INTRODUCTIONPancreatic cancer remains the fourth commonest cause of cancer related death in the western world[1]. The prognosis remains dismal due partly to late presentation, with associated low resectability rates, ...INTRODUCTIONPancreatic cancer remains the fourth commonest cause of cancer related death in the western world[1]. The prognosis remains dismal due partly to late presentation, with associated low resectability rates, and the aggressive biological nature of these tumors. The median survival time from diagnosis in unresectable tumors remains only 4 6 months.For those patients amenable to surgical resection over the last 20 years have seen marked improvements in postoperative mortality and morbidity, especially in specialist pancreatic centres 23. Despite these changes long-term survival remains low. with a total 5-year survival rate remaining less than 5%.Patients with ampullary cancer have a better 5-year survival of 40°%-60°%.展开更多
AIM: To systematically review the literature to assess the efficacy of corticosteroids in treating postparotidectomy facial nerve palsy(FNP). METHODS: We searched the Cochrane library, EMBASE and MEDLINE(from inceptio...AIM: To systematically review the literature to assess the efficacy of corticosteroids in treating postparotidectomy facial nerve palsy(FNP). METHODS: We searched the Cochrane library, EMBASE and MEDLINE(from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies. RESULTS: Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP postparotidectomy is transient. Preoperative factors(size of tumour and malignancy), intraoperative factors(extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur.CONCLUSION: Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term followup are required to increase scientific evidence.展开更多
Background: Current treatment options for neuroendocrine liver metastases are not widely applicable or not that effective. Image- guided thermal ablation offers the possibility of a minimally invasive, albeit palliati...Background: Current treatment options for neuroendocrine liver metastases are not widely applicable or not that effective. Image- guided thermal ablation offers the possibility of a minimally invasive, albeit palliative, treatment that decreases tumor volume, preserves most of the normal liver, and can be repeated several times. We report our experience with image- guided thermal ablation in 25 patients with unresectable liver metastases. Methods: Since 1990 we have treated 189 tumors at 66 treatment sessions in 25 patients (12 female, 13 male; median age, 56 years; age range, 26- 78 years). Thirty treatments were performed with a solid- state laser, and 36 treatments were performed with radiofrequency ablation. All but one treatment was performed percutaneously under image guidance. Sixteen patients had metastases from carcinoid primaries, three from gastrinoma, two from insulinoma, and four from miscellaneous causes. Fourteen of 25 had symptoms from hormone secretion. Results: Imaging follow- up was available in 19 patients at a median of 21 months (range, 4- 75 months). There was a complete response in six patients, a partial response in seven, and stable disease in one; hence, tumor load was controlled in 14 of 19 patients (74% ). Relief of hormone- related symptoms was achieved in nine of 14 patients (69% ). The median survival period from the diagnosis of liver metastases was 53 months. One patient with end- stage cardiac disease died after a carcinoid crisis. There were eight (12% ) complications: five local and three distant, four major and four minor. Conclusions: As a minimally invasive, readily repeatable procedure that can be used to ablate small tumors, preferably before patients become severely symptomatic, radiofrequency ablation can provide effective control of liver tumor volume in most patients over many years.展开更多
Background: Untreated patients with colorectal liver metastases rarely survive 3 years, and the 3- year survival rate for patients treated with chemotherapy is 3% . The best survival rates are for the small subgroup t...Background: Untreated patients with colorectal liver metastases rarely survive 3 years, and the 3- year survival rate for patients treated with chemotherapy is 3% . The best survival rates are for the small subgroup that has operable disease, i.e., 39% at 5 years. Radiofrequency ablation (RFA) offers a new opportunity to destroy liver metastases in patients who are not surgical candidates because of disease distribution or comorbidity. Methods: Acceptance criteria were a maximum of four or five liver lesions with a maximum diameter of 4 or 5 cm and no evidence of active extrahepatic disease. Nearly all treatments were performed percutaneously using ultrasound, computed tomography, or magnetic resonance imaging (or some combination) for guidance and monitoring. RFA is a minimally invasive procedure that can