Radiographic Failure Research Articles

Evaluation of a dry therapeutic urinary diet and concurrent administration of antimicrobials for struvite cystolith dissolution in dogs

BackgroundStruvite urolithiasis with bacterial urinary tract infection (UTI) is commonly reported in dogs; few data exist to describe successful dissolution protocols in dogs with naturally occurring disease. We hypothesized that a dry therapeutic urinary diet combined with targeted antimicrobial therapy can effectively dissolve presumptive struvite cystolithiasis in dogs with naturally occurring urease-producing bacterial UTI.ResultsTen dogs with presumed infection-induced struvite cystolithiasis based on lower urinary tract signs (LUTS), radiodense cystoliths, and urease-producing bacterial UTI were enrolled. At enrollment, antimicrobials and dry therapeutic urinary diet were dispensed. In addition to lack of radiographic resolution of urolithiasis, dogs with persistent clinical signs were considered non-responders. There was no significant difference in pH between responders and non-responders; USG was significantly higher in the responder group. Recheck visits continued until radiographic dissolution or failure was documented. Five of the 10 dogs achieved radiographic dissolution of cystolithiasis within a median of 31 days (range 19–103). In the other 5 dogs, surgical urolith removal was necessary due to persistent LUTS (3 dogs within 2 weeks) or lack of continued dissolution noted radiographically (1 dog with numerous cystoliths failed at day 91; 1 dog failed by day 57 with questionable owner compliance).ConclusionsDissolution of urinary tract infection induced struvite cystoliths can be accomplished in some dogs fed this dry therapeutic urinary diet in conjunction with antimicrobial therapy. Case selection could increase the likelihood of successful dissolution; however, if calcium phosphate is present, this could also prevent stone dissolution. If clinical signs persist despite diet and antimicrobials, stone removal is advised.

Clinical versus radiographic success of necrotic primary molars treated by Lesion Sterilization and Tissue Repair. A randomized controlled trial

The success and failure after treatment of necrotic primary molars causes a hassle to clinicians. This study aims to study the difference between clinical success and radiographic success after treatment using Lesion Sterilization and Tissue Repair technique. The study was conducted on 41 subjects in each group, all subjects were treated by LSTR technique. At the end of the study despite of radiographic failure in 21%from group A & 4% from group B. Molars were clinically successful with absence of pain, swelling, mobility, fistula formation, and were maintained functioning till the end of the study.

Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis.

Background: Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies in vital primary incisors. This study aimed to assess the effect of pulpotomy and pulpecomy in treatment of carious vital pulp exposure in primary incisors. Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials were included and assessed with Cochrane risk of bias tool . Primary outcomes were clinical failure and radiological failure.The effect sizes were calculated as risk ratios with 95%CI using the Mantel-Haenszel method. Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure.For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis. Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.

Direct pulp capping versus pulpotomy with MTA for carious primary molars: a randomised clinical trial.

Aim of this randomised clinical trial was to compare the outcome of direct pulp capping (DPC) versus pulpotomy, both with MTA, for carious primary molars. Healthy, cooperative children aged 3-9years with at least one deep carious primary molar requiring vital pulp therapy were included. Data on the primary outcome (all-cause failure) and secondary outcomes (clinical or radiographic failure) were collected blindly semi-annually for a minimum of 1year up to 3years and analysed with survival analysis and generalised linear regression at alpha = 5%. A total of 74 children were randomly allocated on 1:1 basis to DPC (35 children; 40 teeth) or pulpotomy (39 children; 57 teeth). Survival from all-cause failure was 79.7% [95% confidence interval (CI) 69.3-86.9%] at 12months and 66.0% (95% CI 53.4-76.0%) at 24months which remained stable up to 36 months, with no differences between groups (P > 0.05). No significant difference was found in the survival rate of the two groups for all-cause [hazard ratio (HR) = 0.95; 95% CI 0.45-2.01; P = 0.88], clinical (HR = 0.74; 95% CI 0.0.19-2.92; P = 0.66), or radiographic failure (HR = 0.80; 95% CI 0.0.36-1.82; P = 0.60) throughout the 3-year follow-up. Regression analysis indicated that needing a second attempt for haemorrhage control was associated with higher clinical failure rate. All-case failure was significantly different for class II versus occlusal cavities and in the latter cavities pulpotomy performed better (P < 0.001). The results of the current trial indicate that both DPC and pulpotomy can be reliable options for the treatment of deep carious primary molars in cooperative children, in carefully selected cases.

