Nirschl release appears to be a very successful technique for surgically suitable cases of tennis elbow. However, although the drilling or decortication aspect of the procedure was thought to be of benefit to the immediate outcome, this has not actually been confirmed. This randomised double blind comparative prospective trial shows that drilling confers no benefit and actually causes more pain, stiVness, and wound bleeding than not drilling. (Br J Sports Med 2001;35:200-201) Keywords: Nirschl release; lateral epicondyle; tennis elbow; elbow; epicondylitisThe main presenting complaint of tennis elbow is localised pain over the lateral epicondyle, particularly during activities that require active wrist extension power. As a corollary to this, patients also complain of inability to lift objects or make powerful flexing movements of the wrist because this also painfully stretches the extensor muscles.A variety of surgical techniques are currently available and routinely used for the treatment of tennis elbow. Nirschl's technique 1 involves (a) excision of the histologically proven degenerate fibroblastic origin of the extensor carpi radialis brevis (with or without the digitorum communis if aVected) from the lateral epicondyle, and (b) decorticating or making drill holes (three of 2 mm diameter) through the near cortex of the anterolateral lateral humeral condyle in the hope of increasing the blood supply to the degenerate area to improve healing and hopefully outcome. Nirschl release (including drilling) is 85% successful, 1 which is comparable to published results for simple extensor origin release 2 3; however, simple release in our unit conferred only about 50% success. MethodsThis is a randomised double blind comparative prospective trial. The patients were randomised by sealed envelopes, so that half underwent standard Nirschl release with drilling, and the other half had Nirschl release without drilling. Patients gave informed consent for the study but neither the patient nor the clinician who measured outcome three and six months after the operation knew whether drilling was performed or not. Patients also attended the clinic after two weeks for wound inspection and removal of sutures (skin staples). All patients were operated on as day cases by the same surgeon (the author).To make the sample study relevant to the general population, this study included all patients (male/female) presenting to their general practitioners. People less than 18 years old rarely suVer from this complaint and were excluded from the study. In this particular sample, there were no revision tennis elbows; all were primary cases. All patients were otherwise fit (American Society of Anesthesiologists category I (ASA-I)).In this study, treatment protocols in our unit for tennis elbow involved: (a) resting the aVected elbow from aggravating causes and a standard course of physiotherapy; if this failed, (b) an injection of local anaesthetic (bupivicaine 0.5%) and steroid (40 mg depo-medrone) into the area of tenderness. If ...
Treating cholesteatoma in children is still controversial. This article reviews 93 cases of pediatric cholesteatoma operated on from 1983 to 1991 in the Gruppo Otologico, Placenza, Italy, and details the results in 83 children who underwent the intact canal wall technique. During second-stage surgery, residual cholesteatoma was detected in 38% of patients. Recurrent cholesteatoma was detected in 10% of patients treated with the intact canal wall technique. Residual cholesteatoma was seen in the middle ear cleft in 63%, in the epitympanum in 26%, and in the mastoid in 11% of cases. Social hearing level (< 25 dB) was achieved in 85% of cases with suprastructure, whereas only 53% of patients without suprastructure had these levels. In the treatment of cholesteatoma in children by use of the intact canal wall technique, a preplanned second-look operation is mandatory to eradicate the disease.
Cerebrospinal fluid leakage is the most common complication of translabyrinthine acoustic neuroma surgery. This retrospective study reviews patients who had translabyrinthine acoustic neuroma surgery at the Gruppo Otologico, Piacenza, Italy, and ENT Department of Bergamo General Hospital, Bergamo, Italy, during the last 6 years. The incidence of postoperative cerebrospinal fluid leakage was 6.2%, and 75% of these patients underwent another surgery to control the cerebrospinal fluid leakage. A modification of translabyrinthine approach was used in patients with highly pneumatized temporal bones to prevent cerebrospinal fluid leakage in these high-risk patients.
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