Survivorship of the Neuflex Silicone Implant in MCP Joint Replacement

2009 ◽  
Vol 34 (1) ◽  
pp. 25-28 ◽  
Author(s):  
B. MWAURA KIMANI ◽  
I. A. TRAIL ◽  
A. HEARNDEN ◽  
R. DELANEY ◽  
D. NUTTALL
Keyword(s):  
Range Of Motion ◽  
Joint Replacement ◽  
Silicone Implant ◽  
Fracture Rate ◽  
End Point ◽  
Kaplan Meier ◽  
Swanson Implant ◽  
End Stage

The Neuflex silicone metacarpophalangeal (MCP) joint replacement has previously been shown to provide improved movement, particularly flexion, when compared with the Swanson implant. In this study, we reviewed the outcome of 237 Neuflex implants in 66 patients with a follow-up of up to 7 years. Kaplan–Meier analysis using revision as the end stage revealed survival at 7 years to be 88%. If however an implant fracture, as seen radiographically, is taken as the end point, the survivorship drops to 68% at 7 years. These figures are comparable with a similar analysis for the Swanson implant. We conclude that the improved range of motion of the Neuflex implant demonstrated previously does not result in either a higher or a lower revision or implant fracture rate when compared with the Swanson implant.

scholarly journals Characteristics of patients with coexisting DNAJB9-associated fibrillary glomerulonephritis and IgA nephropathy

2020 ◽  
Author(s):  
Samar M Said ◽  
Alejandro Best Rocha ◽  
Anthony M Valeri ◽  
Mohamad Sandid ◽  
Anhisekh Sinha Ray ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Immunoglobulin A ◽  
Renal Survival ◽  
Hepatitis C Infection ◽  
Clinicopathologic Characteristics ◽  
Fibrillary Glomerulonephritis ◽  
Kaplan Meier ◽  
Dense Deposits ◽  
End Stage

Abstract Background Coexistence of fibrillary glomerulonephritis (FGN) and immunoglobulin A (IgA) nephropathy (IgAN) in the same kidney biopsy (FGN–IgAN) is rare, and the clinicopathologic characteristics and outcome of this dual glomerulopathy are unknown. Methods In this study, 20 patients with FGN–IgAN were studied and their characteristics were compared with 40 FGN and 40 IgAN control patients. Results Concurrent IgAN was present in 1.8% of 847 consecutive FGN cases and was the second most common concurrent glomerulopathy after diabetic nephropathy. FGN–IgAN patients were overwhelmingly White (94%) and contrary to FGN patients were predominantly (60%) males. Compared with IgAN patients, FGN–IgAN patients were older, had higher proteinuria, a higher incidence of renal insufficiency, and a lower incidence of microhematuria and gross hematuria at diagnosis. Six (30%) patients had malignancy, autoimmune disease or hepatitis C infection, but none had a secondary cause of IgAN or clinical features of Henoch–Schonlein purpura. Histologically, all cases exhibited smudgy glomerular staining for immunoglobulin G and DnaJ homolog subfamily B member 9 (DNAJB9) with corresponding fibrillary deposits and granular mesangial staining for IgA with corresponding mesangial granular electron-dense deposits. On follow-up (median 27 months), 10 of 18 (56%) FGN–IgAN patients progressed to end-stage kidney disease (ESKD), including 5 who subsequently died. Serum creatinine at diagnosis was a poor predictor of renal survival. The proportion of patients reaching ESKD or died was higher in FGN–IgAN than in IgAN. The median Kaplan–Meier ESKD-free survival time was 44 months for FGN–IgAN, which was shorter than IgAN (unable to compute, P = 0.013) and FGN (107 months, P = 0.048). Conclusions FGN–IgAN is very rare, with clinical presentation and demographics closer to FGN than IgAN. Prognosis is guarded with a median renal survival of 3.6 years. The diagnosis of this dual glomerulopathy requires careful evaluation of immunofluorescence findings, and electron microscopy or DNAJB9 immunohistochemistry.

