Postoperative Disability Research Articles

Transaxillary First Rib Resection for Thoracic Outlet Syndrome

Most patients with thoracic outlet syndrome can be treated conservatively without surgery in a successful fashion. In general, patients with neurogenic thoracic outlet syndrome should be given physiotherapy when the diagnosis is made. Proper physiotherapy includes heat massages, active neck exercises, stretching of the scalenus muscles, strengthening of the upper trapezius muscle, and posture instruction. Because sagging of the shoulder girdle, which is common among middle-aged people, is a major cause in this syndrome, many patients with less severe cases are improved by strengthening the shoulder girdle and by improving posture. Most patients with thoracic outlet syndrome who have ulnar nerve conduction velocities (UNCVs) of more than 60 meters per second (mps) improve with conservative management. 2 If the conduction velocity is below that level, most patients, despite physiotherapy, may remain symptomatic, and surgical resectionofthefirstribandcorrectionofotherbonyabnormalities may be needed to provide relief of symptoms. If symptoms of neurovascular compression continue after physiotherapy, and the conduction velocity shows slight or no improvement or regression, surgical resection of the first rib and cervical rib, when present, should be considered. The transaxillary route is an expedient approach for complete removal of the first rib with decompression of the seventhandeighthcervicalandfirstthoracicnerverootsandthe lower trunks of the brachial plexus. First rib resection can be performed without the need for major muscle division, the needforretractionofthebrachialplexus,andthedifficultyof removing the posterior segment of the rib. In addition, first rib resection shortens the postoperative disability and provides better cosmetic results than the anterior and posterior approaches, particularly because 80% of patients are female.

Combined thoracoscopic anterior spinal release and posterior correction for Scheuermann's kyphosis

To evaluate the effectiveness of combined thoracoscopic anterior spinal release and posterior correction for Scheuermann's kyphosis. Sixteen patients with a diagnosis of Scheuermann's kyphosis were selected to undergo thoracoscopic anterior spinal release, disc excision, and fusion in conjunction with instrumented posterior correction and spine fusion. Cobb angle of the kyphosis were measured before the operation and during the follow-up period to evaluate the correction. Pre- and post-operative Oswestry disability Index (ODI) were collected to evaluate the pain relief. All 16 patients underwent successfully corrections. The mean preoperative kyphosis (Cobb) was 78.8 degrees (70 degrees-92 degrees), the mean postoperative kyphosis (Cobb) was 40.5 degrees (36 degrees-47 degrees), and the last follow-up evaluation of the kyphosis was 41.7 degrees (36 degrees-50 degrees ). All patients obtained satisfied pain relief. The mean preoperative ODI was 37.3 (0-72), and the mean postoperative ODI was 6.4 (0-30). Combined thoracoscopic anterior spinal release and posterior correction is a good method for the treatment of Scheuermann's kyphosis.

Referral patterns in implant dentistry

omy to more predictably correct these defects. Five consecutive cases of maxillary alveolar distraction (AD) were compared to 5 consecutive osteotomy cases (SO). Parameters studied were the total distraction length desired and achieved, reconstitution of tissue height, favorable vector control, need for additional bone grafting, need for soft tissue grafting, total treatment time. Results: The sandwich alveolar bone graft technique was developed and applied in 5 sites, 5 patients. The surgical technique involves an alveolar osteotomy, for vertical displacement of the inferior fragment and placement of an interpositional autologous mandibular graft. A primary cortical mandibular ramus graft served as the donor site. Key surgical features included elevation of bone to the bone level of adjacent teeth, mobilization of the alveolar segment and retention of the adhering overlying gingival. Mobilization of the distal segment and malleting the graft into place were important for stability. From 5 to 8 mm of desired bony height for SO and 10 to 14 mm for AD were measured using periapical radiographs. Prolonged total treatment time, greater distraction lengths, reduced maintenance of tissue height, and increased need for additional bone grafting as a labial onlay were noted for AD, for equivalent intervals of 6-8 months later. The loss of tissue height could be accommodated for by modification of incision design for implant placement. The disparate distracted lengths may have accounted for the need for additional bone grafting and unfavorable vector control for AD. The recuperation following SO was similar requiring a 2to 5-day postoperative disability period, but there were fewer postoperative visits. AD required a procedure to eliminate the distraction device. Dehiscence over the distraction device could lead to unfavorable esthetic scarring. In contrast, to AD, there was no incidence of dehiscence or delayed labial grafting with SO Conclusion: Advantages of the technique noted include: accurate reliable reconstruction of the alveolus, elimination of additional bony reconstructive procedures, no relapse in the short term, and safer use of an acrylic interim denture for esthetic purposes. On the basis of this pilot study it appears that for vertical lengths of 5-8 mm, SO seems a more predictable procedure simply based on the number of postoperative visits and reduced total treatment time.

