Important Factors For Successful Treatment Research Articles

An alternative method for measuring patient’s sagittal balance parameters in sitting and standing positions

Introduction The understanding of the biomechanics of movements in the spinopelvic segment plays an important role in the successful treatment of patients with hip-spine syndrome. Analysis of the biomechanical processes occurring in the biokinematic chain of the spine–pelvis–hip during the transition from standing position to sitting position allows us to conclude that the acetabular axis of rotation of the pelvis in space is not the only one. Classical methods for measuring PI, PT, overhang S1 are applicable for patients in a standing position and use the hip joint as a starting point, since it is the point of rotation of the pelvis in space in a standing position. Previously, using mathematical modeling, we described spatial changes in the pelvis during a given change in the body position and showed the presence of a second point of pelvis rotation in space, which appears in a sitting position. We assumed that in a sitting position, it is necessary to use other methods for calculating indicators of spinopelvic relationships for their determination.Purpose of the study was to evaluate the parameters of patients’ sagittal balance using the proposed alternative method in standing and sitting positions.Materials and methods Medical documentation and the results of X-ray examination of 20 patients with unilateral idiopathic coxarthrosis who underwent total hip replacement surgery were analyzed. The radiographic parameters were calculated: PI, PT, overhang S1 in standing and sitting positions, anterior inclination of the acetabular component; parameters PI ischial, PT ischial, deviation of the ischial tuberosities in standing and sitting positions were proposed and calculated.Results The study shows that there is no statistical difference in the values of the angles PI standard for a standing position and PI ischial for a sitting position. It corresponds to objective data and is generally accepted. Examples of changes in radiographic parameters of the sacral slope and the deviation of the ischial tuberosities were shown reflecting the rotation of the pelvis in space through the second, ischial axis, that confirm the biaxial concept of pelvic rotation.Discussion The calculations demonstrated the possibility of using alternative indicators of spinopelvic relationships (PT, distance of overhang of the sacrum (overhang S1), deviation of the ischial tuberosities). They enabled assessment of the spatial transformation of the pelvis and the ability to predict the spatial position of the acetabulum, which is an important factor for successful treatment of patients with combined pathology of the hip joint and spine.Conclusion Our findings complement the biaxial concept of pelvic rotation. An alternative method for measuring sagittal balance parameters in a sitting position has been proposed. Further research is required to assess the practical significance of this method.

How group climate in forensic and secured mental health is related to patients’ treatment motivation

ABSTRACT Motivation is an important factor for successful treatment. Unvoluntary treatment conditions forced by law influence motivation negatively. To optimise motivation in these settings, this study aimed to examine whether group climate (GC) is related to motivation and whether the fulfilment of the basic psychological needs (BPN) as described in the Self Determination Theory (SDT) might explain this relationship. Participants (n = 60) were inpatients from two forensic and one secured mental health-care unit. Participants completed questionnaires including GC, BPN, and motivation scales. Demographic information was collected in their personal files. Correlation analyses showed that there was more treatment motivation when participants perceived a chance to learn (GC ‘growth’(r = .27, p < .05)) and perceived flexibility and fairness (GC ‘repression’ (r = .30, p < .05)). The results showed insufficient support for BPN as mediators. However, autonomy did correlate significantly with both growth (r = .50, p < .01) and repression (r = .27, p < .05), as well as motivation (r = .47, p < .01). These results imply that creating prospect, hope for the future, using fair rules and be autonomy-supportive are important factors to pay attention to in reaching optimal motivation in these difficult treatment settings.

Short Term and Long-Term Efficacy of Calcipotriene/ Betamethasone Dipropionate Foam Combination.

Psoriasis is a well-known chronic disease characterized by the development of erythematous, indurated, scaly, pruritic plaques on the skin with cycles of remission and symptom flare-ups. The management of patients with chronic plaque psoriasis has been more challenging since the Covid-19 pandemic as health care professionals have had to adapt to remote consultations for some patients, and patients have had to adapt to the changing health landscape. The rapid resolution of psoriasis symptoms especially those with a substantial impact on quality of life can improve patient satisfaction and adherence, making it an important factor in successful treatment. Cal/BD foam contributes to improved patient adherence and treatment outcome through its rapid action and superior efficacy versus Cal or BD monotherapy, Cal/BD ointment and gel and clobetasol cream in the short-term flare treatment of psoriasis. Moreover, the benefits of proactive long-term management of psoriasis compared to reactive management and its favourable safety profile are higher efficacy and a better health-related quality of life. Cal/BD foam should be considered an effective topical treatment for short-term flare treatment and long-term control of adult psoriatic patients.

