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PubMed1992

Progression of squamous cell carcinoma of the uterine cervix from cervical intraepithelial neoplasia infected with human papillomavirus: a retrospective follow-up study by in situ hybridization and polymerase chain reaction.

A retrospective study was conducted to reveal the natural history of cervical carcinoma infected with human papillomavirus (HPV) and to document latent persistence of HPV infection. Thirty-eight formalin-fixed, paraffin-embedded hysterectomy specimens of cervical carcinoma and cervical intraepithelial neoplasia (CIN) III were examined for the presence of HPV 6, 11, 16, 18, 31, 33, and 35 DNA by in situ hybridization (ISH) with biotinylated DNA probes. The HPV 6 and 11 were not detected, but HPV 16, 18, 31, 33, and 35 were detected in 63% (24 of 38) of CIN III and cervical carcinoma. The HPV-negative specimens by ISH were subjected to polymerase chain reaction (PCR) for detection of HPV 16 and 52b with high sensitivity. In 11 of 14 specimens, specific amplification of HPV 16 was detected and HPV DNA was demonstrated in 92% (35 of 38). A retrospective examination for the presence of HPV DNA by ISH and PCR was performed on sequential biopsy specimens of eight cases whose hysterectomy specimens were judged as HPV 16/18 positive. In the eight cases, HPV 16 was constantly demonstrated in all biopsy specimens throughout the course, from early dysplastic change to carcinoma. This finding indicates long (up to 10 years) persistence of HPV infection in the natural course of progression to carcinoma of the uterine cervix.

Carcinoma, Squamous Cell↗
PubMed1999

Risperidone treatment for juvenile bipolar disorder: a retrospective chart review.

OBJECTIVE: To investigate the effectiveness and tolerability of the atypical neuroleptic risperidone in the treatment of juvenile mania. METHOD: This is a retrospective chart review of outpatients with the diagnosis of bipolar disorder (DSM-IV) treated with risperidone at a university center. Response to treatment was evaluated using the Clinical Global Impression Scale (CGI) with separate assessments of mania, psychosis, aggression, and attention-deficit/hyperactivity disorder (ADHD). RESULTS: Twenty-eight youths (mean +/- SD age, 10.4 +/- 3.8 years) with bipolar disorder (25 mixed and 3 hypomanic) who had been treated with risperidone were identified. These children received a mean dose of 1.7 +/- 1.3 mg over an average period of 6.1 +/- 8.5 months. Using a CGI Improvement score of < or = 2 (very much/much improved) to define robust improvement, 82% showed improvement in both their manic and aggressive symptoms, 69% in psychotic symptoms, but only 8% in ADHD symptoms. CONCLUSIONS: Although limited by its retrospective nature, this study suggests that risperidone may be effective in the treatment of manic young people and indicates the need for controlled clinical trials of risperidone and other atypical neuroleptics in juvenile mania.

Adolescent↗
PubMed1999

Cardiac safety of citalopram: prospective trials and retrospective analyses.

The selective serotonin reuptake inhibitors (SSRIs) are believed to have a more benign cardiovascular safety profile than do the tricyclic antidepressants. The effects of the SSRI citalopram on cardiac conduction and repolarization have been extensively evaluated, both in prospective studies in volunteers and patients and in retrospective evaluations of all electrocardiographic (ECG) data from all clinical trials conducted from 1978 through 1996 (a total of 40 studies). A randomized, double-blind, placebo-controlled study was conducted in healthy volunteers (N = 23) to assess intraindividual variability of the QTc interval, as well as possible changes during treatment with placebo or citalopram, and its correlation to plasma drug levels. To document any dose-related changes, ECGs were performed at baseline and at the end of study in three randomized, double-blind, placebo- or active-controlled, fixed-dose trials in adult and elderly patients (N = 1,460) with major depression and/or dementia. Finally, more than 6,000 ECGs (N = 1,789 citalopram-treated patients) collected from all clinical trials conducted from 1978 through 1996 were reassessed in a standardized manner to identify any effects of citalopram on ECG parameters. Results of both prospective and retrospective analyses showed that the only effect of citalopram on ECG findings is a small reduction in heart rate (< or = 8 beats per minute). There were no significant effects on PQ, QRS, or QTc intervals, indicating that citalopram has no effect on cardiac conduction and repolarization during short- or long-term treatment.

