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Mannion AF, Elfering A, Fekete TF, Pizones J, Pellise F, Pearson AM, Lurie JD, Porchet F, Aghayev E, Vila-Casademunt A, Mariaux F, Richner-Wunderlin S, Kleinstück FS, Loibl M, Pérez-Grueso FS, Obeid I, Alanay A, Vengust R, Jeszenszky D, Haschtmann D. Development of a mapping function ("crosswalk") for the conversion of scores between the Oswestry Disability Index (ODI) and the Core Outcome Measures Index (COMI). Eur Spine J 2022; 31:3337-3346. [PMID: 36329252 DOI: 10.1007/s00586-022-07434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The Oswestry Disability Index (ODI) and the Core Outcome Measures Index (COMI) are two commonly used self-rating outcome instruments in patients with lumbar spinal disorders. No formal crosswalk between them exists that would otherwise allow the scores of one to be interpreted in terms of the other. We aimed to create such a mapping function. METHODS We performed a secondary analysis of ODI and COMI data previously collected from 3324 patients (57 ± 17y; 60.3% female) at baseline and 1y after surgical or conservative treatment. Correlations between scores and Cohen's kappa for agreement (κ) regarding achievement of the minimal clinically important change (MCIC) score on each instrument (ODI, 12.8 points; COMI, 2.2 points) were calculated, and regression models were built. The latter were tested for accuracy in an independent set of registry data from 634 patients (60 ± 15y; 56.8% female). RESULTS All pairs of measures were significantly positively correlated (baseline, 0.73; 1y follow-up (FU), 0.84; change-scores, 0.73). MCIC for COMI was achieved in 53.9% patients and for ODI, in 52.4%, with 78% agreement on an individual basis (κ = 0.56). Standard errors for the regression slopes and intercepts were low, indicating excellent prediction at the group level, but root mean square residuals (reflecting individual error) were relatively high. ODI was predicted as COMI × 7.13-4.20 (at baseline), COMI × 6.34 + 2.67 (at FU) and COMI × 5.18 + 1.92 (for change-score); COMI was predicted as ODI × 0.075 + 3.64 (baseline), ODI × 0.113 + 0.96 (FU), and ODI × 0.102 + 1.10 (change-score). ICCs were 0.63-0.87 for derived versus actual scores. CONCLUSION Predictions at the group level were very good and met standards justifying the pooling of data. However, we caution against using individual values for treatment decisions, e.g. attempting to monitor patients over time, first with one instrument and then with the other, due to the lower statistical precision at the individual level. The ability to convert scores via the developed mapping function should open up more centres/registries for collaboration and facilitate the combining of data in meta-analyses.
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Affiliation(s)
- A F Mannion
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - A Elfering
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - T F Fekete
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - J Pizones
- Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain
| | - F Pellise
- Spine Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - A M Pearson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - J D Lurie
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - F Porchet
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - E Aghayev
- Spine Tango Task Force, EUROSPINE, Uster, Switzerland
| | | | - F Mariaux
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - S Richner-Wunderlin
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - F S Kleinstück
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - M Loibl
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - F S Pérez-Grueso
- Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain
| | - I Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - R Vengust
- Department of Orthopedic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - D Jeszenszky
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - D Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
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Perez FA, Quinet S, Jarvik JG, Nguyen QT, Aghayev E, Jitjai D, Hwang WD, Jarvik ER, Nedeljkovic SS, Avins AL, Schwalb JM, Diehn FE, Standaert CJ, Nerenz DR, Annaswamy T, Bauer Z, Haynor D, Heagerty PJ, Friedly JL. Lumbar Spinal Stenosis Severity by CT or MRI Does Not Predict Response to Epidural Corticosteroid versus Lidocaine Injections. AJNR Am J Neuroradiol 2019; 40:908-915. [PMID: 31048295 DOI: 10.3174/ajnr.a6050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/19/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Epidural steroid injections may offer little-to-no short-term benefit in the overall population of patients with symptomatic spinal stenosis compared with lidocaine alone. We investigated whether imaging could identify subgroups of patients who might benefit most. MATERIALS AND METHODS A secondary analysis of the Lumbar Epidural Steroid Injections for Spinal Stenosis prospective, double-blind trial was performed, and patients were randomized to receive an epidural injection of lidocaine with or without corticosteroids. Patients (n = 350) were evaluated for qualitative and quantitative MR imaging or CT measures of lumbar spinal stenosis. The primary clinical end points were the Roland-Morris Disability Questionnaire and the leg pain numeric rating scale at 3 weeks following injection. ANCOVA was used to assess the significance of interaction terms between imaging measures of spinal stenosis and injectate type on clinical improvement. RESULTS There was no difference in the improvement of disability or leg pain scores at 3 weeks between patients injected with epidural lidocaine alone compared with corticosteroid and lidocaine when accounting for the primary imaging measures of qualitative spinal stenosis assessment (interaction coefficients for disability score, -0.1; 95% CI, -1.3 to 1.2; P = .90; and for the leg pain score, 0.1; 95% CI, -0.6 to 0.8; P = .81) or the quantitative minimum thecal sac cross-sectional area (interaction coefficients for disability score, 0.01; 95% CI, -0.01 to 0.03; P = .40; and for the leg pain score, 0.01; 95% CI, -0.01 to 0.03; P = .33). CONCLUSIONS Imaging measures of spinal stenosis are not associated with differential clinical responses following epidural corticosteroid injection.