be readily repeated. General anesthesia facilitates the procedure but is not essential. Multiple overlapping ablations are required to ensure optimal treatment in all but the smallest tumors. Results: In our cohort of 167 patients with colorectal liver metastases, 73 fulfilled the optimal acceptance criteria (5 or fewer tumors that were ≤ 5 cm). The median survival periods were 38 months, with a 5- year survival rate of 30% , after the diagnosis of liver metastases and 31 months, with a 5- year survival rate of 25% , after the first ablation. Conclusion: RFA increases the therapeutic options for patients with colorectal metastases. Until controlled trials can better define the role of RFA, there are several groups of patients who are not surgical candidates and can be considered for RFA.展开更多
Objective: The purpose of this study was to determine the incidence of ultrasonographically detected cerebral white matter lesions (WMLs) in preterm twins at birth in relation to chorionicity, discordant weight and tw...Objective: The purpose of this study was to determine the incidence of ultrasonographically detected cerebral white matter lesions (WMLs) in preterm twins at birth in relation to chorionicity, discordant weight and twin- twin transfusion syndrome (TTTS). Methods: In this retrospective study, perinatal, neonatal, and cranial scan data of 85 monochorionic (MC) and 94 dichorionic (DC) twin pregnancies (341 infants) delivered between 24 and 34 weeks of gestation were collected. Data were analysed according to chorionicity, discordant birth weight (>20% ), single intrauterine death and TTTS. Results: The cerebral WML was seen in 14% of preterm twins. Monochorionic infants had higher risks of WML than DC twin (odds ratio 7.1; 95% CI 3.28- 15.8). In MC group, discordant weight (37% )- , TTTS (38% ), single intrauterine death (67% ) had higher incidence of cerebral WML than concordant weight infants (7% ). Similarly, incidence of WML was higher in DC discordant compared with concordant weight infants (13% versus 2% ; P <.0.05). Conclusion: Monochorionic infants had a seven- fold higher incidence of cerebral WML than DC infants. Discordant birth weight, TTTS and survivor of co- twin demise are an independent risk of cerebral white matter lesion.展开更多
Advances in foetal imaging have increased our detection rate of craniofacial abnormalities in utero. Nasal glioma is a rare, benign, congenital facial defect. Once detected, further imaging is required to assess for i...Advances in foetal imaging have increased our detection rate of craniofacial abnormalities in utero. Nasal glioma is a rare, benign, congenital facial defect. Once detected, further imaging is required to assess for intracranial communication, the presence of additional defects, determine the patency of the aerodigestive tract and decide on timing of delivery. The authors review the current literature on diagnosis and management of nasal glioma in this rapidly advancing field of craniofacial anomalies detected in utero. Literature search of EMBASE and MEDLINE databases yielded 594 articles, which were screened by 2 independent reviewers. A total of 7 papers were selected after exclusion. There have been seven cases of prenatally diagnosed nasal glioma. The earliest of these was detected at 20 wk gestation. The majority were investigated with foetal magnetic resonance imaging(MRI) to establish any intracranial communication or bony defects. Ultrasound monitoring, doppler waveform and 3D rendered images were utilised to delineate the lesion, monitor growth and differentiate potential diagnosis. Postnatal MRI is favoured by most to re-evaluate the lesion and aid surgical planning. Surgical resection was performed within the first few months of life. Diagnostic uncertainty wasseen in all cases, until formal histology was obtained, emphasising the challenges, and need for early appropriate specialist input. Whilst the prenatal detection of craniofacial abnormalities increases, there remain diagnostic challenges in differentiating prenatal congenital midfacial defects in utero. These defects are best investigated and monitored using prenatal ultrasound and MRI, to narrow the differential diagnosis, guide timing of delivery and allow for appropriate surgical planning. Prenatally detected nasal glioma, may only be confirmed on histology and families must be counselled appropriately to prepare them for the possible alternative diagnoses. Early surgical resection was undertaken to achieve more favourable aesthetic outcomes, reduce complications of ocular development and provide definitive histological diagnosis.展开更多
BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United...BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United Kingdom centre.AIM To evaluate the efficacy and cost-effectiveness of day case TSA compared to standard inpatient total shoulder arthroplasty.METHODS All patients undergoing TSA between January 2017 and July 2018 were included.Outcome measures were:Change in abduction and extension 3 mo postoperatively;30-d postoperative adverse events and re-admissions in day case and inpatient groups.We also conducted an economic evaluation of outpatient arthroplasty.Multivariate linear and logistic regression were used to adjust for demographic and operative covariates.RESULTS Fifty nine patients were included,18 d cases and 41 inpatients.There were no adverse events or re-admissions at 30 d postoperatively in either group.There were no significant differences in adjusted flexion(mean difference 16.4,95%CI:17.6-50.5,P=0.337)or abduction(mean difference:13.2,95%CI:18.4-44.9,P=0.405)postoperatively between groups.Median savings with outpatient arthroplasty were￡529(interquartile range:247.33-789,P<0.0001).CONCLUSION Day case TSA is a safe,effective procedure,with significant cost benefit.Wider use may be warranted in the United Kingdom and beyond,with potential for significant cost savings and improved efficiency.展开更多
AIM: To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension (OHT) patients with inadequate intraocular pressure (lOP) on current therapy. METHODS: Pre- and post-swit...AIM: To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension (OHT) patients with inadequate intraocular pressure (lOP) on current therapy. METHODS: Pre- and post-switch lOPs were analyzed for 59 consecutive patients who were switched from current therapy to bimatoprost monotherapy between 2011-2015. Demographic information, diagnosis, and any adverse events were recorded. Change in lOP post-pre switch was analyzed using a 2-sided Student's paired t-test at the 5% significance level. RESULTS: There was a statistically significant mean reduction in lOP at the first follow up visit, which was maintained at subsequent follow up visits for patients regardless of diagnosis, or pre-switch treatment (P〈0.001). Subgroup analysis also demonstrated a statistically significant mean reduction in lOP when looking at OHT patients only, as well as patients with any diagnosis switched from latanoprost monotherapy to bimatoprost monotherapy (P〈0.001). CONCLUSION: This is the largest independent data set which supports switching glaucoma patients with poor response to current treatment onto bimatoprost monotherapy before considering other adjuvant medical or more invasive therapy.展开更多
Aims: To assess prevalence of the insulin resistance syndrome (IRS: obesity, a bnormal glucose homoeostasis, dyslipidaemia, and hypertension) in obese UK child ren and adolescents of different ethnicities and to asses...Aims: To assess prevalence of the insulin resistance syndrome (IRS: obesity, a bnormal glucose homoeostasis, dyslipidaemia, and hypertension) in obese UK child ren and adolescents of different ethnicities and to assess whether fasting data is sufficient to identify IRS in childhood obesity. Methods: A total of 103 obes e (BMI > 95th centile) children and adolescents 2-18 years of age referred for assessment underwent an oral glucose tolerance test measurement of fasting lipid s, and blood pressure determination. Main outcome measures were prevalence of co mponents of IRS by modified WHO criteria, with IRS defined as ≥3 components (in cluding obesity). Results: There were 67 girls (65%). BMI z-score ranged from 1.65 to 6.15, with 72%having a z-score ≥3.0.Abnormal glucose homoeostasis was identified in 46%(hyperinsulinism in 40%, impaired fasting glucose in 0.8%, impaired glucose tolerance in 11 %). No subjects had silent type 2 diabetes. Dyslipidaemia was identified in 30 %and hypertension in 32%. Thirty one per cent had obesity alone, 36%had two c omponents, 28%had three, and 5%had all four components. Birth weight, BMI, and family history of IRS were not associated with risk of IRS. Higher age increase d the risk of IRS; however the syndrome was seen in 30%of children under 12 yea rs. The use of fasting glucose and insulin data for identifying IRS had a sensit ivity of 88%and specificity of 100%. Conclusions: One third of obese children and adolescents have the IRS; however type 2 diabetes is rare. Obese children wi th the IRS may form a high risk group to whom scarce intervention resources shou ld be targeted. Further work is needed to develop appropriate screening programm es for IRS components in significantly obese children.展开更多
