Clinical Treatment Procedures Research Articles

Treatment of Snoring and Obstructive Sleep Apnea - Oral Appliance Therapy of Snoring and OSA -

Oral appliance therapy is a simple, reversible way for improving snoring and/or obstructive sleep apnea. It may be indicated for the patients who are unable to tolerate continuous positive airway pressure (CPAP) or who have potential risks for surgical intervention. Oral appliance therapy increases airway space by the providing stable anterior positioning of the mandible, pulling out tongue, lifting up soft palate, or changing the muscle activity of the genioglossus. Currently, more than 80 different types of oral appliances have been introduced for snoring and/or obstructive sleep apnea. They are classified by their characteristics such as mode of action, adjustability and material used. This article provides a detailed clinical protocol and treatment procedure for oral appliance therapy.

A Metaanalysis of the Effectiveness and Safety of Ozone Treatments for Herniated Lumbar Discs

To determine statistically significant effects of oxygen/ozone treatment of herniated discs with respect to pain, function, and complication rate. Random-effects metaanalyses were used to estimate outcomes for oxygen/ozone treatment of herniated discs. A literature search provided relevant studies that were weighted by a study quality score. Separate metaanalyses were performed for visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab outcome scales, as well as for complication rate. Institutional review board approval was not required for this retrospective analysis. Twelve studies were included in the metaanalyses. The inclusion/exclusion criteria, patient demographics, clinical trial rankings, treatment procedures, outcome measures, and complications are summarized. Metaanalyses were performed on the oxygen/ozone treatment results for almost 8,000 patients from multiple centers. The mean improvement was 3.9 for VAS and 25.7 for ODI. The likelihood of showing improvement on the modified MacNab scale was 79.7%. The means for the VAS and ODI outcomes are well above the minimum clinically important difference and the minimum (significant) detectable change. The likelihood of complications was 0.064%. Oxygen/ozone treatment of herniated discs is an effective and extremely safe procedure. The estimated improvement in pain and function is impressive in view of the broad inclusion criteria, which included patients ranging in age from 13 to 94 years with all types of disc herniations. Pain and function outcomes are similar to the outcomes for lumbar discs treated with surgical discectomy, but the complication rate is much lower (<0.1%) and the recovery time is significantly shorter.

Orthodontic elastic materials.

Latex elastics and synthetic elastomers have certain similarities and differences. In the fracture tests the latex elastics showed a greater amount of loss in strength than plastic elastomers when stretched over a 21 day period. There is a great variability, as much as 50%, in the tensile strength of the plastic materials taken from the same batch and stretched under the same conditions. The Ormco Power Chain was more resilient than the Unitek AlastiK chain. The Unitek AlastiKs had more force and stretched less. The force decay of synthetic elastomers, stretched over a specific length and time, exhibited a great loss in force. This loss could be as great as 73% during the first day. The decay of force continued at a slower rate during the rest of the 21 day period. Unitek AlastiK C2 double links, when stretched 17 millimeters, had a higher initial force averaging 641 grams (22.5 ounces) than the Ormco Power Chain which averages 342 grams (12.0 ounces). In one day the force was reduced to 171 grams (6.0 ounces) for both materials. The elastic materials within the same batch showed a great variation in the modulus of elasticity under different test conditions. The approximate force generated when stretched dry, within the elastic limit, was 22 grams per millimeter for 3/16 inches heavy latex elastics. The Unitek AlastiK C2 gave a force of 89 grams per millimeter, while the Ormco Power Chain had a value of 46 grams per millimeter. The modulus of elasticity of all of the materials was much lower after immersion in the water bath. The force decay under constant force application to latex, elastic, polymer chains, and tied loops showed that the greatest amount of force decay occurred during the first three hours in the water bath. The forces remained relatively the same throughout the rest of the test period. The elastic materials undergo permanent deformation in shape. The synthetic elastomers exhibited plastic deformation when the elastomers were stretched 17 millimeters for 21 days. In the dry condition the force decay was 63% for the Unitek chains and 42% for the Ormco Power Chain. The synthetic elastomers should be prestretched before being placed in the mouth. The elastomers should be used within their resilient ranges. Clinical treatment procedures should take into consideration the rapid initial force decay of elastic materials that occurs during the first day and the residual forces remaining.

