scholarly journals Esophageal metal stent for malignant obstruction after prior radiotherapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiroyoshi Iwagami ◽  
Ryu Ishihara ◽  
Sachiko Yamamoto ◽  
Noriko Matsuura ◽  
Ayaka Shoji ◽  
...  
Keyword(s):  
Stent Placement ◽  
Radial Force ◽  
Exclusion Criteria ◽  
Exact Test ◽  
Stent Type ◽  
Group 2 ◽  
And Migration ◽  
Esophageal Stenting ◽  
Median Interval

AbstractThe association between severe adverse events (SAEs) and prior radiotherapy or stent type remains controversial. Patients with esophageal or esophagogastric junctional cancer who underwent stent placement (2005–2019) were enrolled in this retrospective study conducted at a tertiary cancer institute in Japan. The exclusion criteria were follow-up period of < 1 month and insufficient data on stent type or cancer characteristics. We used Mann–Whitney’s U test for quantitative data and Fisher’s exact test for categorical data. Multivariate analysis was performed using a logistic regression model. 107 stents were placed. Low radial-force stents (L group) were used in 51 procedures and high radial-force stents (H group) in 56 procedures. SAEs developed after nine procedures, the median interval from stent placement being 6 days (range, 1–141 days). SAEs occurred more frequently in the H (14%: 8/56) than in the L group (2%: 1/51) (P = 0.03). In patients who had undergone prior radiotherapy, SAEs were more frequent in the H (36%: 4/11) than in the L group (0%: 0/13) (P = 0.03). Re-obstruction and migration occurred after 16 and three procedures, respectively; these rates did not differ significantly between groups (P = 0.59, P = 1, respectively). Low radial-force stents may reduce the risk of SAEs after esophageal stenting.

scholarly journals Decrease in Driveline Infections with Change in Driveline Management Protocol

2016 ◽  
Author(s):  
Saima Aslam ◽  
Jennifer Dan ◽  
Amanda Topik ◽  
Michael Belyk ◽  
Francesca Torriani ◽  
...  
Keyword(s):  
Rank Test ◽  
Ventricular Assist ◽  
Exact Test ◽  
Management Protocol ◽  
Group 2 ◽  
Student’S T ◽  
Optimal Approach ◽  
Dressing Change ◽  
Group 1

Background   Driveline infections (DLI) are a significant cause of morbidity and mortality in ventricular assist device (VAD) recipients. We compared driveline infection (DLI) rate after an institutional change in driveline management protocol.    Methods   We retrospectively reviewed records of left VAD recipients at our institution, based on driveline management. Group 1: daily driveline dressing change consisting of chlorhexidine cleansing, sterile 4x4 gauze, and use of an abdominal binder. Group 2: Dressing change every 3 days consisting of chlorhexidine cleansing, non-sterile silver-impregnated foam with overlying clear dressing, and use of a driveline anchor. Follow-up was censored at first DLI, device removal, transplant or death. Additionally, Group 1 patients’ follow-up was censored when the change in protocol occurred. Statistical analysis: Student’s t-test, Fisher’s exact test, Kaplan-Meier curve and log-rank test. Results DLI occurred in 16% of 88 VAD recipients (Group 1 n=24, Group 2 n=64). The new driveline management protocol resulted in significantly fewer DLI in Group 2 (6.3% vs. 41.7%, p<0.0001). Conclusions An updated driveline management protocol demonstrated significant reduction in DLI at our institution. Studies evaluating the optimal approach for driveline management are needed in order to develop a standardized regimen aimed at lowering the risk of DLI.  

Changes of JAK2 V617F Allele Burden Over Time in Patients with Polycythemia Vera or Essential Thrombocythemia: A Retrospective Study of 172 Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1892-1892
Author(s):  
Elisabetta Antonioli ◽  
Alessandra Carobbio ◽  
Lisa Pieri ◽  
Alessandro Pancrazzi ◽  
Paola Guglielmelli ◽  
...  
Keyword(s):  
Jak2 V617f ◽  
Repeated Measure ◽  
Interval Time ◽  
Allele Burden ◽  
Group 3 ◽  
Group 2 ◽  
Over Time ◽  
Group 1 ◽  
Median Interval