Management of brain tumor in Nepal

Management of brain tumors in developing countries displays a different perspective compared to developed nations. The difference starts from the presentation, which is always grossly advanced before the patient seeks treatment. Also, the surgeons must diagnose and plan surgery with the minimum number of diagnostic tools, while the majority of the time operating on the information gained from CT alone. Since cerebral angiography is rarely done, there is chance of vascular damage leading to profound bleeding or brain swelling. Due to the lack of medical insurance, the patient has to pay his/her own bill, a major deciding factor for surgery. Lack of social security is a further concern when morbidity is involved since postoperative disability can lead to further family suffering. Despite these constraints, we provide neurosurgical care to brain tumor patients with modification of surgical indications along with techniques meeting our socio-economic need. Here we present our experience in dealing with brain tumors in Nepal. We discuss the presentation, mode of investigation, the surgical tools and techniques adapted to meet these goals. We also discuss some peculiar differences in the presentation of brain tumors. Such differences in the biological nature of the tumor could be a subject of future study.

Median sternotomy for pneumonectomy in patients with pulmonary complications of tuberculosis

Background Traditionally, a thoractomy incision is used for pulmonary complications of tuberculosis. An attractive alternative is being presented by the use of midline sternotomy in such patients, which is the aim of this study. Methods Five patients (four male, one female) with pulmonary complications of tuberculosis requiring surgical therapy in 1993 and 1994 were treated through a median sternotomy. The median patient age at time of surgery was 40.2 years and the median patient follow-up was 4.0 years (range 1.0 to 5.0 years) in this retrospective review. Results All patients had uncomplicated operative courses and were discharged from the hospital. One patient’s in-hospital postoperative course was complicated by prolonged ventilator dependency requiring temporary tracheostomy; he died 1 year postoperatively after hospital discharge due to recurrent multidrug-resistant tuberculosis. Sternal wound infections and bronchopleural fistulas were not observed in any patients. Conclusions Surgical treatment of pulmonary complications of tuberculosis was traditionally performed through a thoracotomy approach. Many patients with tuberculous lungs have pulmonary adhesions or intrathoracic scarring from previous surgery, which would require extrapleural resection. Bleeding was a frequent complication of this procedure. Sternotomy offers excellent exposure of the intrapericardial vessels, and reduced postoperative disability compared to the standard thoracotomy, which may be an advantage given that the majority of patients in this population have poor pulmonary function. We recommend median sternotomy as an alternative operative approach in selected patients with pulmonary complications of tuberculosis.

Does the outcome 2 months after lumbar disc surgery predict the outcome 12 months later?

Purpose : To assess the prognostic value of some preoperative and early post-operative indicators in the prediction of disability 14 months after lumbar disc surgery. Methods : Of 173 patients, who had participated in baseline measurements, 145 (84%) attended the 14-month follow-up. Before surgery the duration and intensity of pain was assessed. Follow-up questionnaires were completed during check-ups and included items on pain (VAS), Oswestry and Million disability indices, depression (BDS) and work status. Results : Two months after surgery average back pain was 67% lower and leg pain 70% lower than pre-operatively. The median Oswestry and Million disability indices were 14 and 15 at 2-months and remained low also at 14-months check-up. Further, the post-operative Oswestry and Million disability indices and BDS were highly associated with 14-month back and leg pain. Although the outcome of the patients was mostly good, 5% and 8% of them, respectively, reported severe pain at 2- and 14-month check-ups. Conclusions : As recovery following lumbar disc surgery occurred to a great extent during the first 2 months, the early post-operative outcome appears to be quite a reliable indicator of the postoperative outcome in 1-year follow-up. The strong association between pain and the disability indices allows us to conclude that both the Million and Oswestry indices are clinically useful instruments in the evaluation of outcome in these cases.

