A follow-up study of percutaneous intramyocardial septal radiofrequency ablation in the treatment of obstructive hypertrophic cardiomyopathy with mild septal hypertrophy / 中华超声影像学杂志

Objective:To evaluate the clinical efficacy of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in the treatment of obstructive hypertrophic cardiomyopathy (HOCM) with mild septal hypertrophy.Methods:Forty-five HOCM patients with mild septal hypertrophy (the maximal left ventricular wall thickness is 15-19 mm) who were treated with PIMSRA between November 2016 to February 2021 in the Hypertrophic Cardiomyopathy Center of Xijing Hospital of Air Force Military Medical University were enrolled, and their clinical datas were collected and analyzed. The clinical symptoms and NYHA functional class before operation, 6 months and 1 year after operation were collected. Interventricular septum thickness, left ventricular outflow tract pressure gradient, left ventricular outflow tract diameter, mitral regurgitation, left ventricular systolic and diastolic function were evaluated by transthoracic echocardiography before operation, 6 months and 1 year after operation, intraoperative complications were monitored and recorded. Postoperative arrhythmias were monitored by routine 12 lead ECG and 24-hour ambulatory ECG.Results:All patients successfully completed PIMSRA procedure.No clinical adverse events such as death, bleeding and stroke occurred during and around the operation.No left bundle branch block, complete atrioventricular block and malignant arrhythmia occurred after the operation. All patients did not need permanent pacemaker implantation.NYHA functional class and clinical symptoms of patients were significantly improved after 6 months compared with values before operation (all P<0.001, respectively), it remained stable for 1 year after operation; Anterior interventricular septum, posterior interventricular septum, maximal left ventricular wall thickness all significantly decreased (all P<0.001, respectively), left ventricular outflow tract diameter widened ( P<0.001), continuous improvement 1 year after operation; left ventricular outflow tract gradient and provoked left ventricular outflow tract gradient all significantly decreased, mitral regurgitation decreased and SAM classification reduced after 6 months compared with values before operation (all P<0.001, respectively); left ventricular end-diastolic diameter widened and left atrial diameter decreased (all P<0.001, respectively), it remained stable for 1 year after operation. Left atrial volume index decreased ( P<0.001), with continuous improvement 1 year after operation; The ratio of early diastolic mitral valve velocity to early diastolic mitral annulus velocity (E/e′) decreased ( P=0.001), it remained stable for 1 year after operation. There were no significant differences in left ventricular end diastolic volume, left ventricular end systolic volume and left ventricular ejection fraction among the three groups (all P>0.05). Conclusions:PIMSRA is effective in the treatment of obstructive hypertrophic cardiomyopathy with mild ventricular septal hypertrophy.

Safety and effectiveness of superselective embolization of the uterine arteries in the treatment of uterine fibroids / 中国基层医药

Objective:To analyze the safety and effectiveness of superselective embolization of the uterine arteries in the treatment of uterine fibroids.Methods:The clinical data of 60 patients with uterine fibroids who were admitted to Zhejiang Veteran Hospital from February 2020 to February 2022 were retrospectively analyzed. These patients were divided into a control group and an observation group ( n = 30/group) according to different surgical methods. The control group underwent conventional surgery. The observation group underwent superselective embolization of the uterine arteries. Uterine size, uterine fibroid size, postoperative hormone level, and complications were compared between the two groups. Results:There was no significant difference in total response rate between the observation and control groups [93.33 (28/30) vs. 83.33 (25/30), χ2 = 1.46, P > 0.05]. After surgery, serum estradiol, luteinizing hormone, follicle-stimulating hormone, and progesterone levels in the observation group were (164.14 ± 19.97) ng/L, (2.43 ± 1.47) IU/L, (2.51 ± 1.14) IU/L, and (5.05 ± 0.43) μg/L, respectively, which were significantly lower than (190.23 ± 21.62) ng/L, (3.78 ± 1.63) IU/L, (3.94 ± 1.23) IU/L, (8.22 ± 1.35) μg/L in the control group ( t = 4.86, 3.37, 4.67, 12.25, all P < 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group [3.33% (1/30) vs. 20.00% (6/30), χ2 = 4.04, P < 0.05). Conclusion:Compared with conventional surgery, superselective embolization of the uterine arteries is more effective on uterine fibroids, better keep postoperative hormone level stable, and reduce or avoid short- and long-term complications. Therefore, superselective embolization of the uterine arteries for the treatment of uterine fibroids deserves the clinical promotion.

