Obturator Nerve Block by Inguinal Approach in the Transurethral Resection of Lateral wall Bladder Tumor

Background: Single spinal anesthetic has been shown to be ineffective in preventing obturator nerve activation and adductor muscle contraction, which can lead to problems such as bladder perforation during transurethral resection of lateral wall bladder tumor (TURBT) under SA. To counteract this, numerous additional approaches are still being investigated, with the inguinal approach lately gaining traction. The aim of the study was to observe the incidence of jerk/ muscle spasm after obturator nerve block by Inguinal Approach in TURBT of lateral wall urinary bladder tumor under SA. Material & Methods: This retrospective observational study was conducted at the Department of Anesthesiology & ICU of National Institute of Kidney Diseases & Urology, Dhaka, Bangladesh. The study duration was 6 months, from January 2022 to July 2022. During this period, a total of 20 cases of transurethral resection of lateral wall bladder tumor (TURBT) had been included as the study population, following inclusion and exclusion criteria. Results: Among the participants, 45% had been from the age group of 60-69 years, 30% had been from the age group of 50-59 years, 15% had been between the ages of 70-79, and 10% had been of 80 years or older. Hypertension was the most common comorbidity, observed in 70% of the participants. 45% had diabetes, 15% had chronic kidney disease, another 15% had chronic obstructive pulmonary disease, 10% had heart disease, and 15% had benign enlargement of prostate. During TURBT, majority of the patients had no jerk, while only 10% had minimal jerk and 1 patient had maximum jerk. During the 24-hour follow-up, 20% of patients regarded their outcome condition as excellent, while 60% had regraded their outcome as good. Only 1 patient regarded their outcome as poor, while follow-up data was unavailable for 15% of patients. Conclusion: The study observed very few incidence of muscle spasm or jerk during TURBT after using the inguinal approach. The study also found positive short-term outcome in most of the patients.

Terapia de rehabilitación vestibular en alteración mixta (central y periférica). Reporte de un caso / Vestibular rehabilitation therapy in mixed (central and peripheral) disorder. A case report

La terapia de rehabilitación vestibular es el tratamiento con mayor evidencia en la recuperación para la mayoría de los trastornos de equilibrio. En los casos que presentan una alteración estable del procesamiento central del equilibrio, o mixta, es decir, acompañada de una alteración a nivel del sistema nervioso periférico, la terapia de rehabilitación vestibular no se excluye como tratamiento. No obstante, los progresos suelen ser limitados y requieren de una mayor cantidad de sesiones. En este trabajo analizaremos un caso mixto, un paciente con síndrome de núcleo fastigial y el vértigo posicional paroxístico benigno (VPPB), desde la pesquisa y evaluación hasta el tratamiento y alta, en el Hospital Clínico Universidad de Chile.

Vestibular rehabilitation therapy is the treatment with the greatest evidence of recovery for most balance disorders. In the cases that have a loss of central balance processing, or mixed, that is, stable accompanied by a disorder of the peripheral nervous system the vestibular rehabilitation therapy is not excluded as a treatment; however, progress is usually limited and requires a greater number of sessions. In this work we will analyse a mixed case, a patient with nucleus fastigial syndrome and a benign paroxysmal positional vertigo, from the investigation and evaluation to the treatment and discharge, at the Hospital Clínico Universidad de Chile.

Research on assist-as-needed control strategy of wrist function-rehabilitation robot / 生物医学工程学杂志

In order to stimulate the patients' active participation in the process of robot-assisted rehabilitation training of stroke patients, the rehabilitation robots should provide assistant torque to patients according to their rehabilitation needs. This paper proposed an assist-as-needed control strategy for wrist rehabilitation robots. Firstly, the ability evaluation rules were formulated and the patient's ability was evaluated according to the rules. Then the controller was designed. Based on the evaluation results, the controller can calculate the assistant torque needed by the patient to complete the rehabilitation training task and send commands to motor. Finally, the motor is controlled to output the commanded value, which assists the patient to complete the rehabilitation training task. The control strategy was implemented to the wrist function rehabilitation robot, which could achieve the training effect of assist-as-needed and could avoid the surge of assistance torque. In addition, therapists can adjust multiple parameters in the ability evaluation rules online to customize the difficulty of tasks for patients with different rehabilitation status. The method proposed in this paper does not rely on the information from force sensor, which reduces development costs and is easy to implement.

Smoothness of Knee Movement at the Stance Phase in Mild Osteoarthritis of the Knee.

Aims: The purposes of this study were to clarify the changes in smoothness of each phase by making use of the angular jerk cost for the smoothness of the knee joint motion at the stance phase in patients with osteoarthritis, to verify the relationship between the kinetics variables and the smoothness, and to clarify the dynamics in osteoarthritis by comparison with healthy subjects using the angular jerk cost of knee flexion or extension. Methods: The osteoarthritis group comprised 19 knees of 12 subjects with a Kellgren– Lawrence grade of 1 in at least one knee. The control group comprised 10 healthy adults. The subjects walked barefoot along a 10-m walkway at their self-selected habitual speeds. The stance phase of gait was defined as four periods To calculate the smoothness of the knee joint movement, the angular jerk cost of the knee joint angle during the stance phase was calculated by differentiation three times using the knee joint angle data. Results: The angular jerk cost was increased in the early stance phase in both groups. Only the osteoarthritis group showed a large angular jerk cost in the late stance phase. The ground reaction force in the osteoarthritis group showed a small value in the stance phase compared with the control group. Conclusion: The movement of the knee joint at the initial stance phase had a strategy to ensure the smoothness of the movement by decreasing the change in the angular acceleration in accordance with the impairment disorder. In addition, the smoothness of the knee joint movement was decreased at the late stance phase compared from the loading response to mid-stance period in the osteoarthritis group, and the propulsion for forward movement of the body was exerted by a change involving a large angular acceleration with a large force.