Economic Impact of Home-Use versus Office-Use Diphenylcyclopropenone in Extensive Alopecia Areata

Introduction: Diphenylcyclopropenone (DPCP) is the medication of choice for the treatment of severe alopecia areata (AA) according to AA treatment guidelines. Precise initiation and application are important factors for successful treatment. However, it is difficult for patients who live far away to visit their doctor weekly. Methods: We conducted a retrospective cohort study to assess the cost, effectiveness, and side effects of DPCP treatment between office-use DPCP (O-DPCP) and home-use DPCP (H-DPCP) in severe AA patients. A cost-effectiveness analysis was performed from the perspective of healthcare providers and patients using real-world data and the national cost statistics for hospital services comparing O-DPCP and H-DPCP in patients with severe AA at 24, 36, and 48 weeks. Results: Two groups of 41 patients treated with O-DPCP and H-DPCP were enrolled. There was no significant difference in the proportion of patients who showed a favorable outcome (≥50% improvement) with minimal side effects between both groups at 24 (O-DPCP 43.9% vs. H-DPCP 26.8%, p = 0.11), 36 (O-DPCP 58.5% vs. H-DPCP 43.9%, p = 0.19), or 48 weeks (O-DPCP 63.4% vs. H-DPCP 56.1%, p = 0.49). The cost of H-DPCP was half of the cost of O-DPCP. Discussion/Conclusion: H-DPCP is a cost-effective and time-efficient alternative treatment option for severe AA patients.

Analysis of urinary kallikrein-related peptidase 13 for monitoring bladder cancer

Background Bladder cancer (BC) is one of the 10 most common types of cancer worldwide, with approximately 550,000 new cases each year. Early detection and appropriate diagnosis are important factors in successful treatment of the disease. Material and methods We used specific fluorogenic substrate for the quantitative determination of urine kallikrein 13 (KLK13) activity in healthy (n = 15) and BC (n = 54) patients. The proteolytic activity in individual urine samples was determined by fluorescence measurements. Then, immunoenzymatic analyses (ELISA, Western blot) were performed to confirm the presence of KLK13 in the tested samples. Results Urine samples from patients with G2 and G3 grade BC contained proteolytically active KLK13, as confirmed by kinetic analysis and immunochemical detection. KLK13 was not detected in the urine of patients with G1 grade BC. Discussion Previous clinical study reveals the KLK13 significance for BC prognosis as increased KLK13 expression was highlighted in bladder tumours compared to normal adjacent tissues. Our findings correlate to the report. KLK13 activity was confirmed in BC patients with G2 and G3 stage of disease development. Conclusions Using specific chromogenic/fluorogenic peptides could be useful for the non-invasive disease monitoring of BC progress.

Improvement in time to treatment, but not time to diagnosis, in patients with mucopolysaccharidosis type I

ObjectiveEarly diagnosis and treatment initiation are important factors for successful treatment of mucopolysaccharidosis type I (MPS I). The purpose of this observational study was to assess whether age at diagnosis...

Use of Ayurveda in the Treatment of Type 2 Diabetes Mellitus.

