Objective. Our aim is to assess the optimal discriminatory sonographic criteria and relevant threshold values in patients with carpal tunnel syndrome (CTS) and to evaluate quantitative ultrasonography (US) as a tool for diagnosis and treatment of patients suffering from carpal tunnel syndrome in comparison with electrophysiological study. Methods. Seventy-eight patients with CTS and 78 asymptomatic controls were assessed and underwent ultrasonography of the wrists. All patients and controls completed a self-administered questionnaire. Electrophysiological testing was done for all patients and control subjects. Data from the patient and the control groups were compared to determine the diagnostic relations in patients with CTS and the grade of severity. Results. There was a high degree of correlation between the conduction abnormalities of the median nerve as detected by electrodiagnostic tests, self-administered assessment and the measurement of the cross-sectional area of the nerve by US (P<0.05). Various levels of disease severity could also be illustrated by US, giving confident results for diagnosis, treatment planning and following the patients with CTS. In 16 patients (17%) tenosynovitis/localized swelling in the tendons in the carpal tunnel was the primary cause of CTS. A cut-off point of 10 mm² for the mean cross-sectional area of the median nerve was found to be the upper limit for normal values. Based on the results of this study, an algorithm for evaluation and management of CTS has been suggested. Conclusion. High-frequency US examination of the median nerve and measurement of its cross-sectional area should be strongly considered as a new alternative diagnostic modality for the evaluation of CTS. In addition to being of high diagnostic accuracy it is able to define the cause of nerve compression and aids treatment planning; US also provides a reliable method for following the response to therapy.

While traditional nonsteroidal antiinflammatory drugs (t-NSAIDs) are relatively contraindicated in patients with inflammatory bowel disease (IBD) for fear of disease aggravation, controlled clinical trials showed that cyclo-oxygenase-2 inhibitors have fewer gastrointestinal side effects than the t-NSAIDs. Etoricoxib is a new antiinflammatory inhibitor that has high Cox-2 selectivity. To assess the safety of etoricoxib and effect on disease activity in patients with IBD in a multicenter, double-blind, placebo-control study. Study group included 76 patients suffering from IBD (ulcerative colitis (UC) (38), and Crohn's disease (CD) (38)). The control group included 70 patients known to have UC (35) and Crohn's disease (CD) (35). Patients of both groups were referred to the rheumatology clinic for rheumatic manifestations that require antiinflammatory therapy and were intolerable to the t-NSAIDs. The level of the IBD activity at the baseline visit, when drug/placebo therapy was initiated, was scored for all subjects included in the study. In the study group the dose of etoricoxib ranged from 60 to 120 mg tablet once a day according to their rheumatic condition. The control group received a placebo tablet once a day. Adverse events related to the use of the study medication in 1 and 3 months time were documented. Etoricoxib/placebo therapy was stopped once the patient experience flare up of their IBD. There was no significant difference between the patients and the control groups. After 3 months of etoricoxib therapy, 8 of 76 (10.53%) of the study group had aggravation of their underlying IBD and stopped the drug therapy, while 68 of 76 (89.5%) completed the study. The mean disease activity index before etoricoxib therapy was 1.15 + 0.794, whereas it was 1.19 + 0.683 after therapy. In the control group 8 of 70 (11.43%) experienced exacerbation of their symptoms while 62 of 70 (88.6%) completed the study. In the control group the mean disease activity before treatment was 1.16 + 0.253, whereas after placebo therapy was 1.20 + 0.481. 67 of 76 (88.2%) of the study group and 62 of 70 (88.6%) of the control group gave history of using t-NSAID therapy in addition to PPI that caused flare up of their IBD. For the patients who had to stop their drug therapy, all the adverse events occurred in the first month of drug/placebo challenge and all symptoms were reversible. Etoricoxib therapy is safe and beneficial in most patients with IBD treatment with etoricoxib was not associated with exacerbation of the underlying IBD- and GI-related complications.