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[en] Objective: To assess the effect of intrathecal tramadol added to bupivacaine to prolong the duration of analgesia in subarachnoid block for lower limb orthopedic surgeries. Study Design: Randomized controlled trial. Place and Duration of Study: Anesthesia department of Combined Military Hospital Sialkot, from Nov 2015 to Apr 2016. Material and Methods: Patients were selected by non-probability consecutive sampling. One hundred and fifty patients from American Society of Anesthesiologists (ASA) I, II and III category fulfilling inclusion criteria undergoing various lower limb orthopedic surgeries were divided into two groups by lottery system. Group tramadol bupivacaine (TB) received 25mg (1 ml) of tramadol plus 2ml (10mg) of 0.5 percent bupivacaine while group bupivacaine alone (SB) received 1 ml normal saline plus 2ml (10mg) of 0.5 percent bupivacaine. Time to first analgesia request was noted as a measure of duration of analgesia. Time of onset of sensory block level and peak sensory block level and time to reach the peak sensory block level were also noted. Quality of anesthesia was compared among two groups. Data were analyzed by using SPSS version 22. Results: Four patients were excluded from the study. The duration of anesthesia was effectively prolonged in group TB 181.56 ± 12.42 mins as compared to group SB 120.93 ± 15.54 mins. VAS score was significantly lower in group TB. Higher peak sensory block levels (T6) were achieved in group TB as compared to group SB. However time to reach the peak sensory block levels were significantly longer in group TB. (4.5 ± 0.47mins vs 3.09 ± 0.54 mins). Conclusion: This study showed that intrathecal tramadol (25mg) can safely be used along with bupivacaine in subarachnoid blockade to prolong the duration of analgesia and improve the quality of anesthesia as well. (author)
[en] Epilepsy is a typical neural disease in nervous system, and the control of seizures is very important for treating the epilepsy. It is well known that the drug treatment is the main strategy for controlling the epilepsy. However, there are about 10–15 percent of patients, whose seizures cannot be effectively controlled by means of the drug. Alternatively, the deep brain stimulus (DBS) technology is a feasible method to control the serious seizures. However, theoretical explorations of DBS are still absent, and need to be further made. Presently, we will explore to control the absence seizures by introducing the DBS to a basal ganglia thalamocortical network model. In particular, we apply DBS onto substantia nigra pars reticulata (SNr) and the cortex to explore its effects on controlling absence seizures, respectively. We can find that the absence seizure can be well controlled within suitable parameter ranges by tuning the period and duration of current stimulation as DBS is implemented in the SNr. And also, as the DBS is applied onto the cortex, it is shown that for the ranges of present parameters, only adjusting the duration of current stimulation is an effective control method for the absence seizures. The obtained results can have better understanding for the mechanism of DBS in the medical treatment.
[en] Purpose: To propose a simple and effective cost value function to search optimal planning phase (gating window) and demonstrated its feasibility for respiratory correlated radiation therapy. Methods: We acquired 4DCT of 10 phases for 10 lung patients who have tumor located near OARs such as esophagus, heart, and spinal cord (i.e., central lung cancer patients). A simplified mathematical optimization function was established by using overlap volume histogram (OVH) between the target and organ at risk (OAR) at each phase and the tolerance dose of selected OARs to achieve surrounding OARs dose-sparing. For all patients and all phases, delineation of the target volume and selected OARs (esophagus, heart, and spinal cord) was performed (by one observer to avoid inter-observer variation), then cost values were calculated for all phases. After the breathing phases were ranked according to cost value function, the relationship between score and dose distribution at highest and lowest cost value phases were evaluated by comparing the mean/max dose. Results: A simplified mathematical cost value function showed noticeable difference from phase to phase, implying it is possible to find optimal phases for gating window. The lowest cost value which may result in lower mean/max dose to OARs was distributed at various phases for all patients. The mean doses of the OARs significantly decreased about 10% with statistical significance for all 3 OARs at the phase with the lowest cost value. Also, the max doses of the OARs were decreased about 2∼5% at the phase with the lowest cost value compared to the phase with the highest cost value. Conclusion: It is demonstrated that optimal phases (in dose distribution perspective) for gating window could exist differently through each patient and the proposed cost value function can be a useful tool for determining such phases without performing dose optimization calculations. This research was supported by the Mid-career Researcher Program through NRF funded by the Ministry of Science, ICT & Future Planning of Korea (NRF-2014R1A2A1A10050270) and by the Radiation Technology R&D program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (No. 2013M2A2A7038291)
[en] The purpose of this study is to correlate the MR findings with clinical stage and clinical outcome, and to describe the evolutional changes of abnormal MR findings of transverse myelitis. Medical records and spinal MR images of 23 patients with both clinical and radiological diagnosis of transverse myelitis were retrospectively reviewed. MR findings were correlated with clinical stages including interval between MR imaging and full development of clinical symptoms, and compared with the clinical outcome. Diffuse high signal intensity of the spinal cord on T2-weighted image with mild cord bulging (67%) and focal contrast enhancement of the cord (75%) were observed within the first four weeks after full development of clinical symptoms. The findings decreased in extent or vanished later than four weeks on either initial or follow-up MR images. Most patients with either cord atrophy or focal hemorrhage within the cord lesion had poor clinical outcome. The MR findings of transverse myelitis are nonspecific, which may be seen in a variety of diseases. Serial MRIs, especially follow-up examination over at least one month after full development of clinical symptoms are useful in the diagnosis of transverse myelitis and predicting its prognosis
