The double-crush syndrome was initially described by Upton and McComas in 1973. They postulated that nonsymptomatic impairment of axoplasmic flow at more than one site along a nerve might summate to cause a symptomatic neuropathy. This was suggested by their clinical observation that the majority of their patients had a median or ulnar neuropathy associated with evidence of cervicothoracic root lesions. They also hypothesized that one of the constraints on axoplasmic flow could be a metabolic neuropathy, and this is supported by the high association of diabetes and carpal tunnel syndrome. Other researchers have since reported series of patients supporting the frequent association of a proximal and distal nerve compression syndrome, including carpal tunnel syndrome associated with cervical radiculopathy, brachial plexus compression, and diabetic neuropathy. Subsequently, MacKinnon and Dellon have expanded the description of this syndrome to include a) multiple anatomic regions along a peripheral nerve, b) multiple anatomic structures across a peripheral nerve within an anatomic region, c) superimposed on a neuropathy, and d) combinations of the above. We present an unusual case of symptomatic nerve compression caused by two nonanatomic structures within an anatomic region.
DUDRICK, STANLEY J. M.D.; DONNELL, PH J. M.D.; LERT, DEANN M. M.S.N., R.N.; MATHENY, ROBERT G. M.D.; BLUME, ELIZABETH R.; NUTT, ROSS E. R.PH.; HICKEY, MICHAEL S. M.D.; BARROSO, ALBERT 0. M.D.
Rational intravenous therapy is essential for the care of many patients. The history of parenteral therapy is reviewed. The indications, advantages and disadvantages of each parenteral route of administration are discussed. The history and clinical applications of parenteral hyperalimentation are discussed in depth. Techniques used to prepare and administer hyperalimentation solutions are described. Many problems remain to be solved in the field of intravenous therapy.
Ten consecutive malnourished patients with undifferentiated squamous cell carcinoma of the esophagus underwent operation for colon interposition. They received intravenous hyperalimentation preoperatively and/or post-operatively for an average time of 21.5 days and had an average weight gain of 6.5 Ib. There was no significant gastrointestinal morbidity, but one patient succumbed to aspiration pneumonia. All ten patients had postoperative gastrografin swallow radiography which showed no leaks in either anastomosis. With proper use of intravenous hyperalimentation, morbidity and mortality following colon interposition in the malnourished patient for either palliative or curative bypass can be decreased to acceptable levels.
Hemorrhoidal disease may benefit from the use of Nd-YAG laser to decrease surgical recovery time, postoperative hospital stay and complications.Fifty patient charts from 1993 to 1998 were reviewed retrospectively to evaluate postoperative complications and overall patient satisfaction following hemorrhoidectomy. We used the Nd-YAG laser from Surgical Laser Technologies CL60 with the ERP4 sapphire tip and the setting of 20 watts on continuous wave mode. Coagulation posthemorrhoidal excision of the remaining tissue was done using 60 watts pulse wave setting of 0.3 seconds.Laser treated hemorrhoidectomy patients experienced less pain than the standard hemorrhoidectomy patients. One week after surgery, the laser treated patients had 65% less pain than the standard hemorrhoidectomy patients. Painless defecation occurred earlier in the laser treated patients by five days and postoperative drainage was less than standard surgically treated patient. Surgical and hospital costs were lower by 27% and 11% respectively in the laser treated group. 88% of the laser treated patients vs 44% of the standard patients resumed work at one week after surgery.Nd-YAG laser treated hemorrhoid surgery patients had a quicker recovery and earlier return to work.
