Displaced scaphoid waist fractures: the use of a week 4 CT scan to predict the likelihood of union with nonoperative treatment

2011 ◽  
Vol 36 (6) ◽  
pp. 498-502 ◽  
Author(s):  
R. Amirfeyz ◽  
A. Bebbington ◽  
N. D. Downing ◽  
J. A. Oni ◽  
T. R. C. Davis
Keyword(s):  
Bone Resorption ◽  
Ct Scan ◽  
Cross Section ◽  
Longitudinal Axis ◽  
Nonoperative Treatment ◽  
Ct Scans ◽  
Fracture Union

This study assessed whether nonunion of displaced scaphoid waist fractures with nonoperative treatment could be predicted from 4 week CT scans. Thirty-one patients with unilateral displaced scaphoid waist fractures and adequate follow-up were included. CT scans in the longitudinal axis of the scaphoid with sagittal and coronal slices were done 4 weeks after the index injury. The effects of fracture gap, sclerosis and bone resorption on union were assessed. Fracture union was observed in all 13 displaced fractures with a <2 mm gap, four of the seven with a gap of 2–3 mm and only four of the 11 with a gap >3 mm ( p = 0.01). Bone resorption involving more than 50% of the fracture cross-section was also associated with nonunion, but sclerosis was not.

Partial Union of Acute Scaphoid Fractures

2005 ◽  
Vol 30 (5) ◽  
pp. 440-445 ◽  
Author(s):  
H. P. SINGH ◽  
D. FORWARD ◽  
T. R. C. DAVIS ◽  
J. S. DAWSON ◽  
J. A. ONI ◽  
...  
Keyword(s):  
Cross Section ◽  
Longitudinal Axis ◽  
The Other ◽  
Ct Scans ◽  
Fracture Union ◽  
Scaphoid Fractures ◽  
Initial Injury ◽  
Wrist Function ◽  
The Cross ◽  
Plaster Immobilization

Sixty-six patients with acute scaphoid fractures were treated non-operatively in a below elbow plaster for 8 to 12 weeks and underwent CT scans along the longitudinal axis of the scaphoid at 12 to 18 weeks. These scans showed that 14 fractures had not united and that 30 had united throughout the whole cross-section of the scaphoid. The other 22 had partially united with bridging trabeculae in some areas of the cross-section. These 22 partial unions were graded as 0% to 24% union (0 cases), 25% to 49% union (5 cases), 50% to 74% union (7 cases), and 75% to 99% union (10 cases). The 12 patients who had less than 75% fracture union were followed-up further and nine underwent another CT scan at 23 to 40 weeks after the initial injury. These showed union across the whole of the cross-section of the fracture in seven cases and 75% to 99% union in the other two cases, who had full and painless wrist function. We conclude that partial union of the scaphoid is a common occurrence but, in most cases, it progresses to full union without the need for prolonged plaster immobilization.

Abstract TP291: Hematoma Retraction and Perihematoma Hypodensity in Neutral Brain Model of Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Shahram Majidi ◽  
Basit Rahim ◽  
Sarwat I Gilani ◽  
Waqas I Gilani ◽  
Malik M Adil ◽  
...  
Keyword(s):  
Biological Activity ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Early Period ◽  
Ct Scans ◽  
Hematoma Expansion ◽  
Human Cadaver ◽  
Fresh Blood ◽  
The Right

