Anatomical Versus Nonanatomical Resection of Colorectal Liver Metastases: Is There a Difference in Surgical and Oncological Outcome?

Background: The increased use of neoadjuvant chemotherapy and minimally invasive therapies for recurrence in patients with colorectal liver metastases (CLM) makes a surgical strategy

Management of colorectal cancer presenting with synchronous liver metastases

Up to a fifth of patients with colorectal cancer (CRC) present with synchronous hepatic metastases. In patients with CRC who present without intestinal obstruction or perforation and in whom comprehensive whole-body imaging confirms the absence of extrahepatic disease, evidence indicates a state of equipoise between several different management pathways, none of which has demonstrated superiority. Neoadjuvant systemic chemotherapy is advocated by current guidelines, but must be integrated with surgical management in order to remove the primary tumour and liver metastatic burden. Surgery for CRC with synchronous liver metastases can take a number of forms: the 'classic' approach, involving initial colorectal resection, interval chemotherapy and liver resection as the final step; simultaneous removal of the liver and bowel tumours with neoadjuvant or adjuvant chemotherapy; or a 'liver-first' approach (before or after systemic chemotherapy) with removal of the colorectal tumour as the final procedure. In patients with rectal primary tumours, the liver-first approach can potentially avoid rectal surgery in patients with a complete response to chemoradiotherapy. We overview the importance of precise nomenclature, the influence of clinical presentation on treatment options, and the need for accurate, up-to-date surgical terminology, staging tests and contemporary management options in CRC and synchronous hepatic metastatic disease, with an emphasis on multidisciplinary care

Pulmonary rehabilitation [Pulmoner rehabi·li·tasyon]

Pulmonary rehabilitation is a multidimensional continuum of services directed to persons with pulmonary disease and their families, usually by an interdisciplinary team of specialists. The primary goal of rehabilitation is to restore the patient to the highest possible level of independent function. The purpose of this document is to review the current therapeutic methods used in pulmonary rehabilitation

Effectiveness of therapeutic ultrasound in adhesive capsulitis [Efficacité du traitement par ultrasons dans la capsulite rétractile de l'épaule]

[No abstract available

Effectiveness of therapeutic ultrasound in adhesive capsulitis

PubMedID: 18455944Objective: There is a lack of evidence about the effectiveness of therapeutic ultrasound (US) compared with placebo US in the treatment of adhesive capsulitis. This study was performed to assess the effectiveness of therapeutic US in the treatment of adhesive capsulitis. Methods: Forty-nine patients with adhesive capsulitis were randomized to US (n = 25) and sham US (n = 24) groups. Superficial heat and an exercise program were given to both groups. Ultrasound was applied to US group and imitative ultrasound was applied to sham US group for 2 weeks. Shoulder range of motion (ROM), pain and Shoulder Pain and Disability Index (SPADI) were assessed at the beginning, after treatment and after 3 months (control). Short Form-36 (SF-36) was applied for assessing general health status at the beginning and after 3 months. Compliance with the home exercise program was recorded daily on a chart for 3 months. Results: Shoulder ROM, pain with motion, two subscales and total score of SPADI and physical component summary score of SF-36 were improved significantly in both groups after the treatment and after 3 months (p < 0.0001). Improvements in flexion, inner and outer rotation values were significantly higher in the US group when we compared the differences between post- and pre-treatment values of shoulder ROM. The differences between control and pre-treatment values of inner and outer rotation were also significantly higher in the US group (p = 0.002 and p = 0.02 respectively). No significant difference was detected in pain, SPADI and SF-36 scores between groups. The exercise compliance was significantly higher in the sham US group (p = 0.04). Conclusion: Our results suggest that US compared with sham US gives no relevant benefit in the treatment of adhesive capsulitis. Effectiveness of US might be masked by worse pre-treatment values of the US group and higher exercise compliance of the sham US group. © 2008 Elsevier Masson SAS. All rights reserved

Short-term treatment experience with teriparatide in pregnancy- and lactation-associated osteoporosis

PubMedID: 24911426[No abstract available

Efficacy and usage of gabapentin in the treatment of neuropathic pain [Nöropatik agri tedavisinde Gabapentin kullanimi ve etkinligi]

