Development of a German version of the knee outcome survey for daily activities

Introduction The knee outcome survey-activities of daily living scale (KOS-ADLS) is a patient-reported specific measure of knee function. The KOS-ADLS includes items related to both symptoms and functional limitations experienced during ADL. The purpose of this study was to examine the reliability and validity of a cross-culturally adapted German version of the KOS-ADLS. Materials and methods 108 consecutive knee patients (n = 57 males/51 females) scheduled for outpatient physical therapy at an orthopedic hospital were enrolled in the investigation. For the reliability analysis, 50 patients were asked to complete the questionnaire on two non-consecutive days. To assess the validity of the KOS-ADLS, 58 additional patients answered the questionnaire in addition to performing a series of other related tests: (1) visual analogue scale for knee pain intensity, (2) The Get-up-and Go, and (3) time for ascending/descending stairs. The functional tests were selected because they directly related to specific items in the questionnaire and were thought to reflect the major areas of disability for this patient group Results The reliability analysis demonstrated that the German version of the KOS-ADLS had a good reliability (ICC range 0.94–0.97) and internal consistency (alpha 0.89). The functional tests (e.g. Get-up and Go, ascending/descending stairs) showed moderate correlations, whereas the visual analogue pain scale was highly correlated with the subscores and total score of the KOS-ADLS. Conclusion The psychometric characteristics of the German version of the KOS-ADLS produced reliable and valid results, as the original version, in detection of an individual’s symptom and function related knee joint impairment. Financial disclosure: all work was solely funded internally.     

Randomized clinical trial comparing radially expanding trocars with conventional cutting trocars for the effects on pain after laparoscopic cholecystectomy

Background Trocar incisions are important sources of pain the first days after laparoscopic cholecystectomy. Radially expanding trocars may cause less pain than conventional cutting trocars. Methods In a patient- and observer-blinded trial, 80 patients were randomized to undergo laparoscopic cholecystectomy using either radially expanding trocars (radial group) or conventional cutting trocars (cutting group). Two 10-mm and two 5-mm trocars were used in both treatment groups. All the patients received standardized anesthetic and analgesic treatment. The primary outcome was incisional pain. Pain was registered during mobilization using a visual analog scale (VAS) and a verbal rating scale (VRS) before and 6 h after the operation, and at postoperative days 1 and 2. The needs for a fascial incision to retract the gallbladder, active surgical hemostasis, and supplementary requirements of opioids during the hospital stay were registered. In addition, 2 days after the operation, the incidence and severity of suggilations at the trocar incisions were measured. Results Data from 77 patients were available for statistical analysis. In the radial group, 23 patients needed fascial incision for gallbladder retraction compared with 11 patients in the cutting group (p = 0.006). No significant intergroup differences in VAS or VRS pain scores or any other variable were found. Conclusions The use of radially expanding trocars has no effect on incisional pain after laparoscopic cholecystectomy.     

Prognosis Scores of Tokuhashi and Tomita for Patients With Spinal Metastases of Renal Cancer

Background Retrospective evaluation of the prognosis scores of Tokuhashi and Tomita for life expectancy in 37 consecutive patients with spinal metastases secondary to renal cancer who underwent surgery. The score of Tokuhashi, composed of six parameters, each rated from zero to two, has been proposed in 1990 for the prognostic assessment of patients with spinal metastases. In 2001, Tomita et al. created another prognostic score, composed of three parameters, growth behaviour of the primary tumor (slow, moderate and rapid) and the evidence of visceral and bony metastases. Methods Thirty-seven patients, surgically treated for vertebral metastases secondary to renal cancer were studied. The scores according to Tokuhashi and Tomita were calculated for each patient. Results Applying the Tokuhashi Score for the estimation of life expectancy of renal cancer patients with vertebral metastases was found to provide very reliable results with a statistically high significance. The analysis according to Tomita showed no correlation between predicted and real survival. The statistical analysis did not show any significance. Conclusion For surgical decisions in renal cancer patients with spinal metastases, the prognostic score of Tokuhashi appears to be much more valuable than the Tomita score.     

Does intensive rehabilitation improve the functional outcome of patients with traumatic brain injury (TBI)? A randomized controlled trial

Objective: To evaluate the effects of an increase in the intensity of rehabilitation on the functional outcome of patients with traumatic brain injury (TBI).