Adolescent↗
PubMed2000

Effects of clozapine on substance use in patients with schizophrenia and schizoaffective disorder: a retrospective survey.

Substance use disorders, particularly those involving alcohol, marijuana, and cocaine, are highly prevalent among patients with schizophrenia and contribute markedly to its overall morbidity. Unfortunately, standard (typical) antipsychotic medications do not seem to reduce substance use in patients with schizophrenia and may even increase it. Recently, however, a few anecdotal case reports and two previous small "N" surveys have found that clozapine, an atypical antipsychotic medication, seems to decrease substance use in patients treated with this drug for their psychoses. The authors report data from a retrospective survey of substance use in 58 patients treated with clozapine who had a history of comorbid schizophrenia (or schizoaffective disorder) and substance use disorder. Of these 58 patients, 43 were being treated with clozapine at the time of the survey; the remaining 15 patients had discontinued clozapine before the survey. The survey involved chart review and clinician interview to assess change in substance use and global clinical symptoms while receiving treatment with clozapine. More than 85% of the patients who were active substance users at the time of initiation of treatment with clozapine decreased their substance use over the course of clozapine administration. For patients who continued treatment with clozapine up to the present, the decrease in substance use was strongly correlated with a decrease in global clinical symptoms. Data from this retrospective survey further support the previous observations that clozapine reduces substance use among patients with schizophrenic disorders. Moreover, the data suggest the need for prospective controlled studies of the effects of clozapine on substance use in this population.

Adult↗
PubMed1994

Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS)

Recent reports using the Mangled Extremity Severity Score (MESS) suggest that a score of > or = 7 is 100% accurate in predicting the need for amputation of severely injured lower extremities. To further evaluate the value of the MESS in predicting amputation, specifically with respect to type IIIB and type IIIC (Gustilo and Anderson) open fractures of the tibia, we retrospectively evaluated 24 patients with these injuries. A significant difference (p = 0.001) between MESS values of 13 salvaged (6.36 +/- 0.35 SEM) and 11 amputated limbs (6.36 +/- 0.54 SEM) was found. A MESS value of > or = 4 was most sensitive (100%); a MESS value of > or = 7 was most specific, and a MESS value of > or = 7 was found to have a positive predictive value of 100%. Subsequently, we addressed recent criticisms of the MESS by including nerve injury in the scoring system and by separating soft-tissue and skeletal injury components of the MESS. We modified the MESS with a score called the NISSSA and applied it retrospectively to our cases. After careful statistical comparison we found both the MESS and NISSSA to be highly accurate (p < 0.005) in predicting amputation. The NISSSA was found to be more sensitive (81.8% versus 63.6%) and more specific (92.3 versus 69.2%).

Adolescent↗
PubMedDate not supplied

Immunosuppressive therapy of HBsAg-positive chronic active hepatitis in childhood: a multicentric retrospective study on 139 patients.

We analyzed retrospectively the effect of immunosuppressive therapy in 139 children with HBsAG-positive chronic active hepatitis (CAH) observed in four liver units in Italy from 1974 to 1982. All children had been observed for at least 12 months. Of these 139 patients, 38 were treated with steroids (prednisolone or prednisone from 1 to 2 mg/kg daily), 78 with combination therapy (prednisolone or prednisone 1 mg/kg daily in combination with azathioprine, 2 mg/kg daily) and 23 were not treated. The outcome of the disease was assessed by evaluating clinical, biochemical, and histological parameters on the basis of preselected criteria. Untreated patients deteriorated more frequently than those treated with steroids (34.8% versus 13.2%, p less than 0.05) or those receiving combination therapy (34.8% versus 10.3%, p less than 0.01). Remission or improvement was observed more frequently in steroid-treated and combination-treated patients than in the untreated ones (p less than 0.001 and p less than 0.01, respectively). At the end of the study, only one untreated patient had died of liver failure. Remission was observed in about 10% of patients in the two groups of treatment, but in the untreated one, this event never occurred. Although this study is retrospective and presents some shortcomings, the data clearly indicate that steroid and combination therapy are not deleterious, and are possibly helpful, to children with HBsAg-positive CAH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMed2003

Nontuberculous mycobacterial cervical adenitis: a ten-year retrospective review.