The effect of low-level helium-neon (HeNe) laser radiation on the secretion of cytokines that promote chronic graft rejection – An in vitro study

Basically chronic graft rejection is a type-IV hypersensitivity process, also known as delayed-type hypersensitivity (DTH). The role of cytokines secreted from T-cell lymphocytes is known in this process. Among these cytokines, the biggest role belongs to the transforming growth factor beta (TGF-β) and interleukin-2 (IL-2). Many studies have been published on the effect of low level lasers (LLL) on DTH, but not many have focused on the mechanism of LLL effects on DTH, which is also the mechanism of chronic graft rejection. If LLL are able to decrease the level of cytokines effectively in this process, then it would be possible to use it to prevent chronic graft rejection, either alone or combined with routine treatments, to give fewer treatment side effects. This study was designed to evaluate the effect of LLL on the amount of cytokines secreted by T-cells after stimulation in vitro by foreign antigens. Human peripheral blood mononuclear cells were cultured and the cells were divided into 4 groups (control #1, control #2, case #1, and case #2). Control group #1 was the base group and the cells received neither stimulation nor irradiation. Control group #2 was only stimulated by phytohaemagglutinin (PHA); no laser irradiation was carried out. Case group #1 received daily laser irradiation for a total of 9 days, starting one day prior to stimulation with PHA. Case group #2 was given daily laser irradiation for a total of 7 days, starting one day after the stimulation with PHA. Both case groups were irradiated with the same helium-neon (HeNe) laser device (parameters: 632.8 nm, 4 J/cm2). On days 3, 5 and 8 of the experiment, the level of the cytokines interleukins IL-2 and IL-12, TGF-β and interferon gamma (INT-γ) were checked by the ELISA method in all the groups and the data were analyzed using SPSS 11.5. Our results showed that low-level irradiation can decrease the level of cytokines that are known to be stimulators for chronic graft rejection (IL-2, IL-12, TGF-β and INF-γ). However, we did not find any significant differences between our two case groups. Although this study suggests the successful role of LLL in preventing chronic graft rejection by affecting the cytokines known to have significant role in this process, further experimental studies and dosage determination experiments are required before using LLL in clinical treatment procedures. Bei der chronischen Abstoßung von Transplantaten handelt es sich im wesentlichen um eine Typ-4-Überempfindlichkeitsreaktion, auch bekannt als verzögerte Überempfindlichkeit (DTH=delayed-type hypersensitivity). Es ist bekannt, dass dabei die Zytokinproduktion der T-Zellen eine wichtige Rolle spielt. Zu den wichtigsten Zytokinen gehören der transformierende Wachstumsfaktor (TGF-β=transforming growth factor beta) und Interleukin 2 (IL-2). Viele bereits publizierte Studien haben zwar den Effekt von Low-Level-Laserstrahlung auf die DTH untersucht, jedoch sind die dabei wirkenden Mechanismen, die auch der chronischen Abstoßung zugrunde liegen, nur selten betrachtet worden. Wenn es gelingen könnte, mit einer Low-Level-Lasertherapie die Zytokinproduktion effektiv zu verringern, so könnte diese Therapie entweder allein oder in Kombination mit anderen herkömmlichen Therapien eingesetzt werden, um chronische Transplantat-Abstoßungen zu vermeiden. Ziel der vorliegenden In-vitro-Studie war es daher, zu untersuchen, in welchem Maße die Bestrahlung mit einem Low-Level-Laser die Zytokinproduktion der T-Zellen nach Stimulation mit einem Fremdantigen beeinflusst. Humane mononukleäre Zellen des peripheren Blutes (PBMC) wurden mit den üblichen Standardmethoden kultiviert und in vier Gruppen (2 Kontrollgruppen, 2 Versuchsgruppen) untersucht. Die Zellen der Kontrollgruppe 1 wurden weder stimuliert noch bestrahlt. Die Zellen der Kontrollgruppe 2 wurden täglich mit Phytohämagglutinin (PHA) stimuliert, jedoch nicht laserbestrahlt. Proben der Versuchsgruppen 1 und 2 wurden täglich mit einem HeNe-Laser (konstante Laserparameter: 632.8 nm, 4 J/cm2) bestrahlt und mit PHA stimuliert, wobei mit der Bestrahlung entweder einen Tag vor Beginn der PHA-Stimulation (Versuchsgruppe 1) oder einen Tag nach Beginn der PHA-Stimulation (Versuchsgruppe 2) gestartet wurde. Am 3., 5. und 8. Tag des Experimentes wurde in allen Untersuchungsgruppen der Zytokingehalt von Interleukin 2 und 12 (IL-2, IL-12), TGF-β und Gamma-Interferon (INT-γ) mittels ELISA-Methode bestimmt. Die statistische Auswertung erfolgte mit Hilfe von SPSS 11.5. Mit der durchgeführten Low-Level-Laserbestrahlung konnte in vitro die Produktion der Zytokine IL-2, IL-12, TGF-β und INF-γ, von denen bekannt ist, dass sie chronische Abstoßungsreaktionen fördern, verringert werden. Jedoch wurden keine signifikanten Unterschiede zwischen den beiden Versuchsgruppen gefunden. Die vorgestellte Studie unterstützt die Annahme, dass mit einer Low-Level-Lasertherapie möglicherweise eine chronische Transplantat-Abstoßung vermieden werden kann. Es sind allerdings weitere Studien, insbesondere zur Laserdosimetrie nötig, bevor diese Therapieform in die klinische Praxis überführt werden kann.

