Does in-brace correction affect coronal spinal and thoracic cage parameters in individuals with idiopathic scoliosis? A retrospective cohort study.

The aim of the study is to identify the effects of in-brace correction on coronal spinal and thoracic cage parameters in individuals with idiopathic scoliosis (IS). The coronal spinal parameters [Cobb angle, apical vertebral rotation (AVR), lateral trunk shift, coronal alignment, biacromial slope and pelvic asymmetry] and the thoracic cage parameters [T1- 12 height, T1-S1 height, thoracic transverse diameter, and apical vertebral body-rib ratio (AVB-R)] of 89 child and adolescent patients were measured on posterior-anterior full-spine radiographs at pre-brace and in-brace conditions using Surgimap software. The initial in-brace correction (IBC) was calculated as a percentage decrease in the Cobb angle on the in-brace radiographs. The mean IBC rate for the primary curve was 37% (range = 10-100%). In the in- brace condition, the Cobb angle (p<0.001), AVR (p<0.001) and lateral trunk shift (p<0.001) decreased significantly; no statistically significant difference was found in the biacromial slope (p=0.713) and the coronal alignment (p=0.074). The T1-12 height and the T1-S1 height increased significantly (p<0.001) whereas the thoracic transverse diameter and the AVB-R decreased significantly (p<0.001). Unlike IBC rate was below 30% as IBC rate was above 30%, the T1-12 height (p<0.001) increased and the AVB-R decreased (p<0.001). The bracing improved the lateral trunk shift, the AVB-R, the thoracic and spine heights, but decreased the thoracic transverse diameter. The thoracic cage parameters may be better when the IBC rate is above 30%.

Comparison of gait and sagittal plane arm swing between individuals with adolescent idiopathic scoliosis and healthy individuals.

Arm swing and energy consumption play an important role in the realization of an effective gait. However, research on arm swing and energy consumption during gait in individuals with adolescent idiopathic scoliosis (AIS) is limited. The aim of this study was to investigate the spatiotemporal characteristics of gait, arm swing angles in the sagittal plane, energy consumption in individuals with AIS, to compare them with their healthy peers in this regard. 26 diagnosed with AIS and 21 healthy were included in this study. Evaluation measures were based on the Cobb angle, axial trunk rotation, trunk symmetry, sagittal curve measurements, spatiotemporal characteristics of gait with the GAITRite electronic walkway, sagittal plane arm swing with two video-camera recordings, and energy consumption. There were a decrease in right- sided sagittal arm swing, an increase in energy consumption, in left-side step time and right-side double support time in the scoliosis group compared to the control group. The other spatiotemporal characteristics of the gait were similar in both groups. The evaluation of arm swing, energy consumption, and gait of individuals with AIS may contribute to the development of rehabilitation programs by better identifying the deficiencies of individuals with AIS.

Who is responsible for inadequate lymph node retrieval after colorectal surgery: surgeon or pathologist?

BACKGROUND: Many factors have been described influencing survival of patients with colorectal cancer. The most important prognostic factor is lymph node involvement. The National Comprehensive Cancer Network indicates that at least 12 lymph nodes (LN12) must be retrieved for proper staging and treatment planning. The surgeon and the pathologist influence the number of retrieved lymph nodes. METHODS: We retrospectively reviewed all patients with diagnosis and subsequent surgery for colorectal cancer from January 2004 to January 2010 at Gulhane Military Medical Academy in Ankara, Turkey. We investigated the relationship between LN 12 and the independent variables of tumour size, lymph node involvement, metastasis, age, gender, surgeon, pathologist, surgical specimen length, tumour stage, and localization. Statistical analysis utilized the Shapiro-Wilk test, interquartile range, Mann-Whitney test, chi-square and chi-square likelihood ratio tests, and Kruskal-Wallis nonparametric variance analysis. In order to identify influencing factors for retrieval of lymph nodes, multiple linear regression was performed. In order to identify the direction and extent of effects of these influencing factors, logistic regression was performed. OR (Odds Ratio) and 95% CI (Confidence Interval) of the OR were calculated. RESULTS: There were 223 study patients, 134 with colon cancer and 89 with rectal cancer. There was no statistical significance in terms of age, gender, cancer type and postoperative tumour size, number of metastatic lymph nodes > 4, or LN12 (p > 0.05). Statistical significance was found between surgeons and LN12, the number of operations and LN12 (p < 0.001), and pathologists and LN12 (p = 0.049). CONCLUSIONS: Harvesting an adequate number of lymph nodes is crucial for patients with colorectal cancer in terms of staging and planning further treatment modalities such as adjuvant chemotherapy. Multidisciplinary collaboration between surgeons and pathologists is vital for optimal patient outcomes.

