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PubMed2005

Phase I trial of menadiol diphosphate (vitamin K3) in advanced malignancy.

Based on the activity of menadione (M) in the human tumor stem cell assay, we conducted a phase I trial of M in patients with advanced cancer. Forty patients (19 men, 21 women) were treated with 90 courses of M; 82 treatment courses are evaluable for toxicity. The median patient age, Karnofsky performance status, and number of prior chemotherapy regimens were 61 years (range 32-74 years), 80% (range 50-100%), and two, respectively. M was given by a short (1-5 h) intravenous infusion every 3 weeks, starting at 40 mg/m2 and escalating by modified Fibonacci scheme to 1360 mg/m2. Toxicity was graded according to the Southwest Oncology Group toxicity scale with defined hypersensitivity reaction (HSR) scales. No grade > or =2 hematologic toxicity was observed. Non-hematologic toxicity consisted of a HSR syndrome of paresthesiae of the extremities, facial flushing, burning of the eyes and mucous membranes, chest pain and dyspnea. HSR was defined as Grade I toxicity by the presence of facial numbness, flushing, and/or a tingling sensation or burning of the eyes and mucous membranes. Grade II toxicity was defined as the presence of the same above symptoms plus chest tightness, paresthesiae of extremities and/or dyspnea and chest pain. These toxicities were grade 1 in 3 of 4 patients at a dose of 840 mg/m2. At 1360 mg/m2, 2 of 13 patients suffered grade 1 HSR and 7 of 13 grade 2 HSR. No objective partial or complete responses were observed. Plasma menadione concentrations peaked at 1.9-7.4 microM during the infusion in 3 patients receiving 1360 mg/m2. Further phase 1 and 2 combination trials using longer infusion durations have resulted from this trial.

Adult↗
PubMed1984

Abnormal activity of polymodal receptors induced by clioquinol (5-chloro-7-iodo-8-hydroxyquinoline).

To know possible involvement of primary afferents in paresthesia of subacute myelo-optico-neuropathy (SMON), influence on polymodal receptor, a type of nociceptor, of its causal agent clioquinol (5-chloro-7-iodo-8-hydroxyquinoline) was tested using in vitro testis-superior spermatic nerve preparations of dogs. Exposure to clioquinol (greater than 1 microM) induced an abnormal bursting activity in polymodal receptors, and thereafter the receptors were sensitized to an algesic stimulus (hypertonic saline) and gained a new sensitivity to cold, while pure mechanoreceptors were not influenced. On the other hand, clioquinol glucuronide (100 microM), a detoxicated form, had no such effects. These results are consistent with several clinical observations of sensory aberrations, suggesting possible involvement of the abnormal activities of polymodal receptors in SMON paresthesia.

Animals↗
PubMed1986

Mandibular augmentation with hydroxyapatite.

This study investigated the success of hydroxyapatite mandibular augmentation in nine patients, the histologic response around hydroxyapatite, and the effect of collagen in localizing hydroxyapatite. It can be concluded that hydroxyapatite is biocompatible, causes minimal inflammatory response, and can increase denture retention. However, a large number of patients develop lip paresthesia, and hydroxyapatite migrates. Paresthesia might be avoided by altering the surgical technique to avoid manipulation of the mental nerve, and collagen might be a useful binder to confine hydroxyapatite particles. Further studies are in progress to develop new methods to place the hydroxyapatite and materials to confine it.

Adult↗
PubMed1993

Is phantom tooth pain a deafferentation (neuropathic) syndrome? Part I: Evidence derived from pathophysiology and treatment.

