Total Relief Of Symptoms Research Articles

Surgical intervention for carpal tunnel syndrome in individuals with spinal cord injuries-patient characteristics, diagnostic considerations, and treatment outcomes.

A retrospective chart audit. To characterize SCI patients with carpal tunnel syndrome (CTS) and evaluate the diagnostic rationale for surgical decision-making. Swiss Paraplegic Centre, Nottwil, Switzerland. Retrospective investigation of medical history, diagnostics, surgeries, and outcomes of surgical treatments of CTS in patients with para- and tetraplegia. We identified a total of 77 surgeries for CTS in 55 patients: 16 females (25 surgeries) and 39 males (52 surgeries) with spinal cord injury. The majority (47 persons, 68 surgeries) were paraplegic (level of lesion Th2 and below); 8 persons (9 surgeries) were tetraplegic (level of lesion Th1 and above). ASIA scores in the tetraplegic group were A: 0, B: 1, C: 4, D: 3 while complete lesions predominated in the paraplegic group (A: 32, B: 4, C: 5, D: 6). Sixty-six out of 77 patients reported total relief of symptoms. Neither nerve conduction velocity nor motor amplitude correlated well with the severity of CTS. Co-morbidity and specific risk factors were rare. SCI patients with CTS respond well to surgical decompression of median nerve regardless of level and type of spinal cord lesion and risk factors. Nerve conduction parameters and clinical findings can provide additional diagnostic support of CTS although nocturnal hand paresthesia, wrist pain at and after loading as well as failed conservative treatment are the main indications for surgical interventions. Based on symptomatology, clinical findings, and nerve conduction studies, we propose a decision-making tree for suggesting surgery or not.

Microvascular Decompression for Hemifacial Spasm Associated with Vertebral Artery: Biomedical Glue−Coated Teflon Sling Transposition Technique

Microvascular decompression is the most effective treatment for hemifacial spasm. However, when encountering hemifacial spasm associated with vertebral artery (VA), the procedure is more challenging and requires complicated operation techniques. The authors retrospectively analyzed the clinical characteristics of this group of cases and investigated reasonable transposition procedures for different anatomic classifications. We retrospectively analyzed 117 cases that underwent their first microvascular decompression for hemifacial spasm between June 2010 and December 2016, which had all associated with vertebral artery compression diagnosed by preoperational radiology examination. The study first classified offending vessels into 3 types according to operative anatomy and designed personalized decompression management according to different forms of neurovascular conflict. Curative effects and complications were assessed. The offending vessels were artificially divided into 3 types according to both arterial pattern and compression direction: 1) ipsilateral VA plus anterior inferior cerebellar artery compressing the facial nerve from the ventrolateral direction in 72 (61.5%) cases; 2) ipsilateral VA plus posterior inferior cerebellar artery compressing the facial nerve from the caudal-medial direction in 31 (26.5%) cases; 3) bilateral VA compressing the facial nerve in 14 (12.0%) cases. We selected corridors to expose the neurovascular conflict site between the suprafloccular-transhorizontal fissure approach and subtonsillar-transcerebellomedullary fissure approach. The methods of decompression consist of anteromedial and posterolateral transposition by using biomedical glue-coated Teflon sling. Sufficient decompression of the offending vessels was safely performed in all cases. All cases had total relief of symptoms immediately after their operations. Follow-up periods ranged from 16-90 months, and total recovery occurred in 110 cases (94.0%). In 7 cases (6.0%), 90% recovery occurred. Accuracy and comprehensive recognition of anatomic features of the offending vessels are crucial for the management of hemifacial spasm associated with vertebral artery compression. Appropriate approaches combined with the biomedical glue-coated Teflon sling transposition technique can allow adequate mobilization of the vertebral artery and bring complete postoperative symptom relief for most cases.