Background: The temporal evolution of intracerebral hematomas and perihematoma edema in the ultra-early period on computed tomographic (CT) scans in patients with intracerebral hemorrhage (ICH) is not well understood. We aimed to investigate hematoma and perihematoma changes in “neutral brain” models of ICH. Methods: One human and 6 goat cadaveric heads were used as “neutral brains” to provide physical properties of the brain without any biological activity or new bleeding. ICH was induced by slow injection of 4 ml of fresh blood into the right basal ganglia of the goat brains. Similarly, 20 ml of fresh blood was injected deep into the white matter of the human cadaver head in each hemisphere. Serial CT scans of the heads were performed at 0, 1, 3, and 5 hours after inducing ICH. Analyze software (AnalyzeDirect, Overland Park, KS) was used to measure hematoma and perihematoma hypodensity volumes in the baseline and follow up CT scans. Results: The initial hematoma volumes of 11.6 ml and 10.5 ml in the right and the left hemispheres of the human cadaver brain gradually decreased to 6.6 ml and 5.4 ml at 5 hours, showing 43% and 48% retraction of hematoma, respectively. The volume of the perihematoma hypodensity in the right and left hemisphere increased from 2.6 ml and 2.2 ml in the 1 hour follow up CT scans to 4.9 ml and 4.4 ml in the 5 hour CT scan, respectively. Hematoma retraction was also observed in all six ICH models in the goat brains. The mean ICH volume in the goat heads was decreased from 1.49 ml in the baseline CT scan to 1.01 ml in the 5 hour follow up CT scan showing 29.6% hematoma retraction. Perihematoma hypodensity was visualized in 70% of ICH in goat brains, with an increasing mean hypodensity volume of 0.4 ml in the baseline CT scan to 0.8 ml in the 5 hour follow up CT scan. Conclusion: Our study demonstrated that substantial hematoma retraction and perihematoma hypodensity occurs in intracerebral hematomas in the absence of any new bleeding or biological activity of the surrounding brain. Such observations suggest that active bleeding is underestimated in patients with no or small hematoma expansion and our understanding of perihematoma hypodesity needs to be reconsidered.

scholarly journals Osseous Healing With Nonrigid Suture Fixation in the Arthroscopic Latarjet Procedure

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096448
Author(s):  
Jack W. Weick ◽  
Vivek Kalia ◽  
Emily Pacheco ◽  
Jon A. Jacobson ◽  
Michael T. Freehill
Keyword(s):  
Ct Scan ◽  
Case Series ◽  
Ct Scans ◽  
Suture Fixation ◽  
Latarjet Procedure ◽  
Average Percentage ◽  
Cortical Button ◽  
The Mean ◽  
Graft Migration

Background: The Latarjet procedure is a popular means to surgically address anterior glenohumeral joint instability. Although the Latarjet procedure is becoming increasingly common, challenges persist and include postoperative complications secondary to use of the conventional 2 bicortical fixation screws. Recently, a novel surgical technique using a guided surgical approach for graft positioning with nonrigid fixation via a suture suspensory system has been described. Purpose: To evaluate healing rates and stability of the grafts in patients who underwent this new Latarjet technique. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively gathered anonymized computed tomography (CT) data sets from a total of 107 patients who underwent nonrigid suture fixation using a cortical button fixation for anterior glenohumeral instability. Of the 107 patients, 45 had CT scans performed at 2 different time periods. The CT scans of each patient were compared by 2 fellowship-trained musculoskeletal radiologists. Data recorded included age, sex, date of scan, initial graft position on the glenoid, presence and degree of graft migration relative to the equator on follow-up scan, and percentage of osseous healing (as assessed by osseous bridging) on the follow-up scan. Descriptive statistics were calculated to evaluate the average migration and average percentage of healing at both time points. Results: Our population (n = 45) consisted of 38 men (84.4%) and 7 women (15.6%). The mean age was 27.1 ± 1.1 years. The mean time between initial CT scan (2 weeks postoperatively) and follow-up CT scan was 26 ± 2 weeks. On follow-up scan, reviewer 1 found 75.6% of patients had greater than 75% healing, and reviewer 2 found 70.2% of patients had greater than 75% healing. The center of the graft was measured at or below the equator on follow-up examination in 43 of 45 (95.6%) patients by reviewer 1 and 44 of 45 (97.8%) patients by reviewer 2. Conclusion: Based on these findings, nonrigid suture fixation using a cortical button device offers an effective alternative to traditional screw fixation for the Latarjet procedure with a high level of osseous healing and minimal graft migration.

The Use of Cranial CT Scans in the Triage of Pediatric Patients With Mild Head Injury

PEDIATRICS ◽  
1995 ◽  
Vol 95 (3) ◽  
pp. 345-349
Author(s):  
Robert L. Davis ◽  
Michael Hughes ◽  
K. Dean Gubler ◽  
Patti L. Waller ◽  
Frederick P. Rivara
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Ct Scan ◽  
Case Series ◽  
Ct Scans ◽  
Mild Head Injury ◽  
Retrospective Case ◽  
Cranial Ct ◽  
Case Series Study

