TUBERCULAR OSTEOMYELITIS OF METACARPALS AND PHALANGES IN CHILDREN

Hand Surgery ◽  
2011 ◽  
Vol 16 (01) ◽  
pp. 19-27 ◽  
Author(s):  
Anil Agarwal ◽  
Nadeem Akhtar Qureshi ◽  
Pawan Kumar ◽  
Shariq Khan
Keyword(s):  
Soft Tissue ◽  
Clinical Outcome ◽  
Disease Spectrum ◽  
Radiological Staging ◽  
Bony Destruction ◽  
Soft Tissue Swelling ◽  
Three Stages ◽  
Stage 1 ◽  
The Relationship

The purpose of the series is to describe the management of tubercular osteomyelitis of metacarpals and phalanges in 11 children (range, 3–12 years) and to retrospectively analyse the relationship between radiological staging and clinical outcome following treatment. The available literature on the clinical and radiological manifestations of tubercular osteomyelitis of the hand (excluding wrist) was also reviewed. Follow-up averaged 17.7 months following completion of treatment. The different radiological descriptions of the condition could be grouped into three stages: Stage 1 (stage of soft tissue swelling and no bony changes), Stage 2 (stage of bony expansion) and Stage 3 (stage of destruction). The previously described different radiological entities of tubercular osteomyelitis of metacarpals and phalanges appear to be a sequential manifestation of the disease spectrum. Healing with non-operative treatment is excellent provided the diagnosis is made when tuberculosis presents with soft tissue swelling alone and before bony destruction occurs.

scholarly journals Hypertension Burden and the Risk of New-Onset Atrial Fibrillation

Hypertension ◽  
2021 ◽  
Vol 77 (3) ◽  
pp. 919-928
Author(s):  
So-Ryoung Lee ◽  
Chan Soon Park ◽  
Eue-Keun Choi ◽  
Hyo-Jeong Ahn ◽  
Kyung-Do Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Total Study Population ◽  
Increased Risk ◽  
Burden Scale ◽  
History Of ◽  
Study Population ◽  
Korean National Health Insurance ◽  
Stage 1 ◽  
The Relationship

The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.

Potential Impact of BMI on the Aggressiveness of Presentation and Clinical Outcome of Differentiated Thyroid Cancer

2019 ◽  
Vol 105 (4) ◽  
pp. e1124-e1134
Author(s):  
Antonio Matrone ◽  
Giovanni Ceccarini ◽  
Marianna Beghini ◽  
Federica Ferrari ◽  
Carla Gambale ◽  
...  
Keyword(s):  
Risk Factor ◽  
Thyroid Cancer ◽  
Clinical Outcome ◽  
Differentiated Thyroid Cancer ◽  
Normal Weight ◽  
American Thyroid Association ◽  
131I Treatment ◽  
Therapeutic Attitude ◽  
The Relationship

Abstract Background Obesity is a risk factor for several cancers, including differentiated thyroid cancer (DTC). Moreover, it has also been investigated as a potential risk factor for aggressiveness of DTC, but the data gathered so far are conflicting. The aim of our study was to evaluate the relationship between body mass index (BMI), aggressiveness of DTC at diagnosis, and clinical outcome. Methods We evaluated 1058 consecutive DTC patients treated with total thyroidectomy and enrolled at the time of first radioactive iodine (131I) treatment. Patients were divided into 4 groups based on their BMI: underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Histological aggressiveness of DTC at the time of diagnosis and clinical outcome according to 2015 American Thyroid Association (ATA) guidelines were evaluated. Results No differences in histological features, ATA risk of recurrence, activity of 131I administered and prevalence of 131I avid metastatic disease after first131I treatment, have been demonstrated among the groups. Furthermore, at the end of follow up (median = 5.7 years), no differences were evident in the number of further treatments performed as well as in the clinical response. Conclusions In our study group of Caucasian subjects, we could not demonstrate any association between BMI and aggressiveness of DTC, neither at the time of diagnosis nor during follow-up. These data indicate that postsurgical assessment and therapeutic attitude for treatment and follow-up of DTC should be based on the class of risk applied to the general population, with no concern for BMI.

Does component placement affect short-term clinical outcome in robotic-arm assisted unicompartmental knee arthroplasty?

