Use Of Visual Analogue Scale Research Articles

Predictors of Back Pain in Adolescent Idiopathic Scoliosis Surgical Candidates

There are contradictory reports on the overall prevalence of back pain in the adolescent population compared with adolescent idiopathic scoliosis (AIS) patients. Most reports do not investigate pain in patients with AIS but try to identify in which subgroup of patients with AIS an underlying pathology should be excluded. The objective of this study was to find whether AIS in operative candidate patients is a painful condition and to try and find clinical and radiologic predisposing factors, which will help us to predict patients who are going to have pain. Candidates who had to undergo an operative treatment for AIS between October 2004 and October 2009 in our institution, were enrolled to the study. Pain was graded with the use of visual analogue scale (VAS) on a scale from 0 to 10. We recorded the age at presentation, sex, menarchal status, family history of scoliosis, brace treatment history, and neurological findings. Radiologic parameters recorded were: the type of curve according to the Lenke classification, Cobb angle, thoracic kyphosis angle, apex vertebra rotation, Risser grade, coronal balance, and curves flexibility. Seventy patients with AIS were included in this study. Fifty patients (71%) reported of some kind of back pain with 34 patients (48%) grading their pain as ≥5 on the VAS.Patients in whom scoliosis was diagnosed in older age and patients with a more rigid lumbar curve had statistically significant higher VAS scores (P=0.014, P=0.036). Patients who were treated with a brace had a statistically significant lower VAS scores (P=0.019). Back pain is common in patients with AIS who are candidates for operative treatment. The following parameters correlate with worse back pain: older age at diagnosis, no use of brace, and rigid lumbar curve. Type III.

The Management of Sickle Cell Pain in the Emergency Department

Pain is the most common reason for admission to the Emergency Department (ED) in patients with sickle cell disease (SCD). It can be associated with severe complications and impairs quality of life. Pain management in the ED should be well-defined and aggressive. The objective of this study was to evaluate pain management in the pediatric ED of a country recently facing SCD and to identify priority areas of intervention. The charts of SCD children who had accessed the ED from January 2003 to December 2010 were retrospectively reviewed. Pain management was compared before and after 2008. During 2008, educational events on SCD-pain management involved the ED personnel. Twenty-three/28 patients (82%) accessed the ED for/with pain, of a total of 96/185 accesses for/with pain. Mean age was 5.9 years (range, 8 mo to 17.9 y). Fifty-four percent of the episodes resulted in hospital admissions, with a mean length of stay of 6.2 days. Pain was scored in 30% of the episodes; analgesics were administered in 50%. After the educational interventions, high score at triage was assigned more frequently (72% vs. 40%), waiting time for analgesics administration reduced (64 vs. 87 min), and use of Visual Analogue Scale increased (50% vs. 8%). Pain represents the main reason for admission to the ED in children with SCD even in countries recently facing SCD. Educational interventions obtained significant but still limited improvement in pain management. The diffusion of national guidelines with defined pain evaluation and treatment protocols represents a priority to further ameliorate care of SCD children.

