Factors Affecting Willingness to Undergo Carpal Tunnel Release

Background: Factors regarding patient willingness to undergo or avoid joint replacement have been studied; however, these factors have not been studied in patients with carpal tunnel syndrome. To further understand the aspects that are important for a patient with carpal tunnel syndrome in deciding whether to have surgery, we identified factors that affect this decision in women and that are not related to Workers` Compensation status. Methods: We retrospectively reviewed 282 female patients with electrophysiologically confirmed carpal tunnel syndrome without a known cause who were recommended for carpal tunnel release by a single hand surgeon in a tertiary medical setting. Of those, thirty-six female patients who were not entitled to Workers` Compensation canceled the operation during the waiting period, which averaged four weeks. Thirty-three of them were surveyed with a questionnaire sent by mail, and eighteen completed surveys were reviewed at a mean follow-up of thirty-two months. Furthermore, seventy female patients who underwent carpal tunnel release were randomly sampled, and thirty-eight patients completed the survey. The operation and cancellation groups were compared with regard to the reasons for choosing or canceling surgery. Results: The groups were similar with regard to age, sociodemographic variables, follow-up length, initial electro-physiological findings, and functional status. The highest-ranked reason for choosing surgery was symptom severity rather than fear of progression or a positive electrodiagnostic result. Those who canceled the operation rated symptom improvement during the waiting period as the leading reason for doing so, but they were also concerned about transient weakness, the financial burden, and a scar or pillar pain. Disease persistence or recurrence was the issue of most concern in both groups. At the time of the final review, the functional status was significantly improved in both groups and no significant difference between the groups was detected. Conclusions: Women with carpal tunnel syndrome report that subjective symptom severity is the most important reason for undergoing surgery. Understanding this and other patient concerns may help physicians during patient-oriented consultation and decision-making. In particular, recommendations for carpal tunnel release on the basis of symptoms are reasonable from the perspective of the patient who has carpal tunnel syndrome without a known cause.Lee JY, 2008, J SHOULDER ELB SURG, V17, P570, DOI 10.1016/j.jse.2007.12.005Hudak PL, 2008, J BONE JOINT SURG AM, V90A, P1427, DOI 10.2106/JBJS.G.01077Park KK, 2007, CLIN ORTHOP RELAT R, P143, DOI 10.1097/BLO.0b013e31804ea0bcTaylor-Gjevre RM, 2007, CAN FAM PHYSICIAN, V53, P1186Rigler I, 2007, EUR J NEUROL, V14, P783, DOI 10.1111/j.1468-1331.2007.01855.xBallantyne PJ, 2007, ARTHRIT RHEUM-ARTHR, V57, P27, DOI 10.1002/art.22472*AAOS CARP TUNN SY, 2007, AM AC ORTH SURG GUIDSCHOLTEN RJ, 2007, COCHRANE DB SYST REV, V17, P3905Hawker GA, 2006, CURR OPIN RHEUMATOL, V18, P526Mazur DJ, 2005, HEALTH EXPECT, V8, P97FIGARO MK, 2005, J AMBUL CARE MANAGE, V28, P41Hawker GA, 2004, ARTHRIT RHEUM-ARTHR, V51, P635, DOI 10.1002/art.20524Figaro MK, 2004, HEALTH PSYCHOL, V23, P324, DOI 10.1037/0278-6133.23.3.324Chang HJ, 2004, ARTHRIT RHEUM-ARTHR, V51, P117, DOI 10.1002/art.20073AKELMAN E, 2004, HAND SURG, P867Moran M, 2003, J ARTHROPLASTY, V18, P442, DOI 10.1016/S0883-5403(03)00061-5RESENDE LA, 2003, ELECTROMYOGR CLIN NE, V43, P301Ang DC, 2002, MED CARE, V40, P471Hawker GA, 2001, MED CARE, V39, P206Bland JDP, 2000, MUSCLE NERVE, V23, P1280Trousdale RT, 1999, MAYO CLIN PROC, V74, P978Atroshi I, 1999, JAMA-J AM MED ASSOC, V282, P153Homan MM, 1999, SCAND J WORK ENV HEA, V25, P115Padua L, 1998, ITAL J NEUROL SCI, V19, P357Aulisa L, 1998, J HAND SURG-AM, V23A, P687Nathan PA, 1998, MUSCLE NERVE, V21, P711Concannon MJ, 1997, PLAST RECONSTR SURG, V100, P1452Asch DA, 1997, J CLIN EPIDEMIOL, V50, P1129Hudak PL, 1996, AM J IND MED, V30, P372Deber RB, 1996, ARCH INTERN MED, V156, P1414Hudak PL, 1996, AM J IND MED, V29, P602WRIGHT JG, 1994, J BONE JOINT SURG BR, V76B, P229LEVINE DW, 1993, J BONE JOINT SURG AM, V75A, P1585SIMINOFF LA, 1991, SOC SCI MED, V32, P813GRUNDBERG AB, 1983, J HAND SURG-AM, V8, P348