The Laparoscopic Management of the Ureteropelvic Junction Obstruction: Our Initial Experience

Objective: Higher morbidity rates, extensive scar tissue formation and longer hospitalization periods of the standard open surgical methods for ureteropelvic obstruction has led to acceleration of minimal invasive techniques. Success rate and clinical outcomes of laparoscopic pyeloplasty has become comparable with open surgery. Purpose: The aim was to evaluate the clinical results and complications of transperitoneal laparoscopic pyeloplasty in ureteropelvic obstruction. Material and Methods: Thirty-three patients with ureteropelvic obstruction were enrolled into this study. Eighteen patients underwent Anderson-Hynes dismembered Pyeloplasty and 15 underwent Y-V plasty. Patients were followed-up at postoperative 3., 6. months and then yearly. Partial or total relief of symptoms and improvement in diuretic renogram were accepted as success. Results: Median age was 34.5±15.5(13-74) years, number of males were 13 (39.4%) and females were 20 (60.6%). Median Body Mass Index (BMI) was 25.3±15.4(18.5-33.4). Eight were asymptomatic, and 23 had intermittent pain, preoperatively. Fourteen cases had left ureteropelvic obstruction (42.4%) and 19 had in the right kidney . Intraoperatively 19 cases had aberrant vessel. Mean surgery time was 127.9±38.9 (68-245) minutes, median anastomosis time was 20.8±7.3 (8-39) minutes. Median blood loss was 57.1±28.3 (20-150) mL, median postoperative drainage time was 2.6±1.1 (2-7) days. Only one had prolonged ileus and peritoneal irritation findings. Median narcotic and nonnarcotic requirements were 21.5±4.8 (15-30) and 132.6±37.2 (75-200) mg/day, respectively. Median follow-up period was 35.1±13.6 (11-59) months. Conclusions: Laparoscopic pyeloplasty, is minimally invasive and reliable technique replaces open pyeloplasty in many institutions. Shorter hospitalization, lower postoperative morbidity rates, better cosmetic results and higher success rates can be easily achieved..

Gastric mucosa-associated lymphoid tissue lymphoma associated with pancreatic non-Hodgkin′s lymphoma: A case report

Mucosa-associated lymphoid tissue (MALT) lymphomas are extranodal lymphomas that arise from B lymphocytes located in the marginal zone of lymphoid follicles. Although, there is a substantial amount of lymphoid tissue in the gastrointestinal tract, MALT lymphomas usually arise in chronically inflamed sites that are normally devoid of lymphoid tissue. The best example is gastric MALT lymphoma that is almost always associated with Helicobacter pylori. Primary pancreatic lymphoma (PPL) is an extremely rare tumor (1% incidence) and is often confused with pancreatic adenocarcinoma. By suspecting PPL on clinical and imaging grounds, surgery and its associated complications can be avoided, since the mainstay of the treatment is non-surgical strategies including chemotherapy. We represent a case of a 45-year-old male presented with abdominal pain and vomiting. Upper endoscopy showed multiple gastric ulcers, biopsies revealed non-specific inflammatory ulcers. The patient was given 4-weeks course of proton pump inhibitor with no improvement. After few months, he complained of severe abdominal pain relieved by leaning forward and associated with repeated vomiting. Upper endoscopy revealed multiple umbilicated gastric masses, 10-20 mm in diameter. Biopsies were taken, histopathology and immunohistochemistry revealed MALT lymphoma. Endoscopic ultrasonography was done to the patient and it showed a pancreatic head mass, fine-needle aspiration was done, histopathology and immunohistochemistry revealed PPL. The patient received chemotherapy for MALT lymphoma with near total relief of symptoms and disappearance of gastric and pancreatic masses. This is a rare case having MALT lymphoma associated with PPL.

