Long-term results after arthroscopic meniscectomy. The role of preexisting cartilage fibrillation in a 13 year follow-up of 60 patients

Sixty patients with stable knees and arthroscopic menisectomy were matched into two groups according to the presence of early degenerative changes at the operation. Patients with severe cartilage changes were excluded. The patients were between 20 and 40 years of age at the operation and no patient had previous surgery on the involved knee. The intraarticular findings were documented at surgery and the patients were re-examined 12 to 15 years after the meniscectomy. Pre-existing cartilage fibrillation at the meniscectomy did not seem to influence the long-term results. At the follow-up no difference was found between the groups at the physical examination, in subjective complaints, in knee function and activity or in radiographic findings. In the total group 62% had early signs of arthrosis (Fairbank changes) and 42% narrowing of the joint space (Ahlb?ck grade 1-2) in the operated knee. No one had more severe changes. Radiographic signs of arthrosis were 4 times commoner in the operated knee compared to the non-operated knee after partial meniscectomy and 7 times commoner in the operated knee after subtotal meniscectomy. Arthrosis at the follow-up was seen three times more often in patients older than 30 years of age at surgery than in younger patients. The functional outcome was good and 70% were still active in sports compared to 90% before the operation.     

Statistical methods of computing reference values for side-to-side differences in nerve conduction studies

OBJECTIVE: To evaluate the utility of surgery in the treatment of peptic ulcer disease. METHODS: The clinical history of patients operated for peptic ulcer disease in a 15 year period were reviewed. The demographic data, indications for surgery, surgical procedure, morbidity, mortality and long term results, were analyzed. RESULTS: 349 patients were operated for peptic ulcer disease or its complications, 56% male. In 78% surgery was elective, mostly due to pyloric obstruction. In the remaining 22% perforation or bleeding ulcer were the main causes for emergency surgery. The most frequent elective procedure was vagotomy and drainage (66%); in urgent surgery, a definitive procedure was done in 35% of the perforations and in 94% of the bleeding ulcers. The 30-day mortality in urgent surgery was 14%; in elective surgery there was no mortality. A satisfactory long term result was obtained in 80% of the patients. CONCLUSIONS: An indication for surgical treatment of complicated peptic ulcer disease was above 50%, and 90 per cent in recent years. The frequency of urgent surgery is increasing and reached 60% of surgeries for this disease. Whenever possible, a definitive procedure is recommended.     

Diagnosis and treatment of leiomyosarcomas of inferior vena cava

3 clinical cases and literature data, illustrate effective diagnostic and surgical policy in patients with uncommon type of tumor. Two patients were previously operated in other clinics, but the operations were diagnostic because the tumors were estimated as being inoperable. In all 3 patients radical operations were carried out with resection of infrarenal segment of inferior cava vein without its prosthetic reconstruction. In did not result in substantial blood flow disturbances, because before the operation it was known about the presence of well functioning collaterals. The significance of ultrasound examination, especially duplex scanning, computer tomography and angiography (cavagraphy) is emphasized. Favourable results of treatment, especially conclusion of the tumor resectability are more common in specialized institutions.     

Problems with continence in rectal injuries

Authors analyse the group of 17 patients operated for rectal and anal injury. In this group 7 patients were operated primarily after injury and in 11 patients the secondary reconstruction was performed. Authors called the attention to the high diagnostic difficulty before the planned and indicated secondary reconstruction. Based on assessment of own clinical material and conforming with literature, authors conclude that secondary reconstruction are more difficult, and this difficulty is the higher, the less qualified the primary treatment was performed.     