Results of radiotherapy in squamous cell laryngeal cancer: A tomotherapy center experience

Background: Laryngeal cancer is a common type of head and neck cancer (HNC). Radiotherapy (RT) is a mainstay for curative treatment. Intensity-modulated RT (IMRT) is a standard technique today, as it provides of higher survival and local control and lower normal tissue toxicity. One of IMRT devices is helical tomotherapy (HT). The HT treatment results of HNC patients have been reported in few studies. We aimed to investigate the results of squamous cell laryngeal carcinoma patients treated with helical tomotherapy. Methods: Forty-five laryngeal cancer patients were selected according to the inclusion criteria. Radiotherapy (RT) plans were set in the Hi-Art HT planning system. Image-gated RT (IGRT) technique was used. Appropriate patients received simultaneous cisplatin. Treatment response rates were evaluated at the post-RT third and sixth months. Survival times were calculated with the Kaplan–Meier method. The factors affecting the treatment results were evaluated using Log-rank and Cox regression tests. A P value of less than 0.05 was accepted as statistically significant. Results: The median age was 65 (28–84) years. The median symptom duration was 6 (1–60) months. The RT dose for the early and the locally advanced disease was median 63 Gy (60.75–66) and 66 Gy (60–70), respectively. The RT interruption was median two (0-20) days. The patients were followed up to 25 (1–45) months. Grade 2 xerostomia and dysphagia rates were 55% and 7%, respectively. The 3-year estimates of overall survival (OS), disease-free survival (DFS), metastasis-free survival (DMFS), and locoregional recurrence-free survival (RRFS) were 71.7%, 60.4%, 84.9%, and 68.5%, respectively. In univariate analysis, the presence of N2 disease was a negative prognostic for DFS (P = 0.05) and DMFS (P = 0.003). RT interruption >2 days was a negative prognostic for OS (P = 0.005), DFS (P = 0.02), and RRFS (P = 0.023). In the multivariate analysis, symptom duration >6 months was found to be the only significant factor for DFS (P < 0.05). Conclusion: Intensity-modulated radiation with HT achieved comparable clinical outcomes with acceptable toxicity in laryngeal carcinoma.

Vitamin D and ischemic stroke / 国际脑血管病杂志

Ischemic stroke is the second leading cause of disability and death worldwide, which brings heavy burden to society and families. Epidemiological studies have shown that vitamin D level are associated with the prevalence of hypertension, diabetes, atherosclerosis, and cerebrovascular events. This article reviews the relationship between vitamin D level and ischemic stroke risk, infarct volume in acute phase, severity of neurological deficit and functional outcome, and discusses the impact of vitamin D supplementation on ischemic stroke, and expects to provide new ideas for the prevention and treatment of ischemic stroke.

Identación escleral y retinopexia neumática / Scleral buckling and neumatic retinopexy

Objetivo: Determinar los resultados de la técnica quirúrgica de identación escleral y la de retinopexia neumática en el desprendimiento regmatógeno de retina. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en pacientes operados con la técnica de identación escleral y la de retinopexia neumática en el Centro Oftalmológico de Villa Clara entre junio de 2019 y diciembre de 2020. Resultados: Los hombres fueron los más afectados y la edad media fue de 57,5 años. En el 72,7 por ciento la rotura causante del desprendimiento fueron los desgarros en herradura. La media del tiempo de evolución de la enfermedad fue de 7,2 días y el 77,3 por ciento de los ojos presentaba mácula desprendida al momento del diagnóstico. El 68,2 por ciento tuvo una agudeza visual mejor corregida preoperatoria < 20/200. Los pacientes con mácula desprendida preoperatoria alcanzaron como media una agudeza visual final de 0,4 ± 0,3 (desviación estándar). En el 86,4 y el 77,3 por ciento de los ojos se lograron buenos resultados anatómicos y funcionales finales. Las membranas epirretinales se presentaron como complicación posoperatoria en ambas técnicas quirúrgicas y el líquido subretinal residual solo en la retinopexia neumática. Conclusiones: El desprendimiento regmatógeno de retina se presenta con pobre agudeza visual preoperatoria. Con ambas técnicas quirúrgicas, en pacientes con ninguna o mínima vitreorretinopatía proliferativa, se logran buenos resultados anatómicos y funcionales.

Objective: Determine the results of the surgical technique of scleral buckling and neumatic retinopexy in rhegmatogenous retinal detachment. Methods: A prospective longitudinal descriptive study was conduced of patients undergoing scleral buckling and neumatic retinopexy at Villa Clara Ophthalmology Center from June 2019 to December 2020. Results: Male gender prevailed; mean age was 57.5 years. In 72.7 percent of the cases the retinal break causing the detachment was a U-shaped tear. Mean time of evolution of the disease was 7.2 days, and 77.3 percent of the eyes had a detached macula at diagnosis. In 68.2 percent preoperative best corrected visual acuity was <20/200. Patients with a preoperative detached macula achieved a mean final visual acuity of 0.4 ± 0.3 (standard deviation). Good final anatomical and functional results were obtained in 86.4 percent and 77.3 percent of the eyes. Epiretinal membranes were a postoperative complication in both surgical techniques, whereas residual subretinal fluid was a complication only in neumatic retinopexy. Conclusions: Rhegmatogenous retinal detachment presents with poor preoperative visual acuity. Both surgical techniques obtain good anatomical and functional results in patients with minimum or no proliferative vitreoretinopathy(AU)

