The Swedish Elbow Arthroplasty Register and The Swedish Shoulder Arthroplasty Register: Two new Swedish arthroplasty registers

Two new national orthopedic quality registers were started in Sweden in 1999, the Swedish Shoulder Arthroplasty Register and the Swedish Elbow Arthroplasty Register. Both are owned by the Swedish Shoulder and Elbow Section of the Swedish Orthopedic Association. The purpose of the registers is to improve surgical techniques and selection of implants and identify individual risk factors. Two of the main problems in starting a new national quality register involve inducing all centers in the country to participate and deciding on the data to register.     

Impact of trainee involvement with robotic-assisted radical prostatectomy

Robotic-assisted surgery has been rapidly adopted within urology practice. As a result, academic centers are challenged with the burden of how to effectively train residents and fellows to perform robotic-assisted surgery without compromising outcomes. We evaluated the perioperative outcomes of trainee involvement with robotic-assisted radical prostatectomy (RARP) within our healthcare organization. We retrospectively reviewed RARP cases performed at our institution between September 2008 and December 2010 using a single da Vinci robotic platform. Trainees consisted of urology residents and fellows who operated with staff surgeons on select operating days, whereas two staff surgeon teams performed RARP on alternate days. We compared clinicopathologic variables including operating time, estimated blood loss, surgical margin rates, and complication rates between the trainee and staff-only surgeon groups. Overall, 1,019 RARP surgeries were performed within the study period and trainees participated in 162 cases (16 %). Clinical characteristics were similar between men undergoing surgery with a trainee and those without. Positive surgical margin rates were lower for patients with pT2 disease for cases with trainee involvement (11 vs. 19 %, p = 0.02), although overall margin rates and margin rates for patients with pT3 disease were similar between the groups (p = 0.34). Surgical cases involving trainees were longer (241 vs. 200 min, p < 0.001) and resulted in higher estimated blood loss (190 vs. 120 mL, p < 0.001) than the two staff surgeon cases. However, transfusion rates as well as intraoperative and postoperative complication rates did not differ significantly between groups. In conclusion, surgical margin rates were lower in teaching cases for patients with pT2 disease. Importantly, trainee involvement in RARP is safe, with similar perioperative outcomes to staff-only surgical cases. This information may be useful for training and surgical planning.     

Forensic postmortem computed tomography: volumetric measurement of the heart and liver

Purpose

The purpose of this study was to investigate the utility of postmortem computed tomography (PMCT) images in estimating organ sizes and to examine the use of the cardiothoracic ratio (CTR).

Methods

We included 45 individuals (19 females), who underwent a medico-legal autopsy. Using the computer software program Mimics^®, we determined in situ heart and liver volumes derived from linear measurements (width, height and depth) on a whole body PMCT-scan, and compared the volumes with ex vivo volumes derived by CT-scan of the eviscerated heart and liver. The ex vivo volumes were also compared with the organ weights. Further, we compared the CTR with the ex vivo heart volume and a heart weight-ratio (HWR). Intra- and inter-observer analyses were performed.

Results

We found no correlation between the in situ and ex vivo volumes of the heart and liver. However, a highly significant correlation was found between the ex vivo volumes and weights of the heart and liver. No correlations between CTR and the ex vivo heart volume nor with HWR was found. Concerning cardiomegaly, we found no agreement between the CTR and HWR. The intra- and inter-observer analyses showed no significant differences.

Conclusions

Noninvasive in situ PMCT methods for organ measuring, as performed in this study, are not useful tools in forensic pathology. The best method to estimate organ volume is a CT-scan of the eviscerated organ. PMCT-determined CTR seems to be useless for ascertaining cardiomegaly, as it neither correlated with the ex vivo heart volume nor with the HWR.

     

Can we settle with single-band radiometric temperature monitoring during hyperthermia treatment of chestwall recurrence of breast cancer using a dual-mode transceiving applicator?

The total thermal dose that can be delivered during hyperthermia treatments is frequently limited by temperature heterogeneities in the heated tissue volume. Reliable temperature information on the heated area is thus vital for the optimization of clinical dosimetry. Microwave radiometry has been proposed as an accurate, quick and painless temperature sensing technique for biological tissue. Advantages include the ability to sense volume-averaged temperatures from subsurface tissue non-invasively, rather than with a limited set of point measurements typical of implanted temperature probes. We present a procedure to estimate the maximum tissue temperature from a single radiometric brightness temperature which is based on a numerical simulation of 3D tissue temperature distributions induced by microwave heating at 915 MHz. The temperature retrieval scheme is evaluated against errors arising from unknown variations in thermal, electromagnetic and design model parameters. Whereas realistic deviations from base values of dielectric and thermal parameters have only marginal impact on performance, pronounced deviations in estimated maximum tissue temperature are observed for unanticipated variations of the temperature or thickness of the bolus compartment. The need to pay particular attention to these latter applicator construction parameters in future clinical implementation of the thermometric method is emphasized.