scholarly journals Intravitreal Melphalan for Vitreous Seeds: Initial Experience in China

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Xunda Ji ◽  
Peiyan Hua ◽  
Jing Li ◽  
Jiakai Li ◽  
Junyang Zhao ◽  
...  
Keyword(s):  
Vitreous Hemorrhage ◽  
Median Number ◽  
Local Control Rate ◽  
Chinese Patients ◽  
Significant Difference ◽  
Successful Control ◽  
Dust Seeds ◽  
Salt And Pepper ◽  
Vitreous Seeds

Purpose. To evaluate the efficacy of intravitreal melphalan for vitreous seeds from retinoblastoma in Chinese patients.Methods. This is a retrospective review of 17 consecutive Chinese patients (19 eyes) with viable vitreous seeds from retinoblastoma. The patients received multiple intravitreal injections of 20 ug melphalan.Results. The International Classification of Retinoblastoma groups were B in 1 eye, C in 5 eyes, D in 11 eyes, and E in 2 eyes. On average, 6 injections (range: 1–15) were given to each eye at the interval of 2–4 weeks. Successful control of vitreous seeds was achieved in 16 of 19 eyes (84.21%). Globe retention was achieved in 73.68% (14/19) eyes. The patients were followed up for 27 months on average (median: 26; range: 17–42 months). There is a significant difference in response to intravitreal melphalan for cloud, spheres, and dust seeds with a median number of injections of 9, 6, and 3, respectively (P=0.003). Complications related to intravitreal melphalan included vitreous hemorrhage, cataract, salt-and-pepper retinopathy, and pupil posterior synechia. There was no case of epibulbar extension or systemic metastasis within the period of follow-up.Conclusion. Intravitreal melphalan achieved a high local control rate for vitreous seeds without extraocular extension and with acceptable toxicity in Chinese retinoblastoma patients.

scholarly journals The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years

2021 ◽  
Vol 10 (7) ◽  
pp. 1336
Author(s):  
Toshifumi Takahashi ◽  
Shinya Somiya ◽  
Katsuhiro Ito ◽  
Toru Kanno ◽  
Yoshihito Higashi ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Median Number ◽  
Small Sample ◽  
Age At Diagnosis ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Cystine Stones

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.

scholarly journals THU0517 THE ROLE OF ULTRASOUND-DEFINED SYNOVITIS GRADE I IN PATIENTS PRESENTING WITH INFLAMMATORY ARTHRALGIA, A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 497.2-497
Author(s):  
J. Arroyo Palomo ◽  
M. Arce Benavente ◽  
C. Pijoan Moratalla ◽  
B. A. Blanco Cáceres ◽  
A. Rodriguez
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
Statistical Tests ◽  
Median Number ◽  
Painful Joint ◽  
Significant Difference ◽  
The Mean ◽  
Specialized Unit

