Significant Difference In Success Rate Research Articles

Anesthetic Efficacy of Four Percent Articaine for Pulpal Anesthesia by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques in Patients with Irreversible Pulpitis: A Prospective Randomized Double-blind Clinical Trial

Introduction The study was designed as a randomized double-blind trial to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in inferior alveolar nerve block (IANB) and infiltration anesthetic techniques to anesthetize mandibular molars with irreversible pulpitis. Methods The study was composed of 2 test arms and 1 control arm. Subjects in the test arms received either a standard IANB or a buccal infiltration (B Infil) of 4% articaine with 1:100,000 epinephrine, whereas the subjects in the control arm received a standard IANB of 2% lidocaine with 1:100,000 epinephrine. Subject’s self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anesthetic administration during access preparation and pulp extirpation. Results For statistical analysis Pearson χ 2, Student's paired t test, 1-way analysis of variance, and Friedman tests showed no significant difference in success rates among the 3 arms of the trial. Conclusions Although B Infil and IANB of 4% articaine were equally effective, B Infil can be considered a viable alterative in IANB for pulpal anesthesia in mandibular molars with irreversible pulpitis.

Intra-articular Lidocaine Injection for Shoulder Reductions

Context:The shoulder is the most commonly dislocated joint, and shoulder dislocations are very common in sports. Many of these dislocations present to the office or training room for evaluation. Usual practice is an attempt at manual reduction without analgesia and then transfer to the emergency department if unsuccessful. The clinical efficacy of intra-articular lidocaine for reduction of anterior shoulder dislocations in the outpatient setting was examined.Evidence Acquisition:An OVID MEDLINE search (1966-present) was performed using the keywords shoulder, reduction, and analgesia as well as shoulder, intra-articular, and lidocaine. Search limits included articles in the English language. Bibliographic references from these articles were also examined to identify pertinent literature.Results:Six randomized controlled clinical trials were identified that directly addressed this clinical technique. Although the reduction techniques used in these studies were not controlled, there was no statistically significant difference in success rates between groups. The complication rate, length of stay, and costs were significantly less in the intra-articular lidocaine group when compared with the intravenous sedation group.Conclusions:According to current evidence, the use of intra-articular lidocaine injection for reduction of anterior shoulder dislocations is not harmful and is likely advantageous in the outpatient clinical setting.

Effects of virtual reality training on functional reaching movements in people with Parkinson’s disease: a randomized controlled pilot trial

Objective: To investigate whether practising reaching for virtual moving targets would improve motor performance in people with Parkinson’s disease. Design: Randomized pretest–posttest control group design. Setting: A virtual reality laboratory in a university setting. Participants: Thirty-three adults with Parkinson’s disease. Interventions: The virtual reality training required 60 trials of reaching for fast-moving virtual balls with the dominant hand. The control group had 60 practice trials turning pegs with their non-dominant hand. Main outcome measures: Pretest and posttest required reaching with the dominant hand to grasp real stationary balls and balls moving at different speeds down a ramp. Success rates and kinematic data (movement time, peak velocity and percentage of movement time for acceleration phase) from pretest and posttest were recorded to determine the immediate transfer effects. Results: Compared with the control group, the virtual reality training group became faster (F = 9.08, P = 0.005) and more forceful (F = 9.36, P = 0.005) when reaching for real stationary balls. However, there was no significant difference in success rate or movement kinematics between the two groups when reaching for real moving balls. Conclusion: A short virtual reality training programme improved the movement speed of discrete aiming tasks when participants reached for real stationary objects. However, the transfer effect was minimal when reaching for real moving objects.

Pregnancy outcomes in the recurrent miscarriage clinic: an observational study

ObjectiveTo audit pregnancy outcomes in the recurrent miscarriage clinic at St James' University Hospital, Leeds.MethodsRetrospective and prospective study of patients of the recurrent spontaneous abortion clinic (n=100). Patients with primary...

