Integrative treatment in endometriosis

Objective: To study the effectiveness of Yu's Neiyi Recipe on endometriosis.Methods: Yu's Neiyi Recipe was administrated in 48 patients with endometriosis (including 20 infertile cases). The clinical manifestations, ultrasonography, basal body temperature (BBT) and hormonal levels were observed before and 3 months after the treatment. The pregnancy outcome was followed up within 2 years.Results: Efficacy of Yu's Neiyi Recipe in the 48 cases was 93.75% within 3 months of treatment, 15 of the 20 infertile women become pregnant (80%) within 2 years. After the treatment, scores of dysmenorrhea, chronic pelvic pain or dyspareunia, and the size of ovarian endometrioma obviously decreased (P<0.01, P<0.01, P<0.01), meanwhile, the BBT type and high phase score (HPS) significantly improved (P<0.05). During herbal treatment, serum high PRL levels significantly dropped (P<0.05), and serum LH and E2 levels elevated significantly (P<0.05).Conclusions: Yu's Neiyi Recipe not only relieves the symptoms and signs of patients with endometriosis significantly, but also shows a good regulation on patients' ovarian function to improve the rate of ovulation and pregnancy.     

Pain treatment in neonates, infants and children--is the current treatment sufficient?

Paediatric patients quite often have to undergo painful or stressful procedures, e. g. blood sampling, dressing of wounds or removal of a drainage. The key problem is to decide if a child has pain or if there are other reasons for crying. Establishing a high standard in an institution requires regular evaluation and documentation of pain scores. For many clinical situations, clear and functioning concepts exist - we just have to use them. Unanswered questions are the evaluation of pain in small children, the side-effects of opioids, surgery involving the airways and the risk-benefit-ratio of certain techniques. Pain therapy after tonsillectomy is still troublesome: relevant postoperative pain occurs. Local infiltration of the tonsillar bed has no pre-emptive effect and only a minimal impact on the postoperative pain. Management relies on opioids, steroids and non-opioids. Non-steroidal anti-inflammatory drugs should not be used because of an increased risk of bleeding. Promising data have been reported on COX-2-blockers, but experience in children is still limited. Pain management after circumcision is relatively easy to perform. A conduction block with a long-acting local anaesthetic combined with one dose of a non-steroidal anti-inflammatory drug provides sufficient analgesia in over (2/3) of patients. Today, penile block is the standard of care and complications only rarely occur. However, despite successful pain prevention, circumcision remains a stressful procedure for the small patients. Pain treatment per se is not sufficient to relieve all the suffering connected with surgery in children. The concept of balanced analgesia is successful under many circumstances, but continuous efforts are needed to improve the management for difficult situations, e. g. tonsillectomy.     

Cancer treatment: what's ahead?

Surgery, chemotherapy, and radiation therapy are standard modalities for cancer treatment. Biological therapy (immunotherapy, biotherapy, or biological response modifier therapy) is a comparatively novel addition to this armamentarium. Biological therapies use the body's immune system, either directly or indirectly, to fight cancer or to lessen the side effects that may be caused by some cancer treatments. Biological therapeutic agents include interferons, interleukins, colony-stimulating factors, monoclonal antibodies, vaccines, gene therapy, and nonspecific immunomodulating agents. A promising form of cancer treatment is immunotherapy. Immunotherapy for cancer is essentially the stimulation of the immune system through a variety of reagents such as vaccines, infusion of T-cells, or cytokines. These reagents act through one of several mechanisms including stimulating the anti-tumor response, decreasing suppressor mechanisms, altering tumor cells to increase their immunogenicity and making them more susceptible to immunologic defenses, and improving tolerance to cytotoxic agents or radiotherapy. This review describes some novel approaches in the immunotherapy in cancer.     

The flexible Triac-Brace for conservative treatment of idiopathic scoliosis. An alternative treatment option?

