Nivolumab for locally advanced and metastatic cutaneous squamous cell carcinoma (NIVOSQUACS study)-Phase II data covering impact of concomitant haematological malignancies.

BACKGROUND: Monoclonal antibodies, such as cemiplimab and pembrolizumab, against the programmed death receptor (PD)-1 have become the current standard of care and first-line treatment of advanced cutaneous squamous cell carcinoma (cSCC), proving remarkable clinical benefit and acceptable safety. OBJECTIVES: To assess efficacy and safety of the anti-PD-1 antibody nivolumab in patients with locally advanced and metastatic cSCC. METHODS: Patients received open-label nivolumab 240 mg intravenously every 2 weeks for up to 24 months. Patients with concomitant haematological malignancies (CHMs), either non-progressing or stable under active therapy, were eligible for inclusion. RESULTS: Of 31 patients with a median age of 80 years, 22.6% of patients achieved an investigator assessed complete response, resulting in an objective response rate (ORR) of 61.3% and a disease control rate (DCR) of 64.5%. Progression-free survival (PFS) was 11.1 months, and the median overall survival (OS) was not reached after 24 weeks of therapy. Median follow-up was 23.82 months. Subgroup analysis of the CHM cohort (n = 11; 35%) revealed an ORR of 45.5%, a DCR of 54.5%, a median PFS of 10.9 months, and median OS of 20.7 months. Treatment related adverse events were reported in 58.1% of all patients (19.4% grade 3, the remaining grade 1 or 2). PD-L1 expression and CD-8+ T-cell infiltration did not significantly correlate with clinical response, although a trend towards a shorter PFS of 5.6 months was observed with PD-L1 negativity and low CD8+ intratumoral infiltration. CONCLUSION: This study demonstrated robust clinical efficacy of nivolumab in patients with locally advanced and metastatic cSCCs and a tolerability comparable to data of other anti-PD-1 antibodies. Favourable outcomes were obtained despite involving the oldest hitherto reported study cohort for anti-PD-1 antibodies and a significant proportion of CHM patients prone to high risk tumours and an aggressive course otherwise typically excluded from clinical trials.

Real-World Data for Lenvatinib in Radioiodine-Refractory Differentiated Thyroid Cancer (RELEVANT): A Retrospective Multicentric Analysis of Clinical Practice in Austria.

BACKGROUND: Lenvatinib has proven efficacy in progressive, radioiodine- (RAI-) refractory thyroid cancer (TC). Dose reductions are commonly performed due to decreased tolerability and adverse effects. This retrospective multicenter study analyzed overall survival (OS) and progression-free survival (PFS) and tolerability in the Austrian patient population treated with lenvatinib. METHODS: Clinical data of 43 patients (25 males and 18 females) with a median age of 70 years (range: 39-91 years) and RAI-refractory TC with metastases to the lymph nodes (74%), lungs (86%), bone (35%), liver (16%), and brain (12%) were analyzed. The mean duration of treatment with lenvatinib was 26.6 ± 15.4 months with dosage reductions required in 39 patients (91%). RESULTS: PFS after 24 months was 71% (95% CI: 56-87), and overall survival (OS) was 74% (95% CI: 60-88), respectively. OS was significantly shorter (p=0.048) in patients with a daily maintenance dosage ≤ 10 mg (63%) (95% CI: 39-86) as compared to patients on ≥ 14 mg lenvatinib (82%) (95% CI: 66-98) daily. Dose reduction was noted in 39 patients (91%). Grade ≥3 toxicities (hypertension, diarrhea, weight loss, and palmar-plantar erythrodysesthesia syndrome) were most common leading to discontinuation of lenvatinib in 7 patients (16%). CONCLUSION: Lenvatinib showed sustained clinical efficacy in patients with metastatic RAI-refractory TC even with reduced maintenance dosages over years. The effects were comparable to the registration trial, although patients had a higher median age and, more commonly, dose reductions.

Accurate prediction of spontaneous lumbar curve correction following posterior selective thoracic fusion in adolescent idiopathic scoliosis using logistic regression models and clinical rationale.

