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Cimino A, Wall KC, Elphingstone J, Paul K, Arguello AM, Casp A, Brabston E, Ponce B, Momaya A. Extensor Mechanism Reconstruction for Chronic Patellar Tendon Tears. South Med J 2023; 116:208-214. [PMID: 36724537 DOI: 10.14423/smj.0000000000001515] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Reconstruction for a chronic patellar tendon rupture in a native knee is an uncommon surgical procedure. Although there have been case series investigating patient-reported outcomes, there is no systematic review of these studies to date. The purpose of this review is to synthesize the literature on this procedure to better understand its outcomes, complications, and surgical technique options. METHODS A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies that reported outcomes and techniques of patellar tendon reconstruction for chronic disruption in native knees. Searches were conducted through MEDLINE using PubMed, Cochrane Database of Systematic Reviews, and clinicaltrials.gov. RESULTS Ten studies with 103 patients and 105 knees were included. Results for nonnative (arthroplasty) knees were excluded. The mean patient age was 40.3 years, and the mean postsurgical follow-up time was 53.8 months. Of the 105 knees, 75% received a hamstring tendon graft, whereas 13% received a bone-tendon-bone graft and 7% received a whole extensor mechanism allograft. The mean preoperative range of motion was 113.8°, which improved to 126.0° postoperatively. The mean preoperative Lysholm score was 58.6, which improved to 86.0 postoperatively; 100% of patients returned to their normal work activities and 76% returned to their prior level of physical activity. There were no major complications reported in any of the included studies. CONCLUSIONS Chronic patellar tendon disruption in a native knee is an uncommon injury that can result in significant limitations for patients. Although more research is needed to better elucidate which graft is best, outcomes after patellar tendon reconstruction for chronic tears appear to be satisfactory with current techniques.
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Affiliation(s)
- Addison Cimino
- From the Department of Orthopaedics, University of Alabama at Birmingham, Birmingham
| | - Kevin C Wall
- From the Department of Orthopaedics, University of Alabama at Birmingham, Birmingham
| | - Joseph Elphingstone
- From the Department of Orthopaedics, University of Alabama at Birmingham, Birmingham
| | - Kyle Paul
- From the Department of Orthopaedics, University of Alabama at Birmingham, Birmingham
| | | | - Aaron Casp
- From the Department of Orthopaedics, University of Alabama at Birmingham, Birmingham
| | - Eugene Brabston
- From the Department of Orthopaedics, University of Alabama at Birmingham, Birmingham
| | | | - Amit Momaya
- From the Department of Orthopaedics, University of Alabama at Birmingham, Birmingham
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Wall KC, Elphingstone J, Paul KD, Arguello A, Pandey A, Qureshi H, McGwin G, MacBeth L, Feinstein J, Momaya A, Ponce B, Brabston E. Nerve block with liposomal bupivacaine yields fewer complications and similar pain relief when compared to an interscalene catheter for arthroscopic shoulder surgery: a randomized controlled trial. J Shoulder Elbow Surg 2022; 31:2438-2448. [PMID: 36115616 DOI: 10.1016/j.jse.2022.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/13/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Following orthopedic surgery, patients frequently experience pain and discomfort. Multiple methods of regional anesthesia are available; however, the optimal technique to adequately manage pain while minimizing complications remains under investigation. This study aims to compare the complication rates and pain relief of single-injection, liposomal bupivacaine brachial plexus nerve block to a conventional, indwelling ropivacaine interscalene catheter (ISC) in patients undergoing arthroscopic shoulder surgery. We hypothesize that liposomal bupivacaine will have fewer patient complications with similar pain relief than an indwelling catheter. METHODS Patients undergoing arthroscopic shoulder surgery were prospectively assessed after randomization into either ropivacaine ISC or single-injection liposomal bupivacaine brachial plexus nerve block (LB) arms. All patients were discharged with 5 analgesics (acetaminophen, methocarbamol, gabapentin, acetylsalicylic acid, and oxycodone) for as-needed pain relief. Preoperatively, patient demographics and baseline Visual Analog Scale, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Penn Shoulder Scores were obtained. For the first four days postoperatively, complication rates (nausea, dyspnea, anesthetic site discomfort and/or irritation and/or leakage, and