Abstract Abstract 1892 Poster Board I-915 There are conflicting results about quantitative modifications of V617F allele burden in patients (pts) with myeloproliferative neoplasms (MPN) who are either therapy-naive or are treated with hydroxyurea (HU). In a retrospective single center study in 48 pts with polycythemia vera (PV) or essential thrombocythemia (ET) the granulocyte JAK2V617F allele burden remained stable over time (median follow-up was 34 months for PV and 23 for ET) irrespective of the pts being treated or not with cytotoxic therapy (Theocharides A et al, Haematologica 2008). Conversely, another study in 25 patients reported a significant reduction of V617F allele burden (>30% of baseline level) after HU therapy in 52% of the pts, becoming indetectable in 3 of them (Girodon F et al, Haematologica 2008). The aim of this study was to evaluate any modifications of JAK2V617F allele burden during long-term follow-up in patients with PV or ET and the effects of HU treatment. This two-center (Firenze and Bergamo) retrospective study concerned 172 patients with a diagnosis of PV or ET according to the WHO criteria. The only study inclusion criteria were the presence of JAK2V617F mutation and the availability of at least two sequential blood samples drawn at an interval time of at least 6 months. The JAK2-V617F allele load was measured by sensitive quantitative RT-PCR in granulocyte DNA according to the method of Lippert et al (Blood 2006). Differences between median values of JAK2 V617F allele burden were tested by the Wilcoxon matched-pairs signed-ranks test. Repeated measure test for JAK2 V617F mean change over time, irrespective of diagnosis, was also calculated to investigate a significant variance among ordered time measures. There were 103 pts with PV and 69 with ET; median age was 56 yr (range, 15–84), females were 49%. The median interval time between the baseline and follow-up sample in the whole pt population was 27 months (range 6–60), 26 and 28 months for ET and PV, respectively. The median patient follow-up was 3 years (range 0.5–25); no evolution to myelofibrosis or acute leukemia was recorded. According to previous reports, the mean V617F burden was significantly greater in PV than in ET pts (50 ± 26% and 32 ± 18%, respectively; p <0.0001). Sixty-nine pts (41 PV, 28 ET) remained untreated during follow-up (Group 1), whereas 103 received HU; of the latter, 60 pts were already on treatment at the time of first genotyping (Group 2) whereas 43 patients were chemotherapy-naive and started HU after the first blood sampling (Group 3). In Group 1 pts, the median interval between 1st and 2nd sample was 26 months (range 6–60)for PV pts and 24 mo (range 6–59) for ET pts. The JAK2 V617F allele burden was 47.7±22.3% and 48.3±18.9% in the 1st and 2nd sample in PV pts, respectively, and 25.2±13.1% and 28.6±13.5% in case of ET pts, without any significant difference. In pts included in Group 2, the median interval between 1st and 2nd sample was 28 months (range 6–54) for PV pts and 28 mo (range 6–60) for ET pts. The JAK2 V617F allele burden was 55.1±29.2% and 60.3±25.6% in the 1st and 2nd sample in PV pts, respectively, and 36.3±21.7% and 40.7±22.9% in case of ET pts (P=.039). Considering PV and ET pts together, there was a statistically significant increase of V617F allele burden over time from 47.9±28.0% in the 1st sample to 52.8±26.3% in the 2nd (P= .023, repeated measure test). Among pts of Group 3, the median interval time between 1st and 2nd sample was 32 months (range 10–48) for PV pts and 24 mo (range 7–58) for ET pts. The JAK2 V617F allele burden was 47.0±26.2% and 45.5±20.8% in the 1st and 2nd sample in PV pts, respectively, and 37.3±16.2% and 33.3±15.0% in case of ET pts (P= .024). In conclusion, within the observation period of this study we found no evidence for a time-dependent increase of V617F allele burden in untreated PV and ET pts, although we cannot exclude that these results might be related to the relatively short follow-up. Accordingly, in a previous study in ET pts we found that the mutant allele burden increased significantly after 10 years from diagnosis (Carobbio A et al., Exp Hematol, 2009). Furthermore, we observed a very modest reduction of V617F allele burden in HU newly treated ET patients, while in previously treated PV and ET patients the allele burden actually increased over time, suggesting that HU has very little if any likelihood to impact on the size of mutant hematopoietic cell clone. Disclosures: No relevant conflicts of interest to declare.

