Endoscopic carpal tunnel release in a community-based series.

A retrospective analysis of 61 endoscopic carpal tunnel releases was performed. The surgical technique adhered strictly to the Inside Job protocol, as recommended between August and October of 1990. The objective was to provide a baseline for expected results and complications in a community practice setting. Results were rated excellent in 37 cases, good in 11, and poor in 4. Nine patients were not available for follow-up. Decreased postoperative morbidity and a more rapid return to work were found with endoscopic carpal tunnel release. The contribution of pillar pain, scar tenderness, pinch and grip weakness, and persistent numbness to good and poor outcomes were analyzed. One patient required repair of the median nerve. Another patient underwent conventional carpal tunnel release 1 year after the endoscopic procedure. Endoscopic carpal tunnel release promises to reduce morbidity. The results do not justify continued use of the Inside Job device described when conventional release is used as the standard for comparison.

External fixator management of unstable colles' fractures: an alternative method.

Eighty-seven comminuted Colles' fractures of the Frykman III-VIII variety have been treated with the Medium-C-Hoffmann® external fixator, as an alternative to pins in plaster management, over a three-year period, with an average length of followup of 19 months. A standard technique had been used. The results were assessed on the basis of subjective, objective, and roentgenographic findings. The overall goal of a painless wrist with excellent motion, good strength, and satisfactory cosmesis appears to have been achieved by this method of management.

Paget's disease of the scrotum presenting as an inguinal lymph node.

Extramammary Paget's disease is a rare malignant entity. A case with a unique clinical presentation is described and emphasis is placed on the need for early biopsy of skin lesions in the genital area.

The alternate complement pathway in inflammatory bowel disease. Quantitation of the C3 proactivator (factor B) protein.

A component of the complement system's alternate pathway was investigated in ulcerative colitis and Crohn's disease. The mean C3PA (Factor B) titer in normals was 74 +/- 15%; in ulcerative colitis, 92 +/- 18%; and in Crohn's disease, 119+/- 24%. Significance was at the P less than 0.001 level when the mean values for the ulcerative colitis and the Crohn's disease groups were compared to normal subjects. Titers did not change significantly with exacerbation or amelioration of the diseases or when patient groups were analyzed according to the mode of treatment received.

The alternative pathway of complement activation in the neonate.

C3PA (factor B) concentrations taken as an indication of alternate pathway development for neonates and adults were compared. The mean level for umbilical cord sera was 39 +/- 2%, with a range of 19.5-77.5%. The normal adult mean level was 74 +/- 4%, with a range of 43-108%. The difference between the two is highly significant (P less than 0.001). The ration of neonatal C3PA to adult C3PA is 0.52 +/- 0.10. In only one case was the newborn level greater than the mean adult value. There is positive correlation, r = 0.18, with gestational age, although it falls short of statistical significance (P greater than 0.1). There were no differences between the male and female neonates. C3PA titers were compared with C3 concentrations and so plotted. Although there was a positive correlation, r = 0.22, it was not statistically significant (P = 0.1). In an infant with gram-negative septicemia, the C3PA concentrations were much greater than the mean value found in normal cord sera. They were also greater than the mean value for normal adult C3PA titers, the multiple being 1.8-2.5. On first determination, after 2 days of normal to slightly elevated temperatures, a value of 132 +/- 6% was found. The second determination with a spike to 101.5 degrees F, and gave the highest of the three titers, 185 +/- 4%. At the same time that the C3PA levels reached this peak, the fever dropped to normal. At the time of the last determination, the C3PA levels had returned to that of the original sample, 125 +/- 4%. This study demonstrates that the cord sera of the normal term neonate is deficient in C3 and C3PA when compared with adult controls. Neither C3 nor C3PA correlated with gestional age. C3PA levels increase steadily as C3 titers increase and comparable ratios to adult values indicate that the alternate pathway is probably maturing at the same rate as the classic pathway. The results in the septic infant may represent a response to an inflammatory condition (acute phase phenomena), a block in alternate pathway expression, or synthesis beyond increased C3PA catabolism.