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PubMed1997

Comparison of three perineal procedures for the treatment of rectal prolapse.

BACKGROUND: The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to compare the short-term outcome of three perineal procedures in patients with rectal prolapse. METHODS: Between April 1989 and April 1995, all consecutive patients who had Delorme's procedure, perineal rectosigmoidectomy, or perineal rectosigmoidectomy with levatoroplasty for full-thickness rectal prolapse were clinically and physiologically assessed before and after surgery. A standard incontinence scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence), was used to compare the results of each procedure. Additionally, morbidity and mortality and clinical and functional outcome were evaluated and compared. RESULTS: The study group of 61 patients who had perineal procedures for rectal prolapse included 55 women and 6 men, with a mean age of 75 years (range, 48 years to 101 years); 16 patients died of comorbid conditions between 3 months and 42 months after surgery. There were statistically significant differences among the groups relative to short-term recurrence rates, postoperative incontinence scores, mean resection length, coloanal anastomotic stricture, and leak. However, preoperative and postoperative anal manometry did not reveal statistically significant changes within or between the groups. CONCLUSIONS: Perineal rectosigmodectomy with levatoroplasty has the best short-term outcome for the treatment of rectal prolapse.

Aged↗

PubMed2005

Incontinence after a lateral internal sphincterotomy: are we underestimating it?

PURPOSE: This study was designed to assess the long-term outcomes and quality of life of patients who have undergone a sphincterotomy for chronic anal fissure. METHODS: The medical records of patients who underwent this operation between 1992 and 2001 were reviewed. A questionnaire was mailed to assess their current status, along with the Fecal Incontinence Quality of Life and Fecal Incontinence Severity Index surveys. RESULTS: A total of 298 patients were identified (158 males; 53 percent; mean age, 46.9 years; mean follow-up, 4.3 years). Postal survey response was 62 percent. Recurrence of the fissure occurred in 17 patients (5.6 percent) of whom 9 (52 percent) were females. Significant factors that resulted in recurrence were initial sphincterotomy performed in the office and local anesthesia (P < 0.001). When comparing office records and response to the postal survey, significantly more patients had flatal incontinence than that recorded in their medical records (P < 0.001). Twenty-nine percent of females who had a vaginal delivery recorded problems with incontinence to flatus (P = 0.04). Temporary incontinence was reported in 31 percent of patients and persistent incontinence to gas occurred in 30 percent. Stool incontinence was not a significant finding. The overall quality-of-life scores were in the normal range, whereas the median Fecal Incontinence Severity Index score was 12. CONCLUSIONS: Recurrence after lateral internal sphincterotomy may be higher after local anesthesia or office procedure. Females who have two or more previous vaginal deliveries should be warned about possible flatal incontinence. Long-term flatal incontinence that is not reported to the caregiver may occur in up to one-third of patients and could be permanent.

Adult↗

PubMed2000

Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases.

