Australasian experience and trials in sentinel lymph node biopsy: the RACS SNAC trial

PURPOSE: Sentinel lymph node biopsy (SLNB) has been rapidly adopted by surgical oncologists in the management of invasive breast cancer. This study reviews the Royal Australasian College of Surgeons (RACS) Sentinel Node versus Axillary Clearance (SNAC) trial and reports an interim analysis of the first 150 subjects. Other currently open multi-institutional randomized trials in SLNB are reviewed. METHODS: The SNAC trial is a multicentre, centrally randomized, phase III clinical trial. Subjects are randomized to SLNB alone (with completion axillary clearance, AC, for sentinel node-positive patients) or AC plus SLNB, with stratification according to age (< 50 years, more than or equal to 50 years), primary tumour palpability (palpable vs impalpable), lymphatic mapping technique (blue dye plus scintigraphy vs blue dye alone) and centre. RESULTS: The trial was launched in May 2001 in two centres. Randomization continues currently at the rate of approximately 30 subjects per month (total, 1,012 at the time of writing) from 32 participating centres in Australia and New Zealand. Data from the first 150 subjects have been analysed to assess: compliance with randomized treatment allocation; measures of test performance for SLNB (detection, removal, sensitivity, specificity and false-negative rates); measures of arm volume, function, symptoms and quality of life; and sample size estimates. CONCLUSIONS: The SNAC trial is one of the fastest accruing clinical trials in Australasia. It is on track to determine whether differences in morbidity, with equivalent cancer-related outcomes, exist between SLNB and AC for women with early breast cancer.     

BS06PATIENT‐RATED OUTCOME MEASURES WERE MORE SENSITIVE THAN CLINICIAN‐RATED MEASURES AT DISTINGUISHING THE EFFECTS OF SENTINEL NODE BIOPSY AND AXILLARY CLEARANCE IN THE SNAC TRIAL

Purpose We sought to determine which outcome measures were most sensitive at detecting the benefits of Sentinel node based management (SNBM) over routine axillary clearance (RAC) in the SNAC trial. Patients and Methods 1088 women with early breast cancer were randomised to either SNBM or RAC. The primary endpoint was the percent increase in arm volume based on clinicians’ measurements of arm circumference at 10cm intervals. Secondary endpoints included patients self‐ratings of arm swelling and other aspects of quality of life, assessed using the SNAC Study Specific Scales (SSSS: 15 questions asking about symptoms, dysfunction and disabilities). We report a comparison of the relative sensitivity of these endpoints in detecting differences between the treatment groups. Results Patients’ ratings on the SSSS were 3.2 times as sensitive as clinicians’ ratings of arm swelling, requiring 68% fewer patients to detect a given treatment effect. The 7 questions asking patients about symptoms were most sensitive. Questions asking about dysfunctions and disabilities were less sensitive. Conclusion Patient‐rated measures were more sensitive in this trial than clinician‐rated measures at distinguishing the effects of SNBM and RAC. Similar trials would require only a third as many patients if the primary endpoint was rated by patients rather than clinicians.     

Prospective 3D ultrasonographic evaluation of immediate postpartum urine retention volume in 100 women who delivered vaginally

Our objective was to determine the reproducibility and validity of urine retention volumes measured by 3D ultrasonography (3D-US) 2 h postpartum. This was a longitudinal prospective study of 100 women who delivered vaginally. Each woman underwent five successive urine retention measurements with the Bladder Scan 2 h after vaginal delivery, followed by transurethral catheterization to determine the real volume. The reproducibility of only the last four scan values was analyzed with an intraclass correlation coefficient, and that of determinations 4 and 5 with a Bland-Altman plot. The validity of the device was similarly evaluated using the mean four-scan and real values. Pearson's correlation coefficient was calculated and a least-trimmed squares robust linear-regression model was used. All tests were two-sided with a 5% alpha risk. Results showed that 3D-US measurements were highly reproducible, with an intraclass correlation coefficient of 0.974 (95% CI:0.964-0.981). 3D-US also accurately estimated the real urine volume (intraclass correlation coefficient 0.924; 95% CI:0.888-0.949), but tended to underestimate by about 6.8%. The between-technique Pearson correlation coefficient was 0.94 (P < 0.0001) and the regression analysis gave an R2 of 0.914. Urine retention volumes exceeded 500 ml in 55 women, and 11 in 7. We concluded that 3D-US was reliably able to measure postpartum urine retention volume.     

