Duration Of Symptoms In Group Research Articles

Results of evaluation of neurometabolic and rehabilitation therapy for vincristine polyneuropathy in children with acute lymphoblastic leukemia

Introduction. Vincristine-induced peripheral neuropathies (VIPN) is a current problem in the management of pediatric acute lymphoblastic leukemia (ALL). There are no effective therapeutic strategies for VIPN. The aim of the study to present the results of evaluation of neurometabolic therapy in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period. Materials and methods. The single-center prospective comparative pilot study involved 69 children with VIPN who were treated in the acute period with the following drugs: group 1 - pyridoxine, group 2 - thioktovic acid, group 3 - inosine + nicotinamide + riboflavin + succinic acid. Clinical and electrophysiological parameters before and after drug treatment were analyzed. Among 10 children with motor deficits in the lower extremities in the recovery period of VIPN, rehabilitation with immersive virtual reality was performed, and the clinical parameters before and after the course were compared. Results. A positive effect of the studied drugs on the clinical condition of patients by the 30th day of therapy was revealed. In groups 1 and 3 the total score on the NIS-LL scale correlated with mild polyneuropathy - 4 [2÷8] and 2 [2÷6] points, respectively. Neurologic impairment in each of these groups persisted for 19 [14÷25] and 19 [13÷30] days, which was less in contrast to the duration of symptoms in group 2 (p1-2 = 0.021 and p2-3 = 0.046). In the VIPN recovery period before and after virtual rehabilitation: muscle strength in the lower limbs increased (p = 0.025); the severity of polyneuropathy decreased according to the NIS-LL scale (p = 0.003); balance improved according to the Berg scale (p = 0.017); and patients’ mobility increased according to the Functional Walking Category test (p = 0.025) and walking speed according to the time-recorded walking test (p = 0.008). Discussion. Improvement of clinical parameters with neurometabolic therapy and virtual rehabilitation in children with VIPN has been shown. Conclusion. Preliminary results of the effectiveness of pyridoxine and inosine + nicotinamide + riboflavin + succinic acid in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period were obtained.

Long-Term (>24 Months) Duration of Symptoms Negatively Impacts Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy.

Retrospective cohort study. To investigate the impact of long symptom duration (>24mo) on patient self-reported outcomes for pain, function, and quality of life following anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy. ACDF is an effective treatment to relieve the symptoms of cervical radiculopathy. However, there is no consensus on whether prolonged preoperative length of symptoms negatively impacts postoperative outcomes. This study included consecutive patients who underwent ACDF for cervical radiculopathy from May 1, 2012 to Dec 1, 2019 by a single surgeon. Patients were stratified by short (<24mo) and long (>24mo) duration of symptoms. Outcomes including visual analog scale (VAS) neck and arm, neck disability index (NDI), EuroQol-5D (EQ-5D), and overall state of health (EQ-VAS) were compared between cohort both for absolute values and percentage of patients achieving minimal clinically important difference. A total of 111 consecutive patients were included in our study, including 59 patients in the short symptom duration group and 52 patients in the long symptom duration group. The mean age of the patients was 51.4±9.4 and 41 (36.9%) were female. The baseline VAS neck and arm, NDI, EQ-5D, and EQ-VAS were similar between groups. Patients in both long and short symptom duration groups had clinical improvement following surgery. However, patients with short symptom duration had better VAS Neck and EQ-5D outcomes, and were more likely to meet minimal clinically important difference for NDI, EQ-5D, or any outcome. Multivariate analysis confirmed symptom duration <24 months as an independent predictor for better patient-reported outcomes. We appreciated better clinical outcomes in patients with shorter symptom duration who received ACDF for cervical radiculopathy. On the basis of this data, we advocate for prompt treatment of cervical radiculopathy to avoid the potential for long-term impairment. Level 3.

Effect of Symptom Duration on Injury Severity and Recovery in Patients With Achilles Tendinopathy.

