Clinical outcomes of long-acting injectable risperidone in patients with bipolar I disorder: A 1-year retrospective cohort study.

OBJECTIVES: We explored the effect of risperidone long-acting injection (LAI) treatment on patients with bipolar I disorder in a real-world setting. METHODS: In this retrospective cohort study, 469 patients with bipolar I disorder were enrolled and treated with risperidone LAI and different oral antipsychotics and followed for 1 year. Concomitant medications, such as mood stabilizers, antidepressant, anxiolytics, hypnotics, or anticholinergics, were administered. On the basis of risperidone LAI use and treatment compliance, the patients were classified into 4 groups: the first long-acting injectable antipsychotics (LAI1) group (compliant patients receiving risperidone LAI treatment) (N=44), the second long-acting injectable antipsychotics (LAI2) group (non-compliant patients receiving risperidone LAI treatment) (N=33), the first non-LAI (NLAI1) group (compliant patients receiving oral medications) (N =337), and the second non-LAI (NLAI2) group (non-compliant patients receiving oral medications) (N=55). The rate of re-hospitalization, length of hospital stay, and rate of emergency room visit were assessed. RESULTS: Compared with the non-LAI groups, the LAI groups had longer mean duration of illness (8.5 years, P=0.0001), higher rate of admission due to mood episodes (P<0.0001), depressive episodes (P<0.0001), or manic episodes (P=0.0002), and higher rate of emergency room visit (P=0.0003) before enrollment. After a 1-year follow-up, re-hospitalization rates were significantly lower in the LAI1 group than that before enrollment for any episodes (P=0.0001), manic episodes (P=0.005), and depressive episodes (P=0.002). The rates of emergency room visit were significantly lower in the LAI1 (P=0.0001), LAI2 (P=0.013), and NLAI1 (P=0.0001) groups compared with those before enrollment. CONCLUSIONS: Risperidone LAI reduces the clinical severity of bipolar I disorder.

New double-layer design for 1-stage repair of orocutaneous and pharyngocutaneous fistulae in patients with postoperative irradiated head and neck cancer.

BACKGROUND: The development of a postoperative orocutaneous fistula (OCF) or pharyngocutaneous fistula (PCF) in the irradiated tissues of patients with head and neck cancer represents a high burden of morbidity for the patient. With high postoperative recurrence rates, these fistulae result in a reconstructive challenge for the plastic surgeon. In this study, we propose a new double-layer design to successfully repair these fistulae in a 1-stage reconstruction. METHODS: Twelve patients with an average age of 56 years (range, 45-67 years) were operated on between January 2006 and December 2012 using this double-layer single-stage technique. All patients had received postoperative radiotherapy after their initial reconstruction. A circumferential turnover flap was designed and raised from the skin surrounding the fistula to recreate inner lining using a tension-free, water-tight repair. No debridement of the fistula itself was performed. The second-layer of the reconstruction, which represents the outer lining, was achieved with either a local or a free flap. RESULTS: Fistula size ranged from 0.8 × 0.5 cm to 3 × 3.2 cm with a mean size of 2 cm(2) . The outer lining was achieved using a free flap in 5 cases and a local flap in 7 cases. All the flaps survived completely with no cases of postoperative infection, however, 1 case was complicated by mandibular plate exposure necessitating its removal. No major complication or recurrence has yet been encountered in any of our patients with a mean follow-up of 28 months (range, 12-78 months). CONCLUSION: This 1-stage double-layer design can provide a reliable and relatively straightforward means of repairing OCF and PCF in the irradiated tissues of patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E353-E359, 2016.

Risperidone long-acting injection and 1-year rehospitalization rate of schizophrenia patients: A retrospective cohort study.

