Subjective Patient Satisfaction Research Articles

Evaluation of subjective satisfaction of dental implant patients.

ObjectivesThe goal of this study was to estimate the overall satisfaction level of dental implant patients and further evaluate factors influencing satisfaction.Materials and MethodsSelf-administered questionnaires were mailed to patients who received dental implant therapy at Seoul National University Bundang Hospital (Seongnam, Korea) from October 2003 to April 2005. The main portion of the questionnaire was shared to evaluate the level of satisfaction with implant therapy. The questionnaires contained evaluations of influencing factors, which were classified as pain-related, service-related, and complication-related.ResultsThe responses from 93 patients (41 males, 52 females) with a total of 325 implants were included in the analysis, and the mean score for overall satisfaction level with implant therapy was 8.26. Female patients showed higher visual analogue scale (VAS) scores for both pain during (P=0.000) and after implant surgery (P=0.016). Male patients showed more 'negative' values for the reasonability of treatment cost (P=0.008) and the adequacy of the treatment period (P=0.022).ConclusionThe subjective satisfaction of patients was influenced by various factors, especially complication-related factors.

Results of Syndesmotic Screw Fixation versus Posterior Malleolus Fixation in Syndesmotic Injury at Pronation External Rotation Stage IV Ankle Fracture with Posterior Malleolus Fracture: Postoperative One Year Follow-up

Purpose: The purpose of this study is to compare the radiologic and clinical results of syndesmotic screw fixation and posterior malleolar fixation for syndesmotic injury in Lauge-Hansen classification pronation-external rotation (PER) stage IV ankle fractures with posterior malleolus fracture. Materials and Methods: We designed a retrospective study that included patients with Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture. Of 723 patients who underwent ankle fracture surgery from March 2005 to November 2012, 29 were included in this study. In this study, syndesmotic injury was treated with syndesmotic screw fixation or posterior malleolus fixation. There were 15 cases of syndesmotic screw fixation and 14 cases of posterior malleolar fixation. We compared the radiologic and clinical results at one year postoperatively. Posterior malleolus fragment size on a pre-operative computed tomographic image, and tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, and Takakura classification on a postoperative one year followup radiograph were used for comparison of the radiologic results. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society score, visual analogue scale score, and patient subjective satisfaction score. Results: Posterior malleolar fragment size was 12.62%±3.01% of the joint space in the syndesmotic screw fixation group and 27.04%±4.34% in the posterior malleolar fixation group. A statistical difference was observed between the two groups. However, other results, including tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, Takakura classification, and clinical scores showed no statistical difference. Conclusion: In the Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture, if the posterior malleolus fracture can be reduced anatomically and fixated rigidly, syndesmotic screw fixation, which can cause several complications, is usually not required for achievement of a satisfactory syndesmotic stability; this would be a recommendable option for treatment of syndesmotic injury.

Prognostic Factors of Arthroscopic Adhesiolysis for Arthrofibrosis of the Knee

PurposeTo assess the results of arthroscopic adhesiolysis for arthrofibrosis of the knee and to investigate possible prognostic factors.Materials and MethodsAmong the patients who developed arthrofibrosis after knee joint surgery, 68 patients who underwent arthroscopic adhesiolysis and were available for at least one-year follow-up were evaluated with regard to the Lysholm knee score, International Knee Documentation Committee (IKDC) subjective knee score, patient satisfaction, and range of motion (ROM) of the knee. The influence of possible prognostic factors including the cause of arthrofibrosis, duration of disease, and age of the patient on the postoperative ROM was analyzed.ResultsSixty-one patients (89.7%) obtained an average increase of 48.6° in ROM; however, the remaining seven patients (10.3%) did not show any increase at the final follow-up. The Lysholm knee score and IKDC subjective knee score increased significantly at the final follow-up. Patient satisfaction was high or very high in 89.7% of the patients at the final follow-up. There was no association between the cause of arthrofibrosis and the increase in postoperative ROM. The duration of disease was significantly related to the postoperative recovery of ROM. Age had no significant influence on the postoperative recovery of ROM.ConclusionsWe believe that arthroscopic adhesiolysis is effective for the treatment of intraarticular arthrofibrosis. In particular, the duration of the disease had significant influence on the postoperative outcome.

