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PubMed1997

Nonoperative management of adult blunt splenic trauma: a 15-year experience.

From January 1989 to December 1993, 40 consecutive adult patients with ruptured spleen from blunt trauma were examined. Fourteen patients (35%) were taken to the operating room initially because of hemodynamic instability and generalized peritoneal signs. Twenty-six patients (65%) were hemodynamically stabilized at admission and treated by nonoperative management, which included strict bed rest, intensive care unit monitoring, frequent physical examinations, and serial hematocrits. Four patients failed nonsurgical management and required a splenectomy, three because of clinical deterioration within 1 to 3 days of admission; the fourth patient had recurrent bleeding 7 days after injury. The patients in the operative group had a greater severity of injury with a mean injury severity score of 26.6, four deaths, and mean transfusion requirements of 3.7 to 4.0 units of blood, compared to a mean injury severity score of 14.6, one late death from cardiac causes, and average blood requirement of 0.4 to 0.7 units. Splenic injury grading averaged 3.2 in the surgical group (grade 1, one patient; grade 2, four patients; grade 3, eight patients; grade 4, no patients; and grade 5, one patient) and differed significantly from that of the nonoperative group (mean = 2.4; grade 1, 12 patients; grade 2, seven patients; grade 3, six patients; grade 4, two patients; and grade 5, no patients). Recent ultrasound analysis of select grades I to IV has shown excellent resolution or repair of these injuries. This report extends our series from 1978 to 1993 and includes 144 adult patients sustaining blunt splenic ruptures. Seventy-nine (55%) of these patients were treated nonsurgically. Seven patients (of 80) failed nonoperative management and required interval laparotomy, representing a 91 per cent success rate. Follow-up on more than 90 per cent of the patients has shown no sequelae from their splenic injuries. We conclude that adult patients with splenic injuries from blunt trauma who are hemodynamically stable and are without abdominal findings requiring celiotomy can be safely managed by a nonoperative approach.

Adolescent↗
PubMed2006

Influence of margin status and radiation on recurrence after radical hysterectomy in Stage IB cervical cancer.

PURPOSE: To examine the relationship between margin status and local recurrence (LR) or any recurrence after radical hysterectomy (RH) in women treated with or without radiotherapy (RT) for Stage IB cervical carcinoma. METHODS AND MATERIALS: This study included 284 patients after RH with assessable margins between 1980 and 2000. Each margin was scored as negative (> or =1 cm), close (>0 and <1 cm), or positive. The outcomes measured were any recurrence, LR, and relapse-free survival. RESULTS: The crude rate for any recurrence was 11%, 20%, and 38% for patients with negative, close, and positive margins, respectively. The crude rate for LR was 10%, 11%, and 38%, respectively. Postoperative RT decreased the rate of LR from 10% to 0% for negative, 17% to 0% for close, and 50% to 25% for positive margins. The significant predictors of decreased relapse-free survival on univariate analysis were the depth of tumor invasion (hazard ratio [HR] 2.14/cm increase, p = 0.007), positive margins (HR 3.92, p = 0.02), tumor size (HR 1.3/cm increase, p = 0.02), lymphovascular invasion (HR 2.19, p = 0.03), and margin status (HR 0.002/increasing millimeter from cancer for those with close margins, p = 0.03). Long-term side effects occurred in 8% after RH and 19% after RH and RT. CONCLUSION: The use of postoperative RT may decrease the risk of LR in patients with close paracervical margins. Patients with other adverse prognostic factors and close margins may also benefit from the use of postoperative RT. However, RT after RH may increase the risk of long-term side effects.

Adult↗
PubMed1986

Cross-sectional clinical study of quality of amalgam restorations, oral health and prevalence of recurrent caries.

The purpose of the present cross-sectional clinical study was to evaluate the relationship between recurrent caries prevalence, quality of class II amalgam restorations and various oral health parameters. One hundred and forty-four randomly selected 35-yr-old citizens of Oslo were included in the investigation. Caries was scored based on a combined clinical and radiographic examination according to the DMFS index system. Oral hygiene (OHI-S) and periodontal index (PI) were registered, and the quality of class II amalgam restorations was ranked according to a set of occlusal index pictures. A total of 1694 class II amalgam restorations were included and 93 (5.5%) of these were affected by recurrent caries. A statistically significant correlation was found between prevalence of recurrent caries and poor oral hygiene, high PI-scores and prevalence of primary caries. However, a severe deterioration of the quality of amalgam restorations had to be present before a concomitant increase in recurrent caries prevalence could be registered. The present results indicate that measures improving the oral health may be of major importance in preventing recurrent caries and thereby increase the durability of amalgam restorations.