Seven-Year Follow up of An Inception Cohort Study of Patients with Atrial Fibrillation Starting Oral Anticoagulation: Aging as An Independent Bleeding Risk

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4045-4045
Author(s):  
Patricia Casais
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cohort Study ◽  
Independent Risk Factor ◽  
Inception Cohort ◽  
Exclusion Criteria ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Introduction: Our objectives were to investigate if aging is an independent risk factor for major bleeding during oral anticoagulant treatment (OAT) for atrial fibrillation (AF). Patients and Methods: An inception cohort study was designed to include patients (pts) referred to our Department to initiate OAT due to AF from July 2000 to July 2007. Inclusion criteria: no prior OAT, AF being the only reason to OAT, follow-up at our Institution, and signed informed consent. Exclusion criteria: concomitant reason for OAT, and pts refusal to participate. Pts were followed until OAT was stopped by the patient’s cardiologist or until July 2007. Patients who underwent a successful electric cardioversion and were followed up only for 4 weeks were not included unless they presented a bleeding episode. Epidemiological and clinical data were documented for all patients. Major bleeding episodes, age, time on OAT, and INR at the bleeding event were recorded. Deaths were registered and classified as “related” or “not related” to OAT. For the analysis, the inception cohort was divided into three groups according to the age of beginning and ending of OAT. Group 1 included patients younger than 77 at the end of OAT. Group 2 was constituted by the patients that initiated therapy before 80 and were followed after that age. Patients starting after 80 years of age were the group 3. Time in therapeutic range and INR variability were calculated. Incidence rate and relative risk (RR) of major hemorrhage (MH) was estimated. Results: During the study period, 2.971 patients were referred for initiation of OAT, 40% (1.172) had AF, and 671 met the exclusion criteria (138 patients had a prior OAT, 111 were not going to go on control OAT at the Institution, and 422 had a concomitant reason for OAT (mitral estenosis, heart valve prostheses, venous thrombosis, coronary artery by-pass, etc.) Five-hundred and one patients were included in the study, 68 (13.5%) were lost for follow-up after inclusion or had less than 4 weeks after initiation, and 433 had complete follow-up. Patients’ characteristics and MH are shown in Table 1. Time within therapeutic range was similar in all age-groups (65.0%, 62.8%, and 65.4% for group 1, 2 and 3, respectively). There were 28 MH in 23 pts during the study period. In group 3, the rate of MH was 3.39/100 patient-years while in group 1 it was 0.85/100 patient-years. The RR was 3.0 (1.2–7.6 95%CI) in group 3 compared to group 1(p= 0.02). Among patients in group 2, the RR of bleeding increased to 5.8 (2.27–14.95) after the age of 80. The likelihood ratio of MH with increasing age was 14.1 (p= 0.001). INR variability tended to be higher in Group 3 and in bleeding patients regardless their age. Aspirin, number of concomitant medications and CHADS2 score were not associated with the risk of MH. There were 10 deaths, all in pts older than 80. In 9/10 the cause of death was documented and was unrelated to OAT. One patient died after a non-characterized stroke, it was considered hemorrhagic. Rate of death related to bleeding after age of 80 (groups 2 and 3) was 0.54%. Conclusions: This long-term follow up cohort study shows that aging is an independent risk factor for MH; this observation might have clinical implications for the management of elderly pts. Table 1: Patients’ characteristics Group 1 Group 2 Group 3 N 249 55 129 * 8/9 events after the age of 80. Sex Female (%)&#x2028; Male (%) 55 (49.5)&#x2028; 56 (50.0) 29 (54)&#x2028; 25 (46) 69 (55)&#x2028; 57 (45) Age at beginning OAT mean± SD 63.9±8.4 74.9 ± 2.0 82.8 ± 2.7 Age at ending OAT mean± SD 68.7±7.9 81.3 ± 1.4 85.7 ± 3.1 Follow-up (years) mean± SD 5.2±0.2 4.5 ±0.3 2.5 ± 0.1 Prior ischemic stroke N (%) 15 (13.5) 9 (17) 28 (22) Deaths N (%) 0 1 (2) 9 (7%) Major hemorrhages Events (pts) 8 (7) 9 (8)* 11 (8) Mean age (years) 68.4 ± 2.6 79.7 ± 0.5 83.0 ± 0.8 Mean Time on OAT (weeks± SE) 32.1±8 142.2 ± 28.6 77.8 ± 22.5 Mean INR ±SE at 3.9 ± 0.7 3.5 ± 1.0 3.6 ± 0.5 1st event (range) (2.6–8.2) (2.0–10.8) (1.6–6.0)

Abstract P479: Stability of Ambulatory Blood Pressure Patterns Over Time in Children and Adolescents

