Congenital absence of the pedicles and the neural arch of L2

Congenital pedicle abnormalities are rare. Unilateral aplastic and hypoplastic lumbar pedicles have been reported, but these were usually discovered incidentally and did not need surgical treatment. We present a case of absence of both pedicles and the neural arch of L2, with associated kyphoscoliosis with neurological involvement, that needed a two-stage corrective surgery. An L1-L4 fusion was achieved with relief of the symptom

Union after multiple anterior cervical fusion 21 cases followed for 1-6 years

With a mean follow-up of 3 (1-6) years, we report on 21 patients who underwent multiple level cervical fusion, using autologous iliac crest grafts. Dissectomies were performed in 14 patients and corpectomies in another 7. Instrumentation was used in all patients with corpectomies and in 2 patients who underwent 2-level and 3-level dissectomies. Non-union occurred in 1 patient at 1 level. Graft displacement requiring reoperation was observed in 2 patients with massive corpectomies, in 1 of them as a consequence of trauma. In both patients complete bony fusion was obtained after reoperation and no other complications were observed. We conclude that the success rate with multiple-level fusion is comparable to that of single-level fusion when adequate fixation is achieve

Eosinophilic Granuloma of the Spine With and Without Vertebra Plana: Long-term Follow-up of Six Cases (Cast Reports)

Vertebral eosinophilic granuloma is a rare condition frequently associated with vertebra plana. In this paper we present six patients with eosinophilic granuloma of the spine; three were without vertebra plana, which represents a diagnostic problem. The mean follow-up was 9 years, (range 2 to 23) and the mean age was 10.8 years at diagnosis. All complained of pain with no neurological deficit. The lesions were located on the vertebral bodies of C4, T9, T10, L1, L2, and L5, respectively. Histologic confirmation of diagnosis was obtained in all patients, two by puncture and four by open biopsy. The patients with vertebra plana (T10, L1, and L5, respectively) were treated conservatively. Long-term follow-up demonstrated total healing of the vertebral body in two and partial rebuilding 8 years after diagnosis in one. Patients without vertebra plana (C4, T9, and L2, respectively) underwent curettage and bone grafting. In the patient with T9 location, a T8-10 anterior arthrodesis with autogenous rib graft was performed. The outcome was satisfactory in all

Lumbosacral arthrodesis using pedicular screws and ringed rods

Sixty-one patients who had lumbar instability and chronic low back pain or deformity from nontraumatic lumbar pathologies were studied. In all of them a posterior lumbosacral fusion with CUN (Clinic of the University of Navarre) pedicle rod fixation was used. The mean follow-up period was 36 months (range 26-46 months). The consolidation rate was evaluated according to plain and functional radiographs, and a clinical evaluation was made using an analogue pain scale. The rate of fusion was 93.5%. Neurological complications occurred in 3.3%. The incidence of screw failure was 2.3% of all the screws. No other implant failure occurred. The patients rated their clinical results as 'excellent' in 33.8% of the cases, 'good' in 42.2%, 'fair' in 16.9% and 'poor' in 6.7%. CUN instrumentation is a versatile internal fixation system that has been shown to provide satisfactory stability. Furthermore, the clinical results are comparable to those reported in studies in which the most common hardwares were used

Training Experiences by Skills for HPC Ecosystems

peer reviewe

Safety of trastuzumab emtansine (T-DM1) in patients with HER2-positive advanced breast cancer: Primary results from the KAMILLA study cohort 1

