Electromyographic findings of paradoxical puborectalis contraction correlate poorly with cinedefecography

Abstract. Background: Both intra-anal sponge electromyography (SEMG) and needle electromyography (NEMG) are used to diagnose paradoxical puborectalis contraction (PPC). The aim of this retrospective study was to assess the correlation among SEMG and NEMG and cinedefecography (CD) in the diagnosis of PPC. Methods: Between 1992 and 1999, a total of 261 constipated patients underwent both CD and EMG: 64 had NEMG while 197 had SEMG. PPC was diagnosed by EMG when there was failure to achieve a significant decrease in electrical activity of the puborectalis muscle during attempted evacuation. CD criteria for PPC included lack of straightening of the anorectal angle or persistence of the puborectalis impression during evacuation. CD was considered diagnostic and EMG results were thus compared with those of CD. Agreement was calculated using the kappa statistics () for concordance. Results: Both NEMG and SEMG had low positive predictive rates (33% in NEMG, 28% in SEMG) and high negative predictive rates (91% in NEMG, and 78% in SEMG) when correlated with CD findings. Agreement between NEMG and CD was noted in 46 of 64 patients (72%, =0.274) while there was agreement between SEMG and CD in 120 of 197 patients (61%; =0.067); p>0.05 needle vs. sponge. Conclusion: Although both NEMG and SEMG have a low positive predictive values, they have high negative predictive value for PPC. Therefore, neither NEMG nor SEMG alone are optimal tests for diagnosing the presence of PPC.This work was presented in poster format at the Annual Meeting of the Association of Coloproctology of Great Britain and Ireland, 19–12 July 2000, Brighton, UK.     

The immediate effects of a shoulder brace on muscle activity and scapular kinematics in subjects with shoulder impingement syndrome and rounded shoulder posture: A randomized crossover design

BackgroundRound shoulder posture (RSP) is one of the potential risks for shoulder impingement syndrome (SIS) due to alignment deviation of the scapula. Evidence on how the characteristics of a shoulder brace affecting the degree of RSP, shoulder kinematics, and associated muscle activity during movements is limited.Research questionThe purposes of this study were (1) to compare the effects of a shoulder brace on clinical RSP measurements, muscle activities and scapular kinematics during arm movements in subjects with shoulder impingement syndrome (SIS) and RSP; and (2) to compare the effects of two configurations (parallel and diagonal) and two tensions (comfortable and forced tension) of the brace straps on muscle activities and scapular kinematics during arm movements in subjects with SIS and RSP.MethodsTwenty-four participants (12 males; 12 females) with SIS and RSP were randomly assigned into 2 groups (comfortable then forced, and forced then comfortable) with 2 strap configurations in each tension condition. The pectoralis minor index (PMI), acromial distance (AD) and shoulder angle (SA) were used to assess the degree of RSP. Three-dimensional electromagnetic motion analysis and electromyography were used to record the scapular kinematics and muscle activity during arm movements.ResultsAll clinical measurements with the brace were significantly improved (p < 0.05). Under forced tension, muscle activities were higher with the diagonal configuration than with the parallel configuration in the lower trapezius (LT) (1.2–2.3% MVIC, p < 0.05) and serratus anterior (SA) (2.3% MVIC, p = 0.015). For upward rotation and posterior tilting of the scapula, the diagonal configuration was larger than the parallel configuration (1.5°, p = 0.038; 0.4°–0.5°, p < 0.05, respectively).SignificanceDifferent characteristics of the straps of the shoulder brace could alter muscle activity and scapular kinematics at different angles during arm movement. Based on the clinical treatment preference, the application of a shoulder brace with a diagonal configuration and forced tension is suggested for SIS and RSP subjects.     

La fistule artérioveineuse est un facteur supplémentaire de risque de développer un syndrome du canal carpien chez le patient hémodialysé

IntroductionCarpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy reported in patients with renal failure undergoing periodic haemodialysis. The role of arteriovenous fistula was discussed. The aim of this study was to investigate this relationship.MethodsSubjects for this study were hemodialysis patients who underwent systematic electroneuromyography between January 2003 and December 2010. Only patients with unilateral fistulae were included for the study.ResultsOne hundred and thirty-four out of 155 patients were examined. CTS was noted in 106 patients and was detectable only in ENMG in 42% of cases. It was more frequent (P < 0.001) and more severe in the side of fistulae (P = 0.08). Besides, development of CTS was only correlated with the longer duration of dialysis (P = 0.005). This duration was significantly shorter in patients with CTS and diabetes.ConclusionThe positive correlation between CTS and aretriovenous fistulae confirms the pathogenic role of this latter. The risk rises in these patients with the duration of hemodialysis and the presence of diabetes.     

