Missed Gallstones in the Bile Duct and Abdominal Cavity: A Case Report

WOS: 000258504600027PubMed: 1871977

Diagnostic use of dermatomal somatosensory-evoked potentials in spinal disorders: Case series

Objective/Context: Dermatomal somatosensory-evoked potentials (dSEPs) may be valuable for diagnostic purposes in selected cases with spinal disorders

Studying the Liason between Motor Unit Number Estimate (MUNE) and the Total Slope of a Stimulus-Response (SR) Curve of Compound Muscle Action Potential (CMAP) Scan

Objective: This study aims to reveal the connection between the MUNE and the Total Slope of the SR Curve of the CMAP Scan. Introduction: MUNE being a neurophysiological method is utilized in diagnosing and monitoring Neuromuscular Disorders. CMAP Scan relying on the gradual stimulation of motor neurons and recording their responses. A Stimulus-Response (SR) curve results in this process to observe the course of these disorders. In normal cases, SR curve almost represents a sigmoid function. In cases with Motor Unit (MU) loss, beside higher stimulus intensities required for CMAP Scan, the alteration in the shape of SR curve influences the slope of this curve. Thus, a new global variable referred as Total Slope might be described that can be associated with MUNE. Material and Methods: In a simulation software motor neuron groups possessing 5 to-300 axons were created and stimulated gradually with currents from 0 to 99 mA. The CMAPs being the responses in SR curve were used to compute the voltage differences. All slopes corresponding to each voltage differences were summed to compute the Total Slope. The correlation between MU number the Total Slope was investigated statistically. Results and Discussion: The coefficient of determination and the Pearson correlation coefficient between MU number and the Total Slope were found as 0.9973 and 0.999 respectively. This suggests a linear relationship between MU number and the Total Slope. Conclusion and Recommendation: The total slope can be regarded as a new feature in constructing new mathematical models as the mean slope recently described in a recent study. Moreover, new features associated with the slope of the SR curve can be identified in future studies. © 2021 IEEE

Short segment incremental study in ulnar neuropathy at the wrist: report of three cases and review of the literature

Ulnar nerve lesions may occur at different sub-locations at wrist and may involve various branches of the nerve. Standard neurophysiological studies are generally insufficient in revealing these lesions. Demonstration of conduction block and/or focal slowing of nerve conduction is the most definitive electrodiagnostic evidence for the localization of segmental demyelination. Short-segment incremental study (SSIS) is a sensitive technique for detecting the ulnar neuropathy at the wrist (UNW)

Surgeon-performed intraoperative ultrasonography-guided excision of nonpalpable breast masses with adequate surgical margins under local anaesthesia

WOS: 000317861600006Aim With the improvement of expertise in technique and skills of ultrasonography (US), many surgeons now perform image-guided procedures for breast masses themselves. To minimize operative time, and to achieve adequate surgical margins with an acceptable cosmetic outcome, we designed a safe and simple hybrid technique to excise suspicious nonpalpable masses, which is described herein for the first time. Patients and Methods Intraoperatively-marked incision is performed, and a needle is advanced at a 0.5-cm distance to the lesion according to real-time ultrasound measurements. Four deep sutures are passed to fix and hang the predicted specimen adjacent to the needle in four directions. En bloc excision with aimed surgical margins of approximately 0.5cm is achieved by means of retracting sutures, and confirmed by specimen and tumour bed US. Results In the present study, there were 25 women (17 with malignant and 8 with benign lesions), with a mean age of 50.88 years (range: 3069) and mean tumour diameter of 10.6mm (range: 615). All lesions were correctly identified and localized by intraoperative US, and free margins of excision were obtained in all malignant lesions by means of the presented technique. The combined operative technical approach with surgeon-performed intraoperative US-guided needle placement and retracting sutures were feasible, simple and beneficial. We achieved complete tumour removal in all dimensions with no reexcision. The procedure was performed under local anaesthesia in an outpatient fashion with no complications. Conclusion Our report of the operative technique demonstrates that a combination of surgeon-performed image-guided localizations, together with a suture-oriented fashion to assure negative surgical margins in all dimensions, improves margin clearance rate at the time of first surgical intervention. This method can be performed with operative and cost efficiency, and might become a valuable tool to minimize operative time and yield minimal sacrifice of normal breast tissue with maximal cosmetic outcome

Development of a new algorithm for the estimation of the step percentage in compound muscle action potential scan

Compound Muscle Action Potential (CMAP) Scan used in the diagnosis and in the monitoring of Neuromuscular Diseases is based on recording the responses obtained from the gradual stimulation of a peripheral nerve. Clearly visible differences between CMAPs are referred as step. The maximum CMAP percentage of all detected steps are defined as Step Percentage and this is one of the parameters providing evidence for Motor Unit (MU) loss and for reinnervation. The aim of this study is to develop an algorithm which enables to estimate the step percentage more quantitatively. Motor neuron groups which were created through a simulator software were stimulated gradually. The step sizes were computed by utilizing the obtained responses as CMAPs in computing step sizes. Then, these step sizes were sorted in descending order. The step percentage was estimated by taking the cumulative sum of the values greater than two standard deviations (SD) of these sorted step sizes by running the aforementioned algorithm. It was seen that there are larger in fluctuations Step% values in motor neuron groups with lower number of axons, however, a more regular decreasing trend with smaller fluctuations was observed in higher number of axons. In the future studies, the inclusion of further motor neurons with greater axons numbers will be established. Moreover, the application of the algorithm for the patient data will be also considered. © 2019 IEEE