Achilles tendinopathy is a common overuse condition. Distinguishing between early- and late-stage tendinopathy may have implications on treatment decisions and recovery expectations. To compare the effects of time and baseline measures of tendon health on outcomes among patients with varying symptom durations after 16 weeks of comprehensive exercise treatment. Cohort study; Level of evidence, 3. Participants (N = 127) were categorized into 4 groups based on the number of months since symptom onset: ≤3 months (n = 24); between >3 and ≤6 months (n = 25); between >6 and ≤12 months (n = 18); or >12 months (n = 60). All participants received 16 weeks of standardized exercise therapy and pain-guided activity modification. Outcomes representing symptoms, lower extremity function, tendon structure, mechanical properties, psychological factors, and patient-related factors were assessed at baseline and at 8 and 16 weeks after the initiation of exercise therapy. Chi-square tests and 1-way analysis of variance were used to compare baseline measures between groups.Time, group, and interaction effects were evaluated using linear mixed models. The mean age of the participants was 47.8 ± 12.6 years, 62 participants were women, and symptoms ranged from 2 weeks to 274 months. No significant differences were found among symptom duration groups at baseline for any measure of tendon health. At 16 weeks, all groups demonstrated improvements in symptoms, psychological factors, lower extremity function, and tendon structure, with no significant differences among the groups (P > .05). Symptom duration did not influence baseline measures of tendon health. Additionally, no differences were observed among the different symptom duration groups in response to 16 weeks of exercise therapy and pain-guided activity modification.

Efficacy of Single Dose of Fosfomycin Versus a Five-Day Course of Ciprofloxacin in Patients With Uncomplicated Urinary Tract Infection.

Introduction and objective: Treatment has become more challenging due to an aging population, polypharmacy and high prevalence of comorbid illness, antimicrobial antibiotic allergy or sensitivity, an increase in the number of individuals with underlying immunological or structural abnormalities, as well as the frequency of multidrug-resistant infections. Many multidrug-resistant bacteria are still susceptible to nitrofurantoin and fosfomycin, two ancient medicines. Their high urine concentrations and low toxicity give them an advantage over newer medications. This study aimed to compare the efficacy of a single dose of fosfomycin versus a five-day course of ciprofloxacin in patients with uncomplicated urinary tract infections.Methodology and data collection procedure: This randomized control trial was conducted in the Department of Medicine, Benazir Bhutto Hospital, Rawalpindi. A total of 46 patients were enrolled. Patients were divided randomly into two groups by using the lottery method. In group A, patients were given a single 3 g dose of oral fosfomycin. In group B, patients were given oral ciprofloxacin (500 mg) daily for five days. Then patients were followed-up in the Outpatient Department (OPD) for 28 days. After 28 days, patients were evaluated for resolution of symptoms (as per operational definition). Patients in whom symptoms would not be resolved were managed as per standard protocol. All this information was recorded on proforma.Results: The average age of the patients in group A was 39.41±9.80 years while in group B that was 41.32±17.76 years. In both groups, 23 females were equally divided. The mean duration of symptoms in group A was 4.78±1.98 days while in group B was 4.95±1.29 days. The minimum duration of symptoms was three days and the maximum was 10 days. In group A, there were 15 (65.21%) patients with efficacy achieved, and among eight (34.78%) patients, efficacy was not achieved while in group B, there were 15 (65.21%) patients in which efficacy was achieved, and among eight (34.78%) patients, efficacy was not achieved. There was no significant association between efficacy and study groups as the p-value was not significant (p=0.87). Conclusion: The conclusion of the study was that in the treatment of simple urinary infections, a single dose of fosfomycin had equal efficacy and tolerability as a five-day course of ciprofloxacin.

The Impact of Preoperative Symptom Duration on Patient Outcomes After Posterior Cervical Decompression and Fusion.

Retrospective Cohort Study. To determine if decreased preoperative symptom duration is associated with greater clinical improvement in function and myelopathic symptoms after posterior cervical decompression and fusion (PCDF). All patients over age 18 who underwent primary PCDF for cervical myelopathy or myeloradiculopathy at a single institution between 2014 and 2020 were retrospectively identified. Patient demographics, surgical characteristics, duration of symptoms, and preoperative and postoperative patient reported outcomes measures (PROMs) including modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), Visual Analogue Scale (VAS) Neck, VAS Arm, and SF-12 were collected. Univariate and multivariate analyses were performed to compare change in PROMs and minimum clinically important difference achievement (%MCID) between symptom duration groups (< 6months, 6months-2years, > 2years). Preoperative symptom duration groups differed significantly by sex and smoking status. Patients with < 6months of preoperative symptoms improved significantly in all PROMs. Patients with 6months-2years of preoperative symptoms did not improve significantly in mJOA, Physical Component Scores (PCS), or NDI. Patients with > 2years of symptoms failed to demonstrate significant improvement in mJOA, NDI, or Mental Component Scores (MCS). Univariate analysis demonstrated significantly decreased improvement in mJOA with longer symptom durations. Increased preoperative symptom duration trended toward decreased %MCID for mJOA and MCS. Regression analysis demonstrated that preoperative symptom duration of > 2years relative to < 6months predicted decreased improvement in mJOA and NDI and decreased MCID achievement for mJOA and MCS. Increased duration of preoperative symptoms (> 2years) before undergoing PCDF was associated with decreased postoperative improvement in myelopathic symptoms.