INTRODUCTION: Accurate prediction of spontaneous lumbar curve correction (SLCC) after selective thoracic fusion (STF) remains difficult. This study sought to improve prediction accuracy of SLCC. The hypothesis was preoperative and intraoperative variables could predict SLCC < 20°. METHODS: A multicenter observational prospective analysis was conducted to determine predictors of SLCC in AIS patients that had posterior STF. Curve types included major thoracic curves (Lenke 1, 3-4).The primary outcome variable was to establish prediction models, and a postoperative lumbar curve (LC) ≤ 20° was defined as the target variable. Multivariate logistic regression models were established to study the relationship between selected variables and a LC ≤ 20° versus a LC > 20° at ≥ 2-year follow-up. Single and dual thresholds models in perspective of clinical rationales were applied to find models with the highest positive/negative predictive values (PPV/NPV). The secondary outcome measure was SRS scores at ≥ 2-year follow-up. RESULTS: 410 patients were included. At ≥ 2-year follow-up 282 patients had LC ≤ 20°. These patients had better SRS-22 scores than those with LC > 20° (P = 0.02). The postoperative LC and LC ≤ 20° were predicted by preoperative LC and LC-bending Cobb angle (P < 0.01, r = 0.4-0.6). Logistic regression models could be established to identify patients at risk for failing the target LC ≤ 20°.For preoperative LC and LC-bending, the prediction model achieved a NPV/PPV of 80%/72%. If the postoperative main thoracic curve is combined with the preoperative LC and a gray area for difficult decisions was allowed, model accuracy could even be improved (NPV/PPV = 96%/81%). CONCLUSION: An accurate prediction model for postoperative SLCC was established based on a large analysis of prospective STF cases. These models can support prediction and understanding of postoperative SLCC aiding in surgical decision making when contemplating a selective thoracic fusion. These slides can be retrieved under Electronic Supplementary Material.

Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project.

INTRODUCTION AND PURPOSE: Little information exists on surgical characteristics, complications and outcomes with corrective surgery for rigid cervical kyphosis (CK). To collate the experience of international experts, the CSRS-Europe initiated an international multi-centre retrospective study. METHODS: Included were patients at all ages with rigid CK. Surgical and patient specific characteristics, complications and outcomes were studied. Radiographic assessment included global and regional sagittal parameters. Cervical sagittal balance was stratified according to the CSRS-Europe classification of sagittal cervical balance (types A-D). RESULTS: Eighty-eight patients with average age of 58 years were included. CK etiology was ankylosing spondlitis (n = 34), iatrogenic (n = 25), degenerative (n = 9), syndromatic (n = 6), neuromuscular (n = 4), traumatic (n = 5), and RA (n = 5). Blood loss averaged 957 ml and the osteotomy grade 4.CK-correction and blood loss increased with osteotomy grade (r = 0.4/0.6, p < .01). Patients with different preop sagittal balance types had different approaches, preop deformity parameters and postop alignment changes (e.g. C7-slope, C2-7 SVA, translation). Correction of the regional kyphosis angle (RKA) was average 34° (p < .01). CK-correction was increased in patients with osteoporosis and osteoporotic vertebrae (POV, p = .006). 22% of patients experienced a major long-term complication and 14% needed revision surgery. Patients with complications had larger preop RKA (p = .01), RKA-change (p = .005), and postop increase in distal junctional kyphosis angle (p = .02). The POV-Group more often experienced postop complications (p < .0001) and revision surgery (p = .02). Patients with revision surgery had a larger RKA-change (p = .003) and postop translation (p = .04). 21% of patients had a postop segmental motor deficit and the risk was elevated in the POV-Group (p = .001). CONCLUSIONS: Preop patient specific, radiographic and surgical variables had a significant bearing on alignment changes, outcomes and complication occurrence in the treatment of rigid CK.

Reverse shoulder arthroplasty combined with latissimus dorsi transfer: A systemic review.

Reverse shoulder arthroplasty (RSA) combined with latissimus dorsi transfer (LDT) is described for patients with cuff arthropathy and a combined loss of abduction and external rotation. The purpose of this systemic review was to present clinical and radiological outcomes following RSA combined with LDT. A comprehensive literature review was performed to identify studies reporting clinical and radiological results of RSA combined with LDT. Seven articles that describe the treatment of 116 patients were selected. Functional scores, range of motion, radiological outcome, complications, rehabilitation regime, surgical technique, patient demographics and indication were analyzed and discussed. All studies reported significant improvement in functional scores and abduction and external rotation. Complications occurred in 26% of patients. Although high-level studies are lacking, this systemic review shows that RSA combined with LDT is a reliable surgical method with which to treat patients with loss of active abduction and loss of external rotation. The available data are insufficient to draw conclusions regarding the long-term outcomes of this procedure. LEVEL OF EVIDENCE: IV.

