Identification of elderly patients at risk for 30-day readmission: Clinical insight beyond big data prediction

AIM

This study explores the potential benefit of combining clinicians' risk assessments and the automated 30-day readmission prediction model.

BACKGROUND

Automated readmission prediction models based on electronic health records are increasingly applied as part of prevention efforts, but their accuracy is moderate.

METHODS

This prospective multisource study was based on self-reported surveys of clinicians and data from electronic health records. The survey was performed at 15 internal medicine wards of three general Clalit hospitals between May 2016 and June 2017. We examined the degree of concordance between the Preadmission Readmission Detection Model, clinicians' readmission risk classification and the likelihood of actual readmission. Decision trees were developed to classify patients by readmission risk.

RESULTS

A total of 694 surveys were collected for 371 patients. The disagreement between clinicians' risk assessment and the model was 34.5% for nurses and 33.5% for physicians. The decision tree algorithms identified 22% and 9% (based on nurses and physicians, respectively) of the model's low-medium-risk patients as high risk (accuracy 0.8 and 0.76, respectively).

CONCLUSIONS

Combining the Readmission Model with clinical insight improves the ability to identify high-risk elderly patients.

IMPLICATIONS FOR NURSING MANAGEMENT

This study provides algorithms for the decision-making process for selecting high-risk readmission patients based on nurses' evaluations.

Should patients treated with oral anti-coagulants be operated on within 48 h of hip fracture?

To investigate if patients treated with oral anticoagulants (OAC) have delayed surgical intervention (more than 48 h) compared to patients without OAC therapy, and if there is an impact to surgery timing on hospitalization length and mortality. A retrospective cohort study of all patients aged over 65 registered with a new diagnosis of hip fracture who underwent surgery in one of the general hospitals run by Clalit, Israel between 01/01/2014 and 31/12/2017. Data was retrieved for patient demographics, OAC treatment, and Charlson comorbidity index. 5828 patients were operated for hip fractures, mean age was 82.8 years (65-108), 4013 (68.8%) were female. 415 were treated with direct oral anticoagulants (DOACs) (7.1%) and 311 with warfarin (5.3%) prior to their hospitalization. Patients taking OAC were less likely to be operated within 48 h from arrival to the hospital compared to patients not receiving OAC. The 30 day mortality was 4.2% among patients not receiving OAC, 6.0% among patients taking DOACs and 10.0% among patients receiving warfarin (p < 0.001). Adjusted odds ratio for mortality at 30 day among patients taking DOACs was similar to patients who didn't take OAC. (OR 1.0, CI 0.7, 1.6). The 30 day mortality rate of patients who were receiving OAC (either DOACs or warfarin) was not significantly different whether patients were operated within 48 h or not. Mortality rate was highest among patients taking warfarin. For patients who received DOACs, operation within 48 h wasn't associated with lower mortality rate. In these patients it seemed reasonable to adjust surgery time according to patients' characteristics and needs.

Prediction of Long-Term Diabetes Remission After RYGB, Sleeve Gastrectomy, and Adjustable Gastric Banding Using DiaRem and Advanced-DiaRem Scores

PURPOSE

DiaRem is a clinical scoring system designed to predict diabetes remission (DR) 1-year post-Roux-en-Y gastric bypass (RYGB). We examined long-term (2- and 5-year) postoperative DR prediction by DiaRem and an advanced-DiaRem (Ad-DiaRem) score following RYGB, sleeve gastrectomy (SG), and gastric banding (GB).

METHODS

We accessed data from a computerized database of persons with type 2 diabetes and BMI ≥ 30 kg/m² who underwent RYGB, SG, or GB, and determined DR status 2- and 5-year postoperative according to preoperative DiaRem and the Ad-DiaRem calculated scores.

