Inguinal intranodal lymphangiography reveals a high incidence of suprainguinal lymphatic disease in patients with leg edema undergoing stenting for symptomatic chronic iliofemoral venous obstruction.

OBJECTIVE: Recent studies have emphasized the important role lymphatics play in the drainage of interstitial fluid and edema prevention. Although the infrainguinal lymphatics have been studied in some depth, with patterns of pathology identified, such data above the groin are sparse, especially for patients with phlebolymphedema. The present study attempts to evaluate the status of lymphatic flow above the inguinal ligament in patients presenting with edema and undergoing stenting for symptomatic chronic iliofemoral venous obstruction (CIVO). METHODS: A total of 31 lower limbs that underwent pedal lymphoscintigraphy for leg edema and subsequent stenting for symptomatic CIVO formed the study cohort. Each limb underwent intranodal lymphangiography of an ipsilateral inferior inguinal lymph node (10 mL of lipiodol) at the time of stenting. Fluoroscopic visualization of lipiodol transit was performed at 20, 40, and 60 minutes and 3 hours after injection. Enumeration of the lymph nodes and lymphatic collector vessels from above the inguinal ligament to L1, visualization of the thoracic duct, the time delay to visualization of the thoracic duct, and pathologic changes to the thoracic duct when present were all evaluated. These anomalies were independently scored, with the scores combined to generate a total suprainguinal score (range, 0-3). This score was then compared to the limb's lymphoscintigraphically derived infrainguinal score (total infrainguinal score range, 0-3) using the t test and Spearman correlation. The clinical outcomes (grade of swelling, venous clinical severity score) after stenting were appraised. RESULTS: Of the 30 patients (31 limbs), 18 were women, with left laterality noted in 23 limbs. A nonthrombotic iliac vein lesion occurred in 9 limbs and post-thrombotic syndrome in 22 limbs. Of the 31 limbs, 24 (77%) had suprainguinal lymphatic disease (SLD), with 22 of the 24 limbs having severe SLD and 2, mild SLD. When SLD was compared with infrainguinal lymphatic disease, 6 limbs (19%) had the same degree of involvement above and below the groin (1 with normal and 5 with severe disease), 17 limbs (55%) had more severe SLD, and 8 limbs (26%) had more severe infrainguinal lymphatic disease. Three limbs with normal pedal lymphoscintigraphic findings had severe SLD. The Spearman correlation coefficient for the comparison of SLD and infrainguinal disease in the same limb was 0.1 (P = .69). At baseline, the limbs with severe SLD had the same degree of leg swelling and venous clinical severity score as the limbs with absent to mild SLD (P > .1) with similar improvements after stenting (P > .4). Seven limbs underwent complex decongestive therapy (all with severe SLD and concomitant severe infrainguinal disease in one) to treat significant residual leg edema, with improvement. CONCLUSIONS: SLD appears to be common in patients with leg edema undergoing stenting for symptomatic CIVO. Such disease appears to affect the thoracic duct more commonly. Although patients with persistent or residual leg edema after stenting can benefit from complex decongestive therapy, further workup in the form of inguinal intranodal lymphangiography and targeted intervention might need to be considered for those who do not benefit from such therapy. Further study is warranted.

Recovery of two elite footballers from adductor strain with dry needling and eccentric strengthening: Two case studies.

INTRODUCTION: Groin injuries are common in sports, almost 68% adductor strain among them, which generally more prone in football, soccer, hockey, and other games. The available literature well describes the rehabilitation phase of adductor strain but an application of dry needling on adductor injuries are not yet established. CASE DESCRIPTION: Two national-level younger football players were clinically diagnosed with the adductor strain. They had severe pain on medial aspect of the thigh, aggravated with kicking and functional activity (VAS- 8/10, LEFS 58/80, 69/80). The therapist assessed the patients and designed their rehabilitation protocol as per their findings of the examination. OUTCOME: The lower extremity functional scale (LEFS), global rating scale, and VAS were used as outcome variables. The total intervention was given for 10-12 weeks, follow up had been taken for 4 months. DISCUSSION: The application of dry needling reduced the pain, improved and relieved the symptoms. The eccentric strengthening of the adductors and core stability improved the strength as well as functional activity of the lower limb. The case study is not generalized the effect of treatment. Thus, a randomized control trial is suggested for further study.

