Treatment Outcome of Major Fractures of the Talus

1995 ◽  
Vol 16 (6) ◽  
pp. 339-345 ◽  
Author(s):  
Philip A. Frawley ◽  
John A. L. Hart ◽  
David A. Young
Keyword(s):  
Avascular Necrosis ◽  
Treatment Plan ◽  
Activity Level ◽  
University Teaching ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Fusion Procedure ◽  
Appropriate Treatment ◽  
Low Incidence

Twenty-six patients with major fractures of the talus were studied to assess the long-term outcome. The patients were admitted to a university teaching hospital and major trauma center from 1983 to 1991. The study excluded isolated fractures of the talar dome and posterior tubercle. Fifteen patients were treated using internal fixation and 11 patients were treated using nonsurgical methods. Avascular necrosis was detected in only four of the 26 patients. Subtalar osteoarthritis was a significant problem in 61%. Seven of these patients have come to secondary fusion procedures, with another three contem-plating fusion procedures at the time of review. Only one patient developed significant avascular necrosis requiring a fusion procedure. Only three of 26 patients had not returned to work at a mean 6 years after their injury. Eleven of the 26 (42%) had not returned to their premorbid activity level. The majority of these patients (25/26) had sustained multiple injuries, which compromised the functional recovery from the talar injury. Early accurate diagnosis and anatomical reduction gave the best results. The low incidence of avascular necrosis in this study has been attributed to early anatomical stabilization of the fracture. We believe an early CT scan can more accurately assess the severity of the talar fracture and offers the best information for an appropriate treatment plan.

Early Aneurysm Surgery and Preventive Therapy with Intravenously Administered Nimodipine: A Multicenter, Double-Blind, Dose-Comparison Study

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 458-464 ◽  
Author(s):  
Joachim M. Gilsbach ◽  
Hans J. Reulen ◽  
Bengt Ljunggren ◽  
Lennart Brandt ◽  
Hans v. Holst ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Neurological Dysfunction ◽  
Comparison Study ◽  
Double Blind ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Dose Comparison ◽  
Significant Difference ◽  
Low Incidence

Abstract A European, multicenter. prospective, randomized. double-blind, dose-comparison study on preventive therapy with intravenously administered nimodipine was performed to evaluate the efficacy and tolerability of two different doses: 2 and 3 mg/h. Two hundred four patients fulfilled the criteria for enrollment in the study; surgery within 72 hours after the last subarachnoid hemorrhage, and age between 16 and 72 years. All patients who had Hunt and Hess grades of I to III were operated upon: patients who had poor Hunt and Hess grades (IV-V) were operated on according to the surgeon's choice. This treatment regimen was associated with a low incidence of delayed neurological dysfunction with no significant difference between the two dosage groups: three patients (1.5%) remained severely disabled and two (1%) moderately disabled due to vasospasm with or without additional complications. Among the patients with Hunt and Hess grades of IV or V. the long-term outcome was favorable (good-fair) for 40% and unfavorable for 60%. Among the patients with grades of I to III, the long-term outcome was favorable for 89% and unfavorable for 11%.

Thyroid lymphoma: acute presentation and long-term outcome

2011 ◽  
Vol 125 (12) ◽  
pp. 1256-1262 ◽  
Author(s):  
S E Penney ◽  
J J Homer
Keyword(s):  
Case Note ◽  
Thyroid Lymphoma ◽  
Retrospective Case ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Acute Presentation ◽  
Appropriate Treatment ◽  
Diagnostic Pathways ◽  
Single Modality

AbstractBackground:Thyroid lymphomas are relatively uncommon. This study aimed to analyse our experience of thyroid lymphoma management and outcome.Materials and methods:A retrospective case note analysis of 63 patients treated in the previous 13 years was conducted.Results:The five-year survival rate was 68 per cent, with most patients dying of their lymphoma. This is at odds with the British Thyroid Association statement that the prognosis of this condition is ‘generally excellent’. The only presenting symptom found to be significantly associated with prognosis was dysphagia (p = 0.001). Dual modality treatment provided a significantly better outcome than single modality treatment (p = 0.014). Thyroid lymphoma can present to the head and neck surgeon ‘in extremis’; however, it can respond rapidly to appropriate treatment.Conclusion:The outcome of thyroid lymphoma seems unrelated to the acuteness of its presentation. Thyroid surgery has no role other than for diagnosis. However, 51 per cent of the study patients underwent some form of thyroidectomy, indicating the need to implement better diagnostic pathways.

scholarly journals 10-year follow-up after standardised treatment for Achilles tendinopathy

2018 ◽  
Vol 4 (1) ◽  
pp. e000415 ◽  
Author(s):  
Finn Johannsen ◽  
Signe Jensen ◽  
Eva Wetke
Keyword(s):  
Achilles Tendinopathy ◽  
Activity Level ◽  
Primary Study ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Excellent Outcome ◽  
Fair Poor ◽  
Corticosteroid Injections

