Rate Of Symptom Resolution Research Articles

Extraintestinal Manifestations of Celiac Disease: Effectiveness of the Gluten-Free Diet.

The aim of the study was to evaluate the effectiveness of the gluten-free diet (GFD) on extraintestinal symptoms in pediatric and adult celiac populations at the University of Chicago. We conducted a retrospective chart review of the University of Chicago Celiac Center clinic charts from January 2002 to October 2014. Demographics, serologic testing, intestinal biopsies, and extraintestinal symptoms at presentation, 12, 24, and >24 months were recorded. Extraintestinal symptoms included abnormal liver enzymes, arthralgia/arthritis, dermatitis herpetiformis, alopecia, fatigue, headache, anemia, stomatitis, myalgias, psychiatric disorders, rashes, seizures, neuropathy, short stature, delayed puberty, osteoporosis, and infertility. A total of 737 patients with biopsy-confirmed celiac disease or skin biopsy-confirmed dermatitis herpetiformis were included. Patients lost to follow-up, or with insufficient data were excluded leaving 328 patients (157 pediatrics younger than 18 years). For pediatrics, the female to male ratio was 2:1 and the mean age at diagnosis was 8.9 years. For adults, 4:1 and 40.6 years old. Extraintestinal symptom rates were similar in children (60%) and adults (62%). Short stature (33%), fatigue (28%), and headache (20%) were most common in children. Iron deficiency anemia (48%), fatigue (37%), and headache/psychiatric disorders (24%) were common in adults. Children had faster/higher rates of symptom resolution compared with adults. Twenty-eight percent of children with unresolved short stature on a GFD were found to have other comorbidities. Children and adults with celiac disease have similar rates of extraintestinal manifestations. In children short stature, fatigue, and headache were most common, whereas anemia, fatigue, and headache/psychiatric disorders were most common in adults. Children on a strict GFD showed faster and higher rates of symptom resolution as compared to adults. Unresponsive children with short stature must be assessed for comorbidities.

Clinical Outcomes and Return to Sport in Competitive Athletes Undergoing Iliopsoas Fractional Lengthening as a Part of Hip Arthroscopy - Minimum Two-Year Follow-Up

Objectives:The iliopsoas is a hip flexor and stabilizer that may be associated with internal snapping. Although flexion and stability are important in competitive athletes, painful internal snapping may be debilitating and may necessitate arthroscopic iliopsoas fractional lengthening (IFL). The purpose of this study was to report minimum two-year results for athletes’ patient-reported outcomes (PROs), returning to sports, and competitive abilities after IFL during hip arthroscopy. We hypothesized that IFL for internal snapping in athletes is a safe procedure and will demonstrate favorable outcomes, with a majority of athletes returning to sports with the same or higher competitive abilities.Methods:Data were prospectively collected and retrospectively reviewed for 1,682 patients undergoing hip arthroscopy between February 2008 and October 2013. Inclusion criteria were as follows: high school, collegiate, or professional athlete, who underwent arthroscopic IFL, and agreed to preoperative modified Harris Hip Score (mHHS), Non-Arthritic Athletic Hip Score (NAHS), Hip Outcome Score - Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). All patients failed to improve with at least three months of conservative treatment, including physical therapy, anti-inflammatories, and rest. Exclusion criteria were as follows: patients under 16 years old, Tönnis grade > 1, previous hip conditions such as Legg-Calve-Perthes disease, hip fractures, slipped capital femoral epiphysis, avascular necrosis of the femoral head, hip dysplasia, and previous surgical intervention for either hip.Results:Fifty athletes were eligible for inclusion, 44 (88%) of which had minimum two-year follow-up. All PRO scores demonstrated significant improvements at latest follow-up (p < 0.0001). Mean improvements were as follows: mHHS (65.1 to 83.7), NAHS (60.7 to 86.2), HOS-SSS (41.5 to 75.4), VAS (5.8 to 2.0). Mean satisfaction was 8.1. Painful snapping was resolved in 41 patients (93%). Six patients (14%) had non-painful snapping at latest follow-up. Of the 44 athletes, 6 (14%) did not return to sport due to their hip symptomatology, 29 (65.9%) returned to sports, and 24 (54.5%) maintained or improved their competitive abilities. Nine patients (20.5%) did not return to sports for reasons unrelated to their hip (e.g., loss of interest, aging, etc.). The only complications were two (4.6%) superficial wound infections that resolved with topical treatment. There were no complaints of weakness in hip flexion.Conclusion:In competitive athletes, IFL during hip arthroscopy is safe and demonstrates favorable improvements in PROs and VAS, high satisfaction, and high rate of symptom resolution at a minimum of two years postoperatively. The majority of patients were able to return to sports and maintain or improve their competitive levels.