Discussion on the necessity of bilateral inguinal lymphatic area irradiation for cervical cancer with invasion of the lower one-third of the vagina.

Context: According to the National Comprehensive Cancer Network guidelines for cervical cancer, patients with cervical cancer invading the lower one-third of the vagina require bilateral inguinal lymphatic area preventive irradiation. However, it is not clear whether they need preventive inguinal area irradiation. Aims: The aim of this study is to evaluate the necessity of bilateral inguinal lymphatic area irradiation for patients with cervical cancer with invasion of the lower one-third of the vagina. Settings and Design: Patients without inguinal lymph node metastasis were divided into preventive radiotherapy and nonpreventive radiotherapy groups. The occurrence of inguinal skin damage, lower extremity edema, and femoral head necrosis was observed during and after treatment. Methods and Material: In total, 184 patients with cervical cancer with invasion of the lower one-third of the vagina were selected. A trial and control method was used to select 180 patients without inguinal lymph node metastasis. Statistical Analysis: Comparison between groups was performed using a t test. Data were enumerated using frequency (percentage), and comparison between groups was performed using a Chi-square test. Results: Imaging examination revealed inguinal lymph node enlargement in 7.07% of patients, and only four cases (2.17%) were further confirmed by pathology. The inguinal lymph node metastasis rate in these patients was very low. The prophylactic irradiation group showed a high occurrence rate of side injury. In the follow-up of both groups, no recurrence was detected in the inguinal lymph nodes. Conclusions: Prophylactic irradiation of inguinal lymph nodes is not essential for patients without pathological metastasis.

Genitofemoral peripheral nerve stimulator implantation for refractory groin pain: a case report.

PURPOSE: Genitofemoral neuralgia (GFN) is a chronic pain condition that may be refractory to commonly employed treatment modalities. Implantation of a peripheral nerve stimulator (PNS) may provide significant pain relief; however, few reports have described placement of and response to a GFN PNS implant. CLINICAL FEATURES: We implanted a StimRouter® PNS in a 42-yr-old male with severe GFN that did not respond to pharmacologic and interventional pain management modalities and impaired all aspects of his function and quality of life. The often-challenging sonographic visualization of the genitofemoral nerve was aided by intraprocedural sensory mapping using a stimulating probe. Preoperatively, the patient's average pain was rated as 7 on a 0 to 10 numeric rating scale. Following the procedure, the patient experienced over 90% pain relief after one week. At one and five months post implantation, the patient's average pain scores were 1 and 0.5, respectively. The patient also reported substantial improvement in the physical component scores on the 12-Item Short Form Survey (SF-12), which remained similar at the five-month follow-up (from 26.1 preop to 57.2 at one month and 49.7 at five months). CONCLUSIONS: Peripheral nerve stimulator implantation may be a promising intervention when other analgesic modalities fail to manage refractory GFN. Further research to verify the effectiveness of this intervention and evaluate for appropriate integration in patient care is required.

RéSUMé: OBJECTIF: La névralgie génito-crurale (NGC) est une douleur chronique pouvant être réfractaire aux modalités de traitement couramment utilisées. L'implantation d'un stimulateur nerveux périphérique (SNP) peut apporter un soulagement significatif de la douleur. Cependant, peu de présentations de cas ont décrit la mise en place et la réponse à l'implantation d'un SNP pour soulager une névralgie génito-crurale. CARACTéRISTIQUES CLINIQUES: Nous avons implanté un SNP StimRouter® chez un homme de 42 ans atteint d'une NGC grave qui ne répondait pas aux modalités pharmacologiques et interventionnelles de prise en charge de la douleur et entravait tous les aspects fonctionnels et de qualité de vie. La visualisation échographique souvent difficile du nerf génito-crural a été facilitée grâce à une cartographie sensorielle intraprocédurale, réalisée à l'aide d'une sonde de stimulation. Avant la procédure, la douleur moyenne du patient a été évaluée à 7 sur une échelle d'évaluation numérique de 0 à 10. Suite à l'intervention, le patient a ressenti un soulagement de la douleur de plus de 90 % après une semaine. À un et à cinq mois suivant l'implantation, les scores moyens de douleur du patient étaient de 1 et 0,5, respectivement. Le patient a également rapporté une amélioration substantielle des scores de la composante physique du questionnaire SF-12, scores qui sont restés similaires au suivi à cinq mois (de 26,1 avant l'intervention à 57,2 à un mois et 49,7 à cinq mois). CONCLUSION: L'implantation d'un stimulateur nerveux périphérique pourrait être une intervention prometteuse lorsque d'autres modalités analgésiques ne parviennent pas à prendre en charge une névralgie génito-crurale réfractaire. D'autres recherches sont nécessaires pour vérifier l'efficacité de cette intervention et évaluer son intégration appropriée dans les soins aux patients.