Abstract PD8-12: Safety and efficacy of palbociclib and radiotherapy in metastatic breast cancer patients: Initial results of a novel combination

Abstract Purpose: Palbociclib is a selective CDK4/6 inhibitor approved for the treatment of metastatic ER+/HER2- breast cancer. Inhibition of CDK4/6 prevents cell cycle progression from G1 to the more radioresistant S phase, raising the possibility of an enhanced therapeutic effect if combined with radiotherapy (RT). Despite this potential benefit, clinicians seldom use this combination due to fear that RT may exacerbate palbociclib toxicity, particularly leukopenia. Our aim is to report the preliminary results of patients with metastatic breast cancer who received RT while receiving palbociclib. Methods: We retrospectively reviewed records of all patients who were treated with palbociclib at our institution from 2015-2018. Patients who received RT for symptomatic metastases concurrently or within 14 days of last drug administration were included in our analysis. Local treatment effect was assessed by clinical exam and subsequent CT or MRI imaging, if applicable. Toxicity was graded based on CTCAE v5.0. Results: A total of 16 females received palliative RT in association with palbociclib. The median age of the treated patients was 59.6 (range 33.3-91.0) years. The median time of closest palbociclib use to RT administration was 5 (range 0-14) days. The following sites were treated in order of frequency: bone (10-axial skeleton [8-vertebra]; 1-ilium), brain (4: 3-WBRT &amp; 1-SRS), and mediastinum (1). RT dose/fractionation for bone was 30 Gy/10 fxn (7), 35 Gy/14 fxn (2), 37.5 Gy/15 fxn (1), and 18 Gy/1 fxn (1). WBRT dose/fractionation was 30 Gy/10 fxn for all patients. SRS brain dose was 25 Gy/5 fxn. The patient treated to the mediastinum received 36 Gy/18 fxn. At most recent follow-up, 12 patients are still living. The median time from RT to last known follow-up or death is 10.3 (range 1.7-29.6) months. Pain relief was achieved in 15 of 16 (93.8%) patients. No radiographic local failure was noted in the 13 patients with evaluable follow-up imaging. The combination of RT and palbociclib was well-tolerated. Grade 1 fatigue, dermatitis, and nausea was noted in 5, 3, and 1 patient, respectively. One patient with WBRT developed Grade 1 headache. Six of 16 patients were leukopenic prior to RT initiation. Following RT, 7 patients were observed to have a drop in WBC count, of which 2 dropped into the leukopenic range. Only a total of 5 patients were leukopenic following RT, of which 3 were leukopenic before receiving RT. No acute or late Grade 2 or higher cutaneous, neurological, gastrointestinal, or hematologic toxicities were noted. Conclusions: The use of RT in patients receiving palbociclib resulted in minimal Grade 1 and no Grade 2+ toxicities, including leukopenia. This treatment can be used safely in symptomatic patients without discontinuation of systemic therapy. Further larger prospective studies with longer follow-up are needed to confirm these results. Citation Format: Chowdhary M, Sen N, Chowdhary A, Usha L, Cobleigh M, Patel KR, Wang D, Barry PN, Rao RD. Safety and efficacy of palbociclib and radiotherapy in metastatic breast cancer patients: Initial results of a novel combination [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-12.

BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12\u2013month randomized controlled clinical trial

BackgroundThe objective of this clinical study was to prospectively compare the clinical and radiographic success rates of BiodentineTM pulpotomies versus formocresol pulpotomies in children vital primary molars.MethodsA randomized, split–mouth study design was used with a sample of 37 healthy children aged 4– to 8–year–old. A total of 56 pairs (112 teeth) of carious primary teeth, 1 pair per child, were selected for treatment. One tooth from each pair was randomly assigned to either the BiodentineTM pulpotomy group or the formocresol pulpotomy group. Children were followed–up at 3, 6 and 12 months for clinical evaluation and at 6 and 12 months for radiographic evaluation. Data were collected, tabulated and analyzed using Fisher exact and McNemar tests. The level of significance was set at P < 0.05.ResultsAt 12 months, the clinical success rates of both BiodentineTM and formocresol groups were 100%, while the radiographic success rates for BiodentineTM and formocresol groups were 100% and 98.1%, respectively. There was no statistically significant difference between both groups (P=1). The only observed radiographic failure was furcal radiolucency in the formocresol group at 12–month interval. Pulp canal obliteration was radiographically observed in 10/56 (17.9%) and 7/56 (12.5%) cases in the BiodentineTM and formocresol groups, respectively.ConclusionsBoth BiodentineTM and formocresol pulpotomy techniques demonstrated favorable clinical and radiographic outcomes over a 12-month period without any significant difference.Trial registrationRegistered on NCT03779698. Date of Registration: 18 December 2018.

