scholarly journals Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation

2015 ◽  
Vol 14 (2) ◽  
pp. 108-112 ◽  
Author(s):  
Marcelo Italo Risso Neto ◽  
Guilherme Rebechi Zuiani ◽  
Roberto Rossanez ◽  
Sylvio Mistro Neto ◽  
Augusto Celso Scarparo Amato Filho ◽  
...  
Keyword(s):  
Kappa Coefficient ◽  
Lumbosacral Spine ◽  
Interobserver Reproducibility ◽  
Tomographic Images ◽  
Partial Arthrodesis ◽  
Orthopedic Surgeons ◽  
High Concordance ◽  
Lumbar Arthrodesis ◽  
And Training

<sec><title>OBJECTIVE:</title><p> To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.</p></sec><sec><title>METHODS:</title><p> One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analyzed looking for arthrodesis signals. The appearance of bone healing in each operated level was classified in five categories as proposed by Glassman to the posterolateral arthrodesis: 1) bilateral solid arthrodesis; 2) unilateral solid arthrodesis; 3) bilateral partial arthrodesis; 4) unilateral partial arthrodesis; 5) absence of arthrodesis. In a second step, the evaluation of each operated level was divided into two categories: fusion (including type 1, 2, 3, and 4) and non fusion (type 5). Statistical analysis was performed by calculating the Kappa coefficient considering the paired analysis between the two experienced observers and between the two observers in training.</p></sec><sec><title>RESULTS:</title><p> The interobserver reproducibility by the kappa coefficient for arthrodesis consolidation analysis for the classification proposed, divided into 5 types, was 0.729 for both experienced surgeons and training surgeons. Considering only two categories kappa coefficient was 0.745 between experienced surgeons and 0.795 between training surgeons. In all analyzes, we obtained high concordance power.</p></sec><sec><title>CONCLUSION:</title><p> Interobserver reproducibility was observed with high concordance in the classification proposed by Glassman for posterolateral arthrodesis of the lumbar and lumbosacral spine.</p></sec>

Hypophosphatemic Osteomalacia associated with Neurofibromatosis Type-1: A case report and literature review

2020 ◽  
pp. 1-3
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Bone Matrix ◽  
Neurofibromatosis Type ◽  
Lower Limbs ◽  
Laboratory Evaluation ◽  
Lumbosacral Spine ◽  
Café Au Lait Spots ◽  
Hypophosphatemic Osteomalacia ◽  
Subcutaneous Mass

Introduction: Skeleton abnormalities are not uncommon in neurofibromatosis type-1 (NF1), which usually manifest as congenital malformations, such as scoliosis and sphenoid wing dysplasia. However, very rare cases of NF1 have been associated with hypophosphatemic osteomalacia (HO), which is characterized with later onset in adulthood, severe hypophosphatemia and disorder of the mineralization of organic bone matrix. Patient concerns: Here we reported a rare case of a 29-year-old woman presented with weakness and pain in lower limbs for 18 months and aggravated for half a year. On physical examination, her lower limbs’ myodynamia reduced and tenderness in multiple bone areas was detected. Light brown patches and scattered nodules could be seen on her skin, and a soft subcutaneous mass was found in the low back. Laboratory evaluation showed hypophosphatemia. Bone ECT suggested multiple abnormal bone metabolism and MRI scan of lumbosacral spine revealed numerous fractures. Neuroimaging indicated the neurofibromas, and then the biopsy of the subcutaneous lump confirmed neurofibromatosis. Diagnosis: HO associated with NF1 was diagnosed, based on the presence of café-au-lait spots and the results of bone ECT scan and biopsy. Interventions: The patient was treated with oral calcitriol, calcium carbonate d3 and phosphorus, as well as intramuscular carbocalcitonin. Outcomes: During hospitalization, her serum phosphorus level increased and symptoms improved. Conclusion: The case reported here calls attention to that when NF1 patients manifested with weakness and neurology diseases have been excluded, HO should be taken into consideration.

