Experience with peripheral nerve injury in upper extremities

This study reports the results of 87 operations performed on nerves of the upper extremities of 87 patients during the period of 5 years from 2000-2005 in Mansoura University hospital and Emergency Hospital. Among them there were 84 males and 3 females, age ranged from 5 - 53 years. There were 27 patients with isolated median nerve injury, 33 with isolated ulnar nerve injury, 12 with isolated radial nerve injury and 15 patients with combined median and ulnar nerve injury. All patients were treated with nerve exploration within 1 hour, 7 months after combined injury and were followed-up for 3 months - 2 years. There were 77 nerve lesions not in continuity [74 needed suture repair and 3 needed sural nerve graft repair], while 25 nerve lesions where in continuity [9 partial lesions needed neurolysis and 16 complete lesions needed neuroma excision and suture repair]. Analysis of the outcome of surgical treatment was performed with respect to the following parameters: period between the injury and operation, patient age, type of injured nerve, level of injury and type of surgical intervention. Overall significant outcome [>/= 3 Lousiana State University Health Science [LSUHS] grade] was obtained in 67.5% [radial nerve 75%, ulnar nerve 64% and median nerve 71%]. Significant outcome according to the level of the injury were 51% arm, 69% forearm and elbow and 82% wrist. According to the type of intervention and lesion categories, lesions not in continuity had a significant outcome 61% [primary suture repair 75%, secondary suture repair 61%, while graft repair was 0%]. Lesions in continuity had a significant outcome 88% [partial lesions underwent neurolysis 100%, while complete lesions underwent surture repair 81%, cut injuries 79% and crushed injuries 59%]. The most favourable outcome was obtained with lesions that result in partial lesion in continuity

Effect of acute cerebrovascular stroke on QT dispersion

Background: Repolarization and ischemic-like electrocardiographic [ECG] changes observed during acute phase of stroke may cause diagnostic and management dilemmas for the clinician. Some of these changes have been thought to be due either to the stroke state itself or pre-existing heart disease

Objective: The aim of this study is to assess the effect of acute phase of stroke on QT dispersion [QTd]

Patients and Methods: The study consisted of 42 patients [24] males and [18] females [test group], hospitalized for acute cerebrovascular stroke within 24 hours of symptom onset. A control group of 38 healthy presons were submitted to the study. They were age and sex matched. All test and control groups were subjected to history taking, clinical examination especially cardiac and neurological examination, routine laboratory tests, echocardiography. Twelve leads ECG was done for both test group and control group during the first 24 hours after symptom onset then after one week for test group. Norepinephrine level was done for both test and control groups

Results: QT dispersion and corrected QT dispersion [QTcd] were significantly greater in 24h-ECG than in 1 week [1w] ECG and the control ECG [P < 0.001]. In 24h-ECG QTd and QTcd were significantly greater in patients with larger lesions [mean +/- SD [0.048+/-0.009 and 0.053 +/- 0.009] vs small lesions [0.04 +/- 0.009 and 0.041+0.004] seconds, P < 0.001]. In 1w-ECG patients with right sided lesions were found to have significantly greater QTd and QTcd values [[0.034+0.008 and 0.039+0.005] vs left sided lesions [0.025+0.007 and 0.03+0.004] seconds, P< 0.001]

Conclusion: Acute stroke increases QTd and QTcd in patients without any known cardiac diseases. In the first 24hour, QTd and QTcd seem to be more prominent and related to humoral effects of acute insult. However, within one week, stroke localization may also play a role