Last Follow-up In Patients Research Articles

Return to Sport After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Patients With Osteochondral Lesion of the Talus.

To determine the rate of return of patients to sport after arthroscopic autologous matrix-induced chondrogenesis (AT-AMIC) for outcomes 2 years after surgery. Retrospective observational cross-sectional study. C.A.S.C.O.-Foot and Ankle Unit, Istituto Ortopedico Galeazzi, Milan, Italy. Twenty-six consecutive patients, 65.4% male (mean ± SD age: 33.7 ± 11.0 years), that underwent AT-AMIC procedure between 2012 and 2015 were selected retrospectively. From this population, only sporting patients at amateur's level were included. Arthroscopic autologous matrix-induced chondrogenesis was proposed in patients with pain and persistent disability. All patients were assessed with the American Orthopaedic Foot and Ankle Score (AOFAS), physical component score of the 12-Item Short Form Health Survey (SF-12), Halasi ankle activity score, and University of California, Los Angeles (UCLA) activity scale preoperatively and at 24 months postoperatively. Overall, 80.8% of the patient group returned to the same preinjury sport. The mean follow-up was 42.6 ± 10.9 months (range from 25 to 62 months). Significant differences were observed with reference to AOFAS, SF-12, Halasi, and UCLA scores at the last follow-up in patients who had undergone AT-AMIC (all, P < 0.001). A high percentage of patients return to their preinjury sport after AT-AMIC surgery.

Right Ventricle-Dependent Coronary Circulation: Location of Obstruction Is Associated With Survival

Pulmonary atresia with intact ventricular septum (PAIVS) with right ventricle-dependent coronary circulation (RVDCC) carries suboptimal outcomes primarily due to cardiac ischemia. We hypothesize clinical outcomes are affected by the level of coronary obstruction, a surrogate for vulnerable myocardium. We conducted a single-institution retrospective analysis of all neonates with PAIVS with RVDCC from 1995 to 2017. RVDCC was defined as the presence of any coronary-cameral fistula with coronary obstruction proximal to the fistula and angiographic evidence of RV perfusion of the myocardium through the fistulous communication. Location of coronary obstruction was categorized as either proximal or distal segments, using the SYNTAX score criteria. Transplant-free survival was compared between patients with proximal and distal obstruction, then these groups were compared with patients without RVDCC. Of 103 neonates with PAIVS, 28 (27%) had RVDCC: 18 proximal (64%), 10 distal (36%). Median age at last follow-up for patients with RVDCC was 1.8 years (interquartile range, 0.3-8.1 years). All deaths (10 of 28, 36%) occurred at 6 months old or earlier. Proximal coronary artery obstruction was associated with decreased transplant-free survival relative to distal obstruction (hazard ratio= 3.63; 95% confidence interval, 1.01-13.00; P= .048). Transplant-free survival at 1 year was 33% and 70% in the proximal and distal obstruction groups, respectively. Compared with patients without RVDCC, patients with proximal obstruction had significantly lower transplant-free survival (P < .001), whereas patients with distal obstruction did not (P= .217). The location of coronary artery obstruction affects clinical outcome and may represent a potential branch point in the management for PAIVS with RVDCC.

Effects of sirolimus in lymphangioleiomyomatosis patients on lung cysts and pulmonary function: long-term follow-up observational study.

To determine whether sirolimus has beneficial effects on lymphangioleiomyomatosis (LAM) lung cysts in CT with long-term follow-up (FU) and to investigate whether CT is an appropriate imaging biomarker to monitor and evaluate LAM progression. In this retrospective study, 73 female patients diagnosed with definite LAM between May 2001 and June 2018 were included. Among these, 39 (53.4%) were treated with sirolimus. Quantitative and qualitative CT scoring for lung cysts (CS) were performed and compared between time points (baseline vs. FU at starting sirolimus, baseline vs. last FU, and FU at starting sirolimus vs. last FU for patients treated with sirolimus; baseline vs. last FU for patients without sirolimus). The correlation between CS at each time point and pulmonary function tests (PFTs) at each time point in the patients treated with sirolimus was also investigated. The quantitative and qualitative analyses and PFT results were compared between time points. In both quantitative and qualitative analyses, CS significantly increased from baseline to FU after starting sirolimus, and from baseline to last FU (all p < 0.05), whereas there was no significant difference between scores at the start of sirolimus vs. last in the patients treated with sirolimus. After sirolimus treatment, diffusing capacity for carbon monoxide (DLCO) was significantly increased. There were significant correlations between CS at each time point and PFT (correlation coefficient [r], - 0.383-0.935; all p < 0.001). Patients with LAM benefited from sirolimus. CT could be a useful imaging biomarker for evaluating and monitoring lung cysts in LAM. • Qualitative analysis showed a total of 15.8% to 21.1% of patients had a reduced lung cyst volume after sirolimus treatment, and in quantitative analysis, there was no significant difference in lung cyst volume between CT at the start of sirolimus therapy and the last CT. • Pulmonary function was also improved or maintained after sirolimus treatment. • Chest CT could be a useful imaging biomarker for evaluating and monitoring lung cysts in patients with lymphangioleiomyomatosis.

