High-resolution sonography versus EMG in the diagnosis of carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Electrodiagnostic testing (EMG) is used to confirm the diagnosis. It is not known what the diagnostic accuracy of high-resolution sonography is in comparison to EMG. OBJECTIVE: The aim of this study was to compare the diagnostic accuracy of both tests in CTS patients. METHODS: A prospective cohort of 207 patients with possible CTS underwent high-resolution sonography and EMG. The diagnosis of CTS was based on clinical signs and symptoms. The cross-sectional area of the median nerve at the carpal tunnel inlet and at the distal one-third level of the forearm was assessed by an investigator, blinded to the clinical and EMG data. Normal sonographic values were obtained from 137 controls. All patients and 40 controls underwent a standardised nerve conduction study. The kappa coefficient was used to evaluate the relationship between sonography, EMG and clinical diagnosis. RESULTS: The cross-sectional area at the distal one-third of the forearm was not significantly different between the controls and patients (p = 0.59), whereas the cross-sectional area at the carpal tunnel inlet was significantly increased in the patient group (p<0.0001). The kappa coefficient for EMG using the median-ulnar distal sensory latency difference versus clinical evaluation was 0.64 and, for sonography, this coefficient was 0.69; these were not statistically different (p = 0.37). Combining the two tests resulted in a kappa coefficient of 0.72, which was not significantly different from sonography alone (p = 0.73). CONCLUSION: In patients with a clinical diagnosis of CTS, the accuracy of sonography is similar to that for EMG. Sonography is probably preferable because it is painless, easily accessible and preferred by the patients.

[A cocaine-induced variant of the neuroleptic malignant syndrome. A case study]. / Een variant van het maligne neurolepticasyndroom door cocaïne.

In this article we discuss the case of a patient with schizophrenia who presented with the clinical symptoms ofcoma, fever and rigidity. Initially it was suspected that the patient had a neuroleptic malignant syndrome. Closer inspection revealed that the patient had recently used cocaine. It is known that cocaine can cause a variant of the neuroleptic malignant syndrome. The patient was treated with dantrolene sodium and bromocriptine in the Intensive Care Unit and made a complete recovery within four days.

Enhancement of rat hepatic and gastrointestinal glutathione and glutathione S-transferases by alpha-angelicalactone and flavone.

The naturally occurring anticarcinogens flavone and alpha-angelicalactone incorporated separately and simultaneously in the diet at 0.5, 0.1, 0.05 and 0.01% w/w, were studied with respect to their effects on oesophageal, gastric, intestinal, colonic and hepatic (i) glutathione S-transferase (GST) enzyme activity, (ii) GST isozyme levels and (iii) glutathione (GSH) content in male Wistar rats. GST enzyme activity was significantly increased in the three treatment groups at one or more sites. The most substantial inductions were seen in oesophagus and stomach by 0.5% alpha-angelicalactone (1.9- and 2.3-fold respectively); and in small intestine, colon and liver by 0.5% combination diet (2.5-, 1.4- and 4.0-fold respectively). The inducing capacities declined with decreasing anticarcinogen concentrations. GST enzyme activity was induced in liver and to a lesser extent in small intestine and stomach. In general, in combination groups similar effects were seen as after treatment with alpha-angelicalactone or flavone separately. However, colonic GST enzyme activity was increased in the 0.5% combination group (1.4-fold), whereas in the corresponding flavone or alpha-angelicalactone groups no induction was observed. Concomitant changes in GST isozyme levels occurred. The involvement was the highest for GST-alpha (75%), followed by GST-mu (58%) and GST-pi (33%). Increased GSH levels were obtained in stomach and liver in all three treatment groups at various concentrations. These data demonstrate that dietary administration of flavone or alpha-angelicalactone, even at relatively low concentrations, may exert chemopreventive effects in stomach, small intestine, liver and to a lesser extent in oesophagus by enhancing the GST detoxification system, mainly by induction of GST-alpha and GST-mu isozymes. In addition, simultaneous administration of flavone and alpha-angelicalactone may result in anticarcinogenic effects in the colon by the same principle.