Mohammad Ghasemi-Rad

A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment

Carpal tunnel syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities. It is the most commonly known and prevalent type of peripheral entrapment neuropathy that accounts for about 90% of all entrapment neuropathies. This review aims to provide an outline of CTS by considering anatomy, pathophysiology, clinical manifestation, diagnostic modalities and management of this common condition, with an emphasis on the diagnostic imaging evaluation.

Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings.

OBJECTIVE Carpal tunnel syndrome (CTS) represents one of the most prevalent peripheral entrapment mononeuropathies. The purpose of our study was to assess the potential correlation between intraneural hypervascularization, flexor retinaculum bowing, and median nerve cross-sectional area and the severity of CTS in cases confirmed by nerve conduction study. SUBJECTS AND METHODS Sixty consecutive patients with classic or probable symptoms of CTS were enrolled in the study. A control group consisting of 27 healthy volunteers who were never diagnosed with CTS or had any symptoms of CTS was recruited among institution employees. All symptomatic patients were initially examined by a hand surgeon and subsequently referred for sonographic and electrophysiologic examinations. RESULTS A total of 90 wrists (in 60 patients) were included in the study. Twenty-eight (31.1%) had mild CTS, 33 had moderate disease, and 29 had severe disease. We detected significant correlation between median nerve hypervascularization and the severity of CTS (p = 0.01, logistic regression) for moderate CTS and (p = 0.04) for severe disease. We also detected a significant correlation in flexor retinaculum bowing and median nerve cross-sectional area with increase in the severity of CTS (p < 0.001 and < 0.008; chi-square test and analysis of variance, respectively). CONCLUSION Our study suggests that the severity of CTS strongly correlates with color Doppler sonography findings, and this technique may represent a reliable complementary tool in CTS examination.

Evaluation of carotid intima-media thickness and flow-mediated dilatation in middle-aged patients with nonalcoholic fatty liver disease.

Background Nonalcoholic fatty liver disease (NAFLD) has a high prevalence in the general population and is the most common liver disease in Western countries. It is a feature of metabolic syndrome and is characterized by excessive accumulation of fat in the liver cells. Methods We examined 84 consecutive middle-aged (under 45 years) patients with NAFLD and 65 control subjects matched for age, gender, and body mass index to determine carotid intima-media thickness (CIMT) and flow-mediated dilatation (FMD) in the brachial artery. Results There was a statistically significant difference between CIMT and percentage increase in FMD in the patient group (P = 0.002; r = 0.33) when compared with the control group (P = 0.97; r = 0.005). The mean ± standard deviation CMIT was 0.65 ± 0.09 mm in patients and 0.55 ± 0.07 mm in controls. This difference was statistically significant (P = 0.001). Mean FMD in patients was 6.4% and 15.7% in controls. This difference was statistically significant (P = 0.001). Conclusion This study shows that pure NAFLD without metabolic syndrome in middle-aged subjects is strongly associated with morphological (CIMT) and physiological (FMD) changes. These findings may have an important role in increasing cardiovascular risk in these patients.

Evaluation of atherosclerotic findings in patients with nonalcoholic fatty liver disease

Background Nonalcoholic fatty liver disease (NAFLD), a highly prevalent condition, is a feature of metabolic syndrome and is characterized by excessive accumulation of fat in the liver cells. The purpose of this study was to investigate the association between NAFLD and carotid intima-media thickness (CIMT) as an independent risk factor for atherosclerosis. Methods We examined 250 consecutive patients with ultrasonographically confirmed NAFLD and 85 age-matched and gender-matched controls with normal parenchymal liver echogenicity for determination of CIMT and presence of carotid atherosclerotic plaque. Results Compared with control subjects, patients with NAFLD showed an increased mean CIMT (0.81 ± 0.14 mm) compared with control subjects (0.58 ± 0.15 mm). This difference was statistically significant (P = 0.001). After performing multivariate analysis, the presence of NAFLD was associated with abnormal CIMT independent of other atherogenic risk factors or its association with metabolic syndrome. Conclusion NAFLD can be an independent risk factor for developing atherosclerosis. Therefore, NAFLD with and without metabolic syndrome can be associated with increased CIMT and increased risk of cardiovascular events in patients with NAFLD incidentally diagnosed on abdominal ultrasonography.