Clinical Outcomes of Total Ankle Arthroplasty With Total Talar Prosthesis

2019 ◽  
Vol 40 (8) ◽  
pp. 948-954
Author(s):  
Noriyuki Kanzaki ◽  
Nobuaki Chinzei ◽  
Tetsuya Yamamoto ◽  
Takahiro Yamashita ◽  
Kazuyuki Ibaraki ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
The Mean ◽  
End Stage ◽  
Medial Malleolus Fracture

Background: Total ankle arthroplasty (TAA) has been developed to treat patients with end-stage ankle osteoarthritis (OA). However, there is often difficulty in treating complicated pathologies such as ankle OA with subtalar joint OA and severe talar collapse. Therefore, this study aimed to explore the short-term results and complications of TAA with total talar prosthesis, known as combined TAA, as the new techniques to treat such complicated pathology. Methods: We examined postoperative results including ankle range of motion, Japanese Society for Surgery of the Foot (JSSF) scale, and complications. There were 22 patients (15 women), with mean follow-up of 34.9 (range, 24–53 months), and the mean age was 72 (range, 62–80) years. The main indications for combined TAA included osteoarthritis (18 patients), rheumatoid arthritis (3 patients), and talar osteonecrosis with osteoarthritis (one patient). Results: The mean range of motion improved from 4.0 to 14.4 degrees in dorsiflexion and from 23.8 to 32.0 degrees in plantarflexion. The JSSF scale improved from 50.5 to 91.5 points. Prolonged wound healing occurred in 3 patients, and medial malleolus fracture occurred in 4 patients. Conclusion: Combined TAA was a reliable procedure for the treatment of not only ankle OA following avascular necrosis of talus but also of degeneration of both ankle and subtalar joints. Level of Evidence: Level IV, case series.

Assessment of Losartan 50 mg on Survival of Post-Dialysis Euvolemic Hypertensive Patients: Findings from HELD Trial

2019 ◽  
Vol 48 (3) ◽  
pp. 233-242
Author(s):  
Raja Ahsan Aftab ◽  
Amer Hayat Khan ◽  
Azreen Syazril Adnan ◽  
Syed Azhar Syed Sulaiman ◽  
Tahir Mehmood Khan
Keyword(s):  
Cox Regression ◽  
Dialysis Session ◽  
Hypertensive Patients ◽  
Cox Regression Analysis ◽  
Probability Of Survival ◽  
End Point ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Single Blind

Aims and objective: To estimate the effect of losartan 50 mg on survival of post-dialysis euvolemic hypertensive patients. Methodology: A single center, prospective, single-blind randomized trial was conducted to estimate the survival of post-dialysis euvolemic hypertensive patients when treated with lorsartan 50 mg every other day. Post-dialysis euvolemic assessment was done by a body composition monitor. Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm, and the follow-up duration was twelve months. The primary end point was achieving targeted blood pressure (BP) of <140/90 mm Hg and maintaining for 4 weeks, whereas secondary end point was all cause of mortality. Pre-, intra-, and post-dialysis session BP measurements were recorded, and survival trends were analyzed using Kaplan-Meier analysis. Results: Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard (n = 44) and intervention arms (n = 44), and 36 (81.8%) patients in each arm completed a follow-up of 12 months. A total of eight patients passed away during the 12-month follow-up period (6 deaths among standard arm and 2 in intervention arm). However, the probability of survival between both arms was not significant (p = 0.13). Cox regression analysis revealed that chances of survival were higher among the patients in the intervention (OR 3.17) arm than the standard arm (OR 0.31); however, the survival was found not statistically significant. Conclusion: There was no statistical significant difference in 1 year survival of post-dialysis euvolemic hypertensive patients when treated with losartan 50 mg.

REVISION METACARPOPHALANGEAL JOINT REPLACEMENT 30 YEARS AFTER PRIMARY SWANSON FLEXIBLE SILICONE IMPLANT ARTHROPLASTY IN A RHEUMATOID PATIENT: A CASE REPORT

Hand Surgery ◽  
2009 ◽  
Vol 14 (01) ◽  
pp. 25-29 ◽  
Author(s):  
Katsumitsu Arai ◽  
Hajime Ishikawa ◽  
Takehiro Murai ◽  
Junichi Fujisawa ◽  
Naoto Endo
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Joint Replacement ◽  
Revision Surgery ◽  
Metacarpophalangeal Joint ◽  
Joint Arthroplasty ◽  
Implant Removal ◽  
Silicone Implant ◽  
Rheumatoid Patient ◽  
Swanson Implant

We report a case of a patient with rheumatoid arthritis undergoing revision surgery 30 years after primary metacarpophalangeal joint arthroplasty using a Swanson implant. Removal and replacement of the implant were successfully performed, and the patient was satisfied with the revision surgery.

