Standard Conservative Treatment Research Articles

Analysis of advanced non-small cell lung cancer course during high dose antiestrogen therapy use in complex chemoradiotherapy treatment of patients

Aim. To analyze the advanced non-small cell lung cancer course during high dose antiestrogen therapy use in complex chemoradiotherapy treatment of patients.Methods and results. With the help of immunohistochemcial method the low expression of estrogen α and progesteron (1.7%) receptors but rather high expression of estrogen β receptors (50.8%) were established. Separation of patients into the groups with the presence or absence of estrogen β receptors allowed to show in clinical terms different mechanisms of action and the possibility of antiestrogen therapy use in the treatment of advanced non-small cell lung cancer.Conclusion. Effectiveness of treatment and overall survival were shown to be statistically better in patients who received high doses of tamoxifen in addition to standard treatment regimens (one-year and median survival – 48.9% and 12 months, respectively) than in patients who received only standard conservative anticancer treatment (one-year and median survival – 28.2% and 9 months, respectively), which was caused by the antiestrogenic effect of tamoxifen and its non-hormonal mechanisms of antitumor action.

Local intramuscular transplantation of autologous mononuclear cells for critical lower limb ischaemia.

Peripheral arterial disease is a major health problem, and in about 1% to 2% of patients the disease progresses to critical limb ischaemia (CLI). In a substantial number of patients with CLI, no effective treatment option other than amputation is available and around a quarter of these patients will require a major amputation during the following year. This is an update of the review first published in 2011. To determine the effectiveness and safety of local intramuscular transplantation of autologous adult bone marrow mononuclear cells (BMMNCs) as a treatment for critical limb ischaemia (CLI). For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched February 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 1). We included all randomised controlled trials of CLI in which participants were randomly allocated to intramuscular administration of autologous adult BMMNCs or control (either no intervention or conventional conservative therapy). We excluded studies on patients with intermittent claudication. Two authors independently selected trials, assessed trials for eligibility and methodological quality, and extracted data. Disagreements were resolved by consensus or by the third author. Only two small studies, with a combined total of 57 participants, met our inclusion criteria and were finally included. They were classified as having a moderate risk of bias with unclear issues regarding their methods, and according to the GRADE approach, the overall quality of the evidence would be considered as moderate. In one study the effects of intramuscular injections of BMMNCs in the ischaemic lower limbs of patients with CLI were compared with control (standard conservative treatment). No deaths were reported and no significant difference was observed between the two groups for either pain (P = 0.37) or the ankle brachial index (ABI) parameter. However, the treatment group showed a significantly smaller proportion of participants undergoing amputation compared with the control group (P = 0.026).In the other study, following subcutaneous injections of granulocyte colony-stimulating factor (G-CSF) for five days, peripheral blood derived mononuclear cells were collected and then transplanted by intramuscular injections into ischaemic lower limbs. The effects were compared with daily intravenous prostaglandin E1 injections (control group). No deaths were reported. Pain reduction was greater in the treatment group than in the control group (P < 0.001) as was increase in ABI (mean increase 0.13 versus 0.02, P < 0.01). The treatment group experienced a statistically significant increase in pain-free walking distance (PFWD) compared with the control group (mean increase 306.4 m versus 78.6 m, P = 0.007). A smaller proportion of participants underwent amputation in the treatment group compared with the control group (0% versus 36%, P = 0.007). The data from the published trials suggest that there is insufficient evidence to support this treatment. These results were based on only two trials which had a very small number of participants. Therefore evidence from larger randomised controlled trials is needed in order to provide adequate statistical power to assess the role of intramuscular mononuclear cell implantation in patients with CLI.

