-Carpal tunnel syndrome (CTS) has been correlated to body mass index (BMI) increase. The present study was done in a Brazilian population to compare BMI values in the following groups: first, CTS vs. controls subjects, and, second CTS groups of increasing median sensory latency (MSL). According to MSL≥3.7 ms (wristindex finger, 14 cm), median/ulnar sensory latency difference≥0.5 ms (ring finger, 14 cm) or median palm-to-wrist (8 cm) latency≥2.3 ms (all peak-measured), 141 cases (238 hands) had CTS confirmation. All were symptomatic; previous surgery and polyneuropathy were excluded; mean age 50.3; 90.8% female. Controls subjects (n=243; mean age 43.0; 96.7% female) and CTS cases had BMI calculated (kg/m 2 ). Controls subjects had a mean BMI of 25.43±4.80 versus 28.38±4.69 of all CTS cases, a statistically significant difference (p < 0.001). The CTS groups of increasing MSL severity do not show additional increase in BMI (28.44 for incipient, 28.27 for mild, 28.75 for moderate and 29.0 for severe). We conclude that CTS cases have a significant correlation with higher BMI when compared to controls subjects; however, higher BMI do not represent a statistically significant increasing risk for more severe MSL.KEY WORDS: carpal tunnel syndrome, median nerve, compressive neuropathy, body mass index, nerve conduction studies. Índice de massa corporal e síndrome do túnel do carpoRESUMO -Síndrome do túnel do carpo (STC) pode ser estar relacionada ao aumento de índice de massa corporal (IMC). O presente estudo foi realizado em uma população brasileira para comparar valores de IMC entre casos com STC e controles assintomáticos; os casos com STC foram ainda divididos em subgrupos de gravidade progressiva de acordo com a latência distal sensitiva do nervo mediano (LDS-M). Os casos de STC (141, 238 mãos) foram confirmados com LDS-M≥3,7 ms (punho-II dedo, 14 cm), diferença de latência mediano-ulnar≥0,5 ms (punho-IV dedo, 14 cm) ou latência palma-punho do nervo mediano≥2,3 ms (8 cm), todos medidos no pico do potencial. Todos os casos eram sintomáticos; foram excluídos casos com polineuropatia e cirurgia prévia; a média de idade foi 50,3 anos e 90,8% dos casos eram do gênero feminino. Os controles assintomáticos (243) Carpal tunnel syndrome (CTS), a common cause of numbness, paraesthesia and pain in hands due to compression of the median nerve under the transverse carpal ligament, has been correlated to

-According to median sensory latency ≥ 3.7 ms (wrist-index finger [WIF], 14 cm), median/ulnar sensory latency difference to ring finger ≥ 0.5 ms (14 cm) or median midpalm (8 cm) latency ≥ 2.3 ms (all peakmeasured), 141 Brazilian symptomatic patients (238 hands) have CTS confirmation. Wrist ratio (depth divided by width, WR) and a new wrist/palm ratio (wrist depth divided by the distance between distal wrist crease to the third digit metacarpophalangeal crease, WPR) were measured in all cases. Previous surgery/peripheral neuropathy were excluded; mean age 50.3 years; 90.8% female. Control subjects (486 hands) have mean age 43.0 years; 96.7% female. The mean WR in controls was 0.694 against 0.699, 0.703, 0.707 and 0.721 in CTS groups of progressive WIF severity. The mean WPR in controls was 0.374 against 0.376, 0.382, 0.387 and 0.403 in CTS groups of WIF progressive severity. Both were statistically significant for the last two groups (WIF > 4.4 ms, moderate, and, WIF unrecordable, severe). BMI increases togetherwith CTS severity and WR. It was concluded that both WR/WPR have a progressive correlation with the severity of CTS but with statistically significance only in groups moderate and severe. In these groups both WR and BMI have progressive increase and we believe that the latter could be a risk factor as important as important WR/WPR. KEY WORDS: carpal tunnel syndrome, median nerve, compressive neuropathy, wrist and palm ratio, wrist and hand dimension. Índices de palma/punho e síndrome do túnel do carpoRESUMO -Um grupo de 141 pacientes (238 mãos) com síndrome do túnel do carpo (STC) sintomático foi estudado após confirmação por condução nervosa: latência distal sensitiva do nervo mediano (LDS-M) ≥ 3,7 ms (punho -II dedo, 14 cm), diferença de latência sensitiva mediano-ulnar ≥ 0,5 ms (punho -IV dedo, 14 cm) e/ou latência palma-punho do nervo mediano ≥ 2,3 ms (8 cm); as latências foram medidas no pico do potencial. Todos os casos tiveram as seguintes medidas calculadas: 1. Índice do punho (IP, espessura dividido pela largura do punho); 2. Índice punho-palma (IPP, espessura do punho dividido pela distância entre a prega distal do punho e a prega mais proximal do III dedo); a média de idade foi de 50,3 anos com 90,8% do gênero feminino. PALAVRAS-CHAVE: síndrome do túnel do carpo, nervo mediano, neuropatia compressiva, dimensões do punho, condução nervosa.

MACHADO, MN ET AL -Bilateral ostial coronary lesion in cardiovascular syphilis: case reportRev Bras Cir Cardiovasc 2008; 23(1): 129-131

The European Society of Cardiology and the American College of Cardiology redefined the concept of myocardial infarction in the presence of highly positive markers of myocardial injury associated with at least one of the following: ischemic symptoms; development of pathologic Q waves on the ECG or ECG changes indicative of ischemia (positive or negative deviation of the ST segment), making troponins one of the most important aspects in the evaluation and stratification of patients with chest pain in the emergency room. However, although troponin gives excellent accuracy in the identification of myocardial necrosis, it is known that it can also be elevated in a series of nonatherosclerotic heart diseases. We present the case of a 49-year-old female patient admitted to the Chest Pain Unit with a history of supraventricular tachycardia associated with chest discomfort, nausea and diaphoresis. During risk stratification, the patient presented with a high serum troponin T level (0.143 ng/ml) but with a normal coronary angiography.

SummaryBackground: The acute kidney injury (AKI) is a complex disease for which there is no accepted standard definition nowadays. The Acute Kidney Injury Network (AKIN) represents an attempt to standardize the criteria for diagnosis and staging of acute renal dysfunction based on recently published RIFLE criteria, that means, (Risk, Injury, Failure, Loss, and End-stage kidney disease).