Overall Success Rate Of Treatment Research Articles

Treatment, clinical course and outcome of tibial neuropathy in German Holstein cows

As a follow-up to a previous study on the incidence, history and clinical findings of tibial neuropathy (TN), the present work aimed at describing the treatment and prognosis of this disease. Of 88 German Holstein dairy cows with unilateral (UTN, n = 71) or bilateral (BTN, n = 17) TN, 68 (56 UTN, 12 BTN) with a complete data set were analyzed. They were retrospectively assigned to one of four groups: no treatment - spontaneous healing within 48 h (Spontaneous, 5 UTN), no bandage (0Cast, 8 UTN, 3 BTN) or treatment with anti-inflammatory drugs and support bandage (StV, 3 UTN) or fiberglass cast (Cast, 40 UTN, 9 BTN). Treated cows were re-examined five times (14, 21, 28, 42 and 56 days after the first presentation). The plasma activity of creatine kinase was measured at the last re-examination in 29 cows similar to measurement at day 0. The observed overall success rate of treatment of cows with UTN was considerably higher compared with untreated cows (Cast 98 % and StV 100 % vs. 0Cast 62 %). By comparison, the observed difference between treated and untreated cows with BTN was not so clear (78 % vs. 67 %). Recovering cows exhibited a calculated longer median survival time than cows that did not recover (545 d vs. 100 d). Plasma creatine kinase activities were increased initially and returned within the reference interval (434 U/l and 152 U/L) following treatment. Cows with ETN have an excellent prognosis provided that treatment with anti-inflammatory drugs and stabilizing bandage is administered. In cows with BTN, the prognosis depended on the type and degree of the primary injury. Loss of skin sensitivity indicated a poor prognosis. From an economic standpoint, treatment of TN is indicated provided that the prognosis is good. In cows that had healed clinically, the average survival time extended into the following lactation. This study highlights the advantages of a support bandage for the treatment of cows with TN. Compared with other peripheral neuropathies, muscle damage appears to be of particular importance in TN.

Outcome of Parathyroidectomy for Renal Hyperparathyroidism: A Single Center Experience

Background: Renal hyperparathyroidism (HPTH) is a common complication of chronic kidney disease and is known to cause significant morbidity in these patients. There has been substantial debate on the best possible treatment of this condition. Surgical treatment is now considered to be of vital importance as its efficacy is well documented. The present study reported the outcome of parathyroidectomy in King Chulalongkorn Memorial Hospital, a university hospital in Bangkok, Thailand. Objective: To determine surgical outcomes, including success rate and perioperative complications of parathyroidectomy in patients with renal HPTH. Materials and Methods: The data was collected by retrospective review of patients’ records between June 2014 and May 2019. One hundred ten patients were enrolled. Their demographic data, laboratory results, and outcomes were collected and categorized. Results: Among 110 patients, men accounted for 48.6%. The mean age was 49.5 years (SD 13.3). The most frequent operation was total parathyroidectomy with autotransplantation (TPTX+AT). All four glands were identified and excised in 84.5% of all patients. The mean preoperative serum intact parathyroid hormone (iPTH) level was 1,938 pg per dL with a range of 171 to 5,000 pg per dL. Postoperative hypocalcemia requiring intravenous calcium supplement was present in 70%. Postoperative cardiovascular complication occurrences were 16.4%, with one mortality due to myocardial infarction. In addition, one patient suffered unilateral recurrent laryngeal nerve injury, while two had stroke. The overall success rate of treatment was 81.1%, with 7.3% and 8.2% of patients that had persistently high PTH and recurrence of HPTH, respectively. Conclusion: Parathyroidectomy is an essential choice of treatment in patients with renal HPTH. Further validation of correlations with other factors is now being processed, and more data are needed. Keywords: Secondary hyperparathyroidism; Tertiary hyperparathyroidism; Chronic kidney disease mineral bone disease; Parathyroidectomy

The Use of Single Dose Methotrexate in the Management of Ectopic Pregnancy and Pregnancy of Unknown Location: 10 Years' Experience in a Tertiary Center.

