Outcome of carpal tunnel release surgery in patients with diabetes.

The surgical outcomes in 149 patients with diabetes and carpal tunnel syndrome who underwent transverse carpal ligament release surgery are reported. Associated factors such as insulin dependence, length of time with diabetes, electrodiagnostic studies, severity of neurological deficit, presence of polyneuropathy, and cervical disc disease were considered. Analysis of preoperative and postoperative symptoms, clinical findings, diagnostic studies, and patient self-assessment indicated that the majority of patients with diabetes experienced a favorable surgical outcome, regardless of any associated factors. Eighty-four percent of the patients reported good to excellent postoperative results in their hands. Further analysis of the subpopulation of insulin-dependent diabetics showed that 81% experienced good to excellent postoperative results. These results compare favorably with those of the control group: 200 nondiabetic patients, of whom 90% rated their results from carpal tunnel release surgery as good to excellent. There were no major complications in any group.

Bilateral carpal tunnel release at one operation: report of 228 patients.

The division of the transverse carpal ligament for relief of carpal tunnel syndrome has been a standard operative procedure since the early 1950s. The surgical technique, however, is controversial, and the literature is rife with individual preferences and biases. This report describes our results in 228 tensor fasciae patients who underwent a bilateral carpal ligament release in one procedure that used a small transverse incision in the wrist crease. When the patients' responses to a questionnaire, records of postoperative visits, and follow-up phone calls were analyzed, 216 patients (94.7%) had a satisfactory outcome. One hundred fifty-five patients were working before surgery, with 88.3% back to work in 6 weeks or less. There were no major complications.

Carpal tunnel syndrome: surgical treatment using the Paine retinaculatome.

The operative technique for the relief of carpal tunnel syndrome has remained controversial. This report presents the results of 445 patients or 577 hands operated on using a transverse technique that varies little from that described by Paine and Polyzoidis. The patients were followed for 9 months to 3 years. In addition to the data received from follow-up visits, a questionnaire was sent to each patient for evaluation of their results. All surgery was performed under local anesthesia, sometimes with intravenous supplement. Of the 445 patients, 313 had unilateral operations and 132 had bilateral operations at one sitting. Postoperatively, normal hand function was achieved in 59.4% of patients in 1 week or less. Of the 577 hands operated on, 535 (92.7%) exhibited satisfactory results from surgery. No patient required postoperative physical therapy or splinting. There were no injuries to the median nerve or any of its branches.

Treatment of delayed radiation necrosis of the brain. A clinical observation.

The authors report two cases of delayed radiation necrosis of the brain. In these cases a dramatic clinical and computerized tomographic improvement was noted after the institution of anticoagulant therapy. Based on a review of the literature, a possible causal mechanism is suggested. It was believed from both the clinical observation and the literature review that the anticoagulant agents had a direct effect upon the improvement in these patients. Laboratory data are needed to determine the role of anticoagulant therapy in the treatment of delayed radiation necrosis of the brain.

The cutting-edge microvascular needle. A scanning electron microscopic study.

The authors have compared the vascular endothelial damage caused by blunt-tipped microvascular needles as reported previously with that of sharp cutting-edged needles of comparable size. The same four distinct vascular lesions were found with cutting-edged needles as with the blunt-tipped needles. Even though one experimenter made all of the lesions, and all of the tissue was handled in the same fashion, there was much variation in the extent of the intimal damage. Overall, cutting-edged needles produced slightly less intimal tearing and platelet aggregation than blunt-tipped needles, but the difference was not striking.

Scanning electron micrographic study of vascular lesions caused by microvascular needles and suture.

The authors studied the damage to blood vessels 1 to 2 mm in diameter caused by the most commonly used types of microvascular needle. Excluding variables introduced by anastomosis, the study focused specifically on lesions attributable only to the needle and suture. Scanning electron microscopy revealed four distinct types of lesion. A theory is proposed to explain the mechanisms whereby these lesions were produced, and a needle design is recommended that may aid in minimizing vascular trauma.