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PubMed2006

Comparison of outcomes of two different surgeries in regarding to complications for chronic anterior shoulder instability.

INTRODUCTION: The purpose of this study is to compare the early clinical results of two techniques in regarding to complications in the patients who suffered from chronic anterior traumatic isolated shoulder instability. METHOD: Eighty-five patients underwent reconstructive procedures due to chronic isolated traumatic shoulder instability in our clinic between 1990 and 2002. Sixty-four patients in whom preoperatively Bankart lesion were detected with MRI and who participated in the regular follow-up were included in the study. Thirty-four patients were treated with Bankart repair (Group I) and 30 patients were treated with Modified Bristow procedure (Group II). Mean follow-up period was 25 (24-39) months for group I and 28 (24-96) months for group II. All cases were evaluated preoperatively and postoperatively according to Rowe scoring system. RESULTS: Mean Rowe scores were 90 and 88.1 for group I and II, respectively. Due to recurrent dislocation, four revision surgeries (one in group I, three in group II) were performed. Surgical complications were encountered in group II, just as fracture at the bone block in four cases, nonunion in five cases and removal of loose screw in one case. DISCUSSION: According to clinical outcomes, both the techniques are useful and feasible for the treatment of the chronic traumatic isolated anterior shoulder instability; however, complication rate is higher in the Modified Bristow technique and, Bankart repair is directed to the anatomic repair of the original pathology.

Adult↗
PubMed2002

Successful limb salvage of pathological fracture of the distal tibia caused by cancer metastasis.

Pathological fractures of the distal tibia as a result of cancer metastases are rare. In particular, the management of intraarticular fractures of the distal tibia has not been established. In this article, we present a case of pathological intraarticular fracture with an extensive bone defect of the distal tibia that was successfully treated by limb salvage with a locked intramedullary nail and pirarubicin-impregnated methylmethacrylate. A 52-year-old patient with duodenal cancer presented with a painful swelling in the left crus. The condition was diagnosed as an impending pathological fracture of the tibia because of cancer metastasis. During radiation therapy, an actual pathological fracture of the distal tibia occurred due to an accident. Limb-salvage surgery was performed by removing the metastatic lesion, followed by using a locked intramedullary nail. Three distal and seven proximal locking screws were inserted into the tarsal bones and the remaining tibia. About 10 cm of bone defect was reconstructed by pirarubicin-impregnated methylmethacrylate. Consequently, good stability was achieved. One month later the patient could walk without any aid. Postoperative functional score was 77% according to the Musculoskeletal Tumor Society criteria. There was no recurrence; however, the patient died of lung metastases 4 months after the limb-salvage surgery.

Bone Nails↗
PubMed1989

Subcutaneous treatment of deep venous thrombosis with low molecular weight heparin. A dose finding study with LMWH-Novo.

Treatment of deep venous thrombosis with low molecular weight heparin (LMWH-Novo, Logiparin) was carried out with two different doses of Logiparin, 75 XaI U/kg b.w. twice daily and 150 XaI U/kg b.w. once daily subcutaneously for 5 days. Simultaneously warfarin was given from the first day of heparin treatment. Mean age of the twenty patients was 65 years and one third was females. No serious side effects, hematomas, pulmonary emboli or signs of recurrent thrombosis occurred during treatment with either dose regime. Venografic assessment with Marder scoring one week after initiation of Logiparin treatment showed a slight not significant improvement apparent in 40% of the patients. The activities of F-IIaI and F-XaI in the blood plasma were found to increase after injection of Logiparin. These two parameters seem to be the most suitable for monitoring the effect during treatment. For future studies on the therapeutic effect of Logiparin in deep venous thrombosis a single dose of 150 to 200 F-XaI activity per 24 hours seems to be most suitable.

Aged↗
PubMed2005

Does wide primary perirectal dissection during radical retropubic prostatectomy alter pathologic and biochemical outcomes?

