scholarly journals A Staged Treatment of Symptomatic Lumbar Intraspinal Synovial Cysts

2019 ◽  
Vol 5 (22;5) ◽  
pp. E451-E456
Author(s):  
Kyung-Hoon Kim
Keyword(s):  
Minimally Invasive ◽  
Surgical Procedures ◽  
Facet Joint ◽  
University Hospital ◽  
Pain Clinic ◽  
Level Of Evidence ◽  
Endoscopic Surgical Procedures ◽  
Number Of Patients ◽  
Synovial Cysts

Background: Lumbar intraspinal synovial cyst (LISC) refers to a cyst that arises from the zygapophyseal joint capsule of the lumbar spine and contains serous or gelatinous fluid. In cases of LISCs resistant to conservative treatments, various minimally invasive percutaneous spinal techniques (MIPSTs) may be applied prior to open surgery. Objectives: The outcomes of 3-staged MIPSTs for the treatment of symptomatic LISCs resistant to conservative treatments were evaluated. Study Design: An institutional review board approved retrospective chart review. Setting: University hospital inpatients referred to our pain clinic. Methods: Review of charts of all patients who underwent MIPSTs for symptomatic LISCs resistant to conservative treatments during a time period of 13 years at a university hospital pain clinic. Patients with symptomatic LISCs resistant to conservative treatments were treated with 3-staged MIPSTs, including image-guided intraarticular aspiration, cyst distention and rupture, and injection of corticosteroids (ARI), endoscopic cyst enucleation (ECE), and endoscopic superior facetectomy (ESF) by a single pain specialist. A symptom-free period after each intervention was evaluated. Recurrence was defined as the same recurrent symptomatic radicular pain with confirmation of the LISC on magnetic resonance imaging. All patients with a minimum follow-up time of 3 years were included. Results: Of the 40 patients who underwent ARI, 3 patients failed to complete a follow-up and 19 patients (51.4%) who had recurring symptoms received ECE. Ten patients (52.6%) who had rerecurring symptoms after ECE received ESF. There was no recurrence after ESF. Limitations: This retrospective and observational study with a limited number of patients does not represent a high level of evidence. Conclusions: This information provided the recurrence rate after each intervention. Half of the patients who went on to receive ARI experienced recurrence, whereas half of the patients with recurrence who received ECE experienced re-recurrence. ESF treatment resulted in no recurrence within the 3-year study period. Key words: Conservative treatment, endoscopic surgical procedures, facet joint, intraarticular injection, minimally invasive surgical procedures, needle biopsy, nerve root compression, radiculopathy, synovial cysts

Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

2016 ◽  
Vol 37 (12) ◽  
pp. 1333-1342 ◽  
Author(s):  
Prashant N. Gedam ◽  
Faizaan M. Rushnaiwala
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Wound Complication ◽  
Reconstruction Technique ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Perioperative Morbidity ◽  
The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Reguliuojamos skrandžio apjuosimo juostos: lyginamųjų studijų apžvalga

2011 ◽  
Vol 9 (1-2) ◽  
pp. 0-0
Author(s):  
Tomas Abalikšta ◽  
Gintautas Brimas ◽  
Kęstutis Strupas
Keyword(s):  
Weight Loss ◽  
Comparative Studies ◽  
University Hospital ◽  
Cochrane Library ◽  
Band Slippage ◽  
Lap Band ◽  
Number Of Patients ◽  
Significant Difference ◽  
Gastric Bands

