Late complications after open carpal tunnel decompression

BACKGROUND: The NCIC Clinical Trial Group has an ongoing interest in assessing investigational agents in minimally pretreated patients with malignant glioma. Topotecan is one of the first topoisomerase I inhibitors to enter clinical trials and has shown early evidence of activity in several solid tumors. We have conducted a phase II trial of topotecan in patients with malignant glioma. METHODS: Adults with malignant glioma and recurrent contrast enhancing measurable disease (> or = 2 x 2 cm) were eligible. Topotecan 1.5 mg/m2 i.v. was given daily x five days every three weeks. Response and toxic effects were assessed at the end of each cycle. RESULTS: Thirty-one patients were entered onto the study: fifteen had glioblastoma, 16 anaplastic astrocytoma, all had prior radiation, 15 prior chemotherapy, and all were assessable for response and toxicity. Two patients (6%) responded: one had a complete radiographic response, but died with neutropenic sepsis, and the second had a prolonged partial response (> 97 weeks). Twenty-one patients (68%) had stable disease for five to 86 + weeks (median 19) and eight (26%) had progressive disease after one cycle. Toxicity was primarily hematologic; 18 (58%) had grade 4 neutropenia (< 0.5 x 10(9)/1), usually brief, and three (10%) grade 4 thrombocytopenia (< 25 x 10(9)/1). Twelve of 109 cycles (11%) were given at reduced dose. CONCLUSIONS: Topotecan in this dose and schedule has only modest activity in recurrent glioblastoma and anaplastic astrocytoma.     

Single-portal endoscopic carpal tunnel release: agee carpal tunnel release system

This single-group prospective cohort study was conducted to define the efficacy and safety of single-portal endoscopic carpal tunnel release using the redesigned carpal tunnel release system (3M Healthcare, St Paul, MN). Eighty-six procedures in 69 patients were evaluated by objective motor/sensory testing and clinical outcome questionnaire at 10 days, and 6 and 10 weeks postoperatively. All cases were performed by the same surgeon using a similar local anesthetic technique. The subjective symptoms of carpal tunnel syndrome, including paresthesia, numbness, and pain, demonstrated substantial improvement by 10 days postoperatively, and less than 2% of the subjects remained symptomatic by 10 weeks. The percentage of patients with normal, static, two-point discrimination in the median nerve distribution, demonstrated significant improvement by 6 weeks postoperatively. Preoperative grip and three-point pinch strength were regained by 6 weeks postoperatively, while lateral pinch demonstrated substantial improvement in the same time period. Workers' compensation cases required a significantly longer time to return to work (mean, 40.8 days) than nonworkers' compensation cases (mean, 22.2 days). No difference, however, was demonstrated between workers' compensation and nonworkers' compensation cases with respect to the time of return to activities of daily living (mean, 13.5 days). There were no major neurovascular injuries incurred during the performance of the study. The most important complications included one mild reflex sympathetic dystrophy, three transient digital neuropraxias, and one superficial wound infection. In conclusion, the performance of single-portal endoscopic carpal tunnel release using the redesigned Agee carpal tunnel release system is both a safe and efficacious procedure.     

Persistent or recurrent carpal tunnel syndrome following prior endoscopic carpal tunnel release

Immunohistochemistry was applied in the investigation of the possible existence of serotonin in human skin. It was found that epidermal melanocytes express a serotonin-like immunoreactivity. The immunoreactivity was associated with both the cytoplasm and the cellular membrane, though the latter was only found in certain cells. The serotonin anti-serum labeled the same cells as NKI-beteb, which is known as a reliable marker of melanocytes. Blocking experiments showed that both serotonin and NKI-beteb have different epitopes in the melanocytes. In in vitro studies, serotonin-like immunoreactivity appeared in approximately 90% of cultured human melanocytes, and was found both in the cytoplasm and also in the nuclei. Thus, we believe the melanocytes to be the origin of serotonin (or a serotonin-like molecule) in the skin.     

