Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon

BACKGROUND

Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial.

PURPOSE

To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects.

RESULTS

From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups.

CONCLUSION

Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.

Concordance of shoulder strength assessments using a spring balance and isometric dynamometer in patients before and after arthroscopic rotator cuff repair

Background

Shoulder strength is an essential assessment to monitor the outcome of treatment interventions. Isometric strength assessment in the Constant Score (CS) was initially measured with a cable tensiometer or spring balance (SB). Some authors have questioned the validity of this strength assessment and the resulting CS. The purpose of this study was to investigate the concordance of strength measurements using an unsecured SB vs. isometric dynamometer and outline the impact of these methods on the CS.

Methods

In the context of routine clinical examination as well as participation in a Swiss national cohort study, shoulder strength was measured to calculate baseline (before surgery) and 6-month postoperative CS in adult rotator cuff tear patients who had undergone primary arthroscopic rotator cuff repair. Measurements of each of the operated and contralateral shoulders were made per patient routinely using an unsecured SB and study-specific using an isometric dynamometer in patients with the shoulder at 90° abduction in the scapular plane. Absolute and change values of strength and CS data were presented in scatter plots and assessed using concordance correlation coefficients (CCCs) and Bland-Altman plots.

Results

Between June 2020 and October 2021, baseline strength measurements from the operated shoulder of 78 patients ranged from 0.0 to 13.6 kg with a CCC of 0.64 (P < .001) and a mean difference of 0.81 kg between the SB and dynamometer methods. There were 89 measurements of the contralateral healthy shoulder that ranged from 3.6 to 15.6 kg; CCC and mean strength difference were 0.76 (P < .001) and 0.70 kg, respectively. At 6 months postsurgery, strength measurements of the operated shoulder ranged from 1.4 to 12.0 kg with a CCC of 0.66 (P < .001) and mean strength difference of 0.9 kg (n = 68). Respective 6-month measurements of the contralateral side (n = 52) ranged from 2.0 to 15.9 kg with a CCC of 0.73 (P < .001) and mean strength difference of 0.03 kg.

Conclusion

Absolute and change values in shoulder strength assessments using an unsecured SB and isometric dynamometer are fairly concordant with mean differences of less than 1 kg between methods. With the variability of strength differences among patients, interpretation of these values for individual patients may be challenging. Nonetheless, unsecured SB and dynamometer methods share only slight and clinically unimportant differences that can provide similar group mean values for use in research along with the calculation of the CS.

Subpectoral biceps tenodesis with BicepsButton fixation in the young population: which technique works best?

BACKGROUND

Injuries of the long head of the biceps (LHB) tendon are a prevalent source of anterior shoulder pain and are commonly treated with tenodesis. Not only a stable fixation of the LHB but also anatomic restoration of the length-tension relationship plays a central role in providing satisfactory functional and cosmetic outcomes, especially in young patients. We report the clinical outcomes of 2 different subpectoral tenodesis techniques using unicortical button fixation.

METHODS

Patients aged ≤ 50 years who were treated between April 2015 and January 2020 with 1 of the 2 following subpectoral tenodesis techniques were retrospectively selected and enrolled to undergo a follow-up examination at least 2 years after surgery: subpectoral in situ tenodesis followed by resection of the intra-articular portion leaving a residual tendon stump in the bicipital groove (group I) vs. tenotomy followed by resection of the stump and subpectoral tenodesis (group II). Patients who underwent concomitant rotator cuff repair, subsequent shoulder surgery, or contralateral biceps surgery were excluded. Clinical outcomes were evaluated using the LHB score and the Constant-Murley Score (CMS), as well as measurements of isometric elbow flexion and forearm supination strength. Sonographic evaluation included assessment of the integrity of the LHB and tenodesis, examination for signs of inflammation within the sulcus or around the tendon, and measurements of the distalization of the myotendinous junction of the LHB compared with the nonoperative side.

RESULTS

A total of 34 patients comprising group I (24 men; mean age at time of surgery, 40.3 years; mean follow-up period, 57.2 months) and 24 patients comprising group II (19 men; mean age at time of surgery, 39.8 years; mean follow-up period, 51.9 months) were evaluated. The total CMS, as well as the scores for each CMS subcategory, did not reveal significant differences between the groups. The overall LHB score was on average 10 points higher in group I (mean, 94 points) than in group II (mean, 84 points) (P = .016). Regarding the LHB score subcategories, group I showed significantly better results for patient-dependent cosmesis (mean, 15 points in group I vs. 12 points in group II; P = .005) and examiner-dependent cosmesis (mean, 14 points in group I vs. 10 points in group II; P = .001). This finding was substantiated by a significantly higher distalization of the myotendinous junction in group II (mean, 3.0 cm in group I vs. 3.8 cm in group II; P = .030).

