Effect of inferior oblique anterior transposition in correcting vertical hyperdeviation in primary position

Objective

To evaluate the effect of inferior oblique anterior transposition (IOAT) on improvement of vertical hyperdeviation in primary position.

The use of DWI to assess spleen and liver quantitative ADC changes in the detection of liver fibrosis stages in chronic viral hepatitis

This study aimed to evaluate the changes in spleen and liver diffusion-weighted magnetic resonance imaging (DWI) in chronic viral hepatitis patients.     

Abdominal aortic aneurysm or aortic occlusive disease: role of trace element imbalance

The nature of the relationship between atheromatous disease and degenerative aneurysm is yet to be defined. The purpose of this study was to compare tissue Fe, Cu, Zn, and thiobarbituric acid reactive substances (TBARS) levels (as a marker of lipid peroxidation) in the abdominal aorta in relation to the development of aneurysmal and occlusive disease in the infrarenal aorta. This was a prospective clinical study in an institutional referral center, in hospitalized patients. Eighty male patients who underwent surgery for abdominal aortic aneurysm (AAA) or aortic occlusive disease (AOD) were included in the study. Age, risk factors and comorbid conditions were recorded, including diabetes mellitus, hypertension, coronary artery disease, smoking, and chronic obstructive pulmonary disease. Aortic wall biopsies were collected at operation from the anterolateral section of the infrarenal aorta. Tissue Fe, Cu, Zn, and TBARS levels were determined. The mean age of the AAA group was 66.2 (56-75) years and of the AOD group 57.8 (47-72) years (p <0.001). There was a higher prevalence of hypertension in AAA patients compared to AOD patients (62.5%, 35% respectively; p <0.05). The comparison of tissue Zn levels showed no significant difference. Tissue levels of Fe, Cu, and TBARS were found to be higher in the AAA group, compared with the AOD group (p<0.001 for each). These results suggest that higher oxidative stress as a result of higher Fe and Cu levels in the AAA, compared with AOD, may be one of the contributing factors in aneurysmal formation as a result of promoted wall erosion.     

Relationship between serum substance P levels and daytime sleepiness in obstructive sleep apnea syndrome

OBJECTIVE: We hypothesized that intermittent hypoxia might influence serum substance P levels, and that this effect might in turn contribute in excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Fifty-five patients with newly diagnosed OSAS and 15 age-matched nonapneic control subjects were enrolled in this study. Full polysomnography was performed in all patients. Single blood samples were drawn between 8:00 am and 9:00 am after the sleep study. Substance P levels were analyzed with a competitive enzyme immunoassay (substance P EIA kit; Cayman Chemical; Ann Arbor, MI). RESULTS: There were no significant differences in age, gender, body mass index, smoking habit, and snoring between the two groups. Serum substance P levels in the OSAS group were significantly lower than that in the control group (p < 0.0001). Serum substance P levels were positively correlated with rapid eye movement sleep (r = 0.330, p = 0.049) and slow-wave sleep (r = 0.324, p = 0.049) phases. Serum substance P levels were negatively correlated with Epworth sleepiness scale score (r = - 0.253, p = 0.048), number of total apneas during the night (r = - 0.247, p = 0.036), number of respiratory events during the night (r = - 0.266, p = 0.024), apnea-hypopnea index (r = - 0.287, p = 0.015), respiratory arousal index (r = - 0.267, p = 0.026), time spent in apnea and hypopnea (r = - 0.307, p = 0.01), average oxygen desaturation (r = - 0.265, p = 0.026), and oxygen desaturation index (r = - 0.254, p = 0.031). CONCLUSION: We concluded that EDS seen in some of the OSAS patients might be associated with various pathophysiologic mechanisms including substance P levels.     

Spontaneous intracranial hypotension: a case report

Spontaneous intracranial hypotension is a rare syndrome of low cerebrospinal fluid pressure due to spontaneous cerebrospinal fluid leaks. The main feature is orthostatic headache. We describe a case of spontaneous intracranial hypotension in a 5-year-old girl with a 1-month history of headache, sudden onset hearing loss, and ataxia. Magnetic resonance imaging (MRI) showed an enlargement of cervical venous plexus and lumbar puncture revealed a low opening pressure. Magnetic resonance myelography showed leakage of the contrast material at the level of the third and fourth lumbar vertebra. Bed rest and caffeine treatment yielded no resolution of symptoms. Following a lumbar epidural blood patch, her headache and ataxia resolved completely without any improvement in hearing. A second blood patch also yielded no effect on hearing. Spontaneous intracranial hypotension should be considered in the differential diagnosis of headache, also in the pediatric age group.     

Local anesthesia with 20-mL prilocaine infiltration: the ultimate point for analgesia during shockwave lithotripsy?

PURPOSE: The effectiveness of 10 mL and 20 mL local prilocaine infiltration for analgesic purposes during shockwave lithotripsy (SWL) was compared, and the differences in pain intensity and need for additional analgesics were defined. PATIENTS AND METHODS: One hundred and twenty-one patients between the ages of 16 and 69 with kidney stones were randomly separated into two groups. The 60 patients in group 1 received 10 mL prilocaine subcutaneously and deep lumbar infiltration into the area 1 cm below the twelfth rib 2 minutes before SWL. The 61 patients in group 2 received 20 mL subcutaneously and deep lumbar infiltration of prilocaine to the same locale, again 2 minutes before the process. All the patients received one session of SWL. For measurement of pain intensity, the 0 to 100 mm visual analog scale (VAS) was used at 1 minute and every 10 minutes during the process. Intravenous fentanyl was administered to patients who had steady or increasing intensity of pain during the process. RESULTS: VAS values were statistically significantly higher in patients in group 1 compared with patients in group 2 during the process. While 40 patients received additional analgesia in group 1, only three patients in group 2 needed additional analgesia. CONCLUSION: Use of 20 mL subcutaneous and deep lumbar prilocaine infiltration during SWL for analgesic purposes is recommended as an efficient, cost-effective, anesthetist-independent, and reliable method.     

Morphometrical features of the human malleolar groove

BACKGROUND: Our aim was to investigate the morphometric features of malleolar groove of the lateral malleolus in humans. METHODS: This study was performed on the malleolar grooves of 93 (80 dry and 13 cadaveric) fibulae. We measured the length of the fibula; length, width, and depth of the malleolar groove; the angle between malleolar groove and the fibular axis. Furthermore, we measured the distances between the distal tip of the fibula and the lateral and medial tubercles of lateral malleolus, and the width of posterior surface of the lateral malleolus. RESULTS: We found the shape of malleolar groove regularly concave in 63 out of 93 (68%) fibulae. The features of the triangular area at the posterior aspect of the lateral malleolus, where the peroneal tendons pass over, may serve as a bed for the peroneal tendons. There was a significant correlation between the depth of the malleolar groove and the distances between the distal tip of the fibula and the medial and lateral tubercles, as well (p<0.05). CONCLUSION: A strong correlation existed between either the shape of the groove or the values of the reference points. CLINICAL RELEVANCE: The shape of the groove may be important in reinforcing the superior peroneal retinaculum (SPR) and other structures restraining the tendons.