三维扫描技术检测呼吸状态对乳房整形术后体积变化的影响

目的：通过三维扫描技术,检测呼吸状态对乳房整形术后体积变化的影响。方法自2010年1月至2010年12月,随机选取20例假体隆乳术后患者作为研究对象,在不同呼吸状态下接受3次乳房三维扫描：自然呼气末（Scan 1）、自然吸气末（Scan 2）和自然呼气末（Scan 3）。使用计算机软件测量Scan 1和Scan 3之间（R1）、Scan 1和Scan 2之间（R2）的乳房体积变化和三维偏差,并检测乳房体积变化与三维偏差的相关系数。结果本组术后乳房平均体积为（354.1±53.9） mL;R1的乳房体积变化和三维偏差均明显小于R2（9.9 mL VS 22.7 mL,P〈0.05;0.9 mm VS 1.7 mm,P〈0.05）;R1的乳房体积变化与三维偏差无明显相关（P〉0.05）,但是R2的乳房体积变化与三维偏差明显正相关,相关系数为0.766（P〈0.05）。结论保持乳房三维扫描时呼吸状态的一致性,对于准确测量乳房体积变化具有重要意义。     

Renal structure in early autosomal-dominant polycystic kidney disease (ADPKD): The Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) cohort

BACKGROUND: Autosomal-dominant polycystic kidney disease (ADPKD) is characterized by gradual renal enlargement and cyst growth prior to loss of renal function. Standard radiographic imaging has not provided the resolution and accuracy necessary to detect small changes in renal volume or to reliably measure renal cyst volumes. The Consortium for Radiologic Imaging Studies in Polycystic Kidney Disease (CRISP) is longitudinally observing ADPKD individuals using high-resolution magnetic resonance (MR) imaging to determine if change in renal and cyst volumes can be detected over a short period of time, and if they correlate with decline in renal function early in disease. METHODS: Standardization studies were conducted in phantoms and four subjects at each participating clinical center. After, in the full-scale protocol, healthy ADPKD individuals 15 to 45 years old with creatinine clearance>70 mL/min underwent standardized MR renal imaging, renal iothalamate clearance, comprehensive clinical evaluation, and determination of 24-hour urinary albumin and electrolyte excretion. Stereology was used from T1-weighted images to quantify renal volume, and region-growing thresholding was used from T2-weighted images to determine cyst volume. Renal structures were evaluated in relation to demographic, clinical, and biochemical variables using means/medians, standard deviations, and Pearson correlations. RESULTS: Reliability coefficients for MR renal and cyst volume measurements in phantoms were 99.9% and 89.2%, respectively. In the full-scale protocol, 241 ADPKD individuals (145 women and 96 men) were enrolled. Total renal, cyst, and % cyst volume were significantly greater in each decade group. Hypertensive individuals demonstrated greater renal, cyst, and % cyst volume than normotensive subjects. Age-adjusted renal (r = -0.31, P < 0.0001), cyst (r = -0.36, P < 0.0001), and % cyst volume (r = -0.35, P < 0.0001) were inversely related to glomerular filtration rate (GFR). Age-adjusted renal volume (r = 0.42, P < 0.0001), cystic (r = 0.39, P < 0.0001, and % cyst volume (r = 0.41, P < 0.0001) were related with urinary albumin excretion. CONCLUSION: MR measures of renal and cyst volume are reliable and accurate in patients with ADPKD. ADPKD is characterized by significant cystic involvement that increases with age. Structure (renal and cyst volume) and function (GFR) are inversely related and directly related with the presence of hypertension and urinary albumin excretion in individuals with normal renal function.     

