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David E Gyorki - One of the best experts on this subject based on the ideXlab platform.
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post operative survival following metastasectomy for patients receiving braf inhibitor therapy is associated with duration of pre operative treatment and elective indication
Journal of Surgical Oncology, 2015Co-Authors: Mike He, Jane Lovell, Bee Ling Ng, John Spillane, David Speakman, Michael A Henderson, Mark Shackleton, David E GyorkiAbstract:INTRODUCTION: Metastasectomy can provide durable disease control for selected patients with metastatic melanoma. Vemurafenib is a BRAF kinase inhibitor which has demonstrated significant improvement in disease-specific survival in patients with metastatic melanoma with a BRAF gene mutation. This study examined the efficacy and safety of metastasectomy during treatment with vemurafenib. METHODS: A retrospective review was performed of all patients receiving vemurafenib at Peter MacCallum Cancer Centre. Patient records were reviewed to identify patients undergoing surgery within 30 days of vemurafenib therapy. Descriptive statistics and survival analysis were performed. RESULTS: Nineteen patients underwent 21 metastasectomies including craniotomy (57%), Spinal Decompression (14%), small bowel resection (14%), lung resection (9.5%) and neck dissection (4.5%). Indications for surgery were: an isolated residual focus of disease (n = 2); isolated progressive disease in the setting of stability elsewhere (n = 9); and symptomatic disease (n = 8). Grade 2 or higher surgical complications occurred in 19% of cases and there was one peri-operative death. Median post-operative survival was seven months. There was a trend toward improved post-operative survival for patients with longer duration of vemurafenib therapy (P = 0.04) and for those undergoing elective surgery (P = 0.07). CONCLUSION: Resection of oligometastatic disease during BRAF-targeted therapy is safe. Selected patients have durable post-operative disease control.
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post operative survival following metastasectomy for patients receiving braf inhibitor therapy is associated with duration of pre operative treatment and elective indication
Journal of Surgical Oncology, 2015Co-Authors: Jane Lovell, John Spillane, David Speakman, Michael A Henderson, Mark Shackleton, David E GyorkiAbstract:Introduction Metastasectomy can provide durable disease control for selected patients with metastatic melanoma. Vemurafenib is a BRAF kinase inhibitor which has demonstrated significant improvement in disease-specific survival in patients with metastatic melanoma with a BRAF gene mutation. This study examined the efficacy and safety of metastasectomy during treatment with vemurafenib. Methods A retrospective review was performed of all patients receiving vemurafenib at Peter MacCallum Cancer Centre. Patient records were reviewed to identify patients undergoing surgery within 30 days of vemurafenib therapy. Descriptive statistics and survival analysis were performed. Results Nineteen patients underwent 21 metastasectomies including craniotomy (57%), Spinal Decompression (14%), small bowel resection (14%), lung resection (9.5%) and neck dissection (4.5%). Indications for surgery were: an isolated residual focus of disease (n = 2); isolated progressive disease in the setting of stability elsewhere (n = 9); and symptomatic disease (n = 8). Grade 2 or higher surgical complications occurred in 19% of cases and there was one peri-operative death. Median post-operative survival was seven months. There was a trend toward improved post-operative survival for patients with longer duration of vemurafenib therapy (P = 0.04) and for those undergoing elective surgery (P = 0.07). Conclusion Resection of oligometastatic disease during BRAF-targeted therapy is safe. Selected patients have durable post-operative disease control. J. Surg. Oncol. 2015 111:980–984. © 2015 Wiley Periodicals, Inc.
Joseph V Pergolizzi - One of the best experts on this subject based on the ideXlab platform.