Determination of the Efflux Pump-Mediated Resistance Prevalence in Pseudomonas aeruginosa, Using an Efflux Pump Inhibitor

In gram negative bacteria, fluoroquinolone resistance is acquired by target mutations in topoisomerase genes or by reducing the permeation of drugs due to the increase in expression of endogenous multidrug efflux pumps that expel structurally unrelated antimicrobial agents. An ongoing challenge is searching for new inhibitory substances in order to block efflux pumps and restore the antibiotic drugs susceptibility. In this research, we sought to investigate the interplay between ciprofloxacin and an efflux pump inhibitor (EPI), phenyl alanine arginyl beta-naphtylamide (PAbetaN), to determine the prevalence of efflux pump overexpression in clinical isolates of Pseudomonas aeruginosa. Ciprofloxacin was tested at different concentrations (256-0.25 microg/ml) with a fixed concentration of PAbetaN (50 microg/ml). The isolates susceptibility profiles were analyzed by disc diffusion and agar dilution methods using 10 antibiotic discs and 4 powders. It was found that in the presence of PAbetaN, resistance to ciprofloxacin was inhibited obviously and MIC values were decreased. The comparison between subgroups of P. aeruginosa isolates with different resistance profiles indicates that efflux pump overexpression (EPO) is present in 35% of ciprofloxacin resistant isolates with no cross resistance and in variable frequencies among isolates showing cross resistance to other tested antibiotics: gentamicin (31%), ceftazidime (29%), and imipenem (18%). Altogether, these results imply that PAbetaN maybe effective to restore the fluoroquinolone drugs susceptibility in clinical treatment procedures. Results also show that increased use of a fluoroquinolone drug such as ciprofloxacin can affect the susceptibility of P. aeruginosa to other different antipseudomonal agents.

Hot Topics in Dysphagia

Hot Topics in Dysphagia

Postradiation nasopharyngeal necrosis in the patients with nasopharyngeal carcinoma

Radiation-induced nasopharyngeal necrosis is a consequential late effect in the patients with nasopharyngeal carcinoma (NPC). Patients with NPC who have been treated with high-dose radiotherapy are at risk of developing postradiation nasopharyngeal necrosis (PRNN). However, the analysis of PRNN with a significant cohort of patients has not been reported in English-language literature. In this study, we aimed to evaluate PRNN in 28 patients with NPC. From June 2006 to December 2007, 28 patients were diagnosed with PRNN with pathologic evidence. Surgical procedure of endoscopy-guided debridement and systemic anti-inflammatory treatments were conducted for the patients. Their clinical features, treatment procedures, and outcomes were analyzed retrospectively. Clinical symptoms such as foul odor and headache were alleviated in all, 8 patients were cured of their PRNN, 9 patients with exposed internal carotid artery died of sudden nasopharyngeal massive bleeding, and 3 patients died of exhaustion (cachexia). PRNN is an important consequential late effect of radiotherapy in the patients with NPC. Internal carotid artery erosion is a severe situation and acts as an independent prognostic factor for the patients. Diagnosis of PRNN could be made after ruling out the persistent-recurrent NPC proven by pathologic examination. Surgery is effective for improving the quality of life and for curing PRNN.

