In patients with a clinical diagnosis of CTS, the accuracy of sonography is similar to that for EMG. Sonography is probably preferable because it is painless, easily accessible and preferred by the patients.

High-resolution sonography has the same accuracy as electrophysiological studies in confirming the diagnosis in carpal tunnel syndrome (CTS), but the value of sonographic follow-up after surgery requires prospective examination. The aims of the present study were to assess: (1) change in the size of the median nerve at the proximal carpal tunnel after surgery compared to conservative treatment, and (2) the correlation between sonographic characteristics and clinical outcome after surgery. Seventy-nine patients undergoing surgery for CTS were assessed at least 6 months after surgery. The patients completed questionnaires and underwent sonography. Postoperative improvement was scored by the patient on a 6-point ordinal transition scale ranging from "completely recovered" to "much worse." The median cross-sectional area of the median nerve at the proximal carpal tunnel decreased after surgery from 14 mm2 [interquartile range (IQR) 12-16 mm2] to 11.5 mm2 (IQR 11-13.5 mm2) (P < 0.0001); no significant changes in the cross-sectional area occurred in symptomatic hands treated conservatively or in asymptomatic hands. Sonography at the time of diagnosis was not a predictor of postoperative outcome, but in this study only a relatively small number of patients had a poor postoperative outcome.

No abstract

Objective.-To investigate the effect of low-intensity acenocoumarol treatment (target INR 1.5 to 2.0) on the frequency and severity of migraine attacks.Background.-The positive effect of anticoagulation on migraine has been described in case reports and observational studies.Methods.-We conducted a randomized, open, crossover study in migraine patients. After a run-in period of 8 weeks, all patients received acenocoumarol or propranolol during a period of 12 weeks and, after a washout period of 2 weeks, propranolol or acenocoumarol during a second period of 12 weeks.Results.-Nineteen patients fulfilling the criteria were included. In 12 patients with complete data collection, only one good responder could be noted. In the other patients, treatment with low-intensity acenocoumarol did not show improvement of migraine symptoms compared with the run-in period. Treatment with propranolol showed a trend towards improvement compared with the run-in period. No serious adverse events were observed.Conclusions.-Overall, low-intensity acenocoumarol treatment has no prophylactic effect in migraine patients.Key words: migraine, anticoagulation, acenocoumarol, migraine prophylaxis (Headache 2005;45:137-143) The drugs recommended for prophylactic therapy of migraine show a limited effectiveness and a great interindividual variability. In addition, some of these drugs may cause troublesome, sometimes severe, adverse effects, which can contribute to noncompliance.

The naturally occurring anticarcinogens flavone and alpha-angelicalactone incorporated separately and simultaneously in the diet at 0.5, 0.1, 0.05 and 0.01% w/w, were studied with respect to their effects on oesophageal, gastric, intestinal, colonic and hepatic (i) glutathione S-transferase (GST) enzyme activity, (ii) GST isozyme levels and (iii) glutathione (GSH) content in male Wistar rats. GST enzyme activity was significantly increased in the three treatment groups at one or more sites. The most substantial inductions were seen in oesophagus and stomach by 0.5% alpha-angelicalactone (1.9- and 2.3-fold respectively); and in small intestine, colon and liver by 0.5% combination diet (2.5-, 1.4- and 4.0-fold respectively). The inducing capacities declined with decreasing anticarcinogen concentrations. GST enzyme activity was induced in liver and to a lesser extent in small intestine and stomach. In general, in combination groups similar effects were seen as after treatment with alpha-angelicalactone or flavone separately. However, colonic GST enzyme activity was increased in the 0.5% combination group (1.4-fold), whereas in the corresponding flavone or alpha-angelicalactone groups no induction was observed. Concomitant changes in GST isozyme levels occurred. The involvement was the highest for GST-alpha (75%), followed by GST-mu (58%) and GST-pi (33%). Increased GSH levels were obtained in stomach and liver in all three treatment groups at various concentrations. These data demonstrate that dietary administration of flavone or alpha-angelicalactone, even at relatively low concentrations, may exert chemopreventive effects in stomach, small intestine, liver and to a lesser extent in oesophagus by enhancing the GST detoxification system, mainly by induction of GST-alpha and GST-mu isozymes. In addition, simultaneous administration of flavone and alpha-angelicalactone may result in anticarcinogenic effects in the colon by the same principle.