Adult↗
PubMed2001

[Recurrent purulent bacterial meningoencephalitis].

During the period of 25 years there were 55 patients treated in our Institute because of recurrent purulent bacterial meningoencephalitis(rpbme). This group consisted of 42 males (76%) and 13 (24%) females, the prevalent number (53%) of patients being under 21 years of age. The diagnosis of rpbme was based on the commonly accepted criteria and confirmed by the laboratory results of CSF examination. The cause of the recurrences was established considering the skull X-ray examination, CT and MRI. The evaluation of the clinical status was based on the Glasgow Coma Score (GCS). During the first hospitalisation, severe or critic clinical status was noted in 42 patients (76%) and moderate in 13 (24%). The subsequent recurrences were mostly moderate, rarely severe or mild. The number of recurrences varied from 1 to 9. During the first hospitalisation, the etiologic factor was detected in 39 patients (71%), i.e. Streptococcus pneumoniae in 28 (51%), Neisseria meningitidis in 8 (14%), Pseudomonas aeruginosa and Staphylococcus aureus in 2 and 1 patients respectively. In 37 patients (67%) rpbme developed following cranial trauma, in 18 cases (33%) with single or comminuted fractures of the anterior cranial fossa (in 4 cases accompanied by CSF nasal exsudate). In 4 it followed neurosurgical intervention, in 3 it accompanied recurrent purulent highmorities, in 1 case--after removal of the nasal polyps and subsequent CSF nasal exsudate, and in 1 patient with recurrent mastoiditis. In 6 cases (11%) the cause of the recurrences remained unelucidated. The clinical signs and symptoms, diagnostic difficulties and the causative treatment of rpbme are discussed. In the authors' opinion, surgical treatment of the communication between the CSF and the external environment prevents the recurrences and is the only successful way of treatment. Special attention is drawn to the great diagnostic value of CT and MRI. The use of other modern techniques, e.g. positron emission tomography (PET) is recommended, because it is useful not only in the functional evaluation of the cerebral tissue after the injury, but also in assessing the dynamics of pathologic changes.

Adolescent↗
PubMed1991

Improvements observed in care and outcome in carcinoma of the larynx.

The 1978 Patterns of Care Studies (PCS) survey of carcinoma of the larynx reviewed the process (pre-treatment evaluation and treatment) and outcome of 521 patients. When compared to results from the 1973 PCS survey, several important changes have been observed. The use of surgery in conjunction with radiation therapy (RT) increased in Stage III cases from less than 30% to greater than 60% and in Stage IV cases from 48% to greater than 70%. This change in therapy was associated with a decline in locoregional failure in this patient group. Among Stage I and II supra- and subglottic carcinomas, an improvement in 3-year local tumor control (Stage I: 78 to 100% and Stage II: 54 to 74%) and overall freedom from recurrence (Stage I: 78 to 100% and Stage II: 45 to 73%) was seen over this 5-year period with no identifiable change in process for this subgroup. Also noted was an improvement in the freedom from recurrence rate for Stage III and IV patients receiving treatment at facilities with low process scores. The 1978 PCS survey confirmed the presence of superior patient outcome in several subgroups and the relationship of this improvement to patient process.

Clinical Protocols↗
PubMedDate not supplied

Endovascular treatment of experimental wide neck aneurysms: comparison of results using coils or cyanoacrylate with the assistance of an aneurysm neck bridge device.