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Affiliation(s)
- F A Perez
- From the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.)
| | - S Quinet
- Department of Radiology (S.Q.), College of Wisconsin, Milwaukee, Wisconsin
| | - J G Jarvik
- From the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.).,Comparative Effectiveness, Cost and Outcomes Research Center (J.G.J., P.J.H., J.L.F.).,Departments of Neurological Surgery (J.G.J.).,Health Services (J.G.J.)
| | - Q T Nguyen
- From the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.).,Orthopedics and Sports Medicine (Q.T.N.)
| | - E Aghayev
- Spinal Centre Division (E.A.), Schulthess Klinik, Zurich, Switzerland
| | - D Jitjai
- Oregon Health Sciences University (D.J.) Portland, Oregon
| | - W D Hwang
- TRA Medical Imaging (W.D.H.), Tacoma, Washington
| | - E R Jarvik
- University of Washington Medicine (E.R.J.), Seattle, Washington
| | - S S Nedeljkovic
- Department of Anesthesiology, Perioperative and Pain Medicine and Spine Unit (S.S.N.), Harvard Vanguard Medical Associates, Brigham and Women's Hospital, Boston, Massachusetts
| | - A L Avins
- Division of Research (A.L.A.), Kaiser Permanente Northern California, Oakland, California
| | - J M Schwalb
- Department of Neurosurgery (J.M.S., D.R.N.), Henry Ford Medical Group, Detroit, Michigan
| | - F E Diehn
- Department of Radiology (F.E.D.), Mayo Clinic, Rochester, Minnesota
| | - C J Standaert
- Department of Physical Medicine and Rehabilitation (C.J.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - D R Nerenz
- Department of Neurosurgery (J.M.S., D.R.N.), Henry Ford Medical Group, Detroit, Michigan
| | - T Annaswamy
- Department of Physical Medicine and Rehabilitation (T.A.), VA North Texas Healthcare System, Dallas, Texas
| | - Z Bauer
- Cancer and Blood Disorders Center (Z.B.), Seattle Children's Research Institute, Seattle, Washington
| | - D Haynor
- From the Department of Radiology (F.A.P., J.G.J., Q.T.N., D.H.)
| | - P J Heagerty
- Comparative Effectiveness, Cost and Outcomes Research Center (J.G.J., P.J.H., J.L.F.).,Biostatistics (P.J.H.)
| | - J L Friedly
- Comparative Effectiveness, Cost and Outcomes Research Center (J.G.J., P.J.H., J.L.F.) .,Rehabilitation Medicine (J.L.F.), University of Washington, Seattle, Washington
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Abbas M, de Kraker MEA, Aghayev E, Astagneau P, Aupee M, Behnke M, Bull A, Choi HJ, de Greeff SC, Elgohari S, Gastmeier P, Harrison W, Koek MBG, Lamagni T, Limon E, Løwer HL, Lyytikäinen O, Marimuthu K, Marquess J, McCann R, Prantner I, Presterl E, Pujol M, Reilly J, Roberts C, Segagni Lusignani L, Si D, Szilágyi E, Tanguy J, Tempone S, Troillet N, Worth LJ, Pittet D, Harbarth S. Impact of participation in a surgical site infection surveillance network: results from a large international cohort study. J Hosp Infect 2018; 102:267-276. [PMID: 30529703 DOI: 10.1016/j.jhin.2018.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale. AIM To determine the time-trend of SSI rates in surveillance networks. METHODS SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept. FINDINGS Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis. CONCLUSION In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.
