Peyronie's disease的非手术治疗

对于Peyronie's disease活动期,非手术治疗是非常重要的治疗手段,但现有的治疗方案较多,且疗效不统一,本文主要对Peymnie's disease的非手术治疗进行了回顾,以期找出其中较有效的非手术治疗方案.较全面的回顾分析了各种非手术治疗方案的疗效.Peyronie's disease的非手术治疗包括药物治疗(口服药物、病灶注射、局部涂抹、粒子电渗透法),物理治疗(热疗、体外震波治疗、放射治疗,激光治疗、FastSize Medical Extender).多数报道认为上述方法有效,但报道的疗效有差异.现有的非手术治疗方法还不能很好治疗Peyronie's disease,同时多数研究不是前瞻性、随机、双盲对照实验,因此各种治疗方案的真实疗效还需要进一步研究确定.     

Alzheimer’s disease

Opinion statement  

Legg-Calvé-Perthes disease

Legg-Calvé-Perthes disease is an idiopathic hip disorder that produces ischemic necrosis of the growing femoral head. Permanent femoral head deformity is the most significant sequela. Experimental studies indicate that the pathologic repair process, which is marked by an imbalance of bone resorption and formation, contributes to the pathogenesis of femoral head deformity. Important prognostic factors include degree of deformity, age at disease onset, extent of head involvement, head-at-risk signs, and lateral pillar collapse. Treatment should be guided by age at disease onset, current best evidence, and prognostic factors. Patients aged <6 years at onset are best managed nonsurgically, whereas older patients may benefit from surgical treatment. Good surgical results have been reported in 40% to 60% of older patients (>8 years), indicating the need to develop more effective treatments based on the pathobiology of the disease.     

Kienböck disease

Kienb?ck disease, or osteonecrosis of the lunate, is a progressive disease process that can lead to wrist pain and dysfunction. Although it was described over 100 years ago, and advances have been made in understanding this disease, the precise etiology remains uncertain. Anatomic, mechanical, vascular, and traumatic factors have been suggested to contribute to the disease. The natural history is unknown, and radiographic and clinical findings do not always correlate. Progress has been made in recognizing the progression of the avascular process and its deleterious effects on wrist mechanics. Initial treatment is nonsurgical, and it remains unclear whether surgical intervention results in improved outcomes over nonoperative treatment. Traditional surgical procedures such as radial shortening osteotomy and proximal row carpectomy have been shown to be reliable treatment options for relieving pain and improving function. Newer procedures such as pedicled bone grafts from the distal radius may improve direct revascularization of the lunate in earlier stages of the disease, potentially arresting the progression of collapse. Additional data are necessary to determine with certainty whether this type of procedure represents an improvement over the traditional treatment alternatives. Kienb?ck disease remains a challenging problem for hand surgeons.     

Peyronie's disease的非手术治疗

对于Peyronie's disease活动期,非手术治疗是非常重要的治疗手段,但现有的治疗方案较多,且疗效不统一,本文主要对Peymnie's disease的非手术治疗进行了回顾,以期找出其中较有效的非手术治疗方案.较全面的回顾分析了各种非手术治疗方案的疗效.Peyronie's disease的非手术治疗包括药物治疗(口服药物、病灶注射、局部涂抹、粒子电渗透法),物理治疗(热疗、体外震波治疗、放射治疗,激光治疗、FastSize Medical Extender).多数报道认为上述方法有效,但报道的疗效有差异.现有的非手术治疗方法还不能很好治疗Peyronie's disease,同时多数研究不是前瞻性、随机、双盲对照实验,因此各种治疗方案的真实疗效还需要进一步研究确定.     

