Usefulness of Heart Rate Variability for Qualitative Evaluation of Diabetic Autonomic Neuropathy

OBJECTIVE: To investigate the relationship between autonomic neuropathy and peripheral neuropathy through analysis of heart rate variability (HRV) in diabetic patients, and ultimately to investigate usefulness for HRV analysis for quantitative evaluation and prediction of diabetic autonomic neuropathy. METHOD: We performed nerve conduction study (NCS), H- reflex, and HRV test with 42 diabetic patients. We classified patients by presence of peripheral neuropathy and abnormality of H-reflex, respectively. By comparing standard deviation of RR interval (SDNN), high frequency (HF), low frequency (LF), very low frequency (VLF), and total power (whole level of frequency, TP) of HRV, we analyzed the relationship between these parameters and duration of diabetes, age, and results from NCS. RESULTS: There were significant differences of SDNN, HF, TP according to the presence or the absence of peripheral neuropathy. There were significant differences of SDNN, HF according to the presence or the absence of H-reflex abnormality. SDNN and HF had reversed-relationship to the degree of H-reflex abnormality. CONCLUSION: We expect HRV might be used as an efficient quantitative method to detect diabetic autonomic neuropathy and suggest HRV to be used for early detection of diabetic peripheral neuropathy.

Induced Life-Threatening Electrolyte Imbalance in Sub-clinical Hyperthyroidism -A case report-

Thyrotoxic periodic paralysis (TPP) is rare in white Caucasian but a few in Asian. A 36-year-old man presented with suddenly developed paraparesis was brought by ambulance. He got some medications and injection for the upper respiratory infection in the morning of admission day. On admission he revealed bilateral proximal muscle weakness without pain. He didn't have any specific medical history of himself and his family. The laboratory results on admission revealed severe hypokalemia (2.1 mM/l). Potassium replacement was immediately started and his symptom was gone. We found TSH was extremely decreased (<0.005 microIU/ml) but T3 and T4 were within normal level. We guess TPP was induced by some drugs to the patient with sub-clinical hyperthyroidism. Hyperthyroidism is not always clinically apparent and then may be easily missed. However just a single medication or injection that is usually prescribed can induce critical progressive hypokalemia.

A Spontaneous Atlantoaxial Subluxation: A case repor

The atlantoaxial joint has a little stability and is secured and supported chiefly by soft tissue such as ligaments and articular capsule, so it has free motions to all directions. Relaxation or rupture of these supportive structures due to inflammation or trauma may cause instability or subluxation, and it results in compression of the spinal cord and it reveals various neurologic symptoms. The atlantoaxial rotatory subluxation, the rare disease found in children mostly, is known to be one of the reasons of the temporal torticollis in children. An adult type is very rare, but it is possible to be combined with rheumatoid arthritis and/or trauma, but we experienced the 25-year-old female patient who had the atlantoaxial rotatory subluxation spontaneously without rheumatoid arthritis and/or trauma, so we report this case with review of literature.

Development of the Automatic Identifying Instrument for the Spinal Epidural Space

OBJECTIVE: To confirm practical usefulness of the newly invented automatic identifying instrument for the spinal epidural space. METHOD: Epidural block with blind approach has been done for the patients who suffered from lower back pain with radiating pain due to spinal disorders. Conventional blind approaches using the glass syringe (control group) and the newly invented instrument (experimental group) were applied to each 30 patients, respectively. Epidurography was used for the confirmation to conclude success or not. RESULTS: Two cases were failed in the control group. One case showed injected contrast media in the interspinal ligament, another case revealed dura-puncture. But there was no failure in the experimental group. The mean timefrom skin-penetration to epidurography was 299.7+/-13.6 second in control group and 184.0+/-16.3 second in experimental group. The mean time from changing to glass syringe (control group) or epidural detector (experimental group) to epidurography was 146.0+/-14.0 second in control group and 60.0+/-7.0 second in experimental group. The time for epidural block was much less in experimental group (p<0.001). CONCLUSION: This newly invented epidural detector could make the epidural block easier, safer, and faster. We suggest this instrument is useful complementary method for spinal epidural procedure.