Intraarterial polidocanol injection for the treatment of peripheral arteriovenous malformations

Purpose

The purpose of this study was to investigate the efficacy and safety of intraarterial transcatheter administration of polidocanol as an alternative treatment for peripheral arteriovenous malformations (AVMs).

Methods

The study comprised 10 patients (six males and four females) with a mean age of 28.8 years (range 8–52 years). All patients had trunk or extremity AVMs. Following the administration of general anesthesia or intravenous (IV) sedation, the patients underwent staged intraarterial polidocanol sclerotherapy with or without additional embolizations for their AVMs. The administration of polidocanol was executed by intraarterial infusion through a microcatheter or by direct percutaneous entry into the nidus under ultrasound guidance.

Results

A total of 19 sessions were accomplished in 10 patients. Polidocanol was used alone in six of the 19 sessions. In 13 sessions, polidocanol was used in combination with another agent (including n-butyl cyanoacrylate (NBCA), lipiodol, and ethanol) and/or coils. In two sessions, polidocanol was administered percutaneously under ultrasound guidance directly into the nidus documented by arteriography. No major complications occurred.

Conclusion

Intraarterial transcatheter administration of polidocanol alone or in combination with other agents is a safe and effective alternative treatment for peripheral AVMs.     

Venenoperation in Kombination mit Sklerotherapie

Background

Treatment of primary varicosis of the great saphenous vein (GSV) with reflux of the total GSV (down to the ankle or Hach grade 4) by the modified Babcock operation may lead to damage of the saphenous nerve. We combined high saphenofemoral ligation and partial stripping with sclerotherapy of incompetent veins and perforators of the lower leg.

Population and method

A total of 129 legs were treated first by high ligation and partial stripping, 6 weeks postoperatively by sclerotherapy of the remaining incompetent parts of the GSV and incompetent perforators of the lower legs. Before surgery (A), 6 weeks after the operation (before sclerotherapy B) and 9 months after completion of sclerotherapy (C) the venous refilling time (T0) and venous ejection fraction (V0) were evaluated and Duplex scanning performed. The subjective intensity of 7 different complaints of the legs was assessed.

Results

The T0 was highly significantly prolonged from 13.3?s?±?3.8 to 27.0?s?±?4.9 by the operation (B) and again highly significantly to 32.4?s?±?7.6 at (C). At (C) six legs (4.7%) had refluxes in the groin and in five lower legs (3.9%) recurrent incompetent perforators. At (B) there were sensory neurologic deficits in four legs and at (C) in none. All seven assessed complaints improved significantly from point A to B as well as from B to C.

Conclusions

Sclerotherapy significantly improves hemodynamic parameters and subjective complaints compared to operative treatment alone and minimizes the risk of saphenous nerve injury.     

Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis

Introduction and hypothesis

Intravesical instillations of hyaluronic acid (HA) and chondroitin sulfate (CS) may lead to regeneration of the damaged glycosaminoglycan layer in interstitial cystitis/bladder pain syndrome (IC/BPS).

Methods

Twenty-two patients with IC/BPS received intravesical instillations (40?ml) of sodium HA 1.6% and CS 2.0% in 0.9% saline solution (IALURIL?, IBSA) once weekly for 8?weeks, then once every 2?weeks for the next 6?months.

Results

The score for urgency was reduced from 6.5 to 3.6 (p?=?0.0001), with a reduction in pain scores from an average of 5.6 to 3.2 (p?=?0.0001). The average urine volume increased from 129.7 to 162?ml (p?p?p?p?Conclusion The treatment appeared to be effective and well tolerated in IC/BPS in this initial experience.     

Internalized Weight Bias in Weight-Loss Surgery Patients: Psychosocial Correlates and Weight Loss Outcomes

Purpose

In this study, we examined the relationship between pre-operative internalized weight bias and 12-month post-operative weight loss in adult bariatric surgery patients.

Methods

Bariatric surgery patients (n?=?170) from one urban and one rural medical center completed an internalized weight bias measure (the weight bias internalization scale, WBIS) and a depression survey (Beck depression inventory-II, BDI-II) before surgery, and provided consent to access their medical records.

