br Conclusion br Acknowledgments This project

Conclusion
Acknowledgments This project was supported by the KMUH98-8R22 grant.
Introduction Carpal tunnel syndrome (CTS) is the most common order Quercetin dihydrate neuropathy of the upper extremity, and it accounts for 90% of all entrapment neuropathies. The typical symptoms of CTS include paresthesia, tingling sensation and/or pain on the palmar surface of the radial digits, and even motor weakness and signs of thenar muscle atrophy in an advanced disease. From a recent review by the Bureau of Health Promotion Department of Health, Taiwan, R.O.C., the incidence and prevalence of hemodialysis patients increased annually in Taiwan. Chronic renal failure has been recognized as one of the risk factors of CTS, and the risk increases annually in terms of duration of hemodialysis. Pathogenesis of the amyloid fibrils in the carpal tunnel was documented in 1986. Investigations found that one-third of chronic hemodialysis patients suffered CTS after <4 years of dialysis, a percentage that increased remarkably after 5 years, and reached nearly 100% after 20 years. In general, most surgeons prefer an open carpal tunnel release (OCTR) for long-term hemodialysis patients. The disease complexity and its progressive process were the major concerns by the surgeons when choosing the surgical technique. Nonetheless, OCTR may induce several morbidities, such as postoperative edema, bleeding, hypertrophic scar formation, infections, nerve injuries, and subsequently causes long periods of restriction of postoperative daily activities. The first endoscopic carpal tunnel release (ECTR) was described by Okutsu et al in 1989, and endoscopic decompression has been applied to idiopathic or any other secondary carpal tunnel syndrome ever since as a main competitor of the traditional OCTR procedure. Studies comparing OCTR and ECTR have generally concluded that, with its advantages of reduced scar pain, preservation of grip and pinch strength, and early return to work, ECTR is the beneficial application for CTS patients. The effectiveness of both procedures in idiopathic CTS patients appears to be equivalent and thus the ECTR has become a popular alternative carpal tunnel release method. However, there are not many reports discussing the efficacy of ECTR in terms of treating CTS patients with long-term hemodialysis.
Materials and methods
Results The baseline conditions of the two patient groups are compared in Table 1. Basically, two comparable patient groups existed, except for the greater age of the hemodialysis group. No surgical complications, including nerve damage, hematoma, and wound infection, were noted in both groups. Symptoms of two patients in the hemodialysis group failed to respond to ECTR during the follow-up examinations. Extensive OCTR and neurolysis of the median nerve from the distal forearm to the palm was performed. Both patients reported partial relief of their symptoms thereafter.
Discussion CTS is frequently associated with various systemic diseases, such as diabetes mellitus, hypothyroidism, chronic renal failure with long-term hemodialysis, rheumatoid arthritis, systemic lupus erythematosus, acromegaly, and gout. The etiology of CTS correlated with long-term hemodialysis would be attributed to ischemic neuropathy by steal phenomenon and chronic tenosynovitis by extensive β2 microglobulin amyloid deposition. The underlying factors, including local effect of arteriovenous fistula with edema and uremic polyneuropathy, are believed to increase the risk and contribute to more advanced symptoms of hemodialysis-related CTS. Considering the complex disease mechanism and progressively underlying polyneuropathy, Episome change has been recognized that CTS caused by long-term hemodialysis is a more advanced and uncurable disease with active progression. The relatively limited postoperative improvement after carpal tunnel release and the high recurrence rate of CTS would be expected in these patients.