Argon beam coagulation for post-tonsillectomy hemostasis.

OBJECTIVE: The study goal was to evaluate the effectiveness of argon beam coagulation (ABC) in the prevention of post-tonsillectomy hemorrhage. ABC provides monopolar coagulation by arcing ionized argon gas to the target tissue; it is not a laser. METHODS: Two consecutive studies were performed as follows. In the first, a retrospective analysis of post-tonsillectomy bleeding in 344 patients was conducted. Final tonsil fossa hemostasis was achieved with ABC (257 patients) or with electrocoagulation (EC) (87 patients). In the second, a prospective, randomized, patient-blind study of post-tonsillectomy bleeding was conducted in 88 patients. Final hemostasis was achieved using ABC in one fossa and EC in the other fossa, with the sides chosen at random. RESULTS: Post-tonsillectomy hemorrhage was defined as the expectoration of fresh blood, as opposed to blood-streaked saliva. The rates of bleeding for the 2 studies were as follows. In study 1 for EC, 20% for adults, 6.5% for children, and 10.3% for total; for ABC, 4.7% for adults, 0.6% for children, and 1.9% for total. In study 2 for EC, 19.2% for adults, 1.6% for children, and 6.8% for total; for ABC, 7.7% for adults, 0.0% for children, and 1.1% for total. The rates of hospital admission for observation or reoperation to treat the bleeding in study 1 for EC were 8% for adults, 6.5% for children, and 6.9% for total; for ABC, 1.2% for adults, 0.6% for children, and 0.7% for total. Corresponding rates for study 2 for EC were 15.4% for adults, 1.6% for children, and 5.7% for total; for ABC, 3.8% for adults, 0.0% for children, and 1.1% for total. CONCLUSION: ABC is more effective than EC for hemostasis after tonsillectomy. The costs of ABC use vs the savings achieved from reduced bleeding are discussed.     

The effects of granulocyte colony-stimulating factor on the healing of tracheal anastomosis following radiation therapy in rats

Objective: This study evaluates the effects of granulocyte colony-stimulating factor on the healing of tracheal anastomosis following radiation therapy in rats. Methods: Fifty-six male Wistar rats were divided into four groups. Group 1 underwent tracheal anastomosis. Group 2 underwent radiation therapy followed by tracheal anastomosis. Group 3 underwent radiation therapy followed by tracheal anastomosis and received granulocyte colony-stimulating factor. Group 4 underwent sham radiation therapy followed by sham tracheal anastomosis. At 10 days following radiation therapy, the trachea was dissected for histopathological, mechanical and biochemical evaluation. Results: Median scores for inflammation were three points for Group 1, two points for Group 2, two points for Group 3 and one point for Group 4. Median scores for angiogenesis were four points for Group 1, two points for Group 2, three points for Group 3 and one point for Group 4. Median scores for connective tissue regeneration were four points for Group 1, two points for Group 2, three points for Group 3 and one point for Group 4. Median scores for epithelial regeneration were two points for Group 1, one point for Group 2, one point for Group 3 and one point for Group 4. Mean anastomotic bursting pressures were 853 mmHg for Group 1, 293 mmHg for Group 2, 417 mmHg for Group 3 and 966 mmHg for Group 4. Mean hydroxyproline concentrations were 159 μg/mg for Group 1, 177 μg/mg for Group 2, 120 μg/mg for Group 3 and 117 μg/mg for Group 4. Conclusions: This study suggests that granulocyte colony-stimulating factor contributes to the healing of tracheal anastomosis following radiation therapy through improved connective tissue regeneration.     

Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience.