Incidence and Risk Factors for a Partial Anterior Cruciate Ligament Tear Progressing to a Complete Tear After Nonoperative Treatment in Patients Younger Than 30 Years.

Background:Partial anterior cruciate ligament (ACL) tears are observed in 10% to 27% of isolated ACL tears. There is currently no consensus on diagnosis and treatment protocols, and the outcomes of nonoperative treatment remain undefined.Purpose:To assess the incidence and risk factors for the progression of partial ACL tears to complete ruptures after nonoperative treatment in active patients younger than 30 years.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 41 patients, all younger than 30 years and active in sports, were diagnosed with a partial ACL tear, with no associated meniscal or chondral lesions on magnetic resonance imaging (MRI). All were assigned to a nonoperative treatment program. The Lachman test, ≤4-mm side-to-side difference in laxity by Rolimeter, and MRI were utilized for the diagnosis. Tegner and International Knee Documentation Committee (IKDC) scores were assessed before and after the first lesion, and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) score was assessed at last follow-up. Postinjury Tegner and IKDC scores were assessed before the second injury for patients progressing to a complete ACL tear and at last follow-up for patients without progression.Results:At a mean of 43 months (range, 24-96 months), the partial ACL injury progressed to a complete ACL tear in 16 (39%) patients. In the remaining 25 patients without progression, the mean Tegner and IKDC scores were 7.0 and 96.0 before the injury and 5.9 and 85.7, respectively, at last follow-up. The mean ACL-RSI score was 69.3. The Tegner and IKDC scores were significantly lower at final follow-up (P = .0002 and P < .0001, respectively). Only 18 (44%) patients returned to their preinjury level of sports activities. A significantly increased risk of progression to a complete ACL tear was seen in patients ≤20 years (odds ratio, 5.19; P = .037) or patients practicing pivoting contact sports (odds ratio, 6.29; P = .026). Meniscal lesions were found in 50% of patients with a partial tear that progressed to a complete ACL tear.Conclusion:A partial ACL injury progressed to a complete ACL tear in 39% of young active patients treated conservatively, with half of the complete tears presenting with a concomitant meniscal lesion at the time of reconstruction. Age ≤20 years and participation in pivoting contact sports were identified as significant risk factors for progression to a complete tear.

Impact of Food and Drug Administration Approval of Vismodegib on Prevalence of Orbital Exenteration as a Necessary Surgical Treatment for Locally Advanced Periocular Basal Cell Carcinoma.

To test the hypothesis that the US Food and Drug Administration approval of vismodegib in early 2012 has reduced the prevalence of orbital exenteration for locally advanced periocular basal cell carcinoma (BCC). Following institutional review board approval, the authors reviewed clinical and pathological data of patients with locally advanced periocular BCC (T4 per the eyelid carcinoma classification in the 8th edition of the AJCC Cancer Staging Manual) treated by the senior author during 2006-2018. Patients were grouped into those who were treated before February 2012 ("before vismodegib approval") and those who presented later ("after vismodegib approval"). Forty-two patients with locally advanced periocular BCC were treated during the study period, of whom 31 were men. The median age at presentation was 66 years (range, 43-90). Twenty-two patients had T4a and 20 had T4b tumors. Thirteen patients were treated before and 29 were treated after vismodegib approval. The 2 groups did not differ in age distribution (p = 0.164), sex distribution (p = 0.270), prevalence of recurrent tumor at presentation (p = 0.317), or duration of treatment with vismodegib (p = 0.605). Orbital exenteration was significantly more prevalent in patients treated before vismodegib approval than after (46% vs. 10%, p = 0.016), and vismodegib treatment was significantly more prevalent in patients treated after vismodegib approval than before (when vismodegib was given in clinical trials; 69% vs. 23%, p = 0.008). There was a trend toward more patients retaining their eyes at last follow-up in patients treated after vismodegib approval (83% vs. 54%, p = 0.066). The prevalence of orbital exenteration as a necessary surgical procedure in patients with a locally advanced periocular BCC has fallen since the Food and Drug Administration approval of vismodegib. Although vismodegib is not specifically approved for organ-sparing, it has changed the authors' practice and enabled eye preservation in patients with locally advanced periocular BCC, who would otherwise require an orbital exenteration.