The MASTER registry on venous thromboembolism: Description of the study cohort

IntroductionInformation on the epidemiology and long-term clinical outcome of venous thromboembolism (VTE) is mainly based on data from clinical trials and thus may be not representative of the full spectrum of VTE patients. The aim of this multicenter registry (MASTER) was to prospectively collect data on the epidemiology and long-term clinical outcome of VTE in an unselected cohort of patients. Materials and methodsIn symptomatic patients with objectively confirmed acute VTE, information about clinical presentation, diagnostic methods, temporary and permanent risk factors, pre-event prophylaxis and treatment were captured by an electronic data network at the time of the index event. A 24-month follow-up is currently ongoing. ResultsFrom January 2002 to October 2004, 2119 patients were included in the MASTER registry in 25 Italian centers. At entry, the mean patient age was 59.3±18.1 years (range 18–99 years). 1541 patients (72.7%) were affected by deep vein thrombosis, 206 patients (9.7%) by pulmonary embolism and 372 patients (17.5%) by both deep vein thrombosis and pulmonary embolism. 676 patients (31.9%) received home-treatment. 899 patients (42.4%) had one or more temporary risk factors. 381 patients (18.0%) had a known cancer at the time of the index event and in 50 patients (2.4%) a new cancer was discovered at the time of the index event. 311 patients (14.7%) had a previous VTE. ConclusionsFollowing a real world approach, our registry describes the clinical presentation, risk factors, diagnosis and treatment procedures in a large cohort of unselected patients with VTE.

Clinical analysis and treatment procedures for computer aided design and computer aided manufacture of denture

义齿计算机辅助设计(computer aided design,CAD)与计算机辅助制作(computer aided manufacture,CAM)是口腔修复的最大进展之一,从根本上改变了传统的义齿制作方法,被称为义齿制作史上的一场革命.基本方法为对预备好的基牙或人工种植牙上部结构进行三维形态测量,然后对获得的三维数据进行计算机图像化分析与设计,模拟修复体的形态,再通过数据仿真加工完成义齿的制作。

Endometriosis: clinical monitoring and treatment procedures in Rhesus Monkeys

The National Institute on Aging (NIA) sponsored a workshop on September 8, 2004, to discuss the incidence, diagnosis, and clinical treatment of endometriosis in rhesus monkey colonies. Because of the growing number of aging studies using rhesus monkeys, this disease has become more prevalent as monkeys are living into advanced ages in captivity. The objective of the workshop was to gather information from various NIA-supported aging rhesus colonies on the incidence, clinical manifestations, indicators for early detection, and possible treatment options for endometriosis. Participants outlined a course of action for the effective management of this disease that would best maintain the integrity of long-term aging studies.

A Sea-Change in American Dentistry: A National Clinical Licensure Examination, or a Residency-Based Pathway?

