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1.
Ann Hematol ; 99(2): 265-276, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31897675

RESUMO

Autologous stem cell transplantation (autoSCT) can achieve long-term remission in primary refractory or relapsed Hodgkin lymphoma (r/r HL); however, still up to 50% of patients relapse after autoSCT. In this retrospective analysis, we investigated the impact of autologous stem cell transplantation in a consecutive, unselected cohort of primary refractory and relapsed Hodgkin lymphoma patients (n = 66) with the majority of patients treated in the pre-brentuximab vedotin and immune checkpoint inhibitor era. In our cohort, a 5-year overall survival (OS) from autoSCT of 59.5% and a 5-year progression-free survival (PFS) after autoSCT of 46.1% was achieved. Multivariate analysis revealed primary refractory disease and early relapse (< 12 months) after initial therapy as well as the presence of B symptoms at relapse as independent risk factors associated with a higher risk for relapse and an inferior PFS and OS. Several other clinical factors, including the presence of extranodal disease at relapse and failure to achieve a complete response to salvage chemotherapy, were associated with a trend towards an inferior survival. Patients relapsing after autoSCT had a particularly poor outcome, regardless of eligibility to undergo allogeneic stem cell transplantation (alloSCT). We further evaluated recently published prognostic models for r/r HL patients undergoing autoSCT and could validate several risk scores in our independent "real world" cohort.


Assuntos
Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Transplante de Células-Tronco , Adolescente , Adulto , Idoso , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Doença de Hodgkin/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
2.
Ann Hematol ; 99(2): 229-239, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31907572

RESUMO

The prognostic significance of hypercalcemia in lymphoma has only been studied on small series to date. We conducted a retrospective, monocentric, matched-control study that aimed to compare the outcome of patients diagnosed with any histological subtype of lymphoma associated with hypercalcemia, at diagnosis or relapse, with a group of controls matched for histological and prognostic factors. Sixty-two and 118 comparable patients treated between 2000 and 2016 were included in hypercalcemia and control cohorts, respectively. Hypercalcemia was found mainly at diagnosis (71%) in higher-risk patients (prognosis scores ≥ 3, 76%) and those with diffuse large B cell lymphoma (67.7%), stage III/IV disease (91.9%), and elevated LDH (90.3%). Two-year progression-free survival (PFS) was shorter in the hypercalcemia than control cohort [30.1% (95% confidence interval (95% CI) 18.3-41.9) vs 63.9% (95% CI 5.1-72.7), p < 0.001]. Two-year overall survival (OS) was 40.6% (95% CI 28.1-53.1) and 77.7% (95% CI 70.1-85.3) in the hypercalcemia and control cohorts, respectively (p < 0.001). Hypercalcemia was independently associated with poor PFS [HR = 2.5 (95% CI 1.4-3.5)] and OS [HR = 4.7 (95% CI 2.8-7.8)] in multivariate analysis. Among the 40 patients who received autologous stem cell transplantation (ASCT), hypercalcemia was still associated with shorter OS [2-year OS: 65% (95% CI 40.1-89.9) vs 88.0 (95% CI 75.3-100), p = 0.04]. Hypercalcemia may be associated with chemo-resistance, given its impact on PFS and OS. Hence, these data suggest that alternate strategies for lymphoma patients with hypercalcemia should be developed.


Assuntos
Hipercalcemia , Linfoma Difuso de Grandes Células B , Transplante de Células-Tronco , Idoso , Autoenxertos , Intervalo Livre de Doença , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico , Hipercalcemia/mortalidade , Hipercalcemia/terapia , Linfoma Difuso de Grandes Células B/sangue , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
3.
Ann Hematol ; 99(1): 113-119, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31768678