BackgroundAyurveda is an ancient medicine practice that is emerging in the United States as a complementary and alternative treatment for chronic illness. Type 2 diabetes is a chronic illness that has major long-term implications for individuals suffering from the disease as well as the health-care system as a whole. Modifications in diet, exercise, and lifestyle are all important factors in successful treatment of type 2 diabetes and are incorporated into the ancient Indian medicinal practice of Ayurveda.Review Summary: This review summarizes the available evidence for the use of Ayurvedic therapies in the treatment of type 2 diabetes. For the treatment of type 2 diabetes, Ayurvedic practices primarily emphasizes the use of herbal supplements; however, exercise, weight management, and various supplemental procedures are included in Ayurvedic practices. The goal of Ayurvedic practices on the treatment of type 2 diabetes like in Western medicine focuses on bringing the hemoglobin A1c (HbA1c) value into a therapeutic range. Where Ayurveda differs is that it looks at the functionality of a person in the context of striking a balance between the life forces or doshas that each individual possesses. Finally, this article includes a case study received from AyurVAID clinic in Bangalore, India that details the specific Ayurvedic intervention used in a patient, bringing his HbA1c from a level of 11.2 to 5.7 over the course of 9 months.ConclusionPatients with type 2 diabetes may inquire about current complementary and alternative therapies available for the treatment of their disease. Awareness of such modalities is necessary for effective patient counseling and care. The benefits of offering a wide array of treatment options include possible reduction of HbA1c and of comorbidities with adjunct use of supplements and mind–body practices.

Myosites à pyogènes de l’enfant

BackgroundPyomyositis (PM) is defined as a primary pyogenic infection of the striated skeletal muscle. Although it has many dystrophic musculoskeletal complications, it is always misdiagnosed by many orthopedic surgeons. HypothesisPM is rare in temperate climates and usually considered to be a tropical disease, until recent times, after globalization, it is possible to occur in the subtropical climate as in our country. Material and methodsIn the present series, the results of 15 children patients with primary pyomyositis have been reviewed. In five out of them, conservative treatment protocol alone which has been by intravenous and oral antibiotics therapy was effective. The remaining ten patients with confirmed abscess formation needed invasive procedures, which have been percutaneous US-guided drainage in two patients and an open surgical drainage in the remaining 8 patients. ResultsConservative treatment was successful in five cases with marked improvement within 3 days, but in the other ten patients who needed surgical treatment, all were effectively treated except three out of them who showed complications as such as elbow stiffness in one case, hip joint septic arthritis with epiphysitis in the second case and osteomyelitis of the lower femoral end with knee joint septic arthritis in the last one. DiscussionBoth clinical picture and laboratory investigation of PM are not specific and resembled many other differential diagnoses so the proper imaging study is of valuable importance and needs to be accurately identified and treated to avoid its delayed complications. ConclusionIn children complaining of joint pain or muscle aches and septic-appearing, pyomyositis should be considered in the differential diagnosis. MRI is the most valuable tool for diagnosis of PM. Early diagnosis, the use of appropriate antibiotic therapy and complete drainage of the purulent material are important factors for successful treatment that leads to complete resolution of PM. The level of evidenceIV.

Primary pyomyositis in children.

Pyomyositis (PM) is defined as a primary pyogenic infection of the striated skeletal muscle; although it has many dystrophic musculoskeletal complications, it is always misdiagnosed by many orthopedic surgeons. PM is rare in temperate climates and usually considered to be a tropical disease, until recent times, after globalization, it is possible to occur in the subtropical climate as in our country. In the present series, the results of 15children patients with primary pyomyositis have been reviewed. In five out of them, conservative treatment protocol alone which has been by intravenous and oral antibiotics therapy was effective. The remaining ten patients with confirmed abscess formation needed invasive procedures which have been percutaneous US-guided drainage in two patients and an open surgical drainage in the remaining 8patients. Conservative treatment was successful in five cases with marked improvement within 3days, but in the other ten patients who needed surgical treatment, all were effectively treated except three out of them who were complicated as follows; elbow stiffness in one case, hip joint septic arthritis with epiphysitis in the second case and osteomyelitis of the lower femoral end with knee joint septic arthritis in last one. Both clinical picture and laboratory investigation of PM are not specific and resembled many other differential diagnoses so the proper imaging study is of valuable importance needs to be accurately identified and treated to avoid its delayed complications. In children complaining of joint pain or muscle aches and septic-appearing, pyomyositis should be considered in the differential diagnosis. MRI is the most valuable tool for diagnosis of PM. Early diagnosis, the use of appropriate antibiotic therapy and complete drainage of the purulent material are important factors for successful treatment that leads to complete resolution of PM. IV.

