Analgesic Consumption Following Outpatient Carpal Tunnel Release.

PURPOSE: Few studies have examined the consumption of prescribed opioid medications after elective outpatient surgery. A better understanding of opioid consumption after elective upper-extremity surgery may lead to improved prescribing practices, decreased costs, and less leftover medication available for potential misuse. The goal of this study was to evaluate pain control and quantify the amount of leftover pain medication after outpatient carpal tunnel release. METHODS: We performed a prospective study of patients scheduled for outpatient carpal tunnel surgery. All patients had failed nonsurgical treatment and had an electromyelogram/nerve conduction study confirming the clinical diagnosis. All patients were encouraged to remove the dressing on the first postoperative day. A total of 56 patients were initially enrolled in the study; 7 did not meet the inclusion criteria, which left 49 patients who completed the study. Average age was 57 years; 66% of patients were female. Information collected included analgesic prescribed, number of tablets consumed, and number of tablets remaining. Use of postoperative orthoses, complications, use of other analgesic medications, and reasons for not taking the prescribed analgesics were recorded. RESULTS: Paracetamol with codeine and paracetamol with tramadol accounted for all prescriptions. Patients most frequently were given a prescription for 40 tablets. Average number of tablets consumed was 10 (range, 0-40 tablets). More than half of patients consumed fewer than 2 tablets. The average number of postoperative days of analgesic consumption was 2 (range, 0-7 days). Overall 1,531 tablets were leftover from the entire cohort. CONCLUSIONS: This study demonstrates that excess prescription analgesics are being prescribed after carpal tunnel surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

A review on hydrothermal pre-treatment technologies and environmental profiles of algal biomass processing.

The need for efficient and clean biomass conversion technologies has propelled Hydrothermal (HT) processing as a promising treatment option for biofuel production. This manuscript discussed its application for pre-treatment of microalgae biomass to solid (biochar), liquid (biocrude and biodiesel) and gaseous (hydrogen and methane) products via Hydrothermal Carbonisation (HTC), Hydrothermal Liquefaction (HTL) and Supercritical Water Gasification (SCWG) as well as the utility of HT water as an extraction medium and HT Hydrotreatment (HDT) of algal biocrude. In addition, the Solar Energy Retained in Fuel (SERF) using HT technologies is calculated and compared with benchmark biofuel. Lastly, the Life Cycle Assessment (LCA) discusses the limitation of the current state of art as well as introduction to new potential input categories to obtain a detailed environmental profile.

Dupuytren contracture in the pediatric population: a systematic review.

Dupuytren contracture of the palm is a relatively common benign fibroproliferative disease of the palmar fascia typically affecting the adult population. There have however been several reported cases of Dupuytren contracture in children. We sought to review the literature for Dupuytren contracture and highlight the main clinical features and management of the disease in children.

Abdominal compartment syndrome following abdominoplasty: A case report and review.

Abdominoplasty is among the most commonly performed aesthetic procedures in plastic surgery. Despite high complication rate, abdominal contouring procedures are expected to rise in popularity with the advent of bariatric surgery. Patients with a history of gastric bypass surgery have an elevated incidence of small bowel obstruction from internal herniation, which is associated with non-specific upper abdominal pain, nausea, and a decrease in appetite. Internal hernias, when subjected to elevated intra-abdominal pressures, have a high-risk of developing ischemic bowel. We present a case report of patient with previous laparoscopic Roux-en-y gastric bypass who developed acute ischemic bowel leading to abdominal compartment syndrome following abdominoplasty. To the best of our knowledge, this is the first reported case in the literature. We herein emphasise on the subtle symptoms and signs that warrant further investigations in prospective patients for an abdominal contouring procedure with a prior history of gastric bypass surgery.

Propranolol versus corticosteroids in the treatment of infantile hemangioma: a systematic review and meta-analysis.