Assessment of content validity and psychometric properties of VISA-A for Achilles tendinopathy.

A recent COSMIN review found that the Victorian Institute of Sports Assessment-Achilles tendinopathy questionnaire (VISA-A) has flawed construct validity. The objective of the current study was to assess specifically the process of how VISA-A was constructed and validated, and whether the Danish version of VISA-A is a valid patient-reported outcome measure (PROM) for measuring the perceived impact of Achilles tendinopathy. The original item generation strategy for content validity and the process for confirming the scaling properties (construct validity) were examined. In addition, construct validity was evaluated directly using several psychometric methods (Rasch analysis, confirmatory factor analysis (CFA), and multivariable linear regression) in a cohort of 318 persons with Achilles tendinopathy with symptom duration groups ranging from less than 3 months to more than 1 year of chronicity, and a group of 120 healthy persons. We found that the item generation and item reduction in the original construction of VISA-A was based on literature review and clinician consensus with little or no patient involvement. We determined that 1) VISA-A consists of ambiguous conceptual item themes and thus lacks content validity, 2) there was no thorough investigation of the psychometric properties of the original version of VISA-A, which thus lacks construct validity, and 3) rigorous direct assessment of the psychometric properties of the Danish VISA-A revealed inadequate psychometric properties. In agreement with the COSMIN study, we conclude that when used as a single score, VISA-A is not an adequate scale for measuring self-reported impact of Achilles tendinopathy.

Comparison of Short-Duration and Chronic Premenarchal Vulvar Complaints.

To compare clinical characteristics, treatment histories, and microbiology of premenarchal girls who presented to a pediatric gynecology specialty clinic with short-duration and chronic vulvar symptoms. Retrospective cohort study. Pediatric and adolescent gynecology clinic at a tertiary care children's hospital. One hundred eighty-two premenarchal patients ages 2-14years who presented to a pediatric gynecology specialty clinic with vulvar complaints and who were evaluated with a yeast and/or bacterial culture. None. Chronic and short-duration vulvar symptoms, microbiology, and diagnosis. Patients with chronic symptoms were more likely to present with itching (59/102 (57.8%) vs 34/80 (42.5%); P=.04), redness or rash (53/102 (52.0%) vs 22/80 (27.5%); P=.0009), and discomfort (59/102 (57.8%) vs 30/80 (37.5%); P=.006), compared with patients with short-duration symptoms. Overall, 44.5% of patients had a history of antifungal treatment, with a greater proportion of patients with chronic symptoms having received antifungal treatment compared with those with short-duration symptoms (53/102 (52.0%) vs 28/80 (35.0%); P=.02). Despite a history of antifungal treatment in nearly half of the patients, Candida albicans was isolated in only 3/144 (2.1%) yeast cultures. Bacterial vulvar cultures were positive in 75/159 (47.2%), and there was no difference among the symptom duration groups (38/71 (53.5%) vs 37/88 (42.1%); P=.15). Vulvovaginitis is a common gynecological diagnosis among premenarchal girls with short-duration and chronic vulvar symptoms. Regardless of symptom duration, yeast cultures are rarely positive. Antifungal treatment should be avoided in toilet-trained prepubertal girls.