ObjectiveTo study factors associated with the success of single dose methotrexate (MTX) treatment in women with ectopic pregnancy.MethodsThis is a retrospective study of women (n=110) with ectopic pregnancy and treated with single dose of MTX. The clinical presentations, transvaginal sonography (TVS) findings, pretreatment beta-human chorionic gonadotropin (β-HCG), and progesterone values were compared between the treatment success (Group S) and treatment failure (Group F) groups.ResultsThe overall success rate of treatment with single dose of MTX was 75.45%. The majority of patients in both groups presented with pain and bleeding (~55%), and bleeding only was the presenting symptom in about 20% of patients. Only 3 patients (3.61%) in Group S required a repeat dose of MTX. In contrast, 51.8% of the Group F patients required a repeat dose. The mean pretreatment β-HCG level was 2.3 times higher in Group F than in Group S (1734±1684 vs 4036±2940 IU/L). The data showed a β-HCG level of 3924IU/L as a suitable cut-off value with 76.19% sensitivity and 62.5% specificity to predict MTX treatment success. History of ectopic pregnancy had no relation with success/treatment failure or a repeat dose. None of the TVS findings were related to the outcome of the treatment, whereas pretreatment HCG level was a significant predictor.ConclusionThe single dose MTX treatment was successful in 75.45% (83/110) of cases, with 3.61% (3/83) requiring a repeat dose of the drug. Pretreatment β-HCG level is a significant predictor of the treatment outcome.

Two Percentage of Ketoconazole Cream for the Treatment of Adult Female Acne: A Placebo-Controlled Trial.

IntroductionOur objective was to determine the efficacy of ketoconazole (KTZ) 2% cream for the treatment of mild adult female acne (AFA).Materials and methodsThis placebo-controlled trial was conducted in District Headquarters (DHQ) Teaching Hospital, Sahiwal, Pakistan. The study was completed in a period of January 2019-June 2020. A total of 60 females of age > 25 years having mild AFA were included. In Group I, the patients were advised to apply 2.0% KTZ cream covering the whole skin area twice daily for a period of eight weeks. In Group II (placebo group) patients, a topical cream containing propylene glycol was applied for similar period. After eight weeks, the cream was discontinued and participants were advised to use routine skincare products, and follow-up was done after two weeks. The main study outcome was reduction in the total count of acne lesions including both inflammatory and non-inflammatory lesions and overall success rate of treatment.ResultsMean age was 36.2 ± 6.3 years in KTZ group versus 35.4 ± 6.5 years in control group. Mean duration of acne was 14.3 ± 7.3 years in KTZ group versus 15.1 ± 6.9 years in control group. Improvement in facial adult female acne scoring tool (AFAST) scale (AFAST-F) was observed in 13 (43.3%) patients in KTZ group and in only 4 (13.3%) patients in control group (p value = 0.009). Improvement in submandibular AFAST (AFAST-S) was observed in 12 (40.0%) patients in KTZ group and in eight (26.7%) patients in control group. The overall success rate of treatment was 14 (46.7%) in KTZ group versus 4 (13.3%) in control group (p value = 0.012).ConclusionsIn our study, we found significant improvement in reduction of acne lesions as well as complete recovery using 2.0% ketoconazole for the treatment of mild AFA. So KTZ can be used as a preferred treatment option for these patients.

The modified endoscopic retrograde appendicitis therapy versus antibiotic therapy alone for acute uncomplicated appendicitis in children.