self-reported concerns and complications), pain, medication usage, and sleep data were assessed by phone survey every 12 hours. The primary outcome was overall complication rate. At 12 weeks postoperatively, Visual Analog Scale, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Penn scores were reassessed. Outcome scores were compared with Mann-Whitney U tests, and demographics were compared with chi-squared tests. Significance was set at P < .05. RESULTS A total of 63 individuals were allocated into ISC (N = 35) and in the LB arms (N = 28) for analysis. Demographics and preoperative patient-reported outcomes were not different between the arms. Patients in the LB arm experienced fewer (13.1%) overall complications than those in the ISC arm (29.8%) (P < .001), with patients in the ISC arm specifically reporting more anesthetic site discomfort (36.4% vs. 7.1%, P = .007), leakage (30.3% vs. 7.1%, P = .023), and 'other,' free-response complications (ISC: 21.2%; LB: 3.6%; P = .042). No differences were noted in pain, sleep, opioid use, or satisfaction between arms during the perioperative period. More nonopioid medications were consumed on average in the ISC (1.8 ± 1.4) than in the LB arm (1.4 ± 1.3) (P = .001), with greater reported use of acetylsalicylic acid (40.9% vs. 23.4% P < .001) and acetaminophen (69.5% vs. 59.6% P = .013). Patient-reported outcome scores did not differ between groups preoperatively or at 12 weeks. DISCUSSION Patients receiving liposomal bupivacaine experienced fewer complications than traditional ISCs after arthroscopic shoulder surgery. Analgesia, sleep, satisfaction, and functional scores were similar between the 2 groups.
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Affiliation(s)
- Kevin C Wall
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Joseph Elphingstone
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Kyle D Paul
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | | | - Akash Pandey
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hamza Qureshi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- University of Alabama at Birmingham Department of Epidemiology, Birmingham, AL, USA
| | - Lisa MacBeth
- University of Alabama at Birmingham Department of Anesthesiology, Birmingham, AL, USA
| | - Joel Feinstein
- University of Alabama at Birmingham Department of Anesthesiology, Birmingham, AL, USA
| | - Amit Momaya
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA
| | - Brent Ponce
- Hughston Clinic Foundation, Columbus, GA, USA
| | - Eugene Brabston
- University of Alabama at Birmingham Department of Orthopaedic Surgery, Birmingham, AL, USA.
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Wall KC, Reddy GB, Corrigan KL, Toth AP, Garrigues GE. Operative Versus Nonoperative Management of Displaced Midshaft Clavicle Fractures: A Cost-effectiveness Analysis. Orthopedics 2022; 45:e243-e251. [PMID: 35700404 DOI: 10.3928/01477447-20220608-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/03/2023]
Abstract
To date, the optimal management of displaced midshaft clavicle fractures remains unknown. Operatively, plate or nail fixation may be used. Nonoperatively, the options are sling or harness. Given the equivocal effectiveness between approaches, the costs to the health care system and the patient become critical considerations. A decision tree model was constructed to study plate and sling management of displaced midshaft clavicle fractures. Primary analysis used 6 randomized controlled trials that directly compared open reduction and internal fixation with a plate to sling. Secondary analysis included 18 studies that studied either plate, sling, or both. Incremental cost-effectiveness ratios (ICERs) were calculated using quality-adjusted life-years (QALYs). Second-order Monte Carlo probabilistic sensitivity analysis (PSA) was subsequently conducted. In primary analysis, at a willingness-to-pay (WTP) threshold of $100,000, operative management was found to be less cost-effective relative to nonoperative management, with an ICER of $606,957/QALY (0.03 additional QALYs gained for an additional $16,120). In PSA, sling management was cost-effective across all WTP ranges. In secondary analysis, the ICER decreased to $75,230/QALY. Primary analysis shows that plate management is not a cost-effective option. In secondary analysis, the incremental effectiveness of plate management increased enough that the calculated ICER is below the WTP threshold of $100,000; however, the strength of evidence in secondary analysis is lower than in primary analysis. Thus, because neither option is dominant in this model, both plate and sling remain viable approaches, although the cost-conscious decision will be to treat these fractures with a sling until future data suggest otherwise. [Orthopedics. 2022;45(5):e243-e251.].