Results

Participants (BMI?=?47.8 kg/m2, age?=?45.7 years) were mostly female (82.0 %), White (89.5 %), and underwent gastric bypass (83.6 %). The average WBIS score by item was 4.54?±?1.3. Higher pre-operative WBIS scores were associated with diminished weight loss at 12 months after surgery (p?=?0.035). Pre-operative WBIS scores were positively associated with depressive symptoms (p?Conclusion Greater internalized weight bias was associated with more depressive symptoms before surgery and less weight loss 1 year after surgery.     

Evaluation of symptoms related to reflux esophagitis in patients with esophagogastrostomy after proximal gastrectomy

Purpose

We investigated postoperative symptoms related to reflux esophagitis in patients who underwent esophagogastrostomy reconstruction after proximal gastrectomy (PG) by conducting a questionnaire survey.

Method

Quality of life was assessed using two different questionnaires, the gastrointestinal symptom rating scale (GSRS) for postoperative abdominal symptoms and F-scale for reflux esophagitis. The survey was conducted among 39 patients who underwent esophagogastrostomy after proximal gastrectomy for gastric cancer in the upper third of the stomach, and findings were compared with those in patients who underwent total gastrectomy (TG).

Results

The questionnaire was returned by 32 of 39 patients (82%) in the PG group and 40 of 45 patients (89%) in the TG group. On GSRS, the score for indigestion syndrome tended to be higher in the TG group than in the PG group (p?<?0.10), and the score for constipation was significantly higher in the PG group than in the TG group (p?<?0.05). The score for reflux syndrome, however, was almost the same in both groups. Similarly, there was no significant difference in the frequency of GERD symptoms between the PG and TG groups on F-scale questionnaire (47% vs. 63%, p?=?0.18).

Conclusions

Esophagogastrostomy after PG in an end-to-side manner with creation of acute angle at the anastomosis is not associated with an increased risk of reflux esophagitis compared with TG.     

Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain

Background

Psychological distress may be an important determinant of perceived disability in patients with chronic musculoskeletal disorders. We evaluated the relationship between depressive symptoms and perceived disability in patients with chronic shoulder pain and quantified the contribution made by depression to perceived disability.

Methods

In this prospective study, 109 patients with chronic shoulder pain caused by degenerative or inflammatory disorders were evaluated using the Disability of Arm, Shoulder and Hand (DASH) questionnaire and the Center for Epidemiologic Studies-Depression (CES-D) Scale to determine relationships between depressive symptoms and perceived disability in patients with chronic shoulder pain. In addition, pain scores were evaluated using a visual analog scale (VAS) during activity, and range of motion (ROM) and abduction strength (strength) measurements were measured. Multivariate analyses of variance and regression modeling were used to assess the relative contributions made by depressive symptoms (CES-D) and other clinical parameters to patient-perceived disability (DASH).

Results

DASH scores were found to be moderately correlated (0.3?r?r?=?0.58; p?p?p?=?0.04 respectively). Multiple stepwise regression analyses revealed that gender, ROM, pain VAS and CES-D scores independently predicted DASH score and accounted for 43?% of the variance. CES-D score was found to be the strongest predictor of DASH score and accounted for 23?% of the variance.

Conclusions

Degrees of depressive symptoms were found to be significantly associated with higher symptom scores and greater disability in patients with chronic shoulder pain. Although a large proportion of perceived disability remains unexplained, perceived disability in patients with chronic shoulder pain was found to be strongly influenced by depressive symptoms.

Type of study/level of evidence

Level 2, prospective cohort study, prognostic study.     

Patient reported outcome measures in women undergoing surgery for urinary incontinence and pelvic organ prolapse in Denmark, 2006–2011

Introduction and hypothesis

The aim of this study was to evaluate the impact of urogynecological surgery on quality of life based on patient reported outcome measures (PROMs).

Methods

Data were retrieved from the Danish Urogynaecological Database. Inclusion criteria were Danish women undergoing surgery for urinary incontinence (UI) or pelvic organ prolapse (POP) from 2006 to 2011. Using frequency of symptoms and a visual analogue scale (VAS) both pre- and postoperatively, their severity of symptoms and quality of life were measured by questionnaires.

