Long-Term Subjective and Functional Evaluation After Thumb Replantation With Special Attention to the Quick DASH Questionnaire and a Specially Designed Trauma Score Called Modified Mayo Score

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

Download Full-text

DOP59 Maintenance of remission with tofacitinib in patients with ulcerative colitis: Updated results of a subpopulation analysis from an open-label, long-term extension study, OCTAVE Open

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.098 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S098-S099

Author(s):

J F Colombel ◽

M T Osterman ◽

P Ibanez ◽

A J Thorpe ◽

H Zhang ◽

...

Keyword(s):

Ulcerative Colitis ◽

Opportunistic Infections ◽

Safety Data ◽

Similar Efficacy ◽

Major Adverse Cardiovascular Events ◽

Open Label ◽

Phase 3 ◽

Vein Thrombosis ◽

Mayo Score

Abstract Background Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Efficacy and safety were demonstrated in 3 Phase 3, randomised, placebo-controlled studies in patients with moderate to severe UC.1 An ongoing, Phase 3, open-label, long-term extension (OLE) study (OCTAVE Open, NCT01470612) included patients from OCTAVE Induction 1 and 2 and OCTAVE Sustain. Methods We present data (as of May 2019) from the ‘maintenance remission’ subpopulation in the OLE study who were in remission (total Mayo score ≤2, no individual subscore >1, rectal bleeding subscore of 0) at Week 52 of OCTAVE Sustain (having received tofacitinib 5 or 10 mg twice daily [BID]). These patients received tofacitinib 5 mg BID as per protocol in the OLE study. Efficacy data up to Month 36 of the OLE study (as observed and with non-responder and last observation carried forward imputation [NRI-LOCF]) are presented for this subpopulation. Safety data are reported for all patients who received tofacitinib 5 mg BID in the OLE study. Results Of 944 patients receiving ≥1 dose of tofacitinib in the OLE study, 163 were in remission at Week 52 of OCTAVE Sustain (mean age 45 years; 46.0% female). Of these, 66 (40.5%) and 76 (46.6%) received tofacitinib 5 and 10 mg BID, respectively, in OCTAVE Sustain, and 21 (12.9%) received a placebo. In total, 67/163 (41.1%) patients discontinued the OLE study, 16 (9.8%) due to adverse events (AEs) excl. worsening UC and 15 (9.2%) due to insufficient clinical response. Among patients that continued, efficacy (Table) was maintained over 36 months and was similar irrespective of the dose received in OCTAVE Sustain. Of 175 patients who received tofacitinib 5 mg BID (incl. 163 from the maintenance remission subpopulation), 152 (86.9%), 33 (18.9%) and 20 (11.4%) had AEs, serious AEs and severe AEs, respectively. The most frequent treatment-emergent AEs (TEAEs) were worsening UC (41 patients, 23.4%) and nasopharyngitis (38 patients, 21.7%). Six (3.4%) patients receiving tofacitinib 5 mg BID had serious infections, 11 (6.3%) had herpes zoster (non-serious and serious), 4 (2.3%) had opportunistic infections, 2 (1.1%) had major adverse cardiovascular events and 5 (2.9%) had malignancy (excl. non-melanoma skin cancer). No deep vein thrombosis, pulmonary embolism or deaths were reported in patients receiving tofacitinib 5 mg BID. Conclusion Most patients in remission at Week 52 of OCTAVE Sustain maintained efficacy with tofacitinib 5 mg BID over 36 months in the OLE study. Similar efficacy was observed for patients whose dose was reduced from tofacitinib 10 mg BID in OCTAVE Sustain to 5 mg BID in the OLE study, vs. those who received 5 mg BID throughout both OCTAVE Sustain and the OLE study. No new safety risks were identified. Reference

Download Full-text

P467 Can induction and maintenance serum vedolizumab levels predict long-term clinical outcome in inflammatory bowel disease (IBD)?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.596 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S413-S414 ◽

Cited By ~ 1

Author(s):

C Miller ◽

H Morgan ◽

A Steel ◽

M Wahed

Keyword(s):

