DOCSLIB.ORG

Download Poster Abstracts

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Download Poster Abstracts Session 4 Poster # 1 POST-OPERATIVE NEUROMUSCULAR BLOCKER USE IS ASSOCIATED WITH HIGHER PRIMARY FASCIAL CLOSURE RATES FOLLOWING DAMAGE CONTROL LAPAROTOMY Chadi T Abouassaly, MD, William D Dutton, MD, Victor Zaydfudim, MD, MPH, Lesly A Dossett, MD, MPH, Timothy C Nunez, MD, Sloan B Fleming, PharmD, Bryan A Cotton,* MD, MPH. Vanderbilt University. Background: Failure to achieve fascial primary closure following damage control laparotomy (DCL) is associated with increased morbidity, higher health care expenditures, and a reduction in quality of life. The use of neuromuscular blockers (NMB) to facilitate closure remains controversial and poorly studied. The purpose of this study was to determine if exposure to NMB is associated a higher likelihood of primary fascial closure. Methods: All adult trauma patients admitted between 01/02-05/08 who (1) went directly to the operating room, (2) were managed initially by DCL, and (3) survived to undergo a second laparotomy. Study group (NMB+): those receiving NMB in the first 24 hours after DCL. Comparison group (NMB-): those not receiving NMB in the first 24 hours after DCL. Primary fascial closure defined as fascia-to-fascia approximation by hospital day 7. Results: 191 patients met inclusion (92 in NMB+ group, 99 in NMB- group). While the NMB+ patients were younger (31 yrs vs. 37 yrs, p=0.009), there were no other differences in demographics, severity of injury, or lengths of stay between the groups. However, NMB+ patients achieved primary closure faster (5.1 vs. 3.5 days, p=0.046) and were more likely to achieve closure by day 7 (93% vs. 83%, p=0.023). Logistic regression identified NMB use as an independent predictor of achieving primary fascial closure by day 7. Odds Ratio 95% C.I. p-value Exposure to NMB 3.24 1.15-9.16 0.026 Age (years) 0.99 0.96-1.02 0.882 Male gender 0.29 0.06-1.35 0.117 White race 2.81 0.98-8.06 0.055 Penetrating mechanism 0.25 0.07-0.92 0.037 Injury severity score 0.99 0.95-1.02 0.707 Conclusions: Early NMB use is associated with faster and more frequent achievement of primary fascial closure in patients initially managed with damage control laparotomy. Patients exposed to NMB had a 3-times higher likelihood of achieving primary fascial closure by hospital day seven. Session 4 Poster # 2 CT IDENTIFICATION OF LATENT PSEUDOANEURYSM FOLLOWING BLUNT SPLENIC INJURY: PATHOLOGY OR TECHNOLOGY? Jordan A Weinberg*, MD, Mark E Lockhart, MD, Abhishek D Parmar, MD, Russell L Griffin*, MPH, Sherry M Melton*, MD, Gerald McGwin, Jr, PhD, Loring W Rue, III*, MD. University of Alabama at Birmingham. Background: Serial CT imaging of blunt splenic injury (BSI) can identify the latent formation of splenic artery pseudoaneurysms (PSAs), potentially contributing to improved success in nonoperative management (NOM). It remains unclear, however, whether the delayed appearance of such PSAs is truly pathophysiologic or attributable to imaging quality and timing. The objective of this study was to evaluate the influence of recent advancements in imaging technology on the incidence of the latent PSA. Methods: Consecutive BSI patients over 4.5 years were identified from our trauma registry. Follow-up CT was performed for all but low-grade BSI 24 to 48 hours following initial CT. Incidences of both early and latent PSA formation were reviewed and compared with respect to imaging technology (4-slice vs. 16-slice or greater). Results: 411 BSI patients underwent NOM. PSAs were detected as follows: CT Type Patients (n) Early PSA (%) Latent PSA (%) 4-slice 135 6.2 3.8 ? 16-slice 276 6.6 4.1 Comparing 4-slice to ? 16-slice, there were no significant differences in the incidence of early PSA (p = 0.91) or latent PSA (p = 0.90). Splenic injury grade on initial CT was not associated with latent PSA (p = 0.44). PSAs were managed by embolization (14), splenectomy (13), and observation (2). 