OBJECTIVE: To summarize the authors' laparoscopic experience for paraesophageal hernia (PEH). SUMMARY BACKGROUND DATA: Laparoscopic antireflux surgery and repair of small hiatal hernias are now routinely performed. Repair of a giant PEH is more complex and requires conventional surgery in most centers. Giant PEH accounts for approximately 5% of all hiatal hernias. Medical management may be associated with a 50% progression of symptoms and a significant death rate. Conventional open surgery has a low death rate, but complications are significant and return to routine activities is delayed in this frequently elderly population. Recently, short-term outcome studies have reported that minimally invasive approaches to PEH may be associated with a lower complication rate, a shorter hospital stay, and faster recovery. METHODS: From July 1995 to February 2000, 100 patients (median age 68) underwent laparoscopic repair of a giant PEH. Follow-up included heartburn scores and quality of life measurements using the SF-12 physical component and mental component summary scores. RESULTS: There were 8 type II hernias, 85 type III, and 7 type IV. Sac removal, crural repair, and antireflux procedures were performed (72 Nissen, 27 Collis-Nissen). The 30-day death rate was zero; there was one surgery-related death at 5 months from a perioperative stroke. Intraoperative complications included pneumothorax, esophageal perforation, and gastric perforation. There were three conversions to open surgery. Major postoperative complications included stroke, myocardial infarction, pulmonary emboli, adult respiratory distress syndrome, and repeat operations (two for abscess and one each for hematoma, repair leak, and recurrent hernia). Median length of stay was 2 days. Median follow-up at 12 months revealed resumption of proton pump inhibitors in 10 patients and one repeat operation for recurrence. The mean heartburn score was 2.3 (0, best; 45, worst); the satisfaction score was 91%; physical and mental component summary scores were 49 and 54, respectively (normal, 50). CONCLUSION: This report represents the largest series to date of laparoscopic repair of giant PEH. In the authors' center with extensive experience in minimally invasive surgery, laparoscopic repair of giant PEH was successfully performed in 97% of patients, with a minimal complication rate, a 2-day length of stay, and good intermediate results.

Aged↗

PubMed2025

The Effect of Colesevelam on the Microbiome in Postoperative Crohn's Disease.

BACKGROUND: While surgery plays a pivotal role in the management of ileal Crohn's disease, the risk of endoscopic recurrence following an ileocaecal resection can be greater than 65% within 12 months of surgery. More than 90% of patients with Crohn's disease have a concomitant diagnosis of bile acid diarrhea following an ileal resection. This pilot study aimed to assess whether the use of bile acid sequestrants in patients with Crohn's disease who have undergone a primary terminal ileal resection with concomitant bile acid diarrhea can alter the microbiome and prevent disease recurrence. METHODS: Patients with Crohn's disease who underwent a primary terminal ileal resection and had symptoms of diarrhea within 1-3 months of surgery underwent 75SeHCAT testing for bile acid diarrhea. If positive (75SeHCAT ≤ 15%), patients were treated with colesevelam and stool samples were collected at 4 weeks, 8 weeks, and 6-12 months posttreatment. If negative (75SeHCAT > 15%), treatment was not given and were reviewed in the clinic as per local guidelines. All patients underwent a 6-12 month postoperative colonoscopy where further stool samples and mucosal biopsies were taken. Disease activity was established using the endoscopic Rutgeert's score, with disease remission defined as Rutgeert's score <i2 and disease recurrence ≥i2. 16S ribosomal RNA gene analysis was undertaken for the collected fecal and mucosal samples to assess α/β-diversity and microbial composition. RESULTS: A total of 14 patients who completed the study, 10 of whom had a 75SeHCAT positive diagnosis of bile acid diarrhea and were started on treatment with colesevelam. Four patients did not require treatment as 3 were asymptomatic and 1 had a negative 75SeHCAT scan. Three of the fourteen patients had disease recurrence at their 6-12 month postoperative colonoscopy assessment, of which 1 patient was taking colesevelam and 2 patients were not taking colesevelam. A total of 44 fecal samples and 44 mucosal biopsies underwent 16S ribosomal RNA gene analysis to assess α/β-diversity and microbial composition. In the colesevelam treated patients there was no significant difference in α/β-diversity pre- and posttreatment. Pretreatment, the 3 most abundant bacterial classes in all patients were Bacteroidia, Clostridia, and Gammaproteobacteria. Following 6-12 months of treatment, out of the 9 patients on colesevelam, 5/9 (55.6%) had a reduction in Bacteroidia, 9/9 (100%) had an increase in Clostridia, and 7/9 (77.8%) had a reduction in Gammaproteobacteria. Of the 2 patients not given colesevelam, one showed a reduction in Bacteroidia, increase in Clostridia and a reduction in Gammaproteobacteria. CONCLUSIONS: This small pilot study demonstrated that patients who were given colesevelam, were more likely to be in disease remission at their 6-12 months colonoscopy review compared with those not treated. Furthermore, treatment with colesevelam may have a role in altering the microbiome to help maintain remission states in postoperative Crohn's disease. Larger mechanistic studies are now needed to confirm these findings and demonstrate statistical significance as well as investigate whether this benefit may be present even in those patients with 75SeHCAT negative disease.