Efficacies of Acupuncture and Anti-inflammatory Treatment for Carpal Tunnel Syndrome

This study compared the efficacies of acupuncture and anti-inflammatory treatment in patients with carpal tunnel syndrome (CTS). Fifty patients with mild to moderate CTS were randomly divided into two groups. Both groups received night wrist splints as the standard conservative treatment for 1 month. The acupuncture group also received eight sessions of acupuncture therapy (twice a week for 4 weeks). The control group received 400 mg of ibuprofen three times a day for 10 days. The visual analog scale (VAS) score, the score on the Boston Carpal Tunnel Questionnaire for Functional Status and Symptom Severity (BCTQ FUNCT and SYMPT), and the electrodiagnostic findings were evaluated at baseline and 1 month after treatment. At the final follow up, significant improvements were found in both groups (p < 0.05). Statistically significant improvements were observed in the VAS score, the score on the global BCTQ FUNCT and SYMPT, and the electrodiagnostic findings, but not in the distal motor latency (DML), in the acupuncture group (p < 0.05). Our findings indicate that acupuncture affected the score on the global BCTQ FUNCT and SYMPT, the VAS score, and the electrodiagnostic findings, except the DML, more than ibuprofen did and that acupuncture might be an effective treatment for CTS.

The role of preventive uterine artery occlusion during laparoscopic myomectomy: a review of the literature.

Surgical myomectomy is currently regarded as the standard conservative treatment for patients who wish to preserve their fertility. However, it presents two main problems: the intra- and postoperative risk of bleeding and the risk of recurrence of leiomyomas. Preventive occlusion of uterine arteries was described during laparoscopic myomectomy as one of the procedures addressing these issues. We conducted a literature review to define the role of preventive uterine artery occlusion during laparoscopic myomectomy. Nine non-randomized case-control studies and two randomized controlled trials were identified. The permanent and bilateral uterine artery occlusion technique is the most studied in the literature. The main purpose of facilitating the operative procedure by reducing blood loss has not been clearly demonstrated in randomized trials. Observational comparative studies found an improvement in the effectiveness of treatment, both on clinical symptoms and on the recurrence of leiomyomas. Finally, there are few data examining the effect of uterine artery occlusion on later fertility in female patients of childbearing age, which limits its current use. The preventive occlusion of uterine arteries is a safe surgical technique that can be performed during laparoscopic myomectomy. Further randomized studies are needed to better define the role of uterine artery occlusion in the surgical strategy, especially for women who want to preserve their fertility.

Effect of therapeutic insoles on the medial longitudinal arch in patients with flatfoot deformity: A three-dimensional loading computed tomography study

BackgroundInsoles are frequently used in orthotic therapy as the standard conservative treatment for symptomatic flatfoot deformity to rebuild the arch and stabilize the foot. However, the effectiveness of therapeutic insoles remains unclear. In this study, we assessed the effectiveness of therapeutic insoles for flatfoot deformity using subject-based three-dimensional (3D) computed tomography (CT) models by evaluating the load responses of the bones in the medial longitudinal arch in vivo in 3D. MethodsWe studied eight individuals (16feet) with mild flatfoot deformity. CT scans were performed on both feet under non-loaded and full-body-loaded conditions, first with accessory insoles and then with therapeutic insoles under the same conditions. Three-dimensional CT models were constructed for the tibia and the tarsal and metatarsal bones of the medial longitudinal arch (i.e., first metatarsal bone, cuneiforms, navicular, talus, and calcaneus). The rotational angles between the tarsal bones were calculated under loading with accessory insoles or therapeutic insoles and compared. FindingsCompared with the accessory insoles, the therapeutic insoles significantly suppressed the eversion of the talocalcaneal joint. InterpretationThis is the first study to precisely verify the usefulness of therapeutic insoles (arch support and inner wedges) in vivo.

Artrodesis cervical anterior con empleo de autoinjerto de cuerpo vertebral

ObjectiveTo assess fusion rates and functional outcomes in patients undergoing anterior cervical discectomy and fusion by using a vertebral body autograft for interbody filling and anterior cervical plate fixation. Material and methodsThe study included a total of 102 patients, 54 men and 48 women, who underwent surgery between 2006 and 2010 patients with degenerative disease, cervical disc herniation and radiculopathy, and who had failed standard conservative treatment (3 months). The study was limited to patients with fusion levels 1-3. The mean patient follow-up was 44 (24-96) months. Their mean age was 48.8 years. ResultsThe clinical variables analyzed were: duration of symptoms (> 12 months), smoking (31% smokers), employment status (76% active), average days of hospitalization (2.2 days), operation time (62minutes), etiology (100%, degenerative disease), notable comorbidities (28%), fusion levels (42% 1, 49% 2, 9% 3), symptoms (radiculalgia or axial pain). The functional variables analyzed (score pre-and post-operative scores) were: VAS (8.6-1.32), Neck Disability Index (37.7-5.8), and Odom criteria (76% reflected excellent results after surgery). Finally, radiological variables were also analyzed: anterior reactive osteophytosis (16%), significant collapse (0%), and fusion rate (98%). There were 4 cases of acute postoperative complications, and 4 chronic, none of them were related to the surgical technique. DiscussionThe use of autograft bone of the vertebral body itself reduces comorbidities associated with the use of the iliac crest of the patient. Our results using the technique described are comparable to those in the literature, with a fusion rate of 98% and a mean of 62minutes duration of the procedure.