Objective. Recent evidence suggests that patients with a normal cranial CT scan after head injury can be safely discharged home from the emergency department. However, supporting data from previous studies has relied on incomplete patient follow-up. We utilized a statewide comprehensive hospital abstract reporting system (CHARS) to assess whether children with normal CT scans after head injury subsequently developed intracranial sequelae in the month following their initial injury. Design. Retrospective case-series study, with comprehensive statewide follow-up for 1 month. Setting. The emergency department of a Level 1 Trauma Center in Seattle, Washington. Participants. All children (n = 400) with head injury, Glasgow Coma Score of 13 to 15, and initial normal CT scan seen over a 4.5-year time period. All were matched against CHARS to evaluate admissions within 30 days after emergency department disposition. For readmissions, International Classification of Diseases (9th revision) discharge and procedure information was collected. All children were also matched against the state death files. Results. Four children were readmitted for neurologic reasons within 1 month following injury. One child on coumadin for heart disease developed a symptomatic subdural hematoma 5 days after head injury, requiring neurosurgical drainage. One child developed a symptomatic hemorrhagic contusion 3 days after injury, requiring observation only. Two children were readmitted 1 day after injury for concussive symptoms; both were discharged home after observation only. There were no deaths among the study population. Conclusions. Among children with a normal cranial CT scan after mild head injury, delayed intracranial sequelae requiring intervention are extremely uncommon. In otherwise stable patients, a normal cranial CT scan can identify patients to be safely discharged from the emergency department, and would be more cost-effective than 1 to 2 days of hospital observation.

High Risk Adva­nced Stage Hodgkin Lymphoma Is Well Controlled with 2 Cycles of Escalated Beacopp Followed By 4 Cycles of ABVD in Patients Who Rapidly Achieve Metabolic CR on Interim PET/CT Scan

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4442-4442
Author(s):  
Meirav Kedmi ◽  
Arie Apel ◽  
Tima Davidson ◽  
Elinor Goshen ◽  
Yaron Davidovitz ◽  
...  
Keyword(s):  
High Risk ◽  
Prospective Study ◽  
Ct Scan ◽  
Ct Scans ◽  
Hematological Toxicity ◽  
Advanced Stage ◽  
Entire Cohort ◽  
Interim Pet ◽  
Pet Ct

Abstract Patients with advanced stage Hodgkin Lymphoma (HL) and high international prognostic score (IPS≥3), treated with ABVD, have low freedom from progression, estimated as 60-65% at 5 years. Six cycles of escalated (esc) BEACOPP significantly improved the outcome of patients with advanced stage HL with progression free survival (PFS) of 90% and overall survival (OS) of 95% at 5 years. However, 6 cycles of escBEACOPP are associated with significant hematological toxicity and infections, as well as late adverse effects, such as increased incidence of myelodsysplastic syndrome (MDS), acute myeloid leukemia (AML) and infertility. In this retrospective study we analyzed the survival outcome of poor risk advanced stage HL patients who were treated with response- adapted therapy, tailored by the results of early interim FDG-PET/CT scans, after the initial 2 cycles of escBEACOPP. After complete or partial responses were obtained with this regimen, treatment was then de-escalated to 4 cycles ABVD. A total of sixty nine patients were evaluated, 45 of whom participated in the multicenter phase II prospective study which was conducted between 2001 and 2007 (Avigdor et al, Ann Oncol. 2010). The current study includes analyses of long term outcome of the former group, as well as the outcome of an additional 24 consecutive patients who were treated with the same protocol at Sheba Medical Center since the termination of the prospective study. The response and survival outcomes were defined according to the revised response criteria for malignant lymphoma. Scans were scored as positive or negative based only on visual assessment, according to guidelines adopted by the International Harmonization Committee. Survival was calculated with the Kaplan-Meier method and survival comparison was analyzed with the Log-Rank test. Forty five (65 %) were males and median age was 30 years (19-59). The most frequent subtype of HL was nodular sclerosis (78%). Four patients (6%) had unfavorable stage IIB, 12 (17%) had stage III and 53 (77%) had stage IV disease. Nine patients (13%) had an IPS <3, the remaining 60 patients (87%) had 3 or more IPS risk factors. Four patients received involved field radiotherapy with 30 Gy to the initial site of bulky mediastinum, after completion of chemotherapy. After a median follow-up of 5.6 years (0.4-11), 4 patients (6%) have died: 2 due to advanced HL, 1 from catastrophic APLA syndrome and 1 from lung carcinoma; the latter 2 patients were in complete response (CR). After the initial 2 cycles of escBEACOPP,52(75%) patients were in CR and 17 (25%) achieved partial response (PR). Five-year OS for the entire cohort was 93%. Importantly, OS was predicted by the results of the early-interim PET/CT scans: patients in CR had OS of 98% while those in PR had OS of 79% at 5 years (Figure 1A, p=0.015). Seventeen patients (25%) relapsed or progressed. Five-year PFS for the entire cohort was 76%, median PFS was not reached. Early-interim PET/CT results did not predict PFS at 5 years (80% for patients in CR and 60% for patients in PR, Figure 1B, p=0.2) most probably due to small sample size. The presence of extranodal disease or bulky mediastinal mass (≥10 cm on CT scan) did not predict treatment failure. As expected, grade 3-4 acute hematological toxicity was more frequent during the first 2 cycles of escBEACOPP than in the comparable ABVD phase. There was no treatment related mortality, and until now no cases of AML or MDS have been encountered. In conclusion, the current retrospective analysis indicates that combined escBEACOPP-ABVD therapy is well tolerated and certainly less toxic than 6 cycles of escBEACOPP. In patients receiving escBEACOPP-ABVD regimen, negative early-interim PET activity reliably predicted an excellent outcome, while a positive result partly identified patients with a worse prognosis. Based on relatively long follow-up data, it appears that high risk advanced HL patients, who achieve early metabolic CR (after 2 cycles of escBEACOPP), have a favorable outcome after de-escalating therapy to the less toxic ABVD regimen. Disclosures No relevant conflicts of interest to declare.

