Vascularized fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Longer term analysis is required to determine if this technique proves to be durable into adulthood. Cite this article: Bone Joint J 2018;100-B:535-41.
Atopic dermatitis (AD) is a common, chronic inflammatory skin disease characterized by pruritic, often lichenified, patches and plaques. Data were obtained from the Humana database, a large claims-based database encompassing more than 20 million patients under a commercial healthcare insurance plan. Our cohort included 39,526 subjects who saw a dermatologist for a primary ICD-9 diagnosis of atopic dermatitis (691.8) between the years of 2010-2015. Subjects were stratified according to gender, age, and race. Prescribed medication lists were obtained and sorted based on potential indication for atopic dermatitis. The most common medications prescribed for atopic dermatitis in descending order were topical corticosteroids (60.2% of patients), oral antibiotics (17.3% of patients), antifungals (6.7% of patients), antihistamines (6.5% of patients), oral corticosteroids (5.9% of patients), calcineurin inhibitors (2.3% of patients), and emollients (1.2% of patients). Oral corticosteroid prescriptions were lowest among males ages 0-19 (1.4% of patients), and females ages 0-19 (1.6% patients). Males ages 20-39 and 40-59 had the highest rates of oral steroids prescribed, at 9.2% and 9.8% of patients respectively. Females ages 0-19, and 20-39 had higher rates of topical corticosteroids prescribed, at 72.0% and 72.4% of patients respectively when compared to males ages 0-19 (56.7% of patients) and 20-39 (64.0% of patients). Antihistamines were prescribed most commonly in the age range of 0-19, at 9.0% for males, and 10.7% for females. Presumably, individuals who are prescribed multiple courses of oral corticosteroids over time have severe atopic dermatitis with recalcitrance to other options. Given the side effect profile of oral corticosteroids, steroid-sparing systemic agents may be a better long-term option in the absence of contraindications.
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