Sonographic evaluation of the median nerve in diabetic patients: comparison with nerve conduction studies.

OBJECTIVE: Diabetes mellitus is becoming a major cause of premature disability in Japan, and peripheral neuropathy is a common complication of diabetes. The aim of this study was to evaluate the relationship between the results of nerve conduction studies (NCS) and the size of the nerve determined by sonography in diabetic patients. METHODS: Twenty diabetic patients (mean age +/- SD, 57.1 +/- 13.6 years) and 20 healthy volunteers (mean, 61.1 +/- 8.9 years) were enrolled in this study. Patients' wrists that had symptoms of carpal tunnel syndrome were not included in the study; those that were included had negative Phalen test results. We then divided the patients into 2 groups (patients with and without diabetic symmetric polyneuropathy [DPN]). The cross-sectional area (CSA) was measured in the carpal tunnel 5 cm proximal to the wrist and elbow joint of the median nerve. RESULTS: There was a significant increase in the CSA in patients with DPN in the carpal tunnel compared with the control participants (P < .01) and patients without DPN (P < .01). The CSA in the carpal tunnel showed a significant correlation with the motor nerve conduction velocity (r = -0.473). CONCLUSIONS: The CSA of the median nerve in the carpal tunnel of patients with DPN is greater than that in patients without DPN and healthy individuals and correlates with NCS.

[Equipment for epiduroscopy and its clinical applications].

Equipments for epiduroscopy consist of an epidural endoscope, video camera system, video screen, recording system and C arm X-ray system. Epidural endoscope with a diameter of 0.9 mm is inserted from the hiatus sacralis, and has been used clinically for the observation of epidural space of a lumbar vertebrae level since 1996. There are still some problems to be solved in the epiduroscope development, but its dramatic pain reduction effect has been recognized and it has been held as an attractive diagnostic tool.

[Autonomic nerve function in patients with systemic scleroderma using heart rate variability analysis].

We examined autonomic nerve function in patients with systemic scleroderma (SSc) using power spectral analysis of heart rate variability. In the SSc group, both in nighttime (0:00a.m.-5:00a.m.) and daytime (10:00a.m.-5:00p.m.), HF elements, a parasympathetic nerve index, were lower and LF/HF ratios, a sympathetic nerve index, were higher than in the control group. This suggests that in SSc patients, sympathetic nerve activity was increased and parasympathetic nerve activity was decreased throughout the day.

Health-related quality of life after thoracoscopic sympathectomy for palmar hyperhidrosis.

BACKGROUND: Palmar hyperhidrosis is a benign functional disorder regarded as a psychological and social handicap. Improvement of the quality of life is a major goal of treatment. However, little attention has been given to quality of life after thoracoscopic sympathectomy, which is the first line of treatment for palmar hyperhidrosis. This study investigated the impact of thoracoscopic sympathectomy on subjective health-related quality of life (HRQoL) and psychological properties. METHODS: Forty patients who underwent thoracoscopic sympathectomy were followed up for 6 months. The HRQoL measures were the Medical Outcomes Study Short Form 36 (SF-36), the Spielberger State Trait Anxiety Inventory (STAI), and the Zung Self-Rating Depression Scale (SDS). Patients were administered these questionnaires before procedure and then again at 1, 3, and 6 months after sympathectomy. RESULTS: A comparison between the current sample and Japanese normative data for the SF-36 showed mild impairment of HRQoL before sympathectomy. However, it also showed significant improvement of the social functioning domain after sympathectomy. While there was worsening of the bodily pain and role physical domains 1 month after sympathectomy, both domains recovered in 3 months. The results of STAI showed significant improvement of both trait and state anxiety after sympathectomy. However, the results of SDS showed patients remained neurotic. CONCLUSIONS: This study is the first to show the pattern of impairment in health status and therapeutic impact in palmar hyperhidrosis patients. Hyperhidrosis is associated with impaired HRQoL. It was also demonstrated that thoracoscopic sympathectomy is safe, minimally invasive, and improves HRQoL, even if compensatory hyperhidrosis occurs.

Heart rate recovery after exercise and neural regulation of heart rate variability in 30-40 year old female marathon runners.

The aim of the present study was to examine the effects of endurance training on heart rate (HR) recovery after exercise and cardiac autonomic nervous system (ANS) modulation in female marathon runners by comparing with untrained controls. Six female marathon runners (M group) aged 32-40 years and eight age-matched untrained females (C group) performed a maximum-effort treadmill running exercise. Maximal oxygen uptake (VO2max) was measured during the exercise with a gas analyzer connected to subjects through a face mask. Heart rate, blood pressure and blood lactate were measured before and after the exercise. Rating of perceived exertion (RPE) to the exercise was obtained immediately after the exercise. Holter ECG was recorded and analyzed with power spectral analysis of heart rate variability (HRV) to investigate the cardiac ANS modulation. The M group had significantly higher VO2max, faster HR recovery after exercise, higher Mean RR, SDRR, HF power and lower LF/HF ratio at rest compared with the C group. The M group also presented greater percent decrease of blood pressure after exercise, although their blood pressure after exercise was higher than the C group. It is suggested that endurance training induced significant alterations in cardiac ANS modulation at rest and significant acceleration of HR recovery after exercise in female marathon runners. Faster HR recovery after exercise in the female marathon runners should result from their higher levels of HRV, higher aerobic capacity and exaggerated blood pressure response to exercise compared with untrained controls. Key PointsThe effects of endurance training on HR recovery after exercise and cardiac ANS modulation were investigated in female marathon runners by comparing with untrained controls.Time and frequency domain analysis of HRV was used to investigate cardiac ANS modulation.As compared with untrained controls, the female marathon runners showed faster HR recovery after exercise, which should result from their higher levels of HRV, higher aerobic capacity and exaggerated blood pressure response to exercise.

[Significance of the cardiovascular function tests in patients with collagen diseases, especially for SSc (systemic scleroderma)].

The purpose of this study is to evaluate the cardiovascular function in patients with incomplete type of SSc (SSSD; Scleroderma Sjögren syndrome associated Spectrum Disorders), SSc (Systemic Scleroderma) and SLE (Systemic Lupus Erythematosus) by using ECG and digital plethysmograph. We also preformed ambulatory ECG monitoring for cases of SSSD and SSc with QT interval prolongation. 1) In ECG findings, ischemic myocardial damage, left ventricular hypertrophy or QT interval prolongation was observed in 33% cases of SSSD and 32% cases of SSc, respectively. In addition, parasympathetic disorders were observed in approximately 20% cases of SSSD, SSc and SLE. 2) Digital plethysmogram findings suggested that the peripheral vascular damage was present in both cases of SSSD and SSc, and its severity was lower in SSSD than SSc. The incidence of abnormal cardiovascular function tests in SSSD was relatively less than that in SSc. The cardiovascular function tests are useful to find cardiovascular abnormalities in these collagen diseases.