Measurement validity of tests for implicit negative bias

The study by Terbeck et al. (2012) that was published in Psychopharmacology, Online First concluded that propranolol reduces implicit negative racial bias. However, this conclusion is not supported by the study because the implicit association test (IAT) (Greenwald et al. 2009) has not been sufficiently validated and because the claim for clinical treatment due to amygdala suppression is unsupported. The classic race IAT compares whether one is quicker to link European–Americans with words associated with the concept “good” and African–Americans with words related to “bad” or vice versa. Gladwell (2005) summarizes it in the following way: The IAT measures a person’s attitude on an unconscious level or the immediate and automatic associations that occur even before a person has time to think. Is it possible to reliably measure “unconscious attitude” without using presumptions or indirect measures that rely on subjective notions? Blanton et al. (2007) also question the arbitrary nature of the cutoffs for mild, moderate, and strong preferences when no research shows where these limits should be. There is no research to support differences in individuals above or below the cutoffs. The IAT essentially attempts to measure the immeasurable and has been used prematurely in research without sufficient methodological validation. The measurement reliability of the IAT, as determined by test–retest methods, shows negligible consistency. The study only used data from blocks containing less than 15 % errors, but does not state how many of these blocks were discounted, which could be substantial. Moreover, it is mentioned that one participant was excluded due to high errors on both trials, and three participants had onlymain trials analyzed due to extreme errors in the practice session. These breakdowns in measurement quality are further compounded on the IAT developer's website (Greenwald et al. 2012) which states that “besides normal variation in the reliability of assessment, the IAT is also known to be malleable based on differences in the social setting and recent experience. These factors will influence the consistency of measurement across occasions.” The IATcould not have high measurement quality of attitude if so many extraneous factors have such influence. Lastly, the conclusion that the minimal effect seen in response latencies is the result of direct inhibition of amygdala stimulation is not supported. The limitations of previous studies that correlated the participant's IATscore with the extent of amygdala activation are noted, but the same limitations are not applied to the present study. For example, contradictory findings are referenced: “Phelps et al. (2003) found that a patient with bilateral amygdala damage exhibited an intact IATeffect, leading the authors to suggest that the amygdala may not be a critical structure for the manifestation of implicit bias.” In addition, the study concluded that more research needs to be conducted in order to determine whether propranolol acts peripherally or centrally. This means that propranolol may not even directly affect the brain, let alone a specific anatomic structure such as the amygdala. As a last possibility, an explanation that cannot be excluded is that propranolol simply equalizes mental reflex latencies, regardless of task. The study has many strengths, including an excellent review of previous studies, the use of visual analog scales, the use of a control group and two different post-intervention time points, excellent statistical analysis, well-constructed data tables, and most of all, an important topic. However, due to important T. S. Burchett : L. L. Glenn College of Nursing and Institute for Quantitative Biology, East Tennessee State University, P.O. Box 70658, Johnson City, TN 37604, USA

A pilot study: a randomised study comparing the use of two different suture materials for subcuticular skin closure at caesarean section (CS)

Background/Introduction/AimsIn current obstetric practice there is limited evidence to underpin the wide variation of suture material used for skin closure at caesarean section. A pilot study examined the rates of...

Questionnaires to Assess Chronic Itch: A Consensus Paper of the Special Interest Group of the International Forum on the Study of Itch

Chronic itch affects millions of patients worldwide and has a significant impact on quality of life. The assessment of itch and its associated effects is a significant component of clinical practice in itch management. Despite itch being a common complaint, there are few studies describing the use of structured questionnaires for evaluation and measurement of itch and its sensory and affective dimensions. The International Society of the Study of Itch (IFSI) has recently provided invaluable data on the use of visual analogue scales as an assessment tool for itch. However, it is clear that additional tools are needed to better assess the different dimensions of chronic itch and better tailor management. With this goal in mind, a Special Interest Group was initiated by members of IFSI to determine which of the various psychometric properties of itch questionnaires offer the greatest utility in the evaluation of chronic itch. This first consensus paper addresses what domains and structure of itch questionnaires need to be implemented to better assess chronic itch and guide therapy.

Powered-assisted partial turbinectomy versus mometasone furoate nasal spray for relief of nasal blockage in chronic or idiopathic rhinosinusitis

Conclusion: Power-assisted turbinectomy is a safe and reliable alternative for patients with nasal blockage if nasal corticosteroid spray therapy is not suitable. Objective: Powered-assisted partial turbinectomy was compared to the use of a corticosteroid nasal spray for relief of nasal obstruction in chronic or idiopathic rhinosinusitis. Methods: Patients were randomized to either power-assisted partial turbinectomy or daily use of mometasone furoate nasal spray for 6 months. Evaluation by peak nasal inspiratory flow (PNIF) and grading of symptoms by use of visual analog scale was done after 3 and 6 months. Grading of symptoms was also done by use of a questionnaire approximately 30 months after the last visit. Results: PNIF scores improved for all patients, although significantly only for patients on mometasone spray. Patients' self-reported symptoms decreased more for operated patients. Side effects were few and mild in both groups.

