Comparison of Inching Electrodiagnosis Method and Ultrasonographic Findings in the Determination of Median Nerve Entrapment Site in Carpal Tunnel Syndrome.

OBJECTIVE: The purpose of the study was to evaluate the diagnostic value of both inching method through the electrodiagnostic test and ultrasonographic assay in localizing the site of entrapment in patients with symptoms and signs of carpal tunnel syndrome. DESIGN: Thirty-two hands with confirmed carpal tunnel syndrome through electrodiagnostic test and 30 hands as control group were enrolled. For both groups, sensory and motor latencies by inching technique and cross-sectional area by ultrasonography were measured at the inching points. The statistical analysis was performed by SPSS software, and mean difference with 95% confidence interval was calculated. RESULTS: Mean of sensory peak latency with inching method and cross-sectional area by the ultrasonography was greater in case group compared with the control group (P < 0.05). We revealed a significant difference of antidromic sensory latency between two adjacent points belonging to the fifth and sixth segments. In orthodromic sensory and distal motor latency the sixth segment had statistically significant latency difference. Sixth and seventh points had the greatest cross-sectional area. Distal motor latency difference and cross-sectional area had the greatest sensitivity at the seventh point. CONCLUSIONS: In this study, we revealed the most sites of entrapment of the median nerve through carpal tunnel are 2- and 3-cm distal to the distal wrist crease.

Case Report of Lewis and Sumner Syndrome with Bilateral Vagus Nerves Paralysis for 16 Years.

This report describes a patient with dysphonia for 16 years in combination with asymmetric and progressive decrease in sense and power of both upper and lower extremities for the past 3 years. Electrophysiological study revealed asymmetric conduction block and abnormal sensory action potential in 4 limbs. The vagus nerves palsy and abnormal electrodiagnosis of the limbs led us to diagnose the disease as Lewis and Sumner syndrome, also called multifocal acquired demyelinating sensory and motor neuropathy diagnosis, which improved by corticosteroid consumption to some extent. This case is uncommon by its long time presentation and progression. To the best of the authors' knowledge, this is the first report of simultaneous bilateral vagus nerve palsy in combination with upper and lower limbs' demyelinating neuropathy. In conclusion, persistent dysphonia can be a part of the presentation of demyelinating neuropathy.

The effect of amniotic membrane extract on umbilical cord blood mesenchymal stem cell expansion: is there any need to save the amniotic membrane besides the umbilical cord blood?

OBJECTIVES: Umbilical cord blood is a good source of the mesenchymal stem cells that can be banked, expanded and used in regenerative medicine. The objective of this study was to test whether amniotic membrane extract, as a rich source of growth factors such as basic-fibroblast growth factor, can promote the proliferation potential of the umbilical cord mesenchymal stem cells. MATERIALS AND METHODS: The study design was interventional. Umbilical cord mesenchymal stem cells were isolated from voluntary healthy infants from hospitals in Shiraz, Iran, cultured in the presence of basic-fibroblast growth factor and amniotic membrane extracts (from pooled - samples), and compared with control cultures. Proliferation assay was performed and duplication number and time were calculated. The expression of stem cell's specific markers and the differentiation capacity toward osteogenic and adipogenic lineages were evaluated. RESULTS: Amniotic membrane extract led to a significant increase in the proliferation rate and duplication number and a decrease in the duplication time without any change in the cell morphology. Both amniotic membrane extract and basic-fibroblast growth factor altered the expressing of CD44 and CD105 in cell population. Treating basic-fibroblast growth factor but not the amniotic membrane extract favored the differentiation potential of the stem cells toward osteogenic lineage. CONCLUSION: The amniotic membrane extract administration accelerated cell proliferation and modified the CD marker characteristics which may be due to the induction of differentiation toward a specific lineage. Amniotic membrane extract may enhance the proliferation rate and duplication number of the stem cell through changing the duplication time.

Differentiation of Wharton's jelly mesenchymal stem cells into neurons in alginate scaffold.

Alginate scaffold has been considered as an appropriate biomaterial for promoting the differentiation of embryonic stem cells toward neuronal cell lineage. We hypothesized that alginate scaffold is suitable for culturing Wharton's jelly mesenchymal stem cells (WJMSCs) and can promote the differentiation of WJMSCs into neuron-like cells. In this study, we cultured WJMSCs in a three-dimensional scaffold fabricated by 0.25% alginate and 50 mM CaCl2 in the presence of neurogenic medium containing 10 µM retinoic acid and 20 ng/mL basic fibroblast growth factor. These cells were also cultured in conventional two-dimensional culture condition in the presence of neurogenic medium as controls. After 10 days, immunofluorescence staining was performed for detecting ß-tubulin (marker for WJMSCs-differentiated neuron) and CD271 (motor neuron marker). ß-Tubulin and CD271 expression levels were significantly greater in the WJMSCs cultured in the three-dimensional alginate scaffold than in the conventional two-dimensional culture condition. These findings suggest that three-dimensional alginate scaffold cell culture system can induce neuronal differentiation of WJMSCs effectively.

Elephantiasis nostras verrucosa of lower limb: a case report.

Elephantiasis nostras verrucosa (ENV) is a rare condition in which hyperkeratosis, fibrosis and disfiguration of dermis occurs. It is caused mostly by non infectious diseases such as surgery, trauma, tumors, and venous obstructions. To our knowledge there is not any case report of ENV in Middle East region. In this patient, ENV caused by trauma and Patient presented with enlargement of right lower limb.

Parameters that influence the isolation of multipotent mesenchymal stromal cells from human umbilical cord blood.

BACKGROUND AND OBJECTIVES: Umbilical cord blood is an important source of stem cells. However, isolating multipotent mesenchymal stromal cells (MSCs) from umbilical cord blood presents methodological challenges. We compared the effectiveness of six approaches to improve the success rate of MSC isolation and proliferation from umbilical cord blood. METHODS: Thirty umbilical cord blood units underwent investigation. In 10 samples, MNCs from each sample were divided into four groups to test the effect of negative immunodepletion (NI) alone (group A); NI plus basic fibroblastic growth factor (bFGF) supplementation together (group B); bFGF supplementation alone (group C); and culture with neither NI nor bFGF (group D). The cells of each group were isolated from 10mL of umbilical cord blood. For investigating the effect of sample volume (group E) and MesenCult Proliferation Kits (group F), cells were isolated from 45±2ml. MSCs were identified on the basis of morphological, flow cytometric and differentiation potential characteristics. RESULTS: In groups of A-D, one week after the initial seeding, the cells showed a rounded appearance, and in the fourth week, many of them died. MSCs outgrowth was seen in 40% of the samples from group F, and this yield was further enhanced to 60% in cultures done with the MesenCult Proliferation Kit (group F). The fibroblast-like cells expanded rapidly and showed features of MSCs. CONCLUSION: Sample volume was the parameter that showed the greatest influence on the isolation yield of MSCs from umbilical cord blood. This could be further enhanced by adding the MesenCult Proliferation Kit.

Unusual manifestation of cutaneous sarcoidosis: a case report of morpheaform sarcoidosis.

Sarcoidosis is multi organ disease with cutaneous manifestation in 20%-35% patients. Cutaneous sarcoidosis has variable manifestations that make it difficult to diagnose. So clinical, histopathologic and laboratory evaluation is needed for diagnosis. Most of cutaneous lesions presents as nodul, maculopapule and plaque. Morpheaform lesion is a rare presentation of cutaneous sarcoidosis. This case had multiple indurated scaly plaques resemble morphea with granulomatous pattern in histopathologic examination. The patient responded to prednisolone in addition to hydroxychloroquine.