Improvement Rate In Patients Research Articles

Paper 97: Resurfacing Versus Non-resurfacing the Patella in Total Knee Arthroplasty: An Appraisal of Available Evidences

The decision whether to resurface or not the patella in total knee arthroplasty (TKA) is highly controversial and surgeons show a wide variety of attitudes in Europe and in the USA. Surgeons favouring patellar resurfacing advocate that post-operative knee pain following TKA is significantly diminished, which would improve patient-based outcome. On the other hand, patellar replacement carries a number of potential complications which may outweigh the benefit of reduced anterior knee pain. A systematic search of available evidences comparing the outcome of unresurfaced versus resurfaced patellae in TKA was therefore conducted. The purpose of the present paper is providing orthopaedic surgeons with an updated appraisal of relevant evidences that may assist them in their decision-making process. A bibliographic search was conducted through the most representative databases. We searched for meta-analyses (MA), systematic reviews (SR) and randomized controlled trials (RCT) comparing outcome between resurfaced and unresurfaced patellae in TKA. The following databases were used: Cochrane Muskuloskeletal Injuries Group Specialized Register, the Cochrane Register of Controlled Trials, Health Technology Assessment (HTA), PEDro, Medline, EMBASE, CINAHL, AMED, DARE, TRIP, The National Research Register (UK). The search was ended on February 2008. The search term selected from The National Library of Medicine's medical subject heading (MESH) database were: patella; resurfacing; total knee arthroplasty; TKA; total knee replacement; TKR. Additionally, the rate of reduced post-operative anterior knee pain in patients undergoing patellar resurfacing was compared with the current rate of complications associated with patellar replacement. Five MAs, 1 SR and 6 RCTs not included in the published evidence syntheses were retrieved. All evidence syntheses would warrant patellar resurfacing in order to reduce anterior knee pain and the related risk of re-operation. Conversely, 4 RCTs failed to detect significant differences using accepted clinical scores at mid- and long-term follow-up while 2 RCTs did not report significant variations of the biomechanical performance in vivo between replaced and un-replaced patellae. Current evidences would support the decision to resurface the patella when anterior knee pain and the related risk of re-operation are used as end-points of outcome at mid-term follow-up. However, no clinical differences would be detectable between resurfaced and unresurfaced patellae at long-term follow-up. In addition, both patella-replaced and patella-unreplaced TKA exhibit similar biomechanical behaviour in vivo. The rate of anterior knee pain improvement in patients undergoing patellar replacement should be contrasted with the rate of potential complications related to patellar resurfacing.

The Effect of Admission Hyperglycemia in Stroke Patients Treated With Thrombolysis

ABSTRACTBackground: Acute hyperglycemia (HG) has been shown to correlate negatively with an outcome in stroke patients, yet the mechanism remains controversial. The aim of our study is to study the immediate and long-term effects of admission HG on outcome in a cohort of stroke patients treated with thrombolytic therapy. Methods: We reviewed the prospective dataset of a statewide telestroke network for the characteristics of 195 patients who received intravenous tissue plasminogen activator via telemedicine during a 27-month period. We compared outcome and improvement rate of patients with and without HG. We defined good outcome as a modified Rankin Scale score ≤ 2 and neurological improvement after thrombolysis as either a decrease in National Institutes of Health Stroke Scale (NIHSS) at 24 hr by 5 points from baseline or an NIHSS of 0 at 24 hr. Results: Thirty-one percent of patients had admission HG (Blood sugar > 144). Patients with admission HG had higher 3-month mortality and poor outcome rates than those without normoglycemia (NG). The improvement rates with thrombolysis, however, were similar between the two groups. Conclusions: Admission HG is associated with poor neurological recovery in patients with an acute stroke despite thrombolytic treatment without having an effect on the clinical response to thrombolytic therapy. Larger studies are needed to confirm this finding.

