Recurrent carpal tunnel syndrome: treatment options.

Many techniques are available to the surgeon confronted with a patient with recurrent nerve entrapment/traction neuritis. The advantage of local muscle or fat flaps like the ADQ, pronator quadratus, and hypothenar fat flap is the ease at which each can be elevated. The size is very limited, however. Circumferential vein wrapping has been studied extensively and is efficacious despite the absence of vascularity, but length requirements may limit the indications to short nerve segments, as might be expected with recurrent carpal tunnel syndrome. Despite the increased complexity of a pedicled flap and free tissue transfer, the tissue availability, girth, and source of vascularity make these sophisticated techniques more attractive. Such flap transfers should be used only after the more simple techniques have been ruled out as options or failed and only if residual pain and hypersensitivity are due to localized neuritis as opposed to a more generalized dystrophic symptomatology.

Phase II trial of etoposide, doxorubicin (Adriamycin), and cisplatin (EAP regimen) in advanced gastric cancer.

Ten previously untreated patients with gastric cancer were treated with etoposide, 120 mg/m2 intravenously (i.v.) on days 4, 5, and 6, Adriamycin, 20 mg/m2 i.v. on days 1 and 7, and cisplatin, 40 mg/m2 i.v. on days 2 and 8 (EAP). Etoposide, 240 mg/m2 on days 4, 5, and 6, was administered orally instead of intravenously in alternating cycles, and pharmacokinetic studies were performed in those who had previously undergone gastrectomy or who had tumor infiltrating the stomach to determine oral bioavailability. Nine patients had advanced measurable gastric cancer, and one patient had an elevated carcinoembryonic antigen after surgery for synchronous gastric and colon cancer. The median age was 54 years (range 38-69), and the median Eastern Cooperative Oncology Group (ECOG) performance status was 2 (range 0-3). Nine of 10 patients had poorly differentiated adenocarcinoma. Twenty-four cycles were administered to 10 patients, and hematologic data were available for 23 courses. ECOG grade 4 neutropenia and thrombocytopenia developed in 19 (83%) and 8 (53%) courses, respectively. Thirteen courses (54%) were complicated by fever requiring parenteral antibiotics. Two patients (20%) died due to neutropenic sepsis. The profound myelotoxicity observed in our study prompted us to terminate the investigation prior to completing accrual. The oral bioavailability of etoposide was 21% and 36% in the two patients who had had prior gastrectomy.(ABSTRACT TRUNCATED AT 250 WORDS)