Endoscopic retrograde appendicitis therapy (ERAT) is an emerging endoscopic treatment modality for acute uncomplicated appendicitis (AUA) supported by several case series. However, to date, systematic studies have not been conducted in children and the prospective comparative data are lacking. Moreover, due to a concern for future malignancy risk in children from ionizing radiation, we used contrast-enhanced ultrasound (CEUS) instead of endoscopic retrograde appendiceal radiography (ERAR). Therefore, we conducted a prospective, randomized control clinical trial to compare the modified ERAT (mERAT) to antibiotic therapy in children with AUA. The aim of this study was to evaluate the safety and feasibility and of mERAT in the treatment of hospitalized children with AUA. Children with AUA, confirmed by ultrasonography and or abdominal computed tomography, were consecutively enrolled from October 2018 to February, 2020. They were randomly assigned to receive mERAT or routine antibiotic treatment. Patients were followed until May, 2020. Th primary outcome variable was the duration of relief of the abdominal pain after treatment. We collected patient's demographics, ultrasonic imaging findings, colonoscopy findings, and treatment outcomes of the mERAT and adverse even associated with mERAT. A total of 83 children were enrolled. 36 were randomized to mERAT and 47 to antibiotics treatment. All children in the mERAT group had endoscopic confirmed acute uncomplicated appendicitis, and there were no significant complications. However, 9 of patients in antibiotic group were poor responsive to treatment and switched to mERAT. The overall success rate of treatment with mERAT (100%) was significantly higher than that of antibiotics (80.9%) (P = 0.004). The median time to discharge was significantly shorter in mERAT group than in antibiotics treatment group [6.0 ± 1.76days] (P = 0.004). mERAT provide a new alternative therapeutic option for childhood with AUA, especially for families who are reluctant to undergo an appendectomy.

Clinical characteristics and efficacy of endoscopic treatment of gastrointestinal ectopic varices: A single-center study.

Background:Ectopic varices (EcVs) may cause massive bleeding, which can be difficult to control, with a high rate of mortality. The purpose of this study was to analyze the clinical characteristics of EcVs and the efficacy of endoscopic treatment.Methods:From January 2008 to July 2017, the clinical data of 150 patients with EcVs in our center were retrospectively collected and analyzed.Results:One hundred and fifty patients with EcVs (male 74.7%), with a mean age of: 54.1 ± 14.6 years were included. The prevalence of EcVs was 0.92% in gastrointestinal varices. Cirrhosis was the most common cause of EcVs (67.0%). The rates of bleeding were 57.14%, 4.34%, 30.0%, 33.3%, and 100% in the duodenal varices rectal varices, colonic varices, anastomotic varices, and small bowel varices, respectively. An age under 55 years, varices in the duodenum, and erythema were considered risk factors for EcV bleeding. Endoscopic treatments were performed in 15 patients with EcV bleeding. The follow-up period of the patients who underwent endoscopic treatment ranged from 0.5 to 24 months. The overall rate of treatment success was 73.33% for endoscopic treatment of EcV bleeding. The overall rates of rebleeding and mortality during 2 years were as high as 53.3% and 26.7%, respectively.Conclusion:Age, erythema, and the location of EcVs are considered risk factors for EcV bleeding, and the rate of bleeding is higher in patients with duodenal varices than in those with other EcVs. Endoscopic treatment is safe, effective, and feasible for controlling EcV bleeding.

The effect of the two-stage laparoscopic Fowler-Stevens operation on testicular growth and risk of atrophy in boys with intra-abdominal testes.

IntroductionThe aim of our study was to evaluate testicular growth and risk of atrophy at different lengths of time from the 2SLF-SO in boys with intra-abdominal cryptorchidism.Material and methodsTwenty-seven boys aged one to 24 months were treated for 35 non-palpable testes. Twenty-one boys with 29 IAT underwent a two-stage laparoscopic Fowler-Stephens operation. The patients underwent ultrasound examination of the TV at six time points: before treatment (TP1), 3 months (TP2) and 9–12 months after laparoscopic F-S operation (TP3), 3 months after inguinal orchidopexy (TP4), 3–6 years of age (TP5) and 7–9 years of age (TP6). The testicular atrophy index (TAI) of the affected testicle was calculated.ResultsThe overall success rate of treatment was 93.1% (27/29). The median volume of the affected testicles before treatment was less than the median TV of the healthy gonad, but increased systematically at the successive time points, showing significant growth between the second and sixth time points (p < 0.02, R = 2.75). The median TAI value decreased at the subsequent time points from the level of 26% at TP1 to 5.4% at TP6, with no significant difference.ConclusionsTwo-stage laparoscopic Fowler-Stevens operation proved to be an effective procedure for the treatment of intra-abdominal testicles. The undescended testis had a chance to grow and to equalize with the healthy testis after this procedure. The incidence of testicular atrophy was low.

