Sleep quality in hospitalized patients

Aims and objectives. The objective of this study was to evaluate and compare sleep quality of the hospitalized patients and matched healthy controls. Background. Although the functions of sleep are not clearly understood, it is generally accepted that it is necessary for the maintenance of good health. Hospitalized patients’ sleep may not be refreshing or restorative. The reasons for this can be categorized into three groups: environmental, physiological and psychological. Design and methods. This research was conducted at the Cumhuriyet University Hospital in Turkey. One hundred and fifty hospitalized patients (psychiatry = 50; orthopaedic + general surgery + cardiovascular surgery + urology = 50; internal medicine + chest diseases + infectious diseases + physical therapy and rehabilitation = 50) and 50 healthy controls constituted the sample. The researchers administered to the patient and control groups Sociodemographic Information Form and the Pittsburgh Sleep Quality Index. We compared sociodemographic and illness variables with sleep characteristics. The following statistical analyses were used in order to evaluate the data: variance analysis, Tukey HSD test, Student's t‐test, Kruskall–Wallis test. Results. We found that patients in psychiatric ward experienced worse sleep quality than the other patients, worse in female patients than male patients, and worse sleep characteristics in patients than controls. Conclusions. Health professionals must be educated about sleep and must provide intervention when needed. Relevance to clinical practice. The enhancing of sleep quality accelerates to the recovery from illness.     

Diagnostic value of electrical stimulation of lumbosacral roots in lumbar spinal stenosis

OBJECTIVES: This paper compares the diagnostic sensitivity of two tests in lumbar spinal stenosis (LSS): lumbosacral root stimulation with needle electrodes and needle electromyograph (EMG). MATERIAL AND METHODS: Twenty patients with LSS were assigned to two groups: Patients with 'neurogenic intermittent claudication' (NIC) only (n=11), and patients with 'neurological signs' (n=9). Ten normal subjects were also examined. The effects of direct stimulation of the lumbosacral roots and conventional EMG recorded from important muscles [rectus femoris (RF): L4, tibialis anterior (TA): L5, soleus muscle (SOL): S1], were compared with each other and correlated with their respective clinical findings and radiological images. RESULTS: Needle EMG and nerve conduction study revealed pathology in 15/20 patients, and electrical stimulation of the roots in 17/20 patients. Agreement in radiological findings with electrical stimulation of the roots and EMG was found in 12 patients. The other patients were harmonic with radiological findings either in EMG or in electrical stimulation of the roots. CONCLUSIONS: Electrical root stimulation revealed more abnormalities in patients with LSS in comparison with needle EMG. However, both methods seemed to complement each other to show additional pathology in a given patient.     

The role of peritoneal lavage in treatment of penetrating abdominal injuries]

Preventing negative laparotomies is one of the most challenging problems in the management of penetrating abdominal injuries. The term "selective laparotomy" has been therefore introduced and has found an ever increasing acceptance. The peritoneal lavage is a useful tool in patient selection for laparotomy but the main problem is where to set the boundary between a positive and a negative peritoneal lavage. The manipulation of this boundary leads to significant changes in the sensitivity and specificity of the peritoneal lavage. Here we are presenting 162 consecutive cases of penetrating abdominal trauma and discussing our methods of evaluation and management.     

Morphology and Innervation of the Human Cremaster Muscle in Relation to its Function

