scholarly journals The presence of erosive joints is a strong predictor of radiological progression in hand osteoarthritis: results of a 2-year prospective follow-up of the Liège Hand Osteoarthritis Cohort (LIHOC)

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Audrey Neuprez ◽  
Jean-François Kaux ◽  
Médéa Locquet ◽  
Charlotte Beaudart ◽  
Jean-Yves Reginster
Keyword(s):  
Time Course ◽  
Strong Predictor ◽  
Hand Osteoarthritis ◽  
X Rays ◽  
Clinical Progression ◽  
Radiological Progression ◽  
Erosive Osteoarthritis ◽  
Number Of Patients ◽  
Pain Subscale

Abstract Background This study measured the magnitude and determinants of clinical and radiological progression in patients with hand osteoarthritis (HOA) over a 2-year prospective follow-up to gain a greater understanding of the disease time course. Methods Two hundred three consecutive outpatients diagnosed with HOA were followed for 2 years (183 women, median age 69 years). Pain and function were evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and clinical examination recorded the number of painful/swollen joints and nodes. X-rays were scored using Kellgren-Lawrence (KL) and Verbruggen-Veys scales. Clinical progression was defined as deterioration in AUSCAN ≥ the minimal clinically important difference. Radiographic progression was defined as (a) one new erosive/remodeled joint, (b) progression of ≥ one anatomical stage in one joint, or (c) change in KL total score above the smallest detectable difference. Logistic regression was performed to determine whether patient characteristics influenced clinical and radiological progression. Results After 2 years, all radiographic scores deteriorated significantly in the study population (p <  0.05), and the number of proximal and distal interphalangeal nodes was significantly higher (p <  0.01). The AUSCAN, number of painful joints at rest or at pressure, number of swollen joints, and pain measure on a visual analog scale remained unchanged. At the individual level, the number of patients with clinically meaningful progression ranged from 25 to 42% (clinical progression) and from 22 to 76% (radiological progression). The only significant predictor of worsening of total AUSCAN was AUSCAN pain subscale < 74.5 (odds ratio [OR] 1.02 [1.01, 1.03]; p <  0.01). The presence of ≥ four swollen joints (OR 2.78 [1.21, 6.39]; p = 0.02) and erosive osteoarthritis (OR 13.23 [5.07, 34.56]; p <  0.01) at baseline predicted a new erosive joint. A meaningful change in KL was more frequent with painful joints at baseline (OR 3.43 [1.68, 7.01]; p <  0.01). Conclusions Evidence of radiological progression over 2 years was observed in patients with HOA in the LIHOC population even without clinical worsening of disease. For individual patients, baseline pain level is predictive for clinical progression and the presence of erosive or swollen joints are significant predictors of radiological progression.

scholarly journals Natural history of prostate cancer on active surveillance: stratification by MRI using the PRECISE recommendations in a UK cohort

2020 ◽  
Author(s):  
Francesco Giganti ◽  
Armando Stabile ◽  
Vasilis Stavrinides ◽  
Elizabeth Osinibi ◽  
Adam Retter ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Gleason Score ◽  
Rank Test ◽  
Gleason Grade ◽  
Clinical Progression ◽  
Radiological Progression ◽  
Grade Group ◽  
Psa Density

