Chiari malformations in adults: A single center surgical experience with special emphasis on the kinetics of clinical improvement

BackgroundThe Chiari malformation type I (CM-I) is the most commonly found type in adults. The efforts to further improve the treatment offered for these malformations are hampered by the existence of controversial methods and the absence of a uniform scoring system to evaluate clinical outcomes.ObjectivesThe goal of our study is to analyze the clinical and radiological data concerning patients operated for CM and to expose surgical techniques.Patients and treatmentThis is a retrospective study concerning patients of more than 16 years of age, operated on (from 2000 to 2016) in our institution. These patients underwent bony decompression of the cervico-occipital junction, with a duraplasty enlargement. Clinical and radiological follow-up was assessed sequentially.ResultsThe mean age of patients included in this study was 39. Headaches (n = 19) and sensory disturbances (n = 17) were the most common presenting complaints. Furthermore, syringomyelia symptoms were present in 34.5% of the cases (n = 10). Twenty-three patients displayed a Chiari malformation of type I (79.3%), and six patients were classified as Chiari malformation type I.5 (20.7%). A syringomyelia was present in 58.6% of the cases (n = 17). The postoperative complications that were encountered were: one case of pseudo-meningocele, two cases of cerebrospinal fluid leakage, two cases of meningitis, and one case of delayed wound healing. The mean follow-up period was 18 months, which showed beneficial outcomes in 82.8% of the cases (20.7% cured, and 62.1% improved) and an unfavorable outcome in 17.2% of the cases (13.8% stable patients and 3.4% worsened outcomes). Syringomyelia symptoms were improved in 60% of the patients. Among the patients who presented without a syrinx, 82.3% had good outcomes; and those who presented with a syrinx, 83.4% had good outcomes. Symptoms improved for 69% of patients within 3 months.ConclusionAn optimal craniocervical osteo-dural decompression plus duraplasty offered early and sustainable good clinical results in symptomatic CM-I and CM-I.5 patients.     

20 años de experiencia en trasplante renal en bloque de donantes pediátricos en receptores adultos

BackgroundEn bloc kidney transplantation from pediatric donors into adult recipients increases the donor pool. However, this surgical procedure is not widely performed in many transplant centers. To evaluate the long-term outcomes of bloc kidney transplantation from pediatric donors into adult recipients in a single center.Material and methodsRetrospective analysis of 42 patients who received pediatric cadaveric bloc kidney transplantation in our center since 1999. Median follow-up period was 73 months (5-233) in which renal function tests were taken and complications registered.ResultsWe have performed 42 bloc kidney transplantation from pediatric donors into adult recipients in our center. The recipients’ age was 44.1 ± 11.8 years. Pediatric donors were 22.4 ± 14.7 months old and weighted 11.3 ± 3.6 kg. Cold ischemia time was 15.7 ± 4.5 hours. During a median follow-up of 73 months, 35 patients (83.3%) had graft survival with excellent function (first-year serum creatinine levels of 0.99 ± 0.25 mg/dl). There were 7 graft losses (16.7%) in the immediate postoperative period (4 cases of vascular thrombosis, one anastomosis dehiscence and 2 cortical necrosis).ConclusionsThe pediatric en bloc renal graft transplantation into adults is a safe technique with excellent medium- to long-term functional performance. The vast majority of significant complications leading to graft loss were reported in the immediate postoperative period. A good selection of donors and recipients as well as an adequate surgical technique are essential to minimize the occurrence of adverse events.     

Ensayo clínico,aleatorizado, abierto y prospectivo,de 3 años de seguimiento,que compara la eficacia del TVT y la colposuspensión de Burch como tratamiento de la incontinencia urinaria de esfuerzo femenina

