Enhanced understanding of neuropathologies has created a need for more advanced tools. Current neural implants result in extensive glial scarring and are not able to highly localize drug delivery due ...to their size. Smaller implants reduce surgical trauma and improve spatial resolution, but such a reduction requires improvements in device design to enable accurate and chronic implantation in subcortical structures. Flexible needle steering techniques offer improved control over implant placement, but often require complex closed‐loop control for accurate implantation. This study reports the development of steerable microinvasive neural implants (S‐MINIs) constructed from borosilicate capillaries (OD = 60 µm, ID = 20 µm) that do not require closed‐loop guidance or guide tubes. S‐MINIs reduce glial scarring 3.5‐fold compared to prior implants. Bevel steered needles are utilized for open‐loop targeting of deep‐brain structures. This study demonstrates a sinusoidal relationship between implant bevel angle and the trajectory radius of curvature both in vitro and ex vivo. This relationship allows for bevel‐tipped capillaries to be steered to a target with an average error of 0.23 mm ± 0.19 without closed‐loop control. Polished microcapillaries present a new microinvasive tool for chronic, predictable targeting of pathophysiological structures without the need for closed‐loop feedback and complex imaging.
Bevel‐tipped microcapillary brain implants are predictably guided to target sites using needle steering techniques and an empirical relationship between tip bevel angle and insertion trajectory. Needle guidance allows for improved targeting of pathophysiological microstructures with minimal long‐term scarring in the brain and potential applications in other solid organs.
The purpose of this study was to demonstrate that Gardner-Wells skull tong traction up to 140 lb was both safe and effective in reducing dislocation, without fractures, of facet joints involving the ...C4-C7 vertebral bodies when applied by experienced practitioners in a spinal cord injury center under close scrutiny. Twenty-four awake patients were selected for the study (age range, 16-82 years). These patients were evaluated for the number of millimeters (7-17 mm) of dislocation as measured from the posterior aspect of the superior vertebral body to the posterior aspect of the inferior vertebral body at the level of injury. The maximum weight required to produce the reduction of the facet joints and the time from the onset of traction were recorded. The patients' neurologic status was monitored before traction, after each increment in weight applied, and after reduction. Careful examination of motor function and sensation was done and recorded at each interval. The 24 patients with cervical spine dislocation of the facet joints underwent successful reduction with traction weights (range, 10-140 lb). Seventeen patients required weights of more than 50 lb. The traction procedures lasted for a period of 8-187 minutes per procedure. Worsening neurologic status did not occur in any of the patients involved in this study.
A prospective analysis of variations in monthly spinal infection rates at a spinal cord injury center with resident and fellow involvement in surgical care.
To analyze the association between ...resident and fellow participation in spinal surgery and the incidence of perioperative wound infection over the academic year.
It has been hypothesized that resident and fellow participation in surgical procedures may account for increased wound complications. Previous spinal infection studies have not addressed variations in the incidence of perioperative wound infections over the academic year.
All cases of postoperative spinal infections at a spinal cord injury center from January 1994 through December 1997 were analyzed to determine whether monthly variations reflect the changes in surgical house officer experience through the academic year.
A statistically significant (P < 0.027) increase in the incidence of spinal infection was demonstrated for the month of January. No other significant variations in the monthly incidence of spinal infection existed. No significant differences were found when the data were analyzed: year-to-year (P < 0.727), season-to-season (P < 0.204), 4-month resident rotation (P < 0.061), and 6-month fellow rotation (P < 0.075).
A significantly higher incidence of spinal infection (10.5%) was observed for the month of January. Because January does not represent the start of a new resident or fellow rotation, there appears to be no association between the incidence of perioperative spinal wound infections and the level of experience of the surgical house officers in a regional spinal cord injury center.
Hepatocellular carcinoma (HCC) is recognized as a complication of cirrhosis related to nonalcoholic fatty liver disease (NAFLD). Diabetes and the metabolic syndrome are also associated with HCC. ...However, it is not clear whether NAFLD predisposes patients to HCC in the absence of cirrhosis.
To seek evidence that HCC can develop in NAFLD unaccompanied by cirrhosis.
Retrospective case study was performed on cases from 2004 to 2007 at the University of Illinois at Chicago Medical Center, using the key words hepatocellular carcinoma, liver explant, and liver resection. The diagnosis of HCC was identified and confirmed by hematoxylin-eosin-stained slides in 50 cases. Cause of liver disease was determined by review of liver histology, clinical history, and laboratory data.
Three patients presented with advanced HCC with features of metabolic syndrome, including an elevated body mass index. Each patient had bland steatosis on liver biopsy, without fibrosis or cirrhosis. None of the 3 patients had evidence of any cause for liver disease other than NAFLD.
