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Major treatments for small hepatocellular carcinoma (SHCC) include percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), radiofrequency ablation (RFA), or surgical resection (SR). We aimed to compare these therapies concerning with effectiveness and safety.Cochrane Library, PubMed, and Embase were searched for randomized controlled studies (RCTs) from inception to 30 April 2017. Odds ratios (OR) for proportion dead (PD), local recurrence (LR) and adverse events (AEs).Fourteen RCTs were identified. Compared with SR, PEI (OR 2.79, CrI 1.25, 6.45, p 0.01) provided a significantly increased risk of PD. Similarly, PEI (OR 4.29, CrI 1.18, 18.35, p 0.01) yielded more LR than SR. Also, SR significantly conferred more AEs than RFA (OR 0.10; CrI 0.02, 0.35, p 0.01), PEI (OR 0.06; CrI 0.01, 0.31, p 0.01). Besides, RFA conferred the highest efficacy for survival, time to recurrence, and new development of HCC.SR was superior to PEI. Although SR achieved highest cumulative ranking probabilities in clinical efficacy, it obtained a low benefit-to-risk ratio for patients. RFA was superior to the other ablative therapies. For tumor sizes 2 cm or ≤ 2 cm in diameter, SR conferred non-significant effects compared with other therapies for SHCC.

Knee arthroscopic debridement, total hip arthroplasty(THA) and artificial femoral-head replacement are the major treatments for joint diseases, and they have a high degree of dependence on various complicated surgical tools. Structure design, manufacturing precision and cutting performance of surgical tools are important factors that influence the success of operation. This review introduces the arthroscopic cutting tools, acetabular reamers, starter awls and femoral broaches which are used in arthroscopic debridement and THA, And this review also analyzes structural characteristics and cutting mechanism of those surgical tools, and point out design principles, problems and research directions in the design and manufacture.

Most of cerebral aneurysms (CAs) are incidentally discovered without any neurological symptoms and the risk of rupture of CAs is relatively higher in Japanese population. The goal of treatments for patients with CAs is complete exclusion of the aneurysmal rupture risk for their lives. Since two currently available major treatments, microsurgical clipping and endovascular coiling, have inherent incompleteness to achieve cure of CAs with some considerable treatment risks, and there is no effective surgical or medical intervention to inhibit the formation of CAs in patients with ruptured and unruptured CAs, new treatment strategies with lower risk and higher efficacy should be developed to prevent the formation, growth, and rupture of CAs. Preemptive medicine for CAs should be designed to prevent or delay the onset of symptoms from CAs found in an asymptomatic state or inhibit the de novo formation of CAs, but we have no definite methods to distinguish rupture-prone aneurysms from rupture-resistant ones. Recent advancements in the research of CAs have provided us with some clues, and one of the new treatment strategies for CAs will be developed based on the findings that several inflammatory pathways may be involved in the formation, growth, and rupture of CAs. Preemptive medicine for CAs will be established with specific biomarkers and imaging modalities which can sensor the development of CAs.

The increased prevalence of obesity in children and adolescents is becoming a public health problem. As in adults, obesity is associated with other comorbidities and their risks. This systematic review aims to summarize the implications of morbid obesity in adolescents, and identify the currently accepted treatments for its management. Various treatments such as lifestyle changes, drug therapy, and surgery are the classical therapeutic triad. This review attempts to clarify the role of each of the major treatments in terms of safety and efficacy. Although obesity surgery in adolescents remains controversial for some aspects, there is evidence that the lack of effective treatment can lead to serious medical consequences in the future. Gastric bypass and gastric banding techniques remain of choice, but the role of other currently more popular techniques, such as sleeve gastrectomy should be clarified.

Summary Unreamed Intramedullary nailing and external fixation are 2 major treatments widely used in Gustilo grade III open tibial fractures, but the difference in effectiveness and complication remains controversial. We retrieved original publications of comparative studies from medical literature databases and selected 9 of them for a meta-analysis. Observation items include malunion and deep infection rate, non-union and comparison of time to union. The analysis showed a lower malunion rate using unreamed intramedullary nailing than external fixation. No significant differences were revealed in deep infection/nonunion rate and time to union. More studies of larger scale and better design are needed to reach an ultimate and definite conclusion.