Surgical Management of Advanced Coats Disease in 32 Eyes: A 20-Year Study

2020 ◽  
Vol 4 (6) ◽  
pp. 467-471
Author(s):  
Pukhraj Rishi ◽  
Ekta Rishi ◽  
Yamini Attiku ◽  
Mahesh Uparkar ◽  
Pramod Bhende ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Subretinal Fluid ◽  
Vitreous Hemorrhage ◽  
Disease Stage ◽  
Final Visit ◽  
Kaplan Meier ◽  
Coats Disease ◽  
End Stage ◽  
Anatomical Outcome

Purpose: This work studies outcomes of external subretinal fluid (SRF) drainage in management of eyes with advanced Coats disease. Methods: Patients with advanced-stage Coats disease (≥stage 3B), who were younger than 12 years and underwent external SRF drainage from 1996 to 2016, were included in this retrospective study. Surgical intervention involved external drainage of SRF and cryotherapy. SRF drainage was performed by lamellar scleral dissection or by external needle drainage. Favorable anatomical outcome was defined as retinal reattachment with normal intraocular pressure (IOP). IOP greater than 24 mm Hg was considered raised. Univariate and multivariate analyses were performed to measure the association between preoperative or intraoperative factors and retinal status at final follow-up. Outcome measures evaluated included visual acuity, IOP, retinal status, globe status, and complications of surgery. Kaplan-Meier analysis was performed for globe salvage without pain. Results: Thirty-two eyes of 32 patients were included in the study. Mean age at surgery was 3.8 ± 3 years. The mean duration of follow-up was 7 years (range, 6 months-15.7 years). Improvement in visual acuity was seen in 5 eyes. Retina was attached at final visit in 6 eyes. IOP in the range of 8 to 24 mm Hg was noted in 16 eyes. Favorable anatomical outcome was achieved in 3 (9%) eyes. Globe salvage was achieved in 84% of eyes. Complications included intraoperative vitreous hemorrhage (n = 1) and postoperative inflammation (n = 1). Kaplan-Meier ocular survival rate without pain at 10 years was 76%. Conclusions: SRF drainage and cryotherapy in eyes with advanced Coats disease favorably alter the natural history of the disease and prevent end-stage complications. Visual outcomes remain poor.

scholarly journals A Predictive Model for Kidney Transplant Graft Survival using Machine Learning

2020 ◽  
Author(s):  
Eric S. Pahl ◽  
W. Nick Street ◽  
Hans J. Johnson ◽  
Alan I. Reed
Keyword(s):  
Machine Learning ◽  
Random Forest ◽  
Cox Regression ◽  
Risk Index ◽  
Error Rates ◽  
Machine Learning Method ◽  
Learning Method ◽  
Kaplan Meier ◽  
End Stage

Kidney transplantation is the best treatment for end-stage renal failure patients. The predominant method used for kidney quality assessment is the Cox regression-based, kidney donor risk index. A machine learning method may provide improved prediction of transplant outcomes and help decision-making. A popular tree-based machine learning method, random forest, was trained and evaluated with the same data originally used to develop the risk index (70,242 observations from 1995-2005). The random forest successfully predicted an additional 2,148 transplants than the risk index with equal type II error rates of 10%. Predicted results were analyzed with follow-up survival outcomes up to 240 months after transplant using Kaplan-Meier analysis and confirmed that the random forest performed significantly better than the risk index (p<0.05). The random forest predicted significantly more successful and longer-surviving transplants than the risk index. Random forests and other machine learning models may improve transplant decisions.

scholarly journals Total elbow arthroplasty for end-stage rheumatoid elbow arthritis with major instability: a case report

2020 ◽  
Vol 6 (5) ◽  
pp. 1090
Author(s):  
Diogo A. Sousa ◽  
Rita Sapage ◽  
Carlos Branco ◽  
Rita Sousa ◽  
Joao Reis ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Range Of Motion ◽  
Severe Pain ◽  
Daily Activities ◽  
Total Elbow Arthroplasty ◽  
Elbow Arthroplasty ◽  
Active Range Of Motion ◽  
End Stage

<p>A 73 years old female diagnosed with rheumatoid arthritis for over 30 years with an end-stage right elbow arthritis (stage V of Larsen’s classification) with a major instability. The patient presented gross deformity and severe pain with critical limitation of limb function. The patient was treated with a total elbow arthroplasty with an intraoperative olecranon fracture. At six months follow up, the patient presents with an excellent active range of motion and painless joint, without daily activities limitation.</p>

Correlation between range of motion and implant fracture: a 5 year follow-up of 72 joints in 18 patients in a randomized study comparing Swanson and Avanta/Sutter MCP silicone prosthesis

2009 ◽  
Vol 34 (6) ◽  
pp. 743-747 ◽  
Author(s):  
M. TÄGIL ◽  
M. GEIJER ◽  
P. MALCUS ◽  
P. KOPYLOV
Keyword(s):  
Range Of Motion ◽  
Randomized Study ◽  
Ulnar Deviation ◽  
Patient Study ◽  
Silicone Prosthesis ◽  
Swanson Implant

