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Ludwig WD, Schildmann J, Gockel M. [Overtreatment at the End of Life in Oncology]. Ther Umsch 2022; 79:53-60. [PMID: 35100824 DOI: 10.1024/0040-5930/a001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Overtreatment at the End of Life in Oncology Abstract. The term overtreatment refers to situations, in which we evaluate the use of diagnostic or therapeutic measures negatively. On the one hand, these negative judgments refer to questionable scientific foundations of using respective measures. On the other hand, we challenge the adequacy of using medical measures in the context of overtreatment with reference to principle of beneficence. To determine the indication of medical measurements in a medically and ethically reflected way may serve as one starting point for avoiding overtreatment. Over the last two decades numerous studies, mainly in the United States of America and Europe, have shown that the use of anticancer treatments at the end of life has increased considerably. Moreover, the overuse of chemotherapy or targeted therapeutic agents as well as radiotherapy in terminally ill cancer patients in the last months of life was associated with an increased risk of undergoing cardiopulmonary resuscitation, mechanical ventilation or both and of dying in an intensive care unit. More recently, early provision of palliative care for patients with incurable cancer has gained increased attention as a feasible and efficacious approach for improving quality of life. Therefore, the doctor-patient communication is central for the avoidance of overtreatment. It should clarify not only the patient's wishes and priorities, but also his or her understanding of the approaching end of life. In spite of this, both is not the norm in everyday clinical practice; the reasons are to be found in a lack of training, structural obstacles, but also projections and assumptions on both sides. An early and structured approach, if necessary with the help of palliative medicine, can reduce these deficiencies.
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Affiliation(s)
| | - Jan Schildmann
- Profilzentrum Gesundheitswissenschaften, Institut für Geschichte und Ethik der Medizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Kliesch S, Schmidt S, Wilborn D, Aigner C, Albrecht W, Bedke J, Beintker M, Beyersdorff D, Bokemeyer C, Busch J, Classen J, de Wit M, Dieckmann KP, Diemer T, Dieing A, Gockel M, Göckel-Beining B, Hakenberg OW, Heidenreich A, Heinzelbecker J, Herkommer K, Hermanns T, Kaufmann S, Kornmann M, Kotzerke J, Krege S, Kristiansen G, Lorch A, Müller AC, Oechsle K, Ohloff T, Oing C, Otto U, Pfister D, Pichler R, Recken H, Rick O, Rudolph Y, Ruf C, Schirren J, Schmelz H, Schmidberger H, Schrader M, Schweyer S, Seeling S, Souchon R, Winter C, Wittekind C, Zengerling F, Zermann DH, Zillmann R, Albers P. Management of Germ Cell Tumours of the Testes in Adult Patients: German Clinical Practice Guideline, PART II - Recommendations for the Treatment of Advanced, Recurrent, and Refractory Disease and Extragonadal and Sex Cord/Stromal Tumours and for the Management of Follow-Up, Toxicity, Quality of Life, Palliative Care, and Supportive Therapy. Urol Int 2021; 105:181-191. [PMID: 33486494 DOI: 10.1159/000511245] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We developed the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up of germ cell tumours (GCT) of the testes in adult patients. We present the guideline content in 2 separate publications. The present second part summarizes therecommendations for the treatment of advanced disease stages and for the management of follow-up and late effects. MATERIALS AND METHODS An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements. RESULTS Here we present the treatment recommendations separately for patients with metastatic seminoma and non-seminomatous GCT (stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex cord/stromal tumours, the management of follow-up and toxicity, quality-of-life aspects, palliative care, and supportive therapy. CONCLUSION Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present guideline. The guideline also comprises quality indicators for measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented in a future publication.