The effect of gained experience on postoperative complications and mortality in cadaveric liver transplantation: a single-center experience.

AIM: Liver transplantation (OLT) has become the treatment of choice for end-stage liver failure, as well as for selected cases of malignancies and metabolic disorders. Decreased postoperative complications and mortality rates are expected to correlate with improvements in the interdisciplinary team approach, the perioperative anesthesiologic and intensive care management, and careful follow-up after transplantation. In this study, we have evaluated the effect of gained experience on postoperative complications and mortality in cadaveric OLT performed in our institution. MATERIALS AND METHODS: Data from cadaveric OLT patients (n = 34) since 2003 were retrospectively evaluated. Patients were divided into 2 groups: Early (2003-2006; n = 15) and late (2007-2010; n = 19). Age, gender, cold and warm ischemia times, intraoperative transfusion rates, infectious complications, biliary and vascular complication rates, and early and late postoperative mortality rates were compared in the 2 groups. RESULTS: The age and gender distribution was similar among both groups. Mean cold and warm ischemia times, intraoperative transfusion rates, and operative times were significantly lower in the late period group (P = .004, .012, and 0.008, respectively; CI=%95). T-tube usage was also significantly lower in the late period group (P < .001). There was no significant change for postoperative intensive care period (P = .404), but the overall length of stay in hospital was shorter for the patients in the late period group (P = .019). The nonsurgical early postoperative complication rate was lower (P = .001) and early postoperative mortality was nearly significant (P = .06) in patients who comprised the late period group. There was no difference in terms of biliary and vascular complication rates and overall survival rates between patients in the early and late groups (P = .664, .264, and .107, respectively). CONCLUSION: Our results indicate that the institutional improvements toward an interdisciplinary team approach in cadaveric OLT correlate with better results in ischemia and operative times and lower intraoperative transfusion rates and hospital stays. Early postoperative complication and mortality rates were found to decline in parallel to the team experience.

The impact of donor variables on the outcome of orthotopic liver transplantation for hepatitis C.

Morphologic characteristics of the graft have been proposed as a major contributor to the long-term outcomes in orthotopic liver transplantation (OLT). Our objective was to determine the impact of donor variables, including donor age, donor-recipient HLA match, and type of donation (DCD vs donation after brain death [DBD]), on the outcome of OLT in 192 patients with hepatitis C virus (HCV). Fourteen patients underwent OLT from donation after cardiac death (DCD) donors and 188 from DBD donors. Mean donor age, warm ischemia time at recovery, and cold ischemia time were similar between the groups. Overall graft survival rate at 1 year (55% DCD vs 85% DBD) and 5 years (46% DCD vs 78% DBD) was significantly lower in the DCD group (P = .0003). Similarly, patient survival rate at 1 year (62% DCD vs 93% DBD) and 5 years (62% DCD vs 82% DBD) was significantly lower in the DCD group (P = .0295). Incidences of hepatic artery thrombosis, portal vein thrombosis, and primary nonfunction were similar between the DCD and DBD groups. The incidence of liver abscess with ischemic-type biliary stricture was higher in recipients from DCD as compared with DBD (42% vs 2%). A trend toward lower graft survival was noted in recipients from donors older than 60 years of age in the HCV population (P = .07), with statistically lower patient survival (P = .02). Donor- recipient HLA matching did not appear to correlate with OLT outcome in patients with HCV. DCD donors and donors older than 60 years of age significantly impact patient and graft survival. Lower graft and patient survival in recipients from DCD donors does not appear to be related to early disease recurrence.

Liver transplantation in pediatric patients: twenty years of experience at the University of Wisconsin.

Developments in surgical technique, immunosuppression, organ procurement and preservation, and patient selection criteria have resulted in improved long-term patient and graft survival after pediatric liver transplantation. In this study, we examined the results of 196 liver transplants performed in 155 pediatric patients at University of Wisconsin Children's Hospital. Patients were divided into two groups according to age at the time of liver transplant. Infants under 12 months of age comprised Group 1 (n=74) and children from one to 18 yr comprised Group 2 (n=122). Outcomes for whole, reduced-size, and split liver transplantation were compared in infants and children. Biliary atresia was the most common indication in both groups. Patients underwent 128 whole size, 50 reduced size, and 18 split liver transplants. Forty-one retransplantations were performed in 14 infants (18.9%) and in 27 children (22.1%). One hundred eleven patients (56.6%) had one or more rejection episode [37 infants (50.0%) and 74 children (60.6%)]. Thirty-nine patients (19.8%) developed CMV infections, 42 (21.4%) developed EBV infections, and 14 developed PTLD (six infants and eight children). Thirty-six patients (18.3%) developed HAT. Seven patients (4.5%) developed malignancy (one infant and six children). Out of 155 patients, 33 (21.3%) died during the study period. The most common etiology of mortality included central nervous system pathology (n=7; 4.5%), sepsis (n=6; 3.8%), and cardiac causes (n=6; 3.8%). One-, five-, and 10-yr actuarial patient survival was 86, 79, and 74% in infants and 90, 83 and 80% in children. Graft survival at one, five, and 10 yr was 77, 73 and 71% in infants and 88, 81 and 78% in children, respectively. Despite its technical challenges, the outcomes of liver transplantation in pediatric patients with end-stage liver disease are excellent and result in significant long-term patient and graft survival.