Determination of activity of endotoxin gram-negative microorganisms in the diagnostics of sepsis in cancer patients.

e14017 Background: The purpose of the study was to analyze the role of EAA -test in the diagnostics and and evaluation of the effectiveness of intensive treatment of septic complications in cancer patients. Methods: We examined 45 cancer patients with postoperative period affected by the development of septic process. Clinical and laboratory signs of sepsis were identified in all cases. The severity of the condition measured on the APACHE-II scale was over 16, SAPS II - 20, SOFA - 7, MODS - 6 points. The level of activity of endotoxin in EAA -test was from 0,46 up to 1.37. On the 3-5th day from the start of standard conservative intensive treatment (detoxification, infusion-transfusion, antibacterial, syndromic therapy) EAA-test index of 19 pts decreased to 0.30-0,41 which correlated with positive dynamics of clinical and laboratory picture of generalized inflammation process. Progression of the clinical and laboratory signs of multiorgan failure was observed in 33 pts, EAA-test indices remained high from...

Effect of Botox injection at the bladder neck in boys with bladder dysfunction after valve ablation

ObjectiveAfter posterior urethral valve ablation, some boys are still have a hostile bladder. We conducted a prospective randomized study to determine if Botox injection at the bladder neck will help improve vesical dysfunction in this subgroup of boys or not. Patients and methodsTwenty boys with history of posterior urethral valve ablation and severe bladder dysfunction with a mean age of 16 months were studied. Cases were further randomized into two groups. Group I (study group) had endoscopic injection of a single dose of 100 IU of Botox into the hypertrophied bladder neck at 3, 6, and 9 o’clock. Group II (control group) patients with the same parameters had urethroscopy to exclude residual valves. Both groups had the standard conservative treatment. Cases were followed after 6 months of initiating the management protocol. This includes laboratory studies (urine culture and sensitivity, blood urea nitrogen, serum creatinine), ultrasound of the urinary tract. Voiding cysto-urethrogram and urodynamic study (pressure flow study). ResultsThere was no statistical difference in both groups regarding rate of urinary tract infection, improvement of hydronephrosis, resolution of vesico-ureteral reflux, creatinine level at the start or at the end of the study. Urodynamic parameters revealed an increase in cystometric capacity in both groups at the end of the study but without statistical difference. The mean voiding pressure reduced significantly in both groups but without statistical difference. ConclusionsTemporarily abolishing the effect of bladder neck by Botox injection does not seem to improve the outcome of those boys who had a severe voiding dysfunction after valve ablation.

Perineal retraining improves conservative treatment for faecal incontinence: A multicentre randomized study

Anal incontinence is a frequent complaint that profoundly affects quality of life. Our aim was to determine whether perineal retraining gives additional benefits to standard medical treatment. Patients with anal incontinence and a Wexner score >4 were randomly assigned to standard conservative treatment (control) or perineal retraining, including biofeedback, in addition to standard treatments (biofeedback). Diaries, self-administered questionnaires and satisfaction scores quantified the benefits. Self-evaluated improvement was the primary outcome measure. A score ≥3 (in an improvement scale from -5 to +5) defined success. Overall, 157 patients were included; 80 in the control group (75% females, mean age 60.1 ± 13.2 years) and 77 in the biofeedback group (79% females, mean age 61.9 ± 10.2 years). After a 4-month follow-up, the success rate was significantly higher in the biofeedback group (57% versus 37%; p<0.021). In the biofeedback group, daily stool frequency, leakage, and faecal urgency significantly decreased, and daily non-urgent perception of stool increased. Conversely, symptomatic scores and quality of life scales did not significantly differ between groups. In a multivariate model, the adjusted odds ratio showed that perineal retraining was significantly associated with a higher chance of self-rated improvement (adjusted Odd Ratio [95%CI]: 2.34 [1.14-4.80]; p=0.021). Perineal retraining offers a moderate but significant benefit for patients suffering from anal incontinence.

