Long-term outcomes following single-portal endoscopic carpal tunnel release.

Background: There is limited published information about long-term outcomes and recurrence rates following single-portal endoscopic carpal tunnel release.

Methods: We reviewed symptom and function outcomes from a prospectively collected database of patients who underwent single-portal endoscopic carpal tunnel release at a minimum of 8 years follow-up. Out of 207 patients in the original database, we were able to confirm correct current contact information for 106 patients.

Study to Assess Outcome After Open and Closed Carpal Tunnel Decompression.

Carpal tunnel decompression (CTD) is the most commonly performed surgical procedure within a hand unit. We have analyzed data on outcomes after carpal decompression performed by both open and closed techniques to assess whether outcomes differed between the 2 procedures. Data were jointly gathered from 2 units.

The effect of distal radius translation in the coronal plane on forearm rotation: a cadaveric study of distal radius fractures.

Purpose: To determine the effect of lateral translation of the distal radius in the coronal plane on forearm rotation after distal radius fracture.

Methods: Ten fresh cadaveric limbs underwent distal radius osteotomy just proximal to the distal radial-ulnar joint to simulate an extra-articular distal radius fracture. We used an Agee Wrist Jack external fixator to create increasing magnitudes of distal fragment lateral translation in 2-mm increments.

A 6-year outcome of patients who cancelled carpal tunnel surgery.

The long-term outcomes of patients with carpal tunnel syndrome who were scheduled for release but did not proceed to surgery were compared to patients who underwent surgery, matched on preoperative symptom scores. Both groups completed the Levine-Katz questionnaire 6 years after enrolment to our multicentre carpal tunnel syndrome outcomes database. Symptom and function scores improved for the surgical (n = 24) and non-surgical (n = 36) groups (p < 0.

Valsalva maneuver: shortest optimal expiratory strain duration.

Purpose: To quantitate the level of difficulty and determine consistency of hemodynamic responses with various expiratory strain (ES) durations.

Methods: Thirty-four healthy subjects performed the Valsalva maneuver (VM) with an ES duration of 10, 12, and 15 seconds in random order. Level of difficulty after each trial was rated 1 to 10, with 10 being the most difficult.

Radiographic evaluation of the modified Brunelli technique versus the Blatt capsulodesis for scapholunate dissociation in a cadaver model.

Purpose: A variety of soft tissue surgical procedures have been developed for treatment of scapholunate (SL) dissociation. The purpose of this study was to compare the degree of correction obtained (as measured on preoperative and postoperative radiographs) when performing the modified Brunelli technique (MBT) with that of the more commonly performed Blatt capsulodesis (BC) and to evaluate each technique after simulated wrist motion.

Methods: Five cadaver wrists were used for this study.

Are standardized patient self-reporting instruments applicable to the evaluation of ulnar neuropathy at the elbow?

Background: This study attempts to confirm that the Disabilities of Arm, Shoulder and Hand (DASH) Outcome Measure self-administered questionnaire is valid specifically for ulnar neuropathy at the elbow. Validity of the Levine-Katz questionnaire for ulnar neuropathology compared with DASH was also studied.

Materials And Methods: Forty-eight patients with isolated ulnar nerve surgery completed a 6-month evaluation.

Survival after in-hospital cardiopulmonary resuscitation.

Background: The use of postarrest variables to predict survival after discharge following in-hospital cardiopulmonary resuscitation has not been definitive. This study evaluates whether the duration of cardiopulmonary resuscitation (CPR) and other variables affect discharge rates and survival rates after discharge.

Methods: Prospective cohort survival data and arrest variables were collected, including initial observed rhythm, duration of CPR, time of arrest, and number of arrests.

A prospective, longitudinal outcome study of patients with carpal tunnel surgery and the relationship of body mass index.

This study investigated whether body mass index (BMI) was associated with effectiveness of carpal tunnel release as measured by physical and self-assessment tests. This prospective, longitudinal study was conducted from March 2001 to March 2003 using 598 cases (hands) diagnosed with carpal tunnel syndrome and scheduled for surgery at The Curtis National Hand Center, Baltimore, Maryland, and at the Pulvertaft Hand Centre, Derby, England. Body mass index was calculated, and demographic, clinical, and functional data were collected preoperatively and at 6-month follow-up.

Study to assess differences in outcome following open carpal tunnel decompressions performed by surgeons of differing grade.

Introduction: Carpal tunnel decompression is the most commonly performed surgical procedure within a hand unit. Although very effective, the complications following the procedure can be significant. In an attempt to identify the causes of such complications, we assessed whether seniority of the surgeon impacts on outcome for open carpal tunnel decompression.

Primary care management of patients with carpal tunnel syndrome referred to surgeons: are non-operative interventions effectively utilised?

Aim: To investigate the non-operative primary care management (splintage, task modification advice, steroid injections and oral medications) of carpal tunnel syndrome before patients were referred to a hand surgeon for decompression.

Design And Setting: Preoperative data were obtained on age, gender, body mass index, employment, symptom duration, and preoperative clinical stage for patients undergoing carpal tunnel decompression (263 in the USA, 227 in the UK).

Results: Primary care physicians made relatively poor use of beneficial treatment options with the exception of splintage in the US (73% of cases compared with 22.

Relationship between the duration and severity of symptoms and the outcome of carpal tunnel surgery.

Purpose: There is no consensus regarding the prognostic value of preoperative symptom severity and duration for determining the anticipated results of carpal tunnel release. Some studies show a detrimental influence of symptom duration and severity on outcomes; others have found no effect. To study these contradictions, a database was created at 2 separate hand centers to explore the extent to which the duration and severity of symptoms before surgery are predictive of surgical outcome.

