Mean Number Of Treatment Sessions Research Articles

Intense pulsed light treatment for Becker’s nevus

Background Becker’s Nevus (BN) is a benign hamartoma with an esthetically troublesome condition secondary to hyperpigmentation and hypertrichosis. Many treatment modalities have been utilized with variable outcomes. Objectives To evaluate the efficacy and safety of intense pulsed light (IPL) in the treatment of BN. Patients and methods IPL was used at filter of 590 nm, fluence of 18–22 J/cm2, double-pulse mode (pulse width of 3–10 ms, pulse delay of 20–30 ms) at 3-month intervals. Final evaluations were performed by physician global assessment and patient satisfaction. Side effects were monitored at each treatment session and follow-up visit. Results Twenty-four patients (9 females, 15 males) with BN (16 hypertrichotic, 8 atrichotic) completed the study. The mean number of treatment sessions was 5 ± 2.17. The improvement in atrichotic BN group (4.87 ± 0.35) was significantly greater than that observed in hypertrichotic BN group (3.63 ± 0.89) (p = .001). Hair density simultaneously decreased with treatment in hypertrichotic BN. The mean satisfaction score was 5.75 ± 2.05 and 8 ± 0.93 in hypertrichotic and atrichotic BN groups respectively (p = .002). No repigmentation was noted during the follow-up period. No permanent side effects were observed. Conclusions IPL is an effective and well-tolerated treatment option for patients with hypertrichotic and atrichotic BN.

Endovascular treatment results and risk factors for complications of body and extremity arteriovenous malformations

ObjectiveThe objective of this study was to investigate the factors associated with the complication rate and treatment outcomes of arteriovenous malformations (AVMs) during a 20-year period. MethodsThis was a retrospective study of 306 patients (135 men, 171 women; mean age, 30.8 years) with body and extremity AVMs who were treated between 1996 and 2017. A total of 913 sessions of endovascular treatment were performed. Patients were divided into two decades of the study period to compare complications and clinical results. Group 1 comprised 107 patients treated in the first decade of the study period, and group 2 comprised 199 patients treated in the last decade. AVMs were classified according to the angiographic findings. Complication rates, number of treatment sessions, and treatment results were compared between the two groups. ResultsMinor complication (group 1, 20.1%; group 2, 18.5%) and major complication (group 1, 3.1%; group 2, 4.1%) rates were similar between groups (P = .79). The mean number of treatment sessions in group 1 and group 2 was 4.2 and 2.3, respectively, indicating a 45% reduction in treatment sessions (P < .0001). The treatment failure rate decreased from 9.3% in group 1 to 1.5% in group 2 (P = .04). The clinical success rate was 54.2% in group 1 and 64.3% in group 2 (P = .10). ConclusionsWith an accumulation of AVM treatment experience, the number of treatment sessions and the rate of treatment failures were significantly reduced.

Tazarotene gel with narrow-band UVB phototherapy: a synergistic combination in psoriasis

Background: Narrow-band UVB (NB-UVB) has been shown to be one of the most effective treatment modalities for psoriasis. Tazarotene, a known effective anti-psoriatic modality, when combined with NB-UVB may enhance the therapeutic success.Objective: To study clinical efficacy and safety of combination of NB-UVB with topical tazarotene 0.05% gel in psoriasis.Method: Thirty patients with plaque psoriasis having symmetrical lesions were enrolled for 12 weeks. All patients were instructed to apply tazarotene gel on target plaque on left side of body once daily. In addition, the whole body was irradiated with NB-UVB twice weekly. Efficacy was assessed by target plaque scoring and number of treatment sessions for clearance.Result: Our study resulted in 3 key findings: Firstly, therapeutic efficacy of NB-UVB was enhanced by addition of tazarotene. This enhanced efficacy was more apparent in decreasing scaling and thickness as compared to decrease in erythema. Secondly, combination therapy showed faster clearance of target plaques, with reduction in mean number of treatment sessions. Thirdly, mean cumulative NB-UVB dose needed to achieve clearance of target plaques was significantly reduced with combination therapy.Study limitations: The study was not randomized or controlled, but an open-label trial. The study period was relatively short, i.e., 12 weeks, without any follow-up period.Conclusion: Tazarotene gel significantly enhances the therapeutic efficacy of NB-UVB irradiation with faster clearance and without serious side effects.