Thoracoscopic division of vascular rings

Background/PurposeVascular rings are traditionally treated via an open thoracotomy. In recent years the use of thoracoscopy has increased. Herein we report our experience with thoracoscopic division of vascular rings in pediatric patients. MethodsWe reviewed all patients who underwent thoracoscopic or open division of a vascular ring at our institution between 2007 and 2015. We analyzed patient demographics, presenting symptoms, diagnostic imaging modality, ring anatomy, operative details, complications, and symptom resolution. ResultsThirty-one patients underwent thoracoscopic division of a vascular ring while sixteen had open operations. Median age was 24months in the thoracoscopic group and 13months in the open group. Operative time averaged 74min (thoracoscopic) and 95min (open). There were no mortalities at 30days. There was complete symptom resolution in 71% of thoracoscopic patients and 63% of open. Patients in the thoracoscopic group had decreased ICU admissions (10% vs. 94%), chest tube use (62% vs. 100%), chylothorax (6% vs. 38%) and overall length of stay (1.7days vs. 5days). ConclusionsThoracoscopic division of vascular rings in pediatric patients is a feasible alternative to open division and is associated with comparable rates of symptom resolution and decreased length of hospital stay and chylothorax. Level of evidenceIII.

Long-term Symptom-specific Outcomes for Patients With Petrous Apex Cholesterol Granulomas: Surgery Versus Observation.

Review long-term symptom-specific outcomes for petrous apex cholesterol granulomas (PACG). Retrospective review. Tertiary center. Adults with PACG were assessed from 1998 to 2015. Symptomatic patients were stratified into surgical and observation subgroups. Resolution rates of individual symptoms and chief complaints were assessed as was the impact of surgical approach and stent usage on symptom-specific outcomes. Symptom recurrence rates were tabulated. Twenty-seven patients were included whose mean age was 44.8 ± 3.3 years. Fourteen and 13 patients stratified into the surgical and observation subgroups respectively. The surgical subgroup trended toward a longer follow-up period (mean 68.5 vs. 33.8 mo; p = 0.06). Overall, the most frequent symptoms encountered were headache (52%), aural fullness, tinnitus, and vestibular complaints (41% each). Visual complaints, retro-orbital pain, and cranial neuropathies were less common (18%, 15%, 11%). The overall symptom resolution rate was significantly higher in the surgical subgroup (48% vs. 26%, p = 0.03). In both subgroups, headache, retro-orbital pain, and visual complaints had the highest resolution rates. Vestibular complaints and tinnitus were very unlikely to resolve. Significantly more patients in the surgical group resolved their chief complaints (70% vs. 25%, p = 0.02). While approach type and stent usage did not significantly influence symptom outcomes, all patients with symptom recurrence (11%) were initially managed without stents. Symptom-specific outcomes were better in patients managed surgically for PACG. Individual symptom resolution rates were highly variable. Some symptoms were refractory regardless of management strategy. Surgical approach and stent usage did not significantly influence symptom outcomes.

Treating intracranial dural arteriovenous fistulas with gamma knife radiosurgery: A single-center experience.

Objective:We evaluated the effectiveness and safety of gamma knife radiosurgery (GKRS) for the treatment of intracranial dural arteriovenous fistulas (dural AVFs) over the past 10 years.Materials and Methods:The records of 21 patients diagnosed with dural AVFs between 2004 and 2014 and treated with GKRS were reviewed retrospectively. Complete obliteration (CO) was defined as total symptom relief plus confirmation through magnetic resonance imaging or conventional angiography.Results:The median follow-up was 70.5 months (range 3–136 months). Five patients underwent embolization (2 after GKRS). One patient underwent GKRS twice. The CO rate was 47%, and partial to CO rate was 88%. The complete symptom resolution rate was 77%, and all patients achieved partial to complete symptom resolution. The CO rates for Borden Type I and Type II/III dural AVFs were 66.7% and 25% (P = 0.153), respectively, and complete symptom-free rates were 76.9% and 75.0% (P = 1.000%), respectively. The median duration between initial GKRS and complete symptom resolution was 14.3 months. The median treatment to image-free durations for Borden Type I and Type II/III dural AVFs were 25.9 and 60.4 months (P = 0.028), respectively, and treatment to symptom-free durations were 10.6 and 36.7 months (P = 0.103), respectively. One patient had a recurrent hemorrhage. Two patients experienced brain edema after stereotactic radiosurgery and one patient experienced cystic formation after GKRS. The morbidity rate was 19% (four patients) and there was no mortality.Conclusion:Treatment with GKRS for dural AVFs offers a favorable rate of obliteration. Patients with dural AVFs that are refractory or not amenable to endovascular or surgical therapy may be safely and effectively treated using GKRS.