18 patients (4%) underwent unplanned splenectomy (i.e. dropping hematocrit or hemodynamic instability). 88% of patients had follow-up > 7 days. Overall, NOM was successful in 92% of patients. Conclusions: The incidences of both early and latent PSA have remained remarkably stable despite advances in CT technology. This suggests that latent PSA is not a result of imaging technique, but rather a true pathophysiologic phenomenon. While the natural history of latent vs. early PSA remains unclear, adherence to a NOM protocol guided by serial CT results in a high nonoperative success rate with a limited incidence of unplanned splenectomies. Injury grade is unhelpful concerning the prediction of latent PSA formation. Session 4 Poster # 3 A MULTI-CENTER STUDY EXAMINING THE ROLE OF IMAGING AND CLINICAL FINDINGS AS INDICATIONS TO OPERATE FOR PEDIATRIC BLUNT INTESTINAL INJURY Kaveer Chatoorgoon, MD, Richard Falcone, MD MPH, Randall Burd*, MD PHD, APSA Committee on Trauma: Blunt Intestinal Injury Study Group. Cincinnati Childrens Hospital Medical Center. Purpose: Although CT scans are accurate in diagnosing solid organ injuries, their ability to diagnose a blunt intestinal injury (BII) is limited, occasionally requiring repeat imaging. The purpose of this study was to evaluate the role of clinical findings, as well as, original and repeat CT imaging in the ultimate decision to operate for BII. Methods: An 18 institution record review of children (< 15 yrs) diagnosed with a BII confirmed during surgery or autopsy between 2002 and 2007 was conducted by the APSA Trauma Committee. The incidence of imaging, repeat imaging, and final reported indications for operative exploration were evaluated. Results: Among 353 patients identified with a BII, 313 (89%) underwent at least one abdominal CT scan. Sixty-six (21%) underwent at least one repeat scan before operation. Most children who underwent a CT scan (129, 47%) were taken to the operating room based only on clinical indications (fever, abdominal pain, shock or elevated WBC), while 31% were operated on based on both a clinical and CT indication and 22% based on a CT indication alone (p<0.001). Although free air was the most common radiographic indication for surgery, 17% of patients with a repeat scan had free air diagnosed on their first CT. Most children undergoing a repeat CT (56 children, 85%) had findings on the original scan suggesting a BII. Among the 10 patients whose first CT scan was normal, only one went to the OR based only on radiographic findings. Children who had their first CT scan at a referring hospital were more likely to have a repeat study than those imaged at a trauma center (33% vs. 13%, p<0.001). Conclusions: Although abdominal CT imaging may contribute to diagnosing intestinal injury following blunt trauma, most children undergo operation based on clinical findings. Repeat imaging should be limited to select patients with diagnostic uncertainty to avoid unneeded delay and radiation exposure. Session 4 Poster # 4 DIAGNOSTIC LAPAROSCOPY VERSUS NON-THERAPEUTIC LAPAROTOMY IN THE EVALUATION OF ACUTE ABDOMINAL TRAUMA Jay N Collins*,MD, Michael Lofgren, MD, Leonard J Weireter*, MD, Timothy J Novosel,MD, Scott F Reed, MD, Rebecca C Britt,MD, LD Britt*,MD. EVMS. Objective: To evaluate the safety and efficacy of diagnostic laparoscopy (DL) versus non-therapeutic laparotomy (NTL) in the setting of acute abdominal trauma. Methods: A retrospective analysis of prospectively collected data on trauma patients older than 16 years admitted from September 1, 2005 to January 31, 2009 was performed. Hemodynamically normal patients with suspicion for intraabdominal injury after physical exam and/or CT scan underwent either diagnostic laparoscopy or exploratory laparotomy based on the attending surgeon’s preference. Patient demographics, hospital