Good Long-term Clinical Outcomes Research Articles

Skeletal and dental stability after intraoral vertical ramus osteotomy: a long-term follow-up

The purpose of this study was to elucidate the long-term skeletal and dental stability after combined orthodontic and orthognathic surgical treatment of mandibular prognathism with the intraoral vertical ramus osteotomy (IVRO) as the surgical technique followed by 6 weeks of intermaxillary fixation (IMF). Thirty-six patients were included in the study. Mean age at surgery was 21.6 years. Lateral cephalograms and study casts obtained before the start of treatment (T0), and 8 weeks (T1), 1 year (T2), and 12.5 years (T3) after the operation were evaluated. Mean mandibular setback measured at point B was 8.3mm. Between T1 and T2, a mean anterior relapse of 12% of the setback was observed. Between T2 and T3, the anterior relapse persisted, but decreased to 7% of the setback measured at point B. Despite dental adjustments in both jaws, a statistically significant reduction in overjet was observed during both observation periods. However, the change of the mandible in an anterior direction was small and of minor clinical importance for most of the patients. In conclusion these results indicate that combined orthodontic and orthognathic surgical treatment of mandibular prognathism with the IVRO as the surgical procedure followed by 6 weeks of IMF provides predictable and good long-term clinical results.

Effectiveness and outcome of endovascular therapy for late-onset postpancreatectomy hemorrhage using covered stents and embolization

The purpose of this study was to evaluate the clinical and long-term outcome of patients who underwent covered stent treatment because of late-onset postpancreatectomy hemorrhage in a greater number of patients. A secondary study goal was to compare embolization techniques with covered stents regarding differences in early and late clinical outcome, rebleeding, and vessel patency. Between December 2008 and June 2015, 27 consecutive patients suffering from major hemorrhage after pancreatic surgery underwent either covered stent placement or embolization of the affected visceral artery. The patients' medical reports and radiologic images were retrospectively reviewed. The main study end point was technical and clinical success, including survival and complications; the secondary end points were perfusion distal to the target vessel and, for covered stent placement, patency of the affected artery. Covered stent placement was successful in 14 of 16 patients (88%); embolization was successful in 10 of 11 (91%) patients. For the embolization group, the overall 30-day and 1-year survival rate was 70%, and the 1- and 2-year survival rate was 56%; for the covered stent group, these rates were 81% and 74%, respectively. The 30-day patency of the covered stent was 84%, and 1-year patency was 42%; clinically relevant ischemia was observed in two patients. Infarction distal to the embolized vessel occurred in 6 of 11 patients (55%). Endovascular treatment using either covered stents or embolization techniques is an effective and safe emergency therapy for life-threatening postpancreatectomy hemorrhage with good clinical success rates and long-term results. Covered stent placement preserving vessel patency in the early postoperative phase should be preferred to embolization if it is technically feasible.

Revision Total Hip Arthroplasty Using an Acetabular Reinforcement Ring With a Hook: A Precise Follow-Up, at Average 11.4 Years, of a Previous Report

BackgroundThis study aims at determining the average long-term result of revision total hip arthroplasty (THA) using the acetabular reinforcement ring with a hook (ARRH) and bone grafting in severe acetabular bony defect. Expected 15-year survival of ARRH in revision THA is included in the study. MethodsRetrospective review of 48 patients (48 hips) with follow-up duration of average 11.4 years (range, 6.1-21.4 years) was conducted. At each follow-up, Harris hip score was used to assess functional outcome, and radiographic acetabular component osteolysis was measured by DeLee and Charnley classification. Bone defects were assessed preoperatively and intraoperatively using American academy of orthopedic surgeons and Paprosky classification. The common modes of ARRH failures were evaluated. Bone consolidation, presence of heterotopic ossification, and complications such as infection and dislocation were recorded. ResultsThe bone defects were varied and included cavitary, segmental, and combined defects without any pelvic discontinuity. Mean Harris hip score improved from 52.6 points preoperatively to 82.0 points postoperatively. Nine acetabular revisions and 3 stem revisions (2 concurrent with acetabular revisions and 1 isolated stem revision) were performed. There were 5 infected cases and 1 patient with recurrent dislocation. The 11.4-year survival of revision THA with ARRH was 71% as the end point for acetabular revision surgery for any reason. The expected 15-year survival of revision THA with ARRH was 60%. The most common failure mode of ARRH was superomedial migration followed by lateral migration. ConclusionARRH combined with bone grafting produces relatively good average long-term clinical results.

