Background:This study was designed to compare the efficacy of the medical treatment versus the surgical treatment approach to decompression of trigger point nerves in patients with migraine headaches.Materials and Methods:Fifty volunteers were randomly assigned to the medical treatment group (n = 25) or the surgical treatment group (n = 25) after examination by the team neurologist to ensure a diagnosis of migraine headache. All patients received botulinum toxin type A to confirm the trigger sites. The surgical treatment group underwent surgical deactivation of the trigger site(s). The medical treatment group underwent prophylactic pharmacologic interventions by the neurologist. Pretreatment and 12-month posttreatment migraine headache frequency, duration, and intensity were analyzed and compared to determine the success of the treatments.Results:Nineteen of the 25 patients (76%) in the surgical treatment group and 10 of the 25 patients (40%) in the medical treatment group experienced a successful outcome (at least a 50% decrease in migraine frequency, duration, or intensity) after 1 year from surgery. Surgical treatment had a significantly higher success rate than medical treatment (P < 0.001). Nine patients (36%) in the surgical treatment group and one patient (4%) in the medical treatment group experienced cessation of migraine headaches. The elimination rate was significantly higher in the surgical treatment group than in the medical treatment group (P < 0.001).Conclusions:Based on the 1-year follow-up data, there is strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headaches in a lasting manner.

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: Therapeutic, II.

Obesity is a serious problem in our century. Nowadays, the incidence of obesity has been increased to 35%. Two common methods for surgical treatment of obesity are surgical lipectomy and ultrasound-assisted liposuction (UAL). This study included 40 patients in two groups, 20 patients in the surgical lipectomy group and 20 patients in the UAL group. Abdominal surgical lipectomy was done in 20 patients (12 female, 8 male), with ages ranging 28-60 years. Abdominal UAL was done in 20 patients (11 females, 9 male), with ages ranging 20-55 years. General anesthesia was used for surgical lipectomy. Tumescent anesthesia was used for 13 UAL patients and general anesthesia was used for the remaining 7. The average time for surgical lipectomy was shorter than that for UAL. The average hospital stay for the surgical lipectomy group was almost five times longer than for UAL. The UAL group also recovered four times faster and required analgesics half as long. The average amount of fat removed in each case was 2.22 kg with UAL and 1.97 kg with surgical lipectomy. The UAL group received analgesic drugs for five days, whereas the surgical lipectomy group received analgesic drugs for 10 days because they sustained more pain. In this study, I do not discuss or compare the major complications of each method because the groups were not large enough. However, there were some minor UAL complications, echymosis in 80%, orthostatic hypotension for three or four days in 75%, infection in one patient, postoperative epidermal loss in small area of the abdomen in two patients, and cellulitis in 75%. All were resolved after one month. UAL is a special method with fewer major complications and shorter hospital stays than surgical lipectomy. The incisions in UAL are smaller, but the operation lasts much longer than surgical lipectomy.

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