Factors influencing return to work after surgery for ulnar nerve compression at the elbow

Ulnar nerve compression at the elbow (UNE) frequently affects people of working age. Surgically treated patients may not immediately return to work (RTW) postoperatively. In 2008, the Swedish Social Insurance Agency reformed the national insurance policy. We aimed to examine RTW postoperatively for UNE, variations among surgical methods, and potential risk factors for prolonged RTW (sick leave > 6 weeks). Surgically treated cases of UNE (n = 635) from two time periods (2004-2008 and 2009-2014) and two healthcare regions (Southern and South-eastern) were studied retrospectively regarding age, sex, comorbidities, occupation, type of surgery and time to RTW. A sub-analysis of the exact number of weeks before RTW (n = 201) revealed longer RTW for unemployed cases compared to employed cases. Prolonged RTW was seen among younger, manual workers and after transposition or revision surgery. Prolonged RTW was approximately four times more likely after transposition than after simple decompression. Comparisons before and after 2008 showed occupational differences and differences in RTW, where cases operated before 2008 more often had permanent sickness benefit, but the reform of the social insurance system did not seem to influence RTW. In conclusion, unemployment, younger age at surgery, manual labour, transposition, and revision surgery were related to prolonged RTW.

Longer colonic transit time is associated with laxative and drug use, lifestyle factors, and symptoms of constipation

BACKGROUND

Gastrointestinal symptoms and changes in colonic transit time (CTT) are common in the population.

PURPOSE

To evaluate consecutive patients who had been examined for CTT, along with completion of a diary about laxative and drug use, lifestyle factors, and gastrointestinal symptoms, to identify possible associations with longer or prolonged CTT.

MATERIAL AND METHODS

A total of 610 consecutive patients had undergone the radiopaque marker method with an abdominal X-ray for clinical purposes. The patients had completed a diary regarding medical treatment, lifestyle factors, stool habits, and their perceived constipation and abdominal pain during the examination period. The associations between CTT and laxative use, lifestyle factors, stool habits, and symptoms were calculated by logistic regression.

RESULTS

Women had longer CTT (2.5 [1.6-3.9] vs. 1.7 [1.1-3.0] days, P < 0.001), lower weekly stool frequency (6 [3-10] vs. 8 [5-12], P = 0.001), and perceived more constipation (P = 0.025) and abdominal pain (P = 0.001) than men. High coffee consumption (P = 0.045), bulk-forming (P = 0.007) and osmotic (P = 0.001) laxatives, and lower stool frequency, shaped stool, and perceived constipation (P for trend < 0.001) were associated with longer CTT. In total, 382 patients (63%) were treated with drugs affecting motility. In the 228 patients without drug treatment, longer CTT was associated with female sex and smoking, and lower frequency of symptoms and prolonged CTT were observed compared to patients using drugs. Tea, alcohol, and abdominal pain did not associate with CTT.

CONCLUSIONS

Female sex, coffee, smoking, drug use, infrequent stools, shaped stool, and perception of constipation are associated with longer or prolonged CTT.

Impact of smoking and preoperative electrophysiology on outcome after open carpal tunnel release

BACKGROUND

The aim was to evaluate the influence of smoking and preoperative electrophysiology on the outcome of open carpal tunnel release.

METHODS

This retrospective observational study evaluated the outcome in 493 patients (531 hands) primary operated for carpal tunnel syndrome. Data were collected from medical records, health evaluations, and QuickDASH questionnaires before surgery and 1 year after.

RESULTS

Smokers had a higher QuickDASH score preoperatively as well as postoperatively, but the change in total score did not differ. The odds of having a postoperative QuickDASH score >10 were 2.5 times higher in smoking patients than in non-smoking patients. In 124/493 patients (25%), no clinically significant improvement was seen. Normal and extreme preoperative electrophysiology values were associated with higher postoperative scores. No correlation was found between preoperative QuickDASH scores and preoperative electrophysiology values.

CONCLUSIONS

Smokers with carpal tunnel syndrome experience more symptoms preoperatively. Smokers have remaining symptoms after surgery. There is no correlation between preoperative QuickDASH scores and preoperative electrophysiology values. Patients with normal or near to normal preoperative electrophysiology results have limited improvement after surgery.

