Abstract

AL amyloidosis and multiple myeloma result in extracellular deposition of insoluble fibrillary protein in tissue and organs. Untreated median survival is very poor, and even worse with cardiac involvement. Chemotherapy and peripheral blood stem cell transplantation (PBSCT) have been shown to dramatically improve survival, with hematologic remission documented. Regression of cardiac changes has previously been shown, as assessed by echocardiography (TTE) and cardiac magnetic resonance imaging (CMR). This study is a comparison of TTE and CMR in long-term survivors of cardiac amyloidosis with regression. Four long-term survivors with cardiac amyloidosis and regression of cardiac features on TTE were identified. Mean age was 60 years and average survival was 139 months from the time of diagnosis of cardiac involvement. Statistically significant regression of the cardiac features of cardiac amyloidosis were demonstrated on TTE. In these survivors, post-PBSCT structural assessments were similar between TTE and CMR. Classical strain imaging features of cardiac amyloidosis were only present in 50%. All patients had diffuse, patchy gadolinium enhancement on CMR after PBSCT. Treatment of cardiac amyloidosis with chemotherapy and PBSCT may result in regression of abnormalities on TTE with marked improvement in survival. Post treatment, TTE and CMR structural assessments appear similar. Gadolinium imaging suggests that microscopic residual infiltration persists despite macroscopic regression. Significant cardiac improvements with prolonged survival are seen nonetheless. Multimodality imaging has a vital role in the management of cardiac amyloidosis.

Abstract

Although American Indians/Alaska Natives (AI/ANs) have exhibited high rates of alcohol and drug use disorders, there is a paucity of substance use disorder treatment outcome research. In addition, there exists controversy about whether evidence-based treatments (EBTs) are culturally appropriate given that they were derived mainly by and for non-Hispanic White populations and do not explicitly include aspects of AI/AN culture and worldview. In this pilot study, we collaboratively culturally adapted two EBTs, Motivational Interviewing and Community Reinforcement Approach (MICRA), and evaluated substance use and psychological outcomes at 4- and 8-months post-baseline assessment. In preparation for a larger randomized clinical trial (RCT), eight tribal members (75% male) participated in this pilot treatment study. Measures included substance use, urine screens, self-efficacy, psychological distress, and hopelessness. All participants completed follow-up assessments at 4- and 8-months. Due to small sample size, effect sizes were calculated to evaluate outcomes pre- and post-treatment. Despite high rates of abstinence at baseline, percent days abstinent (PDA) increased at the 8-month time point for the most commonly used substances (alcohol, Hedgess g = 0.59, and marijuana, g = 0.60) and for all substances combined (excluding tobacco, g = 0.56). Improvements in psychological distress (g = − 0.66) and 5 of the 7 Addiction Severity Index domains (range of g = − 0.42 to − 0.98) also emerged. Results suggest that culturally adapted EBTs yield significant improvements in alcohol use, psychological distress, and legal problems among AI/ANs. Future research using RCT methodology is needed to examine efficacy and effectiveness.

Abstract

Using internet research to study the current market of programs related to image management, we searched for the best software solutions for the description, dissemination and promotion of a photographic archive. With the experience obtained from using and configuring these programs and with an evaluation using previously established requirements, a list of the most adaptable and versatile software having the added value of being capable of expansion has been elaborated. In addition, we have been able to contribute to establishing the criteria and recommendations to determine which of them are better for each type of archive, for a public or private institution, an agency, or a personal archive.

Abstract

Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it. A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with nonoperative management. Of 241 consecutive patients with PPU, 107 successfully received nonoperative management, and 134 required surgery. In multivariable analysis, the following four variables correlated with surgery and were given one point each toward the clinical score: age ≥70 years, fluid collection detection by ultrasound, contrast extravasation detection by water-soluble contrast examination, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥8. Eighty-five percent of patients with a score of 1 or less were successfully treated with nonoperative management, whereas 23 of 29 patients with a score of 3 or more required surgery. The area under the receiver operating characteristic curve was 0.804 (95% confidence interval = 0.717–0.891). By combining clinical, radiological parameters, and APACHE II score, the clinical score allowed early identification of PPU patients who can benefit from nonoperative management.