Impact of Sagittal Balance on Clinical Outcomes in Surgically Treated T12 and L1 Burst Fractures: Analysis of Long-Term Outcomes after Posterior-Only and Combined Posteroanterior Treatment.

Objective. Long-term radiological and clinical outcome retrospective study of surgical treatment for T12 and L1 burst fractures in perspective of sagittal balance measures. Methods. Patients with age of 16-60 years, complete radiographs, early surgical treatment surgery, and follow-up (F/U) > 18 months were included and strict exclusion criteria applied. Regional and thoracolumbar kyphosis angles (RKA and TLA) were measured preoperatively and at final F/U, as were parameters of the spinopelvic sagittal alignment. Clinical outcomes were assessed using validated measures. Results. 36 patients with age mean age of 39 years and F/U of 69 months were included. 61% of patients were treated with bisegmental posterior instrumentation (POST-I) and 39% with combined posteroanterior instrumented fusion (PA-F). At F/U, several indicators for clinical outcomes showed a significant correlation with radiographic measures in the overall cohort with inferior clinical outcomes corresponding with increasing residual deformity and sagittal malalignment. Statistical analysis failed to reach level of significance for the differences between POST-I and PA-F group at final F/U. Only a strong trend towards better restoration of the thoracolumbar alignment was observed for the PA-F group in terms of the RKA and TLA. Conclusions. Results in a surgically treated cohort of T12 and L1 burst fracture patients indicate that superior clinical outcomes depend on restoration of sagittal alignment.

Maintenance of spontaneous lumbar curve correction following thoracic fusion of main thoracic curves in adolescent idiopathic scoliosis.

AIMS: The aims of our study were to provide long-term information on the behaviour of the thoracolumbar/lumbar (TL/L) curve after thoracic anterior correction and fusion (ASF) and to determine the impact of ASF on pulmonary function. PATIENTS AND METHODS: A total of 41 patients (four males, 37 females) with main thoracic (MT) adolescent idiopathic scoliosis (AIS) treated with ASF were included. Mean age at surgery was 15.2 years (11 to 27). Mean follow-up period was 13.5 years (10 to 18). RESULTS: For the TL/L curve, the mean curve flexibility evaluated with supine pre-operative bending radiographs was 78.6% (standard deviation 16.5%), with no significant loss of correction observed. On comparing patients with an increase of the TL/L curve increase (> 4º, n = 9, 22%) to those without, significant differences were observed in the correction rate of the MT curve at the final follow-up (p = 0.011), correction loss of the MT curve (p = 0.003) and the proportion of patients who had semi-rigid instrumentation (p = 0.003). Pre-operative percentage predicted forced vital capacity (%FVC) was 80%, dropping to 72% at final follow-up (p < 0.001). The Scoliosis Research Society questionnaire score was not significantly different between patients with and without a TL/L curve increase (p = 0.606). Spontaneous lumbar curve correction (SLCC) was maintained up to 18 years following selective ASF in most patients and demonstrated significant correlation with maintenance of MT curve correction. CONCLUSION: Maintenance of MT curve correction using rigid instrumentation provided stable SLCC over time. An observed 8% decrease in %FVC indicates that ASF should be reserved for patients with no or only mild pulmonary impairment. Cite this article: Bone Joint J 2016;98-B:997-1002.

Lateral Fasciectomy Sparing the Superficial Peroneal Nerve with Simultaneous Mesh Graft in Non-healing Lateral Leg Ulcers of Diverse Vascular Origins: Surgical Technique, Short- and Long-term Results from 44 Legs.

