ABSTRACT
High-resolution sonography has the same accuracy as electrophysiological studies in confirming the diagnosis in carpal tunnel syndrome (CTS), but the value of sonographic follow-up after surgery requires prospective examination. The aims of the present study were to assess: (1) change in the size of the median nerve at the proximal carpal tunnel after surgery compared to conservative treatment, and (2) the correlation between sonographic characteristics and clinical outcome after surgery. Seventy-nine patients undergoing surgery for CTS were assessed at least 6 months after surgery. The patients completed questionnaires and underwent sonography. Postoperative improvement was scored by the patient on a 6-point ordinal transition scale ranging from "completely recovered" to "much worse." The median cross-sectional area of the median nerve at the proximal carpal tunnel decreased after surgery from 14 mm2 [interquartile range (IQR) 12-16 mm2] to 11.5 mm2 (IQR 11-13.5 mm2) (P < 0.0001); no significant changes in the cross-sectional area occurred in symptomatic hands treated conservatively or in asymptomatic hands. Sonography at the time of diagnosis was not a predictor of postoperative outcome, but in this study only a relatively small number of patients had a poor postoperative outcome.
Subject(s)
Carpal Tunnel Syndrome/diagnostic imaging , Carpal Tunnel Syndrome/surgery , Decompression, Surgical/methods , Ultrasonography/methods , Electromyography/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Radiography , Severity of Illness IndexABSTRACT
OBJECTIVE: To investigate the effect of low-intensity acenocoumarol treatment (target INR 1.5 to 2.0) on the frequency and severity of migraine attacks. BACKGROUND: The positive effect of anticoagulation on migraine has been described in case reports and observational studies. METHODS: We conducted a randomized, open, crossover study in migraine patients. After a run-in period of 8 weeks, all patients received acenocoumarol or propranolol during a period of 12 weeks and, after a washout period of 2 weeks, propranolol or acenocoumarol during a second period of 12 weeks. RESULTS: Nineteen patients fulfilling the criteria were included. In 12 patients with complete data collection, only one good responder could be noted. In the other patients, treatment with low-intensity acenocoumarol did not show improvement of migraine symptoms compared with the run-in period. Treatment with propranolol showed a trend towards improvement compared with the run-in period. No serious adverse events were observed. CONCLUSIONS: Overall, low-intensity acenocoumarol treatment has no prophylactic effect in migraine patients.
Subject(s)
Acenocoumarol/therapeutic use , Anticoagulants/therapeutic use , Migraine Disorders/prevention & control , Adult , Cross-Over Studies , Double-Blind Method , Female , Humans , Propranolol/therapeutic use , Treatment OutcomeSubject(s)
Central Nervous System Neoplasms/physiopathology , Hematoma, Subdural/physiopathology , Leukemia, Myeloid, Acute/physiopathology , Sarcoma, Myeloid/etiology , Central Nervous System Neoplasms/pathology , Central Nervous System Neoplasms/therapy , Hematoma, Subdural/pathology , Hematoma, Subdural/therapy , Humans , Leukemia, Myeloid, Acute/pathology , Leukemia, Myeloid, Acute/therapy , Magnetic Resonance Imaging/methods , Male , Middle Aged , Sarcoma, Myeloid/pathology , Sarcoma, Myeloid/therapyABSTRACT
We report a 3-year-old boy with influenza A virus-associated encephalopathy. The diagnosis was based on clinical findings, magnetic resonance imaging, repeated isolation of influenza A virus from nasopharyngeal aspirate and seroconversion between acute and convalescent sera. The clinical picture was characterized by fever and aphasia followed by seizures and a rapid deterioriation of consciousness 2 days later. This patient illustrates that influenza A-associated encephalopathy with severe neurological deficit can occur with atypical distribution of brain lesions during the course of the illness, while initial brain MRI and laboratory findings of cerebrospinal fluid are normal, including reverse transcription polymerase chain reaction.
