Anatomical Classification System Research Articles

Renal tumour invasion index as a novel anatomical classification predicting urological complications after partial nephrectomy

Objective. The goal of anatomical classification systems (ACSs) is to assess renal tumour complexity and predict surgical complications. However, the present ACSs may include some relatively unimportant components and may be complicated to use. This study introduces the invasion depth of the renal tumour divided by the parenchymal thickness, called the renal tumour invasion index (RTII), as a novel ACS and compares it with previous ACSs in predicting urological complications after partial nephrectomy. Material and methods. This retrospective single-institution study assessed 280 consecutive patients subjected to a planned partial nephrectomy. The main outcome was perioperative 30-day urological complications. RTII was compared with the PADUA (preoperative aspects and dimensions used for an anatomical) classification score, RENAL (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior and location relative to polar lines) nephrometry score and C (centrality) index to predict urological complications, using statistical methods of receiver operating curve and logistic binary regression. Results. Areas under the curve for RTII, RENAL, C index and PADUA were 0.64 (95% CI 0.57–0.72, p < 0.001), 0.61 (95% CI 0.54–0.69, p = 0.004), 0.64 (95% CI 0.57–0.71, p < 0.001) and 0.57 (95% CI 0.49–0.65, p = 0.06), respectively, indicating that all the ACSs studied are able to predict urological complications. Similarly, in a multivariate logistic regression model adjusted for comorbidity and surgical approach, all ACSs were statistically significant predictors of urological complications. Conclusions. RTII is as good as the previous more complicated ACSs in predicting urological complications after partial nephrectomy. As a simple measurement with a straightforward anatomical interpretation, RTII may be useful in counselling patients and stratifying patients in studies.

Socioeconomic status and differences in medication use among older people according to ATC categories and urban–rural residency

To study how selected indicators of socioeconomic status and urban-rural residency associate with medication use in form of number of daily medications, polypharmacy, and medication use according to Anatomic Therapeutic Classification (ATC) system. Cross-sectional, population-based study among older community-dwelling Icelanders. Criteria for participation were: age ≥65 years, community-dwelling, and able to communicate verbally and to set up a time for a face-to-face interview. Information on medication use was obtained by interviews and by examining each person's medication record. Medications were categorised according to ATC system. A questionnaire and the physical and mental health summary scales of SF-36 Health Survey were used to assess potential influential factors associated with medication use. On average, participants (n=186) used 3.9 medications, and the prevalence of polypharmacy was 41%. No indicators of socioeconomic status had significant association to any aspects of medication use. Compared to urban residents, rural residents had more diagnosed diseases, were less likely to live alone, were less likely to report having adequate income, and had fewer years of education. Controlling for these differences, urban people were more likely to use medication from the B and C categories. Moreover, older urban men, with worse physical health, and greater number of diagnosed diseases used more medications from the B category. There are unexplained regional differences in medications use, from categories B and C, by older Icelanders. Further studies are needed on why urban residents used equal number of medications, or even more medications, compared to rural residents, despite better socioeconomic status and fewer diagnosed diseases.

Classification of Anatomic Involvement of the Ilio-caval Venous Outflow Tract and Its Relationship to Early Outcomes after Ilio-caval Venous Stenting.

Objective Iliocaval venous obstruction (ICVO) includes a wide spectrum of iliac vein and vena cava obstructive patterns but anatomic classification is lacking, making comparisons of treatment modalities difficult. The purpose of this study was to propose an anatomic classification for ICVO based on patterns of venous obstruction and to correlate severity to clinically relevant outcomes. Methods A multi-institutional retrospective evaluation of patients with ICVO who underwent venous stenting procedures was performed to identify anatomic patterns of iliocaval obstruction. The sites of venous disease were categorized on the basis of computed tomography or magnetic resonance venography supplemented by contrast venography or intravascular ultrasound. Proposed anatomic classification was defined as follows: type I, stenosis of a single venous segment; type II, stenosis of multiple venous segments; type III, occlusion of a single venous segment; and type IV, occlusion of multiple venous segments. Anatomic segments included in the classification scheme were defined as inferior vena cava, common iliac vein, external iliac vein, and common femoral vein. All patients underwent attempted stenting to re-establish normal iliocaval outflow. Outcomes, including initial procedural success and rethrombosis rates within 6 months, were determined for each type of ICVO. Results A consecutive 120 patients with ICVO underwent venography and attempted intervention. The type of ICVO was well distributed across all categories, with type I involvement identified in 42.5% of cases, type II in 19.2%, type III in 13.3%, and type IV in 25%. Procedural success was achieved significantly more often in types I and II ICVO ( P = .02). Stent reocclusion was more frequent in type IV ICVO (26.7%) than in type I (7.8%) or type II ICVO (4.3%) ( P = .009). Conclusions On the basis of a proposed anatomic classification, the diversity of ICVO may be stratified according to the severity of venous involvement. The anatomic classification was found to correlate to the technical success and short-term patency of venous intervention. Prospective evaluation is required to further validate the utility of this new anatomic classification system.