Background:Musculoeskeletal ultrasound (MSUS) is frequently used in several rheumatology units to detect subclinical inflammation in patients with joint symptoms suspected for progression to inflammatory arthritis (IA). Synovitis grade I (EULAR-OMERACT combined score) is known to be a casual finding in healthy individuals, but studies headed to unravel its possible role on rheumatic diseases are sparse.Objectives:To investigate the correlation between synovitis grade I, and the diagnosis of IA made after a year follow-up period since MSUS findings, in patients of an MSUS-specialized unit of a Rheumatology Department.Methods:We conducted a descriptive, retrospective and unicentric study. 30 patients were selected from the MSUS-specialized unit of our Rheumatology Department from July-18 to January-19. Patients presenting synovitis grade 0 (exclusively), 2 and/or 3 on combined score were excluded. Data collection at baseline included age, sex, immunological profile and previous physical examination to the MSUS findings, as well as the diagnosis made by the rheumatologist in 1-year visit follow-up: dividing the patient sample into two groups: those who were diagnosed with IA and those not. Non-parametric statistical tests for comparing means were used.Results:The mean age was 51,6 years and 70% were females. 6 (20%) patients were diagnosed with inflammatory arthritis after a year follow-up: 2 (4,8%) psoriatic arthritis, 1 (3,3%) undifferentiated arthritis, 1 (3,3%) rheumatoid arthritis, 1 (3,3%) Sjögren’s syndrome. Non-inflammatory arthropathies were also found 24 (80%), of which, 12 (40%) were non-specific arthralgias and 8 (19%) osteoarthritis.In the group of patients who did not developed an IA the mean C-reactive protein (CPR) value was 3,12 mg/L and erythrocyte sedimentation rate (ESR) was 8,2 mm; all of them were rheumatoid factor (RF) positive and ACPA-negative except one patient. 5 (31,3%) patients presented low antinuclear antibodies (ANAs) levels. In those who HLA B-27 and Cw6 were tested (4,25%); both were negative except for one that was HLA B-27 positive. The median number of swollen and painful joint count was 0, and the mean of joints with MSUS involvement was 3,5; the mean involved metacarpophalangeal (MCP) joints was 1,83; proximal interphalangeal (PIP) joints was 1,48 and distal interphalangeal (DIP) joints 0,21.Among the group of patients that developed an IA the mean of CPR and ESR was 9,27 mg/L and 14,17 mm respectively; 2 (33%) patients were RF- positive, and 1 ACPA-positive. ANAs were positive in 3 cases (50%). The median of swollen joint count was 2 and for painful joint count was 0, the median of joints with MSUS involvement was 4,5. The mean of MSUS involvement was for MCP, PIP and DIP joints: 1,67, 2 and 0. Comparing the means of CPR values in the two groups with Student’s t-test we obtained a statistically significant difference (p=0,023). No other significant differences were found.Conclusion:Despite the limitations and possible statistical bias, the presence of MSUS-defined synovitis grade I and elevated CRP levels could be related to further diagnoses of inflammatory arthropathy. Besides, the absence of synovitis in DIP joints might have a diagnostic role. Normal physical exploration and normal levels of CRP might suggest low MSUS value. However, further research is needed to clarify the role of MSUS-defined synovitis grade I.References:[1]D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1):e000428.[2]Van den Berg R et al. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature review. Arthritis Research & Therapy (2018) 20:228.Disclosure of Interests:None declared

scholarly journals Long-term Observation of Chinese Idiopathic Retinitis, Vasculitis, Aneurysms, and Neuroretinits (IRVAN) Patients and suggestion of a Revised Staging System

2020 ◽  
Author(s):  
Yuhe Qi ◽  
Yongjin Zhang ◽  
Wei Liu ◽  
Lei Li ◽  
Xiaofeng Ye ◽  
...  
Keyword(s):  
Vitreous Hemorrhage ◽  
Staging System ◽  
Neovascular Glaucoma ◽  
Chinese Patients ◽  
Consecutive Series ◽  
Fundus Fluorescein Angiography ◽  
Significant Difference ◽  
One Year ◽  
Long Term Observation ◽  
Retinal Photocoagulation

Abstract Background To investigate the clinical characteristics and intervention effects on Chinese patients with idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN).Methods The consecutive series patients received eye examinations including fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and systemic testing. Laser, including pan-retinal photocoagulation (PRP), oral corticosteroid and Pars plana vitrectomy (PPV) were used during the investigation period.Results Forty-two eyes of 21 patients aged 15-58 years old, 19 females and 2 males, initial decimal BCVA NP ~1.5 (0.55±0.38), were included. Eighteen eyes reached Stage 2; 21 eyes with neovascularization of disc or elsewhere and/or vitreous hemorrhage (VH) reached Stage 3; one eye had neovascular glaucoma (NVG) at Stage 5. Two eyes had proliferative vitroretinopathy (PVR). Thirty-four eyes of 20 patients of stage 2 and 3 accepted retinal photocoagulation. 27 eyes completed PRP. PPV was performed for 3 eyes at the first visit due to VH or PVR. Three eyes developed to Stage 3 from Stage 2. One eye of Stage 3 developed to PDR with retinal detachment. Additional 5 eyes, 3 heavy VH, 1 PVR and 1 macular epiretinal membrane eye, received PPV during the follow-up. Intra-retinal microvascular abnormality (IRMA) was found in 7 eyes. Aneurysms on the optic nerve head and artery bifurcations disappeared in 8 eyes and decreased in number in 2 eyes after one year of photocoagulation. Seven eyes were found with BCVA ≤0.1, of which 3 experienced PVR, 2 exudative maculopathy, 1 acute macular neuroretinopathy (AMN) eye and 1 eye due to NVG. The BCVA of the last visit was NLP~1.2 (0.53±0.38), no significant difference was found with initial BCVA.Conclusions Female is more susceptible to IRVAN. IRMA and AMN are firstly described in IRVAN patients. PVR and exudative maculopathy, the major causes for severe visual impairment, are suggested in the revised staging system.