RESUMO

Novel anti-myeloma drugs have significantly improved the overall survival (OS) of patients with multiple myeloma (MM). However, not all MM patients treated with these drugs show survival benefits, and biologic and genetic prognostic factors are insufficient to predict the response to treatment. Decreasing treatment-related complications is important to improve the efficacy of treatment in patients with MM. The Controlling Nutritional Status (CONUT) score is a screening method for poor nutritional status, which is associated with poor prognosis in several cancers because it increases the rate of treatment-related complications. We retrospectively analyzed the OS of 64 patients with symptomatic MM and evaluated the correlation between the CONUT score and patient prognosis in MM. The median age at diagnosis was 66 years, and multivariate analysis showed that a high CONUT score (≥ 5; hazard ratio, 3.937; 95% confidence interval, 1.214-12.658; P = 0.022) was an independent prognostic risk factor. Subgroup analysis was performed according to patient age because the choice of treatment strategy, particularly autologous peripheral blood stem cell transplantation (auto-PBSCT), can vary depending on age in MM patients. Younger patients (< 65 years old) who received auto-PBSCT and had a lower CONUT score (0-3) showed a significantly better survival outcome than those with a higher CONUT score (≥ 4) (median OS, not reached vs. 64.1 months; P = 0.011). The CONUT score is simple to calculate and provides a useful prognostic indicator in patients with MM, especially transplant-eligible patients.


Assuntos
Mieloma Múltiplo , Estado Nutricional , Transplante de Células-Tronco de Sangue Periférico , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/patologia , Mieloma Múltiplo/fisiopatologia , Mieloma Múltiplo/terapia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
4.
Ann Hematol ; 99(2): 321-330, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31802187

RESUMO

The incidence of multiple myeloma (MM) is increasing worldwide, but the rate of increase is greatest in Asia. Few data describe the epidemiology and treatment of MM in Asia. Building on a cohort study from 2007 to 2012 using the Taiwan National Healthcare Insurance Research database, we extended our analysis to estimate the disease burden and treatment patterns of patients with MM in Taiwan through 2015. A further 1664 patients with newly diagnosed MM from 2013 to 2015 (total 4387 patients from 2007 to 2015) were enrolled and followed up until death or end of the observation period (December 31, 2016), whichever occurred first. The age distribution of the 2013-2015 cohort was similar to that for previous years, but there were fewer men (52.1% versus 58.0%), and more patients had renal impairment at diagnosis (19.7% versus 16.4%). From 2007 to 2015, crude annual incidences per 100,000 population of newly diagnosed MM increased from 1.74 to 2.48 and age-adjusted incidences from 1.41 to 1.65. Crude all-cause mortality rates increased over time. Case fatality decreased from 25.5 to 18.3% and median survival increased from 2.10 to 3.12 years. From 2007 to 2015, the percentage of patients receiving first-line therapy with novel agents increased from 0.4 to 89.4%, autologous stem cell transplantation doubled, and chemotherapy use decreased by 81%. Comprehensive national data covering 9 years of follow-up demonstrate continuing change in the disease burden, treatment, and survival of MM in Taiwan. Despite increased use of new treatments, MM remains largely incurable.


Assuntos
Mieloma Múltiplo , Transplante de Células-Tronco , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Taxa de Sobrevida , Taiwan/epidemiologia
5.
Ann Hematol ; 99(1): 83-91, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31807859

RESUMO

This observational study aimed to evaluate the prognostic significance of interim and final 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT) responses to upfront autologous stem cell transplantation (ASCT) in patients with peripheral T cell lymphomas (PTCLs). A total of 118 patients, from two independent institutions, with newly diagnosed PTCLs were enrolled, and 96 of them were evaluated. PET/CT was assessed at diagnosis, and during and after the primary treatment. Clinical outcomes of interim and final PET/CT were compared between transplanted and non-transplanted patients. The responses of PET/CT were assessed based on visual analysis using the Deauville five-point scale (5-PS). Clinicopathological features of transplanted patients (n = 37) were similar to those of non-transplanted patients (n = 59). After a median follow-up of 60.8 months, only final PET/CT response based on 5-PS was the independent prognostic factor of survival outcome (P < 0.001; HR 8.215; 95% C.I. 2.97-22.72) in multivariate analysis. Interim PET/CT response did not have a differential potential for predicting progression-free survival (PFS). In 59 patients, with score 1 or 2 in final PET/CT, the PFS rate was not significantly different between transplanted and non-transplanted patients (P = 0.970). Moreover, among the 37 patients with final PET/CT response score of 3-4, the PFS rate was equally poor in both transplanted and non-transplanted patients (P = 0.178). Final PET/CT assessment, based on 5-PS, was an important prognostic parameter for primary treatment of PTCLs, regardless of upfront ASCT. Interim PET/CT response could not be an indicator to determine the requirement for upfront ASCT.