Usefulness of Dallon prostheses for blood vessel reconstruction

Experimental and clinical results of the application of Dallon prostheses in vascular surgery are presented. Dallon prostheses are produced in the Medical Materials Department of the Research Development Centre of the Knitting Industry in ?ód?. They are contained in disposable radially sterilized wrappings. The experiments were performed on 17 mongrel dogs and the process of healing in was observed after three and six months. The process was similar to the healing in of other porous, synthetic prostheses. In 37 patients operated because of the artheromasia bypasses or vascular flaps of Dallon prostheses were implanted. The results of experimental and clinical research proved that the radially sterilized Dallon prostheses have similar properties like the prostheses produced be well known foreign firms, and are very useful in arterial reconstruction.     

Components of the ether-insoluble resin glycoside-like fraction from Cuscuta chinensis

The objective of this study was to develop an MR-based technique for quantifying the deformation of articular cartilage during mechanical loading in an intact cadaver joint at high spatial and temporal resolution. A nonmetallic pressure device was constructed for applying loads of >1000 N to a femoro-patellar articulation within an extremity coil of a clinical 1.5 T MRI scanner. Digital image processing methods were used to determine the location- and time-dependent cartilage deformation in consecutive 2D fat-suppressed FLASH images. Additionally, three-dimensional reconstruction of the cartilage was performed from 3D fat-suppressed FLASH image data. During the first 10 min of static compression, thickness changes between 10 and 30% were observed. Thickness changes greater than 50% and volume changes of 20% were recorded after 3 h. The technique permits analysis of the load and time-dependent mechanical behavior of articular cartilage in its natural environment.     

Aortoiliac surgery in chronic hemodialysed patients

Thirty eight patients on chronic hemodialysis were operated on for treatment of complicated aortoiliac atherosclerosis: 31 had aneurysms and 7 had stenotic or obstructive lesions. The 35 male and three female patients ranged in age from 39 to 78 years (mean: 55.3). The duration of hemodialysis treatment before the operation ranged from one month to 22 years but 80% of the patients were operated on during the first five years following the beginning of maintenance hemodialysis. The surgical repairs consisted of long aorta to femoral artery prosthesis in obstructive lesions and of short prostheses in cases of aneurysms so as not to make more difficult subsequent renal transplantation. All patients were operated on from 6 to 18 hours after a dialysis. Hemodialysis was resumed on the day of surgery in few patients or later according to the level of kalemia. Postoperative mortality rate was 10.5% and morbidity 13.5%. Only seven patients underwent secondary renal transplantation. The long-term survival rate was 43% at five years and 11% at ten years. Late deaths were due to coronary artery disease or to worsening of arterial lesions in the lower limbs.     

Autologous buccal mucosal graft for urethral reconstruction

OBJECTIVES: The search for an adequate tissue for reconstruction of the urethra in those patients with a paucity of local skin continues. Over the past 18 months, the use of buccal mucosa as a substitution for urethra was evaluated. METHODS: Six patients who had complex hypospadias had buccal mucosa grafts for urethral reconstruction. All patients had had previous surgery for repair of chordee or significant complications from previous surgery with a result of lack of penile skin. Patients were operated on and followed for 8 to 17 months. RESULTS: Buccal mucosa was used as a rolled tube in 4 patients, an onlay graft in 1, and a folded tube in 1. A urethrocutaneous fistula that was repaired 6 months after the buccal surgery was the only complication. CONCLUSIONS: By virtue of its tissue characteristics, ease of handling, and ease of harvest, buccal mucosa is an excellent tissue for urethral reconstruction.     

