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Infante-Rivard C.,McGill University | Rivard G.-E.,CHU Sainte Justine | Derome F.,CHU Sainte Justine | Winikoff R.,CHU Sainte Justine | And 2 more authors.
Haemophilia | Year: 2012

Radiosynoviorthesis (RS) is an intra-articular injection of a radioactive colloid for the treatment of synovitis administered most often to patients with rheumatoid arthritis or haemophilia. Although highly cost-effective in comparison with surgical or arthroscopic synovectomy, the risk of cancer associated with this treatment is not well known. We evaluated the incidence of cancer in a group of patients treated with RS. A cohort of 2412 adult patients with a variety of underlying conditions (mainly rheumatoid arthritis) and treated with at least one RS between January 1976 and December 2001, was recruited from two centres in Montréal. Cancer incidence and mortality data for cohort members over that time period were obtained from regulatory agencies using linkage. Background rates for all and specific types of cancer were obtained for the provincial (Québec) and national (Canada) population according to age, gender and calendar period categories. Category-specific rates in the cohort were compared with rates in similar categories from the general population generating standardized incidence ratios (SIR). The effects of specific isotope doses and of number of RS treatments were analysed using a Cox-regression model. No increase in the risk of cancer was observed (SIR 0.96; 95% confidence interval 0.82-1.12). There was no dose-response relationship with the amount of radioisotope administered or number of RS treatments. The study provides some indication for the safety of the procedure but homogenous diagnostic groups of younger patients (such as haemophilic patients) receiving RS will need more evaluation. © 2012 Blackwell Publishing Ltd.

Labrosse J.M.,Center Hospitalier Of Luniversite Of Montreal Chum | Cardinal E.,Center Hospitalier Of Luniversite Of Montreal Chum | Leduc B.E.,CHUM | Duranceau J.,University of Montréal | And 3 more authors.
American Journal of Roentgenology | Year: 2010

OBJECTIVE. The objective of our study was to evaluate the effectiveness of ultrasoundguided corticosteroid injection for the treatment of gluteus medius tendinopathy. SUBJECTS AND METHODS. We prospectively evaluated 54 consecutive patients (48 women, six men; mean age, 54.7 years; mean body mass index, 26 kg/m2) with a clinical diagnosis of gluteus medius tendinopathy. Pain assessment using a 10-cm visual analog scale (VAS) was obtained as part of the initial clinical evaluation of all patients. A hip ultrasound study was performed followed by a gluteus medius peritendinous ultrasound-guided injection of 30 mg of triamcinolone combined with 3 mL of bupivacaine 0.5% using an anterior oblique coronal plane. One month after treatment, participants were reassessed clinically, and they were asked to quantify their pain using the VAS pain score and their satisfaction with the outcome of the injection using a 4-point rating scale (very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied). Statistical analysis included a paired Student's t test (comparison of pain levels before and after treatment, p = 0.05) and a multivariate analysis of covariance. RESULTS. There was a 55% average reduction of pain level before versus after treatment (mean VAS pain score, 6.4 vs 2.9 cm, respectively; p < 0.001). One month after treatment, 72% of the patients showed a clinically significant improvement in pain level, which was defined as a reduction in the VAS pain score of ≥ 30%. Seventy percent of patients were satisfied with the results of the intervention. No correlation was shown between treatment outcome and any of the clinical variables or ultrasound findings. CONCLUSION. Our study shows that a peritendinous ultrasound-guided corticosteroid injection may be an effective treatment of gluteus medius tendinopathy. © American Roentgen Ray Society.

