Effects of mechanical irritation on the autonomic part of the median nerve

The diagnosis of median nerve compression is generally based upon a prolonged nerve conduction velocity although this frequently is preceded by clinical symptoms for years. The present study was designed to identify indicators for early decompression of the median nerve in patients exhibiting symptoms compatible with carpal tunnel syndrome (CTS). Microvascular perfusion in finger tip skin and skin temperature were studied during dorsiflexion of the hand prior to and following a manual exercise test in control subjects and in patients with clinical symptoms and signs of CTS. Evaluation of the microcirculation was performed using photoplethysmography (PPG) and laser Doppler fluxmetry (LDF). Fingertip skin temperature was measured by thermography and was significantly reduced in patients after exercise ( P  < 0.001), whereas no significant change occurred in control subjects. During increasing degrees of dorsiflexion (0–75°) and after manual exercise, fingertip skin perfusion remained unchanged in both patients and control subjects. In conclusion, patients with low-grade CTS experience skin temperature reduction, presumably caused by increased sweating as opposed to a generally suspected vasoconstriction. These autonomic median nerve dysfunctions provide the physiological basis for the use of thermography in confirming low-grade CTS.     

Retinal arteriolar changes in patients with hyperlipidemias

Hyperlipidemia is a known risk factor for atherosclerosis systemically. To determine whether it causes changes in retinal arterioles, a group of 26 patients with hyperlipidemia (serum cholesterol or triglycerides greater than 95th percentile for age) were compared with 22 "normal" patients (comparison group) and 35 patients with contralateral branch retinal vein occlusion to determine the presence or absence of changes in the retinal arterioles. The arterioles of all groups were evaluated in a masked fashion to determine the presence of arteriovenous nicking, "sclerosis," narrowing, and tortuosity. No differences in the retinal arterioles between the patients with hyperlipidemia and the comparison group were found. Patients with branch retinal vein occlusion in the contralateral eye had significantly more arteriovenous nicking and "sclerosis" than the other groups. These data suggest that hyperlipidemia by itself is not a risk factor for the development of retinal arteriolar changes. Thus examining the retinal arterioles would not be helpful in detecting hyperlipidemia.     

Home-based transcutaneous tibial nerve stimulation for overactive bladder syndrome: a randomized,controlled study

International Urology and Nephrology - Transcutaneous posterior tibial nerve stimulation (TPTNS) for the treatment of overactive bladder syndrome (OAB), with or without urge urinary incontinence...     

TME quality in rectal cancer surgery

Background

The concept of total mesorectal excision has revolutionised rectal cancer surgery. TME reduces the rate of local recurrence and tumour associated mortality. However, in clinical trials only 50% of the removed rectal tumours have an optimal TME quality. Patients: During a period of 36 months we performed 103 rectal resections. The majority of patients (76%; 78/103) received an anterior resection. The remaining patients underwent either abdominoperineal resection (16%; 17/103), Hartmann''s procedure (6%; 6/103) or colectomy (2%; 2/103).

Results

In 90% (93/103) TME quality control could be performed. 99% (92/93) of resected tumours had optimal TME quality. In 1% (1/93) the mesorectum was nearly complete. None of the removed tumours had an incomplete mesorectum. In 98% (91/93) the circumferential resection margin was negative. Major surgical complications occurred in 17% (18/103). 5% (4/78) of patients with anterior resection had anastomotic leakage. 17% (17/103) developed wound infections. Mortality after elective surgery was 4% (4/95).

Conclusion

Optimal TME quality results can be achieved in all stages of rectal cancer with a rate of morbidity and mortality comparable to the results from the literature. Future studies should evaluate outcome and local recurrence in accordance to the degree of TME quality.