Retrospective review on the outcome and safety of transscleral diode laser cyclophotocoagulation in refractory glaucoma in Chinese patients.

Transscleral cyclodiode laser cyclophotocoagulation (TSCP) is often reserved for treatment of refractory glaucoma. This retrospective study investigates the safety and efficacy of TSCP among the Chinese population. A retrospective review was performed on electronic patient records of all patients receiving TSCP between years 2009 to year 2016. Patient demographics, indication for laser, success and response rate, change in intraocular pressure (IOP), number of treatment sessions, laser energy, glaucoma medication, visual acuity, pain symptoms and complication rate were documented. The study included 126 patients: 81 patients were male and 45 were female, and the mean age was 66.6±14.3years old and the mean follow-up was 22.7±14.1months. The mean number of treatment sessions was 1.5±0.8. The success rate was 67.3%. The mean IOP before TSCP was 67±38.6mmHg and 22.8±14.2mmHg after TSCP, the mean IOP reduction was 38.4%, which was statistically significant (P value<0.001, Wilcoxon signed rank test). The mean laser energy used per eye was 72.7±56.6 and 49.2±22.9J per individual treatment session. The mean number of laser shots was 15.0±6.1. 71% of patients were able to reduce their glaucoma medication after TSCP, (P value<0.01, Wilcoxon signed rank test). 86.1% of patients had improvement in pain symptoms after TSCP. The overall complication rate was 7.1%. TSCP was found to be safe and effective among the Chinese population, with comparably low laser energy setting and complication rate. It was found to be most effective in treatment of glaucoma due to trauma, acute angle closure, uveitis and chronic angle closure.

Percutaneous ultrasound-guided sclerotherapy with polidocanol microfoam for lymphatic malformations.

Lymphatic malformations (LMs) are low-flow congenital lesions that consist of cysts of varying size. Sclerotherapy with intralesional bleomycin and OK-432 has been reported to yield dramatically beneficial results for this disorder. However, inflammation-related symptoms are often seen after treatment with these sclerosing agents. On the other hand, polidocanol (POL) is reportedly associated with fewer allergic and inflammatory reactions. Up to now, however, very few reports have documented the use of POL microfoam for treatment of LMs. This study was performed to assess the efficacy and safety of POL microfoam sclerotherapy for LMs. Between 2003 and 2016, cases were identified from a prospectively compiled database on low-flow congenital vascular malformations before undertaking a retrospective electronic chart review. Patients were included if they had LMs that had been treated by POL microfoam sclerotherapy. The location, size, and type of LMs were assessed using ultrasound and magnetic resonance imaging. Twenty-gauge venous catheters were inserted into the lymphatic space under ultrasound visualization. The LMs were then fully aspirated if they were macrocystic in form. Microfoam composed of 3% POL was then injected under ultrasound guidance. Microcystic LMs were treated by direct injection with POL microfoam under ultrasound guidance. The outcome was assessed by clinical examination combined with findings of postsclerotherapy imaging using ultrasound and magnetic resonance imaging. During a 13-year period, 32 patients met the inclusion criteria. These were 11 (34%) male patients and 21 (66%) female patients with a mean age of 18years. The LMs were localized to the head and neck (47%), the trunk (38%), and the extremities (15%). The lesions were subdivided into macrocystic (56%), mixed macrocystic and microcystic (31%), and microcystic (13%) LMs. The average lesion size was 6.6× 4.6× 3.0cm. The mean number of treatment sessions was 2.8 (range, 1-15), with a mean foam volume of 4.6 (range, 1-10) mL. Excellent (47%) and moderate (41%) responses were seen in 88% of the patients. Notably, half of the patients achieved excellent or moderate resolution with a single treatment session. Intralesional hemorrhage occurred in four patients (13%) but resolved spontaneously. Only one patient with mixed macrocystic and microcystic LMs developed post-therapy infection. However, the other patients did not develop any post-therapy inflammation-related symptoms, including fever, pain, and marked swelling. Percutaneous sclerotherapy using POL microfoam appears to be safe and effective for treatment of LMs. Ultrasound-guided POL microfoam sclerotherapy should be considered for such lesions, particularly those that are exclusively macrocystic.