Effect of Psychopathology on Patient-Perceived Outcomes of Total Knee Arthroplasty within an Indigent Population

Factors other than surgical technique and implants impact patient outcomes following a total knee arthroplasty. The purpose of this study was to analyze the effects of psychopathology on the rate of improvement following total knee arthroplasty in an indigent population. One hundred and fifty-four consecutive indigent patients undergoing a primary total knee arthroplasty for arthritis were enrolled and available for follow-up. Patients were classified as having psychopathology on the basis of the presence of somatization, depression, and/or a panic or anxiety disorder as assessed with the Patient Health Questionnaire. Outcome measures were completed preoperatively and one year postoperatively. Univariate analyses, controlled for sex and age, were used to compare the rates of improvement in patients who exhibited psychopathology with the rates in those without psychopathology. Fifty-four patients (35%) were diagnosed with at least one Axis-I psychological disorder. The psychopathology group showed significantly lower Short Form-36 mental component summary scores both at baseline and one year postoperatively (p < 0.001 for both). The psychopathology group also reported significantly higher levels of perceived disability at baseline on the Pain Disability Questionnaire (p < 0.001) and worse scores on the Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.004); however, the improvement on both of these scales did not differ significantly between the two groups (p > 0.05). The Knee Society Score differed significantly between the two groups at both baseline and the one-year follow-up evaluation (p = 0.003 and p = 0.001, respectively), but there was no significant difference in the total rate of improvement between the two comparison groups (p > 0.05). Not only is there a high prevalence of psychopathology in the indigent population, but psychopathology may result in lower patient-perceived outcome scores at one year after a total knee arthroplasty. Even though outcome scores may be worse for patients with psychopathology, our study showed that these patients still benefit, with the same degree of improvement in function.

Anti-Inflammatory Effect of Keigai-rengyo-to Extract and Acupuncture in Male Patients with Acne Vulgaris: A Randomized Controlled Pilot Trial

The objectives of this study were to evaluate the efficacy and interaction of Keigai-rengyo-to extract (KRTE) and acupuncture in male patients with acne and the feasibility of a large clinical trial. A randomized, assessor single-blinded, 2×2 factorial trial was conducted. The trial is registered with the Clinical Research Information Service, Republic of Korea: KCT0000071. Forty-four (44) participants with acne vulgaris were randomized into one of four groups: waiting list group (WL), KRTE only group (KO), acupuncture only group (AO), and KRTE and acupuncture combined treatment group (KA). After randomization, patients in the AO and KA groups underwent eight sessions of acupuncture treatment, twice per week. Patients in the KO and KA groups were prescribed KRTE 3 times daily, 7.4 g each dose, after meals, for 4 weeks. The following outcome measurements were used in examination of subjects: mean percentage change and the count change of inflammatory and noninflammatory acne lesions, Skindex 29, investigator global assessment from baseline to end of trial, and proportion of dropouts and compliance with KRTE. A significant interaction of KRTE and acupuncture was evident according to mean percent change of inflammatory acne lesions, but not of noninflammatory acne lesions from baseline to the end of the study. Statistically significant differences were observed in the primary effect on mean percent change of noninflammatory acne lesions, not by acupuncture, but by KRTE. Adjusted Skindex 29 score changes indicated no statistically significant reduction within groups and between groups. The improvement rate in patients with KRTE and acupuncture treatment was not significant, compared to patients with no KRTE and acupuncture treatment. The proportion of dropouts was 22.7% and rate of compliance with KRTE was 92.3%. For treatment of acne vulgaris, use of KRTE combined with acupuncture is recommended for inflammatory lesions and KRTE only is recommended for noninflammatory lesions. Further large-scale trials assuming a higher dropout rate and aimed at confirming the ability of KRTE and acupuncture to improve inflammatory and noninflammatory lesions in patients with acne are needed.

Medical treatment for sphincter of oddi dysfunction: Can it replace endoscopic sphincterotomy?

To report the results of a medical management of sphincter of oddi dysfunction (SOD) after an intermediate follow-up period. A total of 59 patients with SOD (2 men and 57 women, mean age 51 years old) were included in this prospective study. After medical treatment for one year, the patients were clinically re-evaluated after an average period of 30 mo. The distribution of the patients according to the Milwaukee's classification was the following: 11 patients were type 1, 34 were type 2 and 14 were type 3. Fourteen patients underwent an endoscopic sphincterotomy (ES) after one year of medical treatment. The median intermediate follow-up period was 29.8 ± 3 mo (3-72 mo). The initial effectiveness of the medical treatment was complete, partial and poor among 50.8%, 13.5% and 35%, respectively, of the patients. At the end of the follow-up period, 37 patients (62.7%) showed more than 50% improvement. The rate of improvement in patients who required ES was not significantly different compared with the patients treated conservatively (64.2% vs 62.2%, respectively). Our study confirms that conservative medical treatment could be an alternative to endoscopic sphincterotomy because, after an intermediate follow-up period, the two treatments show the same success rates.