Tomas Abalikšta, Gintautas Brimas, Kęstutis Strupas Vilniaus universiteto Medicinos fakultetas, M. K. Čiurlionio g. 21, LT-03101 VilniusVilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Darbo tikslas: Remiantis literatūros duomenimis palyginti skirtingas skrandžio apjuosimo reguliuojamas juostas, naudojamas chirurginiam nutukimo gydymui. Tyriamoji medžiaga ir metodai: Publikacijų paieška atlikta elektroninėse MEDLINE, Current Contents ir Cochrane Library duomenų bazėse. Apžvelgtos visos skrandį apjuosiančių reguliuojamų juostų lyginamųjų studijų publikacijos, paskelbtos iki 2010 m. sausio 1 d. Rezultatai: Atlikus literatūros šaltinių paiešką rasta 10 publikacijų, lyginančių skirtingas skrandį apjuosiančias reguliuojamas juostas. Išsamiai atlikta viena studija: perspektyvi, atsitiktinių imčių, jos tiriamųjų skaičius didelis ir stebėjimo laikotarpis ilgas, įvertinti visi gydymo rezultatai. Statistiškai reikšmingo skirtumo tarp SAGB ir LAP-BAND juostų šioje studijoje nerasta. Kitos lyginamosios juostų studijos turi trūkumų: keturios buvo ne atsitiktinių imčių (dvi iš jų retrospektyvios), trijose tiriamųjų imtis maža, visų stebėjimo laikas trumpas. Vienoje iš šių studijų nustatytas kūno masės kritimo skirtumas tarp grupių: LAP-BAND grupėje pradinė viršnorminė kūno masė sumažėjo 41,7 %, Heliogast – 28,3 %. Mechaninių juostų komplikacijų dažnis skyrėsi vienoje studijoje: LAP-BAND – 7 %, SAGB – 1 %. Skirtumas tarp „mažo skrandžio“ išsiplėtimo arba juostos nuslinkimo dažnio rastas trijose studijose (MiniMizer Extra – 0 % ir LAP-BAND – 10,8 %; SAGB – 2,4 % ir LAP-BAND – 27,6 %; SAGB – 2 % ir LAP-BAND – 23 %). Skirtumo tarp gretutinių ligų ir gyvenimo kokybės pokyčio, hospitalizacijos trukmės, juostos reguliavimų skaičiaus/dažnio, juostos penetracijos/migracijos į skrandį bei infekcinių komplikacijų dažnio nerasta. Išvados: Tik viena studija atlikta laikantis šiuolaikinių įrodymais pagrįstos medicinos keliamų reikalavimų, skirtumo tarp lygintų juostų nerasta. Reikalingos perspektyvios, atsitiktinių imčių ilgalaikės (>5 metų) lyginamosios studijos, vertinančios juostų konstrukcijos ar formos skirtumų įtaką gydymo efektyvumui ar komplikacijoms. Reikšminiai žodžiai: nutukimas, bariatrinė chirurgija, skrandžio apjuosimo reguliuojama juosta operacija. Adjustable gastric bands: review of comparative studies Tomas Abalikšta, Gintautas Brimas, Kęstutis Strupas Vilnius University Medical Faculty, M. K. Čiurlionio Str. 21, LT-03101 Vilnius, LithuaniaVilnius University Hospital Santariškių Klinikos Centre of Abdominal Surgery,Santariškių Str. 2, LT-08661 Vilnius, LithuaniaEl. paštas: [email protected] Objective: The objective of this review is to compare different adjustable gastric bands according to the data of comparative studies. Materials and Methods: A search of articles published in any language before January 2010 was carried out through the MEDLINE, Current Contents and Cochrane Library electronic databases. All articles about comparative studies of different adjustable gastric bands were eligible for review. All possible data were extracted from accepted studies and reviewed. Results: Ten comparative studies of different adjustable gastric bands were accepted. Only one comparative study of the bands was accomplished properly. It was a prospective randomised study type with a large number of patients and a long follow-up period with all possible results evaluated. No statistically significant difference between SAGB and LAP-BAND gastric bands was found in this study. The other band studies had shortcomings: four studies were non-randomised (two of them retrospective), a small number of patients in three studies, and a too short follow-up period in all studies. The difference in weight loss was stated in one of these studies: 41.7% of initial excess weight loss in the LAP-BAND group and 28.3% in the Heliogast group. Band leakage frequency was different in one study: LAP-BAND – 7%, SAGB – 1%. A difference between pouch dilatation or band slippage frequency was found in three studies (MiniMizer Extra – 0% and LAP-BAND – 10.8%; SAGB – 2.4% and LAP-BAND – 27.6%; SAGB – 2% and LAP-BAND – 23%). There was no difference between the resolution of comorbidities, improvement of the quality of life, hospital stay, band adjustment frequency, band migration or band infection rate. Conclusion: Only one accepted study was accomplished properly. There was no difference between compared adjustable gastric bands in this study. Prospective randomised long-term (more than 5 years) comparative studies are needed for a proper evaluation of band construction or shape influence on weight loss and complications. Keywords: obesity, bariatric surgery, adjustable gastric banding.

scholarly journals Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome

2018 ◽  
Vol 1 (21;1) ◽  
pp. E501-E508
Author(s):  
Haitham Hamdy Salem
Keyword(s):  
Patient Satisfaction ◽  
Pain Relief ◽  
Group Analysis ◽  
Pain Severity ◽  
University Hospital ◽  
Pain Clinic ◽  
Complication Rates ◽  
Lumbar Surgery ◽  
Time Intervals ◽  
Number Of Patients