length of stay (LOS) and hospital complications were analyzed. Univariate statistical analysis was performed to identify statistically significant differences defined as a p value <0.05 Results: 3665 patients, 2895 blunt and 767 penetrating, were seen during the study period. Thirty underwent NTL and 27 underwent DL. Fourteen DL patients had negative explorations (NDL) and all were discharged within 3 days. Five DL patients underwent laparoscopic repair of stomach, bowel or diaphragm injuries. Eight DL patients required conversion to open laparotomy for injury repair. Age (31.3 v. 32), male gender (87% v. 78%) and ISS (8.4 v. 9.5) were similar. Blunt and penetrating injuries were seen in 6 and 24 of NTL and in 10 and 17 of DL patients. Mean hospital LOS was 1.4 days in NDL and 5.1 days in NTL patients (p<0.05). NDL patients had one complication (cutaneous abscess) and NTL patients had 19 complications including wound infections, C. difficile colitis, pneumonia, urinary tract infections, reintubation, splenectomy, atrial fibrillation and ileus. No NDL patient had missed injuries achieving a negative predictive value of 100%. Fifty-two percent of DL patients safely avoided NTL. Conclusion: Diagnostic laparoscopy in the evaluation of acute abdominal trauma is safe and allows for earlier discharge and return to normal activities when negative. Significantly more complications and longer LOS are associated with NTL. Session 4 Poster # 5 PROSPECTIVE VALIDATION OF AN ALGORITHM DEFINING INDICATIONS FOR PELVIC RADIOGRAPHS IN THE EVALUATION OF BLUNT TRAUMA PATIENTS Andrew R Barleben MD MPH , Fariba Jafari BS, Darren Malinoski MD, Cristobal Barrios MD, Michael Lekawa* MD , Matthew Dolich MD, David Hoyt* MD , Marianne Cinat* MD. University of California Irvine. Introduction: In a previous retrospective study, we demonstrated that plain film pelvic radiographs (PXR) in the evaluation of blunt trauma patients undergoing abdominal CT scan have limited utility in the absence of hemodynamic instability and significant physical findings. The purpose of this study was to prospectively validate an algorithm defining indications for PXR in blunt trauma patients in the emergency department. Methods: We performed a prospective observational study of consecutive blunt trauma patients over six months at a single Level 1 trauma center.
Load more

Recommended publications
  • WHO Manual of Diagnostic Imaging Radiographic Anatomy and Interpretation of the Musculoskeletal System
    The WHO manual of diagnostic imaging Radiographic Anatomy and Interpretation of the Musculoskeletal System Editors Harald Ostensen M.D. Holger Pettersson M.D. Authors A. Mark Davies M.D. Holger Pettersson M.D. In collaboration with F. Arredondo M.D., M.R. El Meligi M.D., R. Guenther M.D., G.K. Ikundu M.D., L. Leong M.D., P. Palmer M.D., P. Scally M.D. Published by the World Health Organization in collaboration with the International Society of Radiology WHO Library Cataloguing-in-Publication Data Davies, A. Mark Radiography of the musculoskeletal system / authors : A. Mark Davies, Holger Pettersson; in collaboration with F. Arredondo . [et al.] WHO manuals of diagnostic imaging / editors : Harald Ostensen, Holger Pettersson; vol. 2 Published by the World Health Organization in collaboration with the International Society of Radiology 1.Musculoskeletal system – radiography 2.Musculoskeletal diseases – radiography 3.Musculoskeletal abnormalities – radiography 4.Manuals I.Pettersson, Holger II.Arredondo, F. III.Series editor: Ostensen, Harald ISBN 92 4 154555 0 (NLM Classification: WE 141) The World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and enquiries should be addressed to the Office of Publications, World Health Organization, CH-1211 Geneva 27, Switzerland, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © World Health Organization 2002 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved.