Practical based approach to left main bifurcation stenting.

Despite the recent developments that have been made in the field of percutaneous left main (LM) intervention, the treatment of distal LM bifurcation remains challenging. The provisional one-stent approach for LM bifurcation has shown more favorable outcomes than the two-stent technique, making the former the preferred strategy in most types of LM bifurcation stenosis. However, elective two-stent techniques, none of which has been proven superior to the others, are still used in patients with severely diseased large side branches to avoid acute hemodynamic compromise. Selecting the proper bifurcation treatment strategy using meticulous intravascular ultrasound evaluation for side branch ostium is crucial for reducing the risk of side branch occlusion and for improving patient outcomes. In addition, unnecessary complex intervention can be avoided by measuring fractional flow reserve in angiographically isolated side branches. Most importantly, good long-term clinical outcomes are more related to the successful procedure itself than to the type of stenting technique, emphasizing the greater importance of optimizing the chosen technique than the choice of method.

The obese patient: a problem of larger consequence.

Obesity is a worldwide epidemic that has both economic and health implications of enormous consequence. The obese patients tend to have earlier symptoms related to osteoarthritis, more peri-operative medical problems, higher rates of infection and more technical difficulties intra-operatively following hip and knee arthroplasty. Nevertheless, these patients have good long-term clinical outcomes and implant survival rates and are often some of the most satisfied patients after joint arthroplasty. Therefore, obese patients should not be denied surgery based on their weight alone.

Isolated Spontaneous Dissection of the Superior Mesenteric Artery: Report of Two Cases

Isolated spontaneous superior mesenteric artery (SMA) dissection is rare, and difficult to diagnose due to nonspecific signs and symptoms. The clinic presentations include abdominal pain, nausea, and vomiting. The incidence appears to be increasing, possibly as a result of the widespread use of computed tomography angiography (CTA) imaging for abdominal pain. There is no consensus regarding the best treatment of spontaneous isolated dissection of the SMA. Herein, we present 2 cases in which isolated superior mesenteric dissection was diagnosed by CTA. The first case received conservative treatment, and the other case received endovascular therapy. Both patients had good long-term clinical results.

Clinical outcome of generalized myasthenia gravis in Hong Kong Chinese

BackgroundMyasthenia gravis (MG) is an organ-specific autoimmune disease characterized by autoantibody-mediated impairment of skeletal muscle neuromuscular transmission. MG causes significant morbidity and even mortality. We studied the long-term clinical outcome of generalized MG (gMG) patients. MethodsRecords of Chinese gMG patients managed in Queen Mary Hospital from 1997 to 2012 were reviewed. Clinical, serological and radiological characteristics were studied for independent predictors of good long-term clinical outcome. ResultsA total of 123 Chinese gMG patients were studied. Their mean onset age was 44.8years (range 7–83years), 87 (70.7%) were female, and median follow-up duration was 114months (interquartile range 67–188months). Thymoma were detected in 45 patients (36.6%). Acetylcholine receptor autoantibodies were detected in 99 patients (87.6%). Ninety-three patients (75.6%) received immunosuppressant therapy (corticosteroid 75.6%, azathioprine 58.5%, mycophenolate mofetil 5.7%, cyclosporin 5.7%) and 77 (62.6%) received thymectomy. Thirty-five (28.5%) patients experienced MG crisis and two died. Ninety-six (78.0%) patients had good outcome defined by Myasthenia Gravis Foundation of America (MGFA) post-intervention status (PIS) of complete stable remission (CSR), pharmacological remission (PR) or minimal manifestation (MM) at latest follow-up, whereas 24 patients (19.5%) had intermediate outcome defined by MGFA PIS of Improved (I); 3 patients (2.4%) had poor prognosis defined by MGFA PIS of unchanged (U), worse (W), exacerbation (E) or died of MG (D). Azathioprine therapy was the only independent predictor of good outcome (OR 3.57, 95% CI 1.05–12.10, p=0.042). Conclusion78.0% of gMG patients had good long-term clinical outcome. Azathioprine therapy independently predicted good clinical outcome.

