MedStar Union Memorial Hospital is a non-profit, acute care teaching hospital located in the North Central section of Baltimore, Maryland. The hospital is a member of MedStar Health, a community-based network of Baltimore/Washington, D.C. area hospitals and other health care services.In 2014, the magazine U.S. News & World Report ranked the hospital 10th in Maryland, and 9th in the Baltimore metropolitan area. For cardiology, cardiac surgery, and orthopedic surgery, it is ranked[by whom?] among the top 50 hospitals in the U.S..[citation needed]Jazz leader Chick Webb worked in the hospital as a youngster, and Mickey Mantle received treatment at the hospital. In 1939, the gangster Al Capone spent time at the hospital to cure his paresis caused by syphilis, after his release from Alcatraz, after which he donated two cherry trees to the hospital. One tree was later cut down to allow the construction of a new wing of the hospital..
Vascularized medial femoral condyle (MFC) flap transfer is a technique that may be used to reconstruct recalcitrant distal radius nonunion. Although union rates are high, the flap provides thin cortical bone requiring rigid fixation. The long-term strengthening and structural integrity of the MFC flap bone remains understudied. We describe two cases of delayed structural failure following distal radius MFC reconstruction. Two patients underwent distal radius reconstruction using vascularized corticocancellous MFC flaps stabilized with spanning fixed-angle volar plates. Both achieved radiographic union. Clinical records and radiographs were retrospectively reviewed following low-energy injuries. Late failure occurred 7 and 9 years after flap incorporation, involving deformity through the MFC bone segment. The spanning plates bent without evidence of screw loosening or hardware failure. These cases highlight a rare pattern of delayed structural failure following MFC reconstruction. Radiographic union alone may not predict long-term structural durability. Rigid fixed-angle fixation may influence load distribution and adaptive remodeling.
Background Patients with relapsed or refractory (R/R) follicular lymphoma (FL) after two or more prior lines of therapy can now be treated with mechanistically distinct modalities, including CD19-directed chimeric antigen receptor (CAR) T-cell therapy, CD20×CD3 bispecific antibodies, and a Bruton tyrosine kinase inhibitor plus anti-CD20 combination. Head-to-head data are lacking, and sequencing decisions are made with limited comparative evidence. We benchmarked durability outcomes across pivotal trials using reconstructed individual patient data (rIPD) derived from published Kaplan-Meier (KM) curves. Methods KM curves and numbers-at-risk tables from pivotal prospective studies in ≥2-line R/R FL were digitized and rIPD-reconstructed using a validated algorithm: axicabtagene ciloleucel (ZUMA-5), tisagenlecleucel (ELARA), lisocabtagene maraleucel (TRANSCEND FL), mosunetuzumab, epcoritamab (EPCORE NHL-1), and zanubrutinib plus obinutuzumab versus obinutuzumab (ROSEWOOD). Prespecified durability endpoints were landmark progression-free survival (PFS) at 12 and 24 months and restricted mean survival time to 24 months (RMST24). Overall survival (OS) landmarks were summarized where follow-up permitted. ROSEWOOD served as an internal validity check using a Cox model fit to reconstructed data. Results At 24 months, landmark PFS was 65.4% (95% confidence interval (CI) 52.0-82.4) for liso-cel, 62.0% (50.2-76.6) for axi-cel, 53.8% (45.2-63.9) for zanubrutinib plus obinutuzumab, 49.3% (39.3-61.7) for mosunetuzumab, 43.7% (31.3-61.1) for epcoritamab, and 24.7% (14.9-40.9) for obinutuzumab monotherapy. Twelve-month PFS ranged from 81.8% (74.5-89.8) with liso-cel and 77.9% (69.4-87.5) with axi-cel to 61.6% (53.6-70.8), 60.4% (50.8-72.0), and 59.1% (50.5-69.1) for zanubrutinib plus obinutuzumab, mosunetuzumab, and epcoritamab, respectively; tisagenlecleucel showed 12-month PFS of 68.3% (57.2-81.6) with shorter follow-up (maximum 18.2 months). PFS RMST24 estimates were 19.5 months for liso-cel, 18.6 for axi-cel, 16.5 for zanubrutinib plus obinutuzumab, 16.2 for mosunetuzumab, 14.8 for epcoritamab, and 11.9 for obinutuzumab. OS at 24 months was high across regimens (mosunetuzumab 87.3%, liso-cel 84.6%, axi-cel 82.8%, zanubrutinib plus obinutuzumab 77.3%, and epcoritamab 67.6%). In ROSEWOOD, reconstructed data reproduced the published PFS benefit for zanubrutinib plus obinutuzumab (hazard ratio (HR) 0.48, 95% CI 0.32-0.71; p < 0.001) with a weaker OS signal (HR 0.61, 0.35-1.07; p = 0.08). Conclusions In this rIPD-based durability benchmark for ≥2-line R/R FL, the estimated landmark PFS and RMST24 values varied across regimens, with numerically higher point estimates for the CAR T-cell therapies and the zanubrutinib plus obinutuzumab combination and numerically lower estimates for the bispecific antibodies and the obinutuzumab control; CIs overlapped substantially, and 24-month OS estimates were broadly similar across regimens. Because the source trials enrolled materially different populations, these side-by-side estimates are descriptive benchmarks and should not be read as head-to-head comparisons of efficacy. Faithful internal reproduction of the randomized ROSEWOOD effect supports reconstruction fidelity. The analysis provides a transparent, durability-focused reference framework to support sequencing discussions and hypothesis generation, not comparative effectiveness conclusions.