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Affiliation(s)
- M Abbas
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - M E A de Kraker
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - E Aghayev
- Swiss RDL, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland; Schulthess Klinik, Zürich, Switzerland
| | - P Astagneau
- Reference Centre for Prevention and Control of Healthcare-associated Infections, APHP University Hospital, Paris, France
| | - M Aupee
- Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France
| | - M Behnke
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Bull
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia
| | - H J Choi
- Division of Infectious Diseases, Office of Infection Control, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - S C de Greeff
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands
| | - S Elgohari
- National Infection Service, Public Health England, London, UK
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Harrison
- Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK
| | - M B G Koek
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - E Limon
- VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain
| | - H L Løwer
- Norwegian Institute of Public Health, Department of Infectious Disease Epidemiology, Oslo, Norway
| | - O Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - K Marimuthu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J Marquess
- Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia
| | - R McCann
- Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia
| | - I Prantner
- National Center for Epidemiology, Budapest, Hungary
| | - E Presterl
- Medical University of Vienna, Department of Infection Control and Hospital Epidemiology, Vienna, Austria
| | - M Pujol
- VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - J Reilly
- Healthcare Associated Infection, Antimicrobial Resistance, Decontamination and Infection Control Group, Health Protection Scotland, NHS National Services Scotland, Glasgow, UK; Safeguarding Health Through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - C Roberts
- Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK
| | | | - D Si
- Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia
| | - E Szilágyi
- National Public Health and Medical Officer Service, Budapest, Hungary
| | - J Tanguy
- Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France
| | - S Tempone
- Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia
| | - N Troillet
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland; Service of Infectious Diseases, Central Institute of the Valais Hospital, Sion, Switzerland
| | - L J Worth
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia
| | - D Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - S Harbarth
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Richner-Wunderlin S, Mannion AF, Vila-Casademunt A, Pellise F, Serra-Burriel M, Seifert B, Aghayev E, Acaroglu E, Alanay A, Pérez-Grueso FJS, Obeid I, Kleinstück F. Factors associated with having an indication for surgery in adult spinal deformity: an international european multicentre study. Eur Spine J 2018; 28:127-137. [PMID: 30218168 DOI: 10.1007/s00586-018-5754-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/20/2018] [Accepted: 09/01/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate factors that distinguish between patients with adult spinal deformity (ASD) with and without an indication for surgery, irrespective of their final treatment. METHODS Baseline variables (demographics, medical history, outcome measures, coronal, sagittal and neurologic parameters) were evaluated in a multicentre, prospective cohort of patients with ASD. Multivariable analyses were carried out for idiopathic and degenerative patients separately with the dependent variable being "indication for surgery" and baseline parameters as independent variables. RESULTS In total, 342 patients with degenerative ASD and 624 patients with idiopathic ASD were included in the multivariable models. In patients with degenerative ASD, the parameters associated with having an indication for surgery were greater self-rated disability on the Oswestry Disability Index [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02-1.07] and a lower thoracic kyphosis (OR 0.97 95% CI 0.95-0.99), whereas in patients with idiopathic ASD, it was lower (worse) SRS self-image scores (OR 0.45 95% CI 0.32-0.64), a higher value for the major Cobb angle (OR 1.03 95% CI 1.01-1.05), lower age (OR 0.96 95% CI 0.95-0.98), prior decompression (OR 3.76 95% CI 1.00-14.08), prior infiltration (OR 2.23 95% CI 1.12-4.43), and the presence of rotatory subluxation (OR 1.98 95% CI 1.11-3.54) and sagittal subluxation (OR 4.38 95% CI 1.61-11.95). CONCLUSION Specific sets of variables were found to be associated with an indication for surgery in patients with ASD. These should be investigated in relation to patient outcomes for their potential to guide the future development of decision aids in the treatment of ASD. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | | | | | - F Pellise
- Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | - B Seifert
- Department of Biostatistics and Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - E Aghayev
- Schulthess Klinik, Zurich, Switzerland
| | | | - A Alanay
- Acibadem University, Istanbul, Turkey
| | | | - I Obeid
- Pellegrin University Hospital, Bordeaux, France
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Schmal H, Froberg L, S Larsen M, Südkamp NP, Pohlemann T, Aghayev E, Goodwin Burri K. Evaluation of strategies for the treatment of type B and C pelvic fractures: results from the German Pelvic Injury Register. Bone Joint J 2018; 100-B:973-983. [PMID: 29954203 DOI: 10.1302/0301-620x.100b7.bjj-2017-1377.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aims The best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization. Patients and Methods The study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly. Calculated odds ratios were adjusted for potential confounders. Outcome criteria were intraoperative and general short-term complications, the incidence of nerve injuries, and mortality. Results Operative stabilization reduced mortality by 36% (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42 to 0.98) but the incidence of complications was twice as high (OR 2.04, 95% CI 1.57 to 2.64). Mortality and the incidence of neurological deficits at discharge were no different after isolated posterior or combined anteroposterior fixation. However, the odds of both surgical (98%, OR 1.98, 95%CI 1.22 to 3.22) and general complications (43%, OR 1.43, 95% CI 1.02 to 2.00) were higher in the group with the more extensive surgery. Conclusion Operative stabilization is recommended for non-complex unstable pelvic fractures. The need for anterior fixation of obturator ring fractures should, however, be considered critically. Cite this article: Bone Joint J 2018;100-B:973-83.
