Valor del reflejo cutáneo palmar en el diagnóstico del síndrome del túnel del carpo idiopático / Value of the cutaneous-plantar reflex in the diagnosis of idiopathic carpal tunnel syndrome

Introducción. El síndrome del túnel del carpo (STC) constituye la primera entidad entre las neuropatías focales. Su diagnóstico se basa en el estudio neurofisiológico de las fibras motoras y sensitivas de grueso calibre en pacientes con una clínica característica, aunque en ocasiones, en casos leves, dicho estudio puede no detectar anomalías. Se decide realizar la evaluación de las fibras simpáticas de pequeño calibre mediante el reflejo cutáneo palmar (RCP) en pacientes con diferente grado de STC idiopático. Sujetos y métodos. Se estudian 54 casos, 15 hombres y 39 mujeres con STC, y 15 controles voluntarios sanos. Los casos se distribuyen en tres grupos: sólo con clínica positiva, con clínica y alteración en la conducción sensitiva, y con clínica y alteración de la conducción sensitiva y motora y pérdida axonal. El RCP se obtiene según la técnica habitual, modificada por nosotros, mediante la estimulación del nervio mediano en la muñeca y registrando la respuesta en la mano contralateral. Se procesan dos respuestas sucesivas con un intervalo superior a un minuto. Se presta especial atención al control de la línea de base y sudoración. Se efectúa un análisis estadístico descriptivo de inferencia y de correlación. Resultados. Se observó una disminución de amplitud de la respuesta en los pacientes con STC, latencias más cortas en las mujeres y buena correlación entre las latencias de la primera y segunda respuesta. No se objetivaron diferencias significativas en los demás parámetros estudiados. Conclusión. El estudio del RCP puede aportar datos complementarios en la evaluación del STC (AU)

Introduction. Carpal tunnel syndrome (CTS) is the most common of all focal neuropathies. Its diagnosis is based on aneurophysiological study of the thick motor and sensory fibres in patients with a characteristic clinical picture, although sometimes, in mild cases, this study does not detect the abnormalities. The decision was made to evaluate the smallcalibre sympathetic fibres by means of cutaneous-plantar reflex (CPR) in patients with different degrees of idiopathic CTS. Subjects and methods. The study involved 54 cases –15 males and 39 females with CTS– and 15 healthy volunteer controls. The cases were divided into three groups: those with only positive clinical features; those with clinical features and alteration of sensory conduction; and those with clinical features, alteration of sensory and motor conduction, and axonal loss. The CPR was obtained by means of the usual technique (which we modified), involving stimulation of the median nerve in the wrist and recording the response in the contralateral hand. Two successive responses were processed with an interval of more than one minute between them. Special attention was paid to controlling the baseline and sweating. A descriptive statistical inference and correlation analysis was performed. Results. A decrease in amplitude of the response was observed in patients with CTS, with shorter latencies in women and a good correlation between the latencies of the first and the second response. No significant differences were observed in the other parameters that were studied. Conclusion. Studying the CPR can provide complementary data in the evaluation of CTS (AU)

[Correlation between E.N.G. changes and the evolution of the hematic constants in patients under prolonged hemodialysis and renal transplantation]. / Correlaciones entre las alteraciones E.N.G. y la evolución de las constantes hemáticas, en enfermos bajo hemodialisis prolongada y tras el trasplante renal

An evolutive study of the E.N.G. on 25 patients affected of chronic renal failure (c.r.f.) in their previous periods and during the dialysis programme was developed. At the same time a large study on various serum changes was carried on. It is observed that the motor conduction velocity (M.C.V.) shows a decreasing evolution during dialysis, which mathematical patters is a branch of an equilateral hyperbola, of equation: (see article) The Na and K evolutive curves are also significatively fitted to the same mathematical pattern. It is observed a direct and inverse lineal correlation between M.C.V. values and those ones of the Na and K respectively, with p less than 0,05 and p less than 0,01. It is not observed any correlation of significatively value with the other serum parameters studied (R.A., Cl, Urea, Total proteins, Hematocrit, Ca, P, Creatinine, fluids and acid-base equilibrium). After a renal transplantation the M.C.V. presents a growing trayectory of the same mathematical pattern described before, reaching normal values about a year post-transplantion. The levels of Sodium serum follow a parallel trayectory than that one of the M.C.V. The recovery of the remainders serum parameters after renal transplantion occour during the first week, except for the hematocrit. It only remains a parallelism between the evolutive changes of M.C.V./Natremia during dialysis stage and after renal transplantion. These results seem to show a close dependence between variation of M.C.V. and Natremia. The hipoxia role over the sodium pump and the consequent variations of Natremia are discussed.