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How I do it…. How infection doctors approach the PJI MDT.
No full textThe management of prosthetic joint infection (PJI) requires discussion between experts working towards the aims and expectations of the patient. Each discipline typically does not offer a single-minded approach, but instead collectively weighs up the strengths and weaknesses of different management options. At a basic level, the infection specialist provides antimicrobial solutions based on laboratory results. During multi-disciplinary team (MDT) discussions however, they can offer additional insights into how the microbiology could influence the surgical decisions, respond to the surgical debate by designing a rational approach to antimicrobials and contribute to an option-appraisal that can be presented to the patient. In this short opinion piece, we describe some of the thoughts we have during MDT discussions to ultimately recommend an optimised treatment plan for the individual patient: is there infection? what is the pathogen? where did it come from? (and where else has it gone), and what is the best treatment strategy
Response to: Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis-dependent chronic kidney disease.
No full textImportance and Evidence of Extent of Resection in Glioblastoma.
No full textMaximal safe resection is an essential part of the multidisciplinary care of patients with glioblastoma. A growing body of data shows that gross total resection is an independent prognostic factor associated with improved clinical outcome. The relationship between extent of glioblastoma (GB) resection and clinical benefit depends critically on the balance between cytoreduction and avoiding neurologic morbidity. The definition of the extent of tumor resection, how this is best measured pre- and postoperatively, and its relation to volume of residual tumor is still discussed. We review the literature supporting extent of resection in GB, highlighting the importance of a standardized definition and measurement of extent of resection to allow greater collaboration in research projects and trials. Recent developments in neurosurgical techniques and technologies focused on maximizing extent of resection and safety are discussed
Mapping the Risk of Fracture of the Tibia From Penetrating Fragments.
No full textPenetrating injuries are commonly inflicted in attacks with explosive devices. The extremities, and especially the leg, are the most commonly affected body areas, presenting high risk of infection, slow recovery, and threat of amputation. The aim of this study was to quantify the risk of fracture to the anteromedial, posterior, and lateral aspects of the tibia from a metal fragment-simulating projectile (FSP). A gas gun system and a 0.78-g cylindrical FSP were employed to perform tests on an ovine tibia model. The results from the animal study were subsequently scaled to obtain fracture-risk curves for the human tibia using the cortical thickness ratio. The thickness of the surrounding soft tissue was also taken into account when assessing fracture risk. The lateral cortex of the tibia was found to be most susceptible to fracture, whose impact velocity at 50% risk of EF1+, EF2+, EF3+, and EF4+ fracture types - according to the modified Winquist-Hansen classification - were 174, 190, 212, and 282 m/s, respectively. The findings of this study will be used to increase the fidelity of predictive models of projectile penetration
Response to the Comment on "Injury or Function-What Is Best to Assess Organ Viability Before Liver Graft Implantation?"
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Extramedullary malignant melanotic schwannoma of the spine: Case report and an up to date systematic review of the literature.
No full textBackground
Melanotic schwannoma is a rare variant of schwannoma. Extramedullary melanotic schwannoma originates in the vicinity of nerve roots mimicking other intervertebral disc disorders. Therefore, T1 and T2-weighted MRI sequences become an essential tool for diagnosis. Aside from case reports, no large studies exist to provide consensus on the signal intensities in T1 and T2-weighted MR imaging. Moreover, no clear evidence is available to delineate prognosis. Here, a case report is presented together with a subsequent systematic review of the literature regarding this rare entity.
Case description
A 45-year old female presented with a one-year history of insidious onset of neck pain and paraesthesia. Magnetic resonance imaging confirmed an extramedullary lesion along the C6 nerve root with T1-weighted hyperintensity and T2-weighted hypointensity. Despite two surgical decompressions and adjuvant immunotherapy, the patient unfortunately passed away due to metastatic progression.
Discussion
According to the systematic review conducted, in over half of the cases of extramedullary melanotic schwannoma, there is local reoccurrence and/or distal metastasis. Moreover, in 64.7% and 70.6% of the cases, the T1-weighted image of the lesion appears hyperintense and hypointense on a T2-weighted image, respectively. It is an aggressive variant of schwannoma, one of the most commonly observed extramedullary tumours presenting to neurosurgical practice.
Conclusion
Our results highlight that specific T1 and T2-weighted imaging findings can provide valuable information, enabling early suspicion, influencing the surgical aims and strategy and the timely commencement of relevant immunotherapy. Considering the poor prognosis, early adjuvant therapy with other modalities should be considered