Effects of cognitive status on outcomes of groin hernia repair using various anesthesia techniques.

BACKGROUND AND AIM: Because of increasing life expectancy, there is an increasing number of cognitively impaired older individuals undergoing surgeries such as groin hernia repair. Here, we evaluated the effects of cognitive status on postoperative complication rates in patients undergoing groin hernia repair using various anesthesia techniques. We also analyzed the rate of same-day hernia surgery in patients with cognitive decline. METHODS: Patients who presented to our general surgery clinic for unilateral or bilateral inguinal or femoral hernia were prospectively classified into general (group 1), local (group 2), and spinal (group 3) anesthesia groups. The Mini-Mental State Examination (MMSE) was used for preoperative evaluation of each patient's cognitive status. The Visual Analog Scale (VAS) was used to evaluate postoperative pain. Groups were compared in terms of age, MMSE and VAS scores, cognitive decline and complication rates, and surgery duration. RESULTS: In total, 33 (35.1%), 30 (31.9%), and 31 (33.0%) of 94 patients underwent surgery using general, local, and spinal anesthesia, respectively. The mean MMSE score did not differ among groups (p = 0.518). Cognitive decline was present in 18 (19.2%) patients, and the proportion did not significantly differ among groups. The complication rate did not differ between patients with and without cognitive decline. The mean surgery duration was similar among the three groups (p = 0.127). Group 2 had a lower mean postoperative VAS score, compared with the other groups (p < 0.001). Complications because of anesthesia and surgery were significantly more common in group 3 than in the other groups (p = 0.025). In the local anesthesia group, 7 patients had cognitive decline and 22 patients had normal cognition. There were no significant differences between patients with and without cognitive decline in terms of mean surgery duration (50.3 ± 15.4 min vs. 45.2 ± 10.7 min; p = 0.338) or mean VAS score (3.14 ± 0.90 vs. 3.13 ± 0.77; p = 0.985). Among the 22 and 7 patients without and with cognitive decline, 11 (50%) and 0 patients were discharged on the same day (p = 0.025). In the local anesthesia group, the respective median ages were 70, 52, and 59 years for patients with cognitive decline, patients with normal cognition discharged on the same day, and patients with normal cognition who were not discharged on the same day (p = 0.001). CONCLUSION: Groin hernia repair was successfully performed under local anesthesia in all patients, including older patients with cognitive decline. Patients with cognitive decline were not discharged on the day of surgery, although the mean surgery duration and postoperative VAS score did not differ between patients with and without cognitive decline. Prolonged hospitalization in patients with cognitive decline may be related to their advanced age. Further studies are needed to determine the safety of same-day surgery in patients with cognitive decline.

Manual Therapy Treatment for Penile Pain- A Clinical Case Report with 6-Month Follow-up.