Lamivudine and entecavir significantly improved the prognosis of early-to-mid stage hepatitis B related acute on chronic liver failure

To clinically study the antiviral effects of lamivudine and entecavir on patients with early-to-mid stage Hepatitis B related acute on chronic liver failure (HBV-ACLF). METHODS; A prospective, randomized, open and parallel controlled clinical trial was designed to observe the antiviral effects of nucleoside analogues on patients with early-to-mid stage HBV-ACLF. Three groups were set for controlled study, i. e. basic treatment group, lamivudine plus basic treatment group and entecavir plus basic treatment group. One month after treatment, the improvement rates of lamivudine group and entecavir group were 58.85% and 59.15% respectively, significantly higher than that of basic treatment group which was 34.84% (Chi(2) = 9.8323, P = 0.043). By the end of six months, the cumulative survival rates of patients with the antiviral treatments, i.e., lamivudine, entecavir, were 65.8%, 60.1%, significantly higher than that (42%) without the antiviral treatment (P = 0.045, P = 0.04 respectively). The cumulative survival rate in patients with a MELD score < 30 was higher than that with a MELD score over 30 (Chi(2) = 3.920, P = 0.048). For the patients with pretreatment HBV DNA > or = 10(7), the cumulative survival rate in patients with entecavir treatments group was higher than that of patients in basic treatment group (Chi(2) = 5. 014 P= 0.025). According to the Ordinal Regression analysis, antiviral therapy by using either lamivudine or entecavia could significantly increase the improvement rate of patients with early-to-mid stage HBV-ACLF. But severe complications, including hepatorenal syndrome, electrolyte imbalance and hepatic encephalopathy, medical history of liver cirrhosis, and pretreatment HBV DNA > or = 10(7) had significant impacts on prognosis of this group patients. Antiviral therapy by using either lamivudine or entecavia could significantly increase the survival rate of patients with early-to-mid stage HBV-ACLF.

Clinical features and prognostic analysis of 51 drug-induced case of liver failure

To enhance the understanding of drug-induced liver failure by analyzing the etiology, clinical features and prognosis associated factors of patients with drug-induced liver failure. Fifty-one cases of drug-induced liver failure admitted to our hospital from 2002 - 2007 were reviewed according to their drug history, clinical features, Laboratory tests, complications and prognosis associated factors. The predominant etiological drugs were the traditional Chinese medicine (54.9%) and antitubercular agent (25.5%). Two predominant types of liver failure were acute liver failure (13.7%) and subacute liver failure (78.4%). The common complications were electrolyte disturbance, ascites and hepatic encephalopathy. The total improvement rate in patients was 29.4%. The incidences of hepatic encephalopathy, electrolyte disturbance and PTA value had statistical difference between improvement group and ineffective group. The etiologies of drugs-induced liver failure are traditional Chinese medicine and antitubercular agent in China. The prognosis of drug-induced liver failure remains poor. During the therapy of these drugs treatment, liver function test should be monitored.

Meta‐analysis used to identify factors associated with the effectiveness of proton pump inhibitors against non‐erosive reflux disease

A lack of published data remains on factors associated with the treatment response to proton pump inhibitors (PPI) in patients with non-erosive reflux disease (NERD). Studies on effectiveness of PPI in patients with NERD were identified using the MEDLINE database and manual searches of the available literature. Twenty publications that comprised a total of 22 study arms were eligible, and meta-analyses of these 22 study arms were carried out. Overall improvement rate in patients with PPI was 68%. Univariate meta-regression analysis was used to explore the source of heterogeneity, P-value for males was 0.192, and in the presence of Helicobacter pylori (H. pylori) infection was 0.186, indicating that these factors are associated with treatment effectiveness. Thus, as the frequency of male and H. pylori-infected patients increased, the effectiveness of PPI against NERD improved. By multivariate meta-regression analysis, the P-value for male and H. pylori infection decreased further (P = 0.002 and P = 0.003, respectively), indicating little interaction between male sex and H. pylori infection. These results suggest that H. pylori infection and patient sex may be associated with the effectiveness of PPI against patients with NERD. The reasons are still unclear, and further examinations are needed to clarify them.

