Stability assessment of serum tumour markers: Calcitonin, chromogranin A, thyroglobulin and anti-thyroglobulin antibodies.

BACKGROUND: There is limited published data on the stability of calcitonin, chromogranin A, thyroglobulin and anti-thyroglobulin antibodies in serum. The aim of this study was to determine stability at three temperature conditions over 7 days, reflecting current laboratory practices. METHODS: Surplus serum was stored at room temperature, refrigerated and in the freezer; for 1, 3, 5 and 7 days. Samples were analysed in batch and analyte concentrations compared to that of a baseline sample. Measurement Uncertainty of the assay was used to determine the Maximal Permissible Difference and thus the stability of the analyte. RESULTS: Calcitonin was found to be stable for at least 7 days in the freezer but only 24 h refrigerated. Chromogranin A was stable for 3 days when refrigerated and only 24 h at room temperature. Thyroglobulin and anti-thyroglobulin antibodies were stable under all conditions for 7 days. CONCLUSION: This study has enabled the laboratory to increase the add-on time limit of Chromogranin A to 3 days, and up to 60 min for calcitonin and inform optimal storage and transportation conditions for referring specimens.

Closed traumatic rupture of the thenar muscles from the origin: a case report and review of the literature.

Closed traumatic rupture of the thenar muscles is an unusual and rare injury. Traumatic musculotendinous injuries in the hand and wrist occur primarily from penetrating trauma. Only 2 such cases were identified in medical literature. We report a case of closed traumatic rupture of the thenar muscles in an otherwise healthy 33-year-old female nurse who sustained a hyperabduction injury of her right thumb and wrist during a daily occupational routine, resulting in complete avulsion of the right abductor pollicis brevis and opponens pollicis from their origins. After declining initial surgical management, the patient subsequently returned 6 months later reporting continued pain, paresthesias, and thenar deformation, and requested surgical intervention. On examination, she continued to exhibit weakness of thumb abduction and mild weakness with opposition. She was again offered an open carpal tunnel release with exploration of the thenar eminence and possible tendon transfer, although she adamantly refused any tendon transfer. An open right carpal tunnel release was performed with exploration and direct muscle repair through a lateral thenar incision. Primary muscular reattachment was accomplished by suturing the abductor pollicis brevis and opponens pollicis to the flexor retinaculum and the trapezium. Functional results 15 months after surgery were satisfactory with improvements in abduction and opposition of the thumb and restoration of the thenar contour. The chosen surgical technique for repair resulted in good functional outcome, while avoiding the need for tendon transfer.

Management of fingertip amputations.

Injuries to the fingertips are among the most common injuries to the hand and result in approximately 4.8 million emergency department visits per year. Most injuries are lacerations or crushes; amputations represent a small but complex spectrum of injury. Treatments available cover a broad range of techniques with no single recommended reference standard for treatment. Although there is no consensus on how these injuries should be treated, the goals of treatment should include minimization of pain, optimization of healing time, preservation of sensibility and length, prevention of painful neuromas, avoidance or limiting of nail deformity, minimization of time lost from work, and provision of an acceptable cosmetic appearance. In this review we present a variety of options in caring for these injuries to help achieve these goals, and the available data that support the various treatment plans.

Muscle hernias of the leg: A case report and comprehensive review of the literature.

A case involving a retired, elderly male war veteran with a symptomatic peroneus brevis muscle hernia causing superficial peroneal nerve compression with chosen surgical management is presented. Symptomatic muscle hernias of the extremities occur most commonly in the leg and are a rare cause of chronic leg pain. Historically, treating military surgeons pioneered the early documentation of leg hernias observed in active military recruits. A focal fascial defect can cause a muscle to herniate, forming a variable palpable subcutaneous mass, and causing pain and potentially neuropathic symptoms with nerve involvement. While the true incidence is not known, the etiology has been classified as secondary to a congenital (or constitutional) fascial weakness, or acquired fascial defect, usually secondary to direct or indirect trauma. The highest occurrence is believed to be in young, physically active males. Involvement of the tibialis anterior is most common, although other muscles have been reported. Dynamic ultrasonography or magnetic resonance imaging is often used to confirm diagnosis and guide treatment. Most symptomatic cases respond successfully to conservative treatment, with surgery reserved for refractory cases. A variety of surgical techniques have been described, ranging from fasciotomy to anatomical repair of the fascial defect, with no consensus on optimal treatment. Clinicians must remember to consider muscle hernias in their repertoire of differential diagnoses for chronic leg pain or neuropathy. A comprehensive review of muscle hernias of the leg is presented to highlight their history, occurrence, presentation, diagnosis and treatment.