scholarly journals Association between Serum Uric Acid and Renal Outcome in Patients with Biopsy-confirmed Diabetic Nephropathy

2021 ◽  
Author(s):  
Yutong Zou ◽  
Lijun Zhao ◽  
Junlin Zhang ◽  
Yiting Wang ◽  
Yucheng Wu ◽  
...  
Keyword(s):  
Uric Acid ◽  
Diabetic Nephropathy ◽  
Survival Analysis ◽  
Serum Uric Acid ◽  
Chinese Patients ◽  
Renal Outcome ◽  
Lowering Therapy ◽  
Kaplan Meier ◽  
Significant Difference

Objective: To investigate the relationship between serum uric acid (SUA) level and renal outcome in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy(DN). Methods: A total of 393 Chinese patients with T2DM and biopsy-proven DN and followed at least one year were enrolled in this study. Patients were stratified by the quartiles of baseline level of SUA: Q1 group286.02± 46.66 μmol/L (n=98); Q2 group: 358.23±14.03μmol/L (n=99); Q3 group: 405.50±14.59μmol/L (n=98) and Q4 group: 499.14±56.97μmol/L (n=98).Renal outcome was defined by progression to end stage renal disease (ESRD). Kaplan-Meier survival analysis and Cox proportional hazards model were used to analyze the association between SUA quartiles and the renal outcomes. Results: During the median 3-year follow-up period, there were 173 ESRD outcome events (44.02%) during follow-up. No significant difference among SUA level the risk of progression of DN (P=0.747) was shown in the Kaplan-Meier survival analysis. In multivariable-adjusted model, HRs for developing ESRD were 1.364(0.621-2.992; p=0.439), 1.518(0.768-3.002; p=0.230) and 1.411(0.706-2.821; p=0.330) for the Q2, Q3 and Q4, respectively, in comparison with the Q1 (P=0.652). Conclusions: No significant association between SUA level and renal outcome of ESRD in Chinese patients with T2DM and DN was found in our study. Besides, the role of uric acid-lowering therapy in delaying DN progression and improve ESRD outcome had not yet been proven. Further study was needed to clarify the renal benefit of the uric acid-lowering therapy in the treatment of DN.

scholarly journals Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

2021 ◽  
Vol 14 (10) ◽  
pp. 1589-1594
Author(s):  
Simon Dulz ◽  
◽  
Toam Katz ◽  
Robert Kromer ◽  
Eileen Bigdon ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Ocular Trauma ◽  
Vitreous Hemorrhage ◽  
Open Globe Injury ◽  
Ocular Trauma Score ◽  
Open Globe ◽  
Significant Difference ◽  
Post Traumatic ◽  
Trauma Score

AIM: To elucidate the question of whether the ocular trauma score (OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment (RD) in patients with open globe injury (OGI). METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12mo follow-up and a median age at of 48.6y (range: 3-104y) were identified. Final best corrected visual acuity (BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score I (P<0.0001) or II (P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >III. OGI associated RD was observed in 36/102 patients (35.3%), whereas post traumatic RD (defined as RD following 14d after OGI) occurred in 37 patients (36.3%). OGI associated RD did not correlate with the OTS and the zone of injury (P=0.193), yet post traumatic RD correlated significantly with zone III injuries (P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone III injury with lower final BCVA and a higher number of surgeries, but only zone III could be significantly associated with a higher rate of RD.

Activity of trastuzumab (t) beyond disease progression in HER2 over-expressing metastatic breast cancer (MBC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1066-1066 ◽  
Author(s):  
G. Metro ◽  
M. Mottolese ◽  
S. Di Cosimo ◽  
P. Papaldo ◽  
G. Ferretti ◽  
...  
Keyword(s):  
Disease Progression ◽  
Overall Response Rate ◽  
Metastatic Breast ◽  
Median Number ◽  
Significant Difference ◽  
Her 2 ◽  
Cytotoxic Therapies ◽  
Hormonal Receptor Status ◽  
Visceral Disease

