Clinical Investigation of Key Parameter Range of AMG Muscle Relaxant Monitor / 中国医疗器械杂志

The accelerometry(AMG) muscle relaxant monitor is the most widely used quantitative muscle relaxant monitor to assess the degree of neuromuscular at present. In this study, the ulnar nerve was stimulated by using train of four stimulation(TOF) mode of the AMG muscle relaxant monitor, and the movement of the adductor pollicis muscle was monitored. In this way, the distribution range of key parameters (acceleration peak value, response time, and TOF ratio) of the adductor pollicis muscle during the use of muscle relaxant in clinical practice is analyzed and will provide a practical basis for the development and improvement of the muscle relaxant monitor.

Anastomosis between median nerve and ulnar nerve in the forearm

Anastomosis between the median nerve and ulnar nerve can occur in the forearm region. It consists in crosses of axons which may produce changes in innervation of the upper limb muscles, mainly motor part of intrinsic muscles in the hand. Anastomosis in the forearm can be classified in two types: Martin Gruber anastomosis and Marinacci anastomosis. This study has as purpose to report the incidence, type, topography of anastomosis found and assess the length of this anastomosis. Material and Methods: For this study, 30 forearms were dissected in the Anatomy Institute of Severino Sombra University. In order to check the incidence of anastomosis and its topography, the length of the anastomotic branch was measured with a measuring tape (3M). In addition schematic drawings were executed. Results: Three (3) anatomical pieces that contained the Martin-Gruber anastomosis with an average length of 6.6 cm were found. One (1) anatomical piece with a 7.4 cm long Marinacci anastomosis was found, even though such type of anastomosis shows low incidence, and was found only in electroneuromyography studies. Conclusion: The study of anomalous communications between median and ulnar nerves in the forearm deserves great attention for its incidence and its clinical importance, mainly in the correct diagnosis of peripheral neuropathies, for example in the Carpal Tunnel Syndrome, which produces changes in the upper limb innervation. The importance of its verification and delimitation is also crucial to avoid lesions in surgical procedures.

Comparisons among different reference values of nerve conduction velocity in forensic appraisal / 法医学杂志

OBJECTIVE@#To provide the evidences for the choice of normal reference value of nerve conduction velocity (NCV) in clinical forensic appraisal.@*METHODS@#One hundred and fourteen cases with normal peripheral nerve and 155 cases with injured peripheral nerve were collected. The NCV of homonymous nerves in two limbs were detected. In the normal cases, the NCV of the left limbs were used as the normal reference values. The NCV of the right limbs were compared with that of left limbs, the commendatory normal reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital. In the injured cases, the results of NCV in injuried limbs were compared with the results of healthy limbs and the reference values from Beijing Xiehe Hospital and Shanghai Huashan Hospital.@*RESULTS@#In the normal group, there was no statistical difference between the left and right limbs in NCV results of homonymous nerve (P > 0.05). The false positive rates (FPR) were 0, 11.4% and 5.2% for three choices normal reference respectively. The false negative rates (FNR) were 0, 9.7% and 12.3% for three choices normal reference in injuried group. Thee false negative cases were all slight nerve injury.@*CONCLUSION@#The reference value of self-control method could decrease the FPR of normal cases and FNR of injured cases. In clinical forensic appraisal of peripheral nerve, the nerve condition study results from healthy homonymous nerve should be regarded as the reference value at first, supplemented by reference values from clinical labs.

Evaluación de los efectos de diversas intensidades de estimulación nerviosa sobre la amplitud de la respuesta en diferentes especies / Evaluation of the effects of various intensities of nerve stimulation on the scale of the response in different species

El comportamiento nervioso a la estimulación eléctrica ha sido ampliamente estudiado desde 1840, época en la que se comienza a entender las características de la amplitud de respuesta nerviosa y velocidades de conducción en nervios de animales. La amplitud de respuesta en segmentos de nervios es producto de los potenciales de acción compuestos resultantes a la estimulación eléctrica. En esta investigación se estudió el comportamiento nervioso a potenciales evocados in vivo en humanos (nervio ulnar) e in vitro como nervio aislado en Bufus marinus. Durante la estimulación de los nervios se encontró respuesta de comportamiento cualitativo creciente y heterogéneo intra e ínter-especie. El análisis de las respuestas y mecanismos que participan en estos resultados se discuten.