LONG-TERM FOLLOW-UP OF THE COMPARE-AMI TRIAL: COMPARISON OF INTRACORONARY INJECTION OF CD133+ BONE MARROW STEM CELLS TO PLACEBO IN PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION WITH LEFT VENTRICULAR DYSFUNCTION

The long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) treated with intra-coronary (IC) CD 133+ bone marrow stem cells (BMSC) has not been previously reported. Therefore, we aim to report the long-term outcomes of patients treated in the COMPARE-AMI trial. A composite end-point of death, MI, stroke, repeat revascularisation and admission for heart failure was assessed at last follow-up for patients enrolled in the randomized placebo-controlled COMPARE-AMI trial in which patients with left ventricular dysfunction were randomized to IC CD133+ injection and or placebo injection following primary percutaneous coronary intervention. Between November 2007 and July 2012, 38 patients were enrolled in the trial; but 1 patient subsequently withdrew. Thus, the study population included 17 patients in the stem cell group injected with 10 million CD133+ cells per patient and 20 patients in the placebo group. Baseline patient’s clinical characteristics were not significantly different between the groups (Table 1). Long-term follow-up was available in all 37 patients at 2800±581 days. The composite end-point event-free survival was similar between the stem cell group and the placebo group (57.1% vs. 50.0%, respectively, p=0.889). Absolute increase of LVEF compared to baseline values was higher in the BMSC group compared to the control group, but was not statistically significant (7.7% vs. 6.3%; p=0.304). In this pilot trial, we found that IC injection of CD 133+ BMSC was safe and not associated with adverse outcomes as compared to placebo up to 10 years of follow-up. Large, prospective, randomized studies are warranted to determine whether there is indeed also benefit.

Treatment and Long-Term Outcomes of Primary Central Nervous System Vasculitis.

Background and Purpose- We aimed to analyze the long-term outcomes of patients with primary central nervous system vasculitis according to the different therapeutic strategies used to induce remission. Methods- We assessed the rate of prolonged remission (defined by the absence of relapse at ≥12 months after diagnosis) and the functional status at last follow-up in patients with primary central nervous system vasculitis included in the French cohort, who achieved a first remission according to the 3 main groups of treatments administered: glucocorticoids only (group 1); induction treatment with glucocorticoids and an immunosuppressant, but no maintenance (group 2); and combined treatment with glucocorticoids and an immunosuppressant for induction followed by maintenance therapy (group 3). Good functional status was defined as a modified Rankin Scale score ≤2 at the last follow-up. Results- Remission was achieved with the initial induction treatment in 106 (95%) of the 112. Prolonged remission without relapse was observed in 70 (66%) patients after 57 (12-198) months of follow-up. A good functional status at last follow-up (ie, modified Rankin Scale score ≤2) was observed in 63 (56%) patients. Overall mortality was 8%. The initial severity and the radiological presentations were comparable in the 3 treatment groups. More prolonged remissions ( P=0.003) and a better functional status at the last follow-up ( P=0.0004) were observed in group 3. In multivariate analysis, the use of maintenance therapy was associated with prolonged remission (odds ratio, 4.32 [1.67-12.19]; P=0.002) and better functional status (odds ratio, 8.09 [3.24-22.38]; P<0.0001). Conclusions- This study suggests that maintenance therapy with an immunosuppressant combined with glucocorticoids lead to the best long-term clinical and functional outcomes in patients with primary central nervous system vasculitis after having achieved remission with either glucocorticoids alone or in combination with another immunosuppressant.

Interventions in children with renovascular hypertension: A 27-year retrospective single-center experience.

Renovascular hypertension (RVH) can be caused by renal artery stenosis (RAS) and/or middle aortic syndrome (MAS). Patients who received surgical or transcatheter treatment for RVH between 1/1991 and 11/2017 were retrospectively reviewed using age = adjusted blood pressure ratio (BPR). Fifty-three patients diagnosed with RVH at a median age of 4.5 (0-18) years were included. Vascular involvement ranged from MAS with RAS (20), RAS only (32), and MAS only (1). The first intervention was transcatheter in 47 patients (transcatheter group: angioplasty = 41, stenting = 5, and thrombectomy = 1), and surgical in 6 patients (surgical group), occurring at a median age of 6.2 (0.1-19.6) years. There was a change toward transcatheter interventions as the first procedure over the study period. First reinterventions in the transcatheter group (27 lesions in 18 patients) were repeat transcatheter (in 20 lesions) and surgery (7 lesions) at a median of 92 (2-2555) days; in the surgical group (5 lesions in 4 patients) first reinterventions were transcatheter (4 lesions) and repeat surgery (1) at a median of 2.2 (1.1-12.0) years. A total of 136 transcatheter and 30 surgical discrete interventions were performed. There was a significant decline in antihypertensive medications and BPR at 4-6 months after the first intervention and on last follow-up in patients initially treated by transcatheter means while the decline was not significant in the surgical group (limited by small sample size). Complications were significantly more common in the surgical group (P < .01), 11/27 (41%) vs 10/136 (7.4%). Four patients died (2 from each group): 2 with congenital renal artery atresia and MAS, 2 with MAS and RAS. The median follow-up interval was 3.6 (0.1-35.2) years. Pediatric patients with RVH treated with transcatheter means as the first intervention had significant improvement in BPR, as well as decline in antihypertensive medications and were less likely to suffer major complications.

