scholarly journals Modified Hardinge approach is an alternative to trochanteric flip osteotomy for Pipkin type IV femoral head fracture

2019 ◽  
Author(s):  
I-Jung Chen ◽  
Ying-Chao Chou ◽  
Yung-Heng Hsu ◽  
Yi-Hsun Yu
Keyword(s):  
Femoral Head ◽  
Blood Loss ◽  
Rank Test ◽  
Type Iv ◽  
Log Rank Test ◽  
Group A ◽  
Group B ◽  
Trochanteric Flip Osteotomy ◽  
Hardinge Approach

Abstract Background Pipkin type IV femoral head (FH) fractures generally have poor prognoses. Although several surgical approaches are used, the optimal procedure is still under debate. The purposes of this study were to compare two approaches, the modified Hardinge approach and trochanteric flip osteotomy, for the treatment of Pipkin type IV FH fractures. Methods This retrospective study included 20 patients who underwent surgical treatment for Pipkin type IV FH fractures between January 2011 and September 2017 at a level 1 trauma center. Thirteen were treated using the modified Hardinge approach (group A) and seven with trochanteric flip osteotomy (group B). All patients completed at least 1 year of follow-up. The clinical outcome of the Merle d’Aubigné-Postel score; and radiological outcomes including the quality of the fracture reduction, the osteonecrosis of the FH (ONFH), the hip joint osteoarthritis (OA), and heterotopic ossification (HO); were compared between the two groups. Conversion to THR was also recorded as an outcome measure, analyzed by Kaplan–Meier curve and log-rank test. Results The mean operative time was similar in the two groups. The estimated blood loss of group B (435.7 ± 307.8 ml) was nearly double that of group A (233.1 ± 116.8 ml), although not statistically significant (P = 0.135). Radiographic outcomes including the quality of fracture reduction, ONFH, hip joint OA, and HO did not differ significantly between the two groups. There were also no significant differences between the two groups in terms of mean Merle d’Aubigné-Postel score at 1 year after injury and the log rank test of conversion to THR. One patient in group A had recurrent dislocation and underwent revision surgery, while one patient in group B requested removal of the trochanteric screws due to discomfort. Conclusions For the management of Pipkin type IV FH fractures, the modified Hardinge approach results in reduced blood loss, similar clinical and radiological outcomes compared with trochanteric osteotomy. The modified Hardinge approach appears to be an acceptable alternative to trochanteric flip osteotomy.

Suboccipital and cervical chordomas: the value of aggressive treatment at first presentation of the disease

2002 ◽  
Vol 97 (5) ◽  
pp. 1070-1077 ◽  
Author(s):  
Alexandre Carpentier ◽  
Marc Polivka ◽  
Alexandre Blanquet ◽  
Guillaume Lot ◽  
Bernard George
Keyword(s):  
Clinical Symptoms ◽  
Rank Test ◽  
Aggressive Treatment ◽  
Actuarial Survival ◽  
High Tendency ◽  
Content Type ◽  
Log Rank Test ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. Chordoma is a locally invasive tumor with a high tendency for recurrence for which radical resection is generally recommended. To assess the benefits of aggressive treatment of chordomas, the authors compared results in patients treated aggressively at the first presentation of this disease with results in patients who were similarly treated, but after recurrence. Methods. Among 36 patients with cervical chordomas who were treated at the authors' institution, 22 underwent primary aggressive treatment (Group A) and 14 were treated secondarily after tumor recurrence (Group B). Two cases were excluded from Group A because of unrelated early deaths and three from Group B because of insufficient pre- or postoperative data. Most tumors were located at the suboccipital level and only eight cases at a level below C-2. Radiotherapy and proton therapy were similarly conducted in both groups of patients. The actuarial survival rates were 80 and 65% at 5 and 10 years, respectively, in Group A patients and 50 and 0% at 5 and 10 years, respectively, in Group B patients (p = 0.049, log-rank test). The actuarial recurrence-free rates were 70 and 35% at 5 and 10 years, respectively, in Group A and 0% at 3 years in Group B (p < 0.0001, log-rank test). The numbers of recurrences per year were 0.15 in Group A and 0.62 in Group B (p > 0.05). All other parameters that were analyzed (patient age, delay before diagnosis, clinical symptoms, chondroid type of lesion, and histological features) did not prove to influence prognosis in a statistically significant manner. Conclusions. Aggressive therapy, combining as radical a resection as possible with radiotherapy, seems to improve the prognoses of suboccipital and cervical chordomas when applied at the patient's first presentation with the disease.