Background:The Rockall scoring system was developed in unselected patients,the majority of whom did not receive endoscopic therapy.The aim of this study was to assess the validity of the Rockall system in high-risk pa...Background:The Rockall scoring system was developed in unselected patients,the majority of whom did not receive endoscopic therapy.The aim of this study was to assess the validity of the Rockall system in high-risk patients who undergo endoscopic therapy for peptic ulcer hemorrhage.Methods:Rockall scores were calculated in 247 patients with major peptic ulcer bleeding entered into a randomized trial of endoscopic therapy.The observed rates of recurrent bleeding and mortality after endoscopic therapy were compared with predicted rates derived from Rockall’s study group.The validity of the Rockall system was assessed in terms of calibration and discrimination.Results:Rates of recurrent bleeding and mortality after endoscopic therapy increased with an increasing Rockall score.Observed rates of recurrent bleeding and mortality were below predicted rates,and calibration of the Rockall system was poor(Mantel-Haenszel chi square = 25.8,p < 0.0001 for recurrent bleeding;Mantel-Haenszel chi square = 15.1,p < 0.0001 for death).For the prediction of recurrent bleeding,the area under the receiver operating characteristic curve was low(63.4%),but the system was satisfactory when predicting mortality(area under the resulting curve,84.3%).Conclusions:After endoscopic therapy for a bleeding peptic ulcer,the Rockall scoring system can identify patients at high risk of death,but it is inadequate for the prediction of recurrent bleeding.展开更多
Objective To review and assess the update studies regarding selective serotonin reuptake inhibitors （SSRIs） in the treatment of premature ejaculation （PE） and then provide practical recommendations and possible me...Objective To review and assess the update studies regarding selective serotonin reuptake inhibitors （SSRIs） in the treatment of premature ejaculation （PE） and then provide practical recommendations and possible mechanisms concerning state of the art knowledge for the use of SSRIs in alleviating PE. Data sources Using the Medline, 48 articles published from January 1st, 1996 to August 1st, 2006 concerning the use of SSRIs and their possible mechanisms in alleviating PE were found and reviewed. Study selection PE, rapid ejaculation, early ejaculation and SSRIs were employed as the keywords, and relevant articles about the use of SSRIs and their possible mechanisms in the treatment of PE were selected. Results Many kinds of SSRIs, such as fluoxetine, sertraline, paroxetine and citalopram, have widely been employed to treat PE. However, their effects are moderate and there is no a universal agreement about the kind, dose, protocol and duration. Dapoxetine, as the first prescription treatment of PE, may change this bottle-neck situation. SSRIs are suggested to be used in young men with lifelong PE, and acquired PE when etiological factors are removed but PE still exists. Phosphodiesterase 5 inhibitors （PDE5-ls） are suggested to be employed alone or combined with SSRIs when SSRIs fail to treat PE or sexual dysfunction associated with SSRIs occurs. The protocol of taking drugs on demand based on taking them daily for a suitable period is proposed to be chosen firstly. The possible mechanisms include increasing serotonergic neurotransmission and activating 5-hydroxytryptamine 2C （5-HT2c） receptors, then switching the ejaculatory threshold to a higher level, decreasing the penile sensitivity and their own effect of antidepression. Conclusion The efficacies of the current SSRIs are moderate in the treatment of PE and they have not been approved by the FDA, therefore new SSRI like dapoxetine needs to be further evaluated.展开更多
Objective:To compare sleep-related outcomes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients following base of tongue resection via robotic surgery and endoscopic midline glossectomy.Methods:This was a re...Objective:To compare sleep-related outcomes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients following base of tongue resection via robotic surgery and endoscopic midline glossectomy.Methods:This was a retrospective study.A total of 114 robotic and 37 endoscopic midline glossectomy surgeries were performed between July 2010 and April 2015 as part of single or multilevel surgery.Patients were excluded for indications other than sleep apnea or if complete sleep studies were not obtained.Thus,45 robotic and 16 endoscopic surgeries were included in the analysis.Results:In the robotic surgery group there were statistically significant improvements in AHI [(44.4 ± 22.6) events/h-(14.0 ± 3.0) events/h,P ＜ 0.001] Epworth Sleepiness Scale (12.3 ± 4.6 to 4.5 ± 2.9,P ＜ 0.001),and O2 nadir (82.0％ ± 6.1％ to 85.0％ ± 5.4％,P ＜ 0.001).In the endoscopic group there were also improvements in AHI (48.7 ± 30.2 to 27.4 ± 31.9,P =0.06),Epworth Sleepiness Scale (12.6 ± 5.5 to 8.3 ± 4.5,P =0.08),and O2 nadir (80.2％ ± 8.6％ to 82.7％ ± 6.5％,P =0.4).Surgical success rate was 75.6％ and 56.3％ in the robotic and endoscopic groups,respectively.Greater volume of tissue removed was predictive of surgical success in the robotic cases (10.3 vs.8.6 ml,P =0.02).Conclusions:Both robotic surgery and endoscopic techniques for tongue base reduction improve objective measures of sleep apnea.Greater success rates may be achieved with robotic surgery compared to traditional methods.展开更多
