scholarly journals Intraoperative neurophysiological mapping and monitoring in spinal tumor surgery: sirens or indispensable tools?

2016 ◽  
Vol 41 (2) ◽  
pp. E18 ◽  
Author(s):  
Antonino Scibilia ◽  
Carmen Terranova ◽  
Vincenzo Rizzo ◽  
Giovanni Raffa ◽  
Adolfo Morelli ◽  
...  
Keyword(s):  
Complex Function ◽  
Spinal Tumor ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Neurophysiological Monitoring ◽  
Predictive Values ◽  
Effective Role ◽  
Mapping Techniques ◽  
Sensitivity Specificity

Spinal tumor (ST) surgery carries the risk of new neurological deficits in the postoperative period. Intraoperative neurophysiological monitoring and mapping (IONM) represents an effective method of identifying and monitoring in real time the functional integrity of both the spinal cord (SC) and the nerve roots (NRs). Despite consensus favoring the use of IONM in ST surgery, in this era of evidence-based medicine, there is still a need to demonstrate the effective role of IONM in ST surgery in achieving an oncological cure, optimizing patient safety, and considering medicolegal aspects. Thus, neurosurgeons are asked to establish which techniques are considered indispensable. In the present study, the authors focused on the rationale for and the accuracy (sensitivity, specificity, and positive and negative predictive values) of IONM in ST surgery in light of more recent evidence in the literature, with specific emphasis on the role of IONM in reducing the incidence of postoperative neurological deficits. This review confirms the role of IONM as a useful tool in the workup for ST surgery. Individual monitoring and mapping techniques are clearly not sufficient to account for the complex function of the SC and NRs. Conversely, multimodal IONM is highly sensitive and specific for anticipating neurological injury during ST surgery and represents an important tool for preserving neuronal structures and achieving an optimal postoperative functional outcome.

Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results

2018 ◽  
Vol 105 (5) ◽  
pp. 378-387 ◽  
Author(s):  
Giulia Bicchierai ◽  
Jacopo Nori ◽  
Diego De Benedetto ◽  
Cecilia Boeri ◽  
Ermanno Vanzi ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Surgical Excision ◽  
Surgical Biopsy ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
B3 Lesions ◽  
Malignant Lesions ◽  
Sensitivity Specificity

PurposeTo evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB).MethodsThe local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41–77 years were included in our study. All patients underwent CESM 2–3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings.ResultsThe sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451–.696), for categorization of BPE from moderate to substantial (κ = .562–.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346–.459).ConclusionIn cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.

Cytomorphometric Neutrophil and Monocyte Markers May Strengthen the Diagnosis of Sepsis

2016 ◽  
Vol 33 (12) ◽  
pp. 656-662
Author(s):  
Joy Mammen ◽  
Jui Choudhuri ◽  
Joshua Paul ◽  
Thomas Isaiah Sudarsan ◽  
T. Josephine ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Donors ◽  
Area Under The Curve ◽  
Standard Test ◽  
Suspected Sepsis ◽  
Predictive Values ◽  
Reactive Protein ◽  
Sensitivity Specificity

Background: The diagnosis of sepsis is challenging in the absence of a gold standard test. Recent studies have explored the role of neutrophil and monocyte volume, conductivity, and scatter (VCS), derived from automated hematology analyzers, in diagnosing sepsis. We assessed the diagnostic accuracy of VCS parameters in critically ill patients with sepsis. Methodology: In this prospective study, VCS parameters, procalcitonin, and C-reactive protein (CRP) were assessed in patients with proven sepsis (cases) and 2 control groups (intensive care unit [ICU] patients without sepsis and healthy blood donors). The diagnostic property of each test was explored by calculating sensitivity, specificity, negative and positive predictive values, and area under the curve (AUC). Results: The study included 65 patients with sepsis, 58 nonseptic ICU controls, and 98 blood donors. Procalcitonin and CRP were not significantly different ( P > .06) between patients with sepsis and nonseptic patients. Mean (95% confidence interval [CI]) neutrophil volume (MNV) was significantly higher ( P < .001) in patients with sepsis (165.5; 95%CI 161.6-169.4) than in nonseptic (157.3; 95%CI 154.6-160.1) patients and donors (148.9; 95%CI 147.9-150). A similar pattern was seen with mean monocyte volume (MMoV). Neutrophil and monocyte conductivity and scatter parameters were variably associated. The AUC was highest for MMoV (0.74) and lowest for CRP (0.62). Among all parameters, MNV and MMoV had the highest specificity of 85% and 80%, respectively. Conclusion: In critically ill patients with suspected sepsis, VCS parameters may help strengthen the diagnostic probability of sepsis. Future studies may explore the role of serial monitoring of VCS to track response to antimicrobial therapy.

