Endovascular Exclusion of a Postendarterectomy Carotid Pseudoaneurysm

Carotid pseudoaneurysms are rare occurrences. They often result from trauma, but can also present following carotid endarterectomy. Treating such pseudoaneurysms can be difficult due to previous surgery and limited access to the high internal carotid artery. A case involving a postendarterectomy carotid pseudoaneurysm treated via a femoral approach with a covered stent using endoluminal techniques is presented.     

Echinococcus of the urinary tract: Radiologic findings

Echinococcal involvement of the urinary tract is extremely rare. We present 11 such cases, 10 with renal and 1 with bladder involvement. Clinical and laboratory findings were nonspecific. Calcification was present in all but 1 case. The excretory urogram and retrograde pyelogram demonstrated parenchymal soft-tissue masses causing pressure on and dilatation of the collecting system. Angiography in 3 cases showed the masses to be avascular. The ultrasound findings of a multicystic lesion with mixed echogenicity were typical of echinococcal cysts, while a CT scan in 1 patient showed a cyst with densely calcified border. The combined findings of these different modalities aid greatly in establishing the correct diagnosis.     

Preoperative lymph-node staging of invasive urothelial bladder cancer with 18F-fluorodeoxyglucose positron emission tomography/computed axial tomography and magnetic resonance imaging: correlation with histopathology

OBJECTIVE: The treatment and prognosis of bladder cancer are based on the depth of primary tumour invasion and the presence of metastases. A highly accurate preoperative tumour, node, metastasis (TNM) staging is critical to proper patient management and treatment. This study retrospectively investigated the value of 1?F-fluorodeoxyglucose (FDG) positron emission tomography/computed axial tomography (1?F-FDG PET/CT) and magnetic resonance imaging (MRI) for preoperative N staging of bladder cancer. Material and methods. From June 2006 to January 2008, 48 consecutive patients diagnosed with bladder cancer were referred to preoperative staging including MRI and 1?F-FDG PET/CT. Eighteen out of 48 patients underwent radical cystoprostatectomy including removal of lymph nodes for histology, and were included in the study. Values of 1?F-FDG PET/CT and MRI for regional N staging were compared to histopathology findings, the gold standard. Results. 1?F-FDG PET/CT and MRI were performed in 18 patients. The specificities for detection of lymph-node metastases for MRI and 1?F-FDG PET/CT were 80% (n = 15) and 93.33% (n = 15), respectively. The negative predictive values were 80% (n = 15) and 87.5% (n = 16) for MRI and 1?F-FDG PET/CT, respectively. The differences in specificity and negative predictive values were not statistically significant. Conclusions. No significant statistical difference between 1?F-FDG PET/CT and MRI for preoperative N staging of urothelial bladder cancer was found in the study. However, the trend of the data indicates an advantage of 1?F-FDG PET/CT over MRI. Larger prospective studies are needed to elucidate the role of 1?F-FDG PET/CT in N staging of bladder cancer.     

Dual diagnosis and psychosocial interventions—Introduction and commentary

Treatment of patients with concurrent mental illness and substance abuse represents a challenge to the traditional treatment systems. This article gives: 1) an introduction of the concept and frequency of dual diagnosis (DD), 2) a presentation and discussion of the latest guidelines on DD treatment, 3) status on the current situation in the DD field in Denmark, and 4) potentials for future research. The article is based on systematic examination of evidence-based research and popularized latest guidelines on DD treatment. Methodologically, both treatment and research is challenged by the diversity in DD combinations. Although integrated treatment with the inclusion of cognitive–behavioural therapy, motivational interviewing and family intervention in DD treatment show promising results, it remains to establish which treatment programme is the most qualified in improving mental health and reducing substance use. A future priority is the development of DD treatment that targets specific co-morbid combinations and treatment needs.     

Patient versus informant reported quality of life in the earliest phases of Alzheimer's disease

OBJECTIVES: The study investigated if patient and informant reported Quality of Life (QoL) differed in early Alzheimer's disease (AD). In addition, we examined whether anosognosia had an impact on the agreement between patient and informant ratings of QoL and whether anosognosia, dementia severity, depression and behavioural symptoms were significantly correlated to QoL in early AD. METHODS: From a prospective research program including newly referred patients (age >60 years and MMSE > or = 20), 48 patients with very early AD were included. QoL was assessed using the QoL-AD and EQ-5D scales. Anosognosia was rated on a categorical scale by an examiner. MMSE, Geriatric Depression Scale, Danish Adult Reading Test and Frontal Behavioural Inventory were also administered. RESULTS: On most QoL measures patients rated their QoL higher than their informants. Anosognosia was not associated with QoL but significantly with an inverse impact on the agreement between patient and informant ratings of QoL. Self-reported QoL was significantly correlated to depression but not to age, dementia severity, behavioural symptoms or memory impairment. Informant ratings of QoL were significantly correlated to behavioural symptoms and informant ratings on the EQ-5D Visual Analogue Scale were significantly correlated to patient reported depression. CONCLUSION: Patients with early AD generally reported higher QoL than their informants. This disagreement was associated with the presence of anosognosia. Self-reported QoL did not correlate with the MMSE score. Behavioural changes and depressive symptoms may be associated with low QoL.     