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Affiliation(s)
- H Schmal
- Department of Orthopaedics and Traumatology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark and Department of Orthopaedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - L Froberg
- Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M S Larsen
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - N P Südkamp
- Department of Orthopaedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - T Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany
| | - E Aghayev
- Spine Centre Division, Department of Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - K Goodwin Burri
- Swiss Medical Registries and Data Linkage (SwissRDL), Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Lenoir U, Slongo T, Aghayev E, Joeris A. [The Value of Conventional Radiographs of the Pelvis in Detection of Perthes Disease 3 Months After an Episode of Acute Transient Synovitis]. Klin Padiatr 2016; 229:76-81. [PMID: 27733000 DOI: 10.1055/s-0042-116150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Transient synovitis is the most common hip joint disorder in children. Perthes disease occurs around the same age and may not be distinguishable to an episode of transient synovitis in the early stage. Therefore all children in our clinic with transient synovitis underwent a follow-up X-ray 3 months later to detect Perthes disease at an early stage. The aim of the study was to evaluate, if a follow-up X-ray is necessary for all children with suspected transient synovitis or if the clinical follow-up can lead to the indication for a follow-up X-ray. Patients and Method: Retrospective study including all children treated with the diagnosis of transient synovitis between 2004 and 2010. 198 patients with the diagnosis of a transient synovitis were included. We analyzed the radiological and clinical findings initially and after at least 3 month follow-up. Results: In the time between the episode of transient synovitis and follow-up 20 children did not remain symptom-free (10.1%). Of these patients 16 had a normal radiological follow-up and 4 (2%) were diagnosed with Perthes disease. All children which remained symptom-free between the episode of transient synovitis and the follow-up had a negative follow-up X-ray (sensitivity 0.2, specifity 1.0). Conclusion: A follow-up X-ray in detection of Perthes disease for children with transient synovitis appears to be necessary only if they have recurrent or persisting symptoms in the clinical course between the episode of transient synovitis and the 3-months-follow-up. A good patient history and an expert clinical follow-up examination are mandatory to decide whether a follow-up X-ray is needed.
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Affiliation(s)
- U Lenoir
- Dept. of Pediatric Surgery, Children's Hospital, Inselspital, University Hospital Bern, Bern, Switzerland
| | - T Slongo
- Dept. of Pediatric Surgery, Children's Hospital, Inselspital, University Hospital Bern, Bern, Switzerland
| | - E Aghayev
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - A Joeris
- Dept. of Pediatric Surgery, Children's Hospital, Inselspital, University Hospital Bern, Bern, Switzerland
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Holstein JH, Stuby FM, Herath SC, Culemann U, Aghayev E, Pohlemann T. Einfluss des Beckenregisters der DGU auf die Versorgung von Beckenringfrakturen. Unfallchirurg 2016; 119:475-81. [DOI: 10.1007/s00113-016-0168-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Röder C, Baumgärtner B, Berlemann U, Aghayev E. Superior outcomes of decompression with an interlaminar dynamic device versus decompression alone in patients with lumbar spinal stenosis and back pain: a cross registry study. Eur Spine J 2015; 24:2228-35. [DOI: 10.1007/s00586-015-4124-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/10/2015] [Accepted: 07/10/2015] [Indexed: 10/23/2022]
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Evangelopoulos DS, Huesler M, Ahmad SS, Aghayev E, Neukamp M, Röder C, Exadaktylos A, Bonel H, Kohl S. Mapping tibiofemoral gonarthrosis: an MRI analysis of non-traumatic knee cartilage defects. Br J Radiol 2015; 88:20140542. [PMID: 26081446 DOI: 10.1259/bjr.20140542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Arthroscopy is "the gold standard" for the diagnosis of knee cartilage lesions. However, it is invasive and expensive, and displays all the potential complications of an open surgical procedure. Ultra-high-field MRI now offers good opportunities for the indirect assessment of the integrity and structural changes of joint cartilage of the knee. The goal of the present study is to determine the site of early cartilaginous lesions in adults with non-traumatic knee pain. METHODS 3-T MRI examinations of 200 asymptomatic knees with standard and three-dimensional double-echo steady-state (3D-DESS) cartilage-specific sequences were prospectively studied for early degenerative lesions of the tibiofemoral joint. Lesions were classified and mapped using the modified Outerbridge and modified International Cartilage Repair Society classifications. RESULTS A total of 1437 lesions were detected: 56.1% grade I, 33.5% grade II, 7.2% grade III and 3.3% grade IV. Cartographically, grade I lesions were most common in the anteromedial tibial areas; grade II lesions in the anteromedial L5 femoral areas; and grade III in the centromedial M2 femoral areas. CONCLUSION 3-T MRI with standard and 3D-DESS cartilage-specific sequences demonstrated that areas predisposed to early osteoarthritis are the central, lateral and ventromedial tibial plateau, as well as the central and medial femoral condyle. ADVANCES IN KNOWLEDGE In contrast with previous studies reporting early cartilaginous lesions in the medial tibial compartment and/or in the medial femoral condyle, this study demonstrates that, regardless of grade, lesions preferentially occur at the L5 and M4 tibial and L5 and L2 femoral areas of the knee joint.
