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Sanmamed N, Alcantara P, Cerezo E, Gaztanaga M, Doval A, Corona J, Gomez S, Bustos A, Rodriguez G, Fuentes M, Sanz A, Vazquez G. Low Dose Radiotherapy in the Management of COVID-19 Pneumonia (LOWRAD-Cov19): Final Results. Int J Radiat Oncol Biol Phys 2022. [PMCID: PMC9595462 DOI: 10.1016/j.ijrobp.2022.07.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Purpose/Objective(s) To evaluate the results of LD-RT to lungs in the management of patients with COVID-19 pneumonia. Materials/Methods We conducted a prospective phase I-II trial enrolling COVID-19 patients ≥50 years-old, with bilateral lung involvement at imaging study and oxygen requirement. Patients received 1 Gy to whole lungs in a single fraction. Primary outcome was radiological response assessed as severity and extension scores at days +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/ FiO2 index (SAFI), at day +3 and +7. Descriptive analyses were summarized as means with standard deviation (SD) and/or medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables. Results Forty-one patients were included. Median age was 71 (IQR 60-84). Eighteen patients (47%) previously received any antiCOVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids during LD-RT. Extension score improved significantly (p=0.02) on day +7 and SAFI on day +3 and + 7 (p<0.01). Median SAFI on day 0 was 147 (IQR 118-264), 230 (IQR 120-343) on day +3 and 293 (IQR 121-353) on day +7. Significant decrease was found in C-reactive protein on day +7 (p=0.02) and in lymphocytes counts on day +3 and +7 (p=0.02). Median number of days in hospital after RT was 11 (range 4-78). With a median follow-up of 60 days after LD-RT, 26 (63%) patients were discharged, 11 (27%) died because of COVID respiratory failure and 4 (10%) died of other causes. Conclusion LD-RT is a feasible and well-tolerated treatment that may lead to rapid clinical improvement. Large randomized trials should be done to establish the efficacy of LD-RT to treat COVID-19 pneumonia.
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Affiliation(s)
- N.S. Sanmamed
- Hospital Clínico Universitario San Carlos, Madrid, ON, Spain,Corresponding author:
| | | | - E. Cerezo
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - M. Gaztanaga
- Departamento Oncología Radioterapia Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - A. Doval
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - J. Corona
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - S. Gomez
- Hospital Clinico San Carlos, Madrid, Spain
| | - A. Bustos
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - M. Fuentes
- Fundacion Investigacion Biomedica Hospital Clinico San Carlos, Madrid, Spain
| | - A. Sanz
- Hospital Rio Hortega, Valladolid, Spain
| | - G. Vazquez
- Hospital Clínico Universitario San Carlos, Madrid, Spain
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Zelenski NA, Corona J, Bishop AT, Shin AY. Outcomes of Surgical Management of Intraosseous Ganglia of the Carpal Bones: A Case Series. Hand (N Y) 2022; 17:893-898. [PMID: 33084381 PMCID: PMC9465773 DOI: 10.1177/1558944720963873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraosseous ganglia of the carpal bones are uncommon with sparse publications to guide treatment. The purpose of this study was to review a single-institution experience to determine the outcomes of patients with surgically treated intraosseous carpal ganglia. METHODS Skeletally mature patients with intraosseous carpal ganglia between 1995 and 2016 treated operatively were identified. Demographic information, clinical data, and radiographic studies were evaluated. RESULTS Thirty-three ganglia in 31 patients were identified. Intraosseous ganglia were located in the lunate (23), scaphoid (9), and trapezoid (1). Patients who presented with pathologic fracture or collapse had larger intraosseus ganglia than those presenting with pain alone. Surgery significantly improved pain. Patients treated with debridement with autograft bone graft had a higher consolidation rate compared with allograft bone but no difference in pain. CONCLUSIONS Patients with large or symptomatic lesions can be treated successfully with curettage and debridement, which leads to relief of pain. The use of bone grafting remains controversial.
