Transscleral diode laser cyclophotocoagulation as primary surgical treatment for secondary glaucoma in juvenile idiopathic arthritis: high failure rate after short term follow up

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

Download Full-text

THE EFFICACY OF THE DIFFERENT ENDOSCOPIC TREATMENTS VERSUS SHAM, PHARMACOLOGIC OR SURGICAL METHODS FOR CHRONIC GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-65 ◽

2018 ◽

Vol 55 (3) ◽

pp. 296-305 ◽

Cited By ~ 4

Author(s):

Martin Andrés CORONEL ◽

Wanderley Marques BERNARDO ◽

Diogo Turiani Hourneaux de MOURA ◽

Eduardo Turiani Hourneaux de MOURA ◽

Igor Braga RIBEIRO ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Meta Analysis ◽

Short Term ◽

Significant Difference ◽

Objective Outcomes

ABSTRACT BACKGROUND: Endoscopic antireflux treatments for gastroesophageal reflux disease (GERD) are still evolving, and most of the published studies address symptom relief in the short-term. Objective - We aimed to perform a systematic review and meta-analysis focused on evaluating the efficacy of the different endoscopic procedures. METHODS: Search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane, SciELO, and EMBASE for patients with chronic GERD (>6 months), over 18 years old and available follow up of at least 3 months. The main outcome was to evaluate the efficacy of the different endoscopic treatments compared to sham, pharmacological or surgical treatment. Efficacy was measured by different subjective and objective outcomes. RESULTS: We analyzed data from 16 RCT, totaling 1085 patients. The efficacy of endoscopic treatments compared to sham and proton pump inhibitors (PPIs) treatment showed a significant difference up to 6 months in favor of endoscopy with no heterogeneity (P<0.00001) (I2: 0%). The subgroup analysis showed a statistically significant difference up to 6 months in favor of endoscopy: endoscopy vs PPI (P<0.00001) (I2: 39%). Endoscopy vs sham (P<0.00001) (I2: 0%). Most subjective and objective outcomes were statistically significant in favor of endoscopy up to 6 and 12 months follow up. CONCLUSION: This systematic review and meta-analysis shows a good short-term efficacy in favor of endoscopic procedures when comparing them to a sham and pharmacological or surgical treatment. Data on long-term follow up is lacking and this should be explored in future studies.

Download Full-text

Influence of 980-nm Diode Laser Vaporization on Sexual Function: A Short-Term Follow-Up Study

Journal of Endourology ◽

10.1089/end.2018.0440 ◽

2018 ◽

Vol 32 (11) ◽

pp. 1065-1070

Author(s):

Lin Huang ◽

Juan He ◽

Yongyi Fan ◽

Minggui Wu

Keyword(s):

Sexual Function ◽

Diode Laser ◽

Laser Vaporization ◽

Short Term ◽

Follow Up Study

Download Full-text

The treatment of chronic periodontitis by non-surgical periodontal therapy in association with diode laser compared to conventional non-surgical therapy

Journal of Advanced Health Care ◽

10.36017/jahc2003-008 ◽

2020 ◽

Author(s):

Bellia Loredana ◽

Ruggiero Roberta ◽

Nicolò Michele

Keyword(s):