Posterior laryngitis: a disease with different aetiologies affecting health-related quality of life: a prospective case–control study

BackgroundLaryngo-pharyngeal reflux (LPR) is assumed to be the most common cause of posterior laryngitis (PL). Since LPR is found in healthy subjects, and PL patients are not improved by acid-reducing therapy, other aetiologies to PL must be considered. The aims of this study in PL were to investigate the prevalence of acid reflux in the proximal oesophagus and functional gastrointestinal symptoms, to analyse motilin levels in plasma, and to assess health-related quality of life (HRQOL) before and after treatment.MethodsForty-six patients (26 women), with verified PL, median age 55 (IQR 41–68) years, were referred to oesophago-gastro-duodenoscopy and 24-h pH monitoring. Plasma motilin was analysed. The 36-item Short-Form questionnaire was completed at inclusion and at follow-up after 43±14 months, when also the Visual Analogue Scale for Irritable Bowel Syndrome was completed. Values were compared to controls. Treatment and relief of symptoms were noted from medical records.ResultsThirty-four percent had proximal acid reflux and 40% showed signs of distal reflux. Ninety-four percent received acid-reducing treatment, with total relief of symptoms in 17%. Patients with reflux symptoms had lower plasma motilin levels compared to patients without reflux symptoms (p = 0.021). The HRQOL was impaired at inclusion, but improved over time. Patients, especially men, had more functional gastrointestinal symptoms than controls.ConclusionsThis study indicates that a minority of patients with PL has LPR and is cured by acid-reducing therapy. Disturbed plasma motilin levels and presence of functional gastrointestinal symptoms are found in PL. The impaired HRQOL improves over time.

Individual surgical treatment of intracranial arachnoid cyst in pediatric patients

Intracranial arachnoid cysts (IAC) are benign congenital cystic lesions filled with cerebrospinal fluid (CSF). This study evaluated microsurgical craniotomy and endoscopy in the surgical treatment of IAC. Eight-one consecutive pediatric patients with IAC were surgically treated between January 2004 and January 2011. The surgical procedures included microsurgical craniotomy and endoscopy. Symptoms at presentation, location of IAC, surgical treatment options, and effectiveness were evaluated. There were 43 males and 38 females and the mean age was 8.7 years (range between 1 month and 14 years) at the time of surgery. The cyst location was supratentorial in 72 patients and infratentorial in 9 patients, arachnoid cyst were identified. Follow-up period ranged between 2 and 8 years. Of the 49 patients with headache 83.67% of patients had cure and 10.2% had significant improvement. Of the eight patients with hydrocephalus and gait disturbances, six (75%) had complete total relief of symptoms and two (25%) patients had significant improvement. Four of the six patients with cognitive decline and weakness showed improvement. Of the 18 patients with epilepsy seizure freedom was: Engle class I grade I in 14 (77.78%) patients; class II in 2 (11.11%) patients; and class III in 2 (11.11%) patients. Follow-up studies from 2 to 8 years showed that headache was cured in 41 of the 49 cases (83.67%), significantly improved in 5 cases (10.20%), and showed no variation in 3 cases (6.12%). Hydrocephalus and gait disturbances were controlled in six of the eight cases (75.00%) and significantly improved in two cases (25.00%). Cognitive decline and weakness were obviously improved in four of the six cases (66.67%) and exhibited no variation in two cases (33.33%). According to the Engle standard, the following results were obtained from 18 patients with epilepsy: Grade I in 14 cases (77.78%); grade II in 2 cases (11.11%); and grade III in 2 cases (11.11%). Eleven cases with local or general enlarged skull exhibited no further progression. On follow-up computed tomography (CT) scan, there was variable alleviation of mass effect in all the 81 patients. Cystic size was significantly reduced in 65 patients with supratentorial arachnoid cysts and in 9 patients with infratentorial archnoid cysts. Twenty-one patients who had decreased skull thickness, had no further progression. Four patients who had cranioplasty had good outcome. The endoscopic approach was highly effective for most cases of IAC, particularly for cysts in the suprasellar and quadrigeminal regions as well as in the posterior fossa. Microsurgical craniotomy was recommended for IAC in the extracerebral convexity and intracerebrum. Local skull cranioplasty is needed for patients, or patients with preoperative diagnosis showed signs of cystic tumor and cyst-related epilepsy.

