Kellywinkel3626

STUDY DESIGN A retrospective cohort of prospective data. OBJECTIVE Determine the frequency of various symptoms in a surgical cohort of cervical myelopathy (CM). SUMMARY OF BACKGROUND DATA CM can be difficult to diagnose as there is no sine qua non "myelopathic symptom." Despite extensive literature, the likelihood or frequency of symptoms at presentation remains unclear. MATERIALS AND METHODS A total of 484 patients treated at a single academic center were reviewed. Preoperative symptoms included axial neck pain; upper extremity (UE) pain; UE sensory or motor deficit; lower extremity (LE) sensory or motor deficit; and sphincter dysfunction. It was noted whether a symptom was the chief complaint (CC) and/or one of a list of overall symptoms (OS) reported by the patient. Magnetic resonance imaging was assessed for the maximal cord compression level and T2 hyperintensity. RESULTS The most common CC was UE sensory deficit (46.5%), whereas the most common OS were UE and LE motor deficits (82.6% and 81.2%). Neck patrospective study.INTRODUCTION Assessment of segmental flexibility at each disk level of the scoliotic curve in patients with adolescent idiopathic scoliosis (AIS) has rarely been performed, despite its importance for surgical planning of fusion levels. The fulcrum-bending radiography method could be used to assess flexibility at specific spinal segments of the scoliotic curve for preoperative planning. Therefore, our aim was to use the fulcrum-bending method to evaluate the pattern of segmental flexibility in patients with AIS. MATERIALS AND METHODS Our retrospective analysis was based on preoperative fulcrum-bending radiographs in 21 patients presenting with main thoracic curve scoliosis. The apex vertebra was defined as the "0" level, with the sequential cranial disk levels defined as "+1 to +5" and the sequential caudal levels as "-1 to -5." The segmental Cobb angle was measured on both, standing and fulcrum-bending radiographs. The segmental flexibility index (FI) was calculated as [(the segmental Cobb angle in standing position-the segmental Cobb angle in the fulcrum-bending position)/the segmental Cobb angle in standing position]×100. The FI was measured from the upper-most to the lower-most end vertebrae of the main curve. RESULTS There was a significant difference in the FI among segments, with the greatest flexibility detected at the level of the -5 disk (median FI, 50%) and least flexibility at the periapical segments (+1 and -1; FI, 50%-66.7%). L(+)-Monosodium glutamate monohydrate CONCLUSIONS The curve around the apex and upper thoracic segments in thoracic AIS is relatively rigid. Understanding differences in FI between each disk level is important for optimal corrective surgery.STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to analyze readmission rates among patients undergoing anterior cervical discectomy and fusion (ACDF), determine which factors were associated with higher readmission rates, and develop a scale for utilization during surgical planning. SUMMARY OF BACKGROUND DATA ACDF is the most common surgical treatment for many cervical disk pathologies. With the Centers for Medicare and Medicaid Services selecting readmissions as a measure of health care quality, there has been an increased focus on reducing readmissions. MATERIALS AND METHODS There were 114,174 recorded ACDF surgeries in the derivation cohort, the State Inpatient Database (SID) of New York and California between 2006 and 2014. There were 115,829 ACDF surgeries recorded in the validation cohort, the SID from Florida and Washington over the same time period. After identification of risk factors using univariate and multivariate analysis of the derivation cohort, a sociated with increased readmission rates may be helpful in identifying patients who require additional optimization to reduce perioperative morbidity. LEVEL OF EVIDENCE Level III-prognostic.OBJECTIVE We estimated the association between the presence of pain and healthcare utilization among older adults residing in long-term care (LTC) facilities. METHODS Using administrative health data maintained by the Saskatchewan ministry of health and time-to-event analyses with multivariable frailty models, we tested for differences in healthcare use (hospitalization, physician and specialist visits, and prescription drug dispensations) as a function of pain status among LTC residents after admission to an LTC. Specifically, we contrasted LTC residents with daily pain or less than daily pain but with moderate or severe intensity (i.e., clinically significant pain group; CSP) to residents with no pain or non-daily mild pain (NP/NDMP group). RESULTS Our cohort consisted of 24,870 Saskatchewan LTC residents between 2004 and 2015 with an average age of 85 years (63.2% female; 63.0% in urban facilities). Roughly one third had CSP at their LTC admission date. Healthcare use after admission to LTC was strongly associated with pain status, even after adjusting for residents' demographic and facility characteristics, prior comorbidities and healthcare utilization one year prior to the study index date. In any given quarter, compared to NP/NDMP residents, those with CSP had an increased risk of hospitalization, specialist visit, follow-up general practitioner visit, and onset of polypharmacy (i.e., 3 or more medication classes). DISCUSSION To our knowledge, this is the first large-scale project to examine the utilization of healthcare resources as a function of pain status among LTC facility residents. Improved pain management in LTC facilities could lead to reduced health care use.Only a few series of patients with systemic sarcoidosis and specific subcutaneous lesions have been reported. We reviewed our patients with systemic sarcoidosis with specific subcutaneous lesions to analyze their histopathological features and their relationship with clinical features of the systemic disease. Patients with systemic sarcoidosis with predominantly subcutaneous sarcoid granulomas diagnosed between 1980 and 2016 in Bellvitge University Hospital were enrolled. We also analyzed patients with clinically and histopathologically identical lesions in whom a diagnosis of systemic sarcoidosis could not be made during follow-up. Twenty-eight patients with systemic sarcoidosis presented specific subcutaneous lesions (23 women and 5 men, mean age 55.64 SD 12.26 years). Dermal involvement was observed in 10 cases, always discrete and limited to deep reticular dermis. The distribution of the granulomatous infiltrate was lobular in 7 cases and lobular and septal in 21. Fibrosis was observed in 21 cases. There were no significant differences in persistence of lesions or persistence of systemic disease activity when comparing patients with and without fibrosis.