Radiosynovectomy for the treatment of rheumatoid arthritis of the elbow

2001 ◽  
Vol 40 (03) ◽  
pp. 91-97 ◽  
Author(s):  
S. Rozeboom ◽  
H. Bihl ◽  
U. Dörr
Keyword(s):  
Therapeutic Option ◽  
Impaired Mobility ◽  
Objective Parameter ◽  
Flexion Extension ◽  
Temporary Response ◽  
Effective Therapeutic Option ◽  
Articular Pain ◽  
Term Response

SummaryThe Aim of this retrospective study was to evaluate the efficiacy of radiosynovectomy (RSO) in patients with rheumatoid elbow arthritis. Patients and Methods: 40 joints of 31 patients were evaluated. At the time of therapy, patients had been suffering from elbow arthritis for 17.5 months (2-72 months). 95% of the joints (n = 38) had severe dally pain or continuous pain, 97.5% (n = 39) had moderate to severe limitation of the mobility and 10% (n = 4) had severe swelling. RSO was performed by intraarticular injection of 74 MBq colloidal rhenium-l 86 and 15 mg triamcinolonehex-acetonide. Before and six to 26 months after therapy (median follow-up 14.7 months) severity of the patients pain, mobility and swelling (transferred to a scoring system) were determined with a standardised questional. A clinical re-evaluation, along with an ar-throsonographical follow-up was performed in 28 joints. Results: A “good to very good” overall long-term response was achieved in 80% (n = 32) of the treated joints and a temporary response in 10% (n = 4). Only 10% (n = 4) had a non-satisfactory response due to advanced articular destruction. The range of motion for flexion-extension increased from 103.8 ± 20.0 degrees to 144.0 ±12.8 degrees (p <0.001). The respective scores for articular pain, impaired mobility and swelling decreased significantly (pain from 3.15 to 0.82, impaired mobility from 3.15 to 0.82, swelling from 2.40 to 0.65; p <0.00U. No deterioration or complication occurred. The effects lasted throughout the entire follow-up time for 36 joints (90%). Conclusion: For patients with rheumatoid involvement of the elbow joint, radiosynovectomy results in a significant decrease of articular pain and improvement of objective parameter, i.e. joint mobility. Thus, radiosynovectomy represents a feasible and effective therapeutic option for elbow arthritis.

Management of fresh odontoid fractures using posterior C1–2 fixation without fusion: a long-term clinical follow-up study

2021 ◽  
pp. 1-11
Keyword(s):  
Scale Score ◽  
Neck Disability Index ◽  
Implant Removal ◽  
Odontoid Fractures ◽  
Significant Difference ◽  
Flexion Extension ◽  
Group A ◽  
Group B

OBJECTIVE Posterior C1–2 fixation without fusion makes it possible to restore atlantoaxial motion after removing the implant, and it has been used as an alternative technique for odontoid fractures; however, the long-term efficacy of this technique remains uncertain. The purpose of the present study was to explore the long-term follow-up outcomes of patients with odontoid fractures who underwent posterior C1–2 fixation without fusion. METHODS A retrospective study was performed on 62 patients with type II/III fresh odontoid fractures who underwent posterior C1–2 fixation without fusion and were followed up for more than 5 years. The patients were divided into group A (23 patients with implant removal) and group B (39 patients without implant removal) based on whether they underwent a second surgery to remove the implant. The clinical outcomes were recorded and compared between the two groups. In group A, the range of motion (ROM) of C1–2 was calculated, and correlation analysis was performed to explore the factors that influence the ROM of C1–2. RESULTS A solid fracture fusion was found in all patients. At the final follow-up, no significant difference was found in visual analog scale score or American Spinal Injury Association Impairment Scale score between the two groups (p > 0.05), but patients in group A had a lower Neck Disability Index score and milder neck stiffness than did patients in group B (p < 0.05). In group A, 87.0% (20/23) of the patients had atlantoodontoid joint osteoarthritis at the final follow-up. In group A, the C1–2 ROM in rotation was 6.1° ± 4.5° at the final follow-up, whereas the C1–2 ROM in flexion-extension was 1.8° ± 1.2°. A negative correlation was found between the C1–2 ROM in rotation and the severity of tissue injury in the atlantoaxial region (r = –0.403, p = 0.024) and the degeneration of the atlantoodontoid joint (r = –0.586, p = 0.001). CONCLUSIONS Posterior C1–2 fixation without fusion can be used effectively for the management of fresh odontoid fractures. The removal of the implant can further improve the clinical efficacy, but satisfactory atlantoaxial motion cannot be maintained for a long time after implant removal. A surgeon should reconsider the contribution of posterior C1–2 fixation without fusion and secondary implant removal in preserving atlantoaxial mobility for patients with fresh odontoid fractures.