Assessment of cognitive and motor deficits in a marmoset model of stroke.

The Stroke Therapy Academic Industry Roundtable noted the need for standardized, well-accepted primate models of stroke to help develop both neuroprotective and restorative therapies. One primate model has been developed using the marmoset, a small New World species of monkey, in which long-term functional deficits can be assessed. The surgery and postoperative care of the animals is described, as well as the behavioral tests used to quantify the postoperative disability. The types of deficits seen are illustrated by reference to some of the findings with neuroprotective treatments. Nevertheless, the long-term nature and consistency of the motor deficits make this model ideal for assessing the worth of restorative therapies.

Incidence of heterotopic bone formation after major hip surgery.

Heterotopic bone formation is a well-established complication of major hip surgery, but traditional reviews of the published literature may have underestimated its frequency. A systematic overview of all the relevant studies was performed to determine reliably the incidence of any heterotopic bone formation and the incidence of each Brooker equivalent grade. Separate estimates were made for patients with total hip replacement and patients with acetabular fracture repair. A computer-based search identified 218 studies with data on the incidence of heterotopic bone formation after either hip replacement or acetabular fracture repair. These studies included data from an estimated 59 121 operated hips among patients that received total hip replacement and an estimated 998 hips among patients that underwent acetabular fracture repair. In these studies, the incidence of any heterotopic bone formation was 43% after total hip replacement and 51% after acetabular fracture repair. The incidence of severe heterotopic bone formation was 9% and 19%, respectively. These results suggest that heterotopic bone formation occurs more frequently after total hip replacement than is generally believed. It is possible that heterotopic bone formation is a more important cause of postoperative disability than has previously been recognized and that effective prophylactic regimens might improve outcome in substantial numbers of patients.

Posterior cervical foraminotomy: long-term results and functional outcome of a consecutive series of patients with minimum two-year follow-up

Neel Anand, MD, MS, John J. Regan, MD, Robert S. Bray, MD, Los Angeles, CA, USAIntroduction: This study presents the long-term functional outcome of posterior cervical foraminotomy with the help of newly designed questionnaires and an objective scoring system.Materials and methods: Between 1993 and 1999, 83 patients had posterior cervical foraminotomy for cervical foraminal stenosis. Twelve patients were lost to follow-up and could not be contacted. All of the remaining 71 patients were mailed a disability questionnaire that was specific for the cervical spine and a treatment intensity questionnaire that objectively scored the extent of treatment received by the patient. The maximum score in both questionnaires was 100. Patients were further asked to grade the procedure as excellent, good, fair or poor, according to Odom's criteria, and were also asked whether they would recommend the procedure to a friend or relative. All 71 patients responded to the questionnaire, with 19 of these patients opting to give responses over the phone.Results: Seventy of the patients were available for long-term study, one patient having died of prostate cancer. A total of 257 foraminotomies were done with 32 bilateral and 38 unilateral cases. There were 11 single-level, 28 two-level, 25 three-level and 6 four-level foraminotomies. The average length of follow-up was 52 months (range, 24 to 98 months). The average age of the patients was 51 years (range, 31 to 72 years). There were 28 women and 42 men. All patients had predominant radiculopathy, and 24 patients were also symptomatic for axial cervical pain. No patient was myelopathic. The average preoperative disability score was 40 (range, 12 to 86), and the average postoperative disability score was 15 (range, 0 to 72). This improvement in disability scores was statistically significant at p<.01. There also was a statistically significant improvement at p<.05, in the treatment intensity scores at final follow-up with the preoperative score being 49 (range, 16 to 84) compared with the postoperative score, which was 22 (range, 0 to 68). Forty-one patients rated the procedure as excellent; 15, good; 8, fair and 6, poor. Sixty-one patients said they would recommend the procedure to a relative or friend, and nine patients said they would not recommend. The six patients who rated the procedure as poor all had no resolution of symptoms and opted no further treatment. Thirty-three patients still had some symptoms but less than preoperative symptoms, and 31 patients had complete resolution of symptoms after surgery. Three patients had repeat cervical spine surgery at the same level, because of persistence of symptoms. No patient had any worsening of symptoms, and there were no complications related to the procedure.Conclusion: Our data would suggest that posterior cervical foraminotomy has excellent to good long-term results in 80% of the patients. There is a significant improvement in disability and a reduction in the intensity of treatment after the procedure. The cervical spine disability questionnaire and the treatment intensity questionnaire serve as easy objective scoring measures to document disability and treatment intensity.