Efficacy of arthroscopic surgery for discoid lateral meniscus injury in knee joint: a self-control study

Background and objectives: Discoid meniscus injury is a rare form of abnormal meniscus morphology with unknown pathogenesis. The complete disc-shaped meniscus is more prone than incomplete disc-shaped meniscus to tearing and adverse reactions such as joint degeneration and osteochondritis. Moreover, its clinical efficacy is not satisfactory. Arthroscopic meniscus surgery can enhance the stability of the meniscus and provide sufficient cushioning pressure to prevent recurrent meniscal tears. Therefore, this study will investigate the efficacy of arthroscopic surgery for discoid meniscus injury in knee joint and analyze risk factors that influence the efficacy of arthroscopic surgery. Methods: This single-center, self-control study will include 196 patients with discoid meniscus injury who will receive arthroscopic meniscus repair (Stryker) from December 2018 to December 2019 at the Department of Sports Trauma and Arthroscopy, First Affiliated Hospital of Anhui Medical University of China. This surgical procedure will include meniscus plasty and subtotal meniscectomy. After surgery, all included patients will be followed up for 6–18 months. Surgical efficacy will be evaluated by Lysholm score. Patients will be divided into an excellent-and-good group (Lysholm score ≥ 85) and a poor group (Lysholm score Results: The primary outcome measure of this study is the change in excellent-and-good rate of Lysholm score that reflects knee joint function measured at the last follow-up in patients undergoing arthroscopic meniscus surgery. Secondary outcome measures are Lysholm score; Outerbridge grade of chondral lesion; knee joint morphology by magnetic resonance images before surgery and at the last follow-up; age, sex, lesion region, and course of disease before surgery; and incidence of adverse reactions at the last follow-up. Clinical data from 115 patients with discoid meniscus injury (150 knees) who received treatment from April 2015 to September 2016 were retrospectively analyzed. Six to eighteen months of follow-up of 115 patients revealed a significant difference in Lysholm scores before surgery (65.80 ± 9.39) and at the last follow-up (89.15 ± 7.45; P Conclusion: Results from this study hope to confirm that arthroscopic surgery for discoid meniscus injury is a definitive treatment technique. Patient age and the degree of chondral lesion are closely related with efficacy, so it is recommended that patients with symptomatic discoid meniscus injury undergo surgery as soon as possible. Ethics and trial registration: This study was approved by the Medical Ethics Committee, First Affiliated Hospital of Anhui Medical University (approval No. PJ2018-02-03) on February 5, 2018. The version of the study protocol is 1.0. Patients and their family members will volunteer to participate in this study. Written informed consent will be obtained from each patient. This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800019182) on October 30, 2018.

Comparison of PSA value at last follow-up of patients who underwent low-dose rate brachytherapy and intensity-modulated radiation therapy for prostate cancer

BackgroundTo compare the PSA value at the last follow-up of patients who underwent prostate low-dose rate brachytherapy (LDR-BT) with that of patients who underwent intensity-modulated radiation therapy (IMRT).MethodsA total of 610 prostate cancer patients (cT1c-3bN0M0) were enrolled, and 445 of them underwent LDR-BT, while 165 received IMRT (74–76 Gy). The median follow-up period of these two groups was 75 months (LDR-BT) and 78 months (IMRT), respectively. We also evaluated the biochemical recurrence (BCR)-free rate using two definitions (Phoenix definition and PSA ≥ 0.2 ng/mL).ResultsThe percentage of patients who achieved PSA < 0.2 ng/mL at the last follow-up was 77.5% in the LDR-BT group and 49.7% in the IMRT group (p < 0.001). Among patients with a normal testosterone level at the last follow-up, the percentage of those who achieved PSA < 0.2 ng/mL at the last follow-up was 79.2% in the LDR-BT group and 32.1% in the IMRT group (p < 0.001). The 5-year BCR-free rate by the Phoenix definition in the IMRT and LDR-BT groups was 89.5 and 95.0% (p < 0.001), respectively. On the other hand, the 5-year BCR-free rate using the definition of PSA ≥ 0.2 ng/mL was 59.1 and 80.1% in the IMRT and LDR-BT groups, respectively (p < 0.001).ConclusionsThe PSA value at the last follow-up of LDR-BT was significantly lower than that of IMRT, and this result was particularly marked in patients with a normal testosterone level at the last follow-up.