The aim of this article is to evaluate wide primary perirectal dissection (WR) during the course of radical prostatectomy as a technique to decrease positive surgical margin rates and improve subsequent biochemical outcomes. A retrospective review of a single surgeon's series of 320 patients, including 61 who underwent WR, from 1998 to the present was performed. Patients were stratified into risk groups based on preoperative data known to predict time to prostate cancer mortality. Pathologic outcomes were tabulated and biochemical outcomes were analyzed at follow-up. Comparisons were made between WR and radical retropubic prostatectomy (RRP) with or without nerve sparing based on these parameters within each risk group. Kaplan-Meier, multivariate, and propensity score analyses were used to evaluate the impact of surgical technique on biochemical recurrence. Urinary morbidity was compared using a retrospective review of University of California-Los Angeles Prostate Cancer Symptom Index self-questionnaires. No increase in urinary or rectal morbidity was noted using the WR technique. A statistically significant decrease in positive surgical margins was noted in the high-risk population (55% vs 16%, P = 0.010) in favor of WR. Biochemical failure was similar between groups (WR vs RRP), and no biochemical survival advantage could be documented. Thus, the WR technique may successfully decrease the rate of positive surgical margins in a high-risk group without any increased urinary morbidity. This technique may affect only local control because biochemical recurrence rates were not statistically different. This finding implies the presence of occult metastatic disease at the time of surgery. A larger population with better-matched subjects is needed to clarify the potential role of WR in an intermediate-risk population.

Follow-Up Studies↗
PubMed1999

Radiofrequency ablation of atrioventricular junction and pacemaker implantation versus modulation of atrioventricular conduction in drug refractory atrial fibrillation.

Modulation of atrioventricular (AV) node conduction and radiofrequency ablation of AV junction are alternative approaches to control ventricular rate in drug refractory atrial fibrillation (AF). In 2 centers, 120 patients were treated either with AV junction ablation (center 1, group 1, 60 patients [30 men, aged 64 +/- 11 years], paroxysmal AF in 24 patients) or with modulation (group 2, 60 patients [32 men, aged 58 +/- 12 years], paroxysmal AF in 43 patients). In group 1, complete AV block was achieved in all patients. In group 2, the procedure was performed in sinus rhythm (30 patients), prolonging the Wenckebach cycle length from 328 +/- 85 to 466 +/- 80 ms (p <0.01) or during AF (30 patients), decreasing ventricular rate from 178 +/- 35 to 96 +/- 35 beats/min (p <0.01), and to <100 beats/min in 17 patients (61%). Complete AV block was induced in 9 of 60 patients (15%). In groups 1 and 2, at a follow-up of 27 +/- 7 and 26 +/- 6 months, there were 2 deaths (1 cardiac, 1 sudden death) and 1 death for end-stage heart failure, respectively. Hospital readmissions decreased from 3.2 to 0.2 and from 4.2 to 0.2/year; late AF recurrences at of >120 beats/min were documented in 6% and 12%, respectively. Symptom score analysis including effort and rest dyspnea, exercise intolerance, weakness, and palpitation showed a significant improvement in both treatment groups, when acutely effective, in patients with paroxysmal and/or chronic AF. In conclusion, ablation of the AV junction shows a higher acute success rate compared with modulation of the AV node conduction in patients with drug refractory AF. Depending on the acute success, both approaches therefore were similarly effective in achieving long-term ventricular rate control and symptom score improvement.

Aged↗
PubMed2002

Crotalidae polyvalent immune Fab (ovine) antivenom is efficacious for envenomations by Southern Pacific rattlesnakes (Crotalus helleri).

STUDY OBJECTIVE: Southern Pacific rattlesnake (Crotalus helleri ) venom is not 1 of the 4 venoms used to produce Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV). There is currently no published clinical experience regarding the efficacy of this new antivenom for confirmed C helleri envenomation, and animal data suggest greatly diminished efficacy. We assessed the efficacy of FabAV for patients with confirmed C helleri envenomation. METHODS: We conducted a prospective observational study of 23 consecutive rattlesnake envenomations that were treated with FabAV at our center. Patients were excluded if the species of snake could not be confirmed, if FabAV antivenom was not given, or if Antivenin (Crotalidae) polyvalent (equine) was given. We collected serial physical examination and laboratory data over a 24-hour period to serially evaluate the severity score and performed follow-up to evaluate delayed reactions. RESULTS: There were 15 patients who received FabAV and had the species of rattlesnake confirmed (9 C helleri, 4 C scutulatus scutulatus, 1 C mitchellii pyrrhus, 1 C ruber ruber ). C helleri envenomations demonstrated similar improvement in serial snakebite severity scores to those of other species. Three patients treated with scheduled dosing had recurrence of progressive swelling (2 C helleri and 1 C mitchellii pyrrhus ) during the 24-hour study period. CONCLUSION: We observed similar improvement in FabAV-treated patients with C helleri envenomation compared with those of other species and conclude that this treatment in standard doses appears efficacious for bites by this species. Progressive swelling may recur despite scheduled dosing.