Elevated Preconception CD56+16+ and/or Th1:Th2 Levels Predict Benefit from IVIG Therapy in Subfertile Women Undergoing IVF

We sought to answer two questions: First, is there a group of patients who benefit from intravenous immunoglobulin (IVIG) in IVF? Second can this group of patients be identified by preconception blood testing? A total of 202 IVF cycles in subfertile women were divided into four groups. Group I: 62 cycles with preconception Th1:Th2 ratio and/or % CD56(+) cell elevation using IVIG; Group II: 27 cycles with similar Th1:Th2 and/or % CD56(+) cell elevation not using IVIG; Group III: 71 cycles with normal Th1:Th2 and/or % CD56(+) cell levels using IVIG; Group IV: 42 cycles with normal Th1:Th2 and % CD56(+) levels not using IVIG. These groups were similar with regard to patient age, diagnosis, and past failure history. The implantation rate (number of gestational sacs per embryo transferred, with an average of two embryos transferred per cycle) was 45% (55/123), 22% (12/54), 54% (75/139), and 48% (40/84) for Groups I-IV, respectively. The clinical pregnancy rate (fetal heart activity per IVF cycle started) was 61% (38/62), 26% (7/27), 69% (49/71), and 71% (30/42), respectively. The live birth rate was 58% (36/62), 22% (6/27), 61% (43/71), and 71% (30/42), respectively, and the live birth per embryo transferred was 40% (49/123), 13% (7/24), 43% (60/139), and 48% (40/84), respectively. There was a significant improvement in implantation, clinical pregnancy, live birth rate and live birth rate per embryo transferred for Group I versus Group II (P = 0.0032, 0.0021, 0.0017, and 0.0002, respectively) and for Group II versus Group IV (P = 0.0021, 0.0002, <0.0001 and <0.0001, respectively). There was no significant difference in success rates between Groups I and III (P = 0.085, 0.23, 0.45, 0.34, respectively) and between Groups III and IV (P = 0.22, 0.48, 0.17, 0.31, respectively). In subfertile women with preconception Th1:Th2 and/or % CD56(+) cell elevation, IVF success rates are low without IVIG therapy but significantly improve with IVIG therapy. In patients with normal Th1:Th2 and normal CD56(+) cell levels, IVF success rates were not further improved with IVIG therapy. IVIG may be a useful treatment option for patients with previous IVF failure and preconception Th1:Th2 and/or NK elevation. Preconception immune testing may be a critical tool for determining which patients will benefit from IVIG therapy. Prospective controlled studies (preferably double-blind, stratified, and randomized) are needed for confirmation.

Bladder base/trigone injection is safe and as effective as bladder body injection of onabotulinumtoxinA for idiopathic detrusor overactivity refractory to antimuscarinics

The purpose of this study was to evaluate the efficacy and safety of onabotulinumtoxinA injections at bladder base/trigone and compare with injections at bladder body or bladder body/trigone for the treatment of idiopathic detrusor overactivity (IDO) refractory to antimuscarinics. A single blind, randomized, paralleled, actively controlled trial was performed in patients with urodynamically proven IDO who failed antimuscarinic therapy. Patients were randomly assigned to receive intravesical injections of 100 U of onabotulinumtoxinA into three different bladder sites. All treatments were evaluated by voiding diary variables, urgency severity score, urodynamic studies, and patient perception of bladder condition. Long-term success rates over 12 months were also determined. Among the patients, 37 were randomized to injections in the bladder body, 35 into the bladder body/trigone, and 33 into the bladder base/trigone. Successful results were reported in 76 (72%) patients at 3 months: 26 (70%) in the bladder body group, 26 (74%) in the bladder body/trigone group, and 24 (73%) in the bladder base/trigone group. There were no significant differences in success rates, changes in urgency and urgency incontinence episodes, urodynamic variables, or long-term success rates among the three subgroups. The incidence of adverse events was similar among three groups. No vesicoureteral reflux was noted in all patients with or without involving trigone injection. Intravesical onabotulinumtoxinA injection is an effective treatment for IDO regardless of the bladder injection site. Bladder base/trigone injection is as safe and effective as bladder body injections with or without trigone involvement.