Gamma Knife Radiosurgery for Skull Base Meningiomas: Long-Term Radiologic and Clinical Outcome

To analyze the long-term outcomes in patients with skull base meningiomas (SBMNGs) treated with Gamma Knife radiosurgery (GKRS). Of the 98 consecutive patients with SBMNGs treated with GKRS between 1998 and 2002, 63 were followed up for more than 48 months. The mean (+/-SD) age of the patients was 50 +/- 12 years, the mean tumor volume was 6.5 cm(3) (range, 0.5-18.4 cm(3)), the mean marginal dose was 12.6 Gy (range, 7.0-20.0 Gy), and the mean follow-up duration was 77 +/- 18 months. The mean number of shots was 13.7 +/- 3.8. The tumor volume was decreased at the last follow-up in 28 patients (44.4%) and increased in 6 (9.6%). The actuarial tumor control rate was 90.2% at 5 years. No notable prognostic factor related to tumor control was identified. Ten patients (15.9%) with a cranial neuropathy showed unfavorable outcomes. The rate of improvement in patients with a cranial neuropathy was 45.1%. Age >70 years was likely correlated with an unfavorable outcome in patients with cranial neuropathy (odds ratio = 0.027; p = 0.025; 95% confidence interval 0.001-0.632). Cavernous sinus location was significantly associated with improvement of a cranial neuropathy (odds ratio = 7.314; p = 0.007; 95% confidence interval 1.707-31.34). Gamma Knife radiosurgery is an effective modality for the treatment of SBMNGs and provides favorable outcomes in patients with cranial neuropathy, even in the long-term follow-up period. However, radiosurgery for patients with no or only mild symptoms should be performed cautiously because neither complication rate is low enough to be negligible, especially in elderly patients. A cranial neuropathy by MNGs involving the cavernous sinus seems to have a higher chance of improvement after radiosurgery than other SBMNGs.

A Meta-Analysis of the Placebo Rates of Remission and Response in Clinical Trials of Active Ulcerative Colitis

Knowledge of the placebo outcomes and understanding specific study features that influence these outcomes is important for designing future clinical trials evaluating therapy of ulcerative colitis (UC). The aims of this study were to estimate the placebo rates of remission and response in placebo-controlled, randomized clinical trials for active UC and to identify factors influencing these rates. We performed a systematic review and meta-analysis of placebo-controlled, randomized clinical trials evaluating therapies for active UC identified from MEDLINE from 1966 through 2005. Forty studies met the inclusion criteria. The pooled estimates of the placebo rates of remission and response were 13% (95% confidence interval, 9%-18%; range, 0%-40%; median, 12%) and 28% (95% confidence interval, 23%-33%; range, 0%-67%; median, 30%), respectively, both with significant heterogeneity. Studies that used more stringent definitions of outcomes had lower placebo rates of remission and response. Study duration, number of study visits, disease duration, baseline composite and rectal bleeding scores of the disease activity index, and inclusion of endoscopic mucosal healing as the remission definition all were associated with the placebo remission rate. Rates of remission in the placebo arm of UC clinical trials ranges from 0% to 40%. The placebo remission rates are influenced by the trial length, number of study visits, use of stricter remission definitions, and design features that enroll patients with more active disease. These factors should be considered when designing future placebo-controlled clinical trials in patients with active UC.