OBJECTIVE: To review the authors' institutional experience with nontuberculous mycobacterial cervical adenitis in children over a 10-year period. STUDY DESIGN: Retrospective chart review. METHODS: The case histories of 79 children with nontuberculous mycobacterial lymphadenitis who presented to a large tertiary care referral center from 1989 to 1999 were retrospectively analyzed, and the demographics, clinical presentation, methods of diagnosis, and types of surgical intervention they underwent were reported. RESULTS: The mean age at presentation was 3.6 years. The male-to-female ratio was 1:2, and the frequency of presentation was highest in the winter and spring months. The diagnosis was not immediately apparent to most primary health care physicians because there was a delay between the appearance of the lump and referral for treatment, which was in excess of 8 weeks. Involved nodes were mainly treated surgically. The recurrence rate of complete surgical resection was less than 1%. CONCLUSION: The study highlights the fact that a high index of clinical suspicion is needed to make an early diagnosis of nontuberculous mycobacterial lymphadenitis and lends further weight to the already existing evidence that surgical excision remains the mainstay of successful treatment for lymphadenitis caused by nontuberculous mycobacteria.

Adolescent↗
PubMed1991

A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use. A time-insensitive predictive instrument (TIPI) for acute cardiac ischemia: a multicenter study.

This study developed and tested a tool to assess the likelihood of patients having acute cardiac ischemia and thus the appropriateness of admitting them to the coronary care unit (CCU). It is valid both for real-time clinical use and for retrospective review: a time-insensitive predictive instrument (TIPI). The authors' earlier acute ischemia predictive instrument, not designed specifically to support retrospective use, could not offer the advantage of a single tool usable by both clinicians and reviewers of care. Over a two-year period, the authors prospectively collected data on 5,773 emergency room patients seen in six New England hospitals for symptoms suggesting acute cardiac ischemia. In the Developmental Phase, based on 3,453 such patients seen during the first year, the authors developed a logistic regression-based TIPI for acute cardiac ischemia. Using seven clinical features reliably ascertainable both in the emergency room setting and by medical record review, the TIPI expressed a patient's probability of having acute ischemia as between 0-100%. In this phase, a risk category system based on the TIPI scale was also devised, which created four similar-sized groups, by cutting at 10%, 25%, and 55%. In the Test Phase, when prospectively tested on the 2,320 emergency room patients seen during the second year, the TIPI showed excellent diagnostic performance. Its receiver-operating characteristic (ROC) curve area of 0.88 was comparable to the original predictive instrument and the ROC curve path suggested performance comparable to physicians as well. Its slope of the relationship between predicted and observed probabilities of having acute ischemia was 1.11 (R2 = 0.97) with a correlation of 0.99 (P less than 0.0001), suggesting excellent calibration of predictions throughout the probability range. For patients who proved to have acute ischemia, the average TIPI probability was 59%, whereas for those without ischemia, the average TIPI value was 21% (P less than 0.0001). This differentiation was maintained even for those given different (including inappropriate) triage to the CCU, ward, or home (P less than 0.0001 for each disposition). When the performance of the four TIPI-based risk groups was prospectively tested on year-two patients, among the 552 patients in the low probability group, only 1.6% had acute cardiac ischemia, including only 0.7% with acute infarctions. Among the 484 patients in the high probability group, 81.6% had acute ischemia, and 53.3% acute myocardial infarctions, suggesting these to be clinically relevant groups for aiding or assessing emergency room triage.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2000

Radiosurgery for epilepsy associated with cavernous malformation: retrospective study in 49 patients.