A pilot investigation of Quest Institute Cognitive Hypnotherapy services using Improving Access to Psychological Therapies as the benchmark

Purpose – The purpose of this paper is to investigate the treatment effects of Quest cognitive hypnotherapy (QCH) on anxiety and depression, and make comparisons with published data from the Improving Access to Psychological Therapies (IAPT) project. Design/methodology/approach – Adult clients of QCH therapists were invited to enrol in a Practice Research Network (PRN) and completed pre- and post-therapy measures of anxiety (GAD-7) and depression (PHQ-9). Findings – Post-treatment scores were available for 83 of the 106 clients reaching caseness (above the clinical cut-off on either or both measures) on their pre-treatment scores. Totally, 59 clients had moved to recovery, representing 71 per cent of cases where post scores were available and 56 per cent of the intent to treat (ITT) population (106 clients). Additionally, including all cases (both above and below cut-offs) 118 clients had post-treatment measures. In total, 86 (73 per cent) clients improved reliably. The mean number of treatment sessions was between three and four. This compares favourably with 2012-2013 IAPT findings using the same measures. Research limitations/implications – This study was exploratory involving a client group paying privately for treatment. There was no randomised control group or attempt to evaluate the effectiveness of specific components of therapy. Practical implications – QCH may offer a brief effective treatment for clients with clinically significant levels of anxiety and/or depression, widening client choice. Originality/value – As the first study to explore the effectiveness of private QCH this study offers an example of how to use a PRN to compare with published IAPT data using the same measurement tools.

A Systematic Review and Meta-Analysis of Brief Versus Ultrabrief Right Unilateral Electroconvulsive Therapy for Depression.

Electroconvulsive therapy (ECT) is an effective depression treatment, but it has potential cognitive side effects. Ultrabrief pulse (UBP) right unilateral (RUL) ECT is an increasingly used treatment option that can potentially combine efficacy with lesser cognitive side effects. However, current trials are underpowered or have conflicting results. A systematic review and meta-analysis was conducted to evaluate the relative efficacy and cognitive effects of brief pulse (BP) and UBP RUL ECT. MEDLINE, EMBASE, PsycINFO, CENTRAL, DARE, and the International Clinical Trials Registry Platform were searched with the search terms ECT, electroconvulsive therapy, electroconvulsive shock, electroconvulsive shock therapy, electrical stimulation, electroconvulsive combined with brief, ultra*, pulse, and trial in English, all fields including title, abstract, subject heading, and full text up to June 20, 2013, for studies comparing BP and UBP RUL ECT in depressed patients that reported formalized mood ratings for depression. Six studies met the inclusion criteria, comprising a total of 689 patients. Efficacy, cognitive, response, and remission outcomes were extracted from each publication or obtained directly from authors. BP RUL ECT was significantly more efficacious in treating depression than UBP RUL ECT (standardized mean difference = 0.25; 95% CI, 0.08–0.41; P = .004) but showed significantly more cognitive side effects in all cognitive domains examined (global cognition, anterograde learning and recall, retrograde memory) (P < .01). The mean number of treatment sessions given was 8.7 for BP ECT and 9.6 for UBP ECT (P < .001). UBP had a lower remission rate (OR = 0.71; 95% CI, 0.51–0.99; P = .045), with a number needed to treat of 12.1. BP compared with UBP RUL ECT was slightly more efficacious in treating depression and required fewer treatment sessions, but led to greater cognitive side effects. The decision of whether to use BP or UBP RUL ECT should be made on an individual patient basis and should be based on a careful weighing of the relative priorities of efficacy versus minimization of cognitive impairment.