Meniscus Allograft Transplantation

Background: Because of the anatomic and biomechanical differences between the lateral and medial menisci, it is believed that the indications, combined injuries, techniques, and outcomes of the 2 meniscus allograft transplantation (MAT) procedures may be different. Hypothesis: Medial meniscus transplantation (medial group) usually combines concomitant surgeries, such as anterior cruciate ligament (ACL) reconstruction, so the medial group will have worse clinical results than the lateral group (lateral meniscus transplantation). Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was conducted on 91 patients who underwent MAT (lateral group, n = 56; medial group, n = 35). There were 33 patients with an absence of a concurrent injury (isolated group) and 58 patients with the presence of a concurrent injury (combined group). The mean follow-up was 40 months (range, 24-125 months). Clinical outcomes for range of motion (ROM), visual analog scale (VAS) for pain score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and Tegner activity score were evaluated, and an objective evaluation was performed using magnetic resonance imaging (MRI) and second-look arthroscopic surgery. Results: At final follow-up, the mean results for ROM, VAS score, IKDC subjective score, Lysholm score, Tegner activity score, and patient subjective satisfaction were not statistically different between the lateral and medial groups (P > .05). The VAS and Lysholm scores of the isolated group were significantly better than those of the combined group. Follow-up MRI was performed on 35 patients (24 in the lateral group and 11 in the medial group). Mean graft extrusion was 1.7 mm in the lateral group and 2.6 mm in the medial group (P = .075). The relative percentage of extrusion was 19.4% in the lateral group and 32.0% in the medial group (P = .011). Anterior cruciate ligament reconstruction occurred more commonly in the medial group, and cartilage procedures occurred more commonly in the lateral group. Conclusion: The clinical results of the lateral group were not different from those of the medial group. More graft extrusion was found in the medial group on MRI, and second-look arthroscopic surgery results of the lateral group were not as good as those of the medial group. The VAS and Lysholm scores of the combined group were worse than those of the isolated group. With regard to concomitant surgery, ACL reconstruction was most common in the medial group and cartilage procedures in the lateral group.

Ventral Inlay Labia Minora Graft Urethroplasty for the Management of Female Urethral Strictures

To evaluate the functional outcomes of ventral inlay labia minora graft urethroplasty (VILGU) for the management of female urethral strictures. Data of 7 consecutive women treated with VILGU between 2011 and 2013 were reviewed. Two patients had cystostomy tubes at repair, and 5 had undergone previous urethral dilations and urethrotomies. Clinical evaluation included assessment of the effect of voiding symptoms with American Urological Association (AUA) symptom score, uroflowmetry, voiding cystourethrography, and intraoperative urethrocystoscopy using a 6.5F pediatric ureterorenoscope. Preoperative AUA symptom score and peak urinary flow rate were compared with postoperative values. Cure was defined as the absence of any restenosis requiring additional intervention with subjective patient satisfaction at the last follow-up. Mean stricture length was 1.5 cm (range, 1-2.5), and mean operative time was 95 minutes (range, 70-110). With a mean follow-up of 18.2 months (range, 3-30), cure was achieved in 6 (86%) women. At the last follow-up, mean maximum urine flow (mL/s) increased from 3.9 ± 3.1 preoperatively to 22.7 ± 8.3 postoperatively (P <.001), and mean AUA symptom score decreased from 25.3 ± 5.2 preoperatively to 6.9 ± 3.7 postoperatively (P = .001). No fistulae developed after surgery. "De-novo" stress urinary incontinence was not evident in any case. VILGU effectively provides better urinary flow and significantly improves patient satisfaction in patients with female urethral stricture disease.

Use of nasal septal bone for septal extension graft after jaw surgery.

