Long-term results and influencing factors of laparoscopic Heller myotomy for achalasia / 中华胸心血管外科杂志

Objective:To assess the long-term outcome and influencing factors of laparoscopic Heller myotomy plus Dor fundoplication(LHM+ Dor) for achalasia by a single operator.Methods:Fifty-four patients who underwent LHM+ Dor consecutively from January 2011 to December 2019 were retrospectively reviewed. Those who had already undergone surgical or endoscopic myotomy and who were complicated with cancer were ruled out. Symptom inquiry and esophagogram were conducted both before and after surgery for assessing surgical results. Esophagoscopy, esophageal manometry and 24 h pH monitoring were performed before surgery, and the effects of these preoperative factors on the long-term outcome were analyzed.Results:All patients had dysphagia for average 6.5 years, ranging from 0.5-30.0 years. Intra-operative mucosal perforation occurred in 4(7.4%) patients, and there were no postoperative morbidity and mortality. At a median follow-up of 5.2 years, the morbidity of dysphagia decreased from 100% before surgery to 5.5% after surgery( P<0.001), Eckardt scores from 4.85±1.64 to 0.71±1.08( P=0.000). After surgery, 94.4% of patients had excellent and good relief of symptoms and good control of gastroesophageal reflux, the morbidity of heartburn being 3.7%. At 5 years after surgery, the probability of being symptoms free(Eckardt score≤1) was 91.7% in patients without preoperative night cough, compared to 54.6% in those with preoperative night cough( P=0.047). The probability was 92.3% in patients with grade Ⅰ and Ⅱ dilation of the esophagus and 79.0% in patients with grade Ⅲ and Ⅳ dilation( P=0.027). At multivariate analysis, heavier esophageal dilation was the independent predicator for poor symptom control after surgery. Conclusion:LHM+ Dor can be safely performed and durably relieve achalasia symptoms. Severe esophageal dilation before surgery is an independent predictor of a poor response to surgery.

Tumores primarios de sacro: análisis de resultados y complicaciones / Primary sacral tumors: analysis of results and complications

Resumen: Introducción: Los tumores primarios de sacro son poco frecuentes, el tratamiento en la mayoría de los casos es quirúrgico con o sin radioterapia adyuvante; los resultados oncológicos y funcionales suelen ser adversos con una tasa alta de complicaciones. Material y métodos: Se realizó un estudio retrospectivo, analítico y observacional que incluye 22 casos tratados entre el 2000 y 2017, se analizaron sus características demográficas, el tipo de tratamiento en la recidiva y el resultado oncológico y funcional; asimismo, se analizó la tasa de complicaciones. Resultados: 22 pacientes fueron sometidos a sacrectomía, con abordaje posterior por cordoma (13 pacientes), tumor de células gigantes (tres pacientes) y otros (seis pacientes). Se realizaron tres sacrectomías totales, 13 sacrectomías parciales, dos hemisacrectomías y cuatro sacrectomías ampliadas. La media de duración quirúrgica fue de 229 minutos, con un sangrado promedio de 2,100 cm3, el tamaño tumoral promedio fue de 13.8 cm (6-30 cm); presentaron complicaciones 10 pacientes, ocho por infección de sitio quirúrgico, uno por hernia sacra y uno por osteomielitis. La supervivencia global fue de 44.4 meses. Discusión: El tratamiento de los tumores sacros es complejo y requiere un equipo multidisciplinario; el resultado oncológico es adecuado cuando se consiguen márgenes libres de neoplasia, los resultados funcionales estarán determinados por el tipo de resección y la tasa de complicaciones es alta; sin embargo, es la mejor alternativa de curación.

Abstract: Introduction: Primary sacral tumors are rare, treatment in most cases is surgical with or without adjuvant radiotherapy; oncology and functional results are usually adverse with a high rate of complications. Material and methods: We conducted a retrospective, analytical and observational studies that includes 22 cases treated between 2000 and 2017, analyzed their characteristics demographic, the type of treatment received, and the oncological, functional results and the rate of complications were analized. Results: 22 patients were subjected to sacrectomy with posterior approah because of cordoma (13 patients), giant cell tumour (three patients) and other (six patients). Three total sacrectomies, 13 partial sacrectomies, two hemisacrectomies and four sacrectomies enlarged were performed. The mean surgical time was 229 minutes, with an average bleeding of 2,100 cm3, the average tumour size was 13.8 cm (6-30cm); 10 patients were presented with complications, eight by surgical site infection, one sacral hernia and one osteomyelitis. Overall survival was 44.4 months. Conclusions: Treatment of sacral tumors is complex, requires a multidisciplinary team; the oncological result is adequate when you get free margins of neoplasia, the functional results will be determined by the type of resection, and the rate of complications is high however is the best alternative healing in our hospital.