Results of acromioclavicular joint reconstruction using a novel minimally invasive technique.

AC joint injury is a common disorder with a reported incidence of three to four cases per 100.000. A multitude of surgical techniques has been described for the treatment of the AC joint injuries with no clear consensus regarding the optimal treatment. We hypothesized that we would obtain favorable clinical outcomes using a novel minimally-invasive polymer cerclage wire system compared to other reported techniques in the literature. All adult patients treated with subacute AC separations in our department between the dates of 2014-2017 were retrospectively reviewed clinically and radiographically. Clinical outcomes scores that were obtained preoperatively and postoperatively included ASES score, constant score and the UCLA shoulder rating scale. Five patients with Type 5 AC separations were included in this study who underwent surgical treatment by the same orthopedic surgeon (G.H.) using the same minimally-invasive technique. The mean follow-up period was 22.4 months (range 18 to 29). Mean preoperative coracoclavicular (CC) distance was 19.7 mm (range 16.4 to 24.5 mm) on the surgical side and 9.48 mm on the contralateral side. Mean early postoperative CC distance was 7.1 mm (range 4.5 to 11.2 mm). At the latest follow-up, the mean CC distance was 13.8 mm (range 7.3 to 21.2 mm). Mean preoperative Constant score was 48, the UCLA shoulder rating score was 14.8, and the ASES shoulder score was 49.26. Mean follow up Constant score was 91.6, UCLA shoulder rating score was 33.8 and ASES shoulder score was 93.75. No neurovascular complication was observed after procedure. There were no cases of clinical or radiographic failure or loss of fixation. No AC joint arthritis was observed at the latest follow-up. We present a novel minimally-invasive polymer cerclage wire technique which provides comparable results as other reported arthroscopic and open techniques for Type 5 AC joint separations.

The Use of Reconstruction Plates and Add-on Condyles with an Alloplastic Unmatched Fossa, Following Partial Mandibulectomy with Disarticulation

The reconstruction of a mandible after ablative surgery poses many challenges. This is particularly true if the temporomandibular joint (TMJ) has been sacrificed, and the intention is to replace the mandibular defect and the joint with an alloplastic reconstruction plate and add-on condyle. A metal only condyle poses serious complication risk, and thus function against a prosthetic fossa is desirable. Currently, no stock matched prosthesis exists to fulfil this role. Aim: a series of cases are presented, whereby unmatched add-on condyles and alloplastic fossas were used safely and effectively. Materials and method: nine patients that received hemi-mandibulectomies and subsequent reconstruction with reconstruction plates, add-on condyles and alloplastic TMJ fossas, were retrospectively reviewed. The radiographs were reviewed for structural integrity of the prostheses, or the formation of heterotypic bone; and the patients were clinically evaluated for localised signs of sepsis or dehiscence. Results: all nine patients showed no sign of clinical or radiographic failure of the hybrid prostheses. Conclusion: it appears as though the use of unmatched TMJ fossas and reconstruction plates with add-on condyles, are an acceptable method of treating an ablated TMJ after hemi-mandibulectomy with disarticulation.

Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis.

Background: Early childhood caries is a serious public health problem in both developing and industrialized countries. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies for pulp treatment of vital primary anterior teeth. This study aimed to assess the effect of pulpotomy and pulpecomy in treatment of carious vital pulp exposure in primary incisors. Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials comparing between pulpotomy and pulpectomy in treatment of vital pulp exposure in primary incisors were included. Primary outcomes were clinical failure and radiological failure. Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure.For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis. Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.