Diced and crushed cartilage plus autologous fibrin matrix obtained by a simple process for dorsal augmentation of the Mestizo nose.

Several alternatives can be used for nasal dorsum augmentation. We report the use of crushed diced cartilage embedded in an autologous fibrin matrix. This construct is placed on the nasal dorsum and is gently molded according to the characteristics of each patient. Rhinoplasty and nasal dorsum augmentation were performed in 45 patients with Mestizo characteristics after a complete medical history and development of a surgical plan. A crushed diced cartilage autologous graft and an autologous fibrin matrix from peripheral blood processed using the Choukroun method was used. Pre- and postoperative photographs were taken at short- and long-term follow-up. Two separate variables were evaluated: reabsorption and irregularities. Three plastic surgeons evaluated the results, using a Likert scale: the first variable was considered very excellent in 88.9%, very good in 6.7%, good in 4.4% with no poor or very poor results. In the second variable, results were excellent in 88.9%, very good in 4.4%, good in 3.4%, and poor in 3.3% with no very poor results. Our patients carry a volume with an aesthetically pleasing contour and form with no changes over a mean follow-up period of 4 years. Long-term effectiveness continues to be the main topic of discussion; however, this method can be considered an alternative not only to augment but also to smoothen irregularities of the nasal dorsum. We used a simple method with good and stable long-term clinical results.

Which technique for double stenting in unprotected left main bifurcation coronary lesions?

Unprotected left main (LM) bifurcation coronary lesions are challenging for interventionists because these lesions are associated with relatively poor outcomes after percutaneous coronary intervention (PCI). Although the single-stent technique is a default treatment strategy for LM bifurcation lesions, elective double stenting is still used in patients with severely diseased side branches. The crush technique and its variants, the culotte technique and the simultaneous kissing stent technique, are applicable for distal LM disease, but none of these has proven to be superior to the others. Good long-term clinical outcomes are closely related to procedural success and optimisation of the stenting technique. The use of kissing balloon inflation during any double-stent technique is known to be an independent predictor of good angiographic and clinical outcomes by avoiding incomplete apposition or expansion. Moreover, procedural guidance using intravascular ultrasound may improve outcomes by helping to determine the appropriate stenting technique and optimise the stent procedure. Therefore, more attention should be paid to optimising the chosen technique than to choosing among techniques.

OP84 – 2797: Childhood chronic inflammatory demyelinating polyradiculoneuropathy: Analysis of a cohort of eight patients

Objective Present the clinical presentation, disease course, response to treatment, and long-term outcome of eight childhood chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients. Methods The medical records of all patients with CIDP seen at our center from 1993 to 2013. Inclusion criteria Age 3 ; electrophysiological studies consistent with an acquired demyelinating disorder in ≥2 nerves. Results Most children (50%) presented with chronic (>8-weeks) symptom-onset while a smaller proportion showed sub-acute (4–8 weeks) or acute ( 1). Conclusion A slow, chronic-onset of symptoms may be a more common presentation of childhood CIDP as this was observed in 50% of patients; however an acute Guillain-Barre syndrome-like onset occurred in 25%. Equal number of patients was observed on the disease course (monophasic versus polyphasic). All children demonstrated a good long-term clinical outcome after methylprednisolone or IVIG, or in combination, compared with functional sequels in children who did not received an initial aggressive therapy.

Prospective multicentre clinical performance evaluation of second and third generation zotarolimus-eluting stents to treat patients with bifurcated coronary lesions.