The impact of laparoscopic surgery in colorectal cancer resection with respect to the development of liver metastasis in the long-term / Impacto da cirurgia videolaparoscópica em ressecções de câncer colorretal quanto ao desenvolvimento de metástases hepáticas a longo prazo

INTRODUCTION: Colorectal cancer (CRC) shows high incidence and mortality worldwide, particularly in Western and developed countries. The objective of this study is to evaluate the oncologic results during a minimum follow-up of 2 years of curable CRC patients submitted to laparoscopic resection in our environment, regarding to the development of hepatic metastases. METHODS: Medical records of 189 colon and rectal patients with potentially curable adenocarcinoma who have been submitted to laparoscopic resection have been reviewed through a retrospective cohort between January 2005 and March 2012 at a single institution regarded as reference to this type of treatment. Pearson's X² and Long-rank tests have been used for statistical analysis and data was analyzed by statistic package STATA version 11.0. RESULTS: The eligible population for the study was 146 patients, 91 women (62%), with a mean age of 61 ± 13 years. Minimum follow-up was 24 months, having an mean follow-up of 60 ± 27 months and an mean follow-up of global disease recurrence of 27 ± 11 months. Hepatic metastases occurred in 7.5% of the population, most from stage III, and the mean recurrence period was 25 ± 16 months. CONCLUSIONS: Laparoscopic resection for potentially curable CRC in this cohort did not change the long-term incidence of hepatic metastases, considering that our results are comparable to large randomized clinical trial results. Laparoscopic resection was effective and safe for analyzed patients, regarding long-term oncologic results.

INTRODUÇÃO: O câncer colorretal (CCR) apresenta elevada incidência e mortalidade mundial, especialmente nos países ocidentais e desenvolvidos. O objetivo deste estudo é avaliar, durante um seguimento mínimo de 2 anos, pacientes com CCR potencialmente curável submetidos a ressecções laparoscópicas, em relação ao surgimento de metástases hepáticas. MÉTODOS: Através de coorte retrospectiva foram revisados os prontuários de 189 portadores de adenocarcinoma de cólon e reto potencialmente curáveis, submetidos a ressecção laparoscópica entre janeiro de 2005 e março de 2012, numa única instituição considerada de referência neste tipo de tratamento. Para análise estatística foram usados o teste X² de Pearson e o teste Log-rank, e os dados foram analisados pelo pacote estatístico STATA versão 11.0. RESULTADOS: A população elegível do estudo foi de 146 pacientes, sendo 91 mulheres (62%), com idade média de 61 ± 13 anos. O seguimento mínimo foi de 24 meses, sendo o tempo médio de seguimento de 60 ± 27 meses, e o tempo médio de recorrência global da doença de 27 ± 11 meses. Metástases hepáticas ocorreram em 7,5% da população, a maioria proveniente do estadio III, e o tempo médio de recorrência no fígado foi de 25 ± 16 meses. CONCLUSÕES: Para esta coorte a ressecção do CCR potencialmente curável por via laparoscópica não modificou a incidência de metástases hepáticas a longo prazo, ao comparar nossos resultados aos dos grandes ensaios clínicos randomizados. Para os pacientes analisados, a ressecção laparoscópica foi eficaz e segura em relação aos resultados oncológicos a longo prazo.

Analysis of the mid and long term results of mitral valve replacement in 48 cases / 中华胸心血管外科杂志

Objective To study the mid-and long-term outcomes and prognostic risk factors of mitral valve replacement (MVR) in children.Methods Retrospectively studied the cases(＜ 14 years) receiving MVR between July 2003 and March 2014 in our hospital,and recorded the gender,age,operation related data and the results of echocardiography,electrocardiogram and chest X-ray in the out-patient department.Results A total of 48 patients were followed up.Age was 8 months 15 days-13 years 9 months and 22 days,the average was (9.5 ± 3.9) years.24 cases were original operations,others were second operations.43 mechanical valves were used,as well as 5 tissue valves.The mortality was 8.3 ％ and the incidence of complications was 25.0％ during the hospitalization or within 30 days after the operations.Follow-up time was 4.7-150.7 months,the average was(62.0 ± 42.3) months.The long-term mortality was 9.1％,and the incidence of complications was 9.4％.Follow-up of left ventricular ejection fraction was 0.30-0.77,the average was 0.61 ±0.08.There was no redo-MVR or implantation of pace maker.The survival rates of 1 year,5 years and 10 years were (89.5 ± 4.5) ％、(83.0 ± 6.1) ％、(77.8 ±7.6)％,respectively.Children younger than 5 years was the risk factor for perioperative mortality or complications (OR =8.47,95％ CI:1.36-52.61).Children with perioperative complications was the risk factor for long-term mortality or complications(OR =9.97,95％ CI:1.39-71.76).Conclusion The results of children with MVR were satisfactory.To perform MVR in children older than 5 years if possible and to reduce the incidence of perioperative complications could improve the prognosis.

