Female Patients Mean Age Research Articles

Functional Outcome of Tip Apex Distance in Predicting Implant Failure in Intertrochanteric Fracture Femur Treated with Dynamic Hip Screw

Objective: To evaluate the importance of tip apex distance in implant failure in intertrochanteric fracture femur treated with Dynamic hip screw, so that optimum tip apex distance should maintain to decrease the implant failure in intertrochanteric fracture femur treated with DHS. Study Design: It was a descriptive cross sectional study. Study Setting and Duration: Patients were selected from orthopedic unit of Nishtar Hospital, Multan, from July 2020 to June 2021. Methodology: All patients meeting the inclusion criteria who presented with a femur fracture were included in the analysis. SPSS version 24.0 was used to analyse the data. Quantitative data analysis was done using means and standard deviations like age and tip apex distance. Categorical variables like gender, functional outcome and implant failure was calculated and presented as frequency and percentage. Results: A total of 81 patients with mean age of male patients were 38.51 and SD was 11.79, similarly in female patients mean age was 41.87 and SD 11.60. Mean tip apex distance in male was 16.08 and SD 8.49, in female mean tip apex distance was 15.40 and SD 9.368. Tip Apex distance was ≤ 25 cm in 61 (75.3%) patients and >25 cm in 12 (24.7%) patients. As concern to the outcome variable (implant failure) 12 (14.8%) patients were having implant failure and 69 (85.2%) patients were having successful outcomes. Practical implication: The use of Dynamic Hip Screw in Intertrochanteric Fracture Femur treated would show improved clinical results and fewer hardware failures Conclusion: Tip Apex distance is a valuable measurement in dynamic hip screw fixation of Intertrochanteric fracture femur. Keywords: Fracture, Femur, Tip Apex Distance, Dynamic Hip Screw, Implant Failure, Orthopedic

Indocyanine Green Is a Safe and Effective Alternative to Radioisotope in Breast Cancer Sentinel Lymph Node Biopsy regardless of Patient Body Mass Index

Introduction: A recent meta-analysis [Lancet Oncol. 2010;11:908–909] has confirmed high sensitivity of indocyanine green (ICG) fluorescence mapping for sentinel node detection in early breast cancer. Concerns have previously been raised regarding the efficacy in patients with high body mass index (BMI). Materials and Methods: All consecutive patients undergoing sentinel lymph node biopsies (SLNBs) for early breast cancer in NHS Tayside were included in a prospective audit of surgical and pathology findings. All patients included in the study received dual injection of patent blue dye and ICG. Approval was obtained from the local Caldicott guardian for collection and use of personal data. Results: Of 239 cases, all were female patients of mean age 62 years (range 27–93). In 4.2% (10/239) of cases, neither blue dye nor ICG was present in the axilla. Of the remaining 229 SLNB cases in this series, surgeons documented retrieval of 451 nodes, with a mean surgical nodal count per case of 1.97 (range 1–5) and pathological nodal count of 2.15 (range 0–7). Eighty three cases were performed in patients with BMI 30–39.9 and 21 cases with BMI ≥40, with nodal detection rates of 96.4% (80/83) and 95.2% (20/21), respectively, in these groups of patients. Twenty percent (48/229) of cases had nodal metastases on histopathology. Conclusions: This is a large single-center study which demonstrates the safety and accuracy of the combined ICG and blue dye technique for SLNB in breast cancer. This is represented by nodal detection rates and node positivity rates which are comparable to previous multicenter studies of standard SLNB regardless of BMI.