OBJECTIVE: Microsurgical resection of a cavernous malformation (CM) with or without associated cortical resection can provide efficient treatment of drug-resistant associated epilepsy. To explore the potential alternative role of radiosurgery and to evaluate its safety and efficacy for this indication, we conducted a retrospective multicenter study. METHODS: We retrospectively reviewed the files of patients with long-lasting drug-resistant epilepsy, presumably caused by CM, who were treated by gamma knife (GK) surgery for the control of their epilepsy in five centers (Marseilles, Komaki City, Prague, Graz, and Sheffield). A satisfactory follow-up was available for 49 patients (mean follow-up period, 23.66 +/- 13 mo). The mean duration of epilepsy before the GK procedure was 7.5 (+/-9.3) years. The mean frequency of seizures was 6.9/month (+/-14). The mean marginal radiation dose was 19.17 Gy +/- 4.4 (range, 11.25-36). Among the 49 patients, 17 (35%) had a CM located in or involving a highly functional area. RESULTS: At the last follow-up examination, 26 patients (53%) were seizure-free (Engel's Class I), including 24 in Class IA (49%) and 2 patients with occasional auras (Class IB, 4%). A highly significant decrease in the number of seizures was achieved in 10 patients (Class IIB, 20%). The remaining 13 patients (26%) showed little or no improvement. The mediotemporal site was associated with a higher risk of failure. One patient bled during the observation period, and another experienced radiation-induced edema with transient aphasia. Postradiosurgery excision was performed in five patients, and a second radiosurgical treatment was carried out in one patient. CONCLUSION: This series is the first to specifically evaluate the capability of GK surgery to safely and efficiently treat epilepsy associated with CM. Seizure control can be reached when a good electroclinical correlation exists between CM location and epileptogenic zone. Although we do not recommend GK surgery for prevention of bleeding for a CM that has not bled previously, our findings suggest that GK surgery can be proposed for the treatment of epilepsy when the CM is located in a highly functional area.

Adult↗
PubMed2002

Ocular and systemic findings and their correlation with hemodynamically significant carotid artery stenosis: a retrospective study.

BACKGROUND: Optometrists often encounter patients with ocular signs and/or symptoms suggestive of carotid artery disease, but criteria for eye care practitioners concerning when to order carotid studies are not well established. A retrospective study in an optometry clinic was performed to determine if certain ocular findings and associated systemic risk factors were associated with hemodynamically significant carotid artery stenosis (HSCAS). METHODS: A retrospective analysis was performed on all patients examined in the optometry clinic at the Sepulveda Ambulatory Care Center from January 1, 1998 through December 31, 1999 to identify all patients who had carotid studies ordered. Charts were then reviewed to determine the ocular finding that prompted the carotid study. Statistical analysis using an odds-ratio was performed to determine whether any ocular sign/symptom or systemic risk factor was associated with HSCAS. RESULTS: Of 3822 patients, 48 (1.26%) had carotid studies ordered. Eight (17%) had HSCAS of >50% and symptomatic patients were 1.6 times more likely to have HSCAS than asymptomatic patients. Patients with HSCAS were 1.8 times more likely to have retinal vascular occlusions, 1.9 times more likely to have normotensive glaucoma, 2.4 times more likely to have peripheral retinal hemorrhages, and 2.6 times more likely to be smokers, although none of these factors were found to be a statistically significant indicator of HSCAS. However, the number of systemic diseases tended to be greater for the HSCAS patients compared with the non-HSCAS patients (HSCAS median = 3.5 and the non-HSCAS median = 2, p = 0.049). CONCLUSION: Although no single ocular or systemic risk factor was found to be a statistically significant indicator of HSCAS, the number of systemic disease risk factors tended to be greater for the HSCAS patients compared with the non-HSCAS patients (p = 0.049). An extensive literature review was also performed to help establish guidelines for when to order carotid studies on the basis of ocular signs and/or symptoms as well as the presence of additive associated systemic risk factors.

Aged↗
PubMed1985

Evaluation of lumbar lordosis. A prospective and retrospective study.