BACKGROUND: Infantile hemangiomas are benign vascular neoplasms that can cause numerous functional or cosmetic problems. The authors reviewed the pathogenesis of hemangioma and compared the efficacy and complications related to therapy with propranolol versus corticosteroids. METHODS: A comprehensive review of the literature was conducted from 1965 to March of 2012 using MEDLINE, PubMed, Ovid, Cochrane Review database, and Google Scholar. All articles were reviewed for reports of clinical cases, reported side effects, doses, duration of treatment, number of patients, and response rate to treatment. RESULTS: A total of 1162 studies were identified. Of those, only 56 articles met inclusion criteria after review by two independent reviewers (A.I. and J.K.). For the meta-analysis, 16 studies comprising 2629 patients and 25 studies comprising 795 patients were included. Less than 90 percent of patients treated with corticosteroids responded to therapy, compared with 99 percent of patients treated with propranolol after 12 months of follow-up. Meta-analysis demonstrated the corticosteroid studies to have a pooled response rate of 69 percent versus the propranolol response rate of 97 percent (p < 0.001). CONCLUSIONS: Propranolol is a relatively recent therapy of hemangiomas with fewer side effects, a different mechanism of action, and greater efficacy than current first-line corticosteroid therapy. Many of these studies do not have the same patient population or duration/regimen of treatment for hemangiomas; however, based on available data in the literature, it appears that propranolol could be an emerging and effective treatment for infantile hemangiomas. Further randomized controlled trials are recommended.

An atypical growth of a giant fibroadenoma after trauma.

BACKGROUND: Fibroadenomas are the most common benign breast lesion in female adolescents. However, it is important to recognize that a small percentage have been shown to progress to giant fibroadenomas. Giant fibroadenomas can spontaneously infarct leading to significant morbidity and are also difficult to distinguish from the more aggressive phyllodes tumors. CASE: We describe the first case, to the best of our knowledge, of a 12-year-old girl who presented with a giant fibroadenoma complicated by a central infarct and an intra-lesional hemorrhage from a trauma to the breast. SUMMARY AND CONCLUSION: The complicated giant fibroadenoma with an intra-lesional hemorrhage has characteristics of both benign and malignant lesions, and is difficult to distinguish by history and physical alone. Ultrasonography is a valuable tool yet the core needle biopsy remains the gold standard to confirm the diagnosis.

Salter-harris type 2 fracture of the proximal phalanx of the thumb with a rotational deformity: a case report and review.

Hand fractures are the most common site of injury in the pediatric population. They commonly involve the epiphyseal growth plates, and their standard classification is that of Salter-Harris (SH). Rotational deformities after SH fractures are rarely reported in literature. However, only 5 degrees of angulation can cause evident rotational deformity. This could be seen clinically and reconfirmed with radiologic evaluation. Up to this date, there are only a few cases of SH fractures with rotational deformity that have been described. We present 2 cases of SH type 2 with evidence of rotational deformity, which were reduced under local anesthesia in the emergency department. A review of literature is performed. Thus, examination for rotational deformities in SH fractures should be kept in mind. A satisfactory closed reduction under local anesthesia can be obtained.

Pediatric boutonniere deformity after blunt closed traumatic injury.

The boutonniere deformity (BD) is a well-described condition in hand surgery. Treatment of acute traumatic BD includes splinting of the proximal interphalangeal joint in extension for 4 to 5 weeks, which often leads to acceptable results. However, the chronic BD is more problematic and often requires surgical intervention with poor functional outcomes. Boutonniere deformity is extremely rare in the pediatric population. We present the case of a 9-year-old girl who presented to the emergency department with an acute traumatic BD after a fall. Being an uncommon entity in this patient population, the patient was referred to the plastic surgery clinic and was subsequently treated appropriately with splinting, resulting in favorable results as early as 4 weeks. To our knowledge, this is the first reported case of BD in the pediatric patient population. Recognition and timely management of BD in a pediatric patient should not be overlooked to obtain favorable results.

Late presentation of a complete complex thumb metacarpophalangeal joint dislocation: A case report.

