The prognostic value of median nerve thickness in diagnosing carpal tunnel syndrome using magnetic resonance imaging: a pilot study

Background@#The median nerve cross-sectional area (MNCSA) is a useful morphological parameter for the evaluation of carpal tunnel syndrome (CTS). However, there have been limited studies investigating the anatomical basis of median nerve flattening. Thus, to evaluate the connection between median nerve flattening and CTS, we carried out a measurement of the median nerve thickness (MNT). @*Methods@#Both MNCSA and MNT measurement tools were collected from 20 patients with CTS, and from 20 control individuals who underwent carpal tunnel magnetic resonance imaging (CTMRI). We measured the MNCSA and MNT at the level of the hook of hamate on CTMRI. The MNCSA was measured on the transverse angled sections through the whole area. The MNT was measured based on the most compressed MNT. @*Results@#The mean MNCSA was 9.01 ± 1.94 mm 2 in the control group and 6.58 ± 1.75 mm 2 in the CTS group. The mean MNT was 2.18 ± 0.39 mm in the control group and 1.43 ± 0.28 mm in the CTS group. Receiver operating characteristics curve analysis demonstrated that the optimal cut-off value for the MNCSA was 7.72 mm2 , with 75.0% sensitivity, 75.0% specificity, and an area under the curve (AUC) of 0.82 (95% confidence interval [CI], 0.69-0.95). The best cut off-threshold of the MNT was 1.76 mm, with 85% sensitivity, 85% specificity, and an AUC of 0.94 (95% CI, 0.87-1.00). @*Conclusions@#Even though both MNCSA and MNT were significantly associated with CTS, MNT was identified as a more suitable measurement parameter.

A comparison of systolic and diastolic time variation with pulse pressure variation as a predictor of fluid responsiveness during pediatric liver transplantation

BACKGROUND: In pediatric patients, dynamic preload indices to predict fluid responsiveness remain controversial. Because each beat of blood pressure (BP) - waveform - contains evidence of a systolic and diastolic time interval (STI, DTI), we compared pulse pressure variation (PPV) with respiratory STI and DTI variation (STV, DTV) as predictors of fluid responsiveness during pediatric liver transplantation. METHODS: A total of 61 datasets from 16 pediatric liver transplant patients (age range one month to seven years), before and after an inferior vena cava clamp was applied, were retrospectively evaluated from electronically archived BP and central venous pressure (CVP) waveforms. STI and DTI were separated by a beat-to-beat blood pressure waveform. STV, DTV and PPV were calculated by averaging three consecutive respiratory cycles. Averaged CVP was used as a static preload index. A PPV threshold of > or =16%, a known cutoff value in pediatric surgery, was used to discriminate fluid responsiveness in the receiver operating characteristic (ROC) curve analysis. RESULTS: PPV showed correlations with STV and DTV (r = 0.65 and 0.57, P < 0.001, respectively), but not with CVP (r = -0.30, P = 0.079). The area under the ROC curves (AUC) of STV, DTV and CVP were 0.834, 0.872, and 0.613, respectively. Cut-off values of STV and DTV were 7.7% (sensitivity/specificity, 0.80/0.83) and 7.7% (sensitivity/specificity, 0.70/0.88), respectively. CONCLUSIONS: This study demonstrates that STV and DTV from a BP waveform showed the potential to predict fluid responsiveness as a surrogate of PPV during pediatric surgery.

Hemolysis of irradiated leukoreduced red blood cells during rapid warming: An in vitro experimental study

BACKGROUND: Although water chambers are often used as surrogate blood-warming devices to facilitate rapid warming of red blood cells (RBCs), these cells may be damaged if overheated. Moreover, filtered and irradiated RBCs may be damaged during the warming process, resulting in excessive hemolysis and extracellular potassium release. METHODS: Using hand-held syringes, each unit of irradiated and leukocyte-filtered RBCs was rapidly passed through a water chamber set to different temperatures (baseline before blood warming, 50℃, 60℃, and 70℃). The resulting plasma potassium and free hemoglobin levels were then measured. RESULTS: Warming RBCs to 60℃ and 70℃ induced significant increases in free hemoglobin (median [interquartile ranges] = 60.5 mg/dl [34.9-101.4] and 570.2 mg/dl [115.6-2289.7], respectively). Potassium levels after warming to 70℃ (31.4 ± 7.6 mEq/L) were significantly higher compared with baseline (29.7 ± 7.1 mEq/L; P = 0.029). Potassium levels were significantly correlated with storage duration after warming to 50℃ and 60℃ (r = 0.450 and P = 0.001; r = 0.351 and P = 0.015, respectively). CONCLUSIONS: Rapid warming of irradiated leukoreduced RBCs to 50℃ may not further increase the extracellular release of hemoglobin or potassium. However, irradiated leukoreduced RBCs that have been in storage for long periods of time and contain higher levels of potassium should be infused with caution.

Unusual venous route of pulmonary artery catheter in a liver transplant recipient: pericardiophrenic or highest intercostal vein?: a case report / 대한마취과학회지

We report an extraordinary case in which the venous route for pulmonary artery catheterization was unusual. A 41 year-old woman with an end-stage liver disease underwent a living-donor liver transplantation. After induction of anesthesia, the pulmonary artery catheter was revealed to be advanced into the left brachiocephalic vein and then slipped into another vein that drains into the left brachiocephalic vein. In this case, we assumed that the catheter had most likely slipped into the left pericardiophrenic vein since the catheter follows the left heart border similarly to the route of this vein according to the chest X-ray. Patients with liver cirrhosis develop many collateral vessels and have enlarged veins due to portal hypertension, which makes this vascular route possible. We present this case for anesthesiologists to be aware of the possibilities of unusual venous route due to dilated collateral vessels especially in liver transplant patients.

Delorme's Procedure for Complete Rectal Prolapse: Does It Still Have It's Own Role?

PURPOSE: Although there are more than a hundred techniques, including the transabdominal and the perineal approaches, for the repair of the rectal prolapsed, none of them is perfect. The best repair should be chosen not only to correct the prolapse but also to restore defecatory function and to improve fecal incontinence throughout the patient's lifetime. The aim of this retrospective review is to evaluate clinical outcomes of the Delorme's procedure for the management of the complete rectal prolapse. METHODS: A total of 19 patients (13 females and 6 males) with complete rectal prolapses were treated by using the Delorme's procedure in St. Vincent's Hospital, The Catholic University of Korea, from February 1997 to February 2007. Postoperative anal incontinence was evaluated using the Cleveland Clinic Incontinence Score. RESULTS: All 19 patients had incontinence to liquid stool, solid stool, and/or flatus preoperatively. Three (15.8%) patients reported recurrence of the rectal prolapse (at 6, 18, 29 months, respectively, after the operation). Information on postoperative incontinence was available for 16 of the 19 patients. Twelve of the 16 patients (75%) reported improved continence (5 [31.3%] were improved and 7 [43.7%] completely recovered from incontinence) while 4 patients had unchanged incontinence symptoms. One (6.3%) patient who did not have constipation preoperatively developed constipation after the operation. CONCLUSION: The Delorme's procedure is associated with a marked improvement in anal continence, relatively low recurrence rates, and low incidence of postoperative constipation. This allows us to conclude that this procedure still has its own role in selected patients.