Treatment of Acquired and Small Congenital Melanocytic Nevi With Combined Er

There is no gold standard for the treatment of benign melanocytic nevi for cosmetic purposes. To investigate the efficacy and safety of combined treatment with the short-pulsed erbium:yttrium-aluminum-garnet (Er:YAG) and long-pulsed alexandrite laser for acquired melanocytic nevi (AMN) and small congenital melanocytic nevi (CMN). Fifty-eight AMN and 7 small CMN in 24 Korean patients were treated with Er:YAG laser followed by long-pulsed alexandrite laser at 1-month intervals. At 8 weeks after the final treatment, all treated nevi showed complete removal of pigmentation, and the mean overall improvement score assessed by physicians, with a quartile grading scale, was 3.6 ± 0.7. The mean number of treatment sessions required to treat CMN (1.5 ± 0.3) was significantly greater than that for junctional (1.1 ± 0.2) or compound (1.2 ± 0.5) AMN. Postinflammatory hyperpigmentation (4.6%), erythema (9.2%), hypertrophic scars (1.5%), and mild atrophic scars (10.8%) were observed, but all resolved within 6 months, except for hypertrophic scars and 1 atrophic scar. Recurrence of pigmentation was observed in 1 CMN (1.5%) during 6 months of follow-up. Combined treatment with Er:YAG laser and long-pulsed alexandrite laser is effective for the removal of small benign melanocytic nevi with minimal adverse effects and low recurrence rates.

Neurological morbidity and mortality associated with the endovascular treatment of cerebral arteriovenous malformations before and during the Onyx era.

The widespread implementation of the embolic agent Onyx has changed the endovascular management of cerebral arteriovenous malformations (AVMs). Recent data suggest that outcomes following embolization and resection may have worsened in the Onyx era. It has been hypothesized that there may be increased complications with Onyx embolization and increased surgical aggressiveness in patients treated with Onyx. In this study the authors analyzed their institutional experience with the endovascular treatment of cerebral AVMs prior to and after the introduction of Onyx to determine factors associated with periprocedural neurological morbidity and mortality. A retrospective review was performed of all patients with cerebral AVMs undergoing embolization at the Barrow Neurological Institute from 1995 to 2012. Endovascular treatment of 342 cerebral AVMs was performed over 446 treatment sessions (mean age 37.8 years, range 1-83 years). Clinical presentation included hemorrhage in 47.6%, seizures in 21.9%, headaches in 11.1%, and no symptoms in 10% of cases. The endovascular pretreatment strategy was preoperative in 78.9%, preradiosurgery in 9.1%, palliative in 5.3%, targeted in 4.4%, and curative in 2.3%. The median Spetzler-Martin grade was III. The mean number of arteries embolized was 3.5 (range 0-13 arteries), and the mean number of treatment sessions was 1.3 (range 1-4 sessions). Onyx was used in 105 AVMs (30.7%), and N-butyl cyanoacrylate (NBCA) without Onyx was used in 229 AVMs (67%). AVMs treated with Onyx had a higher mean number of arterial pedicles embolized than did NBCA cases (4.3 ± 2.7 vs 3.2 ± 2.4, respectively; p < 0.001) and a greater number of sessions (1.5 ± 0.7 vs 1.2 ± 0.5, respectively; p < 0.05). Unexpected immediate postprocedural permanent neurological deficits were present in 9.6% of AVMs, while transient deficits were present in 1.8%. There was 1 death (0.3%). Spetzler-Martin grade was not associated with differences in outcome, as permanent neurological deficits were observed in 12%, 9%, 13%, 11%, and 13% of AVMs for Spetzler-Martin Grades I-V, respectively (p = 0.91). The use of Onyx compared with NBCA was not associated with differences in periprocedural morbidity (p = 0.23). This lack of a difference persisted even when controlling for number of arteries and sessions (p = 0.14). Sex was not associated with differences in outcome. Permanent and transient postprocedural neurological deficits were noted in 9.6% and 1.8% of all cases, respectively. AVM grade was not associated with endovascular outcome. Despite the greater number of sessions required and arteries embolized for Onyx cases, there was no statistically significant difference in the risk of neurological deficits following cerebral AVM embolization with Onyx and NBCA.