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treatment of 94 outpatients with chronic discogenic low back pain with the drx9000 a retrospective chart review
Pain Practice, 2008Co-Authors: Alex Macario, Charlotte Richmond, Martin Auster, Joseph V PergolizziAbstract:▪ Abstract Background: This study's goal was a retrospective chart audit of 100 outpatients with discogenic low back pain (LBP) lasting more than 12 weeks treated with a 2-month course of motorized Spinal Decompression via the DRX9000 (Axiom Worldwide, Tampa, FL, U.S.A.). Methods: Patients at a convenience sample of four clinics received 30-minute DRX9000 sessions daily for the first 2 weeks tapering to 1 session/week. Treatment protocol included lumbar stretching, myofascial release, or heat prior to treatment, with ice and/or muscle stimulation afterwards. Primary outcome was verbal numerical pain intensity rating (NRS) 0 to 10 before and after the 8-week treatment. Results: Of the 100 initial subjects, three withdrew their protected health information, and three were excluded because their LBP duration was less than 12 weeks. The remaining 94 subjects (63% female, 95% white, age = 55 (SD 16) year, 52% employed, 41% retired, LBP median duration of 260 weeks) had diagnoses of herniated disc (73% of patients), degenerative disc disease (68%), or both (27%). Mean NRS equaled 6.05 (SD 2.3) at presentation and decreased significantly to 0.89 (SD 1.15) at end of 8-week treatment (P < 0.0001). Analgesic use also appeared to decrease (charts with data = 20) and Activities of Daily Living improved (charts with data = 38). Follow-up (mean 31 weeks) on 29/94 patients reported mean 83% LBP improvement, NRS of 1.7 (SD 1.15), and satisfaction of 8.55/10 (median 9). Conclusions: This retrospective chart audit provides preliminary data that chronic LBP may improve with DRX9000 Spinal Decompression. Randomized double-blind trials are needed to measure the efficacy of such systems. ▪
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systematic literature review of Spinal Decompression via motorized traction for chronic discogenic low back pain
Pain Practice, 2006Co-Authors: Alex Macario, Joseph V PergolizziAbstract:Objective: The objective of this study was to systematically review the literature to assess the efficacy of nonsurgical Spinal Decompression achieved with motorized traction for chronic discogenic lumbosacral back pain. Design: Computer-aided systematic literature search of MEDLINE and the Cochrane collaboration for prospective clinical trials on adults with low back pain in the English literature from 1975 to October 2005. Methodologic quality for each study was assessed. Studies were included if the intervention group received motorized Spinal Decompression and the comparison group received sham or another type of nonsurgical treatment. Results: Data from 10 studies were fully analyzed. Seven studies were randomized controlled trials using various apparatus types. Because of this low number, we also analyzed three nonrandomized case series studies of Spinal Decompression systems. As the overall quality of studies was low and the patient groups heterogeneous, a meta-analysis was not appropriate and a qualitative review was undertaken. Sample sizes averaged 121 patients (range 27–292), with six of the seven randomized studies reporting no difference with motorized Spinal Decompression and one study reporting reduced pain but not disability. The three unrandomized studies (no control group) of motorized Spinal Decompression found a 77% to 86% reduction in pain. Conclusions: These data suggest that the efficacy of Spinal Decompression achieved with motorized traction for chronic discogenic low back pain remains unproved. This may be, in part, due to heterogeneous patient groups and the difficulties involved in properly blinding patients to the mechanical pulling mechanism. Scientifically more rigorous studies with better randomization, control groups, and standardized outcome measures are needed to overcome the limitations of past studies.
Alex Macario - One of the best experts on this subject based on the ideXlab platform.