Acute carpal tunnel syndrome

Although the carpal tunnel is open at both ends, it has the physiologic properties of a closed compartment bounded by synovium proximally and distally. When the intracarpal canal interstitial pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability. Acute carpal tunnel syndrome is recognized frequently as occurring secondary to wrist trauma and infrequently due to a variety of infectious, rheumatologic, and hematologic disorders. This condition warrants prompt recognition and the treatment is early carpal tunnel release.     

Endoscopic carpal tunnel release

The aspects of various techniques for endoscopic carpal tunnel release, including the Chow technique, the Japanese technique, and the Agee technique, are reviewed. Anesthesia, portal placement, and ligament cutting techniques are considered. Clinical results, complications, and long-term outcomes of the Chow technique are summarized.     

Endoscopic carpal tunnel release

We describe a computer program, named DNA-Protein Search (DPS), for comparing a megabase DNA sequence with a protein sequence database. The DPS program addresses the problems of frameshifts and introns in the DNA sequence. The DPS program was used to compare each of the following sequences with the Swiss-Prot database: the 1.8-megabase sequence of the Haemophilus influenzae Rd genome, the 0.58-megabase sequence of the Mycoplasma genitalium genome, and the 0.56-megabase sequence of Saccharomyces cerevisiae chromosome VIII. The comparisons found new regions that are similar to protein sequences. The sensitivity of DPS was evaluated using as test data the known coding regions of the three DNA sequences. The results demonstrate that the DPS program is a useful tool for finding the coding regions of the DNA sequence. The DPS program uses an order of magnitude less computer memory and is several times faster than the BLASTX program.     

Regeneration of median nerve motor units in an old carpal tunnel syndrome. Electromyographic studies

The healing rates in carpal tunnel syndrome following surgical decompression are known to be excellent only in those cases which mainly show signs and symptoms without marked and permanent muscular atrophy of the thenar (i.e. without advanced damage to the motor units of the median nerve). In accordance with the findings of CURTIS (1973) we have added microsurgical techniques in a group of patients with very advanced disease. In a first series definite clinical recovery of the motor units of the median nerve was found in 80%. These clinical findings are now confirmed by the electrophysiological findings in a group of cases examined pre- and postoperatively by identical electrophysiological parameters. The results are discussed. To avoid additional damage to the nerve, experience in microsurgical techniques is of the utmost importance.     

Reoperation for carpal tunnel syndrome

Although primary carpal tunnel release is usually successful, reoperation is needed in up to 3% of patients. Common indications of reoperation are previous incomplete surgery and postoperative fibrosis. Although most patients improve after reoperation, persistent systems are likely and failure is more frequent than after primary carpal tunnel surgery. Risk factors for failure following reoperation include the presence of an active Worker's Compensation claim, pain in the ulnar nerve distribution, and the absence of abnormality on preoperative EMG.     

Symptomatic carpal tunnel syndrome after orthotopic liver transplantation: a retrospective analysis

BACKGROUND: Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve and has been reported after renal transplantation; there are no reports of CTS after liver transplantation. METHODS: The incidence of and the risk factors for CTS were assessed in 1350 liver allograft recipients. RESULTS: Seventeen women and two men with CTS were identified. Women developed symptoms at a median time of 6.8 months, and all but one received transplants because of primary biliary cirrhosis (PBC). All 17 patients were taking cyclosporine. The only risk factor for CTS was the pretransplant diagnosis of PBC (6.7% of 240 PBC patients surviving 6 months or more compared with 0.4% of 717 patients who received grafts for other indications). CONCLUSIONS: CTS may occur in patients early after liver transplantation; because in many cases the symptoms were attributed to cyclosporine neurotoxicity, the diagnosis should be considered, especially in patients who received grafts because of PBC.     