Success Rate of Microimplants in a University Orthodontic Clinic

Introduction. The purpose of this study was to examine the success rate and find factors affecting the clinical success of microimplants used as orthodontic anchorage. Methods. Seventy-three consecutive patients (25 male, 48 female; mean age, 22.45 years) with a total of 139 screw implants of 2 types were examined. Success rate was determined according to 18 clinical variables. Results. The overall success rate was 87.8%. The clinical variables of microimplant factors (type), patient factors (sex, skeletal and dental relationships, overbite, jaw involved, side involved and site involved), and treatment factors (type of insertion, time of loading, purpose of microimplant insertion, mode of loading, type of anchorage used, direction of forces applied) did not show any statistical difference in success rates. Mandibular angle, vertical position of implant placement, oral hygiene status, and inflammation showed significant difference in success rates. Conclusions. Proper case selection and following the recommended protocol are extremely essential to minimise failures.

A Critical Investigation of the Use and Effectiveness of Interpretive Services

With increasing concern for the environment, there has been a strong interest in ecotourism in Hong Kong, culminating in the opening of the Hong Kong Wetland Park (HKWP) by the local government in 2005. Since the HKWP uses various on-site interpretive services to help to convey education and conservation messages on environmental issues, through the use of a recent survey this paper aims to examine and analyze their use and effectiveness in achieving the intended purpose. The questionnaire was completed by 206 visitors and reveals that experiential facilities, interpretive signs and exhibition materials are the three most frequently used services. Although guided interpretive tours have received the highest satisfaction rating and are considered the most effective means of conveying educational and conservation messages, the survey found that this service is still unknown to many visitors and more public exposure is recommended. Interestingly, in terms of the goal of the wetland park's ability to convey an educational message to its patrons, the survey has also found a significant difference in success rate between visitors with a desire for knowledge and visitors merely enjoying a leisurely activity.

Is a third endoscopic treatment for vesicoureteral reflux indicated if previous attempts have failed?

Objective To evaluate the efficacy of a third endoscopic injection to correct vesicoureteral reflux (VUR). Patients and methods This was a prospective study of 605 patients, of whom 42 (6.4%), involving 44 (4%) ureteral units, received a third injection. The results were analysed regarding VUR grade and aetiology, substance used, volume, location and morphology of the mound, presence of poor prognostic factors, the urologist’s experience, and complications. Results The treatment resolved the VUR in 38 (86.4%) units, 22 of primary cause (91.6%) and 16 with anatomical/functional abnormalities (80%) (no significant difference; P = 0.26). There was also no significant difference in success rate with regard to the substance injected ( P = 0.23), the degree of VUR ( P = 0.76) or the volume injected ( P = 0.17). The success rate was higher (96.9%) if a less experienced urologist had performed the previous procedure versus a more experienced urologist (54.5%), and this difference was significant ( P < 0.005). There was one complication (haematuria) (2.3%). Conclusion Third treatment presents a similar efficacy to first and second treatments, with a very low rate of complications, and could be indicated before open surgery.

Effects of Think–Aloud Pair Problem Solving on Secondary–Level Students’ Performance in Career and Technical Education Courses

A randomized posttest–only control group experimental design was used to determine the effects of think–aloud pair problem solving (TAPPS) on the troubleshooting performance of 34 secondary–level career and technical education students. There was no significant difference in success rate between TAPPS students and students who worked alone (χ 2 (1) = .747, p = .39, ϕ = .148). There was no significant difference in completion time between students who successfully completed the troubleshooting task using TAPPS and those who were successful working alone (t (9) = –.74, p = .48, d = 0.45). The reserachers tentatively concluded that the use of TAPPS may not be an appropriate strategy at the secondary level if the agricultural instructors’ focus is a higher success rate and a reduction in the time to complete the task. However, agricultural instructors may have other legitimate reasons for using TAPPS such as a way to facilitate collaborative learning or as a way for instructors to identify student misunderstandings that could be used to inform decisions about individualized or even group instructional interventions.