Assuntos
Fluordesoxiglucose F18/administração & dosagem , Transplante de Células-Tronco Hematopoéticas , Linfoma de Células T Periférico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adulto , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Linfoma de Células T Periférico/diagnóstico por imagem , Linfoma de Células T Periférico/mortalidade , Linfoma de Células T Periférico/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
6.
J Urol ; 203(2): 422, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31638451
9.
Ann Hematol ; 99(2): 301-307, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31844933

RESUMO

Classical Hodgkin lymphoma (cHL) is considered a curable disease; however, approximately one-third of responders experience disease relapse following first-line therapy. Several studies have shown the efficacy of brentuximab vedotin (BV) in patients with relapsed/refractory HL. We present a retrospective analysis of 58 patients with relapsed/refractory HL treated with BV in a named patient program from 11 centers. The median follow-up duration was 20 (range, 4-84) months. The best overall response rate was 64% (complete response [CR], 31%; partial response [PR], 33%). The 5-year progression-free survival (PFS) and overall survival (OS) rates were 12% (95% confidence interval [CI], 0.05-0.22) and 26% (95% CI, 0.16-0.38), respectively. Among patients who achieved CR, the estimated 5-year PFS and OS rates were 32% (95% CI, 0.13-0.54) and 60% (95% CI, 0.33-0.78), respectively. A total of 26 patients underwent subsequent stem cell transplantation. The 5-year PFS and OS rates for 10 patients who had consolidative stem cell transplantation were 28% and 30%, respectively. Twenty-seven patients required further therapy following BV. At the time of the analysis, 12 patients (21%) were alive. Five patients (9%) had long-term remission after achieving CR with BV monotherapy, with a median PFS of 76 months. Three of them (5%) did not receive any other treatment following BV and their median PFS was 75 months. Our long-term results showed that a small subset of patients with relapsed/refractory cHL may benefit from and even be cured with BV monotherapy.


Assuntos
/administração & dosagem , Doença de Hodgkin , Transplante de Células-Tronco , Adulto , Aloenxertos , Autoenxertos , Intervalo Livre de Doença , Feminino , Seguimentos , Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida
10.
Ann Hematol ; 99(2): 331-341, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31853703

RESUMO

G-CSF administration after high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to expedite neutrophil recovery. Several studies comparing filgrastim and pegfilgrastim in the post-ASCT setting concluded that the two are at least equally effective. Lipegfilgrastim (LIP) is a new long-acting, once-per-cycle G-CSF. This multicentric, prospective study aimed to describe the use of LIP in multiple myeloma patients receiving high-dose melphalan and autologous stem cell transplantation (ASCT) and compare LIP with historic controls of patients who received short-acting agent (filgrastim [FIL]). Overall, 125 patients with a median age of 60 years received G-CSF after ASCT (80 patients LIP on day 1 post-ASCT and 45 patients FIL on day 5 post-ASCT). The median duration of grade 4 neutropenia (absolute neutrophil count [ANC] < 0.5 × 10 [9]/L) was 5 days in both LIP and FIL groups, whereas the median number of days to reach ANC ≥ 0.5 × 10 [9]/L was 10% lower in the LIP than in the FIL group (10 vs 11 days), respectively. Male sex was significantly associated with a faster ANC ≥ 0.5 × 10 [9] L response (p = 0.015). The incidence of FN was significantly lower in the LIP than in the FIL group (29% vs 49%, respectively, p = 0.024). The days to discharge after ASCT infusion were greater in patients with FN (p < 0.001). The study indicates that LIP had a shorter time to ANC recovery and is more effective than FIL for the prevention of FN in the ASCT setting.


