Background: Despite the high incidence and prevalence of CTS, there is no exclusive data about normal values increment of motor and sensory distal latencies of Median nerve at wrist according to age. This research was done in electrodiagnosis lab of Physical Medicine & Rehabilitation ward in Nemazi hospital in Shiraz between 1374-1379. Material and methods: This study was performed on 1200 cases that had no history of paresthesia and numbness in both hands and no history of diabetes mellitus, systemic disease, and electrodiagnosis evidence of no cervical radiculopathy or peripheral neuropathy. Tinel's and phallen 's tests were also negative in all cases. Normal values, increment of motor and sensory distal latencies of both hands Median nerves were studied and analyzed in ten age groups from 10-80 years. Results: In this study, the mean normal value for distal motor latency of Median nerve was 3.3 ms (2.50-4. 20ms). Increment of this value is mild (about 0.1ms per decade after 5th decade of Age – 50 life) and could be calculated with the following formula: DML (8cm)= (3.30+Age- 50 /75) ±0.0025 age. The mean normal value for distal sensory latency of Median nerve was 3.2ms (2.7- 3.70ms). Increment of his value is mild (about 0.1ms per decade after the 51hdecade of life) that could be calculated with the following formula: DSL (14cm) = (3.20 +Age- 50/100) ±0.0025 age. Conclusions: It seems that age has significant influence on distal motor and sensory latencies at wrist. We recommend electrodiagnostic evaluations to be performed according to the age.

Background: Traumatic peripheral nerve injuries (PNIs) caused by penetrating and lacerated trauma are among the most prevalent microsurgical injuries. Post-treatment follow-up and prognosis of patients undergoing repair are often based on clinical examinations and electrodiagnostic findings. Therefore, a reliable, inexpensive, useful, and rapidly accessible diagnostic method is necessary during the patient's follow-up. Objectives: This study aimed to assess the relationship between ultrasound imaging and treatment outcomes in patients with Median peripheral nerve injury. Methods: In this cohort study, 21 eligible patients with symptoms of acute Median nerve injury (MNI) caused by penetrating trauma in microsurgery were studied from June 2018 to June 2019. The patients underwent ultrasonography three months after repair and were followed up for at least nine months. The outcomes of the treatment were compared with those obtained six months after ultrasonography. Results: In all studied patients, mean thicknesses of the repaired nerve on the distal and the proximal sides were 2. 58± 0. 51 and 2. 51± 0. 61 mm2, respectively; 12 cases (57. 1%) recovered very well nine months after surgery and in nine cases (42. 9%) no nerve recovery was observed based on clinical electromyography (EMG) examinations and nerve conduction velocity (NCV). The amount of neuroma formed at the repair site was lower in well-recovered patients (1. 5± 0. 4 mm3) than those with no recovery (4. 9± 1. 5 mm3). No re-rupture was observed at the repair site. Each group underwent two-four repairs of flexor tendons. Conclusion: Ultrasound can be used as an effective and non-invasive method for assessment of PNI and follow-up of reconstructive surgery.

Hemangiomas of the Median nerve are extremely rare; only 12 cases have been reported in the literature. We discuss a patient who presented with paresthesia and pain along the distribution of the left Median nerve secondary to a cavernoma of the proximal part of the nerve as suspected on MRI scan. Total removal of the mass was achieved with immediate relief of the symptoms and no neurologic deficit. We conclude that despite being quite rare, the diagnosis of occult vascular lesions of peripheral nerves such as the Median nerve, should be considered, especially when other common pathologies are excluded.

Entrapment of Median nerve can be developed at multiple sites along this nerve. One of the compression sites of Median nerve is supracondylar area of humerous. Sometimes struther ligament or spur or both of them are the rare cause of entrapment syndrome of the Median nerve. Struther ligament or spur can compress ulnar nerve and/or brachial artery. These cases may have Median ulnar nerve or brachial artery symptoms and they are sometimes asymptomatic which can accidentally be detected by radiography. Most commonly, these cases refer with Median nerve compression syndrome and they complain about numbness and pain in their upper extremity. Sometimes pain radiates to shoulder and neck in the upper part and to hand in the lower part, that is mistakenly diagnosed as a sign of radiculopathy or other compression neuropathies. The present study is a case report of a 25-year-old man who referred with having pain and numbness in right upper extremity.

Schwannoma’, s are benign tumors that can affect all nerves even the peripheric nerve. In the present study, a 66 year old case (man) which had a mass upon his wrist with a diagnostic delay of two years has been studied. Diagnosis was based on imaging features (Ultrasonography and MRI) with Electromyography (EMG) which was assessed by histopathological examination.