BackgroundAchilles tendinopathy is a common and often long-lasting injury. We present a 10-year follow-up on a pragmatic study on Achilles tendinopathy treated with controlled exercises supplemented with corticosteroid injections if necessary in order to continue training.MethodsAll patients who completed the original study (n=93) were invited for a 10-year follow-up. 83% participated. Patients were evaluated with ultrasound scanning (n=58) and with a questionnaire (n=77) using the same outcome measures as in the primary study. The 10-year overall outcome on a 4-point scale (excellent, good, fair, poor), other treatments and adverse event and present activity level were recorded.ResultsExcellent outcome was reported in 63% and good outcome in 27%. 76% reported an activity level at 75%–100% of preinjury level. The average Victorian Institute of Sports Assessment-Achilles score for all patients was 84 (SD 19). 16% had surgery. Three ruptures occurred 5–8 years after the primary study. The improvement from entry to 6 months in the primary study was maintained until 10-year follow-up. Insertional tendinopathy did not differ from mid-substance tendinopathy in any outcome measure (short term and long term). We encountered no prognostic markers on ultrasound for the long-term outcome; however, present heterogeneity and increased flow resemble present pain. Thickened tendons seem to maintain their thickness despite improvement of symptoms.ConclusionOne to two corticosteroid injections are a safe and effective supplement to controlled exercises in the treatment of Achilles tendon pain with no signs of deterioration in the very long term. Mid-substance and insertional tendinopathies benefit equally from this treatment.

Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures

Injury ◽  
2003 ◽  
Vol 34 (7) ◽  
pp. 525-528 ◽  
Author(s):  
K.E Nikolopoulos ◽  
S.A Papadakis ◽  
K.T Kateros ◽  
G.S Themistocleous ◽  
J.A Vlamis ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Internal Fixation ◽  
Avascular Necrosis ◽  
Femoral Neck Fractures ◽  
Term Outcome ◽  
Long Term Outcome

Postremission Therapy with Repeated Courses of HD-Arac, Idarubicin and Limited Autologous Stem Cell Support Achieves a Very Good Long-Term Outcome in ELN Favourable and Intermediate-Risk AML Except in NPM-Mutated Patients Where Relapse May Occur Even after Five Years

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3993-3993
Author(s):  
Erika Borlenghi ◽  
Mirko Farina ◽  
Angela Passi ◽  
Chiara Pagani ◽  
Elisa Cerqui ◽  
...  
Keyword(s):  
Stem Cell ◽  
Treatment Plan ◽  
Chemotherapeutic Agents ◽  
Molecular Characteristics ◽  
High Dose ◽  
Intermediate Risk ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cd34 Cells