Phantom tooth pain is a syndrome of persistent pain or paresthesia in teeth and other oral tissues that may follow dental or surgical procedures such as pulp extirpation, apicoectomy, tooth extractions, or exenteration of the contents of the maxillary antrum. It can also occur when nerves are injured after trauma to the face or even after routine inferior alveolar nerve blocks if the needle pierces the nerve sheath. In the case of tooth extraction, the pain is found in the edentate area. After periodontal surgery, pain or paresthesia is located in the gingiva. The incidence of phantom tooth pain after extirpation may be as high as 3% of cases. Clinically, phantom tooth pain is similar in many essential characteristics to deafferentation pain syndromes also known as phantom pain syndromes. A limitation to this taxonomy is the lack of definitive information with respect to the pathophysiology of deafferentation pain in the trigeminal nerve. This article amplifies previous clinical descriptions of phantom tooth pain. Current concepts in the pathophysiology of neuropathic pain are reviewed as they pertain to phantom tooth pain. Treatments are described that use three routes of drug administration: oral, nerve blocks by injections, and intranasal applications. Reasons are discussed for the high rates of morbidity after dental and neurosurgery in attempts to treat phantom tooth pain.

Afferent Pathways↗
PubMed1991

Sensory disturbances associated with rigid internal fixation of mandibular fractures.

Sensory status of the inferior alveolar nerve was monitored in 133 patients with 150 fractures in the region of the mandibular canal treated with rigid internal fixation preoperatively and 6 weeks postoperatively. Eighty-five of the patients were reevaluated on final follow-up at an average of 15.9 months. Preoperative sensory disturbance (58.5%) correlated significantly only with the presence of fracture displacement. The occurrence of postoperative paresthesia (76.0% at 6.2 weeks, 46.6% at 15.9 months) correlated significantly with the degree of mandibular edentulousness. Patients with edentulous mandibles, especially when a compression plate was used, suffered significantly more often from nerve injury than fully dentate patients. The results indicated that the sensory disturbance was caused by the surgical procedure. In contrast to previous assumptions, displacement of the fracture and preoperative sensory status did not correlate with postoperative occurrence of paresthesia.

Adolescent↗
PubMed1989

A phase I/II study of the hypoxic cell sensitizer misonidazole as an adjunct to high fractional dose radiotherapy in patients with unresectable squamous cell carcinoma of the head and neck: a RTOG randomized study (#79-04).

A randomized prospective trial was performed to study the toxicity and efficacy of the hypoxic cell sensitizer, misonidazole (MISO), used as an adjunct to high fractional dose radiotherapy in the management of unresectable Stage III and IV squamous cell carcinomas of the oral cavity, oropharynx and hypopharynx. From June 1979 to February 1983, 42 patients were randomized with 40 patients available for analysis. In the radiotherapy (RT) only group, 19 patients received a short course of high fractional dose radiotherapy with 400 rad per day, 5 days per week, to a total of 4400 to 5200 rad. In the radiotherapy plus misonidazole group (RT + MISO) 21 patients received the same radiotherapy plus 1.5 gm/m2 of misonidazole 3 times a week for a total of 7 doses. The observed side effects associated with misonidazole were: persistent numbness and paresthesia (1 patient), transient peripheral nerve paresis and persistent paresthesia (1 patient), and nausea and vomiting (2 patients). The treatment related morbidities were similar in both groups. Acute mucositis was seen in 4 of 19 patients in the RT group and 3 of 21 patients in the RT + MISO group. Acute airway obstruction requiring tracheotomy was seen in 2 patients with massive tumor in the base of tongue (1 in each group). Severe dysphagia requiring NG tube feeding was seen in 3 patients in the RT + MISO group and 3 patients in the RT group. The initial complete response rate in the RT group was 53%, versus 48% in the RT + MISO group. The estimated 2-year loco-regional control rates were 10% for RT alone and 17% for RT + MISO (no significancy). These results indicate that the addition of misonidazole does not improve the efficacy of high fractional dose radiotherapy for management of unresectable head and neck carcinomas. However, high fractional dose radiotherapy can be administered for the management of advanced head and neck carcinomas with acceptable morbidity and thus, is a useful regimen for future clinical trials of hyperbaric oxygen or new hypoxic cell sensitizers.

Aged↗
PubMed1990

A self-administered hand diagram for the diagnosis of carpal tunnel syndrome.

A self-administered hand diagram has been developed to assist in the evaluation of upper extremity paresthesias. A rating system was devised to classify diagrams into four categories: classic, probable, possible, or unlikely carpal tunnel syndrome. Diagram ratings of 63 patients (85 hands) evaluated in a hand clinic were compared with diagnoses established independent of diagram results by objective clinical criteria. The sensitivity of diagrams rated classic or probable was 80% and specificity was 90%. We conclude that the hand diagram is valuable in the diagnosis of carpal tunnel syndrome among patients with upper extremity paresthesias.