Introduction: Candidiasis, as an opportunistic infection, is caused by the Candida species. Although Candida albicans is classified in the body as an endogenic flora, it plays an important role in creating Candida related diseases. Candida vulvovaginitis in pregnant women, diabetes mellitus patients and those using multiple antibiotics and contraceptive drugs demonstrates the high resistance of the organism against conventional medication. On the other hand, recurrent vaginitis disintegrates the long-term process of treatment in majority of the patients. The present research was done with the aim of determining the optimum conditions for susceptibility testing before retreatment of patients.Methods: 10 isolates of Candida albicans obtained from 31 suspected patients suffering from recurrent Candida vaginitis were incubated with ketoconazole at two pH of 7.2 and 5.5 and two temperatures of 35ºC and 27ºC. The Microdilution broth test technique was used. The RPMI 1640 medium within the 96 well microplates with range of 12 tests was used to determine the MIC50 , MIC90 and MFC of the drug.Results: The obtained MIC50, MIC90 and MFC for ketoconazole at these conditions (T=35ºC and pH=7.2) were 0.25 to 1 μg/ml, 1 to 4 μg/ml and 64 to ≥ 512 μg/ml respectively, while these values at 27ºC, pH 5.5 were 1 to 8 μg/ml, 8 to 64 μg/ml and 512 to ≥ 512 μg/ml, at 35ºC and pH 5.5 the values were 1 to 8 μg/ml, 4 to 32 μg/ml, 256 to ≥ 512 μg/ml, while at 27ºC and pH 7.2 the values were 1 to 2 μg/ml, 8 to 32 μg/ml, 128 to ≥ 512 mg/ml, respectively.Conclusion: The obtained results confirmed that conditions with temperature of 35ºC and pH 7.2 resulted in better treatment outcomes than other conditions.

In microsurgical nerve repair, the epineural sleeve technique can be used to bridge short nerve defects and to cover the coaptation site with the epineurium of the nerve stump. The epineurium serves as a mechanical aid to reduce gap size, and increase repair strength, effectively assisting nerve regeneration. This article presents a 32-year-old patient who experienced complete transection of the Median nerve at the distal forearm, which was treated with the epineural sleeve graft reconstruction technique. nerve regeneration was followed-up for 18 months and evaluated with the Rosé n and Lundborg scoring system. The final outcome was excellent; at the last follow-up, the patient experienced complete sensory and motor function of the Median nerve.

Atypical connections in the formation of the brachial plexus are prevalent and have been reported in different articles. The present report describes a case of variation of the Median nerve observed in the Iranian male cadaver during routine trial dissection. There are three roots for Median nerve. Median nerve is formed by joining two lateral and medial cords of brachial plexus. Third root of Median nerve which is carried by musculocutaneous nerve 3 cm of coracobrachialis muscle and then it is separated from musculocutaneous nerve but instead of joining Median nerve, it pierces coracobrachialis muscle and outs from a place near entrance point and joins Median nerve in middle arm and normally passes the rest of its passage. It is important for medical staff to be aware of this variation while planning a surgery in the region of axilla or arm, as these nerves are more susceptible to be injured during operations.

Background and Aim: The present study aimed to use the Median nerve Compound Muscle Action Potential (CMAP) amplitude by stimulation at the palm instead of Abductor Pollicis Brevis (APB) needle Electromyography (EMG) for determining axonal loss in patients with Carpal Tunnel Syndrome (CTS). Methods and Materials/Patients: This study was performed on 180 patients with CTS referred to the Electrodiagnostic (EDX) Center, Poursina Hospital, Guilan Province, Iran, in 2018-19. In this study, the APB needle EMG diagnostic test was used as the gold standard, and Median nerve CMAP amplitude with stimulation at the palm and wrist were used to compare the two nerve stimulation tests. Results: All of the cases with abnormal amplitude loss detected by Median nerve stimulation at the palm also had an axonal loss in the needle EMG of APB. So this test could be a good indicator of axonal loss if there is an abnormality (sensitivity: 73%, specificity: 100%). The results with wrist stimulation were not as accurate as of the palm stimulation, and some cases with decreased CMAP amplitude of Median nerve had normal needle EMG of APB muscle (sensitivity: 86. 6%, specificity: 94. 9%). Conclusion: In cases with CTS, the abnormally decreased amplitude of the Median nerve detected by stimulation at the palm could be a good indicator of axonal loss.