Complex trigger wrist associated with carpal tunnel syndrome: a case report.

BACKGROUND: There are few reports of trigger wrist in the literature, as it is a rare pathology. Furthermore, various authors report that it is also hard to diagnose. It manifests with neurological symptoms at the affected wrist, which are usually induced by wrist movement, and can lead to partial or full loss of wrist function and sensitivity. The reason for reporting this specific case is that it was hard to differentiate between trigger finger and trigger wrist by clinical symptoms; no pathology was palpable or clearly seen on magnetic resonance imaging scan of the wrist. We propose a new diagnostic statement relative to this pathology. CASE PRESENTATION: A case of a 45-year-old white slavic man with trigger wrist associated with carpal tunnel syndrome, caused by a fibroma of the flexor tendon sheath, is reported. Despite careful clinical examination, it was not possible to differentiate between trigger finger and trigger wrist. Magnetic resonance imaging was performed to arrive at the right diagnosis but did not reveal any pathology in the wrist area. Carpal tunnel release was performed with a fibroma identified and excised. Wrist function was maintained well; no signs of carpal tunnel syndrome were seen at last follow-up. CONCLUSIONS: Trigger wrist can be misdiagnosed as trigger finger even if adequate clinical evaluation is performed, and this can lead to inadequate treatment. We state that, when clinical symptoms of both trigger wrist and trigger finger are present, except painful palpation of the A-1 pulley region, the case should be referred to as trigger wrist.

Effect of a neurostimulator on postnatal neurogenesis in rodent olfactory bulbs.

The aim of the study was to reveal the effect of neurostimulation with the TKPRPGP neuropeptide on the expression intensity of Doublecortin and Nestin in the olfactory bulb of white Wistar rats using immunohistochemical and computer analysis methods. An isolated assessment of early progenitor differentiation by the density of nestin-positive structures showed that stimulation from birth to 14 days preserves the level of nestin expression, preventing its decrease. When the administration of the neuropeptide is stopped, the expression of nestin decreases sharply, starting from the central zones of the bulb, and after three weeks it is no longer present. The dynamics of doublecortin positive structure density reflects an increase upon neuropeptide administration. Each course of neuropeptide administration caused an increase in the density of the marker, but the degree of effectiveness decreased with age, and the duration of the effect decreased. In conclusion, administration of the neuropeptide TKPRPGP to rats at an early age prolongs the expression of nestin and doublecortin in the olfactory bulbs of rats up to 35 days and up to 74 days of observation, respectively. The administration of the neuropeptide in adulthood does not lead to re-expression of these markers.

Immunomorphological Features of the Placenta in Allogeneic Pregnancy as the Background for the Development of Obstetric Complications.

OBJECTIVE: To study the structural and immunohistochemical features of placentas in women after assisted reproductive technology (ART) with allogeneic eggs (oocyte donation and surrogate motherhood). STUDY DESIGN: The study involved 89 women whose pregnancy occurred as a result of in vitro fertilization (IVF) with a donor egg in a surrogate motherhood program (IVF-SM, n = 47 patients) or oocyte donation (IVF-DO, n = 42). The comparison group consisted of 21 patients in whom pregnancy occurred as a result of IVF with their own egg (IVF-OE). A clinical and anamnestic analysis of the pregnant women was carried out. Morphological and immunohistochemical studies were performed on placental material. Immunohistochemical analysis of CD8, CD56, CD138, and CD25/CD4 markers indicating the processes of impaired tolerance in placenta was carried out. -Results: We observed a predominance of women aged >40 (range 42.7-3.91) years with a burdened somatic and obstetric-gynecological history and a high incidence of hypertensive pregnancy complications, such as gestational arterial hypertension (27.4%) and preeclampsia (28.5%), in the IVF-DO group. The IVF-SM group included mainly somatically healthy women aged <30 (29.4-3.19) years with a high risk of termination of pregnancy in the third trimester (49.6%) and premature birth (21.6%). Placentas taken from women after allogeneic pregnancy had pronounced signs of immune alteration, such as chronic histiocytic intervillositis, lymphoplasmacytic deciduitis, chronic chorioamnionitis, chronic villitis, and perivillous fibrinoid with lymphocytes (p [F] < 0.05). Immunohistochemical study of the placentas showed accumulation of CD138+ plasma cells, CD8+ T lymphocytes, and uterine natural killer cells, and a decrease in the number of CD25/CD4+ regulatory T cells (Tregs) in the structures of the uteroplacental region (Kruskal-Wallis test, p < 0.05). CONCLUSION: Placentas after IVF with oocyte donation and surrogate motherhood programs are characterized by similar changes, associated with the development of chronic inflammation in the structures of the placenta and immunohistochemical signs of impaired immunological tolerance at the maternal-fetal interface. The data we obtained allow us to classify pregnancies under surrogate motherhood programs as a risk factor for the development of pregnancy complications with immune pathogenesis.