2019 ◽  
Vol 101-B (4) ◽  
pp. 435-442 ◽  
Author(s):  
F. Zambianchi ◽  
G. Franceschi ◽  
E. Rivi ◽  
F. Banchelli ◽  
A. Marcovigi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Clinical Outcome ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Robotic Arm ◽  
Short Term ◽  
Soft Tissue Balancing ◽  
Unicompartmental Knee ◽  
Post Implantation

Aims The purpose of this multicentre observational study was to investigate the association between intraoperative component positioning and soft-tissue balancing on short-term clinical outcomes in patients undergoing robotic-arm assisted unicompartmental knee arthroplasty (UKA). Patients and Methods Between 2013 and 2016, 363 patients (395 knees) underwent robotic-arm assisted UKAs at two centres. Pre- and postoperatively, patients were administered Knee Injury and Osteoarthritis Score (KOOS) and Forgotten Joint Score-12 (FJS-12). Results were stratified as “good” and “bad” if KOOS/FJS-12 were more than or equal to 80. Intraoperative, post-implantation robotic data relative to CT-based components placement were collected and classified. Postoperative complications were recorded. Results Following exclusions and losses to follow-up, 334 medial robotic-arm assisted UKAs were assessed at a mean follow-up of 30.0 months (8.0 to 54.9). None of the measured parameters were associated with overall KOOS outcome. Correlations were described between specific KOOS subscales and intraoperative, post-implantation robotic data, and between FJS-12 and femoral component sagittal alignment. Three UKAs were revised, resulting in 99.0% survival at two years (95% confidence interval (CI) 97.9 to 100.0). Conclusion Although little correlation was found between intraoperative robotic data and overall clinical outcome, surgeons should consider information regarding 3D component placement and soft-tissue balancing to improve patient satisfaction. Reproducible and precise placement of components has been confirmed as essential for satisfactory clinical outcome. Cite this article: Bone Joint J 2019;101-B:435–442.

Ectopic Immature Renal Tissue Over the Dorsum of Lumbar and Sacral Area in Two Infants

PEDIATRICS ◽  
1982 ◽  
Vol 69 (3) ◽  
pp. 336-339
Author(s):  
Zoltan Posalaky ◽  
Robert M. Drake ◽  
John R. Mawk ◽  
Ralph A. Franciosi ◽  
Bernard H. Spencer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Renal Tissue ◽  
Female Infant ◽  
Soft Tissue Swelling ◽  
Lumbar Area ◽  
Disease Free ◽  
Renal Abnormalities

During reparative surgery for meningomyelocele of the lumbar area, a 7-week-old female infant was found to have a small, well-delineated, subcutaneous, renal blastema. A 3-month-old female infant was found to have immature renal tissue, consisting of glomeruli and tubules, in a soft tissue swelling dorsal to the sacrum. Neither of these patients showed neuroloic or renal abnormalities. The second patient has had a disease-free follow-up period of six years. The possible etiology and significance of these benign findings and their relation to the origin of Wilms tumors are discussed.

Exploring Relationships of Exposure, Pharmacodynamic Changes and Gene Expression to Clinical Outcome in Adults with Acute Lymphoblastic Leukemia Receiving Inotuzumab Ozogamicin

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3698-3698
Author(s):  
Luke Fostvedt ◽  
A. Douglas Laird ◽  
Jean-Claude Marshall ◽  
Sherry Li ◽  
Joseph P. Boni
Keyword(s):  
Gene Expression ◽  
Bone Marrow ◽  
Clinical Outcome ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Elimination Rate ◽  
Stock Ownership ◽  
Inotuzumab Ozogamicin ◽  
The Relationship