AIMS: We wanted to present a picture of patients with schizophrenia receiving risperidone long-acting injection (RLAI) treatment in a real-world setting. METHODS: This was a retrospective cohort study; 379 patients with schizophrenia were enrolled and treated with different kinds of antipsychotic agents at E-Da Hospital, and received a 12-month follow up. The patients were distributed into three groups: the all-oral antipsychotic, oral risperidone and RLAI groups. The antipsychotic agents and dosages they used were recorded. The rate of rehospitalization, length of hospital stay, emergency room visits and medical expenditures were assessed. RESULTS: The RLAI group had a significantly higher rate of hospitalization before enrolment (the all-oral antipsychotic group was 32.1%, the oral risperidone group, 35.9%, and the RLAI group, 88.4%, P < 0.0001). After a 1-year follow up, all three groups were similar in rehospitalization rates (the all-oral antipsychotic group was 28.9%, the oral risperidone group, 30.1%, and the RLAI group, 30.2%, P > 0.999), length of hospital stay and number of emergency room visits during follow up. The most commonly used oral antipsychotics were risperidone (0.5-7 mg/day), quetiapine (65-1200 mg/day), and olanzapine (2-25 mg/day). CONCLUSIONS: Using RLAI reduces the severity of disease in more difficult patients.

The trapezius perforator flap: an underused but versatile option in the reconstruction of local and distant soft-tissue defects.

BACKGROUND: The trapezius myocutaneous flap is an established reconstructive option in head and neck cases The authors present their experience with 10 trapezius perforator flaps, all raised using a freestyle technique of perforator dissection, to successfully reconstruct both local and distant soft-tissue defects. METHODS: Ten patients underwent soft-tissue reconstruction using trapezius perforator flaps. After mapping the perforator with a handheld Doppler device at the intersection of a horizontal line drawn 6 to 8 cm inferior to the scapular spine and a vertical line drawn 8 to 9 cm lateral to the midline of the back, perforator flaps were raised in a freestyle fashion, with complete preservation of the trapezius muscle. The flap can be pedicled into local defects or transferred as a free flap. RESULTS: Six flaps were elevated as pedicled flaps and four were transferred as free flaps. Flap size ranged from 6 × 4 cm to 25 × 15 cm. The pedicle length ranged from 4 to 14 cm. The pedicle originated from the dorsal scapular artery. In one case, the authors converted from a pedicled flap to a free flap secondary to insufficient pedicle length. All donor sites were closed directly. The follow-up period ranged from 4 months to 4 years. All of the flaps survived completely with no major complications, and no patients developed any shoulder dysfunction. CONCLUSIONS: The trapezius perforator flap is a reliable and versatile reconstructive option that can be used to repair both local and distant soft-tissue defects. The donor-site morbidity is minimal. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

An alternative option to overcome difficult venous return in head and neck free flap reconstruction.

BACKGROUND: The frozen neck secondary to prior neck irradiation and surgery is not uncommon in head and neck surgery. Identifying the optimal and alternative recipient vein in patients with difficult necks is one of most important steps in preceding a free flap for head and neck reconstruction. PATIENTS AND METHODS: This is a retrospective study. From January 2006 to October 2011, the authors performed 544 cases of free flap reconstruction for head and neck cancer. The indications for choosing the retrograde limb of the superficial temporal vein as recipient vein were: (1) the flap pedicle contained only one vein 'and' (2) the patient had frozen neck or vessel-depleted neck from surgery. Amongst them, 10 patients with difficult neck where the retrograde limb of the superficial temporal vein was used as the only recipient vein for outflow were collected for the study. RESULTS: The mean age was 51.7 years. The types of flaps included the anterolateral thigh (ALT) flap (n = 6), anteromedial thigh (AMT) flap (n = 1), medial sural perforator flap (n = 1) and trapezius perforator flap (n = 1). One flap needed take-back due to haematoma compression of the pedicle. All nine flaps survived completely. CONCLUSION: The retrograde limb of the superficial temporal vein used as the only recipient vein served as an alternative option for venous return to precede a successful free flap reconstruction in difficult neck cases. The presence of valves in the vein system in the head and neck does not seem to preclude the use of retrograde flow anastomosis in patients with frozen neck.