P16.26 Surgical Treatment of Pineal Region Tumors

Objective: To analyse short-term results and assess long-term follow-up of patients with pineal region tumors which were operated in Uzhhorod Regional Centre of Neurosurgery and Neurology. Methods: 24 patients with pineal region tumors were operated in Uzhhorod Regional Centre of Neurosurgery and Neurology since 2011. Male to female ratio was 1:1. Mean age of the patients was 25.2 years (10 were of paediatric age). Patients were divided into two groups according to tumor type: low-grade - 12 cases (meningioma - 3, pylocytic astrocytoma - 3, pineocytoma - 2, ependymoma - 1, choroid glioma - 1, papillary tumor - 1, xantogranulema - 1) and high-grade - 12 patients (pineoblastoma - 5, anaplastic astrocytoma - 2, glioblastoma -2, teratoma -1, germinoma - 1, choriocarcinoma - 1). The extent of resection was evaluated on early postoperative MRI. Short-term results were determined based on neurological examination one month after surgery in all patients. Long-term results were assessed based on overall survival in patients with high-grade tumors and Karnofsky Performance Scale (KPS) on last follow-up in patients with low-grade tumors. Mean follow up was 24 months (in low-grade group - 34 months). Results: Gross total resection was achieved in 10 cases (41.7%) and in 6 patients near total resection was performed (25%). 4 patients underwent a subtotal resection of the tumor (16.7%) and in 4 cases only partial resection was done (16.7%). Majority of the patients (83.3%) were neurologically stable or improved compared to preoperative status on day 30 follow-up. 2 patients (8.3%) deteriorated after resection of the tumor. Postoperative mortality was 8.3% (large venous infarction and postoperative meningitis). All patients with high-grade tumors underwent radio- and chemotherapy after surgery according to tumor histology. Mean overall survival in this group of patients was 11.6 months. 7 out of 12 patients (58.3%) with low-grade pineal tumors underwent gross total resection. On last follow-up 10 patients (83.3%) with low-grade tumors were KPS 100 and 2 (16.7%) patients were KPS 70. Conclusions: Resection of pineal region tumors is safe (morbidity/mortality - 16.6%). In patients with high-grade pineal tumors surgical strategy should consist of simple debunking as overall survival is poor (11.6 months). Excellent long-term outcome (KPS 100 in 83.3%) in patients with low-grade tumors was achieved with aggressive surgical strategy (gross total resection in 58.3%).

Distal tibial nonunion using a contralateral anterior L-shaped locking compression plate through a posterior-lateral approach: A retrospective case series

BackgroundDistal tibial nonunion is usually due to severe open distal tibial fractures with high energy injury. The best surgical treatment is not well established because of the poor soft tissue condition. We retrospectively analyzed a series of patients with distal tibial nonunion after severe open distal tibial fractures; our purpose was to introduce a treatment using a contralateral anterior L-shaped locking compression plate through a posterior-lateral approach with Iliac crest bone graft and evaluate the outcomes of patients. MethodsAll patients with distal tibial nonunion who received a contralateral anterior L-shaped locking compression plate fixation through the posterior-lateral approach with Iliac crest bone graft by a single surgeon from 2014 to 2016 were reviewed. 9 patients met the criteria. Five of nine patients had varus deformities (range, 9–40°) and 4 patients had valgus deformities (range, 5–30°). Postoperative radiographs, Postoperative complications, limb alignment and limb functional outcome information of AOFAS ankle-hindfoot score were recorded. ResultsAll patients were followed up for at least 8 months (range, 8–16 months). Union was achieved in all patients after the index surgery without postoperative wound complications while one patient came up with checkrein deformity. Average time to radiographic union was 16 weeks (range, 12–24 weeks). All patients had correction to neutral alignment in both coronal and sagittal planes. The average AOFAS ankle-hindfoot score was 90 (range, 77–100) at the last follow-up of patients. ConclusionsUsing a contralateral anterior L-shaped locking compression plate fixation through a posterior-lateral approach with Iliac crest bone graft to reconstruct the distal tibial nonunion is a safe and reliable method that can successfully treat patients with poor soft tissue condition of anterior portion of leg because of its adequate exposure, both tibia and fibula rigid fixation and plenty of bone graft. We believe the application of this method resulting in a high union and low complication rate.