Clinical Study of a New Design Percutaneous Transpedicular Biopsy System for Spinal Tuberculosis

Purpose: Despite some spinal tuberculosis cases having typical imaging findings, histological/ microbiological evidence is required for definitive diagnosis and management. Percutaneous biopsy is suitable for histopathologic and bacteriologic evaluation of vertebral lesions, as it is a quick and minimally invasive technique to obtain specimens from deep structures and is advantageous for open surgical biopsy. Based on a minimally invasive technique, herein, we describe a newly designed percutaneous transpedicular biopsy system for lumbar vertebral lesion biopsy. Methods: Fifty-six patients who underwent percutaneous transpedicular vertebral biopsy under fluoroscopic guidance were evaluated. Biopsy specimens were obtained by passing a proprietary 6-mm diameter biopsy instrument through the pedicle and into the disease site under C-arm fluoroscopy. Specimens were sent for histological and bacteriologic analyses. Results: There were 36 males and 20 female patients of mean age 47.64 years (range 22-80 years). Biopsies were performed on 56 lumbar vertebral bodies. The average operative time were 15.6 minutes (range 13-18 minutes). All 56 patients (54 tubercular pathology, one metastasis, and one osteoporotic fracture with chronic nonspecific inflammation) had definitive histological/ microbiological diagnosis. Two patients (3.57% of 56 patients) developed a biopsy site small hematoma. Conclusions: A newly designed percutaneous transpedicular biopsy system was successfully used for lumbar vertebral biopsy under local anesthesia. It was easy to use and was safe with a low complication rate for definitive diagnosis of lumbar spinal tuberculosis and could be performed with minimal morbidity and high diagnostic yield as an outpatient procedure.

Efficacy of hyaluronic acid 0.3%, cyanocobalamin, electrolytes, and P-Plus in menopause patients with moderate dry eye disease

PurposeTo study the treatment efficacy of hyaluronic acid 0.3%, cyanocobalamin (vitamin B12), electrolytes, and P-Plus in menopausal patients with moderate dry eye disease.MethodsThirty female patients of mean age 53.06 ± 5.20 years (45–65) were enrolled in this prospective longitudinal study. Meibomian gland loss assessment was determined using a scale with four levels. The Ocular Surface Disease Index (OSDI) questionnaire, phenol red thread (PRT) test, and tear film break-up time (TFBUT) were also completed by the patients. Tear eye drops were formulated with 0.3 g of sodium hyaluronate, P-Plus ™, vitamin B12, sodium chloride, potassium chloride, calcium chloride, magnesium chloride, and SCO® (stabilized complex oxychloride). After 30 days, the patients were re-evaluated.ResultsThe mean meibomian gland loss percentage was 37.97 ± 19.02 % (7.20 to 88.30%). Before treatment, the OSDI was 22.53 ± 14.03 score points (6.25 to 77.08). Posterior OSDI decreased to 16.26 ± 13.69 score points (0.00 to 70.83) (W = 58.00, P < 0.01). Before treatment, PRT was 10.31 ± 4.48 mm (4.00 to 21.00). Posterior PRT increased to 15.41 ± 6.27 mm (4.00 to 21.00) (W = 1520.50, P < 0.01). Before treatment, TFBUT was 6.23 ± 1.75 s (3.00 to 9.00). The posterior TFBUT increased to 8.10 ± 2.06 s (4.00 to 14.00) (W= 1382.50, P < 0.01).ConclusionThe hyaluronic acid 0.3% and vitamin B12 eye drops effectively decreased dry eye symptoms in menopausal women and improved tear stability and volume.

Self-administered daylight-activated photodynamic therapy for the treatment of hand eczema: A prospective proof-of-concept study.

Photodynamic therapy (PDT), traditionally used in patients with nonmelanoma skin cancer, has been found to be effective for various inflammatory skin conditions. Daylight-activated PDT (DL-PDT), in which the sun serves as the light source, is substantially less painful than conventional PDT. This study aimed to determine the safety and efficacy of DL-PDT in a series of patients with chronic hand eczema (CHE). A proof-of-concept prospective design was used. Eight patients diagnosed with CHE at a tertiary dermatology clinic underwent DL-PDT. The first treatment was administered at the clinic and subsequent treatments (up to four total) were self-administered at home at 2-week intervals. Outcome was evaluated with the Investigator Global Assessment (IGA; score 0-4), Dermatology Life Quality Index (DLQI; score 0-24), and blinded review of clinical photographs (graded on a quartile scale by percent improvement). There were six male and two female patients of mean age 35 years. All underwent at least three treatments. The IGA score improved by 2.5 points at 1 month, 2.7 at 3 months, and 2.2 at 6 months post-treatment, and the DLQI score improved by 7.9, 6.6, and 6.1 points, respectively. Clinical photograph grades improved by 2.9 points at 3 months. Side effects were mild and transient. All patients had some degree of recurrence after 6 months of treatment. The self-administered DL-PDT is easy to perform, moderately effective, and safe to use in patients with CHE. Repeated treatments might be required to maintain remission.