Evidence is not available from any controlled studies for many decisions that affect the quality of dental patient care. This is certainly true for entry-level dental licensure. If the purpose of licensure is to protect the public, is there evidence that it does so? Its proponents point to educational accreditation as a process-driven system, without valid or reliable outcome assessments. For many years, the educational community has relied upon the accreditation process for its educational standards, pointing to the licensure process as the external audit of educational outcomes. More recently, leaders in the educational community have called for the elimination of clinical licensure examinations on live patients. Educators have suggested that Bin-house[ solutions, such as portfolios of student performance, are more valid, reliable, and ethical. The other parties in this arena, the dental examiner and organized dentistry communities, have now weighed in. In its most effective role, the American Dental Association has facilitated conversations, conferences, and consensus to bring about licensure by credentials to as many as 44 states. The examiner community, through the American Association of Dental Examiners (AADE), has responded by developing a single national clinical licensure examination. The 2 major organizations within this community, the American Board of Dental Examiners (ADEX) and the Western Regional Examining Board (WREB), are now poised to offer clinical exams that would be accepted by virtually all states and jurisdictions. There is another community of interest, however, the candidates. They have a variety of opinions, but their principal interest is mobility; or, phrased another way, freedom of movement. They want licensure in any and all jurisdictions to result from one exam process. Who can blame them? Their educational institutions are accredited. Their faculty certify them for their doctoral degrees. Why should they have to jump through hoops in 53 different jurisdictions in a mobile society? They are frustrated with what they see as turf battles. That may be, but examiners know (and students know) that every graduate of every accredited dental school is not competent at minimal standards. They’ll tell youVjust ask them. Some of us have a frustration from being members of every one of these communities of interest. We see a system designed over 100 years ago to solve a problem that no longer existsVproprietary diploma mills that had no educational standards, ethical standards, or accreditation. And then, along comes a real pioneering ideaVscrap the clinical licensure exam and substitute another outcomes assessment. After all, why should Dentistry be the only clinical health care profession requiring a university-based doctoral degree recipient to undergo a process requiring clinical treatment procedures on live patients to achieve entry-level licensure? So, the New York State Dental Association successfully lobbied their legislature to eliminate clinical licensure exams. But they didn’t ask for a free ride. They sought and achieved the substitution of an ADA Commission on Dental AccreditationYapproved residency program completion for entry-level licensure. That’s a sea-change, if there ever was one. Who has it right? As one of the cable news networks states: We report, and you decide. Our speakers are:

Magnetic resonance imaging of neck chondrosarcoma: A case report

Chondrosarcoma is a malignancy rarely encountered in the head and neck. The reported prevalence of chondrosarcoma involving the head and neck region has a range of 1–12%. In our case report, we demonstrate a chondrosarcoma of the left lower neck region by means of magnetic resonance imaging. We were not able to show its exact origin and considered the possibility of a rare extraosseous origin. It presented as a slowly growing, painless mass and showed characteristic calcification and high signal intensity on long TR, long TE sequences. It caused left jugular vein compression and left subclavian artery kinking due to mass effect. Histopathologic examination revealed a low-grade mesenchymal myxoid chondrosarcoma. In this study, we review the clinical presentation, imaging features, management, and treatment procedures of these rare tumors.

Effects of inhaled corticosteroids on sputum cell counts in stable chronic obstructive pulmonary disease: a systematic review and a meta-analysis

BackgroundWhether inhaled corticosteroids suppress airway inflammation in chronic obstructive pulmonary disease (COPD) remains controversial. We sought to determine the effects of inhaled corticosteroids on sputum indices of inflammation in stable COPD.MethodsWe searched MEDLINE, EMBASE, CINAHL, and the Cochrane Databases for randomized, controlled clinical trials that used induced sputum to evaluate the effect of inhaled corticosteroids in stable COPD. For each chosen study, we calculated the mean differences in the concentrations of sputum cells before and after treatment in both intervention and control groups. These values were then converted into standardized mean differences to accommodate the differences in patient selection, clinical treatment, and biochemical procedures that were employed across original studies. If significant heterogeneity was present (p < 0.10), then a random effects model was used to pool the original data. In the absence of significant heterogeneity, a fixed effects model was used.ResultsWe identified six original studies that met the inclusion criteria (N = 162 participants). In studies with higher cumulative dose (≥ 60 mg) or longer duration of therapy (≥ 6 weeks), inhaled corticosteroids were uniformly effective in reducing the total cell, neutrophil, and lymphocyte counts. In contrast, studies with lower cumulative dose (< 60 mg) or shorter duration of therapy (< 6 weeks) did not demonstrate a favorable effect of inhaled corticosteroids on these sputum indices.ConclusionsOur study suggests that prolonged therapy with inhaled corticosteroids is effective in reducing airway inflammation in stable COPD.