Low myelinated nerve-fibre density may lead to symptoms associated with nerve entrapment in vibration-induced neuropathy

Prolonged exposure to hand-held vibrating tools may cause a hand-arm vibration syndrome (HAVS), sometimes with individual susceptibility. The neurological symptoms seen in HAVS are similar to symptoms seen in patients with carpal tunnel syndrome (CTS) and there is a strong relationship between CTS and the use of vibrating tools. Vibration exposure to the hand is known to induce demyelination of nerve fibres and to reduce the density of myelinated nerve fibres in the nerve trunks. In view of current knowledge regarding the clinical effects of low nerve-fibre density in patients with neuropathies of varying aetiologies, such as diabetes, and that such a low density may lead to nerve entrapment symptoms, a reduction in myelinated nerve fibres may be a key factor behind the symptoms also seen in patients with HAVS and CTS. Furthermore, a reduced nerve-fibre density may result in a changed afferent signal pattern, resulting in turn in alterations in the brain, further prompting the symptoms seen in patients with HAVS and CTS. We conclude that a low nerve-fibre density lead to symptoms associated with nerve entrapment, such as CTS, in some patients with HAVS.

Impaired vibrotactile sense at low frequencies in fingers in autoantibody positive and negative diabetes

Vibration thresholds in index and little finger pulps in subjects with autoantibody [GADA, IA-2A and/or ICA] positive and negative diabetes 20 years after diagnosis were higher than in age-matched controls at low frequencies (8 and 16 Hz), irrespective of HbA1c values, indicating selective impairment of Meissner's corpuscles and/or their innervating axons.

Disturbed vibrotactile sense in finger pulps in patients with Type 1 diabetes--correlations with glycaemic level, clinical examination and electrophysiology

AIMS

In a cohort of men and women with Type 1 diabetes, prospectively followed for > 20 years, vibrotactile sense in fingers was investigated and related to neurophysiological tests, glycaemic level and clinical score.

METHODS

Out of 58 patients, diagnosed at the age of 15-25 years and recruited 1984-1985, 32 patients (13 women, median age 52 years, range 44-75 years; 19 men, median age 52 years, range 39-69 years; median duration 33.5 years, range 21-52 years) accepted follow-up in 2006. Vibration thresholds were measured in finger pulps of index and little fingers bilaterally at seven frequencies and related to results of touch (monofilaments), tactile discrimination (two-point discrimination test), electrophysiology (median nerve function), glycaemic level (HbA(1c) levels since 1984-1985) and a clinical score.

RESULTS

Vibrotactile sense was reduced in finger pulps, mainly in men, compared with an age- and gender-matched healthy control group with normal HbA(1c) . Vibration thresholds were increased, particularly at 250 and 500 Hz, in both index and little finger pulps. Touch and tactile discrimination correlated with vibration thresholds, but not with each other or with electrophysiology. HbA(1c) levels (at follow-up or mean values from five follow-ups since recruitment) did not correlate with any nerve function variables. Clinical scores correlated with vibrotactile sense, particularly at higher frequencies (> 125 Hz), but not with total Z-scores of electrophysiology. Duration of disease did not correlate with any variables.

CONCLUSIONS

Examination of vibration thresholds in index and little finger pulps may be valuable to detect neuropathy, where thresholds correlate with symptoms and tests.

Physico-chemical characterization of indoor/outdoor particulate matter in two residential houses in Oslo, Norway: measurements overview and physical properties--URBAN-AEROSOL Project

Indoor/outdoor measurements have been performed in the Oslo metropolitan area during summer and winter periods (2002-2003) at two different residential houses. The objective of the measurement study was to characterize, physically and chemically, the particulate matter (PM) and gaseous pollutants associated with actual human exposure in the selected places, and their indoor/outdoor relationship. In this paper, we focus on the PM measurements and examine the relationship between the indoor and outdoor PM concentrations taking into account the ventilation rate, indoor sources and meteorological conditions. The indoor/outdoor measurements indicate the important contribution of the outdoor air to the indoor air quality and the influence of specific indoor sources such as smoking and cooking to the concentration of PM inside houses. However, no specific correlation was found between the indoor/outdoor concentration ratio and the meteorological parameters. This study provides information on the physical characteristics and the relationship of indoor to outdoor concentration of particulate matter in residential houses. Moreover, the parameters that influence this relationship are discussed. The results presented here are specific to the sampled houses and conditions used and provide data on the actual human exposure characteristics which occur in the spatial and temporal scales of the present study.