Abstract Background Inotuzumab ozogamicin (InO) is a targeted antibody-drug conjugate (ADC) under development for treatment of patients with relapsed or refractory CD22-positive acute lymphoblastic leukemia (ALL) and non-Hodgkin's Lymphoma. Correlative analyses from an open-label, Phase 1/2 study (B1931010) included exploring the relationship between InO pharmacokinetic exposure, hematologic measures, and gene expression to treatment response. Methods Patients received 2 to 3 weekly intravenous doses of InO by 1 hour infusion over a 28-day cycle for ≤ 6 cycles (table). Blood samples were drawn during Days 1 and 15 of Cycles 1 and 2 (at 0, 1 and 3 h), and Day 1 of Cycle 4 (at 0 and 1 h) for concentration determination of InO and unconjugated calicheamicin in serum. Samples were analyzed using a validated LC/MS/MS procedure. InO levels were correlated to CD22 protein expression on CD19+ B-lymphocytes in blood and bone marrow, and to minimum residual disease. Lymphocyte regeneration was described using a linear mixed-effects model. To explore the relationship between clinical outcome and expression of genes such as those involved in DNA damage response and apoptosis, optional blood samples for gene expression analysis were collected on Cycle 1 Day 1 and Cycle 1 Day 15 [each at pre- and post-dose time-points]. These samples were assessed for baseline gene expression and gene expression changes using 96-gene TaqMan Low Density Array cards. Results Unconjugated calicheamicin levels were below the limit of quantitation (50 pg/mL) for most patients and time points. Treatment-related decreases in CD22 antigen expression on lymphocytes were rapid but unrelated to InO concentration. Lymphocyte depletion in blood was also rapid, consistently observed regardless of InO dose, and followed by slow regeneration with substantial inter-patient differences in regeneration rate. Percentage of bone marrow blasts was directly related to InO elimination rate. With treatment, as blast percentage decreased, InO elimination rate decreased by approximately 50% by Cycle 4 (ie, after 10 dosing events) compared to the first dose. In bone marrow, lower disease burden at baseline tended to be associated with faster regeneration of lymphocytes during the follow-up period. Patients achieving minimal residual disease (MRD)-negativity tended to have higher peak and trough serum concentrations of InO throughout each cycle compared to patients not achieving MRD-negativity. There was no observed correlation between percentage of blasts at baseline and MRD-negativity. CD22 mRNA levels in blood decreased approximately 10-fold by Day 15 relative to baseline, consistent with selective killing of CD22-positive leukemic blasts by InO. This decrease was more pronounced in subjects who exhibited complete response with/without incomplete platelet count recovery with no evidence of MRD than in subjects who did not exhibit clinical response (p=0.001 using Wilcoxon Rank Sum Test). In addition, multiple other transcripts exhibited decreases following InO administration, including mRNAs encoded by genes regulating proliferation (cyclin-dependent kinase 2), DNA repair (XRCC2), and cell death (death-associated protein kinase 1). Conclusion In patients with ALL receiving InO, CD22 protein expression and lymphocyte count decreased rapidly, followed by slow and variable regeneration, as patients with low disease blast counts at baseline exhibited faster recovery of their counts than those with higher levels. While CD22 expression is not a significant determinant of InO concentration, the number of doses administered did influence drug elimination rate; an effect thought to be associated with target-mediated drug clearance. In related fashion, patients achieving MRD-negativity tended to have higher InO concentrations following InO treatment. Changes in mRNA profiles in blood consistent with the mechanism of action of InO were evident. The extent of reduction in CD22 mRNA was associated with clinical outcome. Study is ongoing for long term follow up. Figure 1. Figure 1. Disclosures Fostvedt: Pfizer Inc: Employment, Other: stock ownership. Laird:Pfizer Inc: Employment, Other: Stock ownership. Marshall:Pfizer Inc: Employment, Other: Stock ownership. Li:Pfizer Inc: Employment, Other: Stock ownership. Boni:Pfizer Inc: Employment, Other: Stock ownership.

Human resource management and innovation in SMEs

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Keyword(s):  
Employee Engagement ◽  
Linear Process ◽  
Content Type ◽  
The Gift ◽  
Three Stages ◽  
One Year ◽  
Gift Exchanges ◽  
The Relationship

Purpose The purpose of this paper is to discuss the relationship between HRM and innovation in SMEs through gift/counter-gift exchanges. Design/methodology/approach This is a qualitative case study of a SME using a diversity of data collection methods with a one year follow up to provide some longitudinal data. Findings The results indicate that the logic of giving has three stages: freeing up gifts, mobilizing gifts and rethinking gifts. The results also indicate that employees need to be central to the innovation from the beginnings of such projects. Research limitations/implications The authors note that their linear process in this study may give the impression that the process of innovation is linear and sequential rather than dynamic. They also point out that some cognitive bias could arise from the research being based on retrospection. Practical implications The authors make six recommendations: 10;1. The leader should share their strategic vision from the outset to gain as much support as possible 10;2. Seek to build a culture conducive to gifting 10;3. Encourage employee engagement using a bottom-up approach 10;4. Detect and enlist key players 10;5. Be aware of frustrations among employees 10;6. Create virtuous collaboration. Originality/value Many questions remain from previous literature regarding the relationship between HRM and innovation in SMEs. This study has originality and value in using the gift/counter-gift theory to explore that relationship.

Lipomatous Hemangiopericytoma

1999 ◽  
Vol 123 (10) ◽  
pp. 941-945
Author(s):  
Katherine M. Ceballos ◽  
Peter L. Munk ◽  
Bassam A. Masri ◽  
John X. O'Connell
Keyword(s):  
Soft Tissue ◽  
Immunohistochemical Staining ◽  
Full Range ◽  
Original Description ◽  
Pulsatile Mass ◽  
Pathologic Features ◽  
Ultrastructural Appearance ◽  
Fibrous Tumor ◽  
The Relationship

