High frequency ultrasonography in the management of carpal tunnel syndrome

To evaluate the diagnostic usefulness of high frequency ultrasound in the management of Carpal Tunnel Syndrome among patients suspected of having this syndrome. Twenty- six patients [22 women and 4 men] with a mean age of 48.5 years [range 27-70 years] suspected of having carpal tunnel syndrome were examined by high frequency ultrasound at the middle of the carpal tunnel within two weeks after electro diagnostic testing and included in the study. Fourteen patients had bilateral symptoms and 12 patients had unilateral symptoms [total 40 symptomatic hands] [Twenty-six patients [five men and 21 women, mean age 38 years, range 23 71 years]]. The cross- sectional area of the median nerve was measured at the carpal tunnel. The hook of the hamate, the pisiform bone and the flexor retinaculum were used as landmarks to margins of carpal tunnel. The cut- off point for the cross -sectional area was chosen to be 9.7milimetre squared. Sensitivity and specificity of ultrasound were determined on the basis of the final diagnosis derived from the patient's history and electromyographic studies results which was used as the gold standard. High-frequency ultrasound had a sensitivity of 94% and a specificity of 75%. The increased cross-sectional area of the median nerve was the most consistent finding in 80% [32 740] of patients, while thickening of the flexor retinaculum was found in 25% [10/40] and tenosynovitis of the flexor tendon in 22% [9/40]. Flattening of the median nerve was present in l0% [4/40] while ganglion and swelling of the median nerve were present in 7.5% [3/40] respectively. High- frequency ultra- sonography is an effective method for the diagnosis of and may be preferred as the first step in the assessment of carpal tunnel. Furthermore, ultrasound may also provide information about the cause of carpal tunnel syndrome and thus helping planning treatment and follow-up of patients

Glucagonoma presenting as necrolytic migratory erythema in a long-standing type II diabetic patient

We report a case of glucagonoma in a 60-year old diabetic lady who was seen by a dermatologist for a superficial erythematous skin eruption with flaccid bullae over both legs of recent onset. These findings warranted further investigations that revealed a pancreatic mass lesion involving the distal body and tail with three metastatic deposits within the right lobe of the liver. Distal pancreatectomy and splenectomy were performed and histological examination of the excised specimen confirmed the diagnosis of pancreatic glucagonoma with liver metastasis. Blood sugar levels became more controlled postoperatively. The skin lesion disappeared completely six months after surgery. The lady enjoys fairly good health, and is maintained on Somatostatin analogues for control of metastasis that are stable after 18 months of follow up

Pica is a cause of acute abdomen

This report is to document a rare and unique case of 18 years- old girl who presented with signs and symptoms of anemia with a cute abdomen. Medical investigation revealed a pica, which was associated with pseudo intestinal obstruction and severe anemia

Diagnostic evaluation of [pregnant] patient with acute abdominal pain. The role of imaging modalities

Assess the pregnant patient with other causes of pain not related to pregnancy presenting to emergency department, using different imaging modalities and to review the basic principles of radiation safety. During 18 months, 55 pregnant patients were referred randomly from emergency department for evaluation of abdominal pain prospectively enrolled into our study. Pregnant with pregnancy-related causes such as premature contractions and other related causes were excluded. US evaluation for all patients including a careful search for gall bladder, kidneys, pancreas and appendix related causes. Clinical, surgical, and/or imaging follow-up data were obtained in some patients. Out of 55 patients, 28[50.90%] were confirmed to have an eight with gall-bladder stones [14.54%] five with hydronephrosis related to pregnancy [9.08%], two of renal calculi [3.63%] one had bowel obstruction and pancreatitis [1.81%],seven with pyelonephritis[12.72%], and four with appendicitis [7.27%]. There is an increased incidence of acute abdomen during pregnancy though clinical pictures sometimes get blunted due to gravid uterus. Early diagnosis followed by surgical intervention if needed decrease morbidity for both mother and fetus, also enhances our knowledge of the principles of radiation safety

Parotid masses: evaluation of diagnostic modalities

This is a retrospective study of 52 cases of parotid swelling at Prince Rashid Ben Al-Hassan Hospital over 2 years period between April 1993 and August 1995, to study the pre and post-operative evaluation of parotid masses. Clinical presentation, computerized tomography, ultrasound and fine needle aspiration cytology were evaluated. Out of 52 cases, 11 patients [21%] had non-neoplastic lesions, 25 [48%] had benign neoplasms and 16 [31%] had malignant neoplasms, of which 9 [17%] were of primary parotid origin, and 7[13%] metastatic lesions. An asymptomatic mass was the most common presentation. We conclude that computerized tomography was found to be more accurate than ultrasound in localization of parotid masses, but both were inaccurate in differentiating benign from malignant lesions