Embolización vesical supraselectiva versus formalina intravesical para la hematuria intratable en pacientes con cáncer de vejiga / Superselective vesical artery embolization versus intravesical formalin for intractable hematuria in patients with bladder cancer

Objetivo La hematuria intratable en los pacientes con cáncer de vejiga (CV) en estadio avanzado no subsidiarios de cistectomía radical es una de las condiciones de más complejo abordaje. El objetivo del presente estudio, pionero en la literatura, fue comparar la eficacia de la formalina intravesical (FI) y la embolización supraselectiva de la arteria vesical (ESAV) en el manejo de la hematuria intratable y potencialmente mortal en pacientes con CV.Métodos El estudio retrospectivo incluyó a 40 pacientes con CV que se sometieron a tratamiento con ESAV o FI por hematuria intratable tras el fracaso de otros métodos. Los pacientes se dividieron en dos grupos de acuerdo con los procedimientos administrados: grupo ESAV (n=24) y grupo FI (n=16).Resultados La tasa de éxito en la terapia de primera línea fue del 50% (12/24) en el grupo ESAV y del 82% (13/16) en el grupo FI (p=0,046). Con base en las tasas de éxito en los tratamientos de primera y segunda línea, la tasa de éxito global en el grupo ESAV fue del 75%; similar a la del grupo FI (p=0,439). La tasa de complicaciones fue significativamente mayor en los pacientes de FI que en los de ESAV (37,5% frente a 8,3%; p=0,024), mientras que la duración de la estancia hospitalaria postoperatoria fue significativamente mayor en el grupo ESAV (15,8 frente a 6 días; p=0,041).Conclusión Entre las ventajas de la FI parecen estar una estancia hospitalaria postoperatoria más corta y mayores tasas de éxito tras una sola sesión, mientras que las ventajas de la ESAV parecen incluir la realización sin anestesia espinal/general, la fácil repetibilidad del procedimiento y las bajas tasas de complicaciones. En el tratamiento de los pacientes con hematuria intratable, se debe tener en cuenta el estado general de los pacientes, las comorbilidades y los riesgos relacionados con la anestesia (AU)

Objective Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients.Methods The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n=24) and IF Group (n=16).Results The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p=0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p=0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p=0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p=0.041).Conclusion The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients’ general condition, comorbidities, and anesthesia-related risks should be taken into consideration (AU)

Superselective vesical artery embolization versus intravesical formalin for intractable hematuria in patients with bladder cancer.

OBJECTIVE: Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients. METHODS: The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n = 24) and IF Group (n = 16). RESULTS: The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p = 0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p = 0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p = 0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p = 0.041). CONCLUSION: The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients' general condition, comorbidities, and anesthesia-related risks should be taken into consideration.

Superselective vesical artery embolization versus intravesical formalin for intractable hematuria in patients with bladder cancer. / Embolización vesical supraselectiva versus formalina intravesical para la hematuria intratable en pacientes con cáncer de vejiga.

OBJECTIVE: Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients. METHODS: The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n=24) and IF Group (n=16). RESULTS: The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p=0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p=0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p=0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p=0.041). CONCLUSION: The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients' general condition, comorbidities, and anesthesia-related risks should be taken into consideration.

Evaluation of retinal and optic nerve vasculature by optic coherence tomography angiography in Migraine with Aura.