Open ear hearing aids in tinnitus therapy: An efficacy comparison with sound generators

Objective: This study aimed to compare the effectiveness of tinnitus retraining therapy (TRT) with sound generators or with open ear hearing aids in the rehabilitation of tinnitus for a group of subjects who, according to Jastreboff categories, can be treated with both approaches to sound therapy (borderline of Category 1 and 2). Design: This study was a prospective data collection with a parallel-group design which entailed that each subject was randomly assigned to one of the two treatments group: half of the subjects were fitted binaurally with sound generators, and the other half with open ear hearing aids. Both groups received the same educational counselling sessions. Study sample: Ninety-one subjects passed the screening criteria and were enrolled into the study. Structured interviews, with a variety of measures evaluated through the use of visual-analog scales and the tinnitus handicap inventory self-administered questionnaire, were performed before the therapy and at 3, 6, and 12 months during the therapy. Results: Data showed a highly significant improvement in both tinnitus treatments starting from the first three months and up to one year of therapy, with a progressive and statistically significant decrease in the disability every three months. Conclusions: TRT was equally effective with sound generator or open ear hearing aids: they gave basically identical, statistically indistinguishable results.SumarioObjetivo: El objetivo de este estudio es comparar la efectividad de la terapia de re-entrenamiento del acúfeno (TRT), con generadores del sonido o con auxiliares auditivos con molde abierto en la rehabilitación del acúfeno, para un grupo de sujetos que, de acuerdo con las categorías de Jastreboff, pueden ser tratados con ambos enfoques hacia la terapia del sonido (límite entre la categoría 1 y la 2). Diseño: Este estudio fue una colección prospectiva de datos con un diseño de grupos paralelos en el que cada sujeto fue asignado al azar en uno de los dos grupos de tratamiento: la mitad de los sujetos fueron adaptados binauralmente con generadores de sonido y la otra mitad con auxiliares auditivos con molde abierto. Ambos grupos recibieron las mismas sesiones de asesoría. Muestra: 91 sujetos aprobaron el tamiz de criterios y fueron incluidos en el estudio. Se realizó una entrevista estructurada con una variedad de mediciones evaluadas en la Escala Visual Análoga y el Inventario del Impedimento por el Acúfeno, un cuestionario auto-administrado, antes de la terapia y a los 3, 6 y 12 meses durante la terapia. Resultados: Los datos mostraron una mejoría altamente significativa en ambos tratamientos desde los primeros tres meses y hasta el primer año de terapia con una significancia estadística progresiva y un descenso trimestral significativo en la discapacidad. Conclusiones: La TRT fue igualmente efectiva con generadores de sonido que con auxiliares auditivos de molde abierto: básicamente dieron resultados idénticos, estadísticamente indistinguibles.

A modified visual analogue scale for the assessment of chronic pain

The present common evaluation of pain is scored through the use of visual analogue scale (VAS) to assess the intensity of pain and, sometimes, an additional table in which the frequency of pain attacks during the day is reported. We propose a modified 2D-VAS to assess both the intensity and the frequency (expressed by the percentage of the time in which pain is experienced during the day). Thus with only one scale and graphic representation, we can have a clear picture of the patient's condition before and during any treatment to relieve his pain.

Bipolar radiofrequency tonsillotomy compared with traditional cold dissection tonsillectomy in adults with recurrent tonsillitis