Abstract Objectives The PRECISE recommendations for magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer (PCa) include repeated measurement of each lesion, and attribution of a PRECISE radiological progression score for the likelihood of clinically significant change over time. We aimed to compare the PRECISE score with clinical progression in patients who are managed using an MRI-led AS protocol. Methods A total of 553 patients on AS for low- and intermediate-risk PCa (up to Gleason score 3 + 4) who had two or more MRI scans performed between December 2005 and January 2020 were included. Overall, 2161 scans were retrospectively re-reported by a dedicated radiologist to give a PI-RADS v2 score for each scan and assess the PRECISE score for each follow-up scan. Clinical progression was defined by histological progression to ≥ Gleason score 4 + 3 (Gleason Grade Group 3) and/or initiation of active treatment. Progression-free survival was assessed using Kaplan-Meier curves and log-rank test was used to assess differences between curves. Results Overall, 165/553 (30%) patients experienced the primary outcome of clinical progression (median follow-up, 74.5 months; interquartile ranges, 53–98). Of all patients, 313/553 (57%) did not show radiological progression on MRI (PRECISE 1–3), of which 296/313 (95%) had also no clinical progression. Of the remaining 240/553 patients (43%) with radiological progression on MRI (PRECISE 4–5), 146/240 (61%) experienced clinical progression (p < 0.0001). Patients with radiological progression on MRI (PRECISE 4-5) showed a trend to an increase in PSA density. Conclusions Patients without radiological progression on MRI (PRECISE 1-3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy. Key Points • Patients without radiological progression on MRI (PRECISE 1–3) during AS had a very low likelihood of clinical progression and many could avoid routine re-biopsy. • Clinical progression was almost always detectable in patients with radiological progression on MRI (PRECISE 4–5) during AS. • Patients with radiological progression on MRI (PRECISE 4–5) during AS showed a trend to an increase in PSA density.

Assessment and determinants of aesthetic discomfort in hand osteoarthritis

2011 ◽  
Vol 71 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Bridget Hodkinson ◽  
Emmanuel Maheu ◽  
Mathilde Michon ◽  
Fabrice Carrat ◽  
Francis Berenbaum
Keyword(s):  
Short Form ◽  
Depression Scale ◽  
Female Gender ◽  
Hand Osteoarthritis ◽  
Tender Joint ◽  
Erosive Osteoarthritis ◽  
Erosive Disease ◽  
Factors Associated ◽  
Pain Scores ◽  
Number Of Patients

BackgroundDissatisfaction with hand appearance is frequently the presenting complaint of patients with hand osteoarthritis (HOA), yet no tool exists for its measurement and few studies have examined aesthetic discomfort.ObjectivesThe aims of this study were to measure the extent and to explore the associations of aesthetic concerns in HOA.Methods172 patients with HOA were assessed with tender joint and node count, global and pain scores, Functional Index for Hand Osteoarthritis, Short Form-12, Hospital Anxiety and Depression Scale and posterior–anterior hand radiographs. Patients scored the aesthetic impact of the disease on a Visual Analogue Scale of 0–100 mm and were classified into low, intermediate and high aesthetic concern (HAC) based on this score.ResultsOf 172 patients (155 women), the majority (92%) had nodes and 46% had erosive disease. The mean aesthetic score was 44.8 mm (SD 35.9), and 59 (34.3%) patients scored their aesthetic discomfort ≥66 mm. Factors associated with HAC were female gender, a high number of tender joints and nodes, high global and pain scores, high radiological damage scores, the presence of erosions and high depression and anxiety levels. The multivariate analysis identified two independent factors associated with HAC: patient's global assessment (p=0.0005) and radiographic erosions (p=0.03).ConclusionsAesthetic discomfort is a major concern for a significant number of patients with HOA, particularly women, those with a high burden of HOA disease and those with erosive osteoarthritis, and is also associated with depression, anxiety and poor health-related quality of life.

scholarly journals Clinical and Radiographic Outcomes of Tibiotalocalcaneal or Pantalar Arthrodesis Using a Novel Lateral Locking Plate

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0041
Author(s):  
Tyler Rutherford ◽  
John Campbell ◽  
Rebecca Cerrato ◽  
Clifford Jeng
Keyword(s):  
Plate Fixation ◽  
Large Diameter ◽  
Lateral Side ◽  
Study Group ◽  
X Rays ◽  
Lateral Plate ◽  
Side Plate ◽  
Tertiary Referral Center ◽  
Number Of Patients

