Three-tesla MRI biphasic angiography: a method for preoperative assessment of the vascular supply in renal tumours—a surgical perspective

Purpose

The new generation of 3TMRI has improved spatial and time resolutions, which are favourable in imaging of the renal vasculature. In this study, we have compared the imaging findings of the renal blood vessels using 3TMRI and CT with intraoperative assessment of the renal vasculature as gold standard.

Methods

This prospective study was approved by the local ethical committee. Between 4/2011 and 12/2011, 80 patients with renal tumours underwent 3TMRA (angiography) (Magnetom SKYRA 3T, Siemens). Twenty of the patients were also examined with CT AG. The results of the CTA- and MRA-imaging studies were correlated with the intraoperative assessment of the renal vessels.

Results

Seventy patients (87.5 %) had a detailed intraoperative assessment of the renal vessels. The sensitivities for CTA and MRA were 88.2 and 88.6 %, respectively. All discrepancies between imaging studies and intraoperative findings were due to inability to identify small polar vessels. The results of MRA were concordant with CTA in 85.0 % of cases. The (three) discrepancies between MRI and CT were due to failure of MRI in identifying small polar vessels.

Conclusions

(1) 3TMRA gives detailed information about the renal vasculature including its topographical anatomy. (2) With MRI, small aberrant vessels are more frequently missed than with CTA. (3) CTA remains the gold standard. However, MRA may be used for planning of laparoscopic operations. (4) The quality of the 3D reconstruction is highly depending on the skills of the radiologist.     

Simulation-assisted burn disaster planning

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System^® (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.     

Treatment of Acute Achilles Tendon Rupture in Scandinavia Does Not Adhere to Evidence-based Guidelines: A Cross-sectional Questionnaire-based Study of 138 Departments

The best treatment of acute Achilles tendon rupture has been discussed for decades. During the past half decade, evidence has increased in favor of nonoperative treatment and dynamic and weightbearing rehabilitation. We hypothesized that the treatment strategies would show great variation and that adherence to evidence-based recommendations would not be as good as desired. The purpose of the present study was to investigate how acute Achilles tendon rupture is treated in Scandinavia. A questionnaire was distributed to all orthopedic departments treating acute Achilles tendon ruptures in Denmark, Sweden, Norway, and Finland. The questionnaire was returned by 138 of 148 departments (response rate 93%). Two-way tables with Fisher’s exact test were used for statistical analysis. In Denmark, Norway, Sweden, and Finland, 19 of 23 (83%), 44 of 48 (92%), 26 of 40 (65%), and 8 of 27 (30%) departments recommended surgical treatment (p < .001). Dynamic rehabilitation was used significantly less often in Denmark (5 of 23 [22%]), Norway (17 of 45 [38%]), and Sweden (11 of 40 [28%]) than in Finland (15 of 26 [58%]; p = .015). A significant difference was found among the countries in the educational level of the performing surgeons (p < .001). Surgical treatment was the treatment of choice in Danish, Norwegian, and Swedish hospitals regardless of the increasing evidence favoring nonoperative treatment. Although increasing evidence has favored dynamic rehabilitation, it has gained limited use across Scandinavia. Weightbearing was used in most hospitals. Surgery was performed by junior surgeons in most hospitals across Scandinavia. Treatment algorithms showed considerable variation and often did not adhere to the clinical evidence.     

Locally-applied Collagenase and Regeneration of Transsected and Repaired Rat Sciatic Nerves

The possible effects of collagenase on peripheral nerve regeneration were evaluated after epineurial repair of rat sciatic nerves. In the control group the repair site was covered by fibrin adhesive and infused with isotonic saline and in the experimental group collagenase was infused into the fibrin adhesive. In the short term study the regeneration distance was measured by a pinch test four, six, or eight days postoperatively. In the long term study the evaluation of nerve regeneration and recovery of motor function was made by testing the tetanic contraction force of the anterior tibial muscle three months postoperatively. There were no significant differences between the two groups in either the short or long term. We conclude that locally-applied collagenase had no effect on peripheral nerve regeneration.     

SPRING-MEDIATED CRANIOPLASTY COMPARED WITH THE MODIFIED PI-PLASTY FOR SAGITTAL SYNOSTOSIS

The aim of this study was to compare the safety, morphological outcome, and degree of parental satisfaction of the new spring-mediated cranioplasty with those of the modified pi-plasty in the management of sagittal synostosis. Ten patients with non-syndromic sagittal synostosis treated with the spring-mediated cranioplasty were followed prospectively. A control group of 10 sex-matched patients operated on with the modified pi-plasty procedure was chosen. Cephalometric radiographs were obtained preoperatively and postoperatively at 1 year of age. Cephalic index, axial width ratio, length ratio, width ratio and height ratio were used as objective measures of outcome. Parents were sent a questionnaire to obtain a subjective aesthetic assessment of outcome. Significantly less blood replacement was required (p?=?0.003), and shorter duration of postoperative anaesthesia (p?=?0.030) and postoperative hospital stay (p?=?0.013) were found in the spring-mediated cranioplasty group. There were no complications or deaths in either group. Also significant was the inter-group difference in the postoperative change in the height ratio (p?=?0.030), the most change being seen in the spring group. The change in the subjective parental aesthetic evaluation of skull shape was significant in both groups. In conclusion, the spring-mediated procedure was morphologically more effective than the modified pi-plasty procedure in the management of sagittal synostosis with the additional benefits of less blood transfusion needed and shorter duration of hospital stay.     

Orthodontic treatment efficiency with self-ligating and conventional edgewise twin brackets: A prospective randomized clinical trial

Objective:To conduct a prospective and randomized study of the efficiency of orthodontic treatment with self-ligating edgewise brackets (SL; Time2 brand, American Orthodontics) and conventional edgewise twin brackets (CE; Gemini brand, 3M).Materials and Methods:One hundred consecutive patients were randomized to treatment with either SL or CE brackets. The participants were treated by one of three specialists in orthodontics and with continuous instructions alternately by five orthodontic assistants according to our normal treatment routine (ie, modified 0.022″ MBT preadjusted edgewise technique). The treatments were evaluated in terms of overall treatment time, number of visits, and treatment outcome using the Index of Complexity, Outcome and Need (ICON). The number of emergency appointments, number of archwires, overjet, relative space, and extractions at treatment start were noted.Results:After dropouts, the analyzed material consisted of 44 patients treated with SL (mean age 15.3 years, mean ICON 60.7, 70.4% female) and 46 patients treated with CE (mean age 15.0 years, mean ICON 56.5, 71.7% female). There were no statistically significant differences between the SL and CE groups in terms of mean treatment time in months (20.4 vs 18.2), mean number of visits (15.5 vs 14.1), mean ICON scores after treatment (13.2 vs 11.9), or mean ICON improvement grade (7.9 vs 9.1).Conclusion:Orthodontic treatment with SL brackets does not reduce treatment time or number of appointments and does not affect posttreatment ICON scores or ICON improvement grade compared with CE brackets.