PubMed | Ford Motor Company, University of Sheffield, McMaster University, Dalhousie University and 24 more.
Type: Review | Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA | Year: 2016

The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of Hyperparathyroidism. Primary was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations.PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

Villeneuve E.,CHUM | Nam J.L.,University of Leeds | Bell M.J.,Sunnybrook Health science Center | Deighton C.M.,Royal Derby Hospital | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Background: Despite the importance of timely management of patients with inflammatory arthritis (IA), delays exist in its diagnosis and treatment. Objective: To perform a systematic literature review to identify strategies addressing these delays to inform an American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) taskforce. Methods: The authors searched literature published between January 1985 and November 2010, and ACR and EULAR abstracts between 2007-2010. Additional information was obtained through a grey literature search, a survey conducted through ACR and EULAR, and a hand search of the literature. Results: (1) From symptom onset to primary care, community case-finding strategies, including the use of a questionnaire and autoantibody testing, have been designed to identify patients with early IA. Several websites provided information on IA but were of varying quality and insufficient to aid early referral. (2) At a primary care level, education programmes and patient self-administered questionnaires identified patients with potential IA for referral to rheumatology. Many guidelines emphasised the need for early referral with one providing specific referral criteria. (3) Once referred, early arthritis clinics provided a point of early access for rheumatology assessment. Triage systems, including triage clinics, helped prioritise clinic appointments for patients with IA. Use of referral forms standardised information required, further optimising the triage process. Wait times for patients with acute IA were also reduced with development of rapid access systems. Conclusions: This review identified three main areas of delay to care for patients with IA and potential solutions for each. A co-ordinated effort will be required by the rheumatology and primary care community to address these effectively.

McLaughlin N.,CHUM | Bojanowski M.W.,CHUM
Journal of Neurosurgery | Year: 2011

Elongation of the anterior cerebral artery (ACA) and subsequent compression of the chiasm rarely have been reported as causes of a visual field deficit. Neither has microvascular decompression of the chiasm been described in this circumstance. The authors report on a case of progressive visual deficits caused by compression of the optic apparatus by a right elongated ACA as documented on MR imaging. Microvascular decompression was proposed as treatment. The right A1 segment was larger than usual and tortuous, transmitting its pulsations into the chiasm. A piece of Teflon was inserted between the A 1 segment and the chiasm. Following surgery, the visual field deficit progressively improved. At 4 months after surgery, the patient's visual fields were normal. Therefore, an elongated ACA can compress the chiasm and result in a visual field deficit. In such circumstances when facing a progressive visual field deficit, microvascular decompression may improve vision.

Picard M.,CHU Sainte Justine | Paradis L.,CHU Sainte Justine | Nguyen M.,CHU Sainte Justine | Begin P.,CHU Sainte Justine | And 2 more authors.
Allergy and Asthma Proceedings | Year: 2012

The practice of elective penicillin skin testing could be compromised by the fact that patients, their parents, or their physicians remain reluctant to reuse penicillin-class antibiotics (PCAs) despite a negative evaluation by an allergist. This study addresses reuse of PCAs in a pediatric population after negative penicillin skin testing and drug challenge and factors associated with its reluctance. All children evaluated for a history of penicillin allergy at the CHU Sainte-Justine Allergy Clinic between January 1998 and June 2000 with negative skin testing and drug challenge were included in the study. A telephone survey was conducted between May and October 2002 to assess the perception of the initial reaction by the parents, subsequent use of antibiotics, and antibiotic-related adverse reactions. Among the 200 children selected, parents of 170 (85%) children completed the survey. Since the allergist evaluation, 130 (76%) children had received antibiotics. PCA was used in 59 (45%) children. Parents of 24 (18%) children refused PCAs because they still feared an adverse reaction. They were more likely to have been very frightened by their child's allergic reaction than other parents whose children had used PCAs (p = 0.008). Although elective penicillin skin testing is useful and safe in the pediatric population, a significant proportion of parents still refuse PCAs even though they are needed. Identification of parents that were very frightened by their children's allergic reactions and additional reassurance could improve this situation. Copyright © 2012, OceanSide Publications, Inc.