Trends but Not Individual Values of Central Venous Oxygen Saturation Agree with Mixed Venous Oxygen Saturation during Varying Hemodynamic Conditions

Background: Previous studies found contradictory results regarding the question whether mixed venous oxygen saturation (Svo2) and central venous oxygen saturation (Scvo2) are equivalent. The inconsistency of study results may result from different study designs and different, partly questionable, statistical approaches.

Methods: The authors performed a prospective clinical trial comparing individual oxygen saturation values as well as the trend of values in blood from the superior vena cava (Scvo2), the right atrium (Srao2), and the pulmonary artery (Svo2) during varying hemodynamic situations. The subjects were 70 patients scheduled to undergo elective neurosurgical operations in the sitting position. Oxygen saturation was measured photospectrometrically in blood samples simultaneously taken at four different time points during supine and sitting positions. Statistical analysis was performed following the recommendations of Bland and Altman.

Results: Five hundred two comparative sets of measurements were obtained. Ninety-five percent limits of agreement ranging from +/-6.83 to +/-9.30% for single values were interpreted as clinically unacceptable. In contrast, correlations between changes of Svo2 and Scvo2 as well as of Svo2 and Srao2 were interpreted as clinically acceptable (R >= 0.755, Pearson correlation coefficient; P <= 0.0001).     

Hyperinsulinaemia as a risk factor for developing benign prostatic hyperplasia

OBJECTIVE: To determine the validity coefficient of the total prostate gland volume as an expression of the transition zone (TZ) volume. To test the hypothesis of hyperinsulinaemia as a causal factor for the development of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Three hundred and seven consecutive patients with lower urinary tract symptoms were studied. A subgroup of 114 patients were tested with regard to the validity coefficient between the total prostate gland volume and the TZ volume. In the total material of 307 men, a BPH risk factor analysis was performed in which groups of men with the following conditions were related to the annual BPH growth rate: men without or with metabolic disease; men with different components of the metabolic syndrome, and men with low or high fasting plasma insulin values. The prostate gland volume and the TZ volume were determined using ultrasound. The presence of non-insulin-dependent diabetes mellitus (NIDDM) and treated hypertension was obtained from the patients' medical records. Data on blood pressure, waist and hip measurement, body height and weight were collected and body mass index and waist/hip ratio were calculated. Blood samples were drawn from fasting patients to determine the insulin and HDL-cholesterol values. RESULTS: In the subgroup of men subjected to measurement of both the total prostate gland volume and the TZ volume, the correlation coefficient between total prostate gland volume and the TZ volume was r.s. = 0.97 (p < 0.0001) which, thus, constituted the validity coefficient. The median annual BPH growth rate in the total group was 1.03 ml/year. The median annual BPH growth rate was faster in men with metabolic disease (p < 0.0001), NIDDM (p < 0.0001), treated hypertension (p < 0.0001), obesity (p < 0.0001) and dyslipidaemia (p < 0.0001) than in men without metabolic disease. Moreover, the annual BPH growth rate correlated positively with the diastolic blood pressure (r.s. = 0.27; p < 0.001), the BMI (r.s. = 0.22; p < 0.001) and four other expressions of obesity, and negatively with the HDL-cholesterol level (r.s. = -0.15; p < 0.001). The median annual BPH growth rate was faster in men with a high than in men with a low fasting plasma insulin level (p = 0.019). When the patients were divided into quartiles, the median annual BPH growth rate increased statistically significantly with increasing fasting plasma insulin levels. The fasting plasma insulin values correlated with the annual BPH growth rates (p = 0.009). When performing a multivariate analysis using the total prostate gland volume as dependent variable, fasting plasma insulin (p = 0.001) and age (p < 0.001) became statistically significant. CONCLUSION: The results of the present report suggest that the total prostate gland volume constitutes a valid expression of BPH. The findings support the hypothesis that hyperinsulinaemia is causally related to the development of BPH and generate the hypothesis of an increased sympathetic nerve activity in men with BPH.     