Outcomes after surgery for thoracic outlet syndrome

Purpose: This study determined whether there is an association between psychological and socioeconomic characteristics and the long-term outcome of operative treatment for patients with sensory neurogenic thoracic outlet syndrome (N-TOS). Methods: Clinical records, preoperative psychological testing results, and long-term follow-up questionnaire data were reviewed for consecutive patients who underwent surgery for N-TOS from 1990 to 1999. Multivariate logistic regression models were developed as a means of identifying independent risk factors for postoperative disability. Results: Operative decompression of the brachial plexus via a supraclavicular approach was performed for upper extremity pain and paresthesia with no mortality and minimal morbidity in 170 patients. After an average follow-up period of 47 months, 65% of patients reported improved symptoms, and 64% of patients were satisfied with their operative outcome. However, 35% of patients remained on medication, and 18% of patients were disabled. Preoperative factors associated with persistent disability include major depression (odds ratio [OR], 15.7; P = .02), not being married (OR, 7.9; P = .04), and having less than a high school education (OR, 8.1; P = .09). Conclusion: Operative decompression was beneficial for most patients. Psychological and social factors, including depression, marital status, and education, are associated with self-reported disability. The impact of the preoperative treatment of depression on the outcome of TOS decompression should be studied prospectively. (J Vasc Surg 2001;33:1220-5.)

The Distress and Risk Assessment Method (DRAM)

Our aim was to judge the influence of preoperative psychological disturbance on the outcome of lumbar discectomy. We evaluated 66 patients, before and after operation, using a self-administered questionnaire. Disability was assessed using the Oswestry disability index and psychological disturbance the Distress and Risk Assessment Method (DRAM) score. Patients were classified as normal, at risk or distressed, and the outcome of surgery in the three groups was compared at a follow-up of six months. The mean self-reported preoperative disability was significantly higher in those with psychological disturbance. A total of 54 patients (82%) returned completed postoperative questionnaires. Postoperative disability scores at six months were not significantly different in the three risk groups. Psychological disturbance improved after surgery. Our study suggests that the early outcome of lumbar discectomy is not affected by preoperative psychological disturbance. We conclude that a patient with a symptomatic prolapsed intervertebral disc should not be denied surgery on the basis of preoperative psychological assessment.

The distress and risk assessment method (DRAM).

Our aim was to judge the influence of preoperative psychological disturbance on the outcome of lumbar discectomy. We evaluated 66 patients, before and after operation, using a self-administered questionnaire. Disability was assessed using the Oswestry disability index and psychological disturbance the Distress and Risk Assessment Method (DRAM) score. Patients were classified as normal, at risk or distressed, and the outcome of surgery in the three groups was compared at a follow-up of six months. The mean self-reported preoperative disability was significantly higher in those with psychological disturbance. A total of 54 patients (82%) returned completed postoperative questionnaires. Postoperative disability scores at six months were not significantly different in the three risk groups. Psychological disturbance improved after surgery. Our study suggests that the early outcome of lumbar discectomy is not affected by preoperative psychological disturbance. We conclude that a patient with a symptomatic prolapsed intervertebral disc should not be denied surgery on the basis of preoperative psychological assessment.