Modified Doppler-guided laser procedure for the treatment of second- and third-degree hemorrhoids.

Hemorrhoids are a common anorectal condition with a major medical and socioeconomic impact. Owing to the high incidence of symptomatic hemorrhoids in the adult population together with the risk of complications of traditional surgery, researchers are seeking less invasive methods of hemorrhoidal treatment.The aim of this study was to present our experience with the mini-invasive Doppler guided hemorrhoidal laser procedure (HeLP) in symptomatic 2nd and 3rd degree hemorrhoids with absent or minimal mucosal prolapse. The cohort included 62 patients with symptomatic hemorrhoids who underwent the HeLP at a tertiary medical center in 2014-2016. Data were collected on clinical and perioperative characteristics and outcome. Findings were compared between patients with second- and third-degree hemorrhoids. The cohort included 41 male and 21 female patients of mean age 41.5 years. Fifty-one had bleeding and 11 had hemorrhoidal syndrome. Mean operative time was 16.6 ± 3.7 minutes. A total of 8-12 arterial branches were treated. Patients were discharged home within a mean of 91.95 ± 20.48 minutes and allowed to resume normal activities. Compared to patients with second-degree hemorrhoids, patients with third-degree hemorrhoids had a significantly higher rate of recto-anal repair (18.2% vs 0, p < 0.05), intraoperative bleeding (11.3% vs 5%, p < 0.05), and thrombus formation in the hemorrhoids (11.3 % vs 0, p < 0.01). At the six-month follow-up, no complications were reported, and there was significant improvement in symptoms.Using the visual analog scale, no pain was reported by 82.3% of patients at one week after surgery and 95.2% of patients at one month after surgery. Patients with hemorrhoids treated with Doppler-guided laser had an excellent outcome in terms of resolution of symptoms and postoperative pain. Only Minor short-term complications were noted. Doppler-guided laser seems to be an effective and painless technique for the treatment of symptomatic second- to third grade hemorrhoids with minimal mucosal prolapse.

Bilateral Tubercular Dactylitis: Unusual presentation of an usual disease

IntroductionBilateral Tubercular Dactylitis (TD) is an unusual presentation of tuberculosis and only handful numbers of cases are reported in the literature. Hence, very little is known about its clinical presentation, statistic, radiological features and its outcome. MethodsWe have included seven male and two female patients of mean age 7.2 years, of the proven cases of bilateral TD by histopathological or microbiological or PCR analysis from core biopsy. Radiological features were recorded from plain radiograph. All patients were given Antitubercular drugs according to WHO 2010 recommendation (four drugs for 3–5 months, three drugs for next 3–5 months and finally two drugs for 6–8 months). Debridement was done whenever required. ResultsOf total 26 lesions, the most common presentation was swelling with or without mild pain. Discharging sinus was present in four lesions. There were six phalanges, 18 metacarpal and two metatarsals. Radiographically, the most common type of lesion was soft tissue swelling followed by lytic lesion. Histopathologically tuberculosis was proven in 10 (55.6%) lesions, bacteria isolated in 5 (27.8%) lesions and PCR was done in 8 lesions and was positive in all. All lesions healed after giving ATT except one which developed psudo-arthrosis and one patient developed coronal plane deformity that was corrected by JESS. ConclusionA clinician should always suspect tuberculosis while dealing with a pathology of hand and feet even if it is bilateral. Suspected case can be diagnosed by histopathological, microbiological or PCR analysis and it can be treated by ATT with a good functional outcome.

Fluoroscopy Guided Percutaneous Transpedicular Biopsy for Thoracic and Lumbar Vertebral Body Lesion: Technique and Safety in 23 Consecutive Cases.

