High-pressure injection injuries to the hand: A 14-year descriptive study.

BACKGROUND: High-pressure injection (HPI) injury is an unusual type of injury in hand trauma, which could lead to a serious morbidity. We aimed to assess the clinical presentation, management, and outcome with HPI injury of the hand. METHODS: A retrospective study was conducted between 2001 and 2015 for patients with HPI injuries who were admitted to a Level 1 trauma center. We reviewed the medical records, imaging files, and demographic data including gender, age, mechanism of injury, and site of hand injury. The kind of injected materials, time to first treatment procedure, clinical management, and complications were also described. RESULTS: A total of 32 cases of HPI injuries were included in the study. The average age of the patients was 32.7 ± standard deviation 8.3 years, and all the patients were right handed. The most common material involved was grease (53%), followed by paints (25.0%), chemicals (9.4%), and air (6.3%). The most commonly affected part of the hand was the palm (31.3%), followed by index finger (25.0%). The average delay in the presentation was 12 h (range 3-96 h), and the mean hospital stay was 5.8 days. Management included debridement (90.6%) or conservative treatment (9.4%). Complications included chronic pain (9.4%), followed by amputation (3.1%). CONCLUSIONS: HPI injury is not uncommon, usually underestimated, and needs more community awareness, particularly laborers. Delay of treatment could increase the risk of amputation. Therefore, it is important to inform the risk groups about the seriousness of such injuries and to take preventive measures.

Intravascular extra-digital glomus tumor of the forearm.

Intravascular glomus tumor in the forearm is very rare and usually presents with persistent pain and focal tenderness. The diagnosis of this condition can be easily missed or delayed. There is no successful treatment so far other than surgical excision in most of cases. We presented a 45-year-old female presented with intravascular glomus tumor in her left forearm. The swelling was excised and the post-operative course was uneventful. Intravascular glomus tumor of the forearm is extremely rare and the persistent pain and tenderness are very suspicious. Diagnostic imaging may not be indicated in every case.

Evolution of the Karnosky Performance Status throughout life in glioblastoma patients.

Functional independence in glioblastoma (GBM) patients is a key factor in measuring the quality of life. Progression free survival (PFS) and overall survival (OS) have been largely described. However, the evolution over time of the performance status during the patients' life remains understudied. We thus studied the time to loss of functional independence as assessed by a Karnosky Performance Status (KPS) below 70 % in GBM patients. We analysed all GBM patients treated in our institution between 2008 and 2013 and meeting the following criteria: age >18 years, supratentorial location, post-surgical KPS ≥ 70 %, initially treated with concomitant radiotherapy (RT) and Temozolomide. Within the 84 patients studied, the median PFS was 9 months and the median OS was 18.7 months. The median survival time with functional independence (KPS ≥ 70 %) was 14.5 months. On average, the patients spent 73 % of their lifespan with a KPS ≥ 70 %. Surgical resection and low steroid dosage were statistically associated with increased survival time with KPS ≥ 70 % (p = 0.015 and p = 0.03, respectively). Sixty-two (62) patients received one or several lines of chemotherapy at recurrence. Under treatment with Bevacizumab (42 Bev-based regimens), radiological responses were seen in 35 % and improvement in KPS occurred in 24 % whereas no response and rare improvement of KPS (3 %) were seen with other type of chemotherapy (97 non Bev-based regimens). In GBM patients, median survival with KPS ≥ 70 % largely exceeds PFS. Surgical resection and low steroids dosage at RT-onset appeared as good prognosis factors for survival with functional independence.

Impact of evergreening on patients and health insurance: a meta analysis and reimbursement cost analysis of citalopram/escitalopram antidepressants.

BACKGROUND: "Evergreening" refers to the numerous strategies whereby owners of pharmaceutical products use patent laws and minor drug modifications to extend their monopoly privileges on the drug. We aimed to evaluate the impact of evergreening through the case study of the antidepressant citalopram and its chiral switch form escitalopram by evaluating treatment efficacy and acceptability for patients, as well as health insurance costs for society. METHODS: To assess efficacy and acceptability, we performed meta-analyses for efficacy and acceptability. We compared direct evidence (meta-analysis of results of head-to-head trials) and indirect evidence (adjusted indirect comparison of results of placebo-controlled trials). To assess health insurance costs, we analyzed individual reimbursement data from a representative sample of the French National Health Insurance Inter-regime Information System (SNIIR-AM) from 2003 to 2010, which allowed for projecting these results to the whole SNIIR-AM population (53 million people). RESULTS: In the meta-analysis of seven head-to-head trials (2,174 patients), efficacy was significantly better for escitalopram than citalopram (combined odds ratio (OR) 1.60 (95% confidence interval 1.05 to 2.46)). However, for the adjusted indirect comparison of 10 citalopram and 12 escitalopram placebo-controlled trials, 2,984 and 3,777 patients respectively, efficacy was similar for the two drug forms (combined indirect OR 1.03 (0.82 to 1.30)). Because of the discrepancy, we could not combine direct and indirect data (test of inconsistency, P = 0.07). A similar discrepancy was found for treatment acceptability. The overall reimbursement cost burden for the citalopram, escitalopram and its generic forms was 120.6 million Euros in 2010, with 96.8 million Euros for escitalopram. CONCLUSIONS: The clinical benefit of escitalopram versus citalopram remains uncertain. In our case of evergreening, escitalopram represented a substantially high proportion of the overall reimbursement cost burden as compared with citalopram and the generic forms.