CONCLUSION

This study shows that subpectoral in situ tenodesis of the LHB followed by arthroscopic resection of the intra-articular portion provides higher LHB scores and better cosmetic outcomes compared with proximal intra-articular tenotomy followed by subpectoral tenodesis.

Parental experience of the neuromotor development of children with congenital heart disease: an exploratory qualitative study

BACKGROUND

Children with severe congenital heart disease (CHD) are a group of children at risk for neurodevelopmental impairments. Motor development is the first domain to show a delay during the first year of life and may significantly contribute to parental concerns, stress, and difficulties in early child-parent attachment. Thus, the aim of the study was to better understand the wishes and concerns of parents of children with CHD and explore their experience of their children's neuromotor development in the first year of life.

METHODS

In this qualitative study, fourteen families were recruited. Their children were aged 1-3 years and had undergone open heart surgery within the first 6 months of life. Semi-structured interviews were audio-recorded and transcribed. The data was explored within an expert group, and a qualitative content analysis was conducted using VERBI MAXQDA software 2020. The study was conducted in accordance with the COREQ checklist.

RESULTS

Parents of children with CHD reported several burdens and needs. Parental burdens concerned the child's motor development, their own physical and psychological strain, and difficulties in communication with healthcare professionals. The needs, parents reported included supporting their child's motor development, a medical coordinator, and better communication between healthcare professionals and parents. During the first phase of their children's illness, parents underwent a dynamic transitional phase and expressed the need to rely on themselves, to trust their children's abilities, and to regain self-determination in order to strengthen their self-confidence.

CONCLUSIONS

It is essential to involve parents of children with CHD at an early stage of decision-making. Parents are experts in their children and appreciate medical information provided by healthcare professionals. Interprofessional teamwork, partnering with parents, and continuous support are crucial to providing the best possible care for children and their families. Family-centred early motor intervention for CHD children might counteract the effect of parental overprotection and improve children's motor development and thus strengthen child-parent interaction. In future work, we aim to evaluate a family-centred early motor intervention for children with CHD developed on the basis of this qualitative study.

TRIAL REGISTRATION

Not applicable.

Minimal important change and patient acceptable symptom state for patients after proximal interphalangeal joint arthroplasty

Our aim was to determine the minimal important change and patient acceptable symptom state for pain and the brief Michigan Hand Outcomes Questionnaire in patients 1 year after proximal interphalangeaI joint arthroplasty. We analysed data of 100 patients from our prospective registry. The minimal important change and patient acceptable symptom state were determined with anchor-based methods, and patients with better or worse baseline status were examined. The minimal important change for pain at rest and during activities, and the brief Michigan Hand Outcomes Questionnaire was -1.2, -2.8 and 18, respectively, with corresponding patient acceptable symptom state values of 1.5, 2.5 and 64. Patients with higher baseline symptoms rated more severe postoperative symptoms as acceptable, whereas patients with lower baseline symptoms were only satisfied with a low level of pain and high level of hand function. The minimal important change and patient acceptable symptom state are useful estimates for patient outcomes and study results. Level of evidence: IV.

Trapeziectomy With Suspension-Interposition Arthroplasty for Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial Comparing the Use of Allograft Versus Flexor Carpi Radialis Tendon

PURPOSE

The objective of this randomized controlled trial was to compare the 12-month postoperative Michigan Hand Outcomes Questionnaire (MHQ) total score between patients with osteoarthritis (OA) at the first carpometacarpal (CMC I) joint who underwent trapeziectomy with suspension-interposition arthroplasty using the flexor carpi radialis (FCR) tendon and those receiving a human dermal collagen template (allograft).

METHODS

We included 60 patients with CMC I OA who met the indications for surgery. They were randomized into 1 of 2 groups: trapeziectomy using the FCR tendon or trapeziectomy with the allograft for suspension-interposition. Patients completed a set of questionnaires including the MHQ and were clinically assessed at baseline, 6 weeks, and 3, 6, and 12 months after surgery. Complications were recorded.

RESULTS

We operated on 29 patients using the FCR tendon; 31 patients received an allograft. Baseline MHQ total scores significantly increased from 51 (95% confidence interval [CI], 46-56) to 83 (95% CI, 78-87) and 53 (95% CI, 47-58) to 76 (95% CI, 69-84) by 12 months in the FCR and allograft groups, respectively. We found similar outcomes for both groups at all follow-up assessments. Five complications occurred in the FCR group, and 10 in the allograft group. Revision surgery was required for one allograft patient.