Abstract Introduction: Postremission treatment in adult acute myeloid leukemia (AML) is mandatory to improve long-term remission duration. Allogeneic stem-cell transplantation (allo-SCT) is considered gold standard in younger patients (pts) with higher risk of relapse, whereas in pts categorized as standard-risk (SR) AML the optimal treatment remains an open issue. High-dose cytarabine (HD-ARAC) is considered the backbone of postremission treatment in SR AML. The optimal dose and schedule, and the clinical benefit of additional chemotherapeutic agents remain controversial (Schaich, 2011- Lowenberg, 2011- Lowenberg, 2013) as well as the relative efficacy of HD-ARAC in the different cytogenetic and molecular subgroups of SR AML. We analyzed the very long term outcome of consecutive unselected AML pts treated according to AML 00 NILG protocol (Bassan, Blood, 2003: 102; 11) with three repetitive HD-ARAC-based cycles, associated with idarubicin, followed by limited peripheral blood stem cell (PBSC) support, in order to reduce toxicities. Methods: We evaluated 263 consecutive AML pts, diagnosed at our Institution, from January 2001 to March 2016 (median age 52 years - range 15-65). The treatment plan included induction with ICE (Idarubicin-Cytarabine-Etoposide) followed by IC consolidation or HD-ARAC/HD-idarubicin (SPLIT therapy) in refractory cases. ARAC 1g/mq bd for 4 days (A8) was given to CR pts, to collect 3-6x10^6 CD34/kg in 3 aliquots. Patients with ELN favorable or intermediate risk AML, considered SR AML, received 3 cycles of HD-ARAC (2g/mq bd for 5 days) plus idarubicin (8mg/mq for 2 days) with PBSC reinfusion (1-2x10^6 CD34/Kg) (A20). The pts with insufficient CD34 cells yield, received 2 courses HD-ARAC (1g/mq bd for 5 days) plus idarubicin (10mg/mq day 1) (A10). The cumulative dose of ARAC and idarubicin given according to A20 protocol were 69,4 g/mq and 162 mg/mq, respectively. Results: Among 263 pts, 142 (54%) pts were considered SR and 116 (44.1%) HR. Only 5 pts were lacking molecular or cytogenetic information (1.9%) to allow ELN risk classification. Accordingly, 65 pts (25.2%) were favorable [35.4% core binding factor (CBF) positive, 9.2% CEPBA mutated and 55.4% NPM mutated], 87 (33.7%) Intermediate-I, 45 (17.4%) Intermediate II and 61 (23.7%) adverse risk. CR rate after ICE treatment was 77.6% (204/263), 95.8% in SR and 56% in HR pts and after ICE+SPLIT it was 88.2% (232/263); early or aplastic death was 6%. A8 course was administered in 218 pts, of whom 179 were successfully mobilized (82.1%). Among 136 SR pts, 127 were received HD-ARAC (A20 or A10), 4 allo-SCT for early relapse, 3 pts did not proceed to A20 because of prolonged cytopenia and 2 are ongoing. Hematological toxicity was acceptable. ANC recovered at a median of 10 days after CD34+ cells reinfusion. Two death in CR occurred within 100 days after A20 therapy (1.6%). After a median follow-up of 53.3 months (range 1-172), the median survival of SR AML patients was 118.9 months, the DFS and OS at 5 y were 51+/-4.8% and 56.5+/-4.7%, and at 10 y 43.3+/-5.9% and 49.6+/-5.7%, respectively. According to ELN risk, the OS at 5 y and 10 y was 78.3+/-6% and 68+/-8.7% in favorable (median OS not reached), 52.3+/-8% and 46+/-9.4% in Intermediate-I (median OS 118.8 months), and 42+10% and 33.6+/-10.9% in Intermediate-II (median OS 33.1 months) (p0.0034) (Figure1). According to molecular characteristics, the OS at 5-y was 100% in CEBPA-mutated, 77+/-9% (+/-SE) in CBF-mutated and 71+/-11% in NPM-mutated subgroups, respectively (Figure 2). In NPM-mutated pts it was 56+/-14% if FLT3 was mutated and 75+/-10% if not. At 8-y OS was not evaluable in CEBPA-mutated, it remained 77+/-9% in CBF mutated but dropped to 47+/-15% in NPM-mutated pts due to late relapses (28%), which occurred in pts without FLT3. The median time to relapse in NPM pts was 17 m, the latest relapse occurred after 97 months. Conclusion: A postremission program with repeated courses of HD-ARAC associated to idarubicin and limited autologous CD34+ cells support was feasible, well tolerated and very effective, also long-term, in pts with ELN favourable or intermediate risk AML. The late relapse tendency of NPM-mutated AML is puzzling and should be considered by innovative programs aimed at improving these results. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals Long-term Outcome of Short-course High-dose Glucocorticoids for Severe Acute Respiratory Syndrome (SARS): A 17-Year Follow-up in SARS Survivors

2020 ◽  
Author(s):  
Chor-Wing Sing ◽  
Kathryn C B Tan ◽  
Ian C K Wong ◽  
Bernard M Y Cheung ◽  
Ching-Lung Cheung
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Avascular Necrosis ◽  
High Dose ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Safety Concerns ◽  
Short Course ◽  
Long Term Consequences

Abstract Use of high-dose glucocorticoids for COVID-19 (caused by SARS-CoV-2) is controversial because of safety concerns. We examined the long-term consequences of glucocorticoid use in severe acute respiratory syndrome (caused by SARS-CoV-1) survivors. Results showed that high-dose glucocorticoids greatly increased the long-term risk of avascular necrosis but not other major diseases.

Biomarkers of psoriatic arthritis outcomes

2018 ◽  
Author(s):  
Katerina Oikonomopoulou ◽  
Vinod Chandran
Keyword(s):  
Psoriatic Arthritis ◽  
Biological Fluids ◽  
Joint Damage ◽  
Cost Effective ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Appropriate Treatment ◽  
Potential Biomarkers ◽  
Future Management

Psoriatic arthritis is an inflammatory musculoskeletal disease that occurs in patients suffering from psoriasis. The disease manifests with symptoms affecting the skin, peripheral and axial joints, and periarticular structures. Diagnosis and management of psoriatic arthritis is challenging due to its heterogeneous presentation. However, early diagnosis and subsequent appropriate treatment reduces disease activity, prevents joint damage, and improves long-term outcome. It is hoped that biomarkers for disease progression and activity will aid in cost-effective clinical management of patients. Potential biomarkers under investigation for psoriatic arthritis are disease-related components derived from skin and articular tissues, biological fluids, such as blood and synovial fluid, and arthritis-associated cell populations. Imaging including ultrasound and MRI are also being evaluated as biomarkers for diagnosis, activity and outcome. Despite the challenge of bringing these new markers into the clinic, many of these markers hold promise for the future management of patients with psoriatic arthritis.