Dacryocystorhinostomy for Acquired Nasolacrimal Duct Stenosis in the Elderly (≥80 Years of Age)

The incidence of acquired nasolacrimal duct obstruction (NLDO) increases with age. Dacryocystorhinostomy, the definitive treatment for NLDO, has a high success rate (80%-100%) with a low complication rate (1%-6%), but surgical outcomes have not been reported previously specifically for an elderly population, in which there may be increased risk for intraoperative and postoperative complications. The purpose of this study was to examine surgical outcomes and complication rates of dacryocystorhinostomy in an elderly population. Retrospective cohort study. Patients 80 years of age or older undergoing external dacryocystorhinostomy at the Mayo Clinic between January 1, 1990, and December 31, 2010, were compared with a matched control group of younger patients (40-79 years of age) undergoing external dacryocystorhinostomy by the same surgeons. We reviewed the medical charts for patients as described above. Data abstracted from patient medical records included symptomatic relief and complications such as tube protrusion, infection, persistent bleeding, and return to operating room. Statistical analysis included a 2-sample t test to compare continuous variables, chi-square testing for categorical comparisons, and the generalized estimating equation model to control for nonindependence. Primary end point was symptomatic improvement at last follow-up. Secondary end points included anatomic patency, adverse event rate, and return to operating room within 1 month of surgery. Forty-two dacryocystorhinostomies (32 patients) were performed in the elderly group. The control group comprised 73 dacryocystorhinostomies in 63 patients. Resolution of symptom rate at last follow-up was 64% in the elderly group versus 86% in the younger cohort (P= 0.02). Although there was no difference between groups with respect to common postoperative complications, there was a higher rate of predefined serious complications in the elderly group (5 events vs. 1 event; P= 0.01). There was no difference between groups regarding need for additional eyelid surgery (P= 0.30). Although most elderly patients experience symptom resolution after dacryocystorhinostomy, the rate of symptom resolution was lower than that of younger patients. The risk of routine complications was similar between the groups. The risk of serious complications was higher in the elderly group.

External validity of the chiari severity index and outcomes among pediatric chiari I patients treated with intra- or extra-Dural decompression.

Chiari malformation type-1 (CM-1) may be treated by intradural (ID) or extradural (ED) posterior fossa decompression, although the optimal approach is debated. The Chiari Severity Index (CSI) is a pre-operative metric to predict patient-defined improvement after CM-1 surgery. In this study, we evaluate the results of ID versus ED decompression and assess the external validity of the CSI. We performed a retrospective cohort study of pediatric CM-1 patients undergoing decompression at a single academic children's hospital. Characteristics of headache, syrinx, and myelopathy were collected to derive CSI grade. The primary outcome measure was pre-operative symptom resolution. The proportion of patients with favorable outcome was tabulated for each of the three CSI grades and compared to previously published results. From 2004 to 2014, 189 patients underwent ID (48%) or ED (52%) decompression at the Children's Hospital of Philadelphia (CHOP). Follow-up ranged from 1 to 75months. Rates of symptom resolution (58-64%) and reoperation (8%) were similar regardless of surgical approach. Although proportions of favorable outcomes differed between the CHOP and Washington University (WU) cohorts, the difference was not related to CSI grade (p=0.63). Furthermore, there was no difference in the proportion of favorable outcomes between the two cohorts regardless of ID (p=0.26) or ED approach (p=0.11). Equivalent rates of symptom resolution and reoperation following ID and ED decompression support the ED approach as a first-line surgical option for pediatric CM-1 patients. In addition, our findings provide preliminary evidence supporting the generalizability of the CSI and its use in future comparative trials.

A Comparison of Surgical Approach for Long-Term Symptom Resolution and Recurrence Rates After Myomectomy

A Comparison of Surgical Approach for Long-Term Symptom Resolution and Recurrence Rates After Myomectomy

Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis.

Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6-8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72-82,25]), longer surgery time (MD = 15,08 [0,48-29,67]), but less prolapse recurrence (OR = 0,22 [01,3-0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.

Indications and Techniques for Spinal Instrumentation in Thoracic Disk Surgery.

Retrospective case series. To identify the indications, techniques, and outcomes for instrumented fusion during thoracic discectomy. Thoracic discectomy may require extensive bone removal to avoid spinal cord manipulation, but the indications and techniques for instrumented fusion during thoracic discectomy remain poorly delineated. The authors identified 220 consecutive patients who underwent thoracic discectomy between 1992 and 2012. Clinical and radiographic variables were compared between patients who underwent instrumented fusion and patients without instrumentation, and among surgical approaches utilized for discectomy. Patient age for the entire cohort averaged 49±13.01 years, and mean clinical follow-up was 45 months (range, 1-218 mo). Patients underwent 226 thoracic discectomy procedures, including 48 thoracotomy, 136 thoracoscopy, and 42 posterolateral approaches. Seventy-eight patients required instrumented fusion and, compared with patients without instrumentation, were more likely to present with myelopathy (P<0.0001) and harbor giant (P=0.0012), calcified (P=0.019), or transdural (P=0.0004) herniated disks. Surgery with instrumentation resulted in greater blood loss (P<0.0001), longer hospital stay (P<0.0001), and a higher complication rate (22% vs. 9.9%), yet patients in both cohorts had similar rates of symptom resolution postoperatively. Of the patients who underwent thoracic discectomy without instrumentation, 3 (2.1%) developed delayed deformity or instability and required subsequent surgery for fixation and fusion at an average 6.3 months postoperatively (range, 4-8 mo). Patients who underwent instrumented fusion exhibited no nonunions or delayed deformity. Thoracic discectomy without fixation is a reasonable clinical option in carefully selected patients, but instrumented fusion is safe and effective in other patients. Indications for fixation and fusion are thus proposed.

Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair.

OBJECTIVE Superior semicircular canal dehiscence (SSCD) is a rare disorder characterized by the formation of a third opening in the inner ear between the superior semicircular canal and the middle cranial fossa. Aberrant communication through this opening causes a syndrome of hearing loss, pulsatile tinnitus, disequilibrium, and autophony. This study analyzed the clinical outcomes of a single-institution series of patients with SSCD undergoing surgical repair by the same otolaryngologist and neurosurgeon. METHODS All patients who underwent SSCD repair at the University of California, Los Angeles, between March 2011 and November 2014 were included. All patients had their SSCD repaired via middle fossa craniotomy by the same otolaryngologist and neurosurgeon. Outcomes were analyzed with Fisher's exact test. RESULTS A total of 18 patients with a mean age of 56.2 years (range 27-84 years) and an average follow-up of 5.0 months (range 0.2-21.8 months) underwent 21 cases of SSCD repair. Following treatment, all patients (100%) reported resolution in ≥ 1 symptom associated with SSCD. Autophony (p = 0.0005), tinnitus (p = 0.0059), and sound- and/or pressure-induced dizziness (p = 0.0437) showed significant symptomatic resolution. Following treatment, 29% (2/7) of patients developed imbalance, 20% (1/5) of patients developed sound- and/or pressure-induced dizziness, and 18% (2/11) of patients developed aural fullness. Among patients with improved symptoms following surgical repair, none reported recurrence of symptoms at subsequent follow-up visits. CONCLUSIONS SSCD remains an underdiagnosed and undertreated condition. Surgical repair of SSCD using a middle fossa craniotomy is associated with a high rate of symptom resolution. Continued investigation using a larger patient cohort and longer-term follow-up could further demonstrate the effectiveness of using middle fossa craniotomy for SSCD repair.

Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

Subclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD. We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model. A total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8%, p = 0.007). Long-term primary patency rates (76.9 vs 79.6%, p = 0.729) and symptom resolution rates (82.2 vs 73.0%, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death. Stent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

Extent of recovery in the first 12months of complex regional pain syndrome type-1: A prospective study.