Low-grade gliomas in children: tumor volume response to radiation

1998 ◽  
Vol 88 (6) ◽  
pp. 969-974 ◽  
Author(s):  
Barbara J. Fisher ◽  
Glenn S. Bauman ◽  
Christopher E. Leighton ◽  
Larry Stitt ◽  
J. Gregory Cairncross ◽  
...  
Keyword(s):  
Ct Scan ◽  
Tumor Volume ◽  
Residual Tumor ◽  
Ct Scans ◽  
Low Grade ◽  
Tumor Shrinkage ◽  
Content Type ◽  
Low Grade Gliomas ◽  
Fine Print

Object. The authors conducted a retrospective review to examine and document the frequency, degree, and timing of the radiologically confirmed response to radiotherapy of low-grade gliomas in children. Methods. Between 1963 and 1995, 80 patients 17 years of age or younger were referred to the London Regional Cancer Centre in London, Ontario after diagnosis of a low-grade glioma. All patients underwent surgical resection or biopsy procedures and 47 underwent radiotherapy (40 postoperatively and seven at the time of tumor progression). Nineteen patients with residual measurable lesions who received radiation therapy were selected for volumetric analysis of tumor response to this treatment. The extent and timing of response to radiation were determined by the process of comparing postoperative, preirradiation computerized tomography (CT) scans with postirradiation, follow-up CT scans. For one patient the comparison was made by using serial magnetic resonance images. Residual tumor was found on postoperative CT scans in all cases. The mean preradiotherapy tumor volume was 17.1 cm3, and the postradiotherapy volume was reduced to a mean of 11.5 cm3. A reduction in tumor volume was demonstrated in eight patients by the time of their first postirradiation follow-up CT scan and in two patients a slower reduction in volume over time was shown, bringing the total number of “responders” to 10. In five of these 10 patients the tumor had shown a maximum response by the time of the first postirradiation CT scan; the median time to response was 3.3 months. A 25% or greater reduction in tumor volume was seen in eight (42%) of the 19 patients. A 50% or greater reduction was noted in five (26%) of the patients. A complete response was demonstrated at 7, 12, and 15 months, and 5 years, respectively, in four patients (21%). One responder's tumor eventually increased in size after radiotherapy and he died of his disease. The magnitude of the radiographically demonstrated response to radiation did not correlate significantly with clinical outcome (that is, survival or symptom improvement). Conclusions. On the basis of this CT scan analysis of the response of low-grade gliomas in children to radiotherapy, the authors suggest that these lesions respond to radiation, as demonstrated by tumor shrinkage on serial imaging. Major or complete responses occur occasionally. However, low-grade gliomas in children mimic other benign brain tumors such as pituitary adenomas and meningiomas in that, although growth is frequently arrested after radiotherapy, residual tumor can persist for many years, illustrating that tumor shrinkage may not be a good measure of treatment efficacy. Nevertheless, radiation therapy can result in improvement of clinical symptomatology in association with or independent of visible tumor reduction. As radiation treatment techniques become increasingly conformal and because studies indicate that lower doses of radiation may be equally effective, improvement of symptoms may be an important consideration when weighing treatment options, particularly in patients with residual or unresectable disease.

