Usefulness of clinical findings, nerve conduction studies and ultrasonography to predict response to surgical release in idiopathic carpal tunnel syndrome.

[EN] OBJECTIVES: To assess the usefulness of clinical findings, nerve conduction studies and ultrasonography performed by a rheumatologist to predict success in patients with idiopathic carpal tunnel syndrome (CTS) undergoing median nerve release. METHODS: Ninety consecutive patients with CTS (112 wrists) completed a specific CTS questionnaire and underwent physical examination and nerve conduction studies. Ultrasound examination was performed by a rheumatologist who was blind to any patient's data. Outcome variables were improvement >25% in symptoms of the CTS questionnaire and patient's overall satisfaction (5-point Likert scale) at 3 months postoperatively. Success was defined as improvement in both outcome variables. Receiver operating characteristics (ROC) curves and logistic regression analyses were used to assess the best predictive combination of preoperative findings. RESULTS: Success was achieved in 63% of the operated wrists. Utility parameters and area under the ROC curve (AUC) for individual findings was poor, ranging from 0.481 of the nerve conduction study to 0.634 of the cross-sectional area at tunnel outlet. Logistic regression identified the preoperative US parameters as the best predictive variables for success after 3 months. The best predictive combination (AUC=0.708) included a negative Phalen maneuver, plus absence of thenar atrophy, plus less than moderately abnormalities on nerve conduction studies plus a large maximal cross-sectional area along the tunnel by ultrasonography. CONCLUSION: Although cross-sectional area of the median nerve was the only predictor of success after three months of surgical release, isolated preoperative findings are not reliable predictors of success in patients with idiopathic CTS. A combination of findings that include ultrasound improves prediction.

Climatic and stratigraphic paleoindicators from the Canary Island

[EN] The last 5 Myr  are characterized by cliamatic variations globally and are reflected in ancient fossiliferous marine deposits visible in the Canary Islands. The fossils contained are identificated as paleoecological and paleoclimatic indicators. The Mio-Pliocene Transit is represented by the coral Siderastrea micoenica Osasco, 1897; the gastropods Rothpletzia rudista Simonelli, 1890; Ancilla glandiformis (Lamarck, 1822); Strombus coronatus Defrance, 1827 and Nerita emiliana Mayer, 1872 and the bivalve Gryphaea virleti Deshayes, 1832 as most characteristic fossils  and typical of a very warm climate and littoral zone. Associated  lava flows  have been dated radiometrically  and provides a range between  8.9 and about 4.2 Kyr. In the mid-Pleistocene, about 400,000 years ago, the called Marine Isotope Stage 11, a strong global warming that caused a sea level rise happens. Remains of the MIS 11  are preserved on the coast of Arucas (Gran Canaria), and associated with a tsunami in Piedra Alta (Lanzarote). These fossilifeorus  deposits contains the bivalve Saccostrea cucullata (Born, 1780), the gastropod Purpurellus gambiensis (Reeve, 1845) and the corals Madracis pharensis (Heller, 1868) and Dendrophyllia cornigera (Lamarck, 1816). Both sites have been dated by K-Ar on pillow lavas (approximately 420,000 years) and by Uranium Series on corals (about 481,000 years) respectively. The upper Pleistocene starts with another strong global warming known as the last interglacial or marine isotope  stage (MIS) 5.5, about 125,000 years ago, which also left marine  fossil deposits exposed in parallel to current in Igueste of San Andrés (Tenerife),  El Altillo, the  city of Las Palmas de Gran Canaria  and Maspalomas (Gran Canaria),  Matas Blancas, the Playitas and Morrojable (Fuerteventura ) and in Playa Blanca and Punta Penedo (Lanzarote ). The fossil coral Siderastrea radians (Pallas , 1766 ) currently living in the Cape Verde Islands , the Gulf of Guinea and the Caribbean has allowed Uranium series dating. The gastropods Strombus bubonius Lamarck, 1822 and Harpa doris (Röding , 1798 ) currently living in the Gulf of Guinea. Current biogeography using synoptic data obtained through satellites provided by the ISS Canary Seas provides data of Ocean Surface Temperature (SST) and Chlorophyll a (Chlor a) . This has allowed the estimation of these sea conditions during interglacials compared to today .