Bulletin of the NYU hospital for joint diseases
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Bull NYU Hosp Jt Dis · Jan 2012
Review"Incidental" bone lesions--when to refer to the tumor specialist.
Incidental bone tumors are, by definition, asymptomatic lesions that are discovered through routine radiographs obtained for other reasons. Generally, these lesions are benign and latent, requiring no further intervention except observation. However, occasionally these radiographs will detect benign aggressive processes or even malignant lesions that do require further treatment and referral to a tumor specialist. ⋯ It will then focus on the types of bone lesions that are often found incidentally by routine radiography. Specific recommendations, including recommendation for referrals to orthopaedic tumor specialists, will be noted for lesions described. Most malignant lesions will present with pain and a constellation of history and physical exam findings that will signal the patient to seek medical care; although they will be mentioned for the sake of comparison and completeness, they will not be the focus of this review.
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In a follow-up study, patients are monitored over time. Longitudinal and time-to-event studies are the two most important types of a follow-up study. In this paper, the focus is on longitudinal studies with a continuous response where patients are examined at several time points. ⋯ We will illustrate that there are interpretational and computational issues with the "classical" approaches. Further, we expand here on more appropriate statistical techniques to analyze longitudinal studies. To this end, we focus on randomized controlled trials (RCTs) and illustrate the approaches on data from a fictive randomized controlled trial in rheumatology.
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Bull NYU Hosp Jt Dis · Jan 2012
ReviewOutcomes of interlaminar and transforminal spinal injections.
Epidural spinal injections can be administered via a translaminar or transforaminal route, depending on the clinical scenario. When it is more desirable to target a specific nerve root, a transforaminal approach is typically used, and when the target is more diffuse, a translaminar method is chosen. Both are commonly used and can be utilized similarly in the lumbar or cervical spine. ⋯ In the lumbar spine, both translaminar epidural steroid injections (TLESI) and transforaminal epidural steroid injections (TFESI) have been shown to provide up to 6 months of pain relief, though long-term benefits are less reliable. In the cervical spine, translaminar injections may provide longer relief and have a lower complication rate than cervical transforaminal injections. Proper technique is essential to minimize the rate of these rare but occasionally severe complications.
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Bull NYU Hosp Jt Dis · Jan 2012
Multicenter StudyHospital for joint diseases participates in international spine registry Spine Tango after successful pilot study.
Spine Tango is currently the only international spine registry in existence. It was developed under the auspices of Eurospine, the Spine Society of Europe, and is hosted at the University of Bern, Switzerland. ⋯ Workflow integration and dedicated research staff are key factors for such an endeavor. Participation enables benchmarking against national and international peers and outcome research and quality assurance of surgical and non-surgical treatments.
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Bull NYU Hosp Jt Dis · Jan 2012
ReviewCorticosteroids as disease modifying drugs in rheumatoid arthritis treatment.
The current approach to treatment of RA includes early and aggressive treatment with routine monitoring of outcomes to give patients the best chance of decreasing disease activity as much as possible, with low disease activity and remission being a realistic goal for many patients. In this quest, DMARDs, especially MTX, are the anchor treatment, and low dose prednisone should also be considered in combination with MTX as the best initial choice for RA treatment. Current data suggest that corticosteroids are disease modifying agents that enhance the effects of DMARDs with no real impact on adverse events. We are much better positioned now then in earlier times to provide a good outcome for our patients, and every available tool needs to be considered and utilized for this purpose.