Background:A case of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after failed radiation therapy and vertical partial laryngectomy had successful oncological and functional outcomes. This is the first reported application of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after the failure of two major treatments.Case report:A 65-year-old man was referred for salvage supracricoid laryngectomy with cricohyoidoepiglottopexy. The right recurrent hemilarynx was successfully resected. After pexis, the right lobe of the thyroid gland was repositioned to overlap and reinforce the pexis gap and fill the devoid portion of the strap muscular closure. Multiple scattered foci (recurrent tumour–node–metastasis stage T2) were identified around the arytenoid cartilage and beneath the musculocutaneous flap. Four years after supracricoid laryngectomy with cricohyoidoepiglottopexy, the patient's recovery was following a favourable course and he had satisfactory laryngeal function.Conclusion:Appropriate case selection and proficient surgical skills were essential for a successful outcome. Head and neck surgeons should not be afraid to adopt functional preservation open surgical procedures in well-selected and well-motivated patients. A requirement for more challenging surgical procedures and meticulous rehabilitation processes should not exclude appropriate treatments from a surgeon's repertoire.

Hemiparalysis is a common symptom of cerebral hemorrhage. Chinese traditional acupuncture and electroacupuncture are two major treatments for the disease. However, they often fail to achieve satisfactory outcome. It reports here successful treatment of three patients with hemiparalysis using electroacupuncture along the meridian therapy along with prescription medicines to restore the muscle strength. The three patients had a history of hemiparalysis and were diagnosed hemiparalysis due to cerebral hemorrhage based on CT or MRI examinations. Acupuncture was applied to restore the muscle strength with routine treatment and prescription medicines. The patients were treated 20 times with electroacupuncture along the meridian. After 1 months of the treatment, case 1 and case 2 regained the muscle strength, and case 3 was remarkably recovered. It is likely that combining Chinese tradition acupuncture with electroacupuncture is more effective to treat hemiparalysis, although more studies are needed to validate the approach.

Quality of life and disability have been compared in patients with ulcerative colitis who were undergoing one of the two current major treatments of choice, proctocolectomy or anti-TNF therapy. The only significant differences between the two groups were increased use of antidiarrhoeal medication and stool frequency in those who underwent surgery.

Objective This study aimed to evaluate the prevalence and difficulties during surgery of tympanostomy tube (TT) insertion, complications after surgery, and modalities for management. Background In view of the high incidence of otitis media with effusion in children and the fact that TT is one of its major treatments, we decided to conduct the present observational study. Patients and methods This study included 220 patients with persistent otitis media with effusion after failed medical treatment for 3 months. All patients underwent TT insertion either unilateral or bilateral in 378 operated ears. Results There were 198 problems detected in 378 operated ears. The difficulties during insertion of TT were observed in 82 ears. The most common was the thick mucoid discharge (P = 0.10), followed by the narrow external auditory canals (P = 0.005). Early complications were observed in 42 ears. The most common was early otorrhea (P = 0.03), followed by early extrusion (P Conclusion TT insertion is a temporary procedure performed until the Eustachian tube function returns to its normal function; however, this procedure has many problems during and after insertion. Difficulties of insertion and late side effects are common problems that can be anticipated in nearly one-fifth of the cases. Therefore, ORL surgeons must be aware of the type of difficulty and its management before performing the surgery.

Four patients with Cushing's diseases were treated by Ketoconazole (KC). Two of them are still successfully treated after 15 and 18 months. One escaped after 15 months of treatment. The last one did not respond at all. General and hepatic tolerance was very good. KC cannot be considered as a curative treatment but is of big interest to delay the use of major treatments as surgery or OP'DDD.

After developing for more than 20 years, image-guided local ablation therapy has become one of the major treatments of hepatocellular carcinoma (HCC). In particular, percutaneous radio-frequency ablation has been widely accepted as the first-line treatment of early-stage HCC. A number of randomized controlled trials have shown some differences between these local ablation techniques. This article reviewed the development of local ablation therapy in the past few years.