Preoperative lower esophageal sphincter manometry data neither impact manifestations of GERD nor outcome after laparoscopic Nissen fundoplication.

BACKGROUND: Experience with laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) and manometrically intact lower esophageal sphincter (LES) is limited. The disease pattern may be different and LARS may fail to control reflux or result in higher rates of dysphagia. This is the first study investigating the impact of preoperative LES manometry data not only on manifestations of GERD and subjective outcome alone but also on objective outcomes 1 year after LARS. METHODS: Three hundred fifty-one GERD patients underwent LARS and had subjective symptom and quality of life assessment, upper gastrointestinal endoscopy, barium swallow esophagogram, 24-h esophageal pH monitoring, and manometry pre- and 1 year postoperatively. Patients were divided into those with a preoperatively intact versus defective LES based on intraabdominal length and resting pressure. Baseline and 1-year postoperative follow-up data were compared. RESULTS: Preoperative manifestations of GERD were similar in each group. Postoperatively, all symptoms except flatulence, quality of life scores, and objective manifestations improved significantly in each group. CONCLUSIONS: The preoperative manometric character of the LES neither impacts the manifestations of GERD nor subjective and objective outcomes after LARS. Patients with GERD and manometrically intact LES have no higher risk for postoperative dysphagia.

Sural nerve harvesting beyond the popliteal region allows a significant gain of donor nerve graft length.

BACKGROUND: The sural nerve is the nerve most commonly used for peripheral nerve reconstruction. According to requirements for nerve graft length, it is dissected from the retromalleolar up to the popliteal region, where the main root of the sural nerve fibers, the medial sural cutaneous nerve, arises from the tibial nerve. It has been recommended to complete sural nerve harvesting below this area, to avoid damage to the tibial nerve. The aim of this study was to determine whether sural nerve fibers can be isolated from tibial and, more proximal, sciatic nerve fibers to gain more sural nerve graft length. METHODS: The sural nerve was dissected in 30 lower limbs. Anatomical characteristics such as the existence of a union forming the sural nerve, identification of the main root of sural nerve fibers, and the site of origin of the branch(es) forming the sural nerve were noted. Careful nerve preparation in the region of the sural nerve and its main root origin was conducted. RESULTS: In 18 specimens (60 percent), the authors found the classic formation of the sural nerve: the union of the medial sural cutaneous nerve and the peroneal communicating branch. The medial sural cutaneous nerve was the main root of sural nerve fibers in 28 of 30 cases (93 percent) and originated from the tibial nerve. Careful nerve preparation and epineurolysis beyond its anatomical origin allowed isolation and gain of sural nerve graft length of a median of 14 cm. CONCLUSION: In the authors' opinion, this is a feasible method of increasing the quantitative and qualitative outcome of sural nerve harvesting when greater length of sural nerve donor graft is needed for adequate nerve reconstruction.

Metal-on-metal hip implants: do they impair renal function in the long-term? A 10-year follow-up study.

INTRODUCTION: The aim of our study was to investigate a potential influence of elevated serumcobalt and serumchromiumlevels on renal function at minimum 10 years after implantation of a metal-on-metal hip. MATERIALS AND METHODS: Between November 1992 and June 1994 98 patients (44 m, 54 f) with an average age of 56 (22-79) years received a metal-on-metal bearing Metasul. At the time of the 10-year follow-up, 15 patients had died and 8 were lost to follow-up. The remaining 75 patients had laboratory analysis including serumcreatinine and full blood cell count as well as chromium and cobalt serum levels. RESULTS: Ten years postoperatively the median serumcreatinine level was 0.86 (0.55-1.51) mg/dl, the serumcreatinine clearance Ccr was in the normal range. The hemogram did not differ from that measured at the time of surgery. The median serumcobalt concentration was 0.75 (0.3-50.10) microg/l and the serumchromium concentration was 0.95 (0.3-58.6) mug/l, 10 years postoperatively. CONCLUSION: Our long-term data do not show any influence of serum cobalt or chromium concentrations on renal function following total hip arthroplasty.

Long-term follow-up of metal-on-metal total hip replacement.

Metal-on-metal articulations were reintroduced to reduce polyethylene particle-induced osteolysis. Elevated serum metal levels have been detected at short- and intermediate-term follow-up. There is little knowledge about long-term effects of increased ionic metal generation. Our study was undertaken to provide information about long-term survival, clinical outcome, radiographic appearance, and serum metal concentrations after a minimum 10 years follow-up with a metal-on-metal hip prosthesis: 105 cementless primary total hip prostheses with metal-on-metal articulating surfaces were implanted in 98 patients with a mean age of 56 years. Clinical data, radiographs, and blood samples were obtained at a follow-up visit 10 years after implantation. Serum cobalt and chromium levels were determined with use of atomic absorption spectrometry. General laboratory analyses included a full blood count and kidney function parameters. The Harris score was 92 points and the UCLA score 6 points after 10 years. Small osteolytic lesions and radiolucent lines were found in Gruen's zones 1, 7, 8, and 14. The probability of survival was 98.6%. The median serum cobalt concentration of the 22 patients with their hip replacement as the only source of cobalt was 0.75 microg/L (range, 0.3-50.1 microg/L). No patient was diagnosed with renal insufficiency during the study period. Five patients were diagnosed with a malignancy between surgery and the follow-up. We do not have evidence of an increased rate of primary malignancies nor could we detect renal failure in our study group. Serum metal levels did not differ from short- and intermediate term follow-up values.

Cementless total hip arthroplasty with the rectangular titanium Zweymuller stem. A concise follow-up, at a minimum of fifteen years, of a previous report.

Between October 1986 and November 1987, 208 total hip arthroplasties were performed with use of the cementless Zweymüller stem and a threaded cup in 200 consecutive patients. Of 102 patients (108 hips) who were available for follow-up at a minimum of 180 months postoperatively, eighty-three (eighty-nine hips) had the primary joint replacement still intact. No stem had been revised because of aseptic loosening, but we found various degrees of osteolysis around sixteen (18%) of the implants. The probability of survival of the stem at fifteen years was 0.98 (95% confidence interval, 0.96 to 1.00). The probability of survival of the cup was 0.85 (95% confidence interval, 0.79 to 0.91).