Stylalgia: a novel approach to treatment

Purpose:(1) To evaluate digital fracture of enlarged styloid as a clinical maneuver, in office setting, in relieving symptoms in stylalgia. (2) To avoid surgery or long term medications as definitive treatment of stylalgia. (3) To reduce the investigations, workload in OPD and thereby ultimately cutting the cost of health care.Methods: This study started with total relief of symptoms in a stylalgia patient instantaneously after incidental fracture of enlarged styloid process of the same side during routine clinical palpation. Encouraged with this we started this study; within the period from June 2008 to May 2010 total 36 patients were included in this study.Results: We had 36 cases with stylalgia, among them 4 cases had enlarged styloid so thick that they were resistant to digital fracture. Those 4 cases were taken for surgery. Among those four cases 3 (75%) were male. We found male styloid tougher and harder than that of females. We were able to fracture enlarged and symptomatic styloid in OPD in 32 cases. Among them after initial 1 hour, observation after the maneuver, 10 (31%) had complete of their symptoms and also 13 (40.6%) cases had considerable improvement of their symptoms within 1 hour, but 9 cases felt no improvement. We followed up our patients after, 1 week, 2 week, 1 month and 6 months. After 1 month, 26 had complete symptoms relief, 3 had considerable improvement and 3 felt no improvement. But after 6 months of follow-up, 2 cases with symptoms relieved completely, developed symptoms but with much lesser intensity.Conclusion: Using this simple in office procedure we were able to avoid long term medicines, recurrent investigations. By giving relief we could avoid surgeries in large majority of cases, making the already over burdened theater available to other patients and also cutting preoperative investigations. Thus we can cut the burden of health care for such chronic cases DOI:http://dx.doi.org/10.3329/bjo.v18i2.11990 Bangladesh J Otorhinolaryngol 2012; 18(2): 133-137

Accommodative spasm with bilateral vision loss due to untreated intermittent exotropia in an adult

Intermittent exotropia (IXT) is an exodeviation intermittently controlled by fusional mechanisms. Patients with IXT may present with asthenopic symptoms, blurred vision, headaches, diplopia or visual confusion and reading difficulties; especially after prolonged periods of near work. To report the presentation and management of a young adult with intractable accommodative spasm secondary to long standing intermittent exotropia. The patient was found to have bilateral accommodative spasm with high pseudomyopia and severe impairment of vision. There was a tendency for recurrence with discontinuation of cycloplegics. A total relief of symptoms was noticed after strabismus surgery was undertaken for the exotropia. A detailed orthoptic evaluation with emphasis on recognizing accommodative spasm as an unusual presentation of IXT, could aid in appropriate diagnosis and treatment of such cases.

Hemifacial Spasm due to Compression of the Posterior Inferior Cerebellar Artery Aneurysm Treated with Botulinum Toxin Type-A: A Case Report

A 79-year-old female presented with five months history of progressive involuntary twitching movement on left face. Brain MR imaging revealed a heterogeneous T2 hyperintense lesion at left cerebellopontine angle. CT angiography showed a partially thrombosed saccular aneurysm of left PICA (posterior inferior cerebellar artery). The patient was treated with Botulinum toxin type A and almost total relief of symptoms was noticed during one month followup. Botulinium toxin injection is an effective symptomatic treatment option in nonsurgical secondary hemifacial spasm (HFS) cases.

Vascular Compromise Secondary to Acromioclavicular Joint Injury: A Case Report

Acromioclavicular dislocation is a common injury in young males. We present an unusual complication of vascular compromise occurring in a 27-year-old male manual labourer with a grade V acromioclavicular joint dislocation. Following modified Weaver–Dunn reconstruction, the patient had a good outcome, with total relief of symptoms, and returned to his previous occupation.