1066 Background: In HER-2 over-expressing MBC patients (pts), preclinical evidence suggests that T therapy should be continued until disease progression. On the other hand, the activity of T beyond disease progression is unknown. Methods: We retrospectively evaluated HER-2 over-expressing (score 3+ by IHC or 2+ and FISH amplified) unselected MBC pts treated at our institution with successive T-based cytotoxic therapies. Results: From 06/2001 to 06/2006 59 patients (57 female and 2 male) receiving at least 1 T-based regimen for advanced breast carcinoma were identified. Characteristics of patients at initiation of T were as follows: median age 51 years (32–73), pre-menopausal 28/57 (49%), HER-2 IHC 3+ 49/59 (83%), negative hormonal receptor status 34/59 (58%), visceral disease 45/59 (76%), adjuvant chemotherapy 47/59 (80%), chemo-naïve for MBC 30/59 (51%), median number of previous chemotherapy lines for MBC prior to T 1 (0–2). A total of 37, 16 and 9 patients received respectively a 2nd, 3rd and 4th T-based regimen. In the 1st T-based line there was an overall response rate (ORr) of 60% (clinical benefit-CB- 83%) while 2nd T-based line yielded an ORr of 29% (CB 62%). None of the 16 and 9 patients who received respectively a 3rd and 4th T-based line responded to treatment. At a median follow up of 26 months (range 7–78), median time to progression was 9.5 months (95%c.i. 8.2–10.9), 6.7 months (95%c.i. 3.9–9.4), 4.0 months (95%c.i. 2.4–6-0) and 4.5 months (95%c.i. 3.7–8.3) from 1st to 4th T-based line respectively. Overall survival (OS) was 37 months (95%c.i. 22.4–53.4). No significant difference was observed in OS between the 22 patients receiving only 1 T-based line and the 37 patients who underwent at least 2 T-containing regimens (28 months vs 38 months, p=0.85). Conclusions: In HER-2 positive MBC patients T beyond disease progression maintains activity in terms of CB, TTP and OS. Prospective randomized trials are warranted to draw definitive results. No significant financial relationships to disclose.

The Effect of Plasma Exchange on Rituximab Levels and Response to Rituximab in Patients with Acute Idiopathic Thrombotic Thrombocytopenic Pupura (TTP).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2297-2297 ◽  
Author(s):  
Vickie McDonald ◽  
Marie Scully ◽  
Ian J. Mackie ◽  
Kate Manns ◽  
Samuel J. Machin
Keyword(s):  
Plasma Exchange ◽  
Limit Of Detection ◽  
Median Number ◽  
Response To Treatment ◽  
Adamts13 Activity ◽  
Median Serum ◽  
Significant Difference ◽  
Before And After ◽  
Anti Cd20

