Pittsburgh, Oct 30 - To treat patients with severe recurrent carpal tunnel  syndrome, orthopaedic surgeons at the University of Pittsburgh Medical Center (UPMC) are performing a novel technique in which they wrap a vein around the involved nerve to insulate it from recurrent compression and the development of painful scar tissue caused by previous unsuccessful surgical treatments.
Dead Sotereanos, M.D. associate professor of orthopaedic surgery at the UPMC, recently described the technique to peers at meetings of the European Federation for Hand Surgery and the American Society for Surgery of the Hand.
Carpal tunnel syndrome (CTS) affects one in 10 people and is the most common type of compressed nerve condition, according to Dr: Sotereanos. 
Its symptoms are: chronic wrist pain, numbness and tingling in the thumb, index and middle fingers, hand and wrist that also can shoot through the upper arm. 
The pain seems to worsen at night and with increased activity. 
People with CTS are usually those  who perform repetitive and forceful movements with their hands over long periods of time, such as typists  and computer operators. CTS also can be caused  by broken or dislocated wrist bones, arthritis, thyroid conditions, diabetes, and hormonal changes in females during menopause or pregnancy.
CTS results from compression of the median nerve, which travels through the carpal tunnel from the forearm to the hand fingers. The tunnel is bordered by wrist bones, ligaments, tendons and muscles  that make up the biomechanical  network for wrist motion. 
The tendons are surrounded by  a smooth lubricating membrane called the synovium, which becomes swollen and irritated in people with CTS. 
The swollen tissue compresses the median nerve, causing the pain, tingling and numbness.
In many cases, CTS can be treated by resting the hand wearing a splint. For some patients, an anti-inflammatory steroid injection may provide temporary relief. 
If these treatments prove ineffective, a surgeon may perform the traditional procedure of cutting the ligament over the carpal tunnel to relieve pressure on the  nerve. “However, CTS remains a challenging problem for surgeons since between 14 and 32 percent of surgical patients have recurrent symptoms and require repeated surgeries due to the build-up of irritating scar tissue around the nerve, “said Dr. Sotereanos.
“Other soft-tissue wrapping techniques have been developed - such as with muscle,  fat or fascia flaps - but these often are associated with complications, and their outcomes are unpredictable.
From our research thus far, we have seen that good  tissue compatibility and minimal complications occur with vein wrapping, “ he said.
Dr: Sotereanos's team performs the vein-wrapping technique only  on patients with severe recurrent CTS who have had at least two previous failed surgeries for CTS. They are the firts and only surgeons in the world to perform this procedure for CTS using the patient's own vein.
During the operation, the nerve is gently freed from surrounding scar tissue. A segment of the saphenous vein is taken from the patient's lower leg and incised longitudinally. The vein is subsequently wrapped around  the median nerve in a candy-striped fashion and ultimately serves as an insulator from surrounding scar tissue. The concept is to prevent recurrent scar tissue around the nerve and allow for better functional outcome.
The post-surgical routine is identical to that of the traditional nerve release procedure for CTS. The overall recovery  period generally takes three months to allow for healing, according to Dr. Sotereanos.
“Since initiating clinical studies for this procedure in 1993, we have performed  the operation on 22 patients at UPMC, 80 percent with good to excellent long-term results”.
said Dr. Sotereanos. “ We believe the procedure is effective for patients with persistent carpal tunnel  syndrome for whom previous surgeries have failed. And, we will continue to study  its  effectiveness”.
For additional information about UPMC Health System, please access 
http://www.upmc.edu  
 

Pittsburgh, Oct 26 - Joseph E. Murray, M.D., the father of kidney transplantation and a 1990 Nobel Laureate, will be the guest speaker at the University of Pittsburgh's third annual Ross H. Musgrave lecture. Dr. Murray's lecture, “Surgical Snapshots from a Curious Career, “ will take place at 5 p.m. on Friday, Nov. 13, in the Mc Cluskey Auditorium at Children's Hospital of Pittsburgh.
Among his numerous scientific achievements, perhaps the most notable is Dr. Murray's performance of the first successful living-related human kidney transplant  in identical twins in December 1954, the firts transplant of a vital  whole organ and the basis for his Nobel Prize in medicine. In addition, Dr, Murray performed the first successful non-identical human kidney transplant  in January 1959 and one of the first successful human cadaveric kidney transplants in April 1962. 
He also was the firts to use azathioprine, an immunosuppressive therapy, which paved the way for new ways to control autoimmune diseases and rejection of transplanted tissues and organs.
“Joe Murray has, over the years, been a great friend, colleague and mentor”, said Thomas E. Starzl, M. D., professor of surgery and director of the Thomas E. Starzl Transplantation Institute, who is credited with performing the world's first liver transplant in 1963. “The entire transplant community , myself included, owes our life's work to Joe because he set the standard; he  presented us  with far-reaching goals and challenges through his ideas and accomplishments”.
Dr. Murray received his undergraduate degree in 1940 from College of the Holy Cross in Worcester, Mass., and his medical  degree in 1943 from Harvard  Medical School. He was a surgical intern at Peter Bent Brigham Hospital in Boston, where he also served as an assistant resident in surgery. He has spent his entire career at Harvard and the Peter Bent Brigham Hospital.
Dr. Murray is a member of several professional societies including the American Surgical Association, the American Medical Association, the America College of Surgeons and the American Society for Surgery of the Hand.  
Additionally, he is a founding member of the Society of Head and Neck Surgeons and the Transplantation Society.
Dr. Murray also is the recipient of many awards including the Nobel Prize in medicine, the 1998 Lifetime Achievement Award from the Massachusetts Medical Society, a Medallion for Scientific Achievement from the  American Surgical Association and the 1991 Lifetime Achievement Award from the American Academy  of Achievement. He was named  an honorary fellow of the Royal Academy of Belgium and of the Royal College of Physicians and Surgeons of Canada and also was elected  to the National Academy of Sciences,
The  Musgrave lecture  was named in honor of Ross H. Musgrave, M. D., who served as  a clinical  professor of plastic  surgery in the  University of Pittsburgh's School of Medicine from 1965 to 1990. 
In addition to publishing widely, Dr. Musgrave's 16 visiting professorships from New York to Guadalajara gave him the opportunity to teach and learn  at many of the nation's most respected  institutions. Dr. Musgrave also served as president of the  American Society of Plastic and Reconstructive Surgeons.
For more information  about the Musgrave lecture, please call (412)648-9090.