Moderate Adverse Events

2018 ◽  
pp. 146-149
Author(s):  
Corrie E. Chumpitazi
Keyword(s):  
Adverse Events ◽  
Airway Obstruction ◽  
Psychological Factors ◽  
Medical Condition ◽  
Patient Harm ◽  
Patient Factors ◽  
Physiologic Change ◽  
Significant Harm ◽  
And Training

The incidence of sedation-related adverse events depends on (1) the medications used; (2) the type, duration, invasiveness, and location of the procedure; and (3) patient factors (e.g., age, medical condition, psychological factors). For the purposes of this chapter, moderate adverse sedation-related events represent physiologic change that is extremely likely to lead to significant patient harm if unnoticed or responded to ineffectively by the sedationist. Apnea, airway obstruction, and laryngospasm are examples. The relative likelihood of events of this type (1 of every 400 sedation episodes) provides significant impetus for effective preparation and training so that sedationists can effectively respond to these adverse events or preempt them. Even though they are categorized as “moderate” and may not be associated with harm in and of themselves, these events may certainly progress to produce significant harm.

scholarly journals Interobserver reproducibility of radiographic evaluation of lumbar spine instability

2016 ◽  
Vol 14 (3) ◽  
pp. 378-383 ◽  
Author(s):  
Saulo de Tarso de Sá Pereira Segundo ◽  
Edgar Santiago Valesin Filho ◽  
Mario Lenza ◽  
Durval do Carmo Barros Santos ◽  
Laercio Alberto Rosemberg ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Lateral View ◽  
Radiographic Evaluation ◽  
Interobserver Reproducibility ◽  
High Reproducibility ◽  
Orthopedic Surgeons ◽  
Vertebral Bodies ◽  
Method Of Measurement ◽  
Vertebral Osteophytes ◽  
Different Levels

ABSTRACT Objective: To measure the interobserver reproducibility of the radiographic evaluation of lumbar spine instability. Methods: Measurements of the dynamic radiographs of the lumbar spine in lateral view were performed, evaluating the anterior translation and the angulation among the vertebral bodies. The tests were evaluated at workstations of the organization, through the Carestream Health Vue RIS (PACS), version 11.0.12.14 Inc. 2009© system. Results: Agreement in detecting cases of radiographic instability among the observers varied from 88.1 to 94.4%, and the agreement coefficients AC1 were all above 0.8, indicating excellent agreement. Conclusion: The interobserver analysis performed among orthopedic surgeons with different levels of training in dynamic radiographs of the spine obtained high reproducibility and agreement. However, some factors, such as the manual method of measurement and the presence of vertebral osteophytes, might have generated a few less accurate results in this comparative evaluation of measurements.

scholarly journals The 160th anniversary of Henry Turner

2018 ◽  
Vol 6 (4) ◽  
pp. 110-116
Author(s):  
Alexey G. Baindurashvili ◽  
Igor D. Vysoschuk ◽  
Alla V. Ovechkina ◽  
Anna V. Zaletina ◽  
Alyona N. Melchenko ◽  
...  
Keyword(s):  
Medical Community ◽  
Orthopedic Treatment ◽  
Organizational Skills ◽  
Military Medical Academy ◽  
Orthopedic Surgeons ◽  
Medical Academy ◽  
Long Time ◽  
To Come ◽  
The Military ◽  
And Training

The year 2018 in the medical community was marked by the 160th anniversary of the birth of Henry Ivanovich Turner. The phenomenal energy of this person, his organizational skills, talent as a scientist and public figure, dedication, and finally, his humanism are admired to this day and will serve as a model for the education of future doctors for a long time. Happiness and at the same time hard work to be the first. Henry Ivanovich Turner had fully experienced this happiness and this work. He was the organizer and leader of the first Russia Department and Clinic of Orthopedics of the Military Medical Academy, the initiator of the first Society of Orthopedic Surgeons, and the founder and honorary director of the USSR’s first Institute for the Rehabilitation of Physically Disabled Children. Henry Turner was one of the first in Russia to raise questions of a disabled child, pointed out the need for a systematic struggle of the state with children’s disability, and urged to come to the aid of a crippled child, initially with orthopedic treatment performed in conjunction with the upbringing, education, and training of any profession. The article presents the biography of the outstanding person, one of the founders of Russian orthopedics, Henry Ivanovich Turner.

