Is combined modality therapy necessary for advanced Hodgkin''s disease?

Urinary infections complicated by structural anomalies, metabolic alterations, abnormalities of host response, or unusual or difficult-to-treat pathogens commonly occur in our practices. Therapeutic regimens for most of these patient populations are empiric and unproven. Our understanding of specific microbial virulence factors is inadequate. Until well-designed interventions are proven, management strategies will depend on clinical biases and "trial and error" therapeutic attempts. Presumably, over the course of the next decade, better answers will emerge that will improve our ability to prevent and more adequately manage our patients with complicated UTIs.     

Current systematic definition and terminology of the face lifting technique

OBJECTIVE: A more precise definition of the term "face lifting" appears to be necessary. The development of new techniques and modifications in the last decade has been the main reason for the proliferation of definitions. Nearly every author has his own terminology for describing his procedures. METHODS: Three criteria are helpful in achieving an overview. 1. The selection according to the anatomical areas of the face and the neck which have to be rejuvenated 2. The selection according to procedures, involving resection of soft tissues as opposed to techniques that solely involve soft tissue reposition, modification of facial bones, and combinations of these principles. 3. The selection according to the different layers of soft tissue or to the combination of different layers which are to be lifted. CONCLUSIONS: The terms "face lifting" and "lifting" are used synonymously in international literature. They refer to those surgical procedures which aim a achieve facial rejuvenation and a younger appearance of the neck. Definitions that refer only to a lifting of the facial skin do not correspond to the actual techniques, which often involve the surgical treatment of different soft tissue layers and sometimes facial bone. A classification is possible because some terms are used more often.     

Regenerative periodontal therapy in mucogingival surgery for root coverage

This article illustrates the potential benefits of regenerative periodontal therapy in mucogingival surgery and esthetic dental treatment. Cases are described in which the treatment of soft-tissue recessions and root exposures are treated with surgical procedures where both clinical soft-tissue augmentation and the regeneration of periodontal attachment are obtained. Cases are also presented to illustrate the clinical application of guided tissue regeneration. Resorbable and nonresorbable barriers are placed over the root surface and bone and covered by the overlying flap, which allows the selective repopulation of the lesion by progenitor cells and the inhibition of a long junctional epithelium. Emphasis is placed on regenerative procedures in soft-tissue augmentation, particularly with respect to rationales, techniques, and indications.     

Covering soft tissue defects

In the past, the main emphasis in the treatment of complex limb injuries was placed upon the reconstruction of bony defects. Recently, however, reconstructive soft-tissue procedures have gained the attention they deserve. The salvage of a severely injured extremity depends rather on the feasibility of reconstructive surgical tissue procedures than on restoration of the bony defect. Sufficient vascularity is an essential condition for fracture healing and the prevention of post-traumatic complications like osteomyelitis and pseudarthrosis. If primary closure of a soft-tissue defect is not possible, preliminary covering has to be obtained with artificial skin replacement (vacuum sealing) until definitive covering with muscle or musculocutaneous flaps can be achieved. With the microvascular restorative techniques available today even complex soft-tissue problems can be solved. Nevertheless, an appropriate infrastructure and a trained and skilled surgeon are essential.     

Sildenafil (Viagra) for treating male erectile dysfunction

Many procedures performed by podiatric surgeons today require the use of a soft-tissue anchoring device. In recent years, many new anchoring devices have become available for use in the foot and ankle. The authors introduce a new soft-tissue anchoring device that has yet to be described in the podiatric literature and present two cases in which the new anchor was used.     

Strategy of surgical management of polytrauma

Operative procedures in multiple injured patients consist in the first stage in life-saving operations such as control of bleeding and cerebral decompression. Operative measures during the urgent second operative phase have to be undertaken under consideration of the development of a multiple organ failure syndrome. Early stabilization of relevant extremity fractures and thorough care of soft-tissue are of particular importance (day-1-surgery). Only second look procedures to optimize soft-tissue injuries and prevent infections may be allowed during this early intensive care period. Delayed operative procedures should only be performed after stabilization of the overall patient situation to prevent enhancement of the systemic inflammatory response. The required operative procedures of the multiple injuries have to be attributed to the respective operative phases.     

Problematic aspects of the Structural Health Regulation and minimal invasive surgery

Decisions in surgery will have to consider economic obligations more than ever before. Consequences are evident: the assessment of surgical efficiency will be insufficient when only considering the accuracy and results of a clinical study. We actually will have to document, moreover, the economic impact of therapeutic procedures, particularly with respect to minimally invasive surgery.     

Sheath detachment during coronary arteriogram

Angiographic procedures are technically difficult when soft-tissue scarring and deformity are present at the site of vascular access. This case demonstrates the rare complication of catheter-sheath separation during an attempted coronary arteriogram. The patient had deformity and soft-tissue scarring due to bilateral lower-extremity amputation secondary to blast injuries sustained in Vietnam.     

