Which parameter is more reliable in a cold hand, NCV or latency.

Temperature affects distal sensory & motor latencies & nerve conduction velocity but not necessarily at the same degree. Purpose of this study is to see which one is affected less and thus could be more reliable in cold conditions. A total of 32 healthy individuals with age range of 18-28 years (mean 22.25 +/- 2.2) participated in this study. Skin Temperature was recorded at wrist. Distal median motor & sensory latencies and transcarpal median NCV were recorded before and after immersion in cold water. Statistical analysis was performed using paired t-test with SPSS. All parameters were affected by cold but the effect was less dramatic in transcarpal NCV. Transcarpal median NCV is least affected parameter by cold, so it may be more reliable than sensory & motor latencies at wrist.

Sympathetic skin response (SSR) in Crohn disease: a pilot study.

Peripheral neuropathy is one of the most frequently reported neurological extra-intestinal manifestations of the Crohn disease. Former studies have showed sympathetic neuropathy as early manifestation of CD by physical tests. The aim of this study is to examine sympathetic neuropathy in CD by using sympathetic skin response (SSR). We performed SSR on 6 Patients (4 male, 2 female) that were diagnosed as CD. Their age was between 26 till 68 years with the mean of (43.3 +/- 17.1) years. The duration of their disease was at least 4 years (mean: 9.0 +/- 8.4) and none of the patients had any symptoms or signs related to autonomic nervous system dysfunction. Hand and foot latencies in CD patients were prolonged relative to controls and the difference of hand latencies was statistically significant. Two patients demonstrated total abnormal results. In conclusion, there is some sub-clinical sympathetic dysfunction in CD patient. This suggests that SSR can be useful in detecting early autonomic changes in these patients.

EMLA cream for carpal tunnel syndrome: how it compares with steroid injection.

BACKGROUND: A standard treatment option for carpal tunnel syndrome (CTS) is local injection of anesthetic-corticosteroid. This clinical trial was designed to compare the safety and efficacy of daily application of the EMLA cream (lidocaine 2.5% plus prilocaine 2.5%) with that of a single injection of methyl prednisolone acetate (Depo-Medrol) 40 mg. METHODS: In this randomized, parallel-group, open-label, single-center, case-controlled, prospective study, 65 participants (70 hands) aged 18-75 years with clinical & electrodiagnostic evidences of CTS were randomized to receive either the EMLA cream (n = 30 patients, 35 hands, group 1) or one injection of methylprednisolone acetate 40 mg at wrist (n = 35 patients, group 2). Outcome assessments included the visual analog scale and clinical assessment. RESULTS: After 4 weeks of treatment, patients in both groups reported significant changes (P < 0.001) in pain intensity. Both treatments were well tolerated, with treatment-related adverse events (AEs) reported in 2 patients in group 1 (5.7%) and 10 patients in group 2 (28.5%) No systemic treatment-related AEs were observed with the EMLA cream. CONCLUSION: EMLA cream was effective in reducing pain associated with CTS and well tolerated and it may offer patients with CTS an effective, noninvasive symptomatic treatment.

Study of sympathetic skin response in visceral leishmaniasis.

BACKGROUND: Neurologic changes in visceral leishmaniasis are rarely reported. Some articles have reported symptoms suggestive of peripheral neuropathy and showed some degree of axonal degeneration and demyelination. The main purpose of the present study was to identify and quantitatively evaluate sympathetic dysfunction in VL. METHOD: Twenty patients with visceral leishmaniasis and 20 healthy controls were studied. All the patients and controls were examined at first and skin sympathetic response was measured in all of the patients and control group by standard protocol. RESULTS: The patients had mean age of 24.2 +/- 17.8 months. The SSR to the electrical stimulus was absent in 10 patients with VL. In four patients all responses were present and, in four patients only one response from hand or foot was present and, in two cases responses were present from both hands. For right median nerve, median latency was 2.4 (min: 1.19, max: 6.92) seconds. CONCLUSION: In conclusion impairment of SSR was demonstrated electrophysiologically in the patients with visceral leishmaniasis.