An Anterosuperior Deltoid Splitting Approach for Plate Fixation of Proximal Humeral Fractures

Background: The purpose of this study was to evaluate the usefulness and safety of the anterosuperior deltoid splitting approach for fixation of displaced proximal humeral fractures by analyzing the surgical outcomes. Methods: Twenty-three patients who could be followed-up for at least 8 months after the treatment of displaced proximal humeral fractures through the anterosuperior deltoid splitting approach were enrolled. We evaluated the reduction of the fractures and surgery-related complications at the last follow-up using X-ray results and clinical outcomes comprising the University of California at Los Angeles (UCLA) scoring system and the Korean Shoulder Society (KSS) score. Results: At the last follow-up of patients treated using the anterosuperior deltoid splitting approach for internal fixation of proximal humeral fractures, we found 22 cases (95.6%) of bone union, a mean UCLA score of 28.3 (range, 15 to 34) and a mean KSS score of 82.1 (range, 67 to 95). Various surgery-related complications were noted; a case of varus malunion after fracture displacement, a case of nonunion, a case of delayed union, two cases of impingement, and a case of partial axillary nerve injury, which recovered completely through the follow-up. Conclusions: Plate fixation using the anterosuperior deltoid splitting approach could be another reliable option for treating displaced proximal humeral fractures.

Pediatrics.

Introduction: The metabolic syndrome and cardiovascular (CV) disease have emerged as leading causes of late morbidity in adult liver transplantation recipients; however, limited data are available in pediatric liver transplantation (PLT). The aim of our study was to examine the prevalence of metabolic syndrome, its components, and cardiac disorders in PLT patients who survived for more than 5 years. Methods: A single-center retrospective review of demographics, clinical, laboratory and echocardiographic parameters was undertaken at the time of last follow-up for patients who had a liver transplantation before 18 years of age and more than 5 years post-transplantation. Results: Fifty-eight patients were included in the study with a mean age at transplantation of 6.3 ± 6.1 years and mean follow-up of 14.1 ± 6.0 years. Of the study group, 24 patients (41.4%) were overweight or obese and 9 patients (17%) met the definition for metabolic syndrome (Figure 1). Echocardiography data was available for 23 patients; of whom 10 patients (43.4%) demonstrated left ventricular hypertrophy and 3 patients (13%) had evidence of pulmonary hypertension (mean estimated pulmonary artery systolic pressure of 46.4 ± 8.5 mm Hg in those elevated). A statistically significant association between steroid intake and metabolic syndrome was found (p<0.05). Other cardiac disorders included hepato-pulmonary syndrome, cirrhotic cardiomyopathy, tacrolimus-associated cardiomyopathy, and moyamoya vascular pattern.Figure 1: Individual criteria met for metabolic syndrome.Conclusion: Metabolic syndrome and its components are prevalent among patients after PLT during long-term follow-up. Routine echocardiography during long-term follow up of PLT patients may be helpful in identifying left ventricular hypertrophy and pulmonary hypertension. The spectrum of CV complications in this population is much wider than in adults.

Treatment of Naviculo–First Cuneiform Coalition of the Foot

Naviculo-first cuneiform coalition is a rare form of tarsal coalition with few reports. We therefore have analyzed its clinical features and the results of treatment. We analyzed 36 feet in 28 patients diagnosed with naviculo-first cuneiform coalition from January 2003 to December 2010. The 28 patients were 10 males and 18 females, with 18 right and 18 left feet, including 8 patients with bilateral coalition. The location and morphological pattern of naviculo-first cuneiform coalition were analyzed radiologically. Symptomatic patients initially received conservative management for 6 months. Six feet of 5 patients were treated operatively, 3 feet by curettage and 3 by fusion. Eighteen feet had symptoms, while 18 feet without symptoms were diagnosed incidentally. Mean patient age at diagnosis was 34.6 years (range, 10-68 years). The mean age at diagnosis of symptomatic patients was 29.6 years (range, 10-50 years). Coalitions were located mainly in the medioplantar area. There was no bony coalition. Computed tomography or magnetic resonance imaging showed a cystic pattern in 7 patients, an irregular pattern in 4, a combined pattern in 5, and a spur-forming pattern in 1. The mean American Orthopaedic Foot & Ankle Society scores at the last follow-up in patients treated conservatively and operatively were 95.3 (range, 87-100) and 83.5 (range, 70-95), respectively. Among the 5 operated patients, 3 patients (60%) complained of pain, including 2 who received curettage and 1 who developed a nonunion after attempted fusion. Conservative treatment should be considered over surgery in treating naviculo-first cuneiform coalition. Level III, comparative case series.