Gastrointestinal symptoms impair quality of life in Italian renal transplant recipients but are under‐recognized by physicians

We assessed patient‐ and physician‐reported prevalence of gastrointestinal symptoms and their impact on quality of life (QOL) in Italian renal transplant recipients with stable graft function. Patients ≥18 years with a renal allograft functioning for ≥6 months and stable serum creatinine levels of <2.5 mg/dl were enrolled. Physicians and patients completed an Italian translation of the Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) questionnaires. The average time since transplantation (n = 1130) was 5.9 years. Forty‐two immunosuppressant drug regimens were reported. The top three regimens (cyclosporine/mycophenolate mofetil/steroids; tacrolimus/mycophenolate mofetil/steroids; cyclosporine/steroids) accounted for approximately 40% of patients. In the physician interview, 39.2% of patients had ≥1 gastrointestinal symptom vs. 88.3% of patients in the self‐administered questionnaire. The prevalence of GSRS symptoms was similar for each of the most frequently prescribed immunosuppressant drug regimens. GIQLI total score was significantly poorer in patients with versus those without gastrointestinal symptoms (121.8 ± 17.6 vs. 138.4 ± 3.7; P < 0.0001), and there was a strong inverse correlation between GIQLI and patient‐reported GSRS scores (Pearson’s correlation coefficient ?0.816; P < 0.0001). Gastrointestinal symptoms are frequent in renal transplant patients, are under‐evaluated by physicians and may adversely impact on patient QOL.     

Evaluation of vertebral volumetric vs. areal bone mineral density during growth

Bone mineral “density” (BMD) measured by dual-energy X-ray absorptiometry (DEXA) does not represent the volumetric density (grams per cubic centimeter), but rather the areal density (grams per square centimeter). This distinction is important during growth. The purpose of this study was to measure vertebral dimensions in cadavers of young pigtail macaques (Macaca nemestrina), and to derive equations to predict the volumetric bone density from noninvasive measurements. We measured the areal bone density by DEXA, vertebral volume by underwater weighing, mineral content by ashing, dimensions of lumbar vertebrae by calipers, and dimensions of vertebrae by radiography. Somatometric measurements of the female lumbar vertebral bodies showed that the shape changed during growth. The bone mineral content from the densitometer correlated significantly with the ash weight (r = 0.99, error 8.7%). The correlation coefficient between the volumetric bone mineral density and areal BMD measurement was significant (r = 0.68, p < 0.0001) with a 9.5% error; this improved significantly to 0.82 (7.2% error) when the BMD was divided by the vertebral depth from the radiograph. Areal BMD showed a strong correlation with age (r = 0.82, p < 0.0001), with an average increase of 7.4%/year. In contrast, volumetric mineral density showed a weak relationship with age (r = 0.43, p < 0.01), for an average increase of 1.5%/year. When studying bone mineral density during growth, the differences between volumetric and areal bone mineral density should be taken into consideration. (     

Relationship between laboratory parameters and intensive care unit stay post-liver transplantation: proposal of a model

