Sheridan Memorial Hospital

Nerve decompression for relief of subjective diabetic sensorimotor polyneuropathy pain and numbness has been labeled of "unknown" benefit. Objective outcomes in treatment and prevention of diabetic foot complications are reviewed. There is growing evidence that plantar foot ulceration and recurrence in high-risk feet are minimized with this operation. Avoiding neuropathic and neuroischemic ulcer wounds should theoretically reduce amputations and perhaps mortality risk. Protective effects are hypothesized to act via relief of neuro-vascular entrapment, thereby improving neurally modulated tissue homeostasis factors. Nerve decompression deserves considerable research attention to understand its role in limiting foot complications. Its apparent benefits challenge the paradigm that diabetic neuropathy is a purely length-dependent axonopathy and may necessitate appreciation of superimposed nerve entrapment as an significant operant factor.

Riazi et al. (1) report that ultrasound demonstrates a consistent enlargement of the posterior tibial nerve in the distal leg in diabetes sensorimotor polyneuropathy (DSP). They also describe an inverse relation between calculated cross-sectional area and objectively measured nerve conduction studies and a direct relationship with subjective DSP severity. Their discussion suggests ultrasound use as a point-of-care screening device for DSP and speculates as to whether a demonstrated nerve enlargement in DSP should be of concern for anesthesiologists considering the use of local or regional nerve block injections, which might hypothetically put the compromised nerve at additional risk. A more …

Depression in children and adolescents is not only widely recognized as a significant public health concern, but the prevalence rates are increasing. As with adult depression, there are numerous possible symptoms, including the cardinal symptoms of depressed mood and loss of pleasure in usual and customary activities (anhedonia). Sleep problems, appetite or weight changes, decreased motivation, and interference with memory and concentration may also be present. Other common symptoms include feelings of guilt or worthlessness, diminished ability to make decisions, and psychomotor agitation or retardation. Furthermore, depression in children and adolescents is typically associated with social withdrawal, interpersonal problems, decreased school performance, and increased school attendance issues. Depression also increases the risk of suicide in children and adolescents (Bhatia and Bhatia, 2007). Suicidal thoughts, ideation, rumination, plans, and attempts may be present, depending on the depth of the depression. Moreover, depression is linked to impairment in social and family functioning. There is also substantial comorbidity between depression and other psychiatric disorders, particularly anxiety disorders and substance use and abuse.

A new cytochemical method is presented for the fluorescent demonstration of zinc in human granulocytes using 8-hydroxyquinoline. This compound is known to form fluorescent complexes with magnesium, calcium and zinc. Specificity for zinc is accomplished by adjusting the staining solution to pH 8.0 with Michaelis universal buffer. The technique is simple, rapid and much more specific for zinc than the dithizone stain.