PURPOSE: This study aimed to evaluate the retina by optic coherence tomography angiography (OCTA) in patients with migraine with aura (MA) in comparison with healthy controls. MATERIALS AND METHODS: A total of 60 patients with MA and 56 control subjects who applied to the Ophthalmology Clinic of Dicle University between January 2020 and February 2020 were included in this study. In all patients, the vascular density (VD) of the radial peripapillary capillaries (RPCs) and optic nerve head (ONH), the VD of deep and superficial macular vascular networks, and foveal avascular zone (FAZ) were measured. RESULTS: Patients with MA showed reduced VD measurements of the nasal and inferotemporal ONH, inferonasal RPCs, and deep macular plexus. No statistically significant difference was observed in the superficial macular VD values between the study groups. The majority of patients with MA showed hypertrophy in the deep FAZ. CONCLUSION: There was a decrease in VD measurements in the deep macular capillary plexus, ONH, and peripapillary capillaries and hypertrophy in the deep FAZ in patients with MA. According to these results, patients with MA may have an increased risk of developing ocular and systemic vascular complications. Therefore, OCTA can be used to evaluate systemic and ocular hypoperfusion in patients with MA.

Diagnostic efficiency of systemic immune-inflammation index in fusion prostate biopsy.

OBJECTIVE: To investigate the diagnostic efficiency of systemic immune response (SII) in prostate cancer (PCa) in patients with PSA < 10 ng/mL undergoing fusion prostate biopsy. METHODS: The prospective study included patients who were planned for fusion prostate biopsy and had PSA < 10 ng/mL and a PI-RADS ≥ 3. All the patients underwent 12-core standard transrectal prostate biopsy followed targeted biopsy (combined biopsy). Based on preoperative complete blood count parameters, SII was calculated using the following formula: SII = platelet × neutrophil-to-lymphocyte ratio. Correlations between PI-RADS score, platelet, neutrophil-to-lymphocyte ratio, PSA, PSA density, SII and PCa were determined using ROC curve analysis. Optimal cut-off values were determined using the maximum Youden Index (defined as: sensitivity + specificity - 1). RESULTS: The study included 508 patients with a mean age of 62.49 ±â€¯6.86 years and a median PSA level of 7.28 (5.69-8.70) ng/mL. The overall clinically significant PCa rate was 39.4%. Although SII had no significant diagnostic value in PCa patients with low ISUP grades (grade 1 and 2) (AUC = 0.487, P = 0.622), it was revealed as a significant marker in PCa patients with an ISUP grade ≥ 3 (AUC = 0.811, P < 0.001). The cut-off value of SII was 533.0. While the combination of SII with PI-RADS score is the most effective marker, neutrophil-to-lymphocyte ratio and platelet were also revealed as effective markers in predicting ISUP grade 3-5 PCa, though not as effective as SII. CONCLUSION: SII and SII combination with PI-RADS score appear to be a significant diagnostic marker in patients with high-grade PCa (ISUP grade 3-5). These values were found to be higher compared to those of patients with a benign pathology and patients with lower ISUP scores.

Eficacia diagnóstica del índice de inmunidad-inflamación sistémica en la biopsia de próstata por fusión / Diagnostic efficiency of systemic immune-inflammation index in fusion prostate biopsy

Objetivo: Evaluar la eficacia diagnóstica del índice de inmunidad-inflamación sistémica (IIS) en el cáncer de próstata (CaP) en pacientes con PSA<10ng/ml sometidos a una biopsia de próstata por fusión.MétodosEl estudio prospectivo incluyó a pacientes con una biopsia de próstata por fusión planificada, con un PSA<10ng/ml y un PI-RADS≥3. Todos los pacientes se sometieron a una biopsia prostática transrectal estándar de 12 cilindros, seguida de una biopsia dirigida (biopsia combinada). Con base en los parámetros del recuento sanguíneo completo preoperatorio, el IIS se calculó mediante la siguiente fórmula: IIS=plaquetas×índice neutrófilo-linfocito. Las correlaciones entre la puntuación PI-RADS, las plaquetas, el índice neutrófilo-linfocito, el PSA, la densidad de PSA, el IIS y el CaP se determinaron utilizando el análisis de curvas ROC. Los valores de corte óptimos se determinaron utilizando el máximo del índice de Youden (definido como: sensibilidad+especificidad−1).ResultadosEl estudio incluyó 508 pacientes con una media de edad de 62,49±6,86 años y un nivel medio de PSA de 7,28 (5,69-8,70) ng/ml. La tasa global de CaP clínicamente significativo fue del 39,4%. Aunque el IIS no tenía un valor diagnóstico significativo en los pacientes con CaP de bajo grado ISUP (grado 1 y 2) (AUC=0,487, p=0,622), se reveló como un marcador significativo en los pacientes con CaP con un grado de ISUP≥3 (AUC=0,811, p<0,001). El valor de corte del IIS fue de 533,0. Aunque la combinación de IIS con la puntuación PI-RADS conforman el marcador más efectivo, el índice neutrófilo-linfocito y las plaquetas también se mostraron como marcadores efectivos en la predicción del CaP de grado ISUP 3-5, aunque no tanto como el IIS. (AU)