OBJECTIVES: The technique of lateral fasciectomy (LF) sparing the superficial peroneal nerve with mesh graft coverage is a novel treatment of non-healing lateral leg ulcers of various vascular origin affecting the fascia. We report short- and long-term results of LF for recalcitrant lateral leg ulcers. DESIGN: This study is a single center, retrospective case series of consecutive patients treated by LF. MATERIALS: From 827 ulcers treated at our institution, 44 recalcitrant lateral leg ulcers affecting the fascia (41 patients) underwent lateral fasciectomy between 2006 and 2013. METHODS: Preoperative indications, step-by-step surgical procedures, and perioperative care methodologies are presented. Long-term effects of healing and recurrence were clinically investigated or obtained through telephone interviews with relatives and local practitioners. RESULTS: Three discrete etiologies were identified: venous ulcers (n = 24), arterial-venous/mixed ulcers (n = 11), and arteriolar Martorell hypertensive leg ulcers (n = 9). Complete healing was achieved in 40 legs (91%) after 3 months, and in 43 of the affected legs (98%) in total. The median duration to complete healing was 64 days. There was no difference between the healing times of different etiologies. No local recurrence was observed during the follow-up period, which ranged from 1.8 to 8.7 years (median: 5.11, mean: 5.12). Twelve patients (27%) died within this period due to multimorbidity. CONCLUSIONS: Following lateral fasciectomy and mesh graft coverage, 43 legs (98%) healed in previously treatment resistant lateral leg ulcers.

Laparoscopic adenomectomy versus Eraser laser enucleation of the prostate.

PURPOSE: To evaluate functional outcomes and morbidity rates after laparoscopic adenomectomy (LA) and Eraser laser enucleation of the prostate (ELEP). MATERIALS AND METHODS: Forty patients with lower urinary tract symptoms suggesting bladder outlet obstruction, with a prostate heavier than 70 g on transrectal ultrasound, were selected to undergo laparoscopic adenomectomy or Eraser laser enucleation of the prostate. All patients were consecutively enrolled without randomization and assessed preoperatively, 3 and 6 months postoperatively. Baseline characteristics, perioperative data, and postoperative outcomes were compared. RESULTS: The total operating time was significantly longer in the LA group (138.8 ± 11.4 vs. 78.4 ± 10.0 min, p < 0.000001). Catheter removal was performed earlier (61.2 ± 21.3 vs. 174.0 ± 13.2 h, p < 0.000001) and the hospital stay was significantly shorter (62.4 ± 21.2 vs. 187.2 ± 12.6 h, p < 0.000001) in the ELEP group. The latter group experienced significantly less perioperative hemoglobin (Hb) loss (0.71 ± 0.25 vs. 2.15 ± 1.08 g/dl, p < 0.000001), and their postoperative Hb levels (14.1 ± 1.21 vs. 11.7 ± 1.31 g/dl, p < 0.000001) were significantly higher. The resected tissue was significantly greater in the LA group (58.5 ± 23.3 vs. 87.9 ± 22.4 g, p = 0.0002). Significant improvements in Qmax, Qol, and symptom scores from baseline to each follow-up time point were noted in both groups. No statistically significant difference in symptom scores or Qmax was registered between the LA and the ELEP group throughout the follow-up period. CONCLUSION: Laparoscopic adenomectomy and ELEP were equally effective for relieving bladder outflow obstruction and lower urinary tract symptoms. The advantages of ELEP include less blood loss, shorter catheterization times, and shorter hospital stays.

Three-question dementia screening. Development of the Salzburg Dementia Test Prediction (SDTP).

BACKGROUND: To date, short dementia screenings are often limited by poor specificity or still take too much time with respect to the restricted resources of primary care physicians and the increasing number of dementia disorders. As a new instrument, the three-question dementia screening (SDTP, Salzburg Dementia Test Prediction) should be compared with the eight-item screening of Chen et al. and the CERAD battery (Consortium to Establish a Registry for Alzheimer's Disease), focusing on specificity and economy of time. MATERIALS AND METHODS: We tested 404 patients (243 women). The mean age of the subjects was 80.1 years (SD = 6.8) for men and 83.2 years (SD = 6.0) for women. The mean Mini-Mental State Examination (MMSE) score was 21.9 (SD = 5.8) for men and 21.1 (SD = 6.3) for women. Artificial neural networks (ANNs) were used to find a mathematical model that allows the total MMSE to be predicted with only three questions of the MMSE. This is achieved by multiplying the outcome of the three best predictor questions with a weighting coefficient, which was delineated by using ANNs. RESULTS: The Salzburg Dementia Test Prediction (SDTP) had a sensitivity of 94% (95% CI: 87-97%) for screening of possible dementia, when the MMSE (MMSE < 25/30) was used as the reference test method and 96% when the CERAD was used. The specificity was 68% (95% CI: 57-77%) if the MMSE was used and 70% if the whole test battery (CERAD) was used, which is as sensitive as and more specific than the eight-item screening. CONCLUSION: The SDTP is a time-saving instrument for screening of dementia, which is as sensitive as and more specific than the eight-item screening of Chen et al. and provides a prediction of the MMSE with high accuracy.