The literature concerning the outcomes of complex regional pain syndrome (CRPS) is contradictory, with some studies suggesting high rates of symptom resolution, whilst others demonstrate that CRPS symptoms can persist and lead to significant disability. The aim of the present study was to carefully document the extent of recovery from each of the signs and symptoms of CRPS. A sample of 59 patients with recently onset (<12weeks) CRPS-1 were followed prospectively for 1year, during which time they received treatment-as-usual. At baseline, 6 and 12months, the following were measured: CRPS severity scores (symptoms and signs of CRPS), pain, disability, work status and psychological functioning. Analyses showed that rates of almost all signs and symptoms of CRPS reduced significantly over 1year. Reductions in symptom severity were clinically relevant and were greatest in the first 6months and plateaued thereafter. However, at 1year, nearly 2/3 of patients continued to meet the IASP-Orlando criteria for CRPS and 1/4 met the Budapest research criteria for CRPS. Only 5.4% of patients were symptom-free at 12months. Overall the results were less optimistic than several previously conducted prospective studies and suggest that few cases of CRPS resolve completely within 12months of onset. Improvements were generally greater in the first 6months, and suggest that it may be worth exploring early interventions to prevent long-term disability in CRPS.

EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Does the Presence of Solid Debris Impact Clinical Outcomes? A Large, Multicenter Study

Introduction: EUS-guided transmural drainage (TM) of pancreatic pseudocysts is well established. It remains unclear if TM alone is sufficient treatment in pseudocysts containing solid debris. Aim: To compare clinical outcomes in patients who undergo TM of pancreatic pseudocysts that are debris-free (PDF) vs those that contain solid debris (PSD). Methods: Multi-center retrospective cohort study across 15 centers of patients who underwent TM of pancreatic pseudocysts during a 6-year period (2008-2014). Outcome measures included technical success, symptom resolution, radiologic resolution, endoscopic re-intervention and adverse events (AE). PSD was defined as a pseudocyst containing solid material at time of index EUS TM drainage. Patients with obvious walled-off necrosis on index imaging were excluded. Technical success was defined as drainage with successful placement of ≥ of 1 transmural stent. Short-term (ST) followup was designated as ≥ 2 weeks following TM, but before stent removal. Long-term (LT) follow-up was defined as ≥ 2 weeks following stent removal. Symptom resolution was defined as the complete absence of symptoms at follow-up. Radiologic resolution was defined as the absence of the pseudocyst on repeat imaging. Re-intervention was defined as the need to repeat endoscopic drainage within a 4-week period. Results: A total of 142 patients underwent TM: 90 PDF and 52 PSD. There were no differences in patient characteristics, indication for drainage, size and location of pseudocyst between the two groups (Table 1). Technical success: PDF 87/90 (97%) vs PSD 51/52 (98%, p=1.00). Endoscopic re-intervention rate was similar between the two groups: PDF 5/90 (6%) vs PSD 6/52 (12%, p=0.21). One patient with PSD underwent endoscopic necrosectomy following initial TM. Median ST and LT follow-up were similar between the two cohorts (Table 2). There was no statistically significant difference in ST symptom resolution rate and LT outcomes in the two groups. ST radiologic resolution was higher in PDF 45/68(66%) compared to PSD 21/41(51%; p=0.009). Overall, procedure-related AE occurred in 13 (14%) in the PDF and 9 (17%) in the PSD group (P=0.64).Table 1: Baseline CharacteristicsTable 2: Short-term (ST) and long-term (LT) outcome measuresConclusion: There is no difference in technical success, ST or LT clinical outcomes in performing TM of PSD, when compared to patients with PDF. Thus, TM alone can be considered a suitable initial intervention in patients with PSD, without increased risk of infectious complications or need for endoscopic debridement.

Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo: A Systematic Review.

To determine the rate of symptom resolution in patients with posttraumatic benign paroxysmal positional vertigo (BPPV) and to determine if it differs from resolution rates in patients with BPPV and without a history of head trauma. Systematic review of the literature was performed using Medline, EMBASE, and Cochrane databases. English and French articles meeting inclusion criteria and published between 1946 and October 2014 were included. Data were independently extracted from the articles by 2 reviewers using data collection forms developed a priori. Inclusion and exclusion criteria were decided a priori. Studies were included if they reported on at least 1 case of posttraumatic BPPV (t-BPPV), reported on outcomes of all patients with t-BPPV, had a clearly defined inception point, and provided a clear diagnosis of BPPV (defined a priori by reviewers). A total of 3017 titles, 362 abstracts, and 67 articles were reviewed, from which 16 articles met inclusion criteria and underwent data extraction. There were a total of 207 patients with posttraumatic BPPV identified. Among the 207 patients, 151 (73%) had resolution of symptoms. The T-BPPV patients may have more multi-canal involvement and may require more repositioning maneuvers for resolution compared to patients with nontraumatic BPPV. Available evidence does not support the notion that symptom resolution rates in patients with posttraumatic BPPV are worse than those with nontraumatic BPPV. However, well-designed studies with adequate cohorts are lacking. Additional well-executed studies are needed to confirm this lack of difference in resolution rates.