CONCLUSIONS

The use of the FCR tendon or allograft for trapeziectomy with suspension-interposition arthroplasty in patients with CMC I OA leads to similar outcomes with more complications, mainly tendon irritations, associated with the latter. Therefore, we only use the allograft in cases of severe instability requiring a larger amount of suspension-interposition material or for revision procedures after failed suspension-interposition with the FCR tendon.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic I.

Measurement Properties of the Brief Michigan Hand Outcomes Questionnaire in Patients With Dupuytren Contracture

PURPOSE

The brief Michigan Hand Outcomes Questionnaire (briefMHQ) was developed as a shorter version of the Michigan Hand Outcomes Questionnaire (MHQ), but its measurement properties have not been investigated in patients with Dupuytren contracture. The objective of the study was to investigate the reliability, validity, responsiveness, and interpretability of the briefMHQ.

METHODS

Fifty-seven patients diagnosed with Dupuytren contracture completed the briefMHQ as well as the full-length MHQ and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at baseline. Two to 14 days after baseline and 1 year after collagenase injection or surgery, patients again filled out the briefMHQ. Reliability was determined using the intraclass correlation coefficient and by calculating internal consistency (Cronbach alpha). Validity was tested by quantifying correlations with the full-length MHQ and QuickDASH. Responsiveness, based on the standardized response mean and the minimally clinically important change, was also determined.

RESULTS

The briefMHQ had an intraclass correlation coefficient of 0.87, Cronbach alpha of 0.88, and correlations of r = 0.88 and -0.82 with the original MHQ and QuickDASH, respectively. The standardized response mean was 0.9 and the minimally clinically important change was 7 points.

CONCLUSIONS

Overall, the briefMHQ demonstrates excellent reliability, good validity, and high responsiveness in patients with Dupuytren contracture.

CLINICAL RELEVANCE

The briefMHQ is an accurate and time-saving tool to evaluate patients with Dupuytren contracture and the effect of a corresponding treatment.

[Cystoscopy in a heifer with rupture of a patent urachus]

This case report describes the clinical, ultrasonographic and cystoscopic findings and treatment in a two-year-old Swiss Braunvieh heifer with rupture of a patent urachus. The lead signs in the seven-month-pregnant heifer were markedly abnormal general condition and demeanour and a pear-shaped abdomen. The heifer had severe azotaemia, and abdominal ultrasonography revealed ascites, which was diagnosed as uroperitoneum based on an elevated creatinine level in the fluid. A patent urachus was identified during cystoscopy; the endoscope could be advanced beyond the apex of the urinary bladder into the urachus. Based on all the findings, a diagnosis of uroperitoneum attributable to rupture of a patent urachus was made. The urachus was ligated twice via a left-flank laparotomy. The general condition normalised within a few days of surgery, and the patient calved normally and was in good health at follow-up evaluation.

Klinische, ultrasonographische, röntgenologische und endoskopische Befunde sowie Therapiemaßnahmen bei 16 Rindern mit retropharyngealen Abszessen

Ziel dieser retrospektiven Arbeit war, die klinischen, ultrasonographischen, röntgenologischen und endoskopischen Befunde sowie die Behandlung von 16 Rindern mit retropharyngealen Abszessen zu beschreiben. Ergebnisse: Klinisch ließen sich Stenosegeräusche, Umfangsvermehrungen im kranialen Halsbereich, Dyspnoe sowie Husten feststellen. Die ultrasonographische Untersuchung zeigte bei allen Tieren die für Abszesse charakteristischen rundlichen Strukturen mit echogenem Inhalt. Röntgenologisch konnte bei allen Rindern eine Verschattung im Bereich des Pharynxdaches und fallweise eine Gasansammlung über einem Flüssigkeitsspiegel dargestellt werden. Mit dem Endoskop waren bei 13 von 15 untersuchten Tieren Schwellungen im Pharynxdach, bei dreien auch Fistelkanäle zu sehen. Drei der 16 Rinder wurden wegen zusätzlicher Erkrankungen ohne Therapieversuch geschlachtet. Bei 9 Tieren erfolgte eine Operation, bei 4 Tieren eine konservative Behandlung. Insgesamt 12 Tiere konnten langfristig geheilt werden. Schlussfolgerung und klinische Relevanz: Die Arbeit zeigt die Bedeutung der sorgfältigen diagnostischen Abklärung solcher Fälle hinsichtlich des Heilungserfolges. Wird die Diagnose früh und korrekt gestellt, ergibt sich bei Behandlung retropharyngealer Abszesse eine gute Prognose.