Comparison of endovascular treatment versus conservative medical treatment in patients with acute basilar artery occlusion.

INTRODUCTION: Basilar artery occlusion (BAO) causes mortality up to 90%. METHODS: A total of 99 patients with BAO received either endovascular (endovascular mechanical recanalization and/or intra-arterial with optional intravenous thrombolysis [IVT] as bridging concept) or conservative medical treatment (IVT and/or medical oral therapy). Outcome parameters were measured in accordance with the thrombolysis in cerebral infarction (TICI), National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS) scores. RESULTS: In all, 78% underwent endovascular and 22% conservative medical treatment. The NIHSS at admission was 20 in both the groups. Postprocedurally, 36% (95% confidence interval: 26%-48%) of the endovascular group and 9% (21%-64%) of the conservative group reached TICI 3 (P = .017). In all, 30% of the endovascular group and 9% of the conservative group were documented with TICI 2b (P = .057). At 90 days follow-up, 45% (31%-60%) of the endovascular-treated patientsand no patient (0%-25%) of the conservative-treated group reached mRS ≤2 (P = .012). CONCLUSION: Endovascular treatment of BAO provides a better chance to survive this severe condition with good clinical outcome.

Preoperative duplex vein mapping (DVM) reduces costs in patients undergoing infrainguinal bypass surgery: results of a prospective randomised study.

OBJECTIVES: Surgical site infections (SSIs) after bypass procedures provoke major costs. The aim of this prospective randomised trial was to assess if preoperative duplex vein mapping (DVM) reduces costs generated by SSI. MATERIALS/METHODS: Patients undergoing primary infrainguinal bypass were randomised to DVM of the ipsilateral greater saphenous vein (group A) or none (group B). Costs were calculated by the hospital's accounting department. RESULTS: From December 2009 to April 2011, 130 patients (65 each group) were enrolled. Both cohorts were equal regarding demographics, risk factors and costs for primary bypass surgery, respectively. SSIs were classified minor (A: n = 13 vs. B: n = 13, P = n.s.) and major (A: n = 1 vs. B: n = 12, P = .0154). Preoperative DVM was the only significant factor to prevent major SSI (P = .011). Theatre costs for SSI: A: 537 € versus B 6553 € (P = .16). Recovery room/intensive care unit (ICU) costs for SSI: A: 0 € versus B: 8016 € (P = .22). Surgical ward costs for SSI: A: 2823 € versus B: 22 386 € (P = .011). Costs for outpatient visits due to SSI: A: 6265 € versus B: 12 831 € (P = .67). Total costs of patients without SSI: 8177 € versus major SSI: 10 963 € (P < .001). CONCLUSION: DVM significantly reduces costs generated by re-admission in patients suffering from major SSI.

[CT scans increase rotational accuracy in total knee arthroplasty]. / Computertomografie erhöht die Rotationsgenauigkeit der Knie-Totalendoprothesenimplantation.

AIM: Several studies have shown that the rotation of the femoral component is an essential factor in total knee replacement. Consequently, different intra-operative landmarks for femoral implantation were established but most of them are either hard to define or have a high variance, so reducing their utility value. The aim of this randomised, prospective study was to prove that a preoperative CT scan is a usable help for femoral orientation. METHOD: In 2006, 57 consecutive patients designated for implantation of a knee arthroplasty were split up in two groups (a and b) corresponding to a randomisation scheme. The implantation of the femoral component in group a) was done with a posterior condylar angle of three degrees of external rotation as invariable determined by the resection guide. In addition the surgeon could correct the rotation following any other landmarks (surgeon's own method). In group b) the posterior condylar angle was measured preoperatively with the help of a CT scan and transferred on a resection guide allowing variation of the posterior condylar angle in single degree steps. In this case variation of femoral rotation (surgeon's own method) was not possible. The rotation of all knee replacements (groups a and b) was measured postoperatively with a CT scan following the technique of Berger et al. The implantation with the femoral component lying parallel to the transepicondylar axis was regarded as correct. Differences were measured in degrees. RESULTS: Regarding the degree of femoral malrotation without consideration of the direction (external/internal rotation) the difference between group a) and group b) was highly statistically significant (p < 0.000001). The highest range of malrotation in group b) was two degrees versus six degrees in group a). In group b) 19 of 30 (= 63.3 %) femoral components showed no malrotation at all, in group a) only 5 of 27 (= 18.5 %) components were implanted completely correctly. CONCLUSION: Preoperative measurement of the posterior condylar angle was proven to be a simple, reproducible examination method which increases the rotational accuracy of total knee replacement.