Background Though some vertebral lesions have typical imaging findings, histological/ microbiological evidence are required for definitive diagnosis and management, specially for tumor and infective lesions so that wrong diagnosis and wrong treatment can be avoided. Conventionally, open biopsy methods are used. With availability of CT scan, MRI, percutaneous transpedicular vertebral biopsy has now become popular as a minimally invasive technique for biopsy of vertebral lesion. Objective To describes technique and to analyzes safety and feasibility of percutaneous transpedicular vertebral biopsy with fluoroscopy guidance for thoracic and lumbar vertebral body lesions. Method Twenty three patients who underwent percutaneous transpedicular vertebral biopsy under fluoroscopy guidance were retrospectively evaluated for demographic data, indication for biopsy, anatomical locations, histological/microbiological diagnosis, complications and final outcome of treatment. True positive, true negative, false positive and false negative cases were defined. Result There were 17 males and 6 female patients of mean age 47 (range 22-73 years). Biopsies were performed in 17 dorsal and six lumbar vertebral bodies. Adequate sample were obtained in all cases. Seventeen patients (12: tubercular pathology, 1: primary tumor, 3: metastasis, 1: osteoporotic fracture) had definitive histological/ microbiological diagnosis. Four patients had no granuloma and tumor. Two had histological features of chronic non specific inflammation. True positive cases were 17, true negative were four and false negative case were two. Overall accuracy was 92%. One patient developed small hematoma at biopsy site. Conclusion Fluoroscopy guided percutaneous transpedicular biopsy of is a safe procedure with high adequacy and accuracy and low complication rate for thoracic and lumbar vertebral body lesion.

Results of Distal femoral locking compression plate (DF-LCP) in supracondylar and intercondylar fractures of distal femur

Introduction: Distal femoral fractures represent a challenging problem in orthopedic practice. Open reduction with internal fixation replaces previous trend of closed conservative management and external fixation. Distal femoral locking compression plate (DF-LCP) requires both locking and compression screw fixation of the femur shaft. This study was conducted to examine the short-term results, early complications and healing rate of distal femoral fractures treated with the DF-LCP. The aim of this study was to critically evaluate the results of this plate in different types of distal femoral fractures (open and close) both clinically as well as radio logically. Methodology: 20 patients were included in the study. Lateral approach was performed as standard surgical technique. Functional results were evaluated using knee society score. Results: There were 17 males and 3 female patients of mean age 52.6 years. Road traffic Accident (65%) was the commonest mode of injury. Most were closed fractures (55%). There were 2 complications in the form of joint stiffness. 100% union rate was seen with an average union time of 17.25 weeks. Conclusion: DF-LCP is an important armamentarium in treatment of Distal femur fractures especially when fracture is closed, severely comminuted and in situations of osteoporosis.

Initial experience of use of an articulated external fixator in treating Legg-Calvé-Perthes disease by means of arthrodiastasis during the active phase of the disease

ObjectiveTo present the preliminary results from treating patients with Legg-Calvé-Perthes Disease (LCPD) by means of hip arthrodiastasis using a monolateral external fixator applied to the hip and to succinctly describe the surgical technique used, in a prospective study. MethodsProspective study on 18 patients with LCPD who underwent surgical treatment by means of the hip arthrodiastasis technique using a monolateral external fixator. There were 13 male and five female patients of mean age 8.5 years, ranging from five to 13 years. All the patients presented unilateral hip impairment: nine on the right side and nine on the left. The results were evaluated at maturity using clinical and radiological criteria. ResultsAll the patients evolved with improvement of joint mobility, and pain relief was achieved in 88.9% of them. Reossification of the femoral epiphysis occurred within the first three months of the treatment. The hips operated at the necrosis stage of the disease did not passed through the fragmentation stage, thus shortening the evolution of the disease. The results were 77.8% satisfactory and 22.2% unsatisfactory. ConclusionHip arthrodiastasis with a monolateral external fixator during the active phase of LCPD improved the degree of joint mobility. Use of the arthrodiastasis technique at the necrosis stage or at the fragmentation stage (active phase of the disease) presented satisfactory results from treatment of LCPD.