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restoration of disk height through non surgical Spinal Decompression is associated with decreased discogenic low back pain a retrospective cohort study
BMC Musculoskeletal Disorders, 2010Co-Authors: Alex Macario, Christian C Apfel, Ozlem Serpil Cakmakkaya, William Martin, Charlotte Richmond, Elizabeth L GeorgeAbstract:Because previous studies have suggested that motorized non-surgical Spinal Decompression can reduce chronic low back pain (LBP) due to disc degeneration (discogenic low back pain) and disc herniation, it has accordingly been hypothesized that the reduction of pressure on affected discs will facilitate their regeneration. The goal of this study was to determine if changes in LBP, as measured on a verbal rating scale, before and after a 6-week treatment period with non-surgical Spinal Decompression, correlate with changes in lumbar disc height, as measured on computed tomography (CT) scans. A retrospective cohort study of adults with chronic LBP attributed to disc herniation and/or discogenic LBP who underwent a 6-week treatment protocol of motorized non-surgical Spinal Decompression via the DRX9000 with CT scans before and after treatment. The main outcomes were changes in pain as measured on a verbal rating scale from 0 to 10 during a flexion-extension range of motion evaluation and changes in disc height as measured on CT scans. Paired t-test or linear regression was used as appropriate with p < 0.05 considered to be statistically significant. We identified 30 patients with lumbar disc herniation with an average age of 65 years, body mass index of 29 kg/m2, 21 females and 9 males, and an average duration of LBP of 12.5 weeks. During treatment, low back pain decreased from 6.2 (SD 2.2) to 1.6 (2.3, p < 0.001) and disc height increased from 7.5 (1.7) mm to 8.8 (1.7) mm (p < 0.001). Increase in disc height and reduction in pain were significantly correlated (r = 0.36, p = 0.044). Non-surgical Spinal Decompression was associated with a reduction in pain and an increase in disc height. The correlation of these variables suggests that pain reduction may be mediated, at least in part, through a restoration of disc height. A randomized controlled trial is needed to confirm these promising results. NCT00828880
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treatment of 94 outpatients with chronic discogenic low back pain with the drx9000 a retrospective chart review
Pain Practice, 2008Co-Authors: Alex Macario, Charlotte Richmond, Martin Auster, Joseph V PergolizziAbstract:▪ Abstract Background: This study's goal was a retrospective chart audit of 100 outpatients with discogenic low back pain (LBP) lasting more than 12 weeks treated with a 2-month course of motorized Spinal Decompression via the DRX9000 (Axiom Worldwide, Tampa, FL, U.S.A.). Methods: Patients at a convenience sample of four clinics received 30-minute DRX9000 sessions daily for the first 2 weeks tapering to 1 session/week. Treatment protocol included lumbar stretching, myofascial release, or heat prior to treatment, with ice and/or muscle stimulation afterwards. Primary outcome was verbal numerical pain intensity rating (NRS) 0 to 10 before and after the 8-week treatment. Results: Of the 100 initial subjects, three withdrew their protected health information, and three were excluded because their LBP duration was less than 12 weeks. The remaining 94 subjects (63% female, 95% white, age = 55 (SD 16) year, 52% employed, 41% retired, LBP median duration of 260 weeks) had diagnoses of herniated disc (73% of patients), degenerative disc disease (68%), or both (27%). Mean NRS equaled 6.05 (SD 2.3) at presentation and decreased significantly to 0.89 (SD 1.15) at end of 8-week treatment (P < 0.0001). Analgesic use also appeared to decrease (charts with data = 20) and Activities of Daily Living improved (charts with data = 38). Follow-up (mean 31 weeks) on 29/94 patients reported mean 83% LBP improvement, NRS of 1.7 (SD 1.15), and satisfaction of 8.55/10 (median 9). Conclusions: This retrospective chart audit provides preliminary data that chronic LBP may improve with DRX9000 Spinal Decompression. Randomized double-blind trials are needed to measure the efficacy of such systems. ▪
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systematic literature review of Spinal Decompression via motorized traction for chronic discogenic low back pain
Pain Practice, 2006Co-Authors: Alex Macario, Joseph V PergolizziAbstract:Objective: The objective of this study was to systematically review the literature to assess the efficacy of nonsurgical Spinal Decompression achieved with motorized traction for chronic discogenic lumbosacral back pain. Design: Computer-aided systematic literature search of MEDLINE and the Cochrane collaboration for prospective clinical trials on adults with low back pain in the English literature from 1975 to October 2005. Methodologic quality for each study was assessed. Studies were included if the intervention group received motorized Spinal Decompression and the comparison group received sham or another type of nonsurgical treatment. Results: Data from 10 studies were fully analyzed. Seven studies were randomized controlled trials using various apparatus types. Because of this low number, we also analyzed three nonrandomized case series studies of Spinal Decompression systems. As the overall quality of studies was low and the patient groups heterogeneous, a meta-analysis was not appropriate and a qualitative review was undertaken. Sample sizes averaged 121 patients (range 27–292), with six of the seven randomized studies reporting no difference with motorized Spinal Decompression and one study reporting reduced pain but not disability. The three unrandomized studies (no control group) of motorized Spinal Decompression found a 77% to 86% reduction in pain. Conclusions: These data suggest that the efficacy of Spinal Decompression achieved with motorized traction for chronic discogenic low back pain remains unproved. This may be, in part, due to heterogeneous patient groups and the difficulties involved in properly blinding patients to the mechanical pulling mechanism. Scientifically more rigorous studies with better randomization, control groups, and standardized outcome measures are needed to overcome the limitations of past studies.