Results

During the study period, 20,629 urogynecological procedures were performed. The questionnaires on severity of symptoms and the VAS had been completed both pre- and postoperatively for approximately one third of women undergoing surgery. For UI surgery, 83 % had improved symptoms, 13 % were unchanged, and 4 % had worse symptoms postoperatively. For POP surgery, 80, 17, and 3 % were improved, unchanged, and worsened, respectively. The postoperative bother of symptoms and interference in everyday life evaluated by VAS were significantly reduced for both UI [preoperative median VAS score 9, postoperative median score 1 (p?<?0.001)] and POP [8 preoperatively and 0 postoperatively (p?<?0.001)].

Conclusions

Based on PROMs, surgery for UI and POP is effective in alleviating symptoms associated with UI or POP, and it can improve quality of life in symptomatic women. Pre- and postoperative questionnaires are useful tools in assessing symptomatic outcome measures after surgery.     

Long-term follow-up evaluation of endoscopic sclerotherapy for dilated gastrojejunostomy after gastric bypass

Background

Endoscopic sclerotherapy using sodium morrhuate has been used to treat patients with weight regain after Roux-en-Y gastric bypass whose presumed etiology is loss of restriction due to gastrojejunostomy dilation. Weight loss and stability have been demonstrated in several studies with short-term follow-up evaluation.

Methods

This retrospective review evaluated all the patients who underwent sclerotherapy for a dilated gastrojejunostomy between 2007 and 2012.

Results

The study identified 48 patients with a mean follow-up period of 22 months (range 12–60 months). The mean age of these patients was 47.5 ± 10.5 years, and 92 % were women. The average weight loss from the primary procedure was 132.5 ± 54.82 lb, and the average weight regain from the lowest weight to the maximum weight before sclerotherapy was 46 ± 40.32 lb. The median number of sclerotherapy sessions was two (range 1–4). The pre-procedure mean gastrojejunostomy diameter was 20 ± 3.6 mm, and the mean volume of sodium morrhuate injected per session was 12.8 ± 3.7 ml. The average weight loss from sclerotherapy to the final documented weight was 3.17 ± 19.70 lb, which was not statistically significant. The following variables in the multivariate analysis were not associated with statistically significant weight loss: volume of sodium morrhuate, patient age, gastrojejunostomy diameter, number of sclerotherapy sessions, decrease in gastrojejunostomy diameter between the first and second sessions, and number of follow-up years. Weight stabilization or loss was achieved by 58 % of our cohort, with a mean weight loss of 15.9 ± 14.6 lb in this subgroup.

Conclusion

The long-term follow-up evaluation of patients undergoing sclerotherapy of the gastrojejunostomy for weight regain after gastric bypass showed only a marginal weight loss, which was not statistically significant in our study population, although more than 50 % of the patients achieved weight loss or stabilization.     

Does concomitant anterior/apical repair during midurethral sling improve the overactive bladder component of mixed incontinence?

Introduction and hypothesis

Midurethral sling (MUS) can improve overactive bladder (OAB) symptoms. It is unclear if anterior/apical prolapse (AA) repair provides additional benefit. We hypothesized that women with mixed urinary incontinence (MUI) experience greater improvement in the OAB component of their symptoms after concomitant MUS and AA repair compared with MUS alone.

Methods

This is a retrospective cohort study of women with bothersome MUI (defined by objective stress test and validated questionnaire) undergoing MUS alone (“MUS-only”) or concomitant MUS and AA repair (“MUS + AA”). Our primary outcome was the Overactive Bladder Questionnaire Symptom Severity (OAB-q SS) change score 6 weeks after surgery.

Results

Of 151 women, 67 (44 %) underwent MUS-only and 84 (56 %) underwent MUS + AA. The MUS-only cohort was younger and had less severe baseline prolapse (p?p?p?=?0.20), indicating similar improvements in OAB symptoms. Multivariate linear regression analysis revealed no difference in OAB-q SS change score between cohorts; however, OAB-q SS change scores were lower for women with a postoperative complication (β?=??19, 95 % CI ?31 to ?6; p?Conclusions In women with bothersome MUI, concomitant AA repair does not result in additional improvement in OAB symptoms over MUS alone. Patients with postoperative complications exhibit less improvement in OAB symptoms.     

Natural course of venous malformation after conservative treatment

Purpose

To investigate the clinical course of patients with venous malformation (VM) treated conservatively.

