RESUMEN
While a simple interrupted sutured anastomosis remains the gold standard in microsurgery, the introduction of the microanastomotic coupler device (MACD) has decreased procedure time and thrombosis risk, and improved the patency of venous anastomoses. The aim of this review is to update the evidence-based advantages of the MACD on arteries, based on clinical and experimental data, and to compare them to the hand-sewn approach in free flap transfer. All relevant articles that appeared in the PubMed and Medline/Ovid databases during the past three decades were reviewed. After exclusions, 11 studies were retained and discussed. The MACD had a generally shorter arterial anastomosis time, with improved flap survival and reduced ischaemia compared with the hand-sewn approach. The use of the MACD in arterial anastomosis is an efficient and less time-consuming alternative to the hand-sewn technique, provided that the selection of vessels is appropriate and the vessel diameter is large enough to do the anastomosis.
Asunto(s)
Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Anastomosis Quirúrgica , Arterias/cirugía , Humanos , Microcirugia , Estudios RetrospectivosRESUMEN
BACKGROUND: Postoperative swallowing pain is one of the most unpleasant after-effects of tonsillectomy. During recent years, the demand for alternatives to drug-based pain therapy has continued to grow, although the topic has received little research attention until now. MATERIALS AND METHODS: A total of 46 patients were randomized into verum acupuncture, control acupuncture, and drug-based treatment groups. All patients received nonsteroidal antirheumatic drugs (NSAIDs). One hour after drug intake, the verum group also received acupuncture according to classical acupuncture rules (S34, S44 and PC5). The control group had acupuncture needles placed at nonspecific acupuncture points in the midaxillary line. Acupuncture was performed by a blinded acupuncturist, who had learnt exclusively these techniques in the run up to the study. Patients were asked to evaluate their pain before, and at intervals of 20 min, 1 h, 2 h, and 3 h after drug intake/acupuncture treatment using a visual analog scale (VAS). RESULTS: The analgesic effect of acupuncture was significant up to 3 hours in the verum group (p < 0.05). The analgesic effect in the control acupuncture group was significant for up to 1 h after acupuncture (p < 0.05). With reference to the time point before acupuncture, the differences between both acupuncture groups and the drug group were significant (p < 0.01) over the whole time. CONCLUSION: Acupuncture is an effective complement to NSAIDs in the treatment of posttonsillectomy pain. Particularly patients with allergies, drug intolerance, or reduced response to the commonly administered drugs may benefit from acupuncture.
Asunto(s)
Terapia por Acupuntura/métodos , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/rehabilitación , Tonsilectomía/rehabilitación , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Manejo del Dolor/métodos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Postoperative swallowing pain is one of the most unpleasant after-effects of tonsillectomy. During recent years, the demand for alternatives to drug-based pain therapy has continued to grow, although the topic has received little research attention until now. MATERIALS AND METHODS: A total of 46 patients were randomized into verum acupuncture, control acupuncture, and drug-based treatment groups. All patients received nonsteroidal antirheumatic drugs (NSAIDs). One hour after drug intake, the verum group also received acupuncture according to classical acupuncture rules (S34, S44 and PC5). The control group had acupuncture needles placed at nonspecific acupuncture points in the midaxillary line. Acupuncture was performed by a blinded acupuncturist, who had learnt exclusively these techniques in the run up to the study. Patients were asked to evaluate their pain before, and at intervals of 20 min, 1 h, 2 h, and 3 h after drug intake/acupuncture treatment using a visual analog scale (VAS). RESULTS: The analgesic effect of acupuncture was significant up to 3 hours in the verum group (p < 0.05). The analgesic effect in the control acupuncture group was significant for up to 1 h after acupuncture (p < 0.05). With reference to the time point before acupuncture, the differences between both acupuncture groups and the drug group were significant (p < 0.01) over the whole time. CONCLUSION: Acupuncture is an effective complement to NSAIDs in the treatment of posttonsillectomy pain. Particularly patients with allergies, drug intolerance, or reduced response to the commonly administered drugs may benefit from acupuncture.