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Affiliation(s)
- Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany
| | - Stefanie Schmidt
- UroEvidence, Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Doris Wilborn
- UroEvidence, Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Clemens Aigner
- Ruhrlandklinik, University Hospital Essen, Essen, Germany
| | - Walter Albrecht
- Department of Urology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | | | - Dirk Beyersdorff
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Busch
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Johannes Classen
- Department of Radiotherapy, Radiological Oncology, and Palliative Medicine, St. Vincentius-Kliniken, Karlsruhe, Germany
| | - Maike de Wit
- Clinic for Internal Medicine - Hematology, Oncology, and Palliative Medicine, Vivantes Clinic Neukölln, Berlin, Germany
| | | | - Thorsten Diemer
- Clinic and Polyclinic for Urology, Pediatric Urology, and Andrology, University Hospital Gießen, Gießen, Germany
| | - Anette Dieing
- Clinic for Internal Medicine - Hematology and Oncology, Vivantes Clinics Am Urban, Berlin, Germany
| | | | | | - Oliver W Hakenberg
- Urological Clinic and Polyclinic, University Hospital Rostock, Rostock, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | | | - Kathleen Herkommer
- Urological Clinic and Polyclinic of the Technical University of Munich, Munich, Germany
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sascha Kaufmann
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | - Marko Kornmann
- Clinic for General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | | | - Susanne Krege
- KEM, Protestant Hospital Essen-Mitte, Clinic for Urology, Pediatric Urology and Urological Oncology, Essen, Germany
| | | | - Anja Lorch
- Department of Urology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Karin Oechsle
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Timur Ohloff
- German Foundation for Young Adults with Cancer, Berlin, Germany
| | - Christoph Oing
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Otto
- Urological Competence Centre for Rehabilitation, Bad Wildungen, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Heinrich Recken
- Hamburger Fern-Hochschule Studienzentrum Essen, Essen, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe GmbH, Bad Wildungen, Germany
| | | | - Christian Ruf
- Department of Urology, Bundeswehrkrankenhaus, Ulm, Germany
| | | | - Hans Schmelz
- Department of Urology, Bundeswehrkrankenhaus, Koblenz, Germany
| | - Heinz Schmidberger
- Clinic and Polyclinic for Radiooncology and Radiotherapy, University Hospital Mainz, Mainz, Germany
| | | | | | | | - Rainer Souchon
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | | | | | | | - D H Zermann
- Vogtland-Klinik Bad Elster, Bad Elster, Germany
| | | | - Peter Albers
- Department of Urology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany,
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Kliesch S, Schmidt S, Wilborn D, Aigner C, Albrecht W, Bedke J, Beintker M, Beyersdorff D, Bokemeyer C, Busch J, Classen J, de Wit M, Dieckmann KP, Diemer T, Dieing A, Gockel M, Göckel-Beining B, Hakenberg OW, Heidenreich A, Heinzelbecker J, Herkommer K, Hermanns T, Kaufmann S, Kornmann M, Kotzerke J, Krege S, Kristiansen G, Lorch A, Müller AC, Oechsle K, Ohloff T, Oing C, Otto U, Pfister D, Pichler R, Recken H, Rick O, Rudolph Y, Ruf C, Schirren J, Schmelz H, Schmidberger H, Schrader M, Schweyer S, Seeling S, Souchon R, Winter C, Wittekind C, Zengerling F, Zermann DH, Zillmann R, Albers P. Management of Germ Cell Tumours of the Testis in Adult Patients. German Clinical Practice Guideline Part I: Epidemiology, Classification, Diagnosis, Prognosis, Fertility Preservation, and Treatment Recommendations for Localized Stages. Urol Int 2021; 105:169-180. [PMID: 33412555 DOI: 10.1159/000510407] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up on germ cell tumours (GCTs) of the testis in adult patients. We present the guideline content in two publications. Part I covers the topic's background, methods, epidemiology, classification systems, diagnostics, prognosis, and treatment recommendations for the localized stages. METHODS An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search was in March 2018) were provided. Thirty-one experts entitled to vote, rated the final clinical recommendations and statements. RESULTS We provide 161 clinical recommendations and statements. We present information on the quality of cancer care and epidemiology and give recommendations for staging and classification as well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I, we separately present the treatment recommendations for germ cell neoplasia in situ, and the organ-confined stages (clinical stage I) of both seminoma and nonseminoma. CONCLUSION Although GCT is a rare tumour entity with excellent survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional expertise and can be reassured by established online-based second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary approach as well as the referral of selected patients to centres with proven experience can help achieve favourable clinical outcomes.