Haraoui B.,CHUM | Cividino A.,McMaster University | Stewart J.,Penticton Regional Hospital | Guerette B.,Abbott Laboratories | Keystone E.C.,Mount Sinai Hospital
BMC Musculoskeletal Disorders | Year: 2011

Background: This multicenter, open-label, prospective, single cohort study evaluated the effectiveness and safety of adalimumab in a clinical setting reflecting the Canadian standard of care for the treatment of patients with rheumatoid arthritis (RA). Methods. Patients 18 years of age with a history of active RA 3 months and fulfilling Canadian requirements for biological therapy received adalimumab 40 mg subcutaneously every other week for 12 weeks. Pre-study DMARD treatment regimens, corticosteroids, or NSAIDs were allowed throughout the study. The primary effectiveness outcome measure was the mean change in 28-joint disease activity score (DAS28) from baseline to Week 12. Secondary measures included the proportion of patients achieving joint remission (DAS28 < 2.6) and low-disease activity (DAS28 < 3.2) at Week 12, and European League Against Rheumatism (EULAR: moderate and good) and American College of Rheumatology (ACR: ACR20, 50, and 70) responses, as well as responses in ACR core components at Weeks 4, 8, and 12. Subgroup analysis included a comparison of patients nave to biological DMARD (BDMARD) therapy versus BDMARD-experienced patients. Safety was assessed in terms of adverse and serious adverse events. Results: A total of 879 patients (mean disease duration > 12 years) were enrolled; 772 (87.9%) completed the 12-week period. Adalimumab treatment was associated with rapid and sustained improvements in the signs and symptoms of RA. Significant improvements in mean DAS28 score were observed as early as Week 4. After 12 weeks of adalimumab treatment, 15.3% and 28.9% of patients achieved clinical remission and low-disease activity, respectively. Similarly, significant improvements in ACR core components were observed as early as Week 4, with continued improvements occurring through 12 weeks. Patients nave to BDMARD therapy demonstrated numerically greater clinical responses when compared with patients who had experienced prior BDMARD therapy, although both subgroups were associated with significant improvements from baseline. The rates and types of adverse events, as well as the results of laboratory measures, demonstrated that adalimumab was generally safe and well-tolerated. Conclusions: This study demonstrated that, under conditions reflective of the normal clinical practice in Canada, adalimumab is an effective and safe treatment for patients with RA. Trial registration. NCT00649545. © 2011 Haraoui et al; licensee BioMed Central Ltd.

Nzokou A.,CHUM | Weil A.G.,CHUM | Shedid D.,CHUM
Journal of Neurosurgery: Spine | Year: 2013

Object. Resection of spinal tumors traditionally requires bilateral subperiosteal muscle stripping, extensive laminectomy, and, in cases of foraminal extension, partial or radical facetectomy. Fusion is often warranted in cases of facetectomy to prevent deformity, pain, and neurological deterioration. Recent reports have demonstrated safety and efficacy of mini-open removal of these tumors using expandable tubular retractors. The authors report their experience with the minimally invasive removal of extradural foraminal and intradural-extramedullary tumors using the nonexpandable tubular retractor. Methods. A retrospective chart review of consecutive patients who underwent minimally invasive resection of spinal tumors at Notre Dame Hospital was performed. Results. Between December 2005 and March 2012, 13 patients underwent minimally invasive removal of spinal tumors at Notre Dame Hospital, Montreal. There were 6 men and 7 women with a mean age of 55 years (range 20-80 years). There were 2 lumbar and 2 thoracic intradural-extramedullary tumors and 7 thoracic and 2 lumbar extradural foraminal tumors. Gross-total resection was achieved in 12 patients. Subtotal resection (90%) was attained in 1 patient because the tumor capsule was adherent to the diaphragm. The average duration of surgery was 189 minutes (range 75-540 minutes), and the average blood loss was 219 ml (range 25-500 ml). There were no major procedure-related complications. Pathological analysis revealed benign schwannoma in 8 patients and meningioma, metastasis, plasmacytoma, osteoid osteoma, and hemangiopericytoma in 1 patient each. The average equivalent dose of postoperative narcotics after surgery was 66.3 mg of morphine. The average length of hospitalization was 66 hours (range 24-144 hours). All working patients returned to normal activities within 4 weeks. The average MRI and clinical follow-up were 13 and 21 months, respectively (range 2-68 months). At last follow-up, 92% of patients had improvement or resolution of pain with a visual analog scale score that improved from 7.8 to 1.2. All patients with neurological impairment improved. The American Spinal Injury Association grade improved in all but 1 patient. Conclusions. Intradural-extramedullary and extradural tumors can be completely and safely resected through a minimally invasive approach using the nonexpandable tubular retractor. This approach may be associated with even less tissue destruction than mini-open techniques, translating into a quicker functional recovery. In cases of foraminal tumors, by eliminating the need for facetectomy, this minimally invasive approach may decrease the incidence of postoperative deformity and eliminate the need for adjunctive fusion surgery. ©AANS 2013.

