Normal Values of Lower Limb Nerve Conduction in Kuwait

The incidence of musculoskeletal injuries among musicians is well documented. The purpose of this study was to describe the neural status of the median and ulnar nerves in young adult violinists. Twenty volunteer violinists were recruited from the Belmont University and the Vanderbilt University Blair School of Music Orchestras (age 18-30 years). The subjects completed a history form and underwent a physical examination. The electrophysiologic status of the median and ulnar nerves in both upper extremities was then evaluated using sensory and motor nerve conduction studies (NCSs). Upon completion of the NCSs, educational materials to prevent upper extremity cumulative trauma disorders were distributed to the subjects. In these subjects, the history and subjective examination were largely noncontributory of upper extremity neuropathies. Their physical examinations were also not diagnostic of upper extremity neuropathies. All subjects’ median and ulnar NCSs were normal when compared with a chart of normal values. However, when comparison studies between the median and ulnar NCSs in the same extremity were performed, seven subjects showed differences in their distal motor latencies (>1.0 msec) or distal sensory latencies (>0.5 msec) that could be suggestive of early median neuropathy at or distal to the wrist. In this descriptive study, 20 young adult violinists had no subjective findings of median or ulnar neuropathy, had normal physical examinations of the neck and both upper extremities, and had normal median and ulnar NCSs when compared with a chart of normal values. However, when comparison NCSs between the median and ulnar nerve in the same extremity were performed, seven violinists were found to have NCS values suggestive of early median neuropathy at or distal to the wrist. In this population of 20 young adult violinists, seven musicians were found to have electrophysiologic findings suggestive of early median neuropathy at or distal to the wrist.

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Efficacy of plasma exchange in patients with ischemia-reperfusion syndrome of the lower extremities

Kazan medical journal ◽

10.17816/kmj2019-130 ◽

2019 ◽

Vol 100 (1) ◽

pp. 130-134

Author(s):

M S Zhigalova ◽

I N Pasechnik ◽

D E Kutepov

Keyword(s):

Plasma Exchange ◽

Lower Limb ◽

Creatine Phosphokinase ◽

Normal Values ◽

Ischemia Reperfusion ◽

Limb Ischemia ◽

Shortness Of Breath ◽

Lower Limb Ischemia ◽

Group 2 ◽

Group 1

Aim. Optimization of treatment of patients with critical lower limb ischemia in ischemia-reperfusion syndrome by a combination of infusion therapy and plasma exchange. Methods. The study included 58 patients (48 men, 10 women) aged 52 to 87 years (mean age 67.1±6.2 years) operated for critical lower limb ischemia. In the postoperative period all patients received standard conservative treatment. Depending on its effectiveness, the patients were divided into two groups: group 1 (n=30) with a positive response to the treatment and group 2 (n=28) where plasma exchange was required. The indications for plasma exchange were a decrease in the rate of diuresis <0.5 ml/kg/h after the surgery for 4-6 hours, exceeding 5 times the normal values of creatine phosphokinase and 3 times the level of myoglobin. Results. In 48% of patients (group 2), deterioration of the condition was registered, which manifested by deterioration of the state, increase in shortness of breath, decrease in the rate of diuresis. In the laboratory analysis of patients of group 2, attention was drawn to an increase in the level of myoglobin to 287.8±30.1 ng/ml, creatine phosphokinase activity to 1769.3±191.8 u/l, and that of lactate to 2.2±0.3 mmol/l. These parameters exceeded not only the normal values, but also the indicators of group 1. These changes indicated the manifestation of ischemia-reperfusion syndrome and the threat of acute kidney injury. Plasma exchange was accompanied by clinical improvement (decrease in shortness of breath, increase in the rate of diuresis) and pronounced positive dynamics of laboratory parameters. The inclusion of plasma exchange into the complex therapy of ischemia-reperfusion syndrome was accompanied by an increase in the rate of diuresis by 1.7 times (p <0.05), a decrease in the level of myoglobin by 3.1 times (p <0.05) and the activity of creatine phosphokinase by 2.8 times (p <0.05). Conclusion. The use of plasma exchange during the first hours of clinical and laboratory manifestations of ischemia-reperfusion syndrome can prevent the development of fatal complications associated with the progression of this syndrome.

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