The Prognostic Value of Serum APRIL Levels in Patients with Chronic Lymphocytic Leukemia

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5648-5648
Author(s):  
Sinem Nihal Esatoglu ◽  
Dilek Keskin ◽  
Muge Kutnu ◽  
Tugrul Elverdi ◽  
Ayse Salihoglu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Demographic Data ◽  
Lymphocytic Leukemia ◽  
Rank Test ◽  
Healthy Controls ◽  
Log Rank Test ◽  
Treatment Naïve ◽  
Group A ◽  
Group B ◽  
Time To First Treatment

Abstract Introduction: Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with variable clinical course. Several studies have been conducted to predict outcome in patients with CLL and also have been going on. A proliferation inducing ligand (APRIL) has been shown to involve in survival and resistance to apoptosis in CLL, and APRIL molecule has been investigated as a prognostic marker in CLL patients. However, there are limited and controversial data regarding APRIL and its impact on prognosis in CLL. We aimed to compare serum APRIL levels in CLL patients with those of age and gender matched healthy subjects, and to investigate the relationship between APRIL and the other common prognostic factors, and to determine whether serum APRIL levels predict time to first treatment in CLL. Methods: After ethical approval and informed consent were obtained, between May and December 2012, venous blood samples were driven from 96 CLL patients’ and 25 healthy controls’, and serum APRIL levels were measured by ELISA. Demographic data and the prognostic markers were obtained from the patients’ files, and patients have been followed for a minimum of 12 months. We tested the correlation between APRIL with the, clinical and biological parameters, and used the log rank test to compare their Kaplan Meier curves. Results: Patients were divided into three groups: Treatment naive (group A, n=49), chemotherapy receiving (group B, n=25) and who had previously received chemotherapy (group C, n=22). Median APRIL level was higher in group A (2.78 vs 1.29; p=0.034) and group C (3.54 vs 1.29; p=0.001) when compared to healthy controls, but was not different in group B (1.56 vs 1.29; p=0.3) (Figure 1). Serum APRIL level in group A was negatively correlated with hemoglobin levels (r=-0.298; p=0.037) and platelet counts (r=-0.321; p=0.025) whereas no correlation with age, Rai and Binet stages, lymphocyte counts, β2-microglobulin and CD38 levels were detected. Group A patients were also divided into 2 subgroups (APRIL levels low, n=20 and APRIL levels high, n=29) using median natural logarithm of serum APRIL level as cut off. April low and high subgroups were similar with respect to demographic data and prognostic factors. Median time to first treatment was not reached in the APRIL low group, but was 104 months in the APRIL high group (p=0.13, log-rank test). Conclusions: Among the treatment naive patients, serum APRIL levels only negatively correlate with hemoglobin levels and platelet counts. These correlations seem to be associated with tumor burden rather than the prognosis, because APRIL levels were not different in chemotherapy receiving patients compared to healthy controls. Since a median survival time could not be reached in the APRIL low group, short follow up time might be an explanation why the APRIL levels did not predict the time to first treatment. In conclusion, our findings let us to think APRIL levels are not a useful marker to predict prognosis in patients with CLL. Figure 1. Median APRIL levels of CLL patients and healthy controls (ng/mL) Figure 1. Median APRIL levels of CLL patients and healthy controls (ng/mL) Disclosures No relevant conflicts of interest to declare.

scholarly journals Correlation between the efficacy of stem cell therapy to osteonecrosis of the femoral head and cell viability

