Diagnostic value of ultrasonography and magnetic resonance imaging in ulnar neuropathy at the elbow.

Aim. To evaluate the diagnostic value of ultrasonography and magnetic resonance imaging (MRI) in patients with ulnar neuropathy at the elbow (UNE). Methods. We prospectively performed electrodiagnostic, ultrasonographic, and MRI studies in UNE patients and healthy controls. Three cross-sectional area (CSA) measurements of the ulnar nerve at multiple levels along the arm and maximum CSA(-max) were recorded. Results. The ulnar nerve CSA measurements were different between the UNE severity grades (P < 0.05). CSA-max had the greatest sensitivity (93%) and specificity (68%). Moreover, CSA-max ≥10 mm(2) defined the severe UNE cases (sensitivity/specificity: 82%/72%). In MRI, ulnar nerve hyperintensity had the greatest sensitivity (90%) and specificity (80%). Conclusion. Ultrasonography using CSA-max is sensitive and specific in UNE diagnosis and discriminating the severe UNE cases. Furthermore, MRI particularly targeting at increased signal of the ulnar nerve can be a useful diagnostic test of UNE.

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients.

AIM: To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV). METHODS: A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible non-invasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni- and multivariate approaches. RESULTS: Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (+/- SD) was 47.5 (+/- 15.9). Portal vein diameter (13.88 +/- 2.42 vs 12.00 +/- 1.69, P < 0.0005) and liver vascular index (8.31 +/- 2.72 vs 17.8 +/- 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 +/- 1.48 vs 13.24 +/- 2.55, P < 0.05 and 6.45 +/- 2.78 vs 10.96 +/- 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 +/- 3.66 vs 20.25 +/- 5.05, P < 0.0005), congestion index (CI) (0.11 +/- 0.03 vs 0.06 +/- 0.03, P < 0.0005), portal hypertensive index (2.62 +/- 0.79 vs 1.33 +/- 0.53, P < 0.0005), and hepatic (0.73 +/- 0.07 vs 0.66 +/- 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 +/- 0.06 vs 0.62 +/- 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV). CONCLUSION: Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.

Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass.

BACKGROUND: Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. METHODS: 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male) underwent preoperative ultrasonography for assessment of carotid artery wall thickness. RESULTS: Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8%) had significant (<50%) and 3 (1.1%) patients had critical (<70%) stenosis in internal carotid arteries. Plaque formation in common carotid was not significantly different between two genders but the stenosis of left internal carotid was more frequently seen among men. Patients with plaques in right or left internal carotid arteries were significantly older. CONCLUSION: Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

Preoperative transcranial and carotid Doppler study in coronary artery bypass graft patients.

OBJECTIVE: To assess the correlation of postoperative neurologic complications with preoperative transcranial and carotid Doppler study findings of coronary artery bypass graft (CABG) patients. METHODS: In a descriptive, analytic, follow up study we prospectively studied 201 patients undergoing elective and isolated CABG surgery during a 12 month period from October 2003 to September 2004 at Madani Hospital of Tabriz Medical Sciences University, Iran. Neurologic examination, intracranial cerebral arterial study using transcranial Doppler (TCD) and carotid duplex were performed preoperatively. Intraoperative and postoperative complications were followed up for one month. RESULTS: Two hundred and one patients (158 male, 43 female) with a mean age of 57.29+/-9.67 were studied. Out of these, 131 patients had 3 coronary vessels disease, 64 had 2 vessels, 5 had one vessel, and one patient had diffuse coronary disease. A TCD was performed in 183 patients and disclosed abnormalities in 22 patients and was normal in 161 cases. The total number of involved arteries was 34. Among 154 carotid duplex studied patients, 102 had plaque, inducing <50% stenosis in 99, 50-74% stenosis in one, and 75-90% stenosis in 2 cases. Postoperative neurologic complication occurred as follows: 4 stroke, 7 delirium, and 3 amnesia. One of the operated patients died. Nine of 161 patients with normal TCD (5.6%) and 5 of 22 (22.7%) with intracranial cerebral arterial disease (ICAD) showed central nervous system (CNS) complications (p=0.015). There were significant correlations between number of involved cerebral arteries and post CABG CNS complications (p=0.0001), including stroke (p=0.007), and between diabetes mellitus history with these complications (p=0.012). CONCLUSION: Our results suggest that lCAD is an independent risk factor for CNS complications after CABG surgery. Hence, we recommend pre-CABG evaluation of the cerebral arteries by TCD, for the risk assessment of CABG surgery.