Background:After jaw surgery, there is often posterior caudal septal defect with dislocation of caudal septum from anterior nasal spine. In such patients, reconstruction of caudal septum is required during rhinoplasty. The authors used septal bone for nasal tip surgery reconstructing caudal septum in patients who have no desire to use autologous or homologous costal cartilage or foreign material.Methods:This study included 50 patients who underwent rhinoplasty using septal bone from November 2009 to September 2012. The subjective satisfaction of patients was evaluated 6 to 12 months after rhinoplasty with a questionnaire.Results:Mean follow-up was 9 months. Forty-three patients (86%) answered the questionnaire after the operation. Postoperative subjective satisfaction was excellent in 28 cases (65%), good in 9 cases (21%), fair in 4 cases (9%), no change in 1 case (2%), and poor or worse in 1 case (2%).Conclusions:Use of septal bone for septal extension graft may serve as a valuable option in septal cartilage–depleted patients. It gives a strong construct for tip surgery with patient satisfaction.

Subjective Satisfaction in Long-term Orthokeratology Patients

To evaluate the subjective satisfaction in visual stability, night vision complains, and light distortion phenomena, and also the number of hours and days per week of lens wear, in patients with myopia undergoing orthokeratology (OK) treatment for at least 1 year. A visual analog scale (VAS) questionnaire containing 18 items was administered to 44 patients, 29 women and 15 men (mean age, 24.39 ± 9.11 years), with a baseline spherical equivalent refractive error of -2.40 ± 0.94 diopters and astigmatism up to -0.5 diopters. Average treatment period by the time of data collection was 19 ± 7 months. Patients rated their satisfaction with the correction, with complaints of visual distortion being graded on a scale of 0 to 10, where 0 indicated no discomfort at all. More than 50% of patients skipped lens wear at least 1 night per week. The most common wearing pattern was 6-8 hours a day for 72.7% with 54.5% of patients wearing lenses every 2-3 nights only. Subjective vision scores after lens removal was 9.1 ± 1.1 after having worn the lenses and 8.1 ± 1.4 after skipping lens wear for 1 night. Subjective vision scores before lens insertion at the end of the day was 6.9 ± 2.0 and 5.8 ± 2.4, respectively. The number of hours until noticeable blur reduced with increased level of baseline myopia (r = 0.396; P < 0.001). Orthokeratology patients show an irregular wearing pattern after 1 year of treatment that has significant effects on the subjective visual performance over the next day of skipping lens wear. Light distortion under low-light conditions seems to be a transient complication of the treatment and most of the patients report an improvement after the first weeks of treatment.

Usefulness of endoscopic breast-conserving surgery for breast cancer

We compared the safety, invasiveness and cosmetic outcomes between endoscopic breast-conserving surgery (endoscopic group) and surgery under direct vision (direct vision group) for treating breast cancer. We compared 100 cases of endoscopic surgery with 150 cases of direct vision surgery. The safety was evaluated in terms of the blood loss, length of the operation and presence or absence of complications, whereas the degree of invasiveness was assessed using preoperative and postoperative leukocyte counts, neutrophil counts, interleukin (IL-6) levels and fever. The cosmetic outcome was assessed on the basis of a breast evaluation by the medical staff and the patient's subjective satisfaction. In both groups, serious postoperative complications were absent. No significant differences were observed in the leukocyte counts, neutrophil counts, IL-6 level or fever between the groups. An evaluation of the cosmetic outcomes by the staff showed a more favorable breast size, breast shape and scar condition in the endoscopic group. A significantly higher level of patient satisfaction was also observed in the endoscopic group. Postoperative local recurrence was absent. The endoscopic approach showed comparable safety and invasiveness, and provided better postoperative cosmetic outcomes than direct vision surgery. Our results suggest that endoscopic breast-conserving surgery is a potentially useful surgical method for the treatment of breast cancer.