BackgroundEvidence comparing the effectiveness of tension-free vaginal tape (TVT) with Burch colposuspension (CS) over a long-term follow-up is scarce.PurposeTo compare TVT with CS as primary treatment for female stress urinary incontinence (SUI).DesignOpen randomised clinical trial with a three-year follow-up period.Participants49 consecutive women aged 35 to 70 with SUI demonstrated by a urodynamic study.SettingUrology department of Severo Ochoa general hospital in Leganés, Madrid, Spain.Intervention24 random patients treated with TVT and 25 with CS.MeasurementsMain variable: assessment before treatment and at six months, one year and three years after the operation using the incontinence severity symptoms index (SSI) and the incontinence impact symptoms index (SII). Secondary variable: three groups for assessing cure, improvement and failure rates.ResultsTime in surgery, consumption of postoperative analgesics and length of the postoperative hospital stay were lower in the TVT group (41.1 ± 10.9 minutes; 6 [2.8-10.5] capsules and 1 [1-2] days vs. 57.1 ± 18.3 minutes, 23.5 [18.0-31.5] capsules and 3 [3-3] days [p < 0.0001]). There was a significant reduction in SSI and SII scores in both groups and no differences in surgical complications, urgency, obstruction, one-hour pad test, urine culture, flowmetry, costs and cure rates at any moment during follow-up (cured/improved 76.2%, 78.3% and 77.3% at six months, one year and three years for TVT vs. 87.5%, 87.5% and 91.3% for CS; p = 0.32, p = 0.4 and p = 0.19).LimitationsThe trial is open, which can create observer bias. A study with a higher number of patients or a longer follow-up time could show differences between the procedures that we were unable to observe in this study, due to our budget and time limits.DiscussionBased on both short-term and long-term results, TVT is as effective as CS for the treatment of SUI, and has similar subjective cure and surgical complication rates. Time in surgery, consumption of analgesics and length of postoperative hospital stay are all lower in the TVT group. In our clinical setting, with a one-day postoperative stay for TVT, the two procedures have similar costs.     

Resultados a largo plazo de cirugía antirreflujo vesicoureteral con técnica de Lich-Gregoir sin drenaje vesical

ObjectiveTo describe our long-term experience with patients with vesicoureteral reflux (VUR) who underwent conventional surgery without postoperative bladder drainage.Material and methodsRetrospective review of 45 patients surgically treated by extravesical Lich-Gregoir's ureterovesical reimplantation without postoperative bladder drainage between 2010 and 2013.Results37 women (82.2%) and 8 men (17.8%). 28 patients with unilateral reflux, and 17 patients with bilateral reflux with a total of 62 operated kidneys. The mean age at surgery was 6 years (2 to 11 years).The main cause of surgical indication was the persistence of reflux in patients older than 6 years (73.3%); with grade III VUR (75.6%) being the most frequent. The mean surgical time was 44 minutes (35-70) for unilateral reimplantation, and 70 minutes (53-98) for bilateral ones.All patients presented spontaneous urination in the immediate postoperative period, without pain, no hematuria, full incontinence, and without a bladder balloon. None required bladder catheter placement, and hospital discharge was indicated between 7 and 36 hours postoperatively (mean 11 h).All continued with spontaneous micturitions, without postvoid residual or voiding dysfunction during the 5-year follow-up.ConclusionThe thorough selection of the patients, the detailed surgical gestures, the bladder emptying without instrumentation of the urethra, together with a correct use of analgesics and early ambulation allowed excellent outcomes obtained in these patients managed with a short hospital stay and without bladder drainage, also demonstrating the safety of the procedure at 5 years of follow-up.     

La preservación del esfínter interno vesical y la uretra proximal durante la prostatectomía radical retropúbica puede mejorar la recuperación temprana de la continencia en pacientes seleccionados

ObjectivesTo evaluate the influence of preservation of the muscular internal sphincter and proximal urethra on continence recovery after radical prostatectomy (RP).Material and methodsFifty-five consecutive patients with organ confined prostate cancer were submitted to RP with the preservation of muscular internal sphincter and the proximal urethra (group 1) and compared to 55 patients submitted to standard procedure (group 2). Continence rates were assessed using a self-administrated questionnaire at 3, 7, 30 days and 3, 12 months after removal of the catheter.ResultsGroup 1 had a faster recovery of continence than group 2 at 3 days (50.9% vs. 25.5%; P = .005), at 7 days (78.2% vs. 58.2%; P = .020), at 30 days (80.0% vs. 61.8%; P = .029) and at 3 months (81.8% vs. 61.8%; P = .017); there were no statistically difference in terms of continence at 12 months among the two groups. Multivariate logistic regression analysis of continence showed that surgical technique was significantly associated with earlier time to continence at 3 and 7 days. The two groups had no significant differences in terms of surgical margins.ConclusionsOur modified technique of RP with preservation of smooth muscular internal sphincter as well as of the proximal urethra during bladder neck dissection resulted in significant increased early urinary continence at 3, 7, 30 days and 3 months after catheter removal. The technique does not increase the rate of positive margins and the duration of the procedure.     