Transcutaneous Parasacral Electrical Stimulation vs Oxybutynin for the Treatment of Overactive Bladder in Children: A Randomized Clinical Trial

We determined the effectiveness of 2 methods to treat overactive bladder in children using intragroup and intergroup comparisons in a randomized clinical trial. Nine boys and 19 girls with a mean ± SD age of 6.4±2.18 years were randomly divided into group 1-parasacral transcutaneous electrical stimulation with placebo drug and group 2-oxybutynin with sham scapular electrical therapy. Success was assessed by 1) the rate of complete symptom resolution, 2) a visual analog scale of 0 to 10, 3) the dysfunctional voiding score system, 4) voiding diary records, 5) Rome III criteria and 6) side effect frequency in each group. A total of 13 and 15 patients were randomized to groups 1 and 2, respectively. Symptoms completely resolved in 6 patients in group 1 (46%) and 3in group 2 (20%) (p = 0.204). A statistically significant improvement was found in the 2 groups in the dysfunctional voiding score system and voiding diary records. However, no statistically significant difference was found between the groups in the visual analog scale score, voiding frequency, and maximum and mean voided volume (p = 0.295, 0.098, 0.538 and 0.650, respectively). Constipation improved in 100% of group 1 patients but in only 55% in group 2 (p= 0.031 vs 0.073). Group 1 showed no side effects while dry mouth, hyperthermia and hyperemia developed in 58%, 25% and 50% of group 2 patients (p=0.002, 0.096 and 0.005, respectively). Treatment was discontinued by 13.3% of patients in group 2. Parasacral transcutaneous electrical stimulation was as effective as oxybutynin to treat overactive bladder in children. However, transcutaneous parasacral electrical stimulation was more effective against constipation and showed no detectable side effects. Oxybutynin was more effective for decreasing voiding frequency.

Treatment of male varicoceles by transcatheter polidocanol foam sclerotherapy: evaluation of clinical success, complications, and patients' satisfaction with regard to alternative techniques.

We report our experience with polidocanol foam sclerotherapy with no additional coils, evaluating clinical success, patients' satisfaction, and complications. We conducted a retrospective study of 141 patients with 146 varicoceles (mean age: 29.3 years; range: 13 - 60 years) who underwent foam sclerotherapy with polidocanol 2% (range: 2 - 12 ml) in an outpatient setting between January 2007 and December 2013. For the follow-up, telephone interviews with the patients were conducted (mean follow-up time: 46.4 months, standard deviation: 20.17 months). The technical success rate was 91.8%. There was a 55.8% response rate to the telephone interviews. Follow-up revealed a clinical success rate of 83.9% and a persistence or relapse rate of 16.1%. Of the patients, 81.9% were absolutely satisfied with the outcome. In 94.9% of cases, pain or discomfort resolution was reported, and in 97% of cases, aesthetic issues were no longer a problem. Of partners, 63.2% achieved pregnancy, and in 50% of patients with preprocedural testicular atrophy, catch-up growth was observed. One patient with pampiniform plexus phlebitis received inpatient treatment with no long-term damage recorded. Polidocanol foam varicocele sclerotherapy is a safe and effective procedure, with a high rate of patients' satisfaction, clinical and technical success, and considerable catch-up growth and pregnancy achievement. • Varicocele treatment using polidocanol foam sclerotherapy is a safe and effective procedure. • It is easily feasible in an outpatient setting. • The clinical and technical success rates are high. • It shows a high rate of patients' satisfaction and symptom resolution. • Postinterventional catch-up growth and pregnancy achievement are considerable.

Induction of clinical and colonoscopic remission of mild-to-moderate ulcerative colitis with budesonide MMX 9mg: pooled analysis of two phase 3 studies.