Methods

We reviewed retrospectively the database of our Congenital Vascular Malformation clinic and interviewed 207 patients with VM, who had been managed only conservatively. The questionnaires asked about changes in size (no change, increase in proportion to growth, increase greater than in proportion to growth, decrease) and changes in symptoms (markedly worse, moderately worse, no change, moderately improved, markedly much improved). Progression of VMs was defined as an increase greater than in proportion to growth or worsening symptoms.

Results

Fifty patients (24 %) reported an increase in size greater than in proportion to growth and 25 patients (12 %) reported symptoms worsening from their initial symptoms. Overall, sixty-six (32 %) of the patients reported evidence of progression of their VM. A binary logistic regression model identified VM combined with capillary malformation (CM) or lymphatic malformation (LM) as an independent predictor of VM progression (OR 2.67, 95 % CI 1.29–5.53).

Conclusions

Based on responses to the questionnaire, the size and symptoms of VM progressed in 32 % of patients over the course of their life. VMs combined with CM or LM were the only independent predictor of progression of a VM after conservative management.     

C1–2 transarticular screws combined with C1 laminar hooks fixation: a modified posterior atlantoaxial fixation technique and outcome in 72 patients

Purpose

To retrospectively evaluate the outcome of C1–2 transarticular screws combined with C1 laminar hooks fixation.

Methods

All patients underwent atlantoaxial fixation during a 5-year period. The surgical technique and treatment procedures were intensively reviewed and clinical symptoms, neurological function and imaging appearance were retrospectively evaluated.

Results

The clinical and radiology follow-up indicated a stable arthrodesis and clinical relief from symptoms for all patients. All patients with neurological defects improved an average of 1.33 grade at their most recent clinical assessment, P < 0.05; their average admission ASIA motor score, pin prick score and light touch score improved to an average follow-up ASIA score of 99.80 (99.83 ± 0.38), 111.83 (111.83 ± 0.45), and 111.89 (111.89 ± 0.32), respectively. No neurovascular impairment and case of implant failure were observed.

Conclusions

The C1–2 transarticular screws combined with C1 laminar hooks fixation is a reliable technique for atlantoaxial instability.     

Factors associated with quality of life among women with fecal incontinence

Introduction and hypothesis

Fecal incontinence (FI) is a distressing, highly prevalent condition affecting quality of life (QOL). The aim of our study was to identify predictors of moderate/severe health-related QOL among women with FI.

Methods

Data were collected from women presenting to a multispecialty clinic from January 2005 to July 2009 with FI. All completed questionnaires on demographics and validated instruments including the Fecal Incontinence Quality of Life Instrument (FIQL), Patient Health Questionnaire (PHQ) for depression, and Fecal Incontinence Severity Index (FISI). Logistic regression was used to identify factors associated with moderate/severe FI.

Results

The study included 226 women with an average age of 59.2 years (SD?=?14.1); 92 % were Caucasian, 67 % were married, and the average body mass index was 30.0 (SD?=?8.6). Their QOL was moderately/severely affected by FI in 35.6 %. Mean overall FIQL score was 2.5 (SD?=?0.8). Median QOL subscale measures were: lifestyle?=?2.7 (SD?=?1.0), coping?=?2.09 (SD?=?0.9), depression?=?2.8 (SD?=?1.0), and embarrassment?=?2.2 (SD?=?0.9). Average FISI score was 31.6 (SD?=?15.7) and average depression score on the PHQ was 8.93 (SD?=?8.1). In univariate analyses, diabetes, irritable bowel symptoms, prior hysterectomy, history of previous medical care for FI, higher FISI and PHQ scores were associated with moderate/severe FIQL scores (p?<?0.05). Higher PHQ scores and prior hysterectomy significantly predicted moderate/severe QOL in logistic regression analysis (p?<?0.05).

Conclusions

We confirm that women with higher depression scores and prior hysterectomy have moderate/severe QOL impairment. When evaluating FI, screening for depression should be undertaken.     

Effects of lowering dialysate sodium on carotid artery atherosclerosis and endothelial dysfunction in maintenance hemodialysis patients

Purpose

Our aim in this study was to examine the effects of low-sodium dialysate on carotid artery atherosclerosis, endothelial dysfunction, and blood pressure (BP) in maintenance hemodialysis (HD) patients.