Evolución alejada de los pacientes operados por hemorroides complejas o más de tres paquetes con técnicas no hemorroidopexia / Remote evolution of patients operated by complex hemorrhoids or more than three packages with non-hemorrhoidopexy techniques

Introducción: Las hemorroides son una patología muy frecuente. La mayor parte de los pacientes son tratados con modificaciones en la dieta, aquellos que no responden al tratamiento son pasibles de tratamientos ambulatorios y los casos más avanzados quirúrgicos. Objetivos: Estudiar la evolución alejada de los pacientes con patología hemorroidal severa. Diseño: Estudio retrospectivo con encuesta telefónica. Material y Métodos: La serie estudiada son 304 pacientes operados entre 1980 y 2012, correspondiendo 124 a casos con más de 50% de la circunferencia comprometida por trombosis, gangrena o casos de importante prolapso, a quienes se efectuó la exéresis de las zonas afectadas y la reconstrucción del canal anal utilizando colgajos cutáneos, y 180 fueron tratados de tres o más paquetes con técnica de Ferguson. Resultados: En el período considerado consultaron por hemorroides 1832 pacientes, de los cuales a 180 (9,8%) se utilizó la técnica de Ferguson para tres o más paquetes y 124 (6,8%) fueron casos complejos. Presentaron complicaciones post operatorias el 13,71% de las complejas y el 6,11% de tres paquetes o más (n s). Por medio de la encuesta encontramos en los casos denominados complejos un 93% de asintomáticos y en los de más de 3 Paquetes un 81%, resultando esta diferencia significativa. Los síntomas más frecuentes, sangrado y dolor, fueron muy esporádicos en el 71,4% vinculado a constipación o transgresiones alimentarias manifestando el 93,5% sentirse mejor que antes de operados. Conclusiones: Tanto los resultados inmediatos como el seguimiento alejado en la serie presentada han sido muy satisfactorios.

Introduction: Hemorrhoidal disease is a very frequent pathology. Most hemorrhoids are medically treated with diet changes. Those who do not respond satisfactorily can receive office-based treatments and the most advanced cases require surgical intervention. Aims/objectives: Study of the long-term evolution of patients with severe hemorrhoidal pathology. Design: Retrospective study with telephonic survey. Material and Methods: The studied series comprises 304 patients operated on between 1980 and 2012, corresponding 124 cases to patients with more than 50% of the anal circumference compromised by thrombosis, gangrene or cases of significant prolapse. These cases underwent exeresis of the affected areas and reconstruction of the anal canal utilizing cutaneous flaps, and 180 cases, which presented more than three bundles, were treated with Ferguson´s technique. Results: In the referred period, 1832 patients consulted about hemorrhoids. Ferguson´s technique was used on 180 patients (9,8%) and 124 patients (6,8%) corresponded to complex cases. Post-surgical complications were seen in 13, 71% of the complex cases and in 6.11% of the cases with three or more hemorrhoidal bundles (n s). The survey showed that 93% of the complex cases were asymptomatic, in comparison to 81% of those with three of more hemorrhoidal bundles, resulting in a significant difference. The most frequent symptoms: bleeding and pain, were very sporadic in 71, 4% corresponding to constipation or dietary transgressions; 93, 5% stated feeling better than before being operated on. Conclusions: The immediate results as well as the long-term follow up of the presented series have both been very satisfactory.

Long-term results of non-valved Glaucoma drainage implant surgery and glaucoma drainage implant combined with trabeculectomy.

Purpose: The purpose was to investigate the efficacy and complications of nonvalved glaucoma drainage implant (GDI) surgery and GDI combined with trabeculectomy. Subjects and Methods: Serial Japanese patients who received GDI were retrospectively investigated. The survival rate of eyes was analyzed using the Kaplan-Meier method, defining death as: (1) Intraocular pressure (IOP) <6 mmHg, or ≥22 mmHg, and <20% reduction of preoperative IOP, (2) additional glaucoma surgery, (3) loss of light perception. Prognostic factors of age, sex, previous surgery, type of glaucoma, synechial closure, preoperative IOP, type of GDI (single‑, double‑plate Molteno, Baerveldt 350) and GDI combined with trabeculectomy were investigated employing proportional hazards analysis. Results: One hundred and twenty‑four eyes of 109 patients aged 53.3 ± 7.8 years old were analyzed. Types of GDI were single‑plate (15.3%), double‑plate Molteno (71.8%), and Baerveldt 350 (12.9%). The results of survival rate analysis were 86.1, 71.1, 71.1, and 64.6% for 1, 3, 5, and 10 years respectively. Thirty‑four eyes (27.4%) died because of uncontrolled IOP (19.4%), loss of light perception (5.6%), and additional glaucoma surgery (2.4%). Single‑plate Molteno was the only risk factor for failure. Persistent unphysiological hypotony (0.8%) and bullous keratopathy (5.6%) were observed. Conclusion: Nonvalved GDI surgery and GDI combined with trabeculectomy using nonabsorbable tube ligature proved to be an excellent device for any type of glaucoma in Japanese patients. Hypotony and corneal endothelial loss are the most serious complication in the long‑term results of our patients.