    [Show full text]
  • Rheumatology-TP 1..2
    Rheumatology 2015 The British Society for Rheumatology and British Health Professionals in Rheumatology Annual Meeting 2015 28 April – 30 April 2015 Manchester Central, Manchester, UK The abstracts are freely available online to all visitors to the Rheumatology website (http://www.rheumatology.oxfordjournals.org). RheumatologyDOI is incorrect10.1093/rheumatology/ker000ker000ContentsRheumatologyContents- Contents2012000000002012Volume 51 Supplement 3 May 2012 Volume 54 Supplement 1 April 2015 CONTENTS Rheumatology 2015 Abstracts INVITED SPEAKER ABSTRACTS (TUESDAY 28 APRIL 2015) I01–I03 Imaging in rheumatology: a practical perspective i1 I04–I06 Biologics in SLE: getting close to lift off (at last!) i1 I07–I09 Shared decision making and self-management support: why they matter in i1 rheumatology I10–I11 Challenges of remote and rural rheumatology i2 I12–I15 A step in the right direction: addressing foot health in rheumatoid arthritis i2 I16–I18 Musculoskeletal health and vocational rehabilitation i3 I19–I21 Making it happen: optimizing the service to RA patients i4 I22–I24 Community-based physical activity for osteoarthritis: the emerging role of i4 non-healthcare professionals I25–I26 Post-doctoral, PhD and postgraduate student network i5 I27–I32 Jewels in the Crown and top scoring abstracts (including Michael Mason and Garrod i5 prize winners and young investigator award) I33 Heberden Round i6 INVITED SPEAKER ABSTRACTS (WEDNESDAY 29 APRIL 2015) I34–I36 Pain in the 21st century: sensory–immune interactions, biologic agents and i8 bisphosphonates
    [Show full text]
  • Multiple Repetitive Fragility Fractures in Young Patients
    Rom J Leg Med [22] 217-220 [2014] DOI: 10.4323/rjlm.2014.217 © 2014 Romanian Society of Legal Medicine Multiple repetitive fragility fractures in young patients- differentiation between osteogenesis imperfecta, osteomalacia (secondary to vitamin D deficiency) and domestic abuse Cristina Capatina1,*, Mara Carsote1, Corneliu Capatina2, C. Poiana1, M. Berteanu3 _________________________________________________________________________________________ Abstract: Fragility fractures (i.e. fractures occuring in abnormal bones, caused by minimal or no trauma) during childhood are infrequent and secondary to rare metabolic or bone diseases. The presence of multiple fractures should also raise the suspicion of inflicted injury (abuse), which is much more frequent, thus it is extremely important to distinguish between genuine fragility fractures and traumatic fractures. We report the case of a 20 years old male with a history of multiple unexplained fractures of the long bones during the entire childhood and adolescence. In this patient a diagnosis of both osteogenesis imperfecta and severe vitamin D deficiency was made on the basis of the clinical picture, biological data and radiographic findings. We provide a brief overview of the most important elements to be sought for in the differential diagnosis between fractures caused by induced trauma and fragility fractures secondary to either osteogenesis imperfecta or defective bone mineralisation due to vitamin D deficiency. Key Words: fragility fractures, osteogenesis imperfecta, vitamin D deficiency, domestic abuse. athological (fragility) fractures (i.e. fractures fractures and bone loss [2]. Multiple fractures in children, occuring in abnormal bones, caused by minimal adolescents and young adults should therefore prompt a P or no trauma) are infrequent in young patients and they thorough investigation aiming at the detection of such rare are caused by the abnormal bone structure secondary to etiologies.