A Deep Learning-enabled Electrocardiogram Model for the Identification of a Rare Inherited Arrhythmia: Brugada Syndrome (Preprint)

2020 ◽  
Author(s):  
Chih-Min Liu ◽  
Chien-Liang Liu ◽  
Kai-Wen Hu ◽  
Vincent S. Tseng ◽  
Shih-Lin Chang ◽  
...  
Keyword(s):  
Deep Learning ◽  
Brugada Syndrome ◽  
Area Under The Curve ◽  
Early Time ◽  
Learning Model ◽  
Kappa Coefficient ◽  
Mcnemar Test ◽  
Inherited Arrhythmia ◽  
Deep Learning Model

BACKGROUND Brugada syndrome is a rare inherited arrhythmia with a unique electrocardiogram (ECG) pattern (type 1 Brugada ECG pattern), which is a major cause of sudden cardiac death in young people. Automatic screening for the ECG pattern of Brugada syndrome by a deep learning model gives us the chance to identify these patients at an early time, thus allowing them to receive life-saving therapy. OBJECTIVE To develop a deep learning-enabled ECG model for diagnosing Brugada syndrome. METHODS A total of 276 ECGs with a type 1 Brugada ECG pattern (276 type 1 Brugada ECGs and another randomly retrieved 276 non-Brugada type ECGs for one to one allocation) were extracted from the hospital-based ECG database for a two-stage analysis with a deep learning model. We first trained the network to identify right bundle branch block (RBBB) pattern, and then, we transferred the first-stage learning to the second task to diagnose the type 1 Brugada ECG pattern. The diagnostic performance of the deep learning model was compared to that of board-certified practicing cardiologists. The model was also validated by the independent international data of ECGs. RESULTS The AUC (area under the curve) of the deep learning model in diagnosing the type 1 Brugada ECG pattern was 0.96 (sensitivity: 88.4%, specificity: 89.1%). The sensitivity and specificity of the cardiologists for the diagnosis of the type 1 Brugada ECG pattern were 62.7±17.8%, and 98.5±3.0%, respectively. The diagnoses by the deep learning model were highly consistent with the standard diagnoses (Kappa coefficient: 0.78, McNemar test, P = 0.86). However, the diagnoses by the cardiologists were significantly different from the standard diagnoses, with only moderate consistency (Kappa coefficient: 0.60, McNemar test, P = 2.35x10-22). For the international validation, the AUC of the deep learning model for diagnosing the type 1 Brugada ECG pattern was 0.99 (sensitivity: 85.7%, specificity: 100.0%). CONCLUSIONS The deep learning-enabled ECG model for diagnosing Brugada syndrome is a robust screening tool with better diagnostic sensitivity than that of cardiologists.

scholarly journals Neurosurgical implications of neurofibromatosis Type I in children

2006 ◽  
Vol 20 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Merdas Al-Otibi ◽  
James T. Rutka
Keyword(s):  
Peripheral Nerves ◽  
Neurofibromatosis Type ◽  
Chromosome 17 ◽  
Low Grade ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Orthopedic Surgeons ◽  
Real Risk ◽  
The Brain

Neurofibromatosis Type 1 (NF1) is one of the most common inherited diseases in humans. It is caused by a mutation in the NF1 gene on chromosome 17, and is associated with numerous central and peripheral nervous system manifestations. Children with NF1 are at high risk of harboring numerous lesions that may require the attention of a neurosurgeon. Some of these include optic nerve gliomas, hydrocephalus, intraspinal tumors, and peripheral nerve tumors. Although most of the neoplasms that affect the brain, spine, and peripheral nerves of children are low-grade lesions, there is a small but real risk that some of these lesions may become high grade over time, requiring other forms of therapy than surgery alone. Other associated disorders that may result from NF1 in childhood include Chiari malformation Type I, scoliosis, and pulsating exophthalmos from the absence of the sphenoid wing. In this review, the major lesions that are found in children with NF1 are reviewed as well as the types of treatment that are offered by neurosurgeons and other members of the treating team. Today, optimum care of the child with NF1 is provided by a multidisciplinary team comprising neurosurgeons, neurologists, ophthalmologists, radiologists, orthopedic surgeons, and plastic surgeons.

