The Effects of Nerve and Tendon Gliding Exercises Combined with Low-level Laser or Ultrasound Therapy in Carpal Tunnel Syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common medical condition that doctors and physiotherapists come across in clinical practice. There are no explicit recommendations concerning which physical therapy methods should be applied in its treatment; however, there have also been no studies on the effects of combining low-level laser therapy (LLLT) or ultrasound with nerve and tendon gliding exercises. The purpose of this study was to evaluate the therapeutic efficacy of ultrasound and LLLT combined with gliding exercises. MATERIALS AND METHODS: A total of seventy patients with mild to moderate CTS, divided into two groups, were included in this study. Group 1 received ultrasound treatment, whereas Group 2 underwent LLLT. The treatment lasted 2 weeks (5 sessions/week). In addition, both groups were treated with nerve and tendon gliding exercises three times daily. The clinical evaluation involved an interview on subjective and objective sensory abnormalities, the intensity of pain, the measurement of grip strength, Phalen's test, Tinel's sign, and the Boston Carpal Tunnel Questionnaire. The assessment was performed before and after the treatment. RESULTS: A decrease in sensory impairments, improvement in visual analog scale, hand grip strength and the Boston Questionnaire results were significant in all patients after therapy. No meaningful differences between groups were noted in any of the examined variables after treatment. No adverse effects were observed. CONCLUSIONS: The results of this study may suggest the clinical efficacy of LLLT or ultrasound combined with gliding exercises in patients with mild to moderate CTS.

[Neurophysiological evaluation of cognitive functions in patients with anorexia nervosa--preliminary report]. / Neurofizjologiczna ocena funkcji poznawczych u chorych na jadlowstret psychiczny--doniesienie wstepne.

INTRODUCTION: Anorexia nervosa (AN) is a disease with multi factorial etiology. Recent studies search the cause of its origin in impairments in neuroendocrinal transmission, genetics, psychological and socio-cultural factors. This disturbance affects the patient's attitude to eating. Many complex physical and psychiatric symptoms of AN require wide approach to the patient on the biological, psychiatric and psychological level. AIM: The purpose of this studies was to determine implications in cognitive functioning in patients with AN. MATERIAL AND METHODS: 10 patients with AN and 20 healthy as a control group were recruited. Cognitive functioning was evaluated using P300 wave component of event related potentials (ERP) and Wisconsin Card Sorting Test. International Federation of Clinical Neurophysiology (IFCN) recommendations for recording and analyzing of ERP were used. These studies were performed using Viking Quest (Nicolet ViaSys Healthcare, U.S.A.). They were recorded using the "oddball paradigm" procedure. The reception of potentials was completed by unipolar method with far-field recording (Fz, Cz, Pz and 10, EOG, 10-20 system). The latencies of the first negative wave N1, next positive P2, the following N2 negative and positive component P300 were evaluated. Moreover, the amplitude differences N1-P2, P2-N2, N2-P3 were analyzed. RESULTS: It was found that both latencies of P300 potential components and WCST results were quite normal. However, reduction of P300 amplitude was observed in patients with AN compared to control group, what can be the result of diminished absorption of cognitive structures during analyzing the stimuli. CONCLUSIONS: The results did not show significant differences in cognitive functioning in patients. Changes in the components of P300 wave indicate the need for further neurophysiological research on larger group to determine the degree of impairments in cognitive functioning in patients with AN.

[Clinical application of visual evoked potentials in evaluation of the visual system in cerebral palsy. Studies on different modes of stimulation]. / Zastosowanie kliniczne wzrokowych potencjalów wywolanych w ocenie ukladu wzrokowego w mózgowym porazeniu dzieciecym. Badanie róznymi sposobami stymulacji.

AIM: In cerebral palsy (CP), besides the early systematic management of the motor disability, there is also a need for a detection of disturbances of visual capacity. The research aimed at presenting various types of visual evoked potentials (VEP) in evaluation of visual impairment in children with CP. MATERIAL AND METHODS: VEPs were registered on 100 children and adolescents, aged 2-19 years, presenting spastic type of CP. According to the degree of patient's cooperation VEPs were elicited with checkerboard pattern reversal (PR), light emitting diodes (LEDs) goggles and flashing screen (F) stimulation. They were recorded by means of Multiliner (Toennies, Germany). Latencies of maximum positive deflection P100, predicting N75 component and following N145 as well as amplitudes of N75/P100 and P1001 N145 were analyzed. The results of VEP obtained in the study group were compared with data recorded from healthy subjects of matched age and sex. The patients were subject of ophthalmological examination prior to electrophysiological testing. RESULTS: Visual acuity ranged from apparently normal to lowered acuity of various degrees. Refractive errors appeared mostly in the form of hyperopia. The study showed that in children with CP, who underwent PR and F stimulation, the latencies of the N75, P100, N145 deflections were significantly longer and the amplitudes were shorter than in the control group. In case of LED stimulation only prolongation of P100 deflection reached statistically significant value in patients. CONCLUSION: Our results indicate that VEPs are objective noninvasive and reproducible means which enable assessment of the functional state of visual system in CP. The data of the present study support the role of VEP in identification of visual impairment that can be an important complementary tool in ophthalmological examination.

[Changes in visual evoked potentials in developmental age. Comparative studies of pattern reversal and two types of flash stimulation]. / Zmiany we wzrokowych potencjalach wywolanych w wieku rozwojowym. Badania porównawcze stymulacji naprzemiennym wzorcem i dwoma rodzajami blysku.