The Implications of Biomarker Status In Breast Metastases Treated with Spine Stereotactic Body Radiation Therapy

While spine stereotactic body radiation therapy (sSBRT) has emerged as a promising modality for the treatment of breast cancer metastases, little is known how biomarker subtypes affect sSBRT outcomes. Studies of primary tumors and brain metastases suggest that luminal A and HER2-amplified cancers exhibit differential responses to radiotherapy, though results are largely treatment-site dependent. Our study investigates whether biomarkers predict treatment response for spine metastases treated with sSBRT. We conducted a retrospective review of 64 patients (99 treatments) with metastatic breast cancer who underwent sSBRT at a single tertiary care institution. The primary outcome was local control and secondary outcome symptomatic failure after achieving pain relief. Fine and Gray regression was used to model associations between treatment demographic, clinicopathologic, and dosimetric parameters and outcomes. All cause mortality was considered as a competing event. Overall, 67% were luminal A, 15% luminal B, 11% HER2+, and 2.0% triple negative (basal). Median KPS was 80 (range, 60-100); median prescription dose was 16 Gy (range, 12-18) in 1 fraction, with a median follow up of 14.3 months. 82 treatments had pain at time of sSBRT, and 72% experienced pain relief. Pain progression occurred in 32.2% of these patients. On multivariate analysis, patients with HER2-amplification (p<.01) and those with cord compression (p<.01) had a lower risk for developing pain progression. The 6/12 month radiographic control was 90.8%/88.7%, respectively. On multivariate analysis, patients with triple negative receptor status showed increased risk for radiographic failure (HR 7.14, p=0.04), while patients with control of primary disease had a lower risk of radiographic failure (HR 0.17, p<0.01). Our study has demonstrated the importance of biomarker status in predicting local treatment outcomes. We show that patients with triple negative breast cancer had a higher risk for radiographic progression, and patients with HER2-amplification have improved pain control. These findings necessitate further investigation of sSBRT for the treatment of patients with HER2-amplified breast cancer.

Success Rates of Calcium-Hydroxide-Iodoform Paste in Vital Pulpotom y of Primary Molars

Background: Despite customary utilization of calcium-hydroxide-iodoform-paste in treatmentof necrotic primary teeth few studies reported its use in vital pulpotomy.Aim: This longitudinal study aimed to evaluate success rates of primary molars treated withvital pulpotomy (VP) using calcium-hydroxide-iodoform-paste and stainless steel crowns (SSC) tothose subjected to cavity preparations (CP) & compomer restorations (CM).Design: Eighty molars were subjected to either VP (n=40) or CP-applying double bond-(n=40). Split mouth technique was employed. Medically free children aged four to eight yearsold possessing carious lower second primary comprised inclusion criteria. Treated molars werefollowed up 3, 6 & 12 months. Treated molars were considered clinically successful when free frompain, abscess and/ or abnormal mobility. When either internal (IR) or external (ER) root resorption,periapical (PR) or inter-radicular (IRR) radiolucency was encountered, radiographic failure wasrecorded. Chi square test was used for data analysis.Results: Clinical success was evident in 97.5% (n=39) of cases treated by VP whereas failurein the form of abscess was noted in 2.5% (n=1) which was statistically insignificant (p=0.33).Radiographically, success was shown in 75% (n=30) whereas failure was noted in 25% (n=10) outof which IR, ER and IRR represented 7.5% (n=3), 15% (n=6) and 2.5% (n=1) respectively. Molarstreated by CP showed neither clinical nor radiographic signs of failure. No significant differencewas noted comparing results of molars treated by VP to CP clinically (p=0.314) whereas significantdifference was noted radiographically (p=0.001).Conclusion: Calcium-hydroxide-iodoform-paste proved to be successful in treatment of vitalprimary molars.

Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis.

Background: Early childhood caries is a serious public health problem in both developing and industrialized countries. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. The choice of proper technique is as important as choosing between different pharmacotherapeutic agents used in treatment of primary teeth. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies for pulp treatment of vital primary anterior teeth. This study aimed to assess the effect of pulpotomy and pulpecomy in treatment of carious vital pulp exposure in primary incisors. Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials comparing between pulpotomy and pulpectomy in treatment of vital pulp exposure in primary incisors were included. Primary outcomes were clinical failure and radiological failure. Data synthesis was performed with a pair wise meta-analysis using fixed-effect models. Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical and radiographic failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was 0.74 with 95% CI 0.46 to 1.21 for radiographic failure and RR 2.69, 95% CI 0.76 to 9.58 for clinical failure. The evidence was limited by the small number of trials included in the meta-analysis. Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time.

Hip arthroplasty for osteonecrosis of the femoral head secondary to alcohol abuse.