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Affiliation(s)
- D S Evangelopoulos
- 1 Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,2 3rd Department of Orthopaedic Surgery, KAT Hospital, University of Athens, Greece
| | - M Huesler
- 1 Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - S S Ahmad
- 1 Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - E Aghayev
- 3 Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Bern, Switzerland
| | - M Neukamp
- 3 Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Bern, Switzerland
| | - C Röder
- 3 Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Bern, Switzerland
| | - A Exadaktylos
- 4 Department of Emergency Medicine, University of Bern, Bern, Switzerland
| | - H Bonel
- 5 Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - S Kohl
- 1 Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
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Kostuj T, Preis M, Walther M, Aghayev E, Krummenauer F, Röder C. [German Total Ankle Replacement Register of the German Foot and Ankle Society (D. A. F.) - presentation of design and reliability of the data as well as first results]. Z Orthop Unfall 2014; 152:446-54. [PMID: 25313699 DOI: 10.1055/s-0034-1382933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Even though arthroplasty of the ankle joint is considered to be an established procedure, only about 1,300 endoprostheses are implanted in Germany annually. Arthrodeses of the ankle joint are performed almost three times more often. This may be due to the availability of the procedure - more than twice as many providers perform arthrodesis - as well as the postulated high frequency of revision procedures of arthroplasties in the literature. In those publications, however, there is often no clear differentiation between revision surgery with exchange of components, subsequent interventions due to complications and subsequent surgery not associated with complications. The German Orthopaedic Foot and Ankle Association's (D. A. F.) registry for total ankle replacement collects data pertaining to perioperative complications as well as cause, nature and extent of the subsequent interventions, and postoperative patient satisfaction. MATERIAL AND METHODS The D. A. F.'s total ankle replacement register is a nation-wide, voluntary registry. After giving written informed consent, the patients can be added to the database by participating providers. Data are collected during hospital stay for surgical treatment, during routine follow-up inspections and in the context of revision surgery. The information can be submitted in paper-based or online formats. The survey instruments are available as minimum data sets or scientific questionnaires which include patient-reported outcome measures (PROMs). The pseudonymous clinical data are collected and evaluated at the Institute for Evaluative Research in Medicine, University of Bern/Switzerland (IEFM). The patient-related data remain on the register's module server in North Rhine-Westphalia, Germany. The registry's methodology as well as the results of the revisions and patient satisfaction for 115 patients with a two year follow-up period are presented. Statistical analyses are performed with SAS™ (Version 9.4, SAS Institute, Inc., Cary, NC, USA). RESULTS About 2½ years after the register was launched there are 621 datasets on primary implantations, 1,427 on follow-ups and 121 records on re-operation available. 49 % of the patients received their implants due to post-traumatic osteoarthritis, 27 % because of a primary osteoarthritis and 15 % of patients suffered from a rheumatic disease. More than 90 % of the primary interventions proceeded without complications. Subsequent interventions were recorded for 84 patients, which corresponds to a rate of 13.5 % with respect to the primary implantations. It should be noted that these secondary procedures also include two-stage procedures not due to a complication. "True revisions" are interventions with exchange of components due to mechanical complications and/or infection and were present in 7.6 % of patients. 415 of the patients commented on their satisfaction with the operative result during the last follow-up: 89.9 % of patients evaluate their outcome as excellent or good, 9.4 % as moderate and only 0.7 % (3 patients) as poor. In these three cases a component loosening or symptomatic USG osteoarthritis was present. Two-year follow-up data using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Scale (AOFAS-AHS) are already available for 115 patients. The median AOFAS-AHS score increased from 33 points preoperatively to more than 80 points three to six months postoperatively. This increase remained nearly constant over the entire two-year follow-up period. CONCLUSION Covering less than 10 % of the approximately 240 providers in Germany and approximately 12 % of the annually implanted total ankle-replacements, the D. A. F.-register is still far from being seen as a national registry. Nevertheless, geographical coverage and inclusion of "high-" (more than 100 total ankle replacements a year) and "low-volume surgeons" (less than 5 total ankle replacements a year) make the register representative for Germany. The registry data show that the number of subsequent interventions and in particular the "true revision" procedures are markedly lower than the 20 % often postulated in the literature. In addition, a high level of patient satisfaction over the short and medium term is recorded. From the perspective of the authors, these results indicate that total ankle arthroplasty - given a correct indication and appropriate selection of patients - is not inferior to an ankle arthrodesis concerning patients' satisfaction and function. First valid survival rates can be expected about 10 years after the register's start.