Objective To compare short- and long-term results of radiofrequency tonsillotomy and traditional cold dissection tonsillectomy in adult patients with recurrent tonsillitis. Study Design A randomized clinical trial. Setting A tertiary referral university hospital. Subjects and Methods Of 62 adults with recurrent tonsillitis, 24 patients were treated with cold dissection tonsillectomy, while radiofrequency tonsillotomy (RF) by use of radiofrequency induced thermotherapy probes was performed in the remaining 38 patients. Duration of surgery, amount of intraoperative bleeding, recovery time, postsurgical pain (measured by use of visual analogue scale on days 1, 3, 5, and 10 after surgery), dysphagia, weight loss, and time of return to normal diet and activity were measured. All the patients were followed for 12 to 24 months for recurrence of tonsillitis episodes. Results Comparing the radiofrequency tonsillotomy group to the cold dissection tonsillectomy group, mean duration of surgery was 16.89 versus 45.04 minutes, recovery time was 14.32 minutes versus 17.08 minutes, and amount of intraoperative bleeding was 15 to 20 cc versus 250 to 300 cc, respectively ( P < 0.005). There was no difference between the two groups in the recurrence of tonsillitis episodes after 24 months. Conclusion Tonsillotomy with radiofrequency is a simple, rapid, and effective method in adult patients with recurrent tonsillitis.

Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis

Lateral epicondylitis usually responds well to nonoperative management. A limited number of refractory cases may require surgical intervention. The objective of this study was to assess the outcome of arthroscopic release of the extensor carpi radialis brevis (ECRB) tendon in a consecutive series of patients. A retrospective review of 36 patients with lateral epicondylitis treated surgically between January 2001 and January 2004 was performed. There were 24 men and 12 women averaging 42 years at the time of surgery. In all patients, nonoperative management failed, and they underwent surgery at a mean of 19 months after the onset of symptoms. An arthroscopic release of the ECRB was performed. Data collection was performed by an independent examiner. Operative findings included 28% of patients with significant intra-articular synovitis and 36% with a Baker type 1 lesion, 39% with a type 2 lesion, and 25% with a type 3 lesion. At a mean follow-up of 3.5 years, the mean Mayo Clinic elbow score was 11.1 (range, 5 to 12). By use of visual analog scales, pain improved from 1.5 +/- 1.3 preoperatively to 8.1 +/- 2.4 at follow-up (P < .01). Of the patients, 10 (31%) reported mild pain with strenuous activities and 2 (6%) received no benefit from the procedure. Patients required a mean of 3.8 weeks to return to regular activities and 7 weeks to return to full work duties. No serious complications were identified. Arthroscopic release of the ECRB is a viable option for recalcitrant lateral epicondylitis. This procedure appears to be safe and effective and allows for management of associated intra-articular pathology.

Sodium Hyaluronate Improves Outcomes After Arthroscopic Lysis and Lavage in Patients With Wilkes Stage III and IV Disease

Among patients with Wilkes stage III and IV disease undergoing arthroscopic lysis and lavage, does the use of an intra-articular injection of sodium hyaluronate (SH), when compared with Ringer lavage, result in better postoperative pain control and temporomandibular joint (TMJ) function? We designed and implemented a randomized, double-blind, pilot controlled clinical trial. The study sample was composed of patients with middle Wilkes stage (late stage III and early stage IV) disease. Subjects were randomized to 1 of 2 treatment limbs. The treatment group received Ringer lactate plus an injection of 1 mL of SH after arthroscopy, whereas the control group was given Ringer lactate during arthroscopy. The primary outcome variables were pain and TMJ function measured by use of visual analog scales. Appropriate descriptive and bivariate statistics were computed. A P value less than .05 was considered statistically significant. The study sample was composed of 40 patients with 20 subjects enrolled in both treatment groups. There were no statistically significant differences between the 2 groups in terms of demographics and preoperative variables. Postoperative analgesia was statistically significant in the treatment group with respect to the control group on the visits on days 14 and 84. No statistically significant differences were observed between the 2 groups in the maximum interincisal opening and tolerance. An intra-articular injection of SH after arthroscopic lysis and lavage is effective in reducing pain in patients with TMJ dysfunction, enhancing postsurgical recovery. The analgesic effect of treatment with SH is maintained in the long term.