Safety and Feasibility Assessment for Treating Severe External Carotid Artery Stenosis and Ipsilateral Internal Carotid Artery Occlusion by External Carotid Artery Stenting / 中国循环杂志

Objective: To assess the safety and feasibility for treating the patients with severe external carotid artery (ECA) stenosis and ipsilateral internalcarotid artery (ICA)occlusion by external carotid artery steting (ECAS). Methods: A total of 17 consecutive patients with severe ECA stenosis and ipsilateral ICA occlusion treated in our hospital by ECAS from 2008-01 to 2013-06 were retrospectively studied. Post-operative improvements of cerebral ischemia and neurocognitive function [Mini-mental state examination (MMSE) and Montreal cognitive assessment (MOCA)] were evaluated, complications at peri-operative and 12 months follow-up period were recorded. Results: The patients' mean age was (65.4±8.0) years including 13(76.5％) male. The success rate of ECAS was 100％;2 patients had hemodynamic depression at peri-operative period and were completely recovered by 2 days treatment.1 patient suffered from contralateral minor stroke at 12 months follow-up time, the other 16 patients were without cerebral ischemia symptoms. No complication occurred at peri-operative and 12 months follow-up period. Compared with pre-operative condition, MMSE score [(25.1±1.4) vs (23.3±1.8), P<0.01] and MOCA score [(23.9±1.2) vs (22.2±1.6), P<0.01] were increased at 3 months after ECAS; both scores were continuously increasing during 12 months follow-up period. Conclusion: ECAS may improve cerebral ischemia and cognitive function in patients with severe ECA stenosis and ipsilateral ICA occlusion.

Evaluación de la respuesta a la terapia de resincronización cardíaca en un grupo de pacientes que asisten a un programa de falla cardíaca / Evaluation of the response to cardiac resynchronisation therapy in a group of patients taking part in a heart failure program

Resumen Introducción: la terapia de resincronización cardiaca es una de las estrategias de tratamiento actuales para pacientes con insuficiencia cardiaca y función sistólica deprimida, que ha demostrado producir un alivio significativo en los síntomas, así como mejoría en la función ventricular izquierda y en la supervivencia a largo plazo. Objetivo: evaluar la respuesta a la terapia de resincronización cardíaca después de seis meses de seguimiento. Metodología: estudio observacional analítico de cohorte retrospectivo, con análisis anidado de casos y controles, en el que se incluyeron pacientes mayores de 18 años pertenecientes a una clínica de falla cardíaca y que fueran portadores de un dispositivo de resincronización cardíaca. Se realizó análisis univariado de las características clínicas y ecocardiográficas y posteriormente un análisis bivariado a las variables relacionadas con la respuesta a la terapia. Resultados: se incluyeron 92 pacientes con historia de falla cardíaca e indicación de terapia de resincronización; el 32,6% de los pacientes tenían cardiopatía isquémica y el 67,4% no isquémica, con una fracción de eyección promedio de 18,9%. Durante el seguimiento a los 6 primeros meses no se presentó ningún caso de muerte ni de trasplante cardíaco. Se definieron como respondedores el 47,8% de los pacientes, en tanto que el 52,2% restante fue clasificado como no respondedores. El porcentaje de pacientes que no requirieron hospitalizaciones luego de la terapia fue del 51,1%, y el 65,2% mejoró la clase funcional y 68,5% la fracción de eyección. Conclusión: en el 47,8% de la población estudiada se observó una respuesta a la terapia de resincronización cardiaca adecuada evaluada de forma combinada con parámetros clínicos y ecocardiográficos, hecho que se tradujo en una mejoría relevante en términos de fracción de eyección y clase funcional, además de menor número de hospitalizaciones por falla cardíaca, al igual que ausencia de requerimiento de trasplante cardíaco y de muertes por causa cardiovascular.

Abstract Introduction: Cardiac resynchronisation therapy (CRT) is one of the current strategies for patients with heart failure and depressed systolic dysfunction. It has shown to produce a significant reduction in the symptoms, as well as an improvement in left ventricular function and long-term survival. Objective: To evaluate the response to CRT after 6 months of follow-up. Materials and method: A retrospective, observational, analytical cohort study, with nested case-control analysis, was conducted, which included patients over 18 years of age attending a heart failure clinic, and were carriers of a CRT device. A univariate analysis was performed on the clinical and echocardiographic characteristics. A bivariate analysis was subsequently performed on the variables associated to the treatment response. Results: The study included 92 patients with a history of heart failure and an indication of CRT, of whom 32.6% had ischaemic heart disease, and with a mean ejection fraction of 18.9%. There no deaths or heart transplants during the first 6 months of follow-up. Just under half (47.8%) of the patients were considered responders to the therapy, with the remaining 52.2% classified as non-responders. The percentage of patients that did not require hospital admission after the therapy was 51.1%, 65.2% improved functional class, and 68.5% their ejection fraction. Conclusion: Just under half (47.8%) of the population studied had an adequate response to CRT, when evaluated combined with the clinical and echocardiographic parameters. This led to a significant improvement in terms of ejection fraction and functional class, including a lower number of hospital admissions due to heart failure, as well as the absence of heart transplants and deaths by cardiovascular cause.