Evaluation of high-resolution computed tomography in diagnosis and treatment of scaphoid fracture

目的 评价高分辨率CT在急性舟骨骨折诊断和治疗中的应用价值. 方法术前对4 6例47侧舟骨骨折患者进行腕关节常规X线片检查,其中对27例采用高分辨率CT检查.术后对全部47侧 腕关节进行X线片及CT检查.结果术前42侧腕关节X线检查显示舟骨骨折 ,5侧未能显示.C T检查明确显示27例舟骨骨折的部位、骨折移位和粉碎的情况.术后发生舟骨骨折不愈合、 畸形愈合、螺钉的位置以及创伤性关节炎等均可在CT扫描时清楚显示.结论 CT检测能提高舟骨骨折的诊断水平,为临床制定治疗方案提供可靠依据。

Solitary extramedullary plasmacytoma arising in the pterygoid fossa

A case of solitary extramedullary plasmacytoma of the left pterygoid fossa is presented, which is an unusual location for such tumors. A 54-year-old male patient was admitted for retro-orbital and left-sided facial pain which had persisted for several months. Physical, nasal endoscopic and optic examinations showed no abnormalities. No palpable cervical lymph nodes were found. MRI revealed a 2-cm mass in the left pterygoid fossa. A biopsy was carried out and the resulting histological evaluation of the mass confirmed a plasmacytoma. A comprehensive work-up, including bone marrow biopsy, total-body skeletal survey, technetium scintigrams, determination of urine Bence-Jones protein and serum myeloma protein, chest radiograph, total blood count and urinalysis, was carried out in order to rule out multiple myeloma. All of these studies were unremarkable in terms of a systemic disease and therefore the patient was diagnosed as having a solitary extramedullary plasmacytoma of the pterygoid fossa. He was referred for radiation therapy, receiving irradiation of 50 Gy for 6 weeks. The clinical manifestations, imaging findings, pathology and treatment procedures of extramedullary plasmacytoma are described, together with a review of the literature.

Management of oral leukoplakia by laser surgery: relation between recurrence and malignant transformation and clinicopathological features.

The aim of the present study was to assess the clinical usefulness of laser surgery for oral leukoplakia. Recurrence and/or malignanT transformation of oral leukoplakia have occasionally been observed following laser surgery. It is reported that the rate of recurrence was 7.7-38.1%, while malignant transformation was 2.6-9%. A total of 154 oral leukoplakias from 116 patients were treated in our department. Comparisons with the rate of recurrence, malignant transformation and clinical futures, epithelial dysplasia, location, and treatment procedure were examined. To evaluate recurrence and malignant transformation, the cases were restricted to those with a minimum follow-up of 6 months. A total of 97 lesions fulfilled this criterion. The rate of recurrence had no association with the location or the epithelial dysplasia, although it differed with the treatment procedure. The rate of recurrence in laser surgery was approximately 29%. Malignant transformation was observed in four of 97 lesions. They were observed in 13.6% of tongue cases and 1.8% of gingival cases. Three of four lesions were treated with excision surgery, and the remaining one treated with laser vaporization. Only 1.2% malignant transformation in laser surgery was revealed. Laser excision is suitable for leukoplakia cases on non-keratinized epithelia (i.e., the tongue and buccal mucosa), while laser vaporization is suitable for the gingival cases. Management of oral leukoplakia prevents not only recurrence and malignant transformation, but also postoperative dysfunction. We believe that laser surgery is an excellent procedure.

Impression cytology in the diagnosis of acanthamoeba keratitis with surface involvement

PurposeTo evaluate the use of impression cytology in the diagnosis of Acanthamoeba keratitis with surface involvement. DesignObservational case series. MethodsThree patients with culture-proven superficial Acanthamoeba keratitis were studied. Patients' medical records were reviewed for clinical information, treatment procedures and disease course. Impression cytology specimens taken from the cornea of those patients were processed and observed by bright field microscopy. The main outcome measure was the cytopathological examination and identification of amoebic organisms. ResultsIn each of these three patients, impression cytology specimens revealed the amoeba cysts. Some specimens also showed pleomorphic trophozoites with typical amoeba nuclei. ConclusionCorneal impression cytology successfully detected the cysts and trophozoites of Acanthamoeba from patients with superficial amoeba keratitis. This indicates that impression cytology can be a useful technique to facilitate early diagnosis of Acanthamoeba keratitis with surface involvement.

C5 palsy after decompression surgery for cervical myelopathy: review of the literature.