Risk assessment of patients before lung surgery

Lung resection offers the best prospect of long-term survival in patients with nonmetastatic pulmonary neoplasia. In view of the dismal prognosis of unresected bronchial cancer, surgical resection should be encouraged even in patients with reduced cardiopulmonary function. Accurate estimation of the postoperative cardiopulmonary function is therefore desirable to avoid (a) refusal of potentially curative treatment and (b) severe postoperative disability. The origins of post-resection morbidity and mortality are multifactorial. Thus, no single pulmonary function test or hemodynamic measurement can accurately and reliably predict postoperative cardiorespiratory complications. Criteria of functional operability should be based on percent of predicted value, so that patient's age, sex, and height will be taken into consideration. Exercise testing offers the advantage that both pulmonary and cardiac risk can be evaluated simultaneously. The high predictive value of maximal oxygen uptake (VO2max) in assessing postoperative morbidity and mortality is established. The calculation of predicted postoperative lung function (ppo) is of importance. The postoperative values for the forced expiratory volume in one second (FEV1-ppo), the transfer factor (TL,CO-ppo), and VO2max-ppo can be predicted by using the same formula. Patients with nearly normal lung function (FEV1, TL,CO > 75% predicted) and no concomitant cardiac disease can undergo lung resection right up to pneumonectomy without further diagnostic procedures. In the others, FEV1-ppo and TL,CO-ppo should be estimated first by taking into account the number of segments to be resected. Patients with values < 30% predicted are usually regarded as being inoperable, whereas values > 40% predicted qualify for resection without the need for further diagnostics. VO2max < 10 ml/kg/min or < 40% predicted are prohibitive for surgery. If VO2max is > 20 ml/kg/min or > 75% predicted, functional operability without limitation is given. For those cases where diagnostic uncertainty still remains, FEV1-ppo, TL,CO-ppo, and VO2max-ppo can be calculated by means of quantitative lung scans. Patients with either FEV1-ppo and TL,CO-ppo < 30% predicted or VO2max-ppo < 8 ml/kg/min or < 35% predicted are deemed inoperable.

Patient satisfaction, function and return to work after knee arthroplasty.

We investigated the working status during 2 years before and 2 years after primary knee prosthetic operation for arthrosis in order to identify preoperative factors predicting patient satisfaction, function and working capacity. 162 patients (86 women) younger than 60 years of age when operated on with a knee prosthesis during 1993 were studied. 91% of the patients returned a Nottingham Health Profile (NHP) questionnaire, and the Social Insurance Office could supply data on all patients. There was a positive association between the duration of pre- and postoperative sick-leave in the patients who returned to work. Preoperative sick-leave longer than 180 days increased the risk of postoperative disability pension, which was not found to be influenced by the grade of the work. Among the 52 patients who returned to work postoperatively, all 6 NHP functional categories were better in the patients with less than 180 days of preoperative sick-leave than in the patients with more than 180 days of preoperative sick-leave. The overall patient satisfaction was greater among patients who went back to work postoperatively. We conclude that long sick-leave before a knee prosthetic operation increases the risk of long postoperative sick-leave and disability pension and impairs the quality of life.

Vergleich der Sektiotechnik nach Misgav-Ladach gegen konventionelle Sektiotechnik

Fragestellung: Die vor einigen Jahren am Misgav-Ladach General Hospital in Jerusalem entwickelte Operationstechnik der Sectio caesarea unterscheidet sich von der konventionellen Technik im wesentlichen durch stumpfe Eröffnung des Bauchraumes, Uterotomie oberhalb der Blasenumscnlaqsfalte und den Verzicht auf einen Verschluß des parietalen Peritoneums. In einer retrospektiven Untersuchung an insgesamt 226 Patientinnen mit erstmaliger Sectio caesarea ab der 37. SSW haben wir Unterschiede zwischen beiden Operationstechniken verglichen.