RESULTS

Among 1459 patients with 5-year postoperative diabetes status data, 53.6% exhibited DR. For RYGB, Ad-DiaRem trended to exhibit mildly improved predictive capacity 5-year postoperatively compared to DiaRem: Areas under receiver operating characteristic [AUROC] curves were 0.85 (0.76-0.93) and 0.78 (0.69-0.88), respectively. The positive predictive values (PPVs) detecting > 80% of those achieving DR (i.e., sensitivity ≥ 0.8) were 78.2% and 73.2%, respectively, and higher Ad-DiaRem scores more consistently associated with decreased DR rates. Following SG, both scores had an AUROC of 0.82, but Ad-DiaRem still had a higher PPV for predicting > 80% of those with 5-year postoperative DR (76.2% and 71.0%). Predictive capacity parameters were comparatively lower, for both scores, when considering DR 5-year post-GB (AUROC: 0.73 for both scores, PPV: 66.3% and 64.3%, respectively).

CONCLUSIONS

Ad-DiaRem provides modest improvement compared to DiaRem in predicting long-term DR 5-years post-RYGB. Both scores similarly provide fair predictive capacity for 5-year postoperative DR after SG.

Long-Term Outcomes of Three Types of Bariatric Surgery on Obesity and Type 2 Diabetes Control and Remission

BACKGROUND

Different bariatric surgeries have demonstrated different effectiveness for weight loss and glucose control in obese persons with diabetes, over a short follow-up time. The aim of this study was to compare weight loss, glucose control, and diabetes remission in individuals with type 2 diabetes, after three types of bariatric surgery: gastric banding (GB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB), with 5 years follow-up.

METHODS

A retrospective study was conducted on bariatric surgeries performed during 2002-2011 in a large nationwide healthcare organization.

RESULTS

Of 2190 patients, 64.8 % were women. The operations performed were 1027 GB, 1023 SG, and 140 RYGB. Mean BMI ± SD at baseline, 1 year postoperatively, and 5 years postoperatively were 43.5 ± 6.18, 37.1 ± 6.35, and 35.5 ± 6.48 for GB; 43.6 ± 6.42, 34.4 ± 6.08, and 35.3 ± 6.7 for SG; and 42.8 ± 5.81, 32.8 ± 4.9, and 34.1 ± 5.09 for RYGB. Mean HbA1c ± SD at baseline, 1 year postoperatively, and 5 years postoperatively were 7.6 + 1.58, 6.5 + 1.22, and 6.8 + 1.48 for GB; 7.7 + 1.63, 6.4 + 1.18, and 6.7 + 1.57 for SG; and 8.0 + 1.78, 6.3 + 0.98, and 7.04 + 1.42 for RYGB. At 1 year follow-up, 53.2 % had achieved remission; at 5 years, 54.4 %. Remission rates at 5 years were similar for the three surgeries. Five-year remission was inversely associated with baseline HbA1c and with treatment with insulin at baseline and positively associated with BMI.

CONCLUSIONS

For all three surgeries, diabetes remission was higher than the baseline after 5 years; mean BMI and HbA1c decreased considerably during the first year postoperatively and remained lower than basal values throughout follow-up. Early improvements were greatest for RYGB, though the advantage over the other operations diminished with time.

What can we learn from simulation-based training to improve skills for end-of-life care? Insights from a national project in Israel

BACKGROUND

Simulation-based training improves residents' skills for end-of-life (EOL) care. In the field, staff providers play a significant role in handling those situations and in shaping practice by role modeling. We initiated an educational intervention to train healthcare providers for improved communication skills at EOL using simulation of sensitive encounters with patients and families.

METHODS

Hospital physicians and nurses (n = 1324) attended simulation-based workshops (n = 100) in a national project to improve EOL care. We analyzed perceptions emerging from group discussions following simulations, from questionnaires before and after each workshop, and from video-recorded simulations using a validated coding system. We used the simulation setting as a novel tool for action research. We used a participatory inquiry paradigm, with repetitive cycles of exploring barriers and challenges with participants in an iterative pattern of observation, discussion and reflection - including a description of our own responses and evolution of thought as well as system effects.

RESULTS

The themes transpiring included lack of training, knowledge and time, technology overuse, uncertainty in decision-making, poor skills for communication and teamwork. Specific scenarios demonstrated lack of experience at eliciting preferences for EOL care and at handling conflicts or dilemmas. Content analysis of simulations showed predominance of cognitive utterances - by an order of magnitude more prevalent than emotional expressions. Providers talked more than actors did and episodes of silence were rare. Workshop participants acknowledged needs to improve listening skills, attention to affect and teamwork. They felt that the simulation-based workshop is likely to ameliorate future handling of EOL situations. We observed unanticipated consequences from our project manifested as a field study of preparedness to EOL in nursing homes, followed by a national survey on quality of care, leading to expansion of palliative care services and demand for EOL care education in various frameworks and professional areas.