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Gaztañaga M, Cerezo E, Sanmamed N, Alcantara P, Doval A, Corona J, Aza Z, Gonzalez B, Pascual A, Montes M, de Luna A, Vázquez G. PO-1146 Perioperative HDR brachytherapy for breast cancer, technique implementation in a single institution. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07597-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Couñago F, de Dios NR, Montemuiño S, Jové-Teixidó J, Martin M, Calvo-Crespo P, López-Mata M, Samper-Ots MP, López-Guerra JL, García-Cañibano T, Díaz-Díaz V, de Ingunza-Barón L, Murcia-Mejía M, Alcántara P, Corona J, Puertas MM, Chust M, Couselo ML, Del Cerro E, Moradiellos J, Amor S, Varela A, Thuissard IJ, Sanz-Rosa D, Taboada B. Response to: Low level evidence supporting the choice of optimal multimodality treatment approach in patients with stage IIIA NSCLC- ain't no mountain high enough…. to keep me getting to you by Jeremic Branislav. Lung Cancer 2018; 123:174-175. [PMID: 30017426 DOI: 10.1016/j.lungcan.2018.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
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Counago F, Rodriguez de Dios N, Montemuño S, Martin M, Calvo-Crespo P, Samper-Ots M, Alcantara P, Corona J, Lopez-Guerra J, Murcia-Mejía M, López-Mata M, Jové-Teixidó J, Chust M, Díaz-Díaz V, De Ingunza-Barón L, García-Cañibano T, Couselo M, Del Cerro E, Moradiellos J, Amor S, Varela A, Sanz-Rosa D, Thuissard I, P.M.M, Taboada B. EP-1359: Preoperative high doses chemoradiotherapy in stage IIIA-N2 NSCLC on behalf of GOECP/SEOR-GICOR. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Couñago F, Rodriguez de Dios N, Montemuiño S, Jové-Teixidó J, Martin M, Calvo-Crespo P, López-Mata M, Samper-Ots MP, López-Guerra JL, García-Cañibano T, Díaz-Díaz V, de Ingunza-Barón L, Murcia-Mejía M, Alcántara P, Corona J, Puertas MM, Chust M, Couselo ML, Del Cerro E, Moradiellos J, Amor S, Varela A, Thuissard IJ, Sanz-Rosa D, Taboada B. Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society). Lung Cancer 2018; 118:119-127. [PMID: 29571989 DOI: 10.1016/j.lungcan.2018.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). MATERIAL AND METHODS A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group). RESULTS Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p < 0.001) were significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus dCRT (OS: 57 vs 29 months, p < 0.001; PFS: 46 vs 15 months, p < 0.001), but not in the comparison between the pneumonectomy subgroup and dCRT. CONCLUSION The findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC.
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Affiliation(s)
- F Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain; Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
| | - N Rodriguez de Dios
- Department of Radiation Oncology, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - S Montemuiño
- Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - J Jové-Teixidó
- Department of Radiation Oncology, Hospital Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain.
| | - M Martin
- Department of Radiation Oncology, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo Km9, Madrid, Spain.
| | - P Calvo-Crespo
- Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Choupana s/n, bloque d. Santiago de Compostela, A Coruña, Spain.
| | - M López-Mata
- Department of Radiation Oncology, Hospital Clinico Universitario Lozano Blesa, San Juan Bosco 15, Zaragoza, Spain.
| | - M P Samper-Ots
- Department of Radiation Oncology, Hospital Universitario Rey Juan Carlos, C/Gladiolo s/n. Móstoles, Madrid, Spain.
| | - J L López-Guerra
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocio, Av. Manuel Siurot, S/N, 41013 Sevilla, Spain.
| | - T García-Cañibano
- Department of Radiation Oncology, Hospital Universitario de Fuenlabrada, Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
| | - V Díaz-Díaz
- Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cadiz, Spain.