Congenital Dacryocystitis- Clinical Profile and Outcome

Aim: To assess the clinical and epidemiological profile of congenital dacryocystis and its treatment outcome. Material and Methods: A prospective study was conducted for duration of two years, cases with congenital dacryocystitis of age less than 5 years were included. A detailed history was taken giving emphasis to epiphora onset, duration, treatment and resolution. Ocular examination was done along with regurgitation on pressure over lacrimal sac test. The plan for the management was standard stepwise approach according to age groups and clinical condition of the cases. The conservative treatment included sac massage and surgical procedure were probing and syringing and endonasal dacryocystorhinostomy. Follow-up was done for 6 months and final clinical assessment was done to assess the success of procedure. Results: Total 65 eyes of 51 cases were included in the study. Mean age of presentation was- 14.6 ± 2.3 months with 52.9% females. Unilateral involvement was more common. Epiphora was most common complaint with 63% ROPLAS positive. The success rate of sac massage was 81% and the overall success rate for treatment of congenital dacryocystitis was 96%. Conclusion: Congenital dacryocystitis is a common pediatric problem. Treatment of congenital dacryocystitis should be started as early as possible and in stepwise manner initially conservative than surgical.

In silico study of medical decision-making for rare diseases: heterogeneity of decision-makers in a population improves overall benefit

BackgroundMedical decision-making is difficult when information is limited due to its rareness. For example, there are two treatment options for patients affected by a rare disease with high lethality. The information about both treatment effects is unavailable or very limited. Patients are inclined to accept one of the interventions rather than waiting for death, but they are reluctant to be assigned the inferior one. While a single patient selects one treatment that seems better based on the limited information, he or she loses the chance to select the other treatment, which may be the better option. This is the so-called dilemma between exploitation (enjoying the benefits of using current knowledge) and exploration (taking the risk to obtain new knowledge). In clinical settings, the statistical advice for individual patients seems to be the maximum expected success rate or something equivalent and patients’ selections tend to be homogeneous, which does not solve the dilemma. In this study, our aim is to investigate the effects of the heterogeneity of decision-makers in the decision process.MethodsHere, we proposed a decision strategy that introduced the heterogeneity of decision-makers by considering patients’ self-decisions where the patients’ heterogeneous attitudes towards the treatment are integrated into the probabilistic utility function based on the Beta Bayesian posterior. Based on the context of two-armed bandit treatment options with limited information, we compared the overall success rate of treatment between our heterogeneous decision strategy and a homogeneous decision strategy that is defined to select the treatment with the largest posterior mean.ResultsThe heterogeneity of decision-makers in a population improved the overall benefit of treatment under some conditions.DiscussionIn clinical settings, there exists heterogeneity of decision-making among patients. Our study investigated a targeting strategy by respecting the self-decision of all individuals and found that the heterogeneity of decision-making can improve the overall benefit under some conditions. In addition, this outperformance may suggest that heterogeneity of decision-making is of importance to human beings. Besides the ethical merit, our findings provide meaningful ideas for better strategies towards decision-making dilemmas in clinical settings for rare diseases or cases where only limited information is available. Furthermore, it is suggested to investigate the effects of heterogeneity of decision-making in other fashions, such as genetic heterogeneity and phenotypic heterogeneity.

Factors contributing to treatment outcomes of post-prostatectomy incontinence surgery for the selection of the proper surgical procedure for individual patients: A single-center experience.

To investigate the clinical and urodynamic parameters affecting the treatment outcomes of post-prostatectomy incontinence (PPI) surgery. We reviewed the patients with PPI who received an artificial urinary sphincter (AUS) or adjustable male sling (MS) from 2001 to 2016. A total of 103 patients (AUS, 53; adjustable MS, 50) with a mean age of 69.9 (±5.6, standard deviation) years were analyzed. The mean number of pads used daily was 4.8 (±3.4). The mean symptom duration and follow-up duration were 46.9 (±31.1) and 31.0 (±21.4) months, respectively. The overall rate of treatment success (≤1 pad per day at last follow-up) at 12 months postoperatively was 81.6%. Based on univariate analysis, previous pelvic irradiation (P = 0.013), prior PPI surgery (P = 0.017), and degree of incontinence (P = 0.010) were inversely associated with the success of PPI surgery. In patients who received AUS, history of neurologic disease (P = 0.038) was inversely associated with treatment success. However, in patients with an adjustable MS, previous pelvic irradiation (P = 0.001), prior PPI surgery (P = 0.022), and degree of incontinence (P = 0.008) were inversely associated with treatment success. Adjustable MS should be avoided in patients with previous pelvic irradiation, prior PPI surgery, or severe symptoms. Physicians should be aware that the treatment outcome of AUS might be compromised in patients with neurologic disease.

