Clinical course of the non-operated hand in patients with bilateral idiopathic carpal tunnel syndrome

PURPOSE: Patients with bilateral carpal tunnel syndrome (CTS) who had unilateral carpal tunnel surgery usually ask about the prognosis for the non-operated, opposite hand. In this study, we investigated the effects of unilateral carpal tunnel surgery on the clinical course of the non-operated, opposite hand in bilateral idiopathic CTS. METHODS: In this prospective study, only patients who had bilateral idiopathic CTS but had unilateral carpal tunnel surgery were included. Sixty-six patients were included in the study. All patients were women with the mean age 47 years and mean duration of symptoms 4 years. Forty-six surgeries were performed on right hands, and 20 surgeries performed on left hands. Forty-eight (73%) patients were housewives. Their non-operated, opposite hands were evaluated before and 6 months after unilateral surgery. The evaluations consisted of subjective symptoms and objective findings. Paired t-test and chi-square test were used for statistical analysis. RESULTS: There were no statistically significant differences between the means of symptom severity score, functional status score, power and pinch grip strength before and 6 months after unilateral surgery in the non-operated, opposite hands. There was no statistically significant differences among the percentages of the Tinel's sign, Phalen test, and electrophysiological changes before and 6 months after unilateral surgery on the non-operated, opposite hands. During the study period, 57 (86%) patients had surgery or intended to have surgery for their opposite hands. CONCLUSIONS: It seems that unilateral surgery for bilateral idiopathic CTS does not affect the clinical course of the non-operated, opposite hand. We recommend that each hand of patients with bilateral CTS be managed separately, based on their symptoms.     

Residual stress of porcelain-fused to zirconia 3-unit fixed dental prostheses measured by nanoindentation

Objective

To evaluate the residual stress (nanoindentation based on hardness) of fatigued porcelain-fused to zirconia 3-unit fixed dental prostheses (FDP) with different framework designs.

Opium and opioid abuse in orthopedic inpatients: a cross sectional study in Urmia University of Medical Sciences

During a cross-sectional study, patients who were admitted to the orthopedic department of the Urmia University of Medical Sciences were asked about opium/opioid abuse. Demographic characteristics, the pattern of consumption, the substance, the duration of the use, the duration of hospital stay and the cause of their injuries were recorded. Among 2,867 patients, 74 (2.5%) patients (71 men and 3 women) with the mean age of 38 were opium/opioid users. Most of the patients used opium through inhalation. The mean duration of the substance use was 7.4 years. The mean duration of hospital stay between the regular orthopedic patients and the opium/opioid abuser orthopedic patients was statistically significant. (P=000). Among four Hepatitis C Virus (HCV) infected patients, three subjects were injection users and Human Immunodeficiency Virus (HIV) also infected two of them. Road traffic accidents (37.8%), and work related injuries (17.5%) were the two most common reasons for the patient's injuries.     

Diseases detected with defecographic examination in 300 patients]

Defecography is a radiological examination providing morphological details of the anorectal tract. Over almost 3 years, 300 patients were examined. The authors report on the method and the pathologic conditions they observed. The patients were seated in latero-lateral position on a radiolucent water-filled commode: lead marks were taped to define perianal skin. 150 ml of high-density barium paste were introduced into the rectum and radiographs were then acquired, at rest and during squeezing and straining. All examination phases, especially the study of dynamic evacuation, were recorded on a videotape connected to a brilliance intensifier. From their experience, the authors conclude that defecography is a valuable tool in the diagnosis and evaluation of: rectocele, occult rectal prolapse, and elevator ani tone. The technique proved less useful in the evaluation of fecal incontinence. The authors strongly suggest that the patient be previously examined by a coloproctologist. Defecography is thought to help the surgeon in the choice of therapy, together with other diagnostic procedures and with clinical history.     

Activation of caspase-8 and caspase-12 pathways by 7-ketocholesterol in human retinal pigment epithelial cells

PURPOSE: To determine whether caspase or cathepsin pathways are activated in human retinal pigment epithelial cells (ARPE-19) after exposure to 7-ketocholesterol (7kCh). METHODS: ARPE-19 cells were exposed to 7kCh with or without z-VAD-fmk, a pan-caspase inhibitor. Caspase-3, -8, and -9 activities were measured by a fluorochrome inhibitor of caspase (FLICA) assay. Caspase-12 activity was detected by Western blotting. RT-PCR was performed for 18s, mortalin-2, cathepsins B, D, and L/V2. RESULTS: At 24 hours, 7kCh-treated cultures had increased caspase-8 (P < 0.001) and caspase-3 (P < 0.001) activities compared with vehicle-treated cultures. 7kCh-induced caspase-3 activation was blocked by z-VAD-fmk (P < 0.001). Caspase-9 was not activated by 7kCh treatment (P > 0.05). Procaspase-12 was cleaved into its active form after treatment with 7kCh for 24 hours. At 6 hours, the RNA level for mortalin-2, a pro-survival gene, was upregulated. ARPE-19 cells did not express RNA for cathepsins B, D, or L/V2 under any conditions. CONCLUSIONS: In ARPE-19 cells, 7kCh-induced apoptosis uses the receptor-mediated caspase-8 pathway and the endoplasmic reticulum stress-induced caspase-12 pathway but not the mitochondrial caspase-9 pathway. The cathepsin pathways are not involved in 7kCh-induced cell death. These data demonstrate that 7kCh causes a loss of cell viability through caspase-dependent apoptosis and can act as an oxidative stressor leading to retinal pigment epithelial cell atrophy. Elucidating the specific apoptotic pathways involved may have therapeutic potential for AMD and other retinal diseases.     

Clinical echinococcosis.

In 221 patients (0.48% of hospital admissions) with hydatid disease (122 female and 99 males), 81% had single and 19% multiple organs involved. Lungs, liver and spleen as single sites of echinococcosis together represented 83.24% of cases and the liver alone represented 95.24% of instances with multiple organ involvement. One hundred seventy-nine single and 74 multiple cysts (ratio of 2.42/1) represented a total of 363 cysts (1.64 cysts/patient). The incidence of intact cysts was 51.52% and 48.48% had ruptured. Ruptures numbered highest in the lungs (73.44%) and greater in multiple (79.66%) than in single cysts (68.12%). In the liver, 27.14% of single and 54.55% of multiple cysts (40.44% of all liver cysts) had ruptured. Cysts varied in size from 0.8 to 35 cm diameter. Single cysts averaged significantly higher (14.16 cm) and multiple ones lower (5.71 cm) as did intact (6.75 cm) versus reptured cysts (4.33 cm). Except for 10 silent and 15 symptomatic cysts treated medically, all the rest were treated surgically by removal of the endocyst or resection of both endo and exocysts including 205 first, 31 second and 5 third procedures (1.75% of all major operations). Complications occurred in 28.57%. Surgical mortality (3.57%) was markedly lower than with conservative treatment (60%) and significantly less than that of the whole group (14.48%).     

Carcinoma of prostate presenting as retroperitoneal mass

The pattern of dissemination of prostatic carcinoma varies, but skeletal metastasis is the single most common symptomatic mode of presentation. The clinical course and treatment of the 2 cases presenting with symptomatic metastases to the retroperitoneum are described in detail and pertinent literature is reviewed.