The Trend of Diagnosis and Treatment for In-hospital Acute ST-segment Elevation Myocardial Infarction Patients in Hebei Province From 2001 to 2011 / 中国循环杂志

Objective:To assess trend of clinical features,diagnosis,treatments and outcomes for in-hospital patients of acute ST-segment elevation myocardial infarction (STEMI) in Hebei province from 2001 to 2011.Methods:Our research was based on the information of China PEACE retrospective acute myocardial infarction (AMI) study.We conducted an analysis from 8 hospitals in Hebei province including 1 third class hospital and 7 second class hospitals for STEMI patients who were diagnosed,treated and discharged in those hospitals in 2001,2006 and 2011.The clinical features,process of diagnosis and treatment and outcomes were summarized.Results:A total of 832 medical records were enrolled.During 2001 to 2011,the mean age for in-hospital STEMI patients was increased as 63.5 years in 2001,65.0 years in 2006 and 66.0 years in 2011,P=0.0097;female ratio was similar as 30.1％ in 2001,30.7％ in 2006 and 30.3％ in 2011,P=0.9846;the ratio for cardiovascular risk factors were elevated as 69.9％ in 2001,87.1％ in 2006 and 87.0％ in 2011,P＜0.0010.In patients without documented contraindications,reperfusion rate was similar,P=0.8990 and primary percutaneous coronary intervention (PCI) conduction rate was similar.The following drug therapies were increased:aspirin (P＜0.0001),clopidogrel (P＜0.0001),β-blockers (P=0.0172),statins (P＜0.0001) and ACEI/ARB (P=0.0008).In 2001,2006 and 2011,the 7-day in-hospital mortality,the ratio of death and gave-up treatment were similar,P=0.5854 and P=0.3516 respectively.Conclusion:During 2001 to 2011,the onset age and the prevalence of cardiovascular risk factors were increased in STEMI patients in Hebei province;drug therapy for secondary prevention of coronary artery disease was elevated by years while the reperfusion rate was similar and 7-day mortality was similar.

The Trend of Diagnosis and Treatment for In-hospital Acute ST-segment Elevation Myocardial Infarction Patients in Hebei Province From 2001 to 2011 / 中国循环杂志

Objective:To assess trend of clinical features,diagnosis,treatments and outcomes for in-hospital patients of acute ST-segment elevation myocardial infarction (STEMI) in Hebei province from 2001 to 2011.Methods:Our research was based on the information of China PEACE retrospective acute myocardial infarction (AMI) study.We conducted an analysis from 8 hospitals in Hebei province including 1 third class hospital and 7 second class hospitals for STEMI patients who were diagnosed,treated and discharged in those hospitals in 2001,2006 and 2011.The clinical features,process of diagnosis and treatment and outcomes were summarized.Results:A total of 832 medical records were enrolled.During 2001 to 2011,the mean age for in-hospital STEMI patients was increased as 63.5 years in 2001,65.0 years in 2006 and 66.0 years in 2011,P=0.0097;female ratio was similar as 30.1％ in 2001,30.7％ in 2006 and 30.3％ in 2011,P=0.9846;the ratio for cardiovascular risk factors were elevated as 69.9％ in 2001,87.1％ in 2006 and 87.0％ in 2011,P＜0.0010.In patients without documented contraindications,reperfusion rate was similar,P=0.8990 and primary percutaneous coronary intervention (PCI) conduction rate was similar.The following drug therapies were increased:aspirin (P＜0.0001),clopidogrel (P＜0.0001),β-blockers (P=0.0172),statins (P＜0.0001) and ACEI/ARB (P=0.0008).In 2001,2006 and 2011,the 7-day in-hospital mortality,the ratio of death and gave-up treatment were similar,P=0.5854 and P=0.3516 respectively.Conclusion:During 2001 to 2011,the onset age and the prevalence of cardiovascular risk factors were increased in STEMI patients in Hebei province;drug therapy for secondary prevention of coronary artery disease was elevated by years while the reperfusion rate was similar and 7-day mortality was similar.