Persistent abnormal muscle response after microvascular decompression for hemifacial spasm

To explore the causes of persistent abnormal muscle response (AMR) after microvascular decompression (MVD) for hemifacial spasm (HFS) and the clinical outcomes of these patients. MVDs performed in Nanjing Drum Tower Hospital in 2017 were retrospectively studied, and 326 patients with HFS were classified into two groups based on whether AMR disappeared or persisted following MVD. The clinical features, treatment efficacy and postoperative complications were compared between the two groups. 305 patients with disappeared AMR after decompression were classified as Group A. In Group B, the 21 patients exhibited persistent AMR after successful MVD. The preoperative duration of symptoms in Group B was significantly longer than that in Group A (P < 0.001), and no significant difference was identified between the two groups in terms of gender, side, age and offending vessels (P > 0.05). The immediate postoperative cure rate of Group A (88.9%)was significantly higher than that in Group B (28.6%, P < 0.001), furthermore, the two groups were not different in the long-term outcome and the incidence of surgical complications (P > 0.05). The long preoperative duration of HFS patients may account for persistent AMR after successful decompression, and it is more likely for these patients to get delayed cured, the long-term outcomes showed no difference compared to those in patients with disappeared AMR after MVD.

Significance of outer retinal undulation on preoperative optical coherence tomography in rhegmatogenous retinal detachment

Rhegmatogenous retinal detachment (RRD) is a vision-threatening pathology. Optical coherence tomography (OCT) is useful for evaluating retinal damage and visual prognosis in patients with RRD. Outer retinal undulation (ORU) is often observed on preoperative OCT in RRD. Therefore, we evaluated the correlation between ORU seen on preoperative OCT and pre/post-operative factors in RRD. Patients with RRD (114 eyes) underwent reattachment surgery and ≥ 6 months of follow-up. According to the condition of the macula on preoperative OCT, cases were divided into macula-on RRD (65 eyes) or macula-off RRD (49 eyes). Patients were classified into acute (< 10 days), subacute (10–30 days), and chronic (> 30 days) symptom duration groups. Clinical findings, histories, and relationships with OCT findings, including ORU, were analyzed. Subacute symptom duration was significantly associated with ORU on preoperative OCT (p = 0.001) and had a higher prevalence of ORU (73.7%) than did acute (OR = 4.48) or chronic (OR = 7.467) durations. Ellipsoid zone (EZ) disruption was significantly associated with poorer best-corrected visual acuity (BCVA) than normal EZ integrity at 6 months postoperatively (p = 0.012). ORU on preoperative OCT suggests a 10–30 days morbidity duration in RRD. EZ integrity is useful for predicting postoperative BCVA in macula-off RRD.

Duration of Symptoms Does Not Affect Clinical Outcome After Lumbar Arthrodesis.

Retrospective cohort study at a single institution. To examine the effect of symptom duration on clinical outcomes after posterolateral lumbar fusion. Nonoperative measures are generally exhausted before patients are indicated for surgical intervention, leaving patients with their symptomatology for varying lengths of time. It is unclear at what point in time surgical intervention may become less efficacious at alleviating preoperative symptoms. Consecutive patients who underwent primary elective open posterior lumbar spinal fusion at a single academic institution were included. Patient and operative characteristics were compared between symptom duration groups (group 1: <12 mo of pain, group 2: ≥12 mo of pain). Preoperative and final postoperative visual analog scale back/leg pain, and Oswestry Disability Index, were collected. Preoperative, immediate postoperative, and final radiographs were assessed to measure lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and the PI-LL difference was calculated. In total, 167 patients were included in group 1, whereas 359 patients were included in group 2. Baseline demographics and operative characteristics were similar between the 2 groups. Both groups had similar changes in sagittal parameters and had no significant difference in rates of complication, reoperation, discharge to rehabilitation facility, or early adjacent segment degeneration. Both groups demonstrated similar improvement in clinical outcome measures. Despite differences in symptom duration, patients who had pain for ≥12 months demonstrated similar improvement after posterolateral lumbar arthrodesis than those who had pain for <12 months. Extended effort of conservative treatments or delay of operative intervention does not appear to negatively impact the eventual outcome of surgery. Level III.

Does the Duration of Cervical Radicular Symptoms Impact Outcomes After Anterior Cervical Discectomy and Fusion?

