[The effects of standardised cold and compression therapy on swelling, pain and functional outcome after division of the transverse carpal ligament in carpal tunnel syndrome]. / Der Einfluss von standardisierter Kälte- und Kompressionstherapie auf Schwellung, Schmerzhaftigkeit und das funktionelle Ergebnis nach Spaltung des Retinaculum flexorum bei Karpaltunnelsyndrom.

OBJECTIVE: This prospective, randomised study examines the effect of standardised cold compression therapy on swelling, pain and functional outcome after division of the transverse carpal ligament in carpal tunnel syndrome in comparison to cooling alone. PATIENTS AND METHODS: Fifty patients for division of the transverse carpal ligament were randomised into two groups. In group 1, postoperative conventional cooling therapy was performed. Group 2 was given standardised cooling and compression therapy with the Cryo/Cuff™-system (3 × 10 min twice daily). Follow-up examinations were performed on days 1, 8 and 21 after the operation. One patient in group 1 and 3 patients in group 2 could not be followed up. Test parameters were pain, swelling, mobility, strength, and the DASH and MHQ score. RESULTS: There were no significant differences between the two groups at any time point. CONCLUSION: In this study, no advantage could be demonstrated for standardised cooling and compression therapy with the Cryo/Cuff™-system in comparison with conventional cooling after division of the transverse carpal ligament.

Large tip electrodes for successful elimination of atrial flutter resistant to conventional catheter ablation.

The most widely accepted criterion for successful radiofrequency catheter (RFC) ablation of typical atrial flutter is the development of bi-directional isthmus block. In a subset of patients, conventional RFC ablation fails to achieve this endpoint because deeper and wider lesions are required. We investigated the efficacy of a long 8-mm tip catheter in these cases. One hundred and seventy-four consecutive patients (137 male; 61 +/- 9 years) with recurrent typical atrial flutter underwent conventional RFC ablation first with a standard 4 mm tip catheter. In resistant cases (n = 52), ablation was continued using a large tip 8-mm catheter when the 4-mm tip catheter failed. Resistant atrial flutter was identified when 21 RFC pulses failed to reach the selected endpoint of bi-directional isthmus block or in cases of transient bi- directional block (at least 3 episodes). In 122 of the 174 patients (70%) conventional atrial flutter ablation was successfully performed with 13 +/- 5 RFC applications. In the remaining 52 subjects (30%), the ablation procedure was completed using the large tip electrode catheter. In 30 of these 52 patients (58%), the catheter was changed because of persistent intra-atrial conduction after 21 RFC pulses and in 22 (42%) because of intermittent conduction block after 11 +/- 5 applications. Using the large tip electrode catheter, the selected endpoint was achieved in all patients of both groups with 3 +/- 2 RFC pulses (power output of 50-60 W, pulse duration of 60 sec). No post-procedure complications were observed. After 15 +/- 5 months of follow-up, 16 patients (9%) had recurrence of atrial flutter. Five of the patients had been in the resistant group. In patients with atrial flutter resistant to conventional ablation therapy, the long tip (8-mm) catheter appears to be a safe and effective alternative to use of the conventional 4-mm tip catheter.