BACKGROUND AND PURPOSE: Endovascular treatment of wide neck aneurysms often results in incomplete occlusion or aneurysm recurrence. The two goals of the present study were to compare results of coil embolization with or without the assistance of an aneurysm neck bridge device (ANBD) and to explore the use of this instrument to control cyanoacrylate embolization. METHODS: Wide necked bifurcation aneurysms were constructed in 28 dogs. Coil embolization of the aneurysms was performed 2 to 4 weeks later, with (n = 11) or without (n = 10) ANBD assistance. In seven other animals, embolization was performed with cyanoacrylate, injected under the protection of ANBDs. Angiographic results were compared immediately after and at 3 and 12 weeks. Neointima formation at the neck was also compared between groups at 12 weeks. RESULTS: Initial angiographic results and recurrences at 12 weeks were not significantly different in aneurysms coiled with or without ANBDs. Neointimal scores were also similar. The use of one ANBD at the neck was not sufficient to safely deliver cyanoacrylate into aneurysms. Cyanoacrylate embolization led to improved angiographic results (P =.05) and to better neointimal sealing of the neck of the aneurysms at 12 weeks (P =.004). CONCLUSION: ANBDs did not prevent recanalization and recurrences after coil embolization of wide neck aneurysms in this animal study. ANBD-assisted cyanoacrylate embolization was unsafe but could decrease recurrences at 12 weeks.

Animals↗
PubMed2006

[Segmental allograft reconstruction in skeletal defect after limb tumor resection].

OBJECTIVE: To study the clinical feasibility of the prosthetic composites of the intercalary allograft and the segmental allograft in reconstruction of the skeletal defect after the limb tumor resection. METHODS: Between August 1999 and December 2003, 28 patients with skeletal defects after the limb tumor resection were treated with the intercalary allograft or the segmental allograft megaprosthesis composite for reconstruction of skeletal defects. The bone involvements were observed in 16 patients with osteosarcoma, 4 patients with parosteal osteosarcoma, 5 patients with Ewing sarcoma, and 3 patients with soft tissue sarcoma. Preoperative biopsy was performed on all the patients, and the pathological result was confirmed after surgery. According to the Enneking system, 5 patients were grouped in I B and 23 patients in I B. The patients with osteosarcoma or Ewing sarcoma received the standard chemotherapy before and after operation. Eighteen and ten patients received the segmental allograft prosthetic composite replacement and the intercalary allograft with the interlocking intramedullary nail fixation, respectively. The functional outcome was evaluated by the MSTS score. RESULTS: According to the follow-up for 5-48 months (average, 24 months), local recurrence was observed in 1 patient who underwent amputation eventually. Of the 28 patients, 3 developed nonunion of the allograft-host junction accompanied by severe resorption and 2 developed deep infection. No allograft fracture was seen in the patients. Most of the patients achieved a good functional result with an average MSTS score of 23. 4. CONCLUSION: The prosthetic composite replacement of the intercalary allograft and the segmental allograft can be used in the skeletal defect reconstruction after the limb tumor resection. The stable contact in the allograft-host junction and the strong intramedullary internal fixation can help to reduce the complication rate of the allograft.

Adolescent↗
PubMed1992

Value of the electroencephalogram in adult patients with untreated idiopathic first seizures.

We prospectively studied the reliability and accuracy of the electroencephalogram as a predictor of the risk of recurrence within 2 years in 157 patients with untreated idiopathic first seizures. In all patients, a standard electroencephalogram and, if necessary, an electroencephalogram after partial sleep deprivation were obtained. All electroencephalograms were scored by one observer according to a fixed protocol. The finding of epileptic discharges was associated with a risk of recurrence of 83% (95% confidence interval, 69% to 97%) vs 41% (95% confidence interval, 29% to 53%) in patients with nonepileptic abnormalities and 12% (95% confidence interval, 3% to 21%) in patients in whom both electroencephalograms were normal. The sensitivity proved to be 48%. Interobserver agreement among four neurologists, who independently read 50 electroencephalograms, was found to be moderate. Predictive value for each observer, however, was good. We conclude that electroencephalogram findings may play a role in the decision to initiate or delay treatment after an idiopathic first seizure.

Action Potentials↗
PubMed1993

Analysis of verbal memory and learning by means of selective reminding procedure in Alzheimer and multi-infarct dementias.