Objective: To investigate the diagnostic efficiency of systemic immune response (SII) in prostate cancer (PCa) in patients with PSA<10ng/ml undergoing fusion prostate biopsy.MethodsThe prospective study included patients who were planned for fusion prostate biopsy and had PSA<10ng/ml and a PI-RADS≥3. All the patients underwent 12-core standard transrectal prostate biopsy followed targeted biopsy (combined biopsy). Based on preoperative complete blood count parameters, SII was calculated using the following formula: SII=platelet×neutrophil-to-lymphocyte ratio. Correlations between PI-RADS score, platelet, neutrophil-to-lymphocyte ratio, PSA, PSA density, SII and PCa were determined using ROC curve analysis. Optimal cut-off values were determined using the maximum Youden Index (defined as: sensitivity+specificity−1).ResultsThe study included 508 patients with a mean age of 62.49±6.86 years and a median PSA level of 7.28 (5.69-8.70) ng/ml. The overall clinically significant PCa rate was 39.4%. Although SII had no significant diagnostic value in PCa patients with low ISUP grades (grade 1 and 2) (AUC=0.487, P=.622), it was revealed as a significant marker in PCa patients with an ISUP grade≥3 (AUC=0.811, P<.001). The cut-off value of SII was 533.0. While the combination of SII with PI-RADS score is the most effective marker, neutrophil-to-lymphocyte ratio and platelet were also revealed as effective markers in predicting ISUP grade 3-5 PCa, though not as effective as SII. (AU)

Genetic polymorphism in sex hormone metabolism and prostate cancer risk.

We compared single-nucleotide polymorphisms for point mutations in cytochrome P450 genes, including cytochrome P450c17α (CYP17), cytochrome P450 aromatase (CYP19), steroid-5-a-reductase (SRD5A2), and prostate-specific antigen (PSA) involved in androgen and estrogen production. Between January 2008 and January 2010, 90 patients were enrolled in the study. Of these patients, 28 were diagnosed with benign prostatic hyperplasia and 32 with prostate cancer, while 30 subjects were included as a control group. CYP19 1531 C>T, SRD5A2 gene V89L, CYP17 gene -34 T/C, PSA-158 (G/A) regions were evaluated for the association between polymorphisms and benign prostatic hyperplasia and prostate cancer in study population. Age, body mass index, peak urinary flow rate (Q max), voided urine volume, post-void residual urine volume, total PSA, free PSA, free/total PSA ratio, prostate weights measured by transrectal ultrasonography, erectile dysfunction score, and international prostate symptom score were compared between groups. No statistically significant difference in CYP19 1531 C>T, SRD5A2 V89L, and CYP17 -34T/C was observed in both groups when compared to the control group. The homozygote variant of PSA- 158 (G/A) was significantly lower for prostate cancer. Age, total PSA, free PSA, free/total PSA ratio, prostate weight, and Q max were evaluated using multi-variant analysis. Only Q max was significant for the homozygote variant. The probability of being homozygous was 5.8- fold higher in subjects with Q max >14 mL/s. In the Turkish population, the homozygote variant of PSA-158 (G/A) was significantly lower for prostate cancer.