Visual analog scale (VAS) and nasal obstruction in persistent allergic rhinitis

Objective Nasal airflow resistance, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). However, rhinomanometry is scarcely available. The aim of this study was to verify the suitability of the use of visual analog scales (VAS) as a surrogate for rhinomanometry in quantifying nasal obstruction in patients with persistent allergic rhinitis. Study Design Prospective study on patients with allergic rhinitis. Setting ENT clinic. Subjects and Methods Fifty patients (27 males, mean age 23 years, SD 2.24) were studied. VAS for nasal obstruction and other AR symptoms and rhinomanometry were performed in all patients. Results A significant, very strong correlation has been observed between VAS for nasal obstruction and nasal airflow resistance (Spearman r = 0.879, P < 0.001). Moreover, a significant correlation exists between VAS for rhinorrhea and resistance (Spearman r = 0.313, P = 0.027). Conclusion The use of VAS for assessing the nasal obstruction appears clinically relevant in that it allows, with good reliability, the quantification of this symptom in the absence of rhinomanometry.

2주간의 도수치료와 요부 안정화 운동이 만성 요통환자들의 요부관절 가동범위와 통증에 미치는 영향

The purpose of this study was to investigate on the lumbar Range of Motion(ROM) and pain with Chronic Low Back Pain(CLBP) used to manipulation and lumbar stabilization exercise for 2 weeks. We introduced Maitland`s manipulation and lumbar stabilization exercise in this study in order to recover the CLBP with pain and lumbar ROM. Forty-eight patients diagnosed with CLBP were included for the study. Among them, twenty-four patients(experimental group) were managed by Maitland`s manipulation and lumbar stabilization exercise, another twenty-four patients(control group) were treated by physical science methods(H/P, TENS, U/S). Each group made use of Visual Analogue Scale(VAS) to pain and tape to lumbar ROM to compare the possible changes of pain and lumbar ROM in two groups after treatment. In experimental group, lumbar ROM has increased in flexion extension, left bending, right bending and pain reduced for 2 weeks. In control group, lumbar ROM has not changed in flexion, extension, left bending, right bending and pain has reduced for 2 weeks. According to the results, we concluded that Maitland`s manipulation and lumbar stabilization exercise for 2 weeks is effective for increasing lumbar ROM and reducing pain by making joints normal position in lumbar vertebrae and lumbar stabilization in spinal muscles.

Humeral Head Arthroplasty and Meniscal Allograft Resurfacing of the Glenoid

Biological glenoid resurfacing with prosthetic humeral head replacement has been suggested as a means to avoid the potential complications of polyethylene use in younger patients with glenohumeral arthritis. The purposes of this report were (1) to describe a technique that was developed to facilitate biological resurfacing of the glenoid with use of meniscal allograft tissue and (2) to report the effectiveness of hemiarthroplasty in conjunction with meniscal allograft glenoid resurfacing. Thirty patients (thirty shoulders) with glenohumeral arthritis were treated with hemiarthroplasty and lateral meniscal allograft resurfacing of the glenoid. Clinical assessments were performed at regular intervals with use of visual analog scales for pain, shoulder comfort, and function and with use of patient self-assessments including the American Shoulder and Elbow Surgeons score and the Simple Shoulder Test. A detailed radiographic analysis was performed to evaluate glenohumeral subluxation, glenoid bone loss, and the glenohumeral joint space. Twenty-seven patients (twenty-seven shoulders) were followed for a minimum of two years. The mean duration of follow-up was three years. For the Simple Shoulder Test and the visual analog scale measures for level of pain, pain at rest, and pain with strenuous activity, the results at the final follow-up evaluation were significantly better than the preoperative results. Similarly, all ten functions of the American Shoulder and Elbow Surgeons questionnaire were significantly improved at the time of the latest follow-up. Over the time frame of the study, there was radiographic evidence of glenohumeral joint-space narrowing. Lateral meniscal allograft resurfacing of the glenoid can protect the glenoid from erosion, can minimize glenohumeral subluxation, and is associated with significant pain relief and improved function for two to five years when used in conjunction with hemiarthroplasty in younger patients with glenohumeral arthritis. However, the progressive decrease in glenohumeral joint space noted radiographically raises concern for both the long-term functional outcome and the durability of the glenoid bone-sparing effect.

