Transperineal template‐guided mapping biopsy of the prostate

Accurate diagnosis of prostate cancer has eluded clinicians for decades. With our current understanding of prostate cancer, urologists should devise and confidently present the available treatment options – active surveillance/radical treatment/focal therapy to these patients. The diagnostic modalities used for prostate cancer have the dual problem of false negativity and overdiagnosis. Various modifications in the prostate biopsy techniques have increased the accuracy of cancer detection, but we are still far from an ideal diagnostic technique. Transperineal template‐guided mapping biopsy of the prostate is an exhaustive biopsy technique that has been improvised over the past decade, and has shown superior results to other available modalities. We have carried out a PubMed search on the available experiences on this diagnostic modality, and along with our own experiences, we present a brief review on transperineal template‐guided mapping biopsy of the prostate.     

传统及数字化口腔种植导板的制作及临床应用研究进展

随着口腔种植手术的广泛开展,种植导板在术中的应用不仅有助于术前诊疗计划的设计,还有助于种植体在牙槽骨中的正确定位、成角优化,从而最终达到兼顾功能和美学的术后效果。以修复为导向设计种植导板应用于临床,可相对降低并发症发生的风险。随着椎形束CT(CBCT)的广泛应用,国内外学者在传统种植导板的基础上,结合数字化技术,完成了各种改良式种植导板的制作,由此推进了种植导板的发展。该文对常用的口腔种植导板的分类、优缺点以及计算机辅助外科种植导板进行综述,为临床中种植导板的应用提供参考。     

Computer-navigated minimally invasive total knee arthroplasty for patients with retained implants in the femur

Total knee arthroplasty (TKA) in patients with knee arthritis and retained implants in the ipsilateral femur is a challenge for knee surgeons. Use of a conventional intramedullary femoral cutting guide is not practical because of the obstruction of the medullary canal by implants. Previous studies have shown that computer-assisted surgery (CAS) can help restore alignment in conventional TKA for patients with knee arthritis with retained femoral implants or extra-articular deformity, without the need for implant removal or osteotomy. However, little has been published regarding outcomes with the use of navigation in minimally invasive surgery (MIS)-TKA for patients with this complex knee arthritis. MIS has been proven to provide less postoperative pain and faster recovery than conventional TKA, but MIS-TKA in patients with retained femoral implants poses a greater risk in limb malalignment. The purpose of this study is to report the outcome of CAS-MIS-TKA in patients with knee arthritis and retained femoral implants. Between April 2006 and March 2008, eight patients with knee arthritis and retained femoral implants who underwent the CAS-MIS-TKA were retrospectively reviewed. Three of the eight patients had extra-articular deformity, including two femur bones and one tibia bone, in the preoperative examination. The anteroposterior, lateral, and long-leg weight-bearing radiographs carried out at 3-month follow-up was used to determine the mechanical axis of lower limb and the position of components. The mean preoperative femorotibial angle in patients without extra-articular deformity was 3.8° of varus and was corrected to 4.6° of valgus. With the use of navigation in MIS-TKA, the two patients in this study with extra-articular femoral deformity also obtained an ideal postoperative mechanical axis within 2° of normal alignment. Overall, there was a good restoration of postoperative mechanical alignment in all cases, with a mean angle of 0.4° of varus. No limb malalignment or component malposition was found. In clinical assessments, there were also significant improvements in knee specific scores, functional scores, and motion arc. The results of this study suggest that navigation can help achieve accurate alignment and proper prosthesis positioning in MIS-TKA for patients with retained femoral implants and for whom intramedullary rod guidance is impractical.     

The evolution of craniofacial resection: A new workflow for virtual planning in complex craniofacial procedures

Complex craniofacial surgery has been later to take advantage of computerized planning than traditional maxillofacial procedures. Virtual reality, 3D model navigation, and bioengineering analyses have changed our approach to the surgical planning of craniofacial resection, increasing the benefits of surgery in terms of accuracy while decreasing complication rate.This study introduces a new workflow for 3D reconstruction, virtual model navigation, and alignment analyses, and demonstrates its successful application in a sample of four patients. A case of squamous cell carcinoma of the maxillary and ethmoid sinus in a 62-year-old patient is presented to evaluate the application of the workflow for a combined transfacial and transcranial resection. Results demonstrate that virtual surgical planning was successfully translated into navigational coordinates and reproduced in the operating room.While the literature provides a wide range of applications of virtual planning for traditional maxillofacial procedures, its introduction for complex craniofacial procedures remains difficult. The presented case shows that it is worth investigating the correlation between virtual reality planning and surgical accuracy for craniofacial resection, and related advantages in terms of surgical safety and improved prognosis.     

