Definition of a safe-zone in open carpal tunnel surgery: a cadaver study

Carpal tunnel decompression is one of the most common surgical procedures in hand surgery. Cutaneous innervation of the palm by median and ulnar nerves was evaluated to find a suitable incision preserving cutaneous nerves. A morphometric study was designed to define the safe-zone for mini-open carpal tunnel release. Sixteen fresh-frozen (8 right, 8 left) and 14 formalin-fixed (8 right, 6 left) cadaveric hands were dissected. Anatomy of the palmar cutaneous branch of the median and the ulnar nerve, motor branch of the median nerve, superficial palmar arch were evaluated relative to the surgical incision. We also identified the motor branch of the median nerve. Detailed measurements of the whole palmar region are reported in this study. The motor branch of the median nerve was extraligamentous as 60%, subligamentous as 34%, transligamentous as 6%. The palmar cutaneous branches of the median and the ulnar nerves in the palmar region were classified as Type A (34%), Type B (13%), Type C (13%), Type D (none), Type E (40%) according to forms of palmar cutaneous innervation originating from the ulnar and median nerves. Injury to the palmar cutaneous branch of the median nerve (PCBMN) is the most common complication of the carpal tunnel surgery. Various techniques were described to decrease post-operative morbidity. Based on these anatomic findings mini incision between the superficial palmar arch and the most distal part of the PCBMN in the palmar region is the safe-zone for carpal tunnel surgery.     

The role of HLA molecules in susceptibility to chronic rheumatic heart disease

Only a small fraction of the streptococcal pharyngitis progress to rheumatic carditis, which implies that environmental, host and microbial factors interact to cause an aberrant immune response against the antigens of the microorganism that cross-react with cardiac tissues. Although there are numerous studies and a general consensus on the relation between human leucocyte antigen (HLA) class II antigens and rheumatic heart disease (RHD), the details and the culprit antigens are still controversial. The study was undertaken to examine 100 patients with chronic RHD and 100 controls for HLA class I and class II antigens for differences in prevalence. All samples were typed at the HLA-DRB1/3/4/5 and DQB1 loci by the sequence-specific primer (PCR-SSP) method at low resolution. For HLA class I antigens, HLA-B13 frequency was marginally increased in patients with RHD compared to controls without reaching statistical significance. For class II antigens, RHD patients had higher frequencies for HLA-DRB1*01 (RHD 24%, controls 10%), DRB1*04 (RHD 35%, controls 26%), DRB1*07 (RHD 18%, controls 11%) and HLA-DQB1*02 (RHD 32%, controls 17%) without reaching statistical significance, and significantly lower frequencies for DRB1*13 (Pc < 0.003, OR: 5.69), DRB5* (Pc < 0.003, OR: 33) and DRB3* (Pc = 0.03, OR: 2.66) compared to controls. It was concluded that host, microbial and environmental factors collude to create acute rheumatic fever (RF) and chronic rheumatic valve disease. The HLA-DRB1*13, DRB5* and DRB3* were protective against the development of rheumatic valve damage.     

Long-term effects of cardiac resynchronization therapy on heart rate and heart rate variability

Congestive heart failure is characterized by significant autonomic dysfunction. Development of left bundle branch block in congestive heart failure is a predictor of worse outcome. There are several lines of evidence that cardiac resynchronization therapy (CRT), by biventricular stimulation in patients with severe heart failure and left bundle branch block, improves autonomic functions which can be quantified by measuring heart rate variability. The aim of the present study was to assess the effect of CRT on autonomic functions quantified by heart rate variability and mean heart rate (HR) in patients with advanced heart failure and left bundle branch block in short and long-term follow-up. A total of 35 patients with systolic heart failure and left bundle branch block (mean-age 60 +/- 11 years; 24 male and 11 female; mean left ventricular ejection fraction [EF]: 22.3 +/- 3%) were enrolled. Clinical assessment and echocardiographic examination were performed at baseline and every three months. Continuous electrocardiographic monitorization by 24-hour Holter recordings was performed pre-implantation, 3 months and 2 years after implantation. Mean HR and one of the time-domain parameters of heart rate variability, standard deviation of the R-R intervals (SDNN) were measured. CRT was associated with a decrease in the mean duration of QRS, and an increase in diastolic filling time, the rate with which the left ventricular pressure rises (dP/dt), and left ventricular ejection fraction. Decrease in mean heart rate and increase in SDNN were statistically significant in the third month and second year recordings when compared to baseline recording (p values were < 0.001 for both). In conclusion, CRT with biventricular pacing provides sustained improvement in autonomic function in patients with advanced heart failure and left bundle branch block.     

