The 2018 Guidelines for the diagnosis and treatment of osteoporosis in Greece.

We report the updated guidelines for the management of osteoporosis in Greece, which include guidance on fracture risk assessment, diagnosis-pharmacological treatment-follow-up of osteoporosis based on updated information, and national evidence from Greek clinical practice and the healthcare setting. PURPOSE: The purpose of this report was to update the Guidelines for the Management of Osteoporosis in Greece that was published in 2011. METHODS: In line with the GRADE system, the working group initially defined the main clinical questions that should be addressed when dealing with the diagnosis and management of osteoporosis in clinical practice in Greece. Following a literature review and discussion on the experience gained from the implementation of the 2011 Guidelines transmitted through the national electronic prescription network, the Hellenic Society for the Study of Bone Metabolism (HSSBM) uploaded an initial draft for an open dialogue with the relevant registered medical societies and associations on the electronic platform of the Greek Ministry of Health. After revisions, the Central Health Council approved the final document. RESULTS: The 2018 Guidelines provide comprehensive recommendations on the issues of the timing of fracture risk evaluation and dual-energy X-ray absorptiometry (DXA) measurement, interpretation of the DXA results, the diagnostic work-up for osteoporosis, the timing as well as the suggested medications for osteoporosis treatment, and the follow-up methodology employed during osteoporosis treatment. CONCLUSIONS: These updated guidelines were designed to offer valid guidance on fracture risk assessment, diagnosis-pharmacological treatment-follow-up of osteoporosis based on updated information and national evidence from clinical practice and the healthcare setting. Clinical judgment is essential in the management of every individual patient for the purpose of achieving the optimal outcome in the safest possible way.

Proposed guidelines for increasing the reliability and validity of Letournel classification system.

The aim of this study was to improve the reliability of Letournel classification system using a guideline algorithm protocol. The study was conducted upon two groups of orthopaedic surgeons with different experience and was consisted of two observation sessions (A and B). In session A, every observer studied, with no instructions or guidelines, a particular set of acetabular fractures on AP and Judet oblique views. In session B the observers had to examine the same set of radiographs by taking into account a guideline algorithm protocol. The unweighted kappa coefficient was utilised to estimate the observers' agreement arising from the examination of the given X-rays. Finally, the agreement of the observers, related to the intraoperative diagnosis was estimated. The main finding of the herein study lies on the improvement of the agreement rate experienced within both groups, in session B over session A. It is reasonable to assume that the main reason behind this result is the provision of the guideline algorithm protocol in the second session. The total agreement rate was increased from 59.9% in session A to 72.1% in session B, (p value=0.0267). Our findings confirm the reliability of Letournel classification system and the proposed guideline algorithm protocol further improve the ability to classify the most complex acetabular fractures types.

Bronchogenic cyst of the lung mimicking a pulmonary hydatid cyst in a child.

Lung bronchogenic cyst may be infected and present with symptomatology and chest radiological findings compatible with an infected lung cyst, including pulmonary hydatid cyst. We describe a case of a 5-year-old girl with a symptomatic solitary mass in the right lower lobe that was initially treated as a hydatid cyst. Eventually, a lobectomy was performed, and a final diagnosis done on pathology showed an infected congenital bronchogenic cyst.

A phase II study of the docetaxel-carboplatin chemotherapy regimen in advanced non-small-cell lung cancer.

The efficacy of the docetaxel-carboplatin combination chemotherapy was studied in various phase II studies. Based on these data we aimed to test the regimen in previously untreated patients with advanced advanced non-smoking lung cancer (NSCLC) with docetaxel 80 mg/m2 a standard dose of carboplatin at AUC = 5, in an attempt to define the efficacy and tolerability of the combination in an open-label phase II study. Patients with histologically confirmed advanced NSCLC stage IIIB and IV were candidates for the present study. Docetaxel was administered at 80 mg/m2 over 1 h by intravenous (IV) infusion followed by carboplatin AUC = 5 in 30 min IV infusion, both on day 1, and recycled every 21 days. Sixty patients received 263 courses of therapy in total; 231/263 (88%) were administered according to the planned doses, and 48/60 (80%) patients received chemotherapy without decrement of the dose; 32/263 (12%) of the courses were administered with a 10%-30% dose reduction. Complete responses (CR) were seen in 5 patients (8.3%) and partial responses (PR) in 16 patients (26.7%) for an overall response rate of 35%. Median duration of response was 7.5 months [95% confidence interval (CI)-7.1-7.9], time to progression (TIP) 11.5 months (95% CI-8.2-14.8), median overall survival (OS) 15.0 months (95% CI-10.8-19.2). One-year survival was 61.7%. Toxicity was acceptable; it was calculated according to the administered cycles and was mainly neutropenia: grade 3, 9% and grade 4, 2%; anemia: grade 3, 8%; nausea and vomiting: grade 3, 8%. The outpatient regimen of docetaxel-carboplatin is effective with acceptable toxicity in patients with advanced NSCLC.