Three-dimensional computed tomography-based, personalized drill guide for posterior cervical stabilization at C1-C2.

STUDY DESIGN: Cadaver and preliminary clinical study. OBJECTIVES: To enhance the precision of screw positions for posterior transarticular fixations according to Magerl at C1-C2. SUMMARY OF BACKGROUND DATA: The vertebral arteries are at risk during the Magerl operation and may be damaged in up to 4.1% of cases. Even intraoperative navigation, as often used nowadays, does not provide optimal screw positioning in all patients. METHODS: According to the three-dimensional CT data obtained for every individual cadaver or patient, a template was designed for the posterior course of C2: the template contains a drill guide allowing navigated screw positioning inside the left and right isthmus of C2. For a first series of five cadavers a template with clamps connecting only to the lamina of C2, excluding the spinous process from the interface, was carried out. For a second series of three cadavers the template was connected not only to the lamina but also to the spinous process of C2. Both cadaver series were performed without any fluoroscopic control at surgery. Eventually the technology was applied in two clinical cases. RESULTS: The rotational stability of the template toward the lamina C2 was insufficient in the first series, but for the second series both the entry points and screw trajectories were very satisfactory. CONCLUSIONS: Although the actual experience is limited, the idea of using a template with drill guide might simplify and shorten the surgical act and at the same time enhance the accuracy of C1-C2 transarticular screw positioning.

High labial incisions for genioplasty.

Clinical experience in genioplasty has shown that high labial incisions heal with fewer scar bands than conventional deep labial incisions. In a prospective randomized trial, we compared 18 high labial curvilinear incisions with 27 high labial W-shaped ('royal') incisions for access and visibility during chin osteotomy. Both incisions were 3 cm wide. Maximal incision lengthening between two skin hooks was recorded with a ruler before closure, and there was no significant difference between the two. The maximum wound area between three skin hooks was photographed and computed, and showed a mean difference of 188.75 mm2 (t-test, P < 0.001), which corroborated the clinical findings that access and visibility were superior in the W-shaped incision group. Complications were few in both groups. We now use the high labial royal incision about 3.5 cm wide, with 90 degrees limb angle for complicated chin osteotomies and ostectomies. A smaller curvilinear high labial incision is used for simple advancement osteotomies.

Internal fixation of the spine in traumatic and scoliotic cases. The potential of pedicle screws.

Internal fixation techniques are in common used to stabilize vertebral fractures and correct severe scoliosis. Consolidation of injured vertebrae with neighbouring intact vertebra is the goal in the former case whilst fusion of the vertebrae in a corrected position is aimed at in the latter case. Degenerative spine diseases are not considered in this paper. Classical instrumentation consists of rods (e.g., Cotrel-Dubousset, Harrington, Luque-Galveston) attached to the bone by means of hooks or wires. More recently, transpedicular screws are introduced as an alternative bone/implant interface. Comparing the results of several studies, the posterior pedicle screw based devices demonstrate the ability to produce the most rigid constructs. However, the insertion of pedicle screws implicates a relatively high complication risk and its success strongly depends on the experience of the surgeon. Incorrect drilled holes or malplacement of the screws can result in nerve root injuries and fracture of the pedicle. Studies reported complication ratios up to 30% with substantial neurological implications. A certain degree of automation of the critical actions may be necessary to enhance the safety of pedicle screw insertion. Two techniques of computer assisted spine surgery are compared. Both techniques permit a computer assisted surgical planning based on CT images. During operation the first system permanently observes the position of the drill relative to the spine and informs the surgeon on the deviation of the actual drill path to the planned drill path. The second system uses a pre-operative surgical planning to design and construct a mechanical drill guide, fitting perfectly on the patient's spine.

Estradiol-17 beta quantified in serum by isotope dilution-gas chromatography-mass spectrometry: reversed-phase C18 high-performance liquid chromatography compared with immuno-affinity chromatography for sample pretreatment.