scholarly journals Successful long-term remission through tapering tocilizumab infusions: a single center prospective study

2019 ◽  
Author(s):  
Chayma Ladhari ◽  
Pierre Le Blay ◽  
Thierry Vincent ◽  
Ahmed Larbi ◽  
Emma Rubenstein ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Sustained Remission ◽  
Single Center ◽  
Open Label ◽  
Open Label Study ◽  
Treatment Interval ◽  
Secondary Failure ◽  
Term Maintenance

Abstract Background Strategic drug therapy for rheumatoid arthritis (RA) patients with prolonged remission is not well defined. According to recent guidelines, tapering biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) may be considered. We aimed to evaluate the long-term maintenance of tocilizumab (TCZ) treatment after the progressive tapering of infusions. Methods We conducted an exploratory, prospective, single-center, open label study, on RA patients with sustained remission for at least 3 months and treated with TCZ infusions every 4 weeks. The initial re-treatment interval was 6 weeks for the first 3 months. Thereafter, the spacing between infusions was determined by the clinician. Successful long-term maintenance following the tapering of TCZ infusions was defined by patients still treated after two years by TCZ with a minimum dosing interval of 5 weeks. Results Thirteen patients were enrolled in the study. Eight out of thirteen were still treated by TCZ after two years. Successful long-term maintenance was possible in six patients, with four patients maintaining a re-treatment interval of 8-weeks or more. We observed 5 patients with TCZ withdrawal: one for adverse drug reaction (neutropenia) and four with secondary failure. Patients achieving successful long-term maintenance with TCZ were significantly younger than those with secondary failure (p<0.05). In addition, RA patients with positive rheumatoid factor and anti-citrullinated peptide antibodies, experienced a significantly greater number of flares during our 2-year follow-up (p<0.01). Conclusions A progressive tapering of TCZ infusions seems possible in most of the patients. However, larger studies, including more patients, are needed to confirm this therapeutic option.

scholarly journals The long-term outcomes of radiosurgery for arteriovenous malformations in pediatric and adolescent populations

2015 ◽  
Vol 16 (2) ◽  
pp. 222-231 ◽  
Author(s):  
Shunya Hanakita ◽  
Tomoyuki Koga ◽  
Masahiro Shin ◽  
Hiroshi Igaki ◽  
Nobuhito Saito
Keyword(s):  
Adverse Events ◽  
Arteriovenous Malformations ◽  
Therapeutic Option ◽  
Long Term Outcomes ◽  
Bleeding Rate ◽  
Study Institute ◽  
Delayed Complications ◽  
Risk Of Hemorrhage

OBJECT Although stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for arteriovenous malformations (AVMs) in children and adolescents, substantial data are still lacking regarding the outcomes of SRS for AVMs in this age group, especially long-term complications. This study aimed to clarify the long-term outcomes of SRS for the treatment of AVM in pediatric patients aged ≤ 18 years. METHODS Outcomes of 116 patients who were aged 4–18 years when they underwent SRS between 1990 and 2009 at the study institute were analyzed retrospectively. RESULTS The median follow-up period after SRS was 100 months, with 6 patients followed up for more than 20 years. Actuarial obliteration rates at 3 and 5 years after SRS were 68% and 88%, respectively. Five hemorrhages occurred in 851 patient-years of follow-up. The annual bleeding rate after SRS before obliteration was calculated as 1.3%, which decreased to 0.2% after obliteration. Shorter maximum nidus diameter (p = 0.02) and higher margin dose (p = 0.03) were associated with a higher obliteration rate. Ten patients experienced adverse events after SRS. Of them, 4 patients presented with delayed complications years after SRS (range 9–20 years after SRS). CONCLUSIONS SRS can reduce the risk of hemorrhage in pediatric and adolescent AVMs, with an acceptable risk of complications in the long term. However, adverse events such as expanding hematoma and radiation necrosis that can occur after substantial follow-up should be taken into account at the time that treatment decisions are made and informed consent is obtained.

