Is surgical indication in multiple myeloma a poor prognosis sign? SEER database analysis.

AIM: This study aims to investigate demographic data, survival rates, and the relationship of these rates with surgery in a large case series including multiple myeloma (MM) patients. METHOD: MM cases were analyzed retrospectively using the latest version of the SEER database published in April 2020. This version covers January 1975 to December 2017. Patients were classified according to gender, age, and race/ethnicity. Tumors were classified according to their localization, grade, year of diagnosis, and follow-up results. RESULTS: There were 60,239 patients diagnosed with Plasma Cell Myeloma. While 670 patients (1.2%) were operated on, 43,976 patients (76.7%) did not indicate operation, and 12,670 patients (22.1%) could not be operated on despite the recommendation. The mean survival was 62 months in those without an indication for surgery, and 42 months in patients with an indication but could not be operated on, and the difference was significant (p = 0.001). The mean survival was 58 months in the operated patients, and 42 months in the patients who could not be operated on despite the indication, and the difference was significant (p = 0.001). There was no difference between those who did not indicate surgery and those who were operated on with an indication (p = 0.243). CONCLUSION: In multiple myeloma, the best prognosis is in the group of patients who received medical treatments without any indication for operation, while an indication for operation indicates a worse prognosis. A worse prognosis should be expected in patients who do not accept the operation or who cannot be operated on compared to the operated patients.

Liberação percutânea do dedo em gatilho com micro bisturi oftalmológico vitreorretiniano de lâmina 19 / Percutaneous trigger finger release with microvitreoretinal 19 gauge ophtalmologic knife

OBJETIVO: Desenvolver uma nova técnica de liberação percutânea do dedo em gatilho, usando microbisturi oftalmológico vitreorretiniano (MVR) de lâmina 19. MÉTODO: O tratamento conservador do dedo em gatilho inclui, com frequência, injeção local de esteroide. Esse método apresenta alta taxa de falha, sendo necessárias injeções repetitivas. Quando o tratamento conservador falha, recomenda-se a liberação a céu aberto da polia A1. Foram relatados vários métodos que empregam diversos instrumentos. Usamos um microbisturi oftalmológico vitreorretiniano (MVR, de microvitreoretinal blade) de lâmina 19 na liberação percutânea do dedo em gatilho. RESULTADOS: Liberamos 50 dedos em gatilho por via percutânea com essa lâmina. CONCLUSÃO: Foram obtidos resultados satisfatórios em 45 deles (90 por cento). Nivel de Evidência VI, série de casos.

OBJECTIVE: Conservative treatment of trigger finger includes often local injection of steroid. This has a high rate of failure and repeated injections may be required.METHODS: When conservative treatment fails, open release of the A1 pulley is recommended. Various methods using various instruments have been reported. We used 19 gauge microvitreoretinal (MVR) ophthalmic knife in percutaneous release of trigger finger.RESULTS: We released 50 trigger fingers percutaneously with this knife. Satisfactory results were achieved in 45 of them (90%). Conclusion: Object of this study is to produce a new technique for percutaneous release of trigger finger using 19 gauge microvitreoretinal (MVR) ophthalmic knife.CONCLUSION: Satisfactory results were achieved in 45 of them (90%). Level of Evidence: Level IV cases series.