홍삼사포닌 Rg3가 함유된 샴푸의 탈모방지와 양모개선 효과

최근 들어 홍삼의 발모효과가 실험적으로 입증이 되었으나 임상적인 효능에 대해서는 아직 연구가 부족한 실정이다. 본 임상시험에서는 홍삼사포닌 Rg3 0.003%가 함유된 샴푸(Somang Co., Korea)의 사용에 따른 탈모방지 및 발모 탈모 및 발모효과를 인체적용시험을 통해 확인하고자 한다. 탈모로 진단된 42명의 환자가 참여하였으며, 홍삼사포닌 Rg3 0.003%가 함유된 헤어샴푸를 사용하는 군과 홍삼사포닌 Rg3 0.003%를 제외한 헤어샴푸를 사용하는 군으로 나누어 16주간 제품 사용 후 모발의 굵기, 밀도, 성장속도를 측정하였고, 탈모 개선정도의 전문가 육안평가 및 피험자의 주관적 만족도로 평가하였다. 또한 제품사용의 피험자 주관적 기호도를 추가적으로 조사하였다. 시험 결과 시험제품 사용 후 16주에서 모발의 굵기, 모발의 밀도 및 모발 성장속도가 모두 통계적으로 유의성 있게 증가하였으며 전문가 육안평가와 피험자의 주관적 설문평가, 환자의 기호도 면에서도 시험제품이 더 우수한 결과를 보였다. 결론적으로 홍삼사포닌 Rg3가 함유된 샴푸는 피부에 자극 없이 탈모방지 및 양모개선 효과에 도움을 주는 제품으로 판단된다. Recently, hair growth effect of red ginseng was proved by many in vitro experiments, but there are not enough clinical studies. In the present study, we evaluated the efficacy of Rg3 hair shampoo (Somang Co., Korea) containing Rg3 0.003% extracted from ginseng radix on preventing hair loss and promoting hair growth by clinical study. 42 volunteers were enrolled present study and devided into two groups; one group used the Rg3 hair shampoo and another group used shampoo not containg Rg3. Before and after 8 and 16 weeks use of Rg3 hair shampoo, we measured the density, thickness and growth rate of hair. At the same time, an assessment of improvement of hair loss and subjective satisfaction of patients were conducted by clinicians and patients. Results obtained from the group used Rg3 hair shampoo showed statistically significant improvement in the density, thickness and growth rate of hair. Results from the clinicians, patients and subjective satisfaction of patients also showed better responses for the group used Rg3 hair shampoo. In conclusion, Rg3 hair shampoo is an effective product on preventing hair loss and promoting hair growth.

Bilateral mix-and-match versus unilateral multifocal intraocular lens implantation: Long-term comparison

To compare the visual outcomes and subjective satisfaction levels of patients who had bilateral mix-and-match implantation or monocular implantation of multifocal intraocular lenses (IOLs). Asan Medical Center, Seoul, South Korea. Retrospective comparative case series. Patients had implantation of a diffractive multifocal IOL (Tecnis ZM900) in 1 eye and a refractive multifocal IOL (Rezoom NXG1) in the other eye via the mix-and-match approach or of a Tecnis ZM900 IOL in 1 eye only. After 1 year, the uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and contrast sensitivity were evaluated. Patient satisfaction, spectacle dependence, and halo and glare symptoms were also evaluated. Twenty-three patients were evaluated. One year postoperatively, the mean values in the bilateral group and unilateral group were, respectively, binocular UDVA, 0.10 logMAR ± 0.18 (SD) and 0.10 ± 0.13 logMAR (P=.574); UIVA, 0.23 ± 0.12 logMAR and 0.29 ± 0.14 logMAR (P=.127); UNVA, 0.25 ± 0.18 logMAR and 0.27 ± 0.25 logMAR (P=.926). Subjective patient satisfaction was slightly higher in the bilateral implantation group (P=.083). There were no significant differences in contrast sensitivity, spectacle dependency, halos, or glare. There were no significant differences in postoperative visual acuity, subjective patient satisfaction, spectacle independence, or other visual symptoms between patients who had bilateral or unilateral implantation of multifocal IOLs. Unilateral implantation of a multifocal IOL is an option to lower spectacle dependency and increase patient satisfaction.