Retrospective cohort study. To compare clinical outcomes after anterior cervical discectomy and fusion (ACDF) based on preoperative duration of radiculopathy symptoms. There is no clear indication of when outcomes after ACDF become less effective in the setting of acute versus chronic symptoms from cervical nerve root compression. A retrospective cohort study of consecutive patients who underwent an ACDF between 2008 and 2015 for radiculopathy was performed. Patients were divided into 3 groups: radicular symptoms lasting for <6 months, symptoms lasting for 6-12 months, and those with symptoms for ≥12 months. Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores for both the neck and arms were obtained at preoperative and final postoperative visits. Radiographs were assessed for adjacent segment degeneration, fusion, and subsidence. Bivariate and multivariate regressions were subsequently used to compare outcomes between groups. A total of 379 patients were included. Patients with symptoms lasting for 6-12 months and those with symptoms lasting for ≥12 months had worse preoperative VAS neck pain compared with patients with symptoms lasting for < 6 months (P=0.000 and P=0.004, respectively). Patients with symptoms lasting for ≥12 months had worse baseline functional status compared with patients with symptoms lasting for <6 months (P=0.009). At final follow-up, there were no significant differences in VAS neck, VAS arm, or NDI between symptom duration groups. However, differences in outcomes were noted when considering the type of preoperative symptom. Patients with pain symptoms of ≥12 months had worse preoperative VAS neck (P=0.001), VAS arm (P=0.008), and NDI (P<0.001) and had significantly worse final VAS arm (P=0.019) and NDI (P=0.016) compared with patients with preoperative pain symptoms lasting for <6 months. The overall reoperation rate was 4.5%. Fusion was achieved in 97.6% of the patients, and subsidence was observed in 5.5%. There were no significant differences in the risk of adjacent segment degeneration, reoperations, fusion rates, or subsidence rates based on preoperative symptom duration. Despite worse preoperative neck pain and functional status in patients with preoperative duration of symptoms >6 months, there were no differences in final clinical outcomes across groups.

Effect of preoperative symptom duration on outcome in lumbar spinal stenosis: a Canadian Spine Outcomes and Research Network registry study

BACKGROUND CONTEXTLumbar degenerative stenosis is one of the most common spine pathologies for which surgical intervention is indicated. There is some evidence that a prolonged duration of neurological compression could lead to a failure of surgery to alleviate symptoms. PURPOSEDetermination of whether longer symptom duration was associated with worse postoperative disability outcomes after decompressive surgery for lumbar degenerative stenosis. STUDY DESIGN/SETTINGThe Canadian Spine Outcomes and Research Network (CSORN) prospective database includes pre- and postoperative data from 18 tertiary care hospitals. PATIENT SAMPLEThe CSORN database was queried for all cases of degenerative lumbar stenosis receiving surgical decompression for neurogenic claudication or radiculopathy. Patients with tumor, infection, fracture, or previous surgery were excluded. Patients were divided into groups based on symptom duration (<6 weeks, 6–12 weeks, 3–6 months, 6–12 months, 1–2 years, and >2 years). OUTCOME MEASURESChange between preoperative and 12-month postoperative Oswestry Disability Index (ODI) was compared between symptom duration groups. Secondary outcomes included SF12 physical component score (PCS), and numeric rating scales for leg and back pain. Outcomes were also assessed at 3 months and 24 months postoperatively. METHODSChange in ODI, and secondary outcome measures, were compared between different symptom duration groups. Multiple regression analysis was used to identify factors interacting with symptom duration to predict change in ODI. RESULTSFour hundred and seventy-eight cases of lumbar stenosis with 12-month postoperative data were identified. Longer symptom duration correlated with less improvement in ODI (p<.001). Patients with >1 year of symptoms were less likely to achieve a Minimal Clinically Significant Difference in ODI (54.4% vs. 66.1%; p=.03) and were more likely to experience no improvement or worse disability, postoperatively (22.1% vs. 11.3%; p=.008). Similar results were found at 3- and 24-month timepoints. Smaller postoperative improvements in SF12 PCS and leg pain scales were also correlated with longer symptom duration (p<.05). CONCLUSIONSMulticenter registry data provides important real-world evidence to guide consent, surgical planning, and health resource management. Longer symptom duration was found to correlate with less improvement in pain and disability after lumbar stenosis surgery suggesting that these patients may benefit from earlier treatment.

