Follow-up results 17 years after resection arthroplasty of the great toe

Resection arthroplasty of the first metatarsophalangeal joint is a well-known operation. The follow-up results more than 17 years after arthroplasty for hallux valgus are reported and discussed. Between 1971 and 1980, 335 resection arthroplasties were performed on 205 patients. The sole indication for resection arthroplasty of the great toe in this study was hallux valgus. The technique involved removal of the proximal one-third of the phalanx with interposition of a capsular flap, occasionally including temporary Kirschner wire fixation. After 17.6 years on average, 102 patients were re-examined clinically and radiographically. Questionnaire assessment revealed a significantly prolonged walking distance, and 70% of the patients were pain-free at follow-up investigation, whereas 67% suffered from severe pain before the operation. Clinical evaluation showed diminished weight-bearing of the great toe during walking and a reduced range of motion of the resected first metatarsophalangeal joint. Radiographic shortening of the proximal phalanx was 37%. The average hallux valgus angle was 23 degrees at follow-up and 34 degrees prior to surgery. The unacceptably high rate of hallux valgus relapse, especially due to a high intermetatarsal angle, emphasizes the unsatisfactory long-term results of the resection arthroplasty. We now recommend this operation for older patients only, and a differentiated approach using reconstructive procedures according to the clinical and radiographical situation for younger patients.     

Follow-up results of 415 patients after endoscopic sinus surgery

Endoscopic sinus surgery (ESS) is a method used with success in the treatment of chronic inflammatory paranasal sinus diseases. Between February 1991 and June 1995 the Messerklinger technique for ESS was used in 415 patients who had been pre-operatively evaluated in detail according to the staging system used in our clinic. Average post-operative follow-up was 23 months. Our general success rate was found to be 86.3% upon evaluating the subjective improvements in the patients' symptoms in the post-operative period. The major and minor complication rates in our series were 0.24 and 20.24%, respectively.     

Psychopathology in young adults with congenital heart disease. Follow-up results

Non-steroidal anti-inflammatory drugs inhibit constitutive (COX-1) and induced cyclooxygenase (COX-2), blocking prostaglandin production. We have compared the effects on nociceptive reflexes of meloxicam, which is COX-2 selective, with indomethacin, which is non-selective, using an in vitro spinal cord preparation. Cords were taken from naive rats, and from rats with carrageenan-induced hyperalgesia of one hindpaw. Reflex thresholds were lower in carrageenan preparations. Superfusion with meloxicam (10-100 microM) dose-dependently inhibited baseline reflexes and wind-up in normal and carrageenan preparations, whereas indomethacin (100-300 microM) had no effect. Thus meloxicam inhibits spinal reflexes, whereas indomethacin does not, despite its high affinity for both COX isoforms. We conclude that meloxicam has spinal antinociceptive actions which cannot be explained by the current concept of COX inhibition.     

Follow-up results of modified Glenn-Andersen operation in children with primary vesicoureteral reflux

A questionnaire survey covered 11 females with temporal arteritis (CA) and 20 healthy controls. Gastrointestinal, joint and spinal complaints were significantly more frequent in CA patients. Clinical characteristics of joint and spinal disorders in CA patients are close to those of chronic reactive arthritis. It is suggested that Horton's disease may be lacking as a stage of the infectious process in elderly patients (chronic intestinal and/or urinary infection-reactive arthritis-CA). A case is reported where CA developed after intestinal and urinary infection. Administration of antibiotics for treatment of the recurrence induced a continuous remission under reduced doses of glucocorticoids. In another case biseptol + glucocorticoids brought about a persistent remission allowing glucocorticoid discontinuation.     

Jejunal lipomatosis with diverticulosis: report of a case

We herein report the very rare case of a 68-year-old Japanese man with multiple jejunal lipomatosis and diverticulosis. He was admitted to our hospital with the chief complaint of melena and anemia. A barium study of the small bowel showed multiple lipomatosis and diverticulosis. An approximately 200-cm length of the jejunum was therefore resected. Thereafter, two diverticula and 215 lipomas were recognized in the resected specimen. A pathological examination showed mature adipose tissue with fibrous septa in the submucosal and muscularis propria. These findings were thus suggested to be due to the attenuation of the muscularis propria. The complications of lipomatosis are also discussed.     

