for the JACE, STABLE and KUDO prostheses were 15, 23, and 0%, respectively, although the follow-up periods were different. The loosening rate decreased to 2.5% when the humeral component was fixed with cement. Intraoperative fractures occurred in eight (10.1%) elbows and ulnar nerve palsy in six. Deep infection developed in three (4.8%) elbows and was treated by removing the prosthesis. Although there were considerable complications, the marked improvements in pain and function favor TEA in patients with rheumatoid elbow.     

Medial plantar sensory response: Sensitive indicator of peripheral nerve dysfunction in patients with diabetes mellitus

The effects of near-normal glucose control on nerve conduction results were studied in 10 patients with insulin-dependent diabetes mellitus who underwent a six-month program of intensification of therapy. The most striking electrophysiologic abnormality was the medial plantar sensory nerve conduction response. A sensory nerve action potential could not be elicited in seven of the 10 patients at the baseline evaluation. Over the six-month period of near-normal glucose control, there was a return of sensory nerve action potential in all 10 patients. Medial plantar sensory nerve conduction responses appear to be a sensitive and early electrophysiologic indicator of peripheral nerve dysfunction in patients with diabetes mellitus. Near-normalization of plasma glucose levels by intensification of diabetes management may be accompanied by correction of this early abnormality.     

Postoperative results and complications of total elbow arthroplasty in patients with rheumatoid arthritis: three types of nonconstrained arthroplasty

Abstract

Postoperative results and complications of total elbow arthroplasty (TEA) conducted for rheumatoid arthritis (RA) patients at our institute were studied. Primary TEAs were performed in 72 patients. The mean follow-up period was 3.5 years. Three types of prostheses were implanted: JACE prosthesis in 34 elbows, STABLE prosthesis in 13 elbows, and KUDO prosthesis (type 5) in 32 elbows. The outcome was evaluated by the change in the range of motion and the Japanese Orthopaedic Association functional evaluation score for the elbow joint (JOA score). The arc of motion and the JOA score at discharge and at final examination significantly improved in patients with the three types of prosthesis. The loosening rates for the JACE, STABLE and KUDO prostheses were 15, 23, and 0%, respectively, although the follow-up periods were different. The loosening rate decreased to 2.5% when the humeral component was fixed with cement. Intraoperative fractures occurred in eight (10.1%) elbows and ulnar nerve palsy in six. Deep infection developed in three (4.8%) elbows and was treated by removing the prosthesis. Although there were considerable complications, the marked improvements in pain and function favor TEA in patients with rheumatoid elbow.     

Does Fourier phase shift correlate with conduction delay in bundle branch block?

Fourier analysis of radionuclide ventriculography is adept at qualitatively demonstrating interventricular conduction delay in bundle branch block. In this study of eighteen patients, there is a considerable individual variation when the phase delay is expressed as an absolute conduction delay (milliseconds). Much of this variability persists after curve representation by the Fourier function has been optimized. It is suggested that this variability is due to differences in the shape of the right and left ventricular time-activity curves, reflecting differences in contraction and relaxation in the two ventricles. Such differences may be more pronounced in some subjects than others. These results suggest that absolute conduction delay cannot be reliably achieved by this method.     

Electrophysiologic assessments in pudendal and sacral motor nerves after ileal J-pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli

PURPOSE: To clarify neurologic function with respect to external anal sphincter and puborectalis muscles after J configuration ileal J-pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli, we examined the terminal motor latency in the pudendal and sacral motor nerve (S2-4). METHODS: Latency of the response in the external anal sphincter muscle following digitally directed transrectal pudendal nerve stimulation (PNTML) and in the puborectalis muscle following transcutaneous magnetic stimulation of the cauda equina at the levels S2-4 (SMNLTSS) were measured in 12 patients with ileal J-pouchanal anastomosis; they were divided into a group with continence (7 cases) and a group with soiling (5 cases). Results were compared with data obtained from 12 patients before operation and 15 controls. RESULTS: Conduction delay of PNTML and SMNLTSS in patients with soiling was longest, followed by delay in those without any soiling, then delay in patients before operation, and then controls. In addition, significant differences were also noted between conduction delay of PNTML in controls and those who are incontinent and experience soiling (P < 0.05 and P < 0.01, respectively), and there were significant differences also noted between conduction delay of PNTML in patients before operation and those who are incontinent and experiencing soiling (P < 0.05 and P < 0.01, respectively). Conduction delay of PNTML and SMNLTSS were found in patients before operation rather than in controls. No significant differences were noted between conduction delay of PNTML and SMNLTSS in patients before operation and controls. Significant differences were also noted between conduction delay of PNTML and SMNLTSS in patients who are incontinent and experiencing soiling (P < 0.01, respectively). CONCLUSION: These findings support the hypothesis that soiling after this procedure may be partially caused by damage to pudendal and sacral motor nerves (S2-4).Read at the meeting of The Japan Society of Coloproctology, Kobe, Japan, September 24 to 26, 1994.     