Nervous behaviour by electrical stimulation has been widely studied since 1840, times that initiated the comprehension of the conduction velocity and nerve's amplitude responses in animals. The amplitude response in nerve segments electrically stimulated is generated by the result of composed action potentials. This research pretended to study the nerve responses to evoked potentials in human in vivo (ulnar nerve) and in vitro in animals (Bufus marinus) in sciatic nerve. Electrical stimulation resulted in rising responses of heterogeneous quality inter and intra-species. Mechanisms involved in each response are examined.

Analysis of compound muscle action potential of median and ulnar nerves: possible anatomical correlation

To analyze the shape of CMAP of both median and ulnar nerves in apparently healthy individuals, and the anatomical innervations of small muscles of hand in cadavers. Motor conduction studies of both median and ulnar nerves for 300 apparently healthy adults were performed. The nerve supply of both thenar and hypothenar muscles were dissected in 10 adult cadavers. The mean amplitude and the mean distal latency [MDL] of the median nerve were significantly higher than that of the ulnar nerve [11.785 +/- 5.0, 10.45 +/- 2.96 mV respectively, and 3.38 +/- 0.41 and 2.698 +/- 0.40 ms respectively]. The median nerve had mostly dome shaped rather than double peaked CMAP [p=0.0001], while in the ulnar nerve it was more frequently double peaked [p=0.0001]. The MDL of the median nerve was significantly longer in those with dome shaped CMAP, while in the ulnar nerve it was significantly longer in those with dome shaped [p=.0001]. There were no statistical significant differences between the amplitude of dome and double peaked CMAP in either median or ulnar nerve.. The anatomical results showed that abductor pollicis brevis is supplied by the median nerve in 90% of specimens, and by both nerves in 10%. The abductor digiti minimi brevis is supplied by the deep branch of the ulnar nerve in 90% and by superficial branch of the ulnar nerve in 10%. There was a connection between the median and ulnar nerves in 50% of specimens. Variability in the pattern of innervations of the small muscle of the hand could be a possible etiological factor for the difference in the CMAP configuration of the median and ulnar nerves

Evaluation of anterior subcutaneous transposition of ulnar nerve in cubital tunnel syndrome

Regarding the frequency of Cubital Tunnel Syndrome, varieties of treatment modalities, and ambiguity of anterior subcutaneous transposition of ulnar nerve method, we aimed to evaluate the efficacy of this procedure in patients with Cubital Tunnel Syndrome referred to Taleghani hospital in 2004-2007. This study was a case series including all referred patients with definite diagnosis of Cubital Tunnel Syndrome, treated by anterior subcutaneous transposition. Treatment results were measured according to modified Bishop rating system, and were ranked into excellent, good, fair, and poor. Variables such as gender, age < 45 years>, causation, and initial severity, determined by Dellon criteria preoperatively, were analyzed by Fisher's exact test. This study was performed on 26 eligible patients including 29 elbows [38% males and 62% females, with mean age of 44.5 years], with an age range of 23-72 years. In a 12 months follow-up post-operatively, 62% showed excellent, 20.7%good, and 17.3% were reported fair with no poor result. In a 1-12 months follow-up post-operatively, results showed improvement, and initial severity and old age were demonstrated to significantly affect treatment results [p < 0.07]. Our study findings strongly support the concept that anterior subcutaneous transposition of ulnar nerve is successful in patients with Cubital Tunnel Syndrome; however, further experimental studies are suggested