Assuntos
Filgrastim/administração & dosagem , Melfalan/administração & dosagem , Mieloma Múltiplo/terapia , Polietilenoglicóis/administração & dosagem , Transplante de Células-Tronco , Idoso , Autoenxertos , Feminino , Filgrastim/efeitos adversos , Humanos , Masculino , Melfalan/efeitos adversos , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Polietilenoglicóis/efeitos adversos , Estudos Prospectivos , Fatores Sexuais
11.
Ann Hematol ; 99(2): 283-291, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31872361

RESUMO

FDG-positron emission tomography (PET) performed early during therapy in advanced Hodgkin lymphoma patients has been confirmed as being important for progression-free survival. A group of patients with a negative interim-PET (i-PET) showed a positive end induction PET (e-PET). The aim of this study was to evaluate the clinical characteristics of patients with a positive e-PET as a secondary end point of the HD0801 study. A total of 519 patients with advanced-stage de novo Hodgkin lymphoma received initial treatment and underwent an i-PET. Patients with negative results continued the standard treatment. i-PET negative patients were then evaluated for response with an e-PET and those patients found to have a positive one were also then given a salvage therapy. Among 409 i-PET negative, 16 interrupted the therapy, 393 patients were evaluated with an e-PET, and 39 were positive. Sixteen out of 39 underwent a diagnostic biopsy and 15 were confirmed as HD. Seventeen out of 39 e-PET were reviewed according to the Deauville Score and, in sixteen, it was confirmed positive (10 DS 5, 6 DS 4). With the exception of high LDH value at diagnosis (p = 0.01; HR 95% CI 1.18-4.89), no clinical characteristics were significantly different in comparison with e-PET negative patients. Positive e-PET after a negative i-PET has a worse outcome when compared with i-PET positive patients salvaged with therapy intensification. It was not possible to identify clinical characteristics associated with a positive e-PET.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Fluordesoxiglucose F18/administração & dosagem , Doença de Hodgkin , Tomografia por Emissão de Pósitrons , Transplante de Células-Tronco , Adulto , Autoenxertos , Bleomicina/administração & dosagem , Dacarbazina/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Feminino , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Humanos , Masculino , Estudos Prospectivos , Taxa de Sobrevida , Vimblastina/administração & dosagem
12.
Ann Hematol ; 99(2): 277-282, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31872362

RESUMO

The International Prognostic Score (IPS) is the most commonly used risk stratification tool for patients with advanced Hodgkin lymphoma (HL). It incorporates seven clinical parameters independently associated with a poorer outcome: male sex, age, stage IV, hemoglobin level, white blood cell and lymphocyte counts, and albumin level. Since the development of the IPS, there have been significant advances in therapy and supportive care. Recent studies suggest that the IPS is less discriminating due to improved outcomes with ABVD therapy. The aim of the present study was to asses if classic prognostic factors maintain their prognostic meaning at the time of response-adapted treatment based on interim PET scans. We evaluated the prognostic significance of IPS in the 520 advanced stage HL patients enrolled in the PET-guided, HD0801 trial in which PET2-positive patients underwent a more intense treatment with an early stem-cell transplantation after 2 cycles of ABVD. We observed that in these patients, the IPS completely loses its prognostic value together with all the single parameters that contribute to the IPS. Furthermore, neutrophils, monocytes, lymphocytes, and the ratio among them also no longer had any predictive value. We believe that the substantial improvement in survival outcomes in PET2-positive patients treated with early autologous transplantation could explain the complete disappearance of the residual prognostic significance of the IPS.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Doença de Hodgkin , Transplante de Células-Tronco , Adulto , Autoenxertos , Bleomicina/administração & dosagem , Dacarbazina/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Feminino , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/mortalidade , Doença de Hodgkin/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Taxa de Sobrevida , Vimblastina/administração & dosagem
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1543-1546, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823555