Effect of Helicobacter pylori infection on pregnancy rates and early pregnancy loss after intracytoplasmic sperm injection.

Background: There is a need to elucidate what affects the implantation and early pregnancy course in pregnancies conceived with assisted reproductive technology (ART) so that pregnancy rates and outcomes can be improved. Our aim was to determine the role of maternal Helicobacter pylori infection. Material and methods: We did a prospective study of 187 infertile couples undergoing intracytoplasmic sperm injection (ICSI) and segregated those according to underlying infertility etiology. We assessed the status of H. pylori IgG antibodies and anti-CagA IgG antibodies by ELISA assay. All pregnancies were followed for early pregnancy loss (EPL, first 12 weeks). Results: The likelihood of H. pylori infection increased with age (1.01, 95% confidence interval [CI]: 1.0–1.13; P = 0.040) but there was no association with EPL. Women infected with CagA-positive strains were more likely to have EPL (19.39, 95% CI: 1.8–208.4; P = 0.014). Women with tubal factor or ovulatory disorder infertility were more likely to abort early (12.95, 95% CI: 1.28–131.11; P = 0.030, 10.84, 95% CI: 1.47–80.03; P = 0.020, respectively). There was no association between EPL and age, number of embryos formed or transferred, or number of oocytes retrieved. Conclusion: Our findings suggest that infection with CagA-positive H. pylori strains is linked to an increase in women’s potential to abort early (possibly through increased release of inflammatory cytokines). In addition, tubal factor and ovulatory disorder infertility are linked to EPL after ICSI due to unknown mechanisms. Proposals to eradicate H. pylori infection prior to ICSI could lead to a decrease in EPL after ART.

Ankylosing spondylitis: A state of the art factual backbone

Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects 1% of the general population. As one of the most severe types of spondyloarthropathy, AS affects the spinal vertebrae and sacroiliac joints, causing debilitating pain and loss of mobility. The goal of this review is to provide an overview of AS, from the pathophysiological changes that occur as the disease progresses, to genetic factors that are involved with its onset. Considering the high prevalence in the population, and the debilitating life changes that occur as a result of the disease, a strong emphasis is placed on the diagnostic imaging methods that are used to detect this condition, as well as several treatment methods that could improve the health of individuals diagnosed with AS.

Aspiration thrombectomy using the penumbra catheter.

Editor: Thromboembolic diseases are among the most prevalent medical problems today and cause stroke, myocardial ischemia, acute limb ischemia, and pulmonary embolism. Various treatment modalities exist, ranging from medical therapy to endovascular techniques. In the management of a thromboembolic condition causing a threatened limb, common options for treatment include surgical thromboembolectomy, percutaneous thrombectomy, and/or thrombolysis. In recent decades, many mechanical thromboembolectomy devices have become commercially available and have proven to be useful in the treatment of acute thrombi. These devices are often limited in efficacy when treating a chronic, organized thrombus. We recently encountered two cases in which an aspiration thrombectomy device (Penumbra, Alameda, California), which is typically used in the treatment of acute stroke, was used to aspirate chronic thrombi in a patient with a cold hand and in a patient with a chronically thrombosed common iliac vein stent. A 59-year-old man with a 20-year history of poorly controlled diabetes and hypertension presented to the emergency department with left hand pain, numbness, and tingling in the dorsal and palmar surfaces of the fingers. On examination, the left hand was cold, with a weak radial pulse and a delayed capillary refill in the fingers. There was limited range of motion, particularly in the third and fourth digits, during active and passive movement. The forearm compartments were soft with no tenderness. A sensory examination had normal findings, and a Spurling test was negative. Doppler ultrasonography and left upper extremity arteriography demonstrated a focal occlusion of the radial artery at the level of the wrist and severely atherosclerotic ulnar

