Three-dimensional computed tomography reconstruction in video-assisted thoracoscopic segmentectomy (DRIVATS): A prospective, multicenter randomized controlled trial.

Objective: Anatomical segmentectomy has been proven to be a viable surgical treatment for small-size peripheral lung nodules. Three-dimensional (3D) reconstruction computed tomography (CT) has been proposed as an effective approach to overcome the challenges of encountering pulmonary anatomical variations when performing segmentectomy. Therefore, to further investigate the usefulness of preoperative 3D reconstruction CT in segmentectomy, we will conduct this prospective, multicenter randomized controlled DRIVATS study to compare the use of 3D reconstruction CT with standard chest CT in video-assisted segmentectomy (ClinicalTrials.gov ID: NCT04004494). Methods: This study began in July 2019 and a total of 190 patients will be accrued from three clinical centers within 4 years. The main inclusion criteria are patients with a single peripheral nodule 0.8-2 cm with at least one of the following requirements: (i) histology of adenocarcinoma in situ; (ii) nodule has ≥50% ground-glass appearance on CT; (iii) radiologic surveillance confirms a long doubling time (≥400 days). Surgical procedures include segmental resection of the lesion and mediastinal lymph node sampling (subsegmental resection or combined subsegmental resection will not be included in this study). The primary endpoint is operative time. The secondary endpoints include incidence of change of surgical plan, intraoperative blood loss, conversion rate, operative accident event, incidence of postoperative complications, postoperative hospital stay, length of hospitalization, duration of chest tube placement, postoperative 30-day mortality, dissection of lymph nodes, overall survival, disease-free survival, preoperative lung function, and postoperative lung function. Discussion: This multicenter DRIVATS study aims to verify the usefulness of preoperative 3D reconstruction CT compared with standard chest CT in segmentectomy. If successfully completed, this multicenter prospective study will provide a higher level of evidence for the use of 3D reconstruction CT in segmentectomy.

Evaluation of Eagle's Syndrome and Assessment of Post-operative Outcome of Excision of Elongated Styloid Process: A Prospective Study, in Tertiary Care Centre, India.

Eagle's syndrome is one of the commonly overlooked cause of foreign body sensation in throat with referred otalgia. Incidence of symptomatic cases was rare. Elongated Styloid process may present with myriad symptoms. The diagnosis needs a cautious approach and the management is mainly aimed at reduction of the length of elongated section. Prospective study in the Department of ENT Stanley Medical College, Chennai. Study period-January 2018 to September 2018. Clinical examination followed by radiological investigations done to confirm the diagnosis. Stylo-tonsillectomy was done in the selected 20 subjects and post-operative outcomes were compared with pre-operative questionnaires. The progression of symptoms were evaluated for resolution and studied. Pharyngeal symptoms are more common. The length of styloid is associated with symptom complex presentation. The incidence was 0.17% in general population coming to ENT OPD and more common among women with mean age of 43 years. Bilateral presentation was more common and the longest length recorded in the study was 78 mm. Single investigation is not enough to confirm the diagnosis. A minimum of two investigations are needed for planning surgical management. Intra-oral approach with stylo-tonsillectomy was done with no major complications in post-operative period. Pre-operative symptoms were recoreded by use of McGill's pain questionnaire and compared with post-operative scores. Dysphagia was the major post-operative early symptom which took a week minimum to subside. Clinical findings and atleast 2 imaging studies needed for diagnosis of the disorder. OPG though economical can be aided to great extent by use of Conebeam CT or 3D CT to study the elongated styloid process. Stylo-tonsillectomy is a safer approach with minimum complications and earlier relief of pre-operative symptoms. Surgical management with reduction of length of elongated styloid followed by adequate analgesia remains mainstay in treatment.

A novel classification for medial malleolar fracture based on the 3-D reconstruction CT.

BACKGROUND: Fracture of the medial malleolus is one of the most frequent injuries treated surgically; however, the classification of the fracture has not attracted much attention and a good classification system is still lacking. METHODS: Consecutive cases of medial malleolus fractures were prospectively enrolled. Based on the 3-D reconstruction CT morphology and centered on the posterior colliculus of the medial malleolus, we classified the fractures into 4 types: type 1 with no involvement of the posterior colliculus, type 2 with partial involvement of posterior colliculus, type 3 with the entire involvement of posterior colliculus, and type 4 with the fracture line 4 vertically extended from the intercollicular groove to the comminuted fracture of the posterior malleolus. Statistical analyses were performed to evaluate the clinical significance of the classification. RESULTS: There were 273 cases prospectively enrolled. The distribution of the cases was type 1 of 12.1%, type 2 of 41.0%, type 3 of 30.0%, and type 4 of 16.8%. Statistics showed that the new classification had significant associations but did not totally depend on the classical ankle fracture classifications. Results showed that the new classification had implications in the severity of ankle fractures. From type 1 to type 4, the ankle joint was more and more unstable. Furthermore, comminuted medial malleolar fractures could be subdivided, and the new classification could provide useful information for surgical decision-making. CONCLUSIONS: The novel classification was a useful system to describe the 3-D geometry of the fractured medial malleolus.

Contrasted enhancement and 3D reconstruction CT anatamy of the intertransverse area of lumbar spine / 中国矫形外科杂志

L3、4,and there was no significatant difference between two sides,and the biggest inner diameter of the main vessels averaged 5.3?0.6 mm.[Conclusion]To begin with,the blood supply is adequate in the intertransverse area,and the distribution of blood vessels follows some regularities,so to be familiar with the anatomy and to operate carefully can reduce bleeding.In addition,ILIF in segment L3、4 and L4、5 is feasible.

Computed Tomographical Evaluation of C1-2 for Transarticular Posterior Screw Fixation / 대한정형외과학회잡지

PURPOSE: To avoid neurovascular injuries and to establish the ideal trajectory of screw insertion, a computed tomographical evaluation was conducted. MATERIALS AND METHODS: Twenty volunteers without cervical disease were employed for this study. Axial and oblique CT scans were selected for evaluation. Oblique CT scans were obtained in the direction of provisional screw insertion, starting from the junction of the lamina and the inferior articular facet of the axis and extending to the center of anterior tubercle of the atlas. In the axial and oblique reconstructed views, the screw length, the diameters of the medial and lateral cortexes of the isthmus, the vertical distance, and the angle of C1 were measured. RESULTS: The screw lengths averaged 37.6 mm (35.1-40.5 mm) in males and 37.2 mm (33.6-43.4 mm) in females. The diameters of the medial cortex of the isthmus were 4.3 mm (3.3-5.2 mm) in males and 4.0 mm (2.8-5.6 mm) in females. No measurement was statistically different between males and females. CONCLUSION: Due to individual variations of atlantoaxial anatomy, especially in terms of the size of cortical diameter of the isthmus, 3-D reconstruction CT is a useful tool for planning transarticular C1-2 screw insertion.