Significance of styloidectomy in Eagle's syndrome: an analysis.

Reported here is a randomized retrospective analysis of 28 cases of elongated styloid process causing nagging cervicofacial pain, both unilateral and bilateral, and the effect of styloidectomy in these cases in relieving the symptom complex of the patient, in situations where conservative management failed in alleviating the symptoms. Randomized retrospective analysis over a period of 25 months. Elongated styloid process causing glossopharyn-geal neuralgia is beginning to be a frequently encountered clinical entity nowadays. Of the 28 cases of elongated styloid process who underwent unilateral/bilateral styloidectomy, 27 patients had total relief of symptoms. Hence, we advocate styloidectomy, following careful diagnosis of the entity with clinical and radiological correlation, if the patient does not respond to medical therapy. The psychological status of the patient would provide clue to the authenticity of the symptoms in unrelieved cases.

Diagnosis and Surgical Treatment of Nutcracker Syndrome: A Single-Center Experience

Conclusion: Left renal vein transposition is an efficient surgical treatment for nutcracker syndrome. In some cases however pelvic pain remains following left renal vein transposition. Summary: The nutcracker syndrome is an unusual problem where the left renal vein is narrowed as it passes between an angle formed between the abdominal aorta and the superior mesenteric artery. This narrowing of the left renal vein can lead to increase venous pressure within the renal circulation and promote development of varices of the renal pelvis and ureter with resulting hematuria. Other symptoms associated with nutcracker syndrome include orthostatic proteinuria, flank pain, left-sided varicocele, pelvic congestion, and chronic fatigue. The authors retrospectively reviewed 23 patients with the diagnosis of nutcracker syndrome treated at their institution from July 1998 to July 2007. Nutcracker syndrome was suspected based on the combination of clinical examination, ultrasound, CT imaging, and MRI imaging. Hematuria was the most common presenting symptom (21 of 23 patients). One patient presented with orthostatic proteinuria and 1 with pelvic congestion syndrome. No patient had renal function deterioration and 13 of 23 undergoing cystoscopy had bleeding noted from the left ureteral orifice. Only 7 underwent transposition of the left renal vein with the indication of transposition being recurrent gross hematuria in 6 patients and persistent orthostatic proteinuria in 1 patient. Sixteen patients who had more mild symptoms were followed without operation. Patients with microscopic hematuria or intermittent short periods of painless gross hematuria were followed closely without treatment. Patients with flank or abdominal pain were treated with low-dose aspirin treatment. Four women with pelvic congestion syndrome were treated with medroxyprogesterone acetate. Patients undergoing left renal vein transposition did so through a mid-line abdominal incision with mobilization of the left colon and small bowel to give access to the retroperitoneum. The inferior adrenal vein, ovarian/testicular vein, and the lumbar vein draining into the left renal vein were ligated and transected. The left renal vein was excised with the small rim of vena cava and injected with heparin. Reanastomosis was then performed to a more caudad portion of the inferior vena cava. All 7 patients treated with renal vein transposition had normal pre-operative creatinine levels with no increase following renal vein transposition. Hematuria and proteinuria ceased spontaneously 5 to 14 days following surgery with no clinical relapses. Of the 16 patients treated conservatively, clinical improvement occurred in 11 with total relief of symptoms in 2 patients and partial relief in 9 patients. There was no relief of symptoms in 5 patients following a mean follow-up of 41.2 months. Comment: The pressure gradient between the left renal vein near the renal hilum is normally between 0 and 1 mmHg (J Urology 1982; 127: 1070-1071). An elevated gradient of more than 3 mmHg between the left renal vein and the vena cava is used as a criteria to diagnose nutcracker syndrome. All patients in this series had such a gradient. The study indicates that left renal vein transposition works well to alleviate symptoms in patients with nutcracker syndrome and elevated renal vein IVC pressure gradients. Equally important is that patients with mild symptoms do well treated conservatively. It would appear reasonable to reserve surgical treatment of nutcracker syndrome to those patients with recurrent gross hematuria or persistent orthostatic proteinuria who are not responsive to conservative management. The authors also point out that children and adolescents can have nutcracker syndrome that will frequently resolve as the child matures into adulthood. Surgical treatment of nutcracker syndrome in children and adolescents therefore, in most cases, should be avoided.

