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PubMed2006

The relationship between falls history and computerized dynamic posturography in persons with balance and vestibular disorders.

OBJECTIVE: To describe the relationship between Sensory Organization Test (SOT) scores and reported falls in persons with vestibular and balance disorders. DESIGN: Descriptive cross-sectional. SETTING: Outpatient tertiary balance and falls clinic. PARTICIPANTS: One hundred physical therapy (PT) charts of people referred to a balance and falls clinic were reviewed. Criteria for inclusion were that the patients had completed the SOT of computerized dynamic posturography (CDP), had a vestibular diagnosis, and had the numbers of falls recorded from patient report within the last 6 months at the initial examination. Rotational chair, caloric testing, oculomotor test, and Activities-Specific Balance Confidence (ABC) results were recorded, if available. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The SOT composite and ABC scores as they related to reports of falls in the last 6 months. RESULTS: The overall proportion of persons with vestibular disorders with positive 6-month history for 1 or more falls was 30% and for recurrent falls (>/=2) was 17%. Vestibular laboratory findings, age, sex, and vestibular diagnosis were not related to reported falls status. Patients who reported multiple falls prior to the PT examination had lower SOT composite scores than patients who reported 1 or no falls in the previous 6 months. The receiver operating characteristic curve identified a composite SOT score of less than 38 as demonstrating the highest likelihood ratio for differentiating between those people who reported no falls in the past 6 months and those who reported 2 or more falls. CONCLUSIONS: Persons who are recurrent fallers perform worse on SOT than either nonfallers or 1-time fallers. CDP performance can help guide the clinician in the development of a safe exercise program.

Accidental Falls↗
PubMed2004

Recurrence rates after endoscopic sinus surgery for massive sinus polyposis.

BACKGROUND AND OBJECTIVES: Most studies on outcome after endoscopic sinus surgery (ESS) include patients with varying degrees of disease severity. Recurrence rates cited by those studies may not apply to the subset of patients with severe polyposis. Our aim is to provide reference information for recurrence rates and need for revision surgery in patients with severe disease. STUDY DESIGN, PATIENTS, AND METHODS: Review of patients with severe polyposis with a minimum Lund-McKay score of 16 and with a Kennedy computed tomography stage 3 or 4. Data collection included demographics, presence of asthma or documented allergy, history of previous surgery, extent of surgery, preoperative and postoperative management, recurrence rates, revision surgery rates, and follow-up. RESULTS: One hundred and eighteen records were reviewed. Fifty-nine (50%) patients had asthma, and 93 (79%) had documented allergy. All patients required extensive bilateral nasal polypectomy, complete anterior and posterior ethmoidectomy, and maxillary sinusotomy. One hundred (85%) also had frontal or sphenoid sinusotomy. Follow-up ranged from 12 to 168 (median 40) months. Seventy-one (60%) developed recurrent polyposis. Fifty-five (47%) were advised to undergo revision surgery, and 32 (27%) underwent surgery. History of previous sinus surgery or asthma predicted higher recurrence (P <.005, P <.001) and revision surgery rates (P =.02, P <.001). History of allergy also predicted recurrence and need for revision (P <.001, P <.001). CONCLUSIONS: Recurrence rates after ESS for severe polyposis are significant. In our study, patients with asthma are at higher risk of recurrence.

Adult↗
PubMed1999

Impact of suppressive antiviral therapy on the health related quality of life of patients with recurrent genital herpes infection.