Design and methods: Sixty-eight patients (age 12-65 years) with moderate-to-severe TBI were included. They were randomized into high (4-hour/day) or control (2-hour/day) intensity rehabilitation programmes at an average of 20 days after the injury. The programmes ended when the patients achieved independence in daily activities or when 6 months had passed.

Outcome and results: No significant differences were found in the Functional Independence Measure (FIM) (primary outcome) and Neurobehavioural Cognitive Status Examination (NCSE) total scores between the two groups. There were significantly more patients in the high intensity group than in the control group who achieved a maximum FIM total score at the third month (47% vs. 19%, p = 0.015) and a maximum Glasgow Outcome Scale (GOS) score at the second (28% vs. 8%, p = 0.034) and third months (34% vs. 14%, p = 0.044).

Conclusions: Early intensive rehabilitation may improve the functional outcome of patients with TBI in the early months post-injury and hence increase the chance of their returning to work early. Intensive rehabilitation in this study speeded up recovery rather than changed the final outcome.     

Surgical Intervention for Malignant Fibrous Histiocytoma of the Lung: Report of a Case

Malignant fibrous histiocytoma (MFH) of the lung is rare, accounting for less than 0.2% of all pulmonary neoplasms, and an optimal treatment strategy has not yet been elucidated. We encountered a 62-year-old male patient with MFH of the lung who underwent a resection of the lymph node of recurrence 7 months after a lobectomy. We herein review 93 cases of pulmonary MFH in the literature, and discuss the surgical treatment for this disorder with special reference to lymph node involvement. Lymphogenic metastasis was observed in 14 of 72 cases (19%) who underwent surgical treatment. The 5-year survival rates for these reported patients with and without surgical treatment were 43% and 0% (P = 0.01) and the 5-year survival rates for “resected” patients with and without lymph node metastasis were 27% and 49%, respectively (P = 0.03). A complete resection with the systematic dissection of regional lymph nodes is therefore considered to positively contribute to the survival of patients with primary pulmonary MFH.     

Outcome of traumatic extradural haematoma in Hong Kong

AIM: Traumatic extradural haematoma (EDH) is a neurosurgical emergency and timely surgical intervention for significant EDH is the gold standard. This study aims to determine the incidence and mortality of consecutive patients with traumatic EDH admitted to the Emergency Department (ED) of Prince of Wales Hospital (PWH), a University Hospital Trauma Centre in Hong Kong. PATIENTS AND METHODS: Retrospective analysis of prospectively collected data for all consecutive trauma cases admitted through the ED during 2001-2004. EDH was diagnosed by CT in all cases. Both primary and delayed onset EDH were included, as were patients with combined EDH and other intracranial lesions (e.g. subdural haematoma). Age, sex, cause of injury, associated intracranial lesions, skull fracture, Glasgow Coma Scale, pupil reactivity, treatment, length of stay and clinical outcome were determined. RESULTS: Two thousand and two hundred and eight patients were in the trauma registry for 2001-2004. Total 1080 head injured patients; 89 patients had traumatic EDH, mean of 1.9 patients per month. Seventy (79%) patients were male, with a mean age of 37.7 years. Fifty (56%) patients were from road traffic crashes, 27 (30%) sustained falls, 10 (11%) had direct head trauma. On admission, 62 (70%) patients were GCS 13-15, 9 (10%) GCS 9-12 and 18 (20%) GCS 3-8. Sixty-six (74%) patients had a skull fracture. Thirty (34%) patients underwent neurosurgical operation. Overall, nine patients (10%) died; eight patients were GCS<8; five had bilateral fixed and dilated pupils; one had a single fixed and dilated pupil. Four patients died after neurosurgical operation, three of whom had fixed dilated pupils and were GCS 3 prior to surgery. Median length of hospital stay for survivors was 10.4 days. CONCLUSION: Survival from traumatic EDH was 90% (80/89) and 91% (73/80) of survivors had a Glasgow Outcome Score of 4 or 5 (good or moderate). The combination of bilateral fixed dilated pupils and GCS 3 suggests severe primary brain injury. Emergency evacuation of intracranial haematomas is unlikely to improve the outcome for these patients. Even in an urban environment with short prehospital times and rapid access to neurosurgery, outcome in patients who are GCS 3 following EDH is likely to be poor.     

