Long-term follow-up of microvascular decompression for trigeminal neuralgia

We conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University Medical Centre Groningen/the Netherlands were evaluated. Baseline data from operative outcome were evaluated using univariate and multivariate analysis. The group consisted of 156 patients with TN: 90 females and 66 males with a median follow-up period of 9.7 years. The average age of initial symptoms was 51 years. The average duration of symptoms was 58 months. Postoperative 22 patients had a facial hyperpathia or hyperesthesia. Postoperatively, 137 patients had immediate relief. Postoperatively 1 year, 140 patients still had a good outcome of the operation. Twenty-seven patients with good immediate postoperative results had recurrent pain. From the group of patients with typical TN, 82% had good long-term results after operation. Patients with typical TN and immediate postoperative remission, in univariate analysis, had significantly more often an excellent/good postoperative outcome. Immediate postoperative remission is an independent predictive factor for a good long-term outcome. The long-term results of MVD in majority of patients were good with no mortalities and no major morbidities. Patients with typical TN had better long-term outcomes and less recurrence.     

Aesthetic pubic reconstruction after electrical burn using a portion of hair-bearing expanded free-forehead flap

Background  Electrical burn in the pubic region usually results in a severe and contractive scar with pubic hair loss. The aesthetic restoration of this area often has become very difficult. Methods  A 22-year-old male electrical engineer experienced severe pubic scarring with hair loss after electrical burn. He was treated successfully with an expanded free-forehead flap including a portion of hair-bearing scalp after microsurgical vascular anastomoses between the bilateral superficial temporal vessels and the bilateral deep inferior epigastric vessels. The donor forehead site was closed directly in the frontal hairline without visible scarring. Results  The pubic area was repaired functionally and cosmetically with the flap, and the pubic hair was growing well after a 1-year following-up period. Conclusions  This successful case strongly indicates that a microsurgical tissue transfer can be a good option for reconstruction of a pubic defect and that the expanded forehead flap could fulfill the high cosmetic demands of pubic reconstruction with minimal donor morbidity.     

The occipital artery flap for transfer of hair-bearing tissue.

The posterior scalp is investigated as the donor site for the transfer of hair-bearing tissue based on the occipital artery. The dissection of fresh cadavers was performed and the occipital artery was noted to have three major branches including a vertical, transverse, and descending branch. The vessel connection across the midline allowed transfer of the posterior scalp to the desired recipient site. This vessel provides the possibility of transfer of large areas of hair-bearing tissue to a single stage. The variability of flap design is described as well as the technical considerations for a successful transfer.     

肱肌肌支移位重建屈指功能的远期疗效

目的报道肌皮神经肱肌肌支移位后的远期疗效。方法对3例行肌皮神经肱肌肌支移位至屈指肌支者,术后随访2年以上,并测定其肌力与肌电。结果2例术前C5、6神经支配肌群良好者(肌力4°,肌电为单纯混合相),术后屈指功能恢复良好(肌力3°,肌电为单纯或单纯混合相)。另1例术前C5、6支配肌群仅个别肌肉良好(肌力3°,肌电为单纯相),术后功能未恢复。结论肱肌肌支的功能状态是影响术后疗效的主要因素,术前C5、6神经根支配的肌群功能状态全面良好者,肱肌肌支移位术后屈指功能恢复良好。     

Long-term morphometric and immunohistochemical findings in human free microvascular muscle flaps

Reinnervation, muscle regeneration, density of microvessels, and muscle-type specific atrophy were studied 3-4 years after surgery in surgically nonreinnervated free microvascular muscle flaps to 13 patients transplanted to the upper or lower extremities. Routine histology and immunohistochemistry for PGP 9.5 and S-100 (neuronal markers), Ki-67 (cell proliferation), myosin (muscle fiber types), and CD-31 (endothelium) were carried out, and results were analyzed morphometrically. Three to 4 years after surgery, severe atrophy of predominantly slow-type fibers was seen in 9 cases. In 4 cases, muscle-fiber diameter and fiber-type distribution were close to normal. Long intraoperative muscle ischemia and postoperative immobilization were associated with poor muscle bulk in flaps. The density of microvessels in flaps did not differ from control muscles. PGP 9.5 and S-100 immunopositive nerve fibers were detected in 7 patients. Reinnervation was associated with good muscle bulk. In 4 patients, activation of satellite cells was evident. The results suggest that in some cases, spontaneous reinnervation may occur in free muscle flaps, and that several years after microvascular free flap transfer, the muscle still attempts to regenerate.     

Long-term clinical follow-up after operation for lung carcinoma

From 1951 to July 1969, 964 lung resections for primary lung carcinoma have personally been carried out. All except eight patients, whose follow-up has been continued by colleagues elsewhere, have been examined at intervals in the outpatient department and chest radiographs have been taken. No patient has been lost from follow-up. The results of this follow-up are presented. The quality of the patient's life after operation, the cause of death, the results, and the relationship of survival to extent of operation are discussed. Details of 151 patients surviving more than five years, and of 49 surviving more than 10 years, are given. Information on the aspects under consideration is believed to be as complete as possible. The cause of death is doubtful in only two patients.     