CONCLUSIONS

Reflective simulation exercises show barriers and paths to improvement among staff providers. When facing EOL situations, physicians and nurses use cognitive language far more often than emotions related expressions, active listening, or presence in silence. Training a critical mass of staff providers may be valuable to induce a cultural shift in EOL care.

[The role of arthroscopy in the diagnosis and treatment of temporomandibular joint disorders]

Arthroscopy means Looking into a joint and is derived from the Greek words Arthros, which means Joint and Scopien, which means To view. It is a minimally invasive surgical procedure aimed at diagnosis and treatment of intra-articular joint disorders. Arthroscopy of the temporomandibular joint was first described in 1974, and since then has become an acceptable therapeutic modality for various joint pathologies. During a 6-year period (April 2010 to January 2016), two hundred and two patients have been treated by arthroscopy in our department. The majority of patients (124) were diagnosed as suffering from acute or chronic closed lock of the temporomandibular joint. Thirty five patients suffered from mild internal derangement conditions, and 33 patients suffered from various forms of osteoarthritic conditions and degenerative joint disease. The success rate for the different groups ranged from 77% to 89%. The complication rate was low (3%) and all adverse events were temporary. The success of the procedure ..depends on careful patient selection (exclusion of muscular, neurologic, and psychogenic disorders), and strict adherence to the surgical protocol with meticulous attention to every detail. Arthroscopy of the temporomandibular joint is a safe and effective treatment,for various derangement and degenerative joint disorders, achieving high rates of success with minimal morbidity and surgical risks.

[Facial femalization in transgenders]

Transsexualism is a gender identity disorder in which there is a strong desire to live and be accepted as a member of the opposite sex. In male-to-female transsexuals with strong masculine facial features, facial feminization surgery is performed as part of the gender reassignment. A strong association between femininity and attractiveness has been attributed to the upper third of the face and the interplay of the glabellar prominence of the forehead. Studies have shown that a certain lower jaw shape is characteristic of males with special attention to the strong square mandibular angle and chin and also suggest that the attractive female jaw is smaller with a more round shape mandibular angles and a pointy chin. Other studies have shown that feminization of the forehead through cranioplasty have the most significant impact in determining the gender of a patient. Facial feminization surgeries are procedures aimed to change the features of the male face to that of a female face. These include contouring of the forehead, brow lift, mandible angle reduction, genioplasty, rhinoplasty and a variety of soft tissue adjustments. In our maxillofacial surgery department at the Sheba Medical Center we perform forehead reshaping combining with brow lift and at the same surgery, mandibular and chin reshaping to match the remodeled upper third of the face. The forehead reshaping is done by cranioplasty with additional reduction of the glabella area by burring of the frontal bone. After reducing the frontal bossing around the superior orbital rims we manage the soft tissue to achieve the brow lift. The mandibular reshaping, is performed by intraoral approach and include contouring of the angles by osteotomy for a more round shape (rather than the manly square shape angles), as well as reshaping of the bone in the chin area in order to make it more pointy, by removing the lateral parts of the chin and in some cases performing also genioplasty reduction by AP osteotomy.

Oral and maxillofacial pathologies in young- and middle-aged adults

OBJECTIVE

To evaluate the distribution of oral and maxillofacial pathologies (OMFPs) and its association with patient age in young- and middle-aged adults.

METHODS

Distribution of histopathologically diagnosed OMFPs (n = 385) treated during 2007-2010 was recorded and the association with patient age was retrospectively analyzed.

RESULTS

The main diagnostic categories included benign exophytic lesions (45.3%), white benign lesions (13.5%), potentially malignant lesions/disorders (10.1%), intrabony lesions (9.8%), mucosal discoloration (7.8%), benign pigmented lesions (7.3%), chronic trauma/inflammation (3.9%), and oral malignancy (2.1%). Potentially malignant lesions/disorders as a diagnostic category were positively associated with age (OR = 1.07 for 1 year; P < 0.001) and specifically the diagnoses of oral lichen planus (OR = 1.04 for 1 year; P = 0.037) and dysplastic changes (OR = 1.08 for 1 year; P = 0.013) that comprised this category. Pigmented melanocytic lesions were negatively associated with age (OR = 0.94 for 1 year; P = 0.039) as well as benign/reactive exophytic lesions (OR = 0.98 for 1 year; P = 0.038), the latter included the histopathological diagnosis of benign salivary gland pathologies (OR = 0.90 for 1 year; P < 0.001).

