Decreased Incidence of Osteonecrosis of the Jaw (ONJ) in Patients with Multiple Myeloma (MM) Treated with Zoledronic Acid (ZA) after Application of Preventive Measures.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3609-3609 ◽  
Author(s):  
Meletios Athanasios Dimopoulos ◽  
Efstathios Kastritis ◽  
Christina Bamia ◽  
Ioannis Melakopoulos ◽  
Dimitra Gika ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Preventive Measures ◽  
Score Test ◽  
Osteonecrosis Of The Jaw ◽  
Incidence Rates ◽  
Exact Test ◽  
Analysis Group ◽  
Dental Procedures ◽  
Group A ◽  
Group B

Abstract Background. Bisphosphonates are widely used in the treatment of MM. ONJ can occur during treatment with bisphosphonates. We have shown that use of ZA and longer exposure are associated with higher frequency of ONJ in a series of patients with both MM and solid tumors. Dental problems or interventions are precipitating factors of ONJ. For this reason, since 2003, we have implemented assessment (and management if necessary) of all patients who are candidates for ZA or who are on treatment with ZA and have dental problems by specialists with particular experience on ONJ. In addition, we recommend improved oral hygiene and we avoid dental procedures during treatment with ZA. We have investigated whether the occurrence of ONJ decreased after the implementation of these measures. Patients and Methods. According to the policy of our center, all patients with MM who demonstrate lytic lesions or osteopenia receive ZA 4 mg i.v. every 4 weeks indefinitely. In our current analysis we included patients who received only ZA wheras patients who initially received pamidronate and were later switched to ZA were excluded. Patients were stratified into two groups depending on the date of initiation of treatment in relation to the start of implementation of the preventive measures (Group A: 26/8/1998–31/12/2002, Group B: 1/1/2003–1/12/2006). Occurrence of ONJ was studied as row percentages as well as incidence rate rates (IR: number of cases of osteonecrosis /person-months). The proportions of patients with ONJ between the two groups were compared with the Fisher’s exact test whereas the respective incidence rates were compared with the score test. The 95% confidence interval of the incidence rate ratio was also estimated. Results. One hundred twenty-eight patients with MM were included in the analysis (Group A: 35, Group B: 93; M/F: 66/62). Overall there were 10 cases of ONJ (8%): 8 cases in Group A (23%) and 2 cases in Group B (2%) (p<0.001). The IR was 0.560/100 person-month for Group A and 0.118/100 person-month for Group B. The IRR was Group A/Group B: 4.76 (p=0.029, 95% CI: 1.01–22.40). Median time of exposure among patients with ONJ was 31 months for Group A and 8 months for Group B (p=0.044). Conclusions. The implementation of detailed assessment by experienced specialists of patients with MM and dental problems and the avoidance of dental procedures during treatment with ZA results in a significant 5-fold reduction of ONJ. Our data provide a basis for a safer use of ZA in MM.

scholarly journals A study of crystalluria: effectiveness of including hygienic-dietary recommendations in laboratory reports

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Paula Sienes Bailo ◽  
María Santamaría González ◽  
Silvia Izquierdo Álvarez ◽  
Raquel Lahoz Alonso ◽  
Patricia Serrano Frago ◽  
...  
Keyword(s):  
General Population ◽  
Observational Study ◽  
Renal Colic ◽  
Incidence Rates ◽  
Retrospective Observational Study ◽  
Dietary Recommendations ◽  
Group A ◽  
Group B

Abstract Objectives To assess the effectiveness of incorporating hygienic-dietary recommendations in laboratory reports in reducing the incidence of renal colic (RC). A study was performed to compare the incidence of RC in two groups of patients who had suffered at least a crystalluria event associated with the risk of urolithiasis. Recommendations were only incorporated in the laboratory reports of one group. Methods A retrospective observational study. The study sample was composed of patients who had at least an episode of crystalluria associated with a higher risk of urolithiasis. The laboratory reports of patients in Group A (n=1,115), treated in 2017, did not include any hygienic-dietary recommendations, whereas patients in Group B (n=1,692), treated in 2018, received hygienic-dietary recommendations through their laboratory reports. χ2 and Mann-Whitney U test were used to assess differences based on sex, age, and type of urinary crystals. Results The incidence of RC was 2.02 times higher in group A (2.24%) than in group B (1.12%). No significant differences were observed in the incidence of RC based on the type of urinary crystal. The incidence of RC was substantially higher in patients who suffered at least an event of crystalluria associated with a higher risk for urolithiasis as compared to the general population during the same period (0.46%, consistently with the incidence rates reported in the literature). Conclusions The incorporation of messages alerting on the risk of urolithiasis and the inclusion of hygienic-dietary recommendations in laboratory reports may be useful for reducing the incidence of RC.

Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

2021 ◽  
Author(s):  
Beniamino Brunetti ◽  
Rosa Salzillo ◽  
Stefania Tenna ◽  
Bruno Brunetti ◽  
Mario Alessandri Bonetti ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Locoregional Recurrence ◽  
Demographic Data ◽  
Exact Test ◽  
Significant Difference ◽  
Chi Squared ◽  
Group A ◽  
The Aesthetic ◽  
One Year ◽  
Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

Prevention of postoperative posterior tethering of spinal cord after resection of ependymoma

2003 ◽  
Vol 99 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Takeo Goto ◽  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Misao Nishikawa ◽  
Akimasa Nishio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Deterioration ◽  
Fisher Exact Test ◽  
Content Type ◽  
Exact Test ◽  
Spinal Ependymoma ◽  
Group A ◽  
Delayed Neurological Deterioration ◽  
Group B ◽  
Fine Print

Object. The authors evaluated an alternative method to avoid postoperative posterior tethering of the spinal cord following resection of spinal ependymomas. Methods. Twenty-five patients with spinal ependymoma underwent surgery between 1978 and 2002. There were 16 male and nine female patients whose ages at the time of surgery ranged from 14 to 64 years (mean 41.8 years). The follow-up period ranged from 6 to 279 months (mean 112.4 months). In the initial 17 patients (Group A), the procedure to prevent arachnoidal adhesion consisted of the layer-to-layer closure of three meninges and laminoplasty. In the subsequently treated eight patients (Group B), the authors performed an alternative technique that included pial suturing, dural closure with Gore-Tex membrane—assisted patch grafting, and expansive laminoplasty. In Group A, postoperative adhesion was radiologically detected in eight cases (47%), and delayed neurological deterioration secondary to posterior tethering of the cord was found in five cases. In Group B, there was no evidence of adhesive posterior tethering or delayed neurological deterioration. A significant intergroup statistical difference was demonstrated for radiologically documented posterior tethering (p < 0.05, Fisher exact test). Moreover, patients with radiologically demonstrated posterior tethering suffered a significant delayed neurological functional deterioration (p < 0.01, Fisher exact test). Conclusions. This new technique for closure of the surgical wound is effective in preventing of postoperative posterior spinal cord tethering after excision of spinal ependymoma.

scholarly journals Effect of Ultrasound Therapy with Cryokinetics versus Ultrasound Therapy with Soft Tissue Massage (Deep Friction Massage) in Acute Supraspinatus Tendinitis - A Comparative Study

2021 ◽  
Vol 11 (7) ◽  
pp. 249-256
Author(s):  
Pradeep Krishna Reddy ◽  
Jayashree Dey ◽  
Yashodhara S Joshi
Keyword(s):  
Soft Tissue ◽  
Analogue Scale ◽  
Ultrasound Therapy ◽  
Exclusion Criteria ◽  
Functional Scale ◽  
Analysis Group ◽  
Total Treatment ◽  
Group A ◽  
Group B ◽  
Supraspinatus Tendinitis

Background and Objective: In supraspinatus tendinitis there is inflammatory and or degenerative changes of tendon. This study was done to assess the effectiveness of ultrasound and cryokinetics versus ultrasound and soft tissue massage (deep friction massage) in patients with acute supraspinatus tendinitis. Method: All subjects were clinically diagnosed by orthopaedician and were screened as per the inclusion and exclusion criteria. 60 patients were randomly divided into 2 groups with n= 30 each group, Group A- received ultrasound therapy and cryokinetics, whereas Group B- received ultrasound therapy and soft tissue massage. The treatment was given 1 session/day, 6 days/week. The total treatment duration was for 2 weeks. Outcome Measures: Patients were evaluated on day 1, day 7 and day 14. All the patients were assessed for pain and shoulder functional scale by taking VAS and SPADI. Results: Both the groups showed statistically significant changes in pre and post values. However, Group B showed greater improvement from baseline to week 1 on VAS and SPADI. After analysis group B showed significance with P<0.001*. Conclusion: Ultrasound therapy with cryokinetics, and ultrasound therapy with soft tissue massage both were effective in reducing pain intensity and increasing the shoulder functional scale but ultrasound therapy with soft tissue massage showed superior hand over ultrasound therapy with cryokinetics. Key words: Acute Supraspinatus Tendinitis, Ultrasound Therapy, Cryokinetics, Soft Tissue Massage, Visual Analogue Scale, Shoulder Pain And Disability Index.