Costs of conservative treatment of patients with cholangitis and cholesystitis

Introduction. There are no guidelines for treating bacterial infections in our country. Antibacterial drugs are selected empirically, which is not always in accordance with the recommended therapy coming from the countries that have their own pharmacotherapy protocols. This study reviews the differences between the standard conservative treatment of cholangitis/cholecystitis and treatment implemented in accordance with current pharmacotherapy guidelines of other countries. The assessment of the therapeutic efficacy of antibacterial drugs implemented in the treatment of cholangitis/cholecystitis and economic viability of that implementation was one of the aims of this study, and another one was comparison of the efficiency and cost of medical treatment using physician?s therapy of choice and treatment according to pharmacotherapy guidelines. Material and Methods. The study was carried out over a threeyear period at the Department of Infectious Diseases of the Clinical Center of Vojvodina. It included 72 patients with the diagnosis of cholangitis/cholecystitis who were divided into two groups. The control group was treated according to the physician?s therapy of choice, while the test group was treated in accordance with pharmacotherapy guidelines. The efficiency and cost of medical treatment were determined for both groups. Results. The comparison of the efficiency and costs of medical treatment of cholangitis/cholecystitis before and after introducing pharmacotherapy guidelines showed no significant differences in the efficiency of administered therapies. However, the cost of medical treatment carried out in accordance with pharmacotherapy guidelines showed a decrease of 17.24%. Conclusion. Medical treatment using physician?s antibacterial therapy of choice and the one which is in accordance with pharmacotherapy guidelines for treating cholangitis/cholecystitis show no differences in terms of efficiency. However, medical treatment proved to be more affordable in the group of patients treated in accordance with pharmacotherapy guidelines of other countries.

Quantifying the Degree Graduated Elastic Compression Stockings Enhance Venous Emptying

Graduated elastic compression (GEC) stockings reduce reflux and venous volume but their performance on augmenting venous return is unproven. The aim of this study was to quantify the ability of stockings to increase venous outflow from the leg. A prospective study comparing venous emptying without compression, versus class 1 (18-21 mmHg) and class 2 (23-32 mmHg) compression, using air-plethysmography (APG). The right legs of 20 healthy subjects were studied supine. A 12-cm thigh-cuff was inflated in 10 mmHg steps from 0 to 80 mmHg while the corresponding increase in calf volume was recorded using the APG sensor calf-cuff. At the 80 mmHg plateau, the thigh-cuff was released suddenly to measure the unrestricted venous emptying. Venous return was assessed by: (a) identifying the incremental thigh-cuff pressure causing the maximal incremental increase in calf volume (IPMIV); (b) measuring the percentage reduction in calf volume in 1 second following thigh-cuff release - outflow fraction (OF); (c) time to empty 90% of the venous volume - venous emptying time (VET90). Median and inter-quartile range (IQR) baseline values of IPMIV, OF, and VET90 without compression were 20 mmHg (range: 20-30 mmHg), 44% (39-50%) and 13 seconds (8.8-15.9 seconds), respectively. These improved significantly with all stockings. The application of any stocking raised the median IPMIV by 30 mmHg. The change from a class 2 stocking compared with no stocking versus the change from a class 1 stocking to no stocking had a more pronounced effect (p < .005). After sudden thigh-cuff deflation, the venous emptying was 41-45% greater and 9-10 seconds faster with all stockings (p < .005). This is the first study to quantify the venous return of below-knee GEC stockings. Assessments of stockings in augmenting venous return may be of use as a way of optimising compression for individual patients unresponsive to standard conservative treatment.

Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia

Patients suffering from inoperable chronic critical leg ischaemia (NR-CCLI) face amputation of the leg. Spinal cord stimulation (SCS) has been proposed as a helpful treatment in addition to standard conservative treatment. To find evidence for an improvement on limb salvage, pain relief, and the clinical situation using SCS compared to conservative treatment alone. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched January 2013) and CENTRAL (2012, Issue 12). Controlled studies comparing the addition of SCS with any form of conservative treatment to conservative treatment alone in patients with NR-CCLI. Both authors independently assessed the quality of the studies and extracted data. Six studies comprising nearly 450 patients were included. In general the quality of the studies was good. No study was blinded due to the type of intervention.Limb salvage after 12 months was significantly higher in the SCS group (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.56 to 0.90; risk difference (RD) -0.11, 95% CI -0.20 to -0.02). Significant pain relief occurred in both treatment groups, but was more prominent in the SCS group where the patients required significantly less analgesics. In the SCS group, significantly more patients reached Fontaine stage II than in the conservative group (RR 4.9, 95% CI 2.0 to 11.9; RD 0.33, 95% CI 0.19 to 0.47). Overall, no significantly different effect on ulcer healing was observed with the two treatments.Complications of SCS treatment consisted of implantation problems (9%, 95% CI 4 to 15%) and changes in stimulation requiring re-intervention (15%, 95% CI 10 to 20%). Infections of the lead or pulse generator pocket occurred less frequently (3%, 95% CI 0 to 6%). Overall risk of complications with additional SCS treatment was 17% (95% CI 12 to 22%), indicating a number needed to harm of 6 (95% CI 5 to 8).Average overall costs (one study) at two years were EUR 36,500 (SCS group) and EUR 28,600 (conservative group). The difference (EUR 7900) was significant (P < 0.009). There is evidence to favour SCS over standard conservative treatment alone to improve limb salvage and clinical situations in patients with NR-CCLI. The benefits of SCS must be considered against the possible harm of relatively mild complications and the costs.

Efficacy of Gastrografin® Compared with Standard Conservative Treatment in Management of Adhesive Small Bowel Obstruction at Mulago National Referral Hospital.

The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin®) with standard conservative management, both non-operative methods, in the management of this condition was conducted in a tertiary Sub Saharan hospital. An open randomised controlled clinical trial was conducted between September 2012 and March 2013 at Mulago National Referral and Teaching Hospital, Uganda. Fifty patients of both genders, with adhesive small bowel obstruction, in the hospital's emergency and general surgical wards were included. Randomisation was to Gastrografin® and standard conservative treatment groups. The primary outcomes were: the time interval between admission and relief of obstruction, the length of hospital stay, and the rates of operative surgery. All 50 recruited patients were followed up and analysed; 25 for each group. In the Gastrografin® group, 22 (88%) patients had relief of obstruction following the intervention, with 3 (12%) requiring surgery. The conservative treatment group had 16 (64%) patients relieved of obstruction conservatively, and 9 (36%) required surgery. The difference in operative rates between the two groups was not statistically significance (P = 0.67). Average time to relief of obstruction was shorter in the Gastrografin® group (72.52 hrs) compared to the conservative treatment group (117.75 hrs), a significant difference (P = 0.023). The average length of hospital stay was shorter in the Gastrografin® group (5.62 days) compared to the conservative treatment group (10.88 days), a significant difference (P = 0.04). The use of Gastrografin® in patients with adhesive small bowel obstruction helps in earlier resolution of obstruction and reduces the length of hospital stay compared with standard conservative management. Its role in reducing the rate of laparotomies remains inconclusive.