Methods

After baseline measurements were obtained, the dialysate sodium concentration was reduced from 140 to 137?mEq/L. Carotid artery intima-media thickness (CIMT) and flow-mediated dilatation (FMD %) were measured before and after 6?months of HD with low-sodium dialysate. Interdialytic weight gain (IDWG), pre- and post-dialysis BP, and dialysis-related symptoms were monitored during the study.

Results

Fifty-two patients were enrolled, and 41 patients completed the study. Twenty-one patients had hypertension and were receiving antihypertensive medications. The average number of antihypertensive drugs per patient was 1.9?±?0.8. There was no significant reduction in BP at the end of the study, but the average number of antihypertensive drugs was reduced to 1.2?±?0.4 (P?<?0.001). There were significant improvements in CIMT (P?=?0.003) and FMD (P?<?0.001) with low-sodium HD. The IDWG decreased significantly during the low-sodium dialysate treatment (P?<?0.001). However, hypotensive episodes and cramps were more frequent during the study period.

Conclusions

Our study demonstrated that the lowering of dialysate sodium concentration reduced CIMT, improved FMD, and provided better control of IDWG and BP, but increased the incidence of dialysis-related symptoms.     

Periampullary Diverticulum May Be an Important Factor for the Occurrence and Recurrence of Bile Duct Stones

Background

The aim of this study was to examine the relation between periampullary diverticula (PAD) and biliary tract stones.

Methods

A total of 732 cases of patients with PAD identified from among 6,221 patients who underwent endoscopic retrograde cholangiopancreatography were compared to 750 controls (without PAD) in terms of biliary stone formation, incidence of sphincter of Oddi dysfunction (SOD), and choledocholithiasis. The biliary tract diseases were diagnosed based on medical history, clinical symptoms and signs, and imaging findings using ultrasonography, computed tomography, or magnetic resonance cholangiopancreatography.

Results

The PAD group contained a significantly larger number of patients with biliary stones including stones in the primary common bile duct, SOD with bile duct stones (p?<?0.05), and choledocholithiasis after cholecystectomy (p?<?0.01).

Conclusions

There is a close correlation between PAD and the formation of biliary tract stones. A particularly close correlation was found between PAD and choledocholithiasis after cholecystectomy. PAD may be an important risk factor for the occurrence or recurrence of biliary tract stones.     

How to determine “ballooning” of the levator hiatus on clinical examination: a retrospective observational study

Introduction and hypothesis

Dimensions of the levator hiatus determined on imaging are strong predictors of symptoms and signs of female pelvic organ prolapse (FPOP) and of FPOP recurrence. A clinical equivalence can be recorded as genital hiatus (Gh) + perineal body (Pb) using the ICS prolapse quantification system. The objective of this study was to stratify the Gh+Pb measurement to provide clinicians with clinical diagnostic criteria similar to those available on imaging.

Methods

A retrospective study of the data sets of 477 patients seen in a tertiary urogynecological clinic.

Results

On average, Gh was 4.2 (range, 1.5–8.5) cm, Pb 3.8 (range, 2.0–7.0) cm, Gh+Pb 7.9 cm (range, 4.2–13.0). The sum of Gh+Pb was strongly associated with symptoms (p?<?0.001) and signs (p?<?0.001) of FPOP. On receiver–operator characteristic statistics, the area under the curve was determined as 0.707 (0.658–0.755) in predicting symptoms of FPOP, and as 0.890 (0.854–0.925) for predicting FPOP?≥?stage 2, using 7 cm as the optimal cut-off for Gh+Pb. Using the data sets of 309 patients with abnormal (i.e. ≥7 cm) Gh+Pb measurements, we stratified abnormal hiatal distensibility, or “ballooning”, into mild, moderate, marked and severe as Gh+Pb?=?7.0–7.99 cm, 8.0–8.99 cm, 9.0–9.99 cm and 10 cm or more respectively, as the optimal compromise between easily remembered cut-off numbers and quartiles.

Conclusions

The sum of Gh+Pb measurement may allow clinicians to determine the degree of excessive hiatal distensibility or ‘ballooning’ without requiring imaging assessment.     