Animals↗
PubMed2002

A randomized clinical trial comparing general exercise, McKenzie treatment and a control group in patients with neck pain.

Seventy-seven patients with neck pain in the primary health care were included in a prospective, randomized clinical trial and randomly assigned to general exercise, McKenzie treatment, or a control group. Seventy patients completed the treatment; response rate 93% at 12-month follow-up. All three groups showed significant improvement regarding the main outcomes, pain intensity and Neck Disability Index, even at 12-month follow-up, but there was no significant difference between the groups. In all, 79% reported that they were better or completely restored after treatment, although 51% reported constant/daily pain. In the McKenzie group compared with the control group, a tendency toward greater improvement was noted for pain intensity at 3 weeks and at 6-month follow-up, and for post-treatment Neck Disability Index. Significant improvement in Distress and Risk Assessment Method scores was shown in the McKenzie group only. The three groups had similar recurrence rates, although after 12 months the McKenzie group showed a tendency toward fewer visits for additional health care. The study did not provide a definite evidence of treatment efficacy in patients with neck pain, however, there was a tendency toward a better outcome with the two active alternatives compared with the control group.

Adult↗
PubMed1993

The efficacy and tolerance of a three-day course of azithromycin in the treatment of community-acquired pneumonia.

The clinical efficacy and tolerance of a three-day course of azithromycin was evaluated in patients with community-acquired pneumonia in an open, non-comparative pilot study. Sixty-six patients with clinical and radiological findings of pneumonia were treated with a total dose of 1.5 g azithromycin (500 mg once-daily for three days). Of these 66 patients, 40 were evaluable clinically and microbiologically. Of the remaining 26 patients, 22 had no organisms isolated at baseline, and could only be evaluated clinically; two patients were lost to follow-up; and two patients were protocol violators. Of the 40 patients in whom aetiological agents were identified, 39 (98%) had a satisfactory clinical response (34 cured, five improved), including all eight patients diagnosed as having Legionella pneumophila pneumonia on the basis of serology. One patient with recurrent Haemophilus influenzae infection on day 8 was considered a failure. Total severity score for overall signs and symptoms was reduced significantly from a baseline level by day 2 (P = 0.0001). Bacteriological eradication was achieved in 32 of 33 (97%) isolates including 27 of 27 Streptococcus pneumoniae, the most frequently isolated pathogen. All six patients with pneumococcal bacteraemia were cured clinically by day 14, and blood cultures were negative for four of these patients within 48 h. Treatment-related side effects were reported in 4 of 66 (6%) patients, but were all mild. Laboratory abnormalities were observed in 5 of 62 (8%) patients: elevated liver enzymes (2), elevated creatine levels (1), haematological test abnormalities (2), including one patient with severe eosinophilia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Causes of chronic vaginitis: analysis of a prospective database of affected women.

OBJECTIVE: To compare women with different chronic vaginal symptoms with a wide variety of sociodemographic, health, behavioral, and psychosocial characteristics. METHODS: Serially recruited subjects answered a questionnaire that asks about demographic information and symptoms and measures depression and stress scores. Patients underwent a standardized history, physical examination, and laboratory examination. Patients with recurrent vulvovaginal candidiasis, vulvar vestibulitis syndrome, desquamative inflammatory vaginitis, physiologic leukorrhea, and other diagnoses were compared with one another. Chi-square tests and one-way analysis of variance with Tukey honestly significant difference (HSD) post hoc analyses were used for categorical and continuous data analysis. RESULTS: Two hundred patients were enrolled in this study. The most common diagnoses were contact dermatitis (21%), recurrent vulvovaginal candidiasis (20.5%), atrophic vaginitis (14.5%), and vulvar vestibulitis syndrome (12.5%); 18% of women had 2 or more diagnoses. In the overall study sample, the mean age was 38.4 years, 78% were white, and 55% were college educated. Sixty-two percent had symptoms for over a year. Desquamative inflammatory vaginitis patients were older and less likely to be menstruating. Those with vulvar vestibulitis syndrome had more frequent complaints of dyspareunia. Recurrent vulvovaginal candidiasis patients felt that their symptoms had the greatest negative impact on work and social life. There were high rates of psychiatric disorder (43.5%), atopic disease (42.5%), and pain syndrome (56%) in all groups. CONCLUSION: Women with chronic vaginal symptoms have a variety of diagnoses, most of them noninfectious. LEVEL OF EVIDENCE: II-3.

