Corticoid injection as a predictive factor of results of carpal tunnel release

OBJECTIVE: To evaluate whether the symptoms relief after local corticoid injection correlate with better results of surgical treatment in carpal tunnel syndrome. METHODS: Between February 2011 and June 2013, 100 wrists of 88 patients were included in the study. All patients were subjected to corticoid injections in the carpal tunnel and evaluated before and after infiltration and surgery. The following parameters were evaluated: visual analog scale (VAS) for pain, Boston questionnaire, sensitivity and strength. RESULTS: Only 28 out of 100 wrists subjected to injection were symptom-free after six months follow up. Sixty out of the 72 patients who did not present relief or relapse symptoms were treated surgically. Surgical results were better regarding VAS, Boston questionnaire and sensitivity in a specific group of patients, which had a longer relief of symptoms after the corticoid injection, with statistical significance. CONCLUSION: Longer relief of symptoms after corticoid injection correlated with better results of surgical treatment. Level of Evidence II, Prognostic Study.

Perfil clínico, laboratorial e complicações de pacientes com síndrome HELLP admitidas em uma unidade de terapia intensiva obstétrica / Clinical and laboratorial profile and complications of patients with HELLP syndrome admitted in an obstetric intensive care unit

OBJETIVO: descrever o perfil clínico e laboratorial e complicações de pacientes com síndrome HELLP internadas em Unidade de Terapia Intensiva (UTI) obstétrica e incluídas em um ensaio clínico randomizado para avaliar a eficácia do uso da dexametasona. MÉTODOS: O PRESente estudo corresponde a uma análise secundária das pacientes submetidas a um ensaio clínico randomizado realizado entre agosto de 2005 e novembro de 2006. A amostra foi composta de puérperas com diagnóstico de síndrome HELLP (pré ou pós-parto), que não fossem usuárias crônicas de corticosteróides ou portadoras de doenças crônicas que pudessem alterar os parâmetros laboratoriais da doença. Pacientes muito graves ou que não tivessem condições de consentir em participar também não foram incluídas no estudo. Os dados foram coletados por meio de formulários padronizados preparados especialmente para serem utilizados no estudo. As variáveis analisadas foram: idade, paridade, idade gestacional na admissão e na interrupção da gestação, época do diagnóstico de síndrome HELLP, classificação da síndrome HELLP (completa ou incompleta), pressão arterial e diurese na admissão. Os resultados laboratoriais analisados no momento do diagnóstico da síndrome HELLP foram: hemoglobina, contagem de plaquetas e dehidrogenase lática, transaminases e bilirrubinas séricas. Analisaram-se ainda as complicações apresentadas: oligúria, insuficiência renal aguda, manifestações hemorrágicas, edema agudo de pulmão, óbito, necessidade de hemotransfusão e tempo de internamento hospitalar. A digitação e a análise estatística foram realizadas usando-se o programa Epi-Info 3.3.2. RESULTADOS: foram avaliadas 105 pacientes. A idade variou de 14 a 49 anos, com média de 26,7. Em relação à paridade, 56 pacientes (53,8 por cento) eram primigestas. O diagnóstico da síndrome HELLP foi feito no período pré-parto em 47 pacientes (45,2 por cento) com idade gestacional média de 32,4 semanas. Entre as complicações, encontraram-se...

PURPOSE: to describe the clinical and laboratorial profile of HELLP syndrome patients admitted at an Obstetric Intensive Care Unit (ICU) and included in a randomized clinical trial to evaluate the efficacy of dexamethasone in this clinical setting. METHODS: the present study is a secondary analysis of a randomized clinical trial design to evaluate the efficacy of dexamethasone in patients with HELLP syndrome. This sample of patients was composed of patients in the puerperium, with the diagnosis of HELLP syndrome (diagnosis made before or after delivery) who were not chronic corticosteroid users and not carriers of any chronic disease which could modify HELLP syndrome's laboratorial parameters. Patients who were too critical or whose condition did not allow them to consent to participate were not included. Data were extracted from the records used in the randomized clinical trial. Age, parity, gestational age at admission and delivery, time of diagnosis (before or after delivery), HELLP syndrome classification (partial or complete), arterial blood pressure, and diuresis at admission were considered for analysis. Among laboratorial findings, hemoglobin, platelet count, liver enzymes, LDH, and serum bilirubin were analyzed. Complications presented by the patients were also analyzed as well as need of blood transfusions and duration of hospitalization. Analysis was made by the Epi-Info 3.3.2 program. RESULTS: one hundred and five patients were analyzed. Age varied from 14 to 49 years (means of 26.7). Regarding parity, 56 patients (53.8 percent) were primiparas. Analyzing the timing of the diagnosis, 47 patients (45.2 percent) had the diagnosis before delivery. The mean gestational age in these patients was 32.4 weeks. Hemorrhagic manifestations were observed in 36 patients (34.3 percent), oliguria was present in 49 patients (46.7 percent) and criteria for acute renal failure were seen in 21 (20 percent) of the cases. Hemotransfusions were...