¿Cuándo se indica y cuáles son los resultados a largo plazo de la cirugía en Enfermedad por Reflujo Gastroesofágico sin hernia hiatal verdadera? / When is GERD surgery indicated and which are their results in the long-term?

Introduction: Laparoscopic Nissen fundoplication is the most used technique in Gastroesophageal Reflux Disease (GERD) patients. Objectives: Review publications on long-term results (10 or more years) for this surgery. Method: Bibliographic research of literature in English language of all articles regarding this topic. Results: A total of 10 articles were found with results for a period of 10 years or more. Recurrence of heartburn was observed in 20-23 percent; post-fundoplication symptoms such as meteorism was observed in 47 percent. After 10 years, approximately 30 percent started using proton-pump inhibitors (PPIs) and another surgery was needed in 9 percent. Six articles showed no objective assessment of surgical results. One article assessed radiology only in some cases. Only 3 European articles performed objective assessments, with endoscopy and only one assessed results with 24-hour esophageal pH test. Conclusions: Nissen fundoplication is a surgical technique for controlling GERD in 75 percent of patients 10 years or more after surgery. However, very few articles present objective assessments; in most publications, assessments are subjective and made based on symptoms.

Introducción: La fundoplicatura de Nissen por vía laparoscópica es la técnica más empleada en pacientes con enfermedad por reflujo gastroesofágico (ERGE). Objetivo: Revisar las publicaciones referentes a los resultados alejados (10 o más años) de esta cirugía. Método: Se realizó una búsqueda bibliográfica en la literatura inglesa de todos los artículos referentes a este tema. Resultados: Se encontraron en total 10 trabajos relacionados con los resultados a más de 10 años. La recurrencia de la pirosis se presentó entre 20 a 23 por ciento, la aparición de síntomas post-fundoplicatura, como el meteorismo, en 47 por ciento. A los 10 años, cerca de 30 por ciento comenzó a ingerir nuevamente inhibidores de la bomba de protones y hubo necesidad de una reoperación en 9 por ciento. En 6 trabajos no hubo ninguna evaluación objetiva de los resultados quirúrgicos. En 1 trabajo sólo evaluaron radiología en algunos casos. Sólo en 3 trabajos europeos se realizaron evaluaciones objetivas, con endoscopia y sólo 1 evaluó los resultados con pHmetría de 24 h. Conclusiones: La fundoplicatura de Nissen es una técnica quirúrgica que controla los síntomas de la ERGE en 75 por ciento de los pacientes a más de 10 años de la cirugía. Sin embargo, muy pocos trabajos efectúan evaluaciones objetivas, en la mayoría de las publicaciones, las evaluaciones son sólo sintomáticas y subjetivas.

Long-term results of cornea collagen cross-linking with riboflavin for keratoconus.

Corneal collagen cross-linking with riboflavin and UVA light (CXL) is the only method designed to arrest the progression of keratoconus. Visual improvement generally starts 3 months after treatment. Reduction is coma seen on aberrometry in early postoperative phase is also responsible for the improvement in visual acuity. In the light of currently available data we can thus say that CXL is a safe procedure that is successful in arresting keratoconus.

Maintenance of the Therapeutic Effect of Two High-Dosage Antimuscarinics in the Management of Overactive Bladder in Elderly Women / 대한배뇨장애요실금학회지

PURPOSE: To improve the long-term efficiency of the pharmacologic management of overactive bladder (OAB) in elderly women. METHODS: The study comprised 229 women (mean age, 66.3 years; range, 65-77 years) with urodynamically and clinically confirmed OAB. All patients received the most effective treatment regimen based on the data obtained in the initial part of the study (trospium 60 mg/day + solifenacin 40 mg/day, for 6 weeks), and positive results similar to those in the first phase were obtained. They were then divided into four groups, based on the maintenance therapy: group A (59 women), trospium (60 mg/day) + solifenacin (40 mg/day) for 1 month; group B (51 women), electrical stimulation of the detrusor muscle for 1 month; group C (63 women), laser puncture for 1 month; group D (56 women), placebo. Maintenance therapy was administered 2.5 months after completion of primary treatment. The patients' condition was monitored through the OAB questionnaire for 1 year and by urodynamic examination at months 6 and 7 from the start of the study. RESULTS: In group A, the clinical and urodynamic results achieved after the initial + main treatment phase (two high-dosage antimuscarinics of different generations, trospium and solifenacin, for a total of 2.5 months) were maintained for at least 7 months. Electrical stimulation of the urinary bladder as a method of maintenance therapy proved to be less effective. In groups C and D, deterioration in results was observed at 6-8 months, which led us to conclude that laser puncture was an inefficient method of maintenance therapy in elderly women with OAB. CONCLUSIONS: Maintenance treatment of OAB in elderly women with a combination of high-dosage antimuscarinics is an effective method for reducing the risk of recurrence of the disease.