| | - L de Ingunza-Barón
- Department of Radiation Oncology, Hospital Universitario Puerta del Mar, Av. Ana de Viya, 21, 11009, Cadiz, Spain.
| | - M Murcia-Mejía
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Av. del Dr. Josep Laporte, 2, 43204 Reus, Tarragona, Spain.
| | - P Alcántara
- Department of Radiation Oncology. Hospital Universitario Clínico San Carlos, C/Prof. Martín Lagos s/n, Madrid, Spain.
| | - J Corona
- Department of Radiation Oncology. Hospital Universitario Clínico San Carlos, C/Prof. Martín Lagos s/n, Madrid, Spain.
| | - M M Puertas
- Department of Radiation Oncology, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain.
| | - M Chust
- Department of Radiation Oncology, Instituto Valenciano de Oncologia, Carrer del Professor Beltrán Báguena, 8, 46009, Valencia, Spain.
| | - M L Couselo
- Department of Radiation Oncology, Hospital Central de la Defensa Gomez Ulla, Glorieta Ejército, 1, 28047, Madrid, Spain.
| | - E Del Cerro
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain; Universidad Europea de Madrid, Calle Tajo, s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
| | - J Moradiellos
- Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - S Amor
- Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - A Varela
- Department of Thoracic Surgery, Hospital Universitario Quirónsalud Madrid, C/ Diego de Velázquez, 1, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - I J Thuissard
- School of Doctoral Studies & Research, Universidad Europea, Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain.
| | - D Sanz-Rosa
- School of Doctoral Studies & Research, Universidad Europea, Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain.
| | - B Taboada
- Department of Radiation Oncology, Complexo Hospitalario Universitario Santiago de Compostela, Choupana s/n, bloque d. Santiago de Compostela, A Coruña, Spain.
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Counago F, Muniz SM, Jove-Teixido J, Taboada B, Calvo-Crespo P, Martin M, Lopez M, Ots PMS, Cerro ED, Lopez J, GarcIa CaNivano T, Diaz V, de Ingunza Baron L, Murcia M, Alcantara M, Corona J, Puertas M, Chust M, Couselo M, De Dios NR. Neoadjuvant Treatment Followed by Surgery Versus Chemoradiation in Stage IIIA-N2 Non–small Cell Lung Cancer on Behalf of GOECP/SEOR-GICOR. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Potty AG, Corona J, Manning BT, Le A, Saleh KJ. Acute periprosthetic fractures of the acetabulum after total hip arthroplasty. Instr Course Lect 2014; 63:199-207. [PMID: 24720306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although periprosthetic fractures of the acetabulum are relatively uncommon after total hip arthroplasty, a variety of patient-, surgeon-, and implant-related risk factors can contribute to the occurrence of this serious complication. These risk factors, combined with the increased use of cementless acetabular cups, will likely result in an increased prevalence of these fractures in the future. By better understanding the risk factors, classification schemes, and treatment options for periprosthetic fractures of the acetabulum, orthopaedic surgeons can achieve better outcomes for their patients.
