This study was performed to determine the utility of sympathetic skin response (SSR) in evaluating the sympathetic function and to follow up the effects of sympathetic blockade in reflex sympathetic dystrophy (RSD). Thirty patients having RSD with upper extremity involvement were randomly divided into two groups. Besides medical therapy and exercise, physical therapy agents were applied to both the groups. In addition to this treatment protocol, stellar ganglion blockade was done by diadynamic current in Group II. The normal sides of the patients were used for the control group. SSRs were measured in all the patients before and after the therapy. The amplitude was found to be increased and the latency was found to be decreased in the affected side in both the groups before the therapy. After the therapy, the amplitude was decreased and latency was increased in both the groups. But, the differences in amplitude (P = 0.001) and latency (P = 0.002) before and after the therapy were significantly higher in Group II. (Before the treatment, SSRs were significantly different between the normal and the affected sides in both the groups. The observed change in SSRs after the treatment was higher in Group II.) It was concluded that, SSR can be a useful and noninvasive method in diagnosing the sympathetic dysfunction in RSD and can be used for evaluating the response to sympathetic blockade and other treatment modalities.
Supression of vagal parasympathetic activity was more apparent in stroke patients with right hemispheric lesions in our series. Therefore, the right hemisphere seems to have a greater effect upon parasympathetic activity.
The present study was designed to determine bone density modifications at the forearm and metacarpal bones in patients with carpal tunnel syndrome (CTS). Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the one-third distal end and for the total of the radius-ulna, together with the third and fourth metacarpal bones, in 48 clinically and electrophysiologically diagnosed (18 unilateral and 15 bilateral) affected extremities in 33 premenopausal women (mean age 38.9 +/- 6.5 years) with CTS. BMD values for non-affected extremities were used as controls for comparison with affected extremities. Bone mass was decreased approximately 7% in the forearm region (P < 0.02) and 18% in metacarpal bones (P < 0.01) of the thenar atrophy associated group compared with controls. A significant correlation was observed between disease duration (mean duration 3.2 +/- 2.7 years) and the decrease in metacarpal bone density (r = 0.43; P = 0.004). This is the first clinical report of quantified bone loss in affected extremities in patients with CTS, and the results suggest the need for further studies to assess the clinical significance and morbidity of this pathology, especially in patients with thenar atrophy.
We investigated the effects of aspirin (300 mg/d), ticlopidine (500 mg/d) and their low-dose combination (aspirin 100 mg/d plus ticlopidine 250 mg/d) on the platelet aggregability using the Wu and Hoak method. Each treatment group consisted of 25 patients with acute ischemic stroke. Platelet aggregation ratios (PAR) were measured on the 1(st) (before treatment), 10(th) and 90(th) days in the treatment groups and compared with those of 25 control cases. On the first day, comparison of PAR in each treatment group with the control was significant, while the differences between treatment groups were not significant. On the 90(th) day, differences of PAR between aspirin and control were significant, but differences between the other treatment groups and the control group were not significant, indicating a lower anti-aggregant efficacy of aspirin. Our study suggests that PAR determination can be used to assess the efficacy of anti-aggregant drugs. Our crude observation also suggests a higher anti-aggregant efficacy of ticlopidine, and aspirin plus ticlopidine, than aspirin. In addition, proper doses of aspirin plus ticlopidine may be a good choice for the prevention of ischemic stroke. Further studies are required to assess whether PAR determination could be useful for assessing patients at risk of stroke, and for drug selection for the prevention of stroke.
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