Shear wave elastography of the radial nerve in healthy subjects

ObjectiveThis study was performed to examine the sonoelastographic features of the radial nerve in healthy subjects.MethodsIn this observational cross-sectional study, shear wave elastography was used to evaluate the radial nerve. The cross-sectional area and stiffness were measured.ResultsThe study included 37 nerves in 20 healthy adult subjects. The mean cross-sectional area of the radial nerve at the arm was 6.1 mm². The mean stiffness of the radial nerve in the short axis was 30.3 kPa, and that in the long axis was 34.9 kPa. The elasticity measurements were significantly different between the long axis and short axis.ConclusionThe elastic modulus of the radial nerve was studied in healthy subjects and can serve as a reference for future assessment of different radial nerve pathologies.     

Epidemiology of Viral Hepatitis in Saudi Arabia: Are We Off the Hook?

Some 400 million people worldwide are currently infected with the hepatitis B virus (HBV), and the infection is common in the Middle East. Another 170 million people around the globe presently live with chronic hepatitis C virus (HCV) infection. Both HBV and HCV represent a worldwide epidemic. Despite significant decline in the prevalence of HBV and HCV infection in Saudi Arabia, these viral diseases cause significant morbidity and mortality, and impose a great burden on the country''s healthcare system. On the other hand, Saudi epidemiology studies have shown that the hepatitis A virus seroprevalence in the country has reduced considerably over the past two decades. The progress in mapping the epidemiological pattern of viral hepatitis in Saudi Arabia has not only aided our understanding of the disease, but has also exposed the small but relevant gaps in our identification of the intricate details concerning the disease''s clinical expression. In this review, we aim to document the timeline of viral hepatitis epidemiology in Saudi Arabia, while summarizing the relevant published literature on the subject.     

Tenecteplase in prosthetic mitral valve thrombosis

In the few reported cases of prosthetic mitral valve thrombosis, where surgical intervention was considered as high risk, fibrinolytic therapy had proved life saving. The authors present clinical, laboratory, and imaging data from such a patient, with prosthetic mitral valve thrombosis and its successful management with tenecteplase. The use of tenecteplase as a viable fibrinolytic agent for the first time was justified, due to the lack of immunogenicity concerns compared to streptokinase.     

Bronchiolitis obliterans following hematopoietic stem cell transplantation: a clinical update

Pandya CM, Soubani AO. Bronchiolitis obliterans following hematopoietic stem cell transplantation: a clinical update.
Clin Transplant 2010: 24: 291–306. © 2009 John Wiley & Sons A/S. Abstract: Hematopoietic stem cell transplantation (HSCT) is an established treatment for a variety of malignant and non‐malignant conditions. Pulmonary complications, infectious and non‐infectious, are a major cause of morbidity and mortality in these patients. The recent advances in prophylaxis and treatment of infectious complications increased the significance of late non‐infectious pulmonary conditions. Currently, bronchiolitis obliterans is one of the most challenging pulmonary complications facing clinicians who are taking care of HSCT recipients. This report provides a clinical update of the incidence, risk factors, pathogenesis, clinical characteristics, and management of bronchiolitis obliterans following HSCT.     

Normalization of middle latency auditory P1 potential following posterior ansa-pallidotomy in idiopathic Parkinson's disease

Abstract

The Pi potential (50 msec) of middle latency auditory evoked potential was evaluated in seven patients with advanced idiopathic Parksinson's disease before and after contemporaneous bilateral posterior ansa- pallidotomy PI potential was lacking in two patients preoperatively and was prolonged in the remainder of the patients when examined in a best medicated 'on' state. All patients showed varying degrees of dementia preoperatively on clinical examination. Remarkable improvement in their Unified Parkinson's Disease Rating Scale (UPDRS) scores during 'on'states from a mean of45.85 to 14.28 post-operatively was achieved. Subsidence of akinetic symptoms; abolishment of dyskinesia, improvement in gait freezing, rigidity' and tremors represented main areas of improvement. Pi latencies and amplitudes reverted back to normal values in six patients including the two patients who lacked P1 wave preoperatively. One patient showed mild worsening of both Pa and P1 values post-operatively attributed to sleepiness during testingr, a transient phenomenon commonly encountered following posterior ansa-pallidotomy. The post-operative PI changes were statistically significant for both latencies and amplitudes at p = 0.078 and p = 0.073, respectively, for all seven patients using one tailed paired t-test. The change in UPDRS post-operatively best correlated with the post-operative difference in PI; specifically; UPDRS subscore II with PI amplitude (x = -0.068, p = 0.09), and UPDRS subscore IV with Pa: P1 ratio (x = + 0.77, p = 0.04). Earlier clinical and experimental work support the tegmental pedunculopontine nucleus (PPN) as the site of origin of P1 wave. In addition, its presence reflects the integrity of output cholinergic projection from PPN to both ascending reticular activating system ARAS and auditory pathway. We believe this is the first report of restoring the integrity of PI wave following posterior ansa-pallidotomy in patients with advanced idiopathic Parkinson's disease. Disinhibition of the PPN by posterior ansa-pallidotomy can explain improvements in motor symptoms in view of reemergence and normalization of P1 wave form. [Neurol Res 1996; 18: 516-520]