Category: Ankle Introduction/Purpose: For patients suffering from severe ankle and hindfoot arthritis or deformity, tibiotalocalcaneal (TTC) or pantalar arthrodesis may be the best option to achieve a plantigrade and painless foot. These fusions are typically fixed with a retrograde intramedullary nail, a lateral side plate, or screws alone. Theoretically, the advantages of a lateral side plate applied via a trans-fibular approach include the use and the multiple points of fixation available in the tibia, talus, and calcaneus. The results of a novel side plate construct with a unique screw hole that extends underneath the calcaneus are presented in this study. A large diameter screw can be inserted retrograde through this inferior hole to engage the medial tibial cortex and provide axial compression across the ankle and subtalar joints. Methods: This study retrospectively evaluated 39 patients that underwent a tibiotalocalcaneal (TTC) or pantalar arthrodesis using this novel lateral plate fixation technique by one of three fellowship trained surgeons at a tertiary referral center. Patients with less than a one year follow up were excluded. Thirty-nine patients were identified between 2012 and 2016. Two patients were deceased from other causes, 2 had a below the knee amputation due to chronic pain, and 9 were lost to follow up. Pre- and postoperative General Health and Wellness (SF-12) and Revised Foot Function Index scores were obtained. Study subjects were seen for a clinical evaluation and final post-operative x-rays. The Shapiro-Wilk test was used to test for normality. The paired student’s t-test was used to compare pre- and post-surgical outcome measures. Results: Twenty-six patients were included in the study group. Mean follow up time was 34.42 ± 12.94 months. The SF-12 score was 32.2 ± 10.22 (physical) and 54.8 ± 10.7 (mental) before surgery, and 41.35 ± 9.21 (p < 0.01) and 56.5 ± 7.47 (p = 0.73) at final follow-up, respectively. The FFI score was 106 ± 32.69 before surgery and 53.94 ± 24.14 after surgery (p = 0.06). Eighteen patients were satisfied or very satisfied with the outcome of the surgery (70%). CT confirmation of joint fusion was obtained in all 26 patients. Twenty out of the 26 patients demonstrated fusion of all joints (77%). There were 2 ankle, 1 subtalar, and 1 talonavicular nonunions. In total, 44 of 48 total joints were fused (91%). Conclusion: Tibiotalocalcanceal and pantalar arthrodesis using a novel lateral plate for the treatment of complex deformity and severe osteoarthritis demonstrated acceptable fusion rates considering the number of patients with high risk factors for nonunion in this study group. Complications included fractures at the proximal end of the plate construct and persistent neurapraxia which was well tolerated. Patients reported significant improvements in SF-12 clinical scores at final 34 month follow-up.

scholarly journals Time course of radiographic hip joint changes in patients with early axial spondyloarthritis

2021 ◽  
Vol 15 (1) ◽  
pp. 46-50
Author(s):  
E. M. Agafonova ◽  
D. G. Rumyantseva ◽  
A. V. Smirnov ◽  
Sh. Erdes
Keyword(s):  
Hip Joint ◽  
Time Course ◽  
Axial Spondyloarthritis ◽  
Disease Onset ◽  
Underlying Disease ◽  
Joint Involvement ◽  
Base Line ◽  
Radiological Progression ◽  
The Mean

The diagnosis of coxitis remains one of the most difficult problems in the management of patients with axial spondyloarthritis (axSpA). In Russia, almost every two patients with axSpA were found to have hip joint (HJ) damage. However, until a certain time, there have been no methods to estimate the rate of progression of radiographic HJ changes in clinical practice. We have previously developed a formula for calculating the rate of coxitis progression, which simplifies the assessment of radiographic HJ changes and allows a physician to make a timely decision about changing therapy if rapidly progressing coxitis is detected.Objective: to estimate the rate of radiological progression of coxitis during a 24-month follow-up of patients with early axSpA.Patients and methods. Examinations were made in 38 patients (20 women and 18 men) who had been followed up for at least 2 years without radiographic and ultrasound signs of HJ joint involvement. The patients' mean age was 28.8±5.5 years; the disease duration was 22.7±15.7 months. HLA-B27 was positive in 35 (92%) patients. The summary stage of radiographic coxitis (ssRC) was used to assess HJ damage; the previously developed formula was applied to estimate the rate of radiological progression of coxitis (R-rpC).Results and discussion. The median cervical-capsular distance (CCD) was 5.2 mm at baseline and 4.9 mm at 2 years (p7 mm increase in the CCD. The mean ssRC was 0.34±0.75 scores at base line, 0.86±0.78 scores at 1 year; and this indicator increased up to 1.24±1.36 scores at 2 years (p=0.004). During 2 years of follow-up, there was no coxitis progression (the difference between ssRC2 and ssRC1 was 0) in 24 (63%) patients; ΔssRC increased by 1 score in 5 (13%); by 2 scores in 6 (16%), and by 4 scores in 3 (8%). On patient inclusion to the investigation, R-rpC averaged 0.5 (it was conventionally assumed that patients had no signs of HJ damage at the disease onset (ssRC=0). During therapy for the underlying disease, the mean R-rpC was 0.3 and 0.2 score/year within the first and second years, respectively. The mean R-rpC in the ΔssRC >0 group was as many as 0.85 score/year at one-year follow-up and 0.53 score/year at two-year follow-up.Conclusion. The developed procedure for estimating the progression of coxitis using ssRC is easy to use and can identify patients at high risk for coxitis progression.