Extraperitoneal laparoscopic colposuspension: short-term cure rate, complications, and duration of hospital stay in comparison with burch colposuspension

Objective: To compare duration of surgery, length of hospital stay, complications, and short-term cure rate of extraperitoneal laparoscopic colposuspension with that of Burch colposuspension. Methods: We retrospectively reviewed 157 consecutive cases of extraperitoneal laparoscopic ( n = 70) or Burch colposuspension ( n = 87) performed between January 1, 1995, and June 30, 1997. Cure rate was assessed by history, physical examination, and questionnaire. Patients not requiring the use of pads were considered continent. Cure rates were compared in the entire group, whereas complications, duration of surgery, and length of stay were compared only in subgroups undergoing colposuspension alone. Results were analyzed statistically. Results: The mean times to follow-up were 12.9 months (laparoscopic group) and 16.3 months (Burch group). At last follow-up, 64 of 70 (91.4%) of the laparoscopic and 80 of 87 (92%) of the Burch colposuspension group were continent. In patients who underwent colposuspension alone, results were as follows for those who underwent laparoscopic (19) and Burch (21) procedures, respectively: average duration of surgery, 49.2 compared with 62.6 minutes ( P < .03); average hospital stay, 14 hours compared with 2.7 days ( P < .001); average postoperative disability period, 1.6 weeks compared with 4.7 weeks ( P < .001); incidence of complications, 15.8% compared with 33.3% ( P = .170). Conclusion: Extraperitoneal laparoscopic colposuspension, compared with Burch colposuspension, resulted in similar short-term cure rates and complications, shorter duration of surgery, hospital stay, and convalescence. It is a feasible option in treatment of stress urinary incontinence when laparotomy is not required.

Extraperitoneal Laparoscopic Colposuspension

In Brief Objective To compare duration of surgery, length of hospital stay, complications, and short-term cure rate of extraperitoneal laparoscopic colposuspension with that of Burch colposuspension. Methods We retrospectively reviewed 157 consecutive cases of extraperitoneal laparoscopic (n = 70) or Burch colposuspension (n = 87) performed between January 1, 1995, and June 30, 1997. Cure rate was assessed by history, physical examination, and questionnaire. Patients not requiring the use of pads were considered continent. Cure rates were compared in the entire group, whereas complications, duration of surgery, and length of stay were compared only in subgroups undergoing colposuspension alone. Results were analyzed statistically. Results The mean times to follow-up were 12.9 months (laparoscopic group) and 16.3 months (Burch group). At last follow-up, 64 of 70 (91.4%) of the laparoscopic and 80 of 87 (92%) of the Burch colposuspension group were continent. In patients who underwent colposuspension alone, results were as follows for those who underwent laparoscopic (19) and Burch (21) procedures, respectively: average duration of surgery, 49.2 compared with 62.6 minutes (P < .03); average hospital stay, 14 hours compared with 2.7 days (P < .001); average postoperative disability period, 1.6 weeks compared with 4.7 weeks (P < .001); incidence of complications, 15.8% compared with 33.3% (P = .170). Conclusion Extraperitoneal laparoscopic colposuspension, compared with Burch colposuspension, resulted in similar short-term cure rates and complications, shorter duration of surgery, hospital stay, and convalescence. It is a feasible option in treatment of stress urinary incontinence when laparotomy is not required. Extraperitoneal laparoscopic colposuspension may be considered an alternative to Burch colposuspension in cases that do not require laparotomy.