PRIMARY HYPERPARATHYROIDISM: COMPARING BETWEEN SOLID AND CYSTIC ADENOMAS AND THE EFFICACY OF ULTRASOUND AND SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY IN THEIR DIAGNOSIS

OBJECTIVE Primary hyperparathyroidism (PHPT) is a disorder that results from abnormal functioning of the parathyroid glands. The purpose of this study was to compare cystic and solid adenomas by analyzing different variables associated with PHPT and parathyroid adenomas (age, calcium, phosphorus, and parathyroid hormone [PTH] levels, adenoma volume) while comparing the efficacy of ultrasound and single-photon emission computed tomography in differentiating between both types of adenoma. METHODS From 152 patients diagnosed with PHPT between January 2013 and 2014, only 109 patients who had positive ultrasonographic findings for single parathyroid adenoma were included in the study. RESULTS A total of 26 patients had cystic adenomas and 83 patients had solid adenomas. Sestamibi (MIBI) was negative in 50% of the cystic adenoma group and 27.7% of the solid adenoma group, with an overall technetium-MIBI efficacy of 67%. Age, phosphorus level, and adenoma volume were significantly higher in patients with cystic adenomas (P = .001, P = .02, and P = .02, respectively), whereas calcium and PTH levels were significantly higher in patients with solid adenomas (P = .02, P = .038, respectively). MIBI had a significant correlation with PTH levels (P = .031) and adenoma volume (P = .05) only in patients with solid adenomas. No significant correlation was found between sex and type of parathyroid adenoma. CONCLUSION The current study is the first to compare age, PTH levels, and adenoma volume between cystic and solid adenoma patients, providing more information for the poorly understood pathology of cystic adenomas. Our findings showed that age and calcium and PTH levels are significantly higher in patients with solid adenomas, whereas adenoma volume and phosphorus levels are significantly higher in patients with cystic adenomas.

Combined letrozole and clomiphene versus letrozole and clomiphene alone in infertile patients with polycystic ovary syndrome.

Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of childbearing age (6.8%–18%), is among the most common causes of infertility due to ovulation factors, and accounts for 55%–70% of infertility cases caused by chronic anovulation. In this study, we used a combination of letrozole and clomiphene in patients resistant to both drugs individually, and studied the effects of this combination in ovulation and pregnancy in resistant PCOS patients. Methods The study population included infertile couples diagnosed as PCOS in the wife. The women used clomiphene for at least six cycles in order to ovulate after failure to form the dominant follicle, and were then put on letrozole for four cycles. Patients who were unable to form the dominant follicle were enrolled on letrozole and clomiphene combination therapy. Results One hundred enrolled patients underwent 257 cycles of a combination of letrozole and clomiphene, in which 213 were able to form the dominant follicle (82.9%) and 44 were unable to do so (17.1%). The number of mature follicles was 2.3±1.1. The mean endometrial thickness in patients on the day of human chorionic gonadotropin administration was 8.17±1.3 mm. The pregnancy rate was 42%. Conclusion According to the results of this study, it can be proposed that in PCOS patients resistant to clomiphene and letrozole used as single agents, a combination of the two drugs can be administered before using more aggressive treatment that may have severe complications or surgery. This combination may also be used as a first-line therapy to induce ovulation in severe cases of PCOS in order to save time and expense.

Metachronous metastasis to the spermatic cord from renal cell carcinoma presenting as a high scrotal mass: a case report.

Abstract Primary malignant lesions and metastatic carcinomas of the spermatic cord are extremely rare. We present the case of a 57-year-old man, who presented with a painless palpable mass in the left high scrotal area 36 months after radical nephrectomy. The patient had received chemotherapy because of disseminated metastases. There was no sign of local recurrence after 3-month follow-up.