Search

Introduction: Luteinising hormone-releasing hormone agonist (LHRHa) injections are currently used in the treatment of advanced prostate cancer, but the frequency of injections may represent a burden to patients and healthcare services. The aim of this study was to collect real-world evidence about clinical and practical outcomes for patients with prostate cancer initiating six-monthly triptorelin, or switching from shorter-acting formulations to six-monthly triptorelin, in hospitals in the DEcapeptyl SERVice Evaluation project., Methods: Up to 2 years of data were collected retrospectively by physicians from records of 88 patients receiving six-monthly triptorelin at three centres. The primary outcome measure was the change in the number of patient-healthcare interactions (patient reviews, prostate-specific antigen (PSA) tests, and LHRHa injections) over a 24-month treatment period., Results: This analysis included 47 patients newly initiated on six-monthly triptorelin and 41 who received 12 months of a one- or three-monthly LHRHa before switching to six-monthly triptorelin. After switching to six-monthly triptorelin, there was a statistically significant reduction in patient reviews (46.8%), injections (46.8%), and PSA tests (26.6%; all P < 0.0001). The total number of patient-healthcare interactions was significantly reduced (41.5%; P < 0.0001). Based upon cost of these interactions only, the cost reduction of switching to six-monthly triptorelin was £10,214.85 (£249.14 per patient) over 12 months. At 12 months, median PSA was 1.30 ng/mL (23.50 ng/mL at diagnosis) for newly treated patients and 0.24 ng/mL (0.35 ng/mL at switch) for patients who had switched treatment. No safety issues were identified., Conclusion: Switching from one- or three-monthly LHRHa to six-monthly triptorelin significantly reduced patient-healthcare interactions and associated costs while maintaining PSA control over a 12-month treatment period. This not only translates into healthcare savings but may release men from the restriction of repeated healthcare interactions and thus improve the overall patient experience as the population of long-term prostate cancer survivors continues to increase., Funding: Ipsen Limited.

The efficaciousness of topical tranexamic acid use at the end of knee arthroplasty surgery to reduce blood loss and transfusion requirements has previously been shown. The aim of this study was to retrospectively assess the effectiveness of topical tranexamic acid use, comparing 155 patients undergoing hip and knee arthroplasty surgery in which tranexamic acid was routinely used, to a group of 149 patients from a similar time frame prior to the introduction of tranexamic acid use. The transfusion rate fell from 19.3% to 2.3% for hip arthroplasty patients and from 13.1% to 0% for knee arthroplasty patients; these differences were significant. We also found significant reductions in haemoglobin loss, blood loss and length of stay of 8 g/L, 244 mL and 1.0 days respectively for hip arthroplasties and 15 g/L, 527 mL and 1.2 days respectively for knee arthroplasties following the introduction of tranexamic acid., (© 2014.)

Introduction: In orthopaedic surgery, small bicortical circular bone defects are often produced as a result of internal fixation of fractures. The aim of this study was to determine the amount of torsional strength reduction in animal bone with a bicortical bone defect and how much residual strength remains if the bicortical bone defect was occluded., Method: Forty pig femurs were divided into four groups. Group 1 femurs were left intact. Group 2 femurs were given a 4 mm bicortical bone defect. Group 3 were prepared as in Group 2, but occluded with a 4.5 mm cortical screw. Group 4 were prepared as in Group 2, but occluded with plaster of paris. Measurements including the length of the bone, working length of the bone, mid-diaphyseal diameter and cortical thickness were recorded. All specimens were tested until failure under torsional loading. Peak torque at failure and angular deformation were recorded. One-way analysis of variance was used to test the sample groups, with a value of P < 0.05 considered to be statistically significant., Results: When compared with Group 1, all of the other groups showed a reduction in peak torque at failure point. Only the difference in peak torque between Groups 1 and 2 was statistically significant (P = 0.007). Group 2 showed the most reduction with 23.11% reduction in peak torque and 38.19% reduction in total energy absorption. No significant difference was found comparing the bone length, bone diameter and the cortical thickness., Conclusion: The presence of the defect remains the major contributing factor in long bone strength reduction. It has been shown that a 10% bicortical defect was sufficient to produce a reduction in peak torque and energy absorption under torsional loading. By occluding this defect using a screw or plaster of paris, an improvement in bone strength was achieved. These results may translate clinically to an increased vulnerability to functional loads immediately following screw removal and prior to the residual screw holes healing.

We present the case of an apparently healthy 22-year-old female who presented with atraumatic stress fractures of both fibulae. Further investigation demonstrated that she had osteopoenia secondary to occult coeliac disease. The fractures were successfully treated non-operatively. The awareness of the prevalence of occult coeliac disease is increasing due to simpler diagnostic tests, as is its significance as a cause of secondary osteoporosis. Knowing the relationship between these two conditions will help orthopaedic surgeons treating such patients to refer them promptly to appropriate specialists.

Brachymetatarsia of the first metatarsal is an uncommon condition, but one that is amenable to treatment by lengthening via distraction osteogenesis, a process that employs 2 groups of pins of an appropriate external fixator inserted in the metatarsal to apply gradual distraction across an intervening osteotomy. We present the case of a female, aged 13 years, who presented with congenital bilateral first brachymetatarsia and left foot pain due to transfer metatarsalgia. The short and plantarflexed first ray could not accommodate both groups of fixator pins, even with the fixator set at its shortest length. An alternative strategy was devised that reduced the degree of plantarflexion using a tarsometatarsal arthrodesis, which effected subsequent lengthening through the healing fusion site. Lengthening commenced after 10 days and continued over a period of 52 days, at a rate of 0.5 mm to 1.0 mm per day. Consolidation occurred at 20 weeks with a final increase in length of 25 mm. The patient returned to vigorous sporting activity 1 year after removal of the fixator. To our knowledge, this is the first account of a metatarsal-lengthening arthrodesis at the tarsometatarsal level.