Two Cases of Pelvic Floor Myoclonic Jerk Syndrome

We report two cases of pelvic floor myoclonic jerk syndrome, which are rarely reported and associated with various etiological conditions. These cases are different from previously reported cases in terms of spontaneous improvement, no pain, and causal event. One patient suffered from this symptom after a suspected mild head and back trauma, and the other patient had no suspected etiological event or medical illness.

The Jaw Jerk in Normal Young Adults

OBJECTIVE: To obtain the mean value of parameters of the jaw jerk and to investigate gender difference on the jaw jerk in normal young adults in Korea. METHOD: In young 40 subjects (20 males and 20 females), the jaw jerks were elicited by chin tapping in the relaxed masseter muscles of both sides. RESULTS: The jaw jerks were recorded in 100% of the total number of chin-taps. The mean latency was 5.39 ms in the males and 5.14 ms in the females (p>0.05). The mean amplitude was 0.75 mV in the males and 0.59 mV in the females (p>0.05). The mean duration was 8.18 ms in the males and 7.85 ms in the females (p>0.05). CONCLUSION: No significant differences were found in the parameters of the jaw jerk between males and females in this study.

A Case of Convulsive Seizure Development Induced by Clozapine

The authors described a case of male schizophrenia who developed myoclonic jerk repeatedly and one episode of convulsive seizure during the treatment of clozapine. According to literatures and reported cases, myoclonic jerks induced in a small amount of clozapine may precede and predict the development of a convulsive seizure. Therefore clinicians have to pay attention to the development of a myoclonic jerk during the administration of clozapine. They may decrease the dosage of clozapine step by step at first in the convulsive state, and observe EEG changes of patients frequently.

Effects of Concomitant Treatment with Drugs Affecting Monoaminergic Systems on the Clozapine-induced Myoclonic Jerks in Partially Restrained Rats

This study was performed to investigate the mechanism of the clozapine-induced seizures in partially restrained rats by concomitant treatment with drugs affecting monoaminergic systems. Partially restrained rats treated with acute single doses of 10mg/kg clozapine exhibited myoclonic jerks(MJs). Drugs affecting the monoaminergic systems, including 2mg/kg haloperidol, 5mg/kg propranolol, 2mg/kg ritanserin, 20mg/kg fluoxetine, and 20mg/kg imipramine, were concomitantly treated with clozapine to observe the effects of these drugs on the MJs. The drugs were given intraperitoneally either as acute single doses(haloperidol, propranolol, ritanserin, and fluoxetine) or as chronic doses for 21 days(haloperidol, imipramine, ritanserin, and fluoxetine). The effects of the concomitant treatment of other drugs on the clozapine-induced MJs were evaluated by comparison of the total numbers of the MJs between the clozapine-treated and concomitantly treated groups. The results were as follows. 1) Concomitant treatment with acute single doses of haloperidol, propranolol, and fluoxetine reduced the total numbers of the clozapine-induced MJs, while concomitant treatment with ritanserin did not. 2) Concomitant treatment with chronic doses of imipramine and ritanserin increased the total numbers of the MJs, while concomitant treatment with fluoxetine reduced them. Concomitant chronic treatment with haloperidol did not affect the numbers of the MJs. These results suggest that dopamine and serotonin, not noradrenalin may be involved in the clozapine-induced MJs in partially restrained rats. Future research needs to study the function of each subtype of monoaminergic receptors on the mechanism of the clozapine-induced seizure.

T-reflex Changes in Asymptomatic Diabetics

BACKGROUND: The loss or depression of ankle jerk has been considered one of the earliest physical findings of diabetic polyneuropathy, even in asymptomatic cases. Therefore, the electronic ankle T-reflex test (ATR) could be a sensitive, objective test for the early detection of polyneuropathy among diabetics. METHOD: In order to verify the sensitivity and usefulness of the ATR, the ankle jerk and ATR were studied in 99 legs of 50 patients with diabetes who did not have any symptoms related to neuropathy or peripheral vascular disease at the time of the study. A sensory nerve conduction study (SNCS) of sural and superficial peroneal nerves was also performed and the results were compared with the ATR. RESULTS: The ATR response was abnormal in 42.4% of the legs tested and was more sensitive than the sural SNCS (18.2%) or superficial peroneal SNCS (30.3%) in revealing subclinical abnormalities. Our results confirm that ATR abnormalities in asymptomatic diabetics are more frequent than conventional SNCS abnormalities and are a reliable indicator of peripheral nerve dysfunction in diabetic patients. CONCLUSIONS: The ATR seems to be a sensitive test in detecting subclinical abnormalities in diabetics and would be useful especially in early or equivocal cases of

Periodic Alternating Nystagmus

Periodic alternating nystagmus is a horizontal jerk nystagmus that periodically changes in amplitude and directions every 3 or 4 minutes. Usually the eyes beat in one direction for approximately 90 seconds and then go into a null phase for 10 to 20 seconds before beginning to move in the opposite direction and continued about 90 seconds. The exact mechanism is unknown but the rhythmic alteration of the null zone of horizontal jerk nystagmus is taken as a possible mechanism. These patients periodically show alternating head turning. The authors report 6 cases of congenital periodic alternating nystagmus which show horizontal jerk nystagmus of rhythmic direction change and confirmed by electro-oculogram.