Robotic and Navigation Systems in Orthopaedic Surgery: How Much Do Our Patients Understand?

BACKGROUND: Technology in orthopaedic surgery has become more widespread in the past 20 years, with emerging evidence of its benefits in arthroplasty. Although patients are aware of benefits of conventional joint replacement, little is known on patients' knowledge of the prevalence, benefits or drawbacks of surgery involving navigation or robotic systems. METHODS: In an outpatient arthroplasty clinic, 100 consecutive patients were approached and given questionnaires to assess their knowledge of navigation and robotics in orthopaedic surgery. Participation in the survey was voluntary. RESULTS: Ninety-eight patients volunteered to participate in the survey, mean age 56.2 years (range, 19 to 88 years; 52 female, 46 male). Forty percent of patients thought more than 30% of National Health Service (NHS) orthopaedic operations involved navigation or robotics; 80% believed this was the same level or less than the private sector. One-third believed most of an operation could be performed independently by a robotic/navigation system. Amongst perceived benefits of navigation/robotic surgery was more accurate surgery (47%), quicker surgery (50%), and making the surgeon's job easier (52%). Sixty-nine percent believed navigation/robotics was more expensive and 20% believed it held no benefit against conventional surgery, with only 9% believing it led to longer surgery. Almost 50% would not mind at least some of their operation being performed with use of robotics/navigation. CONCLUSIONS: Although few patients were familiar with this new technology, there appeared to be a strong consensus it was quicker and more accurate than conventional surgery. Many patients appear to believe navigation and robotics in orthopaedic surgery is largely the preserve of the private sector. This study demonstrates public knowledge of such new technologies is limited and a need to inform patients of the relative merits and drawbacks of such surgery prior to their more widespread implementation.

Combination of intracameral and intrastromal voriconazole in the treatment of recalcitrant Acremonium fungal keratitis

We present a report of a 28-year-old female with fungal keratitis due to Acremonium that was unresponsive to full medical therapy over 3 weeks. The patient was treated with superficial keratectomy, intrastromal and intracameral voriconazole injections. There was a marked clinical improvement beginning on day 3 post-therapy that was sustained until the last follow-up at 6 months. This is the first case of fungal keratitis due to Acremonium treated by a combination of intrastromal and intracameral voriconazole. This cost-effective treatment modality proved to be significant in impeding the progression of this potentially blinding disease and improving visual prognosis

The FISH test for the diagnosis, surveillance, and prognosis of transitional cell carcinoma of the bladder

A brief history of the fluorescence in situ hybridization [FISH] test and its use in the management of bladder tumors is outlined. After a brief review of the subject, between 1990 and the present, including sensitivity and specificity studies, a referenced list of the various uses of the FISH test is provided. It is concluded that the FISH test has almost completely replaced cystoscopy, urine cytology and all other tests and markers for the diagnosis, surveillance, management, and prognosis of bladder tumors. It has completely changed and revolutionized our previous routine of managing bladder tumors

[Primary type 1 hyperoxaluria - about two particular cases]

Primary hyperoxaluria type I is an autosomal recessive disease due to congenital defect in alanine glyoxylate aminotransferase [ACT]. It is a rare disorder in witch only combined liver-kidney transplantation is curative. Our two cases of primary type I hyperoxaluria were particular by the early renal failure, thrombocytopenia and intestinal invagination. On the basis of our two cases we discuss diagnostic and therapeutic methods

[Idiopathic thrombocytopenic purpura. Study of 61 cases]

Idiopathic thrombocytopenic purpura [ITP] represented the most frequent cause of children's thrombocytopenia. Until our days universal management of ITP does not exist. We performed retrospective and then prospective study of 61 children admitted for ITP during 15 years. The aim of the study was to precise the epidemiological, clinical and therapeutic profiles and propose management algorithm. The incidence of ITP was 0.34 per cent. The mean age was 6 years with male predominance. Initial thrombocytopenia was inferior than 10.000/mm3 in 44,2 per cent of cases. Spontaneous recovering was noted in 17 cases. Oral prednisone therapy with 2mg/kg/day during 21 to 35 days and 4mg/kg/day during 4 days was performed respectively in 21 and 19 cases. Intravenous immunoglobulin and methylprednisolone pulse therapy was performed respectively in 17 and 5 cases. Splenectomy was successfully performed in 3 cases. Chronic ITP was noted in 13 cases. Acute ITP without hemorrhagic syndrome should be treated in first stage with oral prednisone at 4mg/kg/day during 4 days. In case of failure, a second cure may be prescribed. If not we return to intravenous immunoglobulin

rare, late complication in a hemispherectomised patient: a brucella abscess in the contralateral hemicranium