    [Show full text]
  • Surgical Treatment of Cervical Cord Compression in Rheumatoid Arthritis
    Ann Rheum Dis: first published as 10.1136/ard.44.12.809 on 1 December 1985. Downloaded from Annals of the Rheumatic Diseases, 1985, 44, 809-816 Surgical treatment of cervical cord compression in rheumatoid arthritis H A CROCKARD,' W K ESSIGMAN,2 J M STEVENS,' J L POZO,1 A 0 RANSFORD,1 B E KENDALL' From 'the National Hospitals for Nervous Diseases and University College Hospital, London WCJ; and the 2Lister Hospital, Stevenage, Herts SUMMARY Cervical myelopathy is a rare but potentially dangerous complication of rheumatoid arthritis and presents considerable therapeutic problems. A conservative approach carries high mortality and surgical intervention is not without serious risks. Reduction of subluxation and posterior fusion is widely practised but may require prolonged bed rest and continuous skull traction, sometimes for many weeks. When anterior decompression has been attempted prolonged immobilisation and external fixation have created problems. In this series 23 rheumatoid patients with cervical myelopathy were investigated over a four-year period. Seventeen underwent anterior decompression of the cervical cord, of whom 14 had a transoral removal of the odontoid peg and pannus and posterior occipitocervical fusion during the same by copyright. anaesthetic without mortality or serious postoperative complications; all but one have improved. The authors believe that early mobilisation after a combined cord decompression and internal fixation has reduced the mortality and morbidity. Management of cervical myelopathy in rheumatoid arthritis and indications for operation are discussed. Key words: atlantoaxial subluxation, rheumatoid pannus, cervical myelopathy, transoral surgery, surgery - rheumatoid arthritis. http://ard.bmj.com/ The involvement of the cervical spine in rheumatoid dangerous complication of trauma (1824) and arthritis has become recognised increasingly over syphilitic ulceration of the pharynx (1830) by Sir the last decade.
    [Show full text]
  • Anti-HMGB1 Monoclonal Antibody Ameliorates Immunosuppression
    Hindawi Publishing Corporation Mediators of Inflammation Volume 2015, Article ID 458626, 10 pages http://dx.doi.org/10.1155/2015/458626 Research Article Anti-HMGB1 Monoclonal Antibody Ameliorates Immunosuppression after Peripheral Tissue Trauma: Attenuated T-Lymphocyte Response and Increased Splenic CD11b+Gr-1+ Myeloid-Derived Suppressor Cells Require HMGB1 Xiangcai Ruan,1,2 Sophie S. Darwiche,2 Changchun Cai,2 Melanie J. Scott,2 Hans-Christoph Pape,3 and Timothy R. Billiar2 1 Department of Anesthesiology, First Municipal People’s Hospital of Guangzhou, Affiliated Hospital of Guangzhou Medical College, Guangzhou, China 2 Department of Surgery, University of Pittsburgh, University of Pittsburgh Medical Center, Suite F1281, 200 Lothrop Street, Pittsburgh, PA 15213, USA 3 Department of Orthopaedic and Trauma Surgery, Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany Correspondence should be addressed to Sophie S. Darwiche; [email protected] and Timothy R. Billiar; [email protected] Received 9 May 2014; Accepted 10 September 2014 Academic Editor: Philip Stahel Copyright © 2015 Xiangcai Ruan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Although tissue-derived high mobility group box 1 (HMGB1) is involved in many aspects of inflammation and tissue injury after trauma, its role in trauma-induced immune suppression remains elusive. Using an established mouse model of peripheral tissue trauma, which includes soft tissue and fracture components, we report here that treatment with anti-HMGB1 monoclonal antibody + + ameliorated the trauma-induced attenuated T-cell responses and accumulation of CD11b Gr-1 myeloid-derived suppressor cells in the spleens seen two days after injury.
