The aim of the study is to specify diagnostic MRI and ultrasound criteria for a sports hernia in order to verify its diagnosis in football players. Materials and methods: The study included 50 professional and amateur football players aged 15 to 34 from 2016 to 2019. The criteria for inclusion in the study were: the presence of groin pain in football players, which prevented them from continuing to actively participate in sports activities. Results: The findings of the study revealed that during MRI the two factors, which had the strongest influence, were “increased MR signal intensity on PDfs observed from the structures of the inguinal canal” and “increased MR signal intensity on PDfs observed from bone marrow of superior ramus of the pubic bone”. During ultrasound of the inguinal area, the main criterion for a sports hernia diagnosis was “increased size of the inguinal canal”. The verification of the diagnosis was carried out on the basis of the presence of a protrusion in the posterior wall of the inguinal canal. For a sports hernia diagnosis the MRI sensitivity is 91.67% (95% CI 77.5 – 98.2), specificity –78.57% (95% CI 49.2 – 95.3) and the sensitivity of ultrasound is 88.89% (95% CI 73.9 – 96.9), the specificity – 50% (95% CI 23.0 – 77). Conclusions: The combination of MRI and ultrasound makes it possible to accurately detect the presence of a sports hernia in the football player. Based on the findings of our study, we formulated MRI and ultrasound criteria for a sports hernia diagnosis.
Uniportal video-assisted thoracoscopic sympathectomy (VATS) is an effective minimally invasive surgical method of choice for the treatment of primary focal hyperhidrosis and blushing syndrome due to uncontrolled operation of the sympathetic nervous system. The aim of this study was to provide an objective assessment of the improvement in the quality of life of patients with primary focal hyperhidrosis and blushing syndrome after bilateral monoport video-assisted thoracoscopic sympathectomy. Materials and methods. The results of surgical treatment were performed for 62 patients aged 17 to 42 years, 26 men and 36 women with a diagnosis of primary focal hyperhidrosis of the extremities and blushing syndrome. All patients underwent bilateral uniport video-assisted thoracoscopic sympathectomy. Patients are divided into 3 groups depending on the level of coagulation of the sympathetic trunk: the first group of the study (n = 9) includes patients after bilateral uniport sympathectomy at the level of R3 (isolated palmar hyperhidrosis), the second (n = 31) - at the level of R3-R4 (palmar and axillary hyperhidrosis), the third group (n = 22) - at the level of R2 (blushing syndrome). Results. In this study, coagulation and separation of the sympathetic trunk through a single port using a silicone port was performed. An excellent clinical result was achieved due to the minimally invasive operation - all 62 patients (100%) were satisfied with the achievement of a rapid stable effect. According to the results of the Dermatology Life Quality Index DLQI (1 month after surgery), the best quality of life measures were observed in patients who underwent separation of the sympathetic trunk at the R3 level – improvement from 20.3 ± 5.9 points to 0.8 ± 0.8 points. After the operation at the R3-R4 level scores the quality of life decreased from 22.77 ± 5.4 points to 2.3 ± 1.3 points, and at the level of R2 - from 16.5 points (QI 14 points - QIII 20 points) to 2 points (QI 1 point - QIII 3 points) p <0.001). There was a difference in quality of life measures in our three groups of patients according to the severity of the disease before surgery. The lowest quality of life was determined in patients with the 4th degree of severity (33 people) and was 26.0 points (QI 23.0 points - QIII 27.3 points) compared with patients with 2d and 3d degrees of severity, 10.0 points (QI 7.7 points - QIII 10.0 points) and 17.0 points (QI 14.0 points - QIII 19.5 points) respectively (p <0.001). After a single-port VATS in three groups there was an increase in quality of life measure, regardless of the severity of the disease before surgery. Conclusions. The most highly specific tests that allow to determine an objective assessment of the severity of the disease and a real assessment of the effectiveness of surgical treatment for hyperhidrosis was TEWL-metry, for blushing syndrome – capillaroscopy. VATS is an effective method of treating patients with hyperhidrosis and blushing syndrome, which significantly improves the quality of life according to the results of the Dermatological Index of Life Quality DLQI (p <0.001) questionnaire.
Мета роботи: визначити оптимальну тактику вибору хірургічного лікування спортивної грижі у футболістів. Матеріали і методи. Проведено аналіз результатів хірургічного лікування 36 футболістів професійних та аматорських клубів віком від 18 до 34 років із діагнозом спортивна грижа, які перебували в хірургічному відділенні КМКЛ № 3 впродовж 2014–2019 рр. Хворих було розподілено на дві групи дослідження залежно від методики хірургічного втручання. В першій групі виділено дві підгрупи, до першої підгрупи хворих увійшли 10 футболістів, яким виконували лапароскопічну інтраперитонеальну герніоалопластику за методикою IPOM. До другої підгрупи увійшли 8 футболістів, яким виконували лапароскопічну інтраперитонеальну герніоалопластику за методикою IPOM із субдермальним ушиванням внутрішніх пахових кілець. До другої групи увійшли 18 футболістів, яким виконували лапароскопічну трансабдомінальну преперитонеальну герніоалопластику за методикою TAPP. Для оцінки показників якості життя застосовували опитувальник The Copenhagen Hip and Groin Outcome Score (HAGOS) та Eura HS Quality of Life score (Eura HS-QoL у модифікації). Результати досліджень та їх обговорення. При аналізі показників за шкалою HAGOS якість життя до операції не відрізнялась в обох групах дослідження, тоді як після проведення хірургічного лікування значно підвищилась у другій групі з 47 до 96 балів та в першій групі з 45 до 80 балів (р<0,05). Також в другій групі встановлено достовірне зменшення больового синдрому в пахвинній ділянці після лапароскопічної герніоалопластики за методикою ТАРР з 8 балів до 2 балів за шкалою ВАШ і після застосування методики IPOM у першій групі з 7,5 до 3 балів (р<0,05). Найкоротший термін повернення спортсмена до тренувань становить 3 тижні після хірургічного лікування спортивної грижі виявлено при лапароскопічній пластиці задньої стінки пахового каналу за методикою ТАРР зі встановленням самофіксуючої сітки. У дослідженні проведено порівняльний аналіз результатів лапароскопічних хірургічних втручань та визначено оптимальну тактику вибору хірургічного лікування спортивної грижі у футболістів.
Sports hernias are diagnosed in over 80% of athletes presenting with chronic groin pain. The genotype distributions of the examined polymorphisms were studied in 95 football players, all males, using the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire. DNA extracted from buccal epithelium. Statistical calculations were performed in the R statistical environment (r-project.org) and Odds ratios (OR) were used to estimate genotype associations. Multifactor dimensionality reduction was used to identify multiple sports hernia susceptibility loci.Two single nucleotide polymorphisms MCT1 rs1049434 and COL1A1 rs1800012 are associated with sports hernias (63% testing accuracy shown by random forest). According to the HAGOS questionnaire outcomes, exercise-related pain, reduced mobility, and range of motion in the groin and thigh are typically associated with sports hernia diagnosis (75% testing accuracy shown by random forest).The combination of genetic research and HAGOS questionnaire helped obtain a sensitivity of 93% for the detection of sports hernia. Active engagement in sport is the most important risk factor for sports hernia, so the identification genes SNP in footballers may contribute to taking timely preventive actions. This study is the first demonstration of an association between sports hernia and COL1A1 rs1800012 genotype. The study discovered a synergistic interaction between the indicated polymorphism and the gene polymorphism MCT1 rs1049434. Further investigations are required to study the association between COL12A1 rs240736 gene SNP and sports hernia.
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