Uso de técnicas de exposición en una clínica de psicología / Use of Exposure Techniques in a Psychology Clinic

El objetivo del artículo es indagar el uso de las técnicas de exposición en la práctica de la psicología clínica asistencial. Se analiza el tipo de técnicas de exposición, su frecuencia de uso, tanto en general como en función del diagnóstico, y su relación con los resultados del tratamiento. De los 880 pacientes de la Clínica Universitaria de Psicología de la Universidad Complutense, con todo tipo de diagnóstico, el 67.2% son mujeres y su edad media es de 32.79 años. Los resultados señalan que el 39.5% de los casos ha utilizado alguna técnica de exposición, siendo la Exposición Gradual la más frecuente (31.6%). Predomina el uso de las técnicas de exposición en trastornos de ansiedad (70.8%), somatomorfos (47.4%) y sexuales (47.1%). Se observa un incremento en el uso de técnicas de exposición en los casos con comorbilidad (55.4% frente a 36.3%). De los casos que han recibido alguna técnica de exposición, el 74.1% ha finalizado con éxito el tratamiento, frente al 61.9% de los que no han utilizado ninguna técnica de exposición. Se discuten los resultados, destacando el valor de usar técnicas de exposición para reducir la evitación o las respuestas de miedo con independencia del diagnóstico.

The aim of this work is to explore the use of exposure techniques at the health care context of a clinical psychology facility. Different modalities of exposure techniques, their frequency of usage - both across the entire sample and considering different diagnostic groups - and their relationship to the treatment results, were analysed. From the 880 patients with diverse diagnosis treated at the University Psychology Clinic of the Universidad Complutense of Madrid, 67.2% were women, with a mean of32.79 years. Results show that exposure techniques were used in 39.5% of total cases, being gradual exposure the most frequent (31.6%). Exposure techniques were employed foremost on anxiety disorders (70.8%), somatoform disorders (47.4%), and sexual disorders (47.1%). Also, it was observed that exposure techniques were used more often in cases with one or more comorbid diagnosis (55.4 vs. 36.3%). 74.1% of the patients treated with exposure techniques received therapeutic discharge, while 61.9% of patients not treated with exposure techniques were discharged. The results are discussed, emphasizing the utility of exposure techniques to treat avoidant or fearful behaviour regardless of the diagnosis.

IBC: índice Board CES / The IBC: CES Board Index

Resumen La medición de resultados de los tratamientos de ortodoncia es fundamental para evaluar objetivamente la calidad de la finalización y el éxito logrado por la terapia, y a su vez en la evaluación de los residentes del posgrado de ortodoncia. En la literatura se han reportado varios sistemas que permiten analizar dichos resultados, pero algunos no integran suficientes criterios o ayudas diagnósticas. La Universidad CES, basada en el American Board of Orthodontics-Objetctive Grading System (ABO-OGS), ha desarrollado un índice con 16 criterios analizados en modelos, radiografías y fotografías, que integran una medición objetiva de la finalización de los tratamientos. El propósito de este artículo fue describir el índice Board CES (IBC) como herramienta de evaluación de resultados clínicos de la ortodoncia y generar retroalimentación para el tratamiento de casos futuros mejorando la calidad de los mismos. Dicho índice podría ser empleado en universidades y en prácticas privadas.

The measurement of orthodontic treatment results is crucial to objectively assess the quality of the completion and success of therapy, and in turn in the evaluation of graduate orthodontic residents. The literature has reported several systems that analyze these results, but some do not integrate sufficient criteria or diagnostic aids. CES University, based on the American Board of Orthodontics - Objective Grading System (ABO - OGS), has developed an index with 16 criteria analyzed in models, radiographs and photographs, which allow an objective measurement of the completion of treatments. The purpose of this article was to describe the CES Board Index (IBC) as a tool for assessing clinical outcomes in orthodontics and generate feedback for the treatment of future cases improving their quality. This index could be used in Universities and in private practices.

Class II malocclusion treatment using high-pull headgear with a splint: a systematic review

OBJECTIVE: To systematically review the scientific evidence pertaining to the effectiveness of high-pull headgear in growing Class II subjects. METHODS: A literature survey was performed by electronic database search. The survey covered the period from January 1966 to December 2008 and used Medical Subject Headings (MeSH). Articles were initially selected based on their titles and abstracts; the full articles were then retrieved. The inclusion criteria included growing subjects between 8 to 15 years of age, Class II malocclusion treatment with high-pull headgear, and a control group with Class II malocclusion. References from selected articles were hand-searched for additional publications. Selected studies were evaluated methodologically. RESULTS: Four articles were selected; none were randomized controlled trials. All of the articles clearly formulated their objectives and used appropriate measures. The studies showed that high-pull headgear treatment improves skeletal and dental relationship, distal displacement of the maxilla, vertical eruption control and upper molars distalization. One of the studies showed a slight clockwise rotation of the palatal plane; the others showed no significant treatment effect. The mandible was not affected by the treatment. CONCLUSION: While there is still a lack of strong evidence demonstrating the effects of high-pull headgear with a splint, other studies indicate that the AP relations improve due to distalization of the maxilla and upper molars, with little or no treatment effects in the mandible. Greater attention to the design should be given to improve the quality of such trials.

