Three-dimensional ultrasonography navigation in spinal cord tumor surgery. Technical note

The authors describe the technical application of three-dimensional (3D) ultrasonography navigation in spinal cord tumor surgery. The spinal cord is a complex neurological structure in which there is the potential for causing neurological morbidity during tumor resection. Standard neuronavigation systems based on computed tomography or C-arm images are not adapted to tumor surgery in the spinal cord. Since 2004 the authors have been using a 3D ultrasonography-based neuronavigation system. During surgery, two-dimensional ultrasound images were acquired and reconstructed into 3D image data to assist in tumor resection. The navigation cameras read the position of a patient reference frame attached to a spinous process, the ultrasonography probe, and surgical instruments. Five- and 10-MHz phased-array ultrasonography probes equipped with optical tracking frames were used for image data acquisition. Spinal cord tumors were visualized using ultrasonography, and 3D ultrasonography-guided tumor biopsy sampling and resection were performed. The practice of attaching the reference frame to a spinous process adjacent to the spinal cord tumor, as well as performing image acquisition just before starting the resection, reduced the possible sources of inaccuracy. The technical application of a navigation system based on intraoperative 3D ultrasound image reconstruction seems feasible and may have the potential of improving functional outcome in association with spinal cord tumor surgery.     

Short-term duodenal seal oil administration normalised n-6 to n-3 fatty acid ratio in rectal mucosa and ameliorated bodily pain in patients with inflammatory bowel disease

Background  

A high dietary intake of n-6 compared to n-3 fatty acids (FAs) may promote the production of pro-inflammatory eicosanoids and cytokines. In two recent studies, short-term (10-day) duodenal administration of n-3 polyunsaturated fatty acid rich seal oil ameliorated joint pain in patients with inflammatory bowel disease (IBD). Using unpublished data from these two studies we here investigated whether normalisation of the n-6 to n-3 FA ratio in blood and tissues by seal oil administration was associated with improved health related quality of life (HRQOL) as assessed by the generic short-form 36 (SF-36) questionnaire.     

Impact of a tertiary Gleason pattern 4 or 5 on clinical failure and mortality after radical prostatectomy for clinically localised prostate cancer

Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? It is known that a tertiary Gleason grade pattern 4 or 5 found in RP specimens has a negative impact on recurrence rate regarding biochemical relapse after radical prostatectomy. This is the first publication addressing clinical outcome in patients with a tertiary Gleason grade pattern 4 or 5 showing a negative influence on clinical failure rates.

OBJECTIVE

• ? To investigate the impact of a tertiary Gleason grade (TGG) pattern 4 or 5 on clinical failure, as the presence of a TGG pattern 4 or 5 in radical prostatectomy (RP) specimens has been associated with biochemical failure.

PATIENTS AND METHODS

• ? In all, 151 consecutive patients undergoing RP between 1985 and 2006 were reviewed, and 148 patients met study inclusion criteria.
• ? The RP specimens were pathologically re‐examined and the presence of a TGG pattern 4 or 5 was recorded.
• ? The endpoint was clinical failure defined as local recurrence and/or development of metastasis at a mean follow‐up of 108 months.
• ? Univariate analyses were performed using the Kaplan–Meier method. Multivariate analyses were performed using Cox proportional hazards regression.

RESULTS

• ? Clinical failure was more likely among men with presence of a TGG pattern 4 or 5 than in men without a TGG pattern 4 or 5 (P= 0.006). In the subgroup of patients with Gleason score 7 the presence of a TGG 5 was significantly associated with clinical failure rate (P= 0.002).
• ? In patients with Gleason score <7 or >7, a TGG pattern 4 or 5 was not associated with increased failure rates.
• ? Multivariate Cox regression analyses in patients with Gleason score 7 showed that a TGG pattern 5 was a statistically significant predictor of clinical failure when adjusting for pathological stage, surgical margin status, extraprostatic extension and seminal vesicle invasion (hazard ratio 4.03, 95% confidence interval 1.72–9.46; P= 0.001).
• ? Further subgroup analyses showed that a TGG pattern 5 was associated with statistically higher clinical progression rates in patients with Gleason score 3 + 4 (P= 0.03).
• ? In patients with Gleason score 4 + 3, a TGG pattern 5 was associated with a trend towards a higher clinical progression rate, although this was not statistically significant (P= 0.189).

CONCLUSION

• ? A TGG pattern 4 or 5 is associated with decreased clinical recurrence‐free survival in Gleason score 7.

     

Analysis of complications and patient satisfaction in pedicled transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flap breast reconstruction

The purpose of this study was to evaluate complications and patient satisfaction after pedicled transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric perforator (DIEP) flap reconstruction at a single institution. There were 346 patients identified from 1999 to 2006 who underwent 197 pedicled TRAM and 217 DIEP flap reconstructions. Flap complication rates were similar between groups, whereas pedicled TRAM reconstructions had higher rates of abdominal bulge (9.5% vs. 2.3%, P = 0.0071) and hernias (3.9% vs. 0%, P = 0.0052). DIEP flap patients had significantly higher general satisfaction (81.7% vs. 70.2%, P = 0.0395), whereas aesthetic satisfaction was similar between groups. Furthermore, DIEP flap patients, particularly those undergoing bilateral reconstructions, were more likely to choose the same type of reconstruction compared with pedicled TRAM patients (92.5% vs. 80.7%, P = 0.0113). Understanding the differences in complications and satisfaction will help physicians and patients make informed decisions about abdominal-based autologous breast reconstruction.     

Ultrasound imaging in neurosurgery: approaches to minimize surgically induced image artefacts for improved resection control

Background

Intraoperative ultrasound imaging is used in brain tumor surgery to identify tumor remnants. The ultrasound images may in some cases be more difficult to interpret in the later stages of the operation than in the beginning of the operation. The aim of this paper is to explain the causes of surgically induced ultrasound artefacts and how they can be recognized and reduced.

Methods

The theoretical reasons for artefacts are addressed and the impact of surgery is discussed. Different setups for ultrasound acquisition and different acoustic coupling fluids to fill up the resection cavity are evaluated with respect to improved image quality.

Results

The enhancement artefact caused by differences in attenuation of the resection cavity fluid and the surrounding brain is the most dominating surgically induced ultrasound artefact. The influence of the artefact may be reduced by inserting ultrasound probes with small footprint into the resection cavity for a close-up view of the areas with suspected tumor remnants. A novel acoustic coupling fluid developed for use during ultrasound imaging in brain tumor surgery has the potential to reduce surgically induced ultrasound artefacts to a minimum.

Conclusions

Surgeons should be aware of artefacts in ultrasound images that may occur during brain tumor surgery. Techniques to identify and reduce image artefacts are useful and should be known to users of ultrasound in brain tumor surgery.     

Use of alcohol,tobacco and illicit drugs among ethnic Norwegian and ethnic minority adolescents in Hordaland county,Norway: the youth@hordaland-survey

Objective: To describe potential differences in unhealthy behaviours among ethnic Norwegian adolescents and minority adolescents from countries within the European Union, European Economic Area or US (EU/EEA countries) and adolescents from non-EU/EEA countries. Specifically, we aimed to investigate ethnic differences in use of alcohol, tobacco and illicit drugs, and potential confounding due to socio-demographic characteristics.

Design: Cross-sectional population-based study of adolescents aged 16–19 (N?=?10,122), with self-reported ethnicity as grouping variable, and self-reported use of alcohol, tobacco and illicit drugs as dependent variables.

Results: We found that minority adolescents from EU/EEA and non-EU/EEA countries differed from ethnic Norwegian adolescents on important indicators of unhealthy behaviours. Compared to Norwegian adolescents, adolescents from EU/EEA were more likely to report having tried to smoke, to be a daily smoker and to ever having tried an illicit drug (adjusted odds ratio (OR) ranging from 2.01 to 3.74). They were, however, less likely to have tried snus (a form of smokeless tobacco; adjusted OR 0.64; confidence interval (CI) 95% 0.43–0.97) and to report daily snus use (adjusted OR 0.31; CI95% 0.15–0.67). There were no differences in having tried alcohol. Non-EU/EEA adolescents were less likely to have ever tried alcohol (OR 0.24; CI95% 0.18–0.31), snus (OR 0.47; CI95% 0.34–0.65) and to smoke (0.68; CI95% 0.52–0.91), and less likely to report daily snus use (OR 0.36; CI95% 0.21–0.62) compared to Norwegian adolescents. There were no differences with regard to having tried illicit drugs and reporting being a daily smoker. All differences observed were robust to adjustment for age, gender and family socio-economic status.

Conclusion: The presents study identified important differences in unhealthy behaviours across different ethnic groups in Norway. The differences in the prevalence of unhealthy behaviours among ethnic minorities are still relevant in a public health perspective, and potential mechanisms should be investigated further.     

CustusX: an open-source research platform for image-guided therapy

Purpose

CustusX is an image-guided therapy (IGT) research platform dedicated to intraoperative navigation and ultrasound imaging. In this paper, we present CustusX as a robust, accurate, and extensible platform with full access to data and algorithms and show examples of application in technological and clinical IGT research.

Methods

CustusX has been developed continuously for more than 15 years based on requirements from clinical and technological researchers within the framework of a well-defined software quality process. The platform was designed as a layered architecture with plugins based on the CTK/OSGi framework, a superbuild that manages dependencies and features supporting the IGT workflow. We describe the use of the system in several different clinical settings and characterize major aspects of the system such as accuracy, frame rate, and latency.

Results

The validation experiments show a navigation system accuracy of \(<\)1.1 mm, a frame rate of 20 fps, and latency of 285 ms for a typical setup. The current platform is extensible, user-friendly and has a streamlined architecture and quality process. CustusX has successfully been used for IGT research in neurosurgery, laparoscopic surgery, vascular surgery, and bronchoscopy.

Conclusions

CustusX is now a mature research platform for intraoperative navigation and ultrasound imaging and is ready for use by the IGT research community. CustusX is open-source and freely available at http://www.custusx.org.

     

Group and individual stability of three parenting dimensions

Background

The Parental Bonding Instrument, present self-report version, (PBI-PCh) includes three scales, Warmth, Protectiveness and Authoritarianism, which describe three dimensions of current parenting. The purposes of this study were to (1) evaluate the true and observed stability of these parenting dimensions related to older children, (2) explore the distribution of individual-level change across nine months and (3) test potential parental predictors of parenting instability.

Methods

Questionnaires were distributed to school-based samples of community parents of both genders (n = 150) twice, nine months apart. These questionnaires measured parenting, parental personality and emotional symptoms.

Results

Based on 1) stability correlations, 2) true stability estimates from structural equation modeling (SEM) and 3) distribution of individual-level change, Warmth appeared rather stable, although not as stable as personality traits. Protectiveness was moderately stable, whereas Authoritarianism was the least stable parenting dimension among community parents. The differences in stability between the three dimensions were consistent in both estimated true stability and observed stability. Most of the instability in Warmth originated from a minority of parents with personality, childhood care characteristics and lower current parenting warmth. For the Protectiveness dimension, instability was associated with higher Protectiveness scores.

Conclusions

True instability with all three self-reported parenting dimensions can occur across nine months in a community sample related to older children (7-15), but it may occur with varying degrees among dimensions and subpopulations. The highest stability was found for the Warmth parenting dimension, but a subgroup of "unstably cold" parents could be identified. Stability needs to be taken into account when interpreting longitudinal research on parenting and when planning and evaluating parenting interventions in research and clinical practice.     

Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

Background  

Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units.