The Comparison between Transperineal and Transrectal Ultrasound-Guided Prostate Needle Biopsy

Purpose: Prostate biopsy is a conventional method for the detection of prostate cancer in men with suspicious findings. However, there is no universal agreement on which method is the better approach to the prostate, with regard to cancer detection rate and complication rate. In this prospective randomized study, we compared cancer detection rates and complication rates between transperineal (TP) and transrectal (TR) prostate biopsy. Materials and Methods: Between March 2006 and December 2007, we analyzed 200 Korean men. One hundred patients underwent randomized TP prostate biopsy and 100 patients underwent TR prostate biopsy. All biopsies were extended 12-core biopsies. With both approaches, 12 biopsy specimens were obtained systematically from the peripheral and transitional zones, including the apex, base, and transitional zone. The patient’s subjective pain scale was measured by use of visual analogue scales. Immediately after the biopsy, the pain score was independently recorded by the patients. One week later, various complications were measured by answer note. Results: The overall cancer detection rate was 22% (22 of 100 patients) with TR prostate biopsy and 29% (29 of 100 patients) with TP prostate biopsy. Considering the prostate cancer detection rate, there were no significant differences between the groups for prostate-specific antigen (PSA), age, body mass index (BMI), and prostate volume. Apart from the cancer detection rate and complication rate, the pain scale, in each different approach, was statistically meaningful. Conclusions: There were no significant differences in the cancer detection rate or complication rate between TP and TR prostate needle biopsy. However, with regard to pain relief and complication rates, TR prostate

Decreasing procedural pain over time of left prefrontal rtms for depression: Initial results from the open-label phase of a multisite trial (OPT-TMS)

There is much interest in whether daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) over several weeks may become a clinically useful antidepressant treatment. Although rTMS appears largely safe, many patients report that this procedure is somewhat painful, which may restrict its ultimate appeal and utility. We analyzed interim results from the open-label phase of a multi-site randomized trial of rTMS as a treatment for depression to investigate whether the procedural pain of left prefrontal rTMS changes over time. Patients with unipolar depression who had failed to respond during at least three weeks of the sham-controlled double-masked rTMS were then offered three more weeks (15 sessions) of open-label rTMS. Retrospective pain ratings and state emotional factors from 20 subjects were assessed using visual analog scales (VAS) recorded on computers before and after each treatment (289 sessions). Over the 15 treatment sessions, subjective reports of the painfulness of rTMS decreased 48% from baseline. This reduction, although greatest in the first few days, continued steadily (average 2.11 points per session) over the 3 weeks of treatment. The analysis found a significant effect for rTMS-session (p<0.0001) on rTMS-procedural pain over and above changes in subjective emotional states. The procedural pain of left, prefrontal rTMS decreases over time, apparently independently of other emotional changes. Since rTMS scalp pain may decline over time, physicians and patients may decide to continue treatment despite initial discomfort. These observational data can be better tested once the data from the blinded phase of the trial becomes available.

Visual Analog Scales for Assessment of Thermal Perception in Different Environments

Subjective thermal perception in stable and dynamic environments has been measured primarily by categorical rating scales. At present, there is an increasing use of visual analog scales (VAS) to assess whole body and body region thermal perceptions in laboratory and other thermal environments. The rationale behind the use of VAS is that individuals are more accurate in conveying their subjective experience if they are not forced to make ratings according to numbers or categories. Unipolar scales have the advantage of focusing on a single subjective perception, such as the amount of cold the subject experiences. With bipolar scales (e.g., cold to hot), the sensitivity in measuring the extent of a specific thermal experience may be diminished because the subject needs to make a discontinuous change from one thermal perception to another. The robust psychometric properties of VAS indicate their usefulness in measuring thermal experience. Unipolar VAS with a large equal interval scoring range will enable the investigator to measure small gradients of change in perceptual experience. However, the subjective perception of thermal status is not highly accurate at thermal extremes, and caution is needed in sole reliance on subjective report in these conditions.