Abstract Background Many patients with metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) are candidates for trastuzumab emtansine (T-DM1) treatment sometime in their disease history. KAMILLA evaluated safety of T-DM1 in patients with previously treated HER2-positive locally advanced or metastatic BC (advanced BC). Methods KAMILLA (NCT01702571) is a single-arm, open-label, international, phase IIIb safety study of patients with HER2-positive advanced BC with progression after prior treatment with chemotherapy and a HER2-directed agent for MBC or within 6 months of completing adjuvant therapy. Patients received T-DM1 (3.6 mg/kg every 3 weeks) until unacceptable toxicity, withdrawal or disease progression. Results Among 2002 treated patients, median age was 55 years (range, 26–88; 373 [18.6%] aged ≥65 years), 1321 (66.0%) received ≥2 prior metastatic treatment lines and 398 (19.9%) had baseline central nervous system metastases. Adverse events (AEs) and serious AEs occurred in 1862 (93.0%) and 427 (21.3%) patients, respectively. Grade ≥3 AEs occurred in 751 (37.5%) patients; the three most common (individual Medical Dictionary for Regulatory Activity terms) were anaemia (3.0%), thrombocytopaenia (2.7%) and fatigue (2.5%). Median progression-free survival (PFS) was 6.9 months (95% confidence interval [CI], 6.0–7.6). Median overall survival (OS) was 27.2 months (95% CI, 25.5–28.7). With increasing lines of prior advanced therapy (0–1 versus 4+), median PFS and OS decreased numerically from 8.3 to 5.6 months and from 31.3 to 22.5 months, respectively. Conclusions KAMILLA is the largest cohort of T-DM1–treated patients studied to date. Results are consistent with prior randomised studies, thereby supporting T-DM1 as safe, tolerable and efficacious treatment for patients with previously treated HER2-positive advanced BC

Transparent nanometric organic luminescent films as UV-active components in photonic structures

A new kind of visible-blind organic thin-film material, consisting of a polymeric matrix with a high concentration of embedded 3-hydroxyflavone (3HF) dye molecules, that absorbs UV light and emits green light is presented. The thin films can be grown on sensitive substrates, including flexible polymers and paper. Their suitability as photonic active components photonic devices is demonstrated. © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim

Histiocitosis X

Presentamos una revisión bibliográfica y de nuestra experiencia clínica en el diagnóstico y tratamiento de la Histiocitosis X, término que engloba el granuloma eosinófilo, el síndrome de Hand-Schüller-Christian y el síndrome de Letterer-Siwe. Tuvimos un total de 28 casos, con un promedio de edad de 11.8 años y una distribución por sexo de 18 (64%) hombres y 10 (36%) mujeres. De los casos estudiados, 17 lesiones fueron solitarias y 8 pacientes tuvieron lesiones óseas múltiples. Tres pacientes padecieron formas diseminadas de la enfermedad. De éstos, dos eran síndrome de Hand-Schüller-Christian y uno de Letterer-Siwe. La localización más frecuente fue el fémur en los pacientes con localización ósea solitaria y el cráneo en los de localización ósea múltiple. El número total de lesiones fue de 47. El tratamiento aplicado dependió del tipo de localización, la forma clínica y el número de lesiones. Los pacientes con localización ósea solitaria (17) fueron tratados con legrado e injerto en 6 casos, resección segmentaria en 3, legrado en otros 3, radioterapia en 1 y 4 pacientes no recibieron tratamiento. Los pacientes con lesiones óseas múltiples (8) fueron tratados con cirugía en 4 ocasiones, radioterapia en 2, cirugía y radioterapia en 1 y, finalmente, un paciente no recibió tratamiento. Las formas diseminadas fueron tratadas con cirugía de la lesión principal dependiendo de las manifestaciones clínicas, así como quimioterapia y radioterapia. El pronóstico de casi todos los casos estudiados fue bueno, observándose regresión de la enfermedad incluso sin tratamiento específico. El caso de enfermedad diseminada aguda tipo Letterer-Siwe falleció por las complicaciones generales propias de la enfermedad

Associaçao da Videolaporoscopia e Quimioterapia Neoadjuvante no Tratamento do Carcinoma de Ovário. Uma Proposta Terapêutica: Relato de um Caso

O presente artigo constitui-se do relato de caso de uma paciente portadora de carcinoma de ovário estádio III (FIGO), que foi submetida à videolaparoscopia como primeira etapa do tratamento. Em virtude da dificuldade da realização de uma citorredução adequada, optou-se por quimioterapia neoadjuvante, seguida pela cirurgia citorredutora. Os autores apresentam os resultados obtidos, bem como a revisão bibliográfica sobre o assunto