Kienböck disease

Kienböck disease is a disorder of undetermined etiology that results in osteonecrosis of the lunate. It most commonly affects the dominant hand in men aged 20 to 40 years. The natural history of the disorder is uncertain. Treatment ranges from immobilization to revascularization of the lunate, but no single treatment has been proven superior. In many cases, the radiographic results do not correlate with the clinical outcome. Copyright © 2001 by the American Society for Surgery of the Hand     

Peyronie's disease的非手术治疗

对于Peyronie's disease活动期,非手术治疗是非常重要的治疗手段,但现有的治疗方案较多,且疗效不统一,本文主要对Peymnie's disease的非手术治疗进行了回顾,以期找出其中较有效的非手术治疗方案.较全面的回顾分析了各种非手术治疗方案的疗效.Peyronie's disease的非手术治疗包括药物治疗(口服药物、病灶注射、局部涂抹、粒子电渗透法),物理治疗(热疗、体外震波治疗、放射治疗,激光治疗、FastSize Medical Extender).多数报道认为上述方法有效,但报道的疗效有差异.现有的非手术治疗方法还不能很好治疗Peyronie's disease,同时多数研究不是前瞻性、随机、双盲对照实验,因此各种治疗方案的真实疗效还需要进一步研究确定.     

Preiser’s disease

Preiser’s disease is a rare condition involving avascular necrosis of the scaphoid, in part or in whole. Diagnosis currently is made most frequently by standard radiographs and magnetic resonance imaging (MRI). Treatment options are varied because no large series of comprehensive results has been reported. Vascularized or conventional bone grafting, proximal row carpectomy, and scaphoid excision/4 bone fusion are performed most commonly. If possible, every attempt to save the scaphoid should be made.     

Wilson’s disease

Opinion statement Appropriate anticopper therapy for Wilson’s disease is the critical element in halting progression of the disease and allowing patient recovery. Selection of the drug or drugs to use for a particular patient depends on the stage of the disease (ie, initial acutely ill patient versus chronic maintenance patient) and the type of presentation (ie, neurologic/psychiatric versus hepatic). I treat patients initially presenting with hepatic disease with a combination of zinc and trientine, those presenting with neurologic/psychiatric disease with tetrathiomolybdate, and those in the maintenance phase with zinc.     

Huntington’s disease

Opinion statement  

Bilateral Legg-Calvé-Perthes disease: different from unilateral disease?

Twenty-five patients or 50 hips with bilateral Legg-Calvé-Perthes disease were reviewed at skeletal maturity in the orthopaedic departments of Leuven, Belgium, and Montpellier, France. The two groups were very similar as to age at onset of the disease, severity of involvement, and classification at skeletal maturity. The results seem to indicate that bilateral disease runs a more severe course as compared with unilateral Legg-Calvé-Perthes disease. Eighty percent presented with a Catterall group III and IV and Herring classification B and C. Forty-eight percent rated as Stulberg 4 and 5 at skeletal maturity.     

Huntington’s disease

Opinion statement Although available treatments for Huntington’s disease (HD) are imperfect, thoughtful application can positively impact quality of life. Dopamine antagonists can provide control of the troublesome hyperkinetic movements. These agents can also diminish the frequency of hallucinations and delusions when symptoms of psychosis occur. Classical neuroleptics have the widest utilization, although atypical antipsychotics are being increasingly used. Suppression of choreiform movements has also been reported with amantadine and tetrabenazine, which is not currently approved in the United States but under investigation. Alteration in mood can be successfully managed with a variety of antidepressant medications. Superior tolerability and value in the management of a variety of behavioral disturbances have lead to extensive use of serotonin reuptake inhibitors. Modest disturbance of mood can sometimes be addressed with anticonvulsant medications. Considered a manifestation of advanced disease, dementia is less commonly addressed therapeutically. However, gathering experience suggests improved cognitive function can occur with cholinesterase inhibitor therapy. Frequently overlooked is the value of rehabilitation services in the management of diverse symptoms. Although the value of a dysphagia evaluation is apparent, the benefit to be derived from physical and occupational therapy involvement cannot be overstated. Current therapeutic trials will undoubtedly provide additional therapies to moderate symptoms, but once the mechanism(s) of selective striatal projection neuron degeneration are delineated, a revolution in the management of HD will occur.