Although the challenges of hip arthroplasty for avascular necrosis (AVN) are known, limited data exist to describe patient demographics and outcomes in the setting of AVN attributed to alcoholism. We retrospectively identified 43 patients (62 hips) who underwent primary hip arthroplasty between 1999 and 2016 for a diagnosis of AVN of the femoral head with a concomitant diagnosis of alcohol abuse and minimum follow-up of 2 years (mean, 8.6 years). The mean age was 51 years, predominantly male (88%), with a high rate of comorbidities. History of cigarette smoking was prevalent (65%). Mean length of stay was 5.3 days, which is prolonged due to a high prevalence of acute postoperative alcohol withdrawal (14.5% of cases). There were 5 early (≤2 years) reoperations (8% of hips) for instability, periprosthetic acetabular fracture and component loosening, heterotopic ossification, superficial infection, and acute periprosthetic infection. There were no additional radiographic failures. The mean postoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement was 97.8 ± 7.8, indicative of excellent outcomes at final follow-up of 2 to 18 years. Early risks associated with hip replacement surgery must be communicated to the predominantly young male subgroup of patients with AVN attributed to alcoholism, but these patients may achieve excellent mid- to long-term outcomes.

Comparing treatment modalities for transplant kidney vesicoureteral reflux in the pediatric population

Non-refluxing ureteral reimplantation is favored in pediatric renal transplantation to prevent complications, such as vesicoureteral reflux (VUR) in the transplant ureter. VUR resulting in febrile urinary tract infections remains a problem in this population, leading to repeated hospitalizations and increased morbidity. Revision of the vesicoureteral anastomosis can be a surgical challenge due to scar tissue and tenuous vascularity of the transplant ureter. Therefore, alternative options such as endoscopic injection of Deflux at the neo-orifice and surveillance with prophylactic antibiotics have emerged as potential treatment modalities for transplant ureter VUR. The authors reviewed their experience of the management of VUR in the transplant ureter, comparing outcomes of various modalities. With Institutional Review Board approval, a retrospective chart review of all renal transplant patients from January 2002 to January 2017 was conducted. All patients with VUR on voiding cystourethrogram (VCUG) after surgery were identified. Indications for end-stage renal disease, urologic comorbidities, pretransplant VCUG, and operative details were recorded. After transplantation, febrile urinary tract infections, ultrasound findings, and any further interventions-surveillance, subureteral endoscopic injection of Deflux, or ureteral reimplantation-were documented along with their outcomes. Overall, VUR was identified in 35/285 (12.3%) transplant patients aftera non-refluxing ureteroneocystostomy. VUR was managed with surveillance in 17/35 (49%), intravesical Deflux injection in 11/35 (31%), and immediate redo ureteral reimplantation in 7/35 (20%). Ten out of 11 patients undergoing Deflux injection had a postoperative VCUG. All patients developed VUR recurrence; the majority showed immediate failure and only 1/10 showed late recurrence. Of the immediate failures, 3/9 patients were maintained on prophylactic antibiotics, and 6/9 patients underwent ureteral reimplantation. In these six patients undergoing reimplantation after failed Deflux, 3/6 (50%) patients required additional surgeries: One patient developed recurrence of reflux and two patients developed ureterovesical junction obstruction. In contrast, no complications were seen in patients undergoing primary ureteral reimplantation. The study is limited by low numbers and a retrospective design. However, the results of this study differ significantly from the published Deflux series showing a success rate of more than 50% in the treatment of transplant kidney VUR. In fact, post-Deflux redo ureteral reimplantation was associated with an increased risk of postoperative complication. The use of Deflux in the post-transplant setting has poor results. In the study series, 11/11 patients demonstrated clinical and radiographic failure. Therefore, as an institution the authors do not recommend Deflux as first-line treatment of VUR in the transplant patient.

Failure Predictor Factors of Conservative Treatment in Pediatric Forearm Fractures.

The aim of this study is to evaluate the predictive efficacy of the radiographic parameters and the relationship between the radiographic results and the clinical data. We carried out a retrospective study analyzing the data of 225 pediatric patients with forearm fractures treated conservatively. Two orthopaedists examined 4 different radiographic parameters. They compared CI and radial translation parameters at T0, in terms of indication of type of treatment and predictive efficacy. Afterwards, the two orthopaedists analyzed X-rays performed at T1, evaluating radiographic results according to radial shortening and angle parameters. From the analysis of the CI measured by Observer 1, 135 patients out of 225 had retrospective indication to conservative treatment; the frequency of failure was 18/135 (13.3%). Observer 2 indicated conservative treatment in 144 patients out of 225 and the proportion of failure was 21/144 (14.6%). As regards the radial translation, Observer 1 reported a frequency of failure of 78/225 (34.7%) and Observer 2 reported 75/222 (33.8%). Furthermore the authors detected a deficit of pronosupination for the patients considered to have failure according to radiographic results. The authors defined the greater reliability of CI with respect to the radial translation parameter and the direct relationship between radiographic failure and clinical-functional data.

