Limited portal with direct-vision carpal tunnel release.

A modified technique of subfascial carpal tunnel decompression is reported. With a small transverse wrist incision, this procedure provides minimal soft-tissue disruption and complete visualization of the carpal ligaments. There is minimal postoperative pain, and the delay in return to work or activities of daily living is greatly reduced. The risks of iatrogenic neurovascular injury or incomplete sectioning of the transverse carpal ligament are virtually eliminated if strict adherence to the technique is observed. Unlike endoscopic carpal tunnel release, it is not a "blind" or "semiblind" procedure and does not require special or expensive instrumentation. On selected patients, this technique is a safe and highly effective alternative of decompressing the carpal canal.

"Saline float" positioning of the polyurethane-covered breast prosthesis.

The use of the "saline float" technique has enabled us to more easily position the foam-covered breast implants through a short aesthetic incision. Of 34 patients in whom this has been used, one breast has been complicated by wrinkling of the prosthesis noted early after surgery. At 6 months this is no longer evident. Retained saline has caused no problems, and no infections have been encountered. This technique offers a safe and simple solution to overcome the tissue friction associated with use of the polyurethane foam-covered prosthesis.

Detrimental effects of ethanol on murine frostbite.

Many references have been made concerning the adverse effects of ethanol in human frostbite. The lack of experimental evidence to support this belief prompted the authors to undertake this investigation. Nineteen Swiss-Webster mice (25 +/- 2 gm) were given intraperitoneal injections of 0.2 cm3 of 50 per cent ethanol (group A) or 0.2 cm3 saline (group B). Thirty minutes later, the animals were anesthetized with pentobarbital (group A 30 mg/kg; group B 50 mg/kg). Lower barbiturate dose was used in group A because of the synergistic central nervous system depressant effect when combined with alcohol. Tail lengths of all animals were measured. The tails were immersed in a 50 per cent ethylene glycol solution (-18 C) for 6 min and then thawed at room temperature (24 C). At 24 hrs, tail circulation was assessed by length of tail perfused with the vital dye alphazurine 2 gm given intraperitoneally. Mortality to 14 days was recorded. All animals survived the initial anesthetic and/or alcohol administration. Group A had a statistically significant (P less than 0.001 Students t test) decrease in length of tail perfused compared with group B at 24 hours (0.98 +/- 0.19 cm versus 2.58 +/- 0.23 cm). Fourteen day survival was 10 per cent in group A compared with 89 per cent in group B (P less than 0.001, chi-square test). We conclude that ethanol has significant adverse effects on tissue perfusion and mortality associated with severe murine frostbite.

Combined therapy in advanced squamous cell carcinoma of the head and neck.

The charts of 102 patients with stage IV squamous cell carcinoma of the head and neck, seen at the East Orange Veterans Administration Hospital between 1975 and 1979, were reviewed. Ninety-one of these patients were submitted to a protocol of high-dose preoperative radiotherapy, followed by surgery. Five-year actuarial survival in patients completing the protocol was 31.6 per cent. All patients who completed radiotherapy and were eligible for surgery, but refusing operation, died of their disease within three years. Historical controls for stage IV head and neck cancer have five-year survival rates of 0-16 per cent, depending on site. A recent review of the literature shows stage IV lesions treated with surgery alone have a five-year survival rate of 6 per cent.

Hemodynamic effects of prolonged infusion of prostaglandin E1 (PGE1) after hemorrhagic shock.

Although one-hour infusions of prostaglandin E1 to animals suffering from hemorrhagic shock have proved beneficial, there is question as to whether the improved hemodynamics can be sustained over a longer infusion time. Following reinfusion of shed blood, an infusion of PGE1 at a dose of 1 microgram/kg/minute showed a significant elevation in cardiac output and left ventricular stroke work and a decrease in systemic vascular resistance when compared to animals receiving only an equal volume of normal saline. There was no diminution in the hemodynamic activity of the drug over the entire infusion period. These data indicate that the drug might be appropriate for hemodynamic support in the clinical situation, where infusion times of greater than one hour are often necessary.

Patterns of mortality in a surgical intensive care unit.

Mortalities in a surgical intensive care unit during a three year period were reviewed. The over-all mortality was 8.2 per cent. Sixty-four per cent of the deaths followed nontraumatic surgical illness and 36 per cent followed trauma. Eighty-one per cent of patients died as a direct result of traumatic injuries, while only 19 per cent died of sepsis or multiple organ failure. On the other hand, 62 per cent of the nontrauma related deaths were a consequence of sepsis or multiple organ failure. Further research into cellular support is needed to reverse the problem of sepsis related organ failure.