Impact of open bursectomy and biceps tendon release with closed manipulation in frozen shoulder

This retrospective observational study evaluated the efficacy of 2 different surgical approaches for the treatment of frozen shoulder (adhesive capsulitis). This study aimed to compare the efficacy, safety, and recovery times of the 2 treatment modalities. Fifty patients diagnosed with frozen shoulder and treated at Seyhan State Hospital were included in the study. The patients were retrospectively divided into 2 groups based on the treatment received. Group 1 consisted of 25 patients who underwent standard closed manipulation under anesthesia, a technique involving passive movements of the shoulder joint to tear the tight capsule and expand the range of motion (ROM). Group 2, which included 25 patients, underwent closed manipulation in addition to open bursectomy and biceps tendon capsule release. Open bursectomy involves surgical removal of the bursa to alleviate inflammation, while biceps tendon capsule release addresses chronic biceps tendonitis by partially removing the capsule of the tendon. Data on demographic information, operative details, preoperative and postoperative conditions, and patient-reported outcomes were collected and analyzed. Data analysis revealed that the combination of closed manipulation with open bursectomy and biceps tendon capsule release was more effective in reducing pain, increasing ROM, and improving quality of life than closed manipulation alone. The discussion would typically elaborate on how the results compare with existing literature, the clinical implications, and any potential limitations of the study. The results showed that the method that combined closed manipulation with open bursectomy and biceps tendon capsule release was better than closed manipulation alone in terms of reducing pain, increasing ROM, and improving quality of life.

Outcome of Chronic Foot Osteomyelitis Treated With Hyperbaric Oxygen: An Observational Study

Chronic refractory osteomyelitis of the foot stands as a formidable challenge in medical care, associated with significant morbidity and escalating healthcare costs. Traditional therapeutic approaches, including surgical debridement and systemic antibiotics, often fall short, leaving patients and clinicians in search of more efficacious interventions. Hyperbaric oxygen therapy (HBOT), an innovative therapeutic modality, has recently emerged as a promising adjunct therapy, offering a beacon of hope in this therapeutic conundrum. In this groundbreaking observational study, we meticulously analyzed the experiences of 80 patients suffering from chronic refractory osteomyelitis of the foot. Following surgical debridement and tailored antibiotic therapy, each patient was treated with HBOT at 2.5 atmospheres absolute for 120 min, 5 days a week, spanning an average of 50 days. Our primary endpoints focused on complete eradication of infection, recurrence metrics, and any adverse effects linked to HBOT. Astonishingly, 68 of the 80 patients (85%) achieved a total infection clearance, maintaining this status through a mean follow-up period of 36 months, all without a single report of HBOT-induced complications. Our compelling findings advocate that HBOT, synergized with standard surgical and antibiotic regimens, can revolutionize the treatment landscape for chronic refractory osteomyelitis of the foot. Given these promising preliminary results, there's an imperative need for extensive research to delineate the long-term advantages and to fine-tune HBOT protocols, potentially paving the way for a new therapeutic gold standard.

Comparison of Outcomes between Open and Arthroscopic Rotator Cuff Repair

Objective

The objective of this retrospective cohort study is to evaluate the long-term clinical and functional outcomes of two surgical techniques for rotator cuff repair, namely, open and arthroscopic methods.

Methods

A total of 100 patients diagnosed with rotator cuff tears and treated at Seyhan State Hospital in the past five years were enrolled, considering the same inclusion criteria for both groups. The study groups consisted of 50 patients who underwent open rotator cuff repair and 50 patients who underwent arthroscopic rotator cuff repair. We used the SPSS programme to analyse the data, focusing on parameters such as postoperative recovery time, functional capacity scores, pain levels measured by the VAS scale, quality of life evaluated by the SF-36 scores, and complication rates.

Results

Both methods resulted in similar recovery times and functional capacity scores, but patients treated with the open method reported slightly lower pain levels (average VAS score: 2.8) compared to those treated with the arthroscopic method (average VAS score: 3.1). The study also found slightly better quality of life scores in the arthroscopic group (average SF-36 score: 71.4) compared to the open surgery group (average SF-36 score: 68.7). The complications rates were lower in the arthroscopic group (2%) than in the open surgery group (4%), but these differences were not statistically significant.

Conclusions

The study suggests that, while there are no significant differences in terms of clinical outcomes between the two surgical methods, short-term pain levels may be influenced by the more frequent application of acromioplasty in arthroscopic methods. Therefore, the choice of the surgical method should be made based on the unique characteristics, including the location and size, the patient's overall health status, and the surgeon's experience. These findings should be used as a guide and not as absolute results.

Impact of systemic inflammatory markers in patients with ALK-positive non-small cell lung cancer treated with crizotinib

OBJECTIVES

To evaluate the prognostic utility of inflammation-based prognostic scores in patients with ALK-positive metastatic or non-resectable non-small-cell lung cancer (NSCLC) treated with crizotinib.

