[Sonography versus electrodiagnosis for the diagnosis of carpal tunnel syndrome in routine practice]. / Comparaison de l'échographie et de l'électroneurographie pour le diagnostic du syndrome du canal carpien en pratique courante.

INTRODUCTION: Many studies had been performed in the last years to prove the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). We wanted to determine its reliability and to compare this technology with electromyography (EMG) in ordinary diagnostic conditions. METHODS: The study involved 90 wrists with suspected CTS, 35 controlateral wrists and 52 control wrists. The diagnosis of CTS was confirmed in 81 cases by the hand symptom diagram and the Tinnel and Phalen sign. The EMG examination evaluated medianulnar sensory latency difference to the ring finger and wrist-to-palm sensory conduction velocity. For the ultrasound diagnosis, the cross sectional area of the median nerve at the level of the pisiform bone, was considered. The sensitivity and specificity of the two techniques was calculated. RESULTS: Sensitive electroneurographic parameters showed a sensibility and specificity respectively of 79 and 80%. The cut-off point for ultrasound sensibility and specificity using ROC analysis was 11mm(2) for mean cross-sectional area. Sensitivity and specificity found in this way were 72% and 56%. Reliability was good with intra- and inter-reader intraclass correlation coefficients of 0.99, and interobserver coefficient of 0.88. Sonography found seven CTS among the 17 clinical CTS with normal electrophysiological findings. A statistically correlation was found between the cross-sectional section and the sensitive electrophysiologic parameters (r=0.43, p<0.001). CONCLUSIONS: In our study, ultrasonographic diagnostic value are not as good as electrophysiological value, like found in recent literature, probably because of the composition of our group of patients which is including many causes of acroparesthesias. This can mean that in clinical practice, sonography is a complementary tool instead, for example in cases of equivocal EMG.

Testing of primers for the study of cyanobacterial molecular diversity by DGGE.

Denaturing Gradient Gel electrophoresis (DGGE) is a PCR-based technique which is widely used in the study of microbial communities. Here, the use of the three specific 16S rRNA cyanobacterial specific primers CYA359F, CYA781R(a) and CYA781R(b) on the assessment of the molecular diversity of cyanobacterial communities is examined. Assignments of the reverse primers CYA781R(a) and CYA781R(b) with cyanobacterial strain sequences showed that the former preferentially targets filamentous cyanobacteria whereas the latter targets unicellular cyanobacteria. The influence of the GC clamp position on the forward or on reverse primer and the use of the two reverse primers separately or in equimolar mixture were investigated. Three environmental samples were subjected to amplification with 6 combinations of primers. The 6 banding patterns as well as the sequences of the bands extracted were analysed and compared. In addition, to assess the effect of the position of the GC clamp, the melting profiles of the sequences of Aphanizomenon flos-aquae PMC9707 and Synechococcus sp. MH305 were determined, with the GC clamp in the 3' or 5' position. Results showed that the use of two separate amplifications allowed a more complete study of the molecular diversity of the cyanobacterial community investigated. Furthermore, similar richness and identical phylogenetic assignments of extracted bands were obtained irrespective of the positioning of the GC clamp.

[EEG contribution to the diagnosis of baclofen overdose]. / Apport de l' EEG dans le diagnostic d'une intoxication au baclofène.

In a young woman presenting with severe coma, the EEG helped diagnosing baclofen overdose. In this patient, the first EEG showed continuous multifocal pseudoperiodic sharp waves. The diagnosis was confirmed by the plasma dosage providing an 8-fold increase above normal baclofen therapeutic range. Following symptomatic therapy, the patient improved within a few days and the EEG normalised. Few other drugs may be responsible for such EEG changes, namely lithium, cephalosporin, and bismuth. In such cases, EEG contribution to the diagnosis should not be ignored.

Sources of variance in milk and caloric intakes in breast-fed infants: implications for lactation study design and interpretation.

Between-individual variation (BIV) and day-to-day variation (DDV) of total caloric and human milk intakes were examined in 17 infants. Nine were studied at months 5 and 6; 8 at months 6 and 7. All 17 were exclusively breast-fed for 5 full mo after which solid foods were added to the diet. Each infant was studied for five consecutive 24-h periods during which serial measurements were made of milk intake (test weighing) and solid food intake (pre- and postfeeding jar weighing). Total daily caloric intakes (kcal/day) were (mean +/- SD) 492 +/- 57, 547 +/- 70, and 567 +/- 98 at months 5, 6, and 7, respectively. Estimates of caloric intakes (kcal/kg/day) adjusted for body weight were 65.9 +/- 6.7, 72.6 +/- 11.2, and 70.9 +/- 13.0 at months 5, 6, and 7, respectively. Milk intakes (g/day) were 735 +/- 85, 640 +/- 106, and 562 +/- 214 at months 5, 6, and 7, respectively. BIV of milk intake increased after the introduction of solid foods. DDV (expressed as coefficient of variation) of caloric intake was nearly constant at each monthly observation and BIV increased from 8.8 at month 5 to 14.6 at month 7. The numbers of 24-h periods and subjects required for estimates of known precision of caloric and milk intakes of older breast-fed infants can be determined from these estimates of variance.