Humans↗

PubMed1992

The effects of alcohol use on rebleeding and mortality in patients with alcoholic cirrhosis following variceal haemorrhage.

The effect of continued alcohol intake on prognosis in alcoholic cirrhotics who have already bled from varices is controversial. To investigate the effect of alcohol intake on prognosis we studied 189 consecutive alcoholic cirrhotics admitted, for the first time, to the Royal Free Hospital with variceal bleeding. Sixty-six died within 30 days of admission and 23 were excluded from the study for other reasons. Of the 100 remaining 15 remained 'probably abstinent' over long-term follow-up, 29 drank occasionally and 56 continued to misuse/abuse alcohol. The percentage survival probability at 2 years was 66% in the probable abstainers, 68% in the occasional drinkers and 63% in the alcohol abuse/misuse group. There were no significant differences in either mortality or rebleeding rates between the three groups. A rebleeding index (designed to take account of the number of rebleeds per patient and the total length of follow-up) also failed to show any significant difference between the three groups. The Cox proportional hazard model was used to study the effect of the following factors on rebleeding and mortality; age, sex, alcohol use, Pugh's score, acute treatment received for initial variceal bleed and long-term treatment received for prevention of recurrent variceal haemorrhage. Pugh's score was significantly related to risk of death during follow-up (p = 0.0122), but none of the other factors was significantly related to risk of rebleeding or mortality. Using conventional methods to determine alcohol use we were unable to demonstrate significant effects of alcohol intake on rebleeding or mortality in alcoholic cirrhotics who had bled from oesophageal varices.

Alcohol Drinking↗

PubMed2000

[PSA rise after radical prostatectomy].

Approximately 18 % of patients will experience PSA failure only after radical prostatectomy. The rate of clinical (local or systemic) recurrence is in the same range. Clinical recurrence is accompanied by an increasing PSA in almost all cases. Altogether, the 10-year risk of PSA recurrence after radical prostatectomy for clinically localized prostate cancer is about 35 %. PSA relapse precedes the development of metastases by a median time of 8 years. The median survival after the manifestation of metastases is about 4-5 years. To differentiate the reasons of PSA failure, recurrence-free interval, Gleason score and PSA doubling time deliver important information. Patients with a high probability of isolated local failure (PSA relapse later than two years after radical prostatectomy) should undergo a biopsy, if a local radiotherapy is considered. The results of current clinical trials are eagerly awaited to answer the question weather immediate, delayed or intermittent hormonal therapy offer best results in individual cases.

Biomarkers, Tumor↗

PubMed1987

Prospective evaluation of prognostic value of morphometry in patients with primary breast cancer.

In a prospective study the predictive value of a multivariate morphometric prognostic index was evaluated in 195 patients with primary breast cancer who had not been treated with any form of chemotherapy or hormonal treatment. The presence or absence of distant tumour recurrence combined with the scores of the prognostic index were compared with the survival curves predicted in a previous study. The value of the presence of lymph node metastases, number of positive nodes, tumour size, mitotic activity index, and oestrogen receptor status in prediction of prognosis were also investigated. In agreement with the results of the previous retrospective study, the prospective use of the index had the strongest predictive prognostic value, followed by the mitotic activity index. Statistical analysis showed that the actual prognoses of 43 of the 195 patients (22%) were more accurately determined by the prognostic index rather than by using the presence of the lymph node metastases as the classifying variable. The prognostic index is consistently reproducible by different technicians; it is a reliable method of predicting distant recurrence of tumour and hence the prognosis of patients with primary breast carcinoma. It provides more prognostic information than the presence of lymph node metastases alone, and the index should be incorporated in routine pathology reports.