Background: Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS). Objectives: The purpose of this study was to compare the efficacy and complication rates of the 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to treat PLSS. Study Design: This study used a case control, blind study. Setting: The research took place at the pain clinic and interventional pain practice room at Asyut University Hospital, Assiut, Egypt. Methods: Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal, S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was performed prior to the procedure to determine the patients’ baseline levels of pain severity. Followup assessments were performed 1-, 3-, and 6-months after the procedure. Results: Results of the group pairwise analysis indicated that, relative to baseline, there were significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by patients’ satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications between the 3 different groups. Limitations: Our study was limited by the low number of patients and the short duration (6 months) of follow-up. Conclusion: The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate. Key words: Post lumber surgery syndrome, post laminectomy back pain, percutaneous adhesiolysis, Racz catheter, percutaneous neuroplasty

scholarly journals Evaluation of the Meniscal repair in Bucket handle. Systematic review

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
Damián Bustos ◽  
Lucas Marangoni ◽  
Pablo Bertiche ◽  
Javier Núñez ◽  
Iván Bitar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Meniscal Repair ◽  
Level Of Evidence ◽  
Meniscal Lesions ◽  
Number Of Patients ◽  
Bibliographic Search ◽  
Rate Of Failure ◽  
Bucket Handle

Introduction: Faced with a bucket meniscal lesion we have two treatment options. A frequently practiced option is to remove the bucket handle, another is to repair it. Generally, they are associated with ligament injuries. In this context, it has been shown that meniscal repair has a good result, but the evolution of isolated meniscal repairs is not entirely clear. The purpose of this systematic review is to determine the results after the repair of bucket handle injuries. Materials and Methods: A bibliographic search of the computerized database was carried out pubmed. Eight articles were included according to the inclusion and exclusion criteria. The results of interest included, level of evidence, number of patients, follow-up, average age, surgical technique,% cure,% failure, complications, associated injuries and average time from injury to surgical repair. Results: The works studied, on average, 43 patients, with ages between 16 and 33 years making 341 patients. The follow-up period was focused on 58 months. The percentage of cure varies from 52% to 98%. Conclusion: The isolated repair of this type of meniscal lesions has a good overall evolution associated with a low rate of failure and complications Level of evidence: IV Type of study systematic review

Early Outcomes of 3D Printed Total Talus Arthroplasty

2019 ◽  
Vol 13 (5) ◽  
pp. 372-377 ◽  
Author(s):  
Daniel J. Scott ◽  
John Steele ◽  
Amanda Fletcher ◽  
Selene G. Parekh
Keyword(s):  
Treatment Option ◽  
Treatment Options ◽  
Case Series ◽  
Level Of Evidence ◽  
Ankle Motion ◽  
Motion Data ◽  
Number Of Patients ◽  
3D Printed ◽  
Radiographic Alignment

Background. Patients with talar avascular necrosis (AVN) have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTRs) has arisen as a treatment option for these patients, possibly allowing better preservation of hindfoot motion. We hypothesized that patients undergoing TTR will demonstrate a statistically significant improvement in Foot and Ankle Outcome Score (FAOS) at 1 year after surgery. Methods. We retrospectively reviewed 15 patients who underwent a TTR over a 2-year period. Patient outcomes were reviewed, including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, radiographic alignment, FAOS and Visual Analog Scale (VAS) score, and range of motion. Data analysis was performed with Student t-tests and multivariate regression. Results. FAOSs and VAS scores showed statistically significant improvements postoperatively as compared with preoperative scores. There was a statistically significant decrease in VAS pain scores from 7.0 preoperatively to 3.6 (P < .001). Average follow-up was 12.8 months. With the number of patients available, there was no statistically significant change in radiographic alignment parameters postoperatively as compared with preoperatively (P values ranged from .225 to .617). Conclusion. Our hypothesis that these patients show statistically significant improvements in FAOSs at 1 year was confirmed. TTR represents an exciting treatment option for patients with talar AVN, though longer-term follow-up is needed. Level of Evidence: Level IV: Case series

Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures

2019 ◽  
Vol 40 (5) ◽  
pp. 515-525 ◽  
Author(s):  
Arno Frigg ◽  
Sandrine Zaugg ◽  
Gerardo Maquieira ◽  
Alex Pellegrino
Keyword(s):  
Minimally Invasive ◽  
Range Of Motion ◽  
Open Surgery ◽  
Aofas Score ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Level Ii ◽  
American Orthopaedic ◽  
Tissue Trauma

