Can electrodiagnostic tests be omitted from surgical decision-making for typical carpal tunnel syndrome? – A randomized controlled trial

Background: Although carpal tunnel syndrome (CTS) is common and frequently seen in daily practice, diagnostic criteria remain the subject of debate. Some authors consider electrodiagnostic tests as essential, whereas others view them as an unnecessary luxury. Objective: The objective is to investigate whether electrodiagnostic tests are necessary for surgical decision-making for typical CTS. Materials and Methods: The study was planned as a randomized controlled trial. After determining normative values for the population of the geographic region, 101 consecutive cases of typical CTS of the hand (suffering palmar dysesthesia that waking from sleep at night) were enrolled in the study. Hands were randomized into two groups using simple randomization. The first group comprised patients whose surgical candidacy was evaluated without electrodiagnostic tests, and the second group comprised patients whose surgery decisions were based on the results of electrodiagnostic testing. The patients were evaluated at 1, 3, and 12 months postoperatively. Results: Sixty-one hands were randomized to the first group and 40 hands were randomized to the second group. Four cases in the second group received medical treatment because their electrodiagnostic test results were within the normal limits, despite the presence of typical CTS symptoms. There were no differences in favor of the second group regarding any evaluation criteria during the entire follow-up period; however, the first group reported significantly more positive outcomes regarding awakening at the 3-month follow-up and regarding satisfaction at the 1-month follow-up. Conclusion: Additional electrodiagnostic tests may not be mandatory to clinically identify classical CTS or make surgical decisions in these cases. However, many cases may be caused by entrapment of the median nerve in the carpal tunnel, but they may lack typical CTS symptoms, such as waking from night-time sleep. In such cases, properly applied electrodiagnostic tests may be of immense help

Normal nerve conduction values of median and ulnar nerves in the Turkish population

Background: Nerve conduction studies (NCS) are an important tool for the diagnosis of neuromuscular diseases. In NCS, factors such as temperature, age, sex, body metrics, and recording technique can affect the values. There are currently no universal normative data. The standardization of NCS is essential for the reliable and consistent identification of pathologic conditions for each laboratory. Aim: We wanted to obtain normal values of our electrophysiology laboratory for the Turkish population. Materials and Methods: The volunteer group consisted of 120 people aged 15–74 years. They were distributed into 12 subgroups according to their age. Each subgroup included five male and five female subjects. Age, sex, weight, height, profession, body mass index, and hand preferences were recorded. Median and ulnar NCS were performed by two experienced clinical neurophysiologists. The skin temperature was corrected to 35.5°C, which was the highest measured value. Results: Age 50 years was used for the cutoff point for nerve conduction velocities (NCVs) because there was no significant difference within the groups aged ≥50 years and 50 years were significantly different. NCVs and action potential amplitudes were higher in females than males in both age groups. Women had higher NCV values and action potential amplitudes of motor and sensory fibers. Conclusion: Age, temperature, and sex are important factors that affect NCS. We believe this study will provide normal values for future studies, especially in the Turkish population

Prevention of Anterior Scar Formation Following Discectomy with a MediShield Adhesion Barrier: Randomized Experimental Trial

WOS: 000321477200004PubMed ID: 23756969AIM: To investigate whether carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel has a protective effect against epidural scar formation anterior to the dura following discectomy. MATERIAL and METHODS: A barrier gel comprised of CMC and PEO (MediShield) was studied as a material to reduce anterior epidural scar formation in a rabbit laminotomy and discectomy model. After laminotomy and disc puncture, the surgical side was either treated with MediShield or used as a surgical control, as determined by random allocation. Two months after surgery, the animals were euthanized, and their lumbar spines were removed in an en bloc excision for pathological evaluation. Scar formation was evaluated as present or absent. RESULTS: The MediShield group contained 12 rabbits, and the control group contained 7 rabbits. Epidural fibrosis was observed in two out of twelve specimens (17%) in the MediShield group and in three of seven (43%) cases in the control group (P=0.305, Fisher's Exact Test). CONCLUSION: Though it was not statistically significant, we observed a difference between the MediShield and control group that favored the MediShield group. The application of the CMC/PEO gel might protect against epidural fibrosis after lumbar discectomy, but its efficacy needs to be investigated in larger experimental trials

Thymoma with Sacral Metastasis

Thymomas are the most common type of mass found in adult anterior mediastinal masses. Thymomas typically metastasize to the ribcage because of their slow growth and affinity for local invasion. Far metastases are rare, with the brain as the most commonly metastasized area. Bone metastases of thymomas are usually observed in the calvarium. A 60-year-old patient, who presented with metastatic mass lesions that developed 18 months after undergoing a surgery for mediastinal thymomas in the sacrum and iliac bones detected by computed tomography, magnetic resonance imaging, and histopathology, is the first mediastinal thymoma case with metastasis to the sacrum in the literature

Dexamethasone Addition Impairs the Therapeutic Effects of Nimodipine for Subarachnoid Hemorrhage: An Experimental Animal Study

Aim:Subarachnoid hemorrhage (SAH) is a devastating disease, resulting in imparting long-term cognitive and sensorimotor deficits. Nimodipine is the only drug that reduces the poor outcomes for SAH patients. Dexamethasone is widely employed for various purposes in SAH patients undergoing microsurgical clipping. For example, postcraniotomy cerebral edema and severe headaches have been attributed to meningeal inflammation. Furthermore, strong evidence suggests that inflammation contributes to the poor outcomes. Recently, interest in the role of inflammation in delayed cerebral ischemia (DCI) has been raised, and studies have demonstrated the beneficial effects of dexamethasone in SAH. In this direction, we aimed to understand the effects of the combination of dexamethasone and nimodipine in SAH.Material and Methods:In this study, 35 female adult Wistar Albino rats were randomly assigned to four groups: Sham (n=8), nontreatment+SAH (n=9), SAH with nimodipine (n=9, oral gavage, 12mg/kg, BID) treatment, and SAH with combined therapy with nimodipine and dexamethasone (n=9, intraperitoneally, 1mg/kg, BID). The cisterna magna double injection of autologous blood model was used. The animals were euthanized 5 days after the first injection.&nbsp;Results:Of the total, five rats died before euthanasia. The nontreatment+SAH group showed the worst score in neurological examinations, and the most severe histopathological findings were noted in terms of vasospasm. The SAH+nimodipine group showed the best neurological score and the closest histopathological results to those of the Sham group, whereas adding dexamethasone to nimodipine treatment (the SAH+nimodipine+dexamethasone group) worsened the neurological and histopathological outcomes.Conclusion:We thus concluded that the therapeutic effects of nimodipine were impaired when combined with dexamethasone. We thus hypothesized that dexamethasone possibly induces the CYP3A4-enzyme that metabolizes nimodipine. However, it should be noted that our results are based on laboratory findings obtained on a small sample, therefore further studies with drugdrug interaction on a larger sample size through CYP3A4-enzyme and clinical confirmation are warranted.</p

Evaluation of Incidentally Detected Pathology Results of Patients with Vertebral Fracture Treated by Vertebroplasty and Kyphoplasty: A Retrospective Study

BACKGROUND: Vertebroplasty and kyphoplasty are minimally invasive techniques used to treat vertebral compression fractures. The etiology of vertebral compression fractures varies among patients. Although osteoporosis and trauma are major etiologic factors in patients with a vertebral compression fracture, unexpected results were found in 11 patients in the present study. The aim of the present retrospective study was to determine the incidentally detected pathology results of patients with vertebral fracture treated by vertebroplasty and kyphoplasty