Long-term radiographic appearance of calcium-phosphate synthetic bone grafts after surgical treatment of tibial plateau fractures

ObjectivesSynthetic bone grafts (SBGs) are widely used to fill bone defects after fracture reduction. This study assessed the long-term resorption of two different calcium phosphate products (A = ChronOS™ inject and B = Norian^® SRS^®; both DePuy Synthes, Oberdorf, Switzerland) used in the surgical treatment of tibial plateau fractures.DesignLong-term clinical and radiologic follow-up of 52 patients after surgical treatment of intraarticular tibial plateau fractures augmented with SBGs.SettingThe study was performed at a level 3 trauma center.PatientsBetween January 2000 and December 2006 a total of 52 patients with intraarticular tibial plateau fractures were operatively treated and augmented with SBGs consisting of a Brushite matix with β-TCP granules (SBG A) or hydroxylapatite with 4–6% carbonate content (SBG B). 46 patients could be contacted and 38 were included in the study. Half of the patients received SBG A and the other half SBG B.Main outcome measurementsLoss of reduction and SBG resorption was investigated by comparison of follow-up X-ray images to pre- and postoperative X-ray images. Furthermore, pain, activity level and knee function were evaluated by means of questionnaires and clinical examination.ResultsThe mean age of patients was 59.7 ± 12.5 years. The follow-up was 8.6 ± 0.9 years for SBG A and 11.6 ± 1.4 years for SBG B (p < 0.001). In most cases SBG A was completely resorbed in a homogenous pattern, while SBG B was still visible on the X-ray images revealing a peripheral resorption pattern. A loss of reduction (>2 mm) could be observed in two patients with SBG A and two patients with SBG B, although only one of them had an impaired knee function.ConclusionsThe composite SBG A reveals a comprehensive long-term resorption in comparison to SBG B. Nevertheless, both provided suitable mechanical support as part of the surgical treatment of tibial plateau fractures.Level of evidenceCase series, Level IV.     

Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus

BackgroundRecurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described.Methods32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%).ResultsPatients were assessed with a mean follow-up of 9.8 ± 4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9 ± 17.8 points to 85.2 ± 14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1 ± 9.1 to 9.7 ± 5.4°, the intermetatarsal angle decreased from 11.5 ± 4.5 to 6.7 ± 4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case).ConclusionsPercutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery.Levels of evidence: IV, Retrospective Case Series.     

Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain

AimTo analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results.MethodSingle-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades.Results128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106 ± 64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo ≥ IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches.ConclusionsThe number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden.     

Asymmetry in gait pattern following bicondylar tibial plateau fractures—A prospective one-year cohort study

IntroductionDespite the high number of studies evaluating outcomes following tibial plateau fractures, the literature lacks studies including the objective assessment of gait pattern. The purpose of the present study was to evaluate asymmetry in gait patterns at 12 months after frame removal following ring fixation of a tibial plateau fracture.Patients and methodsThe study design was a prospective cohort study. The primary outcome measurement was the gait patterns 12 months after frame removal measured with a pressure-sensitive mat. The mat registers footprints and present gait speed, cadence, as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population.ResultsTwenty-three patients were included with a mean age of 54.4 years (32–78 years). Patients presented with a shorter step-length of the injured leg compared to the non-injured leg (asymmetry of 11.3%). Analysis of single-support showed shorter support time of the injured leg compared to the non-injured leg (asymmetry of 8.7%). Moreover, analysis of swing-time showed increased swing-time of the injured leg (asymmetry of 8.9%). Compared to a healthy reference population, increased asymmetry in all gait patterns was observed. The association between asymmetry and health-related quality of life (HRQOL) showed moderate associations (single-support: R = 0.50, P = 0.03; step-length: R = 0.43, P = 0.07; swing-time: R = 0.46, P = 0.05).ConclusionCompared to a healthy reference population, gait asymmetry is common 12 months after frame removal in patients treated with external ring fixation following a tibial plateau fracture of the tibia.     