Use of provisional restorations to enhance soft-tissue contours for implant restorations

The objective of restoring missing teeth with implant-supported restorations should not merely be achieving osseointegration with an implant and a biomechanically sound restoration. The objective must be the esthetic and functional restoration of the missing teeth. To achieve this, proper treatment planning is critical. Precise implant placement and delicate soft-tissue manipulation during surgery will allow the restorative dentist to enhance the peri-implant soft-tissue contours with the use of provisional restorations. Empirically, it seems that the earlier the provisional restoration is delivered in the treatment process the more ideal the esthetics. Several methods of using provisional restorations to enhance soft-tissue contours are presented. The concept of immediately delivering provisional restorations on placement of an implant is discussed.     

Threshold of ventral root stimulation to produce the IS-spike without the M-spike in the same cat motoneuron

PURPOSE: Financial costs from "Z" procedures were evaluated and compared with the amount of direct costs that are needed for the annual activity of a radiation oncology department. MATERIALS AND METHODS: The various components, particularly staff earnings that are estimated for each procedure according to their category and working time, were cumulated for calculation of direct loads. RESULTS: Comparisons between direct expenses and the total amount of Z procedures led to the following results: the global cost is the same; at analysis of therapeutic procedures, however, this apparent similarity masks some very significant gaps; valorization of Z procedures is much lower than that of the corresponding real loads, especially when therapeutic procedures are quite different from techniques that are considered as "standard"; these differences do not apply to all the components of radiation therapy procedures. In particular, medical steps would be uniformly underestimated, while irradiation per se is overestimated. CONCLUSION: The authors suggest modifications of the general objectives and items of the nomenclature of radiotherapy and brachytherapy procedures.     

Therapeutic strategy of chronic heart failure]

Considerable advances have been made in the management of heart failure during the past decade, with the development of new pharmacological agents. Now the therapeutic goals are not only to reduce symptoms but also to decrease the occurrence of acute heart failure, hospitalizations and to delay death. Prevention plays a key role: by correcting predisposing factors, and by slowing the process which leads from asymptomatic left ventricular dysfunction to overt heart failure. The range for therapeutic action is broad: general and dietetic advices, pharmacological agents, surgical procedures which are reserved for the end-stage patient. Angiotensin converting enzyme inhibitors remain the cornerstone of treatment at almost all stages of the disease.     

Role of anticardiolipin antibodies in young persons with migraine and transient focal neurologic events: a prospective study

OBJECTIVES: The aim of this study was to determine the relative risks of pediatric diagnostic, interventional and electrophysiologic catheterizations. BACKGROUND: The role of the pediatric catheterization laboratory has evolved in the last decade as a therapeutic modality, although remaining an important tool for anatomic and hemodynamic diagnosis. METHODS: A study of 4,952 consecutive pediatric catheterization procedures was undertaken. RESULTS: Patient ages ranged from 1 day to 20 years (median 2.9 years). One or more complications occurred in 436 studies (8.8%) and were classified as major in 102 and minor in 458, with vascular complications (n=189; 3.8% of procedures) the most common adverse event. Arrhythmic complications (n=24) were the most common major complication. Death occurred in seven cases (0.14%) as a direct complication of the procedure and was more common in infants (n=5). Independent risk factors for complications included a young patient age and undergoing an interventional procedure. CONCLUSIONS: Complications continue to be associated with pediatric cardiac catheterization. Efforts should be directed to improving equipment for flexibility and size, and finding alternative methods for vascular access. Patient age and interventional studies are risk factors for morbidity and mortality.     

The meta-analytic revolution in outcome research.

Contends that meta-analysis contributes to the quality of studies by demonstrating the needs for more exact conceptual specification of therapeutic goals and procedures, for more comparability and standardization among investigations, and for achieving higher agreement on evaluations of the quality of studies. Meta-analytic work has brought out not only the pandemic problem of method specificity but also the magnitude of the baseline from minimal treatments. Psychotherapeutic-outcome research will clearly be the better for this invention. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Endovascular surgical approach to intracranial vascular diseases

PURPOSE: The endovascular surgical approach to complex disorders of the central nervous system has made rapid and significant advancements over the past decade. Patients with intracranial arterial aneurysms, traumatic carotid and vertebral artery lesions, including fistulas and pseudoaneurysms, hemodynamically significant atherosclerotic lesions, vasospasm, and acute stroke are now being approached and treated by newer and less invasive techniques, including cerebral angioplasty and thrombolytic therapy. METHODS: All procedures are usually performed from a transfemoral approach utilizing a variety of occlusion devices, including detachable silicone balloons, microcoils, electrolytic detachable coils, liquid tissue adhesives, and particulate emboli for vessel occlusion. For dilatation and reperfusion of vessels, balloon angioplasty catheters, stents, and thrombolytic drugs are being used. RESULTS: For the treatment of traumatic vascular injuries, such as carotid cavernous sinus fistulas and vertebral arteriovenous fistulas and pseudoaneurysms, endovascular therapy has become the treatment of choice. The endovascular approach for intracranial aneurysms is emerging as a therapeutic option in selected cases. For occlusive disorders in patients presenting with acute cerebral ischemia, extracranial angioplasty and cerebral thrombolysis techniques are currently under investigation. CONCLUSIONS: As these techniques continue to evolve, the field of interventional neuroradiology will expand the therapeutic options for managing complex cerebrovascular disorders and improve patient outcome in acute stroke therapy.     