Two lordotic angles were measured on roentgenograms of 973 adults in a prospective and retrospective review. The majority of the films were taken because of lumbar complaints. The mean lumbosacral (LS) angle (L2-Sacrum) was 45.05 degrees +/- .85 degrees. The mean lumbolumbar (LL) angle (L2-L5) was 29.96 degrees +/- .74 degrees. Only minor differences were found between a standardized (prospective) and a nonstandardized (retrospective) group. There was a statistically significant difference between men and women with both LS and LL angles, but no racial differences were observed. A "routine" supine lateral lumbar spine roentgenogram is a very accurate means of measuring lordotic angles. A lordotic angle of less than 23 degrees defines hypolordosis and more than 68 degrees, hyperlordosis.

Adolescent↗
PubMed1986

Back injuries in industry: a retrospective study. I. Overview and cost analysis.

To evaluate the impact off back injury on industry, the authors conducted a retrospective analysis of injuries among hourly employees of a large industrial manufacturer in western Washington. The Boeing Company provided injury information on 31,200 employees for a 15-month period from July 1, 1979 to September 30, 1980. Of the 4,645 injuries reported, 900 were back injuries. Claims related to back injuries constituted 19% of all workers' compensation claims but were responsible for 41% of the total injury costs, or approximately $1,800,000. The 90 most expensive back injury claims (10% of all back injury claims) were responsible for 79% of the total back injury costs. The percentage of back injury claimants with claims having a total incurred cost exceeding $10,000 (6.5%) was significantly higher than the corresponding percentage of claimants (1.5%) with claims for other than back injuries (P = 0.000). A similar significant difference was found concerning the tendency of back injury claimants to have multiple claims compared with the non-back injury claimants. This retrospective study reaffirms the significant economic impact of back injuries on industry, and specifically high-cost back injuries. In addition, it provides insight into factors associated with back injury and points to positive measures that may be taken to reduce back pain and economic loss. Characteristics of the back injury and employee-related factors associated with back injury are presented in two subsequent articles.

Back Injuries↗
PubMed1990

Retrospective analysis of microsurgical and standard lumbar discectomy.

This report retrospectively evaluates 112 cases of microsurgical lumbar discectomy (MICRO) and 35 cases of standard discectomy (STND) performed by one neurosurgeon using data derived from a questionnaire and from chart review. The total amount of postoperative pain medication consumed and postoperative temperature curves in each group were compared to determine how postsurgical morbidity was affected by the MICRO and STND procedures. At a mean follow-up interval of 12.3 and 41 months, 97% of the MICRO respondents reported a good or excellent outcome. Patients with preoperative symptoms exceeding 6 months returned to work in 9.9 +/- 1.7 weeks; this interval decreased to 5.58 +/- 0.75 weeks, and overall outcome score improved significantly at 41 months' follow-up if symptoms were less than or equal to 6 months in duration before surgery. At 44 months' mean follow-up, 88% of the STND respondents reported a good or excellent outcome with no decrease in the return-to-work interval in patients who described symptoms of 6 months or less. Mean postoperative pain medication consumed by MICRO patients was one tenth that of STND patients, and temperature curves showed significant temperature elevations in the STND group when compared with the MICRO group, in which patients remained afebrile throughout the postoperative period. Within the limitations of a retrospective study, these data support the conclusion that a microsurgical approach to the lumbar herniated disc provides a more frequent and rapid convalescence than the STND approach.

Adult↗
PubMed2002

Surgical treatment of congenital vertebral displacement Type A in the sagittal plane only: a retrospective study involving eleven cases.