scholarly journals Spondylocostal Dysplasia in a 7-Year-Old Sri Lankan Girl Causing Restrictive Lung Disease: A Case Report and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Phirarthana Kamalanathan ◽  
Meranthi Fernando ◽  
Rohan Jayawardena ◽  
A. Upasena ◽  
Shaman Rajindrajith ◽  
...  
Keyword(s):  
Lung Disease ◽  
Short Stature ◽  
Sri Lankan ◽  
Thoracic Cavity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Restrictive Lung Disease ◽  
Appropriate Treatment

Spondylocostal dysplasia (SCD) is a rare costovertebral malformation characterised by short-trunk short stature. It is a recessively inherited disorder, and commonly identified disease-causing mutations are in DLL3 gene. The reported prevalence is 1 : 200,000 worldwide, and none was reported from Sri Lanka. We report a 7-year-old Sri Lankan girl with spondylocostal dysplasia presenting with short stature and scoliosis. Disproportionate short stature was noted with short upper segment and small thoracic cavity. Skeletal survey revealed fused vertebra involving T5-T6, T9-T10, and L3-L4. Butterfly vertebrae were noted in T2, T4, T6, and T9. Diagnosis of SCD was made based on classic radiological features including vertebral fusion and rib abnormalities. Spirometry was performed due to small thoracic cavity which showed results compatible with moderate to severe restrictive lung disease. The child did not report respiratory difficulties or recurrent chest infections up to the presentation. She was referred to an orthopaedic team which recommended conservative management with close follow-up. In conclusion, spondylocostal dysplasia should be considered in short-trunk short stature with rib abnormalities in the absence of limb shortening. Appropriate treatment and follow-up for restrictive lung disease would determine the long-term outcome.

scholarly journals Aorto-bi-Femoral Bypass for Aorto-Iliac Occlusive Disease: Recent Experience at the National Institute of Cardiovascular Diseases (NICVD)

1970 ◽  
Vol 4 (1) ◽  
pp. 26-31
Author(s):  
AHM Bashar ◽  
GMM Hossain ◽  
E Hakim ◽  
NC Mondol ◽  
MN Sabah ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Graft Infection ◽  
Occlusive Disease ◽  
Recent Experience ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Procedural Complications ◽  
Low Incidence

Background & Objectives: Aorto-bi-femoral bypass is one of the most important surgical strategies in vascular surgical practice. The procedure is employed in surgical revascularization for both stenotic and aneurysmal diseases involving the aorto-iliac segment. The present study was carried out to analyze our recent experiences with this procedure for aorto-iliac occlusive diseases (AIOD) at the National Institute of Cardiovascular Diseases (NICVD). Materials and Methods: Over a period of 3 years (April 2008 to March 2011), a total of 47 patients underwent aorto-bi-femoral or aorto-bisiliac bypass grafting for AIOD using a Y-graft prosthesis. The mean age of the patients was 46.4 years (range 25-75 years). Thirty eight of the patients were male and the remaining 9 were female. A retroperitoneal approach was used in 27 patients. In the remaining 20 patients, the operation was done using a transperitoneal approach. A Gelatin-coated Dacron Y-graft prosthesis was used in 43 (5 of which were silver-coated prosthesis) patients while PTFE (Polytetrafluoroethylene) prosthesis was used in the remaining 4 patients. The operation was carried out under epidural anesthesia with sedation in most cases. Results: The operation was well-tolerated in all patients. There was no intraoperative mortality in this series. Two patients died in the immediate post-operative period- one due to myocardial infarction and the other due to acute renal shut-down leading to renal failure accounting for a mortality rate of 4.3%. Wound infection and lymphorrhoea at the groin incision site were the two main immediate post-operative complications. There was no incidence of graft infection in this series. Twelve patients were available for post-operative follow-up up to 2 years. Out of them, 5 patients returned with occluded grafts 8-23 months after the operation. Three of these patients underwent graft excision with re-do Y-graft bypass. The remaining two were treated with extra-anatomic bypass (Axillobifemoral). Conclusions: Aorto-bi-femoral bypass is an effective surgical strategy for occlusive diseases involving the abdominal aorta and the iliac arteries. The procedure is well-tolerated with a low incidence of early post-procedural complications and graft failure. However, poor adherence of the patients to follow-up remains a significant obstacle for evaluating the long-term outcome of this procedure. Keywords: Aorto-Iliac Occlusive Disease; Aorto-bi-Femoral Bypass. DOI: http://dx.doi.org/10.3329/cardio.v4i1.9386 Cardiovasc. J. 2011; 4(1): 26-31

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