A Radiographic Correlation between Renal and Pulp Stones.

AIM: The purpose of this study was to determine the correlation between pulp stones and renal stones. This study also aims to report associations between the presence of pulp stone and gender, age, tooth type, dental arches and sides. PATIENTS AND METHODS: Data were collected through radiographic examination of bitewing radiographs of 116 kidney stone patients and a similar number of age-matched controls, referred to the Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University. Two oral radiologists examined the radiographs to identify pulp stones. The Chi-squared and Mann Whitney U tests were used to investigate the correlations between the presence of pulp chamber calcification and age, gender, dental status and kidney stone. RESULTS: Pulp chamber opacities were detected in 199 (19.3%) out of the 1031 examined teeth, and in 84 (72.4%) out of the 116 kidney stone patients. There was no statistically significant difference between the study and control group (p = 0.882). The occurrence of pulp stones was significantly higher in molars than premolars and similar prevalences were found between dental arches and sides. CONCLUSION: In this study, no correlation was found between the presence of pulp stones and kidney stones in the investigated group. Therefore, the presence of pulp stones does not seem to be correlated with that of kidney stones.

Investigation of the effects of Enoxaparin, Fondaparinux, and Rivaroxaban used in thromboembolism prophylaxis on fracture healing in rats.

BACKGROUND: Today, there is a small number of studies on the effects of Enoxaparin and Fondaparinux used commonly in the prevention of venous thromboembolism on healing of fracture cases. AIM: The aim of this study was to investigate clinically, radiologically and histopathologically, the effects of Enoxaparin, Fondaparinux and Rivaroxaban used in thromboembolism prophylaxis on fracture healing in a rat model of femur fracture. MATERIALS AND METHODS: Thirty-two male Sprague Dawley rats were randomized into four groups (n=8): the control group (Group 1), the Enoxaparin group (Group 2), the Fondaparinux group (Group 3), and Rivaroxaban group (Group 4). Under general anesthesia, a standard closed fracture was created in the left femur of each rat using an osteotome. Group 1 was given saline solution (1 cc/day, sc), Group 2 Enoxaparin (100 anti Xa IU/kg/day, sc), Group 3 Fondaparinux (0.2 mg/kg/day, sc), and Group 4 Rivaroxaban (3 mg/kg/day, po) for 21 days. After all rats were sacrificed at the end of day 21, their left femurs were disarticulated at the level of the hip and knee. The bony union was radiologically, clinically, and histopathologically evaluated. RESULTS: No differences were found between the groups in terms of clinical, radiological, and histopathological findings in fracture healing (p = 0.849, p = 0.731, and p = 0.395, respectively). CONCLUSIONS: Enoxaparin, Fondaparinux and Rivaroxaban used in thromboembolism prophylaxis cause no significant changes in fracture healing with short term follow up. Thus, they can be safely used in cases of fractures.

Effect of hyperbaric oxygen therapy on healing in an experimental model of degloving injury in tails of nicotine-treated rats.

The aim of this study was to investigate the effect of hyperbaric oxygen (HBO) therapy on healing in an experimental model of a degloving injury of the tails of nicotine-treated rats. Thirty-two male Sprague-Dawley rats were randomized to four groups (n = 8): nicotine (group 1); HBO (group 2); nicotine + HBO (group 3); and control (group 4). The mean length of the necrotic parts of the tails at the degloving injury site was significantly higher in group 1 compared with groups 2, 3, and 4, and was significantly lower in group 2 compared with groups 1, 3, and 4. The mean histopathological stage of ulcers at the degloving injury site was statistically significantly higher (more severe) in group 1 compared with groups 2, 3, and 4, and was statistically significantly lower in group 2 compared with groups 1, 3, and 4. It appears that the negative effects of nicotine on wound healing in degloving injuries are negated by the positive effects of immediate HBO therapy.

