Conventional versus digital radiographs for intraoperative cervical spine-level localization: a prospective time and cost analysis

BackgroundIn today's health-care environment, operational efficiency is intrinsic to balancing the need for increased productivity driven by rising costs and potentially decreasing reimbursement. Other operational factors kept constant, decreasing the time for a procedure can be viewed as one marker for increased efficiency.PurposeTo prospectively evaluate the time and operating room efficiency differences between the two methods for intraoperative level localization.Stydy designProspective nonrandomized study.Patient sampleProspective consecutive patients undergoing a single-level anterior cervical discectomy and fusion (ACDF) with plate and allograft.Outcomes measuresTime for performance and interpretation of intraoperative localization radiograph.MethodsThis is a prospective nonrandomized study of patients treated consecutively with a single-level ACDF with allograft and plating. All the patients underwent a conventional approach to the cervical spine. After exposure, a spinal needle was placed in the exposed intervertebral disc and a radiography was performed. Either a conventional or a digital radiography was used in each case.ResultsEighteen patients were enrolled in this study. Ten patients underwent localization with conventional radiography, whereas eight patients underwent localization with digital imaging. The mean time for conventional radiography was 823 seconds (standard deviation [SD], 159), and for digital, it was 100 seconds (SD, 34; p<.001).ConclusionsCurrent technology provides options for level localization. Digital imaging provides equally accurate information as conventional radiography in a significantly reduced amount of time. Image quality, ease or archival, and manipulation provided by digital radiography are superior to those by provided fluoroscopy. Keeping operational factors constant, decreasing the time for a procedure, and increasing the efficiency of the environment may be viewed as a surrogate for improving the cost basis for a procedure.     

Mechanisms of enhanced carbohydrate and lipid metabolism in adipose tissue in uremia.

OBJECTIVE: Hyperlipidemia is a permanent finding in advanced renal failure. It is supposed to be responsible for the accelerated arteriosclerosis and cardiovascular complications observed in patients with that disease. The background is partially determined, however, our knowledge in this matter is not yet satisfactory. METHODS: This study is based on the experimental rat model of chronic renal failure (CRF). Considering white adipose tissue (WAT) lipogenesis upregulation in CRF, along with the determination of acetyl coenzyme A carboxylase (ACC) and fatty acid synthase (FAS) genes expression, we have measured WAT gene expression for sterol regulatory binding protein 1 (SREBP-1) at the level of protein mass and mRNA abundance. Furthermore, we have determined glucose uptake, glucose-to-CO 2 conversion rate, and glucose translocator (GLUT-4) gene expression in WAT. RESULTS: Upregulation of both FAS and ACC gene expression was found in WAT of CRF rats. It was accompanied by WAT SREBP-1 gene overexpression. Moreover, we have observed the increased glucose uptake, glucose to CO 2 conversion rate, and GLUT-4 gene expression in WAT of CRF rats in comparison with controls. CONCLUSION: SREBP-1 gene overexpression may contribute to enhanced lipogenesis upregulation in WAT of CRF rats. It is not excluded that the increased WAT glucose metabolism activity is also induced by this mechanism, although there is no evidence currently to that end. We hypothesize that the increased WAT lipogenesis capacity could be a part of mechanism(s) leading to CRF-induced hyperlipidemia.     

Effect of polyacid aqueous solutions on photocuring of polymerizable components of resin-modified glass ionomer cements.