OBJETIVO: fazer uma revisão sistemática das evidências científicas mostrando a efetividade do aparelho extrabucal com cobertura oclusal associado à tração alta em pacientes com má oclusão Classe II em crescimento. MÉTODOS: um levantamento na literatura foi realizado por meio de pesquisa em bancos de dados eletrônicos, cobrindo o período de janeiro de 1966 a dezembro de 2008, utilizando o Medical Subject Headings (MeSH). Inicialmente, a seleção foi baseada em títulos e resumos; após essa etapa, os artigos potencialmente selecionados foram integralmente observados. Os critérios de inclusão apresentaram pacientes em crescimento, entre 8 e 15 anos de idade, má oclusão de Classe II tratada com aparelhos extrabucais com cobertura oclusal e tração alta, tendo grupo controle também com má oclusão de Classe II. Os estudos selecionados foram avaliados metodologicamente. RESULTADOS: quatro artigos foram selecionados. Nenhum foi estudo controlado randomizado. Os artigos claramente formularam seus objetivos e usaram medidas apropriadas. Os estudos mostraram que houve melhora nas relações esqueléticas e dentárias, deslocamento da maxila distalmente, controle da erupção vertical e distalização dos molares superiores. Um estudo mostrou uma suave inclinação horária do plano palatino. A mandíbula não foi afetada. CONCLUSÃO: embora exista falta de forte evidência mostrando os efeitos do aparelho extrabucal com cobertura oclusal, estudos realizados indicaram que a relação anteroposterior melhorou devido à distalização da maxila e dos molares superiores, com pequeno ou nenhum efeito na mandíbula. Uma maior preocupação quanto ao desenho deveria ser dada para melhorar a qualidade de pesquisas com esse tipo de abordagem.

Age patients laparoscopic cholecystectomy clinical curative effect and complications influencing factors analysis / 中国基层医药

Objective To explore the more than 80-year-old age patients laparoscopic cholecystectomy clinical curative effects and complications.Methods More than 260 cases of 80-year-old require cholecystectomy older patients,patients with detailed records related history,select one of the 200 patients with laparoscopic cholecystectomy to treatment,the rest of the 60 patients to do open cholecystectomy treatment,to observe the clinical curative effect of the two groups ; For patients with laparoscopic group in postoperative patients according to whether there was the occurrence of complications were divided into two groups,using multiple factors regression analysis the factors caused by complications.Results Laparoscopic surgery group blood loss,operative time,length of hospital stay,drainage time,lead flow,the surgical incision length were (62.7 ± 60.3) ml,(62.7 ± 21.4) ml,(5.6 ± 1.3) d,(3.6 ± 0.7) d,(174.4 ± 121.4)ml,(4.9 ± 1.2)cm,open group were (210.4 ± 120.4)ml,(115.7 ±30.4)ml,(8.8 ±3.4)d,(6.2 ± 2.5) d,(318.2 ± 132.5) ml,(12.2 ± 1.4) cm,two groups of various observation indexes were statistically significant differences (t =3.16,4.16,2.18,3.16,2,56,5.18,P ＜ 0.05).Laparoscopic cholecystectomy patients in 200 cases of 6 patients with complications (3.0％),single factor analysis results showed that:age,diabetes history,operation time and blood loss,drainage laparoecopic cholecystectomy complications had a correlation (P ＜ 0.05) ;Multiple factors analysis results showed that:with the age increasing,diabetes history was laparoscopic cholecystectomy complications independent risk factor (P ＜ 0.05).Conclusion For age more than 80 years patients,laparoscopic cholecystectomy down than open surgery has good curative effect,its complications are the main factors for increased age and always have diabetes history.

Maxillary constriction: are there differences between anterior and posterior regions? / Atresia maxilar: há diferenças entre as regiões anterior e posterior?

OBJECTIVE: To evaluate the transverse constriction of the maxilla in both anterior and posterior regions, using Korkhaus analysis and to check whether there were any statistically significant differences within its values. METHOD: The sample comprised 341 study models. The study models were randomly selected from previous cases, without gender, age and malocclusion restrictions. The models were submitted to Korkhaus analysis. Data from these models were subjected to statistical analyzes in order to evaluate differences in anterior and posterior regions. RESULTS: The transverse discrepancies were statistically significant (p<0.001) with a greater constriction in the anterior region (mean -2.84 mm). CONCLUSION: The results showed that the differential diagnosis is very important and the treatment plan may be adapted to specific therapy focusing in a greater expansion in the anterior region.

OBJETIVO: avaliar a atresia transversa da maxila em duas regiões anatômicas, anterior e posterior, através da análise de Korkhaus, e verificar se há diferença estatisticamente significativa em seus valores. MÉTODOS: a amostra foi constituída de 341 modelos de estudo iniciais, escolhidos aleatoriamente, sem restrições em relação ao sexo, à idade e à má oclusão. Os modelos foram submetidos à análise transversa de Korkhaus e os valores obtidos analisados estatisticamente, para avaliar se as atresias encontradas eram diferentes nas regiões anterior e posterior. RESULTADOS: as discrepâncias transversas são, em média, -2,84mm mais atrésicas na região anterior, sendo essa diferença estatisticamente significativa. CONCLUSÃO: os resultados mostraram que o diagnóstico diferencial é muito importante e devemos adequá-lo aos nossos planos de tratamento e, consequentemente, a uma terapia específica de expansão maior na região anterior.