Effect of hypoxia on atrio-ventricular conduction in severe respiratory insufficiency

The role of hipoxia on A-V conduction was studied in the patients with severe respiratory insufficiency. Intervals of A-V conduction were measured under basal conditions, breathing room air and with increasing atrial rates. Results are compared with those obtained after the administration of 99% oxygen. A-V conduction times were normal in all the patients while breathing room air and in response to atrial pacing. With oxygen administration most patients had a decrease in A-V conduction at the expense of a prolonged A-H time, without significant alteration of the other time intervals. A-V conduction in chronic hipoxia with a PaO2 above 28 mm Hg is not delayed. Intranodal conduction delay with oxygen administration may be due to a decrease in sympathetic nerve stimulation.     

An alternative nerve conduction study method to evaluate early diabetic neuropathy: Ratio of different diameter nerve fibers in peroneal nerve

Different nerve fibers may have disparate conduction parameters even though they are in the same peripheral nerve. Hyperglycemia can have differential effects on nerve fibers, depending on diameter. In diabetes, conventional nerve conduction studies have allowed us to classify a peripheral nerve as normal or not. But, there may be differential involvement in disparate nerve fibers of the same peripheral nerve. This study evaluated the effects of hyperglycemia on nerve fibers of peroneal nerve by diameter. Thirty-five diabetic patients with normal nerve conduction studies and thirty-two healthy controls were included to the study. The peroneal nerve was stimulated from two points (upper and below the fibula head) and recorded from the tibialis anterior (TA) and extensor digitorum brevis (EDB) muscles. Then the ratios of conduction velocity parameters recorded in these sides were compared between the diabetic and control groups. The conduction velocity recorded from EDB seemed to be faster in both groups. But there were no significant differences among the ratios between the groups. Our study has demonstrated the conduction parameters of two nerve fibers with different diameters in the peroneal nerve. The ratios of conduction parameters were similar in both groups, suggesting that fibers in the peroneal nerve are similarly affected by hyperglycemia.

     

117例双心室再同步起搏器植入术并发症分析

目的　双心室同步起搏已经被证明可有效改善充血性心力衰竭患者的心功能。进行双心室再同步治疗 (cardiacresynchronizationtherapy ,CRT)的技术关键是植入左心室导线。植入左心室导线技术难度大 ,操作复杂 ,有一定的并发症发生率 ,本文分析了 117例双心室起搏器植入术并发症。方法　充血性心力衰竭伴心室内阻滞患者 117例 ,其中男性 86例 ,女性 31例 ,平均年龄 (5 3 0 0±8 2 5 )岁。患者在进行逆行冠状静脉窦造影后 ,经冠状静脉窦插入导线至心脏静脉 (主要为心脏后静脉和侧后静脉 )进行左心室起搏。然后植入右心房和右心室电极导线。结果　 117例患者中 111例成功植入双心室起搏系统 ,成功率为 95 %。主要植入术的相关并发症包括 :冠状静脉窦夹层 4例(3 4 % % ) ,膈肌刺激需要重新植入 2例 (1 7% ) ;电极导线脱位 2例 (1 7% ) ,结论　双心室再同步治疗 (cardiacresynchronizationtherapywithbiventricularpacing)起搏器植入术有一定的术中并发症和一定的风险 ,术前应掌握好适应证并作好充分的准备 ,术中必须规范操作 ,严密观察 ,以减少并发症     

Central nervous system involvement in elderly patients with non-insulin-dependent diabetes mellitus

Summary We examined cognitive functions and central conduction velocities in 20 patients, over 63-year old, with NIDDM compared with 20 normal, age-matched controls. Mean conduction velocity of median nerve, was significantly lower in diabetics than in controls, but absolute values were within normal range. Neurological examination showed clinical signs of lower limbs neuroperipheral involvement. Only one cognitive subtest performance was abnormal whereas there was no impairment in central conduction velocities. In our study population, although median nerve conduction velocity values may introduce a bias of low peripheral neuropathy incidence, there was no evidence of a massive or progressive specific central nervous system involvement caused by NIDDM.     