Asunto(s)
Terapia por Acupuntura , Manejo del Dolor , Dolor Postoperatorio , Tonsilectomía , Método Doble Ciego , Humanos , Dolor Postoperatorio/terapia , Estudios Prospectivos , Tonsilectomía/efectos adversos , Resultado del TratamientoRESUMEN
Phytomedicine has become an increasingly important treatment option for patients in the western world. Patients who experienced failure or adverse reactions with conventional western medicine often switch to natural and holistic methods. In eastern countries, with their long history of traditional medicine, patients often resort to herbal preparations as the majority of western medicines are unaffordable. The desire of western physicians for evidence-based medicine also applies in the sector of phytomedicine. A serious perception of natural products in scientific medicine can therefore only be based on data from prospective, controlled, randomized double-blind clinical trials. In order to illuminate the present scientific foundation of effective and reliable phytomedicine, a literature search in PubMed (Medline) was conducted based on inclusion and exclusion criteria. The main focus was on the field of otorhinolaryngology. Besides the presentation of selected, reliable studies and the evaluation of the efficacy of various medicinal plants, shortcomings of selected publications are discussed.
Asunto(s)
Medicina Basada en la Evidencia , Enfermedades Otorrinolaringológicas/tratamiento farmacológico , Enfermedades Otorrinolaringológicas/epidemiología , Fitoterapia/estadística & datos numéricos , Extractos Vegetales/uso terapéutico , Plantas Medicinales , Ensayos Clínicos como Asunto , Humanos , Prevalencia , Resultado del TratamientoRESUMEN
BACKGROUND: Every year there are several hundred thousand new cases of oral cancer worldwide. Clinical oncology is still challenged by toxicity and side effects of multimodal therapy strategies in which is associated with poor prognosis for patients. There is an urgent necessity to develop novel therapy strategies. As the majority of anticancer drugs are of natural origin, natural products represent a valuable source for the identification and development of novel treatment options for cancer. The aim of this investigation was to study the cytotoxicity of Salvia officinalis L. (sage) essential oil. METHODS: Salvia officinalis essential oil was gained by aqueous extraction from plant material and subsequently analyzed by gas chromatography. The cytotoxicity of the essential oil on the squamous human cell carcinoma cell line of the oral cavity (UMSCC1) was assessed with the XTT assay. These experiments revealed the half maximal inhibitory concentration (IC(50)) of the essential oil. It was used in the microarray-based analysis of gene expression of UMSSC1 cells. The results were submitted to a signaling pathway analysis. RESULTS: The main constituents of Salvia officinalis essential oil include the monoterpenes thujone, ß-pinene, and 1,8-cineol. Low concentrations of the essential oil increased vitality of the UMSCC1 cells. Beyond the concentration of the IC(50) of 135 µg/ml, sage essential oil reduced UMSSC1 cells viability to a minimum. In the microarray gene expression analysis, genes involved in cancer, cellular growth and proliferation, cell death, cell morphology, cell cycle, gene expression, and DNA repair were the most prominent. The three most significantly regulated pathways by sage were aryl hydrocarbon receptor signaling, cell cycle (G1/S checkpoint) regulation, and p53 signaling. CONCLUSION: To the best of our knowledge, this study suggests for the first time the ability of Salvia officinalis essential oil to inhibit human HNSCC cell growth. The therapeutic potential of sage essential oil might exceed that of its common use in otorhinolaryngology.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/fisiopatología , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/fisiopatología , Aceites Volátiles/administración & dosificación , Extractos Vegetales/administración & dosificación , Salvia officinalis/química , Antineoplásicos Fitogénicos/administración & dosificación , Apoptosis/efectos de los fármacos , Carcinoma de Pulmón de Células no Pequeñas/patología , Línea Celular Tumoral , Supervivencia Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Humanos , Neoplasias Pulmonares/patología , Resultado del TratamientoRESUMEN
BACKGROUND: To date, no validated instrument for measuring health-related quality of life (QOL) in patients after parotidectomy for benign disease has been available. METHODS: In our retrospective study we included patients who had undergone parotidectomy for benign disease between 2003 and 2006. A group of experts identified single items with a potential impact on postoperative complaints (alpha version). After the patients had filled out the questionnaire item reduction was performed by sequential statistical analysis. The beta version of the instrument resulting from this procedure was then validated by the evaluation of reliability and validity. RESULTS: We included 199 patients in the study, of which 70 (35%) returned the completed questionnaires. The alpha version of the instrument contained 20 items (Parotidectomy Outcome Inventory-20, POI-20), while the beta version consisted of 8 items (POI-8). Cronbach's alpha was 0.84, indicating good internal consistency. The test-retest reliability score for POI-8 in 49 patients was highly correlated (r=0.91). Furthermore, we found a good concurrent validity with a global disease specific question (r=0.78). CONCLUSIONS: The POI-8 is the first reliable and valid instrument for measuring health-related QOL in patients after parotidectomy for benign disease.