OBJECTIVE: To investigate whether suppressive antiviral therapy improves health related quality of life in patients with recurrent genital herpes. METHODS: Health related quality of life was measured using the disease specific recurrent genital herpes quality of life questionnaire (RGHQoL) as part of a randomized, double blind, 52 week, placebo controlled, dose ranging study of once and twice daily valaciclovir or aciclovir for the suppression of recurrent genital herpes in patients with six or more recurrences per year. RESULTS: Of 1479 participants, 1349 patients completed the baseline questionnaire. There were no significant baseline differences in RGHQoL score between any of the treatment groups. After 3 months there were significantly greater improvements in mean RGHQoL scores for all active treatment groups compared with placebo (p < 0.05). Mean RGHQoL score improvements from baseline remained significantly higher in the active treatment groups than in the placebo group after 6 and 12 months, indicating that the improved health related quality of life in patients receiving suppressive antiviral therapy was sustained over a prolonged period of time. CONCLUSION: Suppressive antiviral therapy is an effective strategy for improving the quality of life of patients with recurrent genital herpes. These improvements in quality of life are sustained over time, thus enhancing the clinical benefit in the long term management of this condition.

Acyclovir↗
PubMed2004

Pancreatic pseudocysts following acute pancreatitis: risk factors influencing therapeutic outcomes.

CONTEXT: The natural history of pancreatic pseudocysts has become well known in recent years, but the choice of a proper treatment still remains controversial. OBJECTIVE: This study aims at establishing whether predictive factors influencing therapeutic outcomes exist. SETTING: Patients with pancreatic pseudocysts following an episode of acute pancreatitis treated from January 1980 to December 2001 at the Department of General Surgery and Organ Transplantation of the University of Parma, Italy. PATIENTS: Seventy-four patients were studied: 12 had a spontaneous resolution, 37 patients were treated surgically, 15 were treated endoscopically and in 10, percutaneous drainage was used. MAIN OUTCOME MEASURES: Epidemiological, clinical and pathological characteristics of patients with pancreatic pseudocysts were related to morbidity, recurrence rates and hospital stay. RESULTS: At univariate logistic regression, our data reveal a significant increase in morbidity related to age (P=0.013), etiology (alcoholic vs. biliary, P=0.024), Ranson score of previous pancreatitis (P=0.006), nutritional assessment (P=0.001), residual necrosis (P<0.001) and modality of treatment (P=0.009), whereas none of these parameters has been shown to be significantly correlated to recurrence. At multivariate logistic regression, only residual necrosis was significantly related to morbidity. CONCLUSIONS: Some factors, such as epidemiological (age, etiology), clinical (severity of previous pancreatitis, malnourishment), pathological (residual necrosis), and therapeutical factors (emergency/urgency treatment) are predictive of worse outcomes for invasive treatment of pseudocysts. In particular residual necrosis appeared to be the most important factor influencing invasive treatment outcomes, confirming that this pathological aspect deserves particular attention from surgeons. No risk factors predicting pancreatic pseudocyst recurrence emerged.

Acute Disease↗
PubMed1989

[Prognosis estimation score in advanced ovarian cancer].

The retrospective analysis of 68 advanced ovarian cancer cases was performed mainly to see whether certain predictive factors were present which might distinguish patients with risk for recurrence or death from those with a good prognosis. Six factors, such as the mode of operation, the site of metastasis, the degree of peritonitis carcinomatosa, the rate of the decline in serum CA125. Performance Status, and pathological type were selected as factors influencing prognosis. We then tried to tally the prognosis estimation score using these factors. The correlation between this score and the survival period was noted in only patients with a survival time up to 3 years. The following formula was obtained: Y = 1.286X -3.429 [X: prognosis estimation score, Y: survival period (months)]. Cases were classified as follows according to the this score. When patients had a value equal to or less than 17.84.2% of patients died within 21 months, while if patients had a value greater than 17.34.7% of cases survived more than 36 months. On the other hand, 89.5% of cases with a survival period longer than 36 months had a prognosis estimation score greater than 18. However, there was little significant correlation between this score and the survival period in patients with survival period longer than 3 years. To conclude, although a low value for this score in advanced ovarian cancer, indicates a poorer prognosis, we cannot make an accurate prognosis for more than 3 years from this score.

Adult↗
PubMed2005

Revision of cemented hip arthroplasty using a hydroxyapatite-ceramic-coated femoral component.