Several studies aimed at defining the characteristics of memory impairment resulting from different etiologic forms of dementia have been inconclusive. These unsatisfactory results might be due to the enrollment of various groups of demented patients not matched for disease severity, as well as the use of different psychometric procedures. The object of the present study was to verify the existence of a different pattern of verbal memory impairment that might be useful in clinical practice in two groups of AD and MID patients who were matched for degree of cognitive deterioration. Thirty-seven AD and 41 MID patients were assessed for memory and learning by means of the Supraspan Verbal Learning test (Selective Reminding by Buschke-Fuld), which provides a simultaneous analysis of storage, retention and retrieval abilities. Twenty-four normal subjects were studied as a control group. No differences in storage and retrieval mean scores were found between the two groups. AD patients showed a higher mean score in random retrieval; the mean score in selective retrieval at the end of learning was significantly higher in MID patients, suggesting a more impaired retrieval from long-term storage in AD than in MID patients. Intrusions, defined as inappropriate recurrences from preceding tests, were observed more frequently in AD patients. The presence of intrusions and the delayed retrieval score showed a good level of sensitivity and specificity in the differential diagnosis between the two groups.

Aged↗
PubMed2006

Outcomes following open repair of Bankart lesions for recurrent, traumatic anterior glenohumeral dislocations.

Though open stabilization using the Bankart procedure is still considered the "gold standard," few studies have examined the long-term outcomes. Between 1988 and 2001, 64 patients met inclusion criteria and had an open stabilization performed. Forty-one patients were available for follow-up at an average of 6.5 years. Forty (98%) patients reported having a stable shoulder. Average loss of external rotation was 4 degrees and average Rowe score was 96. This study further supports the trustworthiness of an open anatomic subcapsulolabral reconstruction for recurrent anterior instability and provides another standard from which to compare newer surgical methods.

Adolescent↗
PubMed2004

Histologic recurrence of chronic hepatitis C virus in patients after living donor and deceased donor liver transplantation.

Hepatitis C virus (HCV) recurs in nearly all patients after liver transplantation. This recurrence is associated with progressive fibrosis and graft loss. It remains unclear whether the natural course of HCV recurrence is altered in patients who undergo living donor liver transplantation (LDLT). We conducted a prospective, controlled trial using protocol liver biopsies to evaluate the histologic outcome of recurrent HCV in 23 patients who underwent LDLT and 53 patients who underwent transplantation with a deceased donor liver (DDLT) during the same period of time. Patients who did not survive at least 6 months after transplantation or who had hepatocellular carcinoma or any other coexistent liver disease were excluded from analysis. All patients underwent protocol liver biopsy at 6 months and at 12 months and at yearly intervals thereafter. The mean age, sex, racial distribution, and serum HCV RNA and the percentage of patients with genotype 1 were similar in the 2 groups of patients. The model for end-stage liver disease score at the time of transplantation was slightly lower in patients who underwent LDLT, but this difference was not significant. The distribution of immunosuppression agents used, the mean doses of calcineurin agents, the use of mycophenolate mofetil, and the dose and tapering schedule for prednisone were similar in both groups of patients. The mean duration of follow-up was 40 months. No significant difference in either graft or patient survival or the percentage of patients who developed acute rejection was noted in the 2 groups of patients. At 48 months, graft and patient survival were 82% and 82% and 75% and 79% for patients who underwent DDLT and LDLT, respectively. The degree of hepatic inflammation increased stepwise over 3 years but was not significantly different in the 2 patient groups. In contrast, the mean fibrosis score and the percentage of patients with fibrosis increased stepwise after DDLT but appeared to plateau 12 months after LDLT. At 36 months, fibrosis was present in 78% of DDLT patients, and mean fibrosis score was 1.9, compared with 59% with fibrosis and a mean score of.9 after LDLT. In conclusion, these data strongly suggest that fibrosis progression from recurrent HCV is not more severe in patients after LDLT.

Adult↗
PubMed1998

Prognostic indicators in patients with seminal vesicle involvement following radical prostatectomy for clinically localized prostate cancer.