미성숙 영구 전치의 외상 후 MTA를 이용한 치근단 형성술 : 후향적 연구

미성숙 영구 전치에서 MTA를 이용한 치근단 형성술의 예후를 평가하기 위해, 영구 전치의 외상으로 MTA를 이용한 치근단 형성술을 받은 환자 중 최소 3개월 이상의 경과 관찰이 시행된 환자 49명, 치아 64개의 의무기록과 방사선 사진을 검토하였다. 환자 정보, 치아 및 치주조직 외상 위치와 유형, 치료 전 치근단 병소 유무, 임상 증상 유무, MTA 충전 상태, 치근단 형성술 이후 치근단 병소 치유 및 치근단 경조직 장벽 형성 여부를 조사하고, 임상적, 방사선학적 성공을 평가하여 다음과 같은 결과를 얻었다. 1. 64개의 미성숙 영구전치에 시행된 MTA를 이용한 1-visit 치근단 형성술은 89.1%의 임상적 성공률과 73.4%의 방사선학적 성공률을 보였다. 2. 상악 치아와 하악 치아에 행해진 MTA를 이용한 1-visit 치근단 형성술 비교시 상악에서 유의하게 더 높은 성공률을 보였다. 3. 치아 외상 및 치주조직 외상 유형에 따른 성공률은 유의한 차이를 보이지 않았다. 4. MTA의 적절한 충전 여부는 성공률에 영향을 미치지 않았다. The aim of this study was to assess the outcome of MTA apexification in young permanent anterior teeth. Among the patients with the traumatized permanent incisors which were treated with MTA apexification, the dental records and radiographs were examined only for the patient who had follow-up examination at least 3 months after the treatment. Forty nine patients with 64 teeth were included in this study. Demographic information, location and type of teeth and periodontal injury, pre-treatment periapical lesion, clinical symptoms, status of MTA filling, healing of apical lesion and apical barrier formation after treatment were investigated. The outcome based on clinical and radiographic criteria were assessed. The results were as follows 1. Of 64 immature permanent incisors with MTA apexification, the clinical and radiographic success rates were 89.1% and 73.4%, respectively. 2. The maxillary incisors showed significantly higher success rates than the mandibular incisors. 3. There was no statistically significant difference in success rates among the teeth with different types of teeth and periodontal injury. 4. The status of MTA filling did not influence the clinical and radiographic success.

Presentation and management of keloid scarring following median sternotomy: a case study

IntroductionKeloid scars following median sternotomy are rare and occur more frequently in pigmented skin. Different management strategies have been described with variable success. We present a case of keloid scar formation following cardiac surgery including our management and the final aesthetic result.Case descriptionA 64 year old female of fair complexion underwent mitral valve replacement. The procedure and postoperative recovery were uncomplicated, however, during the following year, thick keloid scars formed over the incision sites. Initial non surgical measures failed to relieve pain and did not offer any tangible aesthetic benefit. Eventually surgical excision was attempted. She presented to our clinic for nine months follow up with significant improvement in pain and aesthetic result.Discussion and EvaluationSeveral theories have attempted to explore the pathophysiology of keloid scar formation. A number of predisposing factors have been documented however none existed in this case. A variety of invasive and non invasive approaches have been described but significant differences in success rates and methodology of investigations still precludes a standardized management protocol.ConclusionsIn this case study a rare presentation of keloid scar has been presented. The variety of methods used to improve pain and aesthetic result demonstrates the propensity of keloid scars to recur and the therapeutic challenges that surgeons have to face in their quest for a satisfactory patient outcome.

P70 Talc slurry pleurodesis: does mixing talc with 50% dextrose rather than normal saline increase success rate?