Clinical Study of Brachial Vein Transposition Fistulas for Hemodialysis / 日本心臓血管外科学会雑誌

Brachial vein transposition fistulas for hemodialysis are embloyed when the superficial veins in arms are not used. In our hospital, 28 patients have received brachial vein transposition fistula in the past 13 years. Post-operative complications were bleeding at the puncture sites in 2 patients, infection at the puncture site in 1, and aneurysm formation in the transposed vein in 1. Access related hand ischemia and venous hypertension were not recognized. For 3 patients of fistula stenosis, percutaneous catheter dilatation was performed. For 2 of 19 patients with fistula occlusion, surgical thrombectomy was performed. The primary patency rates were 76.8% at 1 year and 55.8% at 4 years. The secondary patency rates were 95.5% at 1 year and 66.3% at 4 years. The brachial vein transposition procedure is useful for long-term continuation of hemodialysis using autologous arm vessels.

Long-Term Results of Silicone Tube Intubation in Patients with Common Canalicular Stenosis

PURPOSE: To evaluate the clinical effects of silicone tube intubation in patients with epiphora and a narrow common canaliculus. METHODS: We conducted a retrospective chart review of 107 patients (169 eyes) who underwent silicone tube intubation for treatment of canaliculus between August 2008 and August 2010 and who were followed for more than 12 months. The patients were divided into 3 groups: patients with canalicular stenosis (A), patients with common canalicular stenosis (B), and patients with nasolacrimal duct stenosis (C). Successful treatment was defined as attainment of the predefined requisites, which included improvements in the clinical symptoms following surgery, an adequate passage of tears resulting from post-operative probing and syringing, and continued improvement to the time of the patients' final follow-up visit. In contrast, surgical failure was defined as the lack of post-operative symptom improvement, and recurrence was defined as the appearance of epiphora following the silicone tube extubation. RESULTS: The average follow-up duration for the entire group of patients was 30.5 months. The success rates of Group A, Group B, and Group C were 66%, 75.4%, and 56.3%, respectively, demonstrating that Group B attained the highest success rate. These success rates are similar to rates resulting from other types of surgery such as canaliculodacryocystorhinostomy. CONCLUSIONS: Silicone tube intubation can be considered a relatively simple and effective surgical technology for the long-term treatment of patients with a narrow common canaliculus.

Long-term results after treatment of humeral neck fractures using modified hackethal bundle nailing / Resultados a largo plazo del tratamiento de fracturas del cuello humeral usando el enclavado en haz de hacketal modificado

OBJECTIVES: This study reports the long-term surgical outcomes of elderly patients who underwent surgery using the modified Hackethal bundle nailing method on the basis of an approximately 10-year follow-up study. METHODS: We treated 34 patients (7 males, 27 females) with 2- and 3-fragment fractures of the proximal humeral neck. Their ages at the time of operation ranged from 65 to 75 years (mean age, 69.5 years). They were classified as Neer group I (G-I, 8.8%), III (G-III, 79.4%) or IV (G-IV, 11.8%). The duration of follow-up in patients averaged 130.6 months (range: 125.0 - 156.0 months). Patients were graded according to the Constant-Murley (CM) scoring system. Pre-operative and postoperative X-rays were also assessed. RESULTS: All the fractures united within 6-9 weeks, with an average of 7.4 weeks. The mean overall Constant score was 80.0points (G-I: 83.3; G-III: 80.5; G-IV: 75.6). Among the 34patients, 30 (88.2%) obtained excellent results and 4 (11.8%) obtained good results. Mal-union in the coronal plane was observed in two patients (6.28%) who had 160 degrees angulation in three part fracture. Mal-union of the greater tuberosity occurred in one patient (3.14%) leading to limitation of abduction to 90 degrees. There were no cases ofavascular necrosis, neurovascular complications or deep infections. CONCLUSION: This study suggests that the modified H-technique is simple, less invasive, and a reliable and effective procedure for elderly patients.