Long-term Surgical Outcomes for Large-angle Infantile Esotropia

To report the long-term surgical outcomes for a cohort of children with large-angle infantile esotropia. Multicenter, nonrandomized clinical study. Setting: Two tertiary-care pediatric hospitals. Children with large-angle (≥55 prism diopters) infantile esotropia. Surgical treatment of infantile esotropia. Success rate at final follow-up (postoperative deviation ≤ 10 prism diopters and no need for retreatment). A total of 88 patients with large-angle infantile esotropia were treated during the 13-year study period. Treatment was bilateral medial rectus muscle recessions in 70 patients, botulinum toxin-augmented surgery in 15 patients, and 3-muscle surgery in 3 patients. After a mean follow-up of 40months, 20 patients (23%) had a successful outcome compared to 68 treatment failures (77%). Of the 68 treatment failures, 59 had residual or recurrent esotropia and 9 had sequential exotropia. On multivariate logistic regression, treatment modality was the only factor significantly associated with a successful outcome. Specifically, patients treated with botulinum toxin-augmented surgery were more likely to have a successful outcome compared to patients treated with bilateral medial rectus muscle recessions. For the 26 patients (30%) who underwent retreatment, the mean number of procedures was 2.1, and 7 (27%) had a deviation of ≤10 prism diopters at final follow-up. The overall success rate for treatment of large-angle infantile esotropia was poor in this cohort, with most failures owing to recurrent or residual esotropia. Botulinum toxin-augmented surgery was associated with a higher success rate at final follow-up.

Study the efficacy of intralesional formic acid-80% in verruca vulgaris

Background: Warts have been recognized for thousands of years. A wart an epidermal outgrowth develops due to infection with human papilloma virus (HPV) belongs to the papova viridae group. Various treatment modalities have been tried for warts but none are uniformly effective. The present experimental study with formic acid 80% was undertaken . The objective was to study the verruca vulgaris in relation to age, sex and site and efficacy of intraregional formic acid 80% in verruca vulgaris. Methods: Patients were treated with formic acid - 80% intralesionally on every alternate day till lesions become flat. But the number of application was restricted to ten, after which the treatment was considered as a failure. Then follow up every monthly. Failure was considered if there was recurrence of any lesion and if lesions did not respond to intraregional formic acid. Results: In the present study, out of 67 patients of verruca vulgaris, 64 patients showed complete disappearances of verruca vulgaris before the period of 10 application of formic acid 80%. The overall success rate of treatment of verruca vulgaris with 80% formic acid is 82%. Conclusions: The overall success rate of treatment of verruca vulgaris with formic acid was 82%. Thus the formic acid-80% is effective in the treatment of verruca vagaries.

Experiences with surgical management of undescended testis at a tertiary care hospital in north-western Tanzania

