Category: Nevin Manimala

Graefes Arch Clin Exp Ophthalmol. 2022 Apr 5. doi: 10.1007/s00417-022-05641-6. Online ahead of print.

ABSTRACT

PURPOSE: The study aims to evaluate visual outcome, central corneal thickness, and rebubbling rate in a cohort with oversized DMEK grafts after failed penetrating keratoplasty (PK). The unique feature of the study is a descemetorhexis diameter larger than the full-thickness graft, i.e., peripheral to the PK interface.

METHODS: A monocentric, retrospective evaluation of all patients with endothelial graft failure after PK treated with an oversized DMEK graft and descemetorhexis outside of the PK interface (i.e., in host tissue) between January 2015 and July 2019 at the Department of Ophthalmology at the University of Düsseldorf (Germany) was performed.

RESULTS: Eleven eyes of 10 patients were identified. Mean age was 69 years. On average (arithmetic mean ± standard deviation), 1.7 ± 1.0 previous PKs have been performed per eye in this cohort. The mean time between last PK and DMEK was 10.1 ± 7.3 years (range 2 to 23 years). In all cases, the graft diameter exceeded the diameter of the previous PK and descemetorhexis was performed in host tissue, that is, peripheral to the graft-host interface. Rebubbling was performed in 18.2% of the patients (n = 2 eyes) because of central graft detachment. Mean central corneal thickness showed a statistically significant improvement at 5.3 ± 3.5 months after surgery from 688.23 ± 151.01 to 527.75 ± 88 µm (p = 0.002). Visual acuity increased significantly by 5 lines from 1.24 ± 0.5 logMAR (range from 0.5 to 2) to 0.73 ± 0.76 logMAR (range from 0.1 to 2) within 3 months (p = 0.006). Excluding patients without visual potential and transplant failure, visual acuity improved significantly by 8 lines (p < 0.001), and stayed stable until the last follow-up at 15.1 ± 11.4 months (range 6 to 39 months, p < 0.001, n = 8) after surgery.

CONCLUSION: DMEK can be successfully used to treat endothelial cell failure after PK, and can provide good postoperative results with regards to visual acuity. This study shows that stripping of Descemet’s membrane (DM) peripheral to the PK interface is surgically feasible. Overlapping, larger DMEK grafts with more endothelial cells can be used without increasing rebubbling rates and may potentially improve long-term graft survival.

PMID:35380270 | DOI:10.1007/s00417-022-05641-6

Abdom Radiol (NY). 2022 Apr 5. doi: 10.1007/s00261-022-03497-2. Online ahead of print.

ABSTRACT

PURPOSE: To explore the utility of CTE in the evaluation of bowel invasion in patients with primary ovarian, fallopian tube, and peritoneal cancer.

METHODS: This observational study included 73 patients who received CTE before operation between September 2019 and December 2021. Two radiologists reviewed CTE images, focusing on the sites and depth of bowel involvement. Based on the findings during surgical exploration, we evaluated the diagnostic power, like sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+ LR), and negative likelihood ratio (- LR) of CTE. Additionally, the characteristic images of bowel involvement on CTE corresponding to surgical findings were shown in the study.

RESULTS: The rate of macroscopic bowel invasion in this cohort was 49.31% (36/73), of which eight patients had small bowel involvement, 17 patients had colon involvement and 27 patients had sigmoid-rectum involvement. CTE detected bowel invasion in the small intestine with a sensitivity, specificity, PPV, NPV, and accuracy of 87.50%, 92.31%, 58.33%, 98.36%, 91.78%; for colon, the statistics were 58.82%, 96.43%, 83.33%, 88.52%, 87.67% and for sigmoid-rectum 62.96%, 82.61%, 68.00%, 79.17%, 75.34%, respectively.

CONCLUSION: CTE appeared a preferable diagnostic power on the small bowel and colon invasion in patients with primary ovarian, fallopian tube, and peritoneal cancer.

PMID:35380247 | DOI:10.1007/s00261-022-03497-2

Abdom Radiol (NY). 2022 Apr 5. doi: 10.1007/s00261-022-03502-8. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate if trans-arterial embolization (TAE) of the primary tumor in patients with renal cell carcinoma (RCC) improves symptomatology such as pain and hematuria or oncologic outcomes such as progression-free survival (PFS) and overall survival (OS).

MATERIALS AND METHODS: The systematic review search included PubMed, Ovid/MEDLINE, and Embase for full-text English articles including randomized and non-randomized prospective trials as well as prospective and retrospective case series. To be included, prospective trials needed ≥ 25 patients in each arm while case series and retrospective chart reviews required at least two patients. Evaluated outcomes included PFS, OS, change in tumor size, improvements in pain, improvements in hematuria, and adverse events (AEs).