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Reed LA, Mihas A, Andrews NA, Agarwal A, Wall KC, Spitler CA, Johnson MD. Complication Rates Are Similar Between Patients Aged <50 and >50 Years in Calcaneus Fractures Treated With the Sinus Tarsi Approach. Foot & Ankle Orthopaedics 2022; 7:24730114221115678. [PMID: 35959140 PMCID: PMC9358586 DOI: 10.1177/24730114221115678] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The sinus tarsi (ST) approach for calcaneus fractures has gained popularity in recent years with an increased interest in shifting to less invasive approaches for calcaneal fracture fixation allowing for adequate fixation if complications do not arise. Although the ST approach has gained acceptance as standard for calcaneus fracture fixation, the literature surrounding early complications rates based on age differences for this specific approach and pathology is lacking. The objective of this study was to determine if rates of complications based on age varied for patients undergoing open reduction and internal fixation (ORIF) of closed calcaneus fractures using the ST approach. Methods: A retrospective review of patients undergoing ORIF for closed calcaneus fractures from 2012 to 2020 was performed. Inclusion criteria were based on an age greater than 18 years, surgical management of a closed calcaneus fracture using a ST approach, requirement of a preoperative computed tomographic scan, and a minimum of 180 days’ follow-up. Patients were divided into 2 groups: those aged <50 years and those aged >50 years. Results: A total of 196 fractures were included with 114 fractures in the <50-year age group and 82 fractures in the >50-year age group. Mean age was 34.2 and 59.7 years in the younger and older groups, respectively. The older group had similar rates of wound dehiscence (1.2% vs 4.4%, P = .204), superficial surgical site infection (1.2% vs 2.6%, P = .490), deep infection (9.8% vs 7.9%, P = .648), and nonunion (4.9% vs 3.5%, P = .633) compared with the younger group. Rates of 30-day readmission, unplanned reoperation, and symptomatic hardware were not significantly different. Postoperative Bohler and Gissane angles were not significantly different between both groups. Conclusion: Older patients with intraarticular calcaneus fractures treated via the ST approach maintain complication rates similar to those in younger individuals. Level of Evidence: Level III, retrospective study.
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Affiliation(s)
- Logan A. Reed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander Mihas
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas A. Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abhinav Agarwal
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin C. Wall
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Clay A. Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael D. Johnson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Jardaly AH, Conklin M, Strom SF, Wall KC, Gilbert S. Prognostic Reliability of a New Classification System for Blount's Disease. Cureus 2020; 12:e8353. [PMID: 32617226 PMCID: PMC7325337 DOI: 10.7759/cureus.8353] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective We conducted this study to evaluate the reproducibility of a new classification system for Blount's disease and assess its correlation with established radiological measures used to evaluate the severity of this disorder. Materials and Methods This is a retrospective review of children with Blount’s disease that were younger than 10 years of age. Recurrence was defined as the need for a second corrective surgery. Radiographs immediately pre-surgery and at final follow-up were used to measure mechanical axis (MA), tibial metaphyseal-diaphyseal angle (TMDA), epiphyseal-metaphyseal angle (EMA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA). Patients were stratified according to the new classification (Type A, B, or C). Results Sixty-five limbs from 16 males and 24 females met our inclusion criteria. The average follow-up was 4.2 years. Twelve patients (with 22 Type-A extremities) underwent bracing with a success rate of 54%. Thirty-four patients (53 extremities) underwent surgical correction. The recurrence rate was 35.8%. Group C had a recurrence rate of 62%, higher than that of Group B (33%), and Group A (23%) (P = 0.026). In addition, irrespective of reoperation, patients in Group C had the least change in the MA (62%, P = 0.046) and the most severe values of MPTA and TMDA initially and after the operation (P < 0.05). Conclusion The new classification system for Blount’s disease holds validity for predicting recurrence. The severity of the grades is correlated with the TMDA, MPTA, and varus reversibility. This can aid physicians and families in making an informed decision and setting treatment goals.
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Affiliation(s)
- Achraf H Jardaly
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Michael Conklin
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Shane F Strom
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Kevin C Wall
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Shawn Gilbert
- Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, USA
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Wall KC, Politzer CS, Chahla J, Garrigues GE. Obesity is Associated with an Increased Prevalence of Glenohumeral Osteoarthritis and Arthroplasty: A Cohort Study. Orthop Clin North Am 2020; 51:259-264. [PMID: 32138863 DOI: 10.1016/j.ocl.2019.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The relationship between obesity and glenohumeral osteoarthritis is relatively understudied. The purpose of this study was to better define this relationship by age- and gender-matching 596,874 patients across six body mass index (BMI) cohorts and determining the prevalence of glenohumeral osteoarthritis and the standardized rate of glenohumeral arthroplasty in each cohort. Individuals with a BMI over 24 were found to be at increased odds for developing glenohumeral osteoarthritis, compared to the normal BMI cohort, and individuals with a BMI over 30 were additionally found to be at increased odds for undergoing glenohumeral arthroplasty.