[en] In the author's opinion computed tomography should be applied as an instrument of basic research also in psychiatry. The problem of standardisation is, for the time being, not yet sufficiently solved. Wrong judgements on the cerebral cortex resulting from wrongly positive findings occur frequently. For re-handling the topic 'brain atrophy and psychosyndrome', which is important for clinical psychiatry, the CT-results should be compared with the findings obtained in the preceding systematical pneumoencephalographical-clinical correlation examinations. The excellent possibilities provided by the new method for practical diagnostics and research must be utilized with critical appreciation of the experience gained until now. If groups of examining of capacities closely co-operate over a long-term period, there may be some chances to bring some questions still open and unresolved closer to their solution and, maybe, even to finish the scientific handling of the complex of questions on 'brain atrophic and psychopathological finding' with radiological-morphological methods. (orig./MG)
[de]Die Computertomographie sollte nach Ansicht des Autors auch in der Psychiatrie als Instrument der Grundlagenforschung verwendet werden. Das Problem der Normbildung ist zur Zeit u.E. noch nicht zufriedenstellend geloest. Fehlbeurteilungen an der Hirnrinde i.S. falsch-positiver Befunde sind besonders haeufig. Fuer die Neubearbeitung des fuer die klinische Psychiatrie wichtigen Themas 'Hirnatrophie und Psychosyndrom' sollten die computertomographischen Ergebnisse mit den Befunden verglichen werden, die in den frueheren systematischen pneumencephalographisch-klinischen Korrelationsuntersuchungen ermittelt wurden. Die ausgezeichneten Moeglichkeiten, die das neue Verfahren fuer die diagnostische Praxis und die Forschung eroeffnet, muessen unter kritischer Wuerdigung der bisher vorhandenen Erfahrungen genutzt werden. Wenn Gruppen von Untersuchern mit entsprechender Sachkompetenz langfristig eng zusammenarbeiten, sind u.E. die Aussichten gut, auf diesem Weg einige bisher offene oder umstrittene Fragen meines Fachgebietes einer Loesung naeher und vielleicht sogar die wissenschaftliche Bearbeitung des Fragenkomplexes 'hirnatrophischer und psychopathologischer Befund' mit roentgenologisch-morphologischen Methoden zum Abschluss zu bringen. (orig./MG)
[en] Numerical modelling of magnetic stimulation in the spine is a scarce subject in the literature, although it has been gaining clinical acceptance. In the present work we present the results from a simplified computational model of the spine. The results indicate that it is necessary to use a numerical technique for solving the problem, which takes into account tissue dispersion and both dielectric properties (conductivity and permittivity), since a difference of 14% in the induced electric fields was found when displacement currents were included. With respect to the role of tissues in stimulation efficiency, it was confirmed that water-rich tissues lead to a shielding effect of the spinal cord. However, this effect becomes smaller at the height of the intervertebral discs, resulting in an increase of the field inside the spine.
[en] This paper identifies uncertainties and problems in the practical application of the ICNIRP low frequency basic restriction on current density. This quantity should be averaged over a cross-section of 1 cm2 perpendicular to the current direction. The rationale and the sensitivity of the current density average are investigated. There are difficulties in finding a square centimetre of spinal cord over which to average. The consequences of including neighbouring tissues in the averages are investigated in the male and female voxel models NORMAN and NAOMI for applied uniform electric and magnetic fields at 50 Hz. Also the case of the non-uniform magnetic field from a horizontal current carrying conductor adjacent to the back of the body is investigated. The maximum and 99th percentile current density values are compared with the 1 cm2 average in the derivation of external field reference levels
[en] The aim of the present study was to correlate prognostic factors with spinal cord myelitis and test the role of ERD for probability of myelitis for lesser than conventional, conventional and higher than conventional dose per fraction
[en] Deep brain stimulators, often called 'pacemakers for the brain', are implantable devices which continuously deliver impulse stimulation to specific targeted nuclei of deep brain structure, namely deep brain stimulation (DBS). To date, deep brain stimulation (DBS) is the most effective clinical technique for the treatment of several medically refractory movement disorders (e.g., Parkinson's disease, essential tremor, and dystonia). In addition, new clinical applications of DBS for other neurologic and psychiatric disorders (e.g., epilepsy and obsessive-compulsive disorder) have been put forward. Although DBS has been effective in the treatment of movement disorders and is rapidly being explored for the treatment of other neurologic disorders, the scientific understanding of its mechanisms of action remains unclear and continues to be debated in the scientific community. Optimization of DBS technology for present and future therapeutic applications will depend on identification of the therapeutic mechanism(s) of action. The goal of this review is to address our present knowledge of the effects of high-frequency stimulation within the central nervous system and comment on the functional implications of this knowledge for uncovering the mechanism(s) of DBS
[en] We studied patients with epilepsy by neuro-pharmacological functional MRI technique using diazepam. Five normal volunteers and 7 patients with epilepsy were investigated. MRI was performed by a 1.5 T unit (SIGNA Horizon, GE) using the following parameters: TR/TE 5000 msec/80 msec, FA 90 deg, FOV 200 mm, matrix 128 x 128, slice thickness 7 mm. We performed MRI scanning over 5 minutes (2 minutes before and 3 minutes after injection of diazepam) for each 1 session; we scanned 3 sessions for each patient at intervals of 5 minutes. The diazepam was injected rapidly from the antecubital vein. The dose of diazepam was 0.05 mg/kg/injection (total dose was 0.15 mg/kg). The data were analyzed statistically using t-test. Signal change after administration of diazepam was less than 1 to 2% in healthy volunteers. By contrast, in patient with epilepsy, the signal change was almost 3%, which was significantly greater than that of the normal area (p=0.01). The neuro-pharmacological functional MRI technique using diazepam might be a useful method to identify epileptic foci. (author)