Here, isotope dilution-gas chromatography-mass spectometry is used as a reference technique for determining the concentration of estradiol-17 beta in candidate human serum Reference Material. The accuracy of assigned concentrations in biologic materials is not only determined by instrumental performance, it also depends greatly on the selectivity of the procedure for isolating the analyte from the biological matrix, an issue which we consider insufficiently addressed in the literature. We introduced reversed-phase C18 high-performance liquid chromatography as a fractionation procedure in addition to the commonly used solvent extraction and column chromatography on Sephadex LH-20. The validity of this approach as part of a Reference Method for measurement of estradiol-17 beta by isotope dilution-gas chromatography-mass spectrometry was investigated by comparison with immuno-affinity chromatography, which on theoretical grounds is generally considered as highly selective.

Production, purification and characterization of antibodies to 1,25-dihydroxyvitamin D raised in chicken egg yolk.

For this sensitive RIA for 1 alpha,25-dihydroxyvitamin D, we used antibodies to 1 alpha,25-dihydroxycholecalciferol-3-hemisuccinate conjugated to bovine serum albumin, raised in eggs by immunization of chickens. We describe an efficient method for purification of IgG from egg yolk. We characterized these antibodies with immunoelectrophoresis and by radioimmunoassay. These antibodies show a high affinity for 1 alpha,25-dihydroxyvitamin D3 but cross react with other vitamin D metabolites as well. Extraction and liquid chromatography are necessary to isolate the 1 alpha,25-dihydroxyvitamin D from human serum or plasma before determination by RIA. The sensitivity of the assay is estimated at 5 pg/tube.

Incidence and bacterial aetiology of neonatal conjunctivitis.

Two hundred and twenty-nine infants born consecutively at the maternity ward of the Middelheim Hospital in Antwerp, over a period of 5 months, and an additional 55 randomly selected infants born at the same hospital were clinically and microbiologically investigated before leaving the maternity ward. All infants born at this maternity ward received argyrol eye drops immediately after birth. Twenty-six (11%) of the infants consecutively investigated had neonatal conjunctivitis diagnosed before leaving the maternity ward, where they stayed from 7-10 days. Another 29 infants were reported to have developed sticky eyes and/or red eyes after leaving the maternity hospital and before 1 month of age. The instantaneous risk of developing, a conjunctivitis was equal for each day of the first month of life. Chlamydia trachomatis was isolated from the eyes of 11 of the 229 (4.8%) consecutively born infants but only one had conjunctivitis symptoms before leaving the maternity ward. Overall one or more bacterial species could be isolated from the eyes of 143 (48%) of the infants, but only viridans streptococci and Staphylococcus aureus were cultured significantly more often from the eyes of cases with conjunctivitis than from the eyes of the infants without conjunctivitis (P less than 0.001).

Development and evaluation of a radioimmunoassay for Arg8-vasopressin, after extraction with Sep-Pak C18.

We describe a specific double-antibody radioimmunoassay for measuring arginine vasopressin (AVP) in human plasma. Antisera of high avidity were obtained from rabbits that had been injected with AVP coupled to bovine thyroglobulin. The antibody reacts with both the tripeptide tail and the pentapeptide ring of the molecule, thereby eliminating cross reaction with oxytocin. Synthetic AVP was labeled with 125I by a modification of the Chloramine-T technique. The specific activity of the labeled hormone was 29 MBq/micrograms of AVP, as estimated by self-displacement analysis. The assay involves Sep-Pak C18 extraction of acidified (pH 4) plasma. Recovery of [3H]AVP added to plasma averaged 86.6 (SD 6.1)% (n = 14). Dilution curves for plasma showed linearity of response with concentration. The overall sensitivity was 0.3 ng/L when 2-mL plasma samples were extracted. The intra-assay CV was 7.8% at 4.8 ng/L (n = 12) and the interassay CV was 12.3% (n = 16) and 6.3% (n = 14) at 2.7 and 4.1 ng/L concentrations, respectively.