To assess the "real world" clinical outcome of patients with bifurcated lesions undergoing percutaneous coronary intervention with implantation of second and third generations of zotarolimus-eluting stent. Nine Italian centres participated in a prospective multicentre clinical project evaluating the outcome of patients receiving zotarolimus-eluting Resolute stent and Resolute Integrity stents. Patients with bifurcated lesions entered this evaluation. Clinical characteristics and angiographic and procedural details were prospectively recorded. Clinical outcome was prospectively assessed to evaluate the occurrence of major adverse cardiac events (MACE). A total of 577 patients were enrolled. The target lesion was distal left main in 11.1% and left anterior descending artery in 52.8%, and 30.3% of lesions were Medina 1,1,1. At a mean follow-up time of 27.0 ± 13.5 months, the survival free from MACE was 91.8%. Survival free from MACE was similar in patients grouped according to different bifurcated lesion complexity. On the contrary, patients receiving a single stent had better survival free from MACE as compared with those with double stent (P = 0.005). At multivariable analysis, double stenting (but not bifurcated lesion complexity) was found to be a significant predictor of MACE (hazard ratio, 2.52; 95% confidence interval, 1.28-4.94; P = 0.007). Of note, patients receiving the second stent as a bail-out had worse survival free from MACE compared with those who received it as a planned technique (P = 0.045). The treatment of patients with bifurcated lesions with second and third generation zotarolimus-eluting stents is associated with good long-term clinical outcomes. Clinical outcome seems to be independent of lesion complexity, but may be influenced by the stenting technique (single or double stenting as well as elective or bail-out double stenting). © 2015 Wiley Periodicals, Inc.

MODULUS Stem for Developmental Hip Dysplasia: Long-term Follow-up

Between October 2001 and December 2010, 143 patients with developmental dysplasia underwent hip arthroplasty surgery using a conical stem with modular necks (MODULUS system, Lima Corporate, Villanova di San Daniele del Friuli, Italy). Thirty (21.0%) patients had both hips replaced, for a total of 173 implants. The mean age at the time of surgery was 55years (range: 22–81years). The mean follow-up was 87months (range: 36–146months); average Harris Hip Score increased from 42 (range: 23–65) preoperatively to 92 (range: 76–100) at the last follow-up. Stem revision was required in two cases. The MODULUS stem showed good long-term clinical and radiographic results, with a Kaplan–Meier survivorship of 97.6% (95% CI: 94.8–100.0%) at 8years.

Опыт применения программной санации с использованием устройства АМП-01 в комплексном лечении гнойных лактационных маститов

Relevance The treatment of suppurative lactation mastitis remains urgent surgical problem. Despite significant advances of modern medicine in the treatment and prevention of surgical infections, mastitis is one of the first places in the structure of postpartum purulent-inflammatory complications, making towards them to 26-67% of cases. Until recently, it remained the most common traditional method of surgery at a mastitis, comprising the wide opening purulent focus one or more radial slits without a radical excision of nonviable tissue. Application of active surgical treatment purulent diseases has improved the results of treatment in this complex surgical pathology. However, its implementation in practical surgery is complicated because absence or imperfection of special technical means for active drainage, which leads to poor-quality sanitation purulent cavity and lengthens treatment time. The purpose of the study Analysis of immediate and long-term results treatment of suppurative lactation mastitis using a device AMP-01. Results and their discussion The use of active surgical method for the treatment of patients with GLM (main group, the comparison group 2) have led to a significant reduction in the duration of treatment and get good functional and cosmetic results compared to the comparison group 1 (the traditional method). A comparative study of treatment results in the study group research using the method of rehabilitation program using the device AMP-01 in the comparison group 2 with flow-suction method there are some differences. The use of primary suture in combination with active aspiration of wound and in the creation of a permanent purulent cavity vacuum of 80-100 mm of water. Art. It provides better sanitation of purulent focus and leads to the blocking of its walls and speed up recovery. Therefore, the results of treatment in the study group were slightly better for all the assessment criteria immediate and long-term results compared with a comparison group 2. Conclusion Application of the rehabilitation program using the device AMP-01 in treatment patients with GLM allows significantly accelerate clearance of the wounds from necrotic tissues, microbial bodies, stimulates regeneration processes, all of which helps to reduce the treatment durstion and getting good immediate and long-term clinical results. Method rehabilitation program using the device AMP-01 had advantages over other methods of active surgical treatment for all the assessment criteria of immediate and late treatment results.