The aim of this study was to create a model that forecasted the stay in the intensive care unit in post-liver transplantation. METHODS: Twenty-three consecutive patients who underwent liver transplantation provided samples for serum sodium, serum creatinine, total bilirubin, cholesterol, aspartate and alanine aminotransferase, alkaline phosphatase (ALP), albumin, and platelet count for correlation together with age at transplantation in a Pearson correlation model with intensive care unit stay. Multivariate analysis used a regression model to evaluate the relationship between the dependent variable "intensive care unit stay" and the predictor variables that were correlated by a Pearson correlation test. To test the acceptability and strength of the model, analyses of variance was performed and a multiple correlation coefficient R was calculated for the model. RESULTS: Pearson correlation test showed a strong correlation between intensive care unit stay and creatinine (correlation coefficient = 0.34, P = .03), serum sodium (correlation coefficient = -0.42, P < .01), and total bilirubin (correlation coefficient = -0.29, P = .06). Other variables showed no significant correlation, namely correlation coefficients < 0.24 (P > .1). The final model to evaluate the relationship between the dependent variable "intensive care unit stay" and laboratory parameters included ALP, serum creatinine, serum sodium, and total bilirubin as well as a correction for age. CONCLUSIONS: The most significant parameters were total bilirubin, serum creatinine, and serum sodium. The proposal model significantly correlated with the variable "intensive care unit stay." Such data are particularly important since increased intensive care unit stay correlates with a significant reduction in 1-year survival rate.     

Patient perceived outcome after central corpectomy for cervical spondylotic myelopathy

BACKGROUND: Patient perception of outcome after decompressive surgery for CSM is infrequently reported. We evaluated a simple, quantitative patient-reported assessment of outcome after CC for CSM by comparing it with the NGRR. METHODS: In a prospective study between 1994 and 2004, patients who underwent CC for CSM were asked to quantify the outcome (relative to their preoperative status) on a scale of 0 to 100. Patient perceived outcome score was compared with the NGRR (preoperative grade - postoperative grade / preoperative grade x 100) at the same follow-up. RESULTS: A total of 208 patients with a follow-up ranging from 6 to 72 months (mean, 16.3 months) were evaluated. There was a good positive correlation between PPOS and NGRR for the whole group (Pearson correlation coefficient, 0.62; P < .001), good-grade patients (preoperative Nurick grade of 1-3) (Pearson correlation coefficient, 0.52; P < .001), and poor-grade patients (Pearson correlation coefficient, 0.79; P < .001); the correlation was strongest in the poor-grade group of patients. kappa statistic revealed moderate agreement between the 2 scores in the whole group (kappa = 0.45), substantial agreement in the poor-grade patients (kappa = 0.61), and fair agreement in the good-grade patients (kappa = 0.34). In 28 of the 208 patients (13.5%), there was no agreement between the 2 scores with a significantly greater proportion (24/28), reporting an improvement in spite of no change in their Nurick grade (McNemar chi(2) test, P = .0002). CONCLUSIONS: Although there was good agreement and a positive correlation between PPOS and NGRR, the disagreement in 13.5% of patients suggests that the 2 scores are evaluating some dissimilar functional domains; therefore, PPOS provides additional independent data in the assessment of the results of decompressive surgery for CSM. Patient-reported outcome should be included in reporting outcome of decompressive surgery for CSM.     

Comparison of noninvasive continuous arterial waveform analysis (Nexfin) with transthoracic Doppler echocardiography for monitoring of cardiac output

Study ObjectivesTo compare the Nexfin cardiac output (CO) with the CO obtained from transthoracic Doppler echocardiography (TTE) during routine cardiac function screening.DesignObservational clinical study.SettingEchocardiography laboratory.Patients40 ASA physical status 1 and 2 patients scheduled for routine TTE examination.InterventionsNone.Measurements and Main ResultsIn 40 patients scheduled for routine TTE examination, we obtained simultaneous CO measurements with Doppler ultrasound and derived from Nexfin blood pressure measurements. Correlation and level of agreement between Nexfin and TTE were analyzed using Pearson correlation coefficient and Bland-Altman plots. The Pearson correlation coefficient for Nexfin versus TTE was 0.68 (CI: 0.46 - 0.82, P < 0.0001). Bland-Altman analysis showed a bias of 0.51 ± 1.1 L/min and limits of agreement of -1.6 to 2.6 L/min, with a percentage error of 39%.ConclusionsConsidering limits of precision of CO measurements with Doppler echocardiography (± 30%), the agreement between noninvasive CO measurement with the Nexfin and TTE is reasonable.     