RESULTS: 1327 articles were retrieved and screened. Nine studies met inclusion criteria (retrospective case series, n = 8; non-randomized prospective trial, n = 1) which included 237 patients (M = 156 (65.8%); F = 56 (23.6%); gender unreported = 25 (10.5%); mean age: 69.4 (range: 38-87)) with a mean tumor diameter of 9.3 cm (5.2-10.5). When reported, the TNM stages were stage I (n = 10), II (n = 18), III (n = 36), and IV (n = 121). 60 patients were treated for pain and hematuria. After TAE, pain improved in 59 patients (98.3%) and hematuria improved in 57 patients (95%). A meta-analysis for improvements in pain and hematuria demonstrated an event rate of pain improvement of 0.952 (0.788-0.990; p < 0.001) and an event rate for hematuria improvement of 0.923 (0.809-0.971; p < 0.001). Median OS ranged from 1 to 39 months but only one study reported PFS (10.5 months). Only one study demonstrated a statistically significant improvement in OS with TAE when compared with patients that did not undergo TAE (p = 0.02). A reduction in tumor size was only achieved in 17 patients (17/49; 34.7%) limiting evaluation. AEs included fever (n = 115/237; 48.5%), flank pain (n = 72/237; 30.4%), nausea (n = 58/237; 24.5%), hematuria (n = 12/237; 5.1%), hypertension (n = 12/237; 5.1%), reduced GFR (n = 6/237; 2.5%), hematoma (n = 6/237,2.5%), and ileus (n = 3/237; 1.3%).

CONCLUSION: TAE monotherapy of the primary tumor in patients with RCC improves symptomatology such as pain and hematuria with an acceptable safety profile.

PMID:35380246 | DOI:10.1007/s00261-022-03502-8

Eur Radiol. 2022 Apr 5. doi: 10.1007/s00330-022-08732-4. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Transarterial ⁹⁰Y radioembolization (TARE) is increasingly being used for hepatocellular carcinoma (HCC) treatment. However, tumor response assessment after TARE may be challenging. We aimed to assess the diagnostic performance of gadoxetate disodium MRI for predicting complete pathologic necrosis (CPN) of HCC treated with TARE, using histopathology as the reference standard.

METHODS: This retrospective study included 48 patients (M/F: 36/12, mean age: 62 years) with HCC treated by TARE followed by surgery with gadoxetate disodium MRI within 90 days of surgery. Two radiologists evaluated tumor response using RECIST1.1, mRECIST, EASL, and LI-RADS-TR criteria and evaluated the percentage of necrosis on subtraction during late arterial, portal venous, and hepatobiliary phases (AP/PVP/HBP). Statistical analysis included inter-reader agreement, correlation between radiologic and pathologic percentage of necrosis, and prediction of CPN using logistic regression and ROC analyses.

RESULTS: Histopathology demonstrated 71 HCCs (2.8 ± 1.7 cm, range: 0.5-7.5 cm) including 42 with CPN, 22 with partial necrosis, and 7 without necrosis. EASL and percentage of tumor necrosis on subtraction at the AP/PVP were independent predictors of CPN (p = 0.02-0.03). Percentage of necrosis, mRECIST, EASL, and LI-RADS-TR had fair to good performance for diagnosing CPN (AUCs: 0.78 – 0.83), with a significant difference between subtraction and LI-RADS-TR for reader 2, and in specificity between subtraction and other criteria for both readers (p-range: 0.01-0.04). Radiologic percentage of necrosis was significantly correlated to histopathologic degree of tumor necrosis (r = 0.66 – 0.8, p < 0.001).

CONCLUSIONS: Percentage of tumor necrosis on subtraction and EASL criteria were significant independent predictors of CPN in HCC treated with TARE. Image subtraction should be considered for assessing HCC response to TARE when using MRI.

KEY POINTS: • Percentage of tumor necrosis on image subtraction and EASL criteria are significant independent predictors of complete pathologic necrosis in hepatocellular carcinoma treated with⁹⁰Y radioembolization. • Subtraction, mRECIST, EASL, and LI-RADS-TR have fair to good performance for diagnosing complete pathologic necrosis in hepatocellular carcinoma treated with⁹⁰Y radioembolization.

PMID:35380226 | DOI:10.1007/s00330-022-08732-4

Eur Radiol. 2022 Apr 5. doi: 10.1007/s00330-022-08709-3. Online ahead of print.

ABSTRACT

OBJECTIVES: To analyze the response in the management of both radiological emergencies and continuity of care in oncologic/fragile patients of a radiology department of Sant’Andrea Academic Hospital in Rome supported by a dedicated business analytics software during the COVID-19 pandemic.

METHODS: Imaging volumes and workflows for 2019 and 2020 were analyzed. Information was collected from the hospital data warehouse and evaluated using a business analytics software, aggregated both per week and per quarter, stratified by patient service location (emergency department, inpatients, outpatients) and imaging modality. For emergency radiology subunit, radiologist workload, machine workload, and turnaround times (TATs) were also analyzed.