文摘INTRODUCTIONPancreatic cancer remains the fourth commonest cause of cancer related death in the western world[1]. The prognosis remains dismal due partly to late presentation, with associated low resectability rates, and the aggressive biological nature of these tumors. The median survival time from diagnosis in unresectable tumors remains only 4 6 months.For those patients amenable to surgical resection over the last 20 years have seen marked improvements in postoperative mortality and morbidity, especially in specialist pancreatic centres 23. Despite these changes long-term survival remains low. with a total 5-year survival rate remaining less than 5%.Patients with ampullary cancer have a better 5-year survival of 40°%-60°%.
文摘AIM: To systematically review the literature to assess the efficacy of corticosteroids in treating postparotidectomy facial nerve palsy(FNP). METHODS: We searched the Cochrane library, EMBASE and MEDLINE(from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies. RESULTS: Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP postparotidectomy is transient. Preoperative factors(size of tumour and malignancy), intraoperative factors(extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur.CONCLUSION: Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term followup are required to increase scientific evidence.
文摘Background: Current treatment options for neuroendocrine liver metastases are not widely applicable or not that effective. Image- guided thermal ablation offers the possibility of a minimally invasive, albeit palliative, treatment that decreases tumor volume, preserves most of the normal liver, and can be repeated several times. We report our experience with image- guided thermal ablation in 25 patients with unresectable liver metastases. Methods: Since 1990 we have treated 189 tumors at 66 treatment sessions in 25 patients (12 female, 13 male; median age, 56 years; age range, 26- 78 years). Thirty treatments were performed with a solid- state laser, and 36 treatments were performed with radiofrequency ablation. All but one treatment was performed percutaneously under image guidance. Sixteen patients had metastases from carcinoid primaries, three from gastrinoma, two from insulinoma, and four from miscellaneous causes. Fourteen of 25 had symptoms from hormone secretion. Results: Imaging follow- up was available in 19 patients at a median of 21 months (range, 4- 75 months). There was a complete response in six patients, a partial response in seven, and stable disease in one; hence, tumor load was controlled in 14 of 19 patients (74% ). Relief of hormone- related symptoms was achieved in nine of 14 patients (69% ). The median survival period from the diagnosis of liver metastases was 53 months. One patient with end- stage cardiac disease died after a carcinoid crisis. There were eight (12% ) complications: five local and three distant, four major and four minor. Conclusions: As a minimally invasive, readily repeatable procedure that can be used to ablate small tumors, preferably before patients become severely symptomatic, radiofrequency ablation can provide effective control of liver tumor volume in most patients over many years.
文摘Background: Untreated patients with colorectal liver metastases rarely survive 3 years, and the 3- year survival rate for patients treated with chemotherapy is 3% . The best survival rates are for the small subgroup that has operable disease, i.e., 39% at 5 years. Radiofrequency ablation (RFA) offers a new opportunity to destroy liver metastases in patients who are not surgical candidates because of disease distribution or comorbidity. Methods: Acceptance criteria were a maximum of four or five liver lesions with a maximum diameter of 4 or 5 cm and no evidence of active extrahepatic disease. Nearly all treatments were performed percutaneously using ultrasound, computed tomography, or magnetic resonance imaging (or some combination) for guidance and monitoring. RFA is a minimally invasive procedure that can be readily repeated. General anesthesia facilitates the procedure but is not essential. Multiple overlapping ablations are required to ensure optimal treatment in all but the smallest tumors. Results: In our cohort of 167 patients with colorectal liver metastases, 73 fulfilled the optimal acceptance criteria (5 or fewer tumors that were ≤ 5 cm). The median survival periods were 38 months, with a 5- year survival rate of 30% , after the diagnosis of liver metastases and 31 months, with a 5- year survival rate of 25% , after the first ablation. Conclusion: RFA increases the therapeutic options for patients with colorectal metastases. Until controlled trials can better define the role of RFA, there are several groups of patients who are not surgical candidates and can be considered for RFA.