Management of severe cervical stenosis after conization by detention of nylon threads tied up to intrauterine contraceptive device

To investigate the efficacy of the insertion of intrauterine contraceptive device (IUCD) tied up with nylon threads for the treatment of cervical stenosis after conization. Dilatation of the cervical canal and insertion of IUCD tied up with nylon threads was performed in four patients with symptomatic cervical stenosis after conization. After three courses of regular menstruation, the IUCD with nylon threads was removed. Total relief of symptoms was achieved in all four patients without any management-related complications. There was no evidence of recurrent cervical stenosis at follow-up in any of the patients. Detention of nylon threads tied up to IUCD provides an easy and reliable conservative management technique for post-conization cervical stenosis.

Coronary-Subclavian Steal Syndrome Presenting with Ventricular Tachycardia

Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.

INCREASE OF FREQUENCY IN DEEP BRAIN STIMULATION RELIEVES APRAXIA OF EYELID OPENING IN PATIENTS WITH PARKINSON'S DISEASE

Deep brain stimulation (DBS) of the subthalamic nucleus is an effective treatment in advanced stages of Parkinson's disease. However, approximately 5% of patients might develop apraxia of eyelid opening after DBS of the subthalamic nucleus. We provide data on a new noninvasive treatment approach to this adverse event. We report 2 patients who acquired apraxia of eyelid opening after DBS. This adverse event was relieved by changing the stimulation parameters. The stimulation frequency was increased from 100 Hz to 180 Hz in 1 patient and 160 Hz in the other, resulting in a total relief of symptoms. Increasing stimulation frequency may be beneficial in apraxia of eyelid opening acquired after DBS of the subthalamic nucleus.

An evaluation of butoconazole nitrate 2% site release vaginal cream (Gynazole-1) compared to fluconazole 150 mg tablets (Diflucan) in the time to relief of symptoms in patients with vulvovaginal candidiasis.

BACKGROUND: It is estimated that as many as 13 million cases of vulvovaginal infection occur in the United States annually, the majority of which are the result of Candida albicans infection. The symptoms of vulvovaginal infections are often painful and distressing to the patient. The objective of this study was to compare the time to symptomatic relief of vulvovaginal candidiasis (VVC) with butoconazole nitrate 2% Site Release vaginal cream (Gynazole-1) and oral fluconazole 150 mg tablets (Diflucan). METHODS: This randomized, open-label, parallel study evaluated 181 female patients with moderate to severe symptoms of VVC. Patients were randomized to single-dose therapy with either butoconazole nitrate 2% Site Release vaginal cream or fluconazole. The primary outcome measure was the time to onset of first relief of symptoms. Secondary measures included the time to overall relief of symptoms and the reinfection rate over the first 30 days following treatment. The overall safety of both products was investigated through the collection of adverse event reports. RESULTS: The median time to first relief of symptoms occurred at 17.5 h for butoconazole patients as compared to 22.9 h for fluconazole patients (p < 0.001). The time at which 75% of patients experienced first relief of symptoms was 24.5 h versus 46.3 h for butoconazole and fluconazole, respectively (p < 0.001). By 12- and 24-h post-treatment, 44.4% and 72.8% of patients in the butoconazole treatment group reported first relief of symptoms versus 29.1% and 55.7% of patients in the fluconazole group (p = 0.044 and p = 0.024 respectively). In patients experiencing first relief of symptoms within 48 h of dosing, the median time to first relief of symptoms in the butoconazole treatment group was significantly shorter at 12.9 h compared to 20.7 h for the fluconazole treatment group (p = 0.048). There were no significant differences between the two groups with respect to time to total relief of symptoms or reoccurrence of infection within 30 days of treatment. Butoconazole therapy was shown to have fewer reported adverse events, including drug-related adverse events, than fluconazole therapy. Vulvovaginal pruritis and vulvovaginal burning were the most common drug-related adverse events attributed to butoconazole. Headache, diarrhea, nausea, upset stomach and skin sensitivity were the most common drug-related adverse events attributable to fluconazole. CONCLUSIONS: Single-dose butoconazole nitrate 2% Site Release vaginal cream provides statistically significant improvement in time to first relief of symptoms in the treatment of VVC compared to fluconazole. There is no difference between these two treatments with respect to total relief of symptoms or reinfection rate. Although there was no significant difference in the incidence of adverse events judged by the investigator to be treatment-related, butoconazole treatment did result in fewer patients experiencing adverse events than fluconazole.