RESULTS: Total imaging volume in 2020 decreased by 21.5% compared to that in 2019 (p < .001); CT in outpatients increased by 11.7% (p < .005). Median global TAT and median code-blue global TAT were not statistically significantly different between 2019 and 2020 and between the first and the second pandemic waves in 2020 (all p > .09). Radiologist workload decreased by 24.7% (p < .001) during the first pandemic wave in 2020 compared with the same weeks of 2019 and showed no statistically significant difference during the second pandemic wave, compared with the same weeks of 2019 (p = 0.19).

CONCLUSIONS: Despite the reduction of total imaging volume due to the COVID-19 pandemic in 2020 compared to 2019, management decisions supported by a dedicated business analytics software allowed to increase the number of CT in fragile/oncologic outpatients without significantly affecting emergency radiology TATs, and emergency radiologist workload.

KEY POINTS: • During the COVID-19 pandemic, management decisions supported by business analytics software guaranteed efficiency of emergency and preservation of fragile/oncologic patient continuity of care. • Real-time data monitoring using business analytics software is essential for appropriate management decisions in a department of radiology. • Business analytics should be gradually introduced in all healthcare institutions to identify strong and weak points in workflow taking correct decisions.

PMID:35380224 | DOI:10.1007/s00330-022-08709-3

Osteoporos Int. 2022 Apr 5. doi: 10.1007/s00198-022-06376-0. Online ahead of print.

ABSTRACT

Data are contradictory regarding the relationship between osteoarthritis (OA) and osteoporosis (OP) with some studies showing the increased risk of OP in OA. The study was conducted to determine whether OP prevalence is increased in patients with OA, compared to age and sex-matched population. MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library (inception-2019) were searched for studies reporting the frequency, rate, prevalence, incidence, risk, or excess risk of OP in patients with OA compared to age and sex-matched population. Estimates were combined using a random effects model. Consistency was evaluated using the I² statistic. Articles with fewer than 200 participants were excluded. Of 2772 articles, 49 had full article screening, and 8 articles met the inclusion criteria. Other articles reporting mean BMD and not OP were excluded. In women, 998 participants with OA were compared with 1903 controls. The pooled estimate of the odds ratio for prevalence of OP vs general matched population was not statistically different. In men, 136 participants with OA were compared with 682 controls. The results did not show a statistically significant difference in the frequency of OP in OA in men. According to the site of bone mineral density measurement, a higher prevalence of OP at lumbar spine was found in both men and women. The frequency of OP overall in participants with OA was not different, except for a higher prevalence of OP in lumbar spine in both men and women compared to the matched controls.

PMID:35380214 | DOI:10.1007/s00198-022-06376-0

J Neurosurg Sci. 2022 Apr 5. doi: 10.23736/S0390-5616.22.05606-5. Online ahead of print.

ABSTRACT

BACKGROUND: In our experience, we encountered more blood vessels during deep brain stimulation (DBS) surgeries in epilepsy. In this study, we have quantified and compared the cerebral vascularization in epilepsy, Parkinson’s Disease (PD) and Obsessive-Compulsive Disorder (OCD).

METHODS: A retrospective observational study in 15 epilepsy and 15 PD patients was performed. The amount, location and size of blood vessels within 5 millimeter (mm) of all DBS electrode trajectories (n=120) for both targets (anterior nucleus of the thalamus: ANT and subthalamic nucleus: STN) in both patient groups were quantified and compared on a Medtronic workstation. Additionally, blood vessels in the trajectories (n=120) of another group of 15 PD (STN) and 15 OCD (Ventral Capsule-Ventral Striatum, VC-VS) patients were quantified and compared (trajectories n=120), also to the first group. Statistical analyses were performed with SPSS version 27.0 (descriptive statistics, independent samples T-tests, Mann Whitney U tests, ANOVA test and post-hoc Tukey test). A P-value < 0.05 was considered statistically significant.

RESULTS: Our results showed a significant greater amount of cerebral blood vessels in epilepsy patients (10 SD ± 4) compared to PD (PD1 6 SD ± 1 and PD2 5 SD ± 3) and OCD (5 SD ± 1) with P <0.0001. Also, all other subanalyses showed more vascularization in the epilepsy group.

CONCLUSIONS: Our results show that the brain of epilepsy patients seems to be more vascularized compared to PD and OCD patients. This can make the surgical planning for DBS more challenging and the use of multiple trajectories limited.

PMID:35380200 | DOI:10.23736/S0390-5616.22.05606-5

Quintessence Int. 2022 Apr 5;0(0):2-9. doi: 10.3290/j.qi.b2887673. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate functional and esthetic clinical outcomes and patient satisfaction with narrow-diameter implants in comparison to standard-diameter implants in the anterior zone of the maxilla in a follow-up examination after 1 to 6 years.