Adult↗
PubMedDate not supplied

Lipoma on surface of centroparietal lobes.

A 4-year-old Japanese boy with an intracranial lipoma above the surface of the left centroparietal lobes is reported. Paresthesia occurred in the right lower extremity. This symptom continued for 30 min and recurred several times a day. Three weeks after onset, the paresthesia disappeared spontaneously. Ten months after onset, generalized tonic seizures occurred. Routine cranial computed tomography at onset revealed no remarkable lesion, but subsequently full scans, including the slice at the top of the cerebrum, revealed low-density areas on the surface of the left centroparietal lobes. T1-weighted magnetic resonance imaging revealed a hyperintense area in the same regions. The intensity of these areas was decreased by the fat saturation technique; therefore, an intracranial lipoma at a very rare site was diagnosed.

Brain Neoplasms↗
PubMed2004

Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality?

PURPOSE: To determine whether acetazolamide or furosemide produce allergic cross-reactions in patients with self-reported "sulfa allergy." DESIGN: Retrospective case series. METHODS: A retrospective review included patients with intracranial hypertension and a self-reported sulfa allergy treated with either acetazolamide or furosemide seen at the University of Iowa Hospitals and Clinics from 1972 to 2003. All presumed medication-related side effects were collected, including both predictable adverse effects (for example, paresthesias, fatigue) and unpredictable adverse reactions (for example, cutaneous fixed eruptions, urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, anaphylaxis). RESULTS: We reviewed 363 charts. Of these, 329 patients (91%) were excluded. Of the remaining 34 cases that did report a so-called sulfa allergy, 13 (38%) received acetazolamide alone, 7 (21%) received furosemide alone, and 14 (41%) received both acetazolamide and furosemide. Of the 27 patients who received acetazolamide, 10 (37%) had no documented allergic cross-reaction to sulfa, and 2 (7%) cases had urticaria. The remaining 15 (56%) of acetazolamide-treated patients experienced predictable adverse reactions for this drug (for example, paresthesias). No patient experienced a severe allergic cross-reaction to sulfa. Of 21 patients who received furosemide, no unpredictable adverse reactions or allergic cross-reactions to sulfa were noted. CONCLUSIONS: We find little clinical or pharmacological evidence to suggest that a self-reported sulfa allergy is likely to produce a life-threatening cross-reaction with acetazolamide or furosemide. These medications should be considered for intracranial hypertension if the risk-to-benefit ratio warrants their use.

Acetazolamide↗
PubMed2005

Laparoscopic-assisted axillary dissection in breast cancer surgery.

BACKGROUND: Significant morbidity such as pain, paresthesia, and arm stiffness has often been associated with axillary dissection for breast cancer. We report our experience of 30 patients with stage I and II invasive ductal carcinoma of the breast who underwent laparoscopic-assisted axillary dissection together with segmental mastectomy. METHODS: Tumours were situated in the upper or lower lateral quadrants only. In all cases, initial exposure for axillary dissection was performed through the breast periareolar incision. A 10-mm 30 degrees laparoscope was introduced through the breast incision to gain entry to the axilla. A separate stab incision in the lower aspect of the axilla was used for introduction of the 5-mm Harmonic shears (Ethicon Endo-Surgery, Inc, Cincinnati, OH). A grasping forceps was introduced through the main incision alongside the endoscope. Subsequent axillary dissection was performed laparoscopically, and the axillary content was removed through the breast incision. RESULTS: Average yield of lymph nodes was 15 (range 7 to 25). There were no intraoperative complications. Immediately postsurgery, all patients were able to fully mobilize the upper limb, facilitated by absence of an axillary scar. Patients also reported minimal pain, paresthesia, with no stiffness or frozen shoulder. CONCLUSION: Laparoscopic-assisted axillary dissection offers a safe and improved approach to the axilla, which can be incorporated into breast cancer surgery.