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Affiliation(s)
- Anish G Potty
- Adult Reconstruction Fellow, Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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Corona J, Miller DJ, Downs J, Akbarnia BA, Betz RR, Blakemore LC, Campbell RM, Flynn JM, Johnston CE, McCarthy RE, Roye DP, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, Sturm PF, Thompson GH, Yazici M, Vitale MG. Evaluating the extent of clinical uncertainty among treatment options for patients with early-onset scoliosis. J Bone Joint Surg Am 2013; 95:e67. [PMID: 23677368 DOI: 10.2106/jbjs.k.00805] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Literature guiding the management of early-onset scoliosis consists primarily of studies with a low level of evidence. Evaluation of clinical equipoise (i.e., when there is no known superiority among treatment modalities) allows for prioritization of research efforts. The objective of this study was to evaluate areas of clinical uncertainty among pediatric spine surgeons regarding the treatment of early-onset scoliosis. METHODS Fourteen experienced pediatric spine surgeons participated in semistructured interviews to identify clinical variables that influence decision making in the treatment of early-onset scoliosis. A series of case scenarios of 315 patients with idiopathic and neuromuscular early-onset scoliosis was then developed to be representative of those encountered in clinical practice. Using an online survey, eleven surgeons selected their choice of eight treatment options for each case scenario. Associations between case characteristics and treatment choices were assessed with chi-square and logistic regression analysis. Participants then reviewed the areas of treatment uncertainty identified in the survey, nominated additional research questions of interest, and ranked their interest to further explore the identified research questions. RESULTS Collective equipoise was identified in numerous scenarios in the survey spanning a range of ages and magnitudes of scoliosis, and additional questions were identified during the nominal group technique. Areas that had the greatest clinical uncertainty included the management of patients who have finished treatment with a growing-rod, timing of rod-lengthening intervals, and indications for spine-based and rib-based proximal instrumentation anchors. The use of rib anchors compared with spine-based anchors was ranked highly for consideration in future clinical trials. CONCLUSIONS Variability in decision making with regard to the optimum treatment of certain subsets of patients with early-onset scoliosis reflects gaps in the available evidence. Structured consensus methods identified priorities for higher levels of research in this area of scoliosis. Higher-level studies, including randomized trials, should focus on answering the questions highlighted in this report.
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Affiliation(s)
- Jacqueline Corona
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, 701 North First Street, Room D220, Springfield, IL 62702, USA
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Mackenzie WGS, Matsumoto H, Williams BA, Corona J, Lee C, Cody SR, Covington L, Saiman L, Flynn JM, Skaggs DL, Roye DP, Vitale MG. Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am 2013; 95:800-6, S1-2. [PMID: 23636186 DOI: 10.2106/jbjs.l.00010] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical site infection following correction of pediatric scoliosis is well described. However, we are aware of no recent multicenter study describing the rates of surgical site infection, and associated pathogens, among patients with different etiologies for scoliosis. METHODS A multicenter, retrospective review of surgical site infections among pediatric patients undergoing spinal instrumentation to correct scoliosis was performed at three children's hospitals in the United States. Study subjects included all patients undergoing posterior spinal instrumentation from January 2006 to December 2008. Surgical site infections were defined according to the Centers for Disease Control and Prevention's National Healthcare Safety Network case definition, with infections occurring within one year after surgery. RESULTS Following the analysis of 1347 procedures performed in 946 patients, surgical site infection rates varied among procedures performed in patients with different scoliosis etiologies. Procedures performed in patients with neuromuscular scoliosis had the highest surgical site infection rates (9.2%), followed by those performed in patients with syndromic scoliosis (8.8%), those performed in patients with other scoliosis (8.4%), those performed in patients with congenital scoliosis (3.9%), and those performed in patients with idiopathic scoliosis (2.6%). Surgical site infection rates varied among procedures in patients undergoing primary spinal arthrodesis based on etiology, ranging from 1.2% (95% confidence interval, 0.1% to 1.3%) in patients with idiopathic scoliosis to 13.1% (95% confidence interval, 8.4% to 17.8%) in patients with neuromuscular scoliosis. Surgical site infection rates following primary and revision procedures were similar among patients with different etiologies. In distraction-based growing constructs, rates were significantly lower for lengthening procedures than for revision procedures (p = 0.012). Multivariate analysis demonstrated that non-idiopathic scoliosis and extension of instrumentation to the pelvis were risk factors for surgical site infections. The three most common pathogens were Staphylococcus aureus (25.0% [95% confidence interval, 17.8% to 32.2%]), coagulase-negative staphylococci (17.1% [95% confidence interval, 10.9% to 23.3%]), and Pseudomonas aeruginosa (10.7% [95% confidence interval, 5.6% to 15.8%]). Overall, 46.5% (95% confidence interval, 35.5% to 57.5%) of surgical site infections contained at least one gram-negative organism; 97.0% (95% confidence interval, 90.8% to 100.0%) of these infections were in patients with non-idiopathic scoliosis. CONCLUSIONS Surgical site infection rates were significantly higher following procedures in patients with non-idiopathic scoliosis (p < 0.001). Lengthening procedures had the lowest rate of surgical site infection among patients with early onset scoliosis who had undergone instrumentation with growing constructs. Gram-negative pathogens were common and were most common following procedures in patients with non-idiopathic scoliosis. These findings suggest a role for targeted perioperative antibiotic prophylaxis to prevent surgical site infection following pediatric scoliosis instrumentation procedures.