Abstract Hemangiopericytoma of soft tissue is a controversial pathologic entity. The relative nonspecificity of the characteristic branching capillary pattern and cytologic features of the constituent cells, in addition to the lack of a distinct immunohistochemical staining profile, has resulted in uncertainty and a lack of consensus regarding this subgroup of tumors. Notwithstanding the doubt surrounding this entity, a morphologically unique variant, designated lipomatous hemangiopericytoma, was reported in 1995. To our knowledge, there have been no further reports of these tumors since the original description. We describe a lipomatous hemangiopericytoma that arose within the thigh of a 41-year-old woman. The tumor presented as a slowly enlarging, minimally tender, pulsatile mass. The tumor was completely excised and was found to be composed of an admixture of typical hemangiopericytoma and predominantly mature adipose tissue. Unlike previous descriptions of this entity, the current example exhibited a full range of adipocyte differentiation, including many multivacuolated adipocytes of variable size with characteristic nuclear scalloping (lipoblast-like cells). The mitotic count was less than 2 per 10 high-power fields examined. The clinical course has been benign during the short follow-up period. We discuss the pathologic features, including the immunohistochemical staining profile and ultrastructural appearance of this distinctive tumor, and briefly discuss the relationship between hemangiopericytoma and solitary fibrous tumor of soft tissue, a neoplasm with many clinical and pathologic similarities.

scholarly journals Influence of Depressive Symptoms on Clinical Outcomes of Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Tae Yong Kim ◽  
Jungtae Ahn ◽  
Bi O Jeong
Keyword(s):  
Depressive Symptoms ◽  
Clinical Outcome ◽  
Statistical Difference ◽  
Distal Tibia ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
The Relationship ◽  
Depressive Group ◽  
Surface Angle

Category: Ankle Arthritis Introduction/Purpose: Recently, there have been many reports on the relationship between depression and clinical outcome of knee or hip arthroplasty. However, there is no study on the association between depression and total clinical outcome of total ankle arthroplasty (TAA). This study investigated the relationship between depressive symptoms and clinical outcome after TAA. Methods: Forty patients who underwent TAA for end-stage ankle arthritis from July 2014 to July 2017 and were able to follow- up at least 12 months were selected. Depressive symptoms were evaluated using Center for Epidemiologic Studies Depression Scale (CES-D) and Patient Health Questionnaire-9 (PHQ-9). The subjects were divided into Depressive group and Non-depressive group, and the preoperative and postoperative clinical results were compared using a visual analogue scale (VAS), American orthopedic foot and ankle-hindfoot score (AOFAS). The preoperative and postoperative radiological results were also compared using anterior surface angle of distal tibia (TAS), talar tilt of ankle joint (TT), lateral surface angle of distal tibia (TLS), and heel alignment distance (HD). Results: The mean age of the patients was 61.6±18.2 years and the average follow-up period was 24.3±7.3 months. 13 subjects were in Depression group and 27 subjects were in Non-depression group. There was no statistical difference in baseline characteristics between the two groups. Additionally, there was no statistical difference in preoperative VAS and AOFAS between the two groups (p>.05). Preoperative and postoperative VAS and AOFAS showed statistically significant improvement in both groups (p<.05). However, the depressive group showed higher result in postoperative VAS than the Non-depressive group significantly (3.1±2.4 vs 1.4±2.3, p<.05). The postoperative AOFAS was also higher in the non-depressive group significantly (89.3±13.4 vs 95.0±8.1, p<.05). Both groups showed improvement in postoperative radiologic index. Preoperative and postoperative radiologic index showed no difference in both groups. Conclusion: The clinical outcome after TAA was poor in patients with depressive symptoms when compared to patients without depressive symptoms. Since depressive symptoms is a patient-specific factor that result in less improvement in clinical outcomes after TAA, clinical considerations for depressive symptoms are needed prior to TAA surgery.

Plate Fixation in Closed Ipsilateral Multiple Metacarpal Fractures

2008 ◽  
Vol 33 (6) ◽  
pp. 740-744 ◽  
Author(s):  
J. S. SOUER ◽  
C. S. MUDGAL
Keyword(s):  
Soft Tissue ◽  
Plate Fixation ◽  
Full Range ◽  
Treatment Method ◽  
Stable Fixation ◽  
Functional Rehabilitation ◽  
Metacarpal Fractures ◽  
Soft Tissue Swelling ◽  
Lost To Follow Up

Closed multiple metacarpal fractures are uncommon. They are usually associated with significant soft tissue swelling. Early stable fixation and functional rehabilitation optimises outcome. We present a review of 19 patients with 43 metacarpal fractures treated by early open reduction and internal fixation with 2 mm plates. Eighteen patients recovered a full range of motion, while one patient was lost to follow-up. Implant removal on account of extensor irritation was required in only two metacarpals in two patients. Plating of multiple closed metacarpal fractures is a safe, reliable and consistently reproducible treatment method.

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