An Evaluation of Butoconazole Nitrate 2% Site Release®Vaginal Cream (Gynazole-1®) Compared to Fluconazole 150 mg Tablets (Diflucan®) in the Time to Relief of Symptoms in Patients With Vulvovaginal Candidiasis

Background.It is estimated that as many as 13 million cases of vulvovaginal infection occur in the United States annually, the majority of which are the result ofCandida albicansinfection. The symptoms of vulvovaginal infections are often painful and distressing to the patient. The objective of this study was to compare the time to symptomatic relief of vulvovaginal candidiasis (VVC) with butoconazole nitrate 2% Site Release®vaginal cream (Gynazole-1®) and oral fluconazole 150 mg tablets (Diflucan®).Methods.This randomized, open-label, parallel study evaluated 181 female patients with moderate to severe symptoms of VVC. Patients were randomized to single-dose therapy with either butoconazole nitrate 2% Site Release®vaginal cream or fluconazole. The primary outcome measure was the time to onset of first relief of symptoms. Secondary measures included the time to overall relief of symptoms and the reinfection rate over the first 30 days following treatment. The overall safety of both products was investigated through the collection of adverse event reports.Results.The median time to first relief of symptoms occurred at 17.5 h for butoconazole patients as compared to 22.9 h for fluconazole patients (p&lt; 0.001). The time at which 75% of patients experienced first relief of symptoms was 24.5 h versus 46.3 h for butoconazole and fluconazole, respectively (p&lt; 0.001). By 12- and 24-h post-treatment, 44.4% and 72.8% of patients in the butoconazole treatment group reported first relief of symptoms versus 29.1% and 55.7% of patients in the fluconazole group (p= 0.044 andp= 0.024 respectively). In patients experiencing first relief of symptoms within 48 h of dosing, the median time to first relief of symptoms in the butoconazole treatment group was significantly shorter at 12.9 h compared to 20.7 h for the fluconazole treatment group (p= 0.048). There were no significant differences between the two groups with respect to time to total relief of symptoms or reoccurrence of infection within 30 days of treatment. Butoconazole therapy was shown to have fewer reported adverse events, including drug-related adverse events, than fluconazole therapy. Vulvovaginal pruritis and vulvovaginal burning were the most common drug-related adverse events attributed to butoconazole. Headache, diarrhea, nausea, upset stomach and skin sensitivity were the most common drugrelated adverse events attributable to fluconazole.Conclusions.Single-dose butoconazole nitrate 2% Site Release®vaginal cream provides statistically significant improvement in time to first relief of symptoms in the treatment of VVC compared to fluconazole. There is no difference between these two treatments with respect to total relief of symptoms or reinfection rate. Although there was no significant difference in the incidence of adverse events judged by the investigator to be treatment-related, butoconazole treatment did result in fewer patients experiencing adverse events than fluconazole.