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: achieving lumbar interbody fusion: 194. The Effect of preoperative symptom duration on postoperative outcomes following transforaminal lumbar interbody fusion

BACKGROUND CONTEXT Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is commonly used in the treatment of lumbar degenerative disease. However, there exists a paucity of knowledge regarding the influence of preoperative symptom duration on patient reported outcomes (PROs) following lumbar fusion PURPOSE To examine whether the time spanning from symptom onset to surgical intervention has an effect on postoperative clinical improvement in patients undergoing MIS TLIF. STUDY DESIGN/SETTING Retrospective analysis of a prospectively managed surgical database. PATIENT SAMPLE A total of 195 patients who underwent a MIS TLIF procedure from 2013 to 2016. OUTCOME MEASURES Improvements in Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back pain, VAS leg pain, and inpatient narcotic consumption, as calculated Oral Morphine Equivalents (OMEs). METHODS A prospectively maintained surgical registry was reviewed. Patients who underwent a MIS TLIF procedure for degenerative pathology from 2013 to 2016 were identified. Patients were grouped based on preoperative symptom duration (≤6 months, >6 months). Pain was measured using the VAS, and narcotic consumption was measured using OMEs. Demographics and perioperative outcomes were compared using chi-squared analyses for categorical data and independent Student t-tests for continuous variables. PROs including ODI, VAS back and VAS leg scores were collected at preoperative and postoperative visits (6-weeks, 12-weeks and 6 months). The percentage of patients achieving minimal clinically important difference (MCID) following surgery was compared between groups. RESULTS A total of 195 patients following MIS TLIF were included in this analysis. 80% (N=156) had a symptom duration >6 months and the remaining 20% (N=39) had a symptom duration ≤6 months. No differences in demographics and comorbidity burden were identified between groups. Operative characteristics including operative time, estimated blood loss, inpatient pain, narcotic consumption and length of stay were also similar between symptom duration groups. When comparing PROs, patients with shorter symptom duration had significantly higher ODI scores preoperatively and had greater improvements in ODI scores at 6 weeks, 12 weeks, and 6 months (p CONCLUSIONS Patients undergoing MIS TLIF with shorter symptom duration exhibited significantly higher preoperative ODI scores. However, these patients demonstrated greater clinical improvement postoperatively. These findings suggest delayed surgical intervention may lead to impaired functional recovery in patients with degenerative lumbar disease. As such, further studies evaluating differences in outcomes between early and delayed surgical intervention are required to gain better understanding of the efficacy of nonoperative management of lumbar degenerative disease.

Clinical characteristics and treatment outcomes of natural killer/T-cell lymphoma involving the ocular adnexa

AimsTo evaluate the clinical characteristics and treatment outcomes of natural killer/T-cell lymphoma (NKTL) involving the ocular adnexa.MethodsRetrospective, comparative, observational case series. A total of 350 patients with NKTL, including 27...

Risk Factors of Postoperative Low Back Pain for Low-Grade Degenerative Spondylolisthesis: An At Least 2-Year Follow-Up Retrospective Study.

A retrospective study was conducted to clarify the risk factors of postoperative low back pain (LBP) for low-grade degenerative spondylolisthesis. A total of 239 patients who underwent posterior lumbar fusion between January 2011 and January 2015 were included in this analysis. We investigated patient characteristics, surgical characteristics, and radiographic characteristics. The mean visual analog scale (VAS) score of LBP decreased dramatically after the operation. The mean preoperative VAS score was greater in patients with severe lumbar multifidus (LM) intramuscular adipose tissue (IMAT). The postoperative VAS score was dramatically lower in patients with shorter symptom duration. Postoperative LBP disappeared more often in patients with shorter symptom duration. LBP VAS changing showed significant differences in different symptom duration groups and LM IMAT groups. LM IMAT and symptom duration were risk factors for postoperative LBP. Patients with severe LM IMAT reported more severe LBP before the operation. Postoperative LBP disappeared more often in patients with shorter symptom duration.

Surgical outcomes of laminoplasty for cervical spondylotic myelopathy in very elderly patients (older than 80 years): Time from symptom onset to surgery and changes in spinal cord signal intensity on MRI