OBJECTIVES: Resin-modified glass ionomer cements (RMGI) are hybrid materials prepared by incorporation of polymerizable components (typically 2-hydroxyethyl methacrylate (HEMA) with possible addition of multifunctional methacrylates) into a conventional acid-base mixture (a polymeric acid with powdered calcium fluoro-aluminosilicate glasses). During setting, the photopolymerization process and the acid-base reaction affect each other. The aim of this work was to examine the effect of a 45% aqueous solution of poly(acrylic acid) (PAA) and the liquid component of a commercial glass ionomer cement on HEMA and triethyleneglycol dimethacrylate (TEGDMA) photopolymerization. METHODS: The polymerization was initiated by 2,2-dimethoxy-2-phenylacetophenone (DMPA) and camphorquinone (CQ)/coinitiator system. The reaction course was monitored under Ar and air by isothermal differential scanning calorimetry. RESULTS: The main effect of addition of polyacid solution (PAA and commercial) up to 10wt% to HEMA on the polymerization initiated with DMPA was earlier onset of autoacceleration. For the process initiated by the CQ-based system, the addition of 5wt% of PAA solution strongly accelerated the polymerization and increased the conversion, both in Ar atmosphere as well as in air. TEGDMA photopolymerization was not influenced or slightly retarded by the presence of 3wt% of PAA solution (the upper limit of solubility), depending on the initiating system used. SIGNIFICANCE: Under initiation conditions used in curing of commercial dental products (CQ-based two component initiating system), the presence of polyacid-aqueous solution in HEMA-based photocurable component increases markedly the polymerization rate and the conversion both in Ar atmosphere as well as in air. This result contributes to a characterization of the setting process of RMGIs.     

Minimally invasive spinal surgery

Minimally invasive surgery offers quicker recovery and less morbidity for our patients through smaller surgical wounds and less tissue trauma. Although minimally invasive surgery has progressed in other fields of surgery for many years, spine surgeons have not previously embraced this philosophy for the various reasons discussed. However, minimally invasive spinal surgery has gained much interest in recent years. With the advent of new instrumentation, technology, and techniques, the promise of minimally invasive surgery in the spinal arena has become a reality. With the use of the microscope, navigational tools, newly developed canula for retraction, and image-guided percutenous pedicle screw systems, we can accomplish the same surgical procedures as currently used through smaller wounds and with greater precision. Nevertheless, all new technology does offer us an initial challenge of steep learning curves. Minimally invasive should not equate to minimal and inadequate treatment for our patients. Furthermore, careful analysis of this new technique is underway to assess its true advantages as compared with our current and proven techniques.     

Analysis of blood and hair to investigate the magnesium status of neonates and their mothers.

We examined 83 mothers from Szczecin (north-west part of Poland) and their 83 neonates. Concentrations of total and ionized magnesium in maternal and cord serum, as well as total magnesium in hair were determined. Higher levels of total magnesium were noted in neonates (cord serum, hair) than mothers. A positive correlation was ascertained between total magnesium in maternal and cord serum. Magnesium in maternal hair correlated negatively with ionized magnesium in cord serum. Male neonates demonstrated higher levels of magnesium in cord blood and hair than females. There was no effect of maternal age, education level, or number of past pregnancies on the concentration of magnesium in mothers or neonates.     

Multiple transduction as a means of preserving ganciclovir chemosensitivity in sarcoma cells carrying retrovirally transduced herpes thymidine kinase genes.

The potential value of retroviral gene transfer as a means of targeting therapeutic genes to neoplastic cells is threatened by the tendency of occasional cells to lose transduced genes or their expression. To determine whether this threat could be reduced by transducing multiple copies of a therapeutic gene, we compared 8 murine sarcoma sublines carrying from 1 to 6 copies of a retrovirally transduced herpes simplex virus thymidine kinase gene, which sensitizes cells to ganciclovir (GCV). When variability consequent to differences in vector integration site was excluded, increased copy number was associated with an increase in GCV sensitivity and a major reduction in the frequency of GCV-resistant mutants. The results suggest a potential means of preserving the efficacy of future antineoplastic gene therapy strategies.     

Microorganisms isolated from clinical specimens of patients from the Department of Thoracic Surgery

The clinical specimens received from patients hospitalized in Department of Thoracic Surgery between 1997 and 2001 were microbiologically examined. The main specimen for microbiological examination was pleural fluid (median 34%). The frequency of specimens from bronchial tree increased significantly (from 4% to 26%) with concurrent decrease of sputum (from 29% to 6%). Among isolated pathogens, Gram negative rods were the most frequent (median 48%) and Pseudomonas sp. was the main pathogen among them. Occurrence of staphylococci was median 22% and Staphylococcus aureus, with a little decrease in analyzed period, was still the main Gram positive pathogen. Simultaneously the occurrence of MRSA in the last three years dropped three times. The number of isolations of yeasts have risen from 5.8% to 10.3%.