A comparison of three gastric lavage methods using the radionuclide gastric emptying study

To determine the percentage of liquid gastric contents experimentally removable by available orogastric lavage systems, five healthy young volunteers were asked to ingest 1 mCi of liquid technicium-99m diethylenetriaminepentaacetic acid (Tc99m-DTPA) mixed with 50 ml tap water. Five minutes afterwards, the radionuclide was lavaged using one of three different techniques-a single syringe method, a closed gravity drainage system, and a closed double syringe method--while continuous radioisotope camera images were taken. Control images, with no lavage performed, were also taken. All of the orogastric lavage methods removed a mean of between 80% and 85% of the stomach contents. The double syringe method was the quickest, while the single syringe method was least tolerated. When compared with control, none of the lavage techniques pushed gastric contents into the duodenum. Thus, in terms of amount of liquid gastric contents removed, there was no one method that removed more than the others. Caution should be exercised in assuming that 80-85% of a liquid gastric ingestion can be removed by lavage in the uncontrolled clinical setting. The use of any orogastric lavage for ingestion evacuation should be undertaken knowing that it is a morbid procedure and usually not necessary.

Functional MRI of the activated human visual cortex

We explored the possibility of performing functional magnetic resonance imaging of visual evoked response in the primary visual cortex with a clinical MRI imager of 1.5 tesla. Gradient echo pulse sequence was chosen to acquire the functional image and binocular flash visual stimulation by light-proof goggles containing light emitting diodes was used as the source of cerebral activation. Data processing was performed utilizing direct subtraction for averaged images, correlation coefficient, statistical parametric mapping and matched filter. Of those methods, correlation coefficient and statistic parametric mapping proved to be the methods of choice in our study.

Clinical correlates of quantitative acoustic analysis in ataxic dysarthria

The speech of 15 Taiwanese patients with cerebellar dysfunction and ataxic dysarthria was investigated utilizing techniques of acoustic analysis and instrumental measurement. Semiquantitative assessment of cerebellar function (SQACF) was also performed. The results of the acoustic analysis of the cerebellar speech were then correlated with the findings in the SQACF. The overlapping of voice onset time highly correlates with truncal ataxia as well as eye movement abnormality and eye-hand coordination. The prolongation of vowel duration also correlates significantly with tandem walking, dysdiadochokinesia and eye movement abnormality. The correlation of the speech function with other cerebellar motor functions provides further insight into the functional anatomy for cerebellar speech motor control. This study concludes that the midline structures-vermis and fastigial nucleus-seem to be the primary focus for the coordination of motor speech in the cerebellum.

Treatment of acute gouty arthritis with intramuscular ketorolac tromethamine

Nine consecutive patients presenting with acute gouty arthritis were treated with ketorolac 60 mg intramuscularly (IM). The average age was 58. Seven were male, and six were black. Pain was quantified in 6 of the patients using a 10-cm visual analog scale that the patients completed before and 30, 60, and 90 minutes after ketorolac administration. The mean pain score (+/- standard error of the mean) dropped from 6.43 (+/- 1.25), out of a possible 10, to 1.01 (+/- 35) (P < .01). There were no side effects of the medication. All of the patients were able to leave the treatment area satisfied with their treatment. None of the patients required crutches at discharge.

Autonomic activities in hyperhidrosis patients before, during, and after endoscopic laser sympathectomy

Three hundred palmar hyperhidrosis (PH) patients have been treated with video endoscopic laser sympathectomy during the last 2 years. Monitoring the palmar skin perfusion (PSP) and palmar skin temperature (PST) has been used intraoperatively to aid the confirmation of the correct sympathetic segment for laser ablation. The preoperative and postoperative PSP and PST and sympathetic skin response (SSR) also have been measured to evaluate the therapeutic effect of this method. An apparent increase of PSP would occur intraoperatively after the interruption of the T2 sympathetic segment, and then a gradual elevation of PST would follow after the extirpation of the segment. A rise of PST of about 3 degrees C after laser ablation of the appropriate segment indicated sufficient denervation of the hand and predicted long-lasting relief of PH. Furthermore, both PSP and PST also significantly increased after the operation. The postoperative elevation of the PST (usually about 3 degrees C) is similar to that recorded during intraoperative monitoring. The amplitude and the latency of SSR in the palm and sole were recorded both before and after sympathectomy. A remarkable decrease of palmar SSR amplitude and its ratio was found postoperatively by comparing it with that of plantar SSR in the same patient. These autonomic activity changes have correlated well with the postoperative satisfaction of the patients. Based on our study, the anatomic identification confirmed by the sympathetic monitorings has proved essential to achieve a definite and adequate sympathectomy leading to a satisfactory resolution of PH without the need of a tissue diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)