scholarly journals The Necessity of Follow-Up Brain Computed-Tomography Scans: Is It the Pathology Itself Or Our Fear that We Should Overcome?

2017 ◽  
Vol 5 (6) ◽  
pp. 740-743
Author(s):  
Ahmet Öğrenci ◽  
Orkun Koban ◽  
Murat Ekşi ◽  
Onur Yaman ◽  
Sedat Dalbayrak
Keyword(s):  
Ct Scan ◽  
Pediatric Patients ◽  
Obstructive Hydrocephalus ◽  
Hospital Setting ◽  
Ct Scans ◽  
Time Interval ◽  
Clinical Approach ◽  
Abnormal Finding ◽  
Brain Ct

AIM: This study aimed to make a retrospective analysis of pediatric patients with head traumas that were admitted to one hospital setting and to make an analysis of the patients for whom follow-up CT scans were obtained.METHODS: Pediatric head trauma cases were retrospectively retrieved from the hospital’s electronic database. Patients’ charts, CT scans and surgical notes were evaluated by one of the authors. Repeat CT scans for operated patients were excluded from the total number of repeat CT scans.RESULTS: One thousand one hundred and thirty-eight pediatric patients were admitted to the clinic due to head traumas. Brain CT scan was requested in 863 patients (76%) in the cohort. Follow-up brain CT scans were obtained in 102 patients. Additional abnormal finding requiring surgical intervention was observed in only one patient (isolated 4th ventricle hematoma) on the control CTs (1% of repeat CT scans), who developed obstructive hydrocephalus. None of the patients with no more than 1 cm epidural hematoma in its widest dimension and repeat CT scans obtained 1.5 hours after the trauma necessitated surgery.CONCLUSION: Follow-up CT scans changed clinical approach in only one patient in the present series. When ordering CT scan in the follow-up of pediatric traumas, benefits and harms should be weighted based upon time interval from trauma onset to initial CT scan and underlying pathology.

scholarly journals Long-Term Results of the Treatment of Persons with Hodgkin's Lymphoma in a Resource-Constrained Setting: Real-World Data from a Single Center

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Luisa Fernanda Sánchez-Valledor ◽  
Thomas M. Habermann ◽  
Iván Murrieta-Álvarez ◽  
Andrés A. León-Peña ◽  
Yahveth Cantero-Fortiz ◽  
...  
Keyword(s):  
Stem Cell ◽  
Lymph Node ◽  
Ct Scan ◽  
Peripheral Blood ◽  
Fdg Pet ◽  
Clinical Stage ◽  
Ct Scans ◽  
Ann Arbor ◽  
Pet Scans