Follow-up of radiofrequency catheter ablation in children: results in 100 consecutive patients

OBJECTIVES: The purpose of this study was to determine the outcome of a group of closely followed-up pediatric patients who had undergone radiofrequency ablation for cardiac arrhythmias. BACKGROUND: Although radiofrequency ablation in children has been shown to be effective and safe in the short term, results of longer term follow-up of these children must be considered when determining the place of radiofrequency ablation in the management of pediatric arrhythmias. METHODS: One hundred children aged 2 months to 17 years underwent a total of 119 radiofrequency ablation procedures for cure of tachycardia. Follow-up clinical data, electrocardiograms and 24-h Holter monitors were obtained and analyzed. RESULTS: All patients were alive, and none were lost to follow-up after a mean follow-up of 21.5 months (range 6 to 50). Success at last follow-up included accessory pathways in 66 (89%) of 74 patients, atrioventricular (AV) node reentry in 15 (88%) of 17, intraatrial reentry in 2 (67%) of 3, atrial flutter in 3 (100%) of 3, atrial ectopic tachycardia in 2 (67%) of 3, junctional ectopic tachycardia in 1 (100%) of 1 and ventricular tachycardia in 2 (100%) of 2 (overall success, 90 [90%] of 100). All recurrences were observed within 6 months of ablation. Major and minor complications (7%) included chest burn (one patient), foot microembolus (two patients), hematoma without pulse loss (four patients), femoral arteriovenous fistula requiring repair (one patient) and transient Mobitz I AV block (one patient). Immediate success, recurrence and complication rates were similar in the > or = 12-year old versus the < 12-year old group. Echocardiograms, available in 109 (92%) of 119 patients, showed possible procedure-related abnormalities in 2 (mitral regurgitation in 1, tricuspid regurgitation in 1, both mild), with no aortic insufficiency after 30 left-sided ablations performed by the retrograde approach. Follow-up Holter monitors, available in 77 (77%) of 100 patients, showed possible procedure-related abnormalities in 5 (frequent atrial ectopic tachycardia in 2, atrial flutter in 1, accelerated ventricular rhythm in 2). There were no early or late deaths. CONCLUSIONS: In children, the risks of radiofrequency ablation are low at follow-up evaluation. Longer-term follow-up of children undergoing radiofrequency ablation will be necessary to determine whether coronary abnormalities or serious new arrhythmias will develop.     

Follow-up at a Dutch addiction hospital and effectiveness of therapeutic community treatment

This paper reports on inpatient treatment of addicts. Attention is paid to the Therapeutic Community (TC) model employed with alcoholics. A sample of 881 patients was assessed at intake and was followed up. The results demonstrate that the patients improved on a variety of outcome measures. Some associations were found between patient variables and improvement. Treatment variables predicting a positive outcome were sustained treatment in a TC and attending AA meetings. The relative efficacy of TCs, originally created by drug users, holds for alcoholics as well. It is concluded that an important precondition to a positive treatment outcome is the continuity of the treatment process. Pursuing that continuity seems to be an excellent mediate goal for both addicts and treatment personnel.     

Laparoscopic cystectomy of the ovary; results of a new technique

The results of a prospective study of laparoscopic management of ovarian cysts are discussed. This technique of minimally invasive surgery was introduced at the department of Gynaecology of the Leiden University Medical Centre in 1991. Only premenopausal women with unilocular ovarian cysts smaller than 10 cm in diameter and with sonographically benign characteristics were included in this study. In a period of one year, 25 cystectomies and one ovariectomy were performed. 88% of the cysts were initially treated with hormone therapy. Mean age of the patients was 30 years (range: 21-54), average size of the cysts was 6 cm (range: 4-10) and mean operating time was 80 minutes (range: 35-120), there were no complications during operation or in the postoperative period. No laparotomies had to be performed. Three times (11.5%) pathological specimen examination revealed a corpus luteum cyst. The other 23 were non-functional cysts. No carcinoma was detected. The results of this minimally invasive surgery for removal of ovarian cysts are encouraging. Morbidity compared with the conventional cystectomy by laparotomy is low as appears from a shorter hospital stay and quicker recovery. Cystectomy of the ovary, compared with laparoscopic aspiration and fenestration, has a better therapeutic effect and the histological evaluation is more reliable. Persistent, unilocular ovarian cysts, which fulfill the criteria used in our study, are best treated by laparoscopic removal instead of laparotomy.     

Follow-up of children after fetal treatment for obstructive uropathy

We report a 6-year-old girl with Japanese B encephalitis. The initial symptoms were high fever, headache and vomiting. On the second day of illness, she developed hemiconvulsion and was admitted to our hospital. Physical examination demonstrated a stiff neck. C-reactive protein elevated to 22.7 mg/dl. CSF examination showed a marked increase in the cell count (10,896/3 mm3). During the course of the treatment, she showed transient hemiparesis and dysphagia, followed by akinetic mutism lasting for about a month. The patient was left with severe cognitive and memory impairment and complex partial seizures but no motor dysfunction. Japanese B encephalitis was diagnosed by means of serological examination. Magnetic resonance imaging revealed cystic lesions in the medial and posterior thalamus and substantia nigra and severe atrophy of the hippocampus. Despite the involvement of substantia nigra, the patient had no parkinsonism. The cognitive impairment may in part be explained by the lesions in the medical and posterior thalamus.     