Experiência inicial com o uso de fixador externo articulado no tratamento da doença de Legg‐Calvé‐Perthes por meio de artrodiástase na fase ativa da moléstia

ObjectiveTo present the preliminary results from treating patients with Legg‐Calvé‐Perthes Disease (LCPD) by means of hip arthrodiastasis using a monolateral external fixator applied to the hip and to succinctly describe the surgical technique used, in a prospective study. MethodsProspective study on 18 patients with LCPD who underwent surgical treatment by means of the hip arthrodiastasis technique using a monolateral external fixator. There were 13 male and five female patients of mean age 8.5 years, ranging from five to 13 years. All the patients presented unilateral hip impairment: nine on the right side and nine on the left. The results were evaluated at maturity using clinical and radiological criteria. ResultsAll the patients evolved with improvement of joint mobility, and pain relief was achieved in 88.9% of them. Reossification of the femoral epiphysis occurred within the first three months of the treatment. The hips operated at the necrosis stage of the disease did not passed through the fragmentation stage, thus shortening the evolution of the disease. The results were 77.8% satisfactory and 22.2% unsatisfactory. ConclusionHip arthrodiastasis with a monolateral external fixator during the active phase of LCPD improved the degree of joint mobility. Use of the arthrodiastasis technique at the necrosis stage or at the fragmentation stage (active phase of the disease) presented satisfactory results from treatment of LCPD.

Lack of effect of sacral nerve stimulation for incontinence in patients with systemic sclerosis.

Systemic sclerosis (SSc) is a multisystem disorder of unknown aetiology leading to the deposition of excessive connective tissue in the skin, blood vessels and internal organs. Gastrointestinal involvement occurs in 90% of cases and the prevalence of faecal incontinence (FI) is 38%. This study comprises the largest case series assessing the efficacy of sacral nerve stimulation (SNS) treatment for incontinence in this patient group. A retrospective analysis on prospectively collected data was performed on all SSc patients from our two centres who had undergone SNS for FI. Ten female patients of mean age of 54 (37-72) years had temporary SNS performed. The mean duration of FI was 13 (2-25) years. All had passive FI. Each patient had preprocedure anorectal physiology and endoanal ultrasound examinations documenting internal sphincter atrophy/fragmentation or reduced anal resting pressure. Overall there was no statistically significant difference (P = 0.57) in the total Wexner incontinence scores before (mean 15.1 ± 2.6 SD) and during temporary SNS procedures (mean 13.1 ± 3.6 SD). Two patients with a significant improvement went on to have permanent SNS with only one achieving a favourable outcome at 1 year. This study showed that SNS failed to reduce episodes of leakage in nine out of 10 patients with systemic sclerosis affected with incontinence.

Prognosis of advanced hepatocellular carcinoma (HCC) in patients undergoing surgery combined with peri- or postoperative treatment with sorafenib.

377 Background: Liver resection/transplantation are effective therapies for primary hepatocellular carcinoma (HCC), but high relapse rates can significantly impact long term survival, especially for patients with advanced disease. The objective of this study was to investigate the effects of surgery plus sorafenib on the prognosis of patients with advanced HCC. Methods: 36 male and 2 female patients of mean age 52.6 (range 36-65) years and an ECOG performance status score 0-1 (n=26) or 2 (n=12), received surgical therapy (28 liver resection and 10 liver transplantation) plus sorafenib for treatment of HCC with a high risk of relapse (n=3) or had relapsed. Sorafenib was administered orally 400 mg once or twice daily, and the dose was reduced or the treatment temporarily discontinued if a grade 3 or worse adverse event occurred. Treatment duration was &gt;3 months and patients were evaluated every 4 weeks. The main endpoints were overall survival (OS) and time to progression (TTP). Results: Median follow-up time was 12.9 (range 4-59) months. Kaplan-Meier analysis demonstrated that median OS was 17 months (95%CI: 11.6-22.4), median TTP was 15 months (95%CI: 11.6-18.4). During follow-up, 20 patients died (18 from disease progression, 1 from a lung infection, and 1 accidently). Univariate analysis demonstrated that serum ALT &gt;60 U/L at the beginning of treatment, Child-Pugh grade B, ECOG performance status score 2, tumor cell embolism in blood vessels, tumor volume ≥3 liver segments, and a tumor involving 2 vital organs were important factors affecting OS. The median OS of patients with a tumor volume ≥3 liver segments vs. patients with tumor volume &lt;3 liver segments was 8 vs. 28 months (log-rank test, p&lt;0.001), and median TTP was 5 vs. 24 months (p&lt;0.001). Conclusions: Surgical resection in combination with sorafenib helped prolong OS and TTP in patients with advanced or relapsed HCC. OS for patients treated with sorafenib peri-operatively was longer than that for patients who received therapy after a relapse had occurred. Decreasing tumor burden and administering sorafenib as early as possible are helpful strategies to improve prognosis in patients with HCC.

