[Show abstract][Hide abstract] ABSTRACT: This is a new technique for tendon repair that may improve the results of existing methods.
The study is a nonrandomized retrospective study using historical (nonconcurrent) controls. From May 1994 to March 2004, 53 children aged 5 to 15 years requiring tendon repair (test group) were compared to 53 children conventionally repaired (control group). All patients had flexor tendon injuries, involving zone 2. In the test group (53 patients), a modified Kessler repairing of tendons with 4-0 prolene was used, followed by a core suture of running 7-0 nylon or prolene epitendinous suture. After the tendon repair, a segment of vein through which the tendon had been passed before or a vein patch used as a tendon sheath substitute was used to repair the sheath defects. The results during 6 months of follow-up were compared with those of the control group that were operated using the conventional technique (modified Kessler method).
We assessed the results by measuring the range of motion of the metacarpophalangeal, distal interphalangeal, and proximal interphalangeal joints in the follow-up period and graded them as excellent, good, fair, and poor. In the test group, 86% were graded as excellent, 11% good, 3% fair, and 0% poor results; and in the control group, 0% were excellent, 12% good, 38% fair, and 50% poor results. The differences were significant (P < .005).
Our preliminary results appeared encouraging when compared with the outcomes achieved by the conventional tendon repair technique. As the new technique decreases the need for intensive physiotherapy, it may serve as a substitute method for the conventional tendon repair and eventually become a standard technique in the future.
Journal of Pediatric Surgery 08/2009; 44(8):1662-5. DOI:10.1016/j.jpedsurg.2009.04.012 · 1.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Lymphoedema is the result of impaired lymphatic drainage from the affected organ. This abnormality can be primary or secondary. Different non-operative and operative approaches have been introduced to treat chronic lymphoedema. In the present study, we describe a new surgical technique and compare its results with other more commonplace methods. Materials and Methods: The study included 296 patients who had been diagnosed with chronic lower extremity lymphoedema and who had not responded to non-operative management for at least 6 months. Data was collected over 15 years, between March 1987 and March 2002. Doppler ultrasonography of the deep venous system was routinely undertaken in all patients to confirm its patency. The 296 patients underwent surgery and their progress was followed for at least 1 year postoperatively. Results: All of the patients were operated on using our new technique, which is a modified form of the Homan techniques. The outcome was excellent, and 89.2% of patients were free of complication. The most common complication was wound seroma. Conclusions: Considering the difficulties associated with the treatment of chronic lymphoedema and the variety of surgical options, our method achieves excellent results, and could even become the standard operative procedure for treating intractable forms of disease.
Surgical Practice 05/2009; 13(2):48-52. DOI:10.1111/j.1744-1633.2009.00435.x · 0.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We compare lateral internal sphincterotomy as an effective treatment of chronic fissure in ano to fissurectomy, which is as an alternative surgical treatment.
Sixty two consecutive patients were divided into two groups through sequential sampling. Thirty patients underwent fissurectomy and 32 underwent lateral internal sphincterotomy. After a median follow-up of 22 months, we compared the results of the two procedures. In addition to frequent visits on a predetermined basis, a telephone inquiry into fissure recurrence and continence status was made.
All patients in both groups were pain-free and without bleeding within 1 week. In both groups, urinary retention was noted in one patient. Incontinence to flatus was noted in the fissurectomy (F) group in two (6.2%) patients, but no incontinence was noted in the lateral internal sphincterotomy (LIS) group. There was one patient (3.1%) with fissure recurrence in the F group but none in the LIS group. No patient in either group was afflicted with anal stenosis or perianal infections. All wounds healed within 8 weeks. Twenty nine patients (96.6%) in the LIS group and 28 (87.5%) in the F group reported satisfactory results with their procedure.
In the surgical treatment of chronic anal fissure not responding to conservative management, LIS may be the better treatment and, perhaps, the preferable surgical technique with fewer total complications (P < 0.005).
Journal of Gastrointestinal Surgery 05/2009; 13(7):1279-82. DOI:10.1007/s11605-009-0908-5 · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the long-term therapeutic effect of fish mouth and parachute technique anastomosis for Hirschsprung's disease.
From March 1992 to October 2002, we performed one-stage fish mouth and parachute technique anastomosis for 293 patients with Hirschsprung's disease. Two hundred and fifty-four patients (79 percent) were followed up for three to five years. The operative outcome and postoperative complications were retrospectively analyzed.
Two hundred ninety-three patients were included in the study, the majority of patients were male (n = 205, 70 percent) and ages ranged between 8 months and five years. Early complications were low (n = 7, 2.3 percent) and included urine retention (n = 2), enteritis (n = 2), and intestinal obstruction (n = 3). No infection of the abdominal cavity or wound, anastomotic leakage, or death occurred in any patients. Late complications were present in 10 cases (3.4 percent).
The fish mouth and parachute surgical technique procedure showed some practical benefits and fewer complications than traditional surgical techniques for the treatment of Hirschsprung' s disease.
Diseases of the Colon & Rectum 09/2008; 51(10):1559-61. DOI:10.1007/s10350-008-9369-2 · 3.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper considers the importance of medical ethics in the process of allocating health care resources. Their importance is held to social ethics from the dominant role they play in clinical behavior and the important position of the clinical behavior in the production of health care and economics. It is pointed out that there is a potential conflict between the ethical style, and thus the behavior of the medical profession and organization of health, and the aim of maximizing social benefits from health care resources. This paper argues that medical ethics is very important, in that it raises social confidence which results to social capital and good health care.