Recurrence of Ganglion Cysts Following Re-excision.

BACKGROUND: The recurrence of ganglion cysts after surgical excision has a reported rate of 4% to 40%. Recurrence rate after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a secondary excision procedure. METHODS: With Institutional Review Board approval, we retrospectively identified by CPT code and reviewed charts of patients who had recurrent ganglion cyst excision performed over a five-year period (2010 - 2014). Recurrence was defined as reappearance of a cyst in the same area as it was previously. Demographic information including recurrences and revision surgeries was collected in addition to outcome variables such as patient satisfaction, pain levels, and functional limitations. RESULTS: Out of the 42 revision cases identified 20 patients were reached. Mean time to recurrence of the cyst after the first ganglion cyst excision was 2.5 years (range: 1 month - 12 years). After the second ganglion cyst excision, three patients (15%) had a recurrence, each occurring within one year (mean: 11 months; range: 9-12). One of the three patients underwent a third successful ganglion cyst excision. The other two patients declined surgical intervention to date. Patients without a second recurrence (n=17) reported an average pain score of 0.1 (range: 0-2) on a scale of 1-10. Three (18%) reported some difficulty with day-to-day activities due to their scar. Seven (41%) patients reported at least transient numbness or tingling. Mean satisfaction was 9.8 on a scale of 1-10, and 100% reported that they would undergo another ganglion cyst excision should they ever have another recurrence. CONCLUSION: Patients should be advised about the risk of recurrence after re-excision of ganglion cysts, which was noted to be 15% in our cohort. This rate of recurrence is similar to that of primarily excised cysts.

Validación de cuestionario por juicio de expertos: Perfil del Enfermero/a que labora en el Servicio de Emergencia y Urgencias / Questionnaire validation by expert judgment: Profile of Emergency and Urgency Services Nursing Staff

INTRODUCCIÓN: Los profesionales de enfermería que se desempeñan en el servicio de Emergencia y Urgencia de los Hospitales realizan un trabajo diario de atención directa a pacientes, en situación de altos estímulos y presión de trabajo permanente; por lo que esimportante desarrollar un cuestionario que ayude a establecer un perfil adecuado tanto científico como técnico y ético, que deben poseer las enfermeras/os que trabajan en las áreas hospitalarias de Emergencia y Urgencia. MÉTODOS: El objetivo de este estudio fue validar un cuestionario que ayude a la identificación del perfil que debe poseer la Enfermera/o profesional que labore en el Servicio de Emergencia y Urgencia. El cuestionario estuvo constituido por 32 ítems, y fue validado por 4 expertos; se utilizó el coeficiente de Kappa de Fleiss para evaluar la concordancia entre jueces. RESULTADOS: Uno de los ítems (pregunta N°12) para los 4 jueces fue inadecuada y tuvo que ser retirada; 5 ítems (preguntas 1, 5, 9, 11 y 19) necesitaba de cambios por lo que de acuerdo con los requerimientos entregados por los mismos jueces se realizaron dichos cambios; un total de 26 ítems obtuvieron una concordancia "casi perfecta" de ítems totalmente adecuados. CONCLUSIÓN: Como resultado, el cuestionario original culminó con un total de 31 ítems y tiene la validez de contenido requerido. Este cuestionario podrá ser validado en el constructo mediante el uso de una prueba piloto aplicada a Enfermeras/os en los servicios de Emergencia y Urgencia. El presente cuestionario permite evaluar el perfil del personal profesional de enfermería que debe poseer previo a su ingreso a laborar en el área estudiada.

BACKGROUND: Nursing professionals that work in Emergency and Urgency services, daily carry out direct patient care, in a high stimuli situation and permanent work pressure; therefore it is important to develop a questionnaire that helps establishing an adequate scientific, technical and ethical profile, for nurses who work in Emergency and Urgency hospital areas. METHODS: The aim of this study was to validate a questionnaire able to identify the profile that Emergency and Urgency Services nurses should have. The questionnaire consisted of 32 items, and was validated by 4 experts; Fleiss Kappa coefficient was used to evaluate the agreement between judges. RESULTS: One of the items ( question No.12) was inadequate for all of the judges and had to be withdrawn; 5 items (questions 1,5,9,11 and 19) needed changes, so in accordance with the judges requirements, these changes were made; a total of 26 items obtained an "almost perfect" concordance of totally adequate items. CONCLUSION: The original questionnaire ended with a total of 31 items and has the required content validity. This questionnaire can be validated in the construct through the use of a pilot test applied to nurses in Emergency and Urgency services. This questionnaire makes it possible to evaluate the profile of the nursing staff prior to working in the emergency area.

An Assessment of Online Reviews of Hand Surgeons.