OBJETIVO: Este estudio reporta resultados quirúrgicos a largo plazo de pacientes de edad sometidos a cirugías mediante el método de enclavado en haz de Hacketal modificado, sobre la base de un estudio de seguimiento de aproximadamente 10 años. MÉTODO: Se trataron 34 pacientes (7 varones, 27 hembras) con fracturas en dos y en tres fragmentos del húmero proximal. Sus edades al momento de la operación fluctuaban de 65 a 75 años (edad promedio, 69.5 años). Fueron clasificados como grupo I de Neer (G-I), 8.8%), III (G-III, 79.4%) o IV (G-IV, 11.8%). La duración del seguimiento en los pacientes promedió 130.6 meses (rango: 125.0-156.0 meses). Los pacientes fueron clasificados de acuerdo con el sistema de puntuación Constant-Murley (CM). También se evaluaron los rayos X preoperatorios y postoperatorios. RESULTADOS: Todas las fracturas cicatrizaron en un período de 6 - 9 semanas, para un promedio de 7.4 semanas. El promedio de la puntuación Constant general fue de 80.0 puntos (G-I: 83.3; G-III: 80.5; G-IV: 75.6). De los 34 pacientes, 30 (88.2%) obtuvieron resultados excelentes y 4 (11.8%) obtuvieron buenos resultados. Se observó una mala cicatrizaron en el plano frontal en el caso de dos pacientes (6.28%) que tenían 160 grados de angulación en una factura en tres partes. La mala cicatrización de mayor tuberosidad ocurrió en un paciente (3.14%), y condujo a una limitación de la abducción de 90 adgrados. No se produjeron casos de necrosis avascular, complicaciones neurovasculares o infecciones profundas. CONCLUSIÓN: Este estudio indica que la técnica de Hacketal modificada es simple, menos invasiva, y constituye un procedimiento confiable y efectivo para los pacientes de mayor edad.

Long-Term Results of Reconstruction of Orbital Wall Fracture With Resorbable Copolymer Mesh

PURPOSE: This study examined the postoperative long-term results of the reconstruction of orbital wall fracture using Macropore(R). METHODS: The long-term results for 10 patients who were diagnosed with orbital wall fracture and received the repair of orbital wall fracture using Macropore(R), were examined postoperatively after an average of 23.5 months. RESULTS: The mean difference in orbital volume between the fractured orbit and the unaffected orbit after an average of 23.5 months postoperatively was 1.01+/-0.70 cm3 (4.75+/-2.92%), which slightly increased compared to 0.70+/-0.52 cm3 (3.26+/-2.10%) immediately after the operation, although the difference was not statistically significant (p-value=0.190). At the last follow-up, the shape of Macropore(R) was not observed in 3 out of the 10 patients, and intense ossification was observed at the site of fracture in 6 patients. At the last follow-up, one patient showed 1.5 mm enophthalmos, and the other patients did not show the occurrence of diplopia or the progress of enophthalmos. CONCLUSIONS: According to the long-term results of the reconstruction of orbital wall fracture, Macropore(R) is considered an implant that produces a safe and satisfactory effect without notable complications.

Long-term Results of Silicone Tube Intubation in Incomplete Nasolacrimal Duct Obstruction (NLDO)

PURPOSE: To evaluate the results of long-term follow-up of silicone tube intubation in patients with acquired nasolacrimal duct obstruction (NLDO) that is incomplete. METHODS: A retrospective analysis was conducted of the outcomes of silicone intubation performed between 1998 and 2003. During that period, we performed silicone intubation on 109 eyes, but only 45 eyes that completed at least 6 months of follow-up were included in the analysis. RESULTS: The mean follow-up period was 30.4 months (6~76 months), and silicone tubes remained in place an average of 6.5 months (1~18months). The success rate, which is defined as the improvement of epiphora symptoms with patent nasolacrimal irrigation. CONCLUSIONS: Silicone tube intubation is a simple, cost-effective, and beneficial treatment for patients, but the recurrence rate increases over time, especially several years after the operation.

Long Term Results of Microsurgical Dorsal Root Entry Zonotomy for Intractable Pain Associated with Brachial Plexus Injury

OBJECTIVE: Brachial plexus injury can produce a intractable chronic neuropathic pain. This study was undertaken to assess the long term outcome of microsurgical dorsal root entry zonotomy(MDT). METHODS: Between October 1997 and December 2002, 21 patients received MDT because of a intractable pain resulting from brachial plexus injury. Of these, 19 patients were followed for more than 2 years. Fourteen of 19 patients were male and patient ages ranged from 22 to 69 years. Mean pain duration was 36.8 months and all patients had severe pain of 9~10 visual analogue scale. To achieve complete destruction of abnormal dorsal horns, thermocoagulation of the posterolateral sulcus were performed and careful gluing was done to prevent postoperative adhesion and pain recurrence. RESULTS: Of the 19 patients, 15 patients had excellent (>75% reduction in pain) and good (51~75% pain relief) results in a average postoperative period of 4.1 years. One patient had a poor (less than 25% pain relief) result. Three patients were considered to have a fair result (26~50% pain relief). Postoperative complications were 2 transient ipsilateral ataxia and 1 CSF fistula that resolved without surgical revision. CONCLUSION: These results indicate that MDT provides excellent long-term pain relief in medically intractable chronic neuropathic pain following brachial plexus injury without significant complications.

