RESUMEN
OBJECTIVE: The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. METHODS: A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. RESULTS: Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening (p = 0.66; OR: 0.22; 95% of CI: 0.08-0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06-0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54-18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). CONCLUSION: Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.
Asunto(s)
Ablación por Catéter , Terapia por Láser , Vena Safena/cirugía , Escleroterapia , Várices/terapia , Insuficiencia Venosa/terapia , Ablación por Catéter/efectos adversos , Humanos , Terapia por Láser/efectos adversos , Vena Safena/diagnóstico por imagen , Escleroterapia/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Intervencional , Várices/diagnóstico por imagen , Insuficiencia Venosa/diagnóstico por imagenRESUMEN
Free air within the intraperitoneal cavity most frequently occurs in conjunction with perforation of a hollow viscus and requires urgent surgical intervention. However, approximately 10% of all cases of pneumoperitoneum may not be correlated with disruption of the gastroinestinal tract. In the literature this condition is termed "nonsurgical" (NS) pneumoperitoneum and usually requires conservative management. NS pneumoperitoneum can be classified into the following categories: abdominal, thoracic, gynecologic, and idiopathic. We present a rare case of NS pneumoperitoneum. A 61-year-old woman who underwent a hysterectomy previously is admitted with diffuse abdominal pain without any other symptoms. Chest and abdominal radiographs verified the presence of free air under the diaphragm. We performed an exploration but no evidence of perforated viscus or peritonitis was found. Finally the patient told us that her complaints developed during Jacuzzi usage. We thought therefore that air entered into the intraperitoneal cavity through the vagina by influence of high pressure douche. In the course of postoperative gynecological examination a vaginoperitoneal fistula was detected in the vault which is developed during Jacuzzi usage leading to NS pneumoperitoneum. Essentially, NS pneumoperitoneum usually occurs without signs and symptoms of peritonitis and requires conservative treatment. Detailed physical examination and medical history taking can help to avoid unnecessary surgery in spite of radiological evidence of intraperitoneal free air.
Asunto(s)
Fístula/etiología , Hidroterapia/efectos adversos , Laparotomía , Neumoperitoneo/diagnóstico , Neumoperitoneo/etiología , Presión/efectos adversos , Dolor Abdominal/etiología , Colposcopía , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Peritoneo/patología , Neumoperitoneo/complicaciones , Neumoperitoneo/diagnóstico por imagen , Neumoperitoneo/cirugía , Radiografía , Procedimientos Innecesarios , Fístula Vaginal/etiologíaRESUMEN
INTRODUCTION: The occult inguinal hernia in athletes represents a distinct entity as well as a part of a syndrome known as PIPS (public inguinal pain syndrome). It may be relatively difficult to identify the possible source of inguinal pain, since the spectrum is so wide that it can overlap various medical subspecialties. PATIENTS AND METHODS: This study includes 14 cases of athletes (11 football players) with suspicion of occult inguinal hernia. All of them complained of suprapubic pain on physical activity which was relieved at rest. No hernia was found on physical examination in either patient. Ultrasonography of the region demonstrated protrusion of the posterior abdominal wall by increased intraabdominal pressure (such as coughing) in 12 cases. Diagnostic laparoscopy was performed in every case, and we found 13 medial and 1 femoral hernia, i.e. a hernia was identified in all patients. Laparoscopic hernia repair with TAPP (transabdominal preperitoneal) technique was carried out in every case. RESULTS: Patients were discharged 2-3 days after surgery without any postoperative complication. A gradual increase in physical activity was advised up to the limit of complaints commencing 7-10 days later. All patients could return to competitive sports after 4-6 weeks. CONCLUSION: Differential diagnosis of inguinal pain in athletes includes occult inguinal hernia, which can be diagnosed with laparoscopy and TAPP repair can be carried out at the same time, if needed, to fix it.