Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

Introduction  Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods  A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results  In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion  Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.     

Automated 3D Ιnterstitial Lung Disease Εxtent Quantification: Performance Evaluation and Correlation to PFTs

In this study, the performance of a recently proposed computer-aided diagnosis (CAD) scheme in detection and 3D quantification of reticular and ground glass pattern extent in chest computed tomography of interstitial lung disease (ILD) patients is evaluated. CAD scheme performance was evaluated on a dataset of 37 volumetric chest scans, considering five representative axial anatomical levels per scan. CAD scheme reliability analysis was performed by estimating agreement (intraclass correlation coefficient, ICC) of automatically derived ILD pattern extent to semi-quantitative disease extent assessment in terms of 29-point rating scale provided by two expert radiologists. Receiver operating characteristic (ROC) analysis was employed to assess CAD scheme accuracy in ILD pattern detection in terms of area under ROC curve (A_z). Correlation of reticular and ground glass volumetric pattern extent to pulmonary function tests (PFTs) was also investigated. CAD scheme reliability was substantial for ILD extent (ICC = 0.809) and distinct reticular pattern extent (0.806) and moderate for distinct ground glass pattern extent (0.543), performing within inter-observer agreement. CAD scheme demonstrated high accuracy in detecting total ILD (A_z = 0.950 ± 0.018), while accuracy in detecting distinct reticular and ground glass patterns was 0.920 ± 0.023 and 0.883 ± 0.024, respectively. Moderate and statistically significant negative correlation was found between reticular volumetric pattern extent and diffusing capacity, forced expiratory volume in 1 s, forced vital capacity, and total lung capacity (R = −0.581, −0.513, −0.494, and −0.446, respectively), similar to correlations found between radiologists’ semi-quantitative ratings with PFTs. CAD-based quantification of disease extent is in agreement with radiologists’ semi-quantitative assessment and correlates to specific PFTs, suggesting a potential imaging biomarker for ILD staging and management.     

Oxytocin-secreting neurons: A physiological model of morphological neuronal and glial plasticity in the adult hypothalamus

Oxytocin-secreting neurons of the hypothalamoneurohypophysial system undergo reversible morphological changes whenever they are strongly stimulated. In the hypothalamus, such structural plasticity is represented by modifications in the size and shape of their somata and dendrites, in the extent to which their surfaces are covered by glia, and in the density of their synapses. In the neurohypophysis, there is a parallel reduction in glial (pituicyte) coverage of their axons together, with retraction of pituicyte processes from the perivascular basal lamina and an increase in the number and size of their terminals. These changes occur rapidly, within a few hours. On the other hand, the system returns to its prestimulated condition on arrest of stimulation at a rate that depends on the length of time it has remained activated. Such neuronal-glial changes have several functional consequences. In the hypothalamic nuclei, reduction in astrocytic coverage of oxytocinergic neurons and their synapses modifies extracellular ionic homeostasis and glutamate clearance and, therefore, their overall excitability. Since it results in extensive dendritic bundling, it may also lead to ephaptic interactions and may facilitate dendritic electrotonic coupling. A most important indirect effect may be to permit synaptic remodeling that occurs concomitantly and that results in significant increases in the number of excitatory and inhibitory synapses driving their activity. In the stimulated neurohypophysis, glial retraction results in increased levels of extracellular K+ which can enhance neurohormone release while an enlarged neurovascular contact zone may facilitate diffusion of neurohormone into the circulation. Ongoing work aims to unravel the cell mechanisms and factors underlying such plasticity and has revealed that neurons and glia of the hypothalamoneurohypophysial system continue to express juvenile molecular features associated with similar neuronglial interactions and synaptic events during development and regeneration. They include strong expression of cell surface adhesion molecules like F3/contactin and polysialylated neural cell adhesion molecule, extracellular matrix glycoproteins like tenascin C, and cytoskeletal proteins like vimentin and microtubule-associated protein 1D. Some of these molecules reach the cell surface constitutively while others follow the activity-dependent regulated pathway. We consider many of these molecular features permissive, allowing oxytocin neurons and their glia to undergo morphological remodeling throughout life, provided the proper stimulus intervenes. In the hypothalamic nuclei, one such stimulus is centrally released oxytocin; in the neurohypophysis, an adrenergic, cAMP-mediated mechanism appears responsible.     

Multiple liver abscesses associated with bacteremia due to Leuconostoc lactis

Leuconostoc species, which are members of the family Streptococcacae, have only recently been recognized as potential pathogens. We describe a patient with type II diabetes mellitus who had multiple liver abscesses associated with bacteremia due to Leuconostoc lactis. To our knowledge, this is the first case of this association to be reported in the literature.     

