Assessment of past Results and Current Practice in the Treatment of Rheumatoid Metacarpophalangeal Joints

HAND ◽  
1979 ◽  
Vol os-11 (2) ◽  
pp. 151-156 ◽  
Author(s):  
F. V. Nicolle ◽  
Stephen Gilbert
Keyword(s):  
Soft Tissue ◽  
Current Practice ◽  
Pinch Strength ◽  
Rheumatoid Patient ◽  
Ulnar Deviation ◽  
Metacarpophalangeal Joints ◽  
One Year ◽  
Prosthetic Finger ◽  
Flexion Strength

A new design of prosthetic finger joint for the rheumatoid patient, and the technique for its insertion is described, which has now been in use for five years. The technique includes the soft tissue correction of the ulnar deviation. Results are reported for all the cases performed in one year giving a two year follow up, assessing flexion strength, pinch strength and the degree of recurrence of ulnar drift associated with loss of pinch strength.

scholarly journals Outcome and Toxicity of an Ifosfamide-Based Soft Tissue Sarcoma Treatment Protocol in Children. The Importance of Local Therapy

Sarcoma ◽  
1998 ◽  
Vol 2 (3-4) ◽  
pp. 171-177
Author(s):  
S. Murray Yule ◽  
Roderick Skinner ◽  
Martin W. English ◽  
Mike Cole ◽  
Andrew D. J. Pearson ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Primary Tumour ◽  
Treatment Protocol ◽  
Disease Free Survival ◽  
Local Therapy ◽  
Complete Response ◽  
One Year ◽  
Sarcoma Treatment

Background.Although the survival of children with soft tissue sarcoma (STS) has improved considerably, the outcome of patients with metastatic disease, and those with primary tumours of the extremities or parameningeal sites remains disappointing. We describe the clinical outcome of an ifosfamide-based regimen with local therapy directed only to children who failed to achieve a complete response to initial chemotherapy.Patients and Methods.Twenty-one children with STS (16 rhabdomyosarcoma) who presented with unresectable tumours were treated with five courses of ifosfamide (9 g/m2) and etoposide (600 mg/m2). Patients who did not achieve a complete response then received local therapy. Chemotherapy with ifosfamide combined with etoposide, vincristine (1.5 mg/m2and doxorubicin (60 mg/m2) or vincristine and actinomycin D (1.5 mg/m2) was continued for one year.Results and Discussion.Objective responses to five courses of ifosfamide and etoposide were seen in all patients. Disease free survival (DFS) at a median follow up of 59 months was 57% (95% CI 29–75%). The DFS of children who received local therapy was 89% compared with 33% in those who received chemotherapy alone (p=0.027). Locoregional recurrences did not occur in children who received radiotherapy to the site of the primary tumour. Ifosfamide-based chemotherapy does not reduce the incidence of loco-regional recurrence in children who do not receive local therapy.

scholarly journals Infantile Fibrosarcoma Histologically Mimicking a Benign Soft-Tissue Tumor

2020 ◽  
Vol 7 (4) ◽  
pp. 179-184
Author(s):  
Sam Hajialiloo Sami ◽  
◽  
Farshad Zandrahimi ◽  
Mohamadreza Heidarikhoo ◽  
Mahsa Zahmatkesh ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Tumor ◽  
Vascular Lesion ◽  
Diagnostic Challenge ◽  
Soft Tissue Neoplasm ◽  
Infantile Fibrosarcoma ◽  
Inappropriate Treatment ◽  
Benign Soft Tissue Tumor ◽  
One Year

Infantile fibrosarcoma is a rare soft-tissue neoplasm, which may render a diagnostic challenge leading to misdiagnosis and consequently an inappropriate treatment of patients. This study reports a case of infantile fibrosarcoma that mimicked a hemangioma in an 11-month-old girl. As the lesion signal in the MRI was not consistent with the diagnosis of hemangiomas, we performed a core needle biopsy, which its result was consistent with the diagnosis of infantile fibrosarcoma. The lesion was initially treated with surgical resection. However, the lesion recurred one year after the surgery. The recurrence was managed with debulking surgery. The fifth finger was necrotized during the hospitalization after the relapse surgery. Finally, the necrotic finger was amputated. Also, adjuvant chemotherapy was used to prevent further relapses. The 1-year follow-up of the patient was recurrence-free. These findings highlight the importance of considering infantile fibrosarcoma when an infant presents with a lesion that clinically mimics a vascular lesion.