Predicting survival in patients with early Alzheimer''s disease

BACKGROUND: The indication for urgent cardiac surgical interventions in patients with active infective endocarditis has to be considered carefully following thromboembolic events, because of the high recurrence rate of such complications. In the case of brain embolisms the prognostic benefit of urgent surgery has been discussed controversially as effective anticoagulation during open heart surgery may result in secondary cerebral hemorrhages. PATIENTS AND METHODS: Between 1978 and 1993 infective endocarditis (IE) was proven in 288 consecutive and prospectively followed patients (131 females, 157 males; mean age 53.6 +/- 8.7 [9 to 81] years). To analyze potential benefits and risks of an urgent surgical intervention early after embolic cerebral infarction, cumulated survival rates were calculated for patients with and without surgical intervention with special reference to incremental risk factors and the timing of surgery. RESULTS: In 50 patients (17.4%) the clinical course was complicated by one, and in 58 patients (20.2%) by recurrent embolic events. In 80% the first embolism occurred within 33 days following the first manifestation of typical signs and symptoms of IE. 80% of recurrent events were observed within 32 days following the initial embolism. 71% of all embolic events were cerebral. In patients with cerebral embolism corroborated by computed tomography (CCT), the clinical course was complicated by intracranial hemorrhage in 12.5% while it was only 1.5% for patients without cerebral embolism. Because of a lack of therapeutic alternatives, 22 of 49 patients with recurrent embolic events, of which at least one was cerebral, underwent urgent cardiac surgery within 4 to 366 hours after the first cerebral manifestation. The cumulated survival rate of patients operated within 72 hours after the initial cerebral embolism was significantly more favorable (p < or = 0.000) than for unoperated patients or those who were operated after more than 8 days. CONCLUSION: An embolic event during IE carries a more than 50% risk of recurrence. In patients with short duration of signs and symptoms of IE and postembolic echocardiographic demonstration of persistent vegetations the probability is > 80%. At least for those patients urgent surgical intervention to remove the source of infection and embolic hazard seems to be beneficial. Surgical intervention using the heart-lung-machine should be performed within 72 hours. Such early timing results in a significant lower rate of secondary cerebral hemorrhages (p < or = 0.00) than a postponed operation. To exclude early reperfusion hemorrhage due to spontaneous thrombus fragmentation, CCT should be repeated directly preoperatively.     

Use of a silicone prosthesis in two-staged reconstructive surgery of flexor tendons in fingers]

Since the time of introduction in the sixties by Hunter from Philadelphia of temporary prosthesis of tendon which was a silicone rod reinforced with dacron it has come into regular clinical usage enabling reconstruction of large injuries of tendons of flexors of fingers--particularly in the sheath area. In the work the analysis of the remote results after two-staged reconstructive operations of tendons of flexors of fingers is presented. The clinical material includes 68 patients whom in 1982-1993 tendons were reconstructed with the above mentioned method in the Clinic of Injury Surgery of Medical Academy in Wroc?aw. The results of treatment were evaluated according to Buck-Gramcko scale in three groups. In group I (patients with isolated tendons injury) 28% very good, 17% good and 55% satisfactory results were achieved. In group II (patients with tendons and nerves injury) 15% very, good, 30% good, 45% satisfactory and 10% unsatisfactory results were achieved. In group III (patients with tendons, nerves and bones injury) 4% very good, 20% good 30% satisfactory and 46% unsatisfactory results were achieved. Also proportional loss of muscle strength of the operated fingers, degree of return of two-punctual feeling in case of additional injury of finger nerves were evaluated. The analysis of treatment results depending on the number of injured fingers, method of primary dressing and on the time of undertaking the secondary reconstruction was carried out. On the basis of the carried out tests and their analysis the optimal method of treatment of patients qualified for two-staged reconstructions of tendons of flexors of fingers was presented.     

Experimental studies of mechanically-induced articular cartilage defects following implantation of allogeneic embryonal chondrocytes in a collagen-fibrin gel in chickens

