RESUMEN
BACKGROUND: Osteoporotic and neoplastic vertebral compression fractures (VCF) are common and painful, threatening quality of life and increasing risk of morbidity and mortality. Balloon kyphoplasty is a percutaneous option for treating painful cancer- and osteoporosis-related VCFs, supported by 2 randomized trials demonstrating efficacy benefits of BKP over nonsurgical care. OBJECTIVE: To investigate 12-mo disability, quality of life, and safety outcomes specifically in a Medicare-eligible population, representing characteristic patients seen in routine clinical practice. METHODS: A total of 354 patients with painful VCFs were enrolled at 24 US sites with 350 undergoing kyphoplasty. Four coprimary endpoints-Numerical Rating Scale (NRS) back pain, Oswestry Disability Index (ODI), Short Form-36 Questionnaire Physical Component Summary (SF-36v2 PCS), EuroQol-5-Domain (EQ-5D)-were evaluated for statistically significant improvement 3 mo after kyphoplasty. Data were collected at baseline, 7 d, and 1, 3, 6, and 12 mo (www.clinicaltrials.gov registration NCT01871519). RESULTS: At the 3-mo primary endpoint, NRS improved from 8.7 to 2.7 and ODI improved from 63.4 to 27.1; SF-36 PCS was 24.2 at baseline improving to 36.6, and EQ-5D improved from 0.383 to 0.746 (P < .001 for each). These outcomes were statistically significant at every follow-up time point. Five device-/procedure-related adverse events, intraoperative asymptomatic balloon rupture, rib pain, and aspiration pneumonia, and a new VCF 25 d postprocedure, and myocardial infarction 105 d postprocedure were reported and each resolved with proper treatment. CONCLUSION: This large, prospective, clinical study demonstrates that kyphoplasty is a safe, effective, and durable procedure for treating patients with painful VCF due to osteoporosis or cancer.
Asunto(s)
Fracturas por Compresión/cirugía , Cifoplastia/métodos , Fracturas Osteoporóticas/cirugía , Fracturas de la Columna Vertebral/cirugía , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Femenino , Fracturas por Compresión/etiología , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Estudios Prospectivos , Calidad de Vida , Fracturas de la Columna Vertebral/etiología , Resultado del Tratamiento , Estados UnidosRESUMEN
Deep venous anomalies and cavernous angiomas are two distinct intracranial lesions. Although these lesions can be found in association with each other, they have different pathologic characteristics and developmental mechanisms. These lesions can produce a variety of clinical symptoms or in some cases can be asymptomatic. The management of these anomalies can include conservative measures in some cases and aggressive intervention in others. Several imaging modalities can be used to evaluate these distinct lesions and often more than one are needed for a prompt and reliable diagnosis. Because of the tendency of these lesions to occur simultaneously, thorough evaluation of these anomalies and their surrounding tissues is critical in their clinical management. In this review, the characteristics and radiographic evaluation of these lesions will be presented and the therapeutic options for these anomalies will be discussed.
Asunto(s)
Neoplasias Encefálicas , Hemangioma , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Hemangioma/diagnóstico , Hemangioma/cirugía , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/cirugía , HumanosRESUMEN
Streamwater composition data obtained through periodic sampling of streams that support brook trout (Salvelinus fontinalis) in the mountains of western Virginia were examined for evidence of recovery from acidification during the 1988-2001 period. Measurements of sulfate deposition in precipitation indicate that sulfate deposition in the region declined approximately 40% between 1985 and 2000. While no significant regional trends in acid-base constituents were observed for the set (n = 65) of western Virginia study streams, significant regional trends were observed for a subset (n = 14) of streams in Shenandoah National Park (SNP). For the subset of SNP streams, the median increase in acid-neutralizing capacity (ANC) was 0.168 microequiv L(-1) year(-1) and the median decrease in sulfate concentration was -0.229 microequiv L(-1) year(-1). Although these trends are consistent with recovery from acidification, the degree of apparent recovery is small compared to estimates of historic acidification in SNP streams and much less than observed in other, more northern regions in the United States. Correlation between sulfate concentration trends and current sulfate concentrations in streamwater suggests that recovery from stream acidification in the western Virginia region is determined by sulfur retention processes in watershed soils. A transient increase in nitrate concentrations that occurred among some western Virginia streams following forest defoliation by the gypsy moth (Lymantria dispar) complicates interpretation of the observed patterns of change in acid-base status.