Abstract Most cases of acute idiopathic TTP have ADAMTS13 activity &lt;5% and detectable anti-ADAMTS13 IgG. Rituximab, a monoclonal anti-CD20 antibody, is known to be an effective adjunct to eradicate the antibody. The initial doses of Rituximab are often given in the period that the patient is receiving plasma exchange (PEX). In order to ascertain whether Rituximab is removed by PEX and whether this affects response to treatment, we serially measured ADAMTS13 activity, anti-ADAMTS13 IgG level and serum Rituximab concentrations in patients who were treated with Rituximab within 3 days of admission for acute idiopathic TTP. Rituximab levels were measured before and after PEX, after each dose and then in remission. In addition we measured the above parameters in two patients who received Rituximab electively (not concurrently with plasma exchange). The ADAMTS13 activity (normal value &gt;66%) was measured using a collagen binding assay while the anti-ADAMTS13 IgG (normal range &lt;4%) and Rituximab levels (lower limit of detection 10mcg/ml) were measured using ELISA techniques. 16 patients (11 female, 5 male; median age 39y (range 13y – 75y)) with acute idiopathic TTP were treated with Rituximab. All patients had PEX from admission to remission, received Rituximab 375mg/m2 once weekly for 4 weeks and pulsed methylprednisolone 1g daily for three days. At presentation, all patients had ADAMTS13 activity &lt;5% and anti-ADAMTS13 IgG (median 39.5%; range 12–85%). The median follow up was 6 months (m) (range 1–12 m). 14 patients received 4 doses of Rituximab, 2 received 6 doses. One patient died of TTP related complications before the third dose. The median number of PEX after the first dose of Rituximab was 15 (range 5–21). The median serum Rituximab concentration following each dose was: 1st dose 154 mcg/ml (range 108–467mcg/ml); 2nd dose 175 mcg/ml (range 116–436mcg/ml); 3rd dose 187.5 mcg/ml (157–301mcg/ml); 4th dose 216 mcg/ml (155–243mcg/ml); 5th 155 mcg/ml; 6th 211 mcg/ml. All PEX patients had Rituximab levels &lt;10 mcg/ml immediately prior to the 2nd dose. Of those still being exchanged, 5/7 had levels &lt;10 mcg/ml prior to 3rd dose and 5/6 patients had levels &lt;10mcg/ml prior to the 4th dose. In contrast all the patients who had finished PEX had detectable Rituximab prior to their next dose. The median reduction in Rituximab per PEX expressed as a percentage of the pre-PEX level was 65 % (range 45–72%). The reduction was similar for 1.0 volume (65%) and 1.5 volume exchanges (70%). Rituximab was detected in the PEX fluid. Following completion of Rituximab therapy, the median concentration was 32mcg/ml (range 11–55mcg/ml) at 1m, 20 mcg/ml (range &lt;10 – 42mcg/ml) at 2m and 16 mcg/ml (range &lt;10– 20mcg/ml) at 3m. Seven patients reached 4 month follow up and had levels &lt;10mcg/ml. Patients who had fewer than 10 PEX had higher median Rituximab levels (20mcg/ml) at 3m than those who had more than 10 PEX (Rituximab &lt;10mcg/ml). There was no significant difference in ADAMTS13 activity or anti-ADAMTS IgG levels between these groups at 3m (patients receiving &lt;10 PEX: mean activity 38% and IgG 6%; Patients receiving &gt;10 PEX: mean activity 36% and IgG 15%). In 2 patients receiving elective Rituximab, the median concentrations before and after each dose were: 235mcg/ml after the 1st dose, 95mcg/ml before and 233mcg/ml after 2nd dose, 119mcg/ml before and 289mcg/ml after the 3rd dose, 167mcg/ml before and 373mcg/ml after 4th dose. Follow up is too short to correlate levels and ADAMTS13 activity/anti-ADAMTS13 IgG levels. There have been no relapses in any of the patients. In conclusion, Rituximab is removed by plasma exchange. The peak doses achieved are higher in those not receiving concurrent PEX. Higher Rituximab levels are associated with fewer PEX. Rituximab was still detectable at a low level in a third of patients 3 months after treatment but not at 4 months. Measurement of Rituximab levels will help to modify Rituximab doses and modification of the dosing schedule using higher initial doses or more frequent dosing may achieve higher levels earlier in treatment and a shorter time to remission. Longer term follow will also help to determine whether the peak Rituximab concentration achieved correlates with duration of remission.

Intravitreal Chemotherapy in the Management of Vitreous Disease in Retinoblastoma

2017 ◽  
Vol 27 (4) ◽  
pp. 423-427 ◽  
Author(s):  
Hayyam Kiratli ◽  
İrem Koç ◽  
Ali Varan ◽  
Canan Akyüz
Keyword(s):  
Side Effects ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Vitreous Hemorrhage ◽  
Intravitreal Chemotherapy ◽  
Pars Plana ◽  
Vitreous Seeds ◽  
Number Of Injections ◽  
Vitreous Seeding

Purpose To evaluate the therapeutic outcome of intravitreal melphalan injection in the management of vitreous disease in patients with retinoblastoma. We particularly aimed to assess whether higher melphalan dose with lower number of injections was more effective and associated with fewer side effects. Methods This retrospective, interventional, noncomparative, and nonrandomized study included 39 eyes of 37 patients. Vitreous seeds were classified as dust, sphere, and cloud types. Intravitreal injections were performed through pars plana free of any visible tumor using 30-G needle. Response of the seeds (disappearance, conversion into inactive debris, or progression) and enucleation rate were determined as outcome measures. Results All patients previously received systemic or intra-arterial chemotherapy. Vitreous seeding was primary in 54% of eyes and secondary in 46% of eyes. Vitreous seeds were classified as dust in 9 (23.1%) eyes, sphere in 24 (61.5%) eyes, and cloud in 6 (15.4%) eyes. Melphalan dose varied between 20 and 40 µg and 20 (51.3%) eyes received >30 µg. The total number of injections was 70 (range 1-5, mean 1.8 per eye). Various types of regression were obtained in 27 (69.2%) eyes. Sphere-type seeds were the most responsive to melphalan. Nonresponse and disease progression were noted in 12 (30.8%) eyes. After a mean follow-up of 11.8 months, 17 (44%) eyes were enucleated. Vitreous hemorrhage (18%) and retinal pigment epithelial alterations (8%) were the most common side effects. Conclusions Intravitreal melphalan at 30-40 µg in 1 or 2 injections proved effective in 69.2% of eyes with vitreous disease.