Técnica quirúrgica de la enucleación prostática con energía bipolar con asa TUEB: experiencia de 20 casos

BackgroundLower urinary tract symptomatology secondary to benign prostatic hyperplasia is one of the most common pathologies in men, and transurethral resection of the prostate is the technique of choice for its surgical management. However, in the last few years new technology and techniques have been developed, such as Holmium laser enucleation of the prostate (HoLEP), that have had good functional results and less comorbidity. Transurethral enucleation of the prostate with bipolar energy (TUEB) is a novel technique that has also shown adequate results. AimsTo describe the experience of the first 20 cases of patients that underwent enucleation of the prostate with bipolar energy. MethodsTwenty patients were selected that presented with severe lower urinary tract symptoms, despite medical treatment with alpha blockers, and that had prostate volumes ranging from 50-80 cc and adenomas from 30-50 cc. Bipolar electrosurgical equipment with 120 W coagulation energy and 220 W cutting energy was placed over a 26 Fr continuous flow resectoscope (Olympus®); irrigation was carried out with saline solution and a morcellation unit connected to a suction pump was used for extracting the enucleated tissue. ResultsMean surgery duration was 102 min and mean enucleation time was 41.2 min. The quantity of morcellated tissue was 58.5 g, none of the patients presented with prostate capsule perforation, and the mean postoperative hospital stay was 27.8 h. In regard to follow-up, the mean IPSS score was 4.5 points, residual volumes measured 34.3 ml, and Qmax was 18.5 ml/sec. DiscussionAmong the new techniques currently available for the surgical treatment of prostate hyperplasia, transurethral resection is the treatment of choice. However, laser enucleation of the prostate is a novel procedure that has shown good long-term clinical results. Enucleation of the prostate with bipolar energy has emerged as an alternative to HoLEP, offering the patient a lower cost and good results. ConclusionsThe technique of bipolar enucleation of the prostate is an important alternative to transurethral resection of the prostate and retropubic prostatectomy. It has the advantage that it can be performed regardless of prostate volume and it achieves total resection of the adenoma, with fewer intraoperative and postoperative complications.

Complications of contralateral C-7 transfer through the modified prespinal route for repairing brachial plexus root avulsion injury: a retrospective study of 425 patients.

In this report, the authors review complications related to the modified prespinal route in contralateral C-7 transfer for repairing brachial plexus nerve root avulsion injury and suggest a prevention strategy. A retrospective, nonselected amalgamation of every case of modified contralateral C-7 transfer through the prespinal route was undertaken. The study population comprised 425 patients treated between February 2002 and August 2009. The patients were managed according to a standardized protocol by one senior professor. The surgical complications were grouped into one of the following categories: those associated with tunnel making through the prespinal route, those related to the dissection and transection of the contralateral C-7 nerve root, and those that occurred in the postoperative period. The study population included 379 male and 46 female patients whose average age was 21 years (range 3 months to 56 years). A total of 401 patients were diagnosed with traumatic brachial plexus injury, the leading cause of which was motor vehicle accident, and 24 patients were diagnosed with obstetrical brachial plexus palsy. The contralateral C-7 nerve root was cut at the proximal side of the division portion of the middle trunk in 15 cases and sectioned at the distal end of the anterior and posterior divisions in 410 cases. The overall incidence of complications was 5.4% (23 of 425). Complications associated with making a prespinal tunnel occurred in 12 cases, including severe bleeding due to vertebral artery injury during the procedure in 2 cases (0.47%), temporary recurrent laryngeal nerve palsy in 5 cases (1.18%), pain and numbness in the donor upper extremity during swallowing in 4 cases (0.94%), and dyspnea caused by thrombosis of the brainstem 42 hours postoperatively in 1 case (0.24%); this last patient died 38 days after the operation. Complications related to exploration and transection of the contralateral C-7 nerve root occurred in 11 cases, including deficiency in extensor strength of the fingers and thumb in 4 cases (0.94%) due to injury to the posterior division of the lower trunk, unbearable pain on the donor upper extremity in 3 cases (0.71%), Horner's syndrome in 2 children (0.47%) who suffered birth palsy, a section of C-6 nerve root mistaken as C-7 in l case (0.24%), and atrophy of the sternocostal part of the pectoralis major in 1 case (0.24%). The most serious complications of using the modified prespinal route in contralateral C-7 transfer were vertebral artery laceration and injury to the posterior division of the lower trunk. The prevention of such complications is necessary to popularize this surgical procedure and attain good long-term clinical results.