Quantification of the ionising radiation effect over angiogenesis in the chick embryo and its chorioallantoic membrane by computerised analysis of angiographic images

PURPOSE: We evaluated, in vivo, the effect of ionising radiation on the angiogenesis process in the chick embryo and its chorioallantoic membrane (CAM) using digital subtraction angiography (DSA) in conjunction with computer-assisted image analysis. Information regarding the ionising effect on endothelial cells during radiation treatment was extracted. MATERIAL AND METHODS: Two series of fertilized eggs were irradiated with a single ionising radiation dose of 10 Gy on days 9 and 13 of embryonic development. Angiography was carried out 24 h after irradiation. The angiographic images were digitized and subsequently processed. A set of specific morphological parameters was defined to allow an analytical characterization of the vascularity status. Vessels were classified into three categories according to their diameters (> or = 200 microm, 100-200 microm and 50-100 microm). The data were normalized and statistically evaluated. RESULTS: On day 10, total vascular area and total vascular length presented a 15.6+/-1.2% and 18.4+/-2.4% reduction, respectively, while vascular diameters increased 3.3+/-0.5%. The vessel area and length of the first category > or = 200 microm) increased 9.8+/-1.1% and 8.1+/-0.9%, respectively, while these morphometric parameters for each of the remaining two categories decreased 44.3+/-2.9%, 38.7+/-4.2% and 45+/-3.8%, 30.7+/-3.4%, respectively. On day 14 insignificant changes were observed. CONCLUSION: Computerised analysis of angiographic images showed that the antiangiogenic effect of irradiation during the various phases of CAM development is larger on the 10th day than that observed on day 14 and it depends on the vessel size.     

Dorsal extradural thoracic disc fragment: a diagnostic challenge

Dorsal epidural migration of an extruded disc fragment is an infrequent event, especially in the thoracic spine. An uncommon case involving a 55-year-old man is presented, with a 1-month history of paraparesis and thoracolumbar pain. Magnetic resonance imaging demonstrated a dorsally located, extramedullary mass at the T10-T11 intervertebral level. The lesion was suspected to be a tumor. The patient underwent a T10-T11 laminectomy. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was found. The pathologic diagnosis was inflammatory tissue and disc material. Six months after the operation, the patient remained asymptomatic, and radiologic control showed no residual mass. Although rare, a sequestered disc fragment should be included in the differential diagnosis of an enhancing posterior extramedullary thoracic mass. Preoperative diagnosis of such pathology is difficult because the clinical signs and radiologic images may not entirely exclude other more common thoracic spinal lesions, especially tumors.     

Polysialic acid is required for active phases of morphological plasticity of neurosecretory axons and their glia

The morphology of axons and astrocytes in the neurohypophysis changes considerably during physiological stimulation, increasing neurovascular contact and facilitating neurosecretion. We here assessed the contribution of alpha2, 8-linked polysialic acid (PSA), which intervenes in axonal changes during development and covers all neurohypophysial axon and glial surfaces. Using an in vitro model, we first analyzed neurohypophysial ultrastructure under different conditions of plasticity. After 2 h incubation in hyperosmotic medium or with the beta-adrenergic agonist, isoprenaline, neurovascular contact significantly increased, due essentially to an enhanced number of terminals, and gliovascular contact decreased correspondingly. This morphology was maintained during 22 h exposure to isoprenaline and reversed 2 h after agonist washout. Removal of PSA from cell surfaces with endoneurominidase prevented stimulation-related induction and reversal of axon and glial changes but had no effect once remodeling had occurred. PSA, therefore, by promoting dynamic cell interactions, is necessary for plasticity of axons and their associated glia.     

A study of the effects on the ovarian cycle of athletic training in different sports

AIM: The purpose of this research was to investigate the effects of sports training on the ovarian cycle of athletes of various disciplines, and of non-athletes, their participation and their performance in competition as well as the appearance of symptoms of discomfort pre and during the duration of menstruation. METHODS: Athletes from the disciplines of basketball, track athletics, gymnastics, swimming, synchronized swimming and water polo as well as non-athletes took part in this research. All the participants, both athletes and non-athletes were selected and completed a specially designed questionnaire. RESULTS: The results of the research showed that there are no significant differences in the menarche to the duration of the ovarian cycle and to the duration of the menstrual flow. Also, the involvement in different athletic disciplines appears to affect to different degrees the regularity of the cycle although this does not prevent the athlete from participating in training and in competition. The effects are sometimes beneficial to their performance and sometimes they could have a negative effect on their performance. Regarding the symptoms and the discomforts which occasionally appeared pre and during the duration of menstruation e.g. headache symptoms, these appear to be greatly decreased in the athletes of swimming, synchronized swimming and water polo and perhaps this is a result of the beneficial effects of the water. The percentage for abdominal pain appeared decreased for certain disciplines (such as swimming) or stable both pre and during the duration of menstruation. Concerning the pain in the thoracicolumbar region, the percentages were different for every sport: a noticeable decrease was recorded for the athletes of swimming, gymnasts, synchronized swimming, water polo, track athletes and the non-athletes, but with an increase for the basketball players. For the symptoms of weakness and fatigue, the percentages were increased for all the athletic disciplines as well as for the non-athletic during the duration of menstruation compared with pre menstruation, although for the percentages for symptoms of nervousness, the picture was different, that is, the percentages appeared decreased during the duration of menstruation. CONCLUSION: In conclusion, where problems appear in the function of the ovarian cycle, the assistance of a specialist gynaecologist is considered essential when we are sure that these problems are not caused by training, malnutrition or psychological factors.