PURPOSE: We identify prognostic factors in patients with seminal vesicle involvement and negative lymph nodes following radical prostatectomy for clinically localized prostate cancer. MATERIALS AND METHODS: A total of 93 patients who underwent radical prostatectomy and had seminal vesicle invasion without lymph node metastasis were evaluated. Patients who underwent neoadjuvant/adjuvant hormonal or radiation therapy were excluded from study. Preoperative serum prostate specific antigen (PSA), biopsy and radical prostatectomy specimen Gleason score, surgical margin status, presence of extraprostatic extension and evidence of biochemical disease progression were determined prospectively. Biochemical failure was defined as a single serum PSA elevation greater than 0.4 ng./ml. RESULTS: The presence of positive surgical margins (p = 0.001), and Gleason score 7 or higher from preoperative biopsies (p = 0.03) and from the radical prostatectomy specimen (p = 0.01) were significant predictors of disease progression at a median followup of 43.3 months. Patients with preoperative PSA less than 10 ng./ml. had a better disease-free survival (p = 0.07). On multivariate analysis, after adjusting for biopsy Gleason score, prostatectomy Gleason score and serum PSA, positive surgical margins remained a statistically significant predictor of disease progression (p = 0.002). CONCLUSIONS: Surgical margin status is an independent predictor of disease recurrence in patients with seminal vesicle involvement and negative lymph nodes following radical prostatectomy. Serum PSA 10 ng./ml. or greater and specimen Gleason score 7 or greater also were adverse prognostic factors in these patients. Conversely, patients with negative surgical margins and lymph nodes have a better prognosis than previously expected, despite seminal vesicle invasion.

Aged↗
PubMed2001

Impact of rhinosinusitis in health care delivery: the Quebec experience.

OBJECTIVE: Rhinosinusitis is a common disease affecting 135 per 1,000 population. The cost and the impact on quality of life of this disease are considerable. Health care delivery for a particular disease is evaluated through the health impact of the disease, outcomes of treatments, and their costs. This article reviews our experience with rhinosinusitis and its impact on health, as measured using a generic quality of life instrument, the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), in a selected patient population. Outcomes of treatments will be introduced, and the economic impact of chronic rhinosinusitis based on a U.S. study will be discussed. MATERIAL AND METHODS: One hundred and ten patients (divided into three subgroups: recurrent acute rhinosinusitis, chronic rhinosinusitis, and nasal polyposis) completed the SF-36 survey on the day of the diagnostic visit in the outpatient sinus clinics of two hospitals. RESULTS: The scores of the SF-36, in chronic rhinosinusitis, are compared with the normative values of a healthy U.S. population showing statistically significant differences in seven of eight domains. A comparison of the scores of chronic rhinosinusitis with a U.S. study on chronic rhinosinusitis shows statistically significant differences in five of eight domains. A comparison of the scores in the three diagnostic subgroups shows a statistical significance in two domains: bodily pain and vitality are more affected in recurrent acute and chronic rhinosinusitis. CONCLUSIONS: Chronic rhinosinusitis affects the quality of life of patients with rhinosinusitis and represents an important health burden. Some differences are noted with the U.S. chronic rhinosinusitis population. Recurrent acute and chronic rhinosinusitis seem to have more impact on vitality and bodily pain than nasal polyposis.

Acute Disease↗
PubMed1990

[A clinicopathological study on gestational trophoblastic disease comparing with high risk criteria and diagnostic score of choriocarcinoma].

In the past 15 years, 274 patients with the gestational trophoblastic disease have been treated at Chiba University and the diagnosis of 125 patients was confirmed pathologically. There were 55 cases (44%) in the high risk and 70 cases (56%) in the low risk group with the following criteria: (1) the urinary hCG titer was more than 100,000 IU/L; (2) the duration between antecedent pregnancy and the start of treatment was more than 1 year; (3) antecedent pregnancies were full-term or abnormal pregnancies except hydatidiform mole. These pathologically confirmed patients were evaluated with the choriocarcinoma diagnostic score. From this study, the following results were obtained: (1) The overall remission rates in high risk and low risk patients were 79.1%, 100%, respectively. (2) Out of 55 patients with high risk diagnosed pathologically, 49 (89.1%) patients had choriocarcinomas. On the other hand, 65 (92.9%) patients with low risk had invasive moles. (3) The discrepancies between the pathological and the clinical diagnosis chiefly depended on the inadequate evaluation of recurrent cases and the pretreatment urinary hCG. (4) Compared with our criteria, the choriocarcinoma diagnostic scoring system more closely corresponds to the pathological diagnosis but this system is more complex and inadequate than our criteria for older up patients that have not been adequately followed up.

Biomarkers, Tumor↗
PubMed1990

Papillary thyroid carcinoma.

