PubMed · 2272875
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S Shott. 1990-12-01. Statistics simplified. Comparing proportions.. https://pubmed.ncbi.nlm.nih.gov/2272875/
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BACKGROUND AND OBJECTIVES: The main treatment of extra-abdominal desmoid tumors remains surgery, but recurrence rates up to 80% are reported. The impact of microscopic surgical margin status according to the Enneking classification system is discussed controversially. METHODS: Therefore, the authors screened the published literature for reliable data on the importance of a wide or radical excision of extra-abdominal desmoid tumors. All studies with more than ten patients, a surgical treatment only, and margin status stated were included. RESULTS: Only 12 out of 49 identified studies fulfilled the inclusion criteria. One hundred fifty-two primary tumors were excised with wide or radical microscopic surgical margins, while in 260 cases a marginal or intralesional excision was performed. In the first group 41 patients (27%) and in the second one 187 patients (72%) developed a recurrence. Therefore, microscopic surgical margin status according to the Enneking classification system is a significant prognostic factor (P < 0.001). CONCLUSIONS: The data of this review underline the strategy of a wide or radical local excision as the treatment of choice. Furthermore, as a large number of studies had to be excluded from this analysis, exact microscopic surgical margin status should be provided in future studies in order to allow comparability. .
BACKGROUND: Within the last years, stapled rectal mucosectomy (SRM) has become a widely accepted procedure for second and third degree hemorrhoids. One of the delayed complications is a stenosis of the lower rectum. In order to evaluate the specific problem of rectal stenosis following SRM we reviewed our data with special respect to potential predictive factors or stenotic events. METHODS: A retrospective analysis of 419 consecutive patients, which underwent SRM from December 1998 to August 2003 was performed. Only patients with at least one follow-up check were evaluated, thus the analysis includes 289 patients with a mean follow-up of 281 days (+/-18 days). For statistic analysis the groups with and without stenosis were evaluated using the Chi-Square Test, using the Kaplan-Meier statistic the actuarial incidence for rectal stenosis was plotted. RESULTS: Rectal stenosis was observed in 9 patients (3.1%), eight of these stenoses were detected within the first 100 days after surgery; the median time to stenosis was 95 days. Only one patient had a rectal stenosis after more than one year. 8 of the 9 patients had no obstructive symptoms, however the remaining patients complained of obstructive defecation and underwent surgery for transanal strictureplasty with electrocautery. A statistical analysis revealed that patients with stenosis had significantly more often prior treatment for hemorrhoids (p < 0.01). According to the SRM only severe postoperative pain was significantly associated with stenoses (p < 0.01). Other factors, such as gender (p = 0.11), surgical technique (p = 0.25), revision (p = 0.79) or histological evidence of squamous skin (p = 0.69) showed no significance. CONCLUSION: Rectal stenosis is an uncommon event after SRM. Early stenosis will occur within the first three months after surgery. The majority of the stenoses are without clinical relevance. Only one of nine patients had to undergo surgery for a relevant stenosis. The predictive factor for stenosis in the patient-characteristics is previous interventions for hemorrhoids, severe postoperative pain might also predict rectal stenosis.
Off-road motorcycling is one of the most popular sports activities practiced by millions of people in the world but little has been written on motocross traumatology and its prevention. This paper aims to evaluate motocross injuries in terms of injury ratio, location, causes, and possible prevention in a series of competitions organized by Motorcyclistic Federations over a 12-year period. We retrospectively evaluated 1,500 accidents with 1,870 rider injuries out of a group of 15,870 athletes participating in European off-road competition from 1980 to 1991. Data were collected from race medical reports, insurance declarations and follow-up forms filled up by riders involved in accidents. We then classified the type and location of the injury, modality of the accident, the protective gear used and the recovery of the riders. We compared our data to lesions noted in motorcycle road races using the chi-square test and the z-test. The overall incidence of motocross injuries in our study was 94.5 per thousand, while stadium cross competitions had a 150 per thousand rate and outdoor motocross a rate of 76 per thousand representing a risk of accident of 22.72 per thousand hours of riding. Among the total of 1,870 injuries, 1076 were bruises; 27.9% of these were in the upper extremities, 26.9% on the lower, 21.2% on the trunk, and 16% on the face. There were 450 fractures recorded, 50.9% in the upper extremities, 38% in the lower, and the rest were on the spine, chest, and skull. The 26 spine fractures (5.8%) produced permanent neurologic sequelae in eight patients. Ligamentous lesions accounted for 344 cases with 206 (59.9%) occurring in the lower extremities especially on the knee (42.4%). Head trauma was noted in 86 cases (5.7% of accidents) producing coma in 3%, and loss of consciousness in 14%. Limb involvement for all types of injuries were more frequent on the left side (60%). Motocross is a high-risk sport: our study revealed the most common modalities and types of lesions sustained by the riders. Despite the reduction of some injuries by better protective gears, the occurrence of knee sprain, and wrist and clavicular fractures are still high. Furthermore, the high number of spine lesions with subsequent neurologic deficit noted in indoor races raises doubts about the safety of these events.