RESUMO

Objective: To investigate the influence of gender, age, activity level, and diameter of graft on the anterior cruciate ligament (ACL) reconstruction. Methods: Between February 2012 and June 2017, 179 cases (111 males and 68 females) with an average age of 30.0 years (range, 11-63 years) were included in study. The patients underwent internal fixator removal at 2 years or more after single bundle ACL reconstruction with hamstring tendon autografts. All patients were sports injuries. The time from injury to operation ranged from 3 days to 26 years (median, 120 days). Lachman test and pivot shift test were positive. Univariate analysis was conducted on gender, age, post-operative activity level (Tegner score at the time of internal fixator removal), diameter of graft, and number of graft strands, and logistic regression was used to conduct multivariate analysis to screen the independent risk factors. Results: All patients were followed up 24-90 months (mean, 29.1 months). At last follow-up, Lachman test was positive in 25 cases and pivot shift test was positive in 28 cases. The KT-2000 side-to-side difference was -1-7 mm (mean, 1.89 mm). Eleven patients (6.15%) failed after ACL reconstruction. Univariate and multivariate analyses showed that the age, gender, post-operative activity level, diameter of graft, and number of graft strands were not risk factors for the failure of ACL reconstruction (P>0.05). Conclusion: There was no significant difference in the risk for ACL reconstruction failure among age, gender, and activity level. ACL reconstruction failure rate cannot be reduced by increasing the number of graft strands to increase the diameter of grafts.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Adolescente , Adulto , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Autoenxertos , Criança , Feminino , Tendões dos Músculos Isquiotibiais/transplante , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
14.
Anticancer Res ; 39(12): 6759-6768, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810941

RESUMO

BACKGROUND/AIM: Large full thickness abdominal wall defects following malignancies can be a reconstructive challenge. The purpose of this study was to analyze long-term outcomes and complications following abdominal wall reconstruction using composite antero-lateral thigh (ALT) flaps. PATIENTS AND METHODS: The study retrospectively investigated 16 consecutive patients who underwent abdominal wall reconstruction with autologous flap between May 2003 and March 2018. Volumetric flap analysis was used to assess flap atrophy over time, evaluating the role of denervation and reinnervation. The long-term outcome was assessed to compare the two groups (free vs. pedicled ALT flap reconstructions). RESULTS: All flaps successfully covered the defects. We found a significant increase in flap resorption in free flaps when compared to pedicled ones. Abdominal bulging was seen in 3 out of 16 (19%) patients after more than 12 months follow-up, in close correlation with mesh absence. CONCLUSION: Free flaps were shown to be equally effective as their pedicled counterparts, without significant increase in complication rate.


Assuntos
Parede Abdominal/cirurgia , Retalhos Cirúrgicos/transplante , Autoenxertos , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/inervação , Retalhos de Tecido Biológico/transplante , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/inervação , Coxa da Perna , Resultado do Tratamento
15.
Ann Hematol ; 98(12): 2781-2792, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673775

RESUMO

Autologous stem cell transplantation (ASCT) combined with novel agents is the standard treatment for transplant-eligible, newly diagnosed myeloma (NDMM) patients. Lenalidomide is approved for maintenance after ASCT until progression, although the optimal duration of maintenance is unknown. In this trial, 80 patients with NDMM received three cycles of lenalidomide, bortezomib, and dexamethasone followed by ASCT and lenalidomide maintenance until progression or toxicity. The primary endpoint was the proportion of flow-negative patients. Molecular response was assessed if patients were flow-negative or in stringent complete response (sCR). By intention to treat, the overall response rate was 89%. Neither median progression-free survival nor overall survival (OS) has been reached. The OS at 3 years was 83%. Flow-negativity was reached in 53% and PCR-negativity in 28% of the patients. With a median follow-up of 27 months, 29 (36%) patients are still on lenalidomide and 66% of them have sustained flow-negativity. Lenalidomide maintenance phase was reached in 8/16 high-risk patients but seven of them have progressed after a median of only 6 months. In low- or standard-risk patients, the outcome was promising, but high-risk patients need more effective treatment approach. Flow-negativity with the conventional flow was an independent predictor for longer PFS.