Multiple prognostic factors for outcome in papillary thyroid carcinoma are identified. For a cohort of 1500 consecutive patients followed an average of 16 years, survival rates for tumor recurrence and cause-specific mortality are described. Risk groups derived from novel prognostic scoring or staging systems and the role of DNA ploidy testing are discussed specifically. Lastly, controversies are reviewed regarding the extent of primary surgical resection and the efficacy of postoperative radioiodine remnant ablation in papillary thyroid cancer.

Adolescent↗
PubMed2005

Treatment of pathologic femoral neck fractures with modified Pauwels' osteotomy.

UNLABELLED: Treatment of pathologic femoral neck fractures secondary to extensive lesions of fibrous dysplasia and simple bone cysts has been controversial. We think that modified Pauwels' intertrochanteric osteotomy and osteosynthesis can result in sound healing of the lesion and of the fracture, with no recurrence, low complication rates, and good functional results. Seven patients were treated with a uniform approach consisting of biopsy (Stage I) and osteotomy with osteosynthesis (Stage II). Curettage of the lesion and bone grafting were not done. The average followup was 79.28 months (range, 32-142 months). All of the fractures and osteotomy sites healed in means of 14 weeks (range, 12-16 weeks) and 9.1 weeks (range, 8-10 weeks), respectively. All fibrous dysplasia lesions healed radiologically. Grade IV radiographic healing was seen in both patients with simple bone cysts after 35 and 92 months. Using the Musculoskeletal Tumor Society functional evaluation and Toronto Extremity Salvage Score, all the patients had good to excellent results. Complications such as infection, local recurrence, refracture, femoral neck deformity, osteonecrosis of the femoral head, and growth arrest of capital femoral physis were not seen. In addition to biomechanical advantages, the procedure seems to have had a biologic role in healing of the fracture and of the lesion by initiating osteogenesis to replace the defect with new bone. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed1998

A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer.

BACKGROUND: Few published studies have combined clinical prognostic factors into risk profiles that can be used to predict the likelihood of recurrence or metastatic progression in patients following treatment of prostate cancer. We developed a nomogram that allows prediction of disease recurrence through use of preoperative clinical factors for patients with clinically localized prostate cancer who are candidates for treatment with a radical prostatectomy. METHODS: By use of Cox proportional hazards regression analysis, we modeled the clinical data and disease follow-up for 983 men with clinically localized prostate cancer whom we intended to treat with a radical prostatectomy. Clinical data included pretreatment serum prostate-specific antigen levels, biopsy Gleason scores, and clinical stage. Treatment failure was recorded when there was clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ng/mL or greater and rising), or initiation of adjuvant therapy. Validation was performed on a separate sample of 168 men, also from our institution. RESULTS: Treatment failure (i.e., cancer recurrence) was noted in 196 of the 983 men, and the patients without failure had a median follow-up of 30 months (range, 1-146 months). The 5-year probability of freedom from failure for the cohort was 73% (95% confidence interval = 69%-76%). The predictions from the nomogram appeared accurate and discriminating, with a validation sample area under the receiver operating characteristic curve (i.e., comparison of the predicted probability with the actual outcome) of 0.79. CONCLUSIONS: A nomogram has been developed that can be used to predict the 5-year probability of treatment failure among men with clinically localized prostate cancer treated with radical prostatectomy.

Adult↗
PubMed1996

[Recurrence of inguinal hernia: ambulatory surgery under local anesthesia].

In order to assess the feasibility of repair of a recurrent inguinal hernia in unmonitored local anaesthesia in an ambulatory set-up pain scores and data on patient satisfaction were obtained from 76 unselected patients after 79 consecutive operations. Median age was 63 years, and 25%- and 75% quartiles were 49 and 72 years respectively. All operations were conducted in local anesthesia. Three patients stayed in hospital overnight after the operation. Pain: After one, six and 28 days 27, 14 og 7% respectively had severe pain during function (cough and/or rising). Satisfaction: 82% were satisfied with ambulatory surgery in local anaesthesia, 82% were satisfied with the analgesic therapy (tenoxicam and methadone), but one third needed supplementary analgesics during the first week (acetaminophen was recommended). It is concluded, that ambulatory repair of a recurrent inguinal hernia in unmonitored local anaesthesia is a safe and cost effective alternative to operation in general or spinal anaesthesia.

Aged↗