Background: Undescended testes (UDT) are prone to a lot of complications but early detection and correction give good results. There is paucity of published data on UDT in our setting. This study describes the clinical presentation, management and outcome of this condition at Bugando Medical Centre (BMC) in northwestern TanzaniaMethods: This was a retrospective study of patients who were admitted and operated for undescended testis at BMC between July 2006 and June 2014. Results: A total of 84 patients with 102 UDT were studied. Forty-six (54.9%) patients were aged above 5 years. Majority (72.5%) UDT were non-palpable. The right side was involved in 54.8%; left side in 23.8% while 21.4% were bilateral. Associated inguinal hernia was reported in 48 (77.4%) patients. Ultrasonography was performed in 34 (45.9%) patients with non-palpable testes and was used to locate 12(35.3%) testes. Laparoscopy was not used in any patient. At surgery, 54 (52.9%) testes were found in the inguinal canal, 28 (27.5%) in the superficial inguinal pouch, 10 (9.8%) in the abdomen and 10 (9.8%) testes were not found. Out of the 92 (90.2%) visible testes, 69 (75.0%) underwent orchidopexy (single stage in 54 (78.3%) testes and multistage in 15 (21.7%) testes) and 23 (25.0%) orchidectomy. Single stage procedures were more likely in patients less than 5 years, with palpable testes and those with testes located at the superficial inguinal pouch (p &lt; 0.001). Postoperative complications were recorded in 8(9.5%) patients. The overall success rate of treatment was 95.7%. In this study, only 12 (14.3%) patients were available for follow up at 12 months after discharge.Conclusion: Patients with UDT presented late in our hospital because diagnosis by birth attendants was rarely made even though the anomaly was obvious at birth. The parents, patients themselves and development of complications drew attention to undescended testis. Health awareness campaign, thorough genital examination after birth and regular screening of toddlers for UDT may result in early presentation

Infective complications following tumour endoprosthesis surgery for bone and soft tissue tumours

AimsThis study aims to describe the incidence of infective complications, including tumour endoprosthesis infection, in a cohort of patients undergoing tumour endoprosthesis surgery in Victoria, Australia. MethodsThis retrospective cohort study was performed over 15 years (January 1996–December 2010). Results121 patients underwent tumour endoprosthesis surgery during the study period. Patients were followed for a median of 34 months (interquartile range [IQR] 17, 80). Overall, 34 patients (28%) experienced infective complications including: bacteraemia in 19 patients (16%) and tumour endoprosthesis infection in 17 (14%). The majority of patients with early and late acute infections (haematogenous) were managed with debridement and retention of the prosthesis in addition to biofilm-active antibiotics. Late chronic infections were predominantly managed by exchange of the prosthesis. The overall success rate of treatment was 71%. The success rate for debridement and retention was 75% compared with 67% for exchange procedures. ConclusionsThere is a significant rate of infective complications following tumour endoprosthesis surgery including 14% of patients experiencing infection involving the tumour endoprosthesis. This study is the first to report on outcomes from debridement and retention of the prosthesis; which had comparable success rates to other treatment modalities.

Effects of Bracing in Adolescents With Idiopathic Scoliosis

Research Article| February 01 2014 Effects of Bracing in Adolescents With Idiopathic Scoliosis AAP Grand Rounds (2014) 31 (2): 14. https://doi.org/10.1542/gr.31-2-14 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Effects of Bracing in Adolescents With Idiopathic Scoliosis. AAP Grand Rounds February 2014; 31 (2): 14. https://doi.org/10.1542/gr.31-2-14 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: braces, idiopathic scoliosis, scoliosis Source: Weinstein SL, Dolan LA, Wright JG, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013; 369(16): 1512– 1521; doi: https://doi.org/10.1056/NEJMoa1307337Google Scholar Investigators from the University of Iowa and Washington University sought to determine the effect of bracing on curve progression and rate of surgery in adolescents with idiopathic scoliosis. They conducted a multicenter (25 institutions) randomized trial of patients with scoliosis and typical indications for bracing including age, skeletal maturity, and degree of curve (Cobb angle of 20° to 40°). Both a randomized cohort (randomized to bracing or observation) and a preference cohort were enrolled. Patients in the bracing group (both those randomized and those choosing this treatment) were instructed to wear the brace at least 18 hours per day. Wear time was measured by means of a temperature logger embedded in the brace that logged the date, time, and temperature every 15 minutes. A temperature of 28°C or higher indicated that the brace was being worn. The primary outcome, treatment failure, was defined as curve progression to ≥50°. Treatment success was defined as the patient reaching skeletal maturity without this degree of curve progression. Rates of treatment success were compared between those in the bracing and observation groups. A secondary analysis was conducted to assess the impact on treatment success of the number of hours per day of wearing the brace. A total of 242 patients (age range 10–15 years) were enrolled in the study, including 116 who agreed to be randomized to bracing or observation and 126 who chose between bracing (71%) and observation (29%). The trial was stopped early due to the efficacy of bracing. The overall rate of treatment success was 72% after bracing as compared to 48% after observation (OR = 1.93; 95% CI, 1.08–3.46). Among study participants in the randomized part of the study, the rate of treatment success was 75% among those assigned to bracing as compared with 42% in those randomly assigned to observation (OR = 4.11; 95% CI, 1.85–9.16). There was a significant positive association between hours of brace wear and treatment success (P < .001). Success rate was >90% in patients who wore the brace for at least 13 hours per day and 41% in those who wore the brace for 0 to 6 hours per day. Adverse events included a rash under the brace in 12 of 146 patients (8%) who wore the brace and hospitalization for anxiety and depression in another patient who wore the brace. The authors conclude that bracing significantly reduced the progression of high-risk spinal curves and reduced the need for surgery in adolescents with idiopathic scoliosis. Dr Hennrikus has disclosed no financial relationship relevant to this commentary. The commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Idiopathic adolescent scoliosis develops in about 3% of children. Approximately 0.3% of children progress to spinal curves greater than 20° – a... You do not currently have access to this content.