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Affiliation(s)
- T Kostuj
- Institut für Medizinische Biometrie und Epidemiologie, Universität Witten/Herdecke, Witten
| | - M Preis
- Zentrum für Fußchirurgie, Aukammklinik, Wiesbaden
| | - M Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München-Harlaching
| | - E Aghayev
- MEM Forschungszentrum, Institut für Evaluative Forschung in der Medizin Universität Bern/Schweiz
| | - F Krummenauer
- Institut für Medizinische Biometrie und Epidemiologie, Universität Witten/Herdecke, Witten
| | - C Röder
- MEM Forschungszentrum, Institut für Evaluative Forschung in der Medizin Universität Bern/Schweiz
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11
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Pizanis A, Pohlemann T, Burkhardt M, Aghayev E, Holstein JH. Emergency stabilization of the pelvic ring: Clinical comparison between three different techniques. Injury 2013; 44:1760-4. [PMID: 23916903 DOI: 10.1016/j.injury.2013.07.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/19/2013] [Accepted: 07/06/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Emergency devices for pelvic ring stabilization include circumferential sheets, pelvic binders, and c-clamps. Our knowledge of the outcome of these techniques is currently based on limited information. METHODS Using the dataset of the German Pelvic Trauma Registry, demographic and injury-associated characteristics as well as the outcome of pelvic fracture patients after sheet, binder, and c-clamp treatment was compared. Outcome parameters included transfusion requirement of packed red blood cells, length of hospital stay, mortality, and incidence of lethal pelvic bleeding. RESULTS Two hundred seven of 6137 (3.4%) patients documented in the German Pelvic Trauma Registry between April 30th 2004 and January 19th 2012 were treated by sheets, binders, or c-clamps. In most cases, c-clamps (69%) were used, followed by sheets (16%), and binders (15%). The median age was significantly lower in patients treated with binders than in patients treated with sheets or c-clamps (26 vs. 47 vs. 42 years, p=0.01). Sheet wrapping was associated with a significantly higher incidence of lethal pelvic bleeding compared to binder or c-clamp stabilization (23% vs. 4% vs. 8%). No significant differences between the study groups were found in sex, fracture type, blood haemoglobin concentration, arterial blood pressure, Injury Severity Score, the incidence of additional pelvic packing and arterial embolization, need of red blood cell transfusion, length of hospitalisation, and mortality. CONCLUSIONS The data suggest that emergency stabilization of the pelvic ring by binders and c-clamps is associated with a lower incidence of lethal pelvic bleeding compared to sheet wrapping. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- A Pizanis
- Department of Trauma, Hand, and Reconstructive Surgery, University of Saarland, Kirrberger Strasse 1, 66421 Homburg, Germany
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12
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Kessler JT, Melloh M, Zweig T, Aghayev E, Röder C. Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango. Eur Spine J 2010; 20:369-79. [PMID: 20532924 DOI: 10.1007/s00586-010-1474-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 04/15/2010] [Accepted: 05/25/2010] [Indexed: 11/28/2022]
Abstract
Spine Tango is the first and only International Spine Registry in operation to date. So far, only surgical spinal interventions have been recorded and no comparable structured and comprehensive documentation instrument for conservative treatments of spinal disorders is available. This study reports on the development of a documentation instrument for the conservative treatment of spinal disorders by using the Delphi consensus method. It was conducted with a group of international experts in the field. We also assessed the usability of this new assessment tool with a prospective feasibility study on 97 outpatients and inpatients with low back or neck pain undergoing conservative treatment. The new 'Spine Tango conservative' questionnaire proved useful and suitable for the documentation of pathologies, conservative treatments and outcomes of patients with low back or neck problems. A follow-up questionnaire seemed less important in the predominantly outpatient setting. In the feasibility study, between 43 and 63% of patients reached the minimal clinically important difference in pain relief and Core Outcome Measures Index at 3 months after therapy; 87% of patients with back pain and 85% with neck pain were satisfied with the received treatment. With 'Spine Tango conservative' a first step has been taken to develop and implement a complementary system for documentation and evaluation of non-surgical spinal interventions and outcomes within the framework of the International Spine Registry. It proved useful and feasible in a first pilot study, but it will take the experience of many more cases and therapists to develop a version similarly mature as the surgical instruments of Spine Tango.
