Purpose Dupuytren contracture (DC) is a common benign fibroproliferative hand disorder, causing progressive flexion contractures of the finger joints. DC is a chronic condition with no definitive cure, and treatment is primarily surgical, although percutaneous options also exist. We assessed the safety of DC treatments by analyzing national compensation claims. Methods This retrospective registry study included all compensation claims related to the treatment of DC submitted to the Finnish Patient Insurance Center between 2010 and 2023. The number of filed and compensated claims, the types of treatment injuries claimed, and the proportion of avoidable injuries were analyzed. The national incidence of claimed treatment injuries was calculated using annual procedure volumes. Injury avoidability was assessed retrospectively by expert review. Results During the 14-year study period, 54 compensation claims were filed following treatment for DC, corresponding to an incidence of 4.0 claimed injuries per 1,000 operations. The most frequently reported injuries were nerve injuries, tendon injuries, infections, and recurrent contractures. Of the 54 claims, 20 resulted in compensation, most commonly for nerve injuries, tendon injuries, amputations, and infections. Based on the retrospective assessment, 29.6% of the cases were considered avoidable. Conclusions The number of claims and compensated treatment injuries was low in relation to the total number of procedures performed. Type of study/level of evidence Therapeutic IV.
In chronic pancreatitis (CP), a symptomatic benign biliary stricture (BBS) evolves as an adverse event in 3–30
Longitudinal, nationwide register study. To identify independent predictors of clinical outcomes at 12 months for patients undergoing primary anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease (DCSD). ACDF is an established surgical treatment for DCSD. Identifying factors that predict successful surgical outcomes can improve patient selection and inform decision-making. This study utilized data from the Finnish National Spine Register (FinSpine), covering all Finnish centers that perform ACDF surgery. Patients undergoing primary ACDF surgery for DCSD between June 2016 and February 2024 without prior cervical spine surgery were included (n=5517). Patients were grouped based on the patient symptom status (“improved” vs. “indifferent or worse”) at 12 months postsurgery. Predictive factors were identified using classification tree analysis followed by binary logistic regression. At 12 months, 76.8% (n=1799) of patients reported symptom improvement, while 23.2% (n=542) reported that symptoms were indifferent or worse. Loss to follow-up for the outcome variable was 57.6% at 12 months. The following factors were associated with better outcomes: shorter preoperative pain duration (≤1 yr, OR=1.95, P<0.001), lower preoperative Neck Disability Index (NDI) scores (≤42, OR=1.37, P=0.012), and nonsmoking (OR=1.37, P=0.030). The initial diagnosis also influenced outcomes: patients treated for herniated disks and nerve root stenosis were more likely to report improvement compared to those with central canal stenosis or myelopathy (P<0.001). Gender, age, BMI, working status, regular use of pain medication, perioperative complications, muscle weakness, levels fused, and use of plate versus stand-alone cage were not independently predictive of outcomes. Shorter preoperative pain duration, lower NDI scores, and nonsmoking status were significant predictors of good outcomes at 12 months after ACDF surgery for DCSD. These findings can help to guide preoperative patient counseling and enhance evidence-based decision-making for treating DCSD.
ABSTRACT:Immunodeficiency-associated primary central nervous system lymphoma (ID-PCNSL) represents a clinicopathologically distinct PCNSL subtype, for which large studies and prognostic models are lacking. To address this gap, the International PCNSL Collaborative Group conducted a retrospective multicenter study, integrating clinical, radiological, and pathological data from 308 ID-PCNSL cases, diagnosed at 23 participating sites in 7 countries. Preexisting immunodeficiency included administration of immunosuppressants for transplantation (41.2%) or autoimmunity (36.7%) and HIV infection (21.7%). All tumors were diffuse large B-cell lymphomas, with Epstein-Barr virus (EBV) detected in 79.2%. Immune reconstitution together with rituximab and methotrexate-based chemotherapy was associated with the highest response rates and prolonged progression-free survival, irrespective of immunodeficiency subtype and EBV status. Survival outcomes were highly variable, with a 54-month median overall survival. Multivariable Cox regression identified age (per year increment; hazard ratio [HR], 1.05 (95% confidence interval [CI], 1.02-1.07); P< .001), Karnofsky performance status (KPS) <70 (HR, 3.10; 95% CI, 1.67-5.87; P< .001), and EBV positivity (HR, 3.26; 95% CI, 1.47-7.33; P = .004) as prognostic factors for overall survival. A prognostic score was developed based on the sum of these adverse variables (age >60 years, KPS <70, EBV positivity). Stratification by this score yielded median survival times of 135, 29, and 3 months in patients with up to 1, 2, and 3 unfavorable markers (P< .0001). It allowed improved prognostic stratification of ID-PCNSL as compared with the Memorial Sloan Kettering Cancer Center and International Extranodal Lymphoma Study Group models developed for immunocompetent PCNSL. Collectively, this large international cohort defines clinicobiological features of ID-PCNSL and introduces a prognostic system with potential to guide future management.
Patients with hematological malignancies are a heterogeneous group with special palliative care needs. They are known to have many symptoms and frequent emergency room visits and hospitalizations in the end-of-life phase. However, there are limited data about the symptom burden and health care service utilization in different diagnostic groups of hematological malignancies. The purpose of this study was to define the symptom burden and characteristics of the palliative care phase in patients with hematological malignancies in different diagnostic groups. This retrospective study comprised 195 patients with hematological malignancies who were treated in the Kuopio University Hospital palliative care unit and died between 1.1.2015 and 31.12.2023. Patients were divided into four patient groups: myeloma, lymphoma, leukemia and myelodysplastic syndrome or myeloproliferative neoplasm (MDS/MPN). All patient groups had a considerable symptom burden, with many emergency room visits and hospital admissions near death. Furthermore, palliative care involvement occurred late. Fatigue, pain, and dyspnea were the most common symptoms in myeloma and lymphoma patients; fatigue, pain and loss of appetite in leukemia patients and fatigue, dyspnea and depression or anxiety in MDS/MPN patients in palliative care. Patients with hematological malignancies have a significant symptom burden and remarkable palliative care needs at the end of life. More research and awareness of the benefits of palliative care are needed.