Effect of exercise on ulnar and peroneal nerve conduction velocity

Regarding to sedentary lifestyle and its early complications, electrodiagnostic studies can have valuable effects on prevention, diagnosis, follow up and treatment of neuromuscular disorders. This study aimed to compare nerve conduction velocity [NCV] of the ulnar and peroneal nerves in athletes and nonathletes. This case-control study was performed in athletes in Mashhad University of medical sciences in 2003. Totally 237 university students, I 14 with appropriate exercise activity from the students of school of sport and exercise sciences as study group and 1 23 without appropriate physical activity from. medical students as control group were selected. General data and data related to NCV of ulnar and peroneal nerves in two groups were collected using a previously designed questionnaire and neurogram test. Data were analysed by SPSS software using Mann- whithny test in order to compare means. The results showed NCV of right and left ulnar and peroneal nerves in female students were more than male ones [P= 0.003, P=0.075, P=0.002 and P<0.001 respectively]. NCV of the right and left ulnar in athletes and nonathletes females had statistical differences [P<0.00 1] but there were no significant differences between right and left peroneal nerves. [P=0.131 and P=0.135 respectively]. In male students there were significant differences in NCV of right ulnar nerve of athletes and nonathletes [P<.001] but in left ulnar nerve differences was not much [P=0.08], and NCV of the right and left peroneal in athlete male students were statistically more than nonathlete ones [P<0.001]. Regarding to effect of exercise on increasing NCV and reducing reflective time, it is necessary that physical education centers improve their educational programes

A pharmacodynamic basis for the peak effect of vecuronium: peak twitch versus peak tetanic fade.

Double burst stimulation (DBS), a tetanic test, shows two types of changes during nondepolarising neuromuscular block (NMB) viz, amplitude (D1) suppression and fading of second response (D2), quantified as DBS ratio (D2/D1). During subclinical dose effect of vecuronium bromide both parameters show peak suppression at two distinct intervals. To evaluate, which of the two is the true peak effect of vecuronium, twenty-two ASA 1 patients were given im buprenorphine (5 micro/kg) premedication and iv diazepam (0.1 mg/kg). Vecuronium bromide (0.015 mg/kg) effect was monitored by stimulating ulnar nerve at the wrist. Adductor pollicis response of supramaximal DBS stimuli was recorded on myograph. DBS ratio was calculated with each DBS stimuli, using pocket calculator. In randomly allocated group 1 (n = 11) patients, repeat dose of vecuronium (0.08 mg/kg) was given at the peak D1 suppression and in group 2 (n = 11) at peak DBS ratio suppression. The onset time of repeat dose of vecuronium monitored by one Hz stimuli, to '0' response in group 2 (37.3 +/- 6.65 second) was significantly (p < 0.01) shorter than in group 1 patients (46.8 +/- 9.3 second). It was noteworthy that at the repeat dose of vecuronium while D1 showed recovery in group 2 patients, DBS ratio was concomitantly and significantly lower (0.37 +/- 0.10) (more intense NMB) than in group 1 (0.49 +/- 0.17) patients, with quicker onset of repeat dose. These findings suggest that as the NMB agents show two types of changes during clinical monitoring, DBS test seems to be a better clinical pharmacodynamics-monitoring test for NMB agents. In addition, the peak tetanic fade (peak DBS ratio suppression) correlated with peak effect of vecuronium than the usually measured peak twitch suppression.

Dorsal cutaneous branch of ulnar nerve: an appraisal on the anatomy, injuries and application of conduction velocity studies in diagnosis

Classical textbooks and recent publications about the anatomy of the dorsal cutaneous branch of the ulnar nerve are revisited and correlated with methods of measurement of its conduction velocity, in order to evaluate the indications and limitations of the procedure. Etiology and pathogenesis of isolated lesions of this nerve branch are discussed

Normative data of nerve conduction studies in the upper limb in Kuwait: are they different from the western data?