scholarly journals Role Of C-Reactive Protein in Diagnosis of Acute Appendicitis

2021 ◽  
Vol 10 (4) ◽  
pp. 210-214
Author(s):  
Mirza Tassawar Hussain ◽  
Muhammad Kashif Khan ◽  
Syed Shamsuddin ◽  
Aabid Ali ◽  
Erum Khan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Correct Diagnosis ◽  
C Reactive Protein ◽  
Diagnostic Dilemma ◽  
Senior Registrar ◽  
Predictive Values ◽  
Reactive Protein ◽  
Highly Sensitive ◽  
Sensitivity Specificity

Background: Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. The objective of this study was to identify clinical applicability of C- reactive protein, as a diagnostic test for appendicitis. Methods: This prospective study was carried out in Federal government Polyclinic hospital, Islamabad from January to July 2019, 114 patients underwent appendectomy for clinically diagnosed acute appendicitis. The decision to operate the patient was given by senior registrar. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The C-reactive protein was then compared with the results of histopathology to determine its validity. The data was entered and analysed in SPSS 23. Results: The sensitivity, specificity, positive and negative predictive values of C-reactive protein in patients with clinical diagnosis of acute appendicitis were found to be 94%, 78%, 93% and 74 % respectively. Conclusion: CRP is helpful in making diagnosis of acute appendicitis. It is highly sensitive but has a relatively low specificity.  

S216 – Is Oculomotor Testing Useful in the Modern Era?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P148-P148
Author(s):  
Zameel Dewji ◽  
Brian W Blakley
Keyword(s):  
Diagnostic Odds Ratio ◽  
Likelihood Ratios ◽  
Level Of Evidence ◽  
Predictive Values ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Modern Era

Objectives To understand the role of oculomotor testing in the era of advanced imaging with MRI. Methods First, the literature was evaluated systematically to determine the level of evidence that oculomotor testing is sensitive in central nervous system lesions. Next, the sensitivity and specificity of saccade, pursuit, and gaze testing in detection of brain abnormalities were assessed using a database of 561 patients who underwent ENG using magnetic resonance imaging (MRI) as the “gold standard.” Among the abnormal MRI scans, oculomotor testing was abnormal in 1 and normal in 37. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (PLR and NLR), and the diagnostic odds ratio (OR) with 95% confidence interval (± CI) were calculated. Results For oculomotor testing, our data which concur with the literature indicate: Sensitivity 2.6%, (± 0.005–1.1); Specificity 96%, ± (0.89–0.98); Diagnostic OR 0.71 ± (0.065–5.6); PPV 20% ± (0.043, −0.64); NPV 71% ±(0.62, 0.78). Conclusions Our data suggest that oculomotor testing adds little diagnostic information. The cost and benefit of oculomotor testing are low.

Role of 18F-FDG PET in Management of Sinonasal Neoplasms

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P44-P44 ◽  
Author(s):  
Eric D. Lamarre ◽  
Joseph Scharpf ◽  
Pete S Batra ◽  
Robert R Lorenz ◽  
Martin J Citardi ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Undifferentiated Carcinoma ◽  
High Rate ◽  
Predictive Values ◽  
Positive Study ◽  
Sinonasal Malignancies ◽  
Pet Ct ◽  
Sensitivity Specificity ◽  
Initial Staging