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Affiliation(s)
- Kevin C Wall
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205, USA.
| | - Cary S Politzer
- Department of Orthopaedic Surgery, University of California San Diego, 4150 Regents Park Row, La Jolla, CA 92037, USA
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA. https://twitter.com/grant_garrigues
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Abdelgadir J, Elahi C, Corley J, Wall KC, Najjuma JN, Muhindo A, Nickenig Vissoci JR, Haglund MM, Kitya D. Trends in neurosurgical care in Western Uganda: an interrupted time series analysis. Neurosurg Focus 2019; 45:E15. [PMID: 30269580 DOI: 10.3171/2018.7.focus18270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE In addition to the rising burden of surgical disease globally, infrastructure and human resources for health remain a great challenge for low- and middle-income countries, especially in Uganda. In this study, the authors aim to explore the trends of neurosurgical care at a regional referral hospital in Uganda and assess the long-term impact of the institutional collaboration between Mulago National Referral Hospital and Duke University. METHODS An interrupted time series is a quasi-experimental design used to evaluate the effects of an intervention on longitudinal data. The authors applied this design to evaluate the trends in monthly mortality rates for neurosurgery patients at Mbarara Regional Referral Hospital (MRRH) from March 2013 to October 2015. They used segmented regression and autoregressive integrated moving average models for the analysis. RESULTS Over the study timeframe, MRRH experienced significant increases in referrals received (from 117 in 2013 to 211 in 2015), neurosurgery patients treated (from 337 in 2013 to 625 in 2015), and operations performed (from 61 in 2013 to 173 in 2015). Despite increasing patient volumes, the hospital achieved a significant reduction in hospital mortality during 2015 compared to prior years (p value = 0.0039). CONCLUSIONS This interrupted time series analysis study showed improving trends of neurosurgical care in Western Uganda. There is a steady increase in volume accompanied by a sharp decrease in mortality through the years. Multiple factors are implicated in the significant increase in volume and decrease in mortality, including the addition of a part-time neurosurgeon, improvement in infrastructure, and increased experience. Further in-depth prospective studies exploring seasonality and long-term outcomes are warranted.
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Affiliation(s)
- Jihad Abdelgadir
- 1Department of Neurosurgery, Duke University Medical Center.,2Duke Division of Global Neurosurgery and Neurology
| | - Cyrus Elahi
- 2Duke Division of Global Neurosurgery and Neurology.,3Duke University Global Health Institute
| | - Jacquelyn Corley
- 1Department of Neurosurgery, Duke University Medical Center.,2Duke Division of Global Neurosurgery and Neurology
| | - Kevin C Wall
- 4Duke University School of Medicine, Durham, North Carolina
| | - Josephine N Najjuma
- 5Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara; and
| | - Alex Muhindo
- 6Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Michael M Haglund
- 1Department of Neurosurgery, Duke University Medical Center.,3Duke University Global Health Institute
| | - David Kitya
- 5Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara; and
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Bergen MA, Wall KC, Kim CY, Garrigues GE. Occult Left Common Iliac Vein Compression Increases Postoperative Venous Thromboembolism Risk Following Total Hip Arthroplasty. J Arthroplasty 2019; 34:375-378. [PMID: 30448323 DOI: 10.1016/j.arth.2018.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Left common iliac vein (LCIV) compression by the right or left common iliac artery (RCIA, LCIA) is known to cause venous thromboembolism (VTE), but the extent to which occult LCIV compression synergizes with lower extremity orthopedic surgery is unknown. We hypothesize that occult LCIV compression is associated with increased VTE risk following total hip or knee arthroplasty (THA, TKA). METHODS This case-control study involves all patients at our institution who underwent primary or revision THA or TKA from 2009 to 2017 who had computed tomography or magnetic resonance imaging of the abdomen or pelvis available preoperatively. VTE cases (pulmonary embolism or left-sided deep vein thrombosis) within 30 days of surgery were matched to a control by age, gender, body mass index, Charlson Comorbidity Index, surgical site, and hypercoagulable risk factors. LCIV compression by the right common iliac artery and/or the left common iliac artery was measured in a blinded fashion and was considered present at 50% diameter reduction. RESULTS One hundred twelve patients (22 cases, 90 controls) were included for analysis. Nineteen (86.4%) cases and 46 (51.1%) controls demonstrated LCIV compression. The overall sample odds ratio of postoperative VTE in the presence of LCIV compression was 5.97 (95% confidence interval 1.59-33.67, P = .003). In patients who underwent THA (n = 75), LCIV compression was highly predictive of VTE (odds ratio ∞, 95% confidence interval 2.83-∞, P < .001). Compression in the TKA patients did not significantly predict VTE. CONCLUSION Compression of the LCIV significantly increases odds of developing postoperative VTE following THA. This effect may suggest a new method of stratifying VTE risk in the orthopedic population to reduce VTE-associated morbidity and mortality.