Effectiveness of subtalar arthroereisis with endorthesis for pediatric flexible flat foot: a retrospective cross-sectional study with final follow up at skeletal maturity

BackgroundPediatric flexible flatfoot is sometimes asymptomatic but it can rarely cause physical impairment, pain, and difficulty walking. We evaluated the radiographic effectiveness of intervention of subtalar arthroereisis with endorthesis for pediatric flexible flatfoot with final follow-up at skeletal maturity.MethodsThis is a retrospective cross-sectional study. 56 consecutive patients (112 feet) who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot (mean age at final follow-up 15.5 ± 1.2 years, 39.3% female) were enrolled. All the radiographic studies were performed in the hospital. Radiographs (standard weight-bearing radiographs of the foot with anteroposterior and lateral view) were used to measure lateral talocalcaneal angle (LTC), calcaneal pitch angle (CP), Meary’s angle (MA), anteroposterior talonavicular angle (APTN), talonavicular uncoverage percent (TNU). Minimum follow-up was 18 months. Measures were assessed pre-operatively and at the final follow-up. Clinical and functional parameters were assessed at the final follow-up.ResultsChildren who underwent surgical treatment with subtalar arthroereisis for pediatric flexible flatfoot exhibited a statistically significant improvement in all radiographic measurement parameters at the last follow-up at skeletal maturity (all, p < 0.004). Mean follow-up was 40.1 ± 23.6 months. Clinical parameters were not correlated with the foot radiographic parameters at follow up period.ConclusionsOur results suggest that endorthesis in pediatric flexible flatfoot was effective for improving radiographic parameters at skeletal maturity. The amount of the morphologic correction at the end of the skeletal growth should be expected mainly for lateral tarso-metatarsal alignment and talo-navicular congruency (MA, APTN, TNU).Level of evidenceLevel III, retrospective study.     

A rare case of leiomyoma of the internal anal sphincter

IntroductionLeiomyoma is a benign tumour which derives from the smooth muscle fibres and it may occurs in every site in which this type of muscle is present. Among all benign soft tissue tumours it represents almost 3.8% and its pathogenesis remains still unknown.Presentation of caseThe present case is about a 62 year old woman referred to our centre complaining anal and perineal pain which increase after defecation in association with the appearance of a nodule in the perianal region fixed to the anal sphincter. A 360° tridimensional transanal ultrasound was performed and it showed an anterior nodular thickening of the internal anal sphincter. After an inconclusive preoperative biopsy and a counselling with the patient, the surgeons decided to proceed with the surgical excision. The immunohistochemical examination confirmed the preoperative suspicion of leiomyoma. At 1 year follow-up the patient had not tumour-related symptoms or fecal incontinence and any signs of local recurrence at ultrasound imaging were demonstrated.DiscussionLeiomyomas are relatively insensitive to chemotherapy whereby surgery is the treatment of choice and it should be adequate to the site and dimension of the lesion achieving a complete resection with free margins. A further close follow-up is needed too.ConclusionNowadays there is not a gold standard technique to treat such kind of lesions and the decision of the best surgical approach should depend on the dimension and site. In fact, surgery aims to the oncological outcome trying also to minimize the possible post-operative functional complications.     

