Update on use of Enhanced Imaging to Optimize Lymphadenectomy in Patients Undergoing Minimally Invasive Surgery for Urothelial Cancer of the Bladder

The most commonly used imaging modalities for diagnostic investigation of bladder carcinoma are contrast-enhanced computed tomography, magnetic resonance imaging, and positron emission tomography. More recently, radioisotope and fluorescence staining are being used before, or even during, open or laparoscopic surgery. We report recent results obtained with these imaging modalities and their limitations.     

Anterior cervical plating technique to prevent adjacent-level ossification development

Background contextThe proximity (<5 mm) of the plate to the adjacent disc space is known to be a critical risk factor for adjacent-level ossification development (ALOD). As plates provide many advantages including higher fusion rates and improved alignment, their use will continue. Instead, it is necessary to modify the plating techniques to minimize this complication.PurposeTo determine if our newer plating technique decreases the incidence of ALOD after anterior cervical plating.Study designRetrospective matched cohort analysis of preoperative and postoperative radiographic data.Patient sampleOne hundred patients were classified into two groups; conventional (C) and new (N) plating techniques. The control group (Group C) was matched to the study group (Group N) in a 1:1 fashion using matching criteria of age (within 5 years), gender, number of fusion levels, and comorbidities, including diabetes and tobacco use.Outcome measuresThe lateral plain X-rays of cervical spine taken at postoperative 6 months and 2 years were used for analysis.MethodsIn Group N, the cranial and caudal screws were started at the anterior end plate corners and angled away from the end plates so as to use the shortest possible plate and maximize the distance to the adjacent end plates. Group C was the historical control using a longer plate with more orthogonal screw angulation. On postoperative 6-week lateral films, the distances from the tip of the plate to both cranial and caudal adjacent discs (plate-to-disc distances) were measured. Based on the postoperative 2-year radiographs, the incidence of ALOD was determined, and the severity of ossification was classified on a scale ranging from Grade 0 (no ossification) to Grade 3 (complete bridging).ResultsMean plate-to-disc distances in Group N were significantly longer at both cranial and caudal adjacent levels than those in Group C (p<.001). The incidence of ALOD was significantly lower in Group N than in Group C, both at the cranial adjacent disc spaces (42% vs. 72%) and caudal adjacent disc spaces (20% vs. 42%) (p<.05). Severe ossification (Grade 2 or greater) also developed less frequently in Group N at cranial and caudal levels (6% vs. 20%, respectively; p<.05).ConclusionsThe new technique of using a shorter plate with longer angulated screws resulted in significantly reduced incidence and severity of ALOD.     

Adjunctive Use of Nonsteroidal Anti-inflammatory Drugs for Schizophrenia: A Meta-analytic Investigation of Randomized Controlled Trials

Objective: To meta-analytically assess the efficacy and tolerability of nonsteroidal anti-inflammatory drugs (NSAIDs) vs placebo in schizophrenia. Method: Searching PubMed, PsycINFO, ISI Web of Science, and the US National Institute of Mental Health clinical trials registry from database inception to December 31, 2012, we conducted a systematic review/meta-analysis of randomized placebo-controlled studies assessing the efficacy of adjunctive NSAIDs. Primary outcome was the change in Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcomes included change in PANSS positive and negative subscores, all-cause discontinuation, and tolerability outcomes. Random effects, pooled, standardized mean changes (Hedges’ g) and risk ratios were calculated. Results: Across 8 studies, including 3 unpublished reports (n = 774), the mean effect size for PANSS total score was −0.236 (95% CI: −0.484 to 0.012, P = .063, I² = 60.6%), showing only trend-level superiority for NSAIDs over placebo. The mean effect sizes for the PANSS positive and negative scores were −0.189 (95% CI: −0.373 to −0.005, P = .044) and −0.026 (95% CI: −0.169 to 0.117, P = .72), respectively. The relative risk for all-cause discontinuation was 1.13 (95% CI: 0.794 to 1.599, P = .503). Significant superiority of NSAIDs over placebo regarding PANSS total scores was moderated by aspirin treatment (N = 2, P = .017), inpatient status (N = 4, P = .029), first-episode status (N = 2, P = .048), and (in meta-regression analyses) lower PANSS negative subscores (N = 6, P = .026). Interpretation: These results indicate that adjunctive NSAIDs for schizophrenia may not benefit patients treated with first-line antipsychotics judged by PANSS total score change. NSAIDs may have benefits for positive symptoms, but the effect was minimal/small. However, due to a limited database, further controlled studies are needed, especially in first-episode patients.Key words: schizophrenia, inflammation, treatment resistance, augmentation, concomitant, nonsteroidal anti-inflammatory     

How to recognize stent graft infection after endovascular aortic repair: the utility of 18F-FDG PET/CT in an infrequent but serious clinical setting

Annals of Nuclear Medicine - To evaluate the diagnostic performance of 18F-FDG PET/CT in the detection of stent graft infection (SGI). In a retrospective study, two nuclear medicine physicians have...     

Computerized tomography based 3D modeling of the clavicle

Previous studies have suggested clavicular morphology is highly variable, particularly in the lateral retrocurved section. Current clavicle fracture plating systems require three dimensional intra‐operative contouring to achieve adequate fit and necessitate variable soft tissue dissection placing fracture perfusion and muscular attachments at risk. The aim of this study was to search for a surgically relevant superficial shape pattern. This is a retrospective CT‐based analysis of 174 non‐pathological clavicles in 95 adults (45 females, 50 males). Using the principle of cylindrical parameterisation generated 3‐D computer models, we identified an implant preferred pathway (IPP), defined as a continuous linear region where the least possible soft tissue disruption would be necessary for plate fixation. The IPP mean form was within 3.04 mm (SD ± 1.34) on all clavicles. Clavicle length, and not shape, was found to be the biggest variable (correlation between size and form co‐ordinates r = 0.99, p < 0.05), accounting for 79% of overall variability. This length variation was mainly located in the medial antecurved section. Superior convexity and recurvatum were the main shape variables, however they only contributed 8% and 5% to the overall variation, respectively. Three IPP lengths were shown to match all clavicles when aligned at the acromial end first. In contrast to previous studies, we have shown that the IPP is fairly consistent with respect to the general shape with the exception of length variation which mainly affected the medial antecurved section. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1216–1223, 2016.

CLINICAL RELEVANCE

Future pre‐contoured fracture fixation systems should provide variable length plates with a constant lateral section retrocurve and a variable medial antecurve.