To establish the normal electrophysiological data for the median, ulnar and radial nerves and to compare our results with the Western data published in the literature. Nerve conduction studies were performed prospectively in the upper limbs of 50 carefully screened healthy individuals between the ages of 16 and 56 years using standardized technique. The median motor distal latency [DL] was 3.1 [0.3] ms, amplitude 11.01 [2.8] mV, conduction velocity [CV] 56.5 [3.5] m/s. The ulnar motor studies gave DL of 2.4 [0.3] ms, amplitude 9.2 [2.2] mV, CV 60.4 [5.0] m/s. Sensory studies for the median nerve were: DL of 2.3 [0.3] ms, amplitude 63.3 [18.9] micro V for men and 79.3 [28.8] micro V for women and CV 56.6 [7.6] m/s. For the ulnar nerve [DL] 2.0 [0.23] ms, amplitude 54.5 [18.4] micro V for men and 63.9 [16.8] micro V for women and CV 51.7 [5.3] m/s. The radial sensory studies were DL 1.95 [0.3] ms, amplitude 18.7 [5.5] micro V and CV 52.3 ms. Only gender showed a statistically significant effect on the sensory nerve action potential for the median [p = 0.04] and ulnar nerves [p = 0.07]. Normative conduction parameters of commonly tested nerves in the upper limb were established in our EMG lab in Kuwait. The mean motor nerve conduction parameters for the median and ulnar nerves compare favourably with the existing literature data. However, for the sensory nerves, higher value for the nerve action potential amplitude was demonstrated in the study. Gender was shown to have a significant effect on the sensory amplitude of the median and ulnar nerves

Estudio normativo de velocidad de conducción en nervios cubitales, medianos y tibiales posteriores en adultos / Normative study of conduction velocity in cubital median and posterior tibial nerves in adults

Muchas alteraciones que involucran lesión de nervios periféricos pueden ser detectadas usando la técnica de la velocidad de conducción nerviosa periférica; técnica no invasiva y muy fácil de realizar, útil para valorar la integridad funcional de los nervios. El presente estudio se realizó para obtener valores normales de la velocidad de conducción en una población adulta hondureña, para ser usada como referencia en nuestro medio. Registramos la velocidad de conducción en 189 jóvenes en edades comprendidas entre 18 a 28 años. Se excluyeron del estudio, sujetos que tenian antecedentes de lesiones que afectan sistema nervioso periférico, registramos la velocidad de conducción y latencias en los nervios mediano, cubital y tibial posterior derechos e izquierdos, obteniéndose valores promedio de 65.58 +- 3.95 m/s para fibras más rápidas y 58.05 +- 4.24 m/s para la mayoría de las fibras en nervios de extremidades superiores y de 58.30 +- 3.71 m/s y 53.29 +- 3.33 m/s para fibras rápidas y mayoría de fibras en nervios de extremidades inferiores. concluimos que los presentes datos pueden ser usados como referencia para registros clínicos y de experimentación

Latencia distal, amplitud del potencial de acción sensitivo y velocidad de conducción sensitiva de los nervios mediano y cubital en personas adultas sanas / Distant latency, amplitude of the potential of sensitive action and velocity of sensitive conduction of the median nerve and ulnar nerve in sane adult

En el laboratorio de electrodiagnóstico del Servicio de Medicina Física y Rehabilitación del Hospital Central "Antonio María Pineda", se determinó la latencia distal, amplitud del potencial de acción sensitivo y velocidad de conducción sensitiva ortodrómica y antidrómica de los nervios medianos y cubital en 20 adultos sanos. Se exploraron 40 nervios mediano y 40 nervios cubital, utilizando una técnica sencilla. Se determinaron valores promedios y desviación estándar. Los valores obtenidos son considerados los adecuados; se encuentran dentro del rango de límites normales descritos en la literatura, y servirán para disponer de valores normales de referencia a ser usados en el laboratorio de electrofisiología del Servicio de Medicina Física y Rehabilitación al evaluar los nervios mediano y cubital.