Adult↗

PubMed2000

Effect of disease burden on health-related quality of life in patients with malignant gliomas.

The burden imposed by disease recurrence in patients with high-grade gliomas is not well documented. We studied the frequency of self-report symptoms and the effects on health-related quality of life in patients who had recurrent glioblastoma multiforme or anaplastic astrocytoma and who had a Karnofsky performance score > or = 70. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Items (QLQ-C30) and the Brain Cancer Module (BCM20) before initiation of treatment for first recurrence of disease. Six symptoms (fatigue, uncertainty about the future, motor difficulties, drowsiness, communication difficulties, and headache) were reported with a frequency > 50% by both groups of patients. An additional two symptoms (visual problems and pain) were also reported with frequencies of > 50% by patients with recurrent glioblastoma multiforme. Most of the symptoms were likely due to recurrence, but previous radiation therapy and on-going corticosteroid treatment may have also been casual factors for fatigue, whereas uncertainty about the future and pain were probably nonspecific for brain cancer. Problems with motor functioning, vision, leg strength, and pain were reported more frequently by patients with recurrent glioblastoma multiforme than by those with recurrent anaplastic astrocytoma. Scores on health-related quality-of-life functioning scales were similar in the two groups. Finally, the scores for patients who had recurrent high-grade gliomas and a Karnofsky performance score > or = 70 were compared with the reported health-related quality of life scores of patients with other cancers. Their scores were similar to those of patients with metastatic cancers and worse than those of patients with localized cancers.

Adult↗

PubMed1999

Similarity in oligonucleotide usage in introns and intergenic regions contributes to long-range correlation in the Caenorhabditis elegans genome.

A method is presented which allows detection of a sequence correlation effect not related to patchiness in base composition or to preferences in codon usage. Recurrence plots providing local views of oligonucleotide recurrence regimen show that introns and intergenic regions are often characterised by a highly recurrent use of oligonucleotides. By window analysis it is possible to score a long sequence for the recurrence of a given subset of oligos while filtering away the effects of short-range correlations. Long-range exploration of chromosome III from Caenorhabditis elegans reveals that consistent use of recurrent oligonucleotides in introns and intergenic regions generates a correlation effect that extends over several megabases.

Animals↗

PubMed2003

The University of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast.

BACKGROUND: The original Van Nuys prognostic index (VNPI) was introduced in 1996 as an aid to the complex treatment decision-making process for patients with ductal carcinoma in situ (DCIS) of the breast. This update adds patient age to the previous predictors of local recurrence in breast preservation patients. METHODS: A prospective database consisting of 706 conservatively patients with DCIS was examined using multivariate analysis. Four independent predictors of local recurrence (tumor size, margin width, pathologic classification, and age) were used to derive a new formula for the University of Southern California (USC)/VNPI. RESULTS: In all, 706 patients with pure DCIS were treated with breast preservation. There was no statistical difference in the 12-year local recurrence-free survival in patients with USC/VNPI scores of 4, 5, or 6, regardless of whether or not radiation therapy was used (P = not significant). Patients with USC/VNPI scores of 7, 8, or 9 received a statistically significant average 12% to 15% local recurrence-free survival benefit when treated with radiation therapy (P = 0.03). Patients with scores of 10, 11, or 12, although showing the greatest absolute benefit from radiation therapy, experienced local recurrence rates of almost 50% at 5 years. CONCLUSIONS: Ductal carcinoma in situ patients with USC/VNPI scores of 4, 5 or 6 can be considered for treatment with excision only. Patients with intermediate scores (7, 8, or 9) should be considered for treatment with radiation therapy or be reexcised if margin width is less than 10 mm and cosmetically feasible. Patients with USC/VNPI scores of 10, 11, or 12 exhibit extremely high local recurrence rates, regardless of irradiation, and should be considered for mastectomy, generally with immediate reconstruction or reexcision if technically possible.