Gender differences in long‐term survival post‐transplant: A single‐institution analysis in the lung allocation score era

The purpose of this study was to clarify the significance of recipient gender status on lung transplant outcomes in a large single‐institution experience spanning three decades, we analyzed data from all lung transplants performed in our institution since 1986. Kaplan‐Meier curves and Cox proportional hazard models were used to evaluate the effect of recipient characteristics on survival and BOS score ≥1‐free survival. Logistic regression analysis was used to explore the association of gender with short‐term graft function. About 876 lung transplants were performed between 1986 and 2016. Kaplan‐Meier survival estimates at 5 years post‐transplant for females vs males in the LAS era were 71% vs 58%. In the LAS era, females showed greater unadjusted BOS≥1‐free survival than males (35% vs 25%, P=.02) over 5 years. Female gender was the only factor in the LAS era significantly associated with improved adjusted 5‐year survival [HR 0.56 (95% CI 0.33, 0.95) P=.03]. Conversely, in the pre‐LAS era female gender was not associated with improved survival. Female recipients showed significantly improved survival over 5 years compared to males in the LAS era. A prospective analysis of biologic and immunologic differences is warranted.     

A randomized study on migration of the Spectron EF and the Charnley flanged 40 cemented femoral components using radiostereometric analysis at 2 years

Background and purpose

We performed a randomized study to determine the migration patterns of the Spectron EF femoral stem and to compare them with those of the Charnley stem, which is regarded by many as the gold standard for comparison of implants due to its extensive documentation.

Patients and methods

150 patients with a mean age of 70 years were randomized, single-blinded, to receive either a cemented Charnley flanged 40 monoblock, stainless steel, vaquasheen surface femoral stem with a 22.2-mm head (n = 30) or a cemented Spectron EF modular, matte, straight, collared, cobalt-chrome femoral stem with a 28-mm femoral head and a roughened proximal third of the stem (n = 120). The patients were followed with repeated radiostereometric analysis for 2 years to assess migration.

Results

At 2 years, stem retroversion was 2.3° and 0.7° (p < 0.001) and posterior translation was 0.44 mm and 0.17 mm (p = 0.002) for the Charnley group (n = 26) and the Spectron EF group (n = 74), respectively. Subsidence was 0.26 mm for the Charnley and 0.20 mm for the Spectron EF (p = 0.5).

Interpretation

The Spectron EF femoral stem was more stable than the Charnley flanged 40 stem in our study when evaluated at 2 years. In a report from the Norwegian arthroplasty register, the Spectron EF stem had a higher revision rate due to aseptic loosening beyond 5 years than the Charnley. Initial stability is not invariably related to good long-term results. Our results emphasize the importance of prospective long-term follow-up of prosthetic implants in clinical trials and national registries and a stepwise introduction of implants.Femoral stem loosening in cemented total hip arthroplasty (THA) is a multifactorial process with different mechanisms (Gruen et al. 1979, Barrack 2000). Factors such as the material, design, and surface finish are of fundamental importance for the long-term performance of cemented femoral hip implants (Scheerlinck and Casteleyn 2006). The longevity of cemented femoral stems has been related to the quality, stability, and endurance of the bonding between stem and cement (Chang et al. 1998, Scheerlinck and Casteleyn 2006). Different femoral stem designs have been developed to obtain increased fixation at this interface, since debonding between the cement and stem is an important mechanism in the initiation of loosening (Jasty et al. 1991).The satin-finish Spectron femoral stem has been one of the best performing stems in the Swedish National Arthroplasty Register (Malchau et al. 2002). A modified, proximally roughened version of the Spectron stem, the Spectron EF (Smith and Nephew, Memphis, TN), was introduced in 1989 to enhance stem-cement bonding.The use of this implant gained increasing popularity, and in 2007 the Spectron EF stem used with the Reflection All-Poly acetabular cup (Smith and Nephew) was the most commonly used primary total hip prosthesis in Norway (Espehaug et al. 2009).The degree of migration during the first years after surgery has been shown to correlate with the long-term performance of joint prostheses (Kärrholm et al. 1994, Kobayashi et al. 1997). Radiostereometric analysis (RSA) allows the accurate measurement of implant movement and has been extensively used for measurement of the in vivo migration of implants (Kärrholm et al. 1997).An earlier prospective randomized study reported an increased revision rate of the Charnley stem compared to the satin-finished Spectron stem (Garellick et al. 1999). In the present randomized, controlled clinical trial we wanted to evaluate the early migration of the successor to this stem, the Spectron EF stem and to compare it to that of the Charnley stem using RSA. The null hypothesis was that the migration of the Spectron EF stem was equal to that of the Charnley prosthesis (DePuy International Ltd., Leeds, UK), which has the longest follow-up and the largest volume of documentation of implants used for primary total hip arthroplasty (Aamodt et al. 2004).