A clinical study of fulminant amebic colitis

The administration of metronidazole is generally effective to treat amebic colitis. Fulminant amebic colitis is relatively rare, and it is associated with a high mortality rate. Three cases of fulminant amebic colitis were diagnosed in our hospital between 1993 and 2014. One of these patients died despite our efforts. Amebic colitis often presents with no obvious risk factors and with atypical clinical symptoms. Therefore, the diagnosis of amebic colitis can be difficult. Early diagnosis is the most important factor in successful treatment of fulminant amebic colitis. The present cases demonstrate that it is important to consider the possibility of amebic colitis during evaluation of the acute abdomen.

Successful treatment of a case of primary amoebic meningoencephalitis: How important is history taking.

Sir, Naegleria fowleri is a rare cause of meningoencephalitis leading to a fatal fulminant primary amoebic meningoencephalitis (PAM) acquired after diving, swimming in warm fresh water. Very few patients are reported to survive after acquiring this infection.[1,2] Timely diagnosis requires a high index of suspicion in any individual presenting with a sub-acute onset meningitis after exposure to standing water in lakes and pools. A 6-year-old male child presented with a history of high grade fever, headache, vomiting for 10 days and altered sensorium for 1-day. There was no history of seizures, any other complaints or contact with tuberculosis. There was a history of playing and swimming in water stored in a cement tank, collected from a stream of water (Koohl). On examination, the child was in delirium, febrile with stable vitals. Central nervous system (CNS) examination revealed signs of meningeal irritation with the early papilledema. Rest of the systemic examination was normal. On admission possibilities of acute pyogenic meningitis, rickettsial meningoencephalitis, as this region is endemic for scrub typhus and tubercular meningitis, was kept. Intravenous (IV) ceftriaxone, azithromycin, mannitol, maintenance fluid and supportive care were started. Cerebrospinal fluid (CSF) analysis after lumbar puncture that was done next day, showed 415 cells/mm3 with 30% neutrophils and 70% lymphocytes. Gram-staining did not reveal any bacteria, but the wet mount smear showed plenty of motile, amoeboid flagellate organisms, 15-20 μm in size, Naegleria species. The water that was later on collected from water tank and koohl also showed similar Naegleria. CSF culture was negative for bacteria and computed tomography head done on 2nd day showed mild cerebral edema. The child was started on IV amphotericin B (1 mg/kg/d IV for 21 days), fluconazole (12 mg/kg/d PO on day 1 followed by 6 mg/kg/day for total of 21 days), oral rifampicin (15 mg/kg/d PO for 21 days) and supportive care for 3 weeks. The child showed gradual improvement with normal sensorium in 3 days, afebrile and disappearance of neck rigidity after 6 and 8 days of treatment respectively. He was discharged and followed-up for 3 months with no residual CNS abnormality. Primary amoebic meningoencephalitis is a fulminant and rapidly fatal disease that principally affects children and young adults caused by N. fowleri, an amoeba-flagellate found in most soil and freshwater habitats. Most of the cases reported in children as well as in adults has been fatal.[1,3] One of the key and most important factors for a successful outcome is the promptness in diagnosis and treatment of the patient. Delay in diagnosis and the fulminant nature of the disease results in few survivors.[4] In our case, the child presented with features of meningitis and altered sensorium with sub-acute course with history of swimming in stored fresh water. In a case of meningitis, we routinely do not perform wet mount microscopy but in our case history of swimming in stored fresh water with a sub-acute course of meningoencephalitis led to the investigation and early diagnosis, which is the most important factor for successful treatment of PAM. Early treatment was started, and the child recovered completely. Vargas-Zepeda et al.[2] also successfully treated a 10-year-old boy of PAM with IV amphotericin B, fluconazole, rifampicin, and dexamethasone. So, history taking that is perhaps a dwindling art can create a difference perhaps between death and survival and wet mount microscopy should be routinely done in a case of meningitis or meningoencephalitis with sub-acute course.

Maxillary posterior teeth removal without palatal injection -truth or myth: a dilemma for oral surgeons.