STUDY DESIGN: The essence of congenital vertebral displacement Type A pathology is a congenital structure defect including a vertebral or intervertebral disc with instant curvature of the spinal canal in the sagittal plane. Clinically this defect assumes the shape of kyphosis or kyphoscoliosis. A retrospective review of 11 patients with this congenital deformity was conducted. OBJECTIVES: To evaluate the effectiveness of surgical treatment for congenital vertebral displacement, and to establish the optimal operative management. METHODS: Nine patients with a mean age of 3.3 years (range, 1.8-5.5 years) underwent surgery. Two patients were treated conservatively. All the patients underwent radiologic investigation, which included radiographs, three-dimensional computed tomography scans, and magnetic resonance imaging scans. The neurologic condition was assessed by clinical neurologic examination and somatosensory-evoked potentials. The following surgical techniques were performed: 13 posterior fusions in situ in eight patients; 4 anterior fusions in situ in four patients, 8 total or partial vertebrectomies with anterior fusion and stabilization using cylindric cage in 6 patients, 3 total or partial vertebrectomies with anterior fusion and stabilization using fibula graft in 3 patients, and 5 posterior fusions with instrumentation in 2 patients. The total mean follow-up period was 5.7 years (range, 2.1-9.9 years). RESULTS: The mean follow-up period after the last operation was 22 months (range, 2-48 months). The general results observed during the follow-up period were as follows. Deformity stabilization was obtained in six patients, whereas it was still progressive in three patients. In five patients, regression of neurologic deficits was obtained, whereas in patients, it was stable. Progression of neurologic deficits was observed in one patient (paraplegia). Retrospectively, the best clinical results were achieved after extensive decompression of the spinal cord with anterior stabilization of the spine using a cylindric cage or fibula autograft. These procedures were preceded or followed by posterior fusion. CONCLUSIONS: The findings showed that only extensive vertebrectomy and anterior stabilization using a cylindric cage or fibula graft combined in one operative procedure, preceded or followed by posterior fusion, ensures patients against progression of neurologic deficits and deformity of spine.

Child, Preschool↗
PubMed2005

PELD score and posttransplant outcome in pediatric liver transplantation: a retrospective study of 100 recipients.

BACKGROUND: Pediatric End-stage Liver Disease (PELD) score is proposed as an objective tool to prioritize children awaiting liver transplantation (LT), higher PELD being associated with increased pre-LT mortality. This study investigated whether PELD may also impact on post-LT results. METHODS: PELD was retrospectively analyzed in 100 pediatric recipients of a primary LT from living-related (n = 49) or postmortem donors (PMD, n = 51). The main pre-LT diagnosis was biliary atresia (n = 64), hepatic malignancy and fulminant hepatitis cases being excluded. PELD was calculated in all patients at the time of pre-LT assessment. Considering the median delay of 117 days between listing and LT in the PMD subgroup, a second PELD was calculated at the time of LT, allowing the determination of a delta PELD during the waiting period. PMD grafts were allocated using an allocation system taking into account waiting times as well as medical urgency, operative at EuroTransplant. RESULTS: Overall 5-year actuarial patient and graft survivals were 96% and 91%, respectively. PELD at listing (13.3 +/- 9.7) showed a normal statistical distribution. PELD scores at listing and at LT were not found to significantly impact on post-LT outcome (NS). In contrast, higher delta PELD might be associated with lower posttransplant patient survival (p = 0.094). CONCLUSIONS: The results of this retrospective analysis suggest that giving priority to high PELD recipients may not result in worsening post-LT outcome. Accordingly, these data support such "sickest children first" allocation policy, which should contribute to reduce pre-LT mortality without worsening post-LT results and increasing organ waste.

Child↗
PubMed1998

Loss of crestal bone around dental implants: a retrospective study.

The loss of crestal bone associated with dental implants is a significant clinical phenomenon. The occurrence of such bone loss will often compromise long-term prognosis and, if extensive, ultimately lead to failure. Relatively few studies have focused on the reasons for loss of crestal-supporting bone around implants, although numerous explanations for the phenomenon have been proposed. This retrospective investigation examines one potential causative factor for implant-associated crestal bone loss, which has only recently received attention, i.e., location of the implant/transmucosal abutment interface (ITAI) relative to the crestal bone. A retrospective clinical evaluation of 350 individual implants in 255 patients indicates a direct relationship between subgingival placement of the ITAI and loss of crestal supporting bone. In addition, scanning electron microscopic examination of 45 failed implants showed significant plaque accumulation at the ITAI, the transmucosal abutment/prosthesis interface (TAPI), and the interface between the implant smooth collar and subjacent plasma-spray coated surface.