文摘Objective: The purpose of this study was to determine the incidence of ultrasonographically detected cerebral white matter lesions (WMLs) in preterm twins at birth in relation to chorionicity, discordant weight and twin- twin transfusion syndrome (TTTS). Methods: In this retrospective study, perinatal, neonatal, and cranial scan data of 85 monochorionic (MC) and 94 dichorionic (DC) twin pregnancies (341 infants) delivered between 24 and 34 weeks of gestation were collected. Data were analysed according to chorionicity, discordant birth weight (>20% ), single intrauterine death and TTTS. Results: The cerebral WML was seen in 14% of preterm twins. Monochorionic infants had higher risks of WML than DC twin (odds ratio 7.1; 95% CI 3.28- 15.8). In MC group, discordant weight (37% )- , TTTS (38% ), single intrauterine death (67% ) had higher incidence of cerebral WML than concordant weight infants (7% ). Similarly, incidence of WML was higher in DC discordant compared with concordant weight infants (13% versus 2% ; P <.0.05). Conclusion: Monochorionic infants had a seven- fold higher incidence of cerebral WML than DC infants. Discordant birth weight, TTTS and survivor of co- twin demise are an independent risk of cerebral white matter lesion.
文摘Advances in foetal imaging have increased our detection rate of craniofacial abnormalities in utero. Nasal glioma is a rare, benign, congenital facial defect. Once detected, further imaging is required to assess for intracranial communication, the presence of additional defects, determine the patency of the aerodigestive tract and decide on timing of delivery. The authors review the current literature on diagnosis and management of nasal glioma in this rapidly advancing field of craniofacial anomalies detected in utero. Literature search of EMBASE and MEDLINE databases yielded 594 articles, which were screened by 2 independent reviewers. A total of 7 papers were selected after exclusion. There have been seven cases of prenatally diagnosed nasal glioma. The earliest of these was detected at 20 wk gestation. The majority were investigated with foetal magnetic resonance imaging(MRI) to establish any intracranial communication or bony defects. Ultrasound monitoring, doppler waveform and 3D rendered images were utilised to delineate the lesion, monitor growth and differentiate potential diagnosis. Postnatal MRI is favoured by most to re-evaluate the lesion and aid surgical planning. Surgical resection was performed within the first few months of life. Diagnostic uncertainty wasseen in all cases, until formal histology was obtained, emphasising the challenges, and need for early appropriate specialist input. Whilst the prenatal detection of craniofacial abnormalities increases, there remain diagnostic challenges in differentiating prenatal congenital midfacial defects in utero. These defects are best investigated and monitored using prenatal ultrasound and MRI, to narrow the differential diagnosis, guide timing of delivery and allow for appropriate surgical planning. Prenatally detected nasal glioma, may only be confirmed on histology and families must be counselled appropriately to prepare them for the possible alternative diagnoses. Early surgical resection was undertaken to achieve more favourable aesthetic outcomes, reduce complications of ocular development and provide definitive histological diagnosis.