scholarly journals Single penile incision for combined hypospadias and inguinal surgery: A comparative study

2017 ◽  
Vol 11 (5) ◽  
pp. 192
Author(s):  
Michael E. Chua ◽  
Naif Alqarni ◽  
Jessica M. Ming ◽  
Fahad Alyami ◽  
Joana Dos Santos ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Operative Time ◽  
Conventional Approach ◽  
Fisher Exact Test ◽  
Hypospadias Repair ◽  
Exact Test ◽  
Group A ◽  
Baseline Characteristics ◽  
Group B ◽  
Inguinal Surgery

Introduction: We sought to compare the surgical outcomes of hypospadias repair with correction of inguinal pathology using a single penile incision vs. conventional approach using two incisions.Methods: This is a retrospective study that reviewed all patients who underwent concurrent surgical repair for both hypospadias and inguinal pathologies between January 2003 and November 2015. Patients were classified into Group A, conventional (inguinal or scrotal and penile incision) approach; or Group B, single penile incision approach. Baseline characteristics, including age, degree of hypospadias, type and laterality of inguinal pathology, operative time, and surgical outcomes, were collected. Between groups, variable comparisons were analyzed using Mann-Whitney U-Test and Fisher-exact test. Statistical significant set at <0.05.Results: Seventy-six patients (Group A: 40; Group B: 36) were eligible for study. Baseline characteristics of both groups were comparable, with no significant statistical difference. Overall meanoperative time for Group A was 139.3 ± 56.2 minutes, while Group B was 107.8 ± 46.7 minutes (Z=2.6; U=470.5; p=0.009). Two patients in Group A and two patients in Group B had testicularascension, all of which also had hypospadias-related complications (p=1.0). Hypospadias-related complications in Group A included seven urethrocutaneous fistulae and two repair dehiscence. Eighturethrocutaneous fistulae, one urethral stricture, and two repair dehiscence occurred in Group B (p=0.448). Surgical outcome appearance in both groups were comparable, with no statisticallysignificant difference (p=0.466).Conclusions: Single penile incision for both hypospadias repair and correction of inguinal pathology is a feasible technique and comparable to the conventional approach, with similar surgical outcomes and shorter overall operative time.

scholarly journals CutL: an alternative to Kulldorff’s scan statistics for cluster detection with a specified cut-off level

2017 ◽  
Author(s):  
Barbara Więckowska ◽  
Justyna Marcinkowska
Keyword(s):  
Monte Carlo ◽  
Incidence Rate ◽  
Sensitivity And Specificity ◽  
Multiple Comparisons ◽  
Incidence Rates ◽  
Cluster Detection ◽  
Scan Statistics ◽  
Reference Level ◽  
Statistical Software ◽  
Exact Test

When searching for epidemiological clusters, an important tool can be to carry out one’s own research with the incidence rate from the literature as the reference level. Values exceeding this level may indicate the presence of a cluster in that location. This paper presents a method of searching for clusters that have significantly higher incidence rates than those specified by the investigator. The proposed method uses the classic binomial exact test for one proportion and an algorithm that joins areas with potential clusters while reducing the number of multiple comparisons needed. The sensitivity and specificity are preserved by this new method, while avoiding the Monte Carlo approach and still delivering results comparable to the commonly used Kulldorff’s scan statistics and other similar methods of localising clusters. A strong contributing factor afforded by the statistical software that makes this possible is that it allows analysis and presentation of the results cartographically.

Isozyme variation, morphology, and growth response to temperature in Pythium irregulare

1997 ◽  
Vol 75 (12) ◽  
pp. 2073-2081 ◽  
Author(s):  
D. J. S. Barr ◽  
S. I. Warwick ◽  
N. L. Desaulniers
Keyword(s):  
Growth Rate ◽  
Pythium Ultimum ◽  
Morphological Characters ◽  
Published Data ◽  
Pythium Irregulare ◽  
Analysis Group ◽  
Wide Range ◽  
Pythium Sylvaticum ◽  
Group A ◽  
Group B