The muscle findings in a pediatric patient with live attenuated oral polio vaccine-related flaccid monoplegia

A pediatric patient, who was given live-attenuated oral polio vaccine twice without distinct gait disturbance during infancy, begun to present limp at 3 years. His gait disturbance became remarkable with aging. At 7 years, he was unable to dorsiflex the left ankle, and presented flaccid monoplegia of the left lower extremity, and the left Achilles tendon reflex was diminished. Magnetic resonance imaging revealed multiple crack-lines in the left anterior tibial muscle, but was unable to detect any distinct lesion at responsible level of L4, L5 and S1 anterior horn cells’ degeneration. Electromyography showed continuous fibrillation potentials, but muscle biopsy presented nearly normal in this muscle. The serum levels of polio antibody type 1 and type 2 titers were elevated 64× respectively, while the type 3 antibody titer was not elevated 4×. This patient was diagnosed as live attenuated oral polio vaccine-related flaccid monoplegia, with mild clinical course.     

The influence of positioning in urination: An electromyographic and uroflowmetric evaluation

PurposeWe conducted a cross-sectional study to evaluate whether the different positions during urination influence the electrical activity of the abdominal and perineal musculature, as well as the uroflowmetric parameters of children with lower urinary tract dysfunction (LUTD).Materials and methodsNinety-four children between the ages of 3 and 14 years with symptoms of LUTD were evaluated. All underwent uroflowmetry and electromyography tests (abdominal and perineal) in two different positions: oriented position (trunk bent slightly forward and feet flat) and atypical position (standing on toes for boys and buttocks not in contact with the lavatory seat and legs flexed in girls). We excluded nine patients due to suspicions of outside interference or elements complicating the analysis of charts.ResultsAmong patients evaluated 55 (64.7%) were girls and 30 (35.3%) were boys with an average age of 8.5 years. Children urinating in atypical position showed higher levels of perineal electrical activity than when they were in normal position (p = 0.018). However, there was no difference in the pattern of the curve if normal or abnormal when comparing the two groups (p = 0.824). When evaluated separately, the boys demonstrated no difference between positions, in relation to perineal electrical activity (p = 0.412) or abdominal electrical activity (p = 0.202).ConclusionsThe electrical activity of the pelvic floor musculature is decreased in the oriented position when compared to atypical positions in female children. Our data suggest that special attention should be given to adopting an adequate posture during urination for girls with LUTD.     

Is there an association between anxiety/depression and temporomandibular disorders in college students?

Objective

Considering the high incidence of Temporomandibular Disorders (TMD) in the population aged 15-30 years and the fact that students are exposed to stressful psychosocial factors, the purposes of this study were: to verify clinical symptoms and jaw functionality in college students with TMD according to the anxiety/depression (A/D) level and to evaluate the correlation between A/D and functionality, maximum mouth opening (MMO) and pain and muscle activity.

Material and Methods

Nineteen students with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent two assessments during an academic semester. The evaluations were based on questionnaires (MFIQ - Mandibular Function Impairment Questionnaire; HADS - Hospital Anxiety and Depression Scale), clinical measurements (MMO without pain, MMO and assisted MMO; palpation of joint and masticatory muscles), and electromyography. The HADS scores obtained in the two assessments were used to classify all data as either "high" or "low" A/D. Data normality, differences and correlations were tested with the Shapiro-Wilk test, Student''s t-test (or the Wilcoxon test), and Spearman test, respectively. The alpha level was set at 0.05.

Results

None of the clinical variables were significantly different when comparing low and high A/D data. In low A/D there was a significant correlation between HADS score and: MFIQ (P=0.005, r=0.61), and MMO without pain (P=0.01, r=-0.55).

Conclusions

Variation in A/D level did not change clinical symptoms or jaw functionality in college students with TMD. Apparently, there is a correlation between TMJ functionality and A/D level, which should be further investigated, taking into account the source of the TMD and including subjects with greater functional limitation.     