Introduction Symptomatic malignant pleural effusions can be managed effectively with talc pleurodesis. Various studies document the success rate for talc pleurodesis around 80%. In these studies, talc was mixed with normal saline to make the slurry prior to pleurodesis. We audited the success rate for pleurodesis in our hospital using slurry made by mixing talc with normal saline and slurry made by mixing talc with 50% dextrose to see if changing the ‘solvent’ made any difference to the success of the procedure. The hypothesis that 50% dextrose, being ‘stickier’ than normal saline, will achieve a better success rate was thus tested. Method In group 1, 28 patients underwent pleurodesis using slurry obtained by mixing talc with normal saline. The findings were presented to BTS in 2008. Subsequently we re-audited our practice with group 2, in which 18 patients were pleurodesied using slurry obtained by mixing talc with 50% dextrose. Results Procedure success was defined as absence of fluid reaccmulation requiring intervention at 3 months post pleurodesis. The success rate for the first group was 34% while the success rate for the second group was 76%. The second group underwent more rigorous protocol ensuring drain clamping for 1-h post procedure and use of suction in 100% compared to 80% and 87.5% in the first group. However, subgroup analysis of the first group did not reveal a statistically significant difference in success rate for these variables. Use of NSAID analgesia for 28% patients in group 1 compared to none in group 2 could have influenced the results significantly. Lastly, better patient selection and operator bias might have resulted in better success rate in the second group as recommendations from first audit were implemented in second cycle. Overall best success rate of 76% was inferior to that reported in previous studies due to more liberal patient selection. Conclusions Use of 50% dextrose rather than normal saline to mix talc for talc slurry with strict patient selection and a rigorous pleurodesis protocol as recommended by BTS guidelines can result in better success rate. This is possibly because of the resulting stickier inert slurry. However, research with a randomised control trial is required to assess this question further.

Clinical and Radiographic Success of Pulpotomy with MTA in Primary Molars: 30 Months Follow up.

Pulpotomy of carious primary teeth with an exposed pulp is a common treatment option. Pulpotomy has been conducted with various medicaments over the years. The aim of this study was to evaluate clinical and radiographic success of primary vital pulpotomy with ProRoot and Root MTA. In this randomized clinical trial, children aged between 3-7 years who met the inclusion criteria were enrolled. A total of 70 teeth were deemed suitable under the inclusion criteria and teeth were randomly divided into the 2 groups; ProRoot and Root MTA. Pulpotomy was performed and immediately followed by coronal amalgam restoration. The clinical and radiographic follow ups were conducted 6, 12, 18, 30 months post-operatively. The data were analyzed using Exact Fisher test. At the final follow up, 28 teeth in ProRoot MTA and 26 teeth in Root MTA were evaluated. In the Root MTA group, 1 tooth had exfoliated and one had an abscess and furcal radiolucency radiographically. In ProRoot MTA group, external resorption was observed in 1 tooth. Statistical analysis did not show significant difference in success rate between 2 groups after 30 months. The success rates of Root and ProRoot MTA are similar, indicating that pulpotomy can be carried out successfully in both primary molars.

Use of Laparoscopy in the Management of Pediatric Abdominal Trauma

Anecdotally, laparoscopy has been used for the diagnosis and therapy of pediatric abdominal trauma, but only few studies have been published. We performed a systematic analysis of our experience concerning indications, procedures, and outcomes using laparoscopy in pediatric abdominal trauma patients. Our trauma database was searched for patients who underwent laparoscopy after being admitted for abdominal trauma. Cases were grouped into diagnostic and therapeutic procedures. Success was defined as attaining the correct diagnosis or as the ability to repair the injury by laparoscopy. Of 4,836 pediatric trauma admissions over a period of 12 years, 92 had open or laparoscopic abdominal explorations for blunt (n = 47) and penetrating (n = 35) injuries. In 21 patients, diagnostic laparoscopic procedures were performed, and 5 of these children also underwent a therapeutic laparoscopy. Nineteen patients were treated in the acute setting and two in a delayed fashion. Overall, 19 of 21 laparoscopies correctly diagnosed the injury, and all the 5 laparoscopic therapeutic procedures were successful. There was a significant difference in success rate of diagnostic laparoscopy between acute and delayed cases (p < 0.01). Retrospectively, laparotomy was avoided in 13 of 21 patients overall and in 10 of 10 patients with penetrating trauma (p = 0.02). Laparoscopy is useful in the management of the hemodynamically stable pediatric patient with abdominal trauma but may be less valuable in cases with delayed presentation. Many intraabdominal injuries are amenable to laparoscopic repair. In patients with penetrating trauma, laparoscopy avoided laparotomy is more likely than in those with blunt abdominal trauma. Laparoscopy is currently underutilized in the management of pediatric abdominal trauma.