We report the clinical and radiological outcome of 86 revisions of cemented hip arthroplasties using JRI-Furlong hydroxyapatite-ceramic-coated acetabular and femoral components. The acetabular component was revised in 62 hips and the femoral component in all hips. The mean follow-up was 12.6 years and no patient was lost to follow-up. The mean age of the patients was 71.2 years. The mean Harris hip and Oxford scores were 82 (59 to 96) and 23.4 (14 to 40), respectively. The mean Charnley modification of the Merle d'Aubigné and Postel score was 5 (3 to 6) for pain, 4.9 (3 to 6) for movement and 4.4 (3 to 6) for mobility. Migration of the acetabular component was seen in two hips and the mean acetabular inclination was 42.6 degrees. The mean linear polyethylene wear was 0.05 mm/year. The mean subsidence of the femoral component was 1.9 mm and stress shielding was seen in 23 (28%) with bony ingrowth in 76 (94%). Heterotopic ossification was seen in 12 hips (15%). There were three re-revisions, two for deep sepsis and one for recurrent dislocation and there were no re-revisions for aseptic loosening. The mean EuroQol EQ-5D description scores and health thermometer scores were 0.69 (0.51 to 0.89) and 79 (54 to 95), respectively. With an end-point of definite or probable loosening, the probability of survival at 12 years was 93.9% and 95.6% for the acetabular and femoral components, respectively. Overall survival at 12 years, with removal or further revision of either component for any reason as the end-point, was 92.3%. Our study supports the continued use of this arthroplasty and documents the durability of hydroxyapatite-ceramic-coated components.

Aged↗
PubMed2005

Resection of brain metastases previously treated with stereotactic radiosurgery.

OBJECT: To date, no report has been published on outcomes of patients undergoing resection for brain metastases who were previously treated with stereotactic radiosurgery (SRS). Consequently, the authors reviewed their institutional experience with this clinical scenario to assess the efficacy of surgical intervention. METHODS: Sixty-one patients (each harboring three or fewer brain lesions), who were treated at a single institution between June 1993 and August 2002 were identified. Patient charts and their neuroimaging and pathological reports were retrospectively reviewed to determine overall survival rates, surgical complications, and recurrence rates. A univariate analysis revealed that patient preoperative recursive partitioning analysis (RPA) classification, primary disease status, preoperative Karnofsky Performance Scale score, type of focal treatment undergone for nonindex lesions, and major postoperative surgical complications were factors that significantly affected survival (p < or = 0.05). In contrast, only the RPA class and focal (conventional surgery or SRS) treatment of nonindex lesions significantly (or nearly significantly) affected survival in the multivariate analysis. Major neurological complications occurred in only 2% of patients. The median time to distant recurrence after resection was 8.4 months; that to local recurrence was not reached. The overall median survival time was 11.1 months, with 25% of patients surviving 2 or more years. Conventional surgery facilitated tapering of steroid administration. Conclusions. The complication, morbidity, survival, and recurrence rates are consistent with those seen after conventional surgery for recurrent brain metastases. Our results indicate that in selected patients with a favorable RPA class in whom nonindex lesions are treated with focal modalities, surgery can provide long-term control of SRS-treated lesions and positively affect overall survival.

Adult↗
PubMed1996

Patterns of spread of recurrent intraabdominal sarcoma.