The effects of upper lip height on smile esthetics perception in normal occlusion and nonextraction, orthodontically treated females

The esthetic of smile is influenced by such features as the amount of incisor show and gingival display. The purposes of this study were to compare smile esthetics among normal occlusion and non extraction patients, assess upper lip height in two groups and discuss how this feature relate to smile esthetics. We therefore conducted a case control study to determine the mentioned aims. Thirty females with non extraction orthodontically treated occlusions and thirty three with normal occlusions were selected. Standardized black and white photographs of their posed smiles were evaluated by a panel of 5 men and 5 women of varied vocations by use of visual analogue scale. Then upper lip height of the two groups were measured from photographs. Smile esthetics and differences among the two groups were subjected to ANOVA and Mann-whitney test was used to compare upper lip height in them. This study showed that upper lip height did not differ among the 2 groups ( P = 0.98). Also there were no significant differences in the distribution of fair,good and very good smiles among the two groups. This study demonstrates that the non extraction orthodontic treatment does not influence smile esthetics.

Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?

Breast reconstruction is increasingly performed with the use of the abdominal wall donor site, with potential complications including donor site morbidity and impaired flap viability. As a tool for selecting the optimal perforators which will ultimately supply the flap, preoperative imaging with computed tomography angiography (CTA) has become increasingly popular. Potential benefits include reduced intramuscular dissection, with faster and safer dissection, reduced donor site morbidity and improved flap vascularity and survival. Despite the potential for improvements in operative outcome, any benefits are yet to be established. A cohort study of 104 breast reconstructions in 88 patients was conducted. All patients underwent breast reconstruction based on an abdominal wall free flap. Of these, 40 patients undergoing preoperative imaging with CTA and 48 patients not undergoing CTA were included, with all CTAs undertaken at a single institution. Length of operation, length of stay, and operative complications were assessed. An evaluation of operative stress was achieved with the use of visual analogue scales (VAS) administered to the surgeons. The use of CTA was associated with decreased operating time (mean: 77 min for bilateral cases), significantly decreased complications related to flap viability (particularly partial flap loss), and a statistically significant reduction in donor site morbidity. Psychometric testing of surgeons revealed a statistically significant decrease in operative stress (41% decrease) with the use of preoperative CTA. The use of CTA for preoperative imaging in breast reconstruction is associated with improved operative outcomes.

Fourteen-Year Follow-Up of a Patient-Fitted Total Temporomandibular Joint Reconstruction System

The purpose of this study was to continue the assessment of the safety and effectiveness of the Patient-Fitted Total Temporomandibular Joint Reconstruction System (now, TMJ Concepts Patient-Fitted Total Temporomandibular Joint Reconstruction System, Ventura, CA; previously referred to as Techmedica, Camarillo, CA, the CAD/CAM Patient-Fitted Total Temporomandibular Joint Reconstruction System). Questionnaires were mailed to the available addresses of 193 patients who had been implanted with Techmedica/TMJ Concepts devices between 1990 and 2004. Of 193 recorded addresses, 149 (77.2%) were valid, and 44 (22.7%) were returned by the US Postal Service as undeliverable. Two (1%) surveys were remailed; both were returned completed. A total of 61 (31.6%) surveys were returned properly completed. This represented 102 devices (41 bilateral, 20 unilateral), with a mean follow-up of 11.4 years (standard deviation [SD] 3.0; range, 0 to 14). Subjective data related to pain, perception of mandibular function, diet consistency, and current quality of life were collected with the use of visual analog scales. Objective measures of maximum interincisal opening (MIO) were obtained from direct measurements with the Therabite Measuring Scale (Atos Medical, Milwaukee, WI), which was provided in the survey along with instructions on its use. Analysis of subjective data showed a significant reduction in pain scores and an increase in mandibular function and diet consistency scores (P < .001). Analysis of objective data showed an improvement in mandibular range of motion after 14 years (P = .02). Among all respondents, 85% reported quality of life (QOL) scores that showed improvement since baseline. Long-term quality of life improvement scores also were found to be statistically related to the number of previous temporomandibular joint operations the patient had undergone. Outcome data presented show that the Patient-Fitted Total Temporomandibular Joint Reconstruction System continues to be a safe, effective, and reliable long-term management modality for the specific patient population surveyed in this study.