BACKGROUND: Male genital pain, which is neither related to genitourinary nor other obvious pathology, is an uncommon symptom in male patients and not frequently treated using manual therapy. The purpose of this case study is to describe a clinical reasoning process in combination with anatomy-based differential diagnosis and manual treatment for genital pain. CASE DESCRIPTION: A male patient with a 3-week acute onset of genital pain was hospitalized and referred for evaluation and treatment after unsuccessful treatment with medication and acupuncture. Clinical examination was performed indicating a possible nerve entrapment followed by interventions of ligamentous articular strain, high-velocity low-amplitude (HVLA) manipulation, and strain- and counterstain, coupled with soft tissue stretching to lumbar and inguinal areas to address a possible lumbar referral potentially from L1 and/or ilioinguinal nerve entrapment. OUTCOMES: After 4 consecutive days of manipulative treatment, pain decreased from 9/10 to 0/10 and the Barthel Index improved from 50 to 95. A 6-month follow-up revealed complete resolution of symptoms with no recurrence. DISCUSSION: This case illustrates that a detailed history and examination along with a reasoned diagnostic process to determine an appropriate intervention strategy may improve patient care using manual therapy techniques. CONCLUSION: By utilizing a deductive reasoning process related to the penile area, clinicians may better apply manual therapy techniques for successful treatment.

Osteitis Pubis Treated With Platelet-Rich Plasma: A Case Report.

ABSTRACT: Osteitis pubis is a common source of groin pain in athletes participating in sports requiring kicking, twisting, and pivoting movements. Athletes will present with progressive pain or discomfort in the pubic area or groin. There is usually point tenderness over the pubic symphysis and pain localizing to the adductor or rectus abdominis tendons. Conservative management often includes activity modification, oral medications, progressive rehabilitation, therapeutic ultrasound, steroid injections, and prolotherapy. Osteitis pubis can be refractory to conservative management and can keep an athlete sidelined for as long as 2 years. Platelet-rich plasma (PRP) injections have been used for pubic symphysis pain, but reports have focused on pathology affecting the rectus abdominis or hip adductor muscle tendons. In this article, we present a case of isolated osteitis pubis, without overlapping rectus abdominis or adductor tendon involvement, successfully treated with an ultrasound-guided PRP injection of the fibrocartilage.

Pubic and adductor related groin pain in an athlete: A case report linking pathology to conservative care.

STUDY DESIGN: Case Report. BACKGROUND: Groin pain in athletes is considered a common condition among males participating in sports that require sprinting, twisting, pivoting and kicking activities. While the condition is considered self-limiting, it often keeps athletes away from sport for a prolonged period of time. Much controversy exists regarding the pathogenesis of groin pain. This conflict translates to disagreement regarding diagnostic criteria, reporting and management strategies. CASE PRESENTATION: a 28-year old recreational soccer player presented with a five-month history of groin pain that was resistant to passive care. With reference to the current conservative management literature, the athlete was progressed through an individualized multimodal program of care. OUTCOMES: Following 10-weeks of care, the athlete was able to return to sport participation pain-free. CONCLUSION: It is suggested that groin pain in athletes is likely multifactorial and therefore the management should reflect its multifactorial nature. Conservative therapy can evidently reduce the time to return to play however the benefits of incorporating plyometrics into the rehabilitation program should be investigated.

The inguinal hernia management in Costa Rica according to a survey between surgeons: result comparison with 2018 International Groin Hernia Guidelines.

BACKGROUND: Inguinal hernia surgery is a frequent procedure among general surgeons in Costa Rica, but the management and technique are not uniform. The International Guideline for Groin Hernia management was published in 2018 to standardize the inguinal hernia surgery, but the diffusion of the guidelines and its adherence have been extremely varied. PURPOSE: Collect and analyze the current reality regarding groin hernia management in Costa Rica. Secondly evaluate the diffusion and development comparing it to the guideline's recommendations. METHOD: Questionnaire of 42 single and multiple answer questions according to the topics of the International Guideline directed to general surgeons. Diffusion of the inquiry through surgical and hernia association chats and email. Timeframe June-December 2019. RESULTS: 64 surveys were collected, which is a representative number of the general surgeons national college. The most frequent procedure between these was the abdominal wall surgery. Every surgeon did more than 52 groin hernia surgeries in one year, most of them outpatients. The epidural anesthesia was used the most and Lichtenstein's technique was the most frequently used (64%). 68% of the surgeons know how to perform a minimally invasive inguinal hernia surgery but with variable volumes. 38% of participants considered themselves experts in groin hernia management and 52% did not know the 2018 International Guideline. The recommendations of such guideline are followed only partially. CONCLUSIONS: The 2018 Hernia Surge International Guidelines have low diffusion among Costa Rican surgeons. The laparoscopic approach is widely accepted but there are no studies to assess the results and the quality. There should be protocols and studies adapted to Costa Rica's national situation.