We have reviewed 145 patients who underwent 148 total reconstructions of the hypopharynx and cervical esophagus between 1970 and 1989. The types and numbers of reconstruction included 45 deltopectoral (DP) flaps, 35 musculocutaneous (MC) flaps, 19 colon interpositions, 23 gastric transpositions, and 26 free jejunal transfers. Median hospitalization was 51 days for DP flaps, 24 days for MC flaps, 28 days for colon, 30 days for gastric, and 14 days for jejunum. Median resumption of oral intake was 92 days for DP flaps, 19 days for MC flaps, 12 days for colon, 13 days for gastric, and 9 days for jejunum. Functional failure, defined as the inability to maintain adequate nutrition without tube feedings, was 40% for MC flaps, 42% for colon interposition, 17% for gastric transposition, and 20% for free jejunal transfer. Microvascular free jejunal transfer has become our method of choice for reconstruction of the hypopharynx and cervical esophagus. Gastric transposition is an alternative when resection of the thoracic esophagus is necessary.     

Computer processing of genetic patient data]

A code form for genetic patient data has been devised for computer purposes. This form provides for the clinical and laboratory diagnosis of genetic diseases. A Hewlett-Packard 2100 computer is used for storage and retrieval of the data. Three programmes are currently in use for the retrieval of data, namely programme RETREV, for retrieval of individual patient records; programme STAT9A, for the classification of chromosome results of patients referred with similar clinical diagnoses; and programme STA12A, for classification of chromosome abnormalities and for correlation with the indication for referral and other data. The possibilities for expansion of the programmes are discussed.     

荧光原位杂交技术检测膀胱尿路上皮癌尿液的临床应用研究

目的：评价荧光原位杂交技术（fluorescence in situ hybridization,FISH）检测膀胱尿路上皮癌患者尿液的应用价值。方法：收集我院2007年10月-2009年4月期间77例膀胱尿路上皮癌患者、43例非尿路上皮癌的血尿患者（通过膀胱镜检查排除尿路上皮癌）和泌尿系良性疾病患者的晨尿,同时行FISH检测和尿脱落细胞学分析,再结合病理结果将两种方法进行比较。FISH检测使用荧光标记DNA探针混合物与细胞核上3、7、17号染色体着丝粒和9p16位点进行杂交。结果：FISH总的敏感度和特异度分别为89．6％和95．3％,G1-3各级的敏感度分别为76．1％、90．9％、100％,Ta、Tis、T1、T2-4各期的敏感度分别为55．6％、100％、88．9％、97．4％。尿脱落细胞学分析总的敏感度和特异度分别为37．7％和93．0％,G1-3各级的敏感度分别为0％、33．3％、78．3％,Ta、Tis、T1、T2-4各期的敏感度分别为11．1％、100％、14．8％、56．4％。结论：FISH比尿脱落细胞学提高了膀胱癌患者检测的敏感度,而特异度两者相近。FISH使低级别浅表型膀胱癌的准确率明显提高,几乎能检测出所有高级别的浸润型膀胱癌。相对于尿脱落细胞学,FISH检测更佳。     

Reasons for revision hip surgery: a retrospective review

The purpose of this study was to determine the indications for contemporary revision hip surgery in a consecutive series of patients. We retrospectively reviewed the clinical records and radiographs of 439 revision hip surgeries done between 1996 and 2003. Fifty-five percent of the surgeries were for aseptic loosening, 14% were for instability, 13% were for osteolysis around a well-fixed implant, 7% were for infection, 5% were for periprosthetic fracture, 3% were for conversion of a hemiarthroplasty, 1% was for psoas impingement, 1% was for loose recalled implants, and 1% was for implant fracture. As expected, aseptic loosening was the most common reason for revision surgery. Instability was a common reason for early revision whereas revision for osteolysis around a well-fixed implant was a more common reason for late revision.     

Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II--Clinical aspects and recommendations

We reviewed the incidence, risk factors, and clinical features of thromboembolic and ischemic events associated with diagnostic cerebral angiography, endovascular treatment of aneurysms using coils or balloons, angioplasty and stent placement to treat extracranial carotid artery stenosis, and embolization of arteriovenous malformations using glue or other embolic agents. We performed a cumulative analysis to determine the frequency and characteristics of these events and a subset analysis (whenever possible) to determine the benefits of various strategies for complication avoidance. Of the 1,547 patients who underwent Guglielmi detachable coil treatment, thromboembolic events were observed for 127 (8.2%), consisting of asymptomatic events for 12 patients, transient ischemic attacks for 29, and strokes for 86. The outcomes for the 86 patients with strokes were categorized as full recovery for 15, good recovery for 27, partial recovery for 19, no recovery for 11, death for 12, and undetermined outcome for 2. Of the 834 patients who underwent carotid angioplasty and stent placement, thromboembolic events were observed for 73 (8.8%), consisting of transient ischemic attacks for 26 patients and strokes for 47. The outcomes for the patients with strokes were categorized as full recovery for 20, good recovery for 15, partial recovery for 6, no recovery for 2, and death for 4. High rates of thromboembolic events were also observed with balloon occlusion of aneurysms (11%) or parent arteries (19%) and carotid angioplasty alone (5.9%). Arteriovenous malformation embolization was associated with an ischemic event/procedure rate of 9.4%. High rates of thromboembolic and ischemic complications, with subsequent morbidity and death, are associated with most endovascular procedures. Further research and the formulation of standard preventive guidelines may help to reduce these risks and improve the overall success of these procedures.     

Mortality from cardiovascular diseases in the various population groups in the Republic of South Africa

Cardiovascular mortality rates (MRs) for 1970 were calculated from Department of Statistics reports for the various populations of the RSA and showed that the MRs for chronic rheumatic heart disease were highest in Coloureds and lowest in Whites, the rates for Asians and Blacks being intermediate, and that a relatively high proportion of all cardiovascular deaths in the 15- 24-year group were due to this disease. It was also found that the pattern of cardiovascular diseases differed in the various population groups as follows: in White males the MRs for ischaemic heart disease (IHD) were high (4 times the rate for cerebrovascular disease (CVD). In White females the MRs for IHD and CVD were similar and accounted for most deaths from cardiovascular disease. The MRs for hypertensive disease were low in Whites. Asians in the older age groups had the highest MRs for IHD, CVD and hypertensive disease of all the population groups. The MRs for IHD of Asians in general exceeded those of Whites. Coloureds had high MRs for CVD, relatively high MRs for hypertensive disease and other forms of heart disease (mainly ill-defined heart disease) and relatively low MRs for IHD (compared with Asians and Whites). Blacks had high MRs for CVD and other forms of heart disease (mainly ill-defined heart disease), relatively high MRs for hypertensive disease and very low MRs for IHD. The MRs for cardiovascular diseases in Blacks are not reliable.     

SOLUBILITY OF HALOTHANE IN EQUINE TISSUES AT 37{degrees}C

The solubilities of halothane at a concentration of 0.77% v/vin 5% carbon dioxide in air at 37°C were determined fora variety of equine tissues. The mean values for the tissue/gaspartition coefficients for visceral tissue taken from 36 horseswere 5.42 for whole brain, 4.82 for grey matter, 7.41 for whitematter, 4.18 for myocardium, 2.76 for lung, 8.51 for liver,3.21 for kidney, 2.66 for gastrointestinal tract, 1.77 for bloodand 2.45 for spleen. The mean coefficients for eight differentmuscles taken from 23 horses ranged from 2.43 for extensor carpiradialis to 4.91 for psoas major. The values obtained were,with the exception of liver and brain, consistently lower thanvalues in the literature for rabbit, dog, man and ox. Statisticalanalysis indicated that the condition of a horse was importantin determining the solubility of halothane in its liver andmuscles. The type and sex of a horse appeared to be importantonly in respect of the solubility of halothane in the gastrointestinaltract. ^*Present address: Department of Medical Sciences, College ofVeterinary Medicine, University of Florida, Gainesville, Florida32610, U.S.A.     