CONCLUSION

This study provided baseline information regarding the distribution OMFPs among young- and middle-aged adults. It is important to highlight the high frequency of potentially malignant lesions/disorders and oral malignancy in young- and middle-aged adults, as these lesions require lifelong follow-up.

Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome

Osteonecrosis of the jaw (ONJ) is a well-known devastating side effect of bisphosphonate therapy for cancer. Several ONJ cases of patients using oral bisphosphonates have been reported in the literature. The present study analyzed the clinical features, predisposing factors, and treatment outcome of 11 patients with oral bisphosphonates-related ONJ.

INTRODUCTION AND HYPOTHESIS

Osteonecrosis of the jaw (ONJ) is a well-known side effect of parenteral bisphosphonates therapy. Although ONJ has been reported in patients using oral bisphosphonates, documentation of this entity is sparse. It was hypothesized that the clinical features, predisposing factors, and treatment outcome of this population are different from those of oncologic patients.

METHODS

This retrospective bi-central study involved 98 ONJ patients, 13 of whom were treated with oral bisphosphonates. Two patients were excluded because of previous use of intravenous bisphosphonates. The profiles of 11 patients were analyzed.

RESULTS

The mean duration of alendronate use before developing ONJ was 4.1 years. ONJ was triggered by dental surgery in 9 patients and by ill-fitted dentures in 2. Heavy smokers were the most recalcitrant subjects. Among the nine patients with at least 6 months of follow-up, ONJ healed completely in three, partially in four, and not at all in two.

CONCLUSIONS

ONJ is a rare devastating side effect of oral bisphosphonates associated with patient morbidity and high financial burden. Clinicians must be aware of this entity and inform patients of the risks of dental surgery. The synergistic effect of smoking in the pathogenesis of ONJ should be further investigated.

Osteomylelitis and necrosis of the jaw in patients treated with bisphosphonates: a comparative study focused on multiple myeloma

It was reported that multiple myeloma (MM)-patients suffer from a higher incidence of osteomyelitis and necrosis of the jaws than patients treated with bisphosphonates for other reasons. The aim of this study is to report about 57 cases of bisphosphonate-related osteomyelitis and necrosis of the jaws (BON) and to investigate the differences between BON in MM and non-MM patients. Clinical and laboratory data of 57 cases were assessed. The features of BON and clinical-outcome were compared between the two groups. Treatment approach was assessed as a contributing-factor to treatment-outcome. Clinical presentation included exposed bone, pain, swelling and suppuration with little variation between the two groups. Past dento-alveolar surgery was common in both study-groups. Treatment outcome was poor (33% and 25% responded to treatment in MM group and non-MM group, respectively). Treatment modality did not affect the treatment outcome. The clinical presentation described in this case series should alert the physician to the possibility of BON. Although the literature shows a higher incidence of BON in MM patients compared to non-MM patients, our study suggests that the severity of the clinical presentation and the response to treatment are not worse in MM patients compared with non-MM patients. The predisposition of MM patients to BON should be further investigated.

[Bisphosphonate associated osteonecrosis of the jaws--the role of the dentist in prevention and early diagnosis]

During the past few years numerous cases of osteonecrosis of the jaws in patients receiving bisphosphonate therapy were published in the literature. In most cases, the osteonecrosis was diagnosed following dento-alveolar surgery, especially following extraction of teeth. To date, no efficient therapy is available and most efforts are geared towards prevention. The propose of the present review is to inform the Israeli dental community about osteonecrosis of the jaws in patients receiving bisphosphonate therapy and to suggest strategies for prevention.