Patterns of Disease Relapse and Progression in Patients with Multiple Myeloma After First Line Therapy with Autologous Stem Cell Transplantation: Implications for Patient Monitoring After Transplantation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 825-825
Author(s):  
Dmitriy Zamarin ◽  
Manisha Bhutani ◽  
Danielle Chimento ◽  
Sergio Giralt ◽  
Nikoletta Lendvai ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Soft Tissue ◽  
First Line ◽  
Post Transplant ◽  
First Line Therapy ◽  
Line Therapy ◽  
Group A ◽  
One Year ◽  
Group B

Abstract Abstract 825 BACKGROUND: Autologous stem cell transplantation (ASCT) is a widely used therapeutic option in first line treatment of multiple myeloma (MM). However, many patients eventually relapse. While precise knowledge of relapse and progression (R/PD) patterns would be important to generate evidence based surveillance recommendations after ASCT, such data is limited in the literature, especially in the era following the introduction of the free light chain assay. The purpose of this study is to examine the patterns of post-ASCT relapse and to derive evidence based recommendations for optimal surveillance of patients. METHODS: We performed a retrospective analysis on 258 patients with MM who underwent ASCT within one year of diagnosis at MSKCC between 2000 and 2010, as part of first line therapy. We used the IMWG standard criteria for serologic and clinical R/PD. We first determined for all patients the date of serologic R/PD. Patients identified as having serologic R/PD were further examined to determine whether clinical (anemia, renal failure, hypercalcemia, development of soft tissue lesions), radiologic (skeletal survey) or urinary R/PD had anteceded serologic R/PD. Several groups of patients were derived and further analyzed in terms of relapse patterns and adequacy of follow up. RESULTS: Among 258 patients, 173 were determined to have serologic R/PD at a median of 19.2 months post-transplant. Among these patients, on the dates of their serologic R/PD, 17 (9.8%) had concurrent overt symptomatic evidence of clinical/radiologic R/PD (Group A symptomatic R/PD), while 156 (90.2%) were found to have isolated asymptomatic serologic R/PD without apparent evidence of concomitant clinical/radiologic R/PD (Group B asymptomatic R/PD). Group A included patients with distinct and sometimes coinciding clinical characteristics (poor risk cytogenetics with aggressive disease (n=3), leptomeningeal relapse (n=1), soft tissue relapse (n=4) and acute severe anemia at relapse (n=3)); patients with IgA gammopathy (n=5); and patients considered to have inadequate serologic follow up intervals (range of follow up interval between date of serologic R/PD and prior serologic testing 149 to 245 days) (n=6). Upon further examination of group B, 44 patients had radiologic imaging at the time of serologic R/PD (within 4 weeks following the date of serologic R/PD). Fourteen among them (32%) had evidence of new bone lesions. Among all 173 patients with serologic R/PD, 83 patients had a skeletal survey within one year prior to the date of serologic R/PD. Only 3 (3.6%) had evidence of radiologic R/PD anteceding serologic R/PD. All 3 patients were considered to have had inadequate serologic follow up interval (Range 208 to 252 days). Abnormal urine immunofixation (UIF) anteceded serologic R/PD in 5 out of 41 (12%) patients tested who had achieved CR post transplant. In these patients the abnormal UIF anteceded the serologic R/PD by a mean of 2.4 months. Abnormal UPEP anteceded serologic R/PD by 1.9 months in only 1 out of 40 (2.5%) patients tested who had achieved less than CR post transplant. CONCLUSIONS: Based on the results of this analysis, several conclusions can be drawn: 1) The vast majority of R/PD in patients with MM are asymptomatic R/PD detected first by serologic studies. A small percentage of patients (those with aggressive cytogenetics, specific relapse types including soft tissue, severe cytopenia, and IgA gammopathy) will have symptomatic R/PD with overt concomitant evidence of clinical and/or radiologic R/PD at the time of serologic R/PD; 2) Among patients who have apparent asymptomatic R/PD, a significant percentage will have evidence of skeletal lesions and therefore imaging should be recommended in these patients; 3) In the absence of serological R/PD, routine surveillance screening with yearly skeletal surveys cannot be recommended based on this analysis since this test was not useful in any of the analyzable patients in whom it was obtained; 4) Aside from few patients in CR whose relapse may be detected earlier by UIF (with probably no clinical benefit), all patients with multiple myeloma whose disease progresses will have serologic R/PD at the time of progression and follow up limited to serologic testing may well be sufficient for monitoring patients with MM post transplant. Disclosures: No relevant conflicts of interest to declare.