Tracheo oesophageal puncture voice: an Indian perspective.

Author presents in this study 160 patients who underwent tracheoesophageal puncture (TEP) for voice rehabilitation after laryngectomy. This study represents authors experience in Indian perspective with regards to technique, timing of surgery, i.e., primary or secondary, effect of socioeconomic condition of the patients. Author also narrated complications secondary to the TEP voice and prosthesis, during long follow-up of 15years. The primary and secondary TEP were compared in patients having good socio-economical status with that of relatively poor status patients. As compared to the western literature, this Indian study showed significant differences in success rate of achieving good TEP voice production and also continuing use of TEP voice. Author observed that despite, entirely different socio economic condition and lack of proper follow-up, the secondary TEP done after complete evaluation of the patient yields much better sustained results for successful voice acquisition and continuation of the use of acquired voice. Author has described in details about the surgical procedures for secondary TEP; the prosthesis, care of prosthesis, problems due to TEP and prosthesis and the ways to rectify these problems.

Comparison of Conventional Therapies for Dentin Hypersensitivity Versus Medical Hypnosis

This study compared the efficacy of conventional treatments for dentin hypersensitivity (DHS) and hypnotherapy. During a 1-month period at an urban practice in a service area of approximately 22,000 inhabitants, all patients were examined. A total of 102 individuals were included in the evaluation. Values of 186 teeth were analyzed. The comparison of the different treatment methods (desensitizer, fluoridation, and hypnotherapy) did not show significant differences in success rates. However, a noticeable difference was observed in terms of onset and duration of effect. For both desensitizer and hypnotherapy treatments, onset of effect was very rapid. Compared to the other methods studied, hypnotherapy effects had the longest duration. In conclusion, hypnotherapy was as effective as other methods in the treatment of DHS.

A 10‐year follow‐up after transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia; long‐term results of a randomized controlled trial

To compare long-term results of transurethral resection of the prostate (TURP), contact laser prostatectomy (CLP) and electrovaporization of the prostate (EVAP) in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Between 1996 and 2001, a prospective, randomized controlled trial was conducted in 150 men with LUTS suggestive of BPH, who had a prostate volume of 20-65 mL and a Schäfer's obstruction grade of > or =2. Outcome variables were the International Prostate Symptom Score (IPSS), Quality of Life (QoL) question, Symptom Problem Index (SPI), BPH Impact Index (BII), maximum urinary flow rate (Q(max)), prostate volume, prostate specific antigen (PSA) level, morbidity and mortality. In 2008 we carried out a long-term follow-up in these patients. Long-term values were compared with preoperative values for each treatment group (Wilcoxon signed-rank test), differences among groups were analysed (Kruskal-Wallis test) and actuarial failure-rates of the interventions were determined (Kaplan-Meier analysis). Although we could account for 91% of the initial participants in 2008, 66 (44%) patients (29 TURP, 20 CLP and 17 EVAP) were available for follow-up measurements after a mean (range) of 10.1(6.9-12.7) years Among the three treatment groups, there were no significant differences in IPSS, QoL, SPI, BII, Q(max), PSA level and prostate volume. The IPSS, QoL, SPI and BII were still improved (P < 0.05) from values before treatment for all treatments. Only in the TURP group were the long-term results of Q(max) still improved (P < 0.05). The mortality rate was comparable among the treatments. The 10-year actuarial failure rates (95% confidence interval) were 0.11 (0.03-0.20), 0.22 (0.10-0.35) and 0.23 (0.11-0.35) for TURP, CLP and EVAP, respectively. After a mean follow-up of 10.1 years, there were similar and durable improvements in IPSS, QoL, SPI and BII for patients with LUTS suggestive of BPH after TURP, CLP and EVAP. Between the treatment groups there were no statistically significant differences in Q(max), PSA levels and prostate volume at any time during the follow-up. However, only patients treated with TURP showed minimal durable improvements in Q(max). There was no statistically significant difference in success rate and mortality rate among the three treatments.