Adult↗
PubMed2004

Peripheral nerve entrapments.

Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic. Clinically,nerve entrapment is divided into three stages: in stage I patients feel rest pain and intermittent paresthesias which are worse at night; in stage II, continued nerve compression leads to paresthesias, numbness, and, occasionally, muscle weakness that does not disappear during the day, and in stage III, patients describe constant pain, muscle atrophy, and permanent sensory loss. Diagnostic confusion abounds because of the multiple etiologies of peripheral nerve entrapments and their complex physical and temporal relation. A thorough understanding of the causes of peripheral nerve entrapments, the anatomic course and variation of the peripheral nerves, the diagnostic modalities, and the treatment options can simplify this complex problem.

Diagnosis, Differential↗
PubMedDate not supplied

A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations.

PURPOSE: To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. METHODS: Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. RESULTS: Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. CONCLUSIONS: Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.

Adult↗
PubMed2006

Qualitative descriptors used by patients following orthognathic surgery to portray altered sensation.

PURPOSE: Following orthognathic surgery, patients use qualitatively different words to describe the altered sensation on their face that results from tissue inflammation and nerve injury. These words indicate normal, hypoesthetic, paresthetic, and dysesthetic sensations, and reflect the intrusiveness of the alteration. Our intent was to study the words chosen by patients from a standardized list to characterize sensory recovery during the first 6 months after surgery and to examine whether patients who underwent different surgical procedures tended to choose different sets of words. PATIENTS AND METHODS: Patients' selections from a list of 27 words that described their assessment of spontaneous and evoked facial sensations were obtained before surgery and at 1 week, 1 month, 3 months, and 6 months after surgery. Data were obtained from 146 patients enrolled in a randomized controlled clinical trial designed to evaluate the potential of sensory retraining in the rehabilitation of patients who experience impairment in sensory function after nerve injury. Mantel Haenszel general correlation and row mean score statistics were used to assess the association between time and word choice and to compare the word choice categories of 4 surgical groups: bilateral sagittal split osteotomy (BSSO) only, with or without genioplasty; BSSO + Le Fort I, with or without genioplasty. RESULTS: In general, the number of words selected to describe the alteration in sensation decreased over time, as did the intrusiveness of the category of words chosen. However, the intrusiveness remained the same or worsened from 1 week to 6 months for 32% of patients. With increased time after surgery, the percentage of patients who reported altered evoked sensations exceeded the percentage who reported spontaneous sensations. For example, at 6 months the altered sensation of 66% of the patients was classified in the paresthesia and dysesthesia categories by the evoked assessment of sensation; whereas, that of only 47% of the patients were classified as such by the spontaneous assessment. The addition of Le Fort I to BSSO did not affect the way patients reported altered sensation on their lower face. Hypoesthesia and paresthesia, but not dysesthesia, were less of a problem on the midface than on the lower face after BSSO + Le Fort I. Patients who had genioplasty more frequently chose descriptors for the lower face that reflected soft tissue trauma and inflammation ("swollen," "tender," and "burning") than patients without genioplasty; however, this difference decreased with time after surgery. CONCLUSION: The current findings indicate that patients' selection of words differentiates individuals who experienced only a simple loss in sensation (ie, present negative symptoms), those who experienced active sensations that are not normally present (ie, present positive symptoms), and those whose active sensations are additionally uncomfortable or painful. It is possible that continued study of the latter group of patients will reveal patterns of word usage that predict poor long-term recovery and disabling sensory disorders.

Adolescent↗
PubMed2006

Interscalene block anesthesia at an ambulatory surgery center performing predominantly regional anesthesia: a prospective study of one hundred thirty-three patients undergoing shoulder surgery.

