SummaryFamilial spontaneous pneumothorax is a rare condition. Two families with this condition are described: identical twin sisters of one family and three brothers of another family. The suggestion is made that at least some cases of spontaneous pneumothorax are genetically determined. IntroductionSpontaneous pneumothorax usually occurs sporadically in healthy young adults and the cause is often unknown. Kjaergaard (1935), andBrock (1948) favoured the presence of hereditary congenital lung cysts, which by rupturing, produced a pneumothorax. Familial cases of spontaneous pneumothorax have been described several times since the original description by Faber (1921). The occurrence of spontaneous pneumothorax in the identical twins of one family and in three brothers of another family, as reported below, greatly favours an hereditary aetiology.

Angiosarcoma remains a rare but important diagnosis to include in the differential diagnosis for upper extremity pain and paresthesias in chronic renal failure and nonfunctioning arteriovenous fistula.

Introduction: A common consequence of carpal tunnel release (CTR) is ulnar palmar pain termed pillar pain. Some (very rare) patients do not improve with conservative treatment. We have been treating recalcitrant pain with excision of hook of the hamate. Our purpose was to evaluate a series of patients undergoing excision of the hook of the hamate for post CTR pillar pain. Methods: A retrospective review of all patients undergoing hook of hamate excisions over a 30-year period was performed. Data collected included: gender, hand dominance, age, time-to-intervention, preoperative and post-operative pain scores, and insurance. Results: Fifteen patients were included with a mean age of 49 (range 18-68) years, 7 female (47%). Twelve (80%) of the patients were right handed. Mean time between CTR and excision hook of hamate was 7.4 months (range 1-18 months). Pain prior to surgery was 5.44 (range 2-10). Post-operative pain was 2.44 (range 0-8). Mean follow-up was 4.7 months (range 1-19 months). Patients with a good clinical outcome were 14 (93%). Conclusions: Excision of hook of hamate seems to provide clinical improvement in patients who remain painful despite exhaustive conservative treatment. It may be considered as a very last resort for persistent pillar pain after CTR.

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