Analysis of Treatment Results of Malignant Melanoma / 대한골관절종양학회지

PURPOSE: This study was designed to evaluate the treatment results of malignant melanoma and to analyze the factors influencing prognosis. MATERIALS AND METHODS: Thirty one cases of malignant melanoma were included in this study. They were treated in our hospital surgically, medically and immunologically from January 1996 to December 2005, and were followed more than 5 years. We compared 5 year survival rate (5YSR) according to the age, gender, anatomical site, depth of tumor, TNM stage, involvement of lymph node and immuno-chemotherapy. RESULTS: Overall 5YSR was 80.6%. 5YSR of the age group below 65 years was 89.7% and 66.7% for the age group over 65 (p=0.033). 5YSR for men was 75% and 90.9% for women. 5YSR according to the site of occurrence showed 66.7% in upper extremities, 89.5% in lower extremities, and 66.7% in other site. 5YSR was 100% for the Clark level below III and 62.5% for the level above IV (p=0.032). 5YSR was 53.8% for lymph node metastasis group and 100% for non-lymph node metastasis group (p=0.021). CONCLUSION: We concluded that early diagnosis and wide excision was the most important in treatment of malignant melanoma. The prognostic fractors of malignant melanoma were age, depth of tumor (Clark's stage) and metastasis of lymph node.

Reconstrução anatômica do ligamento cruzado anterior com dupla banda: estudo prospectivo com seguimento de dois anos / Double-bundle anatomical reconstruction of the anterior cruciate ligament: a prospective study with two-year follow-up

OBJETIVO: Avaliação prospectiva dos resultados da reconstrução do ligamento cruzado anterior com dupla banda, de pacientes de nossa clínica, através do protocolo International Knee Documentation Committee 2000. DESENHO DO ESTUDO: Série de casos; nível de evidência IV. MÉTODOS: Cinquenta e oito pacientes submetidos à reconstrução anatômica do ligamento cruzado anterior, com enxerto autólogo de tendões flexores, pela técnica da dupla banda, foram avaliados de acordo com o protocolo do IKDC 2000. A idade dos pacientes variou de 17 a 58 anos, com média de 35,2 anos. O seguimento variou de 24 a 37 meses (média de 28,9 meses). RESULTADOS: No pós-operatório 89,65 por cento dos testes do pivot shift foram negativos; na avaliação final, 44 (75,86 por cento) joelhos dos pacientes foram graduados normais, 13 (22,41 por cento), como praticamente normais e um (1,72 por cento), como anormal. CONCLUSÃO: A técnica utilizada foi eficaz em promover o retorno da estabilidade articular, sem comprometer a mobilidade.

OBJECTIVE: To prospectively evaluate the results from double-bundle reconstruction of the anterior cruciate ligament, among patients at our clinic, by means of the 2000 protocol of the International Knee Documentation Committee (IKDC). STUDY DESIGN: Case series; level of evidence IV. METHODS: Fifty-eight patients who underwent anatomical reconstruction of the anterior cruciate ligament using an autologous flexor tendon graft by means of the double-bundle technique were evaluated in accordance with the IKDC 2000 protocol. The patients' ages ranged from 17 to 58 years, with a mean of 35.2 years. The follow-up ranged from 24 to 37 months (mean of 28.9 months). RESULTS: Postoperatively, 89.65 percent of the pivot-shift test findings were negative. In the final evaluation, 44 (75.86 percent) of the patients' knees were graded as normal, 13 (22.41 percent) as nearly normal and one (1.72 percent) as abnormal. CONCLUSION: The technique used was effective in promoting restoration of joint stability, without compromising mobility.

Changes in Treatment Outcomes of Gastric Cancer Surgery Over 45 Years at A Single Institution

PURPOSE: Although many studies have demonstrated improvements in short-and long-term outcomes of gastric cancer surgery, changes in long-term survival over time are not well-established. This study was conducted to evaluate changes in host, tumor, and treatment factors in patients treated at a single institution over a period of 45-yr. PATIENTS AND METHODS: We retrospectively evaluated 9282 patients with gastric cancer from 1955 to 1999, and divided the 45-yr into 4 time frames based on published articles: 1955 to 1962 (n=228), 1963 to 1972 (n=891), 1973 to 1988 (n=2789), and 1989 to 1999 (n=5374). RESULTS: Remarkable changes were noted in host, tumor, treatment factors, and prognosis. Among host factors, patients of more advanced age were identified in the 4th period and mean age shifted from 49 to 55 yrs. Among tumor factors, early gastric cancers and upper body tumors increased up to 32% and from 7% to 13%, respectively. An increase in the annual number of patients (from 29 to 649), gastrectomies (from 14 to 600), rate of resection (from 50% to 90%), rate of curative resection (up to 92%), and proportion of total gastrectomy (from 8% to 29%) was noted. Operative mortality was reduced from 6.1% to 0.7%. The overall 5-yr survival rate significantly increased from 22% to 65%. CONCLUSION: Treatment results of gastric cancer surgery have improved remarkably over the 45-year period. Increase of early stage gastric cancer with early diagnosis considerably influenced the improved survival of patients with gastric cancer.