Interventional ultrasound in Europe

"Interventional ultrasound," defined as any diagnostic and therapeutic procedure performed under ultrasound guidance was first introduced in Europe, where its early development took place in Vienna, in Copenhagen, in Italy and in Switzerland. However, many of the applications of interventional ultrasound have been based on important pioneer work using other less-suitable needle guiding methods from the pre-ultrasound era. The European contributions to "interventional ultrasound" have especially been in the development of new puncture equipment, in the dissemination of various biopsy techniques, and draining procedures and, more recently, in the development of many different tissue-ablation techniques. The above contributions, which are outlined in this historical review, have, together with significant contributions from the rest of the world-not least from the United States and Japan-created a most efficient diagnostic as well as therapeutic tool for the benefit of our patients.     

Activation of a novel proto-oncogene, Frat1, contributes to progression of mouse T-cell lymphomas

In this paper we will report the results of nation-wide surveys on employee health conducted and published by the Ministry of Labour in 1982, 1987, and 1992. The subjects were approximately 20,000 employees in 1982, approximately 15,000 in 1987, and approximately 16,000 in 1992, from throughout Japan. Using the results of the surveys, we will show trends in the status of employee work-related stress, as well as trends in means of relaxation over the past decade. The percentage of employees with work-related stress among all subjects gradually increased as follows: 50.6% in 1982, 55.0% in 1987, and 57.3% in 1992. The percentage of employees with work-related stress increased remarkably from 1982 through 1992 among the following groups: the 50-59 age group in males; employees in the electricity, gas, heat and water-supply industries; those in the real estate industry; administrative and managerial workers; employees of large establishments with more than 5,000 employees; and employees performing shift work involving no night duty. The problem of "human relationships in the workplace" was associated with the increasing stress levels among 50-59-year-old males, 40-49-year-old females, employees of large establishments with more than 5,000 employees, those in the real estate industry, and service workers. In terms of means of relaxing to relieve fatigue and stress, employees tended to engage in active pursuits such as "eating out and shopping" and "driving and traveling" over the past decade. In 1992, on the other hand, 22.0% of males and 5.9% of females selected "smoking" as a means of relaxation. This shows the need for stress management in the workplace in order to prevent health problems related to smoking.     

Psychology and mental retardation: Emerging research and practice opportunities.

Four questions were asked of 322 authorities in mental retardation: (1) What were the most significant research findings of 1980–1989? (2) What unanswered questions confronting the field of mental retardation will be answered in the next decade? (3) What innovative treatment approaches and services for persons with mental retardation will be the "wave of the future?" (4) What political, economic, and social factors will shape programs and services in the next decade? Biomedical advances, applied behavioral technology, and psychoeducational interventions have led the list for the past decade. The experts predicted advances in community and vocational programs, expanded family support services, and health promotion and prevention activities, which have research and practice implications for not only psychologists in this field but also for program administrators and families of mentally retarded persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck

We have reviewed the transplantation of autogenous fat, fascia, and nonvascularized muscle. Although none of these tissues satisfies all of the requirements for an ideal transplantation material, understanding the indications and each material's limitations will broaden the surgeon's armamentarium when soft-tissue grafting is desired. Although the use of autogenous fat grafts in head and neck surgery has been associated with some unpredictability, fat remains an excellent choice for obliteration of frontal sinuses, for myringoplasty, and for limited soft-tissue augmentation. In most applications, significant resorption of the transplanted fat can be expected, and it should be compensated for accordingly by initial overcorrection. Future research endeavors, including development of preadipocyte transplants and hormonal manipulation of fat grafts, will perhaps improve results of transplantation. The grafting of fascia has been shown to be a very reliable technique, especially when tensile strength is required of the transplant material. In grafts, fascia is much more predictable than fat, in that the majority of the fascia survives as living tissue that retains its original characteristics. A relative lack of three-dimensional bulk, however, limits the use of fascia in soft-tissue augmentation. The transplantation of nonvascularized muscle, because of its enormous metabolic requirements, almost always results in death of the muscle cells and subsequent partial replacement by fibrous tissue. Free muscle grafts therefore have very limited application, except in circumstances in which fibrous tissue obliteration of small defects (such as the nasofrontal duct or eustachian tube) is the desired result. In clinical situations in which maintenance of the substance or bulk of the transplanted material is of paramount importance, consideration should be given instead to the transfer of vascularized tissue. For this purpose, numerous simple and composite flaps of fascia, fat, muscle, and other tissues are now available. Vascularized tissue transfers are certainly not the solution to every reconstructive problem, however. When properly selected and applied, the transplantation of fat, fascia, and occasionally muscle remains an important option for soft-tissue replacement in head and neck surgery.