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Coral D Hanevold ◽  
Yosuke Miyashita ◽  
Joseph T Flynn
Keyword(s):  
Blood Pressure ◽  
Children And Adolescents ◽  
Ambulatory Blood Pressure ◽  
Exclusion Criteria ◽  
The Difference ◽  
The Stability ◽  
Blood Pressure Patterns ◽  
Over Time ◽  
Median Interval

Little is known about the stability of ambulatory blood pressure (ABP) patterns in children and adolescents undergoing evaluation for high blood pressure (HBP). It is possible that children with initially normal ABP may progress to hypertension (HT) or pre-hypertension (PHT), or that those with initial PHT or HT may be normal on repeat. Our objective was to assess stability of ABP patterns over time in children with HBP. We analyzed changes in ABP classification in patients undergoing a minimum of 2 ABP monitoring (ABPM) studies at least 0.5 years (yrs) apart. Exclusion criteria included known secondary HT, therapy with antihypertensive medication and inadequate recordings. ABPM were interpreted according to the 2014 AHA guidelines using BP thresholds of 95 th % for sex and height for children ≤17 yrs. For those > 18 yrs awake and sleep thresholds were 140/85 and 120/70, respectively. Dipping was considered normal if > 10%, blunted if <10% and reversed if < 0%. For those with > 2 ABPM the difference between the 1 st and last were analyzed. Two hundred ABPM on 100 patients (76 males; median age 14.6 yrs at 1st ABPM) were analyzed. Median interval between ABPM was 1.5 yrs. ABP classification was stable in 53% (53/100). As shown in the table 50% (9/18) of those with normal ABPM showed progression to PHT or HT on follow up. PreHT progressed in 31% (8/26) and improved in 38% (10/26). HT improved in 43% (20/46). Dipping designation was stable in 70% (70/100); but blunted dipping normalized in 48% (10/21). In our population ABP patterns were not stable over time, supporting the need for follow up studies even with normal initial ABPM. If confirmed in larger studies, these findings support greater use of repeat ABPM.

scholarly journals How much progress have we made?: a 20-year experience regarding esophageal stents for the palliation of malignant dysphagia

2021 ◽  
Author(s):  
Shria Kumar ◽  
Firas Bahdi ◽  
Ikenna K Emelogu ◽  
Abraham C Yu ◽  
Martin Coronel ◽  
...  
Keyword(s):  
Stent Placement ◽  
Tertiary Care ◽  
Esophageal Stent ◽  
Plastic Stents ◽  
Complication Rates ◽  
Esophageal Obstruction ◽  
Esophageal Stents ◽  
Malignant Dysphagia ◽  
And Migration

Summary Esophageal stents are widely used for the palliation of malignant esophageal obstruction. Advances in technology have made esophageal stenting technically feasible and widespread for such obstruction, but complications remain frequent. We present outcomes of a large cohort undergoing esophageal stent placement for malignant esophageal obstruction at a tertiary care cancer center. Patients who underwent placement of esophageal stents for malignancy-related esophageal obstruction between 1 January 2001 and 31 July 2020 were identified. Exclusion criteria included stents placed for benign stricture, fistulae, obstruction of proximal esophagus (proximal to 24 cm from incisors), or post-surgical indications. Patient charts were reviewed for demographics, procedure and stent characteristics, complications, and follow-up. A total of 242 patients underwent stent placement (median age: 64 years, 79.8% male). The majority, 204 (84.3%), had esophageal cancer. During the last two decades, there has been an increasing trend in the number of esophageal stents placed. Though plastic stents were previously used, these are no longer utilized. Complications are frequent and include early complications of pain in 68 (28.1%) and migration in 21 (8.7%) and delayed complications of recurrent symptoms of dysphagia in 46 (19.0%) and migration in 26 (10.7%). Over the study period, there has not been a significant improvement in the rate of complications. During follow-up, 92 (38%) patients required other enteral nutrition modalities after esophageal stent placement. No patient, treatment, or stent characteristics were significantly associated with stent complication or outcome. Esophageal stent placement is an increasingly popular method for palliation of malignant dysphagia. However, complications, particularly pain, migration, and recurrent symptoms of dysphagia are common. Almost 40% of patients may also require other methods of enteral access after esophageal stent placement. Given the high complication rates and suboptimal outcomes, removable stents should be considered as first-line in the case of poor palliative response.

