Effekt og sikkerhed af tocilizumab i kæmpe cellearteritis: en NHS-oplevelse med et enkelt middle ved brug af billeddannelse (ultralyd og PET-CT) som et diagnostisk og overvågningsværktøj
Tocilizumab (TCZ), an IL-6 receptor blocker, is permitted for relapsing, refractory big cell arteritis (GCA). We report real-life scientific expertise with TCZ in GCA together with evaluation of responses on imaging (ultrasound (US) and 18F-Fluorodeoxyglucose Positron Emission Tomography-computed Tomography (18FDG-PET-CT)) in the course of the first yr of remedy.
We included 22 consecutive sufferers with GCA handled with TCZ the place EULAR core information set on illness exercise, high quality of life (QoL) and treatment-related problems have been collected. Pre-TCZ US and 18FDG-PET/CT findings have been accessible for 21 and Four sufferers, respectively, the place we decided the impact on US halo thickness, temporal and axillary artery Southend Halo Rating and Complete Vascular Rating on 18FDG-PET-CT. The 22 sufferers with GCA (10 cranial, 10 giant vessel, 2 each) had a median illness length of 58.5 (vary, 1-370) weeks previous to initiation of TCZ.
Half had used prior typical artificial disease-modifying antirheumatic drug (csDMARDs). TCZ was initiated for refractory (50%), ischaemic (36%) or relapsing (14%) illness. Median follow-up was 43 (12-52) weeks. TCZ was discontinued as a result of severe hostile occasions (SAEs) in two sufferers. On remedy with TCZ, Four discontinued prednisolone, 11 required doses ≤2.5 mg, 2 required every day dose of two.5-5 mg and 5 wanted prednisolones ≥5 mg every day. QoL improved by 50%.
Complete US halo thickness decreased in 38 arterial segments, median temporal artery Halo Rating decreased from 11 to 0, axillary artery Halo Rating remained steady. Median Complete Vascular Rating on FDG-PET/CT diminished from 11.5 to six.5. In our expertise, TCZ confirmed a superb response with acceptable security in GCA, with enchancment on US and FDG-PET/CT imaging.
Elektromagnetisk navigationsbronkoskopi som et supplerende diagnostisk værktøj i den danske lungekræftdiagnostiske vej: en indledende retrospektiv single center-serie
Background: The efficiency of electromagnetic navigation bronchoscopy (ENB) is reported with substantial variation, which can query its scientific usefulness. Nonetheless, ENB might maintain its true worth when used as an extra minimal invasive diagnostic choice earlier than potential surgical procedure in chosen diagnostically difficult sufferers the place conventional diagnostic strategies have failed. We evaluated the protection and efficiency of ENB when used as an adjunct diagnostic device within the Danish lung most cancers diagnostic pathway (DLCDP) and its means to cut back surgical diagnostic procedures.
Strategies: A retrospective research was carried out on eighty-two consecutive sufferers at Odense College Hospital from June 2016 to March 2018 with diagnostically difficult pulmonary lesions referred for ENB as an adjunct diagnostic process below the DLCDP. Sufferers with benign or inconclusive ENB pathology have been both referred for additional biopsies, surgical procedure or repeated pc tomography (CT) scans for surveillance functions.
Outcomes: Eighty-one ENB procedures have been carried out in 80 sufferers. In 87.7% of the instances earlier diagnostic strategies had been unsuccessful. The imply goal diameter was 1.55 cm and the common follow-up length was 11 months.
The diagnostic accuracy was 75%, whereas the diagnostic yield/sensitivity, destructive predictive worth and destructive probability ratio was 51%, 67% and 0.49, respectively. No pneumothoraces and just one intrapulmonary haemorrhage was recorded, which was managed conservatively. The training curve revealed a rise in diagnostic accuracy from 67.5% to 82.9% when evaluating the primary 40 ENB procedures with the final 41 procedures, nevertheless, this was not statistically vital (p-value: 0.11).
