To compare the efficacy of local steroid injection and open carpal tunnel release, a symptom and functional status questionnaire (Boston Questionnaire) and sensory and motor nerve conduction studies were performed in 90 patients with electrophysiologically proven idiopathic carpal tunnel syndrome, of whom 44 were treated surgically and 46 by two-dose steroid injection. Electrophysiologic studies and the Boston Questionnaire were applied before and at the 3rd and 6th months after treatment. Both groups showed significant improvement at first follow-up. The surgically treated group showed a significant and further improvement of symptoms and conduction values between the 3rd- and 6th-month evaluations, whereas no significant change was observed in the patient group treated by steroid injection. By the end of follow-up, 5% of the hands in the open carpal tunnel release (OCTR) group and 13% of the hands in the local steroid injection (LSIG) group showed electrophysiological worsening, and 5% of the hands in the OCTR group and 22% of the hands in the LSIG group showed symptomatic worsening. Our results show that steroid injection provides an improvement comparable with that from surgical release of the median nerve at a 3-month interval. However, this improvement is not long-lasting.

The relationship between nerve conduction studies and the self-administered Boston Questionnaire that measures the severity of symptoms and functional status in carpal tunnel syndrome was assessed in 44 patients with idiopathic carpal tunnel syndrome. The patients were examined preoperatively and 3 and 6 months postoperatively. Although both the clinical outcome and electrophysiological findings improved significantly after surgery, we observed no correlation between improvements in nerve conduction and the questionnaire scores.

No abstract

A variety of experimental studies have demonstrated the neuroprotective effects of melatonin, based on its antioxidant activity. In a prospective randomized study, the effects of melatonin were investigated in experimental head trauma-induced oxidative stress in rabbits. The experimental study was performed on 30 rabbits. The animals were divided into three groups. Group I (sham procedure): a right parietal craniotomy was performed on each animal, and the dura mater was left intact. Group II: experimental brain trauma (EBT) was performed on each animal using a 1 cm inner diameter x 10 cm long glass tube, through which a 20 g weight (0.5 cm diameter) was dropped onto the brain at the craniotomy site, causing a contusional head trauma. Group III: the same EBT model was performed, but 2.5 mg/kg melatonin was injected intraperitoneally four times (total dose 10 mg/kg); these injections were performed 20 min before the operation, during the trauma, 1 h later and 2 h later. The rabbits were sacrificed after the EBT at 24 h after the brain trauma. The activities of the three principal antioxidant enzymes-catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px)-were determined, and the levels of malondialdehyde (MDA), a product of lipid peroxidation, and glutathione (GSH) were measured in brain homogenates. MDA levels were found to be higher in the EBT group than in the EBT+melatonin group or the sham procedure group. The SOD activity was found to be higher in the EBT group than in the sham procedure group. Enzymatic parameters (except for SOD) were significantly higher in melatonin-treated animals than in EBT animals. GSH levels in melatonin-treated animals were decreased compared with EBT animals. In conclusion, the data indicate that melatonin protects against free radical-mediated oxidative changes in brain tissue by boosting antioxidant enzymes, and in particular lowering lipid peroxidation in rabbits with EBT.

We investigated prognostic importance of electrocardiographic (ECG) changes in ischaemic stroke patients without primary heart disease because of the limited evidence. This study consisted of 162 patients (92 male, age 64 +/- 14 years) with first ischaemic stroke presenting to hospital during 18 months. One-month mortality was analysed by means of ischaemia-like ECG changes, long QT and arrhythmia. Ischaemia-like ECG changes were observed in 79% of stroke patients and long QTc in 26% and arrhythmias in 44%. Early mortality rate was 27% (n = 44). Age, ST-segment change and abnormal U wave were univariate predictors of early mortality (each p < 0.05). In multivariate analysis, age > 65 years (OR = 1.4, p = 0.02) and presence of ST-segment change (OR = 2.6, p = 0.01) were only independent predictors. Although sensitivity and specificity of ST-segment change were relatively low to identify patients at risk of death, its negative predictive value was 82%. The ECG changes are frequently seen in selected patients with ischaemic stroke. Regardless of origin, ST-segment change can be a predictor of early mortality.