Adult↗
PubMed2003

Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience.

PURPOSE: Cryosurgical ablation of the prostate is 1 approach to the treatment of localized prostate cancer. Third generation cryosurgery uses gas driven probes that allow for a decrease in probe diameter to 17 gauge (1.5 mm). The safety, morbidity and preliminary prostate specific antigen (PSA) results of 122 cases are reported. MATERIALS AND METHODS: A total of 106 patients have undergone percutaneous cryosurgery using a brachytherapy template with at least 12 months of PSA followup. Immediate and delayed morbidities were evaluated. PSA results at 3 and 12 months were recorded, and failure was defined as the inability to reach a nadir of 0.4 ng/ml or less. RESULTS: Complications in patients undergoing primary cryosurgery included tissue sloughing (5%), incontinence (pads, 3%), urge incontinence/no pads (5%), transient urinary retention (3.3%) and rectal discomfort (2.6%). There were no cases of fistulas or infections. Postoperative impotence was 87% in previously potent patients. For patients who underwent salvage cryosurgery there were no fistulas reported and 2 (11%) patients required pads after salvage cryosurgery. A total of 96 (81%) patients achieved a PSA nadir of 0.4 ng/ml or less at 3 months of followup, while 79 of 106 (75%) remained free from biochemical recurrence at 12 months. A total of 42 (78%) low risk patients (Gleason score 7 or less and PSA 10 or less) remained with a PSA of 0.4 ng/ml or less at 12 months of followup, compared to 37 (71%) high risk patients. All patients were discharged within 24 hours. CONCLUSIONS: After a followup of 1 year 3rd generation cryosurgery appears to be well tolerated and minimally invasive. The use of ultrathin needles through a brachytherapy template allows for a simple percutaneous procedure and a relatively short learning curve. A prospective multicenter trial is ongoing to determine the long-term efficacy of this technique.

Aged↗
PubMed2003

The evolving role of chemotherapy and other systemic therapies for managing localized prostate cancer.

PURPOSE: The recent literature is reviewed regarding the use of neoadjuvant and adjuvant chemotherapy, and promising new molecular targeted agents in patients with high risk localized prostate cancer. MATERIALS AND METHODS: A MEDLINE literature review was performed of studies evaluating chemotherapy and other systemic therapies for localized prostate cancer. RESULTS: Patients with prostate cancer at high risk for recurrence despite local therapy include those with clinical stage T3 disease, biopsy Gleason scores of 8 to 10 or serum prostate specific antigen greater than 20 ng/ml. Although hormonal therapy has palliative benefit for the majority of patients with metastatic disease, randomized trials have not demonstrated a survival benefit from its administration before surgery for high risk localized disease. Recent trials have shown that cytotoxic chemotherapy has significant activity in hormone refractory prostate cancer, which has led to ongoing clinical trials that are investigating the use of chemotherapy in the neoadjuvant setting. Published and ongoing clinical trials in the use of systemic therapy for localized prostate cancer are reviewed. CONCLUSIONS: Systemic therapy for advanced prostate cancer is improving. Efforts to use such therapies for managing localized disease are ongoing.

Antineoplastic Agents, Hormonal↗
PubMed2025

Computational modeling of human genetic variants in mice.

Mouse models represent a powerful platform to study genes and variants associated with human diseases. While genome editing technologies have increased the rate and precision of model development, predicting and installing specific types of mutations in mice that mimic the native human genetic context is complicated. Computational tools can identify and align orthologous wild-type genetic sequences from different species; however, predictive modeling and engineering of equivalent mouse variants that mirror the nucleotide and/or polypeptide change effects of human variants remains challenging. Here, we present H2M (human-to-mouse), a computational pipeline to analyze human genetic variation data to systematically model and predict the functional consequences of equivalent mouse variants. We show that H2M can integrate mouse-to-human and paralog-to-paralog variant mapping analyses with precision genome editing pipelines to devise strategies tailored to model specific variants in mice. We leveraged these analyses to establish a database containing > 3 million human-mouse equivalent mutation pairs, as well as in silico-designed base and prime editing libraries to engineer 4,944 recurrent variant pairs. Using H2M, we also found that predicted pathogenicity and immunogenicity scores were highly correlated between human-mouse variant pairs, suggesting that variants with similar sequence change effects may also exhibit broad interspecies functional conservation. Overall, H2M fills a gap in the field by establishing a robust and versatile computational framework to identify and model homologous variants across species while providing key experimental resources to augment functional genetics and precision medicine applications. The H2M database (including software package and documentation) can be accessed at https://human2mouse.com.