Objective PET/CT in sinonasal malignancies is largely undefined. The objective of this study was to evaluate PET/CT in the initial staging and oncologic surveillance of paranasal sinus carcinomas. Methods Retrospective review was performed of patients undergoing PET/CT for sinonasal neoplasms from 2001–2006 at tertiary care referral center. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of PET/CT were calculated. The gold standard was histology and clinical course when histology was not available. Any uptake in PET was considered a positive study. Results 78 PET/CT scans were reviewed from 32 patients. Most common histopathologies included esthesioneuroblastoma (28.1%), sinonasal undifferentiated carcinoma (18.8%), sinonasal melanoma (18.8%), squamous cell carcinoma (18.8%), and adenosquamous carcinoma (9%). Overall sensitivity and specificity of PET/CT was 89% and 90% with PPV of 67% and NPV of 98%. PPV at the primary site, neck, and distant sites was 81%, 47% and 69%; NPV was 94%, 100%, and 98% respectively. For initial staging, 9.5% of patients were accurately upstaged at the neck or distant sites. During restaging, 29.6% of patients were accurately upstaged at the neck or distant sites. Conclusions PET/CT serves as a useful adjunct to conventional imaging in initial staging and restaging of sinonasal malignancies. Negative studies are effective in predicting the absence of disease as seen in the consistently higher NPV. Positive studies need to be examined with caution, given the high rate of false positive studies. When viewed along with clinical exam and focused biopsies, they may effectively result in upstaging patients as noted in our series.

scholarly journals Intraoperative neurophysiological monitoring during endoscopic endonasal surgery for pediatric skull base tumors

2016 ◽  
Vol 17 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Cheran Elangovan ◽  
Supriya Palwinder Singh ◽  
Paul Gardner ◽  
Carl Snyderman ◽  
Elizabeth C. Tyler-Kabara ◽  
...  
Keyword(s):  
Skull Base ◽  
Pediatric Patients ◽  
Neurophysiological Monitoring ◽  
Emg Activity ◽  
Skull Base Tumors ◽  
Endoscopic Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Repeat Procedures

OBJECT The aim of this study was to evaluate the value of intraoperative neurophysiological monitoring (IONM) using electromyography (EMG), brainstem auditory evoked potentials (BAEPs), and somatosensory evoked potentials (SSEPs) to predict and/or prevent postoperative neurological deficits in pediatric patients undergoing endoscopic endonasal surgery (EES) for skull base tumors. METHODS All consecutive pediatric patients with skull base tumors who underwent EES with at least 1 modality of IONM (BAEP, SSEP, and/or EMG) at our institution between 1999 and 2013 were retrospectively reviewed. Staged procedures and repeat procedures were identified and analyzed separately. To evaluate the diagnostic accuracy of significant free-run EMG activity, the prevalence of cranial nerve (CN) deficits and the sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS A total of 129 patients underwent 159 procedures; 6 patients had a total of 9 CN deficits. The incidences of CN deficits based on the total number of nerves monitored in the groups with and without significant free-run EMG activity were 9% and 1.5%, respectively. The incidences of CN deficits in the groups with 1 staged and more than 1 staged EES were 1.5% and 29%, respectively. The sensitivity, specificity, and negative predictive values (with 95% confidence intervals) of significant EMG to detect CN deficits in repeat procedures were 0.55 (0.22–0.84), 0.86 (0.79–0.9), and 0.97 (0.92–0.99), respectively. Two patients had significant changes in their BAEPs that were reversible with an increase in mean arterial pressure. CONCLUSIONS IONM can be applied effectively and reliably during EES in children. EMG monitoring is specific for detecting CN deficits and can be an effective guide for dissecting these procedures. Triggered EMG should be elicited intraoperatively to check the integrity of the CNs during and after tumor resection. Given the anatomical complexity of pediatric EES and the unique challenges encountered, multimodal IONM can be a valuable adjunct to these procedures.