2019 ◽  
Author(s):  
ZhanYu Wu ◽  
Qi Sun ◽  
Ming Liu ◽  
Brian Grottkau ◽  
ZhiXu He ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Core Decompression ◽  
Mean Value ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of necrotic area is the key to treatment.At present, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas through the characteristics of stem cells. However, a considerable number of patients cannot achieve a satisfactory outcome in repairing the femoral head necrotic area. It is very important to find out the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression to early-stage of ONFH. Methods: A total of 30 patients with idiopathic ONFH were performed core decompression combined with autologous stem cell transplantation. The Harris score (HHS) and necrosis area change of patients before and after operation were observed. The mean value of repair ratio was set as a threshold dividing the patients into group A (ratios greater than the mean value) and group B (ratios less than the mean value). The ultrastructure, proliferative capacity and multidirectional differentiation ability were compared between the groups. Results: At 9 months after surgery, HHS and magnetic resonance imaging (MRI) findings had improved by varying degrees. Based on the repair ratio, i.e., (62.2 ± 27.0) %, 62.2% was set as a threshold dividing the patients into group A and group B. Better repair(Group A) showed faster proliferation efficiency and healthier ultrastructure. The cells of Group A also showed stronger specific staining after osteogenesis and chondrogenesis induced differentiation. The activity of alkaline phosphatase (ALP) was also higher in group A (OD 2.39 ± 0.44 vs 1.85 ± 0.52; P <0.05) after osteogenic differentiation. Conclusions: The quality of implanted stem cells is closely related to the efficacy of this procedure and determines whether the defects of self-repair in the necrotic areas can be corrected to enhance the repair capacity of necrotic tissue and to promote the repair of necrotic areas to achieve the desired therapeutic outcome.

P4760New minimally invasive and tailor-made strategy for cryoballoon ablation in patients with paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Nakano ◽  
K Suenari ◽  
K Suruga ◽  
H Takemoto ◽  
Y Hashimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Standard Procedure ◽  
Rank Test ◽  
Cryoballoon Ablation ◽  
Freezing Time ◽  
Free Survival ◽  
Log Rank Test ◽  
Group A ◽  
Group B

Abstract Background Currently, cryoballoon ablation (CBA) has proven to be highly effective in achieving free from atrial fibrillation (AF), especially paroxysmal AF. However, the optimal freezing protocol for each patient to achieve successful pulmonary vein isolation by only CBA is still uncertain. The aim of this study was to evaluate the clinical implications of a reduction in the freezing duration (<180s) during CBA guided by the time to target temperature. Methods From November 2015 to August 2018, 286 consecutive paroxysmal AF patients undergoing CBA were enrolled. We compared 107 patients undergoing a tailor-made CBA procedure (Group A; August 2017-August 2018) to 179 patients with a standard CBA procedure (Group B; November 2015–July 2017). In Group A, the freezing duration was reduced to 150s when the temperature reached ≤−40°C within 40s. Furthermore, we reduced it to 120s when it reached ≤−50°C within 60s. In the other patients, the freezing time was 180s except for excessive freezing over −60°C and/or emergent situations while monitoring the esophageal temperature and for phrenic nerve injury as in Group B. Results The baseline clinical characteristics were similar between two groups. In Group A, 89 patients (83%) underwent CBA with a reduction in the freezing time. The rate of having reduction time in left inferior PV (LIPV) and right inferior PV (RIPV) was lower compared with left superior PV (LSPV) and right superior PV (RSPV) (respectively 17%, 29%, 56%, and 63.5%). However, for right inferior PV, in 31 patients having the reduced freezing time, none of them required touch-up ablation. Although the procedure time and frequency of touch-up ablation did not differ between the 2 groups, total freezing time for each PV was significantly shorter in Group A than Group B as shown in figure (LSPV: 164±28s vs. 216±67s; p<0.001, LIPV: 187±44s vs. 218±69s; p<0.001, RSPV: 147±31s vs. 192±51s; p<0.001, RIPV: 180±50 vs. 218±73s; p<0.001). The AF free survival rate during the follow-up period (356±167 days) was similar between the 2 groups (log-rank test, p=0.38). Furthermore, the complication rate was similar 2 groups. The freezing time for each PV Conclusion The safety and efficacy of the new tailor-made CBA strategy were non-inferior to the standard procedure. This study showed that the unnecessary freezing time could be reduced in most of paroxysmal AF patients.