Midterm Results of Cementless Total Knee Arthroplasty: A Retrospective Case Series.

Background:There is an ongoing debate about whether to use cementless or cemented fixation for Total Knee Arthroplasty (TKA).Objective: The study aimed to assess midterm survivorship of the Vanguard cementless system, and to demonstrate the utility of the Bone Hardness Test (BHT) for the selection of cementless fixation TKA.Methods:From September 2009 through November 2014, 123 total knee arthroplasties were completed, with cementless Vanguard Cruciate Retaining TKA in 110 knees (102 patients) and cemented Vanguard in 13 cases (12 patients). Implant fixation was based on intraoperative assessment of posterior cruciate ligament stability, bone quality, and BHT. All patients with a cementless Vanguard implant were eligible for this retrospective study. Preoperative and postoperative Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were obtained. Standardized standing anteroposterior and lateral radiographs were taken.Results:Three patients (4 TKAs) were lost to follow-up. The mean follow-up time was 5.5 ± 1.4 years. All scores significantly improved postoperatively. No radiographic failures were observed. Five-year implant survival, with revision of any component for any reason as an endpoint, was 97.2% (95% confidence interval, 91.7 - 99.1%). Five-year survival with revision for aseptic loosening was 100%. Only one knee required revision due to an isolated unrelated bearing exchange, and two additional knees required secondary resurfacing of the patella for retropatellar pain.Conclusion:Good midterm results were obtained with the cementless Vanguard Cruciate Retaining TKA for the treatment of osteoarthritis. The Bone Hardness Test appears to be an effective way to determine the selection of cementless TKA.

Pulp treatment for extensive decay in primary teeth.

Pulp treatment for extensive decay in primary teeth.

Deleterious role of hepatitis B virus infection in therapeutic response among patients with rheumatoid arthritis in a clinical practice setting: a case-control study

BackgroundPrevious studies have revealed that hepatitis B virus (HBV) infection may be associated with rheumatoid arthritis (RA), while there are no further clinical studies regarding the role of HBV infection in RA progression during disease-modifying anti-rheumatic drug (DMARD) therapy. Here, we aimed to explore the influence of HBV infection on radiographic and clinical outcomes among patients with RA in a clinical practice setting.MethodsThirty-two consecutive patients with RA (Disease Activity Score 28-joint assessment based on C-reactive protein (DAS28-CRP) ≥2.6) with chronic HBV infection (CHB) were retrospectively recruited as the CHB group and 128 age-matched, sex-matched, and disease activity-matched contemporary patients with RA without CHB were included in the non-CHB group. Clinical data were collected at baseline and visits at month 1, 3, 6, and 12. The therapeutic target was defined as DAS28-CRP <2.6 in all patients or <3.2 in patients with long disease duration (>24 months). The primary outcome was the percentage of patients with one-year radiographic progression (a change in modified total Sharp score ≥0.5).ResultsCompared with the non-CHB group, a significantly higher percentage of patients with one-year radiographic progression was observed in the CHB group (53% vs. 17%, p < 0.001), with smaller proportions of patients achieving therapeutic target at month 6 and month 12 (53% vs. 82% and 53% vs. 75%, both p < 0.05), remission at month 6 (DAS28-CRP <2.6, 50% vs. 72%, p = 0.039), and American College of Rheumatology (ACR)20/50 responses and good or moderate European League Against Rheumatism (EULAR) responses mainly at month 6 and 12 (all p < 0.05). Multivariate logistic regression analysis revealed that CHB status was significantly associated with one-year radiographic progression and failure to achieve therapeutic target within 6 months. HBV reactivation occurred in 34% of patients with CHB during one-year follow up, with two patients suffering hepatitis flare.ConclusionsHBV infection may play a deleterious role in radiographic and clinical outcomes in patients with RA, and HBV reactivation should be paid close attention during immunosuppressive therapy.