Les auteurs présentent le cas d'un vétéran âgé retraité ayant une hernie symptomatique du muscle court péronier responsable d'une compression du nerf péronier superficiel associée à une intervention chirurgicale précise. Les hernies symptomatiques des muscles des membres se produisent surtout dans la jambe et constituent de rares causes de douleurs chroniques de la jambe. Par le passé, les chirurgiens militaires traitants ont consigné les premiers cas de hernies de la jambe observés chez les recrues militaires actives. Une anomalie aponévrotique focale peut provoquer la herniation d'un muscle, une masse sous-cutanée palpable entraînant de la douleur et des symptômes au potentiel neuropathique associés à une atteinte nerveuse. On n'en connaît pas la véritable incidence, mais l'étiologie est classée comme secondaire à une faiblesse aponévrotique congénitale (ou constitutionnelle) ou à une anomalie aponévrotique acquise, qui découle habituellement d'un traumatisme direct ou indirect. On pense que l'occurrence la plus élevée s'observe chez les jeunes hommes physiquement actifs. L'atteinte du muscle tibial antérieur est la plus courante, mais d'autres muscles peuvent être touchés. L'échographie dynamique ou l'imagerie par résonance magnétique permet souvent de confirmer le diagnostic et d'orienter le traitement. La plupart des cas symptomatiques répondent bien à un traitement prudent, la chirurgie étant réservée aux cas réfractaires. Il existe diverses techniques chirurgicales, de la fasciotomie à la réparation anatomique de l'anomalie aponévrotique, mais aucun consensus ne se dégage quant au traitement optimal. Les cliniciens doivent se souvenir d'envisager les hernies musculaires dans le diagnostic différentiel des douleurs chroniques ou des neuropathies de la jambe. Une analyse approfondie des hernies musculaires de la jambe est présentée afin d'en faire ressortir les antécédents, l'occurrence, la présentation, le diagnostic et le traitement.

Reduction mammaplasty: a review of managed care medical policy coverage criteria.

BACKGROUND: Insurance companies evaluate the medical necessity for breast reduction surgery based on internal company medical policies, but the correlation of insurance company criteria to the scientifically established indications for reduction mammaplasty has never been studied. The authors obtained 90 insurance company medical policies for reduction mammaplasty to determine whether the criteria on which coverage determinations are made are consistent with published data regarding the indications for this procedure. METHODS: The authors reviewed the medical literature on reduction mammaplasty and identified what conclusions can reasonably be drawn from this literature on the common insurance criteria used to determine medical necessity for reduction mammaplasty. Conclusions based on the medical literature regarding volume of reduction, symptom presentation, conservative therapy, obesity, presence of bra strap grooving and intertrigo, and age at time of reduction were formulated, and these conclusions were compared with the criteria of 90 different health insurance reduction mammaplasty medical policies. RESULTS: The authors were unable to identify any medical policies that could be supported in entirety by the medical literature and many that are completely unfounded based on the medical literature. CONCLUSIONS: Insurance company medical policy requirements with respect to reduction mammaplasty are, in many cases, arbitrary and without scientific basis. Requirements for a specific volume of reduction, a minimum age, a maximum body weight, and a trial of conservative therapy are required by the majority of managed care medical policies, even though scientific support for any of these requirements is not evident in the medical literature.