Eighteen out of 18 rheumatoid patients (at one centre of a two-centre 30 patient study previously reported) with a mean age of 56 years, and 72/72 operated joints were randomized to Avanta/Sutter or Swanson MCP prostheses and followed for 5 years. Both ulnar deviation and extension lag were improved already at 6 weeks and remained improved at 5 years. The Avanta prosthesis had a better range of motion (ROM) than the Swanson. Six of nine patients with Avanta/Sutter implants had at least one implant fracture compared to 1/9 patients with the Swanson implant ( P = 0.05) but fracture did not change the outcome subjectively. The ROM at 3 months correlated with the occurrence of an implant fracture at 5 years and a greater early ROM may be related to implant fracture. At 5 years patients remained satisfied and the deformities remained corrected.

scholarly journals Survival of the Scandinavian Total Ankle Replacement (STAR)

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0022
Author(s):  
Arno Frigg ◽  
Ursula Germann ◽  
Martin Huber ◽  
Monika Horisberger
Keyword(s):  
Survival Rate ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Metallic Component ◽  
Kaplan Meier ◽  
Ankle Replacement ◽  
One Year ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: The purpose of this study was to evaluate survival and clinical outcome of the Scandinavian total ankle replacement (STAR) prosthesis after a minimum of ten years up to a maximum of 19 years. Methods: Fifty STAR prostheses in 46 patients with end stage ankle osteoarthritis operated between 1996 and 2006 by the same surgeon (MH) were included. Minimal follow-up was ten years (median 14.6 years, 95% confidence interval [CI] 12.9-16.4). Clinical (Kofoed score) and radiological assessments were taken before the operation and at one, ten (+2), and 16 (±3) years after implantation. The primary endpoint was defined as exchange of the whole prosthesis or conversion to arthrodesis (def. 1), exchange of at least one metallic component (def. 2), or exchange of any component including the inlay (due to breakage or wear) (def. 3). Survival was estimated according to Kaplan-Meier. Further reoperations related to STAR were also recorded. Results: The ten year survival rate was (def. 1) 94% (CI 82- 98%), (def. 2) 90% (CI, 77-96%), and (def. 3) 78% (CI 64-87%). The 19-year survival rate was (def. 1) 91% (CI 78-97%), (def. 2) 75% (CI 53-88%), and (def. 3) 55% (CI 34-71%). Considering any re-operations related to STAR, 52% (26/50) of prostheses were affected by re-operations. Mean pre-operative Kofoed score was 49, which improved to 84 after one year (n = 50), to 90 after ten years (n = 46), and to 89 after 16 years (n = 28). Conclusion: The survival rate for def. 1 and 2 was high. However, re-operations occurred in 52% of all STAR prosthesis.

scholarly journals Long non-coding RNA HAND2-AS1 downregulation predicts poor survival of patients with end-stage dilated cardiomyopathy

2019 ◽  
Vol 47 (8) ◽  
pp. 3690-3698 ◽  
Author(s):  
Xianlu Cheng ◽  
Hong Jiang
Keyword(s):  
Dilated Cardiomyopathy ◽  
Plasma Levels ◽  
Rank Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Poor Survival ◽  
Kaplan Meier ◽  
Non Coding Rna ◽  
End Stage ◽  
Long Non Coding Rna

Objective Insulin-like growth factor-1 (IGF-1) signaling is inhibited in end-stage dilated cardiomyopathy (DCM), and recombinant IGF-1 improves cardiac function in DCM patients. Long non-coding (lnc)RNA HAND2-AS1 was previously shown to be involved in cancer development, but its role in DCM is unknown. The present study investigated the involvement of IGF-1 and HAND2-AS1 in DCM. Methods Plasma HAND2-AS1 was detected by quantitative real-time PCR. IGF-1 plasma levels were measured by a human IGF-1 enzyme-linked immunosorbent assay. All experiments were performed in triplicate. Pearson’s correlation coefficient analyzed correlations between levels of IGF-1 and HAND2-AS1. Patients were divided into high and low IGF-1 or lncRNA HAND2-AS1 groups, and survival curves were plotted and compared by the Kaplan–Meier method and log-rank test, respectively. Results Plasma levels of IGF-1 and lncRNA HAND2-AS1 were significantly lower in end-stage DCM patients than in healthy controls, and were only positively correlated in end-stage DCM patients. A follow-up study revealed that low levels of IGF-1 or lncRNA HAND2-AS1 were significantly associated with poor survival. In the human cardiomyocyte cell line AC16, lncRNA HAND2-AS1 overexpression failed to alter IGF-1 levels and IGF-1 overexpression did not affect lncRNA HAND2-AS1 expression. Conclusions LncRNA HAND2-AS1 may participate in end-stage dilated cardiomyopathy.

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