Interscalene block (ISB) of the brachial plexus is frequently used for patients undergoing ambulatory shoulder surgery. We previously reported that the incidence of postoperative complaints (neurapraxia) after an ISB was low (3% at 2 weeks), but objective neurologic assessment was not included in the study. The present study combines subjective findings with both preoperative and postoperative objective sensory and motor assessments after an ISB. We prospectively evaluated 133 patients undergoing elective ambulatory shoulder surgery. ISB anesthesia was accomplished by use of 1.5% mepivacaine alone or in combination with bupivacaine (0.5%-0.75%) via a paresthesia technique and a 23-gauge needle. All of the blocks were performed by experienced anesthesiologists. The number of passes with the needle, site of paresthesia, ease of performing the block, and success of the ISB were recorded for each patient. Neurologic assessment was performed preoperatively and up to 2 weeks postoperatively by 1 of 4 health care professionals but not by the anesthesiologists who performed the ISB and included diminished sensation, localized nerve pain, Semmes-Weinstein monofilament pressure threshold sensibility, Weber static 2-point discrimination, and grip strength changes. Patients with postoperative changes were followed up until resolution of symptoms occurred. Successful surgical anesthesia was achieved in 98% of the patients. There was 1 major perioperative complication (0.7%), a seizure that occurred within 5 minutes of the ISB. Two (1.4%) complained of transient postoperative neurapraxias. Neither patient had any changes in objective sensory and motor measurements. Hence, there was no correlation between subjective complaints and objective findings in this study. This study demonstrates that, in the hands of anesthesiologists doing predominantly regional anesthesia, there is a 1.4% incidence of neurologic complications after an ISB. ISB is a safe and effective technique for patients undergoing ambulatory shoulder surgery when an anesthesiologist experienced with regional anesthesia is involved.

Adult↗
PubMed2004

Initial experience with an endoscopic radial artery harvesting technique.

OBJECTIVE: The purpose of the study was to investigate the feasibility of an endoscopic radial artery harvesting technique to improve esthetic results and possibly reduce the incidence of neurologic complications observed with the open method. METHODS: Between July 1, 2002, and October 1, 2003, a total of 54 patients underwent endoscopic radial artery harvesting at our institution. Standard endoscopic equipment and a Harmonic Scalpel (Ethicon Endo-Surgery, Inc, Cincinnati, Ohio) were used. Mean age of the patients was 63 +/- 8.1 years, and 16% were female. All patients underwent a preoperative Allen test and duplex ultrasonography to demonstrate adequate ulnar collateral flow. The nondominant arm was used for radial artery harvesting. Mean clinical follow-up was 13 +/- 4.6 months. RESULTS: The artery was harvested through a 3-cm incision at the wrist and was divided at the elbow either through a small counterincision (n = 16) or endoscopically with the use of clips, Endoloop, and endoscopic scissors (n = 38). Mean harvest time was 42.2 +/- 16.9 minutes but decreased from 85 minutes for the first cases to 25 minutes for the last 5 cases. Mean harvested length was 19.6 +/- 1.7 cm. Harvesting complications included 1 conversion, 2 postoperative hematomas, 1 injury, 8 endoscopically controlled bleedings, and 15 cases of at least some superficial radial nerve paresthesia at 6 weeks (clinically relevant in 4 cases). Selective postoperative angiography revealed 1 occluded graft and 1 stenotic graft requiring percutaneous transluminal coronary angioplasty of the native vessel. Eighty-seven percent of the patients were enthusiastic about this new procedure. CONCLUSIONS: Endoscopic radial artery harvesting is a feasible procedure that requires a definite learning curve. Although nerve paresthesias were not completely eliminated in our experience, the technique provided ample patient satisfaction. Further clinical follow-up is required to determine long-term patency rates.

Adult↗
PubMed2004

Clinical presentation and physical examination.

The main points to assimilate concerning the presentation of peripheral nerve tumors are their subtle features, few symptoms, and even fewer signs. It is no surprise that most lesions become apparent only when a mass becomes palpable. Pain, paresthesia, and a positive Tinel's sign are sometimes the only features, with the paresthesia being variable and unreliable as a clinical entity. Loss of profound sensory function and motor function is generally a late feature. When patients present with progressive pain and significant sensory and any motor deficits, these signs suggest that a more sinister lesion is present. It cannot be overstressed that the stigmata of neurocutaneous disorders should be sought in all patients with suspected peripheral nerve tumors. Similarly, the presence of such stigmata in a patient presenting with vague paresthetic symptoms in a nerve distribution should make the clinician suspect and investigate for an underlying nerve tumor.