SummaryBackgroundConventional oral corticosteroids are effective at reducing inflammation associated with ulcerative colitis (UC); however, systemic adverse effects limit their use. Budesonide MMX is an extended‐release, second‐generation corticosteroid that targets delivery of budesonide to the entire colon.AimTo analyse efficacy and safety outcomes from two phase 3 studies of budesonide MMX in patients with mild‐to‐moderate active UC.MethodsPatients were assigned to budesonide MMX 9 mg, budesonide MMX 6 mg, or placebo once daily in two randomised, double‐blind, placebo‐controlled, 8‐week studies (CORE I and II). Pooled data were analysed for pre‐defined primary (combined clinical and colonoscopic remission), secondary and exploratory endpoints. Primary endpoint data were analysed to evaluate the potential influence of demographical and baseline disease characteristics on remission.ResultsModified intent‐to‐treat population (histological evidence of baseline inflammation) had 232, 230 and 210 patients in budesonide MMX 9 mg, budesonide MMX 6 mg and placebo groups respectively. Combined clinical and colonoscopic remission rates were significantly greater than placebo (6.2%) for the budesonide MMX 9 mg group (17.7%; P = 0.0002), but not the budesonide MMX 6 mg group (10.9%). The primary endpoint of remission with budesonide MMX 9 mg was significantly greater than placebo in most subgroups analysed. Symptom resolution and colonoscopic improvement rates were significantly greater with budesonide MMX 9 mg vs. placebo. Budesonide MMX was safe and well tolerated.ConclusionThis pooled analysis showed that budesonide MMX 9 mg is efficacious, safe and well tolerated for inducing remission of mild‐to‐moderate UC.

Outcomes Following Re-irradiation for Symptomatic Brain Metastasis

We retrospectively analyzed outcomes of patients who underwent reirradiation for brain metastasis. We analyzed the records of 23 patients with brain metastasis who were initially treated with palliative brain radiotherapy (RT) and were retreated with a second course of brain RT between June 2008 and December 2012. WBRT, 3DCRT, and SRS were used for brain metastasis. The median dose of the first course of WBRT was 30 Gy (range, 23.4-30 Gy). The dose of the first course of 3DCRT for the lesion was 30 Gy in 3 Gy per fraction. The median dose of the first course of SRS was 16 Gy in one fraction (range, 12-24 Gy). The median dose of the second course of WBRT was 27.5 Gy (range, 12-30 Gy). The median dose of the second course of 3DCRT for the lesion was 30 Gy (range, 25-30 Gy). The dose of the second course of SRS was 16 Gy in one fraction. The second course of WBRT was administered on the basis of radiographically proven disease progression with clinical symptoms. With a median follow-up of 25 months, the overall symptom resolution rate was 47.8%. The rate of palliative efficacy was 82.6% including patients with stable disease. The median survival time after initiation of reirradiation was 3.2 months. The median Karnofsky performance status (KPS) value prior to reirradiation was 30, and the median KPS value following reirradiation was 60. Reirradiation of brain metastasis is feasible and effective in select patients with performance status of KPS ≥ 60 (Eastern Cooperative Oncology Group (ECOG) 0-2) prior to reirradiation.

Diagnosis and Treatment of Anterior-Canal Benign Paroxysmal Positional Vertigo: A Systematic Review.

Background and PurposeIn contrast to the posterior- and horizontal-canal variants, data on the frequency and therapeutic management of anterior-canal benign paroxysmal positional vertigo (AC-BPPV) are sparse. To synthesize the existing body of evidence into a systematic review regarding the incidence and treatment of AC-BPPV.MethodsSystematic search of medical databases employing predefined criteria, using the term "anterior canal benign paroxysmal positional vertigo."ResultsThe electronic search retrieved 178 unique citations, 31 of which were considered eligible for further analysis. Analysis of the collected data revealed an estimated occurrence of AC-BPPV among benign paroxysmal positional vertigo patients of 3% (range 1-17.1%). No controlled therapeutic trials could be identified, and so the analysis was focused on uncontrolled case series. Treatment was categorized into three groups: Epley maneuver, Yacovino maneuver, and specific, nonstandard maneuvers described in individual articles. All three categories demonstrated success rates of over 75%, and the overall sample-size-weighted mean was 85.6%.ConclusionsThe present analysis demonstrated that AC-BPPV comprises about 3% of all BPPV cases. It can be treated safely using the Epley, Yacovino, and other maneuvers with rates of symptom resolution lying in the range of that reported for the other, more frequent canal variants. Multicenter controlled trials are needed in order to develop evidence-based guidelines for the treatment of AC-BPPV.