The flexible Triac-Brace was developed to improve cosmetic appearance and wearing comfort. It was evaluated in this study with respect to primary curve correction in idiopathic scoliosis (IS). Twenty patients (15 girls, 5 boys, mean age: 12.5) with a diagnosis of IS were treated with the Triac-Brace. Lumbar curves showed an initial average Cobb angle of 26 degrees (SD = 9 degrees), thoracic curves of 25 degrees (SD = 7 degrees). After 6.2 weeks the primary curve correction was measured (Cobb). Further radiological follow-up was done every 6 months during the average wearing time of 15 months. Cosmesis and wearing comfort were assessed by a valid scoring system (Quality of Life Profile for Spine Deformities). We observed a primary correction of 41% in lumbar curves (n = 12) (significant, t-test), and 10% in thoracic curves (n = 17) (not significant, t-test). An increase in correction over time as reported by Veldhuizen et al was not seen. Curve progression was noted in five patients (average 12 degrees). The scores for cosmesis (4.2/5) and flexibility of the back (4.6/5) were high. Ninety percent of the patients reported a wearing time of 22-23 h. We do not recommend treatment of thoracic or double curves with the Triac-Brace. Larger studies are necessary to assess the effectiveness in lumbar curves. The improved wearing comfort is a potential advantage.     

Surgical treatment for complicated acetabular fractures

Objective: To sum up the surgical approaches and clinical outcome of complicated acetabular fractures.Methods: 17 patients with complicated acetabular fractures (including 4 cases of transverse with posterior wall fractures,7 cases of posterior column and wall fractures, 4 cases of anterior and posterior columns fractures, 1 cases of T-type fracture and 1 cases of anterior column with posterior hemitransverse fractures) underwent open reduction and internal fixation with screws and plates by Kocher-Langenbeck (8 cases), ilio-inguinal (2 cases), extended iliofemoral (4 cases) or ilio-inguinal combined with K-L approaches (3 cases). Results: 12 patients with anatomical reduction, 4 patients with satisfactory reduction and 1 patient with non-satisfactory reduction. 15 out of 17 cases were followed up for 6 months to 5 years, and the excellent and good rate was 70.5%. Conclusion: Surgical treatment for complicated acetabular fractures can get a satisfactory reduction and a good clinical outcome.     

C-cell cancer – prevention and treatment

Introduction: C-cell cancer of the thyroid or medullary thyroid carcinoma (MTC) exists in a sporadic and a hereditary form, the latter of which is part of the multiple endocrine neoplasia type-2 (MEN-2) syndromes. Discussion: MTC metastasises early to local (lymph nodes) and distant sites (liver, lung, bone). Therefore, early detection is mandatory to enable a chance of cure. In sporadic MTC, the sensitive tumour marker calcitonin enables detection of the disease at an early stage. In hereditary MTC, more than 95% of the patients have germline RET mutations. Thus, MEN-2 has become the paradigm for the practice of molecular medicine, and gene carriers can be identified before MTC even occurs. Surgery is the only chance of cure and recently developed surgical techniques provide the therapeutic prerequisite to achieve calcitonin normalisation in both sporadic and hereditary MTC. Received: 19 November 1998 Accepted: 25 November 1998     

Diagnosis and treatment of pancreatic trauma

Pdasenisvcterinereactt iiacvbe dt rsoaymumminpaatol mis isn a.ju Brryeult as tioitvm heealytsim caeo hmsig pwhlii ctihantoceuiddte aannncdeyof morbidity and complications.The mortality rate canbe as high as12%-20%.1Essential points inmanagement of pancrea…     

Ureteral lithiasis, what treatment?

Extracorporeal shock wave lithotripsy and ureteroscopy are minimal invasive techniques, both of which have definitively become essential for the treatment of ureteral stones resistant to conservative treatment. At the time of evidence-based medicine, no study makes it possible to recommend one of these methods rather than the other. For stones of identical size and location, this review of the literature shows that extracorporeal shock wave lithotripsy and ureteroscopy prove of comparable effectiveness and innocuousness. The urologist thus has two alternatives of which the technical control, the availability of the endoscopes or lithotriptors as well as the desire and comfort of the patients are the factors which condition his choice of the method for the treatment of ureteral stones.     

Multimodal treatment of colon cancer?