Optimal Trajectory for the Atlantooccipital Transarticular Screw

Radiologic evaluation of computed tomography (CT) scans using screw insertion simulation software. To investigate the optimal entry point and trajectory of atlantooccipital transarticular screws. To our knowledge, no large series focusing on the placement of atlantooccipital transarticular screws have been published. We used 1.0-mm sliced CT scans and 3-dimensional screw trajectory software to simulate 4.0-mm screw placement. Four entry points were evaluated. Screw placement success rate, safe range of medial angulation, and screw length using each entry point were determined. CT scans of 126 patients were evaluated, for a total of 252 screws for each entry point. On simulation, the 2 lateral entry points showed significantly higher success rates and safe range of medial angulation than the 2 middle points. The 2 lateral entry points had similar success rates (98.0% for anteriolateral (AL) point and 97.6% for posteriolateral (PL) point). Although the safe range of medial angulation was significantly wider for the AL point (26.1 degrees) than for the PL point (23.7 degrees), the screw lengths were significantly longer for the PL point (32.6 mm) than for the AL point (29.4 mm). For both points, 30 degrees of medial angulation led to highest rate of successful screw placement, but the rate was only 79.4% and 80.2%, respectively. Although there was no significant difference in success rates between AL and PL points, PL is likely the best entry point. Although 30 degrees medial and approximately 5 degrees upward angulation led to the highest rate of successful screw placement, the rate was only around 80%. Given the wide individual variation, we recommend that a preoperative 3-dimensional CT scan be obtained when attempting atlantooccipital transarticular screw fixation.

Removal of metallic stents using flexible bronchoscope: report of 29 cases

Objective Placement of self expanding metallic stents (SEMS) is invariably associated with complications and often necessitates their removal usually by rigid bronchoscope. There have been few reports published on use of flexible bronchoscope (FB) for the removal. This article summarizes the indications, methods and complications of SEMS removal by FB. Methods We reviewed our experience with removal of SEMS using FB retrospectively. The clinical data on 29 patients with average age of (39.0±13.2) years was analyzed who underwent removal of SEMS using FB between April 2002 and August 2008. Results Thirty-seven procedures were performed in 29 consecutive patients to remove 37 stents. The average duration of stent placement was (55± 94.7) d (0–472 d). Twenty-two procedures (59.4%) were performed under local anesthesia. The percentage of procedures under general anesthesia was 13% (3/24), 67% (4/6) and 100% (7/7) for the short-term (≤30 d), medium-term (31–90 d) and long-term (>90 d) of stents placement, respectively. Indications for stents removal included migration in 15 (40.6%), scar restenosis in 11 (29.7%), airway shaping in 5 (13.5%), stent fracture in 2 (5.4%), stent incomplete expansion in 2 (5.4%), improper size in 1 (2.7%), mucus plugging with chest pain in 1 (2.7%). And 85.7% of long-term stents were removed due to scar restenosis. The total success rate was 92%. There was no significant difference in success rate between the uncovered and covered group (82.3% and 100%, P>0.05). Complications were encountered in 13 patients, bleeding being the most common (53.8%). Conclusion Operation by FB may be an alternative method to remove SEMS effectively and safely based on the proper anesthesia chosen.