Hypnotherapy in the treatment of levator syndrome

Is to evaluate hypnotherapy as a possible treatment for levator syndrome [L S]. In a controlled study 44 patients with levator syndrome were randomly allocated to treatment with either hypnotherapy or traditional therapy over 50 weeks, both groups were comparable in regard to, age, sex, duration of symptoms and pretreatment mean pain scores. The overall results showed highly significant difference in mean pain scores between both groups in favour of hypnotherapy. We noticed that change in pain scores between both groups reached statistical significance by the end of the second week. Of the 15 patients in the hypnotherapy group who had lateral levator tenderness on clinical examination, 10 were totally free from tenderness by the end of treatment, 2 had their tenderness milder and 3 persisted to report the same degree of tenderness, of whom 2 were the same who did not improve at all on hypnotherapy. On the other hand none of the 13 patients with lateral levator tenderness in the traditional therapy group showed any change in the degree of their tenderness by the end of treatment. The results suggest that hypnotherapy seems to be highly effective in treatment of levator syndrome

Immediate modified mid-tram flap reconstruction after skin-sparing mastectomy: further experience with technical refinement and longer term outcome

Objective: to evaluate our previous preliminary report of 15 patients with early breast cancer treated with skin sparing mastectomy [SSM] and immediate breast reconstruction [IBR] utilizing mid-TRAM flap modified by inclusion of the umbilicus; That is by increasing number of patients and period of follow up

Patients and Methods: to the 15 Patients of the previous study we added another 15 patients operated in a similar way from Jan. 2004 to Jan. 2005 with some technical refinements and the whole number of patients [30] were followed up for an average of 32. l months [range = 24-42months]. Data in the form of mortality, recurrence, fat necrosis long-term aesthetic outcome, durability of nipple protrusion, sensation return to the reconstructed breast and abdominal donner site morbidly were recorded

Results: no mortalities only one case of local recurrence and one with fat necrosis were recorded and a good to excellent cosmetic outcome with longstanding protruding nipples were obtained and sensation return occurred in 6cases. All patients were unable to raise their trunks unaided from supine position or to dustups but there was no interference with daily activities. 2 cases with only bulging one with actual herniation,6with dysphasia and 3with hypertrophic scars were recorded

Conclusion: this further experience confirms the results of our previous study that this approach is safe, reliable, emotionally less traumatizing with excellent long-term aesthetic and therapeutic outcome

Temporary defunctioning stomas: a randomized clinical trial comparing loop ileostomy with loop transverse colostomy following low anterior resection with total mesorectal excision

Patients undergoing low anterior resection with total mesorectal excision who required a defunctioning stoma were randomly allocated to receive either a loop ileostomy [n=13] [group A] or a loop transverse colostomy [n=14] [group B]. Postoperative morbidity following closure were compared. From May 1999 to May 2002, 13 patients had a loop ileostomy and 14 had a loop colostomy following low anterior resection. There were no significant differences in the difficulty of formation or closure, or in the postoperative recovery between the groups. However, the ileostomy was associated with significantly less appliance changes. Wound infection was also significantly more common after closure of colostomy compared with the ileostomy. Furthermore, four complications directly related to the stoma in the loop transverse colostomy group have been seen [prolapse [two] and incisional hernia during follow-up [two]]. None of these complications occurred in the loop ileostomy group