Evaluating outcomes of surgical treatment of patients with degenerative changes in the carpometacarpal joint of the thumb using percutaneous stabilization with Herbert screws and Reg-Joint implants – a pilot study

2020 ◽  
Vol 85 (1-2) ◽  
pp. 6-10
Author(s):  
Jakub Florek ◽  
◽  
Filip Georgiew ◽  
Krzysztof Szklany ◽  
Ireneusz Kotela
Keyword(s):  
Surgical Treatment ◽  
Pilot Study ◽  
Degenerative Changes ◽  
Carpometacarpal Joint ◽  
Joint Implants ◽  
Percutaneous Stabilization

A phase II pilot study of the efficacy and safety of nivolumab and ipilimumab in T1aN0M0 renal cell carcinoma patients ineligible for surgical treatment.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. TPS769-TPS769
Author(s):  
Ilya Tsimafeyeu ◽  
Maria Volkova ◽  
Rustem Airatovich Gafanov ◽  
Dmitry Nosov ◽  
Axel Bex
Keyword(s):  
Renal Cell Carcinoma ◽  
Surgical Treatment ◽  
Pilot Study ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Null Hypothesis ◽  
Response Rate ◽  
Complete Response Rate ◽  
Complete Response ◽  
Type I

TPS769 Background: Surgery remains the standard curative-intent therapy for localized renal cell carcinoma (RCC). Thus, systemic therapy for RCC should only be considered in patients who have contraindications to surgery. The phase 3 CheckMate 214 trial showed that a combination of nivolumab and ipilimumab has a significant impact on tumor burden in intermediate- and poor-risk metastatic RCC patients with a complete response rate of 11%. Median time to objective response was 2.8 months. Among all complete responders to nivolumab plus ipilimumab in the intention-to-treat population, 5% achieved a complete response at the first scan. We hypothesize that this combination could eliminate the primary tumor in T1aN0M0 patients ineligible for surgical treatment. Methods: This is a prospective, multicenter, non-randomized phase 2 pilot study. Patients with biopsy-proven clear-cell RCC of ≤4 cm (cT1a), no evidence of any metastases, and unable to have surgery or other nephron-sparing interventions (ablation) for any reason (functional single kidney with a central, high-complexity RCC, high risk of nephrectomy and dialysis, patients with complex coagulation disorders, etc.) or with preference to have no surgery or intervention for any reason will receive combination of ipilimumab (1 mg/kg intravenously) every 3 weeks for four doses, and nivolumab (240 mg intravenously) every 2 weeks during 16 weeks. The primary endpoint is complete response rate. Simon's two-stage design (Simon, 1989) is used. The null hypothesis that the true complete response rate is 11% will be tested against a one-sided alternative. This design yields a type I error rate of 0.05 and power of 0.9 when the true complete response rate is 60% (alternative hypothesis). In the first stage, 3 patients will be accrued. If there are no complete responses in these 3 patients, the study will be stopped. Otherwise, 5 additional patients will be accrued for a total of 8. The null hypothesis will be rejected if 3 or more responses are observed in 8 patients. Clinical trial information: NCT04134182.

scholarly journals Role of Cytological Examination in Diagnosis and Monitoring of Large Joints Peri-Implant Inflammation

2013 ◽  
Vol 20 (1) ◽  
pp. 58-62
Author(s):  
V. P Voloshin ◽  
Eremin V AV ◽  
V. S Zubkov ◽  
S. N Shatokhina ◽  
D. V Martynenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Foreign Body ◽  
Bone Tissue ◽  
Revision Arthroplasty ◽  
Low Grade ◽  
Cytological Examination ◽  
Large Joint ◽  
Joint Implants ◽  
Low Grade Inflammation

Cytologic specimens from pathologic foci of 20 patients aged 20— 80 years with acute, chronic and low-grade inflammation in the area of large joint implants were examined. Three variants of cystograms were differentiated: reactive state in response to foreign body, chronic proliferative inflammation and chronic inflammation with bone tissue resorption. Tactics foe surgical treatment of peri-implant inflammation was chosen according to the variant of cytologic picture. Inflammation process was arrested in all patients. Cytologic method can be recommended as a component of complex examination for patients with forthcoming large joints revision arthroplasty as well as measure to prognosticate the inflammation relapse after sanitation procedures

scholarly journals Surgical and Protocolized Management of Distal Radius Nonunion

2020 ◽  
Vol 48 (02) ◽  
pp. 79-86
Author(s):  
Juan María Pardo García ◽  
Verónica Jiménez Díaz ◽  
Amaya Barberia Biurrun ◽  
Lorena García Lamas ◽  
Miguel Porras Moreno ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Distal Radius ◽  
Case Series ◽  
Degenerative Changes ◽  
Average Score ◽  
Type I ◽  
Bone Stock ◽  
Type Iii ◽  
Metaphyseal Bone

Abstract Introduction Nonunion of the distal radius is an extremely rare and serious complication with unpredictable outcomes. The aim of the present study is to analyze the radiological and functional results after a protocolized surgical treatment. Material and Methods A retrospective review of case series of patients with diagnosis of nonunion of the distal radius surgically treated from 2010 to 2016. The diagnosis of nonunion was made at 6 months without signs of consolidation. According to computed tomography (CT) scan images, we propose a classification of this complication as type I: no deformity or mild deformity, with subchondral metaphyseal bone stock beneath lunate facet greater than 10 mm, with no degenerative changes at the distal radioulnar joint (DRUJ); type II: moderate deformity or degenerative changes in the DRUJ, distinguishing between IIA and IIB based on the subchondral metaphyseal bone stock; and type III: degenerative changes at the midcarpal joint. In all cases, a reconstructive technique consisting of volar locking plate osteosynthesis with autologous tailored iliac crest graft was performed, hence none of the cases were classified as type III. Results In total, six cases were included. Mean follow-up: 58 months (range: 30–108 months). Consolidation was achieved in a mean period of 5 months (range: 3–9 months). Average active range of motion: flexion: 54° (range: 10°–80°); extension: 40° (range: 10°–85°); supination: 82.5° (range: 75°–85°); pronation 80° (range: 55–85°); radial deviation: 15° (range: 5°–20°); and ulnar deviation 15° (range: 5–20°). Mean strength: 24.15 Kg (6.9–35 Kg). The average score on the Visual Analog Scale (VAS) at rest was of 0.6 (0–2), and with movement, it was of 1.8 (0–4). The mean postoperative score on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was of 18.48 (range: 0–50.8). Average radial height: 9.65 mm (range: 7–12 mm); average radial angulation: 17° (10°–20°); volar tilt: 8.36° (range: 0.2°–21°); average ulnar variance: 1.52 mm (range: 0–3.5 mm). Complications: persistent nonunion, superficial wound infection, acquired residual ulnar club hand deformity, radiocarpal arthritis, and midcarpal arthritis. Nevertheless, no salvage techniques were needed or requested during the follow-up, with all patients in an active work situation or living an active life in complete normality. Conclusions The protocolized surgical treatment of pseudoarthrosis of the the distal radius, based on our proposed classification, offers good functional outcomes in the long-term follow-up.

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