睡眠状态下阻塞性睡眠呼吸暂停低通气综合征患者上气道扩张肌肌电活性的变化

目的：观察睡眠状态下阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者上气道扩张肌肌电活性的变化,探讨其在OSAHS中的作用及意义。方法：对中、重度OSAHS患者69例（OSAHS组）及健康志愿者20例（对照组）于诱导睡眠后分别行颏舌肌、腭帆张肌和腭帆提肌等上气道扩张肌肌电图的检测并与诱导睡眠前比较。结果：（1）清醒状态下OSAHS组上气道扩张肌肌电水平较对照组高（均P〈0．01）;②与清醒状态比较,睡眠状态下OSAHS组上气道扩张肌肌电水平显著下降（均P〈0．01）;③从清醒状态到睡眠状态,OSAHS组上气道扩张肌肌电水平下降幅度明显大于对照组（均P〈0．01）。结论：OSAHS患者清醒状态下上气道扩张肌肌电活性代偿性升高及睡眠状态下失代偿是该病发生的重要病理生理机制。     

吸入不同浓度异氟醚对喉返神经肌电活动的影响

目的观察不同浓度的异氟醚吸入对喉返神经肌电活动的影响。方法30例择期甲状腺手术患者,ASAⅠ～Ⅱ级,采用异氟醚吸入复合静脉麻醉。于分离甲状腺前诱导恢复自主呼吸,调整异氟醚呼出浓度为0.1、0.2、0.3、0.4、0.5、0.6、0.7MAC时,观察血压、心率及喉返神经肌电活动波的振幅变化,记录喉返神经肌电波形振幅等于100μV时的异氟醚呼出浓度。结果当异氟醚呼出浓度为0.1、0.2、0.3、0.4MAC时,喉返神经肌电活动显示良好,当异氟醚呼出浓度为0.5、0.6、0.7MAC时,喉返神经肌电活动振幅降低,随异氟醚吸入浓度增高直至消失。结论低浓度异氟醚吸入,基本不会影响喉返神经功能的监控。     

结肠通过时间和盆底肌电图检查对功能性便秘分型的临床意义

功能性便秘是一种常见的胃肠道功能性疾病，随着社会生活方式和饮食结构等的改变，其发病率正逐年增高，并向年轻化发展。正确的分型对该病治疗方法的选择具有指导意义。目的：探讨结肠通过时间和盆底肌电图检查对功能性便秘分型的临床意义。方法：选择符合功能性便秘罗马Ⅱ诊断标准的患者32例，病史6个月-30年不等。应用不透X线的标志物进行结肠通过时间检查，计算传输指数(TI)和结肠排出率；同时结合盆底肌电图检查观察是否存在盆底肌与腹部肌群的矛盾运动。结果：结肠通过时间检查显示20例患者为出口梗阻型便秘，12例为慢传输型便秘。盆底肌电图检查显示出口梗阻型便秘患者均存在不同程度的盆底肌与腹部肌群的矛盾运动，慢传输型便秘患者中有4例存在盆底肌与腹部肌群的矛盾运动。结论：采用结肠通过时间和盆底肌电图检查可对功能性便秘作出分型，方法简便易行且无痛苦。     

半导体激光鼻内照射对糖尿病周围神经病变的影响

目的探讨半导体激光鼻内照射治疗糖尿病周围神经病变(DPN)的疗效及对血脂、纤维蛋白原、肌电图的影响.方法选择我院2004年8月～2005年5月收治的糖尿病周围神经病变患者60例,随机分为治疗组和对照组各30例.治疗组应用半导体激光鼻内照射治疗,同时辅以常规药物.对照组仅应用常规药物.治疗前后观察两组的疗效、血脂、纤维蛋白原、肌电图等的变化.结果治疗组和对照组治疗后在疼痛、感觉等的改善程度、血脂、纤维蛋白原、神经运动感觉传导速度等方面均有改善,但治疗组改善的程度较对照组有显著性差异(p＜0.01或p＜0.05).结论半导体激光鼻内照射治疗可以改善糖尿病周围神经病变的症状,降低血脂及纤维蛋白原,提高神经运动感觉传导速度,是一种安全、有效、简便的治疗手段.