The cases presented here suggest that NAFLD may predispose patients to HCC in the absence of cirrhosis. Further studies are needed to confirm this potentially important observation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The standard for cancer staging in the United States for all cancer sites, including primary carcinomas of the appendix, is the American Joint Committee on Cancer (AJCC) staging system. AJCC staging ...criteria undergo periodic revisions, led by a panel of site-specific experts, to maintain contemporary staging definitions through the evaluation of new evidence. Since its last revision, the AJCC has restructured its processes to include prospectively collected data because large data sets have become increasingly robust and available over time. Thus survival analyses using AJCC eighth edition staging criteria were used to inform stage group revisions in the version 9 AJCC staging system, including appendiceal cancer. Although the current AJCC staging definitions were maintained for appendiceal cancer, incorporating survival analysis into the version 9 staging system provided unique insight into the clinical challenges in staging rare malignancies. This article highlights the critical clinical components of the now published version 9 AJCC staging system for appendix cancer, which (1) justified the separation of three different histologies (non-mucinous, mucinous, signet-ring cell) in terms of prognostic variance, (2) demonstrated the clinical implications and challenges in staging heterogeneous and rare tumors, and (3) emphasized the influence of data limitations on survival analysis for low-grade appendiceal mucinous neoplasms.
CONTEXTHepatocellular carcinoma (HCC) is recognized as a complication of cirrhosis related to nonalcoholic fatty liver disease (NAFLD). Diabetes and the metabolic syndrome are also associated with ...HCC. However, it is not clear whether NAFLD predisposes patients to HCC in the absence of cirrhosis. OBJECTIVETo seek evidence that HCC can develop in NAFLD unaccompanied by cirrhosis. DESIGNRetrospective case study was performed on cases from 2004 to 2007 at the University of Illinois at Chicago Medical Center, using the key words hepatocellular carcinoma, liver explant, and liver resection. The diagnosis of HCC was identified and confirmed by hematoxylin-eosin-stained slides in 50 cases. Cause of liver disease was determined by review of liver histology, clinical history, and laboratory data. RESULTSThree patients presented with advanced HCC with features of metabolic syndrome, including an elevated body mass index. Each patient had bland steatosis on liver biopsy, without fibrosis or cirrhosis. None of the 3 patients had evidence of any cause for liver disease other than NAFLD. CONCLUSIONSThe cases presented here suggest that NAFLD may predispose patients to HCC in the absence of cirrhosis. Further studies are needed to confirm this potentially important observation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Although hepatitis G virus infection (HGV) is usually asymptomatic, it has been associated with mild hepatic injury. Whether hepatitis G co‐infection alters the natural history of other viral ...hepatitis infections remains to be determined. In the present study, we investigated whether hepatitis G impacts on the time to recurrent hepatitis or on the time to progression to fibrosis in hepatitis C‐infected patients who undergo liver transplantation. Forty‐five liver transplantation recipients with persistent hepatitis C viremia by polymerase chain reaction (PCR) were evaluated. Stored sera obtained before and after liver transplantation was tested for HGV RNA by reverse transcriptase (RT)‐PCR using primers to the 5′ region of the HGV genome. A median of eight serial liver biopsy specimens were reviewed per patient. The prevalence of HGV co‐infection was 21% before transplantation and 22% following transplantation. During a median follow‐up of 29 months, 78% (35/45) of patients with hepatitis C viremia developed histological features of recurrent hepatitis. Fifty‐one percent (23/45) progressed to fibrous portal expansion and 16% (7/45) developed bridging fibrosis. Comparisons of patients with and without hepatitis G co‐infection following transplantation showed no significant difference in time to recurrent hepatitis, fibrous portal expansion, bridging fibrosis, or of allograft or patient survival. In conclusion, hepatitis G co‐infection does not seem to impact on the time to recurrent hepatitis C or progression of hepatitis C‐related histological injury after liver transplantation.
Cervical spine trauma Rizzolo, S J; Vaccaro, A R; Cotler, J M
Spine (Philadelphia, Pa. 1976),
10/1994, Letnik:
19, Številka:
20
Journal Article
Recenzirano
The authors reviewed the results of a large number of studies of patients with acute cervical spine dislocations and subluxations.
The authors make recommendations regarding the evaluation and ...treatment of acute cervical spine dislocations based on a thorough review of the available literature.
Realization that a significant percentage of patients with acute cervical dislocations also have disc herniations has led to some controversy regarding the timing of MRI evaluation and attempted closed reduction. This article review studies of spine dislocations at one institution.
The review of the literature included 131 consecutive patients with acute cervical spine dislocations treated by the senior author followed both retrospectively and prospectively. These results were compared with those of many other authors.
Emergent attempted closed reduction remains the treatment of choice for alert cooperative patients with acute cervical spine dislocations. Open or closed reduction under general anesthesia with an uncooperative or unconscious patient should be preceded by an MRI scan. In this situation, the presence of a herniated disc mandates decompression before reduction.
The incidence of acute herniated nucleus pulposus was determined in 55 patients with cervical spine trauma. A standardized protocol and a 1.5-T magnetic resonance image scanner was used to document a ...42% incidence of acute herniated nucleus pulposus in patients studied within 72 hours of injury. The incidence of herniated nucleus pulposus was correlated with the patients' presenting neurologic status and mechanism of injury. The incidence of herniated nucleus pulposus was highest in patients with bilateral facet dislocations (80%) and anterior cord syndromes (100%). There was no statistically significant correlation between the incidence of herniated nucleus pulposus and patients' age or sex.
PDF