Resultados a largo plazo de la cistoplastia de ampliación: una evaluación retrospectiva de 54 niños

Introduction and objectivesThroughout the years, clinicians dealing with pediatric urology disorders have resorted to bladder augmentation (BA), a demanding surgical procedure, to preserve renal functions in sundry congenital urinary tract defects. This study aimed to reveal the very long-term outcomes of BA in a large sample of pediatric patients and the role of underlying disease on renal prognosis after BA.Materials and methodsA retrospective cross-sectional study was conducted on 54 children with congenital urinary defects who underwent BA. The utilized augmentation technique, the location of ureter implantation, complications, and ultrasonography findings were analyzed. Data on serum creatinine levels were collected from preoperative records and anniversaries following BA.ResultsAmong 54 children, 33 (61.1%) were boys. Diagnoses were spinal dysraphism (SD) (n = 13), posterior urethral valve (PUV) (n = 8), bladder exstrophy (n = 32) and trauma (n = 1). The median follow-up duration was 18 (3-31) years. The comparisons of serum creatinine levels between groups revealed that, despite no meaningful difference was present between bladder exstrophy and PUV group in the preoperative period and postoperative 1^st year, cases with PUV had significantly higher levels of serum creatinine levels in the following postoperative years. Therewithal compared with the SD group, subjects with PUV had significantly higher levels at the postoperative 2^nd year (P = .035) and 10^th year (P = .006).ConclusionsIn our study, significantly long-term follow-up outcomes could facilitate the pre- and postoperative approach for enterocystoplasty in children. According to our results, it is noteworthy that kidney functions are at high risk of worsening in subjects with PUV and underwent BA.     

Joint debridement and microfracture for treatment late-stage Freiberg-Kohler’s disease: Long-term follow-up study

BackgroundFreiberg-Kohler’s disease is not a common disease and although various reports have been described since 1914, treatment methods are not completely established. The purpose of the present retrospective study was to evaluate the long-term outcomes following joint debridement and microfracture procedures for the treatment of Freiberg-Kohler’s disease.MethodsFifteen consecutive patients (16 feet) with Freiberg-Kohler’s disease (Smillie’s classification grade III–V) were operated between May 1996 to December 2011. All patients followed the same post-operative protocol. The objective and subjective evaluations were taken at the initial examination and at final follow-up.ResultsMean follow-up was 11 years ±5.5 (range 4.2–19.7 years). The AOFAS score, VAS score and ROM of the MTP joint improved significantly after surgery (p value <0.05).The AOFAS score improved from a preoperative value of 46.7 ± 15.5 points to 83.2 ± 9.4 points postoperative (p < 0.05). The mean preoperative joint ROM was 28° ± 8° and 49° ± 13° postoperative (p < 0.05). VAS score improved from a preoperative value of 5.5 ± 1.2 points to 1.2 ± 1 points at last follow-up (p < 0.05). At the end of follow-up 13 patients (81%) declared they were very satisfied, 3 patients (19%) satisfied and nobody unsatisfied.ConclusionsOur results suggest that joint debridement and microfracture procedure is an effective surgical treatment for late-stage Freiberg-Kohler’s disease with decrease of daily pain, improved ROM, and high patient satisfaction.     

Bisphosphonate therapy for unresectable symptomatic benign bone tumors: A long-term prospective study of tolerance and efficacy

ObjectivesTo evaluate the long-term tolerance of bisphosphonates proposed as an alternative therapeutic option for symptomatic unresectable benign bone tumors and to evaluate the long-term efficacy of this treatment.MethodsFrom March 2007 to March 2011, patients with unresectable symptomatic benign bone tumors were consecutively included in this institutional review board-approved study and treated with bisphosphonates. Prospectively long-term follow-up is reported. The study endpoints were to describe the long-term tolerance, the clinical evolution of pain for each patient and the radiological success defined as a complete disappearance of inflammation and ossification of the bone lesion. All complications and side effects were recorded.ResultsEight patients (mean age 16 years; range 7–42) with various tumor subtypes were included: aneurysmal bone cysts (N = 5), Langerhans cell histiocytosis (N = 1), osteoblastoma (N = 1), and a giant cell tumor (N = 1). Tumors were located in cervical (N = 4) or thoracic (N = 1) vertebrae, femoral shaft (N = 1), acetabulum (N = 1) and sacrum (N = 1). Mean number of bisphosphonate cycles was 3 (range: 1–6) over a median period of 10 months. The median clinical and imaging follow-up period was 21 months (6 to 63 months). No severe complications due to treatment or lesion recurrence were reported. Pain disappeared within 6 weeks of the first cycle for all but one patient. Ossification of the bone lesion was observed for all patients but one, complete for two and partial for the five others.ConclusionsBisphosphonates appear to be an effective option without adverse effects for the non-operative management of symptomatic benign bone tumors.     