Full thickness defects (diameter 1,7 mm; depth 2,5 mm) were created mechanically in articular cartilage and subchondral bone of the condyles of tibiotarsal joints of 9-month old chickens. This full-thickness defects were repaired with cultured allogenic embryonic chick epiphyseal chondrocytes from the tibiae and femura of 10-days-old chicken embryos. The cells were embedded in a collagen-fibrinogen-matrix. Controls were similarly operated, but received either no treatment or implants the delivery substance only. Healing of the defects was observed macroscopically, histologically, histochemically and histomorphometrically after 3, 12 and 24 weeks. This graft was successfully transplanted in mechanically induced defects in 80%. The resulting hyaline cartilage was structurally reorganized according to the host pattern and under the influence of environmental conditions. The articular zone preserved it's cartilaginous phenotype, whereas the subchondral regions were transformed into bone. 12 weeks after the operation the defects in the experimental group were completely filled. In all instances in this group, there was an initial extreme increase of mitotic rate and cell number. After 24 weeks normal and subnormal values were founded. The defects in the control groups healed with fibrocartilage. Our results showed, that only the defects in the experimental group were completely filled with reparative hyaline cartilage tissue. In the present study the mixture of cultured allogenic embryonic chondrocytes and a collagen-fibrinogen-matrix was used successfully as a transplant for repairing defects in articular cartilage of chickens. Thus allogenic transplantation of cultured embryonal chondrocytes appears to be one of the most promising methods for the restoration of articular cartilage.     

Birth after electroejaculation coupled to intracytoplasmic sperm injection in a gun-shot spinal cord-injured man

Cervical reconstruction after postburn scarring remains a challenge for the plastic surgeon. Several well-known procedures are possible: split or full-thickness skin grafts, local flaps, free skin flaps, expanded skin,... In order to evaluate each technique, three procedures are compared with a long-term follow-up (> or = 1 year): skin expansion, free flap surgery and full-thickness skin grafting. Fifteen patients are reviewed, with five patients operated according to each method. In this study, each burn patient was suffering from a severe neck burn contracture, restricting the neck motility to a few degrees. These patients were operated on by different surgeons, according to their personal indications. The full-thickness skin graft is usually harvested from the abdomen (by means of a miniabdominoplasty) and is applied under a tie-over dressing. This simple procedure has few complications and gives satisfactory results. Skin expansion provides a good texture and color matching but has a higher morbidity and necessitates several procedures. Free flap surgery is time-consuming, gives a good functional result but poor cosmetic aspect (different colour, excessive bulk). Comparing the functional and aesthetic result of the three types of reconstruction in terms of morbidity, neck mobility, skin elasticity, skin sensitivity, matching and scar recurrence, full-thickness skin grafting seems to be the most adequate technique.     

Three-dimensional ultrasound study of carotid arteries before and after endarterectomy; analysis of stenotic lesions and surgical impact on the vessel

BACKGROUND and PURPOSE: It has been proved that symptomatic patients with severe carotid stenosis benefit from endarterectomy. Currently used methods for quantitation of the severity of carotid stenosis have limitations, and the impact of endarterectomy on the operated region of carotid artery remains unknown. The purpose of this study was to examine the accuracy of a 3-D ultrasound system for quantitation of stenotic lesions and to evaluate changes in regional vessel volume and cross-sectional area after carotid endarterectomy. METHODS: We studied 14 patients with both carotid angiography and 3-D ultrasound. Of 13 patients who underwent surgery, 12 were reexamined with 3-D ultrasound after surgery. The length and volume of 20 randomly selected plaques were measured from 3-D data sets. The severity of stenosis was quantified by 3-D ultrasound using both a diameter method and an area method on cross-sectional views at the most stenotic site; the results were then compared with those from carotid angiography. The segmental vessel volume and average cross-sectional area of the operated artery both before and after endarterectomy were measured from 3-D ultrasound data. RESULTS: Good correlation was obtained between 3-D ultrasound and carotid angiography in quantitative analysis of carotid stenosis (SEE=12.4%, r=0.76, and mean difference=7.0+/-12.3% with the diameter method; SEE=10.5%, r=0.82, and mean difference=1.8+/-10.5% with the area method by 3-D ultrasound). 3-D ultrasound had excellent reproducibility and small intraobserver and interobserver variability in plaque length and volume measurements. No significant changes in segmental vessel volume and average cross-sectional area of the operated artery were observed after surgery in patients with suture closure. However, a significant increase in segmental vessel volume was obtained in patients with polyfluorethylene patches applied to the surgical opening of the artery. CONCLUSIONS: 3-D ultrasound can be used for both qualitative and quantitative analysis of plaques in the carotid artery and to detect and quantify significant carotid stenosis. Its volumetric potential has important clinical implications in serial follow-up studies for observing the progression or regression of stenotic lesions and for evaluating the outcome of interventional procedures such as endarterectomy or stent placement.     