PIP: Between-individual variation (BIV) and day-to-day variation (DDV) of total caloric and human milk intakes were examined in 17 infants at the Lactation Program of the Children's Nutrition Research Center in Houston, Texas. 9 were studied at months 5 and 6; 8 at months 6 and 7. All 17 were exclusively breast-fed for 5 full months after which solid foods were added to the diet. Each infant was studied for 5 consecutive 24-hour periods during which serial measurements were made of milk intake (test weighing) and solid food intake (pre- and postfeeding jar weighing). Total daily caloric intakes (kcal/day) were (mean + or - SD) 492 + or - 57, 547 + or - 70, and 567 + or - 98 at months 5, 6, and 7, respectively. Estimates of caloric intakes (kcal/kg/day) adjusted for body weight were 65.9 + or - 6.7, 72.6 + or - 11.2, and 70.9 + or - 13.0 at months 5, 6, and 7, respectively. Milk intakes (g/day) were 735 + or - 85, 640 + or - 106, and 562 + or - 214 at months 5, 6, and 7, respectively. BIV of milk intake increased after the introduction of solid foods. DDV (expressed as coefficient of variation) of caloric intake was nearly constant at each monthly observation and BIV increased from 8.8 at month 5 to 14.6 at month 7. The numbers of 24-hour periods and subjects required for estimates of known precision of caloric and milk intakes of older breast-fed infants can be determined from these estimates of variance.

Assessement of quadriceps strength, endurance and fatigue in FSHD and CMT: benefits and limits of femoral nerve magnetic stimulation.

OBJECTIVES: To (i) evaluate the feasibility and the reliability of a test assessing quadriceps strength, endurance and fatigue in patients with fascioscapulohumeral dystrophy (FSHD) and Charcot-Marie-Tooth disease (CMT), (ii) compare quadriceps function between patients and healthy controls. METHODS: Controls performed the test once and patients twice on two separate visits. It involved progressive sets of 10 isometric contractions each followed by neuromuscular assessments with FNMS. RESULTS: Volitional assessment of muscle strength, endurance and fatigue appeared to be reliable in FSHD and CMT patients. Supramaximal FNMS was achieved in ∼70% of FSHD patients and in no CMT patients. In FSHD patients, Femoral nerve magnetic stimulation (FNMS) provided reliable assessment of central (typical error as a coefficient of variation (CVTE)<8% for voluntary activation) and peripheral (CVTE<10% and intraclass coefficient correlation >0.85 for evoked responses) function. Patients and controls had similar reductions in evoked quadriceps responses, voluntary activation and similar endurance. CONCLUSIONS: This test provides reliable evaluation but FNMS exhibits limitations due to insufficient stimulation intensity particularly in neurogenic conditions. It showed similar central and peripheral quadriceps fatigability in patients and controls. SIGNIFICANCE: This test may be a valuable tool for patient follow-up although further development of magnetic stimulation devices is needed to extend its applicability.

Distinction between cultivated and wild chicory gene pools using AFLP markers.

The cultivation area of industrial chicory, Cichorium intybus L. cv Sativum, coincides with the natural distribution area of its wild relative, C. intybus L., which could lead to gene flow between wild and cultivated types. The genetic diversity within and between the two types has therefore been studied using AFLP genotyping of samples from 12 wild populations collected in Belgium and ten commercial varieties. The genotyping of 233 individuals allowed the identification of 254 AFLP markers. Similar levels of genetic diversity were observed within wild populations and cultivated varieties, suggesting the absence of any strong bottleneck in the history of the cultivated types. The phylogenetic analysis pointed to a monophyletic origin of cultivated varieties as compared to the local wild populations studied, hence the two types of chicory form two separate gene pools. The genotyping of some individuals sampled in ruderal sites clearly showed that they belong to the cultivated gene pool, which suggests the existence of feral or weedy types. The low differentiation observed among wild populations indicates that gene flow might be important in this species.

Comparison of hand- and electric-operated breast pumps.

Volume, fat and energy contents were measured in human milk samples collected over 2 24-h periods with either an electric or hand-operated breast pump. The energy content was significantly higher and the variance for this measurement was significantly lower in samples obtained by the electric pump. The type of pump used is an important consideration when the content of energy and other nutrients associated with the fat compartment in human milk is to be evaluated. This observation is especially pertinent to cross-study comparisons, eg studies of well- and malnourished populations.