Clinical Outcome ◽

Clinical Remission ◽

Statistical Significance ◽

Therapeutic Drug ◽

Fisher Exact Test ◽

Positive Outcomes ◽

Mayo Score ◽

Serum Trough

Abstract Background Vedolizumab (VDZ) is an established IBD therapy, however, the role of therapeutic drug levels (TDM) is not fully established.1 Our aim was to assess whether week 6 and maintenance serum trough VDZ levels predict the clinical outcome at week 52. Methods A retrospective review of patients with Crohn’s disease (CD) or ulcerative colitis (UC) on VDZ was performed. Twenty-one IBD patients with serum VDZ trough level monitoring between January 2016 and December 2017 were identified. All patients received VDZ induction and maintenance as per standard protocol. Patients were excluded if complete dataset of VDZ levels was not available. Clinical remission was defined as a partial Mayo score < 2 for patients with UC or a Harvey–Bradshaw index (HBI) score < 4 for those with CD. A trough VDZ level ≥ 27 μg/ml cut-off was used to evaluate remission outcomes for both induction and average maintenance VDZ levels. Statistically, analysis was carried out using the Fisher exact test. Key demographics are 57% CD, 43% UC; Baseline HBI score: 11; Baseline Partial Mayo score: 9; Concurrent Immunomodulator: 55% Results: ( 1) Week 6 induction levels: At week 52, 69% of patients were in clinical remission. Those patients in remission had a higher mean and median trough VDZ levels (Figure A). When the induction serum trough VDZ level ≥ 27 μg/ml 30% more patients were in clinical remission at week 52, although this failed to reach statistical significance (p = 0.40) (Figure C). (2) Average maintenance VDZ levels: At week 52, 63% of patients were in clinical remission. Those patients in remission had a higher mean and median average maintenance trough VDZ levels (Figure B). When the average maintenance trough VDZ level was ≥ 27 μg/ml 17% more patients were in clinical remission, this failed to reach statistical significance (p = .0.39) (Figure D). Conclusion High levels of clinical remission in both CD and UC were seen. In our study, we could use a similar cut-off for induction trough VDZ levels to those used in the literature that correlated with positive outcomes.1 Although the observed levels used to predict remission did not reach statistical significance, this may represent a type 2 error in view of the small numbers of patient. Furthermore, it was not possible to assess whether there is a difference between CD and UC. For maintenance levels, our cut-off of 27 μg/ml was higher than that used in the literature that correlated with positive outcomes.1 Our data suggest there is some correlation between trough VDZ levels for both induction and average maintenance levels and long-term clinical remission. Our induction cut-off was similar to currently available data associated with positive outcomes.1 Further studies are required to fully establish the role of TDM. References

Download Full-text

Surgical Decompression for Thoracic Outlet Syndrome in Adolescent Patients

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00378 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0037

Author(s):

Erin Fynan Ransom ◽

Heather Minton ◽

Bradley Young ◽

Brent Ponce ◽

Gerald McGwin ◽

...

Keyword(s):

