Showing papers by "Dirk R. Larson published in 2011"

Incidence of extramedullary disease in patients with multiple myeloma in the era of novel therapy, and the activity of pomalidomide on extramedullary myeloma

Abstract: We studied 174 consecutive patients with relapsed refractory multiple myeloma (MM) enrolled on a phase II clinical trial of pomalidomide plus low-dose dexamethasone at Mayo Clinic. Extramedullary disease (EMD) was present at the time of trial entry in 7.5% (13 of 174 patients). The rate of EMD in the first 3 years following diagnosis of MM was 3%. The response of EMD to pomalidomide plus low-dose dexamethasone included two complete and two partial responses among the 13 patients (response rate, 31%). Overall survival measured from trial entry was significantly shorter for patients with treatment-emergent EMD compared with those who did not have EMD, (median 16 months versus not reached, P=0.002).

Diagnosis of smoldering multiple myeloma.

Abstract: Smoldering myeloma is diagnosed in patients with bone-marrow plasmacytosis (>10%) in the absence of other stigmata of myeloma. However, in a small subset of these patients, the number of plasma cells exceeds 60%, with rapid progression to myeloma.

The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures

Abstract: Our aim was to determine the effect of the initial pattern of fracture and the displacement of fragments on the outcome of proximal humeral fractures treated conservatively. We followed 93 consecutive patients prospectively for one year. Final movement and strength were compared with those of the contralateral side. The final American Shoulder and Elbow Society score and the Disabilities of Arm, Shoulder and Hand and Short-Form 36 questionnaires were compared with those provided by the patient on the day of the injury. Radiographs and CT scans with three-dimensional reconstruction were obtained in all patients. The pattern of the fracture and the displacement of individual fragments were analysed and correlated with the final outcome. There were two cases of nonunion and six of avascular necrosis. The majority of the fractures (84 patients; 90%) followed one of the following four patterns: posteromedial (varus) impaction in 50 patients (54%), lateral (valgus) impaction in 13 (14%), isolated greater tuberosity in 15 (16%), and anteromedial impaction fracture in six (6%). Head orientation, impaction of the surgical neck and displacement of the tuberosity correlated strongly with the outcome. In fractures with posteromedial impaction, a poor outcome was noted as the articular surface displaced inferiorly increasing its distance from the acromion. A poorer outcome was noted as a fractured greater tuberosity displaced medially overlapping with the posterior articular surface. Lateral impaction fractures had a worse outcome than other patterns of fracture.

Quality of life after coloanal anastomosis and abdominoperineal resection for distal rectal cancers: sphincter preservation vs quality of life

Abstract: Aim A permanent colostomy is considered to have an adverse impact on quality of life (QOL). However, functional outcomes following sphincter preservation also affect QOL. Our aim was to determine differences in QOL of patients undergoing coloanal anastomosis (CAA) or abdominoperineal resection (APR) for distal rectal cancer. Method Eighty-five patients underwent CAA (72 with intestinal continuity and 13 with a stoma because of complications) and 83 patients underwent APR for a distal rectal cancer between 1995 and 2001 at a single institution and responded to our survey. QOL was evaluated using the EORTC QLQ-C30 and QLQ-CR38. Results Patients with CAA were younger than APR patients (mean age 57 vs 62 years, P < 0.001), but gender distribution, tumour stage and proportion of subjects receiving radiotherapy was not significantly different. Patients undergoing CAA had higher scores (better QOL) for physical functioning; lower scores (fewer symptoms) for fatigue, pain, financial difficulties, weight loss and chemotherapy side effects; and higher scores (more symptoms) for constipation and gastrointestinal symptoms compared with APR patients. CAA patients had higher scores (better QOL) for body image in men but not in women. Sexual functioning scores in men and women were lower (worse QOL) in CAA patients compared with APR patients. Conclusions QOL after APR is comparable to sphincter preservation, although there are some differences that need to be considered. QOL and functional results should be taken into account with the oncological outcome when devising management strategy for distal rectal cancer.

Impact of heart failure on hip fracture outcomes: a population-based study

Abstract: Background Hip fracture and heart failure are becoming more prevalent conditions in hospitalized patients. Despite differences in postoperative outcomes from other intermediate risk procedures, guidelines classify hip fracture repair as an intermediate risk operation.

Laparoskopische Operationen bei Rektumkarzinomen

Abstract: Verschiedene minimal-invasive Methoden sind zur Resektion von Rektumkarzinomen beschrieben worden. Jedoch sind die aktuellen Ergebnisdaten fur diese Ansatze von einzelnen Kliniken mit hohen Fallzahlen nach wie vor begrenzt. Unser Ziel war die Untersuchung von Ergebnissen bei Patienten, die sich in unserer Klinik aktuell einer minimal-invasiven Operation wegen eines Rektumkarzinoms unterzogen hatten. Eine retrospektive Analyse zur Evaluierung von Kurzzeitvorteilen und onkologischen Ergebnissen wurde bei Patienten durchgefuhrt, die zwischen 2004 und 2007 einen minimal-invasiven Eingriff wegen eines Rektumkarzinoms gehabt hatten. Insgesamt 100 konsekutive Patienten (61 Manner, medianes Alter 62) mit einem medianen Follow-up von 1,8 Jahren wurden ausgewahlt. Bei 67 wurde eine handassistierte laparoskopische Operation (HALS) und bei 33 eine laparoskopisch assistierte (LA) durchgefuhrt; 72 Patienten hatten eine anteriore, 27 eine abdominoperineale Resektion und ein Patient hatte eine totale Proktokolektomie. Die Tumorstadien waren Stadium 1 (21%), Stadium 2 (17%), Stadium 3 (56%) und Stadium 4 (6%). Im Median wurden 16 Lymphknoten entfernt, ein distaler Rand von 3,4 cm sowie ein in 99% negativer zirkumferenzieller Absetzungsrand erreicht. Das 3-Jahres-Uberleben, erkrankungsfrei und gesamt, betrug 86,2 bzw. 94,5%. Drei Falle erforderten eine Konversion. Der mediane Zeitraum bis zur Nahrungsaufnahme und erster Stuhlentleerung betrug 3 Tage und die mediane Dauer des Aufenthalts 5 Tage. Aufenthaltsdauer, Zeitraum bis zu flussiger Nahrung, Inzisionslange und Schmerzscores waren bei einem LA-Ansatz geringer verglichen mit HALS (p<0,01). Die Gesamtmorbiditat lag bei 26% ohne Mortalitat. Beide eingesetzten minimal-invasiven Methoden erzielten exzellente onkologische Ergebnisse bei Patienten mit Rektumkarzinomen. Der LA-Ansatz hatte geringfugig bessere Kurzzeitergebnisse.