Long Term Results of the Lensectomy in Children with Ectopia Lentis

PURPOSE: To analyze the clinical features and the long term visual results of children with ectopia lentis after lensectomy. METHODS: Enrolled in this study were 79 eyes of 43 patients who were operated on and followed up for at least 3 years. We performed a retrospective analysis of the patient records. RESULTS: The mean age at diagnosis was 4.6 years, mean age at surgery was 5.7 years and average follow-up was 7.1 years. Of the 43 patients with bilateral ectopia lentis, 7 underwent monocular surgery. The mean age at diagnosis was higher and mean postoperative BCVA was significantly lower in the monocular surgery group than in the binocular surgery group. All eyes showed reduced hyperopia for 5 years postoperatively, but the reduction rate of the monocular operated eyes was significantly lower than that of the binocular operated eyes (P<0.05). No complication occurred during surgery and 1 eye (1.3%) with Marfan syndrome showed retinal detachment 9 years after surgery. CONCLUSIONS: Surgical treatment of ectopia lentis was safe and showed good visual outcomes after 7.1 years of follow-up. Nevertheless, consideration must be given to the possibility of amblyopia due to the difference of the degree of dislocation between the two eyes.

Resultados a largo plazo de la valvuloplastía mitral percutánea con balón de Inoue: Experiencia del CMN 20 de Noviembre ISSSTE / Mitral percutaneous valvuloplasty with Inoue Balloon: Long-term results at the National Medical Center 20 de Noviembre ISSSTE, Mexico

La valvuloplastía mitral con balón de Inoue se ha convertido en los últimos 15 años en el procedimiento intervencionista de elección en pacientes con estenosis mitral con valvas flexibles y no calcificadas. En este artículo nosotros reportamos la experiencia a largo plazo de 100 pacientes a quienes se les realizó este procedimiento en nuestro hospital (CMN 20 de Noviembre ISSSTE). El promedio de seguimiento fue de 38.72 ∓ 22.4 meses. Se logró éxito en el 83.3% de los pacientes. El área valvular mitral aumento de 0.95 ∓ 0.16 a 1.62 ∓ 0.24 cm² (P < 0.001) después del procedimiento y al final del seguimiento el área fue de 1.57 ∓ 0.29 cm². El gradiente trans-valvular medio disminuyo de 8.80 ∓ 3.67 mm Hg a 4.74 ∓ 1.90 mm Hg (P < 0.001). Se presentaron complicaciones en el 7.0% de los pacientes, la más frecuente fue la insuficiencia mitral debido a ruptura de una de las valvas. No hubo decesos. Conclusiones: La valvuloplastía mitral con balón es un procedimiento efectivo en pacientes con score de Wilkins ⋜ 8, con un mínimo riesgo de complicaciones y un resultado duradero a largo plazo, con el 90% de los pacientes en clase funcional I NYHA al final del seguimiento.

Balloon mitral valvuloplasty has, over the last 15 years, become an established interventional procedure for patients with pliable non-calcified mitral stenosis. In this article we describe the long-term outcome of 100 patients from our hospital (National Medical Center "20 de Noviembre" ISSSTE, Mexico City), who were treated with this procedure. Average follow-up was 38.72∓22.4 months. The procedure was successful in 83.3% of the patients. After the procedure, the average valvular area changed from 0.95∓0.16 to 1.62∓0.24 cm² (P < 0.001) and, at the end of the follow-up time, it was 1.57 ∓ 0.29. The trans-valvular mean gradient changed from 8.80∓3.67 mm Hg to 4.74∓1.90 mmHg (P ⋜ 0.001). Complications occurred in 7.0% of the patients, the most important one being acute mitral insufficiency due to valvular rupture. No deaths occurred. Conclusions: Balloon valvuloplasty is an effective method in patients with Wilkins score of 8 or less, with minimal risk of complications, and long lasting results. At the end of the follow-up time, patients were in NYAH functional class I. (Arch Cardiol Mex 2003; 73:18-23).

