scholarly journals MANAGEMENT OF LUMBOSACRAL RADICULITIS

2020 ◽  
Vol 8 (4) ◽  
pp. 439-447
Author(s):  
Ie.I. Slynko ◽  
O.O. Potapov ◽  
Yu.V. Derkach ◽  
A.I. Ermoliev ◽  
A.Ya. Andrukhiv
Keyword(s):  
Conservative Treatment ◽  
Treatment Effectiveness ◽  
Additional Treatment ◽  
Clear Correlation ◽  
Long Term Outcomes ◽  
Surgical Methods ◽  
Endoscopic Discectomy ◽  
Methods Of Treatment ◽  
Relapse Rates

4,000 patients with discogenic lumbosacral radiculitis were treated. 2,000 patients were managed conservatively, 1,000 patients underwent microdiscectomy and 1,000 patients underwent endoscopic discectomy. The authors of the paper compared indications for different types of treatment, effectiveness of treatment, and duration of rehabilitation. The age of patients in both groups ranged 18 to 78 years. Treatment outcomes were evaluated using the Macnab scale, including the need for additional treatment, duration of rehabilitation treatment, and terms of return to work. Currently, the results of conservative treatment of lumbar hernias are being discussed in the literature. In general, according to authors, the result of conservative treatment is inversely proportional to the size of hernias: the smaller the hernia, the more successful the treatment results. Moreover, there is no clear correlation with the conservative treatment methods. At the same time, the results of surgical intervention directly correlate with the size of hernias or sequesters: the larger the hernia, the better the outcome. Alternatively, microsurgical and endoscopic interventions were used with similar outcomes and relapse rates. The long-term outcomes were tracked using the Macnab scale. Relapses of hernias in the endoscopic discectomy group were found in 18 patients, which was 1.8%. Relapses of hernias in the microdiscectomy group were found in 11 patients, which was 1.1%. Modern conservative methods of treatment allow good outcomes for treatment of hernias even up to 8 mm. In patients with hernias 8 mm to 10 mm the results of conservative treatment were generally not satisfactory and relapses occurred quickly. In patients with hernias of more than 10 mm, conservative treatment is not recommended; positive outcomes are possible only with the use of surgical methods.

scholarly journals Long-term outcomes of coil embolization of unruptured intracranial aneurysms

2018 ◽  
Vol 129 (6) ◽  
pp. 1492-1498 ◽  
Author(s):  
Masaomi Koyanagi ◽  
Akira Ishii ◽  
Hirotoshi Imamura ◽  
Tetsu Satow ◽  
Kazumichi Yoshida ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Additional Treatment ◽  
Long Term Outcomes ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
Long Term Follow Up ◽  
Multiple Stroke

OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

Sequenced Treatment Alternatives to Relieve Depression

2018 ◽  
Author(s):  
Eric Lin ◽  
Pochu Ho
Keyword(s):  
Long Term Outcomes ◽  
Population Number ◽  
Study Population ◽  
Location Study ◽  
Study Participants ◽  
Study Intervention ◽  
Treatment Alternatives ◽  
Relapse Rates

This chapter provides a summary of the landmark Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial on major depressive disorder. The STAR*D trial was designed to address some basic questions about depression treatment. What are the outcomes and the remission rates for depression? What are the long-term outcomes, especially the relapse rates, for patients receiving sequential depression therapies? Starting with these questions, this chapter describes the basics of the STAR*D trial, including funding, study location, study population, number of study participants, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. In addition, this chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

PS02.098: LONG-TERM OUTCOMES OF ADDITIONAL THERAPY FOLLOWING ENDOSCOPIC RESECTION FOR T1B-SM ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 148-149
Author(s):  
Tsuyoshi Tanaka ◽  
Masaki Ueno ◽  
Toshiro Iizuka ◽  
Shu Hoteya ◽  
Shusuke Haruta ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Lymphatic Invasion ◽  
Additional Treatment ◽  
Long Term Outcomes ◽  
Free Survival ◽  
Risk Factors For Recurrence ◽  
Recurrent Patterns