The electromyographic properties of the cremaster muscle (CM) are quite different from other skeletal muscles. It shows excessive spontaneous discharges, and the motor unit shape and firing frequency of the CM muscle differ from that of limb muscles. In this study, CM of six adult cadavers and six orchiectomy specimens were used to reveal the detailed histology of the muscle and provide an anatomophysiological explanation for these unusual electromyographic properties. Routine histochemical stains revealed the CM was composed of several distinct bundles of smooth and striated muscle fibers within connective tissue. The smooth muscle fibers that were more profuse than previously known and were not arranged in layers, but widely dispersed between striated muscle fibers. Bielschowsky silver staining technique, anti‐neurofilament and anti‐synaptophysin immunostaining showed the presence of multiple motor end‐plates observed as a series of small dots or lines running along the striated muscle fibers and several nerve endings on a single muscle fiber. Myosin immunostaining confirmed the CM is a slow‐twitch muscle, and α‐actin smooth muscle immunostaining confirmed the presence of a large number of smooth muscle fibers. There were also small multipolar neurons forming nerve plexuses between smooth muscle fibers. Anti‐GFAP immunostaining confirmed the presence of glial cells similar to astrocytes. In conclusion, the findings of this detailed anatomical study showed the CM, widely known as a striated muscle, contains a large number of smooth muscle fibers, and the spontaneous electromyographic discharges are due to the presence of multiple motor end‐plates and dense innervation. Anat Rec,291:790‐796, 2008. © 2008 Wiley‐Liss, Inc.     

Dermatological signs in Wilson's disease

Background:  Because no data on skin and mucosal findings of patients with Wilson's disease have been published so far, the aim of the present study was to investigate the prevalence of mucosal and skin findings in childhood Wilson's disease and to determine its specific dermatological findings, if any exist.
Methods:  Thirty-seven 4–17-year-old children with Wilson's disease were included. A complete skin, scalp skin, mucous membrane and nail examination was performed.
Results:  Of the children, 26 (70.3%) had at least one dermatological finding. Twenty-five (67.6%), five (13.5%), nine (24.3%) had at least one skin, mucosal and nail finding, respectively. The most prevalent dermatological diagnosis of the Wilson's disease patients was xerosis (45.7%). The presence of dermatological findings was not related to drug usage, severity of the disease, or malnutrition. The duration of the disease was not different in patients with or without dermatological findings. The frequency of skin findings alone, however, was high in relatively newly diagnosed patients (<2 years).
Conclusion:  Dermatologist should be aware of the various dermatological manifestations of Wilson's disease, because a careful and objective skin, mucosa, nail and hair examination may be indicative of a diagnosis of Wilson's disease, particularly in early cases.     

Cerebral evoked potentials after stimulation of the posterior urethra in man.

Cerebral evoked potentials (EPs) were recorded in 25 neurologically normal subjects aged 22-73 years (mean 44.0) after stimulation of the posterior urethra (PU) and the pudendal nerve. After maximal PU stimulation 2 different configurations of the potential were found. In 12 cases a simple bi-triphasic wave form was recorded while in 12 cases there was a bifid form of the first negative wave. In 1 case identical EPs were recorded after PU and pudendal nerve stimulation. It was concluded that (1) PU stimulation excites fibres in the pudendal nerve at higher stimulation strength, resulting in a bifid wave form of the cerebral evoked potential in some individuals, (2) the most prominent negative peak, N1, with a latency of 102.1 +/- 13.2 msec, is the most reproducible part of the PU-evoked potential, (3) the N1 is probably transmitted through A delta fibres localized in the pelvic nerves, (4) there are differences between individuals concerning pudendal and pelvic nerve involvement in afferent innervation of the urethra.     

The effect of hormone therapy on plasma homocysteine levels: a randomized clinical trial

OBJECTIVE: An elevated plasma homocysteine level is a risk factor for cardiovascular diseases. Hormone therapy (HT) may reduce fasting plasma homocysteine levels. We studied 80 postmenopausal women to determine the effect of medroxyprogesterone acetate (MPA) combined with conjugated equine estrogens (CEE) on fasting plasma homocysteine levels. DESIGN: In a randomized, double blind, prospective, placebo-controlled study, we randomly assigned 80 healthy postmenopausal women between CEE 0.625 mg/d combined with MPA 2.5 mg/d (n = 20), CEE 0.625 mg/d combined with MPA 5 mg/d (n = 20), unopposed CEE 0.625 mg/d (n = 20), and placebo (n = 20) all given for a duration of 6 months. Fasting plasma homocysteine levels were measured before and at the end of the treatment. RESULTS: Before treatment, plasma homocysteine concentrations were similar in all groups. After 6 months of unopposed CEE, the mean fasting plasma homocysteine levels decreased by 19.02% when compared with baseline levels (P < 0.05). The mean fasting plasma homocysteine concentrations decreased by 17.63% and 19.56% from baseline in both the CEE plus MPA 2.5 mg/d and CEE plus MPA 5 mg/d groups, respectively (P < 0.05 for each group). In contrast, plasma homocysteine levels increased by 11.66% in the placebo group. The homocysteine lowering effect did not differ significantly among the three groups of women receiving unopposed CEE alone and CEE plus MPA at two different doses. CONCLUSION: Six months of estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) significantly lower fasting plasma homocysteine levels in healthy postmenopausal women with equal efficacy.     