A prominent site for recurrence of retroperitoneal and visceral sarcoma is the abdominal cavity. In an attempt to understand the causation of local and regional recurrence, 21 sarcoma patients who had previously undergone "complete" surgical removal of the primary tumor were prospectively studied. Data were obtained retrospectively from the first operation and prospectively from the reoperative procedure at the Washington Cancer Institute. At the primary and reoperative surgeries, 9 abdominopelvic regions and 21 sites were scored and then cataloged in a standardized fashion. Tumor locations and surgical resections were statistically analyzed in an attempt to establish patterns of recurrence within the abdomen and pelvis. There was a significant difference in sites of recurrence when sarcomas that involved the parietal structures were compared with those that involved small bowel. Peritoneal implants (nodular recurrences) were uniformly present in both groups. In contrast, resection site recurrences were very common with primary sarcomas invested by parietal peritoneum, while they were absent in those covered by visceral peritoneum. When primary surgeries were compared with reoperations, there was an increasing intraabdominal dissemination; the mean number of regions increased from 1.81 to 5.13. The change in distribution of sarcoma deposits at reoperation was greatest in right upper (because of liver surface) central and pelvic abdominopelvic regions and lowest in the left upper and epigastrium. The four anatomic sites that revealed a significant increase in involvement at the time of recurrence were the greater omentum, liver surface, large bowel, and the cul-de-sac of Douglas (all p < 0.002). Regions with tumor involvement or regions subjected to surgical trauma at the time of primary sarcoma resection were significantly more likely to show sarcoma deposits than to be sarcoma free at reoperation. These data taken together may suggest that sarcoma tumor emboli are frequently present in the abdomen at the time of resection of the primary cancer and that these tumor emboli are entrapped in fibrinous material at or immediately adjacent to sites of surgical trauma and along narrow margins of resection. Tumor cell entrapment of sarcoma emboli released into the peritoneal cavity prior to or at the time of sarcoma resection may help explain the distribution of nodular and fusiform recurrence of abdominopelvic sarcoma.

Abdominal Neoplasms↗
PubMed2005

Risk of recurrence of anal sphincter lacerations.

OBJECTIVE: To estimate the rate of recurrence of anal sphincter lacerations in subsequent pregnancies and analyze the risk factors associated with recurrent lacerations METHODS: Data were obtained from the Pennsylvania Health Care Cost Containment Council, Division of In-Patient Statistics, regarding all cases of third- and fourth-degree perineal lacerations that occurred during a 2-year period (from January 1990 through December 1991). All subsequent pregnancies in this group of women over the next 10 years were identified, and the rate of recurrence of sphincter tears and risk factors for recurrence were analyzed. RESULTS: The rate of anal sphincter lacerations was 7.31% (n = 18,888) during the first 2 years of study (1990-1991). In the next 10 years, these patients with prior lacerations were delivered of 16,152 pregnancies. Of these, 1,162 were by cesarean. Among the 14,990 subsequent vaginal deliveries, 864 (5.76%) had a recurrence of a third- or fourth-degree laceration. Women with prior fourth-degree lacerations had a much higher rate of recurrence than those with prior third-degree laceration (7.73% versus 4.69%). The rate for recurrent lacerations was significantly lower than the rate for initial lacerations (odds ratio 1.29, 95% confidence interval [CI] 1.2-1.4). Forceps delivery with episiotomy had the highest risk for recurrent laceration (17.7%, odds ratio 3.6, 95% CI 2.6-5.1), whereas vacuum use without episiotomy had the lowest risk (5.88%, odds ratio 1.0, 95% CI 0.6-1.7). CONCLUSION: Prior anal sphincter laceration does not appear to be a significant risk factor for recurrence of laceration. Operative vaginal delivery, particularly with episiotomy, increases the risk of recurrent laceration as it does for initial laceration. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMed2005

Oral and oropharyngeal squamous cell carcinomas expressing CCR7 have poor prognoses.

OBJECTIVE AND METHODS: Tumor cell migration and metastasis have many similarities with leukocyte trafficking regulated by chemokines and their receptors. In this study, we investigated the expression of CC chemokine receptor 7 (CCR7) in oral and oropharyngeal squamous cell carcinomas (SCCs) using an immunohistochemical approach. RESULTS: Among 90 cases of oral and oropharyngeal SCCs, 54 cases (60%) were positive for CCR7. The CCR7-positive group had a significantly lower incidence of being disease-free and an overall lower survival rate than the CCR7-negative group (p<0.01 and p<0.01, respectively). Among the 35 patients who died of cancer, 28 patients (80%) were positive for CCR7. The expression of CCR7 was significantly associated with five clinical factors. SCCs expressing CCR7 tend to have large, lymph node metastases, progressive stages, local recurrences and cancer death. The CCR7 expression of metastatic SCCs in draining lymph nodes was detected, and the staining score of CCR7 between primary SCCs and metastatic SCCs were significantly correlated (p<0.01). CONCLUSIONS: The investigation of CCR7 expression in oral and oropharyngeal SCCs may be useful to predict patients prognoses.