Results of Mannerfelt wrist arthrodesis for rheumatoid arthritis in relation to the position of the fused wrist

The wrist is involved early in rheumatoid arthritis and is often severely affected. A stable wrist is crucial to good hand function, which often necessitates a fusion. One of the most commonly used techniques in rheumatoid patients is the Mannerfelt arthrodesis. In this retrospective study the outcome and the patient's subjective satisfaction are presented and compared to other techniques. Also the influence of the position of the wrist following a fusion procedure is analysed. Thirty-four wrists were retrospectively analysed using radiological measurements, functional scores such as the Disabilities of the Arm, Shoulder and Hand (DASH) and a pain assessment. The objective function of the hand with the fused wrist was assessed. In 92.6% of wrists the patients rated their satisfaction as good or excellent. The mean DASH score post-operatively was 63.3. Of the wrists, 17 were fixed in a median flexed position of 13° and 17 wrists in a median extended position of 8°. There was no statistically significant correlation between the position of the wrist and the satisfaction or objective function. The rate of fusion was 94.1%. The Mannerfelt arthrodesis achieves good results and provides a high rate of satisfaction and pain relief in our study. It has major advantages compared to other wrist fusion techniques in the rheumatoid patient. We could not show clear statistical evidence for better results in either a flexed or an extended position, but the ratings of the patients indicated better subjective results with a slightly extended position of the arthrodesis.

One-Stage Procedure Using Spinal Accessory Nerve (XI)–Innervated Free Muscle for Facial Paralysis Reconstruction

For the treatment of facial paralysis, functioning free muscle transplantation has become accepted standard treatment. Choice of donor nerve and number of surgery stages, however, are still matters of great debate. Between 2000 and 2011, 36 patients (out of 329; 11 percent) with 42 functioning free muscle transplantations were treated using spinal accessory nerve (XI)-innervated muscle for facial reanimation as a one-stage procedure. Indications included bilateral or unilateral Möbius syndrome, severe postparetic facial synkinesis, and patient preference. Postoperative smile training was required to achieve spontaneous smile. For outcome assessment, patients were evaluated using multidisciplinary methods, including objective smile excursion score (range, 0 to 4), cortical adaptation stage (range, I to V), tickle test, and subjective patient questionnaire and satisfaction score (range, 1 to 5). Mean smile excursion score improved from 0.5 preoperatively to 3.4 postoperatively. Eighty-three percent of patients were able to perform independent and even spontaneous smile after 1 year of follow-up. Ninety percent of patients had a mean satisfaction score of 3.4 out of 5. However, 50 percent expressed more concern with aesthetic appearance than functional status. There was no functional morbidity of the donor shoulder in daily life. The classic two-stage procedure is still the first choice for facial paralysis reconstruction. However, the effectiveness of XI-innervated free muscle for facial reanimation in a one-stage procedure has proven it to be a good alternative treatment. It has become second in popularity for facial paralysis reconstruction in the authors' center. Therapeutic, IV.

Esthetic evaluation of single‐tooth implants in the anterior mandible

Single-tooth replacement of anterior mandibular teeth is frequently complicated by insufficient bucco-lingual bone width and limited mesio-distal space available for implant placement. The aim of the present study was to assess implant esthetics in the partially edentulous anterior mandible. Esthetic evaluation of 43 anterior mandibular single-tooth implants in 15 women and 28 men was performed using esthetic indices (PES=Pink Esthetic Score, PI=Papilla Index, SES=Subjective Esthetic Score) as well as subjective patients' Visual Analogue Scale (VAS) ratings. Clinical and radiological parameters (implant and crown dimensions, pocket depth, bleeding on probing, plaque, keratinized mucosa, marginal bone level, and distance to adjacent teeth) were tested for influence. Implant esthetics were judged satisfactory (PES ≤10) in 42% of implants compared with a patient satisfaction rate of 87%. Correlation between objective indices (PES/PI: rs =0.62, PES/SES: rs =-0.73, PI/SES: rs =-0.48) was highly significant (P≤0.001); however, no association to subjective patients' ratings could be observed. Type of prosthetic restoration (single crown vs. tulip-shaped double crowns), mesio-distal crown width as well as anatomic crown length significantly affected esthetic scores. Patients' judgment, by contrast, could not be associated to any prognostic factor. Subjective patient satisfaction with implant esthetics in the partially edentulous anterior mandible is high, however, remains hard to predict or objectively quantify.

THU0231 Surgical Treatment of the Dorsal Rheumatoid Wrist : A Long Term Assessment of the Subjective Results

BackgroundWrist problems occur frequently in rheumatoid arthritis, affecting 65 to 95% of cases. The goal of the surgical treatment is to ensure a correct function without return of normal anatomy.ObjectivesThe...

Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers

Background: Nonablative fractional photothermolysis has been reported to show early promise in the treatment of hypertrophic scars, but there are few reports on ablative fractional photothermolysis for the treatment of hypertrophic scars. Aim: To evaluate and compare the efficacy and safety of Er:YAG fractional laser (EYFL) and CO2 fractional laser (CO2FL) for treatment of hypertrophic scars. Methods: Thirteen patients with hypertrophic scars were treated with 2,940 nm EYFL, and ten were treated with 10,600 nm CO2FL. An independent physician evaluator assessed the treatment outcomes using Vancouver scar scale (VSS) and 5-point grading scale (grade 0, no improvement; grade 1, 1–25%; grade 2, 26–50%; grade 3, 51–75%; grade 4, 76–100% improvement). Patients are queried about their subjective satisfaction with the treatment outcomes. Results: After the final treatment, average percentage changes of VSS were 28.2% for EYFL and 49.8% for CO2FL. Improvement was evident in terms of pliability, while insignificant in terms of vascularity and pigmentation. Based on physician's global assessment, mean grade of 1.8 for EYFL and 2.7 for CO2FL was achieved. Patient's subjective satisfaction scores paralleled the physician's objective evaluation.Conclusion: CO2FL is a potentially effective and safe modality for the treatment of hypertrophic scars, particularly in terms of pliability.

A Comparative Study of Meniscectomy and Nonoperative Treatment for Degenerative Horizontal Tears of the Medial Meniscus

Background: It is still debated whether a degenerative horizontal tear of the medial meniscus should be treated with surgery. Hypothesis: The clinical outcomes of arthroscopic meniscectomy will be better than those of nonoperative treatment for a degenerative horizontal tear of the medial meniscus. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 102 patients with knee pain and a degenerative horizontal tear of the posterior horn of the medial meniscus on magnetic resonance imaging were included in this study between January 2007 and July 2009. The study included 81 female and 21 male patients with an average age of 53.8 years (range, 43-62 years). Fifty patients underwent arthroscopic meniscectomy (meniscectomy group), and 52 patients underwent nonoperative treatment with strengthening exercises (nonoperative group). Functional outcomes were compared using a visual analog scale (VAS) for pain, Lysholm knee score, Tegner activity scale, and patient subjective knee pain and satisfaction. Radiological evaluations were performed using the Kellgren-Lawrence classification to evaluate osteoarthritic changes. Results: In terms of clinical outcomes, meniscectomy did not provide better functional improvement than nonoperative treatment. At the final follow-up, the average VAS scores were 1.8 (range, 1-5) in the meniscectomy group and 1.7 (range, 1-4) in the nonoperative group (P = .675). The average Lysholm knee scores at 2-year follow-up were 83.2 (range, 52-100) and 84.3 (range, 58-100) in the meniscectomy and nonoperative groups, respectively (P = .237). In addition, the average Tegner activity scale and subjective satisfaction scores were not significantly different between the 2 groups. Although most patients initially had intense knee pain with mechanical symptoms, both groups reported a relief in knee pain, improved knee function, and a high level of satisfaction with treatment (P < .05 for all values). Two patients in the meniscectomy group and 3 in the nonoperative group with Kellgren-Lawrence grade 1 progressed to grade 2 at the 2-year follow-up. Conclusion: There were no significant differences between arthroscopic meniscectomy and nonoperative management with strengthening exercises in terms of relief in knee pain, improved knee function, or increased satisfaction in patients after 2 years of follow-up.