    [Show full text]
  • Osteomalacia and Vitamin D Status: a Clinical Update 2020
    Henry Ford Health System Henry Ford Health System Scholarly Commons Endocrinology Articles Endocrinology and Metabolism 1-1-2021 Osteomalacia and Vitamin D Status: A Clinical Update 2020 Salvatore Minisola Luciano Colangelo Jessica Pepe Daniele Diacinti Cristiana Cipriani See next page for additional authors Follow this and additional works at: https://scholarlycommons.henryford.com/endocrinology_articles Authors Salvatore Minisola, Luciano Colangelo, Jessica Pepe, Daniele Diacinti, Cristiana Cipriani, and Sudhaker D. Rao SPECIAL ISSUE Osteomalacia and Vitamin D Status: A Clinical Update 2020 Salvatore Minisola,1 Luciano Colangelo,1 Jessica Pepe,1 Daniele Diacinti,1 Cristiana Cipriani,1 and Sudhaker D Rao2 1Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy 2Bone and Mineral Research Laboratory, Division of Endocrinology, Diabetes & Bore and Mineral Disorders, Henry Ford Hospital, Detroit, MI, USA ABSTRACT Historically, rickets and osteomalacia have been synonymous with vitamin D deficiency dating back to the 17th century. The term osteomalacia, which literally means soft bone, was traditionally applied to characteristic radiologically or histologically documented skeletal disease and not just to clinical or biochemical abnormalities. Osteomalacia results from impaired mineralization of bone that can manifest in several types, which differ from one another by the relationships of osteoid (ie, unmineralized bone matrix) thickness both with osteoid surface and mineral apposition rate. Osteomalacia related to vitamin D deficiency evolves in three stages. The initial stage is characterized by normal serum levels of calcium and phosphate and elevated alkaline phosphatase, PTH, and 1,25-dihydroxyvitamin D [1,25(OH)2D]—the latter a consequence of increased PTH. In the second stage, serum calcium and often phosphate levels usually decline, and both serum PTH and alkaline phosphatase values increase further.
    [Show full text]
  • 143 Osteomalacia Due to Vitamin D Deficiency: a Case Report
    Case Report / Olgu Sunumu 143 DOI: 10.4274/tod.galenos.2020.26056 Turk J Osteoporos 2020;26:143-5 Osteomalacia due to Vitamin D Deficiency: A Case Report D Vitamini Eksikliğine Bağlı Osteomalazi: Olgu Sunumu Banu Ordahan, Kaan Uslu, Hatice Uğurlu Necmettin Erbakan University Meram Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Konya, Turkey Abstract Osteomalacia is a metabolic bone disease characterized by demineralization of the newly formed osteoid in adults. Vitamin D deficiency due to insufficient vitamin D intake, inadequate exposure to sunlight, and malabsorption of vitamin D are the most widespread cause of osteomalacia. Here,we present the case of 18 year old female patient who presented to our hospital with complaints of low back pain. Sacral bone pseudofracture was detected by magnetic resonance imaging due to osteomalacia. Patient was treated with vitamin D. Keywords: Osteomalacia, vitamin D deficiency, pseudofracture Öz Osteomalazi, yetişkinlerde yeni oluşan osteoidin mineralleşmesinde azalma ile karakterize metabolik bir kemik hastalığıdır. Yetersiz D vitamini alımı, güneş ışığına yetersiz maruz kalma ve D vitamini malabsorpsiyonu nedeniyle D vitamini eksikliği, osteomalazinin en sık nedenidir. Bu yazıda, bel ağrısı şikayeti ile hastaneye başvuran 18 yaşında kadın hastayı sunduk. Osteomalazi nedeniyle manyetik rezonans görüntüleme ile sakral kemik psödofraktürü saptandı. Hasta D vitamini ile tedavi edildi. Anahtar kelimeler: Osteomalazi, D vitamini eksikliği, psödofraktür Introduction who was seen by the neurosurgery department because of low back pain, was diagnosed as having spondylolisthesis at Osteomalacia is a metabolic bone disease identify by a decrease the L5-S1 level and was given a lumbosacral steel corset. There in the mineralization of the newly formed osteoid in adults.