The anisotropic hydraulic permeability of human lumbar anulus fibrosus. Influence of age, degeneration, direction, and water content

STUDY DESIGN: Experimental investigation to determine the effect of intervertebral disc degeneration on the kinetic behavior of fluid in human anulus fibrosus. OBJECTIVES: To measure the hydraulic permeability coefficient of anulus fibrosus specimens in the axial, circumferential, and radial directions to determine the anisotropic permeability behavior of nondegenerate and degenerate human intervertebral discs over a range of ages. SUMMARY OF BACKGROUND DATA: Fluid, a major component of normal intervertebral discs, plays a significant role in their load-supporting mechanisms. Transport of fluid through the intervertebral disc is important for cell nutrition and disc viscoelastic and swelling behaviors. The hydraulic permeability coefficient is the most important material property governing the rate of fluid transport. However, little is known about the anisotropic behavior of this kinetic property and how it is influenced by disc degeneration. METHODS: Using a permeation testing apparatus developed recently, testing was performed on 306 axial, circumferential, and radial anulus fibrosus specimens from the posterolateral region of 30 human lumbar (L2-L3) discs. A new method, flow-controlled testing protocol, was developed to measure the hydraulic permeability coefficient. RESULTS: The hydraulic permeability coefficient of anulus fibrosus depended significantly on the disc degenerative grade (P = 0.0001) and flow direction (P = 0.0001). For the nondegenerate group (Grade I), the hydraulic permeability was significantly anisotropic (P < 0.05), with the greatest value in the radial direction (1.924 x 10(-15) m4/Ns) and the lowest value in the circumferential direction (1.147 x 10(-15) m4/Ns). This anisotropic kinetic (flow) behavior of anulus fibrosus varied with disc degeneration. For the Grade III specimen group, there was no significant difference in hydraulic permeability coefficient among the three major directions (P = 0.37). With disc degeneration, the hydraulic permeability coefficient was decreased in the radial direction and increased in the axial and circumferential directions. The variations of hydraulic permeability coefficient from nondegenerate discs (Grade I) to mildly degenerate discs (Grade II) in each direction were significant (P < 0.05). However, the changes in permeability from Grade II to Grade III groups were not significant (P > 0.05) except in the circumferential direction (3.8% increase; P < 0.05). CONCLUSIONS: The hydraulic permeability of human nondegenerate anulus fibrosus is direction-dependent (i.e., anisotropic), with the greatest permeability in the radial direction. With disc degeneration, the radial permeability of anulus fibrosus decreases, mainly because of decreased water content, and the axial and circumferential permeability coefficients increase, mainly because of structural change, leading to more isotropic permeability behavior for Grade III discs.     

Accurate assessment of breast volume: a study comparing the volumetric gold standard (direct water displacement measurement of mastectomy specimen) with a 3D laser scanning technique

Preoperative assessment of breast volume could contribute significantly to the planning of breast-related procedures. The availability of 3D scanning technology provides us with an innovative method for doing this. We performed this study to compare measurements by this technology with breast volume measurement by water displacement. A total of 30 patients undergoing 39 mastectomies were recruited from our center. The volume of each patient's breast(s) was determined with a preoperative 3D laser scan. The volume of the mastectomy specimen was then measured in the operating theater by water displacement. There was a strong linear association between breast volumes measured using the 2 different methods when using a Pearson correlation (r = 0.95, P < 0.001). The mastectomy mean volume was defined by the equation: mastectomy mean volume = (scan mean volume × 1.03) -70.6. This close correlation validates the Cyberware WBX Scanner as a tool for assessment of breast volume.     