The Role of Cognitive Evaluation in Predicting Successful Audiometric Testing among Children

2019 ◽  
Vol 160 (6) ◽  
pp. 1106-1110
Author(s):  
Taylor B. Teplitzky ◽  
Kristen Angster ◽  
Lauren E. Rosso ◽  
Anne R. Ferruggiaro ◽  
Amal Isaiah ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Area Under The Curve ◽  
Cognitive Testing ◽  
Predictive Values ◽  
Age Appropriate ◽  
English Speaking ◽  
The Mean ◽  
Performance Area ◽  
Sensitivity Specificity

Objective To determine the role of cognitive testing in predicting age-appropriate audiometric responses among children aged 30 to 42 months. Study Design Prospective. Setting Tertiary care audiology clinic. Subjects and Methods Subjects included primary English–speaking children aged 30 to 42 months. A certified pediatric audiologist performed the cognitive aspect of the Developmental Assessment of Young Children–Second Edition (DAYC-2). A second, blinded audiologist performed age-appropriate audiometry. The raw, age-equivalent, percentile, and standard DAYC-2 scores were compared by agreement between speech reception threshold (SRT) and pure tone average (PTA). Optimal DAYC-2 thresholds were also calculated for prediction of SRT-PTA agreement and assessed for sensitivity, specificity, and positive and negative predictive values. P < .05 was considered significant. Results Complete data were obtained from 37 children. The mean age was 34.9 months (95% CI, 33.5-36.2), and 15 (41%) were female. Among the 37 children, 24 (65%) and 13 (35%) underwent visual reinforcement audiometry and conditioned play audiometry, respectively. SRT-PTA agreement was seen in 32 (87%) tests. Mean DAYC-2 raw score grouped by SRT-PTA agreement was 39.4 versus 33.4 for nonagreement (2.8-9.3, P < .001). The mean age-equivalent score grouped by SRT-PTA agreement was 29.6 versus 23.0 for nonagreement (2.7-10.6, P = .002). Optimal cut points based on DAYC-2 scores achieved moderate overall prediction performance (area under the curve, 0.73-0.77) with a positive predictive value of 100%. Conclusion The DAYC-2 is a useful screen to identify children likely to complete an age-appropriate audiogram.

Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients

2008 ◽  
Vol 8 (3) ◽  
pp. 215-221 ◽  
Author(s):  
Michael O. Kelleher ◽  
Gamaliel Tan ◽  
Roger Sarjeant ◽  
Michael G. Fehlings
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Neurological Deficits ◽  
Prospective Analysis ◽  
Predictive Values ◽  
Cervical Spine Surgery ◽  
Cervical Surgery ◽  
Sensitivity Specificity

Object Despite the growing use of multimodal intraoperative monitoring (IOM) in cervical spinal surgery, limited data exist regarding the sensitivity, specificity, and predictive values of such a technique in detecting new neurological deficits in this setting. The authors sought to define the incidence of significant intraoperative electrophysiological changes and new postoperative neurological deficits in a cohort of patients undergoing cervical surgery. Methods The authors conducted a prospective analysis of a consecutive series of patients who had undergone cervical surgery during a 5-year period at a university-based neurosurgical unit, in which multimodal IOM was recorded. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were determined using standard Bayesian techniques. The study population included 1055 patients (614 male and 441 female) with a mean age of 55 years. Results The IOM modalities performed included somatosensory evoked potential (SSEP) recording in 1055 patients, motor evoked potential (MEP) recording in 26, and electromyography (EMG) in 427. Twenty-six patients (2.5%) had significant SSEP changes. Electromyographic activity was transient in 212 patients (49.6%), and 115 patients (26.9%) had sustained burst or train activity. New postoperative neurological deficits occurred in 34 patients (3.2%): 6 had combined sensory and motor deficits, 7 had new sensory deficits, 9 had increased motor weakness, and 12 had new root deficits. Of these 34 patients, 12 had spinal tumors, of which 7 were intramedullary. Overall, of the 34 new postoperative deficits, 21 completely resolved, 9 partially resolved, and 4 had no improvement. The deficits that completely resolved did so on average 3.3 months after surgery. Patients with deficits that did not fully resolve (partial or no improvement) were followed up for an average of 1.8 years after surgery. Somatosensory evoked potentials had a sensitivity of 52%, a specificity of 100%, a PPV of 100%, and an NPV of 97%. Motor evoked potential sensitivity was 100%, specificity 96%, PPV 96%, and NPV 100%. Electromyography had a sensitivity of 46%, specificity of 73%, PPV of 3%, and an NPV of 97%. Conclusions Combined neurophysiological IOM with EMG and SSEP recording and the selective use of MEPs is helpful for predicting and possibly preventing neurological injury during cervical spine surgery.