Cardiotomy suction versus red cell spinning during repair of descending thoracic aortic aneurysms

Two consecutive series of patients undergoing repair of descending thoracic and thoracoabdominal aortic aneurysms with partial cardiopulmonary bypass and low systemic heparinization (activated coagulation time: ACT greater than 180 sec) for proximal unloading and distal protection were analyzed. During the surgical procedures, thoracic shed blood was recovered either with a red cell spinning autotransfusion device (n=10) or two pump suckers and Duraflo II heparin surface coated cardiotomy reservoirs (n=10). There were 5/10 acute lesions and 1/10 ruptures for the autotransfusion group versus 5/10 acute lesions and 2/10 ruptures for the cardiotomy group (NS). Extension of aortic resection (range 1-8) was 3.6+/-1.2 for autotransfusion versus 3.5+/-1.4 for cardiotomy suction (NS). Mean number of reimplanted patches for intercostal and visceral reperfusion was 0.3+/-0.6 for autotransfusion versus 0.6+/-1.0 for cardiotomy (NS). Perfusion time was 41+/-17 min for autotransfusion versus 60+/-19 min for cardiotomy (p less than 0.05) and cross clamp time was 33+/-14 min for autotransfusion versus 43+/-17 min for cardiotomy (p less than 0.01). Total heparin dose was for 9500+/-2100 IU for autotransfusion versus 9800+/-1300 IU for cardiotomy (NS). The mean of the lowest ACTs measured during perfusion was 281+/-121 sec for autotransfusion versus 258+/-58 sec for cardiotomy (NS). The total protamine dose given was 7800+/-2100 IU for autotransfusion versus 9700+/-1900 IU for cardiotomy (p less than 0.05). The volume of washed red cells prepared was 3186+/-1318 ml for autotransfusion versus 0 for cardiotomy (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

伴或不伴黄韧带骨化的胸椎和胸腰段椎间盘突出症的术式选择

目的 探讨伴或不伴黄韧带骨化的胸椎和胸腰段椎间盘突出症的术式选择.方法 2004年6月至2009年12月,手术治疗伴或不伴黄韧带骨化的胸椎和胸腰段椎间盘突出症患者31例,男22例,女9例;年龄24～71岁,平均54岁;病变节段T4～L2.根据Anand和Regan临床分类:2度1例,3a度2例,3b度3例,4度6例,5度19例;Frankel分级:B级2例,C级6例,D级11例,E级12例.18例不伴黄韧带骨化者行前路手术,采用椎体后缘切除、椎体后侧开槽或椎体次全切除减压并植骨内固定.13例伴有明显黄韧带骨化者行后路半关节突和全椎板切除减压术,未切除前侧突出的椎间盘.结果 前路术后发生硬膜囊撕裂1例,神经根袖损伤1例,肋间神经痛3例,肺不张1例,取髂骨区麻木2例.后路术后发生椎管内血肿1例,脑脊液漏2例,切口感染1例,肺部感染1例.随访6～48个月,平均18个月.末次随访时Frankel分级:C级3例,D级7例,E级21例;Anand和Regan分类:1度2例,2度1例,3a度1例,4度2例,5度10例,15例无明显症状.X线片示内固定均无失败,植骨融合良好.结论 胸椎和胸腰段椎间盘突出以脊髓前侧压迫为主者可选择前路椎体后侧开槽或椎体次全切除减压植骨融合术,伴黄韧带骨化导致脊髓前后侧压迫者可行后路半关节突和全椎板切除减压术.     