Long term functional outcome following reverse shoulder arthroplasty in the elderly

The aim of this study is to analyze the long-term results and possible complications of the Grammont reverse shoulder prosthesis in the management of recent trauma in the elderly patient. Two male and 33 female patients of mean age 75 years (range, 58 to 92), operated on for 24 fractures and eleven facture-dislocations, involving the right side in 11 cases and the left side in 24 cases, were included in a retrospective study and were clinically and radiographically evaluated at a mean follow-up ranging from 1 to 17 years. Eight complications occurred in eight patients (23%): two complex regional pain syndromes, four dislocations, one deep infection and one aseptic loosening of the metaglene. Six patients (17%) had to be reoperated on, without prosthetic replacement in four cases and with revision of their shoulder implant in two. The mean Constant score decreased from 55 to 53 between one postoperative year and last follow-up since patients complained of increased pain and strength loss. This score was 69% of that of the contralateral shoulder. The adjusted Constant score was 68%. Only 58% of the patients were "satisfied" or "very satisfied" with the treatment due to limited shoulder rotations thus preventing proper eating, dressing and body hygiene habits when injury involved the dominant side. Two cases of complete lucent lines surrounding the glenoid component were observed at four and eight postoperative years respectively, a stable inferior bony spur was noted in 14 cases at a mean follow-up of 2.5 years with no functional effects, 20 cases of scapular notching having occurred within two-year follow-up were identified, 10 of which associated with bone resorption and medial proximal humeral lucent lines at the bone-cement interface. The extent of scapular notching progressed with the length of follow-up. Forty-nine percent of the radiographic images were considered abnormal and appeared within seven-year follow-up in 60% of the cases. Clinical and radiographic data comparison revealed a decrease in the Constant score regarding pain, activity, strength and active elevation when scapular notching was associated with abnormal humeral radiographic images. Despite one single case of aseptic loosening of the metaglene at 12-year follow-up, the results of our series are clinically disappointing and radiographically worrying associated with a substantial rate of complications and reopperations. The long-term functional outcome is far from being identical to the pre-trauma clinical status with a potential evolution toward loss of autonomy when the dominant side is affected. New prosthetic design characteristics and surgical technique improvements should be implemented to improve shoulder adduction but also rotations while preventing the occurrence of scapular notching. In the light of these results, we cannot validate the concept of primary reverse shoulder arthroplasty in the management of recent trauma of the proximal humerus.