文摘BACKGROUND Day case total shoulder arthroplasty(TSA)is a novel approach,not widely practiced in Europe.We conducted a retrospective cohort study of patients comparing elective day case and inpatient TSAs in our United Kingdom centre.AIM To evaluate the efficacy and cost-effectiveness of day case TSA compared to standard inpatient total shoulder arthroplasty.METHODS All patients undergoing TSA between January 2017 and July 2018 were included.Outcome measures were:Change in abduction and extension 3 mo postoperatively;30-d postoperative adverse events and re-admissions in day case and inpatient groups.We also conducted an economic evaluation of outpatient arthroplasty.Multivariate linear and logistic regression were used to adjust for demographic and operative covariates.RESULTS Fifty nine patients were included,18 d cases and 41 inpatients.There were no adverse events or re-admissions at 30 d postoperatively in either group.There were no significant differences in adjusted flexion(mean difference 16.4,95%CI:17.6-50.5,P=0.337)or abduction(mean difference:13.2,95%CI:18.4-44.9,P=0.405)postoperatively between groups.Median savings with outpatient arthroplasty were￡529(interquartile range:247.33-789,P<0.0001).CONCLUSION Day case TSA is a safe,effective procedure,with significant cost benefit.Wider use may be warranted in the United Kingdom and beyond,with potential for significant cost savings and improved efficiency.
文摘AIM: To establish the efficacy and safety of bimatoprost 0.03% monotherapy in glaucoma and ocular hypertension (OHT) patients with inadequate intraocular pressure (lOP) on current therapy. METHODS: Pre- and post-switch lOPs were analyzed for 59 consecutive patients who were switched from current therapy to bimatoprost monotherapy between 2011-2015. Demographic information, diagnosis, and any adverse events were recorded. Change in lOP post-pre switch was analyzed using a 2-sided Student's paired t-test at the 5% significance level. RESULTS: There was a statistically significant mean reduction in lOP at the first follow up visit, which was maintained at subsequent follow up visits for patients regardless of diagnosis, or pre-switch treatment (P〈0.001). Subgroup analysis also demonstrated a statistically significant mean reduction in lOP when looking at OHT patients only, as well as patients with any diagnosis switched from latanoprost monotherapy to bimatoprost monotherapy (P〈0.001). CONCLUSION: This is the largest independent data set which supports switching glaucoma patients with poor response to current treatment onto bimatoprost monotherapy before considering other adjuvant medical or more invasive therapy.
文摘Aims: To assess prevalence of the insulin resistance syndrome (IRS: obesity, a bnormal glucose homoeostasis, dyslipidaemia, and hypertension) in obese UK child ren and adolescents of different ethnicities and to assess whether fasting data is sufficient to identify IRS in childhood obesity. Methods: A total of 103 obes e (BMI > 95th centile) children and adolescents 2-18 years of age referred for assessment underwent an oral glucose tolerance test measurement of fasting lipid s, and blood pressure determination. Main outcome measures were prevalence of co mponents of IRS by modified WHO criteria, with IRS defined as ≥3 components (in cluding obesity). Results: There were 67 girls (65%). BMI z-score ranged from 1.65 to 6.15, with 72%having a z-score ≥3.0.Abnormal glucose homoeostasis was identified in 46%(hyperinsulinism in 40%, impaired fasting glucose in 0.8%, impaired glucose tolerance in 11 %). No subjects had silent type 2 diabetes. Dyslipidaemia was identified in 30 %and hypertension in 32%. Thirty one per cent had obesity alone, 36%had two c omponents, 28%had three, and 5%had all four components. Birth weight, BMI, and family history of IRS were not associated with risk of IRS. Higher age increase d the risk of IRS; however the syndrome was seen in 30%of children under 12 yea rs. The use of fasting glucose and insulin data for identifying IRS had a sensit ivity of 88%and specificity of 100%. Conclusions: One third of obese children and adolescents have the IRS; however type 2 diabetes is rare. Obese children wi th the IRS may form a high risk group to whom scarce intervention resources shou ld be targeted. Further work is needed to develop appropriate screening programm es for IRS components in significantly obese children.