scholarly journals Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study

2018 ◽  
Vol 4 (4) ◽  
pp. 601
Author(s):  
Harsha Kumar Koramutla ◽  
Balakondaiah Koyagura ◽  
Bijju Ravindran
Keyword(s):  
Septic Arthritis ◽  
Bacterial Infections ◽  
Specific Marker ◽  
Predictive Values ◽  
Joint Infections ◽  
Group 3 ◽  
Group 2 ◽  
Sensitivity Specificity ◽  
Group 1

<p class="abstract"><strong>Background:</strong> Acute bone infections like septic arthritis and osteomyelitis are a serious threat in management and diagnosis in the department of orthopaedics. Biochemical marker is needed with good sensitivity and specificity in diagnosing acute bone and joint infections. The aim of the present study was to study the role of PCT in conditions of septic arthritis and osteomyelitis.</p><p class="abstract"><strong>Methods:</strong> A two year prospective study was done and cases were grouped into three group and laboratory parameters TC, ESR, CRP and PCT were measured. The sensitivity, specificity and predictive values were compared using SPSS software version 20.<strong></strong></p><p class="abstract"><strong>Results:</strong> 238 patients, (males- 154 &amp; Females– 84) with mean age 34.1±8.20 years. Group-1 included 52 patients with raised PCT and MRSA and <em>Klebsiella</em> as the common isolates. Group-2 with 89 patients and mean PCT in the study group was 4.99 ng/ml. Ninety seven were included in Group-3. The mean PCT value was 2.6 ng/ml. In group-1, the specificity of PCT (comparing Group-1 &amp; 3) was 96.8 [95% CI, 94.2 -98.4], the sensitivity (26% [3.2-60.1], the PPV 16.1% [95% CI 2.3-48.3] and the NPV was 98% [95% CI, 95.5-99.8].</p><p class="abstract"><strong>Conclusions:</strong> To conclude our study, highlights the role of PCT as a sensitive and specific marker in diagnosing cases of septic arthritis and Osteomyelitis. This opens a gateway to further research in evaluating the PCT effectiveness as a response marker to treatment. PCT is more sensitive than CRP in acute bone and joint bacterial infections and raises early and faster.</p>

scholarly journals Sonographic Prediction of Ovarian Malignancy in Adnexal Mass

2016 ◽  
Vol 27 (2) ◽  
pp. 67-71
Author(s):  
Shamsun Nahar ◽  
Latifa Shamsuddin ◽  
Mariam Faruqui ◽  
Gulshan Ara
Keyword(s):  
Adnexal Mass ◽  
Menopausal Status ◽  
Ovarian Malignancy ◽  
Chi Square ◽  
Abdominal Ultrasonography ◽  
Predictive Values ◽  
Serum Ca125 ◽  
Ultrasound Score ◽  
Sensitivity Specificity

Objective: To evaluate the role of ultrasound for preoperative diagnosis of ovarian malignancy in adnexal mass.Materials & Methods: This prospective observational study was conducted on patients having adnexal mass (n-57) admitted consecutively for surgical exploration in Dept. of OB-GYN of BSMMU from January 2000 - March 2001. Abdominal ultrasonography was performed 10 days preoperatively and 5 sonographic criteria were used to calculate ultrasound score (0, 1 & 3 ). Definitive diagnosis was based on histo-pathological study . Sensitivity , specificity , positive and negative predictive values of ultrasound score to diagnose ovarian malignancy were detected . Chi square & student’s ‘t’ test were used for statistical analysis .Results: Sensitivity , specificity , positive and negative predictive values of ultrasound score at cut-off value of 3 were 78% , 80% , 47% and 94 % respectively .Conclusion: For pre-operative diagnosis of ovarian malignancy sonographic scoring system may be introduced easily into the clinical practice where other complementary tests are not available. Combination of serum CA125 and menopausal status into ultrasound score may further improve the diagnostic accuracy in prediction of ovarian malignancy preoperatively.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 67-71

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