Nail gun injury to the median nerve: A barbed issue.

Nail gun injuries to the hand are an increasingly common encounter amongst those in the construction injury and a frequent presentation to the emergency department. Despite their frequency, nail gun injuries rarely involve significant structural injury. We present a rare case of severe injury by a barbed nail to the median nerve requiring surgical exploration. At our latest follow up 14 months post-operatively, the patient had ongoing sensory and motor deficits, cold intolerance and reduced proprioception and range of motion at the index finger. Continued hand therapy resulted in improved range of motion and desensitization. A systematic literature search has revealed no other reported cases of median nerve injury by nail gun.

Exaggerated TSH responses to TRH in depressed patients with "normal" baseline TSH.

BACKGROUND: Subclinical hypothyroidism (elevated thyroid-stimulating hormone [TSH] with normal thyroid hormone levels) can present with depression. This may be confirmed by an exaggerated TSH response to thyrotropin-releasing hormone (TRH) on the TRH stimulation test (TRH-ST). The objective of this study was to determine the prevalence of exaggerated TRH-ST results in a sample of depressed patients with "high-normal" screening TSH levels. METHOD: Depressed patients with TSH levels of 3.00-5.50 mIU/L underwent a TRH-ST. After baseline TSH was drawn, TRH 400 micrograms was injected intravenously, and TSH samples were drawn at +20 min, +30 min, and +40 min postinjection. A rise in TSH after TRH (peak value minus baseline) of > 25 mIU/L represented an exaggerated TSH response. RESULTS: Twenty-three (38%) of 60 patients had an exaggerated TSH response to TRH. The 38% prevalence is significantly (Chi 2 = 59.65, df = 1, p < .001) greater than the 6% prevalence of positive TRH-ST results reported in the euthyroid general population. The prevalence of positive TRH-ST results was not attributable to differential patterns of psychotropic or thyroid hormone treatment. Unexpected observations were a lack of correlation in TSH levels week to week (r = .17, N.S.) and a lack of correlation between screening TSH value and subsequent TRH-ST results (r = .28, N.S.). CONCLUSION: Subtle thyroid underfunction may be contributing to depression in some patients with TSH in the upper half of the range usually considered normal. If so, then the TRH-ST may be more sensitive in identifying this than measurement of TSH alone.

Sharing stories. Group therapy with elderly depressed women.

As the population ages, nurses are challenged to seek and use relevant and effective nursing strategies to assist clients to cope with major life events and chronic conditions. Depression in the elderly, particularly among elderly women, is increasing. This is a serious problem which pervades community, acute and chronic care settings. In order to provide proactive care in the treatment of depression, two nurses in a psychogeriatric clinic developed a unique program, consisting of 10 weekly group sessions for elderly women with a diagnosis of depression. This article describes the formal, content of group sessions and outcomes. Key themes that emerged are illustrated by the stories shared by the women. These stories were central to shaping the group experience and enhanced the learning of group members and facilitators as well. The method of group process and insight into dynamic strategies for teaching/learning in the elderly are discussed. In conclusion, recommendations for future programs have been identified.