Value of Power Doppler and Gray-Scale US in the Diagnosis of Carpal Tunnel Syndrome: Contribution of Cross-Sectional Area just before the Tunnel Inlet as Compared with the Cross-Sectional Area at the Tunnel

OBJECTIVE: To determine the value of gray-scale and power Doppler ultrasonography in the evaluation of carpal tunnel syndrome (CTS). MATERIALS AND METHODS: Median nerves at the carpal tunnel were evaluated by using gray-scale and power Doppler ultrasonography and by using accepted and new criteria in 42 patients with CTS (62 wrists) confirmed by electromyogram and 33 control subjects. We evaluated the cross-sectional area of the nerve just proximal to the tunnel inlet (CSAa), and at mid level (CSAb). We then calculated the percentage area increase of CSAb, and area difference (CSAb-CSAa). We measured two dimensions of the nerve at the distal level to calculate the flattening ratio. The power Doppler ultrasonography was used to assess the number of vessels, which proceeded to give a score according to the vessel number, and lastly evaluated the statistical significance by comparing the means of patients with control subjects by the Student t test for independent samples. Sensitivities and specificities were determined for sonographic characteristics mentioned above. We obtained the receiver operating characteristic (ROC) curve to assess the optimal cut-off values for the diagnosis of CTS. RESULTS: A statistically significant difference was found between patients and the control group for mean CSAb, area difference, percentage area increase, and flattening ratio (p < 0.001, p < 0.001, p < 0.001, p < 0.05, respectively). From the ROC curve we obtained optimal cut-off values of 11 mm2 for CSAb, 3.65 for area difference, 50% for the percentage of area increase, and 2.6 for the flattening ratio. The mean number of vessels obtained by power Doppler ultrasonography from the median nerve was 1.2. We could not detect vessels from healthy volunteers. Mean CSAbs related to vascularity intensity scores were as follows: score 0: 12.3 +/- 2.8 mm2, score 1: 12.3 +/- 3.1 mm2, score 2: 14.95 +/- 3.5 mm2, score 3: 19.3 +/- 3.8 mm2. The mean PI value in vessels of the median nerve was 4.1 +/- 1. CONCLUSION: Gray-scale and power Doppler ultrasonography are useful in the evaluation of CTS.

estimation of cerebral asymmetries in schizophrenia by the Cavalieri principle

To demonstrate hemispheric asymmetry in patients with schizophrenia using a cheap, simple stereologic method on the basis of standard CT scans of the brain. To demonstrate hemispheric asymmetry, standard CT scans of 30 schizophrenic patients [14 males, 16 females] were compared with 39 [13 male, 26 female] control subjects at Eskisehir Osmangazi University, Eskisehir, Turkey in 2005. Brain volumes were investigated by using a cheap, simple stereologic method, namely, Cavalieri. In patients with schizophrenia, we found that as age increases, right and left hemisphere volumes decrease. However, in the control group there was no relationship found between age and hemisphere volumes. In the control group, the left hemisphere was significantly bigger in males compared to females. There was a significant difference in both right and left hemisphere volumes between the control group and the schizophrenic group. In the schizophrenic group, a significant difference was observed in right hemisphere volumes between genders [p = 0.002], while there was no difference in the control group. There was a difference in left hemisphere volumes between genders in both groups. Right and left hemispheric volumes of the schizophrenic group were smaller than those of control group. Cerebral asymmetry is an arguable subject for the diagnosis of schizophrenia. The method that we used in this study will be useful in estimating hemispheric volumes

Post-Traumatic Pneumocele of the Frontal Sinus

A pneumocele is an abnormal dilatation of a paranasal sinus, most commonly affecting the frontal sinus. Although the etiology of pneumocele is not entirely known, several causative factors have been suggested including trauma, surgery, tumor and infection. We report here a case of post-traumatic pneumocele of the frontal sinus following a head trauma.