Percutaneous radiofrequency ablation of malignant liver tumors with ultrasound and CT fusion imaging guidance

To evaluate the feasibility, accuracy, and utility of sonography (US) and CT fusion imaging guidance for radiofrequency ablation (RFA) of malignant liver tumors not visualized on conventional US. Seventy-seven patients with hepatocellular carcinoma and 15 patients with metastatic liver cancer with a total of 136 lesions underwent RFA with US and CT fusion imaging guidance. The mean number of punctures, success rate of a single ablation session, local tumor progression rates, and long-term outcome were evaluated. Treatment efficacy was evaluated by dynamic CT and contrast-enhanced US 1 month after RFA. RFA was technically feasible in all patients, and no major complications occurred. The mean ± SD time needed to synchronize US and CT images was 13.9 ± 11.9 minutes (range, 5-55 minutes). The success rate of a single ablation session was 83.8% (114/136), and tumor residue was present in 7.4% of lesions (10/136). The mean number of treatment sessions was 1.2 ± 0.5 sessions. During follow-up, local tumor progression was observed for 15 (11.9%) lesions. Distant tumor recurrence was found in 51 (55.4%) patients. US and CT fusion-assisted RFA is a safe and efficacious treatment for patients with hepatocellular carcinoma and metastatic liver cancer.

Clinical Characteristics of Posttraumatic Benign Paroxysmal Positional Vertigo

Objectives: Although head trauma is considered a common cause of benign paroxysmal positional vertigo (BPPV), only a few studies have investigated posttraumatic BPPV (PT-BPPV). The aim of this study was to assess the clinical characteristics of PT-BPPV. Methods: We reviewed the clinical records of 19 patients with PT-BPPV during the years 2001 to 2012. Patients with an onset of positional vertigo within 3 days of well-documented head trauma were included in the PT-BPPV group. Their outcome was compared with that of 54 patients with idiopathic BPPV (i-BPPV) who were treated during the first half of 2011. We investigated the clinical characteristics of PT-BPPV and the clinical differences between the PT-BPPV and i-BPPV groups. Results: Members of the PT-BPPV group required more treatment sessions than did the members of the i-BPPV group ( P &lt; 0.05). The mean number of treatment sessions in the PT-BPPV and i-BPPV groups was 3.74 ± 3.07 and 2.22 ± 1.24, respectively. The recurrence rate in the PT-BPPV group (42.1%) was significantly higher than that in the i-BPPV group (18.5%; P &lt; 0.05). Conclusions: Our findings suggest that, compared to i-BPPV, PT-BPPV requires more treatment sessions to achieve remission and has a greater tendency to recur. We suggest the use of frequent treatment sessions and canalith repositioning maneuver for patients with PT-BPPV.

Photodynamic therapy combined with cryotherapy for the treatment of nodular basal cell carcinoma

Carbon dioxide (CO2) laser ablation in combination with photodynamic therapy (PDT) has previously been successfully used to treat superficial basal cell carcinoma (BCC). However, the efficacy of this treatment modality is limited in the treatment of deeper lesions and the more aggressive subtypes of BCC. In order to improve the outcome of PDT, 8 BCC lesions of variable depths (4 lesions ≤2 mm and 4 lesions >2 mm) and subtypes (1 superficial, 6 nodular and 1 infiltrative) were treated with CO2 laser ablation in combination with PDT, followed by modified cryotherapy. The mean number of treatment sessions was 1.5 and the follow-up period was 22 months. All of the patients demonstrated a complete response and no recurrence of disease, while the majority of patients were satisfied with the cosmetic results upon follow-up examination. The combination therapy of CO2 laser ablation with PDT followed by modified cryotherapy demonstrated a good efficacy and satisfactory cosmetic outcomes in the treatment of nodular BCC.