The “bother” of urinary incontinence

Introduction and hypothesis

Patient reported measures are important for the evaluation of symptom-specific bother and the distinction between different types of urinary incontinence. The aim of the study was to assess the validity of physician administered visual analogue scales (VAS) for the bother from stress urinary incontinence (SUI) and urge urinary incontinence (UUI).

Methods

In this prospective cohort study based at a tertiary urogynecological unit, women attending for investigation of lower urinary tract symptoms (n?=?504) were asked to indicate their subjective bother from SUI and UUI on a 10-cm VAS. Clinical assessment, including multichannel urodynamic testing and 4D translabial ultrasound was performed for clinical diagnosis. Linear regression was used to model the average increase in VAS bother score of SUI and UUI for each explanatory variable.

Results

74 % (n?=?375) reported symptoms of SUI, with mean bother of 5.7 out of 10 (SD 2.8), and 73 % (n?=?370) symptoms of UUI, with a mean bother of 6.5 out of 10 (SD 2.6). Bother from UUI was positively associated with the symptoms of nocturia (p?<?0.0001) and frequency (p?=?0.002), and the urodynamic findings of detrusor overactivity (p?<?0.0001). Bother from SUI was positively related to the urodynamic diagnosis of USI (p?<?0.0001) and a low abdominal leak point pressure (ALPP) (p?=?0.002), as well as to the ultrasound findings of cystourethrocele (p?<?0.0001) and funnelling (p?=?0.04). All univariate associations remained highly significant on multivariate analysis, controlling for age, BMI, parity, previous incontinence/prolapse surgery and previous hysterectomy.

Conclusions

Physician-administered VAS are a valid, reliable and practicable tool to measure bother related to SUI and UUI.     

Predictors of health-related quality of life in neurosurgical brain tumor patients: focus on patient-centered perspective

Background

In brain tumor (BT) patients, the association between health-related quality of life (HRQoL) and psychological characteristics remains largely unknown. We evaluated the association of personality traits, clinical factors, psychological distress symptoms, and cognitive state with HRQoL in BT patients.

Methods

On admission for BT surgery, 200 patients (69 % women; age 55.8?±?14.5 years) were evaluated for HRQoL (SF-36 scale), Big-Five personality traits (Ten-Item Personality Inventory), psychological distress symptoms (Hospital Anxiety and Depression Scale or HADS), cognitive function (Mini-Mental State Examination or MMSE) and clinical characteristics, including functional status (Barthel index or BI). The most common BT diagnoses were meningioma (39 %) and high-grade glioma (18 %).

Results

Only factors significantly associated with SF-36 domains in univariable regression analyses were included in their respective multivariable models and predicted from 6 %–49 % of the total variance of SF-36 scores. Greater TIPI emotional stability score was independently associated with greater SF-36 emotional well-being (β?=?0.23, p?<?0.001) and general health (β?=?0.18, p?=?0.01) scores, and greater TIPI consciousness score, with greater SF-36 emotional well-being score (β?=?0.13, p?=?0.02). HADS-anxiety and HADS-depression scores were the strongest independent determinants of all, except physical functioning, SF-36 scores (β-values range from 0.14 to 0.56; p values?≤?0.03). BI score was the strongest independent determinant of SF-36 physical functioning score (β?=?0.36, p?<?0.001). MMSE score was associated with all but emotional well-being and social functioning SF-36 scores.

Conclusions

Consciousness and emotional stability should be considered important personality-related determinants of HRQoL in BT patients. Psychological distress, functional disability, and cognitive impairment are also important predictors of HRQoL.     

Untreated preoperative depression is not associated with postoperative arrhythmias in CABG patients

Purpose

The mechanism by which depression affects postoperative outcome may involve arrhythmias. The purpose of this study was to evaluate whether untreated depression is associated with an increased incidence of postoperative arrhythmias in patients undergoing coronary artery bypass graft surgery (CABG).

Methods

One hundred seven patients were assessed for signs of depression with the Prime-MD Patient Health Questionnaire (brief PHQ) one week before surgery and subsequently underwent Holter monitoring for 48-72 hr postoperatively. The incidences of atrial fibrillation (AF); supraventricular tachycardia (SVT); ventricular tachycardia (VT), defined as three or more consecutive beats at a cycle length less than 600 msec; ventricular fibrillation (VF); and average heart rate (HR) were recorded in patients with and without signs of depression.