Porcine cardiac bioprostheses: evaluation of long-term results in 990 patients

Clinical results with porcine bioprostheses were reviewed for 990 patients who underwent heart valve replacement from January, 1974, to December, 1980. Eight hundred and seventy-four Hancock, 283 Carpentier-Edwards, and 10 Liotta bioprostheses were used. In 23 patients, 26 mechanical prostheses were implanted as well. Overall operative mortality was 60 out of 990 (6.06%): 30 out of 506 (5.9%) for mitral valve replacement (MVR), 13 out of 287 (4.5%) for aortic valve replacement (AVR), 1 out of 4 (25%) for tricuspid valve replacement, 0 out of 2 for pulmonary valve replacement, and 16 out of 191 (8.4%) for multiple valve replacement. Cumulative follow-up covered 1,793 patient-years. (Actuarial survival at 7 years was 76.6 +/- 3% for MVR. At 6 years, it was 83.2 +/- 2.8% for AVR and 55 +/- 13.5% for multiple valve replacement.) Prosthesis-related survival at 7 years was 91.7 +/- 1.9% for MVR, and at 6 years, it was 96.6 +/- 1.5% for AVR and 95.1 +/- 2.2% for multiple valve replacement. Bioprosthesis survival, considering deaths or complications that led to reoperation as final events, was 84.2 +/- 3.7% at 7 years for mitral valves and 87.7 +/- 3.8% at 6 years for aortic valves. Emboli per 100 patient-years numbered 3.2 for MVR, 0.5 for AVR, and 1.6 for multiple valve replacement. Twenty-seven patients underwent reoperation, 12 for perivalvular leak, 5 for endocarditis, 6 for valve thrombosis, and 4 for primary tissue failure (linearized rates of 0.7, 0.3, 0.3, and 0.2% per patient-year, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Interpretation of whole body dual energy X-ray absorptiometry measures in children: comparison with peripheral quantitative computed tomography

The assessment of bone health in children requires strategies to minimize the confounding effects of bone size on dual energy X-ray absorptiometry (DXA) areal bone mineral density (BMD) results. Cortical bone composes 80% of the total skeletal bone mass. The objective of this study was to develop analytic strategies for the assessment of whole body DXA that describe the biomechanical characteristics of cortical bone across a wide range of body sizes using peripheral quantitative computed tomography (pQCT) measures of cortical geometry, density (mg/mm³), and strength as the gold standard. Whole body DXA (Hologic QDR 4500) and pQCT (Stratec XCT-2000) of the tibia diaphysis were completed in 150 healthy children 6–21 years of age. To assess DXA and pQCT measures relative to age, body size, and bone size, gender-specific regression models were used to establish z scores for DXA bone mineral content (BMC) for age, areal BMD for age, bone area for height, bone area for lean mass, BMC for height, BMC for lean mass, and BMC for bone area; and for pQCT, bone cross-sectional area (CSA) for tibia length and bone strength (stress-strain index, SSI) for tibia length. DXA bone area for height and BMC for height were both strongly and positively associated with pQCT CSA for length and with SSI for length (all P < 0.0001), suggesting that decreases in DXA bone area for height or DXA BMC for height represent narrower bones with less resistance to bending. DXA BMC for age (P < 0.01) and areal BMD (P < 0.05) for age were moderately correlated with strength. Neither DXA bone area for lean mass nor BMC for lean mass correlated with pQCT CSA for length or SSI for length. DXA BMC for bone area was weakly associated with pQCT SSI for length, in females only. Therefore, normalizing whole body DXA bone area for height and BMC for height provided the best measures of bone dimensions and strength. DXA BMC normalized for bone area and lean mass were poor indicators of bone strength.     

Reoperation After Recurrent Groin Hernia Repair

OBJECTIVE: To analyze reoperation rates for recurrent and primary groin hernia repair documented in the Swedish Hernia Register from 1996 to 1998, and to study variables associated with increased or decreased relative risks for reoperation after recurrent hernia. METHODS: Data were retrieved for all groin hernia repairs prospectively recorded in the Swedish Hernia register from 1996 to 1998. Actuarial analysis adjusted for patients' death was used for calculating the cumulative incidence of reoperation. Relative risk for reoperation was estimated using the Cox proportional hazards model. RESULTS: From 1996 to 1998, 17,985 groin hernia operations were recorded in the Swedish Hernia Register, 15% for recurrent hernia and 85% for primary hernia. At 24 months the risk for having had a reoperation was 4.6% after recurrent hernia repair and 1.7% after primary hernia repair. The relative risk for reoperation was significantly lower for laparoscopic methods and for anterior tension-free repair than for other techniques. Postoperative complications and direct hernia were associated with an increased relative risk for reoperation. Day-case surgery and local infiltration anesthesia were used less frequently for recurrent hernia than for primary hernia. CONCLUSIONS: Recurrent groin hernia still constitutes a significant quantitative problem for the surgical community. This study supports the use of mesh by laparoscopy or anterior tension-free repair for recurrent hernia operations.     