Two-Year Results of Reduced-Fluence Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

To report the results of a 2-year follow-up study of Japanese polypoidal choroidal vasculopathy (PCV) patients treated with reduced-fluence photodynamic therapy (PDT) monotherapy. Prospective interventional case series. In the present study, 38 eyes of 38 consecutive patients underwent PDT with a reduced laser fluence of 25 J/cm(2). During the 2-year follow-up, visual acuity (VA) and optical coherence tomography measurements were performed every 3 months after the PDT procedure and then compared with baseline values. PCV vascular lesions were evaluated by indocyanine green and fluorescein angiography. At baseline, the mean logarithm of the minimal angle of resolution (logMAR) best-corrected VA (BCVA) was 0.43. There was a significant improvement of the mean logMAR BCVA to 0.28 and 0.29 at 12 and 24 months, respectively (P < .0001, P = .001). The logMAR BCVA was stable or improved by ≥0.3 in 36 (95%) of the eyes at the 2-year follow-up. In 13 eyes in which the baseline VA was better than 20/40, there was a significant improvement of the mean logMAR BCVA at 12 months, with the acuities continuing to be stable at 24 months. The mean number of treatment sessions during the 24-month study period was 1.9. Reduced-fluence PDT monotherapy for PCV effectively improved and maintained the VA over a 24-month period, even in eyes with a baseline VA better than 20/40. In addition, the number of treatments could be much smaller as compared with intravitreal injection of anti-vascular endothelial growth factor agents.

Carbon Dioxide Laser Treatment of Cutaneous Neurofibromas

IntroductionNeurofibromatosis type 1 (NF1) is an autosomal dominant disorder, with multisystem involvement, including cutaneous manifestations of hyperpigmentation and neurofibromas. Multiple cutaneous lesions are often disfiguring and lead to emotional distress and social isolation. Treatment of NF1 is predominantly surgical but alternative treatments should be considered for patients with large numbers of lesions as cold steel excision of multiple lesions can be cumbersome and may not be practical. The authors report a series of patients with multiple neurofibromas successfully treated using a CO2 laser.MethodsData on CO2 laser treatments, follow-up, and recurrence following treatment was collected retrospectively. A post-treatment telephone survey was carried out to assess patient satisfaction using a standardized set of questions and a scoring tool.ResultsFive of seven patients who underwent CO2 laser treatment of their multiple neurofibromas responded to the post-treatment survey. All five patients (age range 36–56 years, mean age 45.2 years, three men:two women) had multiple variable-sized neurofibromas. The mean number of lesions per patient was 114 (range 20–200 lesions). The mean number of treatment sessions was 2.2 (range 1–4 sessions) and mean follow-up was 14.4 months (range 6–24 months). Three patients (60%) reported no recurrence up to 2 years post-laser treatment. Two patients (40%) had recurrences of a few lesions (≤10% of treated lesions per patient). The mean patient satisfaction score was 9.2 out of 10 (range 8–10). All patients mentioned that they would recommend CO2 laser treatment to others with multiple neurofibromas. Hypopigmentation or depigmentation at treatment sites were the only reported adverse effects.ConclusionBased on current results, the authors feel that CO2 laser treatment achieves a high level of patient satisfaction with a low recurrence of treated lesions.

Tu1620 Depth of Mucosectomy Specimens as a Predictor of Stricture Formation in Patients With Barrett's Esophagus (BE) Undergoing Circumferential Endoscopic Mucosal Resection (cEMR)

has been reported for BE eradication. We present our early experience of pressurised CO2 cryotherapy in the treatment of dysplastic BE after endoscopic resection (ER) of nodular areas. Methods: Prior to each treatment, all patients were assessed using high-definition white light, narrow band imaging and magnification endoscopy for variation of pit pattern or vasculature using a prototype endoscope. Any nodular areas were resected by multiband mucosectomy, with ablation of non-nodular Barrett’s scheduled for a subsequent session. Flat areas of irregularity were biopsied. Pressurised CO2 was delivered at 7L/min through a catheter inserted through the working channel of the endoscope. The gas was vented through a suction overtube attached to the endoscope. Our protocol was to apply cryoablation for 20 seconds, let it thaw and then suction excess gas from the stomach. This was performed for a total of 8 freeze/thaw cycles per session. Follow-up endoscopy further treatment is scheduled approximately 4-6 weeks later. Results: 9 patients underwent cryoablation for BE (11 months). Five male patients (mean age 63 years) had endoscopic surveillance to assess the response to treatment and are included in this analysis. Mean pre-treatment length of Barrett’s esophagus was 3.4cms (range 1-5cms). All patients underwent ER of nodular lesions. Pathology (based on mucosectomy) confirmed HGD or CIS in all patients. Mean number of treatment sessions was 2.8 (range 2-4). The average procedure time was 23.8 minutes, which compares favourably with our experience using 90-degree (25.6 minutes) and 360-degree (42.2 minutes) radiofrequency ablation (RFA). No complications were observed and no patients required prescription analgesia following their procedures. Mean follow-up after therapy was 4.8 months (range 1-8). All patients were considered to have successful ablation of residual BE (4/5 with complete ablation and 1/5 with almost complete ablation). No evidence of residual or recurrent disease has been noted at standard follow-up exams to date. Conclusion: Pressurised CO2 cryoablation appears to be a reasonably effective treatment for non-nodular dysplastic BE, particularly for short segment disease. It can be performed at least as rapidly as RFA and appears to be better tolerated. Further data are required to assess for medium to long term efficacy, durability and possible buried BE glands.