Nasal septum repair-plasty with pedicled flap technique in 126 patients--an analysis

BACKGROUND: The surgical closure of a nasal septal perforation is considered to be one of the most difficult procedures in nasal surgery with a relatively poor success rate. After a new surgical concept ("bipedicled-flap technique") was developed, a follow-up study was done in order to find out whether surgical results can be improved by means of this new method. PATIENTS AND METHOD: From 1988-1995 the bipedicled-flap technique was applied in 126 patients with nasal septal perforations (82 males, 44 females). In all patients the closure of the septal perforation was performed with an endonasal bilateral bipedicled-flap plasty and reconstruction of the cartilaginous defect with an autogenous cartilage graft from either the rib, the auricle, or from remnants of the septal cartilage. Postoperative results were evaluated in all patients. The follow-up period varied from a minimum of six months to a maximum of over seven years. RESULTS: The age peak was found in the third decade of life (females) and fifth decade (males), respectively. Most frequent preoperative symptoms were difficult nasal breathing, crusting and recurrent epistaxis. 65.8% of septal perforations were of iatrogenic origin. In 32 patients, the aetlology remained unknown. Six patients used silicone obturators preoperatively without getting any relief from complaints. In nine patients, surgical repair of the septal perforation had been attempted previously at another hospital. With the bipedicled-flap technique, primary closure was achieved in 118 patients (= 93.6%); revision surgery (same technique) was successfully performed in 2 patients, increasing the final success rate to 95.2%. Complications were rare and could always be managed easily. CONCLUSIONS: At present, the bipedicled-flap technique appears to be the most successful method for surgical repair of nasal septal perforations. The underlying principles responsible for the good success rate are: (1) the bilateral closure of the mucosal defects; and (2) the additional reconstruction of the cartilaginous septal defect with an autogenous cartilage graft only.     

Timing of surgery in patients with aneurysmal subarachnoid haemorrhage: rebleeding is still the major cause of poor outcome in neurosurgical units that aim at early surgery

OBJECTIVE: To investigate prospectively the proportion of patients actually operated on early in units that aim at surgery in the acute phase of aneurysmal subarachnoid haemorrhage (SAH) and what is the main current determinant of poor outcome. METHODS: A prospective analysis of all SAH patients admitted during a one year period at three neurosurgical units that aim at early surgery. The following clinical details were recorded: age, sex, date of SAH, date of admission to the neurosurgical centre, whether a patient was referred by a regional hospital or a general practitioner, Glasgow coma scale and grade of SAH (World Federation of Neurological Surgeons (WFNS) score) on admission at the neurosurgical unit, results of CT and CSF examination, the presence of an aneurysm on angiography, details of treatment with nimodipine or antifibrinolytic agents, and the date of surgery to clip the aneurysm. At follow up at three months, the patients' clinical outcome was determined with the Glasgow outcome scale and in cases of poor outcome the cause for this was recorded. RESULTS: The proportion of patients that was operated on early--that is, within three days after SAH--was 55%. Thirty seven of all 102 admitted patients had a poor outcome. Rebleeding and the initial bleeding were the main causes of this in 35% and 32% respectively of all patients with poor outcome. CONCLUSIONS: In neurosurgical units with what has been termed "modern management" including early surgery, about half of the patients are operated on early. Rebleeding is still the major cause of poor outcome.     

