A novel technique to measure severity of pediatric pectus excavatum using white light scanning.

Background/purpose

Computed tomography (CT) derived Haller Index (HI) remains the standard for quantifying severity in patient with pectus excavatum (PE). Optical scanning described in literature reports optimistic results and new indices that correlate with HI. This study assessed the feasibility of a handheld White Light Scanner (WLS) to obtain 3D measurements and indices of PE deformity.

Million Behavioral Health Inventory: its utility in predicting physical function in patients with low back pain

The present study evaluated the use of psychologic measures, in particular, the relatively new Million Behavioral Health Inventory (MBHI), in predicting change in physical function of chronic low back pain patients undergoing a functional restoration program. The first 134 consecutive patients completing this program were assessed. Results demonstrated that various clinical scales of the MBHI were predictive of improvement in physical function. In addition, various scales enabled discrimination between patients who completed the program and those who prematurely dropped out. Although this inventory shows promise in helping to predict response to treatment, no single psychologic test can reliably be used as the sole predictor in clinical cases.     

Cardiac imaging in the evaluation of patients presenting to the emergency department with chest pain

Conclusions  Despite the utility and benefits that each imaging modality has to offer, it is easy to see why there is still no perfect choice for a noninvasive cardiac imaging modality to assist in the management of chest pain patients. All of the current imaging techniques have their own significant strengths and weaknesses when compared with other modalities. SPECT and echocardiography are wellestablished technologies that can directly assess the presence of myocardial ischemia and its functional consequence on RF; newer and more expensive techniques such as MDCT and CMR can directly assess coronary anatomy and have just started to be evaluated in the acute chest pain setting. There are no studies that directly compare these technologies, and more data are clearly needed before the question of whether anatomic imaging versus perfusion/function imaging is the better approach can be answered. Other comparisons such as relative safety, availability, logistics, and cost-effectiveness between the various technologies are also lacking. Of all of the imaging modalities discussed, MCE is the only portable technology. The images do not require expensive software or other technology for offline processing before interpretation, and any trained cardiologist can read the study at the bedside or, potentially, over the Internet, providing near-instantaneous results in the acute cardiac setting, where time is of the essence. MCE is also relatively cheap compared with other technologies, a potential advantage for payors but not necessarily for payees. How reimbursement rates and fee structures eventually affect clinical practice is also unknown. Despite these and other questions that need to be answered before any one technique will be used exclusively, the future of noninvasive cardiac imaging remains an exciting and ever-changing field. The adaptation of any one of these techniques into its proper role in the ED Journal of Nuclear Cardiology Wyrick and Wei 753 Volume 13, Number 6;749-55 Cardiac imaging in patients with chest pain will take considerably more time and effort in terms of research, money, and time-tested clinical experience.     

Retroperitoneal Laparoscopic Nephrectomy in Children

Retroperitoneal pediatric laparoscopic nephrectomy is described in 3 patients requiring 3 to 5 hours with an estimated blood loss of 10 to 60 cc. The children returned to school within 7 days postoperatively. Advantages of this procedure include the avoidance of intraoperative repositioning of the patient and easy conversion to an open lumbodorsal approach, if necessary; early laparoscopic visualization of the renal artery; applicability in cases of previous abdominal surgery, and avoidance of intraperitoneal adhesion.     

Salvage therapy for prostate cancer recurrence after radiation therapy

Radiotherapy has been successful in treating localized prostate cancer; however, a subset of patients will experience disease recurrence. Determination of the recurrence location must be made using pretreatment and posttreatment clinical variables, imaging, and postradiotherapy biopsy. Patients presumed to have local-only recurrence, optimal clinical risk factors, and an extended life expectancy may be considered for salvage local treatment. Current options include salvage surgery, cryoablation, and brachytherapy. Although they are associated with higher morbidity than primary therapy, salvage treatments can be effective and can still provide patients with a good oncologic and functional outcome. As these modalities continue to improve and patient selection is optimized, better results will evolve.