Long-Term Efficacy and Safety of Polyacrylamide Hydrogel Injection in the Treatment of Human Immunodeficiency Virus–Related Facial Lipoatrophy

Facial lipoatrophy, a human immunodeficiency virus-related wasting of the facial soft tissues, can compromise patients' quality of life. Injection of different materials in the cheeks can improve this condition. Concern regarding potential long-term complications of nonbiodegradable fillers remains. The authors investigated the long-term efficacy and safety of polyacrylamide gel injections. Human immunodeficiency virus-infected patients treated with polyacrylamide gel for moderate to severe facial lipoatrophy with a minimum of 5 years' follow-up were included. Aquamid (1 ml) was injected monthly into each cheek until adequate correction was obtained. Outcome measures were ultrasound measurement of cheek soft-tissues thickness, evaluation of aesthetic improvement, and self-evaluation of satisfaction and psychological consequences of treatment (visual analogue scale for the face, Assessment of Body Change and Distress questionnaire, and Beck Depression Inventory score). Adverse events were classified as acute (<1 week), early (1 week to 1 month), midterm (1 month to 1 year), or late (>1 year). One hundred forty-one patients completed the treatment as of June of 2005; 38 (32 men; mean age, 42 years) were available for follow-up of more than 5 years (mean, 62 months). The mean number of treatment sessions was seven over a mean period of 8 months. Significant improvement of cheek thickness and aesthetic result and highly significant satisfaction and psychological improvement were obtained. No serious adverse events occurred during the follow-up period. The long-term efficacy and safety of polyacrylamide gel injection for the treatment of human immunodeficiency virus-related facial lipoatrophy were shown over a period of 5 years. : Therapeutic, IV.

Direct Cholangioscopy-Based Holmium Laser Lithotripsy of Difficult Bile Duct Stones by Using an Ultrathin Upper Endoscope Without a Separate Biliary Irrigating Catheter

We investigated the impact of direct peroral cholangioscopy (POC)-based holmium laser lithotripsy using an ultrathin endoscope with direct irrigation via a 2-mm-diameter working channel to remove difficult common bile duct (CBD) stones without a separate biliary catheter. Few clinical studies have reported the successful removal of difficult CBD stones by direct POC-based laser lithotripsy using an ultrathin upper endoscope. Previous studies used a separate biliary catheter to ensure continuous irrigation. Ten patients (6 males; mean age 63.3 years) with difficult CBD stones who were not amenable to conventional endoscopic procedures were examined. Direct POC using an ultrathin upper endoscope was performed in all patients. Holmium laser lithotripsy with direct saline irrigation via the operating channel of an ultrathin endoscope was performed until stone fragments were captured in a basket. The overall success rate of bile duct clearance was 90% (9 of 10 patients) and the mean number of treatment sessions was 1.2 (range, 1-2). Mechanical lithotripsy was performed to complete stone removal in one patient (10%) who had a distal CBD stricture. One patient experienced mild cholangitis following laser lithotripsy. Holmium laser lithotripsy under direct POC using an ultrathin upper endoscope may be an effective and safe technique for removal of difficult CBD stones. Direct irrigation via the 2-mm-diameter working channel of the ultrathin endoscope provides sufficient fluid medium and affords good endoscopic viewing to assure stone fragmentation without any need for a separate biliary catheter.