An Angiotensin-converting enzyme inhibitor, zofenopril, prevents renal ischemia/reperfusion injury in rats

Zofenopril ameliorates experimental cardiac ischemia/reperfusion (IR) injury in animal models and exhibits beneficial cardiovascular effects in patients with myocardial infarction. The objective of the present research was to investigate whether zofenopril can protect against renal IR injury. Rats were divided into 4 experimental groups: (a) control, (b) IR (60 min of ischemia followed by 24 hr of reperfusion), (c) zofenopril (15 mg/kg/day for 2 days), and (d) zofenopril+IR. All of the rats underwent right nephrectomy, and the rats in the IR and zofenopril+IR groups also underwent IR.then the left kidneys were removed for biochemical analyses and microscopic examination. There were no abnormalities in the biochemical and microscopic findings in the preoperative right kidneys. The lipid peroxidation, protein oxidation, and nitric oxide levels as well as xanthine oxidase and myeloperoxidase activities were increased and the catalase and superoxide dismutase activities were decreased in the IR group; zofenopril treatment prevented these changes (p <0.05). In the IR group, the kidney sections showed severe acute tubular damage including brush border loss, nuclear condensation, cytoplasmic swelling, and loss of nuclei; in the zofenopril+IR group, the normal glomerular morphology was preserved and there was slight edema of the tubular cells. The renal damage score was significantly reduced in the zofenopril+IR group vs the IR group (p <0.05).In conclusion, IR injury caused oxidative damage in renal tissue and zofenopril prevented this IR injury.     

Epidermal nevus syndrome with internal carotid artery occlusion and intracranial and orbital lipomas

We report a case of epidermal nevus syndrome involving the brain in which there is chronic occlusion of the left distal internal carotid artery resulting in ipsilateral atrophy. Orbital and cerebellopontine angle cistern lipomas and a wide cortical developmental malformation are associated with the condition. We present MR imaging findings of a patient and discuss features in the context of other neurocutaneous diseases.     

The role of SPIO-enhanced MRI in the detection of malignant liver lesions

The aim of this study was to evaluate the efficacy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the detection of malignant liver tumors. MRI, using fast spin-echo T₂-weighted and gradient-echo T₁-weighted imagings before and after SPIO infusion, was performed in 32 patients with known or suspected hepatic lesions. Statistical analysis was performed using lesion-by-lesion analysis. SPIO-enhanced T₂-weighted MRI showed results comparable to those of unenhanced T₂-weighted MRI in the detection of focal liver lesions.     

Preparation and characterization of papaverine-loaded poly[(r)-3-hydroxybutyrate] membranes to be used in the prevention of vasospasm

The objective of this study is the preparation and characterization of poly[(R)-3-hydroxybutyrate] (PHB) membrane loaded with a vasodialative agent (i.e., papaverine hydrochloride) as a blood vessel coverage strip to be used in the prevention of undesired vascular vasospasm. Papaverine-loaded PHB membranes were especially designed to act locally and provide an efficient, long term, and sustained prevention of vasospasm at the site of the newly created vascular anastomosis without any systemic vasodilation effect of the papaverine, which may be life-threatening for the patient. The membranes were prepared by gelation of PHB followed by solvent casting. PHB membranes were characterized in terms of morphology, chemical structure, swelling behavior, in vitro drug release, degradation, and blood compatibility studies as in vitro coagulation tests. Activated partial thromboplastin time, prothrombin time, and fibrinogen concentration were measured by blood coagulation assays. Investigated and evaluated parameters for in vitro drug release, degradation, and in vitro coagulation studies were the concentration of PHB and drug content. Similar effective parameters were used for swelling behavior studies (i.e., concentration of PHB and drug content). Drug release, swelling behavior, degradation, and in vitro coagulation of the membranes were found to be influenced by these parameters. Obtained results showed that papaverine-loaded PHB membranes provide an efficient and advantegous means for the prevention of vasospasm during vascular anastomosis as a local application.