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Affiliation(s)
- Michael A Bergen
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Kevin C Wall
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Charles Y Kim
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
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Corrigan KL, Wall KC, Bartlett JA, Suneja G. Cancer disparities in people with HIV: A systematic review of screening for non-AIDS-defining malignancies. Cancer 2019; 125:843-853. [PMID: 30645766 DOI: 10.1002/cncr.31838] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 05/12/2018] [Revised: 07/01/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with HIV (PWHIV) have improved survival because of the advent of antiretroviral therapy. Consequently, PWHIV experience higher rates of non-acquired immunodeficiency syndrome-defining malignancies (NADMs). Previous studies have demonstrated worsened cancer-specific survival in PWHIV, partly because of advanced cancer stage at diagnosis. The objective of the current systematic review was to evaluate screening disparities for NADMs among PWHIV. METHODS The PubMed, Cochrane, EMBASE, and ClinicalTrials.gov databases were searched from January 1, 1996 through April 10, 2018 to identify studies related to screening disparities for NADMs among PWHIV. Eligibility criteria included any study performed in a high-income country that compared screening for NADMs by HIV status. After title/abstract screening and full-text review, articles that met eligibility criteria were analyzed. RESULTS Of 613 unique articles identified through the search, 9 studies were analyzed. Three studies addressed breast cancer screening, 4 addressed colorectal cancer screening, and 2 addressed prostate cancer screening. Five of the reviewed studies demonstrated that PWHIV were less likely to receive indicated cancer screenings compared with the general population, whereas 3 indicated that screening proportions were higher among PWHIV, and 1 demonstrated that screening proportions were comparable. In most of the studies, PWHIV who had regular access to health care were more likely to undergo cancer screening. CONCLUSIONS The available evidence does not uniformly confirm that PWHIV are less likely to receive cancer screening. Social determinants of health (insurance status, access to health care, education, income level) were associated with the receipt of appropriate cancer screening, suggesting that these barriers need to be addressed to improve cancer screening in PWHIV.
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Affiliation(s)
| | - Kevin C Wall
- Duke University School of Medicine, Durham, North Carolina
| | - John A Bartlett
- Division of Infectious Disease, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Global Health Institute, Durham, North Carolina
| | - Gita Suneja
- Duke Global Health Institute, Durham, North Carolina.,Department of Radiation Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
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10
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Wall KC, Schmitz R, Carney JM, Blazer Iii DG. Large mesenteric lymphangioma in an adult patient: an unusual presentation of a rare disease. BMJ Case Rep 2018; 2018:bcr-2018-226319. [PMID: 30297495 DOI: 10.1136/bcr-2018-226319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Lymphangiomas are most commonly described as a small painless mass in the neck or a vesicular rash in an infant patient. Ninety per cent of cases are diagnosed before the age of 2. Treatment usually involves surgical resection. Intra-abdominal lymphangiomas and mesenteric lymphangiomas, as described in our case report, represent a rare pathology. The exact prevalence of this condition is unclear but it has been suggested in the literature that there have been as few as 820 cases since the 16th century. The clinical presentation is usually subacute and diagnosis made incidentally during a workup of chronic gastrointestinal symptoms. Acute abdominal symptoms, as in our case presentation, are unusual but may be explained by the mass effect of a large intra-abdominal lesion. Cross-sectional imaging is key in preoperative workup and operative planning. Complete surgical resection is recommended and curative in the majority of cases with a low risk of local recurrence.