Comparaçäo de técnicas de monitoraçäo da neuropatia hanseniana: teste de sensibilidade e estudo de conduçäo nervosa / Comparison of monitoring techniques of leprosy neuropathy: sensibility test and study of neural conduction

O trabalho compara os testes de sensibilidade e estudos de conduçao nervosa em 30 nervos, 06 medianos e 24 ulnares em pacientes com Neuropatia Hanseniana. Utilizou-se neste estudo, um "Kit"com 05 (cinco) monofilamentos de Semmes-Weinstein e um eletromiógrafo. Na avaliaçao inicial, foi detectado se os nervos avaliados apresentavam ou nao alteraçao. E nas avaliaçoes de seguimento se havia melhora, piora ou condiçao funcional inalterada. Os Estudos Estatísticos realizados demonstraram que os testes apresentam a mesma eficiência na detecçao de déficits funcionais neurológicos e monitoraçao da neuropatia hanseniana.

Ulnar nerve entrapment at and distal to wrist: Clinical, electrophysiological and operative study

This study included 15 patients [7 females and 8 males]. Their mean age was 37.7 years. All cases demonstrated sensory and motor deficits. The clinical evidences of deep palmar entrapment was present in 5 cases. Electrophysiologically, prolongation of distal motor latency to first dorsal interosseous muscle was detected in 5 cases, i.e. latency ranged from 5.8 ms tp 6.7 ms with a mean of 6.1 ms. In 10 cases, there was a prolongation of distal motor latency to abductor digit i.e. the latency ranged from 3.9 ms to 8 ms with a mean of 4.6 ms. All cases demonstrated electromyographic changes. Exploration reveals the presence of ganglion in 7 cases, fibrosis around ulnar nerve trunk in 2 cases and in 6 cases no specific pathology was detected. Follow-up showed complete recovery in 10 cases and partial improvement was obtained in 5 cases

Limb dominance and motor conduction velocity of median and ulnar nerves.

The influence of one-sided limb dominance on the muscles, bones and motor conduction velocity of median nerve has been investigated and reported. We have undertaken a more detailed study of the conduction velocity of the efferent fibres of median and ulnar nerves of both sides in 25 right-handed and an equal number of left-handed subjects of both sexes in the age group of 18-30 years. A significant correlation between "handedness" and motor nerve conduction especially in median nerve, is shown by the results in both right handers and left handers.

Transposiçäo do nervo ulnar para plano muscular profundo: alternativa para o tratamento da neurite hipertrófica hanseniana ulnar / Transposition of ulnar nerve to deepmuscle level: an alternative technique of surgical management of hypertrophic ulnar leprosy neuritis

O autor apresenta uma técnica cirúrgica alternativa para tratamento da neurite hipertrófica hanseniana ulnar, que consiste na transposiçäo do segmento hipertrofiado do nervo para plano muscular profundo, sob o biceps, associando, a este procedimento, a epineurotomia e a técnica cirúrgica proposta por Learmonth

Nerve conduction velocities: normal values for median and ulnar nerves

Cada laboratorio debe establecer sus propios parámetros normales para velocidades de conducción nerviosa, ya que, factores como temperatura, técnicas de medición y la localización de los electrodos pueden afectar los resultados. Cuarenta y cinco voluntarios (35 mujeres y 10 varones) entre las edades de 15 a 64 años, fueron sometidos a un historial completo y examen físico para excluir la posibilidad de neuropatía periférica. Las pruebas de laboratorios incluyeron hemograma, análisis de orina, SMA-12, glucosa plasmática 2 horas post prandial y pruebas de función tiroidea. Los valores obtenidos para las velocidades de conducción de los nervios medianos y ulnares fueron comparables con aquellos descritos previamente en la literatura. Cuando los valores fueron comparados entre grupos de edades, no se hallaron diferencias significativas. El proceso de envejecimiento no se encontró ser un factor determinante en la prolongación de velocidad de conducción o de la latencia distal

Influence of age on residual latency.

From the conduction studies of ulnar nerve on normal individuals of different age groups and sexes the residual latencies were determined. The age has no influence on the residual latency. But the values of residual latency decreased significantly in the case of females as compared with males.