Mitral Valve Repair Versus Revascularization Alone in the Treatment of Ischemic Mitral Regurgitation

For patients with ischemic mitral regurgitation (MR), it is not clear whether adjunctive mitral valve (MV) repair at the time of coronary artery bypass graft surgery (CABG) is beneficial. We sought to test the hypothesis that MV repair with CABG is superior to CABG alone in improving MR without increasing operative or long-term mortality. A total of 107 consecutive patients with moderate or severe ischemic MR, as determined by preoperative echocardiography, underwent CABG with concomitant MV repair (repair group, n=50) or CABG only (CABG group, n=57). Degree of MR was graded as none, mild, moderate, or severe by the proximal isovelocity surface area method. The groups were similar with respect to age, gender, baseline New York Heart Association class, ejection fraction, and number of bypass grafts. The repair group had a higher percentage of patients with atrial fibrillation or severe MR than the CABG group. The operative mortality was significantly higher for the repair group (12%) than the CABG group (2%), whereas the 5-year actuarial survival rate of the 2 groups was similar (88%+/-5% versus 87%+/-6%). On multivariate logistic regression analysis, older age, higher New York Heart Association class, and atrial fibrillation were independent predictors of operative mortality (P<0.05). Among patients with severe MR, ischemic MR was improved in all patients of the repair group and in 67% of patients in the CABG group (P<0.001), whereas improvement rates in patients with moderate MR were similar in the 2 groups (75% versus 67%, P=NS). Although MV repair appears to be more effective at reducing ischemic functional MR, CABG alone may be a preferable treatment option for patients with moderate MR and high operative risk factors such as old age or atrial fibrillation.

Effectiveness of hyperbaric oxygen therapy in idiopathic sudden hearing loss

The aim of this study was to investigate the efficacy of hyperbaric oxygen (HBO) therapy in idiopathic sudden sensorineural hearing loss (ISSHL) by comparing hearing gain and improvement rate in patients who have been placed on both HBO and medical treatment (MT) (37 patients), and patients who have received MT only (17 patients). Both groups were compared with reference to pure tone average (PTA) and the number of patients who experienced hearing gain. Of 37 patients (40 ears) who received HBO + MT, 24 (60 per cent) experienced > or = 10 decibels (dB) improvement in PTA compared to 13 (76.4 per cent) of 17 patients who were placed on MT only. Inter- or intra-group comparison of age stratification (< 50 and > or = 50 ages) did not produce significant differences in PTA and in the number of patients who experienced hearing gain. Although there are numerous studies showing efficacy of HBO therapy; this study did not reveal a trend in favour of HBO therapy.

Efficacy and safety of ecabet sodium on functional dyspepsia: A prospective, double-blinded, randomized, multi-center controlled trial

To compare ecabet sodium and cimetidine in relieving symptoms of functional dyspepsia. We performed a multi-center, prospective, randomized, double-blinded controlled trial to compare the clinical efficacy of ecabet sodium and cimetidine in patients with functional dyspepsia. Two-hundred and seventy-two patients with dyspeptic symptoms fulfilling the Rome-II criteria were enrolled from 7 centers. In the study group (115 patients), 1.5 g ecabet sodium was given twice a day. In the control group (121 patients), 400 mg cimetidine was given twice a day. Symptoms and parameters of quality of life were analyzed at baseline, 3, 14, and 28 d after initiating the treatment. Two-hundred and thirty-six patients completed the clinical trial. After 4 wk of treatment, the rates of improvement in patients with dyspeptic symptoms were not different between two groups (77.4% in the ecabet group and 79.3% in the cimetidine group, respectively, P > 0.05). Likewise, the rates of symptomatic improvement were not different at 3 d and 14 d. The parameters of quality of life did not change significantly during the study period in both groups. There was no clinically significant adverse event in both groups. In patients with functional dyspepsia, ecabet sodium has similar clinical efficacy with cimetidine.

A multi-central, randomized, controlled clinical trial of glucosamine hydrochloride/sulfate in the treatment of knee osteoarthritis

