ABSTRACT
INTRODUCTION: Doppler ultrasonography (DU) has recently been shown to be useful in imaging carpal tunnel syndrome (CTS). In this study, we aim to characterize the changes seen after exercise and electrical stimulation. METHODS: Five patients with CTS were recruited with 5 age-matched subjects. DU was used to visualize the median nerve, flexor tendon, and bone at base line and after 1 minute of: (a) median nerve motor stimulation, (b) median nerve sensory stimulation, (c) abductor pollicis brevis contraction, and (d) adductor digiti minimi contraction. RESULTS: Blood flow in the median nerve was greater after APB exercise. Furthermore, blood flow in the median nerve was greater in cases than controls after APB exercise. At baseline, blood flow in the flexor tendon was greater in cases than controls. CONCLUSIONS: While limited by sample size, this study demonstrates that exercise of median innervated muscles may be useful in enhancing diagnostic utility of DU for CTS.
Subject(s)
Carpal Tunnel Syndrome/diagnostic imaging , Exercise/physiology , Median Nerve/diagnostic imaging , Muscle, Skeletal/diagnostic imaging , Ulnar Nerve/diagnostic imaging , Action Potentials/physiology , Carpal Tunnel Syndrome/physiopathology , Electric Stimulation , Electromyography , Hand/diagnostic imaging , Hand/innervation , Hand/physiopathology , Humans , Median Nerve/physiopathology , Muscle Contraction/physiology , Muscle, Skeletal/innervation , Muscle, Skeletal/physiopathology , Neural Conduction/physiology , Ulnar Nerve/physiopathology , Ultrasonography, DopplerSubject(s)
Granulosa Cell Tumor/pathology , Neoplasm Recurrence, Local , Ovarian Neoplasms/pathology , Aged , Biomarkers, Tumor/analysis , Biopsy , Female , Granulosa Cell Tumor/chemistry , Granulosa Cell Tumor/surgery , Humans , Hysterectomy , Immunohistochemistry , Ovarian Neoplasms/chemistry , Ovarian Neoplasms/surgery , Ovariectomy , Reoperation , Salpingectomy , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Breast Neoplasms , Ophthalmoplegia , Aged, 80 and over , Brain , Breast Neoplasms/complications , Breast Neoplasms/drug therapy , Breast Neoplasms/physiopathology , Breast Neoplasms/radiotherapy , Cranial Fossa, Posterior/diagnostic imaging , Cranial Fossa, Posterior/physiopathology , Female , Humans , Magnetic Resonance Imaging , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/radiotherapy , Ophthalmoplegia/complications , Ophthalmoplegia/diagnosis , Ophthalmoplegia/physiopathology , Ophthalmoplegia/radiotherapy , RadiographyABSTRACT
Recent epidemics and pandemics have highlighted a number of ethical concerns about the response to the increasing threat of emerging infectious diseases. Some of these ethical concerns are very fundamental. They include why a pandemic was declared, how much clinical information can be collected for public health without threatening patient confidentiality and how to ensure fairness in the distribution of resources. We discuss these issues and suggest approaches to resolve these dilemmas as we anticipate the next pandemic.
Subject(s)
Communicable Diseases/epidemiology , Disease Outbreaks/ethics , Ethics, Medical , Pandemics/ethics , Public Health Practice/ethics , Communicable Disease Control , Global Health , Humans , Quarantine , Sentinel Surveillance , Singapore/epidemiologyABSTRACT
OBJECTIVE: Recent studies suggest that high resolution ultrasonography (HRU) is useful in evaluating ulnar neuropathy (UN) at the elbow. These studies do not include UN outside the elbow and lesions related to previous trauma. We investigate diagnostic utility of HRU in UN at any location of traumatic and non-traumatic etiology. METHODS: Patients with clinically suspected and electrophysiologically defined UN at the elbow and outside the elbow were included. Nerve conduction studies (NCS) were compared with HRU. HRU defined UN in terms of change in cross-sectional area. RESULTS: Our retrospective analysis included 46 UN. In 25 cases both NCS and HRU localised neuropathy to the elbow. In 15 where NCS was abnormal but non-localising, HRU localised the lesion in 14, 7 outside the elbow. In three of these, HRU characterised further pathology (synovial osteochondromatosis (n=2), myositis ossificans (n=1). Cross-sectional area of the ulnar nerve at the sulcus significantly correlated with distal NCS parameters. CONCLUSIONS: HRU is of greater use than NCS in the localisation of UN both at the elbow and outside the elbow and in UN related to previous trauma. SIGNIFICANCE: HRU is useful for the localisation of ulnar neuropathy.
Subject(s)
Ulnar Nerve/diagnostic imaging , Ulnar Nerve/injuries , Ulnar Neuropathies/diagnostic imaging , Ultrasonography/methods , Adult , Aged , Cubital Tunnel Syndrome/diagnostic imaging , Cubital Tunnel Syndrome/pathology , Cubital Tunnel Syndrome/physiopathology , Female , Humans , Male , Middle Aged , Myositis Ossificans/diagnostic imaging , Myositis Ossificans/pathology , Myositis Ossificans/physiopathology , Osteochondromatosis/diagnostic imaging , Osteochondromatosis/pathology , Osteochondromatosis/physiopathology , Retrospective Studies , Ulnar Nerve/pathology , Ulnar Neuropathies/pathology , Ulnar Neuropathies/physiopathology , Wounds and Injuries/diagnostic imaging , Wounds and Injuries/pathology , Wounds and Injuries/physiopathology , Young AdultABSTRACT
Localised hypertrophic mononeuropathy is the progressive enlargement of a large peripheral nerve, which can lead to profound loss of function. In this case report, we describe the postoperative occurrence of this phenomenon and possible ways to monitor for this condition.
Subject(s)
Decompression, Surgical/adverse effects , Peripheral Nervous System Diseases/etiology , Peripheral Nervous System Diseases/pathology , Postoperative Complications/pathology , Adolescent , Electrodiagnosis , Humans , Hypesthesia/etiology , Magnetic Resonance Imaging , Male , Muscle Weakness/etiology , Neural Conduction , Neurosurgical Procedures , Reoperation , Ulnar Nerve Compression Syndromes/surgery , Ulnar Neuropathies/etiology , Ulnar Neuropathies/surgeryABSTRACT
INTRODUCTION: Gallbladder carcinoma has been associated with various paraneoplastic syndromes. These may be the presenting manifestations that lead the clinician to a diagnosis. CASE REPORT: We report a case of small cell gallbladder carcinoma complicated by paraneoplastic hyponatremia. The hyponatremia was further exacerbated by platinum-based chemotherapy. DISCUSSION: There have previously been no reports of paraneoplastic hyponatremia in gallbladder carcinoma. We discuss the management of this problem and also provide a short literature review on the other paraneoplastic syndromes associated with gallbladder carcinoma. CONCLUSION: Symptoms and signs of gallbladder cancer may be insidious. Thorough workup is needed if the patient presents with symptoms and signs of a paraneoplastic syndrome.