Mortality and Urological Complications After Open Groin Hernia Repair in Local, General, and Regional Anesthesia: A Nationwide Linked Register Study.

BACKGROUND AND AIMS: The choice of anesthesia method may influence mortality and postoperative urological complications after open groin hernia repair. We aimed to investigate the association between type of anesthesia and incidence of urinary retention, urethral stricture, prostate surgery, and 1-year mortality after open groin hernia repair. MATERIALS AND METHODS: Data were linked from the Danish Hernia Database, the national patient register, and the register of causes of death. We investigated data on male adult patients receiving open groin hernia repair from 1999 to 2013 with either local anesthesia, regional anesthesia, or general anesthesia. In relation to the type of anesthesia, we compared mortality and urological complications up to 1 year postoperatively. We adjusted for covariates in a logistic regression assessing urological complications and with the Cox regression assessing mortality. RESULTS: We included 113,069 open groin hernia repairs in local anesthesia, regional anesthesia, or general anesthesia. The risk of urinary retention adjusted for covariates was higher after both general anesthesia (adjusted odds ratio = 1.64, 95% confidence interval = 1.05-2.57, p = 0.031) and regional anesthesia (odds ratio = 2.99, 95% confidence interval = 1.67-5.34, p < 0.0005) compared with local anesthesia. The adjusted risk of prostate surgery was also higher for both general anesthesia (odds ratio = 1.58, 95% confidence interval = 1.23-2.03, p < 0.0005) and regional anesthesia (odds ratio = 1.90, 95% confidence interval = 1.40-2.58, p < 0.0005) compared with local anesthesia. Type of anesthesia did not influence 1-year mortality or the risk for urethral stricture. CONCLUSION: Patients undergoing open groin hernia repair in local anesthesia experience the lowest rate of urological complications and have equally low mortality compared with patients undergoing repair in general anesthesia or regional anesthesia.

Proclaim™ DRG Neurostimulator System for the management of chronic, intractable pain.

Chronic pain is consistently listed as one of the most costly and disabling health problems worldwide. In an effort to treat these suffering individuals, significant amounts of time and energy have been devoted to discover safe and effective pain relieving treatments. Dorsal root ganglion stimulation is the newest treatment modality to be created for chronic intractable pain. In this manuscript, we review the history and development, published research and safety profile of the Proclaim™ DRG Neurostimulator System (Abbott, TX, USA). At last, we offer our outlook on future developments with dorsal root ganglion stimulation.

Manual therapy and early return to sport in football players with adductor-related groin pain: A prospective case series.

OBJECTIVES: To study the clinical course including return to sport success rates of football players with adductor-related groin pain (ARGP) after manual therapy of the adductor muscles. DESIGN: Prospective case series. METHODS: Thirty-four football players with ARGP with median pre-injury Tegner scores of 9 (IQR 25-75: 9-9) were treated with manual therapy of the adductor muscles. Main outcome measures were numeric pain rating scale (NPRS), Hip and Groin Outcome Score (HAGOS) and global perceived effect (GPE) for treatment and patient satisfaction at 2, 6 and 12 weeks. Return to sport was documented. RESULTS: Pain during (NPRS 7 (6-8) and after (NPRS 8 (6-8) sports decreased to NPRS 1 (0.2-3) and 1 (0.8-3), respectively (p < 0.001). Within 2 weeks 82% of the players returned to pre-injury playing levels with improved (p < 0.001) HAGOS subscale scores. Eighty-five percent reported clinically relevant improvement, 82% reported to be satisfied. At 12 weeks, 88% had returned to pre-injury playing levels. HAGOS showed symptoms were still present. CONCLUSION: Early return to sport seems possible and safe after manual therapy of the adductor muscles in football players with ARGP in the short term. While the majority of injured football players return to sport within two weeks, caution is advised regarding effectiveness as hip and groin symptoms were still present and no control groups were available.

