Median Nerve Conduction Study in different Wrist Position in Normal Persons and the Patients with Diabetes mellitus

OBJECTIVE: To determine whether flexion and extension of the wrist joint produce the change in the conduction study of the median nerve in the normal and diabetic patients, and to compare the susceptibility of median nerve compression injury in two groups. METHOD: Thirty healthy adults as control and thirty diabetic patients without carpal tunnel syndrome were studied. The wrist joint was maintained in flexion or extension position for 5 minutes before performing conduction study. The variables used for statistical analysis included the mean difference of amplitude and latency in median motor and sensory responses in neutral, flexion, and extension positions. RESULTS: The results showed that significant differences in the latency and amplitude of median motor and sensory responses between neutral, extension, and flexion of wrist within each group (p<0.01). The differences in the median sensory latency (p<0.01), amplitude (p<0.05) and the change of wrist-palm segmental conduction velocity (p<0.01) were statistically significant between the diabetes and the normal control. CONCLUSION: The results of this study suggest that median nerves are susceptible to compression pressure in diabetic patients. Therefore, the position of the wrist joint should be considered in the median nerve conduction study.

Cerebral Hemodynamic Evaluation of Diabetes Mellitus by Transcranial Doppler Sonography

OBJECTIVE: The purpose of this study was to evaluate hemodynamics for diabetes mellitus (DM) by transcranial Doppler sonography (TCD) and to evaluate the influences of risk factors to cerebral hemodynamics in DM. METHOD: We examined 54 normal persons, 17 patients with DM without risk factors, and 15 patients with DM and risk factors. The risk factors were hypertension, smoking, and hyper lipidemia (total cholesterol >240 mg/dl, low density lipoprotein >160 mg/dl). Mean blood flow velocity (MBFV) was also analyzed by Angiodine 2 Doppler system operating at 2 MHz frequency from each subjects. RESULTS: There was a significant decrease of MBFV in the diabetes in comparison to control groups (p<0.05). There was a significant decrease of MBFV in the diabetic risk group as compared to diabetic non-risk group (p<0.05). There was significantly increased total cholesterol, low density lipoprotein, low density lipoprotein/high density lipoprotein ratio in the diabetic risk group as compared to diabetic non-risk group (p<0.05). MBFV significantly decreased with increasing concentration of HbA1C and duration of DM (p<0.05). CONCLUSION: We suggest that transcranial Doppler sonography can be used as one of the useful screening tests for early detection of cerebrovascular diseases in DM.

Clinical Application of Digital Infrared Thermographic Imaging for the Prediction of Foot Ulcer Development in Diabetic Patients

OBJECTIVE: To investigate the regional differences of skin blood flow and to evaluate the effects of foot temperature on the severity of neuropathic pain and to predict the development of plantar foot ulceration by measuring of the temperature variations on the plantar surface of feet in the diabetic patients. METHOD: We measured the temperature variations on plantar surface of the feet in controls (n=18) and diabetic patients with(n=20) or without(n=23) polyneuropathy. The surface temperature from the 3rd metatarsal head(MTH), greater toe(GT), heel, medial and lateral longitudinal arch(LA) was measured by Digital Infrared Thermographic Imaging(DITI). RESULTS: The mean foot temperature of diabetic patients with polyneuropathy was significantly increased compared to controls or diabetic patients without polyneuropathy(p<0.001). The surface temperature readings of the GT, medial LA and the 3rd MTH tended to be increased in controls and patients with polyneuropathy. The mean plantar surface temperature was significantly increased according to the duration of diabetes mellitus(DM)(p<0.05). CONCLUSION: The results suggest that DITI provides a diagnostic modality in the prediction of neuropathic foot and increased risks of foot ulcer development in the diabetic patients.