Cricopharyngeal muscle electromyography in laryngopharyngeal reflux

OBJECTIVES/HYPOTHESIS: The objective was to determine whether laryngopharyngeal reflux was associated with an electrophysiological abnormality of the main part of the upper esophageal sphincter, namely, the cricopharyngeal muscle, which could be related to laryngopharyngeal reflux symptoms. STUDY DESIGN: A prospective study of 20 patients with symptoms of laryngopharyngeal reflux. METHODS: The diagnosis was based on clinical, laryngoscopic, and ambulatory 24-hour pH monitoring findings. Double-probe pH monitoring was performed with placement of the distal and proximal probes 5 cm above the proximal border of the lower esophageal sphincter and 15 cm proximal to the distal probe, in or just beneath the upper esophageal sphincter. Electromyographic recordings were obtained simultaneously on submental and cricopharyngeal muscles during water swallowing. The peak of the submental electromyographic amplitude and its duration was measured using bipolar surface electrodes placed under the chin. The electromyographic features of the cricopharyngeal muscle were investigated by means of concentric needle electrodes inserted percutaneously both in 20 normal subjects and in 20 patients with laryngopharyngeal reflux. RESULTS: All electrophysiological parameters were normal in all of the patients. The durations of foreburst revealed significant correlation with the number of reflux episodes and acid exposure time (P = .026 and P = .044, respectively). CONCLUSION: The duration of the foreburst correlating with acid exposure time and number of reflux episodes suggested that foreburst duration was extended because of the irritation caused by the acid reflux.     

Radioprotective effects of melatonin on radiation-induced cataract

One of the mechanisms proposed to explain lens opacification is the oxidation of crystallins, either by radiation or reactive oxygen species (ROS). It has been shown that melatonin has both an anti-peroxidative effect on several tissues and a scavenger effect on ROS. The purpose of this study was to determine the antioxidant role of melatonin (5 mg/kg/day) against radiation-induced cataract in the lens after total-cranium irradiation of rats with a single dose of 5 Gy. Sprague-Dawley rats were divided into four groups. Control group received neither melatonin nor irradiation. Irradiated rats (IR) and melatonin+irradiated rats (IR+Mel) groups were exposed to total cranium irradiation of 5 Gy in a single dose by using a cobalt-60 teletherapy unit. IR+Mel and melatonin (Mel) groups were administered 5 mg/kg melatonin daily by intraperitoneal injections during ten days. Chylack's cataract classification was used in this study. At the end of the 10th day, the rats were killed and their eyes were enucleated to measure the antioxidant enzymes i.e. the activity of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and lipid peroxidation level (malondialdehyde (MDA)). Irradiation significantly increased the MDA level, as an end product of lipid peroxidation, and also significantly decreased SOD and GSH-Px activity, emphasizing the generation of increased oxidative stress. Rats injected with melatonin only did not cause cataract formation. Melatonin supplementation with irradiation significantly increased the activity of SOD and GSH-Px enzymes and significantly decreased the MDA level. Total cranium irradiation of 5 Gy in a single dose enhanced cataract formation, and melatonin supplementation protected the lenses from radiation-induced cataract formation. Our results suggest that supplementing cancer patients with adjuvant therapy of melatonin may reduce patients suffering from toxic therapeutic regimens such as chemotherapy and/or radiotherapy and may provide an alleviation of the symptoms due to radiation-induced organ injuries.