PET/CT in the evaluation of patients with squamous cell cancer of the head and neck

The purpose of this study was to compare the findings of positron emission tomography (PET) with fused PET and computed tomography (CT) in patients with suspected locoregional and distant head and neck cancer and to evaluate the impact of those findings on clinical management. Studies of 25 patients were retrospectively evaluated. PET findings were classified as malignant, benign or equivocal. PET/CT findings were then similarly classified and the PET-only results were amended accordingly. Comparison of findings was done on lesion and patient levels. A total of 45 foci of increased 18F-fluorodeoxyglucose (FDG) uptake were noted in 18 patients. PET/CT imaging defined anatomic localization of 41/45 lesions and clarified 6/10 equivocal PET findings. Additional information was provided by PET/CT regarding 9/45 (20%) of the lesions. PET/CT significantly affected patient management in 3/25 patients (12%) by limiting the extent of disease in one and excluding viable disease in two others. The accuracy of PET/CT was 88%, the sensitivity 100% and the specificity was 77%. The negative predictive value was 100% in this combined group of patients with locoregional and distant head and neck cancer. PET/CT is highly contributory for initial staging and in the evaluation of patients with suspected recurrent SCC of the head and neck, in whom anatomic imaging is inconclusive due to the locoregional distortions rendered by surgery and radiotherapy.

Midline versus paramidline mandibulotomy: A radiological study

Mandibulotomy allows for wide exposure of deep oral cavity and oropharyngeal tumors and may be performed medial or lateral to the mental foramen. Medial mandibulotomy is divided into midline and paramidline. Midline mandibulotomy requires detachment of muscles which may lead to masticatory and swallowing problems and could potentially jeopardize the central incisors. Our study provides a basis for placement of bone cuts in mandibulotomy. The angles between the long axis of the two central incisors, the lateral incisor and canine bilaterally were measured in panoramic radiographs of 100 healthy patients. The distances between the roots were measured. The angle between the lateral incisor and the canine ranged from 1 degrees to 8 degrees compared to 1 degrees -4 degrees (P<0.001) between the central incisors. The distances between the lateral incisor and the canine were 1-6.2mm while the distances between the two central incisors ranged from 0.5 to 4.7mm (P<0.05). Although the measurements were taken from a younger group of patients compared to the usual age of presentation of oropharyngeal cancer, it shows that the paramidline mandibulotomy in which bony cuts are performed through a wider gap is the preferred approach.

The role of gamma-PET in the evaluation of patients with recurrent squamous cell cancer of the head and neck

Squamous cell carcinoma (SCC) is the most common cancer of the head and neck (HNC). Advanced HNC warrants extensive ablative and reconstructive procedures, significantly altering locoregional anatomy, while radiation treatment further adds to the distortion. Anatomic imaging is therefore often inconclusive in suspected recurrent HNC. Functional imaging with fluorodeoxyglucose-positron emission tomography (FDG-PET) has been reported contributory in the evaluation of patients with SCC. While most reports are from dedicated PET systems, full ring PET is of limited availability and gamma-PET may offer a suitable compromise. The therapeutic impact of gamma-PET in patients with suspected recurrent HNC was retrospectively evaluated. Seventeen patients were evaluated. All had undergone surgery for HNC, 16 also received radiotherapy. gamma-PET scans were compared to anatomic imaging, histopathology and clinical follow-up. The impact of the FDG-PET scan on patient management was then evaluated. Eleven positive findings were confirmed. Two false positives were due to radiation changes, a recognized pitfall. There were no false negatives. Overall accuracy of the 18F-FDG gamma-PET scans was 88% with considerable effect on patient management. Gamma-PET with FDG appears valuable in the evaluation of suspected recurrent HNC, and may provide a suitable alternative when dedicated PET is unavailable.

Upper jugular lymph nodes (submuscular recess) in non-squamous-cell cancer of the head and neck: surgical considerations