Isozyme-based genetic diversity, morphological characters, and growth rate at different temperatures were compared in a worldwide collection of 125 isolates presumed to be Pythium irregulare Buisman. The isozyme data was analysed with previously published data for Pythium ultimum Trow and Pythium sylvaticum Campbell & Hendrix. UPGMA cluster analysis yielded a dendrogram with four distinct groups: P. ultimum, P. sylvaticum, and two for P. irregulare. Putative P. irregulare isolates were separated into 33 multilocus genotypes defined by 11 isozyme loci: group A contained 116 isolates in 25 genotypes, and group B, 8 isolates in 7 genotypes. One genotype with a single isolate was determined as P. sylvaticum. Based on the isozyme analysis, group B was considered a distinct taxonomic entity from group A, but lacked any unique morphological character. There was a wide range in oogonium and oospore sizes among different isolates of P. irregulare, with those in group B generally being larger. Some isolates in group A had well developed oogonial spines, but others were essentially spineless, whereas all those in group B were spineless. Both groups A and B contained isolates with distinctly aplerotic oospores and others with essentially plerotic oospores. Antheridial number and shape were highly variable both within and among isolates in the two groups. Growth rate over a range of temperatures varied among isolates in both groups and was not a reliable taxonomic criterion. The irregular shape of oogonia and, when present, oogonial spines were the only reliable characters for distinguishing P. irregulare isolates from other taxa. Key words: taxonomy, Oomycetes, Pythiaceae, Pythium ultimum, Pythium sylvaticum.

Bisphosphonates and Osteonecrosis of the Jaw: Advantages of a New Schedule.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3590-3590
Author(s):  
Patrizia Zappasodi ◽  
Alessandro Corso ◽  
Marzia Varettoni ◽  
Catherine Klersy ◽  
Gianmatteo Pica ◽  
...  
Keyword(s):  
Median Time ◽  
Standard Treatment ◽  
Performance Status ◽  
Pathologic Fracture ◽  
Disease Status ◽  
Osteonecrosis Of The Jaw ◽  
Standard Group ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: Bisphosphonates (Bi) have been proven to be effective in preventing or delaying skeletal complications in multiple myeloma (MM) with a significant improvement of the quality of life. The 2002 ASCO guidelines indicate that once initiated intravenous Bi should be continued until an evident substantial decline of performance status. Recently, osteonecrosis of the jaw (ONJ) has been reported as complication of intravenous Bi treatment, with an incidence ranging between 6 and 13% and a greater occurrence in patients (pts) receiving zoledronic acid (Zol) than in those treated with pamidronate (Pam). Aim. In this retrospective study we evaluated the incidence of ONJ and of skeletal related events (SRE) in a cohort of MM pts divided in two groups according to the schedule of administration of Bi; group A: monthly administrations until tolerated (standard), group B: monthly administrations during the first year and then every 3 months (reduced). Methods: One hundred and six MM pts (M: 63, F: 43) were included in this study: 51 pts received a standard treatment (group A) and 55 a reduced schedule (group B). Pam 90 mg i.v. was administered as a three hour infusion and Zol 4 mg i.v. as a 15 minutes infusion. SRE was defined as: pathologic fracture, radiation to bone, spinal cord compression with vertebral fracture, hypercalcemia. Results: No difference was found between the two groups concerning pts characteristics at the onset: age, sex, extension of bone disease, status of the disease (progressive or responsive). Twenty pts received only Pam, 42 only Zol and 44 pts Pam followed by Zol. The distribution of the different type of Bi was not different in the two groups. ONJ occurred in 7 pts (6.6%) with a significant difference between the two groups: 6 pts in standard schedule (11.7%) and 1 in the reduced (1.8%), p=0.01, after a median time of 22.8 months in group A, and 37.8 months in the case of group B. Four of out 7 ONJ occurred during the second year of treatment (12–24 months): that period resulted significantly related (p=0.000) to the occurrence of ONJ with respect to the others (24–38 months, 40–100 months). All ONJ occurred in pts treated with Zol alone (5 pts) or with Zol after Pam (2 pts), whereas no cases were observed in Pam alone pts (p= 0.005). The median number of infusions was 20 with comparable results in the two groups (20 in group A, 19 in group B). SRE was observed in 38 pts (35.8%): 16 pts in group A and 22 pts in group B without statistical difference (p=0.6), after a median time of 9.8 months. Conclusions: These results suggest that the reduced schedule of Bi is associated with a significant lower incidence of ONJ and, although the sample size is limited, the appearance of ONJ seems delayed with respect to the standard treatment. Moreover, the incidence of SRE is similar in the two groups. In conclusion, the reduced schedule, could be applied in order to combine the antiresorptive efficacy of Bi with a higher safety and a better compliance.