Abstract

Pilonidal sinus treatment includes various surgical and minimally invasive procedures, but there is still no standard treatment. Flap reconstructions and minimally invasive treatment options such as crystallized phenol application have recently been in the center of interest. The aim of this study is to compare crystallized phenol application as a minimally invasive treatment with modified Limberg flap reconstruction from many aspects. Thirty-seven patients diagnosed with pilonidal sinus and treated with modified Limberg flap reconstruction, and 44 patients treated with crystallized phenol application were evaluated retrospectively in terms of age, sex, length of stay in hospital postoperatively, wound complications, and the cause and rate of recurrence. Length of hospital stay was decreased and no postoperative incision problems were found in the group treated with crystallized phenol application (p < 0.001 and p = 0.011, respectively). The difference between the groups in terms of recurrence rate was not statistically significant (p = 0.173). Although the recurrence rate was found to be higher in the patient group treated once with crystallized phenol application, the success rate following multiple applications of crystallized phenol was found to be 94.5%. Higher body mass index (> 24.9 kg/m2) and surgical site infection were strongly correlated with recurrence rate (p < 0.001). Crystallized phenol application is a good alternative to the modified Limberg flap procedure and other surgical procedures, because it has several advantages such as being a minimally invasive procedure performed under local anesthesia with higher success rate after multiple applications, decreased length of stay in hospital, and minimal scar tissue formation.

Abstract

The aim of the study was to evaluate the results of the treatment program for people who have problems with their drinking developed at Centros de Integración Juvenil, institute dedicated to treat, prevent and investigate addictions in Mexico. The evaluation was made by a cuanticualitative, transversal, comparative, ex post facto design. The first estimate was carried out with a purposive sample of 170 people (133 men and 37 women) who were participating in the treatment program. To do this, was design the test of Program Evaluation for Drinkers (CEPROBE ) to examine the emotional and health state, social integration, criminal behavior, assertiveness to confront the offer of alcohol, habit changes attributed to alcohol program and to assess service quality standards. For the second analysis, 24 Psychologists and 1 Physician (18 men and 7 women) were interviewed it means at an open questionnaire that explores the experience of the therapist in the course of the program. Overall, 47.3% of the patients decreased de use of alcohol, while 48.5% were able to quit it. With the Kruskal-Wallis test, the results suggest significant differences in the socio-emotional status mentioned and alcohol use of the subjects. Under the perception of patients and therapist, the program fulfilled adequately quality standards.

Abstract

Penile prosthesis implantation is a common, well‐established treatment for correcting medical refractory erectile dysfunction. Although more invasive than some of the other currently available therapies, PP surgery has the advantages of high patient satisfaction rates. The aim of this study was to evaluate the surgical results and patient satisfaction after implantation of PP in 25 patients treated at the University Hospital of Coimbra (CHUC). We evaluated 25 patients with erectile dysfunction who underwent implantation of PP, inflatable and semi‐rigid, between November 2000 and November 2013. The information was obtained from medical records and telephone interviews and encompassed clinical severity, comorbidity, etiology, PP type, surgical complications, need for reintervention and degree of patient satisfaction. 88% of patients had severe ED. The main etiologies reported were: multifactorial (46.4%), atherogenic (24%) and neurologic (16%). Most devices implanted were inflatable prostheses (84%). In 80% of the cases there were no complications reported, the rate of re‐intervention was 20%. There were a high percentage of satisfied / very satisfied patients (65%). PP surgery remains an excellent alternative in restoring erectile function in patients whose medical therapies have failed. Despite its invasive nature, the implementation of PP has proven to be associated with a low rate of complications and a high degree of patient satisfaction.