Pain control is one of the most important factors for successful treatment. Each new measure to control pain has been looked as miraculous act at the initial stages. The improvements in agents and techniques for local anaesthesia are probably the most important advances in dental science to have occurred in the past years. To evaluate 4% articaine hydrochloride against 2% lignocaine hydrochloride anaesthesia in providing adequate palatal anaesthesia in maxillary posterior regions, without the need for a palatal block. Healthy patients above 15 y of age and requiring bilateral extraction of their maxillary posterior teeth were included in this crossover study. The exclusion criteria included medical history of cardiovascular and kidney diseases, gastrointestinal bleeding or ulceration, allergic reactions to local anaesthetic, pregnancy or current lactation. Eighty patients, requiring bilateral extraction of their teeth due to various reasons were enrolled for this study. Each patient received both lignocaine and articaine anaesthetic in equivalent dose at two different appointments. Maxillary infiltration technique was used for extraction of maxillary posterior teeth at both the appointments. A 170-mm Heft Parker visual analogue scale was used to assess the pain on the palatal mucosa after buccal infiltration of either anaesthetic agent. Blood pressure, Pulse rate and electrocardiographic monitoring were done during the procedure. Adverse effects during the study period were also monitored. Data was analysed by Z-test and student's t-test. Pain scores on probing palatal mucosa after buccal infiltration of the anaesthetic were more for lignocaine as compare to articaine and it was statistically significant (p <.001). However, for hemodynamic parameters and electrocardiographic monitoring, there was no statistically significant difference in blood pressure, pulse rate and electrocardiograph before and after the completion of extraction (p > 0.05). Four percent articaine offers better clinical performance than 2% Lignocaine, particularly in terms of providing adequate palatal anaesthesia with only buccal infiltration.

The influence of thrombus, calcification, angulation, and tortuosity of attachment sites on the time to the first graft-related complication after endovascular aneurysm repair

Endovascular aneurysm repair (EVAR) is associated with high graft-related complication rates during follow-up. Anatomical fit between patient and endograft could be an important factor for successful treatment. Aim was to assess whether extent of thrombus, calcification, angulation, and tortuosity are associated with occurrence of complications after EVAR. Patients in either United Kingdom EVAR trial 1 or 2 were included if they had undergone EVAR within 6 months of randomization and had a preoperative computed tomography (CT) scan of adequate quality in the core laboratory. Three-dimensional CT imaging was used to assess extent of preoperative thrombus, calcification, angulation, and tortuosity in aneurysm neck and iliac segments. Cox regression modeling, adjusted for the variables tested and for known confounding variables, was used to investigate whether these factors were associated with increased rates of reported first complications. A total of 217 patients with 53 first graft-related complications were analyzed after a mean follow-up of 3.6 years. Adjusted hazard ratios (95% confidence intervals, P values) for complications per unit increase of variable were 0.96 (0.92-0.99, 0.018) for neck thrombus, 1.06 (1.00-1.12, 0.044) for neck calcification, 1.02 (1.00-1.05, 0.079) for neck angulation, 1.04 (1.01-1.06, 0.011) for common iliac thrombus, 0.96 (0.93-1.00, 0.033) for common iliac calcification, and 5.96 (1.53-23.28, 0.010) for common iliac tortuosity. Increased neck angulation and calcification and common iliac thrombus and tortuosity are associated with higher rates of graft-related complications after EVAR. Increased neck thrombus and common iliac calcification appear to protect against complications. Careful evaluation of these factors prior to EVAR might lead to lower complication rates.

Effect of Diabetes Education Program on Glycemic Control and Self Management for Patients with Type 2 Diabetes Mellitus

Background: Diabetes mellitus is a chronic disease requiring continuous treatment and vigorous self-management. Reinforcement of effective self management and diabetes educati on are important factors in successful treatment. The aim of this study was to evaluate the effectiveness of the current diabetes education program on blood glucose control, self-management, and self-efficacy of patients with type 2 diabetes mellitus. Methods: A total of 592 patients with newly diagnosed or uncontrolled type 2 diabetes mellitus were recruited to the diabetes education program from January to December 2007. We surveyed 338 patients from April to July 2008. A total of 117 patients had biochemical examinations and completed a questionnaire about knowledge, self-management and self-efficacy of diabetes treatment (no education group (n = 23), education group (n = 94)). Results: The total scores from the questionnaires and the results of laboratory data showed no differences between the two groups. However, there were significant reductions in hemoglobin A1c level in the education group, as compared with the no education group (P = 0.039). Although the score for knowledge about diabetes mellitus was significantly higher in the educati on group (P = 0.005), greater knowledge was not reflected in the self-management or self-efficacy of the pa tients. Conclusion: The current diabetes education program had no effect on the self-management or self-efficacy of patients with diabetes, although did show some degree of association with blood glucose control and diabetes knowledge level. We conclude that a more effective diabetes education program needs to be developed and applied to daily practice for the improvement ofself-efficacy in patients with diabetes mellitus. (Korean Diabetes J 33:518-525, 2009)