Systematized Epidermal Nevus Associated with Neurofibromatosis Type 1

1997 ◽  
Vol 1 (3) ◽  
pp. 159-161
Author(s):  
Mitchell S. Meyerson ◽  
Lesa Kelly ◽  
Philip Don ◽  
Charles Gropper
Keyword(s):  
Neurofibromatosis Type ◽  
Simultaneous Occurrence ◽  
Specific Gene ◽  
Lumbosacral Spine ◽  
Autosomal Dominant Disorder ◽  
Epidermal Nevus ◽  
Computed Tomographic ◽  
Linear Configuration ◽  
Skin Biopsies

Background: Epidermal nevi are hamartomatous, closely set, usually verrucous papules that may coalesce to form papillomatous plaques. A linear configuration is common. A systematized epidermal nevus has a diffuse or extensive distribution and, at times, can be associated with internal abnormalities and malignancies. Neurofibromatosis 1 (NF1) is an autosomal dominant disorder characterized by neurofibromas, café-au-lait macules, and axillary freckling. NF1 can also be associated with systemic abnormalities and neoplasms. Objective: Our aim was to determine if there is an association between epidermal nevi and NF1. Methods: A patient with both NF1 and a systematized epidermal nevus underwent physical examination, skin biopsies, ophthalmologic and neurologic examinations, laboratory analysis, chest and lumbosacral spine films, computed tomographic scan of the head, and renal sonogram. Results: Our patient fulfilled the criteria for NF1 and had epidermal nevi. This is, to our knowledge, the first report of NF1 and a systematized epidermal nevus appearing in the same patient. NF1 and epidermal nevi have been shown to have specific gene defects on different chromosomes. Conclusion: It is most probable that the simultaneous occurrence of NF1 and epidermal nevi is a sporadic event.

scholarly journals The Buttazzoni Classification of Distal Radial Fractures in Adults: Interobserver and Intraobserver Reliability

Hand ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Mats Å. Wadsten ◽  
Arkan S. Sayed-Noor ◽  
Gùran O. Sjù;dén ◽  
Olle Svensson ◽  
Gunnar G. Buttazzoni
Keyword(s):  
Classification System ◽  
Kappa Coefficient ◽  
Intraobserver Reliability ◽  
Classification Systems ◽  
Distal Radial Fracture ◽  
Radial Fracture ◽  
New Classification ◽  
Distal Radial Fractures ◽  
Orthopedic Surgeons ◽  
Fracture Types

Despite the fact that distal radial fracture is the commonest fracture, there is a little evidence-based knowledge about the value of its classification to guide management and predict prognosis. The available classification systems are either complicated or weakly applicable in clinical practice. Older's classification is the most reliable, but does not cover all radial fracture types. We evaluated the interobserver and intraobserver reliability of a new classification system which is a modification of Older's classification covering all radial fracture types. Two hundred and thirty-two consecutive adult patients with acute distal radial fractures were blindly evaluated according to the new classification by three orthopedic surgeons twice with 1-year interval. The interobserver reliability was measured using the Fleiss kappa coefficient, and the intraobserver reliability was measured using the Cohen's kappa coefficient. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable to the reliability of commonly used classification systems. The reliability was better for younger patients and when evaluation was carried out by hand-surgery-interested orthopedic surgeons. The new classification system is simple, covers all radial fracture types, and has an acceptable reliability. Further studies are needed to judge its ability to direct management and predict prognosis.

scholarly journals Vascularized Posterior Iliac Crest Bone Grafting: Indications, Techniques, Clinical Outcomes, and Alternatives

2021 ◽  
Vol 35 (01) ◽  
pp. 037-040
Author(s):  
Sebastian J. Winocour ◽  
Kelly P. Schultz ◽  
Matthew J. Davis ◽  
Amjed Abu-Ghname ◽  
Michael Bohl ◽  
...  
Keyword(s):  
High Risk ◽  
Gold Standard ◽  
Iliac Crest ◽  
Lumbosacral Spine ◽  
Posterior Iliac Crest ◽  
Iliac Crest Bone Grafting ◽  
Risk Patients ◽  
Lumbar Arthrodesis ◽  
Bone Autograft ◽  
Vascularized Bone

AbstractPseudarthrosis is a feared complication of spinal fusion procedures. Currently, the gold standard in prevention or treatment of pseudarthrosis is placement of nonvascularized iliac crest bone autograft. While rates of fusion are significantly higher in patients with use of nonvascularized bone autografts than with allografts, patients who have previously failed lumbar arthrodesis or those at a high risk for pseudarthrosis may benefit from a more robust, vascularized bone graft with enhanced osteogenicity. In this article, we discuss the use of iliac crest vascularized bone grafts as an adjunct for high-risk patients undergoing lumbosacral spine arthrodesis.

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