Utility of MR Cholangiography for Follow-up Examination after Metallic Stent Placement in the Bile Duct

2002 ◽  
Vol 47 (3) ◽  
pp. 279
Author(s):  
Chul Hi Park ◽  
Dal Mo Yang ◽  
Hak Soo Kim ◽  
Seung Whi Cho ◽  
Hyung Sik Kim ◽  
...  
Keyword(s):  
Bile Duct ◽  
Stent Placement ◽  
Metallic Stent ◽  
Mr Cholangiography ◽  
Metallic Stent Placement

Intraocular tuberculosis, a challenge in diagnosis and treatment

2020 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Martina Larroude ◽  
Gustavo Ariel Budmann
Keyword(s):  
Developing Countries ◽  
Clinical Signs ◽  
Steady Increase ◽  
Ocular Tuberculosis ◽  
Industrial Countries ◽  
Choroidal Granuloma ◽  
History Of ◽  
And Migration ◽  
Ocular Tb

Ocular tuberculosis (TB) is an extrapulmonary tuberculous condition and has variable manifestations. The incidence of TB is still high in developing countries, and a steady increase in new cases has been observed in industrial countries as a result of the growing number of immunodeficient patients and migration from developing countries. Choroidal granuloma is a rare and atypical location of TB. We present a case of a presumptive choroidal granuloma. This case exposes that diagnosis can be remarkably challenging when there is no history of pulmonary TB. The recognition of clinical signs of ocular TB is extremely important since it provides a clinical pathway toward tailored investigations and decision making for initiating anti-TB therapy and to ensure a close follow-up to detect the development of any complication.

Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  
Keyword(s):  
Heart Rate ◽  
Closed Loop ◽  
Funding Source ◽  
Chronotropic Incompetence ◽  
First Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

447 Cost-Effectiveness of a 3-Year Tele-OSA Intervention

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A177-A177
Author(s):  
Jaejin An ◽  
Dennis Hwang ◽  
Jiaxiao Shi ◽  
Amy Sawyer ◽  
Aiyu Chen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Incremental Cost ◽  
Economic Benefits ◽  
Small Sample ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Group 2 ◽  
The Cost

Abstract Introduction Trial-based tele-obstructive sleep apnea (OSA) cost-effectiveness analyses have often been inconclusive due to small sample sizes and short follow-up. In this study, we report the cost-effectiveness of Tele-OSA using a larger sample from a 3-month trial that was augmented with 2.75 additional years of epidemiologic follow-up. Methods The Tele-OSA study was a 3-month randomized trial conducted in Kaiser Permanente Southern California that demonstrated improved adherence in patients receiving automated feedback messaging regarding their positive airway pressure (PAP) use when compared to usual care. At the end of the 3 months, participants in the intervention group pseudo-randomly either stopped or continued receiving messaging. This analysis included those participants who had moderate-severe OSA (Apnea Hypopnea Index &gt;=15) and compared the cost-effectiveness of 3 groups: 1) no messaging, 2) messaging for 3 months only, and 3) messaging for 3 years. Costs were derived by multiplying medical service use from electronic medical records times costs from Federal fee schedules. Effects were average nightly hours of PAP use. We report the incremental cost per incremental hour of PAP use as well as the fraction acceptable. Results We included 256 patients with moderate-severe OSA (Group 1, n=132; Group 2, n=79; Group 3, n=45). Group 2, which received the intervention for 3 months only, had the highest costs and fewest hours of use and was dominated by the other two groups. Average 1-year costs for groups 1 and 3 were $6035 (SE, $477) and $6154 (SE, $575), respectively; average nightly hours of PAP use were 3.07 (SE, 0.23) and 4.09 (SE, 0.42). Compared to no messaging, messaging for 3 years had an incremental cost ($119, p=0.86) per incremental hour of use (1.02, p=0.03) of $117. For a willingness-to-pay (WTP) of $500 per year ($1.37/night), 3-year messaging has a 70% chance of being acceptable. Conclusion Long-term Tele-OSA messaging was more effective than no messaging for PAP use outcomes but also highly likely cost-effective with an acceptable willingness-to-pay threshold. Epidemiologic evidence suggests that this greater use will yield both clinical and additional economic benefits. Support (if any) Tele-OSA study was supported by the AASM Foundation SRA Grant #: 104-SR-13

scholarly journals Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Michael Ryan ◽  
Benton Emblom ◽  
E. Lyle Cain ◽  
Jeffrey Dugas ◽  
Marcus Rothermich
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Osteochondritis Dissecans ◽  
Surgical Techniques ◽  
The Other ◽  
Return To Play ◽  
Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

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