[Clinical and laryngoscopic findings in a Swiss Alpine goat with left grade 4 laryngeal hemiplegia]

This case report describes the diagnostic trial of an inspiratory wheeze in a 1.5-year-old Swiss Alpine goat. Left grade 4 laryngeal hemiplegia was diagnosed via laryngoscopy, whereas the severity of the hemiplegia was assessed according to the grading system used in horses. The results of clinical, radiographic, sonographic and endoscopic examinations as well as haematological, biochemical and serological analyses did not reveal the cause of the hemiplegia. Treatment with an antibiotic and vitamin B complex resulted in only slight improvement. A postmortem examination four months later revealed no gross lesions in the left laryngeal nerve, larynx and intrinsic laryngeal musculature. Histological examination of the nerve, arytenoid cartilage and intrinsic laryngeal musculature also showed no lesions. Therefore, the cause of the disease in this goat is suspected to be on the cellular or molecular level of the intrinsic laryngeal musculature.

Improvement of nitrogen removal at WWTP Zürich Werdhöelzli after connection of WWTP Zürich-Glatt

Optimisation of nitrifying activated sludge plants towards nutrient removal (denitrification and enhanced P-removal) leads to a substantial reduction of operating costs and improves effluent and operating conditions. At WWTP Zürich-Werdhöelzli, initially designed for nitrification only, an anoxic zone of 28% of total activated sludge volume was installed and allowed 60% nitrogen elimination besides several other optimisations. In 2001 the operation of WWTP Zürich-Glatt was stopped and the wastewater was connected to WWTP Werdhöelzli. To improve nitrogen removal, WWTP Werdhöelzli co-financed two research projects; one for separate digester supernatant treatment with the anammox process operating two SBRs in series and the other applying NH4 sensors for aeration control in order to decrease energy consumption and raise effluent quality. The results of both projects and the consequences for WWTP Werdhöelzli are discussed in this paper.

Microbiological aspects of diaper dermatitis

BACKGROUND

The microbiological basis of diaper dermatitis is not clearly elucidated, although a better knowledge of microbial colonisation can be of importance with regard to an adequate treatment.

OBJECTIVE

To investigate the relevance of candida sp. and Staphylococcus aureus colonisation in diaper dermatitis and to determine the correlation between the extent of colonisation and the severity of disease.

METHODS

Growth of candida sp. and S. aureus in the perianal, inguinal and oral regions was determined by positive/negative and semi-quantitative analysis in an open, multi-centre (n = 3) study. Forty-eight children with healthy skin and 28 with diaper dermatitis were analysed. The severity of diaper dermatitis was assessed using a total symptoms score.

RESULTS

Colonisation by candida sp. was significantly more frequent in children with diaper dermatitis as compared to those with healthy skin (perianal 75 vs. 19%; inguinal 50 vs. 10%; oral 68 vs. 25%, p < 0.0003), whereas colonisation by S. aureus at the 3 swab locations was not different (p > 0.34). There was a highly significant, positive correlation between severity of disease and extent of candida sp. colonisation at all swab locations.

CONCLUSIONS

Limited microbial colonisation in diaper dermatitis is of questionable relevance, but extensive colonisation seems to aggravate the symptoms; therefore, we suggest that semi-quantitative evaluation should be preferred to the positive/negative assessment for a differential diagnosis.

arrow encodes an LDL-receptor-related protein essential for Wingless signalling

The Wnt family of secreted molecules functions in cell-fate determination and morphogenesis during development in both vertebrates and invertebrates (reviewed in ref. 1). Drosophila Wingless is a founding member of this family, and many components of its signal transduction cascade have been identified, including the Frizzled class of receptor. But the mechanism by which the Wingless signal is received and transduced across the membrane is not completely understood. Here we describe a gene that is necessary for all Wingless signalling events in Drosophila. We show that arrow gene function is essential in cells receiving Wingless input and that it acts upstream of Dishevelled. arrow encodes a single-pass transmembrane protein, indicating that it may be part of a receptor complex with Frizzled class proteins. Arrow is a low-density lipoprotein (LDL)-receptor-related protein (LRP), strikingly homologous to murine and human LRP5 and LRP6. Thus, our data suggests a new and conserved function for this LRP subfamily in Wingless/Wnt signal reception.