To evaluate the efficacy and safety of glucosamine hydrochloride (GH) in the treatment of patients with knee osteoarthritis (OA) comparing with glucosamine sulfate (GS). A multi-central, randomized, parallel-controlled clinical trial of GH vs GS was performed. 142 patients suffering from knee OA were randomized into 2 groups, treated with GH and GS for 480 mg and 500 mg one time respectively. Patients received medicine 3 times daily with total 1440 mg per day for GH group and 1500 mg for GS group, orally for 4 weeks and were assessed for drug efficacy and safety for 2 more weeks. Knee pain at rest, at movement and at pressure, knee swelling, morning stiffness and walking ability were recorded at 1, 2, 3, 4 and 6 week according to Lequesne's criteria. Other features such as therapeutic efficacy, adverse events and laboratory parameters were also recorded. A considerable improvement in OA symptoms and a reduce of total Lequesne's score were observed in both groups after the 4-week treatment. The Lequesne's score decreased to 3.4 +/- 1.9 (P < 0.05) and 3.4 +/- 1.8 (P < 0.05) after 4-week treatment comparing to 0-week in the GH (9.4 +/- 1.8) group and GS (9.5 +/- 1.4) group respectively. There was no significant difference between 2 groups in decreasing the Lequesne's score (P > 0.05). The symptomatic improvement rates in patients were 91.4% and 90.0% at 4-week treatment in the GH and GS group respectively (P > 0.05). There was a remnant therapeutic effect in both groups at 2 weeks after discontinuation of the treatment. And 4.2% (3/71) of patients on GH reported adverse events, vs 7.0% (5/71) adverse events with GS group (P > 0.05), mainly mild stomach discomfort and constipation. There were no significant differences in efficacy and safety between GH and GS groups in the treatment of knee OA. Glucosamine hydrochloride is as effective and safe as glucosamine sulfate.

Colchicine treatment of alcoholic cirrhosis: A randomized, placebo-controlled clinical trial of patient survival

Colchicine improved survival and reversed cirrhosis in several small clinical trials. We compared the efficacy and safety of long-term colchicine, as compared with placebo, in patients with advanced alcoholic cirrhosis. Five hundred forty-nine patients with advanced (Pugh B or C) alcoholic cirrhosis were randomized to receive either colchicine 0.6 mg twice per day (n = 274) or placebo (n = 275). Treatment lasted from 2 to 6 years. The primary outcome was all-cause mortality. Secondary outcomes were liver-related morbidity and mortality. Liver biopsy was requested prior to entry and after 24 months of treatment. Attendance at scheduled clinic visits and adherence with study medication were similar in colchicine and placebo groups. Alcohol intake was less than 1 drink per day in 69% of patients. In an intention-to-treat analysis, all-cause mortality was similar in colchicine (49%) and placebo (45%) patients (P = .371). Mortality attributed to liver disease was 32% in colchicine and 28% in placebo patients (P = .337). Fewer patients receiving colchicine developed hepatorenal syndrome. In 54 patients with repeat liver biopsies after 24 or more months of treatment, cirrhosis improved to septal fibrosis in 7 patients (3 colchicine, 4 placebo) and to portal fibrosis in 1 patient (colchicine). In patients with advanced alcoholic cirrhosis, colchicine does not reduce overall or liver-specific mortality. Liver histology improves to septal fibrosis in a minority of patients after 24 months of treatment, with similar rates of improvement in patients receiving placebo and colchicine. Colchicine is not recommended for patients with advanced alcoholic cirrhosis.

Allergy and parasites reevaluated: wide-scale induction of chronic urticaria by the ubiquitous fish-nematode Anisakis simplex in an endemic region

Background The ubiquitous fish-nematode Anisakis simplex produces acute urticaria or angioedema in the course of gastro-allergic anisakiasis. We studied the relationship between this nematode and chronic urticaria (CU), as well as the clinical usefulness of measuring specific IgG 4 in A. simplex-sensitized patients with CU. Methods First, the prevalence of sensitization to A. simplex was estimated in 135 consecutive CU patients and the result was compared with known data about sensitization in a healthy population. Then, clinical response to a 2-month diet without fish was analyzed in 76 CU patients. The improvement rate in patients with and without sensitization to A. simplex was compared. Finally, the improvement rate, other clinical data and specific immunoglobulins in sensitized patients with and without detectable specific IgG4 were compared. Results a) The A. simplex sensitization rate in CU patients was 52.6 % compared with a known prevalence of between 16 and 20 % in our region. b) Of 65 sensitized patients, 52 experienced clinical improvement after the diet compared with only three of 11 patients without sensitization to A. simplex (p = 0.001). c) Of 43 patients with detectable specific IgG 4, 38 showed clinical improvement compared with only 14 of 22 patients without detectable IgG 4 (p = 0.02). Eight of nine patients with previous fish-associated cutaneous symptoms had detectable specific IgG4 compared with 15 of 32 patients who reported no previous fish-associated symptoms or acute urticaria (p = 0.03). Conclusions Our results indicate that A. simplex is a possibly widespread etiologic agent able to induce CU. This parasite model constitutes the first report that associates an infectious agent with CU on a large scale. The detection of IgG 4 antibodies reflects a previous acute parasitic infection and a temporary diet without fish improves symptoms in most patients with detectable specific IgG 4.