    [Show full text]
  • 761068Orig1s000
    CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 761068Orig1s000 MULTI-DISCIPLINE REVIEW Summary Review Office Director Cross Discipline Team Leader Review Clinical Review Non-Clinical Review Statistical Review Clinical Pharmacology Review MultiͲDisciplinary Review BLA 761068 (burosumab Ͳ twza) MULTIͲDISCIPLINARY REVIEW Application Type BLA Application Number(s) 761068 Priority or Standard Priority Submit Date(s) 8/17/2017 Received Date(s) 8/17/2017 PDUFA Goal Date 4/17/2018 Division/Office Division of Bone, Reproductive and Urologic Products/ Office of Drug Evaluation III Review Completion Date 4/5/2018 Established/Proper Name Burosumab (Proposed) Trade Name Crysvita Applicant Ultragenyx Pharmaceutical Inc. Dosage Form(s) 10, 20 and 30 mg/mL solution for injection in singleͲdose vial Applicant Proposed Dosing Pediatric: 0.8 mg/kg SC Q2 weeks (starting dose; titration to Regimen(s) max 2.0 mg/kg Q2weeks based on serum phosphorus; minimum dose 10 mg, maximum dose 90 mg) Adult: 1 mg/kg SC Q4 weeks, maximum dose 90 mg Applicant Proposed Treatment of XͲlinked hypophosphatemia (XLH) in adult and Indication(s)/Population(s) pediatric patients 1 year of age and older Recommendation on Approval for both adult and pediatric patients Regulatory Action Recommended Treatment of XͲlinked hypophosphatemia (XLH) in adult and Indication(s)/Population(s) pediatric patients 1 year of age and older (if applicable) 1 Reference ID: 4247337 MultiͲDisciplinary Review BLA 761068 (burosumab Ͳ twza) Table of Contents Reviewers of MultiͲDisciplinary Review
    [Show full text]
  • 37-Year-Old Female with Xlh Study*
    CASE 37-YEAR-OLD FEMALE WITH XLH STUDY* No known abnormalities XLH confirmed by CRYSVITA therapy reported genetic testing initiated BIRTH 2 YEARS 13 YEARS 35 YEARS 36 YEARS 37 YEARS XLH Joint stiffness Symptoms diagnosis in hips, knees, improved and ankles MEDICAL HISTORY X-RAY 1: FEET During childhood • Age 2: diagnosed with X-linked hypophosphatemia L L (XLH) as a toddler – Initiated oral phosphate and calcitriol and was compliant XLH diagnosis was confirmed by • Age 13: Enthesophyte genetic testing R Family history • Mother and maternal grandmother had XLH XLH symptoms and associated complications in adulthood • Chiari malformation requiring two corrective surgeries Enthesophyte • Chronic ankle pain and swelling in joints At 35 years old: prominent bilateral calcaneal enthesophytes; • Gait abnormalities severe bilateral tibiotalar osteoarthritis; slight bilateral bowing in • Sustained pelvic fracture during childbirth tibias and fibulas. • Age 33: discontinued oral phosphate and calcitriol Evaluation prior to CRYSVITA • Age 35: presented to adult endocrinology with – Hypertrophic bone formation occurring at the bowing of upper and lower extremities and joint hip articulation and trochanters; sclerosis at stiffness in hips, knees, and ankles the sacroiliac joints; slight bilateral bowing of • Physical exam femurs (X-ray 2, page 2) – Height, 5'2" – Bowing deformity at each femur and – Required the use of assistive walking device degenerative changes of the knees including (cane) for long distances and handicap tags bilateral articular
    [Show full text]
  • The Prevalence of Micronutrient Deficiencies and Inadequacies In
    nutrients Review The Prevalence of Micronutrient Deficiencies and Inadequacies in the Middle East and Approaches to Interventions Nahla Hwalla 1, Ayesha Salem Al Dhaheri 2, Hadia Radwan 3, Hanan Abdullah Alfawaz 4, Mona A. Fouda 5, Nasser Mohammed Al-Daghri 6, Sahar Zaghloul 7 and Jeffrey B. Blumberg 8,* 1 Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; [email protected] 2 Nutrition and Health Department, College of Food and Agriculture, United Arab Emirates University, Al Ain, UAE; [email protected] 3 College of Health Sciences, Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, UAE; [email protected] 4 Department of Food Science and Nutrition, College of Food Science and Agriculture, King Saud University, Riyadh, Saudi Arabia; [email protected] 5 Department of Medicine, Division of Endocrinology, College of medicine and KSUMC, King Saud University, Riyadh, Saudi Arabia; [email protected] 6 Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia; [email protected] 7 Department of Nutrition Requirements and Growth, National Nutrition Institute, Cairo, Egypt; [email protected] 8 Friedman School of Nutrition Science and Policy, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 20111, USA * Correspondence: [email protected]; Tel./Fax: +1-617-556-3334 Received: 29 December 2016; Accepted: 28 February 2017; Published: 3 March 2017 Abstract: Micronutrient deficiencies and inadequacies constitute a global health issue, particularly among countries in the Middle East. The objective of this review is to identify micronutrient deficits in the Middle East and to consider current and new approaches to address this problem.