Surgical therapy is still the basis of therapy of patients with colon carcinoma. Multimodal therapeutical concepts are presently applied as a therapeutical standard in the adjuvant therapy and increasingly in the systemic therapy of patients with primarily inoperable metastases of the liver to reach a secondary operability. Interdisciplinary multimodal therapeutical concepts are even accepted within the therapy of metastasized colon carcinomas. There are still unanswered questions regarding sequences of palliative systemic therapies and their combinations with local ablative methods.     

Surgical treatment for complex acetabular fractures

Objective ： To explore the effect of surgical treatment on complex acetabular fractures. Methods： The data of 46 patients （38 males and 8 females, aged 16-75 years, mean = 38. 5 years ） with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included flioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8. Results： All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients （78.3%）, the surgical procedure was successful （Harris hip score 〉 80 points）. The rate of excellent and good was about 86 %. Conclusions ： The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of factures and choices of appropriate surgical approach and time.     

Which treatment in pericardial effusion?

BACKGROUND: Pericardiocentesis, pleuro-pericardial window, subxiphoid pericardial drainage and pericardioscopy: which methodology to treat pericardial effusion? Each of these surgical treatments can be effective, depending on clinical factors and history of the patients. We considered pericardial effusions during 5 years. METHODS: We reviewed 64 cases: 14 acute pericardial effusions (5 patients with cardiac tamponade), 39 subacute, 11 chronic. Epidemiology and aetiology: 8 cases were between 20 and 25 years old (all affected by lymphoma), 56 were distributed in every age, especially over 60, and of these 45 were neoplastic and 11 non- neoplastic. Non-neoplastic cases were connectivitis (3 patients), uncertain origin effusion (7 patients), tubercular (1 patient). In neoplastic effusions we found lymphoma (at older age) in 7, small cell lung cancer in 6, NSCLC in 12, mesothelioma in 2, breast cancer in 7. RESULTS: Acute pericardial effusions with cardiac tamponade underwent echo-guided pericardiocentesis. In 43 we had a subxiphoid pericardial drainage, among these cases we performed 4 pericardioscopies. We created a pleuro-pericardial window on VATS in 13, on thoracotomy in 4 for technical reasons. CONCLUSIONS: Pericardiocentesis is to be preferred in acute pericardial effusion with cardiac tamponade to avoid general anaesthesia. Pleuro-pericardial window on VATS is better in chronic pericardial effusion (for infective or systemic disease) and in recurrence, after performing subxiphoid drainage. Subxiphoid drainage is suitable for all neoplastic patients, and in case of unknown aetiology in order to perform a pericardioscopy.     

Essential varicocele. Which treatment?

Purpose of the paper is to sum up the problem of surgery of idiopathic varicocele according to the present possibilities, both surgical and sclerotic. A wide review of the literature underlines a high rate of relapses and persistence of the disease (with a percentage from 10 to and 10%) following the two most used technique: retrograde sclerotic therapy under radioscopic control and surgical retroperitoneal or inguinal ligature of the internal spermatic vein; this technique was preferred by us until 1997. The percentage of failures, high with reference to the benign form of the disease (over 10% in our series of more than 100 patients submitted to clinical and flow-meter examinations) let the authors suggest a combined and simultaneous operation of ligature both internal and external of the spermatic vein at the level of the internal inguinal ring. Anatomical reasons confirm the opportunity of this procedure since the involvement of the system of the external spermatic vein is present in about the 20% of the cases of idiopathic varicocele in accordance with various flebografic studies. The possibility of escape through the external spermatic vein is eliminated in the case in which such vessel is preserved, and it seems frequent above all in 3rd degree idiopathic varicocele where many anastomotic vessels between the two systems are present. This procedure can be made both in general or local anaesthesia, it doesn't involve postoperative hospital stay and present the same acceptable postoperative complication of other proposed operations. The laparoscopic treatment even if easily performed at the level of the internal inguinal ring, doesn't seem justified for the higher cost and equal compliance for the patient. Besides, it is not possible to proceed laparoscopically under local anaesthesia.