Carcinoma, Squamous Cell↗
PubMed1997

Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery.

OBJECTIVE: To review the results of the analysis and quantification of the influence of medical factors on the morbidity and mortality associated with emergency surgery for colorectal cancer. PATIENTS AND METHODS: We analyze retrospectively the data for 51 patients who underwent emergency surgery: 34 (67%) to treat acute obstruction and 17 (33%) for perforation. The median follow-up period was 18.5 months (3 to 62 months). RESULTS: The main tumor was located in the right colon in 13 patients (25%), in the left colon in 35 (69%) and in, the rectum in 3 (6%). Primary resection was performed in 94% of the patients: without anastomosis in 35% (18 of 51) and with primary anastomosis in 59% (30 of 51); 6% of the tumors were not resectable. The postoperative morbidity was 41%: 29% (10 of 34) occurring in obstructions and 65% (11 of 17) in perforations. The mortality rate was 14% (9% and 23%, respectively). There were statistically significant associations between mortality and the American Society of Anesthesia grading (p < 0.01) and between both the mortality and morbidity and the score for the acute physiology component of APACHE II (p = 0.01, respectively) and the total APACHE II score (p < 0.01 in both cases). The rate of actuarial disease-free survival was 26% at 36 months. Overall survival was 15% at 62 months. A recurrence rate of 48% (14 of 29) has been recorded. CONCLUSIONS: Emergency surgery for colorectal cancer is associated with a high postoperative morbidity and mortality rate, which correlate with the medical status and, particularly, with the acute physiology score of the APACHE II risk stratification system.

APACHE↗
PubMed1983

[Role of radiotherapy in inflammatory local recurrence of breast cancer : first experiences with combined radio-chemotherapy].

Between June 1976 and October 1981 ten patients with extended inflammatory recurrent mammary carcinoma of the chest wall and distant metastases underwent sequential chemo- and radiotherapy at the University Clinic for Radiotherapy and Radiobiology in Vienna. Five of these patients had received local treatment of recurrent mammary carcinoma of the chest wall before. Eight of ten patients responded to therapy, 5 showed complete remission. The mean remission period of 8.8 months for the chest wall area is significantly longer than that of distant metastases with 6.1 months (p less than 0.05). Local megavolt therapy has no influence on the mean survival time, but improves the quality of life considerably. All patients under treatment achieved at least 80% on the Karnofsky score. After a comprehensive study of recent international literature the authors have come to the conclusion that local and regional recurrence after initial treatment obviously prove an advanced stage. For this very reason the prevention of local regional recurrence by means of postoperative megavolt therapy is of great significance.

Adult↗
PubMed2006

Differences in clinical characteristics and disease-free survival for Latino, African American, and non-Latino white men with localized prostate cancer: data from CaPSURE.