LATERAL INTERNAL SPHINCTEROTOMY

Objective: To observe the prevalence of anal fissure, and outcome of open lateral internal sphincterotomy in terms of symptomatic relief, fissure healing and complications of procedure in female population. Study Design: Cross sectional, Prospective interventional. Setting &amp; Duration: Surgical Unit DHQ (Teaching) Hospital Rawalpindi, Women Medical Complex Sialkot over a period of seven years from 2003 to 2010. Methodology: Female Patients with chronic anal fissure with history of failed conservative treatment were included in the study after taking informed consent. All patients were evaluated and managed by consultant General Surgeon and were subjected to open lateral internal sphincterotomy (LIS). Results: Two hundred and seventy three female patients of mean age of 39.5 years with chronic anal fissure and history of failed / noncompliance to conservative treatment were enrolled in this study. All patients underwent open lateral internal anal sphincterotomy. Post operatively had excellent recovery, were ambulant on same day. Minor complications were noted in 44 patients (0.16%). Moderate pain at operation site was the commonest complication seen in 32 patients (0.11%). No major complication like permanent incontinence of flatus and feces or recurrence was reported in any of the patients. Conclusions: Lateral internal sphincterotomy remains an effective treatment for chronic anal fissure in the hands of experienced surgeon with highest patient satisfaction, and should be considered as the first line therapy in chronic and resistant / recurrent acute anal fissures.

Análise clínica do efeito da fotobiomodulação laser (GaAs - 904 nm) sobre a disfunção temporomandibular

INTRODUCTION: Over the last few years, there has been great interest in studying new methods for treating temporomandibular joint dysfunction (TMD). Pain, described as facial pain, headache or earache, usually exacerbated by jaw use, is generally the patients' main complaint. Laser photobiomodulation has been used for treating pain in cases of TMD. OBJECTIVE: The aim of this study was to investigate the pain levels in TMD patients treated with laser photobiomodulation. MATERIAL AND METHODS: Eighteen female patients of mean age was 27 years (± 7), with a diagnosis of TMD, were studied. They were randomly divided into two groups: Placebo (Control) and Experimental Groups. The Experimental Group (n= 10) received treatment twice a week, for four consecutive weeks (totaling eight applications). The GaAs laser (904 nm) was used, with 6 J/cm2, 0.38 mW/cm2, beam area of 0.039cm2 and continuous emission mode. The laser was applied at four pre-auricular points and one in the external auditory meatus. The Placebo Group (n= 8) was manipulated in the same way as the treated group, but with the laser switched off. To analyze the patients' pain levels, a visual analog scale (VAS) was used, before and after the therapy. To analyze the data, Student's t test was used, with a significance level of 5% (p< 0.05). RESULTS: A significant reduction (p< 0.05) in the pain level was observed in the Treated Group. CONCLUSIONS: The tested laser photobiomodulation (GaAs, 904 nm) demonstrated positive results regarding the relief of painful symptoms in patients with TMD.

The Midterm Results of Cardiac Transplantation Patients

Objective Cardiac transplantation is an important treatment option that increases the survival and decreases the limitations in effort capacity among patients with end-stage heart disease. In this study we have presented the midterm results of 13 patients who underwent cardiac transplantation between 2003 and 2007. Patients and Methods There were 10 male and three female patients of mean age of 32 ± 13.27 years (12 to 54). In one patient, we performed combined cardiac and renal transplantation. Ischemic cardiac disease was present in six patients and cardiomyopathy in seven patients. The mean age of the donors was 23.3 ± 11.8 years (12 to 46). Corticosteroids, cyclosporine, and mycophenolate mofetil were used for immunosuppression. Sirolimus was employed in five cases due to impaired renal function. Patients were followed by echocardiography, endomyocardial biopsy, and dobutamine stress echocardiography. Results The mean follow-up was 18.6 ± 13.4 (1 to 38) months. In four patients, there was grade IIIA (II-R) rejection. In five patients, tacrolimus or cyclosporine was replaced with sirolimus due to elevated creatinine levels. Dobutamine stress echocardiography was positive in one patient, who displayed a severe left main coronary artery lesion. There was no operative mortality. There was only one hospital mortality (7.6%). Two patients died in the midterm. The overall mortality on follow-up was 3 (23.1%). The survival rates in the first, second, and third years were 92%, 88%, and 75%, respectively. Ejection fraction were more than 50%; all of posttransplant survivors showed good effort capacity. Conclusion Cardiac transplantation is a definitive, safe, and effective treatment for patients with end-stage heart failure.