Mark Shackleton - One of the best experts on this subject based on the ideXlab platform.
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post operative survival following metastasectomy for patients receiving braf inhibitor therapy is associated with duration of pre operative treatment and elective indication
Journal of Surgical Oncology, 2015Co-Authors: Mike He, Jane Lovell, Bee Ling Ng, John Spillane, David Speakman, Michael A Henderson, Mark Shackleton, David E GyorkiAbstract:INTRODUCTION: Metastasectomy can provide durable disease control for selected patients with metastatic melanoma. Vemurafenib is a BRAF kinase inhibitor which has demonstrated significant improvement in disease-specific survival in patients with metastatic melanoma with a BRAF gene mutation. This study examined the efficacy and safety of metastasectomy during treatment with vemurafenib. METHODS: A retrospective review was performed of all patients receiving vemurafenib at Peter MacCallum Cancer Centre. Patient records were reviewed to identify patients undergoing surgery within 30 days of vemurafenib therapy. Descriptive statistics and survival analysis were performed. RESULTS: Nineteen patients underwent 21 metastasectomies including craniotomy (57%), Spinal Decompression (14%), small bowel resection (14%), lung resection (9.5%) and neck dissection (4.5%). Indications for surgery were: an isolated residual focus of disease (n = 2); isolated progressive disease in the setting of stability elsewhere (n = 9); and symptomatic disease (n = 8). Grade 2 or higher surgical complications occurred in 19% of cases and there was one peri-operative death. Median post-operative survival was seven months. There was a trend toward improved post-operative survival for patients with longer duration of vemurafenib therapy (P = 0.04) and for those undergoing elective surgery (P = 0.07). CONCLUSION: Resection of oligometastatic disease during BRAF-targeted therapy is safe. Selected patients have durable post-operative disease control.
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post operative survival following metastasectomy for patients receiving braf inhibitor therapy is associated with duration of pre operative treatment and elective indication
Journal of Surgical Oncology, 2015Co-Authors: Jane Lovell, John Spillane, David Speakman, Michael A Henderson, Mark Shackleton, David E GyorkiAbstract:Introduction Metastasectomy can provide durable disease control for selected patients with metastatic melanoma. Vemurafenib is a BRAF kinase inhibitor which has demonstrated significant improvement in disease-specific survival in patients with metastatic melanoma with a BRAF gene mutation. This study examined the efficacy and safety of metastasectomy during treatment with vemurafenib. Methods A retrospective review was performed of all patients receiving vemurafenib at Peter MacCallum Cancer Centre. Patient records were reviewed to identify patients undergoing surgery within 30 days of vemurafenib therapy. Descriptive statistics and survival analysis were performed. Results Nineteen patients underwent 21 metastasectomies including craniotomy (57%), Spinal Decompression (14%), small bowel resection (14%), lung resection (9.5%) and neck dissection (4.5%). Indications for surgery were: an isolated residual focus of disease (n = 2); isolated progressive disease in the setting of stability elsewhere (n = 9); and symptomatic disease (n = 8). Grade 2 or higher surgical complications occurred in 19% of cases and there was one peri-operative death. Median post-operative survival was seven months. There was a trend toward improved post-operative survival for patients with longer duration of vemurafenib therapy (P = 0.04) and for those undergoing elective surgery (P = 0.07). Conclusion Resection of oligometastatic disease during BRAF-targeted therapy is safe. Selected patients have durable post-operative disease control. J. Surg. Oncol. 2015 111:980–984. © 2015 Wiley Periodicals, Inc.