Granulocyte-stimulating Colony Factor Neuroprotection for Thoracic Myelopathy

Granulocyte-stimulating colony factor (G-CSF), commercially available as Neupogen or Neulasta, has long been used for the treatment of neutropenia in cancer patients. Several clinical studies have examined the utility of G-CSF in amyotrophic lateral sclerosis and ischemic stroke, with ambiguous, but generally negative results. Interestingly, its application in rodent spinal cord injury models has shown some promise with demonstrable migration of bone marrow—derived cells into the damaged spinal cord, glial differentiation of bone marrow—derived cells as well as anti-inflammatory and pro-angiogenic effects; all contributing to neuroprotection and improved functional recovery.1,2 Based on the provocative notion that G-CSF can mobilize endogenous hematopoetic stem cells with experimental benefit in spinal cord injury, Sakuma and colleagues have performed a small open-label, controlled trial (phase I/II) examining its clinical potential in thoracic myleopathy.3 A total of 24 adult patients with worsening thoracic myleopathy were enrolled, 10 in the experimental arm and 24 in the control arm. All patients were surgical candidates for decompression of thoracic spondylosis, but did not receive surgery for about 1 month while the study was being conducted. Once enrolled, 5 days of intravenous G-CSF (10 micrograms per kilogram) was given to the experimental arm. The control group did not receive G-CSF but instead received standard conservative treatment, which was described as bedrest. Primary outcome measure was the Japanese Orthopedic Association Score (JOA) score after 1 month. The point estimates for recovery rate, 29.1%, in comparison to only 1.1% in the control group, yielded ostensibly striking results. Similarly, muscle power scores and pain sensation scores were significantly improved in the G-CSF group compared to controls. Limitations of this study include a small sample size and the open-label, non-randomized trial design. As with other early phase investigations of novel therapies, we should look for further trials and hold investigators to high standards of description and trial registration, which were not available in this study. Though the initial results of this Phase I/II trial are tantalizing, even more interesting is the fact that the experimental treatment is already an FDA approved medication with a clinical safety record that is well established. No complications from G-CSF were reported in the 10 patients in this study. Because G-CSF is commercially available, neurosurgeons should resist the pressures to use it in an off-label manner given the current evidence. However, the solid preclinical scientific basis for neuroprotection after G-CSF administration should continue to be explored in the clinical arena.Figure: Crystal structure for granulocyte-stimulating colony factor.

Sex differences in perihemorrhagic edema evolution after spontaneous intracerebral hemorrhage

Clinical data on sex differences in perihemorrhagic edema (PHE) after intracerebral hemorrhage (ICH) are lacking. Patients with spontaneous supratentorial ICH who had received standard conservative treatment were identified retrospectively. PHE development was assessed over a 14-day period on follow-up CT scans (days 1, 2-4, 5-7, 8-11, and 12-14). ICH and PHE volumes were assessed semiautomatically and compared between men and women. A total of 387 patients (233 men) were included. Starting at days 2-4, women showed lower PHE values (P < 0.05; days 2-4, 8-11) or a trend toward significance (P ≤ 0.1; days 5-7, 12-14). Female sex may predict lower PHE volumes.

Successful treatment of localised radiation lesions in rats and humans by mesenchymal stem cell transplantation

Transplantation of mesenchymal stem cells (MSCs), at early and later stages after local exposure of rats to 140 Gy 90Sr/90Y beta radiation, was found to stimulate recovery of damaged skin. The area of local radiation injuries (LRIs) and accelerated healing of radiation ulcers was obtained. Clinical evolution showed the high efficiency of the transplantations of autologous MSCs for the treatment of deep beam ulcers, usually refractive to standard conservative treatment. Analogous to our results in the rats the authors obtained promising results with the application of MSCs for the treatment of severe LRIs in two human patients. Their radiation ulcers showed complete healing after stem cell application. Thus, further developments should determine the best possible conditions for MSC use in LRI treatment.

Short-Term Efficacy of Semicircular Canal Occlusion in the Treatment of Intractable Ménière's Disease