Abstract Background Esophagectomy is the standard treatment strategy for superficial esophageal cancer diagnosed as pT1b(sm) following endoscopic resection (EMR/ESD). However, chemoradiotherapy (CRT) is expected to be an alternative treatment option. This study retrospectively compared the long-term outcomes of surgery and CRT as additional treatments for EMR/ESD pT1b esophageal cancer. Methods In a retrospective single-center study, the data of 83 consecutive patients who underwent EMR/ESD and were diagnosed with pT1b(sm) from January 2002 to December 2013 were collected, and additional treatment was administered to 59 of these patients (26 surgery and 33 CRT). Long-term outcomes, recurrent patterns, and risk factors for recurrence were analyzed. Results Median patient age was 63 (range, 43–79) years, and male/female ratio was 54:5. Tumor characteristics were as follows: location, Ce/Ut/Mt/Lt/Ae/EG = 1/6/32/13/3/4; median size, 25 (range, 5–88) mm; depth, sm1/sm2 = 18/41; vascular invasion (ly, v), + / − = 37/22; and cut end (HM, VM), + or × / − = 17/42. Sex, Charlson comorbidity index, tumor size, macroscopic type, cut end, and resection state were not different between the two groups. Meanwhile, age, tumor location, histological type, tumor depth, and vascular invasion were different between the two groups. The 5-year survival rates (relapse-free survival rate; RFS) were 92.3% (92.3%; RFS) and 80.3% (70.4%; RFS) in the surgery and CRT groups, respectively. The surgery group was significantly superior to the CRT group in terms of RFS (P = 0.042). All tumor recurrence was observed in the CRT group (P = 0.030). Recurrent patterns were as follows: hematogenous metastases (lung, bone, and adrenal gland) in three patients and lymph node metastases (four regional and an extra-regional) in four patients. In multivariate analysis, tumor size (P = 0.048) and lymphatic invasion (P = 0.032) were revealed as significant risk factors for recurrence in the CRT group. Conclusion Surgery is recommended as the additional treatment for ESD/EMR-pT1b esophageal cancer for better recurrent-free survival. Although CRT could be an acceptable treatment choice, the indication should be carefully decided, particularly in cases with large tumor size or lymphatic invasion. Disclosure All authors have declared no conflicts of interest.

Different treatment options for Takayasu arteritis patients with moderate-to-severe aortic regurgitation: long-term outcomes

Rheumatology ◽  
2020 ◽  
Author(s):  
Xuesen Cheng ◽  
Zuozhi Li ◽  
Aimin Dang ◽  
Naqiang Lv ◽  
Qian Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conservative Treatment ◽  
Aortic Regurgitation ◽  
Takayasu Arteritis ◽  
Baseline Risk ◽  
Long Term Outcomes ◽  
End Points ◽  
Severe Aortic Regurgitation ◽  
All Cause Mortality

Abstract Objectives To determine the prognosis of Takayasu arteritis (TA) patients with moderate-to-severe aortic regurgitation treated with surgical vs conservative treatment and to identify independent prognostic factors of long-term outcomes. Methods Between January 2002 and January 2017, 101 consecutive TA patients with moderate-to-severe aortic regurgitation treated with either surgical (n = 38) or conservative (n = 63) treatments were investigated in this retrospective observational case–control study. The primary end point was all-cause mortality, and the secondary end point comprised the combined end points of death, non-fatal stroke and cardiac events (non-fatal myocardial infarction and congestive heart failure). Propensity score matching was used to reduce the bias of baseline risk factors. Results The unadjusted all-cause 10-year mortality in the conservative group was increased compared with the surgical group (28.2% vs 7.4%; log-rank P = 0.036), and the combined end points showed the same trend (52.1% vs 25.3%; log-rank P = 0.005). After an adjustment of baseline risk factors, the conservative treatment was associated with reduced survival rates of both all-cause mortality [hazard ratio (HR): 8.243; 95% CI: 1.069, 63.552; P = 0.007] and combined end points (HR: 6.341; 95% CI: 1.469, 27.375; P = 0.002). Conservative treatment (HR: 3.838, 95% CI: 1.333, 11.053; P = 0.013) and left ventricular end-diastolic diameter (HR: 1.036, 95% CI: 1.001, 1.071; P = 0.042) were risk factors for increased combined end points. Conclusion Surgical treatment improves the outcomes of patients with moderate-to-severe aortic regurgitation due to TA. The dilated left ventricle indicated a worse prognosis.

scholarly journals The effectiveness of the surgical correction of the temporomandibular joint intracapsular disorders