Interferon or corticosteroid: treatment of patients with chronic hepatitis C positive for serum markers of autoimmune diseases

From 1979 to 1994, reparative and reconstructive surgery were used to repair the war injuries of skins, bones, blood vessels and nerves of the limbs in 800 cases. A systematic clinical study was carried out. Many new operative methods were used and the results of treatment were good. Innovations and modifications were made in technique. In 120 cases of war injuries having soft tissues defects including skin and muscles, various tissue transplantations were used with the hope to accomplish one-staged repair of the defect and reconstruction of motor function of muscle. To those infections of bone and joint in war injuries, following early eradication of infected focus, transplantation of musculo-cutaneous flap or omental graft was immediately carried out with the aim to obtain primary healing of the wound. In the treatment of bone defects from war wounds with loss of skin and muscles, the vascularized skeleto-cutaneous graft was used. In the treatment of 150 cases of injury of peripheral nerve from forearms, the result of good to fair rated 68.8 percent for upper extremity and that for lower extremity, it was 62.2 percent. Following the early repair of 500 cases of injury of peripheral blood vessels, the patency rate of the blood vessel was 90 percent. The result following by pass vascular graft in the treatment of forearms injury of blood vessels even with very poor local condition was still very successful.     

Exposure to environmental and mainstream tobacco smoke and risk of spontaneous abortion

The present nationwide, multicenter clinical study was carried out in 26 departments of surgery to define the incidence and attendant mortality of intestinal infarction following abdominal aortic surgery, and to identify patients at risk of it. The data consist of 1752 patients who underwent abdominal aortic reconstruction during 1991-1993 as recorded in the Finnish national vascular registry (FINNVASC). Among the 1752 operations, 27 patients treated at 14 different hospitals had intestinal ischemia, and the complete patient records of all 27 cases were reanalyzed. The incidence of bowel infarction was 1.2%. Among patients operated on for a ruptured aneurysm it was 3.1%, whereas 1.0% of patients with nonruptured aneurysm and 0.6% of those operated on for aortoiliac occlusive disease developed intestinal infarction. In 14 patients (67%) the lesion affected the left colon. The overall 30-day mortality rate was 13% but reached 67% among those with intestinal infarction. We conclude that acute intestinal ischemia with bowel infarction is an infrequent but serious complication of abdominal aortic surgery. It is mainly related to surgery due to aneurysmal disease, and patients with occlusive aortoiliac disease present ischemic complications in the intestines less often. Hypotensive patients being treated for ruptured aneurysm are at greatest risk of intestinal ischemia.     

Repair of large full-thickness articular cartilage defects with allograft articular chondrocytes embedded in a collagen gel

Full-thickness articular cartilage defects are a major clinical problem; however, presently there is no treatment available to regeneratively repair these lesions. The current therapeutic approach is to drill the base of the defect to expose the subchondral bone with its cells and growth factors. This usually results in a repair tissue of fibrocartilage that functions poorly in the loaded joint environment. The use of phenotypically appropriate chondrocytes embedded in a collagen gel delivery vehicle may provide a method that could be used to repair full-thickness articular cartilage defects with functionally satisfactory hyaline cartilage. Allograft articular chondrocytes embedded in a type I collagen gel were transplanted into large (6 x 3 x 3 mm), full-thickness articular cartilage defects in condylar and patellar weight-bearing surfaces to develop clinically applicable methods to repair articular cartilage defects. Chondrocytes were isolated from the articular cartilage of 4-week-old New Zealand rabbits and embedded in type I collagen gels. This composite was transplanted into a full-thickness defect on the medial femoral condyle and patellar groove of adolescent host rabbits. The repair cartilage was assessed histologically by a semiquantitative scoring system and biomechanically with a microindentation technique of specimens 4-48 weeks after chondrocyte transplantation. Defects in both locations were repaired with histologically apparent hyaline cartilage observed from as early as 4 weeks until 48 weeks after transplantation. The repair cartilage in the medial femoral condyle was more irregular than in the patellar groove, but in all other respects was similar. The grafted tissue did not remodel and differentiate into the morphological zones seen in normal articular cartilage. No tidemark or subchondral bony plate formed even 48 weeks after transplantation. Biomechanically, the repaired cartilage demonstrated indentation values similar to normal articular cartilage 12 weeks after transplantation and remained the same 48 weeks after transplantation. By contrast, the control (i.e., empty) defects healed with tissue that exhibited very poor metachromatic staining and exhibited very high indentation values. Incomplete bonding of the repair tissue to the normal cartilage was seen, and the surface was significantly irregular with major discontinuities. These observations provide the basis for considering the use of allograft articular chondrocytes to repair articular cartilage defects in the weight-bearing regions of the knee.     