A simpler device for measuring the mobility of the first ray of the foot

BACKGROUND: Since some devices can be cumbersome to use, we evaluated the validity and reliability of a specially designed device for easily checking the mobility of the first ray of the foot. MATERIALS AND METHODS: To analyze the validity of the device, the dorsal mobility of the first ray of the foot was measured with the modified Coleman block test developed by Fritz et al., the Klaue device, and the custom device. Two-tailed Student's paired t-test and Pearson correlation were used to compare the values of the two tests. For evaluation of inter- and intra observer reliability of the EMC device, 3 independent observers measured the dorsal mobility of the first ray of the foot twice. The results were analyzed with two-tailed Student's paired t-test and ANOVA to evaluate intraobserver and interobserver reliability, respectively. RESULTS: For both the first and second examinations of reliability, the difference between the two values was significant (p < 0.05) for the Coleman block test but not significant (p = 0.118) in comparison with the Klaue device. The measurements from both examinations showed good correlation (Pearson correlation coefficient: comparison with the Coleman block test = 0.84 (p < 0.05), with the Klaue device = 0.92 (p < 0.05)). The paired t-test for intraobserver validity showed no statistically significant difference among observers (p = 0.52, 0.58, 0.96, Pearson correlation coefficient = 0.76, 0.79, 0.80), and ANOVA testing for interobserver reliability showed no significant difference either (p = 0.96, Pearson correlation coefficients = 0.83, 0.84, and 0.86, respectively). CONCLUSION: This study demonstrated that the EMC device is both reliable and valid for measuring the mobility of the first ray of the foot.     

Comparison between manual and semiautomated volumetric measurements of pituitary adenomas

Linear measurements have many limitations. The aim of this study is to compare manual and semiautomated volumetric measurements of pituitary adenomas. Magnetic resonance imaging (MRI) scans of 38 patients with pituitary adenomas were analyzed. Preoperative MRI was acquired on a 1.5 T. MRI volumes of the pituitary adenomas were obtained by two methods: manual (MA) and semiautomated (SA). The concurrent validity for SA and MA methods on 38 patients in the form of correlation coefficient was 0.97 (p < 0.0001). The intraobserver and the interobserver correlation coefficients for SA volumes were both 0.98, as for the intraobserver MA volumes were 0.98. Although the results of both methods are comparable, analysis of volumetric measurements by SA method is more time-efficient than MA segmentation. Precision in volumetric measurement techniques is likely to increase reliability of posttherapeutic monitoring of pituitary adenomas.     

Determination of postvoid residual by translabial ultrasound

Introduction and hypothesis

Urogynaecological assessment routinely includes determination of postvoid residual urine volume (PVR). This study was designed to generate a formula for determining PVR by translabial ultrasound (US).

Methods

This was an observational study using imaging data obtained during urodynamic testing between July 2009 and November 2010. Bladder dimensions were determined by translabial US (midsagittal plane) and blinded against PVR on catheterisation. The relationship between PVR and bladder dimensions was modelled using linear regression. Predictive performance was quantified using Pearson??s correlation and R ² statistic.

Results

In 207 individuals, 243 PVRs were obtained by catheterisation (0?C650?ml). An optimal regression model comprised the product of height and depth US measurements and a coefficient of 5.59 [95?% confidence interval (CI): 5.41?C5.76, p?<?0.0001)] This regression equation yielded an R ²?=?0.94; Pearson??s correlation was 0.97.

Conclusions

Translabial US is a convenient and accurate method for measuring PVR. We propose the formula height?×?depth?×?5.6?=?postvoid residual in millilitres.     

Association of upper arm circumference at muscle flexion with lumbar spine bone mineral density