Conclusions: ENB was discovered to be a protected process with an appropriate diagnostic accuracy and yield in extremely chosen diagnostically difficult sufferers. The introduction of ENB carried a notable studying curve however proved to be a useful adjunct diagnostic choice within the DLCDP, which can assist to cut back the variety of probably pointless or dangerous surgical procedures in frail sufferers.
Key phrases: Electromagnetic navigation bronchoscopy (ENB); diagnostic accuracy and yield
Virkningen af antibiotisk forbehandling på diagnostisk udbytte af CT-styret biopsi for spondylodiscitis: En multicenter retrospektiv undersøgelse og metaanalyse
Introduction: Sufferers with suspected spondylodiscitis typically bear CT-guided biopsy to determine a causative microbiological organism. Antibiotic pre-treatment has been postulated as a trigger for a destructive biopsy, though earlier scientific research have been heterogenous with a meta-analysis suggesting no impact. The intention of this research was to evaluate the influence of antibiotic pre-treatment on microbiological yield.
Strategies: Retrospective evaluation of consecutive grownup sufferers present process CT-guided biopsy for suspected spondylodiscitis in two tertiary centres between 2010 and 2016. Demographic, procedural and scientific information have been collected. Antibiotic pre-treatment was ascertained from affected person drug charts.
Outcomes: Over the 6-year interval, 104 biopsies in 104 sufferers have been included. 51% had a constructive microbiological yield at CT-guided biopsy, with the most typical remoted organism being Staphylococcus aureus (10.6%). Over two thirds of sufferers (69.3%) have been off antibiotics at time of biopsy.
There was no vital distinction in microbiological yield in these sufferers on versus off antibiotics (48.2% vs 54.2%, P = 0.55). 10.6% sufferers had a last prognosis of Mycobacterium tuberculosis spondylodiscitis, and this organism was considerably related to a constructive microbiological yield (90.9% vs 46.2%, P = 0.01). There was an inverse affiliation between the presence of fever and sepsis with constructive microbiological yield.
Conclusions: CT-guided biopsy in suspected spondylodiscitis obtains a constructive microbiological yield in about half of sufferers. This was considerably larger in sufferers recognized with tuberculosis spondylodiscitis, however there was no vital distinction with antibiotic pre-treatment. Subsequently, antibiotic pre-treatment mustn’t preclude clinicians from pursuing a microbiological pattern by CT-guided biopsy.
Håndtering af IKKE-DIAGNOSTISKE biopsier i muskuloskeletale tumorer i et specialcenter: Beslutning om algoritmen
Introduction: Core needle biopsy is an efficient methodology of acquiring tissue prognosis. Nonetheless, a diagnostic dilemma arises when lesional tissue is non-diagnostic which obviates contemplating radiological guided re-biopsy (RB) or an open surgical biopsy however the query raised is which serves as a greater diagnostic device.
Affected person and strategies: We retrospectively reviewed information from a prospectively collected database of 4516 core needle biopsies carried out in our specialist musculoskeletal tumour centre over a 6-year interval. Our intention was to judge the administration of non-diagnostic biopsies (NDB) and set up a protected and correct diagnostic technique within the presence of a NDB.
Outcomes: 2 hundred fifteen (4.8%) NDB instances with full follow-up have been recognized. Of those 157 (73%) have been handled definitively on the premise of imaging and 58 (27%) had a RB, 48 (83%) of which led to a constructive histological diagnosis. The remaining 10 have been once more non-diagnostic giving a complete of 167 sufferers being handled definitively with out a tissue prognosis. The sensitivity and specificity for multidisciplinary group (MDT) evaluation as a diagnostic device was 0.75 and 0.88 respectively whereas that for RB was 0.91 and 0.9.
Conclusion: Re-biopsy after first non-diagnostic core needle biopsy gives excessive sensitivity and specificity, particularly within the presence of malignancy. Within the absence of tissue prognosis, nevertheless, MDT evaluation can be extremely correct and a protected technique in managing this complicated group of sufferers.