Lobular carcinoma in situ of the breast: results of a radiosurgical conservative treatment

From 1980 to 1992, 17 women underwent lumpectomy (13) or quadrantectomy (4) and whole breast irradiation (median dose: 52 Gy) for pure lobular carcinoma in situ (LCIS). Three cases correspond to palpable lesions and 14 were discovered only by mammography. Twelve women also received tamoxifen at 20 mg/day for two years. With a median follow-up of 88 months, no local or regional recurrences have been recorded. The global rate of bilateral carcinoma was 17.6% (2 synchronous and one metachronous). In the literature, only eight other cases of LCIS were treated by lumpectomy and radiation therapy, but without details and data on long-term results. After biopsy alone for LCIS subsequent infiltrating carcinoma occurred in about 15% of the cases. Thus, the classical radiosurgical association should represent an interesting alternative both for biopsy alone and radical surgery until now only proposed to treat LCIS.     

Therapeutic results with Cerebrolysin in the treatment of dementia

BACKGROUND: In the present study patients suffering from dementia were treated with an infusion therapy using the neurotrophic drug Cerebrolysin. The effectiveness of the therapy was examined under conditions of daily clinical practice. METHODS: 645 Patients were treated with 30 ml Cerebrolysin daily. The average period of treatment was 17.8 days. Prior to treatment patients were diagnosed according to DSM-III-R. In addition a differential diagnostic examination using the Hachinski Ischemic Score was performed. Clinical symptoms and the Clinical Global Impression (CGI) were determined before and after therapy. RESULTS: Cerebrolysin therapy led to a significant (p < 0.001) improvement in memory for 62% of the patients. 65% showed improvement in concentration, 50% in mood and fatigue, and 47% improved in vertigo. An improvement in the Clinical Global impression was observed in approximately 80% of the patients. The improvement of symptoms was significantly larger (p < 0.05) in younger, less afflicted patients than in the older, more seriously ill patients. The unusual good tolerance of Cerebrolysin was especially noteworthy. CONCLUSIONS: The present study confirms the results of earlier clinical studies with Cerebrolysin in the treatment of Alzheimer patients and patients with vascular dementia in which similar responder rates were observed. The significant dependence of therapeutic success on the length and severity of illness confirms that timely pharmacological intervention leads to best therapeutic results.     

Follow-up of long-time treatment with intravesical oxybutynin for neurogenic bladder in children

Functional imaging of a language task using positron emission tomography was performed as part of the preoperative assessment of a patient with a left supplementary motor area (SMA) tumor. Positron emission tomography scans were obtained during language tasks (verb generation and word reading of visually presented nouns) that normally lead to increased blood flow in the SMA relative to a control condition (visual fixation). In the patient, the normal SMA response was an order of magnitude larger in the region of the tumor. Other regions, such as left inferior frontal cortex and right cerebellum, showed equivalent activation in the patient and normal subjects. Histopathologic study revealed an anaplastic astrocytoma. Thus, this exaggerated vascular response to local neuronal activation occurred in the setting of a proliferation of glial cells. This is consistent with models of coupling of regional CBF and neuronal activity that implicate glia as the mediator between neurons and vasculature. The concept that tumoral disruption of normal vascular responses could, in some cases, potentially enhance rather than dampen the response is proposed.     

Termination of translation in eukaryotes: new results and new hypotheses

The viscoelastic properties of the human and canine pharyngeal tissue in tension were evaluated, based on both an experimental protocol-consisting of cyclic load, tensile stress relaxation, and incremental step load tests-and the quasi-linear viscoelastic theory. The reduced stress relaxation function and the elastic response of the pharyngeal tissues were derived from the experimental results specifically obtained from those tissues. The characteristic features of viscoelastic property were obtained for both human and canine pharyngeal tissues by applying the quasi-linear viscoelastic theory and compared with each other. The material properties of the pharyngeal tissue were sought to facilitate the three-dimensional biomechanical model of the pharyngeal function by using the finite element method.     

Results obtained with a new analgesic in the treatment of pulmonary diseases

Numerous forces are presently deployed which threaten to produce largescale changes in medical practice and the systems of providing medical care. Some of these changes may be advantageous but others are likely to have deleterious effects on the quality of care, on the physician-patient relationnship and on the physician's freedom to practice as he sees fit. While certain of these pressures cannot be easily diverted, much can be accomplished with a modicum of effort to sway public opinion, the news media, the legislators and the bureaucratic regulation makers. Physicians, both individually and through their societies, must make this effort or suffer the pain of seeing immense decisions made without their leadership or intellectual guidance.