Humans↗
PubMed2006

Somatosensory cortical plasticity in carpal tunnel syndrome--a cross-sectional fMRI evaluation.

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the median nerve characterized by paresthesias and pain in the first, second, and third digits. We hypothesize that aberrant afferent input in CTS will lead to cortical plasticity. Functional MRI (fMRI) and neurophysiological testing were performed on CTS patients and healthy adults. Median nerve innervated digit 2 (D2), and digit 3 (D3) and ulnar nerve innervated digit 5 (D5) were stimulated during fMRI. Surface-based and ROI-based analyses consistently demonstrated more extensive and stronger contralateral sensorimotor cortical representations of D2 and D3 for CTS patients as compared to healthy adults (P < 0.05). Differences were less profound for D5. Moreover, D3 fMRI activation in both the contralateral SI and motor cortex correlated positively with the D3 sensory conduction latency. Analysis of somatotopy suggested that contralateral SI representations for D2 and D3 were less separated for CTS patients (3.8 +/- 1.0 mm) than for healthy adults (7.5 +/- 1.2 mm). Furthermore, the D3/D2 separation distance correlated negatively with D2 sensory conduction latency-the greater the latency, the closer the D2/D3 cortical representations (r = -0.79, P < 0.05). Coupled with a greater extent of SI representation for these CTS affected digits, the closer cortical representations can be interpreted as a blurred somatotopic arrangement for CTS affected digits. These findings provide further evidence that CTS is not manifest in the periphery alone. Our results are consistent with Hebbian plasticity mechanisms, as our cohort of CTS patients had predominant paresthesias, which produce more temporally coherent afferent signaling from affected digits.

Adult↗
PubMed2006

Is saphenofemoral junction reconstruction necessary during stripping of the saphenous vein?

BACKGROUND: Patients who had undergone complete ankle-to-groin stripping of the greater saphenous vein were evaluated retrospectively to assess the necessity of saphenofemoral junction reconstruction during the stripping procedure. Since 1996, in addition to the conventional complete stripping operation, we routinely perform a saphenofemoral junction reconstruction in patients presenting with greater saphenous vein reflux associated with low-grade (grades I-II) saphenofemoral junctional reflux. In this method, the size of the common femoral vein was adjusted to the desired diameter by a running linear suture technique after division of the greater saphenous vein. METHODS: Retrospective evaluation revealed that 73 limbs in 56 patients treated with this technique (group I). This group of patients was matched to another group of 65 patients (78 limbs) with similar characteristics and symptoms (group II) in whom the conventional complete ankle-to-groin stripping of greater saphenous vein was the treatment. The 2 groups were compared with respect to the incidence of complications, including recurrence of varicosities, ecchymosis, lymphocele, lymphorrhagia, wound infection, and paresthesia in the operated extremity. All patients also were evaluated by Doppler ultrasonography at 6 months, 12 months, and annually thereafter to determine the saphenofemoral junction reflux time (valve reflux time). The mean duration +/- SD of follow-up was 6.7 +/- 1.6 years (range, 2.1-10.8 years). RESULTS: Recurrence of varicosity was noted in 14 patients, 3 in group I and 11 in group II (P = .02). There were no statistically significant differences between the 2 groups in terms of ecchymosis, hematoma, lymphocele, lymphorrhagia, wound infection, and paresthesia. At 6 months, a rapid decrease in valve reflux time was noted in group I (P = .0001). In addition, there was a significant improvement in valve reflux time at each subsequent Doppler examination in group I. Group II showed a decrease in valve reflux time, compared with the preoperative value (P = .068). During subsequent Doppler examinations, a decrease in valve reflux time also was noted in group II; this difference reached statistical significance only at 24 months (P = .04). CONCLUSIONS: We believe that saphenofemoral junction reconstruction is a simple technique to perform and that addition of this method to the conventional stripping provides more durable results with a lesser incidence of recurrence. This method should be considered as a treatment modality in patients with greater saphenous vein reflux associated with low-grade (grades I-II) saphenofemoral junctional reflux.

Adult↗