Staged versus simultaneous bilateral endoscopic carpal tunnel release: an outcome study.

Background: This study compared outcomes of bilateral simultaneous endoscopic carpal tunnel release to staged release using the Levine-Katz outcome instrument and physical measurements.

Methods: Seventy-one patients were evaluated preoperatively and at 6 months postoperatively. One group underwent simultaneous releases, a second group underwent staged releases 1 to 3 weeks apart, and a third underwent staged releases more than 3 weeks apart.

A prospective assessment of carpal tunnel surgery with respect to age.

Six hundred and thirty five carpal tunnel decompressions in 490 patients were studied prospectively in two hand surgery centres to assess the effect of increasing age on the outcome after surgery. The outcome was assessed using the Levine-Katz carpal tunnel questionnaire, Tinel's sign, Phalen's test, Semmes-Weinstein monofilaments and pinch and grip strengths. Assessments were made pre-operatively, at 2 weeks and 6 months postoperatively.

Assessment of four midcarpal radiologic determinations.

Several radiologic measurement methods have been described for determining static carpal alignment of the wrist. These include the scapholunate, radiolunate, and capitolunate angles. The triangulation method is an alternative radiologic measurement which we believe is easier to use and more reproducible and reliable than the above mentioned methods.

Clinical utility of portable versus traditional electrodiagnostic testing for diagnosing, evaluating, and treating carpal tunnel syndrome.

Data indicate that a portable electrodiagnostic device (NC-Stat; Neurometrix, Inc, Cambridge, Mass) provides objective preoperative evidence of the severity of median nerve dysfunction as well as useful objective postoperative data. With traditional electrodiagnostic studies for comparison, we studied the utility of this device as a diagnostic tool, evaluated patient satisfaction with the instrument, and found statistically significant improvement in recorded distal motor latency at 6-month follow-up. Such data can be of great value in treating a patient who does not exhibit subjective symptom improvement.

Digital anaesthesia: comparison of the efficacy and pain associated with three digital nerve block techniques.

There are three commonly used methods of digital block anaesthesia: viz. subcutaneous, metacarpal and transthecal. A randomized, single-blinded study on 50 healthy volunteers was performed to determine time to onset, pain level and preference.

Comparison between hospitalized and screening controls in studies assessing breast cancer risk.

Background: In case-control studies, selection of an appropriate group of controls is a critical step which may affect the outcome of the analysis.

Methods: We studied the differences in reproductive, lifestyle, and anthropometric variables between controls from a hospital-based study and controls from a screening clinic. Odds ratios for breast cancer were calculated using the two types of controls, and the impact on the resulting odds ratio was studied.

The effect of a literacy training program on family medicine residents.

Background And Objectives: Pediatric literacy promotion programs carried out in the primary care setting, such as Reach Out and Read (ROR), have been associated with improved language skills for preschool children. Primary care physicians have frequent contact with young families and may be well situated for a literacy promotion program for both children and adults. We examined whether introducing ROR and an adult literacy intervention improves family medicine residents' literacy knowledge, attitudes, and practices.

Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy.

Background: Immediate breast reconstruction is often performed after mastectomy for breast cancer. There has been concern that this will result in a delay in initiating chemotherapy and, as a consequence, may adversely impact survival. In this study we sought to determine whether immediate breast reconstruction affects the interval between surgery and adjuvant chemotherapy.

Serum and urine markers of bone metabolism during the year after hip fracture.

Objective: As part of a larger study to describe indices of recovery during the year after hip fracture, the current prospective study investigated longitudinal changes in serum and urine markers of bone metabolism for the year after hip fracture and related them to bone mineral density (BMD).

Design: A representative subset of participants provided serum and urine samples and had bone density measured at 3, 10, 60, 180, and 365 days postfracture.

Setting: Two Baltimore hospitals.

Effect of lidocaine vs ketorolac tromethamine on postoperative laparoscopy pain control: a randomized study.

Objective: To evaluate and compare the effectiveness of intraperitoneal lidocaine and intramuscular ketorolac tromethamine for immediate and delayed postoperative pain management in patients undergoing laparoscopy.Methods: Design-Seventy-four patients were prospectively randomized into four groups: intraperitoneal lidocaine; intramuscular ketorolac; both drugs; neither drug.Setting-Community Teaching Hospital Outpatient Surgery Center.

The effect of raloxifene on the uterine weight response in immature mice exposed to 17beta-estradiol, 1,1,1-trichloro-2, 2-bis(p-chlorophenyl)ethane, and methoxychlor.

Objective: The purpose of this study was to determine the effects of raloxifene on the uterine responses to both estradiol and the environmental estrogens 1,1,1-trichloro-2, 2-bis(p-chlorophenyl)ethane and methoxychlor in immature mice.

Study Design: Immature female mice received the following compounds alone or in combination: sesame oil (control), 17beta-estradiol 1 mg/kg body weight, tamoxifen 1 mg/kg body weight, raloxifene 5 mg/kg body weight, 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane 10 mg/kg body weight, and methoxychlor 10 mg/kg body weight. The animals were treated subcutaneously once a day for 5 consecutive days with the compound or compounds of interest in 0.

In vitro effects of sildenafil and phentolamine, drugs used for erectile dysfunction, on human sperm motility.

Objective: The aim of this study was to determine the effects of sildenafil and phentolamine on sperm motility in vitro.

Study Design: Semen or washed sperm was mixed with various doses of sildenafil or phentolamine and analyzed for motility during a 30-minute period. The pH was measured for each of the samples tested.

Semen pH in patients with normal versus abnormal sperm characteristics.

Objective: The World Health Organization laboratory manual, last revised in 1992, states that the normal pH of semen ranges from 7.2 to 8.0.