Long-term benefit of liposuction in patients with lipoedema: a follow-up study after an average of 4 and 8 years.

BACKGROUND: Long-term results following liposuction in patients with lipoedema are available only for an average period of 4 years. OBJECTIVE: To find out whether the improvement of complaints persists for a further 4 years. METHODS: In a single-centre study, 85 patients with lipoedema had already been examined after 4 years. A mail questionnaire - often in combination with clinical controls - was repeated after another 4 years (8 years after liposuction). RESULTS: Compared with the results after 4 years, the improvement in spontaneous pain, sensitivity to pressure, oedema, bruising and restriction of movement persisted. The same held true for patient self-assessment of cosmetic appearance, quality of life and overall impairment. Eight years after surgery, the reduction in the amount of conservative treatment (combined decongestive therapy, compression garments) was similar to that observed 4 years earlier. CONCLUSION: These results demonstrate for the first time the long-lasting positive effects of liposuction in patients with lipoedema.

Tumescent liposuction in lipoedema yields good long-term results.

BACKGROUND: Lipoedema is a painful disease in women with circumscribed increased subcutaneous fatty tissue, oedema, pain and bruising. Whereas conservative methods with combined decongestive therapy (manual lymphatic drainage, compression garments) have been well established over the past 50years, surgical therapy with tumescent liposuction has only been used for about 10years and long-term results are unknown. OBJECTIVES: To determine the efficacy of liposuction concerning appearance (body shape) and associated complaints after a long-term period. METHODS: A total of 164 patients who had undergone conservative therapy over a period of years, were treated by liposuction under tumescent local anaesthesia with vibrating microcannulas. In a monocentric study, 112 could be re-evaluated with a standardized questionnaire after a mean of 3years and 8months (range 1year and 1month to 7years and 4months) following the initial surgery and a mean of 2years and 11months (8months to 6years and 10months) following the last surgery. RESULTS: All patients showed a distinct reduction of subcutaneous fatty tissue (average 9846mL per person) with improvement of shape and normalization of body proportions. Additionally, they reported either a marked improvement or a complete disappearance of spontaneous pain, sensitivity to pressure, oedema, bruising, restriction of movement and cosmetic impairment, resulting in a tremendous increase in quality of life; all these complaints were reduced significantly (P<0·001). Patients with lipoedema stage II and III showed better improvement compared with patients with stage I. Physical decongestive therapy could be either omitted (22·4% of cases) or continued to a much lower degree. No serious complications (wound infection rate 1·4%, bleeding rate 0·3%) were observed following surgery. CONCLUSIONS: Tumescent liposuction is a highly effective treatment for lipoedema with good morphological and functional long-term results.

Cognitive function after sevoflurane- vs propofol-based anaesthesia for on-pump cardiac surgery: a randomized controlled trial.

BACKGROUND: Cognitive dysfunction is a frequent complication after cardiac surgery and has been found to be associated with decreases in cerebral oxygen saturation measured with near-infrared spectroscopy. Sevoflurane has neuroprotective properties in vitro and in animal models. This study was designed to determine cognitive and clinical outcomes after sevoflurane- compared with propofol-based anaesthesia for on-pump cardiac surgery and the impact of decreases in under different anaesthesia regimens. METHODS: One hundred and twenty-eight patients were randomly assigned to either i.v. anaesthesia with propofol- (PROP) or sevoflurane-based anaesthesia (SEVO). An intraoperative was defined as desaturation. The Abbreviated Mental Test, Stroop Test, Trail-Making Test, Word Lists, and mood-assessment tests were performed before, 2, 4, and 6 days after cardiac surgery. Markers of general outcome were obtained. RESULTS: The analysis groups had differences in baseline cognitive performance. Analysis of variance for repeated measures (incorporating covariance of baseline scores) showed that in three of four cognitive tests, patients with cerebral desaturation showed worse results than patients without desaturation. Patients assigned to sevoflurane-based anaesthesia showed better results in all cognitive tests than patients after propofol. Interactions between the anaesthetic regimen and desaturation were found in all four cognitive tests. There were no differences in markers of organ dysfunction or general clinical outcome. CONCLUSIONS: Patients with impaired cognitive performance before operation may be at particular risk for intraoperative cerebral insult. A sevoflurane-based anaesthesia was associated with better short-term postoperative cognitive performance than propofol.