Extended rethymectomy in the treatment of refractory myasthenia gravis: original video-assisted technique of resternotomy and results of the treatment in 21 patients

The aim of the study was to analyze the impact of extended rethymectomy in patients with myasthenia gravis. Additionally, an original technique of resternotomy is described. Extended rethymectomy was performed on 21 patients with refractory myastenic symptoms after a previous transsternal thymectomy. In 8 patients the original video-assisted technique of complete longitudinal resternotomy with the aid of a special sternal retractor elevating the sternum from above and below was used. Severe intraoperative haemorrhage from the lacerated left innominate vein occurred in 3/13 patients operated on before the video-assisted technique of resternotomy had been introduced. In none of the 8 patients operated on with video-assisted resternotomy such a complication was noted. retained thymic lobe (4/21 patients), ectopic foci of thymic tissue (13/21 patients) no thymic tissue (4/21 patients). Results of follow-up: complete remission (11.8%), improvement (64.7%); no improvement (35.3%) during the follow-up period (mean 3.4 years). There was neither deterioration of myasthenia nor mortality during follow-up in this group. We conclude that described technique of video-assisted resternotomy reliably prevents the laceration of the heart and great vessels, and that complete remission and improvement rates in patients operated on with the extended rethymectomy are relatively low but deterioration of myasthenia is prevented.

Use of St John's wort (&lt;I&gt;Hypericum perforatum L&lt;/I&gt;) in members of a depression self-help organisation: a 12-week open prospective pilot study using the HADS scale.

The findings of randomised controlled trials confirm that St John's wort (Hypericum perforatum L) is effective in reducing symptoms in mild to moderate depression, but few studies have focused on the effect on anxiety symptoms. Most studies have employed observer-rated scales to measure treatment outcome, only few used self-rated scales. We sought to examine these issues in a cohort of members of the depression self-help organisation Depression Alliance UK (n= 39). Hospital Anxiety and Depression (HADS) scales were used at baseline, prior to St John's wort administration, and for subsequent assessments at weeks 4, 8 and 12. A subject-rated version of the Clinical Global Impression – Improvement (CGI-I) scale was employed at follow-up assessments. HADS scores were significantly reduced after taking St John's wort, particularly for those reporting milder depression and more severe anxiety. HADS scores compared well with patient improvement ratings, indicating the feasibility of use in this population. Controlled studies are needed in a larger cohort to examine these findings, before definitive conclusions can be made.

Thymectomy for Myasthenia Gravis.

No Class I studies of the effectiveness of thymectomy for myasthenia gravis (MG) have been performed. Most Class II studies comparing outcomes in MG patients with and without thymectomy demonstrated higher MG remission and improvement rates in patients undergoing thymectomy. However, these Class II studies were also consistently confounded by important differences between MG patients in surgical and nonsurgical groups. Myasthenia gravis patients undergoing thymectomy were younger, more often women and were more likely to have severe myasthenia. The authors of this paper cannot determine from these Class II studies whether the observed association between thymectomy and improved MG outcomes was a result of a thymectomy benefit or was merely a result of the multiple differences in baseline characteristics between the surgical and nonsurgical groups. The authors concluded that the benefit of thymectomy in non-thymomatous autoimmune MG has not been conclusively established. Thus, for patients with non-thymomatous autoimmune myasthenia gravis, thymectomy should only be considered an option to increase the probability of remission or improvement. The quality standards subcommittee of the American Academy of Neurology recently adopted this position.

Researchers Identify Best Times For Effective Light Therapy

Researchers Identify Best Times For Effective Light Therapy