Folding rate dependence on the chain length of RNA-like heteropolymers

BACKGROUND: Economical studies on surgery of intracranial aneurysms have considered only the significant benefit of surgical approach on unruptured aneurysms and no studies have been performed comparing cost/benefit analysis of early vs delayed surgery. The present study was retrospectively performed in order to verify whether different treatment options in aneurysm surgery have a different cost/benefit ratio. METHODS: We have analysed a series of 137 patients which underwent surgery for intracranial aneurysms (21 unruptured aneurysms, 56 early surgery and 60 delayed surgery). In the analysis we assumed that each state of an operated patient has an assigned quality of life value and an associated medical cost. We expressed the outcome of each patient as the expected length of survival adjusted for quality, and referred to it as "quality-adjusted life years" (QALY). We considered for each patient the direct cost of Hospitalisation (obtained from DRG reimbursement), the Rehabilitation cost and the correction due to QALY adjusted for age and deficit. RESULTS: Significantly higher costs are reported in patients which present as major complication the hydrocephalus and which are treated with nimodipine; moreover, the costs for patients operated for unruptured aneurysms is significantly lower than that of patients which presented with SAH. Meanwhile, the average QALY adjusted for post-operative neurological deficit at three months follow-up is higher in patients operated for unruptured aneurysms than in patients operated after SAH. The cost-effectiveness of different treatment strategies did not significantly differ considering age and neurological deficit adjustment; thus, after SAH, the choice of early or delayed surgery may depend on clinical and logistic conditions related to the neurosurgical department and its organisation, because there is no significant economical advantage leading to recommend early versus delayed surgery. CONCLUSIONS: In conclusion the present data suggest that a decreased length of hospitalisation and a decreased cost for treatment of unruptured aneurysms should justify a more rigorous preventive screening with available non invasive neuroimaging techniques.     

Preperitoneal prosthesis implantation in surgical management of recurrent inguinal hernia. Retrospective evaluation of our results 1989-1994

Recurrent inguinal hernia represents a great problem in surgery given the frequency of this operation, with a recurrence rate of 0.5-8%. Re-recurrence after repair without implantation of a prosthesis occurs in 1-23% of cases. We analyzed our results of patients with recurrent inguinal hernia, operated according to the method of Stoppa. Between 1989 and July 1994 there were 58 operations upon 55 patients with an average age of 65 years, 79% of whom had unilateral and 21% bilateral hernias. 89% of all patients underwent surgery because of a recurrent inguinal hernia. A Marlex mesh was used in 79% of the case. All patients were followed up (mean 35 months, minimum 12 months). Early complications consisted in one hematoma (1.7%), which had to be drained, as well as one early recurrence (1.7%). No infections were observed. The overall recurrence rate was 12%. However, 60% of all recurrences occurred in the few first years after introduction of this technique at our clinic; with growing number of operations and experience with Stoppa's technique, we obtained a recurrence rate of 6-7% per year. In our opinion, supported by the results of other studies, Stoppa's technique is a successful method in the treatment of recurrent inguinal hernia.