糖尿病周围神经病变的神经传导检查特点

目的 分析神经传导检查在糖尿病周围神经病变（DPN）中的特点,提高此方法诊断DPN的敏感性. 方法 对符合标准的213例患者的2283条神经行传统的神经传导、F波、H反射检查,并分析各条神经总的神经电生理检查情况. 结果 2283条神经进行常规神经传导检查结果显示,感觉神经传导速度（SCV）中,正中神经的异常率最高;运动神经传导速度（MCV）中,胫神经、正中神经异常率高;最长的胫神经运动神经神经传导异常率为47.45％,容易合并卡压的正中神经感觉神经传导异常率为46.83％,而腓肠神经感觉神经传导异常率最低（22.60％）.对有临床明确症状的21条神经进行神经传导检查,异常率可达76.19％.对感觉神经传导异常的尺神经进行运动神经传导检查,尺神经异常率为57.14％.常规神经传导检查,正中神经感觉神经传导异常率（46.83％）高于正中神经运动神经传导异常率（41.13％）.正中神经感觉神经传导异常者运动神经传导异常率为76.56％,正中神经运动神经传导异常者感觉神经传导异常率为89.63％.尺神经F波、胫神经H反射的异常率分别为25.83％、52.24％.结论 DPN具有长度依赖性、与临床表现一致、感觉重于运动、全长弥漫受累等特点,根据这些特点选择神经进行神经传导检查,可提高神经传导检查诊断DPN的敏感性.     

Essential fatty acid treatment prevents nerve ischaemia and associated conduction anomalies in rats with experimental diabetes mellitus

Summary In rats with 6 weeks streptozotocin-diabetes there was a 53% reduction in sciatic nerve laser Doppler flux compared to controls (p<0.01). Treatment of a parallel group of diabetic rats with evening primrose oil, by dietary admixture throughout the protocol, prevented this ischaemia (Doppler flux was 91% of evening primrose oil-treated controls and was not significantly different). There were no differences in systemic arterial pressure. In another experiment evening primrose oil markedly antagonised the development of exaggerated resistance to anoxic conduction failure in sciatic nerves from diabetic rats. The resistance to anoxia of nerves from non-diabetic rats was also reduced by evening primrose oil. These observations suggest that the sciatic nerves of diabetic rats with short-term streptozotocin-diabetes are markedly ischaemic and that this ischaemia is involved in the development of increased resistance to anoxic/ischaemic conduction failure in diabetic nerve. The findings also promote evening primrose oil as a potential treatment to prevent nerve ischaemia.     

兔右心室流出道兴奋传导的延迟现象

用微电极细胞内记录法,检测了离体兔动脉圆锥各部的动作电位和传导速度。结果发现,兴奋由肺动脉瓣左瓣下的隆起部(心室肌肉柱的向上延伸部分)传向右瓣下的平滑部,或做反向传导时,均发生明显的传导延迟,延迟时间可达20毫秒以上。延迟主要发生在这两个部位的交界处;该处动作电位幅度较小、传导速度缓慢,仅为0.08mm/ms。作者认为,这种现象可能是发生学上心室—动脉球传导延迟的反映,并可能与u波的形成有关.     

白花丹参水提物对糖尿病大鼠神经病变的干预作用观察

目的 观察白花丹参水提物对糖尿病大鼠神经病变的干预作用.方法 以高糖高脂饮食喂养的60只雄性Wistar大鼠尾腹腔注射链脲佐菌素（40 mg/kg）建立糖尿病大鼠模型,随机分为模型组、白花丹参小剂量组[15g/（kg·d）]、白花丹参中剂量组[30 g/（kg·d）]、白花丹参大剂量组[45 g/（kg·d）]、甲钴胺组[17.5 mg/（kg·d）].均灌胃给药,连续12周.分别于给药第6周和第12周测定坐骨神经运动神经传导速度（MNCV）、感觉神经传导速度（SNCV）,给药第12周检测血清神经生长因子（NGF）和坐骨神经内cAMP、cGMP及空腹血糖（FPG）等指标,并进行统计分析.结果 与模型组比较,白花丹参各剂量组、甲钴胺组FPG、MNCV、SNCV、NGF、cAMP、cGMP等指标均优于模型组（P＜0.05）;白花丹参各剂量组随剂量的增加,效果显著增加（P＜0.05）.结论 白花丹参水提物对糖尿病模型大鼠神经病变有较好的治疗作用,可显著提高神经传导速度、恢复神经功能、延缓糖尿病性神经病变的发生和发展.     

Neurological disorders and adult coeliac disease

An investigation into the incidence of neurological disorder in 30 patients with adult coeliac disease has shown that three patients had severe depression, two had epileptiform convulsions, and one patient only had signs of involvement of the peripheral nervous system. Motor nerve conduction velocity was low in only one patient. When the nerve conduction velocities of the group on a gluten-free diet were compared with the group who were not on a gluten-free diet, there was no statistically significant difference. Similarly, nerve conduction velocities in patients with a low serum pyridoxal level were not significantly different from those with normal serum pyridoxal levels.Measurements of the serum level of pyridoxal in 30 patients confirmed that pyridoxine deficiency occurs in adult coeliac disease and that the restriction of gluten from the diet appeared to affect pyridoxal levels favourably.     