BACKGROUND: Examination of visual evoked potentials (VEP) enables objective, non-invasive diagnostics of vision damage in children and adolescents. It is important to choose proper stimulus for individual patient. AIM OF STUDY: The aim of this research was analysis of VEP variability and disclosure of possible differences recorded in healthy children and adolescents while binocular recording, using four various types of stimulus. MATERIAL AND METHODS: VEPs with pattern reversal (PR 15 and 40 min arc), flashing screen and light emitting diodes (LEDs) in goggles were measured in 100 children and adolescents 1-18 year according to International Federation of Clinical Neurophysiology recommendations. Normative data for VEP's parameters and hemispheric differences under these kinds of simulations were reported. RESULTS: Influence of used stimulation on value of only VEP component latency was confirmed. Application of PR brings longer latencies than with use of flash methods. Changes of VEP parameters connected with maturation of visual pathway in children up to age of 8 were demonstrated. The constant value of responses registered from above left and right cerebral hemispheres was observed which indicates symmetry of recording obtained. CONCLUSION: Variability of VEP recording character depends on application of various stimulus parameters and various methods of their presentations. Consequently, every laboratory performing potential examinations should establish parameter pattern of VEP with strictly defined standardized conditions of stimulation and recording.

Radioiodine therapy in patients with amiodarone-induced thyrotoxicosis (AIT).

INTRODUCTION: Amiodarone (AM) is frequently used in the therapy of patients with cardiac disorders. However, due to high iodine content, it has side effects on thyroid function. The use of radioiodine therapy (RIT) in amiodarone-induced thyrotoxicosis (AIT) with low radioactive iodine uptake (RAIU) is still controversial. In these patients therapeutic choices for refractory disease include surgery, antithyroid drugs, or glu ocorticosteriods. AIM: The aim of the study was to evaluate the efficacy of RIT in patients presenting AIT and low RAIU in two-year follow-up. PATIENTS AND METHODS: 40 patients (25 men and 15 women) aged from 63 to 83 years (x +/- SD: 66.2 +/- 5.0 years; median: 65 years) treated with RIT were included into the study. In these patients AM therapy was essential for the underlying heart disorder, while surgery, antithyroid drugs or glucocorticosteroids, were contraindicated. Forty seven patients with toxic multinodular goiter (TMNG) (39 women and 8 men), matched for age (67 +/- 12 yr; range 54-89 yr), were enrolled into the study as a comparative group. The diagnostic procedures included baseline thyroid function tests (thyrothropin - TSH, free triiodothyronine - fT3 and free thyroxine - fT4 levels), thyroid autoantibodies measurement (antithyroglobulin autoantibodies - TgAb, antithyroid peroxidase autoantibodies - TPOAb, anti-TSH receptor autoantibodies - TRAb), thyroid ultrasonography, thyroid scintiscan and RAIU assessment. RESULTS: Serum values of TSH, TgAb, TPOAb and TRAb were undetectable in both groups. In patients with AIT fT4 level was 18.7 to 38.7 pmol/l (mean: 27.1 +/- 5.8) and fT3 concentration was 3.9 to 5.6 pmo/l (mean: 5.7 +/- 1.4), while in TMNG patients level of fT4 was 31.5 to 22.2 pmol/l (mean: 25,3 +/- 5,8) and fT3 concentration was 3.8 to 4,2 pmo/l (mean: 4,2 +/- 0,2). Mean RAIU values after 5h and 24h in AIT patients were 2.3 +/- 0.5 and 3.1 +/- 0.9%, while in TMNG patients were 18,0 +/- 3,8 and 35,7 +/- 9,1%, respectively. A significant difference (p<0.001) between 5h and 24h RAIU in AIT compared to TMNG was noted. In all patients with AIT, a dose of 800 MBq of 131I was administered. During two-year-observation recurrence of hyperthyroidism was observed in two patients (5%) with TMNG. These patients received a second radioiodine dose 16.2 +/- 15 months later (the mean re-treatment dose was 735.93 +/- 196.1 MBq). In comparison, none of the patients with AIT required a second 131I dose and only one patient (2.5%) 6 months after ablative 131I dose needed anti-thyroid medication. Transient hypothyroidism was observed in only two patients (5%) with AIH, though was not observed in TMNG. During follow-up time, no sudden deaths in AIT patients were observed; one patient was diagnosed with prostate cancer, and in one patient acute toxic hepatitis after AM occurred. CONCLUSION: RIT may be a safe and useful method of AIT therapy in patients with low RAIU, in whom other treatment methods are contraindicated.

Cerebral childhood and adolescent X-linked adrenoleukodystrophy. Clinical presentation, neurophysiological, neuroimaging and biochemical investigations.

Clinical, neurophysiological, neuroimaging and biochemical studies were performed in five boys with childhood and adolescent form of cerebral X-ALD, which is a very rare disease in developmental age. In all patients, rapidly progressive spasticity, ataxia and mental deterioration were found. Seizures occurred in four of them. Additionally, visual and hearing impairment were observed in four and three patients respectively. Adrenal insufficiency was also diagnosed in four cases. MR revealed extensive demyelination located mainly symmetrically in the parieto-occipital areas, in one patient in whom asymmetrical lesions in that region were found. All patients had abnormal visual, brainstem and somatosensory evoked potentials recording, reflecting the central demyelination occurring in X-ALD. The clinical diagnosis in every case was confirmed by the significantly elevated concentration of very long chain fatty acids (VLCFA) measured in plasma in comparison to normal values.