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

Age-Related Changes in Antioxidative Enzyme Capacity in Tongue of Fischer 344 Rats

Objectives Antioxidative enzyme efficiency changes in some organs with age. However, no study has been conducted on age-related antioxidant enzyme changes in tongue. In the present study, the authors investigated the activities of four antioxidative enzymes and their protein expressions in the tongues of young and old Fischer 344 rats. Methods Age-dependent changes in the enzyme activities of total superoxide dismutase (SOD), Mn-SOD, Cu/Zn-SOD, catalase (CAT), and glutathione peroxidase (GPx) were determined using chemical kits, and the protein expressions levels of these enzymes by Western blotting. The study was conducted using rats aged 7 months (the young group, n=8) and 22 months (the old group, n=8). Results Total SOD, Cu/Zn-SOD, and GPx activities in the tongues of old rats were lower than in young rats, and similarly, corresponding protein expressions were downregulated in old rats. On the other hand, although the protein expressions of Mn-SOD and CAT were lower in old rats, their enzyme activities were not. Conclusion The results of this study provide a possible mechanism for the tongue aging process, as in old Fischer 344 rats the antioxidant defense system was diminished with respect to enzyme activity levels and protein abundances

Modified Bilhaut-Cloquet procedure for Wassel type-II and III polydactyly of the thumb. Surgical technique

BACKGROUND: The Bilhaut-Cloquet operation is a combined surgical procedure for the treatment of a symmetric bifid thumb. Although this procedure can obtain a normal-sized thumb with a stable interphalangeal joint, it has limitations, such as the technical difficulty of combining all segments of a duplicated thumb, possible later physeal growth arrest, joint stiffness, and nail plate deformity. We reviewed the results of our modification of this procedure for the treatment of Wassel type-II and III polydactyly of the thumb. METHODS: Seven patients, two with type-II and five with type-III polydactyly of the thumb, underwent this modified Bilhaut-Cloquet procedure and were followed for an average of fifty-two months. Cosmetic and functional assessments were made. RESULTS: All patients and parents were satisfied with the cosmetic and functional results. Compared with the preoperative motion, the postoperative range of motion of the interphalangeal joint was preserved in thumbs with type-III deformity and was increased in those with type-II deformity. No nail deformity or growth arrest occurred, and remodeling and hypertrophy of the distal phalanx occurred with time. CONCLUSIONS: Our modification of the Bilhaut-Cloquet procedure for the treatment of type-II and III thumb polydactyly is effective in preserving interphalangeal joint motion, minimizing nail deformity, and preventing growth arrest

Delayed Treatment of Zygomatic Tetrapod Fracture

Since maxillofacial injury is frequently accompanied by other diseases, its evaluation and treatment are open delayed. When the evaluation is delayed, the surgical treatment can be difficult or impossible. A 21-yr-old man presented with right facial swelling and deformity after injury. We planned immediate surgical repair for his right tetrapod fracture, but the operation was delayed for two months due to severe hyperthyroidism. During the operation, we reducted and fixed the deviated bone after refracture of the zygomatic arch with an osteotome to achieve mobility. The facial deformity and difficulty in mouth opening were improved after the operation. Even in the presence of accompanying fractures, early evaluation and proper management can prevent complications and achieve acceptable cosmetic outcomes in maxillofacial trauma patients. In patients with malunion of fracture sites, fixation after refracture using an osteotome can be a good treatment option for obtaining good mobility

Abdominal pain without bruising or sign of trauma: pancreatic injuries in children is difficult to predict

Pancreatic injuries due to trauma in children are rare. An early diagnosis is difficult as the signs and symptoms are insidious, but delays in diagnosis can lead to significant complications. We report a case of a child who visited the emergency department with aggravating abdominal pain. The physicians first diagnosed the abdominal pain as being caused by a disease in the emergency department, but the patient was subsequently diagnosed with pancreatic injury. Clinicians should be aware of a possible trauma in children who complain of vague abdominal pain even in the absence of corresponding history

Enhancement of angiogenic and vasculogenic potential of endothelial progenitor cells by haptoglobin