PATIENTS AND METHODS

A total of 82 patients with ALK-positive metastatic or non-resectable NSCLC who received ALK TKI crizotinib were included. Pre-treatment modified Glasgow prognostic score (mGPS), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) were calculated. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment mGPS, PNI, and SII on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR).

RESULTS

The ORR was 77.2%, while 1-year OS and PFS rates were 95.0% and 93.5%, respectively. The univariate analysis revealed significantly higher 1-year PFS (89.4 vs. 64.4%, p=0.043) and OS (92.0 vs. 83.3%, p=0.01) rates in patients with low (<934.7) vs. high (≥934.7) SII scores. Multivariate analysis revealed that PNI ≥0.09 was a significant determinant of poorer 1-year OS rates (hazard ratio [HR]: 2.46, 95% confidence interval [CI] 0.88-4.85, p=0.035). No significant difference was observed in survival rates according to gender, age, smoking status, prior lines of therapy, or mGPS scores, while higher mGPS scores (odds ratio [OR]: 0.1, 95%CI 0.16-1.04; p=0.009) and higher PNI scores (OR: 0.16, 95% CI 0.02-0.55; p=0.035) were associated with poorer ORR.

CONCLUSION

Our findings indicate the prognostic significance of PNI and SII in terms of survival outcome and the impact of mGPS and PNI on treatment response in patients with ALK-positive NSCLC treated with crizotinib.

A Comparison of the Efficacy of Cannulated Screws against Modified Tension Band Wire in the Management of Slightly Displaced Fractures of the Patella: A Novel Technique

AIM

The study aimed to compare the outcomes of Open Reduction and Cannulated Screw Fixation (ORCF) and Open Reduction and Tension Band Wire Fixation (ORTF) for treating minimally displaced patellar fractures, with the intention to discern the more efficacious surgical method in terms of various clinical and radiographic parameters.

METHODS

The research was a retrospective controlled trial encompassing 63 patients, culminating in a final data set of 52 patients with transverse patellar fractures with less than 8 mm of displacement. Patients were assessed postoperatively at three, six, and twelve months using measures such as the Lysholm score, Visual Analog Scale (VAS) for pain, and goniometry for active knee extensions and flexion. Statistical analyses were performed using SPSS version 22.0.

RESULTS

Results indicated superior clinical outcomes for the ORCF group at twelve months post-treatment, with notable higher Lysholm scores and lower VAS scores for pain at three-, six-, and twelve-month intervals. The ORCF group also demonstrated improved flexion and range of motion, with an average fracture healing time of 2.65 months and significantly lower complication rates, compared to the ORTF group.

CONCLUSIONS

The ORCF method, leveraging headless compression screws and cerclage wire fixation, emerges as a promising approach for managing minimally displaced transverse patellar fractures, potentially offering improved clinical results and patient satisfaction in comparison to the traditional ORTF method. Further expansive and diverse studies are warranted to substantiate these findings.

Elevated serum lactate dehydrogenase to albumin ratio is a useful poor prognostic predictor of nivolumab in patients with non-small cell lung cancer

OBJECTIVE

This study aimed to evaluate the prognostic significance of the LDH-to-albumin ratio (LAR) in patients with non-small cell lung cancer (NSCLC) receiving nivolumab monotherapy. We comprehensively analyzed the associations between LAR and clinical parameters, progression-free survival (PFS), and overall survival (OS) to identify reliable biomarkers for treatment selection.

PATIENTS AND METHODS

A total of 144 patients with metastatic NSCLC treated with nivolumab were included. Patient characteristics, including demographic data, smoking history, albumin, lactate dehydrogenase (LDH) levels, and LAR were recorded. Univariate and multivariate analyses were conducted to determine the associations between these factors and PFS/OS. The LAR cut-off value was determined using receiver-operating characteristics (ROC) curve analysis.

RESULTS

The median overall survival was 14.2 months, and the median progression-free survival was 5.28 months. Univariate analysis showed that smoking, ECOG performance score, brain metastasis, PD-L1 level, nivolumab treatment line, albumin, hemoglobin, LDH levels, platelet count, monocyte count, lymphocyte count, and LAR were associated with PFS. In the multivariate analysis, only LAR remained significantly associated with PFS. For overall survival, smoking, ECOG performance score, albumin level, LDH level, platelet count, monocyte count, lymphocyte count, brain metastasis, LAR, nivolumab treatment line, and PD-L1 level were significant in the univariate analysis. Albumin level, ECOG performance score, and LAR were independently associated with overall survival in the multivariate analysis.

CONCLUSIONS

The LAR, reflecting tumor burden, tumor hypoxia, immune response, nutritional status, and systemic inflammation, emerged as a potential prognostic biomarker in NSCLC receiving nivolumab monotherapy. This study highlights the importance of considering multiple factors in treatment decisions and supports the need for personalized approaches in NSCLC immunotherapy. Further research is needed to validate the utility of LAR as a predictive biomarker in this patient population.