Association of left varicocoele with height, body mass index and sperm counts in infertile men.

The aim of this study was to evaluate interrelation of left varicocoele with height, body mass index (BMI) and sperm counts. We retrospectively evaluated the data of all patients who consulted for infertility at a tertiary academic referral centre from 2000 to 2010. Patient's height, weight, BMI, semen analysis, presence or absence of varicocoele and varicocoele side and grade were evaluated. In statistical evaluations chi-square, student's t, Mann-Whitney U, anova and logistic regression analyses were performed. In anova analyses, Bonferroni post hoc test was performed when needed. The data of 1842 among 2780 men, presenting for infertility, were included in the study. There were 587 men (31.9%) with left varicocoele and 1255 (68.1%) men without varicocoele. Two hundred and seventy-two men (14.8%) had grade I or II, and 315 men (17.1%) had grade III varicocoeles. Mean height was 174.3 ± 6.7 and 172.5 ± 7.0 cm in men with and without varicocoele respectively (p < 0.001). The mean BMI of cases without varicocoeles (25.8 kg/m(2) ) was greater than varicocoele group (24.9 kg/m(2) ) (p < 0.001). Percentage of varicocoele was the highest in moderately oligozoospermic males and significantly higher than the men with normal sperm count. As the height increased, the probability of having varicocoele increased, and the inverse is true for BMI. If varicocoeles are a progressive lesion, perhaps taller men with varicocoeles should be followed more closely to evaluate their fertility and androgenic status.

Treatment approaches and outcomes in childhood supracondylar humerus fractures.

BACKGROUND: Being one of the most frequent elbow fractures during childhood, supracondylar humerus fractures require rapid diagnosis and treatment, as they may be associated with significant neurovascular and functional problems. QUESTIONS AND PURPOSES: To evaluate demographic and clinical features, and treatment outcomes of the patients with supracondylar humerus fractures who underwent open reduction+minimal osteosynthesis or closed reduction+percutaneous wiring. PATIENTS AND METHODS: Forty patients (30 boys + 10 girls) between 2 and 13 years of age who were operated on with the diagnosis of supracondylar humerus fracture, between August 2003 and December 2006, were included. Open reduction+minimal osteosynthesis (n=34) and closed reduction+percutaneous wiring (n=6) were performed. The fractures were classified according to the Gartland classification and outcomes were assessed according to Flynn's criteria. RESULTS: All patients (mean age, 7.35 years; range, 2-13 years) had closed fractures (28 left and 12 right). Seven (17.5%) and 33 (82.5%) patients had Gartland type II and III fractures respectively. Three patients had flexion-type and 37 patients had extension-type fractures. Based on Flynn's criteria, cosmetic results were excellent in 37 (92.5%) patients and good in 3 (7.5%) patients, and functional results were excellent in 36 (90%) patients, good in 3 (7.5%) patients, and poor in 1 (2.5%) patient. A surgical success rate of 97.5% was noted. No significant difference was found between wire configurations (p > 0.05). CONCLUSIONS: Treatment of supracondylar humerus fractures in children should be patient-specific based on factors such as patient's age, soft tissue conditions and deformity status.

Carpal tunnel decompression: two different mini-incision techniques.

AIM: To compare two different mini-incision surgical techniques for carpal tunnel surgery. MATERIALS AND METHODS: A total of 45 patients in Group 1 underwent carpal tunnel release through a 2-cm longitudinal incision made distal to the flexor crease, whereas the 45 patients in Group 2 underwent carpal tunnel release through a 2-cm longitudinal incision made proximal to the flexor crease. The self-administered Boston Questionnaire was used to assess the severity of patients' symptoms and their functional status, both before and after the surgical intervention and at their final follow-up. Patients were also asked, during the final follow-up, about the pain level of their scar tissue. RESULTS: There was a significant decrease in the Boston Carpal Tunnel Questionnaire scores for the symptom severity scale and the functional status scale of patients in both groups, pre-operatively, post-operatively at one month and at final follow-up (p < 0.001 for both). The mean operative time for Group 2 was significantly shorter than for Group 1 (p < 0.001). At final follow-up, 11 patients in Group 1 stated they had scar tissue pain, compared to three patients in Group 2. The pain in scar tissue among Group 2 was significantly less than for Group 1 (p = 0.02). CONCLUSIONS: Due to shorter operative times, mini-incisions proximal to the flexor crease can be performed. The absence of relapse and good clinical results make both surgical techniques suitable. For this reason, we consider that the selection of the mini-surgical technique used should depend on the experience and skill of the surgeon.

