No abstract

Background: Our purpose was to describe structural and morphological features of the median nerve and carpal tunnel on magnetic resonance imaging (MRI) studies obtained before, immediately after, 6 weeks after, and 6 years after endoscopic carpal tunnel release (ECTR). Methods: In this prospective cohort study, 9 patients with a diagnosis of carpal tunnel syndrome (CTS) underwent ECTR. Standardized MRI studies were obtained before ECTR, immediately after ECTR, and 6 weeks and 6 years after surgery. Structural and morphological features of the median nerve and carpal tunnel were measured and assessed for each study with comparisons made between each time point. Results: All 9 patients had complete symptom resolution postoperatively. On the immediate postoperative MRI, there was a discrete gap in the transverse carpal ligament in all patients. There was retinacular regrowth noted at 6 weeks in all cases. The median nerve cross-sectional area and the anterior-posterior dimension of the carpal tunnel at the level of the hamate increased immediately after surgery and these changes were maintained at 6 years. Conclusions: We defined structural and morphological changes on MRI for the median nerve and carpal tunnel in patients with continued symptom resolution 6 years after ECTR. Changes in median nerve and carpal tunnel morphology that occur immediately after surgery remain unchanged at mid-term follow-up in asymptomatic patients. Established imaging criteria for CTS may not apply to postoperative patients. Magnetic resonance imaging appears to be of limited clinical utility in the workup of persistent or recurrent CTS.

No abstract

This study was conducted to examine the effect of impairment status and computer-specific anxiety on the performance of a computerized neuropsychological assessment measure. Computer related anxiety was measured using a standardized self-report measure tapping anxiety specific to computers and technology. Outcome on this measure was compared with error scores and response timing variables on a computerized version of the Category Test (CT) in both normal individuals and individuals with neurological, psychiatric, or substance abuse histories. Multivariate analysis results, controlling for psychomotor performance, revealed significant main effects for group status and computer-related anxiety. CT performance was significantly related to the level of computer-related anxiety, in that high anxiety resulted in higher CT error scores and longer response times, and the negative impact of computer-related anxiety on computerized neuropsychological assessment performance was stronger in individuals with impairment histories. Our results suggest that as computer-related anxiety increases, performance on computer administered neuropsychological assessment measures tends to decrease. Key words: computers, anxiety, computer-based task performance, clinical neuropsychology, Category Test

Sulfamethoxazole-trimethoprim was administered prophylactically to 786 patients judged to be at sufficient risk for development of Pneumocystis carinii pneumonitis. The selection of patients, administration of the agents, and surveillance for compliance were the responsibility of the attending oncologists rather than specialists in infectious diseases, as in an earlier trial at this center. The recommended dosage was trimethoprim, 150 mg/sq m/day, and sulfamethoxazole, 750 mg/sq m/day. Over a three-year study period, nine cases of P carinii pneumonitis occurred at this institution, with none attributable to drug failure. Adverse reactions, skin rashes mainly, were noted in 43 patients, and one patient died with Stevens-Johnson syndrome. These results confirm the efficacy of sulfamethoxazole-trimethoprim in preventing P carinii pneumonitis in childhood cancer patients and illustrate the feasibility of large-scale unstructured delivery of the combination to patients with malignant diseases frequently associated with this pneumonia.

No abstract

No abstract

\s=b\The cases of 31 children with acute leukemia and concurrent hepatitis were evaluated for the outcome of their hepatitis. Thirteen of these children had hepatitis B and 18 children had a non-B hepatitis. Chronic hepatitis developed in more than half of the children with acute hepatitis, with the majority of cases being of the chronic, active type. A majority of these children had received at least one blood transfusion in the preceding year. No relationship was seen between the development of chronicity of the liver disease and the management of the acute hepatitis or the state of underlying disease. With the potential for a cure for acute leukemia increasing, a method of reducing the sequelae of hepatitis in children with leukemia is needed.(Am J Dis Child 134: [584][585][586][587] 1980) Hepatitis is recognized as a threat to children with cancer because they frequently receive blood-replace¬ ment therapy during intensive myelosuppressive therapy. risks of acquiring hepatitis range from 1% to 20% among children with leukemia.'"' Recently, two patients cared for at St Jude Children's Research Hospital, Memphis, who had apparently been cured of leukemia later died of hepatitis and its compli¬ cations. This led us to review our experience with hepatitis in children with acute leukemia. REPORT OF CASESCase l.-This 20-year-old man was diag¬ nosed as having acute lymphocytic leuke¬ mia five years before his death. He was treated according to the "Total Therapy VIH" protocol (first with prednisone, vin¬ cristine sulfate and daunorubicin hydro¬ chloride, followed by cranial irradiation and intrathecal methotrexate sodium for CNS prophylaxis, and then maintenance therapy with mercaptopurine, methotrex¬ ate and cyclophosphamide)1 and remained in continuous, complete remission.One month before this therapy was to be completed, nausea and vomiting developed. On physical examination, he had a lowgrade fever and mild scierai icterus. Labo¬ ratory evaluation showed an SGOT level of 72 Karmen units (normal level, 6 to 40 units) and his serum contained the hepati¬ tis surface antigen (HBsAg). A diagnosis of acute hepatitis was made. The hepati¬ tis antigenemia and elevation in trans¬ aminase levels persisted for the next 21 months. With the development of marked jaundice in September 1977, a percuta¬ neous liver biopsy was performed; the spec¬ imen showed chronic active hepatitis with cirrhosis. Over the next six months, the patient's condition progressively deterio¬ rated despite prednisone therapy, salt re¬ striction, and the administration of diuret¬ ics. No autopsy was obtained.Case 2.-This 19-year-old man was first diagnosed as having acute lymphocytic leu¬ kemia 15 years before his death. He was treated according to the Total Therapy III protocol (prednisone and vincristine fol¬ lowed by craniospinal irradiation for CNS prophylaxis and then treatment with mercaptopurine, methotrexate, and cyclophosphamide for maintenance) ' for three years, at which time his therapy was stopped. He remained in continuous, complete r...