Journal Article↗
PubMed1997

Microarousals in patients with sleep apnoea/hypopnoea syndrome.

Upper airway obstructions during sleep cause recurrent brief awakenings or microarousals. Standard criteria exist for sleep and respiratory event scoring, however, there are different definitions currently used to score microarousals. We therefore compared three definitions of microarousal (ranging from 1.5-3 s in duration) and one of awakening (>15 s). We examined their occurrence at the termination of apnoeas and hypopnoeas and their correlation with daytime sleepiness in patients with sleep apnoea/hypopnoea syndrome (SAHS). Sixty-three patients (aged 49, SD 10) had overnight polysomnography, multiple sleep latency tests (MSLT) and Epworth Sleepiness Scales (ESS). There were significantly more microarousals by any definition than there were awakenings (P<0.001) and there were more 1.5 s than 3 s microarousals (P<0.001). Significantly more apnoeas and hypopnoeas were terminated by 1.5 s microarousals (83% and 81%) than by 3 s microarousals (75%) (all P<0.001). Apnoea/ hypopnoea index (AHI) correlated significantly with objective daytime sleepiness (rho=-0.30, P<0.01). There were weakly significant relationships between all three microarousal definitions (-0.24<rho<-0.22, 0.03<P<0.04) and objective daytime sleepiness. None of the arousal definitions correlated with Epworth Sleepiness Scales scores. These results suggest that although 1.5 s microarousals are found at the end of more respiratory events, relationships between 3 and 1.5 s definitions, and daytime sleepiness are similar. This indicates that any of the three microarousal definitions can be used for visual assessment of sleep fragmentation.

Arousal↗
PubMedDate not supplied

A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis.

Ketoconazole (KET) and zinc pyrithione (ZPT) are compounds active against the Malassezia spp. yeasts, which are believed to play a major role in dandruff and seborrheic dermatitis. We compared the efficacy and safety of KET 2% and ZPT 1% in shampoo formulations for the alleviation of severe dandruff and seborrheic dermatitis. This open randomized, parallel-group trial began with a 2-week run-in phase during which subjects applied a neutral non-antidandruff shampoo. It was followed by a 4-week randomized treatment phase and a subsequent 4-week follow-up phase without treatment. Shampooing during the treatment period was carried out twice weekly for the KET group and at least twice weekly for the ZPT group in accordance with the label instructions. A total of 343 subjects were recruited to enter the trial. Of the 331 eligible volunteers, 171 were randomized to KET 2% and 160 to ZPT 1%. Clinical assessments were performed. Beneficial effects were evidenced for both medicated shampoos, but the effect was significantly better for KET 2%, which achieved a 73% improvement in the total dandruff severity score compared with 67% for ZPT 1% at week 4 (p < 0.02). The recurrence rate of the disease was also significantly lower following KET 2% treatment than following ZPT 1% treatment. As a consequence, the overall clearing of the skin condition at the end of treatment and follow-up phase was in favor of the KET 2% formulation (p = 0.004). Side effects were minimal. It is concluded that after a 4-week treatment, KET 2% shampoo was significantly superior to ZPT 1% shampoo in the treatment of subjects with severe dandruff or seborrheic dermatitis of the scalp. It is our assumption that this difference is noticeable for the patient and as a consequence relevant. Both formulations were well tolerated.

Adolescent↗
PubMed2005

Acute lupus myocarditis: clinical features and outcome of an oriental case series.

Symptomatic myocarditis in systemic lupus erythematosus (SLE) is uncommon. We describe the clinical characteristics, management and outcomes of 11 SLE patients without any atherosclerotic risk factors, who presented with acute lupus myocarditis (ALM). All patients were female, 46% Chinese with mean age of 27 +/- 10 years at diagnosis of SLE. ALM was one of the initial manifestations of SLE in eight (73%) patients. The median duration from onset ALM to initiation of treatment was two weeks (range: 0.3-8). All had clinical feature of left ventricle dysfunction. The most common electrocardiographic feature was nonspecific ST/T wave changes (91%). Common echocardiographic findings included segmental wall motion abnormalities (81%) and decreased left ventricular ejection fraction (81%). Median SLE disease activity index at presentation was 16 (range: 4-30). All patients received high dose corticosteroids and 64% received intravenous pulse cyclophosphamide. There were two deaths (18%) from infections. The remaining nine survivors had no recurrence of ALM nor suffer any SLE-related damage (median SLICC damage score of 0), up to a median follow-up of four years (range: 2.5-10.1). Repeat echocardiography after six months or later showed normal LVEF in eight patients (89%). Early immunosuppressive therapy in ALM, with high dose corticosteroids and pulse intravenous cyclophosphamide, results in good cardiac outcome.