Analysis of circulating tumor DNA (ctDNA) in pseudoprogression in anti-PD1 treated metastatic melanoma (MM).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9546-9546
Author(s):  
Jenny HJ Lee ◽  
Georgina V. Long ◽  
Alexander M. Menzies ◽  
Alexander David Guminski ◽  
Richard Kefford ◽  
...  
Keyword(s):  
Disease Progression ◽  
Circulating Tumor Dna ◽  
The Other ◽  
Clinical Progression ◽  
Radiological Progression ◽  
Digital Droplet Pcr ◽  
Droplet Pcr ◽  
True Progression ◽  
Tumor Dna

9546 Background: We have previously shown that undetectable ctDNA either at baseline or during therapy predicted response in mm patients (pts) treated with anti-PD1 antibodies (aPD1). Pseudoprogression, defined as radiological progression prior to response, occurs in 8% of pts treated with aPD1. We sought to determine if ctDNA could differentiate pseudoprogression from true progression, defined as continued clinical or radiological disease progression. Methods: Between July 2014 and May 2016, pts receiving aPD1 had serial bloods for ctDNA. Included pts either had RECIST PD at first restaging or early clinical progression. Those with untreated brain metastases were excluded from the analysis. ctDNA was quantified using digital droplet PCR for mutations (BRAF/NRAS) at baseline and during the first 12 wks of treatment. Based on our prior studies, ctDNA results were grouped in to ‘favorable’ and ‘unfavorable’ ctDNA profiles (see Table), and these were compared in pts with true and pseudoprogression. Results: 29 pts were included, 28 with RECIST PD at first restaging and one with early clinical progression. 9 (31%) pts had a subsequent RECIST PR or SD and were considered pseudoprogression and 20 (69%) had true progression. Of the pseudoprogressors, 7/9 pts remained in response with a median follow-up of 20 months (mths). 2/9 pts had disease progression at 7 and 18 mths, with ctDNA that remained detectable with a > 10-fold decrease during treatment in both patients. Of those with true progression and a favourable profile, 1 had a > 10-fold decrease in ctDNA by wk 12 and was switched to MAPK therapy prior to further imaging, and the other had an undetectable ctDNA at wk 6 which increased again at wk 12. The latter pt had a new lesion on first restaging CT scan despite PR in all existing lesions with true PD on second restaging at wk 24. Conclusions: ctDNA in patients with mm at baseline and early on aPD1 treatment differentiates pseudo from true progression. [Table: see text]

scholarly journals P09.04 Natural history of meningiomas: review with meta-analyses

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii39-iii39
Author(s):  
S Nakasu ◽  
Y Nakasu
Keyword(s):  
Growth Rate ◽  
Tumor Size ◽  
Incidental Finding ◽  
Growth Speed ◽  
Individual Data ◽  
Clinical Progression ◽  
Radiological Progression ◽  
Perifocal Edema ◽  
Meta Analyses