Long Term Results of the Selective Spinal Nerve Root Block for the Herniated Lumbar Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To access the 5-year outcomes of patients with sciatica, not caused by spinal stenosis, spondylolysis, spondylolisthesis or congenital deformity, but by a lumbar herniated intervertebral disc (HIVD), treated by a selective nerve root block (SNRB). A review of the alternative treatments, during the follow up period, is also presented. SUMMARY OF LITERATURE REVIEW: Controversy exists about the therapeutic effects, particularly the long-term effects of a SNRB, in sciatica caused by a lumbar HIVD. MATERIALS AND METHODS: SNRB was performed on a total of 288 patients, diagnosed with a lumbar HIVD, through the clinical manifestations and physical and radiological findings, including MRI, between Jan. 1992 and Dec. 1997. Of the 288 patients, the 79 that underwent SNRB treatment only, and were minimally followed up for five years, were reviewed. The type of HIVD was based on the MRI findings, and the results of the SNRB were analyzed, with regard to the presence or absence of a relapse, the other treatments for recurrent or remnant symptoms following the SNRB, return to previous daily living and working activities and the degree of subjective symptomatic improvement, as assessed by a chart review, or an out patient department follow up or a telephone interview. RESULTS: With regard to the HIVD, there were 17 cases of bulging type (21.5%), 37 of protrusion (46.8%), 21 of extrusion (26.6%) and 4 of sequestration (5.1%) types. Medication and physical therapy was required in 13 cases (16.5%) and 35 cases (44.3%) used herbal medication and acupuncture. Thirteen of the 79 cases relapsed, and 10 were treated by microscopic discectomy. SNRBs were reperformed in 3 cases. Twenty-three cases (29.1%) required no treatment. Fifty-six cases (84.8%) returned to their previous daily living and working activities. SUMMARY: As this study did not accurately evaluate the change in the natural history of a HIVD following a SNRB, a further prospective study is still required. However, a SNRB is still a valuable non-operative treatment method for the acute radicular pain associated with a HIVD.

Long Term Follow-up Results of Total Knee Arthroplasty

PURPOSE: We purpose to analyse the clinical and radiologic results of total knee arthroplasty and long term survival rate and to assess the cause of failure. MATERIALS AND METHODS: We retrospectively investigated 156 TKAs(110 patients) from January 1985 to March 1992 followed up for more than 10 year. These series of 110 patients included 20 men and 90 women, the mean follow-up period was 12 years 3 months(range 10~18 years). In primary diagnosis, there were Degenerative Arthritis (DA) 105 knees, Rheumatoid Arthritis(RA) 45 knees, others 6 knees. Of 156 knees, there were 139 Cruciate-Retaining type(CR), and 17 Posterior-Stabilized type(PS). Both femoral and tibial component were fixed with cement in 71 knees, 15 knees were fixed without cement, and only one component was fixed with cement in 70 knees(Hybrid). Press Fit Condylar(PFC) prosthesis were 133, Miller Galante(MG) were 16, and others 7. 16 cases of patella were preserved and 140 knees were resurfaced. The clinical outcome was evaluated according to the HSS and American Knee Society scoring system and radiologic analysis was made by tibiofemoral angle and radiolucent line by American Knee Sociey system. Results: The HSS score was improved from 51.7 to 86.4 and ROM was improved from 101.3 degrees to 111.7 degrees. The last ROM was improved in DA group than RA, and HSS score of PFC prosthesis was higher than Miller-Galante. The failure were seven(5.3%) in PFC, but seven(43.8%) in MG. The survival rate was 93.0% after 10 years, and 88.8% after 14 years when the endpoint was defined as revision arthroplasty. The arthroplasty fails due to wear, aseptic loosening and deep infection and patellofemoral complication. CONCLUSION: The total knee arthroplasty is a safe, durable, and predictable procedure and has a long survivorship if we select the proper prosthesis.

Long-term Results of Laser in Situ Keratomileusis for High Myopia Above-15D

PURPOSE: We have evaluated the results of laser in situ keratomileuresis (LASIK) for high myopia above -15D over the follow-up periods of three years. METHODS: Twenty-two eyes from 15 LASIK patients were analyzed (10 eyes from 6 males and 12 eyes from 9 females). The average age was 30+/-6.7 years (20~42 years). The follow-up evaluations were performed at 6 months, 1 year and 3 years. RESULTS: The preoperative spherical equivalent ranged from -15.00D to -37.00D (average: -20.38+/-5.06D) and the mean postoperative spherical equivalents -2.07+/-3.43D at 6 months, -3.01+/-2.88D at 1 year, -3.05+/-2.86D at 3 years. Myopic regression continued during three-year follow-up, but, was not statistically significant (p>0.05). The incidence of increased BCVA 2 lines or more was 64% at 3 years and the case of decreased BCVA 2 lines or more was not found. The mean preoperative astigmatism was -2.93+/-2.11D and the mean postoperative astigmatisms were -0.81+/-0.81D at 6 months, -1.06+/-1.07D at 1 year and -1.16+/-1.44D at 3 years. It was significantly decreased (p<0.05). The intraoperative complications were not found. The postoperative complications after 3 years were myopic regression in 8 eyes, night glare in 8 eyes, decentration in 7 eyes and the foreign bodies in the border of the flap in 1 eye and there was no corneal haze. CONCLUSIONS: LASIK for high myopia above -15D is relatively safe. Howerver it needs further longterm evaluation.