文摘Background:The Rockall scoring system was developed in unselected patients,the majority of whom did not receive endoscopic therapy.The aim of this study was to assess the validity of the Rockall system in high-risk patients who undergo endoscopic therapy for peptic ulcer hemorrhage.Methods:Rockall scores were calculated in 247 patients with major peptic ulcer bleeding entered into a randomized trial of endoscopic therapy.The observed rates of recurrent bleeding and mortality after endoscopic therapy were compared with predicted rates derived from Rockall’s study group.The validity of the Rockall system was assessed in terms of calibration and discrimination.Results:Rates of recurrent bleeding and mortality after endoscopic therapy increased with an increasing Rockall score.Observed rates of recurrent bleeding and mortality were below predicted rates,and calibration of the Rockall system was poor(Mantel-Haenszel chi square = 25.8,p < 0.0001 for recurrent bleeding;Mantel-Haenszel chi square = 15.1,p < 0.0001 for death).For the prediction of recurrent bleeding,the area under the receiver operating characteristic curve was low(63.4%),but the system was satisfactory when predicting mortality(area under the resulting curve,84.3%).Conclusions:After endoscopic therapy for a bleeding peptic ulcer,the Rockall scoring system can identify patients at high risk of death,but it is inadequate for the prediction of recurrent bleeding.
文摘Objective To review and assess the update studies regarding selective serotonin reuptake inhibitors （SSRIs） in the treatment of premature ejaculation （PE） and then provide practical recommendations and possible mechanisms concerning state of the art knowledge for the use of SSRIs in alleviating PE. Data sources Using the Medline, 48 articles published from January 1st, 1996 to August 1st, 2006 concerning the use of SSRIs and their possible mechanisms in alleviating PE were found and reviewed. Study selection PE, rapid ejaculation, early ejaculation and SSRIs were employed as the keywords, and relevant articles about the use of SSRIs and their possible mechanisms in the treatment of PE were selected. Results Many kinds of SSRIs, such as fluoxetine, sertraline, paroxetine and citalopram, have widely been employed to treat PE. However, their effects are moderate and there is no a universal agreement about the kind, dose, protocol and duration. Dapoxetine, as the first prescription treatment of PE, may change this bottle-neck situation. SSRIs are suggested to be used in young men with lifelong PE, and acquired PE when etiological factors are removed but PE still exists. Phosphodiesterase 5 inhibitors （PDE5-ls） are suggested to be employed alone or combined with SSRIs when SSRIs fail to treat PE or sexual dysfunction associated with SSRIs occurs. The protocol of taking drugs on demand based on taking them daily for a suitable period is proposed to be chosen firstly. The possible mechanisms include increasing serotonergic neurotransmission and activating 5-hydroxytryptamine 2C （5-HT2c） receptors, then switching the ejaculatory threshold to a higher level, decreasing the penile sensitivity and their own effect of antidepression. Conclusion The efficacies of the current SSRIs are moderate in the treatment of PE and they have not been approved by the FDA, therefore new SSRI like dapoxetine needs to be further evaluated.
文摘Objective:To compare sleep-related outcomes in obstructive sleep apnea hypopnea syndrome (OSAHS) patients following base of tongue resection via robotic surgery and endoscopic midline glossectomy.Methods:This was a retrospective study.A total of 114 robotic and 37 endoscopic midline glossectomy surgeries were performed between July 2010 and April 2015 as part of single or multilevel surgery.Patients were excluded for indications other than sleep apnea or if complete sleep studies were not obtained.Thus,45 robotic and 16 endoscopic surgeries were included in the analysis.Results:In the robotic surgery group there were statistically significant improvements in AHI [(44.4 ± 22.6) events/h-(14.0 ± 3.0) events/h,P ＜ 0.001] Epworth Sleepiness Scale (12.3 ± 4.6 to 4.5 ± 2.9,P ＜ 0.001),and O2 nadir (82.0％ ± 6.1％ to 85.0％ ± 5.4％,P ＜ 0.001).In the endoscopic group there were also improvements in AHI (48.7 ± 30.2 to 27.4 ± 31.9,P =0.06),Epworth Sleepiness Scale (12.6 ± 5.5 to 8.3 ± 4.5,P =0.08),and O2 nadir (80.2％ ± 8.6％ to 82.7％ ± 6.5％,P =0.4).Surgical success rate was 75.6％ and 56.3％ in the robotic and endoscopic groups,respectively.Greater volume of tissue removed was predictive of surgical success in the robotic cases (10.3 vs.8.6 ml,P =0.02).Conclusions:Both robotic surgery and endoscopic techniques for tongue base reduction improve objective measures of sleep apnea.Greater success rates may be achieved with robotic surgery compared to traditional methods.