Angioplastie avec mise en place d’un stent pour occlusion fessière

We report the case of a patient presenting severe buttock claudication with normal neurologic and osteoarticular exams. He underwent a guidewire recanalization of his occluded superior gluteal artery followed by a percutaneous angioplasty with stenting, resulting in total relief of symptoms. This observation represents the first publication describing the use of a stent with recanalization of the gluteal artery. The technique seems promising for buttock pathology. (J Mal Vasc 2004 ; 29 : 210-212).

Laparoscopic repair of paraesophageal hernia.

Surgical repair of paraesophageal hernia is mandatory, due to the risk of severe complications, and it can be accomplished via the laparoscopic route. This study presents the results of laparoscopic repair of paraesophageal hernia combined with anterior hemifundoplication. During a two-year period, ten consecutive patients with paraesophageal hernia (six men, four women; mean age 73, range 55-82) underwent laparoscopic treatment. Five patients presented with symptoms of gastroesophageal reflux, while another four reported lower chest pain. There was one patient in whom the paraesophageal hernia was manifested with upper gastrointestinal bleeding. Six patients had type III hiatal hernia. They all underwent esophagography, upper gastrointestinal endoscopy, stationary manometry, and 24-hour ambulatory pH-metry, preoperatively and within three months postoperatively. At laparoscopy, the hernia content was completely reduced, the sac excised, and the diaphragmatic crura approximated. The operation was completed with an anterior hemifundoplication. In three cases, a prosthetic mesh was applied to close the hiatal defect securely. Operating times ranged from 75 min to 125 min (mean 90 min). There were no postoperative deaths. One patient developed atelectasis, and another had empyema of the left pleura, treated with drainage and antibiotics. All patients but one were discharged on the second or third postoperative day. At the three-month follow-up examination, none of the patients had symptoms related to the paraesophageal hernia, gastroesophageal reflux, or fundoplication. Esophagography demonstrated restoration of normal anatomy at the gastroesophageal region, while esophageal motility was improved, and esophageal pH-metry showed no gastroesophageal reflux. Laparoscopic repair of paraesophageal hernias is a safe, technically feasible, and well tolerated procedure, which offers rapid and total relief of symptoms. The addition of an anterior hemifundoplication not only cures preexisting gastroesophageal reflux, but also prevents the development of postoperative gastroesophageal reflux.

Ovarian Vein Embolization for the Treatment of Pelvic Congestion Syndrome: Long-Term Technical and Clinical Results

Ovarian vein embolization has been used recently to treat pelvic congestion syndrome. The purpose of this study is to evaluate the clinical efficacy and safety of ovarian vein embolization in the treatment of symptomatic pelvic varices. We performed ovarian vein embolization in 41 patients (mean age, 37.8 years; range, 30-58 years): 32 patients underwent unilateral embolization and nine patients underwent bilateral embolization. All had lower abdominal pain and pelvic varicosities were found on retrograde ovarian vein venography. Embolization was performed with a mixture of enbucrilate and lipiodized oil in all but one patient, in whom enbucrilate and minicoils were used. Initial technical success rate and clinical follow-up (1-61 months; mean, 19.9 months), conducted with use of mailed questionnaires, are reported. Initial technical success rate was 98%. Immediate complications were noted in two patients (4%) in the form of migration of some fragments of glue (used as embolic agent), which was treated conservatively. Clinical follow-up reveals variable symptomatic relief in 9.7% of cases and a total relief of symptoms in 58.5% of cases. Results in patients who had insufficient ovarian veins bilaterally were no better than those in patients for whom only the left ovarian vein was found insufficient. Transcatheter embolization of the ovarian veins is a safe and feasible technique leading to complete relief of symptoms in more than half of cases. No statistically significant difference in clinical outcome could be noted between patients presenting with bilateral insufficient ovarian veins, who underwent bilateral embolization, and patients presenting with an insufficient left ovarian vein, who underwent left unilateral embolization.