Comparative study between mini-incision and conventional surgical approaches for carpal tunnel release

Background: Conventional approach is an effective method for carpal tunnel release, however it causes scar discomfort, pillar pain and cosmetic complaints. Several mini-incision techniques were introduced to avoid such complications. Aim of the study The aim of this study is to compare the results of two surgical techniques, the conventional longitudinal incision over the transverse carpal ligament (TCL), and the mini-incision at the distal wrist crease and near the proximal border of the TCL for carpal tunnel release. Patients and Methods: This study included 20 patients with carpal tunnel syndrome. 10 were operated upon by classical open palmar incision (group A) and 10 through mini-incision technique at distal wrist crease (group B). Follow up was after 2 weeks, 1, 3 and 6 months. Incisional pain, pillar pain using Visual Analog Scale (VAS), Levine symptom and function severity scores were evaluated at 3rd and 6th months postoperatively. Patients' satisfaction about surgery and cosmetic results were evaluated using Visual Analog Patient Satisfaction Scale (VAPSS). Patients graded their cosmetic results from poor to excellent. Results: There were no intraoperative complications. Group B showed significantly less incisional and pillar pain. Patients were significantly more satisfied about cosmetic results in group B. There was no significant difference between both groups regarding time taken to return to daily life activities. Conclusion: Conventional and mini-incision surgical approaches are both safe effective methods for carpal tunnel release. Mini-incision technique provided smaller and less painful scar, hidden in the wrist crease

use of gated cardiac single photon emission computed tomography [SPECT] in healthy smokers

As cigarette smoking is a major cardiovascular risk factor, this study was designed to find the effect of chronic cigarette smoking on cardiovascular system of apparently healthy subjects by using gated SPECT. This study included 20 healthy young males heavy smokers with smoking index 379 +/- 193.4. Also 10 age and sex matched non smokers volunteers served as controls. Smokers and non smokers persons were subjected to complete history taking, thorough clinical examination, X-ray chest, resting ECG and resting echocardiography to exclude any abnormalities. In addition the following laboratory investigations were done; blood urea, serum creatinine, serum glucose, lipogram and C-reactive protein. Also, stress gated cardiac SPECT using Tc99m MIBI was performed for all subjects. Mean values of serum cholesterol and LDL-c were significantly higher in smokers than non smokers [p <0.001, p <0.05 respectively]. Mean values of HDL-c were significantly lower in smokers than controls [p<0.05]. The percentages of positive CRP were significantly higher in smokers versus non smokers [p<0.05]. The mean values of EF% and SV were insignificantly lower in smokers versus controls at post-stress SPECT. Also, 50% of smokers had diminished myocardial perfusion versus 0% of non smokers [p<0.01] at post stress SPECT. There were also abnormal wall motion and thickness at post stress SPECT. Cigarette smoking is a major risk factor for atherosclerosis in young adult male. Post stress cardiac SPECT may be useful for early detection of cardiovascular events of smoking

Evaluation of efficacy and toxicity of 186RE-HEDP in palliation of breast cancer painful bone metastases

This study included 20 female, breast cancer patients with painful bone metastases, presented to Radiation Oncology Department and Nuclear Medicine Unit, Assiut University Hospital, Faculty of Medicine, Assiut University in the period from July 1999 to April 2001. Their mean age was 46.7 years [range 32-61 years]. They were evaluated consecutively, for the efficacy of 186Re-hydroxyethylidene diphosphonate [HEDP] on pain from bone metastases and the toxicity of this agent. 30 mCi of 186Re-HEDP was intravenously administered for each patient, after performing a baseline bone scan with 99mTc-MDP, followed by 24-hour bone scan with the injected rhenium agent. All patients were followed up bi-weekly in the first month then monthly by clinical and laboratory assessment up to three months. Bone scan with 99mTc-MDP was repeated on day 45 and day 90 for evaluation of bone metastases. The results revealed that 19 patients were evaluated for response [one patient was excluded due to acute evolution of her disease and receiving chemotherapy during the period of response assessment]. An objective response was observed in 78.9% of patients with a mean duration of 58 days, nine patients [47.4%] were relieved of pain during the second week and another six patients [31.5%] enjoyed pain relief during the third week; while, the rest of patients [21.1%] continued complaining of pain, three patients [15.7%] without increase intensity, and one patient [5.3%] with increased pain intensity. No major adverse effects were observed. Marrow toxicity did not exceed grade II for white blood cells and grade III for platelets using National Cancer Institute criteria. In conclusion, 186Re-HEDP provides safe symptomatic relief of pain for bone metastases of breast cancer with correctable minimal adverse effects