Abstract BACKGROUND A recent investigation using MRI showed 2.5% frequency of meningioma as an incidental finding in the population-based neuroimaging study. Although observation has been a mainstay in asymptomatic meningiomas, it may increase the risk of surgery due to enlargement of the tumors and aging of patients. It is important to characterize tumors that will grow to be symptomatic in order to select appropriate treatments and radiological follow-up. MATERIAL AND METHODS We reviewed 26 studies (3 from the same institute) that analyzed natural courses in asymptomatic or untreated meningiomas. Radiological progression of tumor was redefined as tumor growth by 15% of initial volume or more whenever possible. To adjust the difference of follow-up interval in each study, the percentages of growing tumors in each study were compared with each mean follow-up period. Individual data were extracted from seven studies for univariate or multivariate analyses. Weighted meta-analyses were performed using the 25 studies. RESULTS In time-growth rate analysis, nearly 70% of meningiomas showed radiological progression defined by a volume criteria and the rate approached plateau at 5–6 years. Meta-analyses showed that each radiological progression, growth speed (annual volume change (AVC) or relative growth rate (RGR)) and symptomatic progression had different factors related to their progression. Age, calcification and high intensity on T2 weighted image related to radiological progression and growth speed but not to clinical progression. In individual data analyses, tumor size (diameter 2.6cm (AUC 0.773; specificity 0.759, sensitivity 0.800), volume 5.6cm3 (AUC 0.775, specificity 0.717, sensitivity 0.800)) was a possible marker for symptomatic growth.AVC (>= 2.1cm3/year) was the strongest indicator for clinical progression. In the group of >=2.1cm3/year, Kaplan-Meier analysis showed that progression free rate was 69.3% at 3 years, and reached to 55.4% at 6 years whereas 100% in slower growth group. CONCLUSION Radiological features may not be very much useful for prediction of clinical progression except for perifocal edema. This may be due to dynamic changes of these radiological markers in a long term. Initial quantitative tumor size and growth speed especially AVC were reliable factors for decision of treatment for asymptomatic meningiomas.

scholarly journals AB1073 DYNAMICS OF X-RAY CHANGES IN THE HIP JOINTS WITH EARLY AXIAL SPONDYLOARTHRITIS PATIENTS.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1825.1-1826
Author(s):  
E. Agafonova ◽  
T. Dubinina ◽  
S. Erdes ◽  
D. Rumiantceva
Keyword(s):  
Disease Duration ◽  
Axial Spondyloarthritis ◽  
Hip Joints ◽  
Radiological Progression ◽  
X Ray ◽  
Asas Criteria ◽  
Number Of Patients ◽  
Axial Spondylarthritis ◽  
Radiological Changes

Background:in almost half of patients with ankylosing spondylitis (AS) in Russia, damage to the hip joints (HJ) is detected, but the rate of its progression has not been studied.Objectives:to evaluate the radiological progression of coxitis in patients with early axial spondylarthritis (axSpA) for two years.Methods:the study involved the patients of the Moscow cohort CORSAIR (Early Spondyloarthritis Cohort), which was formed in V.A. Nasonova Research Institute of Rheumatology. We analyzed 62 patients with a diagnosis of axSpa (ASAS criteria 2009), observed for at least 2 years and having survey images of the pelvic bones during inclusion in the cohort and 2 years after the start of observation. The average age at the time of inclusion in the cohort was 29.2 ± 6.4 years with an average disease duration of 23.8 ± 16.2 months, 32 men and 30 women, 92% of patients positive for HLA-B27. All patients received standard anti-inflammatory therapy.Results:when including out of 62 patients in the study, only one (2%) patient showed X-ray changes in HJ, Fig. 1 (a; b)). After 2 years of follow-up, the number of patients with radiological changes in HJ increased to 13 (21%), Fig. 1 (a; b).Patients were divided into two groups depending on the presence of radiological progression in HJ.A comparative analysis of the groups revealed that progression is more common in men and in younger people (p <0.05). In other parameters presented in Table 1, the groups did not differ from each other.ParameterΔBASRI hip=0n=39ΔBASRI hip >0n = 23pSex (m/w), n15/2417/6<0,05*Duration of the disease months., Me [25; 75 percentile]22 [7;36]24 [18,8;24,8]>0,05Age, years, Me [25; 75 percentile]29 [25,5;32,5]26,5 [23,2;28,7]<0,05*BASDAI, Me [25; 75 percentile]3,6 [2,1;5,2]3,45 [1,1;5,2]>0,05BASFI, Me [25; 75 percentile]1,5 [0,5;2,8]0,7 [0,3;2,4]>0,05ASDAS (CRP), Me [25; 75 percentile]2,5 [1,6;3,35]2,4 [1,25;3,45]>0,05ESR, mm/h, Me [25; 75 percentile]8 [6;22]10 [5;28,75]>0,05CRP, mg/L, Me [25; 75 percentile]5,3 [1,3;24,5]5,2 [1,1; 23,4]>0,05Peripheral Arthritis, n%12 (32%)5 (22%)>0,05Conclusion:it has been shown that in some patients with axSpA already in the first years of the disease, radiological signs of HJ destruction are detected. The progression of coxitis was not dependent on the activity of the disease and was more often detected in men than in women.Disclosure of Interests:Ekaterina Agafonova: None declared, Tatiana Dubinina Speakers bureau: Novartis, BIOCAD, MSD, Pfaizer, Abbvie, UCB, Shandor Erdes: None declared, Daria Rumiantceva: None declared