Independent regulation of anterior/posterior and equatorial/polar polarity in the Drosophila eye; evidence for the involvement of Wnt signaling in the equatorial/polar axis

The Drosophila retina is made from hundreds of asymmetric subunit ommatidia arranged in a crystalline-like array with each unit shaped and oriented in a precise way. One explanation for the precise cellular arrangements and orientations of the ommatidia is that they respond to two axes of polarized information present in the plane of the retinal epithelium. Earlier work showed that one of these axes lies in the anterior/posterior(A/P) direction and that the polarizing influence is closely associated with the sweep of the Hedgehog-dependent morphogenetic wave. Here we present evidence for a second and orthogonal axis of polarity, and show that it can be functionally separated from the A/P axis. Further, we show that the polarizing information acting in this equatorial/polar axis (Eq/Pl) is established in at least two steps - the activity of one signaling molecule functions to establish the graded activity of a second signal.

Epithelial planar polarity in the developing Drosophila eye

Experiments with the insect ectoderm have suggested that planar polarity in epithelia results from the local orientation of cells to the slope of a gradient of positional information. Here we show that planar polarity in the Drosophila eye is inverted when the morphogenetic wave that sweeps through the presumptive retinal epithelium is induced to move in the reverse direction. We suggest that the movement of the morphogenetic wave may be causal in establishing the planar polarity of this epithelium.

Nonequivalent requirements for PS1 and PS2 integrin at cell attachments in Drosophila: genetic analysis of the alpha PS1 integrin subunit

We report on the generation and phenotype of mutant alleles of multiple edematous wings (mew), the gene encoding the alpha PS1 subunit of the PS1 integrin of Drosophila. None of the six alleles examined makes detectable protein, and one allele results from a chromosome break near the middle of the translated sequence, so we are confident that we have described the null phenotype. In contrast to if (alpha PS2) and mys (beta PS) mutants, most mutant mew embryos hatch, to die as larvae. Mutant mew embryos display abnormal gut morphogenesis but, unlike mys or if embryos, there is no evidence of defects in the somatic muscles. Thus, the complementary distributions of PS1 (alpha PS1 beta PS) and PS2 (alpha PS2 beta PS) integrin on tendon cells and muscle, respectively, do not reflect equivalent requirements at the myotendinous junction. Dorsal herniation, characteristic of the mys lethal phenotype, is not observed in mew or in mew if embryos. Clonal analysis experiments indicate that eye morphogenesis is disrupted in mew clones, but if clones in the eye are relatively normal in morphology. Adult wings display blisters around large dorsal but not ventral mew clones. In contrast to dorsal mys clones, small mew patches do not necessarily display morphogenetic abnormalities. Thus, another integrin in addition to PS1 appears to function on the dorsal wing surface.

Drosophila PS1 integrin is a laminin receptor and differs in ligand specificity from PS2

We have expressed Drosophila position-specific (PS) integrins on the surfaces of Schneider S2 cells and tested for adhesion and spreading on various matrix molecules. We report that PS1 integrin is a laminin receptor and that PS1 and PS2 integrins promote cell spreading on two different Drosophila extracellular matrix molecules, laminin and tiggrin, respectively. The differing ligand specificities of these two integrins, combined with data on the in vivo expression patterns of the integrins and their ligands, lead to a model for the structure of integrin-dependent attachments in the pupal wings and embryonic muscles of Drosophila.

Cloning and characterization of alpha PS1, a novel Drosophila melanogaster integrin

The Drosophila position-specific integrins (PS integrins or PS antigens) comprise two heterodimeric complexes, alpha PS1 beta PS and alpha PS2 beta PS. With the cloning of alpha PS1 described here, we complete the characterization of the primary structure of the three PS integrin subunits. We have purified the alpha PS1 subunit, obtained peptide sequence and isolated genomic and cDNA clones. The encoded alpha PS1 protein contains the cysteine pattern of the cleaved alpha integrins, three putative metal binding domains and shows the other characteristic features of alpha integrins. Regions of sequence variation indicate that alpha PS1 is distinct from all other alpha chains. The transcript analysis shows that the patterns of both alpha PS1 mRNA and protein expression are the same, suggesting that the gene is controlled transcriptionally. We compare the gene structures of the Drosophila alpha PS1, alpha PS2, the human alpha IIb and alpha X (p150,95) and the C. elegans F54G8.3 integrins. We find several positions and phases of introns conserved which, supported by conservation also in the amino acid sequence, indicates that they all derive from a common ancestral gene.

Superselective embolization for intractable epistaxis: experiences with 19 patients

Twenty-eight patients with intractable nose-bleeds were treated with either superselective embolization and/or surgery between 1983 and 1986. The follow-up time ranged between 6 months and 3 years. The results for the 2 groups were similar. The success rate for embolization was 74% and that for surgery 65%. Complications however, were more frequent after embolization, (i.e. facial nerve paralysis, soft tissue necrosis). Surgery is recommended as the treatment of choice in intractable nose-bleeds, until therapeutic embolization techniques have been further refined and the complication rate reduced.