Post-dural puncture headache in young adults: comparison of two small-gauge spinal catheters with different needle design.

BACKGROUND: To reduce the risk of post-dural puncture headache (PDPH) in continuous spinal anaesthesia, small-gauge spinal catheter systems with different techniques of dural perforation have been developed. METHODS: Two systems, the catheter through-needle technique (MicroCatheter, Portex, UK) and the catheter over-needle technique (22G Spinocath, B. Braun, Germany), were used in 18 young healthy volunteers (age 18-30 yr), who were enrolled in a neuroendocrinological investigation for analysis of neuropeptides in cerebrospinal fluid (CSF). After intermittent sampling of CSF (17 x 0.5 ml over 4 h), the catheter was removed and the development of PDPH and pain intensity were documented prospectively by the subjects in a standardized headache assessment (11-point numerical rating scale [NRS]). RESULTS: The study revealed a high overall incidence of PDPH (78%) with no significant differences between groups (P=0.26). However, the over-needle group showed a significantly shorter duration of PDPH (2.4 [SD 2.3] vs 5.1 [3.1] days, P=0.050) and lower maximum pain intensity (3.1 [2.9] vs 7.3 [3.4] NRS, P=0.014) than the through-needle group. CONCLUSIONS: The results demonstrate a potential benefit of the catheter over-needle technique for the reduction of the duration and intensity of PDPH.

Detection of causal relationships between factors influencing adverse side-effects from anaesthesia and convalescence following surgery: a path analytical approach.

BACKGROUND AND OBJECTIVE: The anaesthesiologist's preoperative interview with the patient is important in preparing the patient for surgery. Its potential protective influence on adverse side-effects from anaesthesia and convalescence is rarely investigated within the context of other perioperative factors. Structural equation modelling allows detection and quantification of all causal relationships and mediator effects in multivariate models. Therefore, this method is presented as a tool and applied to discover the influence of the preoperative interview within socio-demographic variables and duration of surgery on complaints and recovery after anaesthesia. METHODS: The influence of individual satisfaction with the anaesthesiologist's preoperative interview on postoperative events such as nausea/vomiting, difficulties in recovering from anaesthesia, experience of postoperative pain, physical discomfort and satisfaction with convalescence expressed by the patient was analysed by means of structural equation modelling. The variables gender, age and duration of surgery were also included as predictors in the analyses. The model in the total sample of 710 patients was then analysed for structural differences between groups treated either with propofol (n = 204) or with isoflurane + nitrous oxide (n = 267) for maintenance of anaesthesia. RESULTS: The model revealed that the anaesthesiologist's preoperative interview in combination with associated mediating side-effects explains 45% of the variance of 'feeling physical discomfort' and 18% of the variance of 'satisfaction with convalescence'. The same model could be fitted in the propofol and the isoflurane + nitrous oxide group. Moreover, the structure and the strength of causal relations between variables were identical in the two groups. CONCLUSIONS: The anaesthesiologist's efforts to improve the interview with the patient by more reassuring and proper information will result in less side-effects from anaesthesia and better recovery from surgery. It could be demonstrated that structural equation modelling is a powerful tool for detection of causal relationships and mediator effects in perioperative medicine.

Time course of aortic valve function and root dimensions after subcoronary ross procedure for bicuspid versus tricuspid aortic valve disease.