Antimicrobial Chemotherapy in the Control of Surgical Infectious Complications

In spite of the progress in surgical technique and antibiotic prophylaxis, postoperative infection still accounts for both the commonest surgical complication and one of the most frequent nosocomial infections, also causing an increase in duration and costs of hospital stay. The choice of treatment for post-surgical infections requires an understanding of the usual infecting flora, available antimicrobial agents, and susceptibility patterns. The most common organisms in simple wound infection are Gram-positive cocci and mainly Staphylococcus aureus. Staphylococcus epidermidis and S. aureus (quite often methicillin-resistant strains) are the organisms which predominate in the infectious complications following clean surgical procedures with implantation of vascular grafts or prosthetic devices. Mixed aerobic and anaerobic flora are mainly responsible for cases of intra-abdominal and intra-pelvic postoperative infections: the most common aerobes are Enterobacteriaceae (Escherichia coli, Proteus spp., and others) and enterococci, and among anaerobes Bacteroides fragilis group prevails. Adequate drainage and surgical control of the source of infection, when needed, and adjunctive effective antimicrobial therapy are important factors in successful treatment of postoperative infections. Semisynthetic penicillinase-resistant penicillins and glycopeptides (vancomycin and teicoplanin) are the drugs of choice for the treatment of infections caused by penicillin-resistant methicillin-sensitive, and methicillin-resistant, respectively, S. aureus and S. epidermidis. For the treatment of intra-abdominal and intra-pelvic infections, animal and human studies support the recommendation that treatment should be directed against both Gram-negative enteric and anaerobic bacteria. Combinations of aminoglycosides with clindamycin or metronidazole have been widely used with great success; however adverse reactions such as nephrotoxicity and ototoxicity have been a problem in some patients. In recent years monotherapy with either a carbapenem (imipenem/cilastatin or meropenem) or a penicillin/β-lactamase inhibitor combination has been proposed. Among these combination antimicrobials, piperacillin combined with tazobactam is a very well designed formulation. Indeed, piperacillin is active against a broad range of Gram-negative and Grampositive pathogens, and tazobactam is a potent β-lactamase inhibitor which acts on a variety of clinically important plasmid and chromosomal beta-lactamases. This combination seems particularly attractive for the treatment of mixed polymicrobial anaerobic-aerobic infections such as intra-abdominal and intra-pelvic postoperative infections.

大腿骨転子部骨折に対するｃｏｍｐｒｅｓｓｉｏｎ ｈｉｐ ｓｃｒｅｗの治療成績

We investigated the results of surgical treatment of 49 trochanteric femoral fractures using the compression hip screw.The patients included 13 males and 36 females, with the mean age of 83 years. According to the classification of Evans, 33 cases were stable and 16 cases were unstable.Local complications were observed in 2 cases; loosening of the lagscrew in 1, cutting out with rotational displacement in 1. The telescoping amount of the lagscrew was significantly (p<0.001) more in the case of unstable fractures and poor reduced group than in that of stable fractures and good reduced group. In stable fractures and good reduced group, positive correlation was found between the length of screw in contact within the barrel and the telescoping amount. These results suggest that the shorter the length of screw in contact within the barrel, the more resistance there is to slide.It is, therefore concluded that an important factor for successful treatment with CHS is to engage the lagscrew with the barrel sufficiently under good reduction.