Fluoroscopy-free distal screw locking in intramedullary nailing: A retrospective study

Intramedullary nailing is a common orthopedic procedure, but current methods for distal screw locking have several limitations. This study introduces and evaluates a novel technique that aims to overcome these challenges. The findings were statistically significant, with P-values set at .05. Compared to the traditional method, the novel technique demonstrated several advantages. Mean operation times were reduced to 1.2 hours for the new method, in contrast to 1.5 hours for the control group. Hospital stays also favored the new technique, with a mean duration of 2 days, while the control group averaged 3 days. A significant benefit was the marked decrease in radiation exposure, with the new technique eliminating radiation entirely, recording 0.0 mSv compared to the control group's 2.5 mSv. The procedure's success, gauged by the accurate positioning of screws, was higher for the new technique at 92% versus the control's 78%. Furthermore, complication rates were notably lower in the new method, with a 6% incidence compared to 16% in the traditional approach. While the data suggest that the new technique holds promising advantages, such as reduced operation times, decreased radiation exposure, and fewer complications, it is essential to conduct more extensive research for comprehensive validation. Despite the optimistic results, the study acknowledges the need for larger-scale trials to solidify these findings.

Abstract P6-18-37: The efficacy and safety analysis of the treatments of everolimus and exemestane combination in 101 metastatic breast cancer patients: Real-life experience from Turkey

Background: Endocrine treatment and chemotherapy are a treatment options for patients with hormone receptor (HR) positive and HER2-negative metastatic breast cancer (MBC). However, response to first-line hormone treatment could not obtained in all patients, and even patients who havea response will eventually relapse. After disease progression, second-line hormonal treatmentoptions are used sequentially. Everolimus with exemestane has demonstrated promising activity in patients with HR-positive HER2-negative endocrine-resistant MBC with respect to the results of the BOLERO-2 study. In the present study, we aimed to evaluate the efficacy and safety of this combination in the real-life clinical setting for the unselected population in Turkey. Material and Methods: One hundred and one patients with HR-positive HER-2 negative MBC progressing after prior endocrine treatment who were treated with everolimus with exemestane were retrospectively analyzed. The tolerability and efficacy of this combination were evaluated in the unselected Turkish patients. Results: Among 101 patients, 45% of patients had visceral and %50 patients had only bone metastasis. Everolimus with exemestane treatment was administered as a second-line in 21.3% of patients, third-line in 40.4% and forth-line and later in 38.2%. The objective response rate was 24.7% (CR+PR) and stable disease was obtained in 37.7% of patients. At the median follow-up time of 13.5 months, the median progression-free survival (PFS) time and 1-year PFS were 13.8 months and 57.2%, while the median overall survival (OS) interval and 1-year OS were 40 months and 85%. The median treatment duration was 8.3 and 6.5 months for exemestane and everolimus, respectively. The most frequent reason for discontinuation of treatment were disease progression (39%). Moreover, the most common advers events (AE) causing permanent discontinuation were stomatitis (3%) and pneumonitis (3%). A total of 81 % of patients experienced at least one AE of any grade, 25% of patients at least one grade 3 or 4 AE. Due to AEs, everolimus dosage was reduced to 5 mg in 16 (15.8%) of patients. Conclusions: Our findings confirmed that the combination of everolimus with exemestane was the safe and effective treatment options for patients with HR-positive HER-2 negative MBC after second or later lines treatments.

Citation Format: Bilici A, Menekse S, Akin S, Degirmenci M, Olmez OF, Avci N, Sakalar T, Tural D, Kaplan MA, Tanriverdi O, Bilgetekin I, Uslu R. The efficacy and safety analysis of the treatments of everolimus and exemestane combination in 101 metastatic breast cancer patients: Real-life experience from Turkey [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 P6-18-37.

Combined use of propagation velocity and intraventricular dispersion of E wave velocity for the evaluation of diastolic functions in patients with rheumatoid arthritis

PURPOSE

The aim of this study was to evaluate diastolic functions in patients with rheumatoid arthritis (RA) by propagation velocity and intraventricular dispersion of E wave velocity.

METHODS

Thirty-four patients fulfilling American Rheumatism Association (ARA) criteria for the diagnosis of RA without evidence of cardiac disease and left ventricular systolic dysfunction were enrolled in this study. Echocardiographic examinations were performed for the evaluation of diastolic dysfunction in all patients.

RESULTS

Propagation velocity in RA patients was significantly lower than the control group (42+/-16 cm/s, 54+/-15 cm/s, p=0.002). There was significant intraventricular dispersion of E wave velocity towards the cardiac apex in RA patients (p<0.001) when compared with the controls (p=0.79). There was a significant correlation between intraventricular dispersion of E wave velocity and diastolic dysfunction in the patients in which the duration of illness was longer than 10 years (p<0.001).

CONCLUSION

Structural myocardial abnormalities may cause impaired left ventricular relaxation in RA patients and these changes are correlated with the duration of the disease. Our findings demonstrate that combined use of propagation velocity and intraventricular dispersion of E wave velocity can help the early determination of diastolic functions in the patients with RA.