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Cooke HL, Schaeffer CV, Gabig AM, Karzon A, Savani U, Gottschalk MB, Wagner ER. Total Wrist Arthroplasty as a Motion-Sparing Option for Distal Radius Malunion in a Patient of Advanced Age: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00058. [PMID: 37590422 DOI: 10.2106/jbjs.cc.23.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE A 62-year-old woman presented with wrist pain secondary to a distal radius fracture malunion 4 months after a fall onto an outstretched hand. She was not an ideal candidate for osteotomy and bone graft because of the degree of displacement and osteoporosis, so after nonoperative treatment was unsuccessful, she was offered total wrist arthroplasty (TWA) or arthrodesis and opted for TWA. CONCLUSION At 14-month follow-up, the patient reported significant improvement in her pain and function. The current generation of TWA implants may allow use in the management of symptomatic distal radius malunions in older, low-demand patients.
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Affiliation(s)
- Hayden L Cooke
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Engelhardt BG, Savani U, Jung DK, Powers AC, Jagasia M, Chen H, Winnick JJ, Tamboli RA, Crowe JE, Abumrad NN. New-Onset Post-Transplant Diabetes Mellitus after Allogeneic Hematopoietic Cell Transplant Is Initiated by Insulin Resistance, Not Immunosuppressive Medications. Biol Blood Marrow Transplant 2019; 25:1225-1231. [PMID: 30738170 PMCID: PMC6559863 DOI: 10.1016/j.bbmt.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
New-onset post-transplant diabetes mellitus (PTDM) occurs frequently after allogeneic hematopoietic cell transplant (HCT). Although calcineurin inhibitors and corticosteroids are assumed to be the cause for hyperglycemia, patients developing PTDM have elevated fasting C-peptide levels before HCT and before immunosuppressive medications. To determine if PTDM results from established insulin resistance present before transplant, we performed oral glucose tolerance tests (OGTTs) and measured whole body, peripheral, and hepatic insulin sensitivity with euglycemic hyperinsulinemic clamps before and 90 days after HLA-identical sibling donor HCT in 20 patients without pretransplant diabetes. HCT recipients were prospectively followed for the development of new-onset PTDM defined as a weekly fasting blood glucose ≥ 126 mg/dL or random blood glucose ≥ 200 mg/dL. During the first 100 days all patients received calcineurin inhibitors, and 11 individuals (55%) were prospectively diagnosed with new-onset PTDM. PTDM diagnosis preceded corticosteroid treatment. During the pretransplant OGTT, elevated fasting (87 mg/dL versus 101 mg/dL; P = .005) but not 2-hour postprandial glucose levels predicted PTDM diagnosis (P = .648). In response to insulin infusion during the euglycemic hyperinsulinemic clamp, patients developing PTDM had lower whole body glucose utilization (P = .047) and decreased peripheral/skeletal muscle uptake (P = .031) before and after transplant, respectively, when compared with non-PTDM patients. Hepatic insulin sensitivity did not differ. Survival was decreased in PTDM patients (2-year estimate, 55% versus 100%; P = .039). Insulin resistance before HCT is a risk factor for PTDM independent of immunosuppression. Fasting pretransplant glucose levels identified PTDM susceptibility, and peripheral insulin resistance could be targeted for prevention and treatment of PTDM after HCT.
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Affiliation(s)
- Brian G Engelhardt
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Ujjawal Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dae Kwang Jung
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alvin C Powers
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine, VA Tennessee Valley Healthcare, Nashville, Tennessee
| | - Madan Jagasia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason J Winnick
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Robyn A Tamboli
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James E Crowe
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Naji N Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Gupta R, Savani U, Gatwood K, Culos K. The Recurring Problem of Drug Shortages-How Do We Overcome It? Clin Hematol Int 2019; 1:75-77. [PMID: 34595413 PMCID: PMC8432384 DOI: 10.2991/chi.d.190321.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Rishabh Gupta
- College of Arts and Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235-2004, USA
| | - Ujjawal Savani
- College of Literature, Science, and the Arts, University of Michigan, 500 S State Street, Ann Arbor, MI 48109, USA
| | - Katie Gatwood
- Department of Pharmacy, Vanderbilt University Medical Center, 1301 Medical Center Drive, Nashville, TN 37232, USA
| | - Katie Culos
- Department of Pharmacy, Vanderbilt University Medical Center, 1301 Medical Center Drive, Nashville, TN 37232, USA
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Savani U, Jung DK, Crowe JE, Abumrad NN, Powers AC, Jagasia M, Cornell RF, Goodman S, Kassim AA, Culos KA, Gatwood KS, Byrne MT, Engelhardt BG. Metabolic Complications Precede Alloreactivity and are Characterized by Changes in Th1/Th17 Immunity. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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