Is intraoperative pedography helpful in clinical use—Preliminary results of 100 cases from a consecutive,prospective, randomized,controlled clinical study

BackgroundThe purpose of this study was to assess the clinical use, and to analyze the potential clinical benefit of intraoperative pedography (IP) in a sufficient number of cases in comparison with cases treated without IP.MethodsPatients (age 18 years and older) which sustained an arthrodesis and/or correction of the foot and ankle were included.ResultsOne hundred cases were included (ankle correction arthrodesis, n = 12; subtalar joint correction arthrodesis, n = 14; arthrodesis without correction midfoot, n = 15; correction arthrodesis midfoot, n = 26; correction forefoot, n = 33). Fifty-two patients were randomized for the use of IP. In 24 of the 52 patients (46%), the correction was modified after IP during the same operation.ConclusionsIn 46% of the cases a modification of the surgical correction was made after IP in the same surgical procedure. Whether IP improve the plantar force distribution of the foot and the mid- or long-term clinical outcome has to be critically analyzed when longer follow-up is completed.     

Surgical treatment of hourglass-like radial nerve constrictions

IntroductionSpontaneous radial nerve palsy with the surgical revelation of an hourglass-like constriction is a complicated condition. In general, the surgical strategy is decided in accordance with the results of surgical exploration. This study aimed to investigate the efficacies of various choices of surgical methods in the treatment of hourglass-like radial nerve constrictions.Material and methodsTen patients with spontaneous radial nerve palsy undergoing surgical exploration with the revelation of hourglass-like constrictions between November 2010 and December 2018 were reviewed in our hospital. Preoperative physical, electrophysiological and ultrasound examinations were performed for all patients. Varying levels, degrees and numbers of radial nerve constrictions were shown by surgical exposure. Epineurectomy and interfascicular neurolysis were performed in 4 cases with incomplete constrictions; resection and primary suture repair in 2 radial nerves with neurotmesis; resection and autologous nerve grafting in 4 patients with nerve defect > 2 cm. Both motor and sensory evaluations were performed at a follow-up visit.ResultsTen patients underwent different history before the onset of symptom. Nerve ultrasound demonstrated swelling as well as constrictions of the radial nerve. All patients who were followed up presented with good to excellent recovery of motor function. The effectiveness of suture and autograft repair tended to be better than that of simple neurolysis.ConclusionThe etiology of hourglass-like fascicular constrictive neuropathy of radial nerve involve with torsional factors. Nerve ultrasound is an important and useful measurement in diagnosing the pathology of spontaneous radial nerve palsy and in helping determine surgical approach. The surgical intervention is beneficial for the patients who do not recover in 4 weeks after onset of symptoms and for severe hourglass-like constrictions that are confirmed by preoperative ultrasound imaging. We recommend that nerve grafting be a suitable method in confrontation of nerve defect > 2 cm.     

Mortalidad por cáncer de próstata en la rama española del European Randomized Study of Screening for Prostate Cancer (ERSPC). Resultados tras 15 años de seguimiento