Optimum First-Line Treatment Technique for Benign Cystic Thyroid Nodules: Ethanol Ablation or Radiofrequency Ablation?

The purpose of this article is to compare the efficacy and safety of ethanol ablation and radiofrequency ablation (RFA) used as treatment of benign cystic thyroid nodules. Fifty-seven patients (44 women and 13 men) with benign cystic nodules (cystic portions > 90%) inducing pressure symptoms or cosmetic problems were treated with ethanol ablation (n = 36) or RFA (n = 21). Ethanol ablation was performed using 16- or 18-gauge needles with 95-99% ethanol, and RFA used a cooled-electrode RFA system and 17- or 18-gauge internally cooled electrodes. Of nine viscous nodules, five were treated with ethanol ablation and four with RFA, with all except for one nodule in the RFA group being treated only after evacuation of internal colloid material. Nodule volume, symptom score (0-10), cosmetic score (1-4), and complications were evaluated before and after treatment. Both ethanol ablation and RFA resulted in significant decreases in nodule volume (p < 0.001), symptom score (p < 0.001), and cosmetic score (p < 0.001). There were no between-group differences in mean volume reduction (p = 0.15), decreases in symptoms (p = 0.53), cosmetic scores (p = 0.69), or therapeutic success rate (p = 0.61). However, the mean number of treatment sessions was significantly lower in the ethanol ablation than in the RFA group (p = 0.026). No serious complications were encountered in either group. Ethanol ablation yielded similar results with fewer treatment sessions compared with RFA. Because ethanol ablation is also less expensive and simpler to perform than RFA, our findings suggest that ethanol ablation, rather than RFA, should be the first-line treatment technique for benign predominantly cystic thyroid nodules.

Retention in the National Institute on Drug Abuse Clinical Trials Network Women and Trauma Study: Implications for posttrial implementation.

This study aimed to identify factors that influenced retention in the National Institute on Drug Abuse-funded Women and Trauma Study, conducted within the Clinical Trials Network (CTN). Women (N=346) were recruited from and received treatment in 6 CTN-affiliated sites. Log-linear and logistic models were used to explore factors associated with retention. The mean number of treatment sessions attended was 6.8 (SD=3.9). Women with more education, higher attendance at 12-step meetings, and strong therapeutic alliance between facilitator and participant had better retention rates. Significant site differences were found; the site with the highest retention rate provided child care and had the lowest average monthly intake. To retain women with histories of trauma and substance abuse in "real world" psychiatric settings, emphasis on regulating individual-level and site-related modifiable variables are crucial.

Contents of physical therapy, occupational therapy, and sports therapy sessions for patients with a spinal cord injury in three Dutch rehabilitation centres

Purpose. To describe the contents of interventions to improve self-care and mobility for patients with spinal cord injury (SCI) in early post-acute rehabilitation, using the Spinal Cord Injury-Interventions Classification System (SCI-ICS), and to compare these interventions between rehabilitation centres. The SCI-ICS describes therapy to improve self-care and mobility at three levels of functioning and consists of 25 categories with a total of 139 different interventions.Methods. Fifty-three physical therapists, occupational therapists and sports therapists of three Dutch SCI rehabilitation centres recorded interventions with the SCI-ICS for patients with SCI in early post-acute rehabilitation for four consecutive weeks.Results. Therapists recorded 1640 treatment sessions of 48 patients with a SCI. The mean number of treatment sessions per patient per week (8.9 overall) differed between centres (p < 0.05), unlike the mean therapy time in minutes per patient per week (259 overall). Highest frequencies for individual categories were found for ‘Muscle Power’, ‘Walking’, and ‘Hand rim wheelchair propulsion’.Conclusions. We described the specific contents of therapy of patients with a SCI in three Dutch rehabilitation centres. The largest proportion of time was spent on interventions to improve muscle power, walking, and hand rim wheelchair propulsion.