Chemotherapy-induced alopecia: A novel observation

no abstract avaibl

Evans, Richard J., Contrafactuales. ¿Y si todo hubiera sido diferente?, Madrid, Turner Noema, 2018 (ed. original: Altered pasts. Counterfactuals in history, London, Little, Brown, 2014), 192p. ISBN: 9788417141530. 18,90€

Background: Chemotherapy-induced alopecia (CIA) is one of the most dramatic side effects of chemotherapy. Currently no guidelines are available for its prevention and treatment. Several devices and drugs are used, but results are often disappointing. Aims: Our aim is to analyze drugs and devices proposed in the literature for prevention and treatment of CIA induced by cytotoxic drugs and to discuss the evidenced-based opinion. Methods and Results: Scalp cooling is the only agent that has been approved by the US Food and Drug Administration for CIA prevention. Minoxidil and bimatoprost should not be used during chemotherapy administration, but they can be used after chemotherapy discontinuation to obtain greater regrowth. Conclusions: Therapy should always be modulated for the patient and no fixed protocol should be used. Trichoscopy and trichogram could be useful tools in supporting this treatment

Risk of PCL avulsion during the tibial cut in cruciate retaining total knee arthroplasty and sagittal slope of tibial plateau

Fluoroscopic investigations have shown that femoral rollback is more often preserved in posterior stabilized (PS) than posterior cruciate-retaining (CR) implants. Possible explanations include degenerative changes of PCL and iatrogenic division of PCL fibres insertion during the tibial cut. In this study we evaluated the effects of a tibial cut with different degrees of posterior slope on the PCL insertion and whether a correlation does exist between the entity of PCL avulsion during the tibial cut and patients sagittal slope of tibial plateaus. MATHERIALS AND METHODS: We analyzed 83 MRI of the knee of patients with mild or moderate knee pain with no history of previous knee surgery or trauma. There were 42 males and 41 females, with a mean age of 49 years (range 45-52 years). The sagittal anatomical axis of the tibia was first identified on MR images and translated in the sagittal scan in which PCL fibers insertion in the tibia was best visualized. In the latter, tibial cuts with angles of different posterior slope ( 0,3°, 5° and parallel to the tibial plateaus) were simulated. The effects of each tibial cut on PCL fiber insertion was assessed. We also evaluated whether any correlation was present between the entity of PCL avulsion due to the tibial cut and the degree of posterior slope of tibial plateaus. RESULTS: A tibial cut of 0° caused a detachment of 63% of PCL fibers insertion; this figure raised to 70% and 75% when a 3° and 5° tibial cut was performed, respectively. The greatest percentage of PCL fibers avulsion (85%) was found with a tibial cut parallel to the sagittal slope of patient’s tibial plateaus. The percentage of PCL avulsion for each tibial cut was found to be significantly higher in patients showing a mild sagittal slope (8°) of tibial plateaus. DISCUSSION: In this study we analyzed the effects of different tibial cuts on PCL preservation. Our results demonstrated that any tibial resection angle we used for tibial cut caused a PCL avulsion greater than 50%. Patients with a marked sagittal slope of the tibial plateaus showed reduced PCL avulsion compared with those with mild sagittal slope. However, even in the former group, a PCL avulsion greater than 50% was observed. CONCLUSION: When performing a CR TKA, most of PCL fibers may be lost during the tibial cut. As a result, techniques to preserve PCL insertion should be planned to avoid that a CR TKA is implanted without a functioning PCL

Tibial Component Alignment May Improve By Setting The Extramedullary Instrumentation To The Proximal Tibia Only

BACKGROUND: A proper alignment of total knee arthroplasty (TKA) was found to influence knee biomechanics and long term survival of the implants. However, using standard instrumentation, varus-valgus malalignment of tibial component greater than 3° has been reported in 2% to 40% of cases. A major issue in achieving a correct coronal when extramedullary instrumentation are used for tibial cut, is tibial torsion, i.e., the axial rotation of the tibia along its longitudinal axis. As tibial torsion causes a rotational mismatch between proximal and distal ephiphysis, the anterior projection of mechanical axis at the distal tibia is externally rotated compared to the proximal one, whereby if the centre of intermalleolar axis is used ad distal reference for the extarmedullary road, a varus tibial cut is likely to occur. OBJECTIVE: In this study we investigated the accuracy of a new surgical technique in which the influence of tibial torsion on the alignment of the tibial component is bypassed by positioning the extramedullary guide in line with the proximal tibia only MATERIAL AND METHODS : Eighty-six patients (94 knees) with primary or secondary osteoarthritis of the knee who underwent underwent TKA were analysed. There were 49 women and 37 men with a mean age of 72 years (range 53-86 years). In the first 43 patients (47 knees) a standard procedure was used (group 1) while in the second 43 patients (47 knees) operated on in the following year, a modified surgical technique was performed (group 2). In particular, the extramedullary guide was set in line with the proximal alignment on the TT (medial 1/3), leaving the extramedullary rod locked in neutral alignment (varus-valgus= 0) in the malleolar clamp, without align it to any anatomical landamark. Limb and components alignment, including femoro-tibial alngke (FTA), femoro-tibial mechanical axis and femur and tibia component alignmnet was assessed on postoperative long-leg radiographs taken 3 months after surgery. A FTA between 2° to 8° of valgus and a component and FT mechanical axis alignment of 0± 3° of varus/valgus were considered within the normal range. RESULTS: A FTA within the normal range was found in 39 (83%) knees in gr 1 and in 41 (87%) of group 2 (p= 0.3). The mean FT mechanical axis was 3.4°± 1.9 in group 1 and 2.7 ± 1.8 in group 2 (p=0.07). Femoral component alignment averaged 2.1° ± 2.4 in group 1 and 1.7 ± 2.1 in group 2 (p=0.3) Tibial component alignment in the coronal plane averaged -2° ± 1.9 in group 1 and - 0.6° ± 1.8 in group 2 (p=0.0001). A varus malalignmnet of the tibial component (>3°) in the coronal plane was present in 16 and in 2 knees of group I and II, respectively (p=0.0008). CONCLUSIONS: The results of this study showed that, by setting the extramedullary road to the anterior projection of the mechanical axis at the proximal tibia and maintaining the same axial orientation of extramedullary road at the ankle joint, the effects of tibial torsion on the distal alignment of the extramedullary systems may be neutralized. This was found to improve the percentage of patients with neutral alignment and reduce significantly the rate of malalignment in varus of tibial component

Dermatologic Management of Oncotherapy Side Effects: A Proposed Algorithm

Since the introduction of the first chemotherapeutic regimens for the treatment of oncological disease, hundreds of drugs have been approved for cancer treatment and many more are under investigation. The development of newer drugs such as target therapies, immuno-oncotherapies and hormonal therapies have increased in specificity with the development of smaller molecules and more selective targets. Cutaneous side effects are now well known for both standard chemotherapy and targeted therapies. The correct diagnosis and management of these effects are of vital importance both to optimize therapeutic success rates and to reduce the patient's suffering. In fact, the appearance of a cutaneous adverse event can be responsible for a reduction in drug dosage, or worse its suspension. In order to achieve this objective, we propose a management algorithm, based on three different steps, before, during and after the oncological treatments, respectively. Our proposal underlines the importance of correct skin care measures to limit or reduce the severity of side effects