ObjectiveWe aimed to assess the surgical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) in very elderly patients (older than 80 years), focusing specifically on the time from symptom onset to surgery and on the loss in spinal cord signal intensity on magnetic resonance imaging (MRI). Patients and methodsWe retrospectively reviewed 100 consecutive patients (61 males and 39 females) with CSM who underwent laminoplasty between 2006 and 2014. The patients were stratified based on the age at the time of surgery, with Group A consisting of 26 patients aged 80 years or older and Group B consisting of 74 patients younger than 80 years. The severity of myelopathy was assessed in terms of the Japanese Orthopaedic Association (JOA) score. Signal intensity loss on MRI was graded from I to III based on the size of the area with intensity changes (Grade I, one disk; Grade II, larger than one disk) and presence of intramedullary hypointensity on T1-weighted sagittal scans (Grade III). Surgical outcome, morbidities, and changes in spinal cord signal intensity on MRI were analyzed. ResultsThe time from symptom onset to surgery was 6.2±5.2 and 16.5±18.8months in Groups A and B, respectively, with significantly shorter duration of symptoms in Group A (p<0.001). Compared to Group B, Group A had lower mean JOA score preoperatively (8.8±1.9 vs. 10.1±1.7) and postoperatively (12.1±1.7 vs. 13.5±1.6), as well as lower mean JOA score recovery rate (40.7±12.5% vs. 51.0±15.4%) (p<0.05 for all). However, there was no difference between the groups regarding achieved JOA score (Group A, 3.3±1.0; Group B, 3.4±1.0). Preoperatively, intramedullary signal intensity change was observed in 84.6% of patients in Group A (22/26; 3, 13, and 6 patients with Grade I, II, and III, respectively), and in (82.4%) of patients in Group B (61/74; 18, 38, and 5 patients with Grade I, II, and , respectively), with significantly higher incidence of Grade III pattern in Group A than in Group B. ConclusionCompared to younger patients, very elderly patients had a shorter time from symptom onset to surgery but lower preoperative JOA score, indicating that the condition of very elderly patients is likely to deteriorate and become severe rapidly after the onset of myelopathy. However, it is very important to know these pathologies and optimize the timing of surgery, as laminoplasty for CSM can be beneficial even in very elderly patients.

Multicenter study on the asymmetry of skin temperature in complex regional pain syndrome: An examination of temperature distribution and symptom duration.

According to the International Association for the Study of Pain (IASP) and American Medical Association (AMA), the diagnostic criteria for complex regional pain syndrome (CRPS) require the presence of skin temperature asymmetry. In CRPS, it is generally accepted that the temperature of skin of affected limbs changes from warm to cold; however, in our clinical practice, we have experienced many cases with different thermographic characteristics. Therefore, we conducted a retrospective multicenter study that examined the distribution of skin temperature in patients with CRPS and skin temperature asymmetry versus symptom duration.Patients diagnosed with type 1 or 2 CRPS were recruited. After confirming CRPS according to the IASP diagnostic criteria, infrared thermographic images were evaluated for skin temperature differences (ΔT) between the affected and unaffected limbs.A total of 296 patients with CRPS were included in this study. The median duration of symptoms was 6 months and the mean ± standard deviation of ΔT was –0.72 ± 1.65°C. A skin temperature difference between bilateral limbs (|ΔT|) of 1°C or less was seen in 131 patients (44.3%); thus, these 131 patients did not meet the IASP criteria for CRPS. Further, cool skin temperature was not observed in 88 patients (29.7%), meaning that these patients did not meet the AMA criteria for CRPS. There was no correlation between the symptom duration and ΔT (Spearman's rho = –0.075, P = 0.196) and there was no significant difference in the average ΔT among the 4 symptom duration groups (0–3 months, 4–6 months, 7–12 months, >12 months, P = 0.08).In conclusion, a considerable proportion of the patients that participated in this study did not meet the thermal criteria set forth by the IASP and AMA. Further, there was no correlation between symptom duration and skin temperature difference.

Risk Factors for Retear After Arthroscopic Repair of Full-Thickness Rotator Cuff Tears Using the Suture Bridge Technique: Classification System