Purpose: Gabapentin is an antiepileptic agent used for the treatment of neuropathic pain. This study was aimed to evaluate the usage and efficacy of gabapentin in neuropathic pain. Material and Methods: A hundred and six patients who prescribed gabapentin for neuropathic pain were assessed. Demographic data, initial diagnosis, symptom duration, previous medications, medications used with gabapentin, duration and dosage of gabapentin were recorded retrospectively. Patients were asked to evaluate efficacy of treatment by Likert scale (0-4) via phone visits. Results: Mean age of patients was 56.8±12.6 and 57.5% of them were female. Mean duration of symptoms and duration of gabapentin usage were 5.35±5.0 years and 11.13±9.9 months respectively. Mean gabapentin dosage was 1606.6±505.3 mg. Global assessment of treatment efficacy was 1.9±1.3. 51% of our patients rated the efficacy of treatment as mild or moderate, whereas 32% of them rated as good or very good. No statistically significant difference was detected between patients with central and peripheral neuropathic pain based on global assessment of treatment efficacy. Conclusion: Gabapentin was evaluated as moderately effective for the treatment of neuropathic pain. Majority of patients had radiculopathy and spinal cord compression due to spinal stenosis. Prospective, randomized controlled trials are needed to investigate efficacy of gabapentin in these particular neuropathic pain conditions

THE ASSOCIATION OF PATELLA ALTA WITH THE SEVERITY OF RADIOLOGICAL TIBIOFEMORAL KNEE OSTEOARTHRITIS

Annual European Congress of Rheumatology (EULAR) -- JUN 08-11, 2016 -- London, ENGLANDWOS: 000401523104136

Effects of a multimodal exercise program for people with ankylosing spondylitis

PubMedID: 16813473Background and Purpose. Few randomized controlled studies have examined the effects of exercise in patients with ankylosing spondylitis (AS). This study investigated the effects of a 12-week, multimodal exercise program in patients with AS. Subjects. A convenience sample of 30 patients with AS (18 male, 12 female), with a mean age of 34.9 years (SD=6.28), participated in the study. Twenty-six subjects were classified as having stage I AS and 4 subjects were classified as having stage II AS according to the modified New York Criteria. Methods. This study was a randomized controlled trial. Subjects were assigned to either a group that received an exercise program or to a control group. The exercise program consisted of 50 minutes of multimodal exercise, including aerobic, stretching, and pulmonary exercises, 3 times a week for 3 months. Subjects in both groups received medical treatment for AS, but the exercise group received the exercise program in addition to the medical treatment. All subjects received a physical examination at baseline and at 12 weeks. The examinations were conducted under the supervision of a physician who specialized in physical medicine and rehabilitation and included the assessment of spinal mobility using 2 methods: clinical measurements (chin-to-chest distance, Modified Schober Flexion Test, occiput-to-wall distance, finger-to-floor distance, and chest expansion) and inclinometer measurements (gross hip flexion, gross lumbar flexion, and gross thoracic flexion). In addition, vital capacity was measured by a physiologist, and physical work capacity was evaluated by a doctorally prepared exercise instructor. Results. The measurements of the exercise group for chest expansion, chin-to-chest distance, Modified Schober Flexion Test, and occiput-to-wall distance were significantly better than those of the control group after the 3-month exercise period. The spinal movements of the exercise group improved significantly at the end of exercise program, but those of the control group showed no significant change. In addition, the results showed that the posttraining value of gross thoracic flexion of the exercise group was significantly higher than that of the control group. Physical work capacity and vital capacity values improved in the exercise group but decreased in the control group. Discussion and Conclusion. In this study, a multimodal exercise program including aerobic, stretching, and pulmonary exercises provided in conjunction with routine medical management yielded greater improvements in spinal mobility, work capacity, and chest expansion

Musculoskeletal complaints and quality of life after open heart surgery [Açik kalp operasyonu sonrasi kas-i·skelet si·stemi· yakinmalari ve yaşam kali·tesi·]

There is a tremendous increase in the number of cardiac operations correlating the technical advances in the last years. The aim of this study is to investigate about the musculoskeletal complaints and the health status of patients after open heart surgery. 154 patients enrolled the study, 62.3% had coronary artery by pass grafting, 32.4% had valve replacement. Detailed physical examination with laboratory and radiological evaluations were performed. Health related quality of life was assessed with the SF-36 Health Status Questionnaire (SF-36) and the scores of the patients were compared with age and gender comparable healthy individuals. In the patient group, 11 adhesive capsulitis (%7.1), 9 postthoracotomy pain syndrome (%5.8), 3 myofascial pain syndrome (2%), 2 fibromyalgia syndrome (%13) and 2 polymyalgia rheumatica (%1.3) were determined in the postoperative period. According to New York Heart Association (NYHA) functional classification, 92.9% of patients were in class 1 or 2. Significant relationship was found between NYHA functional class and physical function scale of SF-36 (r=-0.66, p<0.01). Although the scores of social functioning and role limitations due to emotional problems were similar in patient and control group, scores of general health perceptions, physical functioning, limitations due to physical problems, bodily pain, mental health and vitality were found significantly lower (p<0.05). It was concluded that some musculoskeletal complaints independent of cardiac pathologies might be observed after open heart surgery and the quality of life of these patients are lower than that of normal population in many aspects