Long-term Postoperative Treatment Research Articles

Оценка изменения эллипсоидной зоны сетчатки до и после хирургического лечения сквозных макулярных разрывов

Relevance. Restoring the retinal integrity during surgical treatment of macular holes (MH) does not always guarantee a significant improvement in visual acuity in the postoperative period. The possibility of regeneration of the retinal ellipsoid zone (EZ), as well as the relationship between the structural restoration of the outer retina and the improvement of visual functions are very contradictory. Purpose. To assess the possibility and degree of repair of the ellipsoid zone in the early and long-term postoperative treatment of MH of medium and large diameters. Material and methods. A prospective study of 13 patients (13 eyes) – 12 women and 1 man with a MH of medium and large diameters was conducted. Patients were divided into 2 groups depending on the presence or absence of an EZ defect after 6 months postoperatively. The structure of the retina was evaluated according to OCT data and the visual acuity of patients in the distance before surgery, 1, 3 and 6 months after MR surgery. Results. In patients with complete restoration of retinal EZ, the initial size of the holes was 1.5 times smaller than in the comparison group, the time from the moment of diagnosis to surgery was 122.7±51.8 and 383.5±125.7 days, respectively. The defect of photoreceptors of the EZ by 1 month after surgery in patients of the first and second groups was 369.6±245.61 microns and 276.07±233.37 microns, respectively. By 6 months of follow–up in the first group, complete closure of the defect was observed, in the second group its decrease to 91.61±97.51 microns, while visual acuity in the first group was 0.46±0.83 by six months of followup and in 3 out of 5 cases it increased to 0.6–0.9, in the second group in all cases this indicator did not exceed 0.5. Conclusion. Complete regeneration of EZ was observed in 38.5% of cases 6 months after surgery, however, anatomical repair of the photoreceptor field of the macular area in the postoperative period does not guarantee improvement of visual functions in all patients. Key words: macular hole, ellipsoid zone, ellipsoid zone regeneration

Therapeutic outcomes of one-minute application of sodium hydroxide versus phenol in the chemical cauterization of ingrown toenails.

Ingrown nails are frequently encountered in dermatology practice. The recurrence tendency of the disorder makes chemical cauterization essential during surgical procedures. In studies comparing nail matrix cauterization with sodium hydroxide (NaOH) versus phenol, phenol's application time was highly variable. To compare the therapeutic outcomes of matrix cauterization for a standard duration of one minute for NaOH versus phenol in stage II and III ingrown nails. The medical records of patients undergoing matrix cauterization with 10% NaOH or 88% phenol were evaluated. The primary outcome measure was the lack of recurrences on long-term follow-up. The secondary outcome measures were complete healing duration, patient-reported pain scores, and adverse effects related to the procedure. Enrolled in this study were 62 ingrown toenail sides treated with 10% NaOH and 56 ingrown toenail sides treated with 88% phenol. The mean follow-up duration was 25.17months. Recurrence was observed in four nail sides of the NaOH group (%6.45) and three nail sides of the phenol group (%5.35). The difference between the recurrence rates did not reach statistical significance. Patients treated with both methods were free of pain on the post-procedural tenth day. The visual analog scale pain scores and complete healing duration were similar between the two groups (p>0.05). In a large group with long-term follow-up results, the short-term and long-term post-operative treatment outcomes were similar between the one-minute applications of 10% NaOH versus 88% phenol groups.

The Efficacy of Synthetic Oral Progestin Pills in Patients with Severe Endometriosis

Endometriosis is an important public health issues concerning women of reproductive age due to its debilitating painful symptoms. Deep infiltrating endometriosis is the severe form, involving uterosacral ligaments, rectum, bowel and bladder. There is no optimal treatment for this disease, but there are 3 main therapeutic options: medical, surgical and a combination of both. A modern approach for the treatment of endometriosis pain uses dienogest, a progestin, as a long-term solution for women who do not wish to procreate or to whom surgery is not an option. Dienogest 2mg daily has a positive effect on the reduction of pain and endometrial lesions when used perioperatively or as a long-term postoperative treatment. This article focuses on the literature evidence on the efficacy of newly approved oral synthetic progestins in the treatment of severe endometriosis.

Healing period after open high tibial osteotomy and related factors: Can we really say that it is long?

High tibial osteotomy (HTO) is a general procedure for the treatment of degenerative gonarthrosis. In recent years, it has been reported that opening wedge high tibial osteotomy (OWHTO) has become widespread with good results. Despite these facts, HTOs tend to be avoided due to the need for long-term postoperative treatment. To investigate the treatment period for total recovery (healing period) after OWHTO and the factors affecting it. There were 47 cases of medial type degenerative gonarthrosis who underwent OWHTO from 2008 through 2011. The definition of the healing period was based on the time-dependent changes of the Japanese Orthopaedic Association score, focusing especially on pain on walking and pain on ascending/descending stairs. This score was defined as the Ability score. In this study, the healing period ended when the Ability score reached its maximum or when it showed a perfect score. Patients’ characteristics were examined to determine their effect on the healing period. The Ability score was 36.7 ± 10.1 (mean ± SD) before surgery and 51.6 ± 5.4 12 months after OWHTO. The healing period was 6.3 ± 3.9 months. Factors correlated with a longer healing period included female sex (correlation coefficient −0.35) and high BMI (correlation coefficient 0.33). Our study suggested that the healing period after OWHTO is approximately 6 months, and patients’ BMI and sex appear to be related to this period. This information is expected to be helpful for counseling patients undergoing treatment for gonarthrosis.Level of evidence Therapeutic study, Level IV.