BACKGROUND: The purpose of this study is to evaluate the number of reviews and scores for active members of the American Society for Surgery of the Hand (ASSH) in popular physician rating websites (Healthgrades.com and Vitals.com). METHODS: A total of 433 ASSH active members were searched in two popular rating websites for a total of 866 web searches. Demographic data, overall and subcategory scores, number of reviews, and wait times were scored from each member's webpage. RESULTS: The average number of reviews per surgeon on Healthgrades.com and Vitals.com were 13.8 (range 1-108) and 9.4 (range 0-148), respectively. The average overall score for physicians was 8.1 out of 10 points. For both websites, the vast majority (80-90%) of active members of the ASSH had 20 or less reviews. Multivariate data analysis revealed no statistical differences in overall score by region (P=0.24) or gender (P=0.38). Increasing physician age negatively correlated with overall score (P=0.01). Wait time was not associated with a negative score (P=0.38). CONCLUSION: Active members of the ASSH received generally positive reviews. The average number of reviews for active members of the ASSH was exceedingly small, bringing into question the legitimacy and validity of these scores. This is especially important when taking into consideration the increasing popularity of these websites, and the reliance of patients on them to obtain physician information. The clinical implication of this study is that physicians have a vested interest in the legitimacy of the data provided by these websites and other physician rating outlets.

Frequency of Incidental Median Thenar Motor Nerve Branch Visualization During Mini-Open and Endoscopic Carpal Tunnel Release.

Background: Clinical studies using extensile approaches for carpal tunnel release (CTR) report a fairly high incidence of thenar motor branch (TMB) variants. As mini-open and endoscopic CTRs have become commonplace, the likelihood of encountering one of these variants in current practice is unknown. The purpose of the present study was to assess prospectively the frequency with which TMB variants are encountered during routine surgery. Methods: All patients who underwent a primary CTR between August 2014 and April 2015 by 11 hand fellowship-trained, orthopedic surgeons were prospectively evaluated. All surgeons performed releases in their usual technique and notified the lead investigator of any median nerve variations encountered. A total of 890 primary CTRs in 795 patients were performed during the study period. Results: Four TMBs seen were transligamentous variants (4/890 of procedures = 0.45%; 4/795 of patients = 0.50%). Three were identified during open CTR, and 1 during endoscopic CTR. In 2 cases, the transligamentous TMB originated from the volar aspect of the median nerve and penetrated the midportion of the transverse carpal ligament. One TMB originated from the volar and ulnar aspect of the median nerve. One TMB originated from the ulnar aspect of the median nerve proximal to the carpal tunnel. There were no cases of TMB injury during the course of the study. Conclusions: TMB variations are encountered infrequently during routine CTR. The most commonly encountered variant during routine mini-open or endoscopic CTR in our study was a transligamentous branch.

Ossified Dorsal Wrist Ganglion Cyst: A Case Report.

Ganglion cysts are the most common wrist tumors, and 60 -70% originate dorsally from the scapholunate interval. Ossification of these lesions is exceedingly rare, with only one such lesion located in the finger reported in the literature. We present a case of an ossified dorsal wrist ganglion in a 68-year-old woman.

Hand Dominance and Common Hand Conditions.

The goals of this study were to (1) assess how frequently patients present for evaluation of common hand disorders in relation to hand dominance and (2) evaluate the effect of hand dominance on function in patients with these conditions. The authors hypothesized that (1) the majority of patients who seek evaluation would have a condition that affects the dominant hand, and (2) disability scores would be worse if the dominant hand is involved. They retrospectively reviewed the records of consecutive patients who presented for treatment to their institution with unilateral symptoms of 5 common disorders of the hand: carpal tunnel syndrome (CTS), de Quervain's tenosynovitis (DEQ), lateral epicondylitis (LE), hand osteoarthritis (OA), and trigger finger (TF). The authors assessed the effect of diagnosis and hand dominance on Disabilities of the Arm, Shoulder and Hand (DASH) scores. The study group comprised 1029 patients (379 men and 650 women) with a mean age of 59.5 years. Ninety percent were right-hand dominant. The dominant and nondominant hands were affected with relatively equal frequency for CTS, DEQ, OA, and TF (range, 45%-53%). Patients with LE had a significantly higher incidence of dominant hand involvement. Men had lower DASH scores than women by an average of 7.9 points, and DASH scores were significantly but slightly higher for the overall group (3.2 points) when the dominant side was affected. Men with LE and women with TF and OA had significantly higher DASH scores when their dominant extremity was affected. Common hand disorders such as CTS, DEQ, OA, and TF affect the dominant and nondominant hands in roughly equivalent proportions, whereas LE is more common on the dominant side. Dominant hand involvement results in significantly worse DASH scores, although the magnitude of this is relatively small. Women have significantly higher DASH scores than men for the conditions evaluated. [Orthopedics. 2016; 39(3):e444-e448.].