In many nerve injuries, tissue destruction, scar, and other factors prohibit surgical reapproximation of the nerve ends without excessive tension. The resultant nerve gap has traditionally been bridged using autologous sensory nerve; however, the harvest of autologous nerve graft adds time and donor site morbidity. Over the past decades, a variety of commercially available hollow conduits designed for nerve gap reconstruction have been used. More recently, commercially available processed human nerve allograft has been introduced with the promise of reconstruction whose success rivals the results of nerve autograft. In the case of digital nerve reconstructions, a number of studies indicate that for small nerve gaps (<15 mm) the recovery of sensation is the same for nerves repaired with nerve autograft, hollow nerve conduit, or processed nerve allograft. Although processed nerve allograft appears to outperform hollow conduits for slightly larger nerve gaps, it is unclear how it compares to nerve autograft across a variety of different nerve injuries. Overall, the results of nerve reconstruction are often disappointing, regardless of whether by direct repair or by spanning an intervening nerve gap. Further work on the biology of nerve regeneration is needed, not only to improve existing nerve conduits, but to improve the results of all nerve repairs and reconstructions.
Purpose Our purpose was to determine whether the quantity of initial opioid prescriptions combined with routinely collected clinical factors and patient-reported data (PRD) can be used to predict prolonged opioid use after hand surgery and to generate a presurgical prediction model that can be tested for use every day. Methods We performed a retrospective analysis of 12,117 adults who underwent hand surgery at a single, large academic hand center from 2018 to 2022. Opioid prescription data were obtained from electronic medical records, and patients were categorized into high/low initial opioid prescription groups based on quantile regression-adjusted total morphine milligram equivalents (MMEs). Multivariable logistic regression was performed to predict postoperative opioid use at 3 months, incorporating demographic, clinical, and PRD variables, including high versus low initial prescription status from the quantile model. Stepwise logistic regression across 15 imputed data sets generated pooled odds ratios and 95% confidence intervals. Model performance was assessed using receiver operating characteristic and precision–recall curves. Results Patients receiving adjusted high initial opioid doses had significantly greater odds of continued opioid use 3 months after surgery. Additional predictors included higher Charlson Comorbidity Index, greater preoperative pain, lower preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health scores, opioid/marijuana/medication history, postoperative antibiotic use, minority racial background, and Medicare/Medicaid insurance. Predictive model performance was moderate, with a 3-month precision-recall curve area under the curve of 0.135 in the training set and 0.157 in the test set. Conclusions Combining adjusted postoperative prescription amount and PRD with routinely captured electronic health record variables yields a predictive algorithm that accurately flags hand surgery patients at risk for prolonged postoperative use. If prospectively validated, embedding this tool into clinical workflows may enable targeted counseling, opioid prescribing guidance, proactive multimodal analgesia, and overall safer, data-driven opioid stewardship. Type of study/level of evidence Prognostic IIb.
Rotator cuff repair (RCR) failure and retear remain a persistent problem and concern in shoulder surgery. Successful healing is paramount for long-term functional results. Failure of rotator cuff healing can be broadly separated into biologic and structural complications. Biologic issues include poor host variables such as healing ability and blood flow. Structural problems include tendon thinning and loss as well as poor time-zero fixation. Recently, commercial grafts or "patches" designed for rotator cuff augmentation have increased dramatically. Various grafts aim to enhance biology, provide structure, or both. In addition, grafts are designed to be placed either on-lay, over an RCR, or interpositional, at the bone-tendon interface. Graft may be allograft, xenograft, or fully synthetic. This article discusses the current RCR augmentation graft types and representative products currently available.