scholarly journals Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability

2020 ◽  
Author(s):  
ZhanYu Wu ◽  
Qi Sun ◽  
Ming Liu ◽  
Brian Grottkau ◽  
ZhiXu He ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Core Decompression ◽  
Necrotic Area ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of the necrotic area is key to successful treatment. Currently, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas based on the characteristics of stem cells. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area, and it is very important to determine the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression for early-stage ONFH. Methods: A total of 30 patients with idiopathic ONFH underwent core decompression combined with autologous stem cell transplantation. The Harris hip score (HHS) and difference in necrosis area before and after surgery were measured. The mean repair ratio was set as the threshold to divide the patients into group A (ratio above the mean) and group B (ratio below the mean). The ultrastructure, proliferative capacity, and multidirectional differentiation ability were compared between the groups. Results : At 9 months after surgery, the HHS and magnetic resonance imaging (MRI) findings improved by varying degrees. Based on the mean repair ratio of (62.2 ± 27.0)%, the threshold for dividing the patients into groups A and B was set to 62.2%. Better repair (group A) was associated with more rapid proliferation and a healthier ultrastructure. The cells in group A showed stronger specific staining signifying osteogenic and chondrogenic differentiation; alkaline phosphatase (ALP) activity, an indicator of osteogenic differentiation, was higher in group A than in group B (OD, 2.39 ± 0.44 and 1.85 ± 0.52; p < 0.05). Conclusions: The quality of implanted stem cells is closely related to treatment efficacy and determines whether the defective self-repair in the necrotic area can be corrected to enhance repair and thus achieve the desired therapeutic outcome.

scholarly journals Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability

2019 ◽  
Author(s):  
ZhanYu Wu ◽  
Qi Sun ◽  
Ming Liu ◽  
Brian Grottkau ◽  
ZhiXu He ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Femoral Head ◽  
Cell Therapy ◽  
Core Decompression ◽  
Necrotic Area ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Background: Osteonecrosis of the femoral head (ONFH) is a common disease that greatly affects the quality of life of patients. Repair of the necrotic area is key to successful treatment. Currently, the combination of stem cell transplantation and decompression is used clinically to promote the repair of necrotic areas based on the characteristics of stem cells. However, a considerable number of patients do not achieve a satisfactory outcome in terms of repair of the femoral head necrotic area, and it is very important to determine the reasons for the poor curative effect. The aim of this study was to investigate the correlation between stem cell viability and the repair efficacy of stem cell therapy combined with core decompression for early-stage ONFH. Methods: A total of 30 patients with idiopathic ONFH underwent core decompression combined with autologous stem cell transplantation. The Harris hip score (HHS) and difference in necrosis area before and after surgery were measured. The mean repair ratio was set as the threshold to divide the patients into group A (ratio above the mean) and group B (ratio below the mean). The ultrastructure, proliferative capacity, and multidirectional differentiation ability were compared between the groups. Results : At 9 months after surgery, the HHS and magnetic resonance imaging (MRI) findings improved by varying degrees. Based on the mean repair ratio of (62.2 ± 27.0)%, the threshold for dividing the patients into groups A and B was set to 62.2%. Better repair (group A) was associated with more rapid proliferation and a healthier ultrastructure. The cells in group A showed stronger specific staining signifying osteogenic and chondrogenic differentiation; alkaline phosphatase (ALP) activity, an indicator of osteogenic differentiation, was higher in group A than in group B (OD, 2.39 ± 0.44 and 1.85 ± 0.52; p < 0.05). Conclusions: The quality of implanted stem cells is closely related to treatment efficacy and determines whether the defective self-repair in the necrotic area can be corrected to enhance repair and thus achieve the desired therapeutic outcome.

