Gray scale and color Doppler sonography in the diagnosis of carpal tunnel syndrome

Purpose

To determine the diagnostic accuracy of gray scale and color Doppler sonography in the diagnosis of patients with carpal tunnel syndrome.

Patients and methods

A total of 53 wrists in 41 consecutive patients with clinical suspicion of carpal tunnel syndrome, referred from the Department of Physical medicine, Rheumatology & Rehabilitation were examined with ultrasonography using a 12 MHz linear array transducer. The presence of median nerve edema, swelling, and bowing of the flexor retinaculum was evaluated by gray scale sonography, while intraneural hypervascularity was evaluated by color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature and compared with electrodiagnostic test (EDT) results.

Results

Electrodiagnostic tests confirmed carpal tunnel syndrome in 48 wrists. A median nerve cross sectional area (CSA) of 11 mm² was calculated as a definition of median nerve swelling. In comparison with electrodiagnostic tests, median nerve swelling showed the highest accuracy (89%) among the gray scale sonographic criteria, and the presence of median nerve hypervascularization showed the highest accuracy (94%) among all sonographic criteria. Median nerve edema and bowing of the flexor retinaculum showed accuracies of 81% and 77% respectively.

Conclusion

Median nerve intraneural hypervascularity detected by color Doppler sonography is more accurate in detection of median nerve involvement than gray scale sonography criteria in patients with suspected carpal tunnel syndrome.     

Nodular regenerative hyperplasia: a controversial indication for orthotopic liver transplantation

Nodular regenerative hyperplasia of the liver is an uncommon cause of portal hypertension. Patients with nodular regenerative hyperplasia have signs and symptoms of portal hypertension, without evidence of hepatocellular failure or encephalopathy. We report the case of a 44-year-old woman with recurrent esophageal bleeding and refractory ascites who had a history of hemosiderosis, hepatitis C, and chronic renal allograft rejection. Our preoperative diagnosis was cirrhotic end-stage liver disease and end-stage renal disease for which the patient underwent combined hepatic and renal transplantation. Her portal hypertension symptoms resolved, and her renal function has been normal for 18 months of follow-up. Histologic examination of the liver revealed nodular regenerative hyperplasia, and a review of the literature regarding the surgical management of patients with nodular regenerative hyperplasia revealed that various shunting procedures are generally recommended. After the failure of medical management in patients with nodular regenerative hyperplasia, portosystemic shunting may be indicated before proceeding to hepatic transplantation.     

Bilateral globus pallidus internus deep brain stimulation in tardive dyskinesia: a case report.

The clinical response of a 53-year-old woman with tardive dyskinesia treated with bilateral globus pallidus interna deep brain stimulation is described. At 18 months follow-up, her Burke-Fahn-Marsden Dystonia Rating Scale score fell from 52 (preoperative) to 21 (60% improvement).     

Frequency of mitochondrial m.1555A > G mutation in Syrian patients with non-syndromic hearing impairment

Background

Mitochondrial maternally inherited hearing impairment (HI) appears to be increasing in frequency. The incidence of mitochondrial defects causing HI is estimated to be between 6 and 33% of all hearing deficiencies. Mitochondrial m.1555A?>?G mutation is the first mtDNA mutation associated with non-syndromic sensorineural deafness and also with aminoglycoside induced HI. Its prevalence varied geographically between different populations.

Methods

We carried out PCR, restriction enzyme based screening, and sequencing of 337 subjects (including 132 patients diagnosed clinically with hereditary deafness) from 54 families from Syria for m.1555A?>?G mitochondrial mutation.

Results

Mitochondrial m.1555A?>?G mutation was detected in one of fifty-four families (1.85%), six out of the 132 (4.5%) of all patients with NSHI and one propositus of the 205 individuals with normal hearing (0.48%).

Conclusion

This is the first study to report prelingual deafness causative gene mutations identified by sequencing technology in Syrian families. It is obvious from the results that the testing for the m.1555A?>?G mutation is useful for diagnosis of hearing loss in Syrian patients and should also be considered prior to treatment with aminoglycosides in predisposed individuals.