Good long-term outcome of the untreated contralateral hip in unilateral slipped capital femoral epiphysis

PurposeThere is no consensus regarding prophylactic fixation of the contralateral hip in slipped capital femoral epiphysis (SCFE). In order to further study this question, we evaluated the long-term natural history of untreated contralateral hips.MethodsForty patients treated for unilateral SCFE without evidence of subsequent contralateral slip during adolescence were reviewed with a mean follow-up of 36 years (range 21–50 years). The deformity after SCFE may demonstrate radiographic signs of cam-type femoroacetabular impingement. We, therefore, measured α-angles in the contralateral hips on anteroposterior (AP) and frog-leg lateral radiographs. The angles were compared with those of a control group of adults without SCFE. Five years after the radiographic examination, with a mean follow-up of 41 years, all patients were evaluated by telephone interview. As range of motion and deformity could not be examined, a modified Harris hip score (HHS) (maximum score of 91 points) was used. A modified HHS <76 points and/or radiographic osteoarthritis (OA) was classified as a poor long-term outcome.ResultsThe mean value of the AP α-angle was significantly higher in the contralateral hips in SCFE patients than in the control group (55° vs. 46°), while the mean value of the lateral α-angle was not. Abnormally high values for one or both α-angles were found in 16 contralateral hips (40 %), of which five patients had abnormal values for both α-angles and were considered to have had an asymptomatic contralateral slip. Five patients (13 %) had a poor outcome in the contralateral hip, of which three patients (8 %) had OA. There was a significant association between hips with both α-angles that were abnormal and poor outcome.ConclusionsSince the natural history showed good long-term radiographic and clinical outcome in 35 of 40 patients and only three had OA, we conclude that routine prophylactic fixation of the contralateral hip is not indicated.

Two-year clinical outcomes of patients with overlapping second-generation drug-eluting stents for treatment of long coronary artery lesions

The aim of this study was to compare the 2-year clinical outcomes of overlapping second-generation everolimus-eluting stents (EES) with those of overlapping resolute zotarolimus-eluting stents (R-ZES) in the treatment of long coronary artery lesions. This retrospective analysis included 256 patients treated with overlapping EES (n=121) and R-ZES (n=135) for long coronary artery lesions (total stent length per lesion ≥34 mm). Study endpoints included major adverse cardiac events (MACE) defined as the composite of cardiac death, myocardial infarction, and target-vessel revascularization (TVR), as well as target-lesion revascularization and definite stent thrombosis separately at 2 years. In the two groups, the mean age was older and the average number of disease vessel was higher in the R-ZES group. The mean lesion length and total stent length per lesion were longer in the R-ZES group. EES were more frequently implanted in the left anterior descending coronary artery. No significant differences in the estimated MACE (5.8% for EES vs. 8.1% for R-ZES; P=0.548) or TVR (3.4% for EES vs. 4.0% for R-ZES; P=0.806) rates were noted between the two groups at 2-year follow-up. The incidence of definite stent thrombosis was low and similar in both groups (0.83% for EES vs. 0% for R-ZES; P=0.473). No significant differences were noted with respect to MACE or TVR between the two groups following propensity score matching. Stent overlap with second-generation EES or R-ZES was associated with low rates of MACE, TVR, and stent thrombosis at 2-year follow-up. Our results suggest that the use of overlapping EES or R-ZES in long coronary lesions is associated with good long-term clinical outcomes. These results need to be validated with randomized controlled trials.

Long-term outcome after adjacent two-level anterior cervical discectomy and fusion using stand-alone plasmaphore-covered titanium cages.

