Can the Boston Carpal Tunnel Syndrome Questionnaire Be Used as a Screening Tool Among a Potentially High-Risk Population in Singapore?

Introduction  Carpal tunnel syndrome (CTS) causes significant morbidity with delayed diagnosis or management. The Boston Carpal Tunnel Questionnaire (BCTQ) is validated for monitoring CTS following diagnosis; however, it has not been trialed in a screening capacity. The study aimed to determine whether it can be utilized when screening a focused population in Singapore. Materials and Methods  A single-center survey-based study was undertaken prospectively to identify whether positive symptoms could be identified among nursing and administrative staff. Results  A total of 605 staff responded. Positive symptoms were identified in 317 (52.4%) of participants and 23 (3.8%) reported them to be severe. Functional limitations were detected in 157 (26.0%) of participants with 5 (0.8%) reporting these as severe. Positive symptoms (84.9%) and functional limitations (81.5%) were more prevalent among nursing staff. Cronbach’s α scores (0.896 for symptoms and 0.84 for functional limitations) suggested good reliability in matching symptoms and functional limitations. Conclusion  The BCTQ can potentially be implemented as a screening tool for CTS among those without a prior diagnosis. It has a greater depth of questioning with symptomatic and functional limitations considered, and in situations where a formal diagnosis is subsequently made, the same tool can be subsequently used for progression tracking pre- and post-treatment. Level of Evidence  This is a Level II study.     

Sonographisch gef��hrte Gelenkpunktionen in der Rheumatologie

Joint and soft tissue injections are routinely performed in daily rheumatology practice to establish the diagnosis or as part of the treatment in patients suffering from rheumatic diseases. Consequently, joint injections have been included in the rheumatology further training curriculum. Despite numerous studies demonstrating a poor accuracy and outcome of joint injections guided only by clinical examination, most of the injection procedures are still performed in a "blind" fashion based on clinical judgment. Ultrasound has evolved as an established imaging method in rheumatology within the past decade and is considered the preferred imaging modality for joint interventions due to its availability and lack of radiation exposure. In this article the indications and important aspects of the practical management of ultrasound-guided injections performed in daily rheumatology practice are summarized.     

Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy

Background

Sleeve gastrectomy is gaining popularity whether as a primary, staged or revisional operation. The aim of this study is to evaluate the perioperative safety and the learning curve for laparoscopic sleeve gastrectomy (LSG).

Methods

We performed a retrospective review of the prospectively collected data for all patients who underwent LSG for the treatment of morbid obesity at our institution from January 2003 to December 2008.

Results

Data from 230 consecutive patients [male 47%, female 53%; mean age 44.0?±?10.0?years, mean preoperative body mass index (BMI) 56.7?±?11.5?kg/m²], who were operated upon by three surgeons with different degrees of bariatric experience, were analyzed. There was no 30-day mortality, but there were two cases of late mortality (0.87%). Early complications were noted in 23 cases (10.0%), including 10 cases of leak (4.3%) and 10 cases of hemorrhage (4.3%). In 17 cases (7.4%) reoperations were performed. The rates of overall and major complications did not differ among surgeons or between early and late period of experience for the three surgeons; this trend held true individually and in subgroups. Overall, over the course of the learning curve, a significant decrease in operative time was noted. The only factor that was independently associated with complications was use of buttress material; the likelihood of complications was found to be 72% lower in patients in whom buttress material was used.

Conclusions

LSG constitutes a potentially safe anti-obesity procedure with acceptable morbidity. Experience at the beginning can be discouraging, even for surgeons with advanced laparoscopic skills. LSG can be performed safely, with proper mentoring and in appropriate settings, even by less experienced bariatric surgeons. The use of staple-line reinforcement was associated with improved perioperative outcomes, and it should be considered in an attempt to decrease leaks.     

Stabilisierung instabiler Beckenfrakturen mittels pneumatischer Beckenschlinge im Schockraum

A 58-year-old man was suffered multiple trauma in a traffic accident. Besides fractures of the extremities, the clinical investigation showed an unstable pelvic injury which was stabilized in the resuscitation room by means of a pneumatic pelvic sling. In a CT of the trunk active bleeding from the liver was detected as well as free liquid in the small pelvis. The dorsal and ventral pelvic rings were anatomically repositioned. An emergency laparotomy was carried out with the pelvic sling still in position and the pelvic injury was stabilized with external fixation afterwards. This case demonstrates that unstable pelvic injuries can be stabilized by applying a pneumatic pelvic sling in the resuscitation room and that anatomical repositioning of the dorsal and ventral pelvic rings becomes possible in a simple way. Further diagnosis and treatment can thus be initiated without delay.     

Percutaneous liver biopsy: retrospective study over 15 years comparing 287 inpatients with 428 outpatients

Background and Aim:  Liver histology still represents the gold standard for the assessment of liver inflammation, necrosis, and fibrosis. The least cumbersome way of obtaining liver tissue is percutaneous liver biopsy. The aim of this retrospective study was to compare the complications following liver biopsy in in- and outpatients and to evaluate for which patients the benefit from liver biopsy is highest.
Methods:  All patients undergoing percutaneous liver biopsy at a teaching hospital between January 1990 and April 2005 were evaluated for indications, complications and impact of histology.
Results:  Liver biopsy was performed in 287 inpatients and 428 outpatients with a success rate of 99.4%. The total complication rate was 6.3% in inpatients and 11% in outpatients. Only two major complications, but no deaths occurred. Pain was the main complication, especially in young patients with chronic viral hepatitis. Despite normal alanine aminotransferase (ALT) levels advanced liver fibrosis was found in 9.3%, 2.6%, and 5.4% of all patients with HBV-, HCV infection, and non viral liver diseases, respectively. In 3% of all patients evaluated a previously unrecognized second liver disease was found. In 21.4% of the patients alkaline phosphatase (AP) levels were elevated, and in more than 90% of these patients liver biopsy led to the final diagnosis.
Conclusion:  Liver biopsy is safe in in- and outpatients. Biopsy is particularly helpful in patients suspected of having liver disease in spite of normal ALT levels or in patients exhibiting unexplained elevated AP levels.