A MODIFIED TECHNIQUE OF INTERPOSITIONAL ARTHROPLASTY IN TREATING THE BASAL JOINT ARTHRITIS OF THE THUMB IN A CHINESE POPULATION

Hand Surgery ◽  
2009 ◽  
Vol 14 (02n03) ◽  
pp. 83-87 ◽  
Author(s):  
Tak-Chuen Wong ◽  
Fu-Keung Ip
Keyword(s):  
Pain Syndrome ◽  
Chinese Patients ◽  
Modified Technique ◽  
Interpositional Arthroplasty ◽  
Significant Difference ◽  
Basal Joint ◽  
Before And After ◽  
Operative Evaluation ◽  
Joint Arthritis

We performed a retrospective review of 22 thumbs in 22 Chinese patients attending for the basal joint arthritis of the thumb over the last 14 years. There were 16 women and six men with a mean age of 50 years old. All were treated surgically by partial trapeziectomy and volar oblique ligament reconstruction with flexor carpi radialis tendon and interpositional arthroplasty with a free palmaris longus tendon ball after failure of conservative treatment. The mean follow-up time was 48 months. Radiographs did not show any differences in the arthroplasty space index, arthroplasty space, trapezial space ratio and scaphoid-thumb metacarpal distance at the pre-operative evaluation and at the final follow-up evaluation. There was significant difference in the pain score, grip strength, Kapandji score and functional status before and after surgery at final follow-up period. One patient had complex regional pain syndrome which was resolved after receiving a course of anti-inflammatory drugs and physiotherapy. The authors suggest that the modified technique of partial trapeziectomy with tendon interpositional arthroplasty is a safe and effective method in treating basal joint arthritis of the thumb with good short term functional and radiological outcomes and minimal complication.

Is intravitreal topotecan toxic to retinal function?

2020 ◽  
pp. bjophthalmol-2020-316588
Author(s):  
Jennifer Nadelmann ◽  
Jasmine H Francis ◽  
Scott E Brodie ◽  
Engjel Muca ◽  
David H Abramson
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Retinal Toxicity ◽  
Cancer Center ◽  
Ocular Toxicity ◽  
Significant Difference ◽  
Vitreous Seeds ◽  
Paired T Test

BackgroundIntravitreal injections of topotecan are used in the management of retinoblastoma with vitreous seeds. This study evaluated whether intravitreal topotecan was associated with retinal toxicity.MethodsRetrospective cohort study of patients with retinoblastoma who were treated with intravitreal topotecan at Memorial Sloan Kettering Cancer Center between December 2014 and May 2019. Electroretinogram (ERG) responses under anaesthesia were measured immediately before treatment with intravitreal topotecan and at the next visitor approximately one-month. Ocular toxicity was defined by a decrease in the ERG response at 30 Hz at follow-up.ResultsOcular toxicity was evaluated by ERG on 50 evaluable injections administered to 28 eyes. 22 (44.0%) injections were performed with concurrent intravitreal melphalan. The median time to ERG measurement following an injection was 27 days. By using a paired t-test, intravitreal topotecan combined with melphalan (n=22) at a dose of 25 μg or 30 μg was associated with a significant decrease in ERG amplitude at follow-up (p=0.046, 95% CI −20.4 μV to −0.2 μV). Among eyes that only received topotecan (n=28) at doses of 20 μg or 30 μg, there was not a significant difference in ERG amplitude measured (p=0.85, 95% CI −7.0 μV to 5.8 μV).ConclusionIntravitreal topotecan combined with intravitreal melphalan was associated with a decrease in ERG amplitude; there was not a significant decrease in ERG amplitude observed in patients who received topotecan alone. These findings suggest that intravitreal topotecan injections at doses of 20 μg or 30 μg are not associated with retinal toxicity in patients with retinoblastoma.

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