The Long-Term Efficacy of Hydrocele Treatment with Aspiration and Sclerotherapy with Polidocanol Compared to Placebo: a Prospective, Double-Blind, Randomized Study

We evaluate whether aspiration and sclerosing of hydrocele testis is an effective treatment. Men with symptomatic hydrocele testis were included in this prospective, double-blind, randomized study with polidocanol and placebo. Patients were randomized to active treatment or placebo at the first treatment. Depending on hydrocele testis size (less than 100, 100 to 200 and greater than 200 ml), the patients were treated with 1, 3 or 4 ml polidocanol after aspiration. Patients with recurrence at the 5-week followup received active treatment. A total of 77 patients were included in the study. In group 1 (active treatment) there were 36 patients with a median age of 63 years (range 34 to 92). In group 2, comprised of 41 patients, the median age was 59 years (range 26 to 82). Median followup was 72 months. A significant difference between the groups was observed after the first and second treatments. Recurrence after the first treatment was seen in 16 (44%) patients from group 1 and in 32 (78%) from group 2 (p <0.05). Recurrence after re-treatment with the active drug in both groups was seen in 4 (25%) patients in group 1 and in 14 (44%) in the former placebo group (p <0.05). The overall success rate of treatment in the active group was 89%. There was no difference between the 2 groups in terms of volume of fluid aspirated, symptoms or complications. This long-term efficacy randomized study with placebo showed that polidocanol is effective for the treatment of hydrocele testis with a low recurrence rate.

Management of Restenosis After Urethral Stent Placement

We describe our experience with the management of restricture after urethral stent placement, including endoscopic and open surgical treatment. We surveyed our prospectively collected database for patients with restenosis after urethral stent insertion. We reviewed patient age, comorbidities, indications for stent placement, restricture length, management of restricture, postoperative complications and the further restenosis rate. Overall we have treated 22 patients with failed urethral stents with a median followup of 30 months (range 1 to 96). All stents were initially placed for urethral stricture management. Stricture etiology included prostate cancer therapy in 9 cases, idiopathic causes in 6, urethral instrumentation in 2, trauma in 2, simple prostatectomy in 2 and gender reassignment/phalloplasty in 1. Ten patients had anterior urethral stricture, 11 had posterior stricture and 1 patient had each type. Of the 22 patients with stenosis after stent placement 13 underwent urethroplasty. Of the 18 patients with indwelling stents at treatment the stent was removed in 8 intraoperatively and in 10 the stent was left in situ. Ten of the 11 anterior strictures were treated with urethroplasty. Only 4 of the 12 posterior strictures were treated with urethroplasty, while 8 were managed endoscopically. Our overall success rate for treatment after stent failure was 67% (8 of 12 cases) for posterior urethral strictures and 82% (9 of 11) for anterior strictures. Urethral stent failure requires complex intervention. A failed posterior urethral stent can often be managed endoscopically. Conversely we have managed failed anterior urethral stents by urethroplasty.

