RESUMEN
BACKGROUND: Carpal tunnel syndrome is the most common focal mono-neuropathy. A study was designed to compare the effects of traditional open carpal tunnel release with median neurolysis and Z-plasty reconstruction of the transverse carpal ligament on post-operative hand pain and hand function in patients with idiopathic carpal tunnel syndrome. METHODS: Fifty-two patients with idiopathic carpal tunnel syndrome entered the study. The patients were randomly assigned into two groups to undergo simple transverse carpal ligament release or division of the ligament with Z-lengthening reconstruction. Forty-five patients completed the study. Two patients of the simple open surgery group and 5 patients of the Z-plasty reconstruction group did not complete the follow up course. After the procedure, the patients were followed to assess post-operative pain and hand function during a 12-week period. RESULTS: The scores of hand pain on the first day after surgery were not statistically different between the two groups (P=0.213). But the score of hand pain was significantly lower in the Z-plasty reconstruction group at week 1, week 3, and week 6 after surgery (P<0.001). However, at week 12, no patient complained of hand pain in both groups. Considering hand function, no patient had normal hand grip after the first week, but after three weeks, a significantly higher proportion of patients in the Z-plasty reconstruction group had reached near normal hand grip (76.1% vs. 29.1%;). However, at weeks 6 and 12, the differences were not statistically different between the two groups. CONCLUSION: We observed significant reduction in hand pain, shorter duration of hand pain and shorter period of time to reach normal hand grip by Z-plasty reconstruction of the TCL.
RESUMEN
The genus Cladophialophora comprises etiologic agents of disease in immunocompetent patients, ranging from mild cutaneous colonization to cerebral encephalitis, in addition to saprobic species. Due to the high degree of phenotypic similarity between closely related species of the genus, identification problems are imminent. In the present study, we described rapid and sensitive rolling circle amplification (RCA) method based on species-specific padlock probes targeted for the internal transcribed spacer regions of rDNA. ITS regions of 12 Cladophialophora species were sequenced, and subsequently, 10 specific padlock probes were designed for the detection of single nucleotide polymorphisms. The majority of circularizable padlock probes were designed based on single nucleotide polymorphisms (SNPs), while for C. bantiana, C. immunda and C. devriesii were characterized by two or more nucleotides. Individual species-specific probes correctly identified in all ten Cladophialophora species correctly by visualization on 1.2 % agarose gels used to verify specificity of probe-template binding; no cross-reactivity was observed. Simplicity, sensitivity, robustness and low costs provide RCA a distinct place among isothermal techniques for DNA diagnostics. However, restriction and specificity and sensitivity should be lowered and increased, respectively, to be useful for a wide variety of clinical applications.
Asunto(s)
Ascomicetos/aislamiento & purificación , Técnicas de Diagnóstico Molecular/métodos , Micosis/diagnóstico , Técnicas de Amplificación de Ácido Nucleico/métodos , Ascomicetos/clasificación , Ascomicetos/genética , ADN de Hongos/genética , ADN Intergénico/genética , Humanos , Sondas de Oligonucleótidos/genética , Sensibilidad y Especificidad , Análisis de Secuencia de ADNRESUMEN
We present a severe case of disseminated phaeohyphomycosis due to Veronaea botryosa. A 32-year-old female, native from Cuautla, Morelos, Mexico, presented a chronic dermatosis which started 10 years earlier with multiple exophytic, multilobulated, soft, and pedunculated or sessile neoformations of diverse sizes from 2 to 10 cm in diameter, which became verrucose and increased in size. The patient was immunocompetent, and no hereditary or familiar precedents of importance were known. No treatment was given, and the dermatosis remained relatively stable until the patient became pregnant in 2001 and 2003. The infection then exacerbated and worsened, leading to dissemination to the extremities, trunk, and face. The initial diagnosis was chromoblastomycosis which was treated with terbinafine and itraconazole but without visible improvement. Histopathology revealed pigmented, irregular, unbranched, and septate hyphae. Veronaea botryosa was isolated (CBS 127264 = JX566723), and its identity was confirmed by sequencing the internal transcribed spacer (ITS) rDNA. Therapy with posaconazole (800 mg/day) was started showing a gradual improvement of lesions with a reduction in size and flattening of the eruptions.