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Affiliation(s)
- J T Kessler
- Center for Osteopathy Zürich, Mainaustrasse 15, 8008 Zurich, Switzerland
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13
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Schluessmann E, Diel P, Aghayev E, Zweig T, Moulin P, Röder C. SWISSspine: a nationwide registry for health technology assessment of lumbar disc prostheses. Eur Spine J 2009; 18:851-61. [PMID: 19301042 DOI: 10.1007/s00586-009-0934-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 01/30/2009] [Accepted: 03/04/2009] [Indexed: 11/26/2022]
Abstract
SWISSspine is a so-called pragmatic trial for assessment of safety and efficiency of total disc arthroplasty (TDA). It follows the new health technology assessment (HTA) principle of "coverage with evidence development". It is the first mandatory HTA registry of its kind in the history of Swiss orthopaedic surgery. Its goal is the generation of evidence for a decision by the Swiss federal office of health about reimbursement of the concerned technologies and treatments by the basic health insurance of Switzerland. During the time between March 2005 and 2008, 427 interventions with implantation of 497 lumbar total disc arthroplasties have been documented. Data was collected in a prospective, observational multicenter mode. The preliminary timeframe for the registry was 3 years and has already been extended. Data collection happens pre- and perioperatively, at the 3 months and 1-year follow-up and annually thereafter. Surgery, implant and follow-up case report forms are administered by spinal surgeons. Comorbidity questionnaires, NASS and EQ-5D forms are completed by the patients. Significant and clinically relevant reduction of low back pain VAS (70.3-29.4 points preop to 1-year postop, p < 0.0001) leg pain VAS (55.5-19.1 points preop to 1-year postop, p < 0.001), improvement of quality of life (EQ-5D, 0.32-0.73 points preop to 1-year postop, p < 0.001) and reduction of pain killer consumption was revealed at the 1-year follow-up. There were 14 (3.9%) complications and 7 (2.0%) revisions within the same hospitalization reported for monosegmental TDA; there were 6 (8.6%) complications and 8 (11.4%) revisions for bisegmental surgery. There were 35 patients (9.8%) with complications during followup in monosegmental and 9 (12.9%) in bisegmental surgery and 11 (3.1%) revisions with 1 [corrected] new hospitalization in monosegmental and 1 (1.4%) in bisegmental surgery. Regression analysis suggested a preoperative VAS "threshold value" of about 44 points for increased likelihood of a minimum clinically relevant back pain improvement. In a short-term perspective, lumbar TDA appears as a relatively safe and efficient procedure concerning pain reduction and improvement of quality of life. Nevertheless, no prediction about the long-term goals of TDA can be made yet. The SWISSspine registry proofs to be an excellent tool for collection of observational data in a nationwide framework whereby advantages and deficits of its design must be considered. It can act as a model for similar projects in other health-care domains.
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Affiliation(s)
- E Schluessmann
- Institute for Evaluative Research in Orthopedic Surgery, University of Bern, Stauffacherstr.78, 3014, Bern, Switzerland
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14
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Sobottke R, Csécsei G, Kaulhausen T, Delank S, Franklin J, Aghayev E, Zweig T, Eysel P. Wirbelsäulenchirurgie bei Patienten in höherem Lebensalter. Orthopäde 2008; 37:367-73. [DOI: 10.1007/s00132-008-1233-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Jackowski C, Lussi A, Classens M, Kilchoer T, Bolliger S, Aghayev E, Criste A, Dirnhofer R, Thali MJ. Extended CT Scale Overcomes Restoration Caused Streak Artifacts for Dental Identification in CT - 3D Color Encoded Automatic Discrimination of Dental Restorations. J Comput Assist Tomogr 2006; 30:510-3. [PMID: 16778631 DOI: 10.1097/00004728-200605000-00027] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Besides DNA, dental radiographs play a major role in the identification of victims in mass casualties or in corpses with major postmortem alterations. Computed tomography (CT) is increasingly applied in forensic investigations and is used to scan the dentition of deceased persons within minutes. We investigated different restoration materials concerning their radiopacity in CT for dental identification purposes. METHODS Extracted teeth with different filling materials (composite, amalgam, ceramic, temporary fillings) were CT scanned. Radiopacities of the filling materials were analyzed in extended CT scale images. RESULTS Radiopacity values ranged from 6000-8500HU (temporary fillings), 4500-17000HU (composite fillings) and >30710HU (Amalgam and Gold). The values were used to define presets for a 3D colored volume rendering software. CONCLUSIONS The effects of filling material caused streak artifacts could be distinctively reduced for the assessment of the dental status and a postprocessing algorithm was introduced that allows for 3D color encoded visualization and discrimination of different dental restorations based on postmortem CT data.
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Affiliation(s)
- C Jackowski
- Institute of Forensic Medicine, University of Bern, and Department of Diagnostic Radiology, Lindenhofspital, Bremgartenstrasse 117, 3001 Bern, Switzerland.
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16
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Yen K, Weis J, Kreis R, Aghayev E, Jackowski C, Thali M, Boesch C, Maier SE, Dirnhofer R, Lövblad KO. Line-scan diffusion tensor imaging of the posttraumatic brain stem: changes with neuropathologic correlation. AJNR Am J Neuroradiol 2006; 27:70-3. [PMID: 16418359 PMCID: PMC7976083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Following trauma, imaging of brain stem lesions is often inconclusive. In a man who suffered a lethal accident, postmortem MR diffusion tensor (DT) imaging of the brain and neuropathologic examination were performed. DT imaging showed a disorganization of fibers in the brain stem that was not found in 2 controls and corresponded to changes on neuropathologic correlation. Diffusion tensor imaging provides an insight into the organization of myelinated structures of the CNS, potentially allowing diagnosis of traumatic fiber tract rupture.