Life expectancy of elderly and very elderly patients with chronic heart failure

The survival of patients with chronic heart failure is typically reported as a comparison of different groups of patients using the hazard ratio from a Cox proportional hazards analysis. The absolute survival is generally neglected. Furthermore, attention is often focused on relatively young patients although chronic heart failure largely affects older patients. The present study was undertaken to determine the life expectancy (a measure of absolute survival) of older patients with chronic heart failure. Patients >75 years with chronic heart failure caused by impaired left ventricular systolic function who attended an outpatient clinic were included in the study. Follow-up commenced on August 1, 1993, and continued until September 30, 2005, when vital status was ascertained. Mean survival time was calculated as a measure of life expectancy. There were 210 patients included in the study. Male patients of mean age 80 years had a life expectancy of 3.9 years (95% CI 3.2-4.5), compared with that of 7 years for men in the general population of the same age. For female patients of mean age 80 years, the life expectancy was 4.5 years (95% CI 3.6-5.7), compared with 8.5 years for the general population of women of the same age. The presence of chronic heart failure in older patients results in an approximately 50% reduction in life expectancy.

Laparoscopic colorectal surgery: a prospective assessment and current perspective.

Between August 1991 and June 1993, 74 laparoscopic and laparoscopically assisted colonic and rectal operations were performed. A variety of procedures were carried out including 32 total abdominal colectomies (group 1), 32 segmental resections (group 2) and ten constructions of a diverting stoma without formal resection (group 3). Indications for surgery were mucosal ulcerative colitis in 20 patients, carcinoma in 12, polyposis in six, Crohn's disease in seven and other conditions in the remaining 29. The 74 comprised 42 male and 32 female patients of mean age 45 (range 12-88) years. The median (range) duration of the procedure was 3.0 (1.0-6.5) h for the entire group, 3.9 (2.5-6.5) h for group 1, 2.9 (1.5-5.5) h for group 2 and 1.8 (1.0-2.5) h for group 3. The median (range) length of ileus was 3.0 (2-7) days overall; respective times for groups 1-3 were 3.5 (2-7), 3.0 (2-7) and 2.0 (1-4) days. The median (range) length of hospitalization was 7.0 (2-40) days, 8.1 (4-19) days in group 1, 7.0 (4-20) days in group 2 and 6.0 (2-40) days in group 3. Ten patients (14 per cent) developed intraoperative and 15 (20 per cent) postoperative complications; there were no deaths. These results failed to confirm any significant advantages of laparoscopic or laparoscopically assisted colorectal surgery. Specifically, neither the operating time, nor length of ileus, nor length of hospitalization was improved over standard procedures. Advances in technology and surgical technique may improve such findings in the future.

Aortic Graft Infections: Treatment With Arterial Allograft

Since its reintroduction by Kieffer in 1991, many authors have used arterial allografts for surgical management of vascular prosthetic graft infection. During a decade, 25 patients with aortic graft infection were treated using in situ revascularization with arterial allograft. There were 23 male and 2 female patients of mean age of 65.7 ± 8.8 years (range, 43–78). Antibiotic therapy was administered for a mean time of 26 ± 5 days (range, 21–45) in the postoperative period. The mean follow-up time was 2.3 ± 3 years (range, 22 days–8.7 years). The mean in-hospital postoperative stay was 29.6 ± 14 days (range, 9–68). An aorto-enteric fistula (AEF) was present in 11 patients (44%), producing gastrointestinal bleeding. The overall mortality rate was 13 of 23 (56.5%) patients. The allograft-related mortality rate was 5 of 23 (22%). The overall allograft-complicated patient rate was 15 of 23 (65%); we observed 18 allograft ruptures in 12 patients and 8 allograft thromboses in 6 patients. The overall amputation rate was 8.7% (2 of 23). Age of the recipient older than 69 years ( P = .02), positive preoperative marked-leukocyte scanning ( P = .04), and persistent postoperative leukocytosis ( P = .03) were significant variables associated with an increased risk of allograft-related complications. The use of arterial allografts for aortic graft infections represents an interesting alternative for the treatment of graft infection. Nevertheless, there are some problems related to the durability of this type of graft, which can still be considered as a “bridge transplant.”