We investigated the association of upper arm circumference at muscle flexion with lumbar spine (L2–L4) bone mineral density (BMD) in 252 postmenopausal Japanese women (mean age, 62.0 ± 7.6 years; range, 43–78 years) with right-side dominance. Age, age at menopause, years since menopause (YSM), weight, and height were recorded. Dominant upper arm circumference (cm) was measured at muscle flexion. Lumbar spine BMD was measured by dual-energy X-ray absorptiometry (DXA). Correlations between BMD and variables were determined using Pearson's correlation coefficient. Significant predictors of the lumbar spine BMD were determined using stepwise multiple regression analysis. Upper arm circumference, weight, and height were positively correlated with BMD (r = 0.397, 0.343, and 0.323, respectively), whereas YSM and age were inversely correlated with BMD (r = −0.415 and −0.392, respectively). On stepwise multiple regression analysis, YSM, upper arm circumference, and weight were significant predictors of BMD (R ² = 0.322, P < 0.0001). Predicted value of the lumbar spine BMD was calculated by the following formula: Predicted BMD = 0.249 − 0.0078 (YSM) + 0.016 (upper arm circumference) + 0.0046 (weight). Dominant upper arm circumference at muscle flexion in combination with YSM and weight is a useful predictor of lumbar spine BMD. Received: July 21, 1998 / Accepted: April 1, 1999     

Reducing distress for children during invasive procedures: randomized clinical trial of effectiveness of the PediSedate®

Background: Procedural pain control remains problematic for young children, especially during anxiety‐causing procedures for which children should not be deeply sedated. The PediSedate^® was designed to address this problem by delivering nitrous oxide in oxygen through a simple nosepiece, combined with an interactive video component, so that children can use attention and distraction with drug delivery. Objectives: We conducted a randomized clinical trial to evaluate the effectiveness of the PediSedate^® for reducing children’s behavioral distress in comparison with standard care in the emergency department. Secondary objectives were to assess children’s acceptance, cooperation, and pain. Methods: Thirty‐six children, aged 3–9 years old, who required invasive procedures associated with high levels of anxiety and low levels of pain such as sutures, IVs, and lumbar punctures were randomized to receive either the standard care or the PediSedate^®. The primary outcome was children’s distress (observational scale of behavioral distress) that was monitored before and during the procedure. Results: Children randomized to the PediSedate^® group had significantly less distress during invasive procedures (mean = 1.8, sd = 3.2) than children receiving standard care (mean = 9.3, sd = 5.6; anova , P < 0.0001). Also, children in the PediSedate^® group were more cooperative [χ²(1) = 22.05, P < 0.0001] and fewer children reported pain [χ²(1) = 14.45, P < 0.001]. Conclusions: Previous studies have demonstrated the effectiveness of nitrous oxide sedation alone for minimizing pain and distress during invasive procedures. We have found that delivering nitrous oxide sedation via a system combined with an interactive video component is also effective. Further studies should determine which factors are dominant and determine the specific failure rate for this delivery system in comparison with other systems.     

A new computer tool for systematic evaluation of intracranial volume and its capacity to evaluate the result of the operation for metopic synostosis

Abstract

The aim of this project was to develop a tool for systematic evaluation of volumetric changes after surgery for craniosynostosis. A computer program using MATLAB was developed to measure total intracranial volume and frontal volume, anterior to the coronary sutures, by multiplying the area with slice thickness of each slice from just above foramen magnum to just beneath the vertex in CT examinations. The ratio between frontal volume and total volume was used for evaluation of the clinical result in 12 patients operated on for metopic synostosis. In 0.625 and 5 millimetre slices the coefficients of variation were 0.00049 and 0.00058, respectively, for measurements of total volume. The highest coefficient of variation was found in postoperative measurements of the frontal volume and was 0.014 in 0.625 millimetre slices. Measurements in 5 millimetre slices resulted in 3.8% ± 1.5% (mean ± SD) lower total volumes and 5.8% ± 5.3% lower frontal volumes than measurements in 0.625 millimetre slices. In patients operated on for metopic synostosis the ratio between frontal volume and total volume increased 25% ± 16% for patients operated on with cranioplasty in combination with a spring (n = 6) and 20% ± 13% for patients operated on with cranioplasty in combination with a bone transplant (n = 6). In summary, this study has developed a tool that can determine frontal and total intracranial volume with little variation. This tool can be used for systematic evaluation of the result of the operation for metopic synostosis.