ObjectiveTo address if prostate cancer (PCa) screening decreases PCa mortality in the asymptomatic population, within the setting of the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC).Material and methodsFrom 1996 to 1999, 4,278 men aged 45–70 years were recruited and randomized to the screening arm (PSA every 4 years, prostate biopsy when PSA  ≥ 3 ng/ml) and control arm (no tests). Dates and causes of death were collected on an annual basis. A Kaplan-Meier analysis was used to calculate overall and cancer-specific survival.ResultsA total of 2,416 men were recruited in the screening arm and 1,862 in the control arm. Mean age was 57.8 years, median follow-up was 13.3 years. At the end of the follow-up period, 427 deaths (9 from PCa) were observed. Survival analysis did not show any difference between the study arms with respect to overall and cancer-specific survival (p = 0.939 and p = 0.544 respectively). Most relevant causes of death were malignant tumors (52.9%), cardiovascular disease (17.3%) and respiratory (8.9%). Only 2.1% of deaths (0.2% of all recruited men) were due to PCa (2.5% screening, 1.6% control).ConclusionsThe Spanish arm of ERSPC failed to reproduce the long-term results shown in the whole study. No differences in mortality (overall or cancer-specific) were observed after 15 years of follow-up. PCa mortality was infrequent (less than 1%). These results suggest limited yield of PCa screening in our setting.     

Outcome of the TURP-TUVP sandwich procedure for minimally invasive surgical treatment of benign prostatic hyperplasia with volume larger than 40cc over a 4-year period in Nigeria

IntroductionTransurethral resection of the prostate (TURP) remains the reference standard for the surgical treatment of infravesical obstruction due to benign prostatic hyperplasia (BPH). While TURP has proven long-term efficacy, it has some associated morbidities. This has fuelled the drive to develop alternative cost-effective options with comparable functional outcomes and a superior safety profile.ObjectivesThe aim of this study was to evaluate transurethral electro-vaporization of the prostate (TUVP) combined with TURP as a “sandwich” procedure in relieving the obstruction caused by BPH with volume of 40-80cc.Patients and MethodsThe medical notes of 57 consecutive patients with moderate to severe bladder outflow symptoms due to BPH who underwent TURP-TUVP as a sandwich procedure from April 2007 to March 2011 were reviewed for prostatic volume, duration of surgery, volume of irrigation fluid used intra-operatively and post-operative hospital stay. Similarly, the patients IPSS, Qmax and PVR were evaluated pre- and postoperatively.ResultsThe mean patient age was 64.1 years (SD = 9.1), mean prostatic volume was 56.8 cc (SD = 8.9), mean resection time was 69.5 minutes (SD = 23.9) and mean volume of irrigation fluid (1.5% Glycine) used was 21.5 L (SD = 4.9).The mean post-operative hospital stay was 3.5 days (range 3- 4 days). Overall, 11 (19%) patients had blood transfusion, there was no incidence of TUR syndrome and one mortality was recorded from primary plasminolysis. Compared with baseline values, on follow-up at 3 months the IPSS, Qmax and PVR had improved significantly. Bladder neck stenosis occurred in 3 patients and was successfully treated with bladder neck incision.ConclusionsThe sandwich combination of TURP and TUVP for the surgical treatment of BPH with volume larger than 40cc had satisfactory patient safety profile and resulted in significant improvement in IPSS, Qmax and PVR on follow-up at 3 months.     

Trapézectomie totale avec tendinoplastie de suspension et d’interposition dans le traitement de la rhizarthrose : résultats à 6,5 ans de recul moyen

ObjectivesTotal trapeziectomy remains the main surgical treatment of trapeziometacarpal osteoarthritis. Little has been reported on the long-term results of this technique. We report in this study our experience with our technique of trapeziectomy associated with interposition and suspension tendinoplasty using the abductor pollicis longus tendon with 78 months average follow-up.MethodsEighteen patients (22 thumbs) of 62.7 years average age underwent this procedure. According to Dell classification, there were two stage II, five stage III and 15 stage IV. Signs of osteoarthritis of the scaphotrapezoidal joint were associated in 19 cases.ResultsAt 78 months average follow-up, 73 % of the patients were painfree. Average opposition was 9.4 out of 10 according to Kapandji, the grip strength was equal to 18.5 kg and the key pinch to 4.4 kg. The quick DASH was equal to 20 over 100. Ninety-one percent of the patients were satisfied or very satisfied with the results. Space between scaphoïd and thumb metacarpal was 3.2 mm and was down by 27 %. There were only two complications related to a reflex sympathetic dystrophy.Discussion and conclusionTrapeziectomy associated with interposition and suspension tendinoplasty gives satisfactory functional results which are maintained with follow-up with high satisfaction rate and low complication rate.