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Affiliation(s)
- Kevin C Wall
- Duke University School of Medicine, Duke University Health System, Durham, North Carolina, USA
| | - Robin Schmitz
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - John M Carney
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Dan G Blazer Iii
- Department of Surgery, Duke University Hospital, Durham, North Carolina, USA
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11
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Wall KC, Toth AP, Garrigues GE. How to Use a Graft in Irreparable Rotator Cuff Tears: A Literature Review Update of Interposition and Superior Capsule Reconstruction Techniques. Curr Rev Musculoskelet Med 2018; 11:122-130. [PMID: 29327176 DOI: 10.1007/s12178-018-9466-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW To introduce the challenges in addressing irreparable rotator cuff tears and examine the surgical options, specifically interposition grafting and superior capsule reconstruction. RECENT FINDINGS Interposition grafting of rotator cuff tears shows promising results in reducing pain and improving function postoperatively and one study demonstrated that it performs significantly better than partial repair alone. Superior capsule reconstruction has become popular rapidly, but given the novelty of the procedure, there is currently a paucity of outcomes data to review. Irreparable rotator cuff tears are a challenging condition with a variety of surgical options available. Two such options-interposition and superior capsule reconstruction-both employ grafts in an attempt to restore joint stability and function. In the past 3 years, literature discussing interposition grafting has explored the different types of grafts, and mostly employed pre-post analysis. The recent superior capsule reconstruction articles strictly used human dermal allograft and offer a variety of surgical techniques without quantitative data.
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Affiliation(s)
- Kevin C Wall
- Duke University School of Medicine, Duke University Health System, Durham, NC, USA
| | - Alison P Toth
- Section for Shoulder Reconstruction, Department of Orthopaedic Surgery, Duke University Medical Center, Box 3639, Durham, NC, 27710, USA
| | - Grant E Garrigues
- Section for Shoulder Reconstruction, Department of Orthopaedic Surgery, Duke University Medical Center, Box 3639, Durham, NC, 27710, USA.
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Choueiri TK, Michaelson MD, Posadas EM, Sonpavde G, McDermott DF, Walsh MK, Wall KC, Seon BK, Jivani MA, Adams BJ, Theuer CP. A phase Ib dose-escalation study of TRC105 (anti-endoglin antibody) in combination with axitinib in patients with metastatic renal cell carcinoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
426 Background: Resistance to VEGF-targeted therapy is a major challenge in contemporary treatment of metastatic renal cell carcinoma (mRCC), and endoglin (CD105) activation may be an important mechanism leading to resistance. Endoglin is an essential angiogenic receptor expressed on proliferating tumor vessels and mRCC cancer stem cells that is upregulated following VEGF inhibition. TRC105 is an anti-endoglin monoclonal antibody that potentiates bevacizumab (Bev) and VEGF receptor tyrosine kinase inhibitors (VEGFR TKI) in preclinical models. Methods: Heavily-pretreated mRCC pts with ECOG PS 0-1, and acceptable organ function were treated with TRC105 weekly (8 mg/kg and then 10 mg/kg) in combination with axitinib (initially at 5 mg PO BID and then escalated per patient tolerance to a maximum of 10 mg PO BID). Results: Eighteen mRCC pts (median age=61.5; M:F 16:2; median number of prior therapies=3, including >1 VEGFR TKI, clear cell=13, prior axitinib allowed) were treated. TRC105 dose escalation proceeded from 8 mg/kg (n=3) to 10 mg/kg (n=15) without dose limiting toxicity. Low grade AEs characteristic of each drug were not increased in frequency or severity at the recommended phase 2 doses of the two drugs. Three pts (18%) were PR by RECIST and 8 of 17 pts (47%) exhibited >10% tumor reduction. Median PFS is not mature and is at least 5.8 months in the overall population and at least 5.9 months in ccRCC pts. The single patient who progressed on axitinib immediately prior to study entry remains progression free at month 5 with minor tumor regression. Conclusions: TRC105 at 8 and 10 mg/kg was well tolerated with axitinib in mRCC pts with signs of activity. A multicenter randomized phase II trial of axitinib +/- TRC105 is accruing at this time. Clinical trial information: NCT01806064.
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Affiliation(s)
| | | | - Edwin M. Posadas
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Guru Sonpavde
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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Choueiri TK, Posadas EM, Sonpavde G, Figlin RA, Walsh MK, Wall KC, Seon BK, Jivani MA, Adams BJ, Theuer CP. A phase 1b dose-escalation study of TRC105 (anti-endoglin antibody) in combination with axitinib in patients with metastatic renal cell carcinoma (mRCC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Edwin M. Posadas
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Guru Sonpavde
- The University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
| | - Robert A. Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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