Diabetic neuropathy increases stimulation threshold during popliteal sciatic nerve block.

BACKGROUND: Peripheral nerve stimulation is commonly used for nerve localization in regional anaesthesia, but recommended stimulation currents of 0.3-0.5 mA do not reliably produce motor activity in the absence of intraneural needle placement. As this may be particularly true in patients with diabetic neuropathy, we examined the stimulation threshold in patients with and without diabetes. METHODS: Preoperative evaluation included a neurological exam and electroneurography. During ultrasound-guided popliteal sciatic nerve block, we measured the current required to produce motor activity for the tibial and common peroneal nerve in diabetic and non-diabetic patients. Proximity to the nerve was evaluated post-hoc using ultrasound imaging. RESULTS: Average stimulation currents did not differ between diabetic (n=55) and non-diabetic patients (n=52). Although the planned number of patients was not reached, the power goal for the mean stimulation current was met. Subjects with diminished pressure perception showed increased thresholds for the common peroneal nerve (median 1.30 vs. 0.57 mA in subjects with normal perception, P=0.042), as did subjects with decreased pain sensation (1.60 vs. 0.50 mA in subjects with normal sensation, P=0.038). Slowed ulnar nerve conduction velocity predicted elevated mean stimulation current (r=-0.35, P=0.002). Finally, 15 diabetic patients required more than 0.5 mA to evoke a motor response, despite intraneural needle placement (n=4), or required currents ≥2 mA despite needle-nerve contact, vs three such patients (1 intraneural, 2 with ≥2 mA) among non-diabetic patients (P=0.003). CONCLUSIONS: These findings suggest that stimulation thresholds of 0.3-0.5 mA may not reliably determine close needle-nerve contact during popliteal sciatic nerve block, particularly in patients with diabetic neuropathy. CLINICAL TRIAL REGISTRATION: NCT01488474.

[Perioperative chemoprophylaxis in percutaneous nephrolitholapaxy]. / Perioperative Chemoprophylaxe bei der perkutanen Nephrolitholapaxie.

In 48 patients suffering from giant renal calculi a percutaneous nephrolitholapaxy was done. The use of perioperative antibiotic prophylaxis using aminoglycosides or cephalosporins was effective in reduction of postoperative urinary tract infections.

[Life-threatening allergic reactions caused by the administration Urocomb gel]. / Lebensbedrohliche allergische Reaktionen durch Einsatz von Urocomb-Gel.

It is reported on 2 patients with severe intraoperative anaphylactic shock due to repeatedly use of Urocomb-Gel in transurethral resection. As the cause of allergic reaction in both patients the local anesthetic Propipocain is suspected. Since that time no mucosal anesthetics are used during transurethral resection.

[Uniform theory on the pathomechanism of closed renal stalk injuries--subpelvic ureteral ruptures and kidney vascular stalk lesions]. / Beitrag für eine einheitliche Theorie über den Pathomechanismus geschlossener Nierenstielverletzungen--subpelvine Harnleiterrupturen und Nierengefässstielläsionen.

There are no homogeneous opinions concerning the pathomechanism of closed renal stalk injuries. On the basis of a literary analysis of 168 renal vessel stalk lesions and 78 ruptures of the ureter the attempt is made to contribute to the clarification of the etiology of these injuries. Subpelvic ruptures of the ureter and renal vessel stalk lesions are regarded as a constituent of closed renal stalk injuries and traced back to a uniform pathomechanism. Deceleration traumas leading to cranial, caudal and ventral movements of the kidney are regarded as predominant cause of closed renal stalk injuries. In accidents with deceleration processes should more be thought of closed renal vessel stalk lesions and subpelvic injuries of the ureter, also when there are no blunt abdominal traumas.

[Enzyme immunoassay for pregnancy-specific beta 1-glycoprotein (SP-1) in patients with testicular tumors]. / Enzymimmunoassay für schwangerschaftsspezifisches beta 1-Glycoprotein (SP-1) bei Patienten mit Hodentumoren.

The use of a two-side-binding-enzyme-immunoassay for pregnancy-specific beta 1-glycoprotein (SP-1) in tumours of the testicles is described. The lower limit of evidence is with 4 ng/ml near to the physiological region. In 17 of 41 non-seminomatous germinal tumours of the testicles (41%) initially increased SP-1-serum concentrations were present, the other measuring values correlated with the course of the disease. In all tumours of the testicles with initially increased SP-1-titres the use of the SP-1-test gives a further possibility of the regulation of therapy and control of the course.

[Urine pseudocyst following multiple injury with closed subpelvic ureteral rupture in childhood]. / Urinpseudozyste nach Mehrfachverletzung mit geschlossenem subpelvinen Harnleiterabriss im Kindesalter.

The authors discuss special aspects concerning children and traffic accidents, prompted by the frequency of such accidents. They present a model of the pathogenesis of closed injuries of the ureter. On the basis of the mechanics of accidents and clinical experience, closed subpelvic rupture of the ureter is to be seen as the result of a deceleration trauma. Problems of the treatment of patients with multiple injuries and the diagnosis and therapy of closed injuries of the ureter are presented on the basis of a clinical observation.

[Enzyme immunoassay of alpha 1-fetoproteins in patients with testicular tumors]. / Enzymimmunoassay für Alpha-1-Fetoprotein bei Patienten mit Hodentumoren.

The use of a newly developed immunoassay for alpha-1-protein in testicular tumours is described. With 2 ng AFP/ml serum the lower detection group of the test is in the physiological range. Of 39 non-seminomatous testicular tumours, 59% had a high AFP-serum level post-operatively, of 51 on initial diagnosis 54%; 12 seminomas remained AFP-negative. Checking the AFP level ist valuable for diagnosis, staging and prognosis of all testicular tumours.