Background: Stiffness after open hallux valgus surgery affects 7% to 38% of patients. Minimally invasive surgery (MIS) is thought to decrease this rate by reducing soft tissue trauma. MIS, now in its third generation, is advertised as delivering results superior to open surgery. However, no studies have reported stiffness or range of motion (ROM). Methods: Between January 2014 and December 2015, a total of 50 patients received open scarf-Akin surgery and 48 received minimally invasive Chevron Akin (MICA) surgery. The endpoints were American Orthopaedic Foot & Ankle Society (AOFAS) score, range of motion, visual analog scale for pain, scar length, and subjective foot value. The minimal follow-up time was 2 years. Results: Moderate stiffness occurred in 3 cases in both groups. In MICA, extension increased by 10 degrees while it remained unchanged in scarf. Both groups showed similar improvements in AOFAS score, pain, and subjective foot value. Radiographic evidence of correction was comparable, except for an increased shortening of the first metatarsal by 3 mm in MICA. The scars were smaller in MICA (1.2 cm) than in scarf (5 cm). Wound problems included delayed healing in 10% in scarf and wound infections in 4% in MICA. The rate of recurrence and other complications were comparable, except for reoperations, which were higher in MICA (27% mainly for protruding screws) than in scarf (8% mainly for stiffness). In MICA, 14% were intraoperatively converted to open surgery. Conclusion: MICA showed no advantages over scarf other than a shorter scar. The observed gain in extension could be related to the increased shortening of the first metatarsal because of the size of the burr. Level of Evidence: Level II, prospective cohort (nonrandomized, comparative) study.

scholarly journals THERAPEUTIC VALUE OF COMBINED THERAPY WITH DEFERASIROX AND SILYMARIN ON IRON OVERLOAD IN CHILDREN WITH BETA THALASSEMIA

2013 ◽  
Vol 5 (1) ◽  
pp. e2013065 ◽  
Author(s):  
Adel Abd elhaleim Hagag
Keyword(s):  
Iron Overload ◽  
Serum Ferritin ◽  
Iron Status ◽  
Iron Chelator ◽  
University Hospital ◽  
Beta Thalassemia ◽  
Control Group ◽  
Healthy Children ◽  
Number Of Patients

abstractBackground: Beta thalassemia is an inherited hemoglobin disorder resulting in chronic hemolytic anemia requiring life-long blood transfusion that cause iron overload. Silymarin plays a role as oral iron chelator and hepatoprotective agents in thalassemic patients.The aim of this work was to determine silymarin value as an iron chelator in thalassemic patients with iron overload.Patients and Methods: This study was conducted on 40 children with beta thalassemia major under follow-up at Hematology Unit, Pediatric Department, Tanta University Hospital having serum ferritin level more than 1000 ng/ml and was divided in two groups. Group IA: Received oral Deferasirox (Exjade) and silymarin for 6 months. Group IB: Received oral Deferasirox (Exjade) and placebo for 6 months and 20 healthy children serving as a control group in the period between April 2011 and August 2012 and was performed after approval from research ethical committee center in Tanta University Hospital and obtaining an informed written parental consent from all participants in this research. Results: Serum ferritin levels were markedly decreased in group IA cases compared with group IB (P= 0.001). Conclusion: From this study we concluded that, silymarin in combination with Exjade can be safely used in treatment of iron-loaded thalassemic patients as it showed good iron chelation with no sign of toxicity. Recommendations: Extensive multicenter studies in large number of patients with longer duration of follow up and more advanced methods of assessment of iron status is recommended to clarify the exact role of silymarin in reduction of iron over load in children with beta thalassemia.  

Efficacy of Yttrium-90 Zevalin Outside of Clinical Trials: Preliminary Results of a Retrospective Bi-Center Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5015-5015
Author(s):  
Francesco Cicone ◽  
Francesco Scopinaro ◽  
Sebastien Baechler ◽  
Nicolas Ketterer ◽  
Franz Buchegger ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Setting ◽  
Patient Population ◽  
Statistical Significance ◽  
University Hospital ◽  
Low Grade ◽  
Number Of Patients ◽  
Significant Difference ◽  
Routine Clinical Setting

