Early identification of DPAM in at-risk low-grade appendiceal mucinous neoplasm patients: a new approach to surveillance for peritoneal metastasis.

BACKGROUND: Disseminated peritoneal adenomucinosis (DPAM) patients often have a history of appendectomy with identification of an incidental mucinous neoplasm (low-grade appendiceal mucinous neoplasm (LAMN)). The rate of developing DPAM is not well established. METHODS: Twenty-two patients with incidental LAMN were identified and monitored with cancer markers and CT every 4-6 months. Laparoscopy with peritoneal washing was performed in patients either in the event of radiographic disease or after 12 months in absence of radiographic disease. The rate of detecting peritoneal metastasis was determined for CT scan and laparoscopy. RESULTS: Peritoneal metastasis was detected in 5 (23 %) patients. Occult disease was detected in four patients at laparoscopy without a detectable disease on CT scan. One patient developed radiographic progression at 6 months confirmed with laparoscopy. Four patients were treated with cytoreductive surgery (CRS)/HIPEC and one with CRS only. The 17 patients with negative laparoscopy remain disease free with a median follow-up of 50 months. CONCLUSIONS: The rate of peritoneal metastasis in incidental LAMN patients was 23 %. Laparoscopy was the primary screening tool identifying occult metastasis. The median PCI of 7 was low, and all the patients underwent R0/R1 resections. This study revealed 1 in every 4.4 patients with LAMN may develop PMP. Longer follow-up and further patient surveillance is warranted.

The Effect of Plate Thickness on Fusion, Complications, and Outcomes in Anterior Cervical Spine Surgery.

Background and objective Anterior cervical discectomy and fusion (ACDF) is a common surgery involving the cervical spine. The goals of ACDF include obtaining a solid fusion and minimizing complications such as dysphagia. The effect of plate thickness on fusion, dysphagia, and patient outcomes is not well established. In light of this, this study aimed to evaluate the effect of plate thickness on fusion rates, complications, and outcomes in ACDF. Methods A case-control study involving ACDF performed by a single surgeon was conducted with the aim of comparing two commercially available plating systems: the Medtronic plate (Atlantis Vision Elite, Medtronic, Memphis, TN) and Aegis plate (CastleLoc-P, Aegis, Englewood, CO). The patients treated with the Medtronic plate served as the control group (Std) as the plate is widely utilized, while those treated with the Aegis plate, which is touted as one of the thinnest plates on the market, constituted the case low-profile group (LP). Demographic variables, fusion status, and patient-reported outcome measures (PROM) were compared between the two systems. Results Baseline demographic data were not significantly different between groups. The LP plate group had a significantly lower rate of fusion per patient as well as per level at 12 months. PROM did not significantly differ at any time point between the groups. Dysphagia scores could be correlated with radiographic measures reported in the Prevertebral Soft Tissue Swelling - Index (PVSTS-I).  Conclusion Based on our findings, the plate thickness was not associated with dysphagia rates; however, the use of a thinner plate correlated with a lower rate of radiographic fusion at 12 months. The PVSTS-I may be useful for identifying patients with abnormal and severely abnormal dysphagia scores.