2019 ◽  
Vol 10 (2) ◽  
pp. 6-13
Author(s):  
Ilya N. Lyashev ◽  
Andrey M. Dybov ◽  
Polina V. Kholmogorova
Keyword(s):  
Temporomandibular Joint ◽  
Treatment Effectiveness ◽  
Surgical Correction ◽  
Patient Treatment ◽  
Joint Diseases ◽  
Splint Therapy ◽  
Orthopedic Rehabilitation ◽  
Surgical Methods ◽  
Stable Result

Background. The prevalence of temporomandibular joint diseases covers about 40% of the population. The main place (from 70 to 82%) among these diseases is occupied by the so-called intracapsular disorders of the temporomandibular joint (TMJ). The lack of consensus on the use of treatment methods and clear protocols for the rehabilitation of patients with intracapsular TMJ disorders was the basis for the conduct of this study. Objective. The purpose of the study was to analyze the treatment effectiveness in patients with intracapsular disorders of the temporomandibular joint using the complex of pathogenetically substantiated conservative and surgical methods. Methods. The research included 43 patients with complaints to pains and dysfunction of TMJ. Everything fulfilled the uniform protocol of inspection. Depending on disease degree to patients were assigned or a course of conservative treatment with use splint therapy, or surgical correction of defect. Results. After analyzing the dynamics of patient treatment in the framework of this study, it was found that surgical correction of intracapsular disorders of the temporomandibular joint was effective in all patients examined by us. Conclusion. To maintain a long-term stable result, this group of patients is shown orthodontic-orthopedic rehabilitation, with the goal of creating and maintaining correct occlusal relationships.

Robotic surgery in gynecology

2012 ◽  
Vol 153 (25) ◽  
pp. 967-972
Author(s):  
Roland Csorba
Keyword(s):  
Robotic Surgery ◽  
Gynecologic Oncology ◽  
Surgical Approaches ◽  
Long Term Outcomes ◽  
Post Operative Pain ◽  
Surgical Methods ◽  
Adnexal Surgery ◽  
The Right ◽  
Oncologic Diseases

Minimally invasive surgery has revolutionized gynecological interventions over the past 30 years. The introduction of the da Vinci robotic surgery in 2005 has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. It can be utilized mainly in general gynecology and reproductive gynecology. The robot is being increasingly used for procedures such as hysterectomy, myomectomy, adnexal surgery, and tubal anastomosis. In urogynecology, the robot is being utilized for sacrocolopexy as well. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomy and lymphadenectomy in oncologic diseases. Despite the rapid and widespread adaption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. This article presents the development, technical aspects and indications of robotic surgery in gynecology, based on the previously published reviews. Robotic surgery can be highly advantageous with the right amount of training, along with appropriate patient selection. Patients will have less blood loss, less post-operative pain, faster recovery, and fewer complications compared to open surgery and laparoscopy. However, until larger randomized control trials are completed which report long-term outcomes, robotic surgery cannot be stated to have priority over other surgical methods. Orv. Hetil., 2012, 153, 967–972.

scholarly journals Review and Long-Term Outcomes of Cruciate Ligament Reconstruction versus Conservative Treatment in Siblings with Congenital Anterior Cruciate Ligament Aplasia

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Diego Davanzo ◽  
Paolo Fornaciari ◽  
Geoffroy Barbier ◽  
Mauro Maniglio ◽  
Daniel Petek
Keyword(s):  
Anterior Cruciate Ligament ◽  
Conservative Treatment ◽  
Cruciate Ligament ◽  
Patient Counseling ◽  
Long Term Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Anterior Cruciate

There is no consensus on the best treatment for anterior cruciate ligament hypoplasia or aplasia. To our knowledge, no comparative study between operative and conservative treatment of this condition has ever been performed. Conservative treatment is a viable alternative to surgery for ACL aplasia. Two siblings were examined at our outpatient clinic. The male patient underwent bilateral ACL reconstruction, while his sister was treated conservatively. Our results show a worse long-term outcome for the operative patient. At her last follow-up, the female patient treated conservatively showed subjective improvement in stability and gait. A review of the literature shows inconsistent outcomes after reconstruction in contrast to reports with cruciate ligament agenesis that did not undergo reconstruction with acceptable to good outcomes. Cruciate reconstruction should be reserved for cases of impaired articular instability, objectively manifest in the frequency of giving-way episodes. Treatment depends on the patient’s condition and expectations. Surgery should therefore only be suggested after proper patient counseling.

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