Correlation between change in graft height and change in segmental angle following central corpectomy for cervical spondylotic myelopathy

OBJECT: This study was undertaken to examine the correlation between change in graft height and change in angulation across grafted segments (segmental angle) in patients undergoing central corpectomy (CC) with autologous bone reconstruction for cervical spondylotic myelopathy (CSM). METHODS: The authors performed a retrospective analysis of 70 cases in which patients with CSM underwent uninstrumented single- or multilevel CC and had evidence of osseous fusion of their grafts at follow-up. The segmental angles and heights of the grafted segments on preoperative, postoperative, and follow-up radiographs were compared. RESULTS: The mean change in graft height (+/- standard deviation) was -7.3 +/- 3.8 mm (mean duration of follow-up 19.7 +/- 5.4 months, range 13-53 months). There was a mean kyphotic change in segmental angle of -7.3 +/- 3.8 degrees (p < 0.001). In patients who had a straight or kyphotic cervical spine (28 patients) or a straight or kyphotic segment (32 patients) preoperatively, there was a significant linear correlation between changes in graft height and changes in segmental angle (Pearson correlation, r = 0.40, p = 0.03; r = 0.40, p = 0.02, respectively). Such a correlation was not seen in the patients who had a lordotic cervical spine (42 patients) or a lordotic segment (38 patients) preoperatively (Pearson correlation, r = -0.04, p = 0.81; r = 0.08, p = 0.62, respectively). The change in segmental angle did not influence improvement in Nurick grade (p = 0.8). The degree of agreement between the 2 observers was almost perfect for measurement of graft height (postoperative intraclass correlation coefficient [ICC] = 0.94, follow-up ICC = 0.90) but was significantly lower for measurement of segmental angles (postoperative ICC = 0.71, follow-up ICC = 0.67). CONCLUSIONS: Among patients undergoing uninstrumented CC for CSM, there is a significant correlation between postoperative settling and kyphotic change across fused segments in those who had straight or kyphotic cervical spines or segments preoperatively but not in those who had lordotic cervical spines or segments preoperatively. A more vigorous surgical correction of the segmental kyphosis than achieved in this study might have caused the kyphotic segments to behave like the lordotic segments. Paraspinal muscles and ligaments may play a role in determining the segmental angle as graft settling in patients with lordotic spines or segments is not linearly correlated with angular change.     

Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy

BACKGROUND: To counsel patients adequately, it is important to understand the variables influencing satisfaction and regret following prostatectomy. OBJECTIVE: To identify independent predictors for satisfaction and regret after radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS: Patients who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy (RALP) between 2000 and 2007 were mailed cross-sectional surveys composed of sociodemographic information, the Expanded Prostate Cancer Index Composite (EPIC), and questions regarding satisfaction and regret. MEASUREMENTS: Sociodemographic variables, perioperative complications, type of procedure, length of follow-up, and EPIC scores were evaluated as independent predictors of satisfaction and regret in multivariate logistic regression analysis. RESULTS AND LIMITATIONS: A total of 400 patients responded (response rate 61%) of whom 84% were satisfied and 19% regretted their treatment choice. In multivariate analysis, lower income (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.03-0.23), shorter follow-up (OR, 0.63; 95% CI, 0.41-0.98), having undergone RRP versus RALP (OR, 4.45; 95% CI, 1.90-10.4)], urinary domain scores (OR, 2.70; 95% CI, 1.60-4.54), and hormonal domain scores (OR, 2.01; 95% CI, 1.30-3.12) were independently associated with satisfaction (p相似文献   

Robotic extended pyelolithotomy for treatment of renal calculi: a feasibility study

Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for staghorn renal calculi. Many reports suggest that laparoscopy can be an alternative treatment for large renal stones. We wished to evaluate the role and feasibility of laparoscopic extended pyelolithotomy (REP) for treatment of staghorn calculi. Thirteen patients underwent REP for treatment of staghorn calculi over a 12-day period. Twelve patients had partial staghorn stones and one had a complete staghorn stone. All patients had pre-operative and post-operative imaging including KUB and computed tomography. All procedures were completed robotically without conversion to laparoscopy or open surgery. Mean operative time was 158 min and mean robotic console time was 108 min. Complete stone removal was accomplished in all patients except the one with a complete staghorn calculus. Estimated blood loss was 100 cc, and no patient required post-operative transfusion. REP is an effective treatment alternative to PCNL in some patients with staghorn calculi. However, patients with complete staghorn stones are not suitable candidates for this particular technique.     

Flow cytometric evaluation of platelet–leukocyte conjugate stability over time: methodological implications of sample handling and processing

Journal of Thrombosis and Thrombolysis - Platelet activation and subsequent aggregation is a vital component of atherothrombosis resulting in acute myocardial infarction. Therefore, quantifying...     

Syncope in a middle aged male due to acute rheumatic fever

Rheumatic fever is a multi system disease which occurs following infection with group A beta hemolytic streptococcus. It is commonest in the age group of 5-15 years but can occur in adults also. First degree atrioventricular block is a common manifestation of acute rheumatic fever and is included in the Jones criteria but Wenckebacks phenomena and complete heart block are relatively rare manifestations of rheumatic fever. Syncope occurring in acute rheumatic fever is also infrequently reported. We report the case of a 38-year-old male with rheumatic carditis who had advanced atrioventricular block which resulted in syncope and required a temporary pacemaker insertion.     

A molecular insight of CTLA-4 in food allergy

Food allergy is an immune provocation induced by certain food in susceptible individuals. Most of the food allergic manifestations are evident in the individual having impaired oral tolerance. In spite of worldwide prevalence, there is no permanent cure of food allergy. Food allergic reactions are complex immunological events that comprises of several immune molecules like IgE, IL-4, IL-13 and T-cells, therefore, researchers are trying to pick the correct molecule to find out pivotal therapeutic solutions. Being a key regulatory molecule in suppressing T-cells functional activities, cytotoxic T-cell lymphocyte antigen-4 (CTLA-4) or cluster of differentiation-152 (CD-152) has contributed a novel and revolutionary dimension toward therapeutic research of several diseases. This review focuses on different immunological and mechanistic perspectives of CTLA-4 in correlation with food allergy.     

Effect of Immunosenescence on the Induction of Cardiovascular Disease Pathogenesis: Role of Peripheral Blood Mononuclear Cells

It is well established that the immune potential declines with age. However, there is a great paucity of information regarding role of monocytes in elderly suffering from cerebrovascular accident. This present study was undertaken to investigate if the functions of peripheral blood mononuclear cells have any correlation to the manifestation of an age-associated cerebrovascular disorders: myocardial infraction, cerebrovascular (infract & hemorrhage). An age-associated inhibition in the production of interleukin-1 (IL-1) by monocytes was observed while the production of nitric oxide (NO) remained unaltered in the response of monocytes, obtained from normal elderly donors, to Lipopolysaccharide (LPS) treatment in vitro. Cerebrovascular pathologies were found to be associated with an augmentation of IL-1 production by monocyte, while NO production was augmented in case of CVA (hemorrhage) and MI. Trace element copper was found to be lower in the serum of patients suffering from CVA, while concentration of zinc was found to be elevated in serum compared to these trace elements in normal adults. Thus these factors are likely to play a role in the pathogenesis of age-related cerebrovascular disorders.     

Revisiting rhino-orbito-cerebral acute invasive fungal sinusitis in the era of COVID-19: pictorial review

Emergency Radiology - COVID-19 patients have been found to have an increased incidence of superadded fungal infections because of multiple factors such as impaired cell-mediated immunity,...     

Rare peritoneal bands and recesses: incidental findings in a cadaveric dissection

Variable arrangement of the visceral peritoneum would result in the formation of unexpected peritoneal bands and associated recesses. These could confound the unsuspecting clinician in both the diagnostic and therapeutic approach to the abdomen. It is thus imperative to be alert to the surprises the peritoneum may throw up and, however rare, abdominal conditions resulting from such aberrations must be kept in mind. Cadaveric dissection of an elderly female revealed a number of peritoneal anomalies. Apart from a cysto-duodenal extension of the lesser omentum, there was a bilaminar, avascular band passing from the inferior surface of the right lobe of liver to both the duodenum and the transverse colon. This anomalous band lay posterior to and distinct from the lesser omentum. The epiploic foramen was thus delimited by two unconventional folds. Further, the distal half of the transverse mesocolon failed to reach the posterior abdominal wall and instead formed an arched continuity with an aberrant mesentery of descending colon. An unusual type of peri-caecal recess was also present.