The Relation between Nocturnal Polyuria and Diurnal Variation of the ADH in Patients with Cervical Cord Injury

OBJECTIVE: It was reported that nocturnal polyuria in cervical cord injured patients may be due to attenuation of diurnal variation of antidiuretic hormone (ADH) level. However, it has been unclear whether the attenuation of diurnal variation of ADH level caused nocturnal polyuria and bladder overdistension. To improve the management of neurogenic bladder with overdistension during the night, we investigated whether the attenuation of diurnal variation of ADH level is the cause of nocturnal polyuria or bladder overdistens-ion in patients with cervical cord injury. METHOD: The subjects consisted of 17 patients with cervical cord injury. The age distribution ranged from 31 to 63 years with an average of 41.5 years. The duration of illness ranged from 5 months to 4 years. Oral intake was restricted below 2,000 ml per day. We measured urine volume and urine osmolarity during the day (8 AM~8 PM) and night period (8 PM~8 AM) and the level of plasma ADH and serum osmolarity at 2 PM and 2 AM. RESULTS: Plasma ADH level was 0.81+/-0.51 pg/ml during the day and 1.04+/-0.65 pg/ml during the night (p=0.17). Urine volume was 1050+/-410 ml during the day and 970+/-550 ml during the night (p=0.92). The average of urine osmolarity was 450.4+/-182.8 mosm during the day and 558.4+/-359 mosm during the night (p=0.25). The average of serum osmolarity was 292.4+/-14.5 mosm during the day and 290.4+/-9.3 mosm during the night (p=0.53). CONCLUSION: This study showed that there was no significant difference in each parameter for two periods and urine volume was not increased in spite of attenuation of diurnal variation of ADH level. Therefore this indicated that attenuation of diurnal varia-tion of ADH was less likely responsible for nocturnal polyuria in patients with cervical cord injury.

Function of Trapezius Muscle after Various Types of Neck Dissection

Radical neck dissection(RND) has been a standard treatment for the head and neck cancer with metastasis to the cervical lymphatics. The sacrifice of the spinal accessory nerve innervating trapezius muscles creates a definite deficit of the shoulder function. Therefore, the modified radical neck dissection(MRND) preserving one or more structures of the spinal accessory nerve, internal jugular vein or sternocleidomastoid muscle was introduced to minimize the postoperative morbidities. We studied the shoulder function by clinical examinations and electrodiagnosis for the various types of neck dissection in 39 cases of 24 patients and compared the results of each test according to the types of neck dissection. Correlation between the clinical parameter and electrodiagnostic results showed a statistical significancy. The functional results of trapezius muscle in the group of modified radical neck dissection were better than those of the radical neck dissection. The fact that 80% of the cases in the RND group presented incomplete denervation of the trapezius muscle, suggests the innervation of other nerves to this muscle. Forty five percents of the cases in the MRND group which presented partial denervation of the trapezius muscle, might be due to the damages during operations. To preserve the spinal accessory nerve, a careful manipulation of the nerve is required. Further studies including an anatomic dissection and intraoperative electrophysiologic evaluation of the trapezius muscle should be performed for the better rehabilitation outcomes.

The Clinical Feature and Pressure Threshold in a Chest Wall Syndrome

Thirty-eight patients with a musculoskeletal chest wall syndrome were evaluated for the musculoskeletal findings of chest wall. All patients had the chest wall tenderness and the typical chest pain could be reproduced by the palpation. There was no significant difference in the diagnostic features of the pain for the onset, location, characteristics, duration, radiation, and area of references for chest pain among the different groups of the patients. However, a reproduction of pain by palpation and the pressure threshold difference between the lesion and control points by using pressure algometry was a reliable and specific diagnostic tool. Pressure threshold difference was correlated with numerical rating scale by the correlation coefficient 0.96. The common causes of the chest wall syndrome were the myofascial pain syndrome, chostochondritis, sternalis syndrome, rib-tip syndrome, xiphodynia in order. Six patients had chest wall disorders in conjunction with other associated intrathoracic condition. Thirty-two patients had an isolated chest wall syndrome. Chest wall syndrome should be considered in all patients with the chest pain, as its recognition could help the patient management.