Carpal tunnel syndrome: a frequent, invalidating, long-term complication of chronic hemodialysis.

Among 100 patients treated by chronic hemodialysis, 12 developed a carpal tunnel syndrome (CTS). After surgery, improvement was dramatic with regression of pain and paresthesiae within a few hours. Recovery of motor and sensory deficits was longer (2-3 weeks). No relationship could be established between CTS and the type of nephropathy, severity of polyneuritis, Ca and PO4 metabolism, the presence of vascular access and efficacy of dialysis. The bilaterality of the lesions in 7 patients suggests general pathogenic mechanisms superimposed to the presence of the vascular access. While only 3 out of 65 patients treated for less than 4 years complained about CTS, 9 out of 35 treated for more than 4 years were symptomatic.

[Treatment of sequelae of burns on the trunk]. / Die Behandlung von Spätfolgen nach Verbrennungen im Bereichedes Rumpfes]

The management of burn scars of the trunk is discussed, in respect of the specific problems related to different areas such as the axilla, thorax and back, the female breast and the perineum as well as the external genitalia. Special emphasis is placed on the different aspects of burn sequelae of the female breast with regard to pre- and postpuberty age. The prevention and therapy of the burn scar carcinoma are dealt with.

Long-term results from metacarpophalangeal arthroplasty.

The authors have been using Swanson's prostheses for MP joint replacement in rheumatoid arthritis since 1968. After thirteen years of experience, they present an analysis of these prostheses from a clinical and radiological point of view. 88 joints replacements in 20 patients are reviewed. These operations were performed between 1968 and 1976. The average follow-up is nine years. The authors compare their results with those obtained in a previous study made in 1975. They show that a replacement arthroplasty with a Swanson type prosthesis, imparts considerable benefits to the patient in the form of complete disappearance of pain, improvement in function, and a more normal looking hand, in spite of radiologic deterioration.

The carpal tunnel syndrome in chronic dialysis patients, it is a late complication of the arterio-venous fistula?

Out of 100 patients undergoing chronic hemodialysis in Lausanne (Switzerland), 12 developed a carpal tunnel syndrome (i.e. 8 men and 4 women, from 34 to 76 years old). Out of 66 patients with an arteriovenous fistula for less than 4 years, it is interesting to note that only 3 carpal tunnel syndrome were observed; whereas, out of 34 hemodialysis patients being dialyzed more than 4 years, 9 of them showed that syndrome. The symptomatology of the carpal tunnel syndrome is described by the authors. It has always been confirmed by EMG. On 10 patients, the symptoms were so acute that they needed a decompression of the median nerve. Five cases were bilateral. The operation is performed under axillary block, without tourniquet. The results were very satisfactory. Paresthesias disappeared after a few hours or a few days following the operation. No relationship could be established between CTS and the type of nephropathy, severity of polyneuropathy, Ca and P metabolism, vascular access complications, efficacity of dialysis, fluid overload or medical treatment. The authors are investigating the etiology of the carpal tunnel syndrome, ship hypothesize particularly concerning the direct or remote relation between the carpal tunnel syndrome and the arteriovenous fistula.

[Plastic surgical reconstruction of cutaneous loss of the heel or sole of the foot with sensitive free flaps]. / A propos de la reconstruction plastique du talon et de la plante du pied par lambeaux libres sensibles.

In cases of total cutaneous loss of the heel or extensive cutaneous loss of the sole of the foot, the plastic surgical reconstruction by use of classical pediculated flaps requires following: - an adequate physical condition and articulations capable of enduring prolonged bed confinement in a position which is frequently uncomfortable; - a minimum of two operating procedures. It should be kept in mind that these free flaps are always insensitive and therefore subject to recurrence of wounding and trophic ulcers, etc. In order to avoid these drawbacks the authors suggest the use of a sensitive free flap, in which the neurovascular bundle is anastomosed to the existing bundle in the foot, using microsurgical techniques. Amongst the possible sensitive free flaps the authors favor the use of a sensitive latero-thoracic free flap. A detailed description of this free flap technique, its advantages and disadvantages for use in this kind of problem is described in their article. A clinical case is presented.