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Affiliation(s)
- K Yen
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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Jackowski C, Thali M, Aghayev E, Yen K, Sonnenschein M, Zwygart K, Dirnhofer R, Vock P. Postmortem imaging of blood and its characteristics using MSCT and MRI. Int J Legal Med 2005; 120:233-40. [PMID: 16328426 DOI: 10.1007/s00414-005-0023-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 05/30/2005] [Indexed: 11/26/2022]
Abstract
The rapid development of computed tomography (CT) and magnetic resonance imaging (MRI) led to the introduction and establishment in postmortem investigations. The objectives of this preliminary study were to describe the imaging appearances of the early postmortem changes of blood after cessation of the circulation, such as sedimentation, postmortem clotting, and internal livores, and to give a few first suggestions on how to differentiate them from other forensic findings. In the Virtopsy project, 95 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy and therefore 44 cases have been investigated in this study. Postmortem alterations as well as the forensic relevant findings of the blood, such as internal or subcutaneous bleedings, are presented on the basis of their imaging appearances in multislice CT and MRI.
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Affiliation(s)
- C Jackowski
- Institute of Forensic Medicine, University of Bern, IRM-Buehlstrasse 20, 3012 Bern, Switzerland.
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Jackowski C, Aghayev E, Sonnenschein M, Dirnhofer R, Thali MJ. Maximum intensity projection of cranial computed tomography data for dental identification. Int J Legal Med 2005; 120:165-7. [PMID: 16237561 DOI: 10.1007/s00414-005-0050-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 08/03/2005] [Indexed: 11/25/2022]
Abstract
Dental radiographs play the major role in the identification of victims in mass casualties besides DNA. Under circumstances such as those caused by the recent tsunami in Asia, it is nearly impossible to document the entire dentition using conventional x-rays as it would be too time consuming. Multislice computed tomography can be used to scan the dentition of a deceased within minutes, and the postprocessing software allows visualization of the data adapted to every possible antemortem x-ray for identification. We introduce the maximum intensity projection of cranial computed tomography data for the purpose of dental identification exemplarily in a case of a burned corpse. As transportable CT scanners already exist, these could be used to support the disaster victim identification teams in the field.
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Affiliation(s)
- C Jackowski
- Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
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19
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Orljanski W, Aghayev E, Zazirnyj I, Schabus R. [Treatment of focal articular cartilage lesions of the knee with autogenous osteochondral grafts]. Acta Chir Orthop Traumatol Cech 2005; 72:246-9. [PMID: 16194444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE OF THE STUDY A chondral/osteochondral defect involving the articular surface of a joint is still a therapeutic problem. Many surgical techniques have been studied in an attempt to restore the damaged articular cartilage. Autogenous osteochondral graft has gained in clinical popularity because of its technical feasibility and cost effectiveness, however, only a few series have been reported in the literature. MATERIAL A retrospective study included 14 patients with 14 knees with focal full thickness articular cartilage defects hospitalised in our department between January 1997 and June 2000. The diagnoses included six knees with osteonecrosis, five knees with osteochondritis dissecans and three knees with traumatic cartilage defect. METHODS All these patients underwent an osteochondral autografts of the knee with 2 years follow-up. The evaluations were based on functional assessments, which included pain, giving way, locking, recurrent effusion, knee scores, functional scores and Lysholm scores. The postoperative values of functional assessments among the three categories of diagnosis were compared statistically using Kruskal-Wallis test. Radiographs of the knees were examined for joint congruence, joint space narrowing and degenerative changes. RESULTS The study showed good or excellent clinical results in over than 85%. The duration of pain of the knees relief ranged from six to 16 weeks after surgery. DISCUSSION There was no correlation of the clinical results with the underlying diagnosis, including osteonecrosis, osteochondritis dissecans and traumatic cartilage defect. Improvement in symptoms appeared time-dependent, ranging from 6 to 16 weeks, suggesting that postoperative protection of the graft is warranted. There was no radiographic progression of degenerative changes of the knee on the medium-term follow-up. CONCLUSION There was no correlation of the clinical results with the underlying diagnoses. It appears that an osteochondral graft has the potential to prevent or delay the development of degenerative changes of the knee in the medium-term follow-up. Autogenous osteochondral graft is considered as a good method in the treatment of knees with moderately sized articular cartilage defects.
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Affiliation(s)
- W Orljanski
- Department of Sport Traumatology, Vienna, Austria.
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