Predictors of rate of return to work after surgery for carpal tunnel syndrome

OBJECTIVE: To evaluate the impact of patient demographics, clinical features, and job-related factors on the time until return to work after carpal tunnel release surgery. METHODS: We employed a cross-sectional community-based study of 59 patients who had undergone carpal tunnel release surgery. Sociodemographic, clinical, and job-related characteristics and time to return to work were obtained by interview and from medical records. Exposure to ergonomic risk was derived from an independently validated job matrix. Time to return to work after surgery was analyzed by survival techniques. RESULTS: Median time to return to work was 5 weeks. After adjustment, the relative rate (RR) of return to work per week after surgery was most strongly decreased by the receipt of workers' compensation, RR 0.2 (95% confidence interval [CI] 0.1-0.5), and by the exposure to bending and twisting of the hand prior to surgery, RR 0.7 (95% CI 0.5-0.9) per hour. Female gender was another predictor of decreased return to work, RR 0.5 (95% CI 0.3-0.8). CONCLUSIONS: Patients receiving workers' compensation, those exposed to higher levels of bending and twisting of their hands and wrists, and women were slower to return to work after carpal tunnel release surgery.     

Less common causes of carpal tunnel syndrome

A new DRB3*02 allele (DRB3*0207) was detected in a female Luxembourg Caucasian blood donor by sequence-based typing. The new allele differs from DRB3*0202 by two substitutions in codon 57 resulting in an amino acid change from a charged aspartic acid to a neutral valine. This is the first example of a DRB3 allele pair differing only at codon 57.     

The electrophysiological diagnosis of carpal tunnel syndrome

Electrophysiological investigations were carried out both in patients with carpal tunnel syndrome (CTS) and in healthy individuals. The evoked potentials were examined during stimulation of sensitive branches of n. medianus and of other nerves. The most sensitive and important for diagnosis appeared to be the electrophysiological test of alteration of responsive reaction to the stimulation of the sensitive branch of n. medianus for 4 finger and the considerable difference of evoked reactions on stimulation of skin palm branch and branch of the 1-st finger of n. medianus. The diagnostic importance of these indices corresponds well to anatomical and pathophysiological characteristics of CTS.     

Predicting acute denervation in carpal tunnel syndrome

OBJECTIVE: Defects of the cochlear modiolus have been found to be associated with most cases of large vestibular aqueduct. The clinical significance of these modiolar defects has not been studied previously. The purpose of this article is to correlate clinical (functional) parameters, such as hearing outcomes, with the severity of the radiographic findings in these dysplastic inner ears. STUDY DESIGN: The study design was a retrospective chart review, supplemented with telephone interviews and clinic visits. SETTING: The study was conducted at an academic, tertiary care center. PATIENTS: Thirty consecutive patients with large vestibular aqueducts participated. RESULTS: Scores of modiolar deficiencies yielded inconsistent correlations with hearing loss. Vestibular aqueduct morphology and thickness correlated very strongly with the severity of hearing loss. CONCLUSIONS: These observations support the hypothesis that large vestibular aqueduct-related hearing loss may be caused by transmission of subarachnoid pressure forces into the inner ear. However, the thickness and morphology of the vestibular aqueduct may simply be markers for more subtle cochlear dysplasia manifest by modiolar deficiency.     

Silent period abnormalities in carpal tunnel syndrome

Zygosaccharomyces bailii inactivation was evaluated in oscillatory high hydrostatic pressure (HHP) treatments at sublethal pressures (207, 241, or 276 MPa) and compared with continuous HHP treatments in laboratory model systems with a water activity (aw) of 0.98 and pH 3.5. The yeast was inoculated into laboratory model systems and subjected to HHP in sterile bags. Two HHP treatments were conducted: continuous (holding times of 5, 10, 15, 20, 30, 60, or 90 min) and oscillatory (two, three, or four cycles with holding times of 5 min and two cycles with holding times of 10 min). Oscillatory pressure treatments increased the effectiveness of HHP processing. For equal holding times, Z. bailii counts decreased as the number of cycles increased. Holding times of 20 min in HHP oscillatory treatments at 276 MPa assured inactivation (< 10 CFU/ml) of Z. bailii initial inoculum. Oscillatory pressurization could be useful to decrease Z. bailii inactivation time.