Accuracy assessment of cone beam computed tomography-derived laboratory-based surgical templates on partially edentulous patients

Objectives: The aim of the present prospective clinical study was to evaluate the match between the positions and axes of the virtually planned and the placed implants using laboratory‐based surgical guides generated from cone beam computed tomography (CBCT). Materials and methods: A total of 132 implants were placed with the aid of 3D‐based transfer templates in 52 consecutive partially edentulous patients between April 2008 and March 2010. After individual adaptation of the scan templates and CBCT scanning, the acquired data for virtual implant planning and simulation were processed using the med3D software program. After finalizing the virtual placement of the implants the radiographic templates were converted into operative guides containing titanium sleeves for cavity preparation. Preoperative planning was merged with postoperative CBCT data to identify linear and angular deviations between virtually planned and placed implants. Results: Compared with the planned implants the installed implants showed linear deviations in the median at the neck and apex of 0.27 mm (range 0.01–0.97 mm), and of 0.46 mm (range 0.03–1.38 mm), respectively. The angle deviation was 1.84° in median, with a range of 0.07–6.26°. The extent of deviation depends on the size of the tooth gap and the distribution of the remaining teeth. Conclusion: The results of this study suggested that laboratory‐fabricated surgical guides using CBCT data may be reliable in implant placement under prosthodontic considerations in partial edentulism. To cite this article:
Behneke A, Burwinkel M, Knierim K, Behneke N. Accuracy assessment of cone beam computed tomography‐derived laboratory‐based surgical templates on partially edentulous patients.
Clin. Oral Impl. Res. 23 , 2012; 137–143.
doi: 10.1111/j.1600‐0501.2011.02176.x     

三维影像配合手术导板在口腔种植中的美学应用

目的:探讨三维放射影像配合3D手术导板于人工种植的临床美学研究及其应用特点。方法:随机选择10例患者,术前三维影像学予以检查并设计方案,在3D手术导权引导下行不翻瓣口腔牙种植术,术后再以三维放射影像与原软件手术计划比较,以测量其角度的误差。结果:和传统植牙方法相比,术前三维影像学检查设计,并辅以3D手术导板引导植牙术后植体角度误差<1～3°,术后行12个月跟踪调查,未见种植体有松动和脱落,X线片显示未发现种植体周围有阴影存在,种植后修复效果良好,美观效果佳。结论:三维影像医学检查设计辅以3D手术导板引导牙种植术手术简便,易于美观且效果好,手术创伤小,患者不适感相对小,值得临床借鉴和参考。     

Assessing the mechanism of response in the retrosplenial cortex of good and poor navigators

The retrosplenial cortex (RSC) is consistently engaged by a range of tasks that examine episodic memory, imagining the future, spatial navigation, and scene processing. Despite this, an account of its exact contribution to these cognitive functions remains elusive. Here, using functional MRI (fMRI) and multi-voxel pattern analysis (MVPA) we found that the RSC coded for the specific number of permanent outdoor items that were in view, that is, items which are fixed and never change their location. Moreover, this effect was selective, and was not apparent for other item features such as size and visual salience. This detailed detection of the number of permanent items in view was echoed in the parahippocampal cortex (PHC), although the two brain structures diverged when participants were divided into good and poor navigators. There was no difference in the responsivity of the PHC between the two groups, while significantly better decoding of the number of permanent items in view was possible from patterns of activity in the RSC of good compared to poor navigators. Within good navigators, the RSC also facilitated significantly better prediction of item permanence than the PHC. Overall, these findings suggest that the RSC in particular is concerned with coding the presence of every permanent item that is in view. This mechanism may represent a key building block for spatial and scene representations that are central to episodic memories and imagining the future, and could also be a prerequisite for successful navigation.