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Affiliation(s)
- Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany,
| | | | - Doris Wilborn
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Clemens Aigner
- Ruhrlandklinik at University Hospital Essen, Essen, Germany
| | - Walter Albrecht
- Department of Urology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | | | - Dirk Beyersdorff
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Busch
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Johannes Classen
- Department of Radiotherapy, Radiological Oncology and Palliative Medicine, St. Vincentius-Kliniken, Karlsruhe, Germany
| | - Maike de Wit
- Clinic for Internal Medicine - Hematology, Oncology and Palliative Medicine, Vivantes Clinic Neukölln, Berlin, Germany
| | | | - Thorsten Diemer
- Clinic and Polyclinic for Urology, Pediatric Urology and Andrology, University Hospital Gießen, Gießen, Germany
| | - Anette Dieing
- Clinic for Internal Medicine - Hematology and Oncology, Vivantes Clinics Am Urban, Berlin, Germany
| | | | | | - Oliver W Hakenberg
- Urological Clinic and Polyclinic, University Hospital Rostock, Rostock, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | | | - Kathleen Herkommer
- Urological Clinic and Polyclinic of the Technical University of Munich, Munich, Germany
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sascha Kaufmann
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | - Marko Kornmann
- Clinic for General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | - Jörg Kotzerke
- Klinik und Poliklinik für Nuklearmedizin, University Hospital Dresden, Dresden, Germany
| | - Susanne Krege
- KEM, Protestant Hospital Essen-Mitte, Clinic for Urology, Pediatric Urology and Urological Oncology, Essen, Germany
| | | | - Anja Lorch
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Karin Oechsle
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Timur Ohloff
- Advisor, German Foundation for Young Adults with Cancer, Berlin, Germany
| | - Christoph Oing
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Otto
- Urological Competence Centre for Rehabilitation, Bad Wildungen, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Heinrich Recken
- HFH, Hamburger Fern-Hochschule Studienzentrum Essen (Distance Learning University, Essen Study Centre), Essen, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe GmbH, Bad Wildungen, Germany
| | | | - Christian Ruf
- Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Ulm, Germany
| | | | - Hans Schmelz
- Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Koblenz, Germany
| | - Heinz Schmidberger
- Clinic and Polyclinic for Radiooncology and Radiotherapy, University Hospital Mainz, Mainz, Germany
| | | | | | | | - Rainer Souchon
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | | | | | | | | | | | - Peter Albers
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
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Gockel M, Ludwig WD. Verbesserungwürdige Aspekte in der akuten palliativmedizinischen Versorgung. HNO 2013; 61:224-5. [DOI: 10.1007/s00106-012-2658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gockel M, Lindholm H, Niemistö L, Hurri H. Perceived disability but not pain is connected with autonomic nervous function among patients with chronic low back pain. J Rehabil Med 2008; 40:355-8. [DOI: 10.2340/16501977-0172] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Krombach G, Gockel M, Temur Y, Bücker A, Hohl C, Günther RW. MS 325 zur Darstellung des ischämisch geschädigten Myokards. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lindholm H, Gockel M. [Measuring the effects of stress on various organs]. Duodecim 2002; 116:2259-65. [PMID: 12017635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- H Lindholm
- Työterveyslaitos Laajaniityntie 1, 01620 Vantaa.
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Gockel M. Operative treatment of thoracic outlet syndrome in Finland. Ann Chir Gynaecol 1996; 85:59-61. [PMID: 8739935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The data from the nationwide hospital discharge register was used for collecting the diagnoses of the thoracic outlet syndrome (TOS) which were combined with the procedure numbers of first rib resection and scalenotomy. During the years 1987-1993 the total number of operative operative periods for patients with a TOS diagnosis was 483 for 464 patients. Each year first rib resections were done significantly (P = 0.001) more often (55.7 SE 7.1; 1.11/100,000) than scalenotomies (13.4 SE 1.8; 0.27/100,000). The operation for TOS was most commonly combined with the diagnosis of TOS with brachial plexus lesion in 53%, TOS NUD (not classified) in 21%, TOS with subclavian artery compression in 19%, with a cervical rib in 4% and TOS with venous compression in 3%. The large proportion of the diagnosis TOS NUD clearly shows the need for a better definition for the TOS diagnosis. As long as clear diagnostic criteria are lacking, the division of TOS into subgroups is arbitrary. Diagnostic division into true neurogenic, major arterial and venous TOS, and classifying the rest of the TOS diagnoses under TOS NUD or cervicobrachiale diffusum is recommended.