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Affiliation(s)
- W G Stuart Mackenzie
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, Suite 8 North, New York, NY 10032, USA
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Abstract
BACKGROUND Radiographic measures such as the rib vertebral angle difference (RVAD), Cobb angle, and space available for the lung (SAL) help to guide treatment and measure treatment effects in patients with infantile idiopathic scoliosis. This study aimed to evaluate the intraobserver and interobserver reliability of these radiographic measures. METHODS Forty-five spine radiographs of skeletally immature patients (age, two months to four years) with infantile idiopathic scoliosis were measured with use of Surgimap software. Three pediatric orthopaedic surgeons and a pediatric orthopaedic fellow identified the major curve apex, rib-vertebra phase, Cobb angle, and end vertebrae and calculated the RVAD and SAL values at two separate time points. Interobserver and intraobserver reliability of the RVAD, Cobb angle, and SAL values were assessed with use of intraclass correlation coefficients (ICCs). Fleiss kappa coefficients were calculated for categorical variables. RESULTS The RVAD (ICC = 0.86 to 0.92) and Cobb angle (ICC = 0.99) measurements had high reliability. The SAL value had substantial interobserver reliability (ICC = 0.66) and moderate intraobserver reliability (ICC = 0.73). Despite the high agreement for the Cobb angle, the choice of the major curve vertebrae (kappa = 0.19 to 0.39) and apical vertebra varied (kappa = 0.57 to 0.62). Observers were more likely to choose the same apical vertebra in large curves (r = 0.483, p = 0.001). The agreement for the apical rib-vertebra phase was substantial (kappa = 0.67). Paired RVAD measurements fell within ≤ 10° of each other in 82% of cases, but the remaining 18% of the RVAD measurements showed >10° of variation. CONCLUSIONS Measurements used to guide treatment of infantile idiopathic scoliosis curves were reliable despite standard radiographic measurement error and the difficulty in obtaining quality images in young patients. Clinicians are dependent on seemingly objective radiographic data. The reliability of the Cobb angle and RVAD measurements in infantile scoliosis was high but not devoid of variability that could skew the ability to accurately and reliably suggest the best course of treatment. The SAL value was a less reliable measure. Treatment recommendations for infantile idiopathic scoliosis should rely on the synthesis of objective and clinically subjective data, as variations in radiographic measurements can lead to inconsistencies in management and to inconsistent treatment outcomes.
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Affiliation(s)
- Jacqueline Corona
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, 701 North First Street, Room D220, Springfield, IL 62702, USA.