Pathology in the contralateral hemicranium following hemispherectomy has been reported only once; a meningioma was found at autopsy, compressing the remaining hemisphere of a patient who had been submitted to a hemispherectomy for a malignant glioma [14] Intracranial brucella abscess have been reported only 10 times in the literature. We are reporting a case of cerebral brucella abscess in the remaining hemisphere following a hemispherectomy for infantile uncontrollable seizures and behaviour problems. The literature is reviewed and a new approach to the medial aspect of the remaining hemisphere is described

effect of stressful exercise and / or local implants of labeled Buffy coat cells on muscle regeneration

The process of muscle regeneration is an important field in scientific work Thus. An attempt has been carried out to find the link between the most important factors which may affect this process and these are exercise and local buffy coat implantation. 168 male albino rats were divided into 5 groups. All of these groups were exposed to unilateral calf muscle injury of their right legs. The 1[st] group was regarded as control, the 2[nd] was exposed to stressful exercise, the 3[rd] was exposed to local implantation of labelled autogenous buffy coat cells at the site of muscle injury, the 4[th] was exposed to both events while the 5[th] was exposed to local injection of the labelling material at the injury site. Follow up of the process of muscle regeneration had been carried out for 28 days. Results have shown that muscle regeneration was enhanced in the 2[nd] and 4[th] groups where stressful exercise had been performed, possibly by providing myoblast precursors from the circulation and / or increasing myoblast spillage into the area by multiple fiber disruptions . Buffy coat had also enhanced muscle regeneration by transformation of some of them into myoblasts as indicated by the presence of labelled cells in the regenerated muscle tissue in the 3[rd] and 4[th] groups. These findings had led to the conclusion that, muscle regeneration can be improved by using stressful muscle exercise together with local implantation of buffy coat cells at the site of muscle injury. An intimate relation had been predicted between buffy coat implantation, stressful exercise and muscle regeneration

Agenesis of gall bladder, A case report

Congenital absence of gall bladder is a rare anomaly, we report a case of agenesis of gall bladder in a 62-year-old female patient who presented with obstructive jaundice misdiagnosed as a gall bladder and common bile duct stones on a pre-operative ultrasound and computerized tomography. The diagnosis of absent gall bladder was confirmed during laparotomy by per-operative cholangiogram. The relative embryological development, diagnostic pitfalls, intra operative management, and therapeutic strategies are discussed

Renal cell carcinoma ta with slow growth and prolonged survival

Three cases of renal cell carcinoma with prolonged survivals of 26, 23 and 15 years are reported.The three possible theories about prolonged survival are discussed in the light of a review of the literature

Death under anesthesia in the Middle East

An account of the first reported death under chloroform of an 18 years old man, in 1899 at a hospital in Beirut. The local government showed concern and investigated the cause of death. The auther called for awareness of the lethal dangers of chloroform, advised the use of ether and local analgesies

Renal fibrohistiocytic sarcoma. Three cases and a review of the literature

The purpose of this paper is to report three unpublished cases of so-cealed renal malignant fibrous histiocytoma which should be more appropriately called renal fibrohistiocytic sarcoma and to review and analyze the data concerning 41 cases collected from the literature and our three new cases making a total of 44 cases. Our third case is very interesting; in addition to the fact that this condition is rare, this particular patient also had concomitant nonmalignant ascites and compression of the descending colon, both conditions being rarely associated with renal cancer. The average age of the parients was 58 years; in 66'% of the cases the tumor involved the left kidney; 57% of the patients were males; the average tumor size was 12 cm; nephrectomy was performed in 93% of the cases; the average survival was 16 months. In none of the cases was a preoperative diagnosis correctly made. It is concluded that a triad of symptoms and signs [renal pain, weight loss, and large tumor size] as well as a triad of imaging characteristics [areas of low density on the CT scan, hypoechoic areas on ultrasound, and hypovascularity on angiography] may hold the promise of a preoperative diagnosis. It is suggested that the tumor arises from the system of Gerota's fascia-renal capsule