Total Knee Arthroplasty in the Valgus Knee: Can New Operative Technologies Affect Surgical Technique and Outcomes?

2021 ◽  
Vol 39 ◽  
Author(s):  
Robert Marchand ◽  
◽  
Laura Scholl ◽  
Manoshi Bhowmik-Stoker ◽  
Kelly Taylor ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
3D Modeling ◽  
Preoperative Planning ◽  
Soft Tissue Release ◽  
Valgus Knee ◽  
Flexion Extension ◽  
Total Knee ◽  
One Year

Introduction: Valgus knee deformities can sometimes be challenging to address during total knee arthroplasties (TKAs). While appropriate surgical technique is often debated, the role of new operative technologies in addressing these complex cases has not been clearly established. The purpose of this study was to analyze the usefulness of computed tomography scan (CT)-based three-dimensional (3D) modeling operative technology in assisting with TKA planning, execution of bone cuts, and alignment. Specifically, we evaluated valgus TKAs performed using this CT-based technology for: (1) intraoperative implant plan, number of releases, and surgeon prediction of component size; (2) survivorship and clinical outcomes at a minimum follow up of one year; and (3) radiographic outcomes. Materials and Methods: A total of 152 patients who had valgus deformities receiving a CT-based TKA performed by a single surgeon were analyzed. Cases were performed using an enhanced preoperative planning and real-time intraoperative feedback and cutting tool. The surgeon predicted and recorded implant sizes preoperatively and all patients received implants with initial and final implant alignment, flexion/extension gaps, and full or partial soft tissue releases recorded. A modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.) scores were collected preoperatively and at approximately six months and one year postoperatively. Preoperative coronal alignment ranged from 1 to 13° valgus. Follow-up radiographs were also evaluated for alignments, loosenings, and/or progressive radiolucencies. Results: A total of 96% of cases were corrected to within 3° of mechanical neutral. For outlier cases, initial deformities ranged from valgus 5 to 13°, with final alignment ranging from 4 to 8° valgus (mean 4° correction). Patients had mean femoral internal rotation of 2° and mean femoral flexion of 4°. The surgeon was within one size on the femur and tibia 94 and 100% of the time, respectively. Only one patient required a lateral soft tissue release and one patient had osteophytes removed, which required a medial soft tissue release. Five patients required manipulations under anesthesia. Aside from these, there were no postoperative medical and/or surgical complications and there was 100% survivorship at final follow up. WOMAC and KOOS, JR. scores improved significantly from a mean of 21 ± 9 and 48 ± 10 points preoperatively to 4 ± 6 (p<0.05) and 82 ± 15 (p<0.05) at final follow up, respectively. None of the cases exhibited progressive radiolucencies by final follow up. Discussion: A limitation of this study was not evaluating dynamic kinematics in these patients to determine if rotation had any effects on kinematics. Future studies will evaluate this concern. Nevertheless, the technology successfully assisted with planning, executing bone cuts, and achieving alignment in TKAs complicated by the deformity. This may allow surgeons to predictably avoid soft tissue releases and accurately know component sizes preoperatively, while consistently achieving desired postoperative alignment. Conclusions: This study demonstrated the utility of CT-based 3D modeling techniques for challenging valgus deformity cases. Use of 3D modeling allowed the TKA components to be positioned according to the patient’s anatomy in the coronal, transverse, and sagittal planes. When making these intraoperative implant adjustments, the surgeon may choose to place components outside the preoperative planning guidelines based on the clinical needs of the patient.