Results

The incidence of preoperative untreated depression was 27% (29/107). Twenty patients had mild depression (brief PHQ score of 5-9), seven patients had moderate depression (a score of 10-14), and two patients had severe depression (a score of 20). The incidences of postoperative AF, SVT, and non-sustained VT in depressed and non-depressed patients were 37.9% vs 35.9%, respectively (P = 0.50), 34.4% vs 52.5%, respectively (P = 0.07), and 17.2% vs 37.1%, respectively (P = 0.04). The average (SD) postoperative HR was similar in both groups [95 (12) beats·min^?1 in depressed patients and 92 (10) beats·min^?1 in non-depressed patients, (P = 0.25)]. Multivariate regression analysis showed that older age, but not depression, was a risk factor for postoperative arrhythmia.

Conclusions

Preoperative untreated depression is not related to postoperative arrhythmia in the early postoperative period in patients undergoing elective CABG. This trial was registered at clinicaltrials.gov (number: NCT00622024).     

Novel endoscopic delivery modality of infrared coagulation therapy for internal hemorrhoids

Background

A novel endoscopic delivery system for infrared coagulation therapy (IRC) has been designed recently. IRC is a well-established treatment for symptomatic internal hemorrhoids. Patients frequently undergo lower endoscopy before hemorrhoid treatment to eliminate other sources of bleeding. Current treatment options are difficult to perform without an anal retractor, adequate lighting, and specialized instruments. Endoscopic IRC is an attractive alternative to standard IRC, because it can be performed during the lower endoscopy.

Technique

Endoscopic IRC utilizes infrared radiation generated by a control box, which is applied to the tissue through a flexible, fiber optic light guide (Precision Endoscopic Infrared Coagulator?). The light guide is placed through the colonoscope or flexible sigmoidoscope in the same chamber as other endoscopic instruments.

Methods

A retrospective review was performed using a prospectively collected database. A standardized protocol was utilized in all patients. Patients graded their symptoms before and after therapy by using the visual analog symptom severity scoring system (range, 0–10). These results were analyzed by using the nonparametric Wilcoxon signed-rank test. Exact P values were computed by using the R function wilcox.exact.

Results

A total of 55 patients underwent endoscopic IRC for predominately grade II and grade III symptomatic internal hemorrhoids (71?%). There were 22 (40?%) female patients. Posttherapy results indicated a significant improvement in global symptoms (pretreatment average global score?=?2.24 vs. posttreatment average global score?=?0.28; P?<?0.0001). There have been no adverse events reported to date.

Conclusions

Endoscopic IRC provides improved visibility and efficiency, allowing simultaneous treatment of symptomatic internal hemorrhoids at the time of lower endoscopy. Patients experienced significant improvement in their symptoms after a single session of endoscopic IRC. There are a variety of additional endoscopic IRC therapeutic utilities: endoscopic management of angiodysplasia, inflammation, hemostasis, and NOTES applications.     

Cementless second-generation hydroxyapatite CaP-coated tibial component: an 8.7-year follow-up

Background

This is the first study that reports on the mid-term results of 81 patients suffering from arthritis of the knee, treated with a cementless second-generation hydroxyapatite calcium phosphate (CaP)-coated tibial component.

Materials and methods

Seventy-six knees with osteoarthritis were evaluated according to the Knee Society clinical, functional and radiological score, the Hospital for Special Surgery Rating System and the Patella Score. The clinical and radiological parameters were assessed preoperatively and after a mean follow-up of 8.7?years.

Results

All the three score systems revealed excellent clinical outcomes after the follow-up period. The mean preoperative Knee Society clinical Score was 124.41?±?12.99 and the mean postoperative score was 187.07?±?14.59 at the time of the final consultation (p?=?0.0008). The survival rate was 97.5?%. Radiolucency of <1?mm around the uncemented hydroxyapatite CaP-coated tibial component without accompanying pain symptoms was seen in fewer than 6?% of cases. In two cases, a medial cyst, also without other clinical symptoms, was observed beside the tip of the tibial fixation screw.

Conclusion

These findings indicate that the uncemented second-generation hydroxyapatite CaP-coated tibial component performed well at mid-term follow-up, and provides sufficiently stable bone ingrowth fixation.