To identify factors that predict retears after arthroscopic repair of full-thickness rotator cuff tears. Factors included age, sex, diabetes, smoking, symptom duration (group I, <12months; group II, ≥12months), tear size according to the Kim classification (group I, A and B; group II, C; group III, D), tendon involvement (group I, supraspinatus; group II, supraspinatus and subscapularis; group III, supraspinatus and infraspinatus; group IV, all 3 tendons), and degree of fatty degeneration of the supraspinatus and infraspinatus (group I, Goutallier stages 1 and 2 for each tendon; group II, Goutallier stages 3 and 4 for each tendon). Two hundred eighty-two patients underwent arthroscopic repairs of full-thickness rotator cuff tears. The overall retear rate was 13.1%. Age, sex, diabetes, smoking, and degree of fatty degeneration of the supraspinatus and infraspinatus did not affect retear rates. However, symptom duration (P= .006), Kim classification (P < .001), and tendon involvement (P < .001) did affect retear rates. The retear rates were 8.5% (14 of 165 patients) and 19.7% (23 of 117) in symptom duration groups I and II, respectively; 8.0% (13 of 163), 15.2% (16 of 105), and 57.1% (8 of 14) in Kim classification groups I, II, and III, respectively; and 6.6% (11 of 167), 22.2% (18 of 81), 10.0% (2 of 20), and 42.9% (6 of 14) in tendon involvement groups I, II, III, and IV, respectively. In the multiple logistic regression analysis, the respective odds ratios of symptom duration group II, Kim classification group III, tendon involvement group II, and tendon involvement group IV were 2.853 (P= .011), 18.108 (P= .001), 4.184 (P=.001), and 5.727 (P= .021), respectively. To preoperatively predict retears after arthroscopic repair of full-thickness rotator cuff tears, the duration of symptoms before surgery, tear size, and tendon involvement can be used. In addition, regarding tear size, the Kim classification can be used more effectively than the modified DeOrio and Cofield classification. Level IV, prognostic case series.

Comparison of Short and Chronic Duration Premenarchal Vulvar Complaints

Abstract Study Objective To compare clinical characteristics, treatment histories, and microbiology of premenarchal girls presenting to a pediatric gynecology specialty clinic with short-duration and chronic vulvar symptoms. Design Retrospective cohort study Setting Pediatric and adolescent gynecology clinic at a tertiary care children’s hospital Participants One hundred eighty two premenarchal patients ages 2-14 years presenting to a pediatric gynecology specialty clinic with vulvar complaints and evaluated with a yeast and/or bacterial culture Interventions None Main Outcome Measures: Chronic and short duration vulvar symptoms, microbiology, and diagnosis. Results Patients with chronic symptoms were more likely to present with itching (57.8% v 42.5%, p=0.04), redness or rash (52.0% v 27.5%, p=0.0009), and discomfort (57.8% v 37.5%, p=0.006), compared to patients with short-duration symptoms. Overall 44.5% of patients had a history of antifungal treatment, with a greater proportion of patients with chronic symptoms having received antifungal treatment compared to those with short-duration symptoms (52.0% v 35.0%, p=0.02). Despite a history of antifungal treatment in nearly half of patients, Candida albicans was isolated in only 3/144 (2.1%) yeast cultures. Bacterial vulvar cultures were positive in 75/159 (47.2%), and there was no difference among the symptom duration groups (53.5% v 42.1%, p=0.15). Conclusions Vulvovaginitis is a common gynecological diagnosis among premenarchal girls with both short-duration and chronic vulvar symptoms. Regardless of symptom duration, yeast cultures are rarely positive. Antifungal treatment should be avoided in toilet trained prepubertal girls.

Clinical analysis of the correlation between preoperative severity and duration of symptoms and the outcomes of carpal tunnel decompression

Objective To investigate the relationship between the severity and duration of preoperative symptoms and the outcomes of carpal tunnel release in patients with carpal tunnel syndrome. Methods Forty patients of carpal tunnel syndrome treated from January 2013 to June 2014 were divided into two groups, namely symptom severity group and symptom duration group, based on the severity and duration of the symptoms. Postoperative recovery of these patients was assessed using carpal tunnel syndrome evaluation criteria after standard carpal tunnel release. The excellent and good recovery rate in each group was calculated. The distribution of excellent and good recovery was analyzed. Results In symptom severity groups the excellent and good recovery rate was 95.83% in the moderate group and 92.31% in the severe group. The difference was not statistically significant(P>0.05). However distribution of the recovery was quite different, showing more excellent recovery in the moderate group and more good recovery in the severe group. In symptom duration groups the recovery rates were not significantly different(P>0.05). Functional recovery of opposition was the best, followed by sensory recovery. Grip strength recovery was the poorest. Conclusion Preoperative duration of the symptoms does not affect the surgical outcomes in carpal tunnel syndrome patients. Surgical release can greatly improve functions in both moderate and severe carpal tunnel syndrome cases although better recovery is seen in moderate cases. Thumb opposition recovers the best, while grip strength recovery is the poorest. Key words: Carpal tunnel syndrome; Treatment outcome; Symptom duration; Symptom severity