Carpal tunnel syndrome in women undergoing reduction mammaplasty.

Women with mammary hypertrophy who present for reduction mammaplasty have several well-described musculoskeletal complaints, but a high prevalence of carpal tunnel syndrome has not been reported. We identified 151 patients from a plastic surgery practice who underwent reduction mammaplasty from 1994 to 1996. To this group we added a convenience sample of 64 women volunteers with relatively smaller breasts (brassiere cup size B or smaller). We questioned the entire group about specific symptoms and examined them using standard provocative tests. Carpal tunnel syndrome was defined as the coexistence of symptoms and at least two physical examination findings. We examined its association with breast size, age, race, and body mass index. Stepwise logistic regression was used to determine which physical characteristics were predictive of the condition. Carpal tunnel syndrome was found in 30 patients (19.9 percent) (95 percent confidence interval, 13.8 to 27.1) and in none of the women in the convenience sample. Breast size and, to a lesser degree, body mass index were found to be highly significant predictors of carpal tunnel syndrome. After controlling for breast size, race was also significant. Breast size displayed an independent risk ratio of 6.67 when comparing the upper quartile of size to the lower quartiles. There is a markedly higher prevalence of carpal tunnel syndrome in women who present for reduction mammaplasty than in those with smaller breasts. Breast size was a significant predictor of carpal tunnel syndrome.

[The endoscopic treatment of pancreatic pseudocyst]. / Tratamiento endoscópico del pseudosquiste de páncreas.

We define in this paper different modalities of endoscopic treatment as well as the criteria for this procedure. Endoscopic drainage were done through cystoenterostomy and nasocystic drainage and enterocystic prosthesis plus sphincterostomy of the principal pancreatic and biliary duct, in all patients, but only in eleven of them we implanted the prosthesis in both ducts. The complication was bleeding, in two patients (16.7%) and they were treated with endoscopic inyectotherapy.

Surgical treatment of an aggressive metastasized eccrine poroma.

We report the successful surgical treatment of a 24-year-old male with an aggressive metastasized eccrine poroma. The primary lesion was on the left plantar surface and resembled a pyogenic granuloma. Two months after we excised this lesion, the patient presented with a mass on the left groin, apparently a metastatic occurrence related to the tumor. We performed a radical lymph node dissection with no adjunctive treatment. Five years later, the patient is apparently free of any related disease.

"Supercharging" the rectus abdominis muscle to provide a single flap for cover of large mediastinal wound defects.

Mediastinitis continues to be a devastating complication of open heart surgery. Supercharging the rectus abdominis muscle through revascularisation of the deep inferior epigastric vessels in the neck adds another safety factor in the management of these difficult problems. Large mediastinal wound defects that would usually require more than one muscle for cover can be covered adequately with this technique. Viability of the entire rectus abdominis is assured and permits use in its entirety. Details of the technique are presented as well as a review of the reconstructive options for mediastinal wound infections.