Cervical lymphadenectomy of level II encompasses lymph nodes associated with the upper internal jugular vein and the spinal accessory nerve (SAN). Removal of tissue superior to the SAN (submuscular recess-(SMR)) was recently shown to be unwarranted in selected cases of squamous-cell cancer. Thirty-five patients with non-squamous-cell cancer (SCC) of the head and neck treated with cervical lymphadenectomy were prospectively evaluated. Thirty-seven neck dissection specimens were histologically analysed for the number of lymph nodes involved with cancer. At the time of surgery, level II was separated into the supraspinal accessory nerve component (IIa) and the component anterior to the SAN (IIb). Neck dissections were most commonly performed for cancer of the thyroid gland (19) followed in frequency by the parotid gland (seven), skin: melanoma (five), basal-cell cancer (two), and other sites (four). Twenty-five neck dissections were modified-selective procedures and 12 were either radical or modified radical neck dissection. Twenty-nine necks were clinically N+ and eight N0. Histological staging was pathologically N+ in 32 neck dissection specimens. Level IIb contained an average of 12 nodes and the IIa component contained a mean of 5.0 nodes. Level II contained metastatic disease in 28 of 32 histologically node-positive specimens (87 per cent). Level IIa was involved with cancer in six cases (16 per cent), five of which were pre-operatively staged as clinically N+. All cases (100 per cent) with level IIa involvement had level IIb positive nodes. Three of the level IIa positive cases were cancer of the parotid gland comprising 43 per cent of this sub-group of patients. Incidence of involvement of SMR in non-SCC cases is not uncommon. The additional time required and morbidity associated with dissection of the supraspinal accessory nerve component of level II are probably justified when performing neck dissection in cancer of the thyroid gland. The SMR should be excised in cancer of the parotid gland. Large-scale prospective controlled studies with long-term follow-up periods are necessary to support resection of level IIb only.

Patterns of metastases to the upper jugular lymph nodes (the "submuscular recess")

BACKGROUND

Cervical lymphadenectomy to remove metastatic disease in level II encompasses lymph nodes associated with the upper third of the internal jugular vein and the adjacent spinal accessory nerve (SAN). Conservative neck dissection (ND) preserves these structures but requires manipulation of the SAN to remove tissue located in the posterosuperior aspect of level II. Limiting the dissection to the nodal group anterior to the SAN may reduce operating time and limit injury to it without compromising the removal of lymph nodes at risk for involvement with cancer.

METHODS

Seventy-one patients with squamous cell carcinoma of the head and neck treated with cervical lymphadenectomy at two separate institutions were prospectively evaluated. One hundred two neck dissection specimens were histologically analyzed for number of lymph nodes present and number involved with cancer. At the time of surgery, level II was separated into the supraspinal accessory nerve component (IIa) and the component anterior to the SAN (IIb). Nodal involvement in level II was analyzed according to characteristics of the cancer at the primary site as well as nodal involvement of other levels.

RESULTS

Neck dissections were most commonly done for cancer of the oral cavity (n = 33), followed in frequency by the larynx (n = 17), oropharynx (n = 7), skin of face (n = 4), unknown primary (n = 4), and other sites (n = 6). Eighty NDs were selective and 22 were either radical or modified radical NDs. Pathologic staging of the neck specimen was most commonly N0 (n = 61), followed in frequency by N1 (n= 17), N2 (n= 11), and N3 (n= 11). Data were unclear for two specimens. Level IIb contained an average of 6.9 nodes and the IIa component contained an average of 4.2 nodes. Level II contained metastatic disease in 31 of 39 node positive specimens (79%). Level IIa was involved with cancer in four cases, all of which were preoperatively staged N2 or greater.

CONCLUSIONS

The additional time required and morbidity associated with dissection of the supraspinal accessory nerve component of level II may not be necessary when performing elective ND. More research with larger numbers of patients, long-term follow-up, and meticulous tissue analysis is needed to permit conclusions as to where to draw the line in determining extent of cervical lymphadenectomy.

Incidence of secretory otitis media following maxillectomy

OBJECTIVE

The purpose of this investigation was to determine the incidence and characteristics of secretory otitis media after maxillectomy procedures.

STUDY DESIGN

Retrospective chart analysis was performed with the cases of 49 patients who underwent maxillectomy for tumor in the Departments of Otolaryngology-Head and Neck Surgery and Oral and Maxillofacial Surgery between the years 1990 and 1996.

RESULTS

In 10 patients (20%), secretory otitis media manifested itself from 1 week to 6 months after surgery; 1 patient developed a central perforation with chronic otitis media. Nearly one third of patients who underwent total maxillectomy had secretory otitis media. Six patients (8 ears) required insertion of ventilation tubes.