Reports on long-term outcome of stand-alone contiguous two-level anterior cervical discectomy and fusion (ACDF) using stand-alone Plasmaphore-coated titanium cages (PCTCs) are rare, and data on follow-ups > 3 years are missing. To evaluate the long-term outcome of adjacent two-level microsurgical ACDF using stand-alone PCTC. A total of 33 consecutive patients presented with cervical degenerative disc disease (DDD) underwent contiguous two-level ACDF. Clinical long-term evaluation (mean: 61 ± 14 months) included documentation of neurologic deficits (motor deficits, sensory deficits, reflex status, and gait disturbance), neck pain, and radicular pain. Functional outcome was measured using the Odom criteria, patient-perceived outcome, and evaluation of work status. Radiographs were evaluated to assess intervertebral disc height, subsidence, level of fusion, sagittal balance, and implant position. Surgery was performed at levels C5-C6 and C6-C7 in 30 patients and at C4-C5 and C5-C6 in 3 (mean age: 50.1 ± 7.7 years). Symptoms and neurologic deficits improved as follows: neurologic deficits (pre: 100%; post: 36%), radicular pain (pre: 85%; post: 15%), and neck pain (pre: 94%; post: 33%). Excellent and good functional and subjective outcome was noted in 75%. Cage subsidence was found to be more prominent in the lower (52%) than the upper (36%) mobile cervical segment. Two-level fusion was documented in most patients (n = 29 [88%]). Kyphotic deformity occurred in two cases (n = 2 [6%]). Stand-alone contiguous two-level ACDF using PCPT proved to be effective, yielding good long-term clinical and functional outcomes. The relatively high rate of subsidence did not affect the good clinical and functional long-term outcome.

External fixation versus open reduction with locked volar plating for geriatric distal radius fractures.

The optimal management of displaced dorsal radius fractures (DRFs) in older patients remains an issue of debate. Bridging external fixation is a well-accepted treatment modality for severely comminuted DRFs, while open reduction and internal fixation with locked volar plating has emerged as a promising alternative in recent years. The current body of randomized trials supports the trend toward locked volar plating, as it allows for quicker improvement in subjective and functional outcomes. There is no clear evidence to suggest that one technique carries significantly less complications than the other. Locked volar plating should be considered in patients for whom an accelerated functional recovery would be advantageous. Otherwise, both external fixation and locked volar plating provide good long-term clinical outcomes.

Results for a series of 697 arteriovenous malformations treated by gamma knife: influence of angiographic features on the obliteration rate.

Stereotactic radiosurgery (RS) is an effective tool in treating brain arteriovenous malformations (AVMs). Careful study of AVM angiographic characteristics may improve results. To report the long-term outcomes of Gamma Knife RS (GKRS) in brain AVMs, focusing on how the angioarchitectural and hemodynamic parameters of AVMs affect the post-RS results. This was a retrospective, longitudinal study of 697 consecutive GKRS treatments of brain AVMs in 662 patients performed at a single center between 1993 and 2005. The mean age of the patients was 37 years; the median AVM volume was 3.6 cm(3); and the mean follow-up was 11 years. Forty-five percent of patients presented with intracranial hemorrhage; 44% underwent embolization; and 7% had multiple RSs. AVM characteristics in the RS-planning angiograms were analyzed, and their relationship to the post-RS obliteration rate was determined by univariate and multivariate analyses. The obliteration rate after a single RS was 69.3%; after multiple RS, it was 75%. Positive predictors of obliteration included compact nidus (odds ratio = 3.16; 95% confidence interval, 1.92-5.22), undilated feeders (odds ratio = 0.36; 95% confidence interval, 0.23-0.57), smaller AVM volume (odds ratio = 0.95; 95% confidence interval, 0.92-0.99), and higher marginal dose (odds ratio = 1.16; 95% confidence interval, 1.06-1.27). Improvement or clinical stability was observed in 89.3% of patients; postprocedural bleeding was noted in 6.1%; and clinical worsening attributable to RS was seen in 3.8%. The annual risk of hemorrhage in the 4 years after RS was 1.2%. GKRS yielded a good long-term clinical outcome in most patients. Certain angiographic features of brain AVMs such as a well-defined nidus and undilated feeder arteries contribute to AVM occlusion by RS. GKRS can be regarded as the treatment of choice for AVMs <6 cm(3), even after bleeding.