A literature review was conducted to integrate and compile available reports on postoperative C5 palsy. To review the clinical features, possible pathogenesis, and procedures for treatment and prevention of postoperative C5 palsy as a complication of surgery for cervical compression myelopathy. Although postoperative C5 palsy develops in approximately 5% of patients after decompression surgery of the cervical spine, its pathogenesis and the options for prevention and treatment remain unidentified and many controversies exist. We reviewed and analyzed papers published from 1986 to 2002 regarding C5 palsy as a postoperative complication. Statistical comparisons were made when appropriate. Postoperative C5 palsy is reported to occur in an average of 4.6% of patients after surgery for cervical compression myelopathy. No significant differences were noted between patients undergoing anterior decompression and fusion and laminoplasty, nor were distinctions apparent between unilateral hinge laminoplasty and French-door laminoplasty, or between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. Two theories were put forth to account for the pathogenesis of C5 palsy: nerve root injury and segmental spinal cord disorder. Neither of these hypotheses has been consistently supported and evidence to refute each hypothesis can be found in the literature. Recently, surgeons have advocated foraminotomy combined with laminoplasty to prevent or treat C5 palsy, but further studies into the efficacy of this procedure are needed. Although patients with C5 palsy generally have a good prognosis for neurologic and functional recovery, those with severe paralysis require significantly longer recovery times when compared to more mild cases. The incidence of postoperative C5 palsy has been reported at 4.6% after surgery for cervical compression myelopathy and this value has not varied with different surgical procedures or disease etiologies. The pathogenesis of postoperative C5 palsy remains unclear at the present time. Patients with postoperative C5 palsy generally have a good prognosis for functional recovery, but the severely paralyzed cases required significantly longer recovery times than the mild cases.

The Impact of the Day of the Week and Month of Admission on the Length of Hospital Stay in Stroke Patients

Background: Length of hospital stay (LOS) in many diseases is determined by patient-related sociodemographic and clinical factors but also by the management of treatment and care. We examined the influence of the day of the week (DW) and month of admission on LOS in stroke patients. Methods: We used data from a large regional stroke registry in the northwest of Germany for the years 2000 and 2001. The registry is based on a standardised data assessment in participating hospitals, including patient-related sociodemographic and clinical items, diagnostic and treatment procedures, stroke classification, as well as admission and discharge dates. Data management and analysis were done centrally. Results: A total of 11,942 patients from 42 hospital departments were included. Median LOS was 13 days for ischemic stroke and 8 days for TIA. Patients with ischaemic stroke admitted on Tuesdays or Wednesdays had the longest LOS. We observed a significantly shorter LOS in patients discharged towards the weekend, both for ischaemic stroke and TIA, independent of age, gender and symptom severity. Discharges were predominantly done on Fridays (25%), transferrals to rehabilitation centres most often on Thursdays (28%) in neurologic departments but on Tuesdays in departments of internal medicine. LOS according to the month of admission revealed a biphasic curve for both ischaemic stroke and TIA, with shortest LOS in July and December. Conclusions: Discharge patterns on weekends contribute to differences in LOS for the various DWs of admission. Changes in discharge organisation and improved co-operation with rehabilitation centres may shorten LOS. Differences in LOS between the months show considerable seasonal variability.

Ausstattungsmerkmale von Krankenhäusernund ihr Einfluss auf die Liegezeit von Schlaganfallpatienten

Length of hospital stay (LOS) is determined not only by medical procedures or complications but also by institutional factors. We examined the influence of various institutional factors in neurological, medical and geriatric departments on LOS in patients with ischemic stroke. We used data of 12,410 patients from the Westphalian Stroke Register for the years 2000 and 2001. Forty-two centres including 24 neurological, 13 medical and five geriatric departments participated in the register. The register is based on a standardized data assessment, including patient-related sociodemographic and clinical items, diagnostic and treatment procedures, complications, and status at discharge. 7855 patients with ischemic stroke from 37 centres (median age: 73 years, 51 % female) were included in the analysis. In neurological departments, the LOS decreased with increasing numbers of stroke patients treated per centre and year, presence of a stroke unit or a rehabilitation unit. Conversely, the ratio beds to number of physicians was positively associated with LOS. In geriatric departments, a significant decrease in LOS with an increasing number of stroke cases and availability of a rehabilitation unit was also observed. In departments of medicine, no significant influence on LOS was found for the institutional factors analysed. Institutional factors have a significant influence on LOS in patients with stroke. In this analysis, the influence varied between the different medical specialties. Institutional factors gain importance in the management of stroke patients, when Diagnosis Related Groups (DRG) are introduced.