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Affiliation(s)
- M Gockel
- Rehabilitation Unit of the Orthopaedic Hospital of the Invalid Foundation, Finland
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Gockel M, Lindholm H, Alaranta H, Viljanen A, Lindquist A, Lindholm T. Cardiovascular functional disorder and stress among patients having neck-shoulder symptoms. Ann Rheum Dis 1995; 54:494-7. [PMID: 7632093 PMCID: PMC1009909 DOI: 10.1136/ard.54.6.494] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To investigate if autonomic nervous system function, reflected in cardiovascular variables, among patients with neck-shoulder symptoms (tension neck group (T)) differed from that in a symptom free control group (C), and to establish its relation with pain and psychological stress. METHODS Twelve women with tension neck and nine controls in secretarial jobs were studied. They underwent an orthostatic test, deep breathing test, Valsalva manoeuvre, isometric handgrip test, and muscular endurance test. Pain was measured using visual analogue scales, and psychological stress by the Modified Somatic Perception Questionnaire (MSPQ). Plasma endothelin-1 (ET-1) was measured using high pressure liquid chromatography and radioimmunoassay. RESULTS Signs of psychological stress were significantly (p < 0.001) more common in group T than in group C. Mean resting heart rate in group T (77.8 (SE 2.9) beats/min; range 64-100) was significantly greater than that in group C (63.8 (3.1) beats/min; range 52-80) (p < 0.01). In the orthostatic test, the overall changes in R-R intervals during the first 40 heart beats after standing up and during seven minutes of testing differed significantly between the groups (p < 0.001, < 0.05, respectively). The increase in diastolic blood pressure in the three minute isometric handgrip test was significantly less in group T (19.4 (3.5) mm Hg; range -5 to 35) than in group C (30 (3.4) mm Hg; range 15-50) (p < 0.05). The MSPQ score in the study group (n = 21) correlated positively with resting heart rate (r = 0.462, p < 0.05) and negatively with increase in diastolic blood pressure (r = -0.514, p < 0.05). Plasma concentrations of ET-1 did not differ between the groups. CONCLUSION Increased sympathetic activity was found among patients having neck-shoulder symptoms. Local mechanisms may have influenced the cardiovascular changes observed during isometric testing in these patients.
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Affiliation(s)
- M Gockel
- Rehabilitation Unit, Invalid Foundation, Helsinki, Finland
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Gockel M, Lindholm H, Vastamäki M, Lindqvist A, Viljanen A. Cardiovascular functional disorder and distress among patients with thoracic outlet syndrome. J Hand Surg Br 1995; 20:29-33. [PMID: 7759929 DOI: 10.1016/s0266-7681(05)80011-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cardiovascular functional stability of 11 women with thoracic outlet syndrome (TOS; mean age 34.5) and nine female controls (mean age 35.1) was studied using an orthostatic test, a deep breathing test, Valsalva manoeuvre and hand-grip test. The heart rate at rest was significantly higher in TOS patients. The TOS group showed significant accentuation in T wave vacillation in the orthostatic test. The rise in diastolic blood pressure of the TOS group during a hand-grip test was significantly less than that of the control group. TOS patients experienced significantly more distress according to the modified somatic perception questionnaire (MSPQ) than the control group. Pain was correlated with the score of MSPQ, the resting heart rate and increase in diastolic blood pressure in a hand-grip test. The results suggest that TOS patients' symptoms often reflect a wider disturbance than merely anatomical compression in the thoracic outlet. It seems possible that sympathetic tone is higher in TOS patients than in controls. In addition to possible operative treatment, it may be necessary to provide psychological help, relaxation and endurance training.
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Affiliation(s)
- M Gockel
- Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland
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Abstract
A total of 107 patients with thoracic outlet syndrome were reviewed an average of 4.1 years (range 2-11 years) after primary scalenotomy. The sample included 86 women and 21 men, and the mean age at surgery was 41.9 years (range 16-59 years). The three most disturbing pre-operative symptoms were pain at rest (87%), numbness (66%) and lack of power (55%). The post-operative success rate diminished from 71% 1 month after operation to 63% at follow-up. The retirement frequency increased from 6% up to 33% during the follow-up time. It was highest among factory workers at 60%. Of the patients older than 45 years at surgery, 68% were retired at follow-up. The importance of careful selection for operation is emphasized, and also the need to consider vocational rehabilitation before resorting to surgical treatment of thoracic outlet syndrome. We recommend surgical treatment for this disabling disorder, especially for younger patients with clear evidence of thoracic outlet syndrome who are engaged in occupations demanding little repetitive work. The best results have occurred in this group.
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Affiliation(s)
- M Gockel
- Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland
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