BACKGROUND: Few studies of ethnicity and prostate cancer have included Latino men in analyses of baseline clinical characteristics, treatment selection, and disease-free survival (DFS). The present study examines the impact of Latino ethnicity on these parameters in a large, multiinstitutional database of men with prostate cancer. METHODS: We compared baseline disease characteristics and clinical outcomes for Latino (N = 138), non-Latino White (NLW, N = 5619), and African-American (AA, N = 608) men with localized prostate cancer by using chi-square and ANOVA for baseline variables and survival analysis to examine differences in time to recurrence. RESULTS: Latino men resembled AA men more than NLW on sociodemographic characteristics. AA men had higher Gleason scores and prostate-specific antigen (PSA) at diagnosis than Latino or NLW men (both P < 0.01). 10% of both Latino and AA men presented with advanced disease (T3b/T4/N+/M+) versus 4% of NLW (P < 0.01). Latino men did not receive different treatments than NLW or AA men after controlling for clinical and demographic factors; however, AA men were more likely to receive external beam radiation (OR = 1.51, 95% confidence interval [CI] = 0.99-2.31) and hormone treatment (OR = 1.56, 95% CI = 1.05-2.32) then NLW men. For prostatectomy patients, 3-year actuarial DFS rates were 83% for NLW men and 86% for Latino men versus 69% for AA men (P < 0.01). After controlling for clinical and sociodemographic variables, AA men were somewhat more likely than NLW to experience disease recurrence after radical prostatectomy (RP) (HR = 1.38, 95% CI = 0.98-1.94, P = 0.06). CONCLUSIONS: Latinos are more similar to African Americans on sociodemographic characteristics but more similar to NLW on clinical presentation, treatments received, and DFS.

Black or African American↗
PubMed2004

Anxiety and depressive symptoms measured by the Hospital Anxiety and Depression Scale as predictors of time to recurrence in localized cutaneous melanoma.

The purpose of this study was to investigate anxiety and depression as predictors for recurrence-free survival in cutaneous melanoma, when corrected for known prognostic factors. The association between known prognostic factors and anxiety and depression were also studied. Consecutive patients (n = 437) completed the Hospital Anxiety and Depression Scale (HAD) approximately three months after diagnosis of melanoma. Neither anxiety, nor depression turned out to be prognostic factors for time to recurrence. A higher proportion of young patients, women, patients without ulcerated tumours, patients with tumours with low mitotic index and Clark's level II tumours scored > or = 8 (possible clinical levels of anxiety) on the anxiety scale. Furthermore, on the depression scale, a higher proportion of young patients scored > or = 8 (possible clinical level of depression). Using the HAD scale, a well-validated instrument for assessing anxiety and depression in patients with somatic diseases, our data did not show any associations between anxiety or depression and outcome in terms of recurrence in patients with localized disease.

Age Factors↗
PubMed2005

Facets and determinants of quality of life in patients with recurrent high grade glioma.

OBJECTIVES: To assess patients with recurrent high grade brain glioma with the aim of evaluating facets of quality of life (QOL) and their association with mood, cognition, and physical performance. METHODS: Ninety four glioma patients (four groups with different duration of glioma recurrence) were compared with 24 patients with other chronic neurological diseases and 48 healthy subjects. The Functional Living Index-Cancer (FLIC) provided QOL self evaluations, and standardised scales and neuropsychological tests assessed physical performance, mood, and cognition. RESULTS: In glioma patients, factor analysis of the FLIC items documented five domains: Psychological well being, Role/sociability, Inner experience of disease, Isolation/sharing, and Nausea. Higher FLIC total scores were related to better cognition, physical performances, and mood, and lower grading; poorer Psychological well being and worse Inner experience of disease to depressed mood; minor Role/sociability to worse cognitive and physical performances and higher grading; worse Nausea to longer disease duration. Compared with healthy subjects, all glioma groups were cognitively impaired and more anxious, and two groups with short duration of recurrence were also more depressed. Patients with chronic neurological diseases showed worse mood and cognitive abilities compared with healthy subjects, but performed attention tests better than glioma patients. Glioma and chronic disease patients showed similar FLIC scores and autonomy. CONCLUSIONS: These results show that QOL of recurrent high grade glioma patients is multifaceted and determined by multiple factors. Disease severity does not necessarily eliminate the possibility of expressing personal feelings and opinions which could provide criteria for clinical decision making and psychological support.

Adult↗
PubMed1986

Prognostic value of a malignancy grading system in treatment of recurrent cervical carcinoma.