Significance and reliability of pathologic marker Ki-67 in patients with neuroendocrine cancers.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 264-264 ◽  
Author(s):  
S. Singh ◽  
Y. Feinberg ◽  
C. Rowsell ◽  
C. Law
Keyword(s):  
Treatment Options ◽  
Kappa Statistic ◽  
Categorical Variables ◽  
Rank Test ◽  
Ki 67 ◽  
Exact Test ◽  
Expert Pathologist ◽  
Group A ◽  
Group B ◽  
Neuroendocrine Cancers

264 Background: Molecular markers, especially Ki-67, in neuroendocrine cancers (NETs) have become increasingly important. Debate exists as to the optimal role of ki-67 in the treatment of this uncommon cancer. This study was designed to examine the significance of ki-67 as a clinical predictor and its reliability in the treatment of NETs. Methods: A retrospectively assembled integrated database with prospectively collected data of patients undergoing multidisciplinary management for NETs between 2000 to 2009 was analysed. Clinical and outcomes data were collected. Ki-67 was then categorized to Group A (≤2%), B (3-15%) and C (>15%). We compared the original Ki-67 value to the reviewed value. We then used a kappa statistic to calculate the inter-rater agreement between the original and reviewed determination of Ki-67. Fisher's exact test was used to compare categorical variables. Survival was evaluated using the log-rank test. All analyses were carried out using SAS 9.1.3. Results: A total of 184 patients were seen at our clinic. Ki-67 correlated with metastases at presentation (36, 52, 63% for Groups A, B, C respectively, p<0.05), while influencing treatment with chemotherapy even in the absence of metastases (14, 29, 57% for Groups A, B, C respectively, p< 0.002). Ki-67 predicted overall survival (p=0.0005) in favor of Group A. 99 patients had an original Ki-67 reported from the referring center and then a review by an expert pathologist at the multidisciplinary clinic. In Group A, there was 94.4% agreement, with 3.7% of cases upgraded at review to Group B and 1.9% of cases upgraded to Group C. In Group B, there was 94.3% agreement, with 5.7% of cases downgraded to Group A, and 0% upgraded. In Group C, there was 90% agreement, with 10% of cases downgraded to Group B and none to Group A (kappa = 0.89). Conclusions: Our previous report had demonstrated that Ki-67 influenced decisions regarding treatment options. In our updated population of NETs patients, Ki-67 continued to predict biology, influence treatment, and predict survival. In addition we demonstrated high reproducibility of Ki-67. It appears that with modern techniques Ki-67 can be highly reproducible and reliable tool in improving outcomes in this patient population. No significant financial relationships to disclose.

Three-Year Experience with Totally Endoscopic Robotic Thymectomy

2006 ◽  
Vol 1 (3) ◽  
pp. 111-114 ◽  
Author(s):  
Charles Y. Ro ◽  
Joseph J. DeRose ◽  
Cliff P. Connery ◽  
Sandhya K. Balaram ◽  
Robert C. Ashton
Keyword(s):  
Myasthenia Gravis ◽  
Operation Time ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Entire Cohort ◽  
Bilateral Approach ◽  
Group A ◽  
Robotic Thymectomy ◽  
Group B ◽  
Robotic Resection

Background Robotic technology has facilitated the evaluation and treatment of anterior mediastinal pathology. We describe a 3-year experience using the da Vinci Robotic Surgical System to perform thymectomies for a range of diseases. Methods From March 2002 to November 2004, 9 patients (3 myasthenia gravis, 3 mediastinal mass, 2 myasthenia gravis plus thymoma, 1 hyperparathyroidism) underwent totally endoscopic robotic thymectomy. Medical records and operative databases were reviewed. The cohort was divided into an early experience (group A) and a later experience (group B). Data were analyzed with the Fisher exact test and Mann-Whitney test. Results Complete robotic resection of the thymus was accomplished in all 9 patients. The mean age for the entire cohort was 40 ± 12 years (range 28–66 years) and 78% of the patients were women. No significant differences in age, gender, or operative conversions were detected between the groups. Patients in group A were more likely to have a bilateral approach. Group B demonstrated statistically significant reductions in operating room and operation time and a trend toward decreased chest tube days and length of stay. No morbidity or mortality associated with the procedure was noted in either group. Conclusions Robotic thymectomy is a safe and effective procedure. Its steep learning curve promises to allow more surgeons to adopt minimally invasive approaches to the mediastinum safely and efficiently.

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