A Canine Model for Lymphangiography and Thoracic Duct Access

OBJECTIVE: To evaluate the technical feasibility of intranodal lymphangiography and thoracic duct (TD) access in a canine model.MATERIALS AND METHODS: Five male mongrel dogs were studied. The dog was placed in the supine position, and the most prominent lymph node in the groin was accessed using a 26-gauge spinal needle under ultrasonography (US) guidance. If the cisterna chyli (CC) was not opacified by bilateral lymphangiography, the medial iliac lymph nodes were directly punctured and Lipiodol was injected. After opacification, the CC was directly punctured with a 22-gauge needle. A 0.018-in microguidewire was advanced through the CC and TD. A 4-Fr introducer and dilator were then advanced over the wire. The microguidewire was changed to a 0.035-in guidewire, and this was advanced into the left subclavian vein through the terminal valve of the TD. Retrograde TD access was performed using a snare kit.RESULTS: US-guided lymphangiography (including intranodal injection of Lipiodol [Guerbet]) was successful in all five dogs. However, in three of the five dogs (60%), the medial iliac lymph nodes were not fully opacified due to overt Lipiodol extravasation at the initial injection site. In these dogs, contralateral superficial inguinal intranodal injection was performed. However, two of these three dogs subsequently underwent direct medial iliac lymph node puncture under fluoroscopy guidance to deliver additional Lipiodol into the lymphatic system. Transabdominal CC puncture and cannulation with a 4-Fr introducer was successful in all five dogs. Transvenous retrograde catheterization of the TD (performed using a snare kit) was also successful in all five dogs.CONCLUSION: A canine model may be appropriate for intranodal lymphangiography and TD access. Most lymphatic intervention techniques can be performed in a canine using the same instruments that are employed in a clinical setting.

Pain during and after-hernioplasty in raquidian or locorregional anesthesia by locking peripheral nerves.

PURPOSE: To analyze pain scores after surgery in a group of patients submitted to inguinal hernia repair under peripheral nerve block with local or spinal anesthesia. METHODS: Fifty patients were divided into two groups (both with 25 patients each). In the first group the patients were submitted to herniorrhaphy under peripheral block and local anesthesia (LG) and in the other group the patients were submitted to the same procedure under spinal anesthesia (RG). The pain was assessed using the international visual analog pain scale at four different moments. The analysis cost of the procedure was performed using the hospital's average final cost, without including medical expenses. RESULTS: The groups were homogeneous in relation to the epidemiological and clinical features. There was no significant difference between the pain in the intraoperative period and in the return visit for both groups (p = 0.17 and p = 0.18). In the immediate postoperative period, both groups reported no pain at all. In general, the RG reported a greater pain score (16% for RG and 12% for LG). Complications were more frequent in patients submitted to spinal anesthesia (40% versus 8%) (p = 0.008). The surgical time was higher in the LG (39.3 ± 9.2 min) versus (28.7 ± 7.5 min) (p = 0.01). The average final cost of the procedure was US$ 100.98 for the LG and US$ 166.19 for the RG (p = 0.00). CONCLUSION: The inguinal hernioplastia under local anesthesia plus sedation is a safe method, with a low incidence of complications, great acceptance by patients and less expensive.

[Unmittelbare Remission eines mit großzelligem B-Non-Hodgkin-Lymphom befallenen inguinalen Lymphknotens unter alleiniger homöopathischer Behandlung mit Conium: Wann ist eine alleinige adjuvant-homöopathische Tumortherapie zulässig und sinnvoll?] / Immediate Remission of an Inguinal Lymph Node Afflicted with Large-Cell B-Non-Hodgkin's Lymphoma Under Sole Homeopathic Treatment with Conium: When Is a Sole Adjuvant-Homeopathic Tumor Therapy Permissible and Useful?