Long-term follow-up after unilateral nephrectomy and radiotherapy for Wilms' tumour

Twenty-nine patients who had had unilateral nephrectomy for Wilms' tumour in one hospital were known to have survived more than 12 years. Sixteen agreed to attend for clinical review, of whom 14 had estimation of serum creatinine, 24-h urine protein excretion and endogenous creatinine clearance. The follow-up period was 13–26 years (median 17 years). All but one had had radiotherapy and all had chemotherapy (actinomycin D, 16; vincristine, 5). Some degree of kyphoscoliosis was present in all except the patient who did not receive radiotherapy. Four patients had diastolic blood pressure 90 mmHg or greater. Two patients had mild proteinuria (392, 361 mg/day). Serum creatinine ranged from 53 to 125 mol/l and endogenous creatinine clearance ranged from 39 to 173 ml/min (median 81, mean 89). Of the 7 patients who were 20–26 years postnephrectomy, 2 were hypertensive and 1 had elevated urinary protein excretion. We conclude that the long-term prognosis of unilateral nephrectomy in childhood is good.     

Free microvascular fibular transfer for idiopathic femoral head necrosis: long-term follow-up.

The authors discuss free microvascular bone transfers in general, and propose a new classification for idiopathic femoral head necrosis. They then present a technique they have been using for 11 years, with the goals of providing both mechanical support and an improved blood supply to the femoral head. This technique involves clearing the necrotic area of the femoral head, filling the area with cancellous bone taken from the greater and lesser trochanters, and transferring a fibular microvascular graft. The approach is transtrochanteric and spares the capsule. Vascular anastomosis is done with the lateral branches of the deep femoral artery, sparing the anterior circumflex artery which is important to the blood supply of the femoral head. Forty-five cases have been surgically managed over 11 years. Eighteen cases with follow-up longer than five years were analyzed, providing an 84 percent successful outcome with both very good and good results.     

退行性脊柱侧凸后路矫形术35例远期随访

目的 回顾退行性脊柱侧凸后路矫形术后的远期临床效果,分析晚期并发症的发生原因,探讨合理的应对措施.方法 回顾1997年9月至2002年9月,采用后路椎问融合器结合经椎弓根螺钉治疗退行性脊柱侧凸35例.按照Oswestry功能障碍指数(ODI)评价临床效果,影像学检查评价术后融合节段以及邻近节段病变,测量侧凸冠状位Cobb角、腰前凸角,脊柱冠状面平衡,并分析融合范围、脊柱力线与远期并发症的关系.结果 术后ODI为17.8～62.2(平均34.7),患者对手术的主观满意率为71.4%.13例患者发生远期并发症,发生率为37.1%,10例出现临床症状,6例进行翻修手术,4例拒绝再次手术.远期并发症包括:近端交界区侧凸4例、近端交界区后凸4例、近端椎体压缩骨折1例、融合区假关节形成1例、远端椎管狭窄2例,螺钉松动1例.交界性后凸与脊柱力线异常无明显关系,融合至L1及以下邻近节段病变发生率(9/18)明显高于融合至T12以上(4/17).结论 退行性脊柱侧凸后路矫形远期并发症较高,术前应仔细评价脊柱力线情况,为减少远期近端交界性侧凸,近端可融合至T12以上.     

Long-term follow-up study after pylorus-preserving gastrectomy for gastric ulcer

The long-term follow-up study of pylorus-preserving gastrectomy (PPG) for benign gastric ulcer was described in terms of postoperative subjective symptoms related to gastrectomy and recurrent ulceration. Of 134 patients who underwent PPG, 5 patients died within one month after operation, 33 patients died in the follow-up period and 22 patients have not been traced. Seventy-four patients were available for a 3-24 year follow-up (mean 16.6 years) Recurrent ulcer developed in 4 patients, 1, 2, 9 and 11 years after surgery at the greater curvature of pre-pyloric region in all cases. Two patients underwent reoperation. These patients revealed higher gastric acid secretion as compared with that of one month after primary operation. But gastrin hypersecretion and G-cell hyperplasia were not recognized in these patients. According to detailed questionnaires, no patient showed the symptoms of dumping syndrome. The results indicate that PPG is preferable for the surgical treatment of gastric ulcer.     

Long-term follow-up after surgery for patients with biliary atresia

Long-term results after surgery for biliary atresia (BA) in 48 patients, ranging in age from 10 to 33 years, were examined. There were 19 males and 29 females. Twelve had correctable type BA and 36 had the noncorrectable type. Forty-one cases had no jaundice; seven did. Thirty-seven of the 48 cases were leading normal lives. Among them, six cases were enjoying their lives after overcoming sequelae, such as portal hypertension. The main morbidities of the remaining 11 long-term survivors were jaundice and portal hypertension. The growth of most cases were comparable to those of the normal Japanese population. The data of liver function tests were variable and disclosed a moderate degree of abnormality in patients mainly complicated by cholangitis. Eleven cases, including six jaundice cases, required treatment for esophageal varices and/or hypersplenism. In conclusion, the cured states of most cases without jaundice are satisfactory and these former patients have achieved a favorable quality of life. Early operations are essential to obtain good short-term results as well as good long-term results.