Glomus tumors treated with stereotactic radiosurgery: A retrospective study.

Background: Glomus tumors are difficult to manage surgically because they are vascular tumors that are topographically associated with important vascular and neuronal structures. Hence, there is a strong risk of incomplete resection and a high morbidity rate. In addition, they grow slowly.

Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization.

Purpose: To describe a technique of segmental radioembolization for the treatment of patients with unresectable hepatocellular carcinoma (HCC). Radiation segmentectomy was defined as radioembolization of two or fewer hepatic segments. We sought to (1) calculate dose when activity is delivered segmentally assuming uniform and nonuniform distribution and, (2) determine safety and efficacy of this novel technique.

Increased risk of high-grade dermatologic toxicities with radiation plus epidermal growth factor receptor inhibitor therapy.

Background: The addition of epidermal growth factor receptor (EGFR) inhibitors to radiotherapy has produced increased locoregional control and has reduced mortality from various solid tumors with few additional toxicities. Although anecdotal reports have suggested increased radiation dermatitis, the overall effect of these regimens on dermatologic toxicities has not been ascertained.

Methods: Dermatologic toxicity data were analyzed from abstracts presented at the annual meetings of the American Society of Clinical Oncology, the American Society of Therapeutic Radiology and Oncology, Cochrane Collaboration, MEDLINE, and EMBASE databases.

Assessment of carotid artery dose in the treatment of nasopharyngeal cancer with IMRT versus conventional radiotherapy.

Purpose: To determine the radiation dose to the carotid artery in nasopharyngeal cancer patients treated with intensity-modulated radiotherapy (IMRT) and to compare it to the dose delivered by a conventional three-field (3F) technique.

Materials And Methods: Sixteen patients with nasopharyngeal cancer who were treated at UCSF with IMRT were selected for this analysis. 3F plans were reconstructed for comparison.

Daily electronic portal imaging for morbidly obese men undergoing radiotherapy for localized prostate cancer.

Purpose: We summarize our experience with a series of morbidly obese men treated using daily online portal imaging and implanted gold markers to guide external beam radiation therapy (EBRT).

Methods And Materials: Three consecutive morbidly obese men were treated with EBRT for localized prostate cancer. Daily electronic portal imaging was used to verify patient position.

Gamma knife radiosurgery for recurrent salivary gland malignancies involving the base of skull.

Background: The management of skull base recurrence of salivary gland tumors is challenging, because complete surgical resection and fractionated reirradiation are seldom possible. Experience is being gained with radiosurgery for this indication.

Methods: From 1994-2000, eight patients with 16 skull base recurrences of salivary gland tumors underwent Gamma Knife radiosurgery at the University of California San Francisco.

Factors prolonging disability in work-related cumulative trauma disorders.

Workers' compensation costs for management of soft tissue disorders continue to increase. The complexity of medical management of these cases has increased due to social factors. The purpose of this study is to improve the physician's ability to recognize nonmedical issues that prevent a rapid return to employment.

Occupational soft-tissue and tendon disorders.

Reports of work-related musculoskeletal disorders have increased. The cause of the problem has yet to be determined. Thus far, only cross-sectional case and controlled studies exist.

Management of work-related upper-extremity nerve entrapments.

Peripheral nerve symptoms are common in the worker. Great care must be given to obtain an accurate diagnosis. Diagnostic labels should not be used unless one is sure of the diagnosis.

A team approach to reduce disability in work-related disorders.

Work-related disorders require a multidisciplinary approach. One must understand musculoskeletal disorders, job issues, and psychosocial issues that prolong disability. This introductory article presents an overview of the approaches to management that will be detailed in the articles that follow.

Intrinsic muscle flaps: the treatment of painful neuromas in continuity.

Treatment of the pain that is caused by neuroma in continuity in a digital nerve on the palmar surface of the hand is a challenging problem. Eight digital nerves were covered with intrinsic muscle flaps after neurolysis to obtain relief of symptoms in eight patients. Four of the cases involved intrinsic muscles for digital nerves in the thumb.