Creon 10,000 Minimicrospherestrade mark (Creon) 10,000 MMS) is a pancreatic enzyme formulation that contains smaller spheres of pancreatin in a 50% smaller capsule than conventional microspheres (Creon) 8,000). This three-centre study investigated the preference of cystic fibrosis (CF) patients for these products. In one centre, 72 h stool fat excretion and coefficient of fat absorption (CFA) were also compared. Fifty-nine patients with a mean age 10 years (range 3-17) took Creon 8,000 ms for 14 days and were then randomised to 28 days of Creon 8,000 ms followed by 28 days of Creon 10,000 MMS, or vice versa. Dosing was lipase for lipase according to the labelled declaration. At the end of the second treatment period, 51 of 54 patients who completed the study expressed a preference, with a statistically significant preference in favour of Creon 10,000 MMS (47/51; 87%) vs. Creon 8,000 ms (4/51; 7.4%; P<0.0001). Stool fat (g/day) and CFA (%) were measured in 24 patients at the end of each treatment period: the products were therapeutically equivalent (Creon 10,000: 8.4 g/day, 91.3% CFA; Creon 8,000: 6.7 g/day, 93.5% CFA). Both products were well tolerated. In conclusion, in CF children we found a clear preference for Creon 10,000 MMS compared with Creon 8,000 ms with no difference in fat absorption between the two products. Creon 10,000s smaller capsules are easier to take and should aid patient compliance.

A total of 213 patients were recruited to a multicentre, randomised, double-blind, double dummy, general practice study lasting eight weeks. The objectives of the study were (i) to demonstrate therapeutic equivalence of mebeverine hydrochloride 200 mg b.i.d. capsules (Colofac MR) and 135 mg t.i.d. tablets (Colofac) in the treatment of abdominal pain in irritable bowel syndrome (IBS) and (ii) to evaluate safety and physicians' and patients' assessments of therapeutic response. Patients were randomised at day 0 and assessments performed after four and eight weeks. Primary and secondary efficacy endpoints were number of responders (response being defined as 50% or more improvement in global mean visual analogue scale for abdominal pain); patients' and physicians' global assessment of therapeutic response; and physicians' global impression of patient symptoms. Safety was assessed from adverse event reports and routine laboratory tests. Therapeutic equivalence was proven statistically (difference < 18%; p = 0.003), with 65/92 (71%) of the 135 mg t.i.d. group and 64/92 (70%) of the 200 mg b.i.d. group classified as responders. The patients' evaluation of response (week 8) was that 75% of 135 mg t.i.d. and 81% of 200 mg b.i.d. improved; the physicians' assessment of therapeutic response (week 8) was that 64% of 135 mg t.i.d. and 70% of 200 mg b.i.d. had no or mild symptoms. In conclusion, Mebeverine hydrochloride 200 mg b.i.d. (Colofac MR) was shown to be therapeutically equivalent to mebeverine hydrochloride 135 mg t.i.d. (Colofac) in the treatment of abdominal pain in IBS. Results for the secondary efficacy variables were comparable. No safety concerns were identified.

We conducted a hospital-based case-control study in Brisbane, Queensland, to investigate the specific determinants of basal cell carcinoma (BCC), as distinct from squamous cell carcinoma (SCC), with emphasis on ancestry, residential history, pigmentary characteristics, sun sensitivity and other constitutional factors. The sample was recruited from a dermatology outpatient clinic during an eight-week period in 1991, and comprised 51 incident or recently diagnosed cases of BCC, and 112 randomly selected controls with no known history of BCC or SCC. Twenty-six cases with both BCC and SCC were analysed separately. We found no risk factor specific to BCC which might explain its extremely high prevalence. The strongest risk factors for BCC were advanced age, male sex and a propensity to freckle (independent of skin colour and tendency to burn), all of which have previously been observed for SCC. A finding not previously reported was an apparent protective effect of increasing body mass, specific to BCC alone.

The dose-related effects of oestradiol on responses of thymic and splenic lymphocytes to mitogenic stimulation were studied in immature female Wistar rats. An attempt was made to relate responses not merely to dose but also to the circulating levels of the steroid. Lymphocytes were prepared from thymus and spleen and stimulated with phytohaemagglutinin (PHA) and concanavalin A (Con A) prior to measurement of 3H-thymidine incorporation. Oestradiol suppressed lymphoid tissue weight and cell number in a dose-related manner, but it was found, unexpectedly, that the dose of oestradiol used actually stimulated responsiveness of lymphocytes to mitogenic stimulation. Log dose-response curves indicate that the effects of oestradiol on responsiveness are complex, and the results suggest that the atrophic effects of oestradiol on lymphoid tissue and its enhancement of response to mitogens might be mediated by different mechanisms. Since the stimulant effects of the steroid were observed with serum levels of oestradiol attained both physiologically and pharmacologically, the results suggest a possible mechanism of action of oestradiol in abnormal cell proliferation, as occurs in neoplastic tissues, and might also help to explain certain sex-linked immune-related disorders.