Clinical Characteristics and Treatment Results of Nasopharyngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasopharyngeal cancer (NPC) is a rare cancer with relatively poor prognosis because they tend to be diagnosed in the far advanced stage. Radiotherapy had been the treatment of choice; however, chemotherapy combined with radiotherapy has also been used to improve the treatment outcomes. The authors attempted to investigate the clinical characteristics and the prognostic factors, and also to evaluate the efficacy of combined chemotherapy. MATERIALS AND METHODS: We analyzed 65 patients who were diagnosed with NPC and treated at Asan Medical Center. The cumulative survival rates according to various clinical factors were computed and compared using the Kaplan-Meier method and the Log-rank test. RESULTS: The most common complaint was neck mass (43.1%), followed by hearing loss (15.4%), nasal obstruction (12.3%), epistaxis (10.8%), and headache (9.2%) in order of frequency. One fifth of patients had single or multiple cranial nerve defects at the time of diagnosis. The cumulative survival rates for 3-year period and 5-year period were 63.0%, and 53.6% respectively. The location of neck metastasis, distant metastasis, cranial nerve involvement, and the response to the initial treatment were significantly related with the survival rate. T and N stages proposed by AJCC (1988) did not affect the survival rates. There was no difference in the survival rates between radiotherapy and combined chemotherapy. CONCLUSION: These results suggest that the TNM stagings proposed by AJCC (1988) might not be a good indicator in predicting the prognosis of NPC. The newer staging system which includes the location of neck metastasis should be preferred to predict the prognosis. The combination chemotherapy was not a superior method to radiotherapy in our cases, although a prospective controlled study is needed.

Age-related Clinical Characteristics and Outcome of Hepatic Resection Therapy in Hepatocellular Carcinoma Patients / 대한암학회지

PURPOSE: A retrospective clinical study of 213 patients who underwent curative resection due to hepatocellular carcinoma was performed in order to compare the mortality and survival rates of elderly patients with those of younger patients following the resection. MATERIALS AND METHODS: All subjects underwent curative resection at Shinchon & Yongdong Severance Hospital between January 1985 to December 1994. The subjects were classified into three age groups: Group I (n=26) under 40, Group II (n=142) between 41 and 60, and Group III (n=45) over 60. Variables considered include sex, family history, accompanied diseases, Hbs Ag, -PF, Child classification, operative method, resection margin, number of mass, size of mass and gross-appearance were evaluated by X2-test (p=0.05). The one, three and five year survival rates were analysed in each group by the Kaplan- Meyer method and survival curves were compared by the log-rank test. A probability of <0.05 was accepted as significant. RESULTS: The results showed that elderly patients have no significant differences from the younger patients in any of the variables considered including postoperative morbidity, survival rate and disease-free survival rate, except for the family history and positive Hbs Ag in which the elderly patients showed significantly lower values. CONCLUSION: These results suggest that hepatocellular carcinoma in the aged can be treated in identical manner as in younger patients.

Treatment of Langerhans Cell Histiocytosis / 대한정형외과학회잡지

Histiocytosis X patients present with a variety of clinical manifestations and outcomes. The principal difficulty in the establishment of a definite protocol for treatment is based on the poor understanding of the basic nature of this disease, the absence of reliable prognostic criteria, and the problems with nomenclature. The objectives of this study were to analysis the course of the disease and the results of treatment in patients who had Langerhans cell histiocytosis and to suggest prognostic factors and guidelines for management. We reviewed the thirty patient who had Langerhans cell histiocytosis for past ten years. These patients were followed for an average 4.8 years (range, excluding patients who died of the disease, two to eleven years). The patients were divided into tow group; eighteen patients who Langerhans cell histiocytosis localized in skeleton (group I) and twelve patients who had Langerhans cell histiocytosis disseminate in both skeleton and extra-skeleton (group II). Methods of treatment included curettage with or without bone graft, radiotherapy, or watchful observation alone in group I; chemotherapy, chemotherapy and radiotherapy, or curettage in group II. All eighteen patients in group I had a complete response to the therapy. Seventeen of these eighteen patients had not a recurrence by the time of the latest follow-up examination; one had a recurrence. Four of twelve patients in group II had a complete response to the therapy, four had a partial response, and four had no response. Eight of these twelve patients had a recurrence; four did not. Two patients in group II died of the disease. The significant prognostic factor was the extent of the disease, limited to the skeleton or not, and the age of onset was an indirect prognostic factor predictin multiple organ involvement.