Objective To investigate the short-term efficacy and safety of triple semicircular canal occlusion （TSCO） in the treatment of intractable Meniere's disease （MD）, so as to provide an alternative surgical procedure for treating MD. Methods Seventeen patients, who had received standardized conservative treatment for at least one year with poor effect, underwent TSCO were retrospectively analyzed. Vertigo control and auditory function were evaluated. Pure tone audiometry, caloric test, and vestibular evoked myogenic potential （VEMP） were performed for evaluation of audiological and vestibular function. Postoperative follow-up period was 6-13 months, with an average of ten months. Results According to the preoperative staging of hearing, among the 17 patients, there were 2 cases in stage Ⅱ （with an average hearing threshold of 25-40 dBHL） and 15 in stage Ⅲ （41-70 dBHL）. No vertigo was found during the follow-up period, with 100% control rate of vertigo. During the same period, we had performed endolymphatic sac decompression operation in 25 MD patients. The control rate of vertigo was 72.0%. The vertigo control rate of TSCO was significantly higher than that of endolymphatic sac decompression operation （X2 = 3.87, P < 0.05）. Three months after surgery, 12 patients showed no significant change in comparison to primary status, 5 patients presented with an mild increase in the average hearing threshold of less than 20 dBHL, with 29.4% of hearing loss rate. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3 days, while, balance disorders were disappeared in 10 patients within 1-2 weeks after surgery, and in another 7 patients within 2 months, with an average recovery time of 12.6 days. Three months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in VEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Conclusions TSCO, which can reduce vertiginous symptoms in patients with intractable MD, represents an effective and safe therapy for this disorder. TSCO is expected to be used as an alternative procedure for the treatment of MD in selected patients suffering from moderate to severe hearing loss. Key words: Meniere's disease; Semicircular canals; Otologic surgical procedures; Treatment outcome

Evidenzbasierte Indikationsstellung bei Patellaluxation

Patellar dislocation is a common knee injury with mainly lateral dislocations, leading to ruptures of the medial patellofemoral ligament in most of the cases. Reliable data and prognostic factors for stability of the patellofemoral joint and satisfaction of the patient after either conservative or operative treatment have not been established yet. Until now, there are no randomized controlled trials for recurrent patellar dislocation at all. As a synopsis of the randomized controlled trials about first-time patellar dislocation, no significant difference between operative and conservative management is evident. This applies to both children and adolescents as well as to adults. There is a clear tendency towards first-line conservative therapy after traumatic patellar dislocation. Operative treatment is only required in case of accompanying injuries like osteochondral fractures or in case of recurrent dislocations. Further prospective randomized controlled trials with standardized operative and conservative treatment and patient cohorts of sufficient size are necessary in the future.

Radiofrequency upper thoracic sympathectomy in the treatment of critical upper limb ischemia - a case series

Patients with significant medical and social problems resulting from impaired perfusion of the upper limbs caused by micro- or macro-angiopathy are now frequent in clinical practice. Vasospastic disease of the upper limbs of combined origin is a difficult condition to treat by conservative methods and therapeutic strategies are usually multidisciplinary. In addition to standard pharmacotherapy, treatment may involve regional anaesthesia, thoracoscopic or radiofrequency sympathectomy and surgical treatment of defects, including plastic surgery. This paper describes our successful work in the treatment of upper limb critical ischemia using radiofrequency upper thoracic sympathectomy. In three case reports we present the results of radiofrequency thermolysis applied to treat patients with chronic defects of the hand and fingers. These patients were diagnosed with upper limb critical ischemia of combined origin, standard conservative treatment methods failed and surgical intervention was originally not indicated, however, radiofrequency thermolysis proved to be beneficial. Radiofrequency thoracic sympathectomy could improve peripheral perfusion of the upper limbs and thereby contribute to healing of chronic defects, reduction of pain and improvement in the quality of life of the patients.

Are venotonic drugs effective for decreasing acute posttraumatic oedema following ankle sprain? A prospective randomized clinical trial

Lower leg oedema after trauma may cause various degrees of pain, disability and delay in patient recovery. In this prospective randomized study, we hypothesized that venotonic drugs had no effect in clinical outcome of patients with ankle sprain. Eighty-one patients with type II and III ankle sprain were screened and randomly assigned for receiving standard conservative treatment alone (control group, 39 patients) or with oral intake of a venotonic drug (micronized purified flavonoid fraction, Daflon 1,000mg×3) for 20days (study group, 42 patients). Measurement of the circumference of ankle region in two different locations and assessment of pain intensity with the Visual Analogue Score were performed at the time of patients' admission and during the 7th and 20th posttraumatic day. Patients demographics were comparable in both groups. There were no significant differences between the two groups regarding the values of perimeter of ankle joint or pain intensity at all the examined time points. Venotonic drugs seem not to decrease the posttraumatic oedema or pain in patients who suffer from moderate or severe ankle sprain.