Michael A Henderson - One of the best experts on this subject based on the ideXlab platform.
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post operative survival following metastasectomy for patients receiving braf inhibitor therapy is associated with duration of pre operative treatment and elective indication
Journal of Surgical Oncology, 2015Co-Authors: Mike He, Jane Lovell, Bee Ling Ng, John Spillane, David Speakman, Michael A Henderson, Mark Shackleton, David E GyorkiAbstract:INTRODUCTION: Metastasectomy can provide durable disease control for selected patients with metastatic melanoma. Vemurafenib is a BRAF kinase inhibitor which has demonstrated significant improvement in disease-specific survival in patients with metastatic melanoma with a BRAF gene mutation. This study examined the efficacy and safety of metastasectomy during treatment with vemurafenib. METHODS: A retrospective review was performed of all patients receiving vemurafenib at Peter MacCallum Cancer Centre. Patient records were reviewed to identify patients undergoing surgery within 30 days of vemurafenib therapy. Descriptive statistics and survival analysis were performed. RESULTS: Nineteen patients underwent 21 metastasectomies including craniotomy (57%), Spinal Decompression (14%), small bowel resection (14%), lung resection (9.5%) and neck dissection (4.5%). Indications for surgery were: an isolated residual focus of disease (n = 2); isolated progressive disease in the setting of stability elsewhere (n = 9); and symptomatic disease (n = 8). Grade 2 or higher surgical complications occurred in 19% of cases and there was one peri-operative death. Median post-operative survival was seven months. There was a trend toward improved post-operative survival for patients with longer duration of vemurafenib therapy (P = 0.04) and for those undergoing elective surgery (P = 0.07). CONCLUSION: Resection of oligometastatic disease during BRAF-targeted therapy is safe. Selected patients have durable post-operative disease control.
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post operative survival following metastasectomy for patients receiving braf inhibitor therapy is associated with duration of pre operative treatment and elective indication
Journal of Surgical Oncology, 2015Co-Authors: Jane Lovell, John Spillane, David Speakman, Michael A Henderson, Mark Shackleton, David E GyorkiAbstract:Introduction Metastasectomy can provide durable disease control for selected patients with metastatic melanoma. Vemurafenib is a BRAF kinase inhibitor which has demonstrated significant improvement in disease-specific survival in patients with metastatic melanoma with a BRAF gene mutation. This study examined the efficacy and safety of metastasectomy during treatment with vemurafenib. Methods A retrospective review was performed of all patients receiving vemurafenib at Peter MacCallum Cancer Centre. Patient records were reviewed to identify patients undergoing surgery within 30 days of vemurafenib therapy. Descriptive statistics and survival analysis were performed. Results Nineteen patients underwent 21 metastasectomies including craniotomy (57%), Spinal Decompression (14%), small bowel resection (14%), lung resection (9.5%) and neck dissection (4.5%). Indications for surgery were: an isolated residual focus of disease (n = 2); isolated progressive disease in the setting of stability elsewhere (n = 9); and symptomatic disease (n = 8). Grade 2 or higher surgical complications occurred in 19% of cases and there was one peri-operative death. Median post-operative survival was seven months. There was a trend toward improved post-operative survival for patients with longer duration of vemurafenib therapy (P = 0.04) and for those undergoing elective surgery (P = 0.07). Conclusion Resection of oligometastatic disease during BRAF-targeted therapy is safe. Selected patients have durable post-operative disease control. J. Surg. Oncol. 2015 111:980–984. © 2015 Wiley Periodicals, Inc.