Open mini-incision parathyroidectomy for solitary parathyroid adenoma

Parathyroid surgery is the acceptable definitive treatment for primary hyperparathyroidism (pHPT) due to parathyroid adenoma. Open mini-incision parathyroidectomy (O-MIP) has an excellent cure rate and minimal morbidity. We aim to demonstrate the safety, efficacy and subjective patient satisfaction of O-MIP and investigate the accuracy of pre-operative radiological localisation in relation to operative findings. A retrospective review of patients who underwent O-MIP for pHPT due to solitary parathyroid adenoma from April 2006 to August 2012 was performed. All patients were initially investigated by an endocrinologist to confirm pHPT with pre-operative localisation imaging using ultrasound scan (USS) and 99mTc-sestamibi (MIBI). One hundred and fifty consecutive patients were included with a median age of 62 years. Pre-operative USS and MIBI scans were concordant in 71 % of cases. In combined modality (USS and MIBI), localisation was 94.8 % accurate. There was 95.5 % identification of parathyroid tissue confirmed by intra-operative frozen section. Ninety-one percent of patients were treated as a day case. The median operative time was 60 min. The mean pre-operative calcium level was 2.98 mmol/l, and the short-to-medium term mean calcium level was 2.49 (Paired t test, p < 0.001). There was no significant complication. O-MIP confers significant advantages over the traditional gold standard treatment of bilateral neck exploration. Accurate localisation is the key to successful O-MIP. In experienced hands, ultrasound and MIBI may be the only pre-operative investigations required for accurate localisation.

Operative Management of Partial-Thickness Tears of the Proximal Hamstring Muscles in Athletes

Background: Partial tears of the hamstring muscle origin represent a challenging clinical problem to the patient and orthopaedic surgeon. Although nonoperative treatment is frequently met with limited success, there is a paucity of data on the efficacy of surgical management for partial proximal hamstring tears in the active and athletic population. Purpose: To evaluate the results of an anatomic repair for partial tears of the hamstring muscle origin in athletes. Study Design: Case series; Level of evidence, 4. Methods: The records of 17 patients with partial tears of the proximal hamstring origin were reviewed after institutional review board approval was obtained. All patients were treated with open debridement and primary tendon repair after failure of at least 6 months of nonoperative therapy. Clinical and operative records, radiographs, and magnetic resonance images were reviewed for all patients. A patient-reported outcomes survey was completed by 14 patients that included the Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and subjective patient satisfaction scores. Early and late postoperative complications were recorded. Results: There were 3 male and 14 female patients; their average age was 43 years (range, 19-64 years) and average follow-up was 32 months (range, 12-51 months). There were 2 collegiate athletes (field hockey, track), 14 amateur athletes (distance running, waterskiing, tennis), and a professional bodybuilder. Postoperative LEFS was 73.3 ± 9.9 (range, 50-80) and custom LEFS was 66.7 ± 17.0 (range, 37-80) of a maximum 80 points. The most commonly reported difficulty was with prolonged sitting and explosive direction change while running. The average Marx score was 6.5 ± 5.3 (range, 0-16) of a maximum 16, correlating with a greater return to recreational running activities in this patient cohort than regular participation in pivoting or cutting sports. Marx custom scores were 20 of a maximum 20 in all patients, demonstrating no disability in the operative extremity with activities of daily living. No patient underwent a subsequent surgery. One patient was not satisfied with the result and reported persistent symptoms during competitive distance running. All patients were able to return to their preoperative level of activity after surgery. Conclusion: Anatomic surgical treatment of partial proximal hamstring avulsions can lead to satisfactory functional outcomes, a high rate of return to athletic activity, and low complication rate. This procedure should be reserved for patients who have failed an extended course of nonoperative treatment, and the proximity of the sciatic nerve mandates a careful assessment of the risk-benefit ratio before surgery is undertaken.