Abstract Background and Aim: Due to limited data regarding the efficacy of Radioimmunotherapy with 90Y-Zevalin (RIT-Z) outside of controlled clinical trials, we carried out a biinstitutional, international retrospective study to assess the efficacy of RIT-Z in a routine clinical setting. The relationship between the number of previous therapies and outcomes as well as the response to the last therapy was assessed. Possible differences in outcomes for patients treated in the two different centers were also analyzed. Materials and Methods: Forty-three consecutive patients treated at the University Hospital of Lausanne (CHUV, Switzerland) and at S. Andrea University Hospital of Rome (Italy) were evaluated, none of which had been previously included in clinical trials. Only 31 patients entered the final analysis: patients lost at follow up, undergoing autologous transplantation (ASCT), or treated within the last 3 months were excluded. Efficacy of therapy was evaluated in terms of Overall Survival (OS), Progression Free Survival (PFS), and Time to Next Treatment (TTNT). Survival curves were obtained with the Kaplan- Meier method (statistical significance = p&lt;0.05). Results: Characteristics of the patient population are listed in Table 1. Although 50% of the patients had aggressive histologies, patients treated at S. Andrea had slightly more favorable features than those treated at CHUV. Fourteen patients (45%) had received at least 4 previous treatments, and all had received Rituximab. Fourteen patients (45%) had not responded to the last therapy, while 6 (19%), all treated at S.Andrea, were considered disease-free at the time of RIT-Z, which was administered for consolidation. Median follow up time was 20 months (11.5 vs. 25 months for S.Andrea and CHUV, respectively). Median PFS and TTNT were similar. After achieving a partial response, 2 patients were referred to Rituximab maintenance after RIT-Z and remain progression-free. Median OS was still not attained. Although not statistically significant, a trend towards better outcomes for S. Andrea patients was found. In comparing patients with indolent and aggressive lymphoma, only PFS was found to be significantly different (median PFS: 10 vs. 5 months, p&lt;0.05). In patients with &lt;4 and ≥ 4 previous therapies, twenty month OS was 88% vs. 53.6% (p=0.02), respectively; median TTNT was 22 vs. 5 months (p=0.013), while differences in PFS did not attain statistical significance. The duration of response in non-responders to their last therapy was shorter than in responders: 20-month OS- 44% vs. 94% (p=0.0015), median PFS and TTNT- 3.5 vs. 15 months (p=0.0002) and 4 vs. 15 months (p=0.0001), respectively. Median PFS and TTNT after RIT-Z did not differ from those found after the last therapy. A significant difference in outcomes for heavily pretreated or refractory patients was found in those with low grade follicular lymphoma. Conclusions: Poorer outcomes were found in our patient population treated in a routine clinical setting compared to those enrolled in clinical trials. This may be related to greater heterogeneity of our study cohort which included more patients with unfavorable conditions (e.g. aggressive NHL, ≥4 treatment courses including rituximab in all, and ASCT in 25%). Our results suggest that the best benefit may be expected with RIT-Z either for consolidation or relatively earlier in the course of NHL treatment. Table 1. Total CHUV S. Andrea Population Analyzed (72%) Number of patients 43 23 20 31 Median Age 61 63 58,5 62 Aggressive Histology (FL grade 3 or DLBCL) 18 (41,8%) 8 (34,7%) 10 (50%) 11 (35,5%) Indolent Histology (FL grade 1 or 2) (%) 25 (58,2%) 15 (65,3%) 10 (50%) 20 (64,5%) Patients with ≥4 previous treatments 19 (44,2%) 12 (52,1%) 7 (35%) 14 (45,2%) Patients with previous ASCT 11 (25,6%) 6 (26%) 5 (25%) 8 (25%)

Late toxicity described using patient reported outcomes measures (PROMS) in men treated with salvage radiation following primary high intensity focal ultrasound (HIFU) for localized prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 131-131 ◽  
Author(s):  
Reena Davda ◽  
Clement Orczyk ◽  
Mark Prentice ◽  
Aylin Sarova ◽  
Manit Arya ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Minimally Invasive ◽  
Symptom Score ◽  
Late Toxicity ◽  
Salvage Radiotherapy ◽  
Small Problem ◽  
Ablative Therapies ◽  
Number Of Patients ◽  
Patient Reported