PubMed | CHUM
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

17005 Background: RAS gene mutations have been shown to occur in certain malignancies and have an impact on response to treatment and overall prognosis for certain types of cancer, more specifically NSCLC. Studies of these mutations in head and neck oncology literature have shown inconsistent results.To determine the prevalence K-RAS codon 12 mutations in patients with locally advanced HNSCC treated with chemo-radiation therapy with/without surgery and to evaluate the impact of these mutations on loco-regional control as well as overall, disease free and distant metastasis free survival.Out of 428 consecutive patients treated with chemo- radiation therapy in our institution and followed for a median of 37 months, 199 paraffin embedded biopsy or surgical specimens were retrieved. DNA was isolated and analyzed for K-RAS mutational status by PCR and nested PCR techniques. Statistical analysis was performed using Fishers test for categorical data and Kaplan-Meiers curves and log-rank statistics for failure times.DNA extraction was successful in 197 patients. Of the 197 specimens, 3.5% presented K-RAS codon 12 mutations using a single PCR technique. Patient characteristics did not differ statistically. For mutated cases and non-mutated cases, complete initial response to chemo-radiation therapy was 71 and 73% (p=0.32). LRC was respectively 83 and 32% (p=0.03), DFS was 68 and 27% (p=0.12), distant metastasis free survival was 81 and 100% (p=0.30) and OS was 65 and 57% (p=0.14) at three years. Mutational status results from nested PCR are pending and will be presented at the meeting.K-RAS mutational status, although not associated with a difference in response rate, may influence failure pattern and overall aggressiveness and may influence the type of therapy offered to such patients. No significant financial relationships to disclose.

PubMed | CHUM, University of Montréal and Dalhousie University
Type: Journal Article | Journal: Canadian journal of anaesthesia = Journal canadien d'anesthesie | Year: 2016

New regulations are in place at the federal and provincial levels in Canada regarding the way medical cannabis is to be controlled. We present them together with guidance for the safe use of medical cannabis and recent clinical trials on cannabis and pain.The new Canadian regulations on the use of medical cannabis, the provincial regulations, and the various cannabis products available from the Canadian Licensed Producers were reviewed from Health Canada, provincial licensing authorities, and the licensed producers website, respectively. Recent clinical trials on cannabis and pain were reviewed from the existing literature.Health Canada has approved a new regulation on medical marijuana/cannabis, the Marihuana for Medical Purposes Regulations: The production of medical cannabis by individuals is illegal. Health Canada, however, has licensed authorized producers across the country, limiting the production to specific licenses of certain cannabis products. There are currently 26 authorized licensed producers from seven Canadian provinces offering more than 200 strains of marijuana. We provide guidance for the safe use of medical cannabis. The recent literature indicates that currently available cannabinoids are modestly effective analgesics that provide a safe, reasonable therapeutic option for managing chronic non-cancer-related pain.The science of medical cannabis and the need for education of healthcare professionals and patients require continued effort. Although cannabinoids work to decrease pain, there is still a need to confirm these beneficial effects clinically and to exploit them with acceptable benefit-to-risk ratios.

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