Resection of the Distal Scaphoid for Scaphotrapeziotrapezoid Osteoarthritis

1999 ◽  
Vol 24 (4) ◽  
pp. 448-452 ◽  
Author(s):  
M. GARCIA-ELIAS ◽  
A. L. LLUCH ◽  
A. FARRERES ◽  
F. CASTILLO ◽  
Ph. SAFFAR
Keyword(s):  
Patient Satisfaction ◽  
Soft Tissue ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Pinch Strength ◽  
Wrist Flexion ◽  
Flexion Extension ◽  
Preoperative Status

Twenty-one patients with symptomatic scaphotrapeziotrapezoid osteoarthritis were treated with partial distal scaphoid excision. In 12 wrists the joint defect was filled with either capsular or tendinous tissue, while in nine no fibrous interposition was done. At an average follow-up time of 29 (range, 12–61) months, 13 wrists were painfree, while eight had occasional mild discomfort. Mean wrist flexion-extension was 119°. Grip and pinch strength improved by an average of 26% and 40% respectively compared with their preoperative status. Fifteen patients returned to their original jobs, while six, who were unemployed, felt unrestricted for activities of daily living. Although patient satisfaction was comparable for both types of treatment, the wrists without fibrous interposition showed significantly greater wrist flexion-extension than patients with soft-tissue interposition. Removal of the distal scaphoid resulted in a DISI pattern of carpal malalignment in 12 wrists. At follow-up, none of these wrists showed further joint deterioration due to residual malalignment.

scholarly journals Decision Making in Preservation Rhinoplasty: A 100 Case Series With One-Year Follow-Up

2019 ◽  
Vol 40 (1) ◽  
pp. 34-48 ◽  
Author(s):  
Aaron M Kosins ◽  
Rollin K Daniel
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Open Rhinoplasty ◽  
Level Of Evidence ◽  
Soft Tissue Envelope ◽  
Primary Rhinoplasty ◽  
Proper Patient Selection ◽  
Total Preservation ◽  
One Year

Abstract Background Preservation rhinoplasty (PR) is a new chapter in rhinoplasty history. The term was coined by Daniel in 2018 and represents a fundamental change in philosophy. Objectives The aim of this study is to discuss a single-surgeon case series utilizing PR techniques. Methods One hundred fifty-three primary rhinoplasty cases were studied retrospectively between December 2016 and August 2017. One hundred cases had at least 1 year of follow-up. Technical details were recorded, including dissection plane, ligament preservation, tip support, lateral crural maneuvers, alar contour grafts, and preservation of the dorsum vs traditional reduction. These 100 cases can be categorized as either complete preservation rhinoplasty (PR-C) or partial preservation rhinoplasty (PR-P). Results All patients had open rhinoplasty and the average follow-up time was 13 months. All patients had preservation of the dorsal soft tissue envelope, and in 36 the entire soft tissue envelope and ligaments were preserved. Fifty-four had preservation of the alar cartilages. Thirty-one had dorsal preservation. The combinations include: PR-C (skin, dorsum, and alars): 24; PR-P (skin and dorsum): 2; PR-P (alars and dorsum): 2; and PR-P (skin and alars): 7. Conclusions In most patients, the dorsal soft tissue envelope and nasal ligaments can be preserved. When possible, the lateral crura should be preserved and tensioning chosen over excision. Dorsal preservation is a versatile technique when proper patient selection is undertaken, and long-term issues with the middle vault and keystone area can be avoided. Some patients will benefit from total preservation where nothing is removed/disrupted and underlying structures are reshaped. Level of Evidence: 4

scholarly journals Treatment of sepsis secondary to blast injuries

2021 ◽  
pp. 31-40
Keyword(s):  
Intensive Care ◽  
Soft Tissue ◽  
Care Service ◽  
Young Patients ◽  
Infectious Agent ◽  
Blast Injuries ◽  
Soft Tissue Infections ◽  
Mortality And Morbidity ◽  
One Year