Background: Hodgkin's lymphoma (HL) is the model of curative care with radiation therapy, combination chemotherapy, staging approaches, peripheral blood stem cell transplantation, and immunotherapy. However, the value of the novel anti cancer drugs has been recently analyzed and questioned in view of the results in the real improvement of overall survival (OS). Material and methods: All consecutive patients seeking medical care after 1986 in our institution as a result of HL and followed for at least 3 months were entered in the study. A diagnosis of HL was based on the histological study of a pathology specimen, mainly a lymph node; the same pathologist analyzed all the specimens and defined the histological subtype. Clinical stage was defined according to the Ann Arbor classification. Bone marrow biopsies were done only in patients with clinical stages III or IV. Computed tomography (CT) scans were done in all cases, prior to starting the treatment. Fluorodeoxyglucose positron emission tomography (FDG-PET) scans were performed since 2002. Between 1986 and 1997, patients were treated with MOPP, and after 1997 with ABVD as frontline therapy. For stages I and II, four cycles of chemotherapy were delivered and a computerized tomography (CT) scan was performed; if lymph node enlargement were present at this point in time, four additional cycles were given, whereas two additional cycles were given if the CT scan was negative. For stages III and IV, the CT scans were performed at the end of six cycles and two or four more cycles. Mediastinal radiotherapy was delivered only to persons with a positive FDG-PET scan at the end of the treatment. Patients showing activity after these treatments were considered as refractory and treated with four courses of ICE (ifosfamide, carboplatin and etoposide). Autologous or allogeneic peripheral blood hematopoietic stem cell transplants (HSCT) were given to refractory patients after achieving a complete remission (CR): High-dose melphalan (200mg/m2) was employed in autologous transplants, whereas cyclophosphamide, fludarabine and busulfan were employed in allogeneic transplants, all of them from HLA-identical siblings. After the completion of the treatment, patients were every two months for one year and every four months later on. No FDG-PET scans were done during the follow up, unless clinically indicated. Results: Among 91 patients with HL identified between 1986 and 2020, 88 were followed three months or more and were included in the analysis. There were 37 females and 51 males. The median age was 29years (range5-73years). There were 62 patients with nodular sclerosing HL (70%), 19 mixed cellularity (HL), 2 lymphocyte depleted HL, and one lymphocyte predominant HL; in 4 cases the histologic variant could not be defined. According to Ann Arbor classification, 5 patients were found in stage I, 48 in stage II, 19 in stage III and 16 in stage IV. Ten patients presented with a mediastinal mass larger than 10 cm. in the chest X-ray film. Three cases presented with relapsed disease. Patients have been followed for a median of 114 months (range4-402). 44 patients are alive, 10 have died and 34 were lost to follow-up. Median OS for all the patients has not been reached, being above 402 months, the OS at 310 months is 88% and at 402 months 77%. Median OS has not been reached and is above 94, 109, 90 and 98 months for stages I, II, III and IV, respectively (p=0.2). The 310-month OS was 83% for patients treated with MOPP and 88% for those treated with ABVD (HR:0.76, 95% CI 0.2-2.8; p=0.6).Sixteen patients (18%) were refractory to the treatment and 9 (10%) relapsed; they were treated with ICE followed by HSCT (autologous 15 patients and allogeneic 10 patients). Patients who underwent auto-HSCT had a median survival of 329.1 months and an OS of 92.3%, whereas those given allo-HSCT had a median survival of 59.3 months and an OS of 45.7% (HR0.2, 95%CI 0.04-1.3, p=0.057). The OS of patients given or not HSCT was 73.5% and 92.9% at 266 and 404 months, respectively (HR4.09, 95%CI 1.0-16.6, p=0.01). The OS was similar. The causes of death were breast carcinoma in 2 cases, liver carcinoma in one and uncontrolled lymphoma activity in the remaining. Conclusion: HL may be less aggressive in Mexican population than in Caucasians. Combined chemotherapy renders acceptable results, irrespective of clinical stage. Disclosures No relevant conflicts of interest to declare.

Importance of Computed Tomography (CT) in Talar Neck Fractures. Case Studies

2018 ◽  
Vol 20 (1) ◽  
pp. 31-42 ◽  
Author(s):  
Tomasz Stołtny ◽  
Jarosław Pasek ◽  
Maria Leksowska-Pawliczek ◽  
Alina Ostałowska ◽  
Małgorzata Piechota ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Ankle Joint ◽  
Weight Bearing ◽  
Correct Diagnosis ◽  
Ct Scans ◽  
Type I ◽  
Joint Rotation ◽  
Talar Neck Fractures

Computed tomography is a modern technique producing high quality image of scanned organs. It plays a significant role in diagnostic work-up on orthopedics wards. This paper presents an analysis of management of two cases of Hawkins type I talar neck fracture with ankle joint rotation. In both patients, the diagnosis was based on conventional radiographs of the ankle joint in two projections and was subsequently verified with CT scans. The findings of a CT scan of the talus had a significant impact on further treatment and physiotherapy. Non-surgical treatment consisting in immobilization with a short leg cast combined with medication and magnetic field therapy produced a positive therapeutic outcome. A follow-up CT scan of the talus revealed bone union with remodelling in both patients. The functional outcome according to the AOFAS scale should be regarded good. Computed tomography is the radiological modality for detecting talar neck fractures and determining the presence of displacement. Follow-up CT scans evaluate the natural process of bone healing, which is crucial for treatment decisions regarding weight-bearing status. A correct diagnosis based on CT helps to prevent the development of necrosis and posttraumatic (secondary) degenerative changes as well as advanced physical disability, especially among youn­ger patients, in whom the injury is most common, consequently helping to avoid a long and costly treatment.