Assuntos
Lenalidomida/administração & dosagem , Quimioterapia de Manutenção , Mieloma Múltiplo , Transplante de Células-Tronco , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Autoenxertos , Bortezomib/administração & dosagem , Dexametasona/administração & dosagem , Intervalo Livre de Doença , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/mortalidade , Mieloma Múltiplo/terapia , Taxa de Sobrevida
16.
Stomatologiia (Mosk) ; 98(5): 32-45, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31701927

RESUMO

The purpose of the study was to increase the effectiveness of surgical treatment and rehabilitation of patients with severe mandibular atrophy by means of autogenous free vascularized fibula transplant use with subsequent dental implants placement in the reconstructed mandible and implant-retained fixed dentures. In 2017 5 female patients underwent surgical treatment of severe mandibular atrophy with autogenous free vascularized fibula transplant in Maxillofacial Surgery department of CRID with additional nonvascularized iliac bone grafts and functional rehabilitation with implant-supported constructions in two of the cases. Due to its form, length and vascularization fibular bone represents a good plastic material for full length mandibular alveolar part reconstruction. The inclusion of the skin paddle in the autogenous free vascularized fibula transplant promotes secure primary closure of the surgical wound in the oral cavity. The use autogenous free vascularized fibula transplant in patients with severe mandibular atrophy with demands a thorough presurgical planning and intraoperative modeling.


Assuntos
Reconstrução Mandibular , Procedimentos Cirúrgicos Reconstrutivos , Atrofia , Autoenxertos , Transplante Ósseo , Feminino , Fíbula , Humanos , Mandíbula , Resultado do Tratamento
17.
Expert Rev Med Devices ; 16(11): 981-988, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31663385

RESUMO

Introduction: Although the Ross procedure offers several advantages over standard prosthetic AVR, its use remains limited. The risk of pulmonary autograft dilatation requiring reintervention remains one of the main concerns. Consequently, multiple techniques have been developed in attempt to mitigate this complication.Areas covered: This article reviews the incidence of pulmonary autograft dilatation, its risk factors and pathophysiology. The techniques of external pulmonary autograft support are discussed along with their respective advantages and limitations. Finally, future areas of research and developments are examined.Expert opinion: The risk of autograft dilatation is mainly prevalent in patients with aortic regurgitation and a dilated aortic annulus. In these selected patients, an external support may prevent dilatation of the autograft. However, any permanent support potentially restricts autograft root motion, mitigating some of the advantages associated with the Ross procedure. A bioresorbable matrix that could support the root during its initial adaptative phase could alleviate this problem. In our opinion, aggressive blood pressure control during the first postoperative year along with annular and sino-tubular junction support in selected patients provides optimal stability of autograft root dimensions while preserving root dynamics. Serial imaging and clinical follow-up are necessary to define the role of these various strategies.


Assuntos
Autoenxertos/cirurgia , Pulmão/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Valva Aórtica/cirurgia , Dilatação Patológica , Humanos , Tecidos Suporte
18.
J Craniomaxillofac Surg ; 47(11): 1728-1738, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31601466

RESUMO

OBJECTIVE: to assess the reliability of bone marrow nucleated cell (BMNc) intra-articular injection in patients with degenerative temporomandibular joint disorders (TMDs), and to compare its efficacy with that of hyaluronic acid (HA). MATERIALS AND METHODS: this study was designed as a randomized, controlled trial of parallel groups. Patients affected by degenerative joint mandibular disorders were enrolled in this prospective clinical trial and randomly divided into two groups. The HA group underwent temporomandibular joint (TMJ) arthrocentesis and HA injection, whilst patients in the BMNc group were inoculated with BMNc inside the joint after lavage. Outcome measures were: assessing pain at rest and during motion, joint noises, chewing efficiency, and maximum interincisal opening. A postoperative MRI scan was performed and compared with the preoperative one, while examining for cartilage regeneration. Clinical and radiological data were collected from baseline to 12 months follow-up. RESULTS: Thirty patients, 15 for each group, complaining of different degrees of unilateral TMD with internal derangement, were enrolled and treated. In both groups, significant clinical improvements were detected after the procedure up to 1 year postoperatively. The BMNc group presented significantly better pain relief than the HA group after 6 months (p = 0.028) and 12 months (p = 0.000). No significant differences were observed in terms of joint noises. In terms of chewing efficiency, the BMNc group showed positive significant differences after 12 months (p = 0.000). Maximum interincisal opening presented significantly better values in the BMNc group after 6 months (p = 0.001) and 12 months (p = 0.000). No MRI evidence of cartilage regeneration was reported. CONCLUSION: intra-articular TMJ BMNc injection improved clinical outcomes in TMD treatment. The Results of this first human-model study are promising but further studies are needed to determine whether BMNc can represent the best treatment for TMDs.