Association of carotid intima-media thickness with the presence and severity of coronary artery disease.

OBJECTIVE: To examine, prospectively, whether the intima-media thickness (IMT) of the common carotid artery and the overlying plaque predicts the presence and severity of coronary artery events. METHODS: Two hundred and one consecutive patients (100 men and 101 women), who had recently undergone coronary angiography in Tabriz University of Medical Sciences, were enrolled in the study carried out from May 2004 to May 2005. Measurements of IMT were performed by ultrasound, while blood pressure, blood sugar and cholesterol levels were recorded. RESULTS: The mean IMT of the common carotid artery was significantly higher in patients with coronary artery disease (CAD) compared with non-CAD patients, as well as in patients with significant CAD compared to non-significant CAD in both genders. The same was observed for the plaque area. Clinical systolic blood pressure, clinical diastolic blood pressure, low-density lipoprotein and high-density lipoprotein cholesterol did not significantly differ between the 3 groups. Fasting blood sugar was higher in the non-significant CAD patients. CONCLUSION: The IMT of the common carotid artery is a clinically valuable parameter in the non-invasive diagnosis of non-significant CAD, as well as significant coronary artery lesions.

Transcranial and carotid Doppler study in coronary artery bypass graft patients.

OBJECTIVE: Atherosclerosis is a pathogenesis which is common in both coronary and intracranial arterial diseases. Therefore, we designed a group of coronary artery bypass graft (CABG) surgery patients for transcranial Doppler (TCD) to assess intracranial artery diseases and carotid duplex studies to assess carotid artery diseases. METHODS: In a prospective randomized study, 129 elective CABG patients with proven coronary artery disease by angiography, were examined by TCD and 45 patients by carotid duplex preoperatively. Neurologic examination was carried out pre- and post- operatively. This study was carried out from April 2001 to August 2002 at Imam Hospital of Tabriz Medical Science University, Iran. RESULTS: Out of the 129 CABG patients, there were 105 males and 24 females, with an average age of 57+\-9.9 years. Risk factors were as follows: smoking in 44.8%, hypertension in 38%, hypercholesterolemia in 29%, and diabetes mellitus in 18.6%. The TCD findings of 30 patients (23.2%, 11 female and 19 male) revealed the following abnormalities: stenosis of basilar artery in 7 patients (5.4%), carotid siphon in 3 (2.3%), intracranial internal carotid in 5 (3.9%), middle cerebral artery in 3 (2.3%) and vertebral artery in one patient (0.8%). Multiple vessel abnormality was detected in 11 patients (8.5%). There was a significant correlation between severity of coronary artery disease in angiography and abnormality in TCD (p=0.008). The TCD abnormality was detected more in females (p=0.008) or hypertensive patients (p=0.004). In the carotid duplex study of the randomized 45 patients, 23 (51.1%) had abnormal results as follows: stenosis <50% in 17 (38%) cases, stenosis between 50-70% in 5 (11%), and hemodynamically significant stenosis (>70%) only in one (2%) patient. There was also significant correlation between severity of coronary involvement and carotid involvement (p<0.01). No stroke occurred in the first postoperative week following CABG surgery. CONCLUSION: Stenosis of intracranial and carotid arteries was more common in CABG patients with more than 2-coronary vessel involvement or hypertensive or female patients. We recommend TCD and carotid duplex studies in these patients for prevention of probable cerebrovascular accidents.