Background In selected patients with a desire to maintain activity levels greater than those recommended after reverse total shoulder arthroplasty, hemiarthroplasty remains an option for treatment of cuff tear arthropathy (CTA). However, given the relatively small case series that have been reported to date, little is known regarding which patients will show functional improvement after this surgery.Questions/purposes We asked: What factors are associated with achieving the minimum clinically important difference in the simple shoulder test (SST) after hemiarthroplasty for cuff tear arthropathy? Patients and Methods Between 1991 and 2007, two surgeons at one academic center performed 48 shoulder hemiarthroplasties for CTA. No patients were known to have died before data collection, and of those not known to have died, 42 (88%) were available for followup at a mean of 48 months (range, 24-132 months). During that time, the general indications for this approach were glenohumeral arthritis with superior decentering of the humeral head. The majority of the patients with CTA were treated nonoperatively with patient-directed physical therapy and other modalities. A total of 42 patients (42 shoulders; 24 males and 18 females) with CTA were treated with hemiarthroplasty and followed for a mean of 48 months (range, 24-132 months). This is a retrospective study that made use of a longitudinally maintained database, which included physical examination of ROM, the SST, VAS, and standardized radiographs. At latest followup, 33 of 42 patients achieved a clinically important percentage of maximum possible improvement (%MPI) in SST score, One of the authors certifies that he (KB), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from DepuySynthes (Warsaw, IN, USA). One of the authors certifies that he (CAR), has or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001 from Depuy-Synthes (Warsaw, IN, USA). One of the authors certifies that he (MAW), has or may receive payments or benefits, during the study period, an amount of USD 100,001-1,000,000 from Depuy-Synthes (Warsaw, IN, USA) and less than USD 10,000 from Tornier (Lyon, France), Saunders (Philadelphia, PA, USA) and Arthrex (Naples, FL, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained....
In a randomized study 30 patients with chronic stationary psoriasis were treated with 3 different topical schemes. Group 1 (n = 10) received monotherapy (dithranol (D) twice a day, D/D), group 2 (n = 10) calcipotriol mornings/dithranol evenings (calcipotriol (C)/dithranol (D) C/D) and 3 (mometasone (M) mornings/dithranol (D) evenings, M/D). During the therapy period of 4 weeks we documented the PASI-Score as well as infiltration, erythema and desquamation weekly. The M/D group revealed in the first week a significantly faster reduction of the PASI-score (5.3) than in the D/D group (PASI 13.22). The C/D group (PASI 10.5) show a not significantly faster reduction. After 4 weeks of treatment and after a follow period of 6 weeks there were similar PASI-Scores in all groups. There were less side-effects in the M/D group than in the others. The beginning, more anti-psoriatic effectiveness was achieved by the mometasone/dithranol combination than the other schemes. In the long term, the effects were similar.
We examined whether it is possible to increase the antipsoriatic action by combining dithranol with a retinoid (tazarotene). In a randomized, open, prospective study with 50 psoriatic patients (22 females, 28 males, PASI>10) the antipsoriatic effectiveness of dithranol monotherapy to was compared combined therapy with dithranol and retinoid. The combination dithranol/retinoid (collective 2, reduction of the PASI from 17,2 to 2,8) revealed a significantly faster healing than the dithranol monotherapy (collective 1, reduction of the PASI from 18,5 to 4,8). The irritation of the combination therapy as evaluated with clinical score and laser doppler imaging was increased. Anti-psoriatic effectiveness of dithranol can be increased by combining it with tazarotene.
Kollektive CDT (PASI: 18,8 ± 1,9) und MDT (PASI: 18,9 ± 2,0) zeigten einen signifikant schnelleren Rückgang des PASI als das UDTKollektiv (PASI: 18,1 ± 3,1). Lokale Irritationen waren in den Kollektiven CDT und MDT deutlich geringer als in dem Kollektiv UDT. Dithranol-Hyperpigmentierungen fehlten bei allen Gruppen! Im Vergleich zu einem historischen Kollektiv (1995; n = 30; klassische Dithranol-Monotherapie) verkürzte sich die Therapiedauer von 28,5 auf rund 19,5 Tage in den Kombinationsgruppen (MDT; CDT). Damit entsteht ein deutliches Kosteneinsparpotential.
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