Treatment of pilonidal sinus by phenol application and factors affecting the recurrence.

BACKGROUND: Phenol injection, a less invasive method, has become more popular for the treatment of sinus pilonidalis. Recurrence rates after the use of phenol have been reported to be less than those after other surgical methods. METHODS: In this study, we applied 80% phenol to 143 patients with sinus pilonidalis. Patients were reevaluated at 1, 3, 6, 12 and 24 months after the phenolization procedure to search for any recurrences. Age, sex, skin color, occupation, hair distribution, complaints, macroscopic characteristics of the lesion, pouch volume, microbiological yield, complications of phenol injection, healing time, and recurrences were determined. RESULTS: The mean follow-up period was 24 months and the recurrence rate was 8.3% (12 of 143 patients). Volume of the sinus tract and number of sinus orifices were determined to be the factors significantly affecting recurrences (p<0.05). CONCLUSIONS: Injection of 80% phenol is an ideal approach for the conservative treatment of sinus pilonidalis. This study confirms that this is an effective and costless method with low recurrence rates.

Diagnostic features and treatment modalities in solitary rectal ulcer syndrome.

Solitary rectal ulcer syndrome (SRUS) is a traumatic lesion of the anterior or circular rectal wall caused by straining due to functional disorders of defecation. Defecography, transrectal ultrasonography or anorectal manometry are suitable procedures that may be used to detect the causative disorder and should, therefore, be performed in patients with solitary rectal ulcer syndrome. Histopathological features of SRUS are characteristic and pathognomonic, nevertheless the endoscopic and clinical presentations may be confusing. The lesions may mimic other rectal pathologies and lead to wrong diagnosis. We retrospectively evaluated 34 patients with SRUS who had various treatments. Rectosigmoidoscopy, defecography, transrectal ultrasonography and anorectal manometry were performed for evaluation of cases. The operative management was rectopexy in 26 patients, rectal mucosectomy in 4 patients, segmental colonic resection in 2 patients, local excision in 1 patient and colostomy in 1 patient. Total regression and healing of the ulcer occurred in 32 of 34 patients. Partial regression of symptoms in 2 patients, who underwent rectopexy and rectal mucosectomy, occurred, but we could not get complete healing.

Successful conversion from conventional immunosuppression to anti-CD154 monoclonal antibody costimulatory molecule blockade in rhesus renal allograft recipients.

BACKGROUND: Several conventional forms of immunosuppression have been shown to antagonize the efficacy of anti-CD154 monoclonal antibody- (mAb) based costimulatory molecule blockade immunotherapy. Our objective was to determine if allograft recipients treated with a conventional immunosuppressive regimen could be sequentially converted to anti-CD154 mAb monotherapy without compromising graft survival. METHODS: Outbred juvenile rhesus monkeys underwent renal allotransplantation from MHC-disparate donors. After a 60-day course of triple therapy immunosuppression with steroids, cyclosporine, and mycophenolate mofetil, monkeys were treated with: (1) cessation of all immunosuppression (control); (2) seven monthly doses of 20 mg/kg hu5C8 (maintenance), or; (3) 20 mg/kg hu5C8 on posttransplant days 60, 61, 64, 71, 79, and 88 followed by five monthly doses (induction+maintenance). Graft rejection was defined by elevation in serum creatinine>1.5 mg/dl combined with histologic evidence of rejection. RESULTS: Graft survival for the three groups were as follows: group 1 (control): 70, 75, >279 days; group 2 (maintenance): 83, 349, >293 days, and; group 3 (induction+maintenance): 355, >377, >314 days. Acute rejection developing in two of four monkeys after treatment with conventional immunosuppression was successfully reversed with intensive hu5C8 monotherapy. CONCLUSIONS: Renal allograft recipients can be successfully converted to CD154 blockade monotherapy after 60 days of conventional immunosuppression. An induction phase of anti-CD154 mAb appears to be necessary for optimal conversion. Therefore, although concurrent administration of conventional immunosuppressive agents including steroids and calcineurin inhibitors has been shown to inhibit the efficacy of CD154 blockade, sequential conversion from these agents to CD154 blockade appears to be effective.