Oral tacrolimus as maintenance therapy for refractory ulcerative colitis—an analysis of outcomes in two London tertiary centres

BackgroundThe medical management of refractory ulcerative colitis (UC) remains a significant challenge. Two randomised controlled studies have demonstrated tacrolimus therapy is effective for the induction of remission of moderate to severe UC. However, the long term outcomes of UC patients treated with tacrolimus as maintenance therapy are not certain. AimsThis study aims to assess the efficacy of tacrolimus maintenance therapy for refractory UC. MethodsA retrospective review of patients with UC treated with tacrolimus at two London tertiary centres was performed. Clinical outcomes were assessed at six months, at the end of tacrolimus treatment, or at the last follow-up for patients continuing tacrolimus treatment. Modified Truelove–Witts score (mTW) and Mayo endoscopy subscores were calculated. Results25 patients with UC, treated with oral tacrolimus between 2005 and 2011, were identified. The median duration of tacrolimus treatment was 9months (IQR 3.7–18.2months). The median duration of follow-up was 27months (range 3–66months). At six months thirteen (52%) patients had achieved and maintained clinical response and eleven (44%) were in clinical remission. The mean mTW score decreased from 10+/−0.5 before therapy, to 5.8+/−0.8 (p≤0.001 95% CI 2.7–5.8) at cessation of treatment or last follow-up. Mayo endoscopy subscore decreased from 2.6+/−0.1 to 1.2+/−0.2 (p≤0.001 mean reduction 1.4, 95% CI 0.8–1.9). Eight patients (32%) subsequently underwent a colectomy within a mean time of 17months (range 2–45months). ConclusionTacrolimus is effective for the maintenance of refractory UC and can deliver sustained improvement in mucosal inflammation.

1699 IDENTIFYING NOVEL DNA METHYLATION MARKERS TO MONITOR BLADDER CANCER RECURRENCE IN URINE SEDIMENTS FROM TURBT PATIENTS

You have accessJournal of UrologyBladder Cancer: Superficial (I)1 Apr 20131699 IDENTIFYING NOVEL DNA METHYLATION MARKERS TO MONITOR BLADDER CANCER RECURRENCE IN URINE SEDIMENTS FROM TURBT PATIENTS Andre Luis de Castro Abreu, Sheng-Fang Su, Kimberly Siegmund, Yvonne Tsai, Yoshitomo Chihara, Eila Skinner, Sia Daneshmand, Peter A. Jones, and Gangning Liang Andre Luis de Castro AbreuAndre Luis de Castro Abreu Los Angeles, CA More articles by this author , Sheng-Fang SuSheng-Fang Su Los Angeles, CA More articles by this author , Kimberly SiegmundKimberly Siegmund Los Angeles, CA More articles by this author , Yvonne TsaiYvonne Tsai Los Angeles, CA More articles by this author , Yoshitomo ChiharaYoshitomo Chihara Los Angeles, CA More articles by this author , Eila SkinnerEila Skinner Los Angeles, CA More articles by this author , Sia DaneshmandSia Daneshmand Los Angeles, CA More articles by this author , Peter A. JonesPeter A. Jones Los Angeles, CA More articles by this author , and Gangning LiangGangning Liang Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3009AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The high risk of recurrence in patients following transurethral resection of non-muscle invasive bladder tumor (TURBT) requires lifelong maintenance treatment and surveillance, currently by cytology and cystoscopic examination which creates a substantial financial burden. Aberrant DNA methylation occurs early during tumorigenesis and is present in premalignant lesions, and therefore, DNA methylation analysis of cancer-related genes serve as promising biomarkers. However, urine-based DNA methylation analysis to monitor TURBT patients longitudinally, which also may allow non-invasive recurrent tumor detection before clinical diagnosis, has not yet been well established thus far. METHODS Using pyrosequencing, we analyzed DNA methylation levels in a panel of six methylation markers in 368 serial urine samples from 90 post-surgical patients. The sensitivity and specificity in detecting tumor recurrence were summarized by ROC curves and AUC values. The optimum combination of markers was identified using five-fold cross-validation in 29 urine samples from patients at first recurrence on study and 54 samples from the last follow-up of patients without recurrence; the combination was then validated in 23 urine samples indicating tumor and 135 recurrence-free samples. RESULTS The methylation profiles of six markers individually showed a high sensitivity and specificity in detecting tumor recurrence (all AUC≥0·9; p<0·0001). The three-marker model displayed 86% sensitivity and 89% specificity in discriminating between samples with and without recurrence, as well as 83% sensitivity and 97% specificity in a separate set of samples from the same cohort. Significantly, the sensitivity of this three-marker DNA methylation analysis was higher than that of urine cytology at the time of recurrence (90% vs 16%). Furthermore, when including the period before recurrence, the established cut-off value that indicates positive urine test by DNA methylation analysis has a higher sensitivity than cytology (62% vs 6%) and also successfully predicts the subsequent recurrence of bladder tumor in 90% of samples, compared to only 7% by cytology. CONCLUSIONS We identify a panel of markers for which methylation can be analyzed in urine to accurately detect and predict bladder tumor recurrence in TURBT patients. Given its superior sensitivity and non-invasive nature, urine-based DNA methylation analysis would be useful in follow-up visits screening for recurrence and would improve treatment strategies in clinical utility. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e699 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andre Luis de Castro Abreu Los Angeles, CA More articles by this author Sheng-Fang Su Los Angeles, CA More articles by this author Kimberly Siegmund Los Angeles, CA More articles by this author Yvonne Tsai Los Angeles, CA More articles by this author Yoshitomo Chihara Los Angeles, CA More articles by this author Eila Skinner Los Angeles, CA More articles by this author Sia Daneshmand Los Angeles, CA More articles by this author Peter A. Jones Los Angeles, CA More articles by this author Gangning Liang Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment of mesial temporal lobe epilepsy with amygdalohippocampal stimulation: A case series and review of the literature