Avaliação da reação em cadeia da polimerase no diagnóstico da tuberculose pulmonar em pacientes indígenas e não indígenas

The DOTS strategy was proposed by the World Health Organization (WHO) in 1993 with the objective of containing the global expansion of tuberculosis (TB). This strategy emphasizes the decentralization of diagnosis and treatment in order to increase the access of the population to the health system, while maintaining the quality of health care through supervision, quality control and monitoring. The goals of the WHO have been the detection of 70% of the patients with active TB, in addition to the treatment success of at least 85% of the cases detected. In countries that have achieved high levels of implementation of the DOTS strategy, the overall rate of treatment success has increased from 60% to 82%. However, case detection remained stable at 43%.(1) Therefore, the increase in the case detection of pulmonary TB has come to be considered an additional worldwide strategy for the 2006 to 2009 period.(2) The majority of studies that evaluate molecular biology techniques for the diagnosis of TB have been carried out in industrialized countries, and few studies have evaluated the clinical usefulness of such techniques as routine procedures.(3-5) In developing countries, the analysis of molecular biology techniques in the diagnostic field has not been prioritized, due to its elevated costs, technical and operational difficulties of implementation, even in reference laboratories, and due to the lack of information on its clinical relevance and/or the cost-effectiveness ratio in different clinical scenarios. Among the few reports described in these regions, most of those evaluating new molecular methods for the diagnosis of TB are based on laboratory diagnostic criteria or on the use of clinical information to evaluate conflicting results.(6-7) In addition, Evaluating the efficiency of polymerase chain reaction in diagnosing pulmonary tuberculosis in indigenous and non-indigenous patients

The treatment of multidrug-resistant tuberculosis in Turkey.

We evaluated the results of treatment in 158 consecutive patients with multidrug-resistant tuberculosis who were treated at our center in Istanbul. A total of 21 female patients and 137 male patients (age range, 15 to 68 years) received treatment for multidrug-resistant tuberculosis between March 1992 and October 1999. The patients had previously received a mean of 5.7 antituberculosis drugs and were infected with organisms that were resistant to a mean of 4.4 drugs. All patients were infected with organisms that were resistant to both isoniazid and rifampicin. The regimens we used were selected on the basis of previous treatment protocols and the results of susceptibility tests. All patients received at least three drugs thought to be active; the treatment was continued for at least 18 months after the conversion to a negative culture and for at least 24 months in the absence of first-line drugs. The mean number of drugs given during the study was 5.5 (range, 3 to 9). Surgical resection was performed in 36 patients. Adverse effects led to discontinuation of one or more drugs in 62 patients (39 percent). Cultures became negative in 150 patients (95 percent) after a mean of 1.9 months (range, 1 to 9). The overall success rate of treatment was 77 percent, with cures in 78 patients (49 percent) and probable cures in 43 (27 percent). Treatment failed in 13 patients (8 percent). Seven patients died (4 percent). Seventeen patients (11 percent) did not complete the treatment regimen. The patients with unsuccessful outcomes were older than those with successful outcomes (mean age, 42 years vs. 36 years; P=0.008), had received a larger number of drugs previously (median, six vs. five; P=0.048), were more likely to have been treated previously with ofloxacin (57 percent vs. 30 percent, P=0.004), and were less likely to have received ofloxacin as part of the study protocol (65 percent vs. 84 percent, P=0.018). Thirty-eight percent of the patients with unsuccessful outcomes were infected with organisms that were resistant to more than five drugs. In a step-down logistic-regression analysis, a successful outcome was independently associated with a younger age (P=0.013) and the absence of previous treatment with ofloxacin (P=0.005). Most patients with multidrug-resistant tuberculosis can be cured with the use of appropriate, intensive treatment regimens.

Comparison of three treatments for bovine endometritis

Three commercial preparations for the treatment of bovine endometritis were compared: an intrauterine infusion of 1500 mg oxtytetracycline hydrochloride solution, an intramuscular injection of 500 μg cloprostenol (a synthetic analogue...