Supportive Nutrition on Recovery of Metabolism, Nutritional State, Health-Related Quality of Life, and Exercise Capacity After Major Surgery: A Randomized Study

The aim of this study was to investigate whether specialized supportive enteral and parenteral feeding have superior effects compared to oral nutrition on recovery during long-term postoperative treatment of cancer patients with preoperative weight loss and reduced maximum exercise capacity. One hundred twenty-six patients referred for resection of the esophagus (n = 48), stomach (n = 28), or pancreas (n = 50) were considered to be included before operation. Included patients (n = 80) received supportive enteral or parenteral nutrition postoperatively at home corresponding to 1000 kcal/d until the patients did not wish to continue with artificial nutrition for any reason. Patients randomized to oral nutrition only served as control subjects. Caloric intake, body composition (dual-energy x-ray absorptiometry), and respiratory gas exchanges at rest and during exercise were measured including health-related quality of life. Survival and hospital stay did not differ among the groups, whereas overall complications were higher on artificial nutrition (P < .05). Changes in resting energy expenditure and biochemical tests did not differ during follow-up among the groups. Body weight and whole body fat declined similarly over time in all groups (P < .005), whereas lean body mass was unchanged during follow-up compared to preoperative values. Maximum exercise capacity and maximum oxygen consumption were normalized within 6 months postoperatively in all groups. There was no difference in recovery of food intake among the groups. Parenteral feeding was associated with the highest rate of nutrition-related complications, whereas enteral feeding reduced quality of life most extensively. After major surgery, specialized supportive enteral and parenteral nutrition are not superior to oral nutrition only when guided by a dietitian.

Long-term administration of low-dose cisplatin plus 5-fluorouracil prolongs the postoperative survival of patients with esophageal cancer

To evaluate the efficacy of long-term postoperative adjuvant chemotherapy with low-dose cisplatin (CDDP) plus 5-fluorouracil (5-FU) (CDDP/5-FU), we retrospectively examined 167 patients with squamous cell carcinoma of the esophagus who received the treatment after curative surgery (R0 resection). We classified the patients into the following three groups according to their postoperative therapies and analyzed their outcomes: a) low-dose CDDP (10 mg body(-1) day(-1) x 5 days) plus 5-FU (250-500 mg body(-1) day(-1) x 5 days) repeated every 6 months for 3 years, with an oral fluoropyrimidine (5-FU 150-200 mg body(-1) day(-1) or UFT 300-400 mg body(-1) day(-1)) administered between each treatment cycle (low-dose CDDP/5-FU group, 98 patients); b) high-dose CDDP (80 mg body(-1) day(-1) x 1 day) plus 5-FU (750-1,000 mg body(-1) day(-1) x 5 days) administered once only, followed by treatment with an oral fluoropyrimidine (5-FU 150-200 mg body(-1) day(-1) or UFT 300-400 mg body(-1) day(-1)) for 3 years (high-dose CDDP/5-FU group, 17 patients); or c) surgery alone (surgery alone group, 52 patients). The 3-year survival rates were 83.7% in the low-dose CDDP/5-FU group, 61.4% in the high-dose CDDP/5-FU group, and 62.2% in the surgery alone group; the difference between the low-dose CDDP/5-FU group and surgery alone group was significant (log-rank, p<0.05). A significantly better outcome in the low-dose CDDP/5-FU group than in the surgery alone group was associated with pStage III disease (p<0.001), pN1 lymph node metastasis (p<0.001), and lymphatic invasion (p<0.01). We conclude that long-term postoperative treatment with low-dose CDDP/5-FU is therapeutically beneficial and prolongs survival in patients with esophageal cancer who have regional lymph node metastasis or lymphatic invasion.

An unusual coincidence of endometriosis and ovarian stimulation

This report describes a rare coincidence of ureteral endometriosis and ovarian stimulation. A patient presented with acute renal colic after ovarian stimulation. Although rare intrinsic ureteral endometriosis should be considered when establishing differential diagnosis. Laparoscopic treatment for extensive endometriosis has been described but should only be performed by very experienced operative laparoscopists. A new long-term post-operative treatment is proposed combining LH-RH analogues with the new molecule tibolone as add-back therapy.

Round Window Ultrasonic Treatment of Meniere Disease

The neurosensory structures within the vestibular labyrinth of the inner ear are selectively irradiated with ultrasonic energy to alleviate the vertiginous symptoms of Meniere disease. However, correct application and coupling of the ultrasonic transducer to the inner ear is essential for maximum transmission of energy into the vestibule. The importance of assessing the results of long-term postoperative treatment is demonstrated by a change in the success rate that decreased by approximately 10% when the results obtained within the first 12 months of treatment were compared with those after four years. In this investigation, 32 patients were treated by the round window approach between 1970 and 1972, and after four years it was found that 72% of these were successful in relieving the giddiness symptoms.