Influence of decortication of the recipient graft bed on graft integration and tissue neoformation in the graft-recipient bed interface

The objective of the present study was to assess the influence of decortication of the posterior elements of the vertebra (recipient bed) and the nature of the bone graft (cortical or cancellous bone) on graft integration and bone, cartilage and fiber neoformation in the interface between the vertebral recipient bed and the bone graft. Seventy-two male Wistar rats were divided into four experimental groups according to the presence or absence of decortication of the posterior vertebral elements and the use of a cortical or cancellous bone graft. Group I—the posterior elements were decorticated and cancellous bone used. Group II—the posterior elements were decorticated and cortical graft was used. Group III—the posterior elements were not decorticated and cancellous graft was used. Group IV—the posterior elements were not decorticated and cortical graft was used. The animals were killed 3, 6 and 9 weeks after surgery and the interface between the posterior elements and the bone graft was subjected to histomorphometric evaluation. Mean percent neoformed bone was 40.8% in group I (decortication and cancellous graft), 39.13% in group II (decortication and cortical graft), 6.13% in group III (non-decorticated and cancellous graft), and 9.27% in group IV (non-decorticated and cortical graft) for animals killed at 3 weeks (P = 0.0005). For animals killed at 6 weeks, the mean percent was 38.53% for group I, 40.40% for group II, 10.27% for group III, and 7.6% for group IV (P = 0.0005), and for animals killed at 9 weeks, the mean was 25.93% for group I, 30.6% for group II, 16.4% for group III, and 18.73% for group IV (P = 0.0026). The mean percent neoformed cartilage tissue was 8.36% for group I, 7.46% for group II, 11.1% for group III, and 9.13% for group IV for the animals killed at 3 weeks (P = 0.6544); 6.6% for group I, 8.07% for group, 7.47% for group III and 6.13% for group IV (P = 0.4889) for animals killed at 6 weeks, and 3.13% for group I, 4.06% for group II, 10.53% for group III and 12.07% for group IV (P = 0.0006) for animals killed at 9 weeks. Mean percent neoformed fibrous tissue was 11% for group I, 6.13% for group II, 26.27% for group III and 21.87% for group IV for animals killed at 3 weeks (P = 0.0008); 7.67% for group I, 7.1% for group II, 9.8% for group III and 10.4% for group IV (P = 0.7880) for animals killed at 6 weeks, and 3.73% for group I, 4.4% for group II, 6.67% for group III and 6.8% for group IV (P = 0.0214) for animals killed at 9 weeks. The statistically significant differences in percent tissue formation were related to decortication of the posterior elements. The use of a cortical or cancellous graft did not influence tissue neoformation. Ossification in the interface of the recipient graft bed was of the intramembranous type in the decorticated animals and endochondral type in the non-decorticated animals.     

Venous cutdown for pacemaker implantation

Two hundred sixty-eight dual-chamber pacemaker implants using polyurethane leads for atrium and ventricle were analyzed for the vein of entry for both atrial and ventricular leads. The cephalic vein was used for both leads in 61.2%, the external jugular vein for both leads in 8.6%, both veins in 7.8%, and the subclavian vein alone in 16.4%. The total for venous cutdown alone was 77.6%. There were no complications relevant to the vein of approach for the venous cutdown leads, but there was one pneumothorax requiring thoracic intubation for the subclavian puncture route. Venous cutdown is satisfactory for dual-chamber pacing requiring two lead systems.     

Revisional Surgery for Severe Obesity with Fascia Banded Stoma Roux-en-Y Gastric Bypass

The fascia banded stoma Roux-en-Y gastric bypass (RYGBP) has been effective both as a primary and revision operation for severe obesity or failure of another operation. Since May 1984, 361 primary and 100 revisional fascia banded RYGBP operations have been reported. Weight loss achieved a mean body mass index of 30 for primary and 31 for revision patients at most recent follow-up of 3-6 years (mean 4.3 years) postoperatively. Mean overweight was 28% for primary, and 34% for revision patients. Eighty percent of primary and 79% of revision patients were within 50% of ideal weight. Revision rates for these patients were 0 for primary and 1% for revision patients. Operative mortality was 0 for primary and 1% for revision patients. Since morbidity and mortality, although low, are higher for revision than primary surgery, it is important to use an effective primary operation.     

The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: I. A comparison of computed tomography (CT), myelography, CT-myelography, discography, and CT-discography

The accuracy of five imaging modalities for the diagnosis of lumbar herniated nucleus pulposus (HNP) is compared prospectively in 124 patients, all of whom underwent surgical exploration. All tests were read independently of each other and the level of confidence in each diagnosis was recorded. The results are based on negative (106) as well as positive (125) findings at the 231 disc sites (level and side) explored. Computed tomography-discography (disco-CT) was the most accurate test (87%) compared to 77% for CT-myelography (myelo-CT), 74% for CT, 70% for myelography, 64% for disc injection pain, and 58% for discography. The false positive rate was lower for disco-CT (19%) than for myelo-CT (24%), CT (24%), and myelography (30%). The false negative rate was also lower for disco-CT (8%) than for myelo-CT (22%), CT (29%), and myelography (30%). Disco-CT was the most accurate test (94%) in patients who had prior disc surgery compared with 81% for myelo-CT, 80% for CT, and 74% for myelography. Disco-CT was also the most accurate test for patients with foraminal HNP (91% compared with 71% for CT, 65% for myelo-CT, and 58% for myelography). Disc injection reproduced the patient's clinical pain pattern in only 36% of herniated discs. This test has high specificity (89%), but low sensitivity (43%). The risks from myelography followed by discography within a 72-hour period are similar to those reported for myelography alone. Disco-CT is the most accurate of these tests (P less than 0.05) for the diagnosis of lumbar HNP.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prospective Analysis of Accuracy of Positron Emission Tomography,Computed Tomography,and Endoscopic Ultrasonography in Staging of Adenocarcinoma of the Esophagus and the Esophagogastric Junction

Background: Exact preoperative staging of esophageal cancer is essential for accurate prognosis and selection of appropriate treatment modalities.Methods: Forty-two patients with adenocarcinoma of the esophagus or the esophagogastric junction suitable for radical esophageal resection were staged with positron emission tomography (PET), spiral computed tomography (CT), and endoscopic ultrasonography (EUS).Results: Diagnostic sensitivity for the primary tumor was 83% for PET and 67% for CT; for local peritumoral lymph node metastasis, it was 37% for PET and 89% for EUS; and for distant metastasis, it was 47% for PET and 33% for CT. Diagnostic specificity for local lymph node metastasis was 100% with PET and 54% with EUS, and for distant metastasis, it was 89% for PET and 96% for CT. Accuracy for locoregional lymph node metastasis was 63% for PET, 66% for CT, and 75% for EUS, and for distant metastasis, it was 74% with PET and 74% with CT. Of the 10 patients who were considered inoperable during surgery, PET identified 7 and CT 4. The false-negative diagnoses of stage IV disease in PET were peritoneal carcinomatosis in two patients, abdominal para-aortic cancer growth in one, metastatic lymph nodes by the celiac artery in four, and metastases in the pancreas in one. PET showed false-positive lymph nodes at the jugulum in three patients.Conclusions: The diagnostic value of PET in the staging of adenocarcinoma of the esophagus and the esophagogastric junction is limited because of low accuracy in staging of paratumoral and distant lymph nodes. PET does, however, seem to detect organ metastases better than CT.