Surgical Treatment ◽

Diode Laser ◽

Surgical Therapy ◽

Test Group ◽

Control Group ◽

Probing Depth ◽

Baseline Test ◽

Mechanical Therapy ◽

Non Surgical Treatment

Mechanical surface treatment and removal of the above and subgingival biofilm (Tartar ablation; SRP) are considered the most suitable tools for the treatment of periodontal inflammatory diseases, with the aim of destroying bacterial bioflim, reducing bacteria, and slowing down recolonization by pathogenic microorganisms. Often, however, the only S&RP are not enough, as there are patients who are experiencing relapses. Recently, laser therapy has been suggested as a potential tool to improve the outcome of periodontal non-surgical treatment. The objective of the following study was to evaluate the clinical healing of periodontal pockets treated with mechanical therapy, scaling and root planing, and diode laser application, compared to that obtained with non-surgical mechanical therapy alone. The study was designed as a randomized controlled clinical trial. Patients in the control group (13 patients) underwent conventional non-surgical therapy only, while patients in the test group (17 patients) were associated with conventional non-surgical treatment, a laser irradiation session. At baseline and after 6 months, the parameters of probing depth (PD), bleeding on probing (BOP), gingival recession (REC) were assessed The main variable of this study was the PD (probing depth) FMPS and FMBS at follow-up improved in both groups. The FMPS baseline test group 32.59 ± 6.74 - follow up 12.00 ± 3.16. The baseline of the control group showed 33.00 ± 9.55, the follow up 13.15 ± 4.85 The FMBS baseline test group found 24.29 ± 5.01 while at follow 9.65 ± 2.69. The baseline control group 30.31 ± 7.74, Follow up 11.08 ± 2.33. There is a statistical significance. (P.VALUE 0.0001) There were no significant differences between the groups in terms of PD, CAL and BOP at baseline and at follow-up. PD Test group 4,89±1,58 3,95±0,85 0,0001 Control group 5,02±1,57 4,01±0,86 CAL (mm)Test group 0,89±2,29 0,77±1,91 Control group 0,28±1,38 0,24±1,14 REC Test group 0,19±0,49 0,19±0,51 Control group 0,06±0,29 0,57±029 BOP Test group 51,2% 23,5% Control group 54,0% 20,9% The results showed differences in both baseline and follow-up for REC. Test group 0,19±0,49 0,19±0,51-Control group0,06±0,29 0,57±029 In intra-group analyzes, there are differences between baseline and follow-up for all values, except for REC in the control group. The diode laser can be used as an appropriate device for periodontal treatments, but it can offer additional and significant benefits if used according to appropriate protocols and parameters, and especially if associated with non-surgical, manual and ultrasound periodontal instrumentation, always site-specific , as it is a tool that does not replace traditional methods.

Download Full-text

A new technique for diode laser cyclophotocoagulation: short term results

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2009.3155.x ◽

2009 ◽

Vol 87 ◽

pp. 0-0

Author(s):

M SURIANO ◽

O STIRBU ◽

J VILA ARTEAGA

Keyword(s):

Diode Laser ◽

New Technique ◽

Short Term ◽

A New Technique ◽

Diode Laser Cyclophotocoagulation

Download Full-text

Micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma

European Journal of Ophthalmology ◽

10.1177/1120672119858226 ◽

2019 ◽

Vol 30 (5) ◽

pp. 1149-1155 ◽

Cited By ~ 1

Author(s):

Eman M Elhefney ◽

Tharwat H Mokbel ◽

Sherein M Hagras ◽

Ahmed A AlNagdy ◽

Adel A Ellayeh ◽

...

Keyword(s):

Intraocular Pressure ◽

Diode Laser ◽

Congenital Glaucoma ◽

Secondary Outcome ◽

Cumulative Probability ◽

Pediatric Glaucoma ◽

Significant Difference ◽

The Mean ◽

Diode Laser Cyclophotocoagulation

Purpose: To evaluate the intermediate-term efficacy and safety of micropulsed diode laser cyclophotocoagulation in recurrent pediatric glaucoma. Patients and Methods: A prospective interventional study included children <16 years old diagnosed with recurrent glaucoma, attending Mansoura University, during the period from July 2017 to November 2017. Micropulsed diode laser sessions were performed in all the cases. The main outcome was the intraocular pressure reduction with monitoring of complications as secondary outcome. The mean follow-up period was 15.08 ± 1.1 (mean: 12–16) months. Results: A total of 36 eyes of 29 patients were included (62% males) with median age of 24 months. Primary congenital glaucoma represented 47.2% of the initial diagnoses. At the 15th month, the mean intraocular pressure dropped significantly from 37.5 ± 11.3 mmHg at baseline to 20.03 ± 2.7 mmHg (p < 0.001) with 37.15% reduction. The mean number of glaucoma medications decreased significantly from 2.6 ± 0.5 pretreatment to 1.7 ± 0.6 at the 15th month (p < 0.001). A total of 24 eyes (66.7%) required second session of treatment with mean number of 1.7 ± 0.5 sessions per eye. The cumulative probability of qualified success was 69.4%, 58.3%, 52.8%, 47.2%, and 41.7% at 1, 3, 6, 12, and 15 months after treatment. Qualified success was achieved in 61% at 15 months without statistically significant difference between the initial diagnoses (p = 0.61). None of the eyes developed any major ocular complications throughout the follow-up period. Conclusion: Micropulsed diode laser was proved to be a safe approach with relative effectiveness in controlling intraocular pressure in children with recurrent glaucoma.

Download Full-text