An Approach to Work-Related Disorders of the Upper Extremity.

Management of work-related musculoskeletal disorders has been frustrating for the orthopaedist. The so-called cumulative-trauma disorders have few objective findings, and patients often do not respond to well-established orthopaedic treatments, both nonsurgical and surgical. In some areas of the country the rate of reimbursement is low; that factor, combined with the excessive paperwork and the legal burden, discourages many orthopaedists from treating patients with these conditions.

Camitz palmaris longus abductorplasty for severe thenar atrophy secondary to carpal tunnel syndrome.

This is a retrospective review of 29 patients (33 hands) who underwent a palmaris longus transfer because of severe thenar atrophy secondary to median nerve entrapment at the wrist. The mean follow-up was 17 months. Ninety-four percent of our patients were satisfied because their thumb function improved.

Long-term results after Russe bone-grafting: the effect of malunion of the scaphoid.

Twenty-five patients had Russe anterior corticocancellous bone-grafting between 1973 and 1984 for twenty-six symptomatic established non-unions of the scaphoid. The mean duration of follow-up was eleven years (range, seven to eighteen years). Twenty-one (81 per cent) of the twenty-six scaphoid bones united.

Factors that determine reexploration treatment of carpal tunnel syndrome.

Eighteen patients (20 hands) underwent reexploration of the carpal tunnel after a primary carpal tunnel release. The patients complained of unrelieved symptoms after their initial surgical procedures. We recommend reexploration for patients with unrelieved carpal tunnel syndrome if they have a positive Phalen's test, have symptoms that cause nocturnal wakening or are exacerbated by activities, or have a short or transverse initial incision.

Reconstruction of the rheumatoid thumb.

Most rheumatoid patients will present with one or more thumb deformities at some stage of their clinical history. The goal of treatment is restoration and maintenance of stable and painless motion. Treatment is based on the type and stage of the deformity.

Silicone rubber arthroplasty of the wrist.

The wrist is often referred to as the keystone of the hand. It is often affected in rheumatoid arthritis. Salvage procedures for patients with rheumatoid arthritis involving the wrist include silicone wrist arthroplasty, total joint arthroplasty, and wrist arthrodesis.

Boutonniere rheumatoid thumb deformity.

The boutonniere deformity is the most common rheumatoid thumb deformity. It can be classified into early, moderate, and advanced types, depending on whether the deformity is passively correctable. Fifty-three patients with 74 procedures form the basis of these recommendations.

Nonoperative treatment of anterior interosseous nerve paralysis.

Although the current recommendation for the treatment of spontaneous anterior interosseous nerve paralysis is surgical decompression, there has been recent evidence in the neurologic literature that these lesions are examples of a neuritis. We followed 10 cases of spontaneous partial anterior interosseous nerve paralysis. All patients were seen initially with a typical history of pain.

Medial epicondylectomy for the treatment of ulnar nerve compression at the elbow.

Decompression of the ulnar nerve at the elbow with medial epicondylectomy was done in 43 patients and reviewed with an average follow-up of 2.3 years. Eight were graded as excellent, 23 as good, 9 as fair, and 3 as poor results.

Treatment considerations in the complicated rheumatoid hand.

The rheumatoid patient with complex involvement or multiple deformities of the hand and wrist can be a challenge to the hand surgeon. A systematic and orderly approach is used to formulate and execute a treatment plan that is realistic and that can result in modest, but significant improvement in overall hand function. The evaluation and treatment philosophy which is described can help turn a complicated and seemingly overwhelming situation into smaller components which can be treated in one or more surgical stages.

Surgical treatment of the boutonniere rheumatoid thumb deformity.

The boutonniere deformity is the most common rheumatoid thumb deformity. Its treatment is based on the type or stage of the deformity. We have reviewed our recent cases which are the basis for our current recommendations.