Blast injuries are an important cause of morbidity and mortality due to ongoing conflicts, especially among young patients. Due to the adversities of warfare, the first interventions for these patients are performed in unsuitable environments. Patients generally do not receive further treatment in their own country, but in other countries as wounded war refugees. Local and systemic infections in patients with associated polytrauma, soft tissue damage, and blast effects cause mortality and morbidity. All of the patients were injured during the Libyan civil war and the first intervention was performed in hospitals in their own country or in Tunisia. The patients were transferred to our clinic by ambulance plane. All patients presented bone-soft tissue infection and sepsis. Bone-soft tissue and blood cultures were obtained from the patients. The first interventions for the patients were performed multidisciplinarily in orthopedics, general surgery, infection, and intensive care clinics. The patients were followed in our clinic for one year including inten-sive care, service, and outpatient monitoring. Sixteen patients with a mean age of 28.8 years were included in the study. All patients were wounded by explosives or missiles. The patients were admitted to our clinic at a mean of approximately 24.4 days after these events. The patients were followed in the intensive care unit for an average of 7.9 days. The mean follow-up was 4 months. After the service follow-up, each patient continued outpatient follow-up for a total of 12 months. Antibiotics were given according to the causative infectious agent during the intensive care and service follow-up. Three patients had lung infections. Colistin-induced renal failure or hepatotoxicity developed due to resistant infections in 4 patients. After colistin was ceased, this situation resolved. Two of the 16 patients died. The sepsis and bone-soft tissue infections were controlled in all other patients. Four patients had femoral nonu-nion and one patient had short femoral healing. While 2 patients were able to walk without support and 11 patients could walk using support and one patient who was Quadriplegic was unable to walk. The treatment of bone-soft tissue infections accompanied by sepsis should be multidisciplinary. This should be kept in mind for patients with systemic injuries due to explosion effects. The infectious agents in these patients are often drug-resistant and there may be complications secondary to the antibiotics used during treatment.

The Effect of the Additional Use of Grommets in Silicone Implant Arthroplasty of the Metacarpophalangeal Joints

1999 ◽  
Vol 24 (5) ◽  
pp. 561-564 ◽  
Author(s):  
K. SCHMIDT ◽  
R. WILLBURGER ◽  
A. OSSOWSKI ◽  
R. K. MIEHLKE
Keyword(s):  
Rheumatoid Arthritis ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Metacarpophalangeal Joint ◽  
Joint Arthroplasty ◽  
Silicone Implant ◽  
Active Movement ◽  
Ulnar Deviation ◽  
Metacarpophalangeal Joints

After silicone arthroplasty of the metacarpophalangeal (MP) joint there is increasing osteolysis, subsidence and fracture of the implants in the longer postoperative term. In 44 patients with rheumatoid arthritis (54 hands) 151 arthroplasties of the metacarpophalangeal joint were assessed at a mean of 3.9 years postoperatively. In 57 arthroplasties titanium protectors (grommets) were used. There were no significant differences in the clinical outcomes with respect to swelling, correction of ulnar deviation, range of active movement and grip strength. The additional use of grommets in MP joint arthroplasty slightly reduced reactive osteolysis, protected the spacers from breakage and slightly reduced the amount of pain with only a few additional complications in the midterm follow-up.

Thumb Ulnar Collateral Ligament Repair with Suture Tape Augmentation

2020 ◽  
Vol 25 (01) ◽  
pp. 32-38 ◽  
Author(s):  
Steven J. Lee ◽  
Remy V. Rabinovich ◽  
Andrew Kim
Keyword(s):  
Postoperative Outcome ◽  
Ulnar Collateral Ligament ◽  
Pinch Strength ◽  
Collateral Ligament ◽  
Short Term ◽  
Joint Range Of Motion ◽  
One Year ◽  
Joint Range ◽  
Suture Tape

Background: The purpose of this study is to describe our technique of thumb ulnar collateral ligament (UCL) repair with suture tape augmentation and to evaluate the short-term outcomes in our initial series of patients treated with this method of repair. Methods: Patients with minimum one-year follow up after isolated UCL repair with suture tape augmentation were contacted for clinical evaluation, radiographs, and postoperative outcome questionnaires, including the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and study-specific questions. Thirteen of 15 (87%) consecutive patients who were treated using this method of repair were available for follow-up, 9 with acute tears and 4 with chronic tears. Results: Average post-operative thumb metacarpophalangeal (MCP) and interphalangeal (IP) joint range-of-motion (ROM) was 0–57.5° and 0–71°, respectively, for chronic tears and 2.2–53.9° and 0–71°, respectively, for acute tears. Average grip and pinch strength relative to the unaffected hand was 102% and 84%, respectively, among patients with chronic tears and 103.3% and 88.7%, respectively, among those with acute tears. All patients demonstrated stability with a firm endpoint, relative to the unaffected thumb. The average QuickDASH score among all patients was 11.9 for the disability/symptom module, 0 for the sport module and 16.5 for the work module. Stiffness was reported among 4 patients and no patient suffered wound-related issues or other complications. Conclusions: Thumb UCL repair with suture tape augmentation demonstrates short-term outcomes comparable to what has been reported for other methods of repair. It may potentially allow for an expedited recovery and rehabilitation process.

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