Adult↗

PubMed2003

Subfascial endoscopic perforator surgery for venous ulcers.

We report the treatment and outcomes of 12 patients who underwent subfascial endoscopic perforator surgery for severe chronic venous insufficiency and venous ulceration. All patients had received prior superficial venous ablative surgery and presented with incompetent perforating veins in the calf and persistent venous ulceration (lasting >10 years). Outcome measures included ulcer healing time, recurrence, clinical symptom, and disability scores. There was one wound complication after subfascial endoscopic perforator surgery. The cumulative ulcer healing rate was 25% at 3 months, 42% at 6 months, and 92% at 1 year. One patient developed ulcer recurrence at 12 months after surgery. The mean clinical score and disability score decreased from 13.00 (standard deviation, 2.26) to 4.83 (1.47) and 1.75 (0.45) to 0.50 (0.52), respectively (P<0.001) after a median follow-up of 15.0 months (interquartile range, 12.0-21.5 months). Subfascial endoscopic perforator surgery was safe and effective in the treatment of patients with severe chronic venous insufficiency and venous ulceration caused by incompetent perforating veins in the calf.

Adult↗

PubMed2004

Upper extremity limb salvage with microvascular reconstruction in patients with advanced sarcoma.

Limb salvage is a viable alternative to amputation in many cases of advanced sarcoma. The authors examined their experience with microvascular reconstruction of upper extremity defects after sarcoma resection, focusing on oncologic and functional outcomes. A retrospective analysis yielded 17 patients who underwent 18 free flap procedures and met the inclusion criteria. Most patients (71 percent, n = 12) had recurrent sarcoma at presentation to the authors' institution. Malignant fibrous histiocytoma was the most common pathologic subtype (n = 6). High-grade tumors were present in 94 percent of patients (n = 16). The free flap survival rate was 100 percent. The rectus abdominis flap was the most common free flap used (39 percent; n = 7). Local recurrence occurred in nine flaps (50 percent), and five patients ultimately required amputations. Six patients (35 percent) had distant recurrence. The mean Enneking score for limb function was 73 percent of the maximum (21.9 of 30). The 5-year disease-specific survival rate was 61.3 percent. In select patients with advanced upper extremity sarcoma undergoing limb salvage, microvascular flap reconstruction can provide reliable, safe coverage with reasonable preservation of function.

Adult↗

PubMedDate not supplied

The effects of perceived stress, traits, mood states, and stressful daily events on salivary cortisol.

This study examined the effects of perceived stress and related individual characteristics, mood states, and stressful daily events on salivary cortisol levels. Forty-one "high stress" and 46 "low stress" subjects were selected on the basis of Perceived Stress Scale scores from a sample of male, white collar workers. Subjects completed Experience Sampling self-reports and collected saliva samples 10 times a day over 5 consecutive days. Multilevel analysis revealed that trait anxiety and depression, but not perceived stress, were associated with small but statistically significant cortisol elevation. No effects on cortisol were found for recent life events, chronic difficulties, trait anger, or psychosomatic symptoms. Distress, as reflected by the mood states Negative Affect and Agitation, was associated with higher cortisol levels, whereas Positive Affect had no statistically significant effect. Stressful daily events were associated with increased cortisol secretion, the magnitude of the effect depending on whether the event was still ongoing and on how frequently a similar kind of event had occurred previously. Although perceived stress, anxiety, and depression did not increase cortisol reactivity to daily events, we found evidence for reduced habituation to recurrent events in subjects scoring high on these traits. Mood appeared to play a mediating role in the relationship between stressful events and cortisol secretion. These results suggest that negative affectivity is not just a confounder but is related to elevated cortisol secretion during normal daily activities. The finding that even minor events and fluctuations in mood states were associated with increased adrenocortical activity points to a possible mechanism linking subjective experience to health outcomes.