     

Differential Expression of RAGE,EGFR and Ki-67 in Primary Tumors and Lymph Node Deposits of Breast Carcinoma

Background: Breast cancer is a complex disease that results from the inheritance of a number of susceptible genes.Intensive search wok was conducted world-wide on molecular bases of breast cancer in order to achieve the besttherapeutic modalities; however, breast cancer still remains a challengeable task. It is very important to determine ifthe biological parameters in metastatic regional lymph nodes are similar to that in the primary breast cancer becausetherapy is indicated for patients with synchronous metastatic regional lymph nodes of breast cancer. Difference intherapeutic response in cases of breast cancer may be assumed partially to variability in the biological behavior of tumortissue in primary breast cancer and lymph node metastasis. Aim: Our aim is to evaluate any variability in the expression ofthree types of tissue markers in both the primary breast tumors and corresponding axillary lymph nodes in order toexpect the targeted therapeutic effect on both sites. Material and Methods: Three markers from different categories;RAGE, EGFR and Ki-67 were immunohistochemicalyl studied for their expression in biopsy specimens from primarybreast tumors and their corresponding axillary lymph nodes. Results: There was a statistically significant difference inthe expression of these markers between benign and malignant breast lesions.Although we found some differences inthe expression of the three studied markers between primary breast cancer and corresponding axillary lymph nodes, yetthese variations were mostly not statistically significant. Conclusion: Our findings support the validity of anti-RAGEand anti-EGFR therapy for treatment of both primary and nodal metastatic breast cancer in immunopositive cases.     

Recurrent cerebrovascular accident with L-asparaginase rechallenge

We report a 15-year-old boy diagnosed with acute lymphoblastic leukemia (ALL) in 1983. Induction therapy included L-asparaginase. After the second dose of L-asparaginase, he had a left sided focal seizure and computed tomography (CT) scan of the head showed a right frontal infarct. No further L-asparaginase was given. Complete remission was achieved and he successfully completed therapy in 1986. Eight months later he had an isolated bone marrow relapse. Reinduction therapy included L-asparaginase. After the fourth dose of L-asparaginase, he presented with severe headache and a CT scan showed a right temporal infarct. Repeat infarction on rechallenge with L-asparaginase has not been previously reported. Prophylactic therapy, such as fresh frozen plasma, should be considered before patients, with a previous cerebral insult, are rechallenged with L-asparaginase. However the effectiveness of such therapy has not been established. © 1992 Wiley-Liss, Inc.     

The percutaneous toxicokinetics of VX in a damaged skin porcine model and the evaluation of WoundStat™ as a topical decontaminant

This study used a damaged skin, porcine model to evaluate the in vivo efficacy of WoundStat? for the decontamination of superficial, nerve agent‐contaminated wounds. Anaesthetized animals were randomly assigned to either control (n = 7), no decontamination (n = 12) or WoundStat? (n = 12) treatment groups. Pigs were exposed to a 5× LD₅₀ dose of neat, radiolabelled S‐[2‐(diisopropylamino)ethyl]‐O‐ethyl methyl‐phosphonothioate (VX; or equivalent volume of sterile saline for the control group) via an area of superficially damaged skin on the ear. WoundStat? was applied at 30 seconds post‐exposure to assigned animals. The VX contaminant (or saline) and decontaminant remained in place for the duration of the study (up to 6 hours). Physiological parameters and signs of intoxication were recorded during the exposure period. Skin and organ samples were taken post mortem for ¹⁴C–VX distribution analyses. Blood samples were taken periodically for toxicokinetic and whole‐blood acetylcholinesterase (AChE) activity analyses. VX exposure was accompanied by a rapid decrease in AChE activity in all animals, regardless of decontamination. However, decontamination significantly improved survival rate and time and reduced the severity of signs of intoxication. In addition, the distribution of ¹⁴C–VX in key internal organs and post mortem blood samples was significantly lower in the WoundStat? treatment group. This study demonstrates that WoundStat? may be a suitable medical countermeasure for increasing both survival rate and time following VX exposure. The results also suggest that AChE activity is not a useful prognostic indicator.