[Brain metastases occurring more often in colorectal carcinoma]. / Vaker hersenmetastasen bij colorectaal carcinoom.

BACKGROUND: Colorectal carcinoma (CRC) has a high incidence. If metastatic disease develops, the liver and lungs are the most frequently involved sites. Brain metastases are rare. CASE DESCRIPTION: We present a male patient (70 years old) with lung and liver metastases of CRC. For many years the disease was in good remission with palliative chemotherapy. He developed very acute neck pain and later also vomiting. The latter turned out to be based on the presence of brain metastases, which was soon fatal. CONCLUSION: The incidence of CRC is rising and with it the incidence of symptomatic brain metastases in CRC. Due to the development of more effective systemic chemotherapy, survival of advanced CRC has improved, providing more time for symptomatic brain metastases to develop.

Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial.

CONTEXT: Carpal tunnel syndrome (CTS) can be treated with nonsurgical or surgical options. However, there is no consensus on the most effective method of treatment. OBJECTIVE: To compare the short-term and long-term efficacy of splinting and surgery for relieving the symptoms of CTS. DESIGN, SETTING, AND PATIENTS: A randomized controlled trial conducted from October 1998 to April 2000 at 13 neurological outpatient clinics in the Netherlands. A total of 176 patients with clinically and electrophysiologically confirmed idiopathic CTS were assigned to wrist splinting during the night for at least 6 weeks (89 patients) or open carpal tunnel release (87 patients); 147 patients (84%) completed the final follow-up assessment 18 months after randomization. MAIN OUTCOME MEASURES: General improvement, number of nights waking up due to symptoms, and severity of symptoms. RESULTS: In the intention-to-treat analyses, surgery was more effective than splinting on all outcome measures. The success rates (based on general improvement) after 3 months were 80% for the surgery group (62/78 patients) vs 54% for the splinting group (46/86 patients), which is a difference of 26% (95% confidence interval [CI], 12%-40%; P<.001). After 18 months, the success rates increased to 90% for the surgery group (61/68 patients) vs 75% for the splinting group (59/79 patients), which is a difference of 15% (95% CI, 3%-27%; P =.02). However, by that time 41% of patients (32/79) in the splint group had also received the surgery treatment. CONCLUSION: Treatment with open carpal tunnel release surgery resulted in better outcomes than treatment with wrist splinting for patients with CTS.