Evaluation of effectiveness of local insulin injection in non-insulin-dependent diabetic patient with carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common type of peripheral nerve entrapment and is a significant cause of morbidity. Carpal tunnel syndrome (CTS) has more incidences in diabetic patients. It has been suggested that insulin has an effect on nerve regeneration similar to that of nerve growth factor (NGF). Therefore, we aimed to evaluate the effectiveness of local insulin injection on the median nerve in patients with non-insulin-dependent diabetes mellitus (NIDDM) who have mild-to-moderate carpal tunnel syndrome (CTS). MATERIALS AND METHODS: We carried out a prospective, randomized, single-blind, case-controlled study in these patients. We randomly selected 50 patients, 20 of whom had bilateral mild-moderate CTS. Therefore we had 70 hands and categorized them into two groups. At the baseline we injected NPH insulin (10U) directly into the carpal tunnel in group 1, and performed physiotherapy for the other group (group 2). Two weeks later, NPH insulin (10U) was injected into the carpal tunnel again and we continued physiotherapy for group 2. Electrodiagnostic study was performed for these two groups before treatment and 4 weeks after the last injection and physiotherapy. The patients were followed up for 6 weeks. RESULTS: In both groups decrement of distal motor latency (DML) of the median nerves statistically was significant. In both groups, the increment of the sensory nerve conduction velocity was statistically significant. Also the decrement of pain, paresthesia, numbness, weakness/clumsiness and nocturnal awaking was statistically significant in both groups. But there was no significant difference between the two groups. CONCLUSION: Local insulin injection is an effective and safe treatment for carpal tunnel syndrome in NIDDM patients as physiotherapy

The diagnostic value of ultrasonography in patients with electrophysiologicaly confirmed carpal tunnel syndrome.

OBJECTIVE: To evaluate the diagnostic value of ultrasonography in patients with electrophysiologically confirmed carpal tunnel syndrome. DESIGN: A prospective ultrasonographic study of 70 wrists with electrophysiologically confirmed carpal tunnel syndrome and of 80 normal wrists. Receiver-operating-characteristics curves for the ultrasonographic measurements of median nerve were plotted to identify the most optimal cutoff values. RESULTS: The ultrasonographic measurements of median nerves were found to be increased significantly in patients with carpal tunnel syndrome when compared with controls, particularly in terms of cross-sectional area (P <0.001). According to receiver-operating-characteristics curve results, the most optimal cutoff value for the cross-sectional area of the median nerve was obtained at the level of middle carpal tunnel, which was 9.3 mm2, with a sensitivity of 80% and specificity of 77.5%. CONCLUSION: Ultrasonographic examination of the median nerve seems to be a promising method in the diagnosis of carpal tunnel syndrome, evaluating the morphologic changes of the median nerve in patients with clinical signs and symptoms. Further studies with wider series are needed to confirm our preliminary results.

Autologous blood injection in carpal tunnel syndrome (CTS).

INTRODUCTION: Most medical treatments for carpal tunnel syndrome (CTS) have focused on suppressing the inflammatory process. An injection of autologous blood might provide the necessary cellular and humoral mediators to induce a healing cascade. The purpose of this study was to evaluate prospectively autologous blood injection in CTS. METHOD & MATERIALS: Twenty patients with CTS were recruited using strict inclusion and exclusion criterias. All patients were injected with 1 ml of autologous blood and 0.5 ml lidocaeine 1% under the carpal tunnel. Pain intensity (based on VAS) and electrophysiologic parameters of median nerve (transcarpal SNCV, DML and DSL) were recorded before and 3 weeks after autologous blood injection. RESULTS: The average pain scores before and 3 weeks after autologous blood injection was 8.70 +/- 0.92 and 4.30 +/- 0.76 respectively (P < 0.005). Also transcarpal SNCV of median nerve was 33.7 +/- 6.3 m/s and 24.5 +/- 6.8 m/s (P = 0.001); DML of medin nerve was 5.16 +/- 1.04 ms and 4.70 +/- 0.53 ms (P = 0.001) and DSL of median nerve was 4.84 +/- 0.77 ms and 4.2 +/- 0.6 ms (P = 0.001), respectively. CONCLUSIONS: After autologous blood injection, pain intensity and electerophysiologic parameters were significantly improved. This study offers encouraging results for an alternative minimally invasive treatment for CTS. This study cannot prove conclusively whether the blood itself induced an inflammatory cascade or the injury created by the injection was responsible.