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Dissertation
Longkankerscreening: Waarom? Hoe? Waar staan we vandaag?

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Abstract

INLEIDING: Longkankerscreening is erop gericht vroegtijdig longkanker te detecteren om de mortaliteit te verbeteren. Er is geen duidelijk antwoord over de effectiviteit van longkankerscreening en hoe het best geïmplementeerd wordt in de gezondheidszorg. Ter verduidelijking willen wij de resultaten van de belangrijkste studies zoals de Amerikaanse NLST, Europese DLCST en DANTE en Nederlands-Belgische NELSON vergelijken. METHODE: Na doorname van Pubmed en de Cochrane Library werden 22 artikels geïncludeerd die overeenkwamen met onze zoektermen en eindpunten. Het screeningbeleid van de NLST en het volume management protocol van NELSON werden uitgelegd. RESULTATEN: Het merendeel van de longtumoren in de NLST, NELSON, DLCST en DANTE werd gedetecteerd in stadium I (respectievelijk 62%, 69%, 68% en 45%) met het adenocarcinoom als meest frequente histologische type (40%, 51%, 70%, 42%), gevolgd door het squameus cel carcinoom (21%, 17%, 10%, 24%). Het aantal vals positieve scans bedroeg respectievelijk 23,3%, 1,2% en 3,1% in de NLST, NELSON en DLCST. DISCUSSIE: De NLST toonde 20% longkankergerelateerde mortaliteitsreductie aan die niet bevestigd werd in de DLCST of DANTE studies. Lage dosis computertomografie vindt niet-kleincellige longkankers in de vroege stadia I-II. De NELSON studie resulteerde dankzij haar volume management en screeningsbeleid in minder vals positieve scans dan de andere studies. Vooraleer longkankerscreening geïmplementeerd kan worden is meer onderzoek nodig naar het meest efficiënte screeningsbeleid, risicovoorspellingsmodellen en kosteneffectiviteit. CONCLUSIE: Longkankerscreening met lage dosis computertomografie heeft de mogelijkheid om niet-kleincellige longtumoren te ontdekken in de vroege stadia(I-II). Het is wachten op de mortaliteitgegevens van de NELSON trial alvorens we een finale inschatting kunnen maken over de effectiviteit van longkankerscreening.

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Dissertation
Long term follow-up of semi-constrained total elbow arthroplasty: a single center retrospective analysis.

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Background and Study Aims: Total Elbow Arthroplasty (TEA) is pivotal in treating elbow pathology. In this retrospective study conducted at a university hospital between 2003 and 2019, the long-term outcome and implant survival of semi-constrained TEA implants is assessed. Materials and Methods: A series of 122 semi-constrained elbow implants were included, with a minimum 2-year follow-up and three prosthetic designs: 94 Coonrad-Morrey, 11 Latitude, and 17 Nexel prosthesis. Comprehensive patient demographics, surgical indications and adverse events are detailed. Prospective data, including Visual Analogue Score (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Mayo Elbow Performance Score (MEPS), were collected during follow-up. Radiographic evaluation was performed to asses wear or loosening. Implant survival was analyzed using Kaplan-Meier survival curves. Results: The primary TEA Coonrad-Morrey group had a survival of 96% at 5 years, 92% at 10 years and 70% at 15 years, aligning with earlier reports, but emphasizing the need for ongoing vigilance. The Latitude implant had a 100% 5-year survival, while Nexel demonstrated a 78% 5-year survival, highlighting the importance of long-term follow-up duration. Adverse events occurred in 31.3%, with periprosthetic fractures (8.2%), ulnar nerve neuropathy (7.4%), and infections (4.2%) most prevalent. Revision (13.1%) was primarily indicated due to loosening (4.1%) and periprosthetic fractures (4.1%). Survival analysis indicated comparable outcomes between primary and revision TEA. Conclusions: Although the postoperative complication rate is quite high, this study provides comparable good mid- to long-term functional outcome of semi-constrained TEA. A similar high short-term survival was seen in Coonrad-Morrey and Latitude designs, but lower in Nexel. However, all implants demonstrated an increasing revision rate in long-term follow-up. Ongoing monitoring, careful implant consideration and nuanced adverse event interpretation are crucial for optimizing long-term outcome of TEA. Keywords: Total elbow arthroplasty, semi-constrained implants, implant survival, patient outcomes, adverse events, revision surgery. Level of evidence: III

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