Adult↗

PubMed2003

Coughing, mucus accumulation, airway obstruction, and airway inflammation in control horses and horses affected with recurrent airway obstruction.

OBJECTIVE: To investigate relationships between cough frequency and mucus accumulation, airway obstruction, and airway inflammation and to determine effects of dexamethasone on coughing and mucus score. ANIMALS: 13 horses with recurrent airway obstruction (RAO) and 6 control horses. PROCEDURE: 6 RAO-affected and 6 control horses were stabled for 3 days. Coughing was counted for 4 hours before and on each day horses were stabled. Before and on day 3 of stabling, tracheal mucus accumulation was scored, airway obstruction was assessed via maximal change in pleural pressure (deltaPpl(max)), and airway inflammation was evaluated by use of cytologic examination of bronchoalveolar lavage fluid (BALF). Effects of dexamethasone (0.1 mg/kg, IV, q 24 h for 7 days) were determined in 12 RAO-affected horses. RESULTS: To assess frequency, coughing had to be counted for 1 hour. In RAO-affected horses, stabling was associated with increases in cough frequency, mucus score, and deltaPpl(max). Control horses coughed transiently when first stabled. In RAO-affected horses, coughing was correlated with deltaPpl(max), mucus score, and airway inflammation and was a sensitive and specific indicator of deltaPpl(max) > 6 cm H2O, mucus score > 1.0, and > 100 neutrophils/microL and > 20% neutrophils in BALF Dexamethasone reduced cough frequency, mucus score, and deltaPpl(max), but BALF neutrophil count remained increased. CONCLUSIONS AND CLINICAL RELEVANCE: Because of its sporadic nature, coughing cannot be assessed accurately by counting during brief periods. In RAO-affected horses, coughing is an indicator of airway inflammation and obstruction. Corticosteroid treatment reduces cough frequency concurrently with reductions in deltaPpl(max) and mucus accumulation in RAO-affected horses.

Airway Obstruction↗

PubMedDate not supplied

Immediate surgical repair of the medial patellar stabilizers for acute patellar dislocation. A review of eight cases.

An open surgical repair of the injured medial patellar stabilizers, including the vastus medialis obliquus muscle and the medial patellofemoral ligament, after acute patellar dislocation was studied in eight patients. At initial examination, all patients had tenderness over the adductor tubercle and a positive patellar apprehension sign. Four of eight patients had obvious ecchymosis over the adductor tubercle. Magnetic resonance imaging, diagnostic arthroscopy, and open surgical exploration documented injury to both the medial patellofemoral ligament and the origin of the vastus medialis obliquus muscle. In all patients, the torn muscle was retracted in an anterior and superior direction and an arthroscopic lateral release was performed followed by open primary repair of the medial patellofemoral ligament to the adductor tubercle and repair of the vastus medialis obliquus muscle to the adductor magnus tendon. Patients were evaluated postoperatively with the Kujala scoring questionnaire. The average follow-up was 3.0 years, with a minimum of 1.5 years. No patients experienced a recurrent dislocation. The average Kujala score was 91.9. Patients rated their return to athletic activity at an average 86% of their pre-injury level. The average subjective satisfaction was 96%. In appropriate cases of acute patellar dislocation, we recommend primary repair of the medial patellofemoral ligament and the vastus medialis obliquus muscle to avoid recurrent dislocation, chronic subluxation, pain, and disability.

Adolescent↗

PubMed2003

Assessment of cardiovascular reactivity by fractal and recurrence quantification analysis of heart rate and pulse transit time.