V261 VENTRAL INLAY LABIUM MINUS GRAFT URETHROPLASTY FOR THE MANAGEMENT OF FEMALE URETHRAL STRICTURES

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction & Incontinence)1 Apr 2013V261 VENTRAL INLAY LABIUM MINUS GRAFT URETHROPLASTY FOR THE MANAGEMENT OF FEMALE URETHRAL STRICTURES Fikret Fatih Onol, Sinasi Yavuz Onol, Ugur Boylu, and Eyup Gumus Fikret Fatih OnolFikret Fatih Onol Istanbul, Turkey More articles by this author , Sinasi Yavuz OnolSinasi Yavuz Onol Istanbul, Turkey More articles by this author , Ugur BoyluUgur Boylu Istanbul, Turkey More articles by this author , and Eyup GumusEyup Gumus Istanbul, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1644AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral stricture disease is rare in women. Female urethroplasty is a topic of increasing attention with multiple surgical approaches described including use of both grafts (vaginal wall, buccal mucosal membrane, lingual mucosa, and labia minus) and flaps (vaginal vestibule, anterior and lateral vagina). We present our experience with ventral inlay labium minus graft urethroplasty (VILGU). METHODS Five consecutive women (aged 47 to 52 years) with mid- to distal urethral strictures were treated with VILGU between 2011 and 2012. The etiology was caruncle excision in 2 and idiopathic in 3. All but one patient had previous internal urethrotomy and repeated uretheral dilatations. Two were cytostomized at the time of repair. Pre- and postoperative evaluation included assessment of voiding symptoms with AUA symptom score, uroflowmetry with residual urine determination, voiding cystourethrography (VCUG), and intraoperative urethrocystoscopy. In the surgical technique, ventral urethra was exposed through a midline anterior vaginal wall incision, the fibrotic urethra was incised from distal to proximal stricture site at six o'clock. A labium minus skin graft of 2.5–3 cm in length and 1–1.5 cm in width was harvested and augmented to the urethra as ventral inlay on a 20–22 Fr catheter with running 4/0 absorbable suture. Catheter was removed after 2 weeks. Postoperative follow-up was scheduled at 1st, 3rd, 6th months, and yearly thereafter. Cure was defined as the absence of any re-stenosis requiring additional intervention with subjective patient satisfaction. RESULTS Mean operative time was 95 minutes (70–110 min.). With a mean follow-up of 13.6 months (range: 6 to 20) cure was achieved in all patients. At the last follow-up, mean Qmax (ml/sec) increased from 3.8±3.2 preoperatively to 22.9±6.5 postoperatively (p<0.001), and mean AUA symptom score decreased from 25.3±5.2 preoperatively to 6.9±3.7 postoperatively (p=0.001). CONCLUSIONS VILGU seems as a simple and effective treatment method for the reconstruction of female urethral strictures, potentially eliminating the need for oral mucosal graft harvesting. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e107 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fikret Fatih Onol Istanbul, Turkey More articles by this author Sinasi Yavuz Onol Istanbul, Turkey More articles by this author Ugur Boylu Istanbul, Turkey More articles by this author Eyup Gumus Istanbul, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Arthroscopic Primary Rotator Cuff Repairs in Patients Aged Younger Than 45 Years

The purpose of this study was to evaluate the mechanism of injury, patient characteristics, tear size, and clinical outcomes after arthroscopic primary rotator cuff repair of full-thickness tears in patients aged younger than 45 years. A total of 70 consecutive patients were reviewed in a retrospective, multicenter (2 institutions) study evaluating prospectively collected data. Fifty-three patients, with a mean age of 37.5 years (range, 16.2 to 44.9 years), were available for follow-up at a mean of 35.8 months (range, 13.8 to 59.1 months). Exclusion criteria included patients with revision procedures, repair of partial tears, and follow-up of less than 12 months. Follow-up evaluation included physical examination with dynamometer strength testing and clinical outcome measures including the Single Assessment Numeric Evaluation score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, pain score on a visual analog scale, and Simple Shoulder Test score. A total of 60% of the patients (32 of 53) had a traumatic etiology, with 38% (12 of 32) of these related to an athletic event. Of the tears, 36 (68%) were medium tears. Concomitant procedures performed at the time of rotator cuff repair included acromioplasty (51), biceps tenodesis or tenotomy (24), distal clavicle excision (10), anteroinferior stabilization (2), and labral repair (1). The mean postoperative ASES score was 84.6 (range, 21.6 to 100.0), with 2 patients recording ASES scores of less than 50 (21.7 and 41.7) at final follow-up. In the 38 patients available for clinical follow-up examination, forward flexion improved from 158.7° (range, 45° to 180°) to 168.4° (range, 120° to 180°) (P = .014). At the time of follow-up, no patients had undergone revision surgery. On the basis of poor clinical outcome scores, 2 patients (4.0%) were considered failures. Arthroscopic primary rotator cuff repair of full-thickness tears in patients aged younger than 45 years results in improved outcomes with regard to pain, subjective patient satisfaction, and shoulder function. Level IV, therapeutic case series.