Topical Tacrolimus in the Treatment of Erosive Pustular Dermatosis of the Scalp

2007 ◽  
Vol 11 (6) ◽  
pp. 222-225 ◽  
Author(s):  
Marta J. Cenkowski ◽  
Shane Silver
Keyword(s):  
Light Exposure ◽  
Therapeutic Option ◽  
Rare Condition ◽  
Initial Therapy ◽  
Topical Steroids ◽  
Topical Tacrolimus ◽  
History Of ◽  
Prevention Of Relapse

Background: Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by chronic, sterile, pustular erosions leading to scarring alopecia. Although the etiology is unknown, it appears to be associated with ultraviolet light exposure and trauma. Histologic findings include nonspecific atrophy of the epidermis and chronic inflammation. Case History: A 71-year-old female presented with a 1-year history of a boggy, erythematous, friable plaque on the vertex of her scalp. A diagnosis of EPDS was made based on presentation, negative cultures, and histologic findings. Initial therapy with intralesional and topical steroids and oral antibiotics resolved the inflamed plaques; however, steroid-induced atrophy became prominent after 5 months of use. The treatment was discontinued, resulting in recurrence of disease. Topical tacrolimus 0.1% ointment was initiated, which has been successfully controlling the lesions with reversal of skin atrophy and clinical evidence of hair growth. Conclusion: This is the fourth reported case of the successful treatment of EPDS with topical tacrolimus for the resolution of atrophy and the prevention of relapse of inflammation. Although its long-term use warrants close follow-up for side effects, tacrolimus may constitute a novel therapeutic option for the treatment of EPDS.

Long-Term Remission (>3 years) after Rituximab Monotherapy Used for Patients with Relapsed Indolent Non-Hodgkin Lymphomas (NHL)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1709-1709
Author(s):  
Anne-Sophie Michallet ◽  
Florence Beckerich ◽  
Fadhela Bouafia-Sauvy ◽  
Daniel Espinouse ◽  
Gilles Salles ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Complete Response ◽  
Bulky Disease ◽  
Entire Cohort ◽  
The Subject ◽  
Disseminated Disease ◽  
Question Today ◽  
Term Response

Abstract Background: Rituximab has demonstrated significant clinical efficacy in the treatment of NHL, particularly in combination with chemotherapy, and its use has dramatically changed the treatment and outcome of both indolent and aggressive B-cell NHL over the past decade. Furthermore, consistent toxicity data have been obtained with a safe and tolerable profile in a large majority of patients. Aim: The objective of this retrospective study is to evaluate the long-term efficacy of rituximab monotherapy (4 weekly infusion at induction followed by 4 infusion every 2 months as consolidation) used for patients with relapsed indolent NHL. Results: From May 1998 through January 2011, Among 919 patients with indolent NHL treated in our department, 488 (53%) relapsed and were treated with rituximab alone (first and later relapse). 126 (26%) responded and were still in response 2 years later. These 126 patients (68 (54%) males and 58 (46%) females with a median age of 61 y; range: 17-94) are the subject of our analysis. 24% were over 70 years old, 45% were in first relapsed and 25% in later relapsed. Only 16% of the population have more than one co-morbidities (cardiac and or renal respectively); 79% a normal PS (0-1) with only 4 patients having a PS >2; 80% no bulky disease but 72% a disseminated disease (73% stage III and IV). In this study, 60 (48%) patients had a follicular lymphoma with 50% at an intermediate risk group according to the FLIPI score ; 20 (16%) a marginal zone lymphoma, and 43 (34%) a small lymphocytic or lymphoplasmacytic lymphoma and 3 patients other characteristics of lymphoproliferative disorders. After rituximab monotherapy, 55% of the entire cohort was in complete response (CR) and 31% in CRu or partial response and 5% in stable disease. Among these 126 patients, 74% progressed later than 3 years (38% later than 5 years). With a median follow-up of 6.5 years, 4-year and 8-year PFS were 70% and 30%, respectively. 18% had transformation into Richter syndrome and 12 patients have died. Conclusion: Rituximab monotherapy is an effective therapy in selected relapsed indolent NHL and allows long-term response. This strategy could be used as “spare of chemotherapy” which is an important question today, especially in indolent not curable disease. Disclosures No relevant conflicts of interest to declare.