Disability and benefit from tonsillectomy in adults

In many areas of the United Kingdom, tonsillectomy in adults is as common as in children. However, little is known about the immediate postoperative disability and the longer term benefits from surgery in this group. The object of this study was to assess these factors in adults undergoing tonsillectomy for recurrent sore throats. One hundred and ten adults who had undergone tonsillectomy as an inpatient at least 6 months previously were sent a questionnaire. Sixty-seven (61%) responded. Seventy per cent were women and the median age was 25 years (range 14–48). The median time ill was 5.5 days (range 0–28). It took 7 days (range 0–56) to return to normal activities. Those who were employed returned to work after 15 days (range 0–63). Benefit from tonsillectomy was assessed by the Glasgow Health Benefit Inventory, a questionnaire designed to assess benefit from health care interventions. Adult tonsillectomy patients reported a mean benefit of 29 ( SD 22). This compares with a parent report of benefit in children undergoing tonsillectomy of 43 ( SD 7), surgery to improve hearing in adults of 17 ( SD 5) and surgery for active chronic otitis media in adults of 8 ( SD 5). On average, adult tonsillectomy is thus a highly beneficial operation but the range of benefit is large. Data is now available for preoperative advice as to the speed of postoperative recovery.

The Inflammatory Response to Open Tension-free Inguinal Hernioplasty Versus Conventional Repairs

Background: The tension-free inguinal hernioplasty is now a popular method because of less postoperative disability and low recurrence rate. The laboratory evaluation of the inflammatory response to the injury is an objective approach to determine the stress status of a surgical procedure. The aim of this study is to evaluate and to compare inflammatory responses to open tension-free and conventional repairs of inguinal hernias. Methods: Forty-eight male patients with primary indirect inguinal hernias were treated with elective operations, and separated into three groups according to surgical procedure: 12 pediatric patients treated with dissection of hernia sac in group 1, 16 adult patients with open tension-free hernioplasty in group 2, and 20 adult patients with conventional repairs in group 3. Ten healthy adult volunteers formed group 4 as control. The repair was performed with polypropylene mesh and suture as the Lichtenstein technique in group 2, and with polypropylene suture as one of Bassini, McVay, or Shouldice techniques in group 3. The inflammatory response was evaluated with serum interleukin-6 (IL-6) levels at 12 hours and serum C-reactive protein (CRP) levels at 48 hours postoperatively. Serum levels of IL-6 and CRP were measured in group 4 as control. Patient characteristics, operating time, and IL-6 and CRP levels were compared among the four groups. Results: There were no significant differences in mean age and operating time between the two groups of adult patients with hernia repair. Mean serum IL-6 levels of 12.1 ± 5.2 and 8.2 ± 2.7 pg/mL, and CRP levels of 34.3 ± 13.8 and 7.5 ± 4 mg/L in pediatric and control groups, respectively, were significantly lower than in the other two hernia groups. Mean serum IL-6 levels were 58.9 ± 25.4 pg/mL in group 2 (tension-free repair) and 44.3 ± 18.1 pg/mL in group 3 (conventional repair) ( P >0.05). Mean serum CRP levels were 111.3 ± 41.3 and 83 ± 43.2 mg/L in groups 2 and 3, respectively ( P >0.05). The differences not being statistically significant, a similar and considerable inflammatory response was noted in patients with either prosthetic mesh repair or with conventional repairs of indirect inguinal hernias. Conclusions: The reinforcement of the posterior wall of the inguinal canal induces significant cytokine response regardless of tension-free or conventional repair. Open tension-free hernioplasty offered no advantages over conventional repairs from the standpoint of the inflammatory and acute phase response.

筋肉内血管腫の治療成績

We review the clinical results of 19 cases with intramuscular hemangioma. Subjects included 6 males and 13 females ranging in age from 5 to 58 years (median, 23 years). The tumor was located in the upper extremities in 3 patients, the trunk in 3, and the lower extremities in 13. Pain on motion was found in 17 patients (89.5%) and limitation in motion range was reported in 60%. Surgical planning was done using MRI and a wide surgical margin was used in regard to the affected muscle and a marginal margin for surrounding tissues. The excision was performed in all patients and no recurrence was found in the duration of follow-up ranging from 7 to 101 months (median, 57 months). Furthermore, the limitation of motion was completely improved and the postoperative disability such as gait disturbance was not noted. Thus, the wide surgical excision of intramuscular hemangioma achieved satisfactory results.