A malignancy grading system (MGS) comprising 8 histopathological parameters has been used to evaluate the response rate and prognosis for patients receiving chemotherapy for recurrent cervical carcinoma. Seventy-two women were treated with an adriamycin-cyclophosamide-vincristine (ACO) regimen or bleomycin-adriamycin-cisplatin (BAD) regimen. The mean value in the MGS was 16.7 for the primary tumors and 17.4 for the recurrences. Correlations between the individual parameters of the MGS when used on the primary tumors and on the recurrences were low. Only parameters 7 (vascular invasion) and 8 (lymphocytic response) were significantly higher in the recurrences. Responders had significantly longer survival than non-responders (P less than 0.001), but the two groups did not differ regarding the malignancy scores for the 8 individual parameters nor for the MGS sums.

Aged↗
PubMed2006

Arthroscopic Bankart repair in traumatic anterior shoulder instability using a suture anchor technique.

PURPOSE: The purpose of this study was to prospectively evaluate the surgical outcome of arthroscopic Bankart repair via suture anchors in patients with recurrent traumatic anterior shoulder instability with a minimum follow-up of 2 years. METHODS: We included 54 consecutive patients without an osseous Bankart lesion of greater than 25% of the glenoid circumference with a mean age of 25.3 years (range, 16 to 58 years) undergoing arthroscopic Bankart repair via suture anchors for traumatic anterior shoulder instability. The mean follow-up was 3.7 years (range, 2.3 to 5.2 years) at the final follow-up examination. Patients were evaluated prospectively according to the rating scales of Rowe, the American Shoulder and Elbow Surgeons, and Constant and Murley. One patient was lost to follow-up. RESULTS: After 3.7 years, 4 patients had recurrent instability: 3 had redislocated and 1 had recurrent subluxations. Thus the overall redislocation rate was 7.5%. Of the 4 redislocators, 3 had a traumatic onset of the redislocation. All shoulder scores (Rowe, American Shoulder and Elbow Surgeons, and Constant and Murley) revealed highly significant improvements postoperatively. At final follow-up, 85.7% of patients had returned to their preoperative sports level. CONCLUSIONS: Our results in this series demonstrate the efficacy of arthroscopic Bankart repair with suture anchors for the treatment of recurrent traumatic anterior shoulder instability with respect to recurrence rate, range of motion, and shoulder function during a mean follow-up of 3.7 years. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Adolescent↗
PubMed1995

The effects of spinal flexion and extension exercises and their associated postures in patients with acute low back pain.

STUDY DESIGN: A prospective randomized clinical trial compared the effects of flexion and extension back exercises and postures among soldiers with acute low back pain. OBJECTIVE: To compare the immediate effects of back exercise on functional status, spinal mobility, straight leg raising, pain severity, and treatment satisfaction, and to determine whether spinal exercise during the acute stage of low back pain reduces recurrent episodes of low back pain. SUMMARY OF BACKGROUND DATA: Conflicting reports exist concerning the efficacy of spinal flexion and extension exercises in patients with low back pain of varying duration. Poor study design and lack of functional outcomes characterize many of these studies. METHODS: One-hundred-forty-nine subjects with acute low back pain received flexion exercise and posture (n = 57), extension exercise and posture (n = 62), or no exercise or posture (n = 30) for 8 weeks. Outcomes were assessed 1, 2, 4 and 8 weeks after treatment onset. A questionnaire assessed the recurrence of low back pain 6-12 months after study entry. RESULTS: Flexion and extension exercise groups did not differ in any outcome over 8 weeks. After 1 week, both exercise groups had reduced disability scores, a higher proportion returning to work, and fewer subjects with a positive straight-leg raise compared with the control group. There was no difference among groups regarding recurrence of low back pain after 6-12 months. CONCLUSIONS: There was no difference for any outcomes between the flexion or extension exercise groups. However, either exercise was slightly more effective than no exercise when patients with acute low back pain were treated.

Acute Disease↗