Role of high-resolution sonography in the diagnosis of carpal tunnel syndrome in patients with normal electrodiagnostic studies

Diagnosis of carpal tunnel syndrome [CIS] is based on a combination of symptoms, clinical signs, and abnormal electrodiagnostic [EDX] studies. Although EDX studies are highly specific, however, they have a substantial false-negative rate of between 10% and 20%. High-resolution ultrasonography [US] has received increased attention in the evaluation of CIS. The aim of this study was to prospectively evaluate the accuracy of sonography for the diagnosis of CTS in patients who were clinically suspected of having the disease and have normal EDX studies. This was a prospective cross sectional study. Patients were enrolled in the study if they had the signs and typical history of carpal tunnel syndrome. They were classified into 2 groups: group I [30 patients, 42 hands]: EDX confirmed CTS, group II [30 patients, 39 hands]: normal EDX studies. Also a normal control group [group III] was included [20 volunteers, 40 hands]. All patients underwent standardized EDX studies then sonographic examinations were performed within 2 days. Transverse images of the median nerve were obtained at three levels: proximal to the tunnel, at the level of the pisiform bone and at the level of the hook of the hamate. Then the transverse and anteroposterior diameters were measured and the flattening ratio and the cross sectional area were calculated. The sonographic findings [except for the flattening ratio] had significant differences among the three groups at the level of the pisiform bone only. Using one way analysis of variance, the cross sectional area showed the greatest differences between the three groups. The significant differences were mainly between group III and both group I and II [p < 0.001]. The difference between group I and II was less, but still was also highly significant [P < 0.01]. There was a highly significant positive correlation between the EDX diagnosis of CTS and the cross sectional area [p < 0.001]. A cutoff of 9.89 mm[2] of the cross sectional area that was extrapolated from the receiver operating characteristics curve was found to be highly diagnostic for CTS with sensitivity, and specificity of 100% and 80% respectively. The higher mean amplitude of the sensory nerve action potentials of group II patients was the only significant EDX variance that differentiated this group from the normal control group. In patients with clinical diagnosis of CTS, high resolution sonography is an efficient complementary test to EDX when the latter is normal. These patients have similar sonographic findings to patients with EDX confirmed CTS, suggesting that they also have similar pathology. A cross sectional area of the median nerve at the pisiform bone of >/= 9.89 mm[2] was found highly diagnostic for CTS. It is also concluded that EDX normal CTS patients are mostly patients with dense sensory innervation that might have lead to low pain threshold and buffered the electrophysiological consequences of nerve entrapment in its early stages

Role of 64 MSCT in the evaluation of aortic lesions

Multslice CT [MSCT] has proved its importance and applicability in the evaluation of vascular disease including stenosis, occlusion, aneursyms and dissection as well as evaluation of post-traumatic events. The aim of the work will be directed to identify the role of MSCT in the evaluation of aortic lesions. The study will be conducted on patients suspected of having aortic lesions based on clinico- laboratory basis. Each patient will be subjected to thorough history taking, Clinical examination, and MSCT aortography. The advance of cardio-thoracic surgery techniques adds the burden of many questions that need to be answered including the extent, width, and shape of the flap and implication of the coronary arteries and major aortic branches. The presence of leakage is of equal importance in both dissecting and atherosclerotic aneurysms. Evaluation of abdominal aortic aneurysm and leakage by MSCT has proved its usefulness particularly in planning for operative intervention including the length, size of the aneurysm and implication of the major aortic branches. 64 MSCT is an excellent tool for examining the aorta. It gives a great deal of information that, abolishes the need of another diagnostic tool prior to operative intervention. It offers a great mapping of dissecting aortic flap, abdominal aortic aneurysms and coarctation. Time of an essence in dealing with emergency patients and 64 MSCT offers a great portal of diagnosis considering time efficacy and accuracy

role of the nurse in health education of preoperative patients as perceived by surgeons

This study was carried out to identify the general health education needs of preoperative patients, and the nurses' role in health education of preoperative patients from the view points of surgeons. The sample consisted of 50 surgeons, selected randomly from the Faculty of Medicine of Alexandria, Surgeons supported the importance of preoperative health education and nurses' role as a patient teacher. They recommended that the quality, depth and methods of presenting information must be adjusted to each patient's capacity and needs

Mitral valvotomy under 20 years

Out of 450 mitral valvotomies, 165 patients [36.6%] submitted for closed mitral valvotomy with an average age 17 years. All of them were in sinus rhythm with no history of embolisation, 83% had dyspnea Grade II to III. The mitral valve orifice was 0.5-1 cm in 69.2% and calcified valve in 6%. In 25 patients the lung biopsy showed parenchymal and vascular changes in most of them. The follow-up of 115 patients [70%] from 6 months to 20 years showed excellent, good and fair results in 87.7% and restenosis in 4.3%

Iatrogenic perforation in caustic esophagitis

Perforation of the oesophagus is a serious complication of dilatation of caustic strictures. This report illustrated the value of early conservative treatment [within 12 hours] in 40 patients with iatrogenic perforation of the oesophagus after corrosive intake. Conservative treatment reduced the mortality from 60% to 15% provided these patients are managed within 12 hours from perforation. Dilatation after healing of the perforation is risky in corrosive strictures, as an alternative retrosternal colon interposition was performed for 22 patients