Predicting Revision Following In Situ Ulnar Nerve Decompression for Patients With Idiopathic Cubital Tunnel Syndrome.

PURPOSE: To determine the incidence of revision and potential risk factors for needing revision surgery following in situ ulnar nerve decompression for patients with idiopathic cubital tunnel syndrome (CTS). METHODS: We conducted a retrospective chart review of all patients treated at 1 specialty hand center with an open in situ ulnar nerve decompression for idiopathic CTS from January 2006 through December 2010. Revision incidence was determined by identifying patients who underwent additional surgeries for recurrent or persistent ulnar nerve symptoms. Bivariate analysis was performed to determine which variables had a significant influence on the need for revision surgery. RESULTS: Revision surgery was required in 3.2% (7 of 216) of all cases. Age younger than 50 years at the time of index decompression was the lone significant predictor of need for revision surgery. Other patient factors, including gender, diabetes, smoking history, and workers\u27 compensation status were not predictive of the need for revision surgery. Disease-specific variables including nerve conduction velocities, McGowan grading, and predominant symptom type were also not predictive of revision. CONCLUSIONS: For patients with idiopathic CTS, the risk of revision surgery following in situ ulnar nerve decompression is low. However, this risk was increased in patients who were younger than 50 years at the time of the index procedure. The findings of this study suggest that, in the absence of underlying elbow arthritis or prior elbow trauma, in situ ulnar nerve decompression is an effective, minimal-risk option for the initial surgical treatment of CTS. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III

Evaluation and Management of Sleep Disorders in the Hand Surgery Patient.

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition

Usporedba kemijskih i fizikalno-kemijskih metoda obezbojavanja otpadnih voda

Today\u27s chemical and physical-chemical wastewater discoloration methods do not completely meet demands regarding degree of discoloration. In this paper discoloration was performed using Fenton (FeSO4 · 7 H2O + H2O2 + H2SO4) and Fenton-like (FeCl3 · 6 H2O + H2O2 + HCOOH) chemical methods and physical-chemical method of coagulation/flocculation (using poly-electrolyte (POEL) combining anion active coagulant (modified poly-acrylamides) and cationic flocculant (product of nitrogen compounds) in combination with adsorption on activated carbon. Suitability of aforementioned methods was investigated on reactive and acid dyes, regarding their most common use in the textile industry. Also, investigations on dyes of different chromogen (anthraquinone, phthalocyanine, azo and xanthene) were carried out in order to determine the importance of molecular spatial structure. Oxidative effect of Fenton and Fenton-like reagents resulted in decomposition of colored chromogen and high degree of discoloration. However, the problem is the inability of adding POEL in stechiometrical ratio (also present in physical-chemical methods), when the phenomenon of overdosing coagulants occurs in order to obtain a higher degree of discoloration, creating a potential danger of burdening water with POEL. Input and output water quality was controlled through spectrophotometric measurements and standard biological parameters. In addition, part of the investigations concerned industrial wastewaters obtained from dyeing cotton materials using reactive dye (C. I. Reactive Blue 19), a process that demands the use of vast amounts of electrolytes. Also, investigations of industrial wastewaters was labeled as a crucial step carried out in order to avoid serious misassumptions and false conclusions, which may arise if dyeing processes are only simulated in the laboratory.Današnje kemijske i fizikalno-kemijske metode obezbojavanja otpadnih voda ne zadovoljavaju u potpunosti zahtjeve vezane uz stupanj obezbojavanja. U ovom radu obezbojavanje se provodilo pomoću Fentonove kemijske metode (FeSO4· 7 H2O + H2O2 + H2SO4) i modificirane Fentonove kemijske metode (FeCl3 · 6 H2O+H2O2+ HCOOH), te pomoću fizikalno-kemijske metode upotrebom koagulanata/flokulanata (polielektrolita-POEL), koja kombinira anionski koagulant (modificirani poliakrilamid) i kationski flokulant (produkt dušikovih spojeva) uz adsorpciju na aktivnom ugljenu. Prihvatljivost opisanih metoda ispitivana je za reaktivna i kisela bojila, s obzirom na njihovu raširenu primjenu u tekstilnoj industriji. Također, provedena su ispitivanja na bojilima različitih kromogena (antrakinon, ftalocijanin, azo i ksanten) s ciljem određivanja važnosti prostorne strukture molekule. Oksidativno djelovanje Fentonovog i modificiranog Fentonovog postupka dovodi do razgradnje obojenog kromogena i visokog stupnja obezbojavanja. Međutim, ustanovljena je nemogućnost dodavanja POEL u stehiometrijskom odnosu (također prisutno kod modificiranog Fentonovog postupka), odnosno dodavanje koagulanata u suvišku kako bi se postigao viši stupanj obezbojavanja, što u konačnici dovodi do opterećenja voda POEL-ima. Kvaliteta vode na ulazu i izlazu kontrolirana je pomoću spektrofotometrijskih mjerenja i uobičajenih bioloških parametara. U prilog tome, dio ispitivanja bio je vezan za industrijske otpadne vode bojadisaone, u kojoj se pamučni materijal bojadisao bojilom C. I. Reactive Blue 19 i to tehnološkim postupkom koji zahtijeva uporabu velike količine elektrolita. Također, ispitivanje industrijskih otpadnih voda označeno je ključnim korakom izbjegavanja niza krivih pretpostavki i zaključaka, koji bi mogli nastati u slučaju laboratorijskog simuliranja procesa bojadisanja

Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques.

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P \u3c .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P \u3c .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P \u3c .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P \u3c .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion: A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm

Geographic and Age-Based Variations in Medicare Reimbursement Among ASSH Members.

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members\u27 Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). Hand-surgeons-per-capita and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state\u27s average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. Results: A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states\u27 average reimbursement, reimbursement was not significantly correlated with the state\u27s hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Conclusions: Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons\u27 peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons

A 12.5 GHz-Spaced Optical Frequency Comb Spanning >400 nm for near-Infrared Astronomical Spectrograph Calibration

A 12.5 GHz-spaced optical frequency comb locked to a Global Positioning disciplined oscillator for near-IR spectrograph calibration is presented. The comb is generated via filtering a 250 MHz-spaced comb. Subsequency nonlinear broadening of the 12.5 GHz comb extends the wavelength range to cover 1380 nm to 1820 nm, providing complete coverage over the H-band transmission widow of Earth's atmosphere. Finite suppression of spurious sidemodes, optical linewidth and instability of the comb have been examined to estmiate potential wavelength biases in spectrograph calibration. Sidemode suppression varies between 20 db and 45 dB, and the optical linewidth is ~350 kHz at 1550 nm. The comb frequency uncertainty is bounded by +/- 30 kHz (corresponding to a radial velocity of +/- 5 cm/s), limited by the Global Positioning System disciplined oscillator reference. These results indicate this comb can readily support radial velocity measurements below 1 m/s in the near-IR.Comment: 16 pages, 12 figures, new file fixes some readability problems on Mac