AbstractEndothelial progenitor cells (EPCs) were transfected with the haptoglobin (Hp) gene to investigate the effect of Hp on cell function. Hp potentiated the gene expression of various pro-angiogenic factors in the EPCs. The Hp-modified EPCs also increased in vitro tube formation on Matrigel compared with control cells. In hindlimb ischaemia models, Hp–EPCs showed a greater ability for improving blood perfusion and recovery from ischaemic injury. These results indicate that Hp improves EPC function in neovasculogenesis, which suggests that ex vivo modification of EPCs with the Hp gene can be applied to the treatment of vascular damage

Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Report

Primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is very rare, and little is known about its clinical course or effective treatment. We describe a case of primary duodenal MALT lymphoma that was resistant to Helicobacter pylori (H. pylori) eradication and regressed after chemotherapy with cyclophosphamide, vincristine, and prednisolone (CVP). A 71-year-old woman was referred to our department because of epigastric pain and dyspepsia. Gastroduodenoscopy revealed an irregular mucosal nodular lesion with ulceration extending from the bulb to the second portion of the duodenum. Histopathological examination of a biopsy specimen disclosed low-grade MALT lymphoma composed of atypical lymphoid cells with lymphoepithelial lesion. Abdominal CT scans revealed 0.5 to 1.5 cm lymph nodes in the peritoneal cavity, suggestive of lymph node metastasis. We successfully eradicated H. pylori but did not see signs of remission. We administered systemic CVP chemotherapy every 3 weeks. After 6 courses of CVP, the patient achieved complete remission and was followed up without recurrence for about a year

Age-Related Changes in Nuclear Factor Erythroid 2-Related Factor 2 and Reactive Oxygen Species and Mitochondrial Structure in the Tongues of Fischer 344 Rats

Objectives Previously the authors reported age-related changes in the activities of anti-oxidative enzyme activities and protein expressions in the tongues of rats. Because more information is required about relations between aging and oxidative stress and anti-oxidative enzyme efficiency, the authors investigated differences between the expression of master regulator of anti-oxidative enzymes (nuclear factor erythroid 2-related factor 2 [Nrf2]), levels of reactive oxygen species (ROS), and mitochondrial structures in the tongues of young and aged Fischer 344 rats. Methods Age-dependent changes in Nrf2 protein and ROS were determined by Western blotting and using chemical kits, respectively. Tongue specimens were examined by electron microscopy. The study was conducted using rats aged 7 months (young, n=8) or 22 months (old, n=8). Results Nrf2 protein levels in the tongues of aged rats were lower than in young rats. ROS levels were higher in older rats and mitochondrial structural deficits were observed their tongues. Three young rats showed moderate mitochondrial degeneration, whereas profound degeneration with mitochondrial cristae disruption, swelling, rupture, or intramitochondrial vacuole formation was observed in all 8 old rats. Notably, mitochondrial rupture was observed in 5 old rats. Conclusion Antioxidant defense systems of old rats were compromised by Nrf2 deficiency, which could lead to the deleterious accumulation and release of ROS and probably mitochondrial structural deficits in aged tongue tissues

Customized Energy Down-Shift using Iridium Complexes for Enhanced Performance of Polymer Solar Cells

School of Molecular Sciences(Chemistry)For the higher performance of polymer solar cells (PSCs), many researchers tried to develop new polymers that can absorb broader range of spectrum. However, there are some limits to absorb broader range with single donor. Therefore, multi donor systems and energy transfer systems have been researched. With two different donors it is easier to enhance absorption range. As a result, multi donor and energy transfer was successful to increase performance. However, the existing systems are applying polymer-polymer systems. When two different polymers are mixed, the compatibility between two polymers is critical to morphology of blend film. Also, in polymer-polymer energy transfer, the boundary between charge transfer and energy transfer is unclear. Therefore, for the first time, we developed customized iridium (Ir(III)) complexes, with Ir(III) complex incorporated into the active materials poly(thieno[3,4-b]-thiophene/benzodithiophene) (PTB7, amorphous) or poly(3-hexylthiophene) (P3HT, high crystalline) as energy donor additives. The Ir(III) complex with the 2-phenyl quinolone ligand energy donor increased the power conversion efficiency of the corresponding devices by approximately 20%. The enhancements are attributed to the improved molecular compatibility and energy level between the Ir(III) complex and the active materials, long F??rster resonance energy transfer radius, and high energy down-shift efficiency. Overall, we reveal Ir(III) complex additives for amorphous and highly crystalline polymer active materialsthese additives would enable efficient energy transfer in polymer solar cells, while retaining the desirable active layer morphology, thereby resulting in improved light absorption and conversion.ope