Adolescent↗
PubMed2004

Spinal cord stimulation for refractory angina pectoris: a retrospective analysis of efficacy and cost-benefit.

BACKGROUND: Patients with refractory angina pectoris have severe symptoms despite optimal medication, but are not suitable for revascularisation. Spinal cord stimulation (SCS) has been used for treating refractory angina pectoris since 1985. The efficacy of SCS has been proven by randomised controlled trials and follow-up studies have shown that SCS is a safe treatment. The objective of the current study was to retrospectively analyse the clinical outcomes and cost-benefit of SCS in patients with refractory angina pectoris. METHODS: Eighteen months after SCS implantation, the effects on Canadian Cardiovascular Society (CCS) functional level and acute symptom relief of 24 patients with permanent SCS were analysed by review of medical records. Nineteen of these 24 patients were able to report their anginal frequency, nitroglycerin consumption and subjective perception on physical activity and quality of life. RESULTS: Angina frequency decreased from a median of 14.0 to 2.3 attacks/week (p < 0.01). Nitroglycerin intake decreased from a median of 27.5 to 1.5 doses/week (p < 0.01). Canadian Cardiovascular Society angina class improved from a median of three to two (p < 0.001). During a three-year period before SCS implantation, the hospitalisation rate and duration related to coronary artery disease increased progressively. The duration of hospitalisation increased from a median of three to 10 days/patient/year. In the year after SCS implantation the duration of hospitalisation decreased to a median of 0 day/patient/year (p < 0.001). The cost of hospital care due to coronary artery disease decreased significantly thereafter. The total cost of SCS procedure was recovered within 16 months after implantation, which is less than 40% of the device life span. CONCLUSIONS: This retrospective study indicates that SCS treatment alleviates angina symptoms and improves quality of life. The treatment is also effective in preventing hospitalisations and saving costs in hospital care. A prospective study is warranted to confirm the current observations.

Adult↗
PubMed2002

Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions.

A retrospective review of medical records and radiographs of patients receiving anterior cervical discectomy and fusion (ACDF) without anterior plating and with anterior plating was performed. The objective of the study was to determine whether a difference exists in cervical lordotic alignment between subjects undergoing single-level ACDF with and without anterior cervical plating instrumentation for symptomatic cervical disc disease. Collapse or settling of grafted bone into the vertebral endplates with resulting kyphotic deformity of the cervical spine is a commonly described complication of anterior discectomy and fusion. Despite the increasing use of instrumentation for the treatment of cervical spine injuries and degenerative conditions, little is known regarding lordotic alignment of the cervical spine in patients who receive plating instrumentation compared with conventional fusion without plating. Accumulating evidence suggests that plating is superior to non-plating techniques in patients with multiple level cervical disc lesions in regard to fusion, return to work rates, and complication rates; however, little is known about maintenance of lordotic curve alignment in single- and multiple-level procedures. Neutral lateral cervical radiographs of 57 patients who underwent single-level ACDF between 1994 and 1999 with anterior screw plates (n = 26), and conventional single-level fusion without anterior screw plates (n = 21) were retrospectively assessed. Measurements were made on weight-bearing lateral cervical radiographs to assess overall sagittal spinal alignment and intersegmental sagittal alignment at the surgical site before surgery, immediately after surgery, 4 to 12 weeks after surgery, and 12+ months after surgery. The average magnitude of overall lordosis measured between C2 and C7 decreased 4.2 degrees in the non-plated group, while being preserved in the plated group. This finding did not reach statistical significance in the long-term follow-up. At the surgical site, the segmental contribution to lordosis decreased an average 2.5 degrees in the non-plated group versus an increase of 5.67 degrees in the plated group, and this finding was statistically significant between groups measured at all pre- and postoperative visits (p < 0.01). On average, the plating procedure resulted in preserving overall lordosis while increasing the magnitude of segmental lordosis at the surgical site. In comparison, the conventional method resulted in a net loss of overall lordosis and segmental lordosis at the surgical site.

Analysis of Variance↗