Bei einer 63-jährigen Patientin wird mittels Biopsie eines linksinguinalen Lymphknotens ein großzelliges B-Non-Hodgkin-Lymphom diagnostiziert. Unmittelbar nach Beginn einer homöopathischen Therapie mit Conium C 30 beginnt sich der Lymphknoten in der linken Leiste zurückzubilden. Bei Exzision des Lymphknotens vierzehn Tage nach Therapiebeginn können histologisch keine Residuen des Tumors mehr nachgewiesen werden und es darf von einer vollständigen Remission ausgegangen werden. Die Patientin bleibt in der Folge rezidivfrei. Das homöopathische Mittel Conium (Schierling) kommt in der adjuvanten homöopathischen Tumortherapie und bei vergrößerten Lymphknoten als häufig indiziertes Mittel zur Anwendung.A large-cell B-cell non-Hodgkin Lymphoma (LCBCL) was diagnosed bioptically in a female patient (age 63 years) in one left inguinal lymph node. Immediately after beginning homeopathic treatment with Conium C 30, the lymph node started to show a reduction in size. Two weeks after starting homeopathic therapy, histological examination of the excised lymph node showed no evidence of a residual tumor ­ suggestive of a complete remission. The patient remains disease free until now. The homeopathic remedy Conium (hemlock) is frequently applied for adjuvant homeopathic tumor therapy as well as for the treatment of enlarged lymph nodes.

Effectiveness of Active Rehabilitation Program on Sports Hernia: Randomized Control Trial

OBJECTIVE: To determine whether an active rehabilitation program that involves repetitive effortful muscle contractions, including core stability, balancing exercises, progressive resistance exercises, and running activities, after a sports hernia, is effective. METHODS: Forty soccer players with sports hernias were randomly divided into two equal groups: group A (active rehabilitation program) and group B (conventional treatment). The methods of assessment included a visual analog scale (VAS) and hip internal and external range of motion assessments. Group A received conventional treatment (heat, massage, transcutaneous electrical nerve stimulation, and mobilization) plus an active rehabilitation program, while group B received only conventional treatment. Three treatment sessions were given each week for 2 months. Evaluations were performed pre- and post-treatment. RESULTS: A decrease in VAS was seen in both groups at the end of treatment, 80.25% in group A and 41.93% in group B. The difference between the two groups was statistically significant (p=0.0001), whereas there were no statistical differences in internal and external rotation between the groups at the end of treatment (p>0.05). After treatment, an improvement in outcome measures of group A compared to group B (p=0.01) was seen. Thirteen patients in group A and only three patients in group B returned to sports activities without groin pain. CONCLUSION: Active rehabilitation was effective for sports hernia management measured by a decrease in pain and the return to sports.

Tratamiento de la enfermedad de Hailey-Hailey generalizada con fototerapia UVB de banda estrecha / Narrowband UV-B Phototherapy in the Treatment of Generalized Hailey-Hailey Disease

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Repair of groin hernia under local anaesthesia in secondary health facility.

BACKGROUND: Repair of groin hernias is the most commonly performed elective procedure by general surgeons worldwide. The techniques of anaesthesia differ among surgeons and vary from one health facility to another. General anaesthesia is much favoured in spite of the lack of anaesthetists in our setting. We aim to determine the feasibility of groin hernia repair under local anaesthesia (LA) with respect to patients' morbidity, acceptability and satisfaction. METHOD: Ninety-seven patients with uncomplicated groin hernias treated between July 2012 and June 2015, at the State Specialist Hospital, Ikere-Ekiti, Nigeria were recruited for the study. RESULTS: One hundred and five hernias in 97 patients of American Society of Anesthesiologists categories I-III were successfully repaired under LA. Their ages ranged between 16 and 95 years with a median age of 52. There were 91 (93.8%) males and six (6.2%) females, giving a male to female ratio of 15:1. Most hernias were indirect (81.9%) and inguinoscrotal (65.7%) type. Nylon darn and modified Bassini were surgical techniques of repair in 60.9 and 36.2%, respectively. The mean operating time was 51.1 ± 11.2 min. Two patients (1.9%) developed scrotal haematoma while a patient each (1%) developed superficial surgical site infection and scrotal burns. Ninety (92.8%) patients were satisfied with anaesthesia technique. The mean follow-up was 8.9 ± 4.1 months and there was no recurrence. CONCLUSION: Groin hernia repair under LA is safe, feasible with high patient's satisfaction and would be the most ideal technique in our local setting where anaesthetists are not readily available.