scholarly journals Arthroscopic Meniscus Repair: Clinical and Isokinetic Results

1998 ◽  
Vol 4 (3) ◽  
pp. 119-125 ◽  
Author(s):  
Christoph Erggelet ◽  
Carmen Grosse ◽  
Hans-Rudolph Henche ◽  
Bart De Koning
Keyword(s):  
Meniscus Repair ◽  
Lysholm Score ◽  
Long Term Effects ◽  
Isokinetic Testing ◽  
Experienced Surgeon ◽  
Time Period ◽  
Flexion Extension ◽  
Choice Of Therapy

The importance of the menisci for transmitting workloads in the knee joint to protect the articular cartilage is widely acknowledged. Therefore various techniques have been introduced to repair the damaged meniscus.We performed an arthroscopic meniscus repair with a modified outside-in technique on 29 patients (average 25 years) between 2/91 and 10/94. The average time between trauma and operation was 29 weeks (1–186) – the follow-up 16.3 months (4–49). All the patients were interviewed by phone – 23 were available for clinical respectively isokinetic examination, and categorized following the Lysholm and Lais scores.Twenty-eight patients were happy with the result of the procedure. Following the Lysholm score we found 78% good/excellent results (Lais score 74%). Isokinetic testing showed a muscular deficit of less than 20% in 91% of the cases for flexion (extension 69%). No significant influence neither of the age of the patient nor the time period between trauma and operation on the outcome of the procedure could be found. No complications were reported.Based on our results and well aware of the deleterious long term effects of total meniscectomy the arthroscopic menical repair performed by an experienced surgeon should be generous choice of therapy for the treatment of the ruptured meniscus.

scholarly journals Fludarabine and rituximab for relapsed or refractory hairy cell leukemia

Blood ◽  
2012 ◽  
Vol 119 (9) ◽  
pp. 1988-1991 ◽  
Author(s):  
Alina S. Gerrie ◽  
Leslie N. Zypchen ◽  
Joseph M. Connors
Keyword(s):  
Hairy Cell Leukemia ◽  
Therapeutic Option ◽  
Hairy Cell ◽  
Cell Leukemia ◽  
First Line ◽  
Response Data ◽  
Purine Analog ◽  
Duration Of Response ◽  
Effective Therapeutic Option

Abstract The purine analogs, pentostatin and cladribine, induce high remission rates when used as first-line monotherapy for hairy cell leukemia (HCL); however, patients continue to relapse. Re-treatment with the same or alternate purine analog produces lower response rates and a shorter duration of response. Fludarabine is another purine analog widely used in indolent lymphoid cancers, often in combination with rituximab, but there are few reports of its use in HCL. We identified 15 patients treated in British Columbia with fludarabine and rituximab (FR) from 2004 to 2010 for relapsed/refractory HCL after first-line cladribine (n = 3) or after multiple lines of therapy (n = 12). All patients with available response data responded to FR. With median follow-up of 35 months, 14 patients remain progression-free, whereas 1 patient has developed progressive leukemia and died. Five-year progression-free and overall survivals are 89% and 83%, respectively. FR is a safe and effective therapeutic option for relapsed/refractory HCL.

scholarly journals Case 1 – Long-term response to bevacizumab and paclitaxel as second-line therapy in metastatic vaginal carcinoma

2016 ◽  
Vol 4 (1) ◽  
pp. 36-40
Author(s):  
Sebastian Schroecksnadel ◽  
Jasmina Suljkanovic ◽  
Christian Marth ◽  
Antonio González-Martín ◽  
Domenica Lorusso
Keyword(s):  
Pulmonary Metastases ◽  
Complete Response ◽  
Second Line Therapy ◽  
Disease Response ◽  
Vaginal Carcinoma ◽  
Initial Surgery ◽  
Term Response

The role of chemotherapy in the treatment of vaginal carcinoma has not been well studied and is controversial. This case report describes a 59-year-old patient diagnosed with vaginal squamous cell carcinoma in May 2008. Initial surgery was performed with subsequent radiation therapy; 3 months later histologically-confirmed pulmonary metastases were detected. Chemotherapy with cisplatin and topotecan was administered and resulted in a mixed-disease response. Therefore, chemotherapy was switched to weekly paclitaxel and bevacizumab, which induced a complete response. After more than 70 months of follow-up there has been no sign of recurrence and the patient shows no evidence of disease. This patient had an exceptional response to the combination of bevacizumab and paclitaxel, and this combination warrants further investigation for its potential in vaginal carcinoma.

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