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Vitale MG, Corona J, Matsumoto H, Avendano J, Pinder D, Miller DJ, Roye DP. Development and initial validation of a disease specific outcome measure for early onset scoliosis. Stud Health Technol Inform 2010; 158:172-176. [PMID: 20543419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Treatment of children with early onset scoliosis (EOS) seeks to improve natural history and health related quality of life (QOL). QOL measurement presents a significant challenge given the young age, comorbidities, and heterogeneity of this population. OBJECTIVE To develop a disease specific measure reflecting issues of importance to EOS patients and caretakers. MATERIALS AND METHODS Review of the literature and relevant measures informed development of semi-structured qualitative interviews. Interviews of caregivers of EOS patients were interpreted through the framework technique. A master-list of 75-items was created and responses were scaled on a 5-point Likert-scale. Psychometric analysis was performed to group items into domains, to maintain score distribution, to create a responsive instrument, and to identify question redundancy. RESULTS Content validation revealed 8-items with low content validity indices. Item distribution analysis demonstrated 19-items with skewed distribution. Item reliability demonstrated redundant items within domains (r> or =0.5). Construct validity demonstrated unique domains measuring intended issues of interest. The resulting Early Onset Scoliosis Questionnaire (EOSQ) includes 33-items in 13-domains: General Health, Pain, Physical Function, Pulmonary Function, Daily Living, Fatigue, Emotion, Surgical Concerns, Satisfaction, Transfer, Financial Burden, Parental Burden, and Treatment Outcomes. CONCLUSION The EOSQ reflects QOL and caregiver burden in the EOS population. The EOSQ will expand options for outcome assessment in this unique population.
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Affiliation(s)
- Michael G Vitale
- Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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Shapiro M, Greenstein AJ, Byrn J, Corona J, Greenstein AJ, Salky B, Harris MT, Divino CM. Surgical management and outcomes of patients with duodenal Crohn's disease. J Am Coll Surg 2008; 207:36-42. [PMID: 18589359 DOI: 10.1016/j.jamcollsurg.2007.12.049] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 11/29/2007] [Accepted: 12/14/2007] [Indexed: 01/16/2023]
Abstract
BACKGROUND Duodenal Crohn's disease (DCD) has been reported to occur in 0.5% to 4% of patients with Crohn's disease. When patients fail to respond to conservative therapy or severe narrowing of the duodenum develops, operation is required. The recent literature is limited in description of surgical treatment of such patients. We reviewed our experience with surgical management and outcomes in patients with DCD, including outcomes of laparoscopic bypass procedures. STUDY DESIGN A retrospective review was undertaken of all patients who underwent surgical intervention for DCD between 1995 and 2006. Data collected included demographics, clinical presentation, operative and hospital course, and postoperative followup. RESULTS Thirty patients had surgical intervention for DCD during the selected period. Four patients had duodenoenteric fistulas, resulting from complications of their disease in the distal gastrointestinal tract. Operations done for intrinsic DCD were: open bypass (n = 11), laparoscopic bypass (n = 13), and stricturoplasty (n = 2). Only one vagotomy was done. Mean followup was 58 months (range 6 to 144 months). Patients resumed oral diet 3.0 days after laparoscopic bypass, with mean discharge of 6.9 days, as compared with 4.4 days and 12.2 days after open bypass, respectively. In the early postoperative period (0 to 30 days), six major complications (n=5, 19%): persistent obstruction, anastomotic leak, small bowel obstruction, anastomotic bleeding (two patients), and respiratory failure, developed in four patients in the open (36%) and one patient in the laparoscopic (8%) bypass group. There were two more complications during longterm followup, for an overall major morbidity rate of 27%. Two patients experienced recurrence requiring revision (one in the open group and one in the laparoscopic group). Gastroduodenal ulcers requiring operation did not develop in any of the patients. CONCLUSIONS Surgery is a viable and safe option for patients with intractable duodenal Crohn's disease. The laparoscopic approach during a bypass procedure, as opposed to an open bypass, may result in faster recovery, less morbidity, and comparable recurrence rate. There is no role for vagotomy in bypass procedures.
