We performed a double-blind, placebo-controlled study to evaluate the efficacy of low and high dose of intravenous immunoglobulins (IVIG) in relapsing/remitting (RR) multiple sclerosis (MS). Patients (n = 49) with clinical definite RR MS were randomly allocated to three groups and treated with 0.2 g/kg (n = 17) or 0.4 g/kg (n = 15) once a month of IVIG and placebo (n = 17) for 12 months. Clinical data were assessed monthly and magnetic resonance imaging (MRI) was performed every 3 months during the study period. Annual relapse rate (ARR) and change of the mean Expanded Disability Status Scale (EDSS) and Neurological Rating Scale Score (NRSS) from baseline to study conclusion were used as the clinical end-points. For MRI activity total lesion volume on T2-weighted image (T2WI), new lesions and gadolinium (Gd)-enhanced lesions on T1WI were analysed. ARR in both IVIG groups (0.88 for 0.2 g/kg and 0.86 for 0.4 g/kg) was reduced compared with placebo (1.24) during treatment period. Neurological disability measured with EDSS decreased slightly in both the IVIG groups (0.029 and 0.066, respectively) and increased by 0.29 in placebo (P = 0.0117). The neurologic impairment measured by NRSS showed similar trend. The total lesion volume on T2WI increased by 13.56% in placebo whereas in the 0.4 g/kg IVIG group decreased by -3.95% and in the 0.2 g/kg IVIG group increased by 3.6%. The cumulative numbers of Gd-enhancing lesions and new T2WI lesions in the IVIG groups were reduced in comparison with the placebo group. Our findings suggest that the dose 0.2 g/kg of IVIG is equally effective as 0.4 g/kg in reducing MS activity.

StreszczenieWstęp: Zespół cieśni nadgarstka (ZCN) jest najczęściej występującą mononeuropatią kończyn górnych. Od wczesnych lat 90. wymieniana jest ona jako możliwy skutek przeciążeń intensywną pracą przy komputerze, choć dotąd nie ma bezspornych dowodów takiej zależności. Celem pracy była analiza zawodowych i pozazawodowych czynników ryzyka ZCN w populacji osób zawodowo używających klawiatury i myszki komputera. Materiał i metody: Badaniem objęto 60 pacjentów -58 kobiet i 2 mężczyzn (śred-nia wieku: 53,8±6,35 lat) z podejrzeniem ZCN o etiologii zawodowej, wykonujących pracę zawodową przy użycia komputera. U wszystkich przeprowadzono badanie kwestionariuszowe oraz badanie przewodnictwa nerwowo-mięśniowego (elektroneurografia -ENeG) nerwów pośrodkowych i łokciowych. Wyniki: Badani wykonywali pracę z użyciem komputera przez 6,43±1,71 godzin dziennie. Czas od rozpoczęcia pracy do wystąpienia objawów klinicznych neuropatii wynosił 12,09±5,94 lat. Wszyscy badani spełnili kryteria kliniczne i elektrofizjologiczne rozpoznania ZCN. W badanej grupie dominowały pozazawodowe czynniki ryzyka ZCNotyłość, niedoczynność tarczycy, przebyta panhisterektomia, owariektomia, hormonalna terapia zastępcza, hormonalna antykoncepcja, menopauza, cukrzyca i zapalenie pochewek ścięgnistych. U 7 chorych nie zidentyfikowano potencjalnego czynnika etiologicznego ZCN. U żadnego z pacjentów nie rozpoznano ZCN o etiologii zawodowej. Wnioski: Wyniki naszego badania wskazują, że przyczyny zespołu cieśni nadgarstka są zwykle inne niż praca z wykorzystaniem komputera. Med. Pr. 2013;64(1):37-45 Słowa kluczowe: zespół cieśni nadgarstka, praca, komputery, czynniki ryzyka Abstract Background: Carpal tunnel syndrome (CTS) is the most frequent mononeuropathy of upper extremities. From the early 1990's it has been suggested that intensive work with computers can result in CTS development, however, this relationship has not as yet been proved. The aim of the study was to evaluate occupational and non-occupational risk factors for developing CTS in the population of computer-users. Material and Methods: The study group comprised 60 patients (58 women and 2 men; mean age: 53.8±6.35 years) working with computers and suspected of occupational CTS. A survey as well as both median and ulnar nerve conduction examination (NCS) were performed in all the subjects. Results: The patients worked with use of computer for 6.43±1.71 h per day. The mean latency between the beginning of employment and the occurrence of first CTS symptoms was 12.09±5.94 years. All patients met the clinical and electrophysiological diagnostic criteria of CTS. In the majority of patients etiological factors for developing CTS were non-occupational: obesity, hypothyroidism, oophorectomy, past hysterectomy, hormonal replacement therapy or oral contraceptives, recent menopause, diabetes, tendovaginitis. In 7 computer-users etiological factors were not identified. Conclusion:The results of our study show that CTS is usually generated by different causes not related with using computers at work. Me...