Children in Sweden admitted to intensive care after trauma

OBJECTIVE: The aims of this study were to describe the demographics, injuries, mechanisms and severity of injury, prehospital and hospital care during the first 24h, and patient outcome, in the most severely injured children cared for following trauma at a paediatric intensive care unit in Sweden. METHODS: The medical records of 131 traumatised children (0-16 years of age), admitted to the paediatric intensive care unit in Gothenburg from January 1990 to October 2000, were retrospectively examined. Nine internationally recognised scoring systems were used to calculate severity of injury, in order to predict the chances of patient survival. RESULTS: Paediatric trauma was more common in boys (68%). The mean age at injury was 7.9 years (S.D. 4.7 years). Traffic-related accidents (40%) and falls (34%) were the leading causes of injury. Injuries to the head were the most frequent, forming 24% of all injuries. Severity of injury was recorded as an Injury Severity Score median of 14, Trauma Score Injury Severity Score median of 99% and Paediatric Risk of Mortality Score median of 0.69%. The mortality rate was 3%. CONCLUSION: Trauma with admission to a paediatric intensive care unit is rare in a Swedish paediatric population. When cared for at a centre with the necessary facilities and trained personnel, these children have a good chance of survival.     

Histologic bile duct invasion by a mass-forming intrahepatic cholangiocarcinoma

Abstract. Background/Purpose: Although curative surgical resection provides the best chance of long-term survival for patients with intrahepatic cholangiocarcinoma, the presence of bile duct invasion decreases postoperative survival rates in patients with mass-forming intrahepatic cholangiocarcinoma. We carried out this study to determine a surgical strategy for patients with bile duct invasion of these tumors. Methods: Forty-one patients with mass-forming intrahepatic cholangiocarcinoma were classified as either having bile duct invasion (n= 26) or not having bile duct invasion (n= 15). Clinicopathologic findings, including postoperative outcomes, were compared between these two groups. Results: Perineural invasion, lymphatic invasion, and a positive resection margin were more frequent in patients with ductal invasion. Patients with ductal invasion had lower survival rates than those without ductal invasion. Conclusions: Intraoperative frozen section examination of the bile duct stump to confirm a clear resection margin is required in patients with mass-forming tumors. Resection of the extrahepatic bile duct should be considered when tumor cells are identified at the surgical margin of the resected bile duct. Received: October 30, 2001 / accepted: November 16, 2001     

两种内镜下术式治疗胆总管结石的临床效果与安全性比较

目的比较两种内镜下术式治疗胆总管结石的临床效果与安全性。 方法对2015年3月至2017年5月90例胆总管结石患者进行前瞻性对照研究,使用随机数字表法将其分为A组、B组,各45例,A组接受内镜下十二指肠乳头括约肌切开术(EST)联合腹腔镜下胆囊切开术(LC)治疗,B组接受经皮经胆囊十二指肠乳头肌球囊扩张排石术治疗。数据采用SPSS 22.0进行分析,术中术后指标及实验室指标以( ±s)表示,并采用独立t检验;临床预后及术后并发症采用χ²检验,以P<0.05为差异有统计学意义。 结果B组术后近期急性胰腺炎发生率及远期结石复发率低于A组(P<0.05)。两组患者术后1周、术后1个月CA19－9、总胆红素、直接胆红素、ALT、AST均较术前降低,术后1周B组上述指标低于A组(P<0.05)。 结论两种内镜下术式治疗胆总管结石的临床效果相当,经皮经胆囊十二指肠乳头肌球囊扩张排石术的安全性更为理想,值得推荐。     

Liver transplantation is an alternative treatment of hepatocellular carcinoma beyond the Milan criteria

Background

The decision to perform liver transplantation (LT) or liver resection (LR) for patients with hepatocellular carcinoma (HCC) who are beyond the Milan criteria remains controversial.

Methods

We retrospectively analyzed outcome data for 179 patients with HCC beyond the Milan criteria who were treated with LR (n = 135) or LT (n = 44). Univariate and multivariate Cox proportional hazard models were established. Kaplan-Meier survival curves were generated, and a log-rank test was performed to compare group survival status.

Results

Patients who underwent LR group were significantly older, had a lower TNM stage, and were more likely to have unilateral disease and noncirrhotic liver. Significantly more patients in the LR group had recurrence (53.3% vs 29.5%) or died (61.5% vs 43.2%) than patients in the LT group. Recurrence-free survival rates were 11.9% for the LR group and 61.5% for the LT group. The median overall survival duration showed no statistically difference between the LR group (28.0 months) and the LT group (50.0 months).

Conclusions

LT may be the better choice for patients with HCC beyond the Milan criteria.