Impact of patient position on coronal Cobb angle measurement in non-ambulatory myelodysplastic patients.

OBJECTIVE: The purpose of this study was to assess the impact of patient position on the magnitude of the coronal Cobb angle measurements in relation to the change of position using plain radiograph on non-ambulatory children with myelodysplasia. Whole-spine radiographs with the patient sitting generally are preferred for the diagnosis and monitoring of progression of scoliosis in neuromuscular patients. Supine, supine traction, and sitting push-up positions have been used as substitutes, although there is no general consensus validating if these positions correlate with the sitting position. The magnitude of the Cobb angles in neuromuscular scoliosis may vary greatly depending on the position of the patient. METHODS: Radiographs of 39 myelodysplastic, non-ambulatory children were evaluated to assess the impact of change in positions (unsupported sitting, sitting push-up, supine, and supine traction) on coronal Cobb angle measurement using plain whole-spine radiographs. RESULTS: The mean difference in thoracic Cobb angle measurements between sitting and all other positions ranged from 6° to 12°. At the lumbar level, the Cobb angles ranged from 12° to 16°. CONCLUSIONS: Statistically significant differences in the Cobb angle measurements were identified between plain radiographs of the whole spine with the patient in the unsupported sitting position compared to sitting push-up, supine, and supine traction positions. The data support that the magnitude of the Cobb angles in neuromuscular scoliosis varies greatly depending on the position of the patient. LEVEL OF EVIDENCE: III.

Early Experience with the Senhance Surgical System in Bariatric Surgery.

Background and Objectives: Robotic-assisted surgery advancements have paralleled growing bariatric surgery demands. The Senhance robotic platform offers an alternative to the da Vinci surgical system but there are limited studies evaluating the Senhance system in bariatric surgery. This study aims to review a single surgeon's experience comparing outcomes between traditional laparoscopic and Senhance-assisted sleeve gastrectomy. Materials and Methods: All sleeve gastrectomies performed laparoscopically, Senhance-assisted, or da Vinci-assisted by a single surgeon at an academic center from January 2019 to July 2021 were retrospectively reviewed. Primary outcomes and quality measures were 30-day complications, operative times and length of stay. Results: A total of 268 patients, including 162 laparoscopic, 92 Senhance, and 14 da Vinci cases, were included. Operative times were significantly longer with Senhance (115.7 min) and da Vinci (122.7 min), compared to laparoscopic (94.8 min, P < .0001). Length of stay (measured in days) was significantly longer in the Senhance (1.8) and da Vinci (2.2) groups compared to laparoscopic cases (1.5, P < .0001). These differences remained significant after controlling for age, sex and body mass index. 30-day complication rates were 8.7% (n = 8) in the Senhance group, 7.1% (n = 1) in the da Vinci group and 2.5% (n = 4) in the laparoscopic group (P = .0567). Conclusion: Senhance-assisted sleeve gastrectomy is safe in bariatric surgery and comparable to laparoscopic sleeve gastrectomy with respect to 30-day complications.

Racial and ethnic healthcare disparities in patients undergoing laser lead extraction.

BACKGROUND: The rate of cardiovascular implantable electronic device infections (CIEDIs) has mirrored or exceeded the increased use of implantable cardiac devices in the United States. The presence of racial and ethnic disparities associated with CIEDIs has not been published. Our aim is to describe the presence of racial and ethnic disparities with respect to the management of CIEDIs. METHODS: We reviewed a prospective single-center registry for patients undergoing removal of an implantable cardiac device between 1/2004 and 1/2016. 1173 consecutive patients underwent device extraction. 699 patients were identified as having an infection, 305 were identified as Caucasian and 394 were minorities (91 African Americans, 303 Hispanics). Patients had pre-operative transesophageal echocardiograms (TEEs) and collection of blood and exudate cultures. All underwent complete hardware extraction; leads were removed through the use of locking stylets and traction or laser extraction. En-bloc capsulectomy was performed with intraoperative specimen collection from pocket tissue, exudate, lead tips, and vegetations. RESULTS: Minority patients were: younger (67.9 ±â€¯14.5 years vs 72.4 ±â€¯13.2 years), had a higher proportion of male gender, diabetes, and chronic renal failure (p < 0.001). Minorities experienced a higher rate of complications during extraction and a longer hospitalization (15.3 ±â€¯9.9 days versus 17.4 ±â€¯13.4 days, p < 0.001). There was no significant difference between the proportion of types of infection in both groups. CONCLUSION: Minority patients with CIEDIs experienced more procedural complications during extraction and had a significantly longer length of index hospitalization than Caucasian patients.

Recovery of outer retinal laminations on optical coherence tomography after treatment of cancer associated retinopathy.

PURPOSE: To report novel optical coherence tomography findings in a case of anti-α-enolase cancer associated retinopathy. OBSERVATIONS: An elderly female presented with bilateral decreased vision and a recent diagnosis of ovarian carcinoma. Optical coherence tomography demonstrated bilateral loss of outer retinal structures and macular edema. Serum testing found antibodies against α-enolase and 82-84 kDa proteins. Outer retinal structures showed recovery, macular edema resolved and repeat anti-retinal antibody testing became negative following cancer therapy and topical difluprednate treatment. CONCLUSIONS AND IMPORTANCE: Cancer associated retinopathy is a paraneoplastic disease that results in damage to retinal structures through an autoimmune response. The damage is generally considered to be irreversible; however, in rare cases, such as observed here, retinal structures may demonstrate recovery after treatment.