Objectives: To evaluate: a) the prevalence of bilateral idiopathic carpal tunnel syndrome (CTS) in manual workers; b) a correlation between the duration of unilateral and bilateral CTS symptoms; c) a correlation between the onset of CTS symptoms in the unilateral dominant/non-dominant hand and the time of developing bilateral CTS; and d) findings of the nerve conduction study (NCS) in symptomatic and asymptomatic hands of patients with unilateral CTS. Material and Methods: Clinical and neurophysiological examinations were conducted along with a detailed analysis of job exposure of 332 manual workers admitted to the Occupational Medicine Department, the Nofer Institute of Occupational Medicine, with suspected occupational CTS. Eventually, 258 patients were excluded from the study: 34 with associated neuropathies and 206 with other conditions potentially associated with CTS. Cases with work-related CTS (18) were also excluded. Results: A total of 74 patients were diagnosed as idiopathic CTS. In idiopathic CTS, the right hand was affected in 15 (20.3%) patients, the left hand in 4 (5.4%) patients, and both hands in 55 (74.3%) patients. Symptoms duration was longer in the patients with bilateral CTS (4.01 years) than in those with a unilateral right (1.7 years, p = 0.002) or left hand condition (2.8 years, p = 0.313). Median nerve impairment at the wrist was revealed by NCS in 6 left and 2 right asymptomatic hands. Conclusions: The findings of the study indicate the need for "alerting" patients with unilateral CTS about the risk of the disease developing in the contralateral hand. Therefore, NCS should be routinely performed in the asymptomatic hands of patients with unilateral CTS, which is essential for the prevention of neuropathies, especially among manual workers performing repetitive manual tasks. Int J Occup Med Environ Health. 2020;33(2):151 -61

Occupational ulnar neuropathy at the elbow joint develops in the course of long term direct pressure on the nerve and a persistently flexed elbow posture, but first of all, it is strongly associated with "holding a tool in a certain position" repetitively. Therefore, computer work only in exceptional cases can be considered as a risk factor for the neuropathy. Ulnar hypermobility at the elbow might be one of the risk factors in the development of occupational ulnar neuropathy; however, this issue still remains disputable. As this condition is mostly of congenital origin, an additional factor, such as a direct acute or chronic professional or non-professional trauma, is needed for clinical manifestations. We describe a patient - a computer user with a right ulnar nerve complete dislocation and left ulnar nerve hypermobility, unaware of her anomaly until symptoms of left ulnar neuropathy occurred in the course of job exposure. The patient was exposed to repetitive long lasting pressure of the left elbow and forearm on the hard support on the cupboard and desk because of a non-ergonomically designed workplace. The additional coexistent congenital abnormal displacement of the ulnar nerve from the postcondylar groove during flexion at the elbow increased the possibility of its mechanical injury. We recognized left ulnar neuropathy at the ulnar groove as an occupational disease. An early and accurate diagnosis of any form of hypermobility of ulnar nerve, informing patients about it, prevention of an ulnar nerve injury as well as compliance with ergonomic rules are essential to avoid development of occupational and non-occupational neuropathy.

StreszczenieWstęp: Zespół cieśni nadgarstka (ZCN) jest najczęstszą neuropatią kończyn górnych i najczęstszą chorobą przeciążeniową ukła-du mięśniowo-szkieletowego. Powstaje wskutek ekspozycji zawodowej na powtarzalne, monotypowe ruchy w stawach nadgarstka oraz konieczności użycia siły i narażenia na drgania mechaniczne. Celem pracy była ocena czynników etiologicznych zespołu cieśni nadgarstka u osób zawodowo wykonujących monotypowe ruchy w nadgarstku. Materiał i metody: Zbadano 300 chorych (261 kobiet, 39 mężczyzn) o średniej wieku 52 lata (odchylenie standardowe: ±6,93) hospitalizowanych w Klinice Chorób Zawodowych i Toksykologii Instytutu Medycyny Pracy im. prof. J. Nofera w Łodzi z podejrzeniem etiologii zawodowej ZCN. Wyniki: Badanie ujawniło wysoki odsetek chorób i czynników ogólnoustrojowych uczestniczących w patogenezie ZCN (68,7% badanej populacji). Dominowała otyłość (32%), choroby gruczołu tarczowego (28,7%), hormonalna terapia zastępcza i/lub owariektomia (16,3%) i cukrzyca (12%). U 111 pacjentów współistniało co najmniej kilka potencjalnych czynników etiologicznych powyższej neuropatii. Jedynie u 18 chorych (6%) analiza kliniczna i narażenia zawodowego pozwoliły na rozpoznanie choroby zawodowej -zespołu cieśni nadgarstka. Stwierdzono u nich długotrwałe (20,2±9,3 roku) narażenie zawodowe na monotypowe, wymagające dużej siły ruchy w stawach nadgarstka. Wnioski: W badanej grupie dominowały pozazawodowe czynniki etiologiczne ZCN, a u 37% badanych było ich co najmniej kilka. Wśród pacjentów badanych z powodu podejrzenia zawodowej etiologii ZCN, a także u tych z rozpoznanym zawodowo pochodnym ZCN, przeważały osoby zatrudnione w różnych sektorach przemysłu. Wyniki naszej pracy potwierdzają wieloczynnikową etiologię zespołu cieśni nadgarstka -tylko u 6% badanych miała ona uwarunkowania zawodowe. Med. Pr. 2014;65(2):261-270 Słowa kluczowe: zespół cieśni nadgarstka, etiologia zawodowa, pozazawodowe czynniki ryzyka, przemysł, wykonywane zawody Abstract Background: Carpal tunnel syndrome (CTS) is the most common neuropathy of upper limbs and a leading cause of upper extremity musculoskeletal disorders, in terms of work exposure, repetitive and forceful exertions of the hand and use of vibrating hand tools. The aim of the study was to evaluate etiological factors of carpal tunnel syndrome in subjects occupationally exposed to monotype movements in wrist. Material and Methods: We conducted the retrospective analysis of 300 patients (261 women, 39 men), mean age 52 years (standard deviation: ±6.93) hospitalized with the suspicion of occupational CTS. Results: The study revealed high percentage (68.7%) of diseases and systemic factors involved in the pathogenesis of CTS in the analyzed population, especially obesity (32%), thyroid diseases (28.7%), hormone replacement therapy and/or oophorectomy (16.3%) and diabetes mellitus (12%). In 111 patients the coexistence of at least a couple of potential etiological factors of the neuropathy was recognized. Clinical analysis and occupational exposure allowed to diagnose occ...