145 patients on haemodialysis for 1 month to 16 years were examined for carpal tunnel syndrome. Typical signs and symptoms of the syndrome, mostly in both hands but more pronounced on one side, were seen in 21 patients (15%). In these cases carpal tunnel syndrome was frequently (19%) accompanied by Raynaud's phenomenon of the digits supplied by the median nerve. There was a significant correlation between the incidence of carpal tunnel syndrome and the duration of dialysis. The association of carpal tunnel syndrome with analgesic nephropathy was significantly higher than with other kidney diseases. Immediate relief of pain was achieved after carpal tunnel release in eight patients (11 hands). Sensory and motor function was gradually, but often only partially, restored. Unoperated carpal tunnel syndrome progressed to loss of sensory and motor function within 1 to 4 years after onset of symptoms. Carpal tunnel syndrome should be considered an important late complication of chronic haemodialysis.

No abstract

Robotic prostatectomy was found to be a safe and successful option for prostate cancer treatment in a community teaching hospital.

Energetic and ambitious clinicians frequently present new disruptive technologies and growth opportunities to hospital management. Far too often, established medical staff leadership respond to these replacement services with derision, as they sense that the value of their hard-fought experience is threatened. In this regard, derision is often disguised validation and may be the first indicator that the visionary physician is on to something. Truly disruptive service offerings cannot survive the scrutiny of layered medical staff structure or traditional fiscal review. Innovative hospital CEOs should take notice when a new idea is treated with derision and consider resourcing them through an alternative pathway.