METHOD AND MATERIALS: The study was designed as a retrospective cohort study investigation including 27 patients receiving a 3.3-mm diameter single implant (NDI, n = 14) or a standard-diameter 4.1-mm single implant in the anterior zone of the maxilla (SDI, n = 16). Descriptive and analytical statistics were performed comparing both groups with regard to clinical examination including esthetic outcome, sulcus fluid flow-rate, crown esthetics, patients’ satisfaction on visual analog scales, occurrence of biologic or technical complication, probing pocket depths (Fisher exact test), pink esthetic score (PES) and Periotest (Mann-Whitney U test). The level of significance was set at α = .05.

RESULTS: The mean observation period was 4.8 years after crown insertion in the NDI group, and 4.9 years in the SDI group. Significant differences were observed for Periotest values in favor of the 4.1-mm implants (P = .014). No differences were found with regards to esthetics (PES; P = .27) or sulcus fluid flow-rate (P = 0.73) and probing pocket depths (P = .35). Overall patient satisfaction was high for both groups with visual analog scale scores of 9.3 ± 1.1 for NDI and 9.4 ± 1.0 for SDI (P = .39).

CONCLUSION: Clinical outcome with narrow-diameter implants was comparable to standard-diameter implants in the anterior zone of the maxilla with similar esthetic assessments and patients’ satisfaction.

PMID:35380207 | DOI:10.3290/j.qi.b2887673

J Neurosurg Sci. 2022 Apr 5. doi: 10.23736/S0390-5616.22.05553-9. Online ahead of print.

ABSTRACT

BACKGROUND: Degenerative disc disease (DDD) is a prevalent disorder that brings great incapacity and morbidity to the world’s population. Its pathophysiology is not fully understood. DNA damage can influence this process, but so far, there have been few studies to evaluate this topic and its true importance in DDD, as well as whether there is a relation between degeneration grade and DNA damage. The objective of this study is to evaluate the degree of damage to the DNA and the relation to the severity of DDD and measure its response to this insult compared to live/dead cell parameters and reactive oxygen species activity in human discs.

METHODS: An experimental study was performed with 15 patients with grade IV or V Pfirrmann classification who underwent spinal surgery. Five patients were operated on two levels, resulting in 20 samples that were submitted to the comet assay to measure DNA damage. Of these, six samples were submitted to flow cytometry, and apoptosis, necrosis, cell membrane integrity, intracellular esterase activity, reactive oxygen species (ROS), caspase 3 and mitochondrial membrane potential were evaluated.

RESULTS: All samples had DNA damage, and the average of index damage (ID) was 78.1 (SD ± 65.11) and frequency damage (FD) was 49.3% (SD ± 26,05%). There was no statistical difference between the Pfirrmann grades and genotoxic damage. Likewise, all samples that underwent flow cytometry showed apoptosis and ROS to many different degrees.

CONCLUSIONS: DNA damage occurs in high-grade degeneration of human discs and contributes to activation of the apoptosis pathway and ROS production that can accelerate disc degeneration.

PMID:35380199 | DOI:10.23736/S0390-5616.22.05553-9

Swiss Med Wkly. 2022 Mar 22;152:w30136. doi: 10.4414/smw.2022.w30136. eCollection 2022 Mar 14.

ABSTRACT

PURPOSE: To compare in-hospital treatment costs of aquablation and transurethral resection of the prostate (TURP) in the treatment of benign prostatic enlargement.

PATIENTS AND METHODS: Patient data and procedural details were derived from a prospective database. In-hospital costs were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs including those arising from surgical procedures, consumables, personnel and accommodation were analysed for 24 consecutive patients undergoing aquablation and compared with 24 patients undergoing TURP during the same period. Mean total costs and mean costs for individual expense items were compared between treatment groups with t-tests.

RESULTS: Mean total costs per patient (± standard deviation) were higher for aquablation at EUR 10,994 ± 2478 than for TURP at EUR 7445 ± 2354. The mean difference of EUR 3549 was statistically significant (p <0.001). Although the mean procedural costs were significantly higher for aquablation (mean difference EUR 3032; p <0.001), costs apart from the procedure were also lower for TURP, but the mean difference of EUR 1627 was not significant (p <0.327). Medical supplies were mainly responsible (mean difference EUR 2057; p <0.001) for the difference in procedural costs.

CONCLUSIONS: In-hospital costs are significantly higher for aquablation than for TURP, mainly due to higher costs of medical supplies for the procedure. This difference should be taken into consideration, at least in patients for whom the different side effect profiles of both treatments are irrelevant.

PMID:35380182 | DOI:10.4414/smw.2022.w30136