MULTIPLE PERIPHERAL NERVE ENTRAPMENT IN FORESTIER'S DISEASE (DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS)

A patient with typical diffuse idiopathic skeletal hyperostosisand characteristic new bone formation around the elbows exhibitedbilateral ulnar nerve entrapment at these sites as well as mediannerve compression at one wrist. KEY WORDS: Ulnar nerve, Median nerve, Heterotopic bone, Surgical decompression     

硫辛酸联合甲钴胺用于糖尿病周围神经病变的治疗效果研究

目的分析α-硫辛酸联合甲钴胺用于糖尿病周围神经病变的治疗效果。方法选取该院2017年1月—2019年4月糖尿病周围神经病变患者共102例,数字表随机分两组,每组51例,对照组的患者给予甲钴胺治疗,观察组给予甲钴胺联合硫辛酸治疗。比较两组治疗前后患者神经传导速度中腓总神经运动神经传导测定值、感觉神经传导测定值以及胫神经速度运动神经传导测定值、感觉神经传导测定值、总有效率。结果治疗前两组患者神经传导速度中腓总神经运动神经传导测定值、感觉神经传导测定值以及胫神经速度运动神经传导测定值、感觉神经传导测定值比较,差异无统计学意义(P>0.05)。治疗后两组测定值均加速,差异有统计学意义(t=4.480、3.914、4.194、6.233,P<0.05)。观察组总有效率100.00%高于对照组,差异有统计学意义(χ²=7.799,P<0.05)。结论甲钴胺联合α-硫辛酸对于糖尿病周围神经病变的治疗效果确切,可显著改善患者症状及周围神经功能,是一种有效的治疗方案。     

Discrimination between painful and painless diabetic neuropathy based on testing of large somatic nerve and sympathetic nerve function.

The syndromes of painful diabetic neuropathy and painless foot ulceration are distinct clinical entities. To investigate whether there is a pattern of nerve fibre involvement that could clearly discriminate between them, we have studied three groups of diabetic patients, 19 with painful neuropathy, 14 with painless foot ulceration, and 19 with no clinical neuropathy. Large somatic nerve fibre function was assessed by nerve conduction studies and vibration thresholds, small somatic nerve function by cooling and warming thresholds, the parasympathetic system by heart-rate dependent cardiac autonomic reflexes, and the sympathetic system by postural drop in blood pressure and plasma noradrenaline (supine and erect). Normal ranges were obtained from 25 age-matched healthy subjects. Painful neuropathy was characterized by uniform dysfunction of small somatic fibres and preserved sympathetic nerve activity (plasma noradrenaline) with a wide range of large somatic fibre and autonomic reflex abnormalities. By contrast, in painless foot ulceration there was universal severe dysfunction of all nerve fibre populations. Discriminant analysis identified peroneal motor conduction velocity as the best single variable for distinguishing between painful and painless neuropathy (81% of cases). A combination of peroneal motor conduction velocity with vibration threshold and plasma noradrenaline discriminated completely between the two clinical syndromes. These findings suggest that the key differences between painful and painless diabetic neuropathy are in large somatic and sympathetic fibre function.     

The effects of zenarestat, an aldose reductase inhibitor, on peripheral neuropathy in Zucker diabetic fatty rats

We studied the effects of zenarestat, an aldose reductase inhibitor (ARI), on peripheral neuropathy in Zucker diabetic fatty (ZDF) rats, an animal model of type 2 diabetes. ZDF rats and their lean rats counterparts were fed a sucrose-containing diet, and zenarestat was given orally once a day for 8 weeks. Motor nerve conduction velocity (MNCV), F-wave minimal latency (FML), and sorbitol concentrations in the sciatic nerve were measured. In ZDF control rats, a remarkable accumulation of sorbitol, a delay in FML, and a slowing of MNCV were observed compared with lean rats. At a dose of 3.2 mg/kg, zenarestat had no significant effect on the delay in FML and the slowing of MNCV, although the sorbitol accumulation in the sciatic nerve was partially inhibited in ZDF rats. On the other hand, 32 mg/kg zenarestat treatment improved these nerve dysfunctions in ZDF rats, along with a reduction of nerve sorbitol accumulation almost to the level of lean rats. These data showed that zenarestat improved diabetic peripheral neuropathy in ZDF rats, a type 2 diabetes model, providing evidence for the therapeutic potential of zenarestat for the treatment of diabetic neuropathy.