scholarly journals Treatment of Displaced Intra-articular Calcaneal Fractures with the Intramedullary Nail

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
Julien Lucas ◽  
Antoine Fourgeaux
Keyword(s):  
Intramedullary Nail ◽  
Weight Bearing ◽  
Ct Scans ◽  
Nerve Lesion ◽  
X Rays ◽  
New Device ◽  
Subtalar Arthrodesis ◽  
Number Of Patients ◽  
The Mean

Category: Trauma Introduction/Purpose: In 2010, a new closed reduction, internal fixation procedure for displaced intra-articular calcaneus fractures (DIACF) was developed with an intramedullary nail introduces through a channel in the calcaneal tuberosity. The goal was to reduce the rate of skin complications following principles of open reduction procedures. The aim of this prospective mono-centric study was to assess the occurrence of complications and the functional results using the AOFAS-AHS score. The secondary objectives were to assess first the restoration of the Böhler and Gissane angles on X-ray and shape of the calcaneus (Height, length, width) on CT scans, then thalamic reduction on 3D CT scans based on Goldzak’s global articular reduction classification. Methods: 26 Patients were included prospectively between 2014 and 2016 with analysis of X-rays and CT scans. Two were lost to follow-up and 2 patients sustained a secondary subtalar arthrodesis. After positioning a distractor and drilling, reduction was done with tamps and spatula. The nail was then introduced and locked with screws in the tuberosity and the constant fragment. After 3 weeks of non-weight bearing and 3 weeks with hindfoot off-loading shoe, full weight bearing was allowed. The functional outcome and restoration of the radiographic angles were evaluated postoperatively, at 3 months, 1 year and at the last follow-up. Global calcaneal shape and thalamic surface were evaluated postoperatively, at 1 year and at the last follow-up. The following early complications (delayed healing, infection, annoyed material, sural nerve lesion) and later complications (painful stiffness of the subtalar joint, hindfoot varus malalignment and calcaneofibular conflict) were recorded. Results: Mean follow up was 2.4 years. The mean AOFAS-AHS score was 79 ± 12 [100; 61] in the 22 patients examined. The mean Böhler angle rose from -1.29°± 18° [-35; 28] pre-operatively to 33°± 6° [22; 44] post-operatively. The mean calcaneal height index and length rose respectively from 0.44± 0,18 [0,12; 0,83] to 0.86± 0,22 [0,46; 1,1] and 82,4± 5,4 [72; 93] mm to 86,7mm ±4,6 [76; 97], and the width decreased from 49,8± 4,8 [38; 59] to 46,3± 3,7 [38; 55] mm. The Goldzak global articular reduction assessment was excellent in 39% of cases, good in 42% of cases and poor in 19% of cases. One case of deep infection was reported. Three patients needed device removal and two sustained a secondary subtalar arthrodesis. Conclusion: Our prospective study on this new device has the longest time of follow-up. The results confirm the effectiveness and the reliability over time of the procedure to restore the global shape and the thalamic surface with a low rate of complications and quick return to activities. It appears to be an excellent compromise between the respect of the principles of reduction as applied in the ORIF procedures, and the low cutaneous risk of percutaneous procedures. A subsequent study, with a larger number of patients, will enable analysis of the correlation between the radiological markers and the AOFAS-AHS.

