Early Diagnosis and Treatment of Cardiac Amyloidosis by Screening Biopsy During Trigger Finger Release.

Patients undergoing trigger release surgery are known to be at increased risk of amyloidosis and heart failure, and therefore, amyloidosis screening during trigger release surgery may facilitate early diagnosis and treatment of cardiac amyloidosis. However, the reported prevalence of amyloid on biopsies taken during trigger release surgery has varied widely, and no biopsy-positive patients in prior studies have been diagnosed with occult cardiac amyloidosis or started on disease-modifying therapy. We review the existing literature on this topic and present a case of a patient with cardiac amyloidosis diagnosed from a biopsy taken during trigger release surgery and subsequently started on disease-modifying therapy.

Revision Carpal Tunnel Release Following Endoscopic Compared With Open Decompression.

Importance: Carpal tunnel release (CTR) technique may influence the likelihood of revision surgery. Prior studies of revision CTR following endoscopic CTR (ECTR) compared with open CTR (OCTR) have been limited by sample size and duration of follow-up.

Objective: To estimate the incidence of revision CTR following ECTR compared with OCTR in a national cohort.

An unusual case of lower trunk brachial plexus zoster reactivation.

We discuss the case of a 42-year-old woman who presented with severe left cubital tunnel neuropathic pain and subsequently developed a vesicular rash spanning the C8-T1 dermatomal distribution. These symptoms resolved after initiation of acyclovir, highlighting VZV brachial plexopathy as a potentially treatable etiology of acute onset severe neuropathic pain.

Risk of Amyloidosis and Heart Failure Among Patients Undergoing Surgery for Trigger Digit or Carpal Tunnel Syndrome: A Nationwide Cohort Study With Implications for Screening.

Purpose: Tenosynovial biopsy during carpal tunnel release (CTR) leads to an earlier diagnosis of amyloidosis. Surgery for trigger digit-trigger release (TR)-may provide a similar opportunity. We sought to characterize the risk of amyloidosis diagnosis after TR and/or CTR.

Diagnosing Systemic Amyloidosis Presenting as Carpal Tunnel Syndrome: A Risk Nomogram to Guide Biopsy at Time of Carpal Tunnel Release.

Background: As carpal tunnel syndrome often precedes other signs of systemic amyloidosis, tenosynovial biopsy at the time of carpal tunnel release may facilitate early diagnosis and treatment. However, evidence-based guidelines for amyloidosis screening during carpal tunnel release have not been established. We sought to develop a predictive model for amyloidosis after carpal tunnel release to inform screening efforts.

Respiratory Failure following Abdominal Wall Reconstruction: An Analysis of the Nationwide Inpatient Sample.

Background: Patients undergoing abdominal wall reconstruction are at increased risk of postoperative respiratory failure. Understanding the epidemiology of this complication may guide preventive efforts.

Methods: The authors performed a population-based retrospective cohort study of adults undergoing elective abdominal wall reconstruction (ventral hernia repair with component separation) in the United States from 2004 through 2011 using the Nationwide Inpatient Sample.

Vascularized Composite Allotransplantation of the Elbow Joint: A Cadaveric Study.

Background: Surgical options for the unreconstructable elbow are limited to arthrodesis, total arthroplasty, or osteoarticular allograft reconstruction. Each of these options is limited by severe functional impairment and/or high complication rates. Vascularized allotransplantation of the elbow joint has the potential to mitigate these complications.

Nerve Transfers for the Restoration of Wrist, Finger, and Thumb Extension After High Radial Nerve Injury.

High radial nerve injury is a common pattern of peripheral nerve injury most often associated with orthopedic trauma. Nerve transfers to the wrist and finger extensors, often from the median nerve, offer several advantages when compared to nerve repair or grafting and tendon transfer. In this article, we discuss the forearm anatomy pertinent to performing these nerve transfers and review the literature surrounding nerve transfers for wrist, finger, and thumb extension.

Complications Within 30 Days of Hand Surgery: An Analysis of 10,646 Patients.

Purpose: The American College of Surgeons Surgical Quality Improvement Program database collects detailed and validated data on demographics, comorbidities, and 30-day postoperative outcomes of patients undergoing operations in most subspecialties. This dataset has been previously used to quantify complications and identify risk factors in other surgical subspecialties. We sought to determine the incidence of postoperative complications following hand surgery and to identify factors associated with increased risk of complications in order to focus preventive strategies.

Axillary arterial catheter use associated with hand ischemia in a multi-trauma patient: case report and literature review.

A case of hand ischemia associated with use of an axillary arterial catheter in a multi-trauma patient is presented. Despite removal of the arterial catheter and limb salvage procedures, distal hand gangrene developed. Simple measures such as minimizing dressings, use of distal continuous pulse oximetry, placement of invasive arterial catheters in the nondominant extremity, and avoiding their use whenever possible may prevent complications and minimize morbidity.

Intraneural synovial sarcoma of the median nerve.

Synovial sarcomas are soft-tissue malignancies with a poor prognosis and propensity for distant metastases. Although originally believed to arise from the synovium, these tumors have been found to occur anywhere in the body. We report a rare case of synovial sarcoma arising from the median nerve.

Helmet versus active repositioning for plagiocephaly: a three-dimensional analysis.

Background And Purpose: Orthotic helmets and active repositioning are the most common treatments for deformational plagiocephaly (DP). Existing evidence is not sufficient to objectively inform decisions between these options. A three-dimensional (3D), whole-head asymmetry analysis was used to rigorously compare outcomes of these 2 treatment methods.

Videofluoroscopic and nasendoscopic correlates of speech in velopharyngeal dysfunction.

Objective: To compare videonasendoscopy, lateral videofluoroscopy, and perceptual speech examination in the assessment of velopharyngeal dysfunction.

Design: Retrospective observational.

Setting: Multidisciplinary cleft palate team at a tertiary academic institution.

Filarial lymphedema is characterized by antigen-specific Th1 and th17 proinflammatory responses and a lack of regulatory T cells.

Background: Lymphatic filariasis can be associated with development of serious pathology in the form of lymphedema, hydrocele, and elephantiasis in a subset of infected patients.

Methods And Findings: To elucidate the role of CD4(+) T cell subsets in the development of lymphatic pathology, we examined specific sets of cytokines in individuals with filarial lymphedema in response to parasite antigen (BmA) and compared them with responses from asymptomatic infected individuals. We also examined expression patterns of Toll-like receptors (TLR1-10) and Nod-like receptors (Nod1, Nod2, and NALP3) in response to BmA.