The effects of intraoperative infusion of dexmedetomidine on early renal function after percutaneous nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) may interfere with renal function because of continuous fluid irrigation and compression. The aim of this study was to evaluate the effects of an intraoperative infusion of dexmedetomidine on renal function in patients undergoing PCNL. METHODS: This study included 40 patients between the ages of 18 and 65 years who underwent PCNL. After induction of anesthesia, we administered 100 ml of normal saline to the patients in the control group (n=20) and 1 mcg/kg dexmedetomidine in 100 ml of normal saline to the patients in the dexmedetomidine group (n=20) over 10 min. Throughout the surgery, 1 mcg/kg/h dexmedetomidine and 1 ml/kg/h normal saline infusions were given to the dexmedetomidine and control groups, respectively. Renal function, electrolytes, serum levels of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C were analyzed after induction and post-operatively at 2, 8 and 24 h. Renin levels and blood gas analyses were performed after induction and before extubation. RESULTS: No statistically significant differences were found between the two groups with regard to renal function, creatinine clearance (CrCl), NGAL, cystatin C and serum electrolyte levels at 0, 2, 8 and 24 h post-operatively. End-surgery renin levels in the dexmedetomidine group were significantly lower than the baseline levels in the control group. CONCLUSION: In PCNL, an intraoperative infusion of dexmedetomidine was not found to have beneficial effects on CrCl, NGAL or cystatin C levels early after the procedure; however, it reduced renin levels.

Can simple release relieve symptoms of carpal tunnel syndrome caused by a persistent median artery? Clinical experience.

INTRODUCTION: Compression of the median nerve at the wrist by a persistent median artery is one of the uncommon reasons for carpal tunnel syndrome. Most of the studies in the literature deal with thrombosed persistent median artery. MATERIALS AND METHOD: In this study, we present surgical treatment of four carpal tunnel syndromes, which had persistent median arteries. The mean age of the patients was 51 years. All four median arteries were patent and only transverse carpal ligament releases were performed using a standard anterior open approach for decompression of the carpal tunnel. Neither ligation nor transposition of the arteries was done. RESULTS: All patients became symptom free after a few weeks. Only one patient had a slight recurrence 13 months postoperatively. Splint use and modification of her activities reduced her disturbance, and no further treatment was applied. CONCLUSION: If the patient has no additional anomaly, our clinical experiences lead us not to advise resection or transposition because simple release of the transverse carpal ligament can relieve symptoms.

Natural history of degenerative spondylolisthesis. Pathogenesis and natural course of the slippage.

To clarify the natural course of degenerative spondylolisthesis, the mechanism and progression of disk slippage were studied clinically and radiographically in 40 patients. Progressive slippage was observed in 12 patients (30%). No progression of slippage was noted in patients who showed narrowing of the intervertebral disk, spur formation, subcartilaginous sclerosis, or ossification of ligaments. These suggest that the mechanisms of spinal restabilization prevent progression of the disease. General joint laxity was observed in many patients (65%), and this was believed to be involved in the pathogenic mechanism of this disease. There was no correlation between the clinical symptoms and progression of slippage. These findings suggest that careful consideration of the natural mechanisms of spinal restabilization as well as the natural course of the disease is important.