Simultaneous determination of common benzodiazepines in blood using capillary gas chromatography

Blood samples were extracted with n-butyl acetate, and the extracts analysed by capillary gas chromatography using DB-1 and DB-1701 capillary columns with electron-capture detection. The DB-1701 column was found to give better separation of different benzodiazepines (BZDs). Recoveries ranged from 79 to 98%. Detection limits ranged from 0.005 to 0.015 microM for triazolam and flunitrazepam, and from 0.02 to 0.1 microM for other BZDs. Data on accuracy and precision are given for diazepam, desmethyldiazepam, flunitrazepam and nitrazepam.

Health and lifestyle characteristics of professional singers and instrumentalists

Ninety-one instrumentalists and 51 opera singers of the Royal Theatre in Copenhagen, Denmark, were examined, in order to study the frequency of symptoms from the musculoskeletal system and upper airways. The response rate was 91 per cent. Estimates of odds ratios (OR) with 95 per cent confidence interval were calculated, using multiple logistic regression equations, adjusting for age and gender. The frequency of musculoskeletal complaints was the same in singers and instrumentalists. Musculoskeletal problems were however not identical. Instrumentalists had statistically significantly more symptoms from the arm region than singers, OR = 3.1 (1.02-9.5), P less than 0.05. In contrast, instrumentalists had significantly fewer complaints from hip-, knee- and foot joints than singers, OR = 0.2 (0.07-0.61), P less than 0.001. Singers had significantly more symptoms from mouth, lips or throat than instrumentalists, OR = 4.5 (1.7-11.5), P = 0.002. Both male and female instrumentalists had a higher blood pressure. This difference seemed at least in part to be explained by a higher alcohol intake among instrumentalists. We suggest these differences in life style and health characteristics are likely to be caused by professional, ie occupational, work loads.

Relationship between drug plasma concentrations and psychomotor performance after single doses of ethanol and benzodiazepines

In a placebo controlled, crossover study psychomotor effects of single doses of diazepam, 10 and 20 mg, flunitrazepam, 1 and 2 mg, as well as 0.9 g ethanol/kg body weight were investigated over a time period of 6 h in 12 healthy men. Blood samples were collected simultaneously with the test sessions to determine drug concentrations in plasma or blood. The ethanol dose caused the least performance impairment, followed by 10 mg diazepam. The most pronounced impairment was caused by 2 mg flunitrazepam, whereas 20 mg diazepam and 1 mg flunitrazepam caused intermediate impairment and were approximately equipotent on group level. Considerable interindividual differences with respect to maximal impairment following a particular drug treatment were observed, with poor correlation between individual maximal impairments and individual peak plasma concentrations of the drug. The maximal impairment in simple reaction time following the flunitrazepam treatments occurred earlier relative to the peak plasma concentration of the drug as compared to the diazepam treatments. This may indicate that acute tolerance develops differently for the two drugs.

Hearing impairment in orchestral musicians

Symphony orchestra musicians from The Royal Danish Theatre (15 females and 80 males) aged 22 to 64 years were audiologically examined to elucidate the presence and the frequency of noise-induced hearing loss among classical musicians. Compared to a reference material (ISO 7029) the median hearing thresholds of the musicians were increased for all age groups. When using hearing sensitivity in one or both ears less than 20 dB HL as a criterion for normality, it was found the 58% of the musicians had a hearing impairment. 50% of the males and 13% of the females showed a typical audiogram with a notched curve at higher frequencies normally attributed to occupational noise exposure. Furthermore, a significantly poorer hearing on the left ear was found at higher frequencies among the violinists. It is concluded that symphonic musicians suffer from hearing impairment and that the impairment might be ascribed to symphonic music.

Interference with analysis of amphetamine in blood by N-ethylbenzenamine from rubber septums

When blood stored in glass vials sealed with natural rubber septums was screened for amphetamine, a contaminant was seen. The contamination originated from the rubber septums and was identified by GC/MS as N-ethylbenzenamine. Like amphetamine, N-ethylbenzenamine was extracted from strongly alkaline solutions. N-Ethylbenzenamine and amphetamine chromatographed with the same retention time on a packed Apiezon/KOH column and on nonpolar capillary columns. Separation was achieved on a medium polar capillary column. Trifluoroacetyl derivatives of amphetamine and N-ethylbenzenamine had the same retention time on a packed SP-2250 column, but separated on nonpolar capillary columns. The amounts of N-ethylbenzenamine found were high enough to give rise to significant false positive results if N-ethylbenzenamine was erroneously read as amphetamine. N-Ethylbenzenamine is believed to be formed by thermal decomposition of the vulcanizing agent zinc ethylphenyldithiocarbamate used in rubber production.