CONCLUSIONS

Patients undergoing total and partial maxillectomies are prone to occurrences of secretory otitis media. Insertion of ventilation tubes easily resolves the problem. Preoperative and routine postoperative patient follow-up should always include otoscopy and audiometry, and tympanometry should be performed when warranted.

DentaCT for evaluating mandibular and maxillary invasion in cancer of the oral cavity

We used a retrospective analysis of charts, imaging studies, and histologic findings when available in 17 patients with cancer of the oral cavity to define the value of DentaCT or multiplanar reformation software in assessing bony involvement by malignant tumors of the oral cavity. From two academic tertiary-referral medical centers, the 17 patients had a mean age of 63 years and suspected maxillary (2) or mandibular (15) invasion. All patients had conventional computed tomography scanning and multiplanar reformation scans with several additional imaging studies obtained. Two patients demonstrated no bony involvement by imaging and histologic studies. Twelve of the remaining 15 patients had surgically documented bony involvement also correctly detected by DentaCT. DentaCT was found to be a valuable tool in defining extent of bony invasion by tumor. Although not compared to other imaging modalities, our experience supports the use of DentaCT where available for this purpose.

Single-dose fosfomycin trometamol versus 5-day cephalexin regimen for treatment of uncomplicated lower urinary tract infections in women

A randomized study was conducted to assess the clinical and microbiological efficacies of a single 3-g dose of fosfomycin trometamol for the treatment of uncomplicated lower urinary tract infections in women compared with a 5-day regimen of cephalexin at 0.5 g four times daily. One hundred twelve women, all of whom had documented infections with bacteria sensitive to both antibiotics, were included. Fifty-eight women received fosfomycin trometamol, and 54 women received cephalexin. The two groups did not differ in age, severity, or duration of current urinary tract infection, menstrual status, sexual activity, or use of contraceptives. Ninety percent of pathogens in the fosfomycin trometamol group and 81% in the cephalexin group were Escherichia coli (the difference is not significant [NS]). A clinical evaluation at the 5-day follow-up showed that 91% of the women in each group were free of symptoms, while five women in each group were considered therapy failures and were treated by another antibiotic course. A microbiological evaluation at the 5-day follow-up showed a 91% eradication rate in the fosfomycin trometamol group and an 83% eradication rate in the cephalexin group (NS). At the 1-month follow-up, a clinical evaluation demonstrated prolonged resolution in 86 and 78%, respectively, of the participating women (NS). A microbiological evaluation at 1 month demonstrated prolonged eradication in 47 (81%) women treated with fosfomycin trometamol and in 37 (68%) women treated with cephalexin (NS). Three and six women, respectively, had relapsed. No adverse reactions were reported by the fosfomycin trometamol-treated women, while three women treated with cephalexin reported mild adverse reactions but completed the study period. Fosfomycin trometamol in a single 3-g dose is as effective as a 5-day regimen of cephalexin for the treatment of uncomplicated lower urinary tract infection in women.

Optical thresholding and switching using a fiber-coupled phase-conjugate mirror

A fiber-coupled-ring passive phase-conjugate mirror is used to achieve mutual thresholding free of bistability effects and to obtain switching among several mutually incoherent light beams.

Demonstration of amplitude-distortion correction by modal dispersal and phase conjugation

We demonstrate experimentally and explain theoretically polarization-preserving imaging through a lossy amplitude-distorting medium. This is accomplished by propagating the beam, before its arrival at the lossy distorting medium, through a (multi) mode- and polarization-scrambling fiber and reflecting the signal, after it has passed the lossy distorting medium, from a photorefractive phase-conjugate mirror.

Fidelity of polarization and spatial information recovery using a fiber-coupled phase-conjugate mirror

We report the investigation of polarization and spatial information recovery using a fiber-coupled phase-conjugate mirror. A marked dependence of the phase-conjugate output on the input-beam conditions is experimentally observed. A theoretical model for these phenomena is also discussed.

Optical phase-conjugate correction for propagation distortion in nonreciprocal media

We demonstrate experimentally that the effects of nonreciprocal elements or media that would otherwise spoil phase conjugation can be neutralized by using a tandem combination of a modal- and polarization-scrambling fiber and a phase-conjugate mirror. A theoretical model to explain the experimental results is presented.