Injection therapy for management of stenosing tenosynovitis (de Quervain's disease) of the wrist.

Stenosing tenosynovitis of the first dorsal compartment of the wrist (de Quervain's disease) is a common cause of radial wrist and hand pain and disability. Nonoperative management of the disease has been thought to provide only temporary relief of pain and swelling, while surgical intervention has been viewed as a more definitive treatment. This retrospective study examines the results of 58 patients who presented with de Quervain's disease from January 1993 through December 1995 and were initially treated with a combination steroid/lidocaine injection. After 1 to 3 years of follow-up, 35 patients had complete relief of symptoms with a single injection, 14 had relief of symptoms with two injections, 2 are still under observation, and 7 patients had to undergo operative management. These results indicate that in most patients with de Quervain's disease, treatment with a steroid/lidocaine injection can provide complete relief of symptoms.

Experience with the Keller bunionectomy.

The Keller resection arthroplasty was first described in 1904. Ninety years later, this operation continues to be useful to orthopaedic surgeons and their patients. This article presents the results of Keller bunionectomies in a private practice setting. Indications, surgical techniques, postoperative management, and results are discussed. The outcome in this series shows the Keller bunionectomy to be a useful operation when properly performed for the right indications.

Planning the family.

PIP: In the United Kingdom, nurses, and especially family planning nurses, can help families live healthier lives by providing family members with appropriate family planning counseling and education. The provision of family planning education has not kept pace with the expanded availability of contraceptive supplies in the United Kingdom. Free family planning services were made available at all area health authority clinics beginning in 1974. Although contraceptive use increased considerably in the intervening years, the number of unwanted births and aboritons remains unacceptably high. The public is generally not provided with family planning education at an early enough age and family planning education for men is grossly inadequate. Groups in special need of more intensive family planning education are young people, unmarried couples, couples planning the birth of their 1st child, postpartum women, couples with completed families, women who want no more children, handicapped persons, and socially deprived groups. The choice of an appropriate method depends on the characteristics and needs of each couple. Combined oral contraceptives are highly effective and are the preferred method for many women. Natural methods can be effective if couples are willing to adhere conscientiously to all method requirements. Barrier methods, when used correctly, are also highly effective. IUDs have several disadvantages but may be an appropriate method for some women. Couples contemplating sterilization must be counseled carefully to ensure that they understand fully the implications of the methods. The use of postcoital methods, e.g., the morning after pill and IUD insertions, should be viewed only as emergency techniques. In addition to a knowledge of contraceptive methods, nurses must be sensitized to patient's contraceptive attitudes, concerns, and prejudices. Unfortunately, most nursing colleges do not provide sufficient family planning training for their students.^ieng

Detection of breast disease in a family planning association clinic.

The incidence and prevalence of disorders of the breast have been assessed in 13,456 women examined annually at a family planning clinic over 5 years. Screening for disorders of the breast was by clinical examination alone and abnormalities were detected in 1 of every 58 women attending the clinic and these were referred for hospital opinion: biopsy was required in 1 in 114. Only 12 cancers of the breast were detected and all of these in women over 35 years. It is suggested that the usual policy of examining the breasts of women taking oral contraceptive preparations should be restricted to those over 40 years.