Clinical Outcome ◽

Thoracic Outlet Syndrome ◽

Patient Characteristics ◽

Mechanism Of Injury ◽

First Rib ◽

Patient Reported ◽

Long Term Follow Up ◽

Quick Dash

Objectives: Thoracic outlet syndrome represents a complex combination of symptoms in the upper extremity that occurs due to compression of the neurovascular structures of the thoracic outlet or subcoracoid space. It can be seen in overhead athletes and is commonly misdiagnosed as other shoulder pathology. This study seeks to highlight patient characteristics, intraoperative findings, and both short term and long term outcomes of thoracic outlet decompression in the adolescent population as well as a comparison of outcomes by mechanism of injury including athletes. Methods: A retrospective chart review was performed of patients between the ages of 13 and 21 with a clinical diagnosis of TOS that were treated surgically by a single surgeon between 2000 and 2015. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient reported outcome scores including quickDASH, CBSQ, VAS, and SANE were obtained for a cohort of patients with long-term follow up ranging from 2 to 15 years. Results: The study population consisted of 54 adolescents (61 extremities) aged 13-21 at the time of presentation. There was a 3:1 female to male ratio. Patients saw an average of 2.08 other healthcare providers before referral to our institution. The most common surgical procedures included neurolysis of the brachial plexus (60; 98.4%), anterior scalenectomy (59; 96.7%), middle scalenectomy (54; 88.5%), excision of the first rib (28; 45.9%), excision of cervical rib (5; 8.2%), and subclavian artery manipulation (50, 81.9%). A second incision in the subcoracoid space was utilized in 28 (45.9%) extremities for exploration of the infraclavicular brachial plexus with release of the coracocostal ligament in 26 of these 28 patients (92.9%). Long-term follow-up data, including patient reported outcomes, was collected for 24/54 patients (44%). In this patient subset, the average follow-up was 69.5 months and ranged from 24 months to 180 months. The average preoperative VAS was recorded at 8.2 with an average postoperative VAS of 2.0, showing an improvement of 6.2 points. The average preoperative SANE score was 28.9 and the average postoperative SANE score was 85.4 with an improvement in 56.5. The average postoperative quickDASH score was 11.4. The average postoperative CBSQ score was 27.4 . The average postoperative NTOS Index score was 17.2. Subgroup analysis was performed analyzing patients having a first rib excision versus patients where their first rib was left intact. There was no difference regarding clinical outcome measures in these groups including CBSQ, VAS, SANE score, quick DASH and NTOS index. An additional subgroup analysis was performed comparing mechanism of injury including overuse from sports, trauma, and idiopathic causes. There was also no difference regarding clinical outcome measures in these groups including CBSQ, VAS, SANE score, quick DASH and NTOS index. Conclusion: We found no difference in clinical outcome scores in patients treated with rib resection versus patients with the first rib left intact. We also found no difference in outcomes with respect to mechanism of injury including overhead sports athletes. Overall, patients did well long-term after decompression of the thoracic outlet. Thoracic outlet syndrome should be considered in the differential diagnosis of athletes with upper extremity pain especially if they have neurologic findings.

Download Full-text

Functional evaluation in orthodontic surgical treatment: long-term stability and predictability

Progress in Orthodontics ◽

10.1186/s40510-015-0097-6 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

Giampietro Farronato ◽

Lucia Giannini ◽

Guido Galbiati ◽

Santo Andrea Stabilini ◽

Michele Sarcina ◽

...

Keyword(s):

Surgical Treatment ◽

Functional Evaluation ◽

Term Stability ◽

Long Term Stability

Download Full-text

LONG TERM FUNCTIONAL EVALUATION AUTOFIBULAR STRUT GRAFT IN CASE OF FRACTURES NECK FEMUR IN RSUD DR SOETOMO SURABAYA

(JOINTS) Journal Orthopaedi and Traumatology Surabaya ◽

10.20473/joints.v7i1.2018.55-64 ◽

2019 ◽

Vol 7 (1) ◽

pp. 55

Author(s):

Achmad Sjarwani ◽

OK Ilham Abdullah Irsyam

Keyword(s):

Medical Record ◽

Operating Room ◽

Femur Fracture ◽

Primary Data ◽

Harris Hip Score ◽

Functional Evaluation ◽

Medical Record Data ◽

Strut Graft ◽

Record Data

Background: Neck femur fracture has a poor prognosis due to its anatomical structure. Fractures that occur in the elderly often have a heavy comorbid so that the mortality rate in 1 year in this case reaches 30-50%. The techniques that have been developed at this time are not satisfactory results with non-union rate of about 30%.Purpose: Assessing the long-term effectiveness of fibular auto strut graft techniques for neck femoral fracture therapy.Methods: The study was conducted retrospectively using primary data in the form of clinical evaluation and secondary data in the form of medical record data and questionnaires of neck femur fracture patients who performed non-vascularized autofibular strutgraft therapy in the period January 2005 to August 2015 in operating room IRD RSUD Dr. Soetomo Surabaya. Patients were evaluated with Harris Hip Score.Result: Medical record data shows that surgery was performed in January 2005 until August 2015 in the IRD hospital operating room. Soetomo Surabaya with 15 patients that fit criteris inclusion. The final result of Harris Hip Score is excellent in 66.66% of patients, good in 20% of patients, and poor on 13.33% of patients. It can be seen that in large part, the technique of autofibular strutgraft (Surabaya Technique) gives good results to the sufferer.Conclusion: Autofibular strutgraft and reinforcement with cancellous lag screw on neck femur fracture can generally provide good functional results in long term evaluation. From the assessment of functional aspects, abnormal anatomical conditions, and Range of Motion (ROM), obtained satisfactory results. This supports autofibular strutgraft as a neck femur fracture therapy as a major therapeutic option at a young age.

Download Full-text