Alternative treatment of the carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a painful disease of the wrist which is usually treated with corticoids locally or surgically. In this study combined infusion therapy with procain, pentoxyphyllin and magnesium sulphuricum in patients with CTS was evaluated retrospectively. 101 manually working patients (65 male, 36 female) aged 42.8 +/- 8.6 years, initially examined at our department to assess professional origin of the disease and who had abnormal conduction to the distal section of median nerve on electromyography (EMG), were entrolled. The group of patients was heterogenous etiologically. 41% of patients were found to be exposed to overlimit vibrations, while 21% of patients were exposed to overload of upper extremities and 16% patients to both the risks. The professional hazard was not proved in 23% of patients. In these patients 166 CTS were diagnosed of which 144 improved after the treatment, while the condition remained unchanged in 11 and even worsened in another 11 cases. Using the clinical and EMG criteria the findings were divided to mild, moderate and severe CTS. 77 mild CTS improved by 61% in average, 63 moderate CTS were improved by 47% and 26 of severe CTS improved by 50%. There was no association between the treatment outcome and sex, age or severity of symptoms. Patients with unfavourite outcome and the possible causes of treatment failure are discussed in detail.

[Latent tetany in patients with a negative coronarographic finding]. / Výskyt latentní tetanie u pacientu s negativním koronarografickým nálezem.

UNLABELLED: Chest pain, constriction of the throat and palpitations are symptoms common to tetany and ischaemic heart disease. The objective of the work was to assess the latent prevalence of tetany in patients with typical chest pain and a negative outcome of coronarographic examination. The group comprised 20 patients (5 men and 15 women), mean age 54 years (28-74) with a history of chest pain, who had selective coronarography with a negative or minimal (up to 30% stenosis) outcome. In this group EMG, the ischaemic and hyperventilation test for latent tetany was made. A metabolic cause of tetany was ruled out. The results of the EMG test were positive in 10 patients (50%, 8 women, 2 men). Patients with a positive finding were treated with magnesium lactate by the oral route. All patients reported after one month regression of complaints. CONCLUSION: With regard to the high rate of positive EMG tests in patients with a history of chest pain and a negative coronarographic finding the authors recommend to add this simple test to the algorithm of examinations of these patients and supplement treatment according to its results.

[Magnesium balance in patients with spasmophilia. Relation to results of electromyography]. / Magneziová bilance u nemocných se spazmofilií. Vztah k výsledkum elektromyografie.

BACKGROUND: The pathophysiological basis of spasmophilia is frequently magnesium deficiency and the therapeutic administration of magnesium salts has usually a favourable effect. However the parameters of magnesium balance are not always consistent with the results of electromyography. The objective of the present work was to test and interpret the relationship of results of these two basic diagnostic procedures indicated when spasmophilia is suspected. METHODS AND RESULTS: Thirty-three subjects (9 men and 24 women) with suspected spasmophilia were examined by non-invasive electromyography, using the technique of surface electrodes. All subjects had concurrently biochemical examinations: serum calcium and ionized calcium, serum magnesium (S-mg), magnesium in erythrocytes (ery-Mg) and magnesium in the blood haemolysate (H-Mg). In 29 patients and oral magnesium loading test was made with evaluation of the urinary Mg excretion after a constant Mg load (U-Mg). Statistical evaluation of the investigated parameters of the magnesium balance revealed a highly significant relationship between ery-Mg and U-Mg and H-Mg and ery-Mg (p < 0.005). A less close relationship was found between H-Mg and S-Mg (p < 0.05). Total and ionized calcium was in all examined subjects within the range of the arbitrary normal range. The EMG finding was positive (the finding of two and more multiplets in the ischaemic and hyperventilation test resp.) in 30 instances, i.e. in 91% of the examined subjects. In 72% there was agreement of the positivity of the EMG and magnesium deficiency (i.e. reduced values of ery-Mg and U-Mg), positivity of EMG combined with normal parameters of the Mg balance was recorded in 18%. In 6.1% of the examined subjects magnesium deficiency was confirmed combined with a normal EMG finding. CONCLUSIONS: Concurrent positivity of EMG and magnesium deficiency in 72% justifies the therapeutic administration of magnesium. In patients with a normal magnesium deficiency and positive EMG another cause of spasmophilia must be taken into consideration, incl. technical errors of interpretation of EMG results. A negative EMG associated with magnesium deficiency can suggest the central form of tetany, where magnesium treatment is also unequivocally indicated.

Advanced EMG techniques in diagnostics of spinal muscular atrophies and motor neuron disease--magnetic stimulation, single fiber EMG and macro EMG.

Motor neuron disease (MND) and spinal muscular atrophies (SMA) are difficult to diagnose with classical EMG methods because significant findings appear relatively late and both groups of diseases show neurogenic type of record differing only in a relatively greater amount of fasciculations and higher amplitude of motor unit potential (MUP) in MND compared with SMA. We examined 12 patients with MND-amyotrophic lateral sclerosis and 7 patients with SMA type III and IV according to Swash with advanced EMG techniques-magnetic stimulation, single fiber and macro EMG. With transcranial magnetic stimulation, a significant prolongation of cortical latency was found in MND (P < 0.0001 right hand and P < 0.0005 left hand) against SMA, where it was almost normal. With single fiber EMG, mean jitter was less markedly increased in MND (P < 0.05 against SMA) and fiber density was lower in MND (P < 0.005). With macro EMG, no significant difference was found in either macro amplitude or area. Macro fiber density was also lower in MND (P < 0.005). Advanced EMG techniques proved to differentiate clearly the III. (Kugelberg-Welander) and IV. (adult) type of SMA from MND-amyotrophic lateral sclerosis.

Single fiber EMG in multiple sclerosis.

A group of 25 patients with sclerosis multiplex (SM) was examined by means of single fiber (SF) EMG. This group had the mean value of jitter 55.0 +/- 4.5 microseconds and fiber density (FD) 2.15 +/- 0.12. The findings of the patients with the first attack of illness and the findings of the patients with twenty-year duration are the same. A hypothesis is suggested that not only the peripheral neuron but also the CNS structures take part in the increase of jitter. The different results of stimulated single fiber (SSF) and SF EMG are discussed; the former reflects only the peripheral part of the nervous system due to peripheral stimulation. The higher levels of CNS cannot take part in it.

Single fiber EMG in cerebrovascular stroke (CVS).

This paper gives previously unpublished data about fiber density (FD) and jitter in patients with CVS. The cluster of these values is very similar to that found in sclerosis multiplex (SM). There is a problem whether both clusters represents the same disorder of CNS compared with amyotrophic lateral sclerosis (ALS) or spinal muscular atrophy which have different values. Another problem is the participation of presumed central lesion on the increased jitter, the mechanism of which is still unknown.

Tetanic syndrome and its examination.

The article presents a new electromyographic method; it describes the non-invasive examination of tetany with surface electrodes. This method is more sensitive than the classical needle technique and, moreover, the necessity to use expensive disposable needle electrodes is avoided.