Vigilancia del consumo de antimicrobianos en hospitales de México: situación actual y guía práctica para su implementación

Antibiotic use in Mexico is characterized by high levels of consumption, irrational use in primary care services, and high rates of bacterial resistance that cause hospital infections. Changes are needed in the recommended method for reporting antimicrobial drug use, so that quantification can be carried out through drug utilization studies. Such studies, which make it possible to know which drugs are used in hospitals, require an accessible source of data on antimicrobial drug use with the least risk of biases, a single drug identification system, and the adoption of units of measure that can be extrapolated. The methodology developed by the WHO Collaborating Centre for Drug Statistics Methodology, based on the anatomical, therapeutic, and chemical classification (ATC) system and the daily defined dosage (DDD), is proposed. Despite its limitations, employing this methodology to monitor local antimicrobial drug use will make it possible to detect differences in usage patterns among institutions, and, especially, trends within a given institution. This would facilitate timely alerts about potential problems related to the use of antimicrobial drugs and the need for specific interventions.

Choledochal cysts : A review of literature

Choledochal cysts are cystic dilation of extrahepatic duct, intrahepatic duct, or both that may result in significant morbidity and mortality, unless identified early and managed appropriately. The incidence is common in Asian population compared with western counterpart with more than two third of the cases in Asia being reported from Japan. The traditional anatomic classification system is under debate with more focus on etiopathogenesis and other aspects of choledochal cysts. Even though categorized under the same roof, choledochal cysts vary with respect to their natural course, complications, and management. In this review, with the available literature on choledochal cysts, we discuss different views about the etiopathogenesis along with the natural course, complications, diagnosis, and surgical approach for choledochal cysts, which also explains why the traditional classification is questioned by some authors.

The posterior meniscofemoral ligament: Morphologic study and anatomic classification

The meniscofemoral ligaments (MFLs) run from the medial femoral condyle to the posterior horn of the lateral meniscus and consist of anterior MFL (aMFL) and/or posterior MFL (pMFL) components according to whether it passes anterior or posterior to the posterior cruciate ligament (PCL). The purpose of this study was to analyze the incidence and morphologic features of the MFLs in Koreans and formulate an anatomic classification system of MFLs to aid the detailed interpretation of medical imaging or biomechanical data. One hundred knees from 52 cadavers were studied. Eighty-seven knees had pMFLs, whereas an aMFL was only found in one knee from a male cadaver. The pMFLs and PCLs were longer in males than in females (P < 0.05). The most common type of MFL was the high crossing of a typical pMFL against the PCL in both genders. Regarding other types, the incidence of absent pMFLs was higher in males than in females and the oblique bundle of the PCL was easily confused with the pMFL in several cases in both genders. These results provide the basis for the classification system of the MFL and will contribute to better outcomes for evaluating the MFL and PCL when using medical imaging such as arthro-CT scan or MRI through a better understanding of the anatomy of the MFL and PCL.

Osseous and Ligamentous Scaphoid Anatomy: Part I. A Systematic Literature Review Highlighting Controversies

The interpretation of scaphoid anatomy and kinematics is confusing and controversial. This results from a lack of consensus on the anatomy of the ligaments attaching to the scaphoid and an overwhelming variety of substantially different anatomic descriptions and classification systems of the wrist joint in the literature. The present study systemically reviews the consistencies or inconsistencies of the various scaphoid ligament descriptions and aims to clarify and unify different concepts and classification systems. We performed a systematic search of the medical literature from 1950 to 2010. We included all descriptive reports of the anatomy or morphology of the scaphoid, ligaments, or both. With the aim to describe the best available evidence, we considered all anatomical descriptions but emphasized a selection of the most frequently cited articles. The literature search resulted in 555 potentially eligible descriptive reports, 58 of which met the inclusion criteria and were included in the review. Variations in the anatomic descriptions appear to be mostly due to the difficulty of identifying individual interdigitating ligaments or bundles by macroscopic dissections, as well as the interindividual variability in ligament anatomy. The most important areas of controversy in the scaphoid ligament attachments include the radial collateral ligament, dorsal radiocarpal ligament, dorsal intercarpal ligament, volar scaphotriquetral ligament, and scaