Noninvasive Quantitative Assessment of Bone Healing After Distraction Osteogenesis

One of the greatest challenges of limb lengthening and deformity correction is deciding when the bone has healed enough to remove the external fixator. Standard radiography is the most common imaging method used to assess bone healing after distraction osteogenesis because it is widely available, cheap, and relatively safe. However, other imaging technologies and methods are being investigated that will help quantify bone healing after distraction osteogenesis, providing an objective method for deciding when it is appropriate to remove an external fixator. This review will examine the latest techniques used to assess bone healing after distraction osteogenesis including dual-energy X-ray absorptiometry scans, ultrasound, quantitative computed tomography, and digital radiography (X-ray). Recommendations for clinical practice will be outlined.     

Assessing the Need for Anesthesia and Sedation Services in Kuwaiti Dental Practice

The objective of this study was to examine the public health relevance of the prevalence of dental fear in Kuwait and the resultant barrier that it creates regarding access to dental care. The study analysis demonstrated a high prevalence of dental fear and anxiety in the Kuwaiti population and a perceived need for anesthesia services by dental care providers. The telephone survey of the general population showed nearly 35% of respondents reported being somewhat nervous, very nervous, or terrified about going to the dentist. In addition, about 36% of the population postponed their dental treatment because of fear. Respondents showed a preference to receive sedation and anesthesia services as a means of anxiety relief, and they were willing to go to the dentist more often when such services were available. People with high fear and anxiety preferred to receive some type of medication to relieve their anxiety. In conclusion, the significance and importance of the need for anesthesia services to enhance the public health of dental patients in Kuwait has been demonstrated, and improvements are needed in anesthesia and sedation training of Kuwaiti dental care providers.     

非心脏手术围术期心脏事件危险评估与保护性干预

围术期心脏事件是非心脏手术围手术期严重并发症和死亡的重要原因。在临床广泛应用的修订心脏风险指数及ACC／AHA制定的非心脏手术围术期评估指南．可协助临床医生评价非心脏手术心脏风险并做出围术期诊治决策。β受体阻滞剂和他汀类药物可减少高危患者非心脏手术围术期心脏事件及死亡的发生,术前血管重建治疗对于严重冠心病患者是必要和有益的。     

Insular carcinomas of the thyroid exhibit poor prognosis and long-term survival in comparison to follicular and papillary T4 carcinomas

Background Insular thyroid carcinoma was described as a tumor with aggressive behavior, and patients usually present themselves with an advanced tumor stage. Whether the insular component is an independent factor for poor prognosis remains unclear. Therefore, in the present study, we compared the survival of patients with advanced insular, follicular, and papillary thyroid cancer. Materials and methods The clinical behavior of tumors in three groups of patients with T4 thyroid carcinoma—8 patients with insular, 11 patients with follicular, and 21 patients with papillary thyroid carcinomas—was compared. Disease-free survival and disease-specific death were analyzed statistically. Cox regression analysis was used to evaluate the influence of histotype and other prognostic factors. Results At 3 years, survival was 37.5% (mean 26 months) among patients with insular thyroid carcinoma, 80% (mean 59 months) among those with follicular, and 89% (mean 126 months) among those with papillary thyroid carcinomas (p = 0.007). Disease-free survival in patients without initial distant metastasis was worst in patients with insular thyroid carcinoma (20%) compared to those with follicular (75%) and those with papillary thyroid carcinomas (71%). Conclusion Patients with advanced insular thyroid carcinoma have a poorer outcome in comparison to patients with similar advanced stage who have follicular or papillary thyroid carcinoma.     

Prognosis Scores of Tokuhashi and Tomita for Patients With Spinal Metastases of Renal Cancer

Background Retrospective evaluation of the prognosis scores of Tokuhashi and Tomita for life expectancy in 37 consecutive patients with spinal metastases secondary to renal cancer who underwent surgery. The score of Tokuhashi, composed of six parameters, each rated from zero to two, has been proposed in 1990 for the prognostic assessment of patients with spinal metastases. In 2001, Tomita et al. created another prognostic score, composed of three parameters, growth behaviour of the primary tumor (slow, moderate and rapid) and the evidence of visceral and bony metastases. Methods Thirty-seven patients, surgically treated for vertebral metastases secondary to renal cancer were studied. The scores according to Tokuhashi and Tomita were calculated for each patient. Results Applying the Tokuhashi Score for the estimation of life expectancy of renal cancer patients with vertebral metastases was found to provide very reliable results with a statistically high significance. The analysis according to Tomita showed no correlation between predicted and real survival. The statistical analysis did not show any significance. Conclusion For surgical decisions in renal cancer patients with spinal metastases, the prognostic score of Tokuhashi appears to be much more valuable than the Tomita score.     

Intraoperative Touch Preparation Cytology for Margin Assessment in Breast-Conservation Surgery: Does It Work for Lobular Carcinoma?

Background Breast carcinoma is the most frequently diagnosed malignancy in women of the North America. The combination of breast-conservation surgery and radiotherapy has become a standard of treatment for most breast cancers. It is critical to obtain clear margins to minimize local recurrence. The literature suggests that intraoperative touch preparation cytology (IOTPC) can be useful in evaluation of margins. Invasive lobular carcinoma (ILC) accounts for 10% to 15% of all breast cancers. Obtaining clear margins in ILC can be more challenging. Literature shows the positive margin rate for ILC to be as high as 60%. This report describes our experience with IOTPC for margin assessment in ILC by a single surgeon at Beth Israel Medical Center. The purpose of this study is to determine whether IOTPC is reliable for ILC. Methods A prospective review of 73 patients who underwent breast-conservation surgery with the use of IOTPC for margin assessment at Beth Israel Medical Center was performed. Pathology revealed ILC in 12 of these patients (16.4%), who are the subjects of this study. The lumpectomy specimens were oriented by the surgeon intraoperatively and were submitted fresh to pathology for cytologic assessment. IOTPC consisted of touching the corresponding margin onto the glass slide. The principle of this technique is that if cancer cells are present, they will stick to the slide, whereas fat cells will not. Six slides were prepared for each lumpectomy specimen. Air-dried samples were stained immediately by the Diff-Quik method and examined under the microscope by a cytopathologist. Results Twelve patients with ILC underwent breast-conservation surgery with IOTPC for assessment of 72 margins. Ten patients had lobular carcinoma only, and the remaining two patients had a combination of lobular and ductal carcinoma. There was a correlation between IOTPC and final pathology in 60 of 72 margins, which accounted for 83.3% of the cases. IOTPC for assessment of margins in patients undergoing breast-conservation surgery for ILC has a sensitivity of 8.3%, specificity of 98.3%, positive predictive value of 50%, and negative predictive value of 84.3%. Conclusions On the basis of our experience, IOTPC is of limited value for intraoperative assessment of margins for ILC. Poster presentation at the Sixth Annual Meeting of the American Society of Breast Surgeons, March 16–20, 2005, Los Angeles, California.     

Timing of Resection of Liver Metastases Synchronous to Colorectal Tumor: Proposal of Prognosis-Based Decisional Model

Background Timing of hepatectomy for synchronous metastases of colorectal cancer is still debated. The aim of this retrospective study was to analyze prognostic factors after synchronous and delayed liver resections to define selection criteria for choosing timing of hepatectomy. Methods The study was performed on 127 patients with synchronous metastases undergoing radical hepatectomy. We divided patients according to the timing of hepatectomy: 70 synchronous (group A) and 57 delayed (group B). Results Overall survival was similar between the two groups (5-year survival 30.8% vs. 32.0% A vs. B, P = .406). The multivariate analysis evidenced four independent prognostic factors in group A: male sex (P = .04), T4 (P = .0035), more than three metastases (P = .0001), and metastatic infiltration of nearby structures (P < .0001). There were no statistically significant prognostic factors in group B. Patients with more than three metastases had a significantly worse survival in group A than in group B (3-year survival, 15.0% vs. 34.3%, P = .007); similarly, borderline significant difference was encountered in patients with T4 primary tumor (3-year survival, 16.7% vs. 60%, P = .064) Conclusions Patients with liver metastases synchronous with colorectal cancer with T4 primary tumor, metastasis infiltration of neighboring structures, and especially with more than three metastases should receive neoadjuvant chemotherapy before liver resection.     

The Mental Health Needs Council of Harris County: A Case Report on Community Collaboration and Adult Mental Illness Prevalence Assessment and Service Need Analysis

Accurate mental illness prevalence and service needs assessment are critical to the development and delivery of effective mental health programs. Assessment precision and efficient service development and delivery are best facilitated by a close collaboration of all relevant major stakeholders. This report examines the history, mission, and composition of the Mental Health Needs Council of Harris County, Texas. This Council, located in Houston, has for the past 25 years investigated mental health service problems and recommended strategies for their solution. This Council consists of all of Harris County’s major public service providers, professional groups and advocacy organizations. This report traces the evolution of the Council’s prevalence and needs assessment methodologies. Its current methodologies are examined. These assessment strategies are applicable to other metropolitan areas. The Mental Health Needs Council is a model for effective community collaboration on the needs and problems of persons with mental illness.     

Memory functioning in post‐traumatic stress disorder: objective findings versus subjective complaints

Although memory complaints are common in post‐traumatic stress disorder (PTSD), the only published study of objective and subjective memory in PTSD by Roca and Freeman indicates that subjective complaints may not accurately reflect objective performance. The present study examined memory in 21 PTSD patients, 20 combat controls and 23 non‐combat controls using two objective memory measures (Rey Auditory Verbal Learning Test; Backward Digit Span) and one subjective measure (Memory Functioning Questionnaire). Analysis of variances (ANOVAs) and analysis of co‐variances generally did not reveal group differences for objective memory performance. For subjective memory complaints, ANOVAs indicated group differences; PTSD participants reported more memory problems than controls. These differences disappeared, however, when depression was included as a covariate. Also, we provide some preliminary evidence that depression may mediate the relationship between PTSD symptomatology and subjective memory complaints. Findings suggest that reductions in depressive symptomatology in PTSD may be associated with decreased subjective memory complaints. Copyright © 2010 John Wiley & Sons, Ltd.