Effect of RAAS Inhibition on the Incidence of Cancer and Cancer Mortality in Patients with Glomerulonephritis

Angiotensin II type 1 receptor blocker (ARB), which is frequently prescribed in patients with glomerulonephritis (GN), is suggested to increase the risk of cancer. We registered 3,288 patients with renal biopsy and analyzed the relationship between the use of renin-angiotensin-aldosterone system (RAAS) blockade and the incidence of cancer or cancer mortality. After renal biopsy, cancer developed in 33 patients with an incidence rate of 1.0% (95% of CI for incidence: 0.7%-1.3%). There was no difference in the cancer incidence among the groups according to the use of angiotensin-converting enzyme inhibitors (ACEI) or ARB: 1.2% in the None (23/1960), 0.7% in the ARB-only (5/748), 0.4% in the ACEI-only (1/247), and 1.2% in the ACEI-ARB (4/333) (P = 0.487) groups. The cancer mortality was 2.1%, 0.4%, 0.0%, and 0.3% in None, ACEI-only, ARB-only, and ACEI-ARB group, respectively (P < 0.001). The risk of cancer mortality in patients with ARB was only 0.124 (0.034-0.445) compared to that of non-users of ARB by Cox's hazard proportional analysis. In conclusion, prescription of ACEI or ARB in patients with GN does not increase cancer incidence and recipients of ARB show rather lower rates of all-cause mortality and cancer mortality

Very Late Stent Thrombosis in a Drug-Eluting Stent due to Interruption of Anti-Platelet Agents in Patients With Acute Myocardial Infarction and Thrombocytosis

Stent thrombosis is a fatal complication in patients who have undergone percutaneous coronary intervention, and discontinuation of anti-platelet agent is a major risk factor of stent thrombosis. We report a rare case of very late stent thrombosis (VLST) following discontinuation of anti-platelet agents in a patient who experienced acute myocardial infarction and essential thrombocytosis. She had undergone implantation of a drug eluting stent (DES) and a bare metal stent (BMS) two and half years prior to her presentation. VLST developed in DES, not in BMS, following interruption of anti-platelet therapy

Pharmacokinetic properties and antitumor efficacy of the 5-fluorouracil loaded PEG-hydrogel

<p>Abstract</p> <p>Background</p> <p>We have studied the <it>in vitro </it>and <it>in vivo </it>utility of polyethylene glycol (PEG)-hydrogels for the development of an anticancer drug 5-fluorouracil (5-FU) delivery system.</p> <p>Methods</p> <p>A 5-FU-loaded PEG-hydrogel was implanted subcutaneously to evaluate the drug retention time and the anticancer effect. For the pharmacokinetic study, two groups of male rats were administered either an aqueous solution of 5-FU (control group)/or a 5-FU-loaded PEG-hydrogel (treated group) at a dose of 100 mg/kg. For the pharmacodynamic study, a human non-small-cell lung adenocarcinoma (NSCLC) cell line, A549 was inoculated to male nude mice with a cell density of 3 × 10⁶. Once tumors start growing, the mice were injected with 5-FU/or 5-FU-loaded PEG-hydrogel once a week for 4 weeks. The growth of the tumors was monitored by measuring the tumor volume and calculating the tumor inhibition rate (IR) over the duration of the study.</p> <p>Results</p> <p>In the pharmacokinetic study, the 5-FU-loaded PEG-hydrogel gave a mean residence time (MRT) of 8.0 h and the elimination half-life of 0.9 h; these values were 14- and 6-fold, respectively, longer than those for the free solution of 5-FU (p < 0.05). In the pharmacodynamic study, A549 tumor growth was significantly inhibited in the 5-FU-loaded PEG-hydrogel group in comparison to the untreated group beginning on Day 14 (p < 0.05-0.01). Moreover, the 5-FU-loaded PEG-hydrogel group had a significantly enhanced tumor IR (p < 0.05) compared to the free 5-FU drug treatment group.</p> <p>Conclusion</p> <p>We suggest that 5-FU-loaded PEG-hydrogels could provide a useful tool for the development of an anticancer drug delivery system.</p