    [Show full text]
  • Clinical Pediatric Endocrinology
    Clinical Pediatric Vol.29 / No.1 January 2020 Endocrinology pp 9–24 Special Report Clinical Practice Guidelines for Hypophosphatasia* Toshimi Michigami1, 9, Yasuhisa Ohata2, 9, Makoto Fujiwara2, 9, Hiroshi Mochizuki3, 9, Masanori Adachi4, 9, Taichi Kitaoka2, 9, Takuo Kubota2, 9, Hideaki Sawai5, 9, Noriyuki Namba6, 9, Kosei Hasegawa7, 9, Ikuma Fujiwara8, 9, and Keiichi Ozono2, 9 1 Department of Bone and Mineral Research, Research Institute, Osaka Women’s and Children’s Hospital, Osaka Prefectural Hospital Organization, Osaka, Japan 2 Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan 3 Division of Endocrinology and Metabolism, Saitama Children’s Medical Center, Saitama, Japan 4 Department of Endocrinology and Metabolism, Kanagawa Children’s Medical Center, Kanagawa, Japan 5 Department of Obstetrics and Gynecology, Hyogo College of Medicine, Hyogo, Japan 6 Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Tottori, Japan 7 Department of Pediatrics, Okayama University Hospital, Okayama, Japan 8 Department of Pediatrics, Sendai City Hospital, Miyagi, Japan 9 Task Force for Hypophosphatasia Guidelines Abstract. Hypophosphatasia (HPP) is a rare bone disease caused by inactivating mutations in the ALPL gene, which encodes tissue-nonspecific alkaline phosphatase (TNSALP). Patients with HPP have varied clinical manifestations and are classified based on the age of onset and severity. Recently, enzyme replacement therapy using bone-targeted recombinant alkaline phosphatase (ALP) has been developed, leading to improvement in the prognosis of patients with life-threatening HPP. Considering these recent advances, clinical practice guidelines have been generated to provide physicians with guides for standard medical care for HPP and to support their clinical decisions. A task force was convened for this purpose, and twenty-one clinical questions (CQs) were formulated, addressing the issues of clinical manifestations and diagnosis (7 CQs) and those of management and treatment (14 CQs).
    [Show full text]
  • 74Th Annual Meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery
    74th Annual Meeting of the American Association for the Surgery of Trauma and Clinical Congress of Acute Care Surgery September 9 — September 12, 2015 WYNN LAS VEGAS LAS VEGAS, NV HISTORICAL BACKGROUND AAST The American Association for the Surgery of Trauma started with conversations at the meetings of the Western Surgical Association and Southern Surgical Association in December, 1937. The 14 founders, who were present at one or both of these meetings, sub- sequently invited another 68 surgeons to a Founding Members meeting in San Francisco on June 14, 1938. The first meeting of the AAST was held in Hot Springs, Virginia, in May, 1939, and Dr. Kellogg Speed’s first Presidential Address was published in The American Journal of Surgery 47:261-264, 1940. Today, the Association holds an annual scientific meeting, owns and publish- es The Journal of Trauma and Acute Care Surgery, initiated in 1961, and has approximately 1,300 members from 30 countries. American Association for the Surgery of Trauma (AAST) Annual Meeting of AAST and Clinical Congress of Acute Care Surgery Learning Objectives and Outcomes Exchange knowledge pertaining to current research practices and training in the surgery of trauma. Design research studies to investigate new methods of preventing, correcting, and treating acute care surgery (trauma, surgical critical care and emergency surgery) injuries. CONTINUING MEDICAL EDUCATION CREDIT INFORMATION Accreditation This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Surgeons and the American Association for the Surgery of Trauma.
    [Show full text]