同側下肢複合骨折の治療経験

Thirteen cases of ipsilateral fractures of the femur and tibia were treated. they were classified according to Fraser's classification into type I (8 cases), IIa (3 cases), IIb (1 case), IIc (1 case). Using the criteria for assessment described by Karlstrom, cases were graded as excellent, good, acceptable and poor. Excellent results were achieved en 8 cases, good in one, acceptable in three and poor in one. Cases with injury of the knee joint achieved relatively poor results.We concluded that repair of the knee joint is the most important factor for successful treatment of ipsilateral fractures of the femur and tibia.

Risk factors in amblyopia

Any intervention to prevent serious amblyopia is based on the knowledge about normal versus subnormal visual development. Our ability to predict with high degree of certainty which children will develop amblyopia will be dependent on the characteristics of various risk factors for initiating the development of squint or amblyopia. We have used longitudinal studies of population based cohorts of young children to define some of these risk factors such as refractive errors. Three hundred and ten children with an astigmatism greater than or equal to 1.0 D at one year of age were refracted yearly between the age one and four years. Astigmatism and anisometropia were found to be highly variable during infancy and early childhood. Longitudinal follow-up seems to be needed to separate the normal from the abnormal refraction development, which initiates the development of the amblyopia. Children with constant or increasing astigmatism or anisometropia between one and four years were 'at risk'. In parallel we have studied important factors for successful treatment of amblyopia. Based on these findings we conclude that a population screening at four years of age seems to be advantageous in Sweden in order detect and successfully treat most cases of amblyopia.

Replantation of amputated extremities (author's transl)

After some short remarks about the organization of microsurgery in Australia, the microsurgical technique of retransplantation of dissected extremities and the conservation methods are described in detail. In 175 out of 208 cases, retransplantation of extremities was successful, i.e. certain functions were reestablished. Results were better in children than in adults. The most important factors in successful treatment are the conservation methods, skilled technique, and postoperative care, which may last up to 1 year. One retransplantaion center with 4 experienced surgeons per 5,000,000 population seems to be mandatory.

Failures in Orthodontics

There are several dogmatic rules for the prevention of orthodontic failure and to aid in the philosophical approach to orthodontic problems: 1. No occlusion is so stable as a malocclusion once established and in equilibrium. 2. Stability of the anterior teeth can more easily be maintained when upright over basal bone and closest to the position of the original malocclusion. 3. The intercuspal widths and intermolar widths of the mandibular teeth are most stable when contained within the arch form and muscular balance of the original malocclusion. 4. Growth of the jaws is largely a product of genetics, endocrine balance, and nutrition. 5. Proper skeletal relationships may be more important than dental relationships in evaluating the severity of a malocclusion. 6. Relapse is more likely to occur in the mandibular arch first than in the maxillary arch. 7. Most well-treated malocclusions will lose about 10 to 15 per cent of the treatment result after retention. Disregard of the following factors, singly or in combination, probably leads to most failures in orthodontic treatment: 1. Tooth-to-bone discrepancies. 2. Bone-to-bone discrepancies. 3. Tooth-to-tooth discrepancies. 4. Aberrant neuromuscular patterns. 5. Changing growth patterns. 6. The limitations of treatment goals. 7. The limitations of appliance therapy. 8. The effects of orthodontic therapy on the psyche of the patient, his self image, his goals, and his cooperation. Today, it is naive to anticipate that a good dental cusp–fossa relationship, a good centric occlusion and centric relation, proper contact points, and reasonable alignment of the anterior teeth with good cuspid rise, and other mechanistic parameters, will suffice as the sole criteria for tissue health, dental stability, and facial esthetics. Most orthodontic failures cannot be laid to one single factor. Failures usually are the cumulative effect of several factors, one leading to another like a series of fallen dominoes. The important factors in successful treatment can be linked to a chain of events with each link having importance, and the omission of a link causing a break in the successful outcome of treatment. The orthodontist strives, along with his dental colleagues, for perfection in occlusion, stability, function, and dental and facial esthetics, but it is simpler to move a tooth into a given position with known mechanical forces than to maintain the tooth in a new position subject to the unknown forces of occlusal stress and a new muscular environment. Fortunately, the oral mechanism is forgiving of ignorance and abuse, will tolerate many minor errors, and will adjust and compensate to establish harmony and homeostasis within its functional limits.