Deep brain stimulation (DBS) is being used with increasing frequency for the treatment of mesial temporal lobe epilepsy (MTLE). Here, we report two patients treated with amygdalohippocampal (AH)-DBS for drug-resistant temporal lobe epilepsy. Two patients with temporal lobe epilepsy were admitted to Beijing Sanbo Brain Hospital. The first patient was a 34-year-old male with a 31-year history of epileptic seizures. The second patient was a 27-year-old male with a 19-year history of drug-resistant epilepsy. The patients received a comprehensive presurgical workup and were considered unsuitable candidates for resective surgery. AH-DBS was recommended for the two patients. The last follow-up for patient 1 was 36 months after surgery and the final parameter settings were 3.6 mA, 450 μsec, 130 Hz and cycling with 60 sec on, 180 sec off. The last follow-up for patient 2 was 18 months after surgery and the final parameter settings were 2.6 mA, 450 μsec, 130 Hz and cycling with 60 sec on, 180 sec off. The patients experienced a seizure frequency reduction of 90 and 65%, respectively, with respect to the baseline. AH-DBS is a safe, micro-invasive alternative in patients with MTLE who are not candidates for resective surgery. It effectively reduces seizures without a negative effect on memory performance.

A reduction in body mass index lowers risk for bilateral slipped capital femoral epiphysis.

Slipped capital femoral epiphysis (SCFE) is occurring in greater numbers, at increasingly younger ages, and more frequently bilaterally (BL-SCFE). Obesity is one risk factor for SCFE. However, it is unclear whether postoperative decreases or increases in body mass index (BMI) alter the risk of subsequent contralateral SCFE. We therefore determined whether (1) BMI percentile was a risk factor for BL-SCFE; and (2) postoperative increases and/or decreases in BMI percentile influenced the risk for BL-SCFE. We retrospectively reviewed the records of 502 patients surgically treated for SCFE and identified 138 (27%) with BL-SCFE and 364 (73%) with unilateral SCFE (UL-SCFE); 173 patients, 60 (35%) with BL-SCFE and 113 (65%) with UL-SCFE met our inclusion criteria. Risk factors included sex, age, slip stability, slip chronicity, slip angle, and obesity. Percentile BMI was recorded at the time of first SCFE surgery, at the time of last followup for patients undergoing UL-SCFE, and at the time of second SCFE surgery for patients undergoing BL-SCFE. Sex, age, slip stability, and slip angle were not associated with BL-SCFE. Postoperative obesity (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.2-9.7) and acute slip chronicity (OR, 2.9; 95% CI, 1.3-6.7) had higher risks for sequential BL-SCFE. Obese patients who became nonobese postoperatively had a decreased risk of sequential BL-SCFE compared with those who remained obese (OR, 0.16; 95% CI, 1.2-116.5). Only postoperative obesity and an acute slip were risk factors for sequential BL-SCFE. BMI reduction to lower than the 95% percentile after SCFE surgery was associated with lower risk for BL-SCFE development. The data suggest early supervised therapeutic weight management programs for patients treated for UL-SCFE are important to reduce risk of subsequent SCFE. Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Cutaneous manifestations in CMML: Indication of disease acceleration or transformation to AML and review of the literature

Our retrospective analysis explored the role of leukemia cutis (LC) in disease progression of chronic myelomonocytic leukemia (CMML). Of 108 patients with CMML, 11 patients (10.2%) had LC including its equivalent (2 patients). Four of these patients developed acute myeloid leukemia (AML) within 0–4 months. The remaining 7 patients demonstrated increased monocytes (<20% blasts), with 3 demonstrating extramedullary involvement. Overall survival from LC to disease progression was 7.8 months. Overall survival from diagnosis to the last follow-up in patients with LC was 28.2 months, shorter than patients without LC (44 months). LC and its equivalent could predict disease progression to AML.