Metacarpophalangeal (MP) joint injuries and dislocations of the fingers and thumb are not uncommon. They can be classified directionally as either being volar or dorsal, and are further categorized as incomplete, simple complete or complex complete. Complex dislocations are described as dislocations that are irreducible and often require surgical intervention. This is often because tissue has become entrapped within the MP joint, precluding its anatomical reduction. For the thumb MP joint, anatomical structures that may become trapped include the volar plate, sesamoid bones, bony fracture fragments or the flexor pollicis longus tendon. Both dorsal and volar surgical approaches have been described, and their relative merits will be discussed. The unusual case of a late presentation (two months postinjury) of a complex complete dorsal dislocation of the thumb MP joint approached from a dorsal incision is presented.

Full-face treatments with the 2790-nm erbium:YSGG laser system.

BACKGROUND: Traditional full-face resurfacing has been limited to erbium-doped yttrium aluminium garnet (Er:YAG) and carbon dioxide (CO2) lasers. These devices offer wavelength-specific advantages and disadvantages. METHODS: Nine patients were enrolled in a pilot study of a resurfacing system using a 2790-nm erbium:yttrium-scandium-gallium-garnet (Er:YSGG) laser system. Two treatments were carried out 1 month apart over the entire face. Test spots were performed prior to the full-face sessions to determine the optimal fluence for 1-pass laser resurfacing. Biopsies were performed at the time of treatment and at the final follow-up visit one month after the second treatment. Clinical endpoints included changes in pigment dyschromias, wrinkles, and skin tone. All outcomes were graded by blinded observers. RESULTS: Eight patients completed the 2 treatments. Biopsies showed thermal damage extending as deep as 80 microm below the stratum corneum. Reepithelialization was complete within 4 days. No scarring, post inflammatory hyperpigmentation (PIH), or infections were observed. CONCLUSION: A 2790-nm laser can be used for skin rejuvenation with a 4 day recovery window.

Digitocutaneous dysplasia.

Digitocutaneous dysplasia is a rare X-linked dominant genetic syndrome characterized by multiple digital fibromas, atrophic plaques, dental anomalies, dysmorphic features, and bone anomalies. We report the case of a 2-year-old Mexican girl with this rare condition and discuss the clinical, histologic, and genetic features.

Antimicrobial peptides.

Antimicrobial peptides (AMPs) are small molecular weight proteins with broad spectrum antimicrobial activity against bacteria, viruses, and fungi. These evolutionarily conserved peptides are usually positively charged and have both a hydrophobic and hydrophilic side that enables the molecule to be soluble in aqueous environments yet also enter lipid-rich membranes. Once in a target microbial membrane, the peptide kills target cells through diverse mechanisms. Cathelicidins and defensins are major groups of epidermal AMPs. Decreased levels of these peptides have been noted for patients with atopic dermatitis and Kostmann's syndrome, a congenital neutropenia. In addition to important antimicrobial properties, growing evidence indicates that AMPs alter the host immune response through receptor-dependent interactions. AMPs have been shown to be important in such diverse functions as angiogenesis, wound healing, and chemotaxis. As our knowledge of AMP biology expands, the precise role and relevance of these peptides will be better elucidated.

Mohs micrographically controlled surgery and the treatment of malignant melanoma.

Mohs micrographic surgery is a technique that offers surgeons and pathologists a means to examine the entire surgical margins of excised cutaneous malignancies in a more complete manner than conventional methods. Initially developed to treat nonmelanoma skin cancers, its use has been expanded to include histologic margin evaluation for treatment of malignant melanoma. Clinical studies demonstrate equivalent or better 5-year survival rates with Mohs surgery compared to conventional wide local excision. For surgical treatment of melanoma, it offers unique advantages for lesions requiring tissue conservation and accurate margin determination, particularly in anatomic sites where cosmetic and functional concerns are of importance (head and neck, hands, and feet), and for large or ill-defined lesions such as lentigo maligna or lentigo maligna melanoma.