MP69-05 PREDICTORS OF FAILURE IN 90 COMPLEX URETERS USING ROBOT-ASSISTED LAPAROSCOPIC SURGERY

You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Reflux1 Apr 2018MP69-05 PREDICTORS OF FAILURE IN 90 COMPLEX URETERS USING ROBOT-ASSISTED LAPAROSCOPIC SURGERY Maria Veronica Rodriguez, Aaron Wallace, Nimrod Barashi, William Boysen, and Mohan S Gundeti Maria Veronica RodriguezMaria Veronica Rodriguez More articles by this author , Aaron WallaceAaron Wallace More articles by this author , Nimrod BarashiNimrod Barashi More articles by this author , William BoysenWilliam Boysen More articles by this author , and Mohan S GundetiMohan S Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted laparoscopic ureteral (RALUR) reimplantation has been adopted as an alternative surgical approach to treat children with persistent high-grade vesicoureteral reflux (VUR). The debate continues in regards to the safety, feasibility and standardized technique. We performed a retrospective analysis of perioperative outcomes in patients undergoing RALUR; using our recent technique modifications to identify predictors of surgical failure. METHODS We reviewed a prospectively maintained database of children undergoing RALUR at a single-institution from 2010-2017. Only patients with high-grade VUR at age 5, urinary tract infections, or renal scarring were selected for surgical correction. This series included patients who received the previously reported LUAA technique, which stands for length of detrusor tunnel (L), U stitch (U), ureteral alignment suture (A), and the inclusion of ureteral adventitia (A). Patients with ureterovesical junction obstruction were excluded. Radiographic failure was defined as persistent VUR on postop VCUG. Complications were grade using Clavien-Dindo scale. Logistic regression analysis was used to determine predictors of failure. Significance was set at p<0.05. RESULTS A total of 63 patients (90 ureters) met inclusion criteria. Mean age was 68.41 months (4.32 yrs) and 75.38% were female. Our cohort included patients with complex anatomies, such as duplex ureters, bladder diverticulum, and post-deflux injection. Of the 90 ureters reimplanted 85.56% showed radiographic VUR resolution at 4-months. In our cohort of 63 patients, 10 (15.87%) presented with grade II complications and 1 (1.59%) with grade I. However, none presented grade III, IV or V complications. Out of the 13 ureters that failed surgery, 9 had preoperative high-grade VUR (IV-V) and concomitant complex anatomy features. On univariate analysis, length of the detrusor tunnel was associated with increased odds of radiographic failure after RALUR (p=0.01). (Table 1) CONCLUSIONS Using the LUAA technique, RAL surgery has shown to improve operative outcomes in children undergoing extravesical ureteral reimplantation for persistent high-grade and complex VUR. We observed that the length of the detrusor tunnel is a critical step to optimize outcomes and prevent complications while doing this operation. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e926-e927 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Maria Veronica Rodriguez More articles by this author Aaron Wallace More articles by this author Nimrod Barashi More articles by this author William Boysen More articles by this author Mohan S Gundeti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

High Rate of Early Revision After Custom-Made Unicondylar Knee Arthroplasty

BackgroundThere has been a recent interest in custom-made partial knee arthroplasties to provide patient-specific instrumentation and better fit of the prosthesis. While unicondylar knee arthroplasties (UKAs) have demonstrated good outcomes and durable results in many studies, there is little evidence on outcomes of these custom-made implants. MethodsWe performed a retrospective review of all custom-made UKAs performed at our institution by one surgeon from 2008 to 2015. We analyzed preoperative demographics, clinical follow-up evaluations, and radiographs and performed an analysis of risk factors including age, gender, height, weight, body mass index, and tibial insert thickness. The incidence of revision surgery, radiographic failures indicating component loosening, and symptomatic clinically failed implants was calculated at an average of 54.0 months of follow-up. ResultsWe analyzed 115 consecutive custom-made medial UKAs from a single surgeon at our institution and found 29 (25.2%) UKAs had failed at an average of 33.1 months after surgery. Reasons for failure included aseptic femoral loosening (10), aseptic tibial loosening (8), loosening of both components (4), infection (3), progression of osteoarthritis (2), pain (1), and dislodged polyethylene insert (1). We found a significant relationship between implant failure and body mass index; no other study variables were statistically significant. ConclusionWe found a relatively high rate of aseptic loosening and particularly femoral component loosening in the short- to intermediate-term follow-up period. While further study of larger numbers of custom-made UKA from multiple institutions may help verify these findings, we recommend careful consideration of the use of this implant.