131 Background: In primary treatment of localised prostate cancer, minimally invasive ablative therapies such as HIFU aim to achieve cancer control whilst offering a potentially favourable toxicity profile. At 5 years median follow up, 12% of patients treated with focal HIFU require salvage therapy. PROMS using Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC‐CP) provide a validated and clinically relevant tool to assess and quantify side effects from pelvic radiotherapy. There is limited data on late toxicity using PROMs with salvage radiotherapy in this setting. Methods: Retrospective analysis from prospectively collected data of 28 patients who received salvage radiotherapy at our institution 2010-2018 was performed. Late bowel and urinary toxicity measured by EPIC-CP is reported. Results: Gleason score at diagnosis: 3+3 4/28; 3+4 22/28; 4+3 2/28. HIFU treatment received: focal: 9/28; whole gland: 6/28; focal and redo focal: 7/28; focal and redo whole gland: 1/28; whole gland and redo: 5/28. All patients had mpMRI and biopsy proven recurrence with median PSA 6.6 ng/ml (0.57- 30.89). Median age at radiation was 67 years (55-80). Patients received 74 Gy to the prostate and 4 patients received additional pelvic lymph node irradiation. Three men received conformal radiotherapy (multiphase technique) and 25 arcing intensity modulated radiotherapy with hormone therapy as per risk stratification. Cumulative incidence of toxicity is reported at median follow-up of 43 months (7-99). Overall urinary function: no problem 8/28; very small problem 4/28; small problem 7/28; moderate problem 5/28; big problem 4/28 Urinary Incontinence Symptom Score: 2.5/12 (0-12) Urinary Irritation /Obstructive Symptom Score: 3.1/12 (0-12) Bowel Symptom Score: 3.5/12 (0-11) Biochemical relapse has occurred in 2/28 patients. Conclusions: Functional and oncological outcomes for a greater number of patients treated with minimally invasive ablative therapies followed by salvage radiation are required, however this data suggests radiation is a well-tolerated and effective salvage option following primary HIFU.

Clinical and Ultrasonographic Results of Ultrasonographically Guided Percutaneous Radiofrequency Lesioning in the Treatment of Recalcitrant Lateral Epicondylitis

2011 ◽  
Vol 39 (11) ◽  
pp. 2429-2435 ◽  
Author(s):  
Cheng-Li Lin ◽  
Jung-Shun Lee ◽  
Wei-Ren Su ◽  
Li-Chieh Kuo ◽  
Ta-Wei Tai ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Grip Strength ◽  
Surgical Intervention ◽  
Current Trend ◽  
Case Series ◽  
Lateral Epicondylitis ◽  
Extensor Tendon ◽  
Level Of Evidence ◽  
Vas Score

Background: In patients with lateral epicondylitis recalcitrant to nonsurgical treatments, surgical intervention is considered. Despite the numerous therapies reported, the current trend of treatment places particular emphasis on minimally invasive techniques. Purpose: The authors present a newly developed minimally invasive procedure, ultrasonographically guided percutaneous radiofrequency thermal lesioning (RTL), and its clinical efficacy in treating recalcitrant lateral epicondylitis. Study Design: Case series: Level of evidence, 4. Methods: Thirty-four patients (35 elbows), with a mean age of 52.1 years (range, 35-65 years), suffered from symptomatic lateral epicondylitis for more than 6 months and had exhausted nonoperative therapies. They were treated with ultrasonographically guided RTL. Patients were followed up at least 6 months by physical examination and 12 months by interview. The intensity of pain was recorded with a visual analog scale (VAS) score. The functional outcome was evaluated using grip strength, the upper limb Disability of Arm, Shoulder and Hand (QuickDASH) outcome measure, and the Modified Mayo Clinic Performance Index (MMCPI) for the elbow. The ultrasonographic findings regarding the extensor tendon origin were recorded, as were the complications. Results: At the time of the 6-month follow-up, the average VAS score in resting (from 4.9 to 0.9), palpation (from 7.6 to 2.5), and grip (from 8.2 to 2.9) had improved significantly compared with the preoperative condition ( P < .01). The grip strength (from 20.6 to 27.0 kg) and QuickDASH score (from 54.3 to 21.0) had also improved significantly ( P < .01). The MMCPI score improved from “poor” to “excellent.” The ultrasonographic finding revealed that the thickness of the common extensor tendon origin did not change significantly. At the final follow-up (mean, 14.3 months; range, 12-21 months), the patients reported a 78% reduction in pain compared with the preoperative status. No major complications were noted in any patient. Conclusion: Ultrasonographically guided RTL for recalcitrant lateral epicondylitis was found to be a minimally invasive treatment with satisfactory results in this pilot investigation. This innovative method can be considered as an alternative treatment of recalcitrant lateral epicondylitis before further surgical intervention.

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