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Affiliation(s)
- Mark Shapiro
- Department of Surgery, The Mount Sinai Medical Center, New York, NY, USA
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Greenstein AJ, Nguyen SQ, Berlin A, Corona J, Lee J, Wong E, Factor SH, Divino CM. Pneumatosis intestinalis in adults: management, surgical indications, and risk factors for mortality. J Gastrointest Surg 2007; 11:1268-74. [PMID: 17687617 DOI: 10.1007/s11605-007-0241-9] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 07/04/2007] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pneumatosis intestinalis (PI) is an unusual finding that can exist in a benign setting but can indicate ischemic bowel and the need for surgical intervention. We present a series of cases of PI in adults to illustrate factors associated with death and surgical intervention. METHODS We reviewed the radiology database of the Mount Sinai Medical Center for cases of PI between 1996-2006 in adult patients. Chi-square and multivariable logistic regression analyses were used to identify factors significant for surgery and death. RESULTS Forty patients developed PI over a 10-year span. The overall in-hospital mortality rate was 20%, and the surgical rate was 35%. Factors independently associated with surgical management on multivariable analysis were age >or= 60 years (p = 0.03), the presence of emesis (p = 0.01), and a WBC > 12 c/mm3 (p = 0.03). Pre-existing sepsis was independently associated with mortality (p = 0.03) while controlling for surgery. CONCLUSION Patients with the concomitant presence of PI, a WBC > 12 c/mm3, and/or emesis in the >60-year-old age group were most likely to have surgical intervention, whereas PI patients with sepsis had the highest risk for death. A management algorithm is proposed, but further research will be needed to determine which patients with PI may benefit most from surgery.
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Affiliation(s)
- Alexander J Greenstein
- Department of Surgery, The Mount Sinai Medical Center, 5 E. 98th Street, 15th Floor, P.O. Box 1259, New York, NY 12029, USA
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Bramson HN, Corona J, Davis ST, Dickerson SH, Edelstein M, Frye SV, Gampe RT, Harris PA, Hassell A, Holmes WD, Hunter RN, Lackey KE, Lovejoy B, Luzzio MJ, Montana V, Rocque WJ, Rusnak D, Shewchuk L, Veal JM, Walker DH, Kuyper LF. Oxindole-based inhibitors of cyclin-dependent kinase 2 (CDK2): design, synthesis, enzymatic activities, and X-ray crystallographic analysis. J Med Chem 2001; 44:4339-58. [PMID: 11728181 DOI: 10.1021/jm010117d] [Citation(s) in RCA: 204] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two closely related classes of oxindole-based compounds, 1H-indole-2,3-dione 3-phenylhydrazones and 3-(anilinomethylene)-1,3-dihydro-2H-indol-2-ones, were shown to potently inhibit cyclin-dependent kinase 2 (CDK2). The initial lead compound was prepared as a homologue of the 3-benzylidene-1,3-dihydro-2H-indol-2-one class of kinase inhibitor. Crystallographic analysis of the lead compound bound to CDK2 provided the basis for analogue design. A semiautomated method of ligand docking was used to select compounds for synthesis, and a number of compounds with low nanomolar inhibitory activity versus CDK2 were identified. Enzyme binding determinants for several analogues were evaluated by X-ray crystallography. Compounds in this series inhibited CDK2 with a potency approximately 10-fold greater than that for CDK1. Members of this class of inhibitor cause an arrest of the cell cycle and have shown potential utility in the prevention of chemotherapy-induced alopecia.
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Affiliation(s)
- H N Bramson
- GlaxoSmithKline Inc., Five Moore Drive, Research Triangle Park, North Carolina 27709, USA
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Abstract
PURPOSE To investigate the evolution of postoperative astigmatism in children having cataract extraction with intraocular lens (IOL) implantation through a 6.25 mm superior scleral tunnel wound. SETTING A university clinical practice. METHODS A retrospective chart review of all pediatric patients having cataract extraction and IOL implantation in the practice of 1 surgeon from 1995 to 2000 was performed. Statistical comparisons were performed using the Student t test for nonpaired data. RESULTS Ten eyes of 9 children were included. Six cataracts were due to corneal or corneoscleral lacerations, 3 were idiopathic, and 1 occurred after blunt trauma. Eight eyes could not be refracted preoperatively because of mature cataract. The mean cylindrical correction of all refractions performed 1 to 15 days after surgery (n = 6) was 6.71 diopters (D) +/- 1.63 (SD); of those performed at 16 to 30 days (n = 6), 2.71 +/- 2.09 D; and of those performed at 31 to 45 days (n = 7), 1.93 +/- 1.48 D. The mean spherical equivalent of the final (dispensed) refraction was -0.21 +/- 1.79 D; the mean cylindrical correction of this refraction was 1.13 +/- 0.79 D. The difference between the cylindrical correction of the final prescription and the corneal astigmatism in fellow eyes was not statistically significant (P =.29). CONCLUSIONS Relaxation of large amounts of suture-induced astigmatism occurs in children having cataract extraction. Surgeons should not hesitate to secure scleral wounds meticulously in children for fear of a permanent undesirable refractive outcome.
