[Value of ultrasonography in the diagnosis of carpal tunnel syndrome confirmed by nerve conduction study]

Carpal tunnel syndrome [CTS] is the most common form of peripheral entrapment neuropathy. The use of sonography for investigation and diagnosis of musculoskeletal conditions has been rapidly increasing over the past few decades. The purpose of this study was to determine whether sonography can be an alternative method to nerve conduction study [NCS] in the diagnosis of CTS. Material and This prospective cross-sectional descriptive study included patients with electrodiagnostically proven CTS and healthy control subjects. Anthropometric and demographic data included age, height, body mass index [BMI], sex, occupation, medication history, hand dominance, and underlying disorders associated with CTS. Median nerve Cross-Sectional Area [CSA], Flattening Ratio [FR], and flexor retinaculum thickness were measured. Then, we compared the results between ultrasonography and nerve conduction study. In this study, we assessed 120 wrists with CTS [cases] in 90 patients and 60 healthy wrists in 30 patients [control group]. CTS was mild in 57, moderate in 29, and severe in 34 wrists. Post hoc comparisons between the patients with CTS and controls demonstrated that the cross sectional areas at various levels of the median nerve were significantly greater in the CTS group compared to the control group. CSA at the tunnel inlet with a threshold higher than 9.15 mm2 showed the best diagnostic accuracy with a sensitivity and specificity of 99.2% and 88.3% respectively. Cross-sectional areas of the median nerve in mild, moderate and severe carpal tunnel syndrome showed statistically significant differences. Ultrasonographic measurement of the cross-sectional area of median nerve is useful for the diagnosis and grading of CTS. Use of sonography as the first-line measure may effectively reduce the number of nerve conduction studies in the diagnosis of CTS

Papillary carcinoma of the thyroglossal duct cyst: case report

Thyroglossal duct cysts are the most common form of congenital cysts on the neck. The incidence of thyroid papillary carcinoma in thyroglossal duct cyst is less than 1%. In most cases the diagnosis is made postoperatively. We present a 22-year-old female with thyroid papillary carcinoma arising from thyroglossal duct cyst, identified in pathologic study after sistrunk operation. In our case there was neither invasion to adjacent tissue nor lymph node involvement. The patient then underwent total thyroidectomy and bilateral neck dissection. The patient was treated with radioactive iodide and thyroid suppression therapy was given as adjuvant treatment. The patient has been following for two years without any metastasis

Prevalence of celiac disease in patients with recurrent aphthous stomatitis

Celiac disease [CD] is an immune-mediated inflammation of the small intestine caused by sensitivity to dietary gluten and related proteins in genetically sensitive individuals. Recurrent aphthous stomatitis [RAS] is an inflammatory condition characterized by painful recurrent, single or multiple ulcerations of the oral mucosa. The association between CD and RAS has been evaluated in several studies. The purpose of this study was to determine the prevalence of CD in patients with RAS. This was a prospective cross-sectional study that enrolled 181 patients with recurrent oral ulcers [at least three attacks per year]. Patients' peripheral blood samples were studied in terms of anti-tissue transglutaminase [anti-tTG] antibodies [IgA], anti-endomysial antibody [IgA] and serum IgA levels. Each patient that had a positive celiac serology underwent a duodenal biopsy. Information from all patients was entered into checklists. After completion of the checklists, the obtained data were analyzed by SPSS v19 statistical software. Of the 181 enrolled patients with recurrent aphthous, 43 [23.75%] were male and 138 [76.25%] were female. Average age of these patients was 28.45 +/- 12.27 years. The average age of disease onset was 23.39 +/- 9.46 years. Serologic survey results showed that only 2 patients were positive for these antibodies - both were women whose average age was 29 years. The average age of their disease onset was 22.5 years and biopsy results confirmed the presence of lymphocytic enteritis with crypt hyperplasia [Marsh II]. According to the results of this study, although there is a low prevalence of CD in patients with RAS, screening RAS patients for key serological markers of CD has clinical value.