BACKGROUND: The freestanding aortic root, which is the currently preferred operative technique for pulmonary autografts, is reported to dilate and potentially promote aortic insufficiency, which has led to a controversial debate on the appropriate surgical technique, especially for congenital bicuspid aortic valve disease. Desirable data on the time course of valve function and root dimensions for the alternative subcoronary technique comparing bicuspid and tricuspid aortic valve disease are scarce. METHODS AND RESULTS: Echocardiographic examinations of 31 patients with congenital bicuspid aortic valve disease (group A; age 50.5+/-11.0 years) and 51 patients with acquired tricuspid aortic valve disease (group B; age 48.1+/-15.7 years) who were operated on between June 1994 and August 1998 were performed twice postoperatively. At first and second follow-up, respectively, maximum (mean) pressure gradients were 6.0+/-2.0 (3.6+/-1.0) and 5.1+/-2.1 (2.9+/-1.1) mm Hg in group A and 6.5+/-3.5 (3.9+/-1.9) and 5.0+/-1.7 (2.9+/-1.0) mm Hg in group B (P>0.05 between groups). In group A, grade 0 aortic insufficiency at first and second follow-up occurred in 8 and 7 patients, respectively, grade 0-I in 12 and 9 patients, grade I in 9 and 11 patients, grade I-II in 1 and 0 patients, and grade II in 1 and 4 patients; in group B, grade 0 aortic insufficiency occurred in 16 and 18 patients, grade 0-I in 16 and 8 patients, grade I in 17 and 21 patients, grade I-II in 0 and 1 patient, and grade II in 0 and 1 patient (P>0.05). Aortic insufficiency decreased in 10 patients (17%). However, there was an overall tendency for aortic insufficiency to increase over time (n=23, 38%), although it remained subclinical. Aortic root dimensions did not differ between groups and were constant during follow-up. CONCLUSIONS: This study provides some evidence that the function of the subcoronary pulmonary autograft in bicuspid aortic valve disease is excellent, with stable root dimensions, and is not different from that of tricuspid aortic valves at least up to 5.5 years postoperatively, which suggests the subcoronary technique should be reconsidered.

Size and distensibility of the aortic root and aortic valve function after different techniques of the ross procedure.

OBJECTIVES: In the Ross procedure, 3 different techniques are used for aortic valve replacement with the pulmonary autograft: freestanding root, inclusion, and subcoronary implantation. The objective of this study was to evaluate echocardiographically the influence of the particular operative technique on dimension, distensibility, and valve function. METHODS: Between February 1990 and August 1998, the Ross procedure was performed in 111 patients (mean age, 48.6 +/- 14.1 years; range, 15.2-70.6 years), with 1 early and 1 late death, 1 autograft replacement, and 1 patient lost to follow-up. The remaining patients underwent the freestanding root (n = 9 patients), inclusion (n = 14 patients), and subcoronary techniques (n = 84 patients). Echocardiography was performed at a mean follow-up of 26 +/- 21.3 months after operation and was compared with the echocardiographic findings of the control subjects (n = 10 subjects). Root sizes were measured at the level of the anulus, sinus, and supra-aortic ridge; the distensibility was calculated as pressure strain elastic modulus and percent change of radius. RESULTS: Size and distensibility of the aortic root were normal, except for a larger diameter at the sinus level in the root technique in comparison to the subcoronary technique (P <.05; maximum diameter, 41.3 +/- 8.6 mm vs 32.6 +/- 4.0 mm). Aortic valve function was comparable among groups with low pressure gradients and most patients with no or trace aortic insufficiency. CONCLUSIONS: The freestanding root, inclusion, and subcoronary techniques in the Ross procedure provide comparable excellent hemodynamics, normal root size, and distensibility, except for the enlarged sinus diameter in the freestanding root. These results may have some impact on the operative procedure and follow-up investigations.

Personality traits, coping styles, and mood in patients awaiting lumbar-disc surgery.

The objective of this study was to characterize personality traits, coping styles, and mood state in patients with lumbar-disc disorders. In two studies (N = 112; N = 84) patients expecting lumbar-disc surgery were compared to patients awaiting another kind of surgery. Personality traits and coping styles were assessed with a personality inventory (FPI-R) and a stress-coping questionnaire (SVF). Mood was measured several times before surgery using a multidimensional self-report inventory [BSKE (EWL)]. The same inventory was used by anesthetists to rate the patient's mood. Heart rate and blood pressure also were measured. The groups did not differ with regard to personality traits, coping styles, self-reported mood state, or somatic variables. The physicians rated lumbar-disc patients as being in a better mood than control patients. Significant correlations between self-ratings and physician ratings were not observed. The results characterize lumbar-disc patients as a subgroup that is not different from other surgery patients and, therefore, does not need a specific form of psychological management prior to surgery. The importance of using patients expecting another type of surgery as a control group rather than healthy individuals is clearly demonstrated.