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Affiliation(s)
- S M Brown
- Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, Texas 79430-7217, USA.
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Abstract
PURPOSE To describe the first case of intraocular teratoma associated with eyelid coloboma and the second reported case of intraocular teratoma. DESIGN Interventional case report. METHODS A left intraocular tumor was surgically resected from a 2-day-old female with an associated lower eyelid coloboma. RESULTS Pathologic evaluation revealed a completely intraocular tumor comprising derivatives of all three germ cell layers giving a diagnosis of intraocular teratoma. The eyelid coloboma was repaired, and a scleral-wrapped hydoxyapatite-integrated orbital implant was placed. CONCLUSION To our knowledge, this is the second reported instance of teratoma originating within the globe and the only reported case of teratoma associated with eyelid coloboma. Although exceedingly rare, intraocular teratoma should be added to the differential diagnosis of congenital intraocular tumors.
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Affiliation(s)
- D B Leventer
- Department of Ophthalmology, West Virginia University, Morgantown, USA.
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Medina-Mora ME, Padilla GP, Más CC, Ezban BM, Caraveo AJ, Campillo SC, Corona J. [Prevalence of mental disorders and risk factors in a population of a general medical practice]. Acta Psiquiatr Psicol Am Lat 1985; 31:53-61. [PMID: 4050494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The present paper reports the most relevant results from an epidemiologic survey that was carried out in a hospital's general practice service in Mexico. The survey comprises several issues such-as: the validity and standardization of the General Health Questionnaire (GHQ), a screening instrument, designed for the early detection of mental disorders, which is validated against the clinical criteria expressed through the Standardized Psychiatric Interview (SPI), the prevalence of psychiatric disorders which includes type of syndromes and affected subgroups, the relation between the ratings of the SPI and the scales of the GHQ (somatic symptoms, sleep disturbances, social disfunction and severe depression) with demographic variables. From the population attending the service during a period of 5 weeks, a total of 619 patients, to whom the GHQ was administered, were randomly selected. From this sample 364 patients were separately interviewed by means of the SPI. No significant differences were found between the sample and the population regarding age, sex, and educational level. The prevalence of mental disorders obtained for the mixed population was of 34%, being of 26% for men and of 36% for women. The only risk factor found for both populations was the low educational level of the head of the family. In the multiple regression analysis, significant differences were found among some groups in spite of the low predictive power of the studied variables.
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Medina-Mora ME, Padilla GP, Campillo-Serrano C, Mas CC, Ezbán M, Caraveo J, Corona J. The factor structure of the GHQ: a scaled version for a hospital's general practice service in Mexico. Psychol Med 1983; 13:355-361. [PMID: 6878522 DOI: 10.1017/s0033291700050984] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This paper reports the factor structure of the symptoms comprising the GHQ when it is administered in the general practice service of a hospital. Two shorter versions are proposed: one with 6 scales and 30 items, and the other with 4 scales and 28 items. The latter is compared with the 28-item English version. Preliminary data concerning the validity of the scales are presented. In a comparison of the screening potentiality of the 60- and 28-item versions, no significant differences were found.
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