Methods used for the assessment of cardiovascular reactivity are flawed by nonlinear dynamics of the cardiovascular responses to stimuli. In an attempt to address this issue, we utilized a short postural challenge, recorded beat-to-beat heart rate (HR) and pulse transit time (PTT), assessed the data by fractal and recurrence quantification analysis, and processed the obtained variables by multivariate statistics. A 10-min supine phase of the head-up tilt test was followed by recording 600 cardiac cycles on tilt, that is, 5-10 min. Three groups of patients were studied, each including 20 subjects matched for age and gender--healthy subjects, patients with essential hypertension (HT), and patients with chronic fatigue syndrome (CFS). The latter group was studied on account of the well-known dysautonomia of CFS patients, which served as contrast against the cardiovascular reactivity of the healthy population. A total of 52 variables of the HR and PTT were determined in each subject. The multivariate model identified the best predictors for the assessment of reactivity of healthy subjects vs CFS. Based on these predictors, the "Fractal & Recurrence Analysis-based Score" (FRAS) was calculated: FRAS=76.2+0.04*HR-supine-DET -12.9*HR-tilt-R/L -0.31*HR-tilt-s.d. -19.27*PTT-tilt-R/L -9.42*PTT-tilt-WAVE. The median values and IQR of FRAS in the groups were: healthy=-1.85 (IQR 1.89), hypertensives=+0.52 (IQR 5.78), and CFS=-24.2 (5.34) (HT vs healthy subjects: P=0.0036; HT vs CFS: P<0.0001). Since the FRAS differed significantly between the three groups, it appears likely that the FRAS may recognize phenotypes of cardiovascular reactivity.

Adult↗

PubMed1982

[Familial recurrent laryngeal nerve paralysis, a genetically fixed syndrome -- additional remark on linkage of deficiency gene and HLA (author's transl)].

Hereditary laryngeal paralysis has been rarely reported. Some authors describe additional neurological signs in connection with the cranial nerve, or mental retardation. It has been assumed that there is a causal connection with genetic deficiency. Familial studies, presented with this article, showed abductor and adductor paralysis in the mother and in the son, aged 13, abductor paralysis in the daughters, who were 11 and 5 years old, respectively, and normal laryngeal function in the father and in one 10-year old daughter. There were no neurological signs or mental deficits in any member of the family. Genetic analysis of blood-group and HLA systems confirmed linkage of the HLA system and vocal cord disorder, as suggested by Mace et al. (5). Hence, further observations and investigations will be necessary to prove this statement.

Adolescent↗

PubMedDate not supplied

Arthroscopic capsulolabroplasty for posteroinferior multidirectional instability of the shoulder.

BACKGROUND: Arthroscopic treatment of posteroinferior multidirectional instability of the shoulder is not well documented. PURPOSE: To evaluate pathologic lesions of posteroinferior multidirectional instability and the results of arthroscopic capsulolabroplasty. STUDY DESIGN: Prospective nonrandomized clinical trial. METHODS: Thirty-one patients with posteroinferior multidirectional instability were prospectively evaluated after arthroscopic capsulolabroplasty (mean follow-up, 51 months). Labral lesion and height were measured in the MRI arthrogram and arthroscopic examination. RESULTS: All patients had a labral lesion and variable capsular stretching in the posteroinferior aspect. There were 11 type I labral lesions (incomplete detachment), 12 type II (the Kim's lesion: incomplete and concealed avulsion), 6 type III (chondrolabral erosion), and 2 type IV (flap tear). All patients with type II and III lesions had chondrolabral retroversion, with lost labral height in the MRI arthrogram and arthroscopic examination. Twenty-one patients had an excellent Rowe score, nine had good scores, and one had a fair score. Thirty patients had stable shoulders, and one had recurrent instability. All patients had improved shoulder scores and function and pain scores. CONCLUSIONS: Symptomatic patients with posteroinferior multidirectional instability had posteroinferior labral lesions, including retroversion of the posteroinferior labrum, which were previously unrecognized. Restoration of the labral buttress and capsular tension by arthroscopic capsulolabroplasty successfully stabilized shoulders with posteroinferior multidirectional instability.

Adult↗