Active Surveillance Strategies Have Neither Clinical or Survival Benefit Following High-Dose Chemotherapy and Progenitor Cell Rescue in Follicular Lymphoma.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3251-3251
Author(s):  
Marco Gerlinger ◽  
Janet Matthews ◽  
Andy Davies ◽  
T. Andrew Lister ◽  
Silvia Montoto ◽  
...  
Keyword(s):  
Stem Cell ◽  
Follicular Lymphoma ◽  
Ct Scan ◽  
Median Time ◽  
Ct Scans ◽  
High Dose ◽  
Clinical Relapse ◽  
Stem Cell Rescue ◽  
Time To Relapse

Abstract Introduction: Annual surveillance CT scans and bone marrow (BM) biopsies are frequently performed in follow-up of patients (pts.) receiving high-dose therapy (HDT) with autologous stem cell rescue for recurrent follicular lymphoma (FL). The impact of this active surveillance strategy on the outcome of a homogeneously treated population was analysed. Methods: Ninety-nine consecutive pts. who received HDT (cyclophosphamide and total body irradiation) with autologous stem cell rescue for recurrent FL at St Bartholomew’s Hospital between February 1986 and October 1991 were included. The surveillance policy at that time included an annual CT scan and BM biopsy. Time to relapse, time to next treatment and overall survival (OS) from the time of HDT were calculated and compared, according to whether disease progression had been diagnosed on the basis of surveillance investigations or on clinical grounds. Seventy out of 99 pts. are evaluable, the remainder are not, due to: relapse or death within one year of HDT (20 pts.), follow-up elsewhere (8 pts.) or patient’s wishes (1 pt.). 86% of pts. who commenced surveillance actually had annual CT scans and BM biopsies until disease progression or death. Results: After a median follow-up of 16.7 years (y), progression was documented in 35/70 pts. (50%). It was detected by surveillance alone in 14 pts. and clinically, in 21 pts. (40% and 60% of all recurrences, respectively). The commonest presentations of clinical relapse were peripheral lymphadenopathy (62%), pain (19%) and B-symptoms (10%). Surveillance relapses were diagnosed on the basis of a CT scan in 43% of pts., a BM biopsy in 36% and both in 14%. The median time from HDT to relapse was 2y for pts. with a clinically detected relapse and 2.8y in those with a surveillance relapse but the difference was not statistically significant (p=0.2). Treatment was started immediately in 13 of 21 pts. (62%) with a clinical relapse, contrasting with only one of 14 pts. (7%) diagnosed on surveillance. The main reasons for starting treatment were biopsy-proven transformation to diffuse large B-cell pathology (8 of the pts. with a clinical relapse and one with a surveillance relapse) and rapidly progressing lymphadenopathy. All other pts. were managed expectantly (observation). The median time from HDT until clinical progression was 8.2y in the 14 pts. whose relapse was detected by surveillance; 4 of the 14 have not yet developed signs or symptoms of recurrence. Thus, the clinical relapse rate in the cohort under surveillance is 44% (31/70). Six of the pts. with a surveillance relapse have still not started treatment (median follow-up: 13.8y; range: 1.9y–22.1y). Only 2 of the 21 pts. with a clinically detected relapse have not started treatment after 5.6y and 14.3y of follow-up. Thus, the median time from HDT to next treatment was significantly shorter for pts. with a clinical relapse (3.6y) in comparison with those in whom the recurrence was diagnosed by surveillance investigations (11.3y; p=0.0004). Median OS was 5.6y and 13.4y for pts. with a clinical and a surveillance relapse, respectively (p=0.03). Conclusions: In pts. with FL, relapses diagnosed on the basis of surveillance investigations usually have an indolent course and frequently do not require treatment. In contrast, clinically detected relapses have a more aggressive clinical course and treatment is initiated immediately in the majority of cases. Thus, annual surveillance investigations do not help to identify pts. that require treatment and do not improve the outcome of this population. They should therefore be abandoned. Time to relapse based on data from pts. on annual surveillance should be interpreted with caution because of the poor correlation with time to next treatment and OS.

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