Adult↗
PubMed2005

Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer.

PURPOSE: To assess whether detriments in quality of life (QOL) among women with breast cancer persist over years. PATIENTS AND METHODS: QOL was assessed in a population-based cohort of 314 women with breast cancer from Saarland (Germany) 1 and 3 years after diagnosis and compared internally and with reference data from the general population. RESULTS: Three years after diagnosis, deficits in QOL were still apparent for role, emotional, cognitive, and social functioning and for the symptoms of insomnia, fatigue, dyspnea, and financial difficulties. Differences between breast cancer patients and women from the general population were predominantly found in younger ages. Compared with the QOL scores measured 1 year after diagnosis, only minor functional changes were observed, but recurrence of breast cancer during the follow-up interval had a deleterious effect on QOL. CONCLUSION: Deficits in role, emotional, cognitive, and social functioning persist over years in women with breast cancer and predominantly affect younger patients.

Adult↗
PubMed1995

The results of surgery for benign tumors of the cavernous sinus.

CAVERNOUS SINUS SURGERY has been performed increasingly in the last 2 decades because of new knowledge and technologies. With increasing international expertise in cavernous sinus surgery, the results must be analyzed critically to search for accurate prognosticators of outcome. We performed a retrospective review of 124 patients (40 male, 84 female; mean age, 45 years) who underwent cavernous sinus surgery for benign tumors from 1983 to 1992. Sixty-five percent had tumors encasing the internal carotid artery. Mean follow-up was 29 months (median, 26 mo). Gross total or near-total resection was possible in 80%. Patients with neurilemomas, angiofibromas, epidermoids, chondroblastomas, and hemangiomas were more likely to have total or near-total resection (100% versus 75%, P < 0.025). Disabling complications (five cerebral infarctions, two meningitis, and one hydrocephalus with chiasmal prolapse) occurred only in patients with meningiomas or pituitary adenomas. On follow-up, excellent/good binocular vision was achieved in 53% of patients entering surgery with excellent/good function versus 25% who entered surgery with fair/poor binocular vision (P < 0.025). Ninety-three percent of patients had a Karnofsky score > or = 70 on follow-up. There were a total of 12 recurrences (10%), 6 in patients with meningiomas, 2 in patients with angiofibromas, 2 in patients with craniopharyngiomas, 1 in a patient with a pituitary adenoma, and 1 in a patient with an osteoblastoma. Patients with tumor growth or neurological symptoms indicative of progressive cavernous sinus involvement should undergo cavernous sinus exploration. This surgery has acceptable morbidity and mortality and, if the tumor can be removed easily, the surgeon should try to perform radical tumor resection. To avoid major complications, the surgeon must exercise utmost care to preserve the neurovascular structures of the cavernous sinus, with special attention to tumors that extend into the petroclival region. Better results from surgery can be expected in those patients with neurilemomas, hemangiomas, or epidermoids than in patients with meningiomas, craniopharyngiomas, or pituitary adenomas. Good functional outcome can be expected, particularly if the patient's preoperative clinical status is good. Particular attention must be paid to the reconstruction of anatomic barriers in order to prevent cerebrospinal fluid leakage and subsequent meningitis.

Adult↗
PubMed1999

Radiolunate arthrodesis: A procedure for stabilising and preserving mobility in the arthritic wrist.

We carried out arthrodesis of the radiolunate joint in 46 wrists (38 patients) for pain and ulnar translation of the carpus because of rheumatoid (42) or psoriatic arthritis (4). At follow-up, three patients had died and in three (1 bilateral) an additional midcarpal arthrodesis had been undertaken. The remaining 32 patients (39 wrists) were evaluated after a mean of five years. The clinical results were good with a mean visual analogue score of 8.3 for pain, 7.2 for hand function and 9 for overall satisfaction. Except for palmar flexion, mobility was equal to or better than before operation. Radiologically, there was deterioration of the midcarpal joint with an increase in the Larsen score from 1.8 to 2.7 (p < 0.001), some decrease in carpal height and recurrence of carpal translation. Radiolunate arthrodesis gives good clinical results at five years although there is some deterioration radiologically.

Adult↗