Assuntos
Artrocentese , Autoenxertos , Medula Óssea , Ácido Hialurônico/administração & dosagem , Transtornos da Articulação Temporomandibular/terapia , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Medição da Dor , Estudos Prospectivos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Articulação Temporomandibular , Resultado do Tratamento
19.
Int J Oral Maxillofac Implants ; 34(6): 1424­1433, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31532824

RESUMO

PURPOSE: The purpose of this study was to compare the efficacies of autogenous bone ring and autologous growth factor-enriched bone graft matrix as graft materials in extraction sockets. MATERIALS AND METHODS: Subjects (n = 34) requiring extraction of a single incisor or premolar in a type II socket were segregated into two groups: BR and AFG. Autogenous bone ring transplant and autologous fibrin glue with particulate bone graft (sticky bone) was used in subjects under the BR and AFG groups, respectively, for socket augmentation. After 6 months, osteotomy preparation was carried out, and implants were placed in all subjects. The efficacies of both of the procedures were compared by assessing measures of bone density, buccal/lingual plate height, implant stability quotient (ISQ) readings, and mineralized tissue volumes. RESULTS: At 6 months, there was a highly significant gain (P ≤ .001) in the buccal (3.09 ± 1.6 mm vs 1.90 ± 0.94 mm) and lingual/palatal bone heights (3.31 ± 2.66 mm vs 1.99 ± 1.22 mm) and a significant difference in the bone density (659.6 ± 133.8 vs 552.1 ± 65.6; P = .016) in the BR group compared with the AFG group. Significant differences were observed between the two groups for ISQ values at the end of 6 months (61.60 ± 8.9 vs 45.02 ± 6.33; P = .034). Biopsy specimens from the BR group showed a highly significant increase (50.39% ± 11.96% vs 38.91% ± 12.22%; P ≤ .001) in the percentage of tissue mineralization over the AFG group. CONCLUSION: Autogenous bone ring procedure seemed to confer additional benefits over autologous growth factor-enriched bone graft when various parameters were compared. The sites augmented with autogenous bone ring at the end of the study period showed a sufficient gain in bone height and quality for implant placement.


Assuntos
Aumento do Rebordo Alveolar , Alvéolo Dental , Autoenxertos , Transplante Ósseo , Humanos , Extração Dentária , Zigoma
20.
Int J Oral Implantol (New Malden) ; 12(3): 299-312, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31535099

RESUMO

PURPOSE: To report the 5-year outcomes of autogenous bone block grafts fixed at a distance (BBG-D) versus a resorbable poly-D-L-lactide foil fixed at a distance (SonicWeld Rx shell technique [SWST]) randomised controlled trial, for lateral alveolar ridge augmentation. MATERIALS AND METHODS: Thirty patients with a buccopalatal bone width of ≤ 3 mm were randomised into the following treatment groups: BBG-D and SWST. The implant survival, changes in bone morphology visualised in a cone beam computed tomography scan and periodontal parameters were assessed. RESULTS: Thirteen patients in the BBG-D group and seven in the SWST group could be included in the analysis. All implants that osseointegrated initially (BBG-D = 13 and SWST = 7) were functional at the 5-year re-evaluation. The buccopalatal bone width significantly (P < 0.001) decreased over time regardless of the study group. A bone loss of 0.00 mm was observed at the distal implant shoulder in the BBG-D group and 0.29 mm (SD 0.49 mm) in the SWST group (P = 0.04). The mean buccal bone loss was 2.56 mm (SD 3.65 mm) in the BBG-D group and 1.71 mm (SD 4.11 mm) in the SWST group (P = 0.64). The mean probing pocket depth was within sound limits in both groups without significant differences (P > 0.05). Bleeding on probing was low. CONCLUSIONS: Within the limitations of this study, a similar implant survival rate was observed between the BBG-D and SWST techniques during the 5-year follow-up. The buccopalatal bone width decreased over time regardless of the augmentation method used.


Assuntos
Aumento do Rebordo Alveolar , Autoenxertos , Transplante Ósseo , Dioxanos , Humanos , Método Simples-Cego
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