scholarly journals Neoplasia papilomucinosa intraductal de páncreas: experiencia a 10 años, en un único centro

2021 ◽  
Vol 113 (1) ◽  
pp. 73-82
Author(s):  
María F. Fernández ◽  
◽  
Leonardo Montes ◽  
Martín Uranga ◽  
Hugo Delle Donne ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Pathological Examination ◽  
Rank Test ◽  
Biliary Surgery ◽  
Term Survival ◽  
Log Rank Test ◽  
Group A ◽  
Group B ◽  
Made In

Background: The incidence of intraductal papillary mucinous neoplasm (IPMN) of the pancreas has increased over the past years along with the development of diagnostic imaging tests. Objective: The aim of this study is to describe our experience on long-term management of patients with IPMNs in a reference center. Material and methods: We conducted a retrospective and descriptive analysis of patients with pancreatic neoplasms followed-up at the Department of General Surgery and Hepato-Biliary Surgery, Hospital Universitario Fundación Favaloro, between January 2010 and December 2019. The patients were classified into 2 groups: group A (diagnosis of IPMN made in the outpatient clinic), and group B (diagnosis of IPMN in the pathological examination). Results: Eighty-six patients were analyzed: 79 (90%) in group A and 7 in group B. In group A, a watchful waiting with monitoring (AM) was decided in 57 cases (66%). Of the remaining 22 patients, 18 (29%) patients underwent surgery (AS) and 4 are waiting for surgery. Survival at 5 years was 89% in group AM, 86% in group AS and 43% in group B (Breslow 0.001, log-rank test 0,001 vs. group A). Conclusion: The diagnosis and management of IPMNs is currently standardized. Surgery is indicated in MD-IPMN and mixed type IPMN. Patients with BD-IPMN type should be monitored due to the risk of malignant transformation. When surgery is indicated, long-term survival should be similar to that of the surveillance group.

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

Joint involvement influences quality of life in systemic lupus erythematosus patients

Lupus ◽  
2020 ◽  
pp. 096120332097903
Author(s):  
Francesco Natalucci ◽  
Fulvia Ceccarelli ◽  
Enrica Cipriano ◽  
Carlo Perricone ◽  
Giulio Olivieri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lupus Erythematosus ◽  
Disease Duration ◽  
Joint Involvement ◽  
Systemic Lupus ◽  
Median Disease Duration ◽  
Group A ◽  
Musculoskeletal Manifestations ◽  
Group B

Introduction Joint involvement represents the major determinant in quality of life (QoL)in Systemic Lupus Erhytematosus (SLE) patients. However, QoLhas been generally evaluated by non-specific questionnaires. We evaluated the relationship between SLE musculoskeletal manifestations and QoL, assessed by LupusQoL. Methods Patients with joint involvement (group A) were compared with those without this feature (group B). Disease activity was assessed by SLEDAI-2k in the whole population, while DAS28 and swollen to tender ratio were applied to assess joint activity. LupusQoL was administered to all the patients. Results Group A included 110 patients [M/F 8/102; median age 49 years (IQR 13), median disease duration 156 months (IQR 216)], group B 58 [M/F 11/47; median age 40 years (IQR 15), median disease duration 84 months (IQR 108)].We found significanlty lower values in all the LupusQoL domains except for one (burden to others) in group A in comparison with group B. A significant correlation between DAS28 values and all the LupusQoL domains in group A was found; only three domains correlated with SLEDAI-2k. Conclusions SLE-related joint involvement significantly influences disease-specific QoL. DAS28 better correlated with LupusQoL domains in comparison with SLEDAI-2k, confirming the need for specific musculoskeletal activity indices.

scholarly journals Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mohamed I. Refaat ◽  
Amr K. Elsamman ◽  
Adham Rabea ◽  
Mohamed I. A. Hewaidy
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Decompression Surgery ◽  
Microsurgical Decompression ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

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