Recovery Over Time and Prognostic Factors in Treated Patients with Post-Infectious Olfactory Dysfunction: A Retrospective Study

2020 ◽  
Vol 129 (10) ◽  
pp. 977-982
Author(s):  
Takao Ogawa ◽  
Keigo Nakamura ◽  
Sayuri Yamamoto ◽  
Ichiro Tojima ◽  
Takeshi Shimizu
Keyword(s):  
Prognostic Factors ◽  
Time Course ◽  
Early Period ◽  
Olfactory Dysfunction ◽  
Olfactory Function ◽  
Clinical Predictors ◽  
Younger Age ◽  
Number Of Patients ◽  
Over Time

Objectives: The aims of the present study were to clarify the time-course of olfactory recovery and the prognostic factors in PIOD patients treated with Toki-shakuyaku-san (TSS). Methods: A retrospective cohort study of patients with PIOD was conducted by reviewing patients’ medical records. This study included patients who received TSS or a combination of TSS and zinc sulfate. Olfactory function was examined by T&T olfactometer at each 3-monthly follow-up visit. Patients with normal and mild olfactory dysfunction were excluded. Gender, age, treatment, duration of disease until the first visit and olfactory function scores of the T&T olfactometer at the first visit were analyzed as candidate clinical predictors of recovery. Results: A total of 82 PIOD patients with ages ranging from 16 to 79 years were included. The mean duration of follow-up was 14.5 months (range 3-45 months). The number of patients with olfactory recovery increased for 24 months and the cumulative recovery rate was 77.3%. In about 60% of patients, olfactory recovery occurred within 6 months. Multivariate analysis showed that younger age (<65 years) and residual olfactory function were significantly associated with good olfactory recovery. Conclusions: We revealed recovery rates over time in patients with PIOD. The recovery of olfactory function often occurred during the early period (≤6 months). However, the number of patients with olfactory recovery increased for a long-term of 24 months after the first visit. Residual olfactory function and younger age were prognostic factors exactly. TSS may be a useful therapeutic agent for patients with PIOD. We believe that these results provide important information that is useful for counseling patients with PIOD.

scholarly journals Virtual arthroplasty follow-up: five-year data from a district general hospital

2020 ◽  
Vol 102 (3) ◽  
pp. 220-224 ◽  
Author(s):  
R Fisher ◽  
V Hamilton ◽  
S Reader ◽  
F Khatun ◽  
M Porteous
Keyword(s):  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Oxford Knee Score ◽  
District General Hospital ◽  
Assessment Process ◽  
X Rays ◽  
X Ray ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Introduction Follow-up after hip and knee arthroplasty is advocated to identify asymptomatic loosening and improve patient satisfaction. There are, however, financial and time implications associated with regular clinic appointments. Assessment through virtual means has been suggested as an alternative. Materials and methods At the West Suffolk Hospital, following arthroplasty surgery of the lower limb, patients are followed-up via a questionnaire at one and five years postoperatively, then subsequently at five-yearly intervals. Patients are recalled based on the outcome of these assessments. Using a locally compiled data base we identified all patients reviewed between 2011 and 2015 using this virtual assessment process and examined their outcomes. Results During the five years of follow-up, 5,380 patients were eligible for assessment. Compliance varied from 77% follow up for hips and 83% for knees. Ten patients were recalled following total hip replacement, eight for x-ray changes and one for a poor satisfaction score. Five went on to undergo revision surgery. Some 56 recalls to clinic following knee arthroplasty were seen; 42 due to a poor Oxford Knee Score, 6 with associated x-ray abnormalities and 6 isolated abnormal x-rays. Five subsequently underwent revision surgery; 30 (54%) were discharged after initial review and 18 (32%) were referred to different subspecialties. As a result of the virtual review process, 4,219 clinic appointments were avoided, with no documented admissions as a result of a missed complication from virtual review. Discussion A virtual arthroplasty clinic significantly reduces the number of patients attending regular follow-up clinics, without compromising safe practice.

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