Endovascular management versus surgery for proximal subclavian artery lesions.

Current management of subclavian artery (SA) lesions is controversial. Subclavian-to-carotid artery transposition (SCT) may be challenging but exhibits unparalleled long-term results. Stent-supported percutaneous transluminal angioplasty (sPTA) is technically easier but not always feasible. Long-term results and comparisons have not been published. We compared both methods performed by vascular surgeons. Data were collected prospectively with retrospective analysis at a tertiary-care center. sPTA was performed through a retrograde transbrachial access using self-expanding nitinol stents. Open surgery was SCT only. Society for Vascular Surgery/International Society of Cardiovascular Surgery reporting standards were applied. Seventy-four patients underwent treatment from January 1995 to August 2007 (median age 62.6 years, 40 female; left-sided pathology 60 [81.1%]; risk factors: hypertension 45 [60.8%], dyslipidemia 47 [63.5%], diabetes 21 [28.4%], smoking 43 [58.1%], SA occlusion 50 [67.6%]). Forty patients (54.1%) underwent primary sPTA (62.5% occlusions) and 34 SCT (73.5% occlusions). The two groups were comparable with regard to risk factors. In 12 patients occlusions could not be recanalized (30%), and in two stents failed within 1 month (both for stenosis). All but one underwent subsequent uneventful SCT. All SCTs were successful. No risk factor could be identified for treatment failure except sPTA (p = 0.002, Fisher's exact test). Median follow-up was 50.1 months with sPTA and 52.6 months with SCT. No procedure failed during follow-up in either group. sPTA can be performed successfully by surgeons. Primary sPTA failed in 48% of occlusions (30% of all sPTAs). Prediction of failure is not possible. According to our experience, we recommend primary sPTA for SA stenosis and surgery for SA occlusions.

Opioid sparing effect of epidural levobupivacaine on postoperative pain treatment in major spinal surgery.

BACKGROUND AND OBJECTIVE: Continuous epidural administration of a local anesthetic drug for postoperative pain treatment of patients, who undergo a fusion operation of lumbar vertebrae is limited by the suction of wound drainage. The effect of the single epidural administration of levobupivacaine 0.25% 10 mL 20 minutes before finishing of skin closure was examined on the postoperative demand for piritramide. METHODS: The study was conducted in a prospective, single blind and randomized manner. Forty patients scheduled for posterior intervertebral body fusion of two or three vertebrae were divided into two groups. Group A received levobupivacaine 0.25% 10 mL epidurally, Group B received piritramide 0.08 mg kg(-1) i.v. Time of administration was 20 minutes before predicted finish of skin closure in both groups. Piritramide was administered intravenously to achieve a VAS of 3 or less during the phase of awakening. After regaining of co-operativity, piritramide was self administered via PCA pump. VAS and the demand of piritramide within 12 hours postoperative were recorded. RESULTS: VAS at the time of being approachable (P = 0.23), VAS at the time of regaining co-operativity (P = 0.53) and VAS 12 hours postoperative (P = 0.27) did not differ significantly. The postoperative demand of piritramide was significantly lower in Group A (0.36 +/- 0.25 mg kg(-1) vs. 0.52 +/- 0.19 mg kg(-1) in Group B) (P = 0.026). CONCLUSION: The epidural administration of levobupivacaine 0.25% 10 mL 20 minutes before finishing of skin closure effects opioid sparing in the pain treatment of patients undergoing posterior interbody fusion of two or three vertebrae.

Long-term prognosis of medullary thyroid carcinoma.

OBJECTIVE: The clinical course of patients with medullary thyroid carcinoma (MTC) is variable, even in the subgroup of patients after surgery with curative intent and postoperatively persistent elevated calcitonin levels. This study aimed to evaluate the long-term prognosis of survival in patients with MTC. PATIENTS: Long-term survival was analysed in 32 patients with MTC being treated in an endocrine centre over a 40-year period. Patients were classified as having sporadic MTC, familial MTC (FMTC), multiple endocrine neoplasia (MEN) IIA or MEN IIB. RESULTS: Seventeen patients had sporadic MTC (53.1%), eight had MEN IIA (25%) and three had MEN IIB (9.4%); the remaining four patients (12.5%) had not undergone genetic analysis until now. The overall average age at diagnosis was 42.0 years, and the median follow-up time was 9.5 years (range 0.5-39 years). Mortality due to progressive MTC was 15.6%. The 5-year survival rate was 96% (95% CI 89-100), the 10-year survival rate 91% (95% CI 79-100), and the 15-year survival rate 85% (95% CI 78-100). The estimated mean survival time after initial diagnosis was 31 years (95% CI 26.7-37.0). There is a significant difference in survival time between patients achieving complete remission compared with patients with biochemical persistent disease (P = 0.038) or metastasis (P = 0.0003). In five patients, advanced imaging with positron emission tomography/computed tomography (PET/CT) identified additional sites of tumour load. Eight more lymph node metastases were found in four patients and one local tumour recurrence in one patient by PET/CT. CONCLUSION: The overall prognosis of MTC is favourable, even if the rate of biochemical cure is lower in MTC than in differentiated types of thyroid cancer. This is also true for patients with biochemically persistent disease. Whether the identification of further tumour sites by advanced imaging procedures such as PET/CT translates into a better prognosis in patients with persistently elevated calcitonin levels remains to be investigated.

[Comparison of central corneal thickness in patients participating in a glaucoma screening programme and those who were examined in the glaucoma unit]. / Vergleich der mittleren zentralen Hornhautdicke bei Patienten eines Glaukomvorsorgeprogramms und ambulanten Glaukompatienten.

BACKGROUND: The aim of this study was to compare central corneal thickness (CCT) and intraocular pressure in patients participating in a glaucoma screening programme and patients who were examined in the glaucoma unit. MATERIALS AND METHODS: 406 patients of a glaucoma screening programme (Salzburg-Moorfields collaborative glaucoma study) were included in this study. In addition a group of 406 patients who were admitted to the glaucoma clinic for a detailed glaucoma examination was included (outpatient clinic group). In all participants central corneal thickness (CCT) was measured and possible relations of CCT within the study groups were statistically analysed. RESULTS: In the population screening group the mean central corneal thickness in normal subjects was 536+/-4.3 microm, in patients with ocular hypertension (OHT) 552+/-5.7 microm, patients suffering from a normal tension glaucoma (NTG) showed a mean CCT of 534+/-14.2 microm and those with primary open angle glaucoma (POAG) had a value of 521+/-17.9 microm. In the 'outpatient clinic group' the OHT subgroup had a mean CCT of 553+/-6.8 microm, the NTG subgroup of 529+/-26.5 microm and the one with POAG had a mean of 527+/-19.8 microm. In addition, CCT was measured in all glaucoma patients whose "partner" eye was healthy (544+/-5 microm) and included in this study as part of the normal subgroup. In both groups (screening group and outpatient group), CCT was significantly higher in OHT patients than in normals. In contrast, no statistically significant difference between normals and NTG or POAG patients was detected. Intraocular pressure was significantly lower in the screening groups than in the other ones. CONCLUSIONS: Our data confirm the previously published results concerning OHT and healthy subjects. In this study no significant difference between NTG or POAG subjects and normal eyes was detected. The lower IOP in the screening population can be explained by the fact that patients contacting the screening program are self selected whereas patients of the glaucoma unit are admitted by practising ophthalmologists and are, therefore, rather advanced cases or carrying special risk factors.

Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment.

The best treatment for Rockwood type III injuries is still controversial. During a retrospective study, 24 patients who were treated surgically with a hook plate and 17 conservatively treated patients were examined with a mean follow-up of 34 months. The Oxford Shoulder Score, Simple Shoulder Test, and Constant score were assessed at the follow-up examination. Stress radiographs of both shoulders were taken, and the coracoclavicular distance, as well as the width of the acromioclavicular joint, was measured. The mean Constant score was 80.7 in the conservatively treated group and 90.4 in the group that underwent surgery. The mean coracoclavicular distance was 15.9 mm in the conservatively treated group and 12.1 mm in the surgically treated group. These differences were significant (P < .05, Mann-Whitney U test and Student t test). In this study, better results were achieved by surgical treatment with the hook plate than by conservative treatment.

[On the relationship between age and prevalence and/or incidence of primary open-angle glaucoma in the "Salzburg-Moorfields Collaborative Glaucoma Study"]. / Uber den Zusammenhang zwischen Lebensalter und Prävalenz sowie Inzidenz des primären Offenwinkelglaukoms in der "Salzburg-Moorfields-Collaborative-Glaucoma"-Studie.

BACKGROUND: It is the aim of this study to describe both the relationship between age and prevalence as well as age and 5-year incidence of primary open angle glaucoma (POAG) for a homogeneous population cohort. The result of the regression model for the prevalence are compared with the models of Tuck-Crick and Quigley-Vitale. In addition, estimations for the number of 5-year incidence cases of POAG are provided for individuals at the age of 40-80 years in Austria for the years in 2001-2006, 2010-2015, 2020-2025 and 2030-2035. PATIENTS AND METHODS: The "Salzburg Moorfields Collaborative Glaucoma Study" (SMCGS) is embedded in a government-supported glaucoma blindness prevention programme in Salzburg county, Austria, which is designed for a screening and follow-up period of at least 10 years. Each subject receives a complete ophthalmological examination. In total, the findings of 853 subjects are analysed and evaluated applying the guidelines of the European glaucoma society. RESULTS: The results of the regression analysis for the prevalences are in good agreement with the models of Tuck-Crick and Quigley-Vitale. The best correlation was found for individuals between 40 and 80 years of age. The 5-year incidences increase is statistically significant (p < 0.001) with increasing age: the 5-year incidences of individuals at the age of 40, 50, 60, 70 and 80 years are 0.07 % (95 % confidence interval: 0.005 - 0.9 %), 0.2 % (0.04 - 1.2 %), 0.7 % (0.3 - 1.9 %), 2.3 % (1 - 5.2 %) and 6.9 % (1.7 - 24.0 %), respectively. CONCLUSION: The age-dependent prevalences in this glaucoma screening program are in good agreement with the regression models of Tuck-Crick and Quigley-Vitale, especially in the age range of 40 - 80 years. The model for the 5-year incidences describes the tight relationship between age and 5-year risk for POAG. We estimate the number of new POAG cases in Austria in 2001-2006, 2010-2015, 2020-2025 and 2030-2035 at the age between 40 and 80 years to reach 49 100, 52 100, 62 000 and 69 600 patients, respectively.

[The Salzburg-Moorfields Collaborative Glaucoma Study: first results of the prevalence and 5-year incidences in this prospective, population-based longitudinal study]. / Die Salzburg-Moorfields-Collaborative-Glaucoma Study: Erste Ergebnisse der Prävalenzen und 5-Jahres-Inzidenzen in dieser prospektiven, bevölkerungsbasierten Longitudinalstudie.

BACKGROUND: This prospective, population-based longitudinal study describes prevalences and 5-year incidences of individuals with normal findings, ocular hypertension (OHT) and primary open-angle glaucoma (POAG) admitted to the Salzburg-Moorfields Collaborative Glaucoma Study (SMCGS). PATIENTS AND METHODS: The SMCGS is embedded in a government-supported glaucoma blindness prevention programme in Salzburg (Austria) which is designed for a minimum of 10-years follow-up. Each subject receives a complete ophthalmological examination. In total, the findings of 853 subjects with complete data sets were analysed and evaluated. RESULTS: The prevalence of participants with normal findings was 75 % (95 % CI: 72 - 78 %) at the initial examination, decreasing to 64 % (95 % CI: 60 - 67 %) at the 5-year follow-up. The prevalence of OHT at the initial exam of 2.3 % (95 % CI: 1.4 - 3.6 %) increased to 3.5 % (95 % CI: 2.4 - 5.0 %) at the 5-year follow-up exam with an incidence of 1.2 % (95 % CI: 0.6 - 2.2 %). Finally, the prevalence of POAG of 0.6 % (95 % CI: 0.2 - 1.4 %) increased to 1.6 % (0.9 - 2.7 %) at the 5-year exam which corresponds to a 5-year incidence of POAG of 1.0 % (0.5 - 2.0 %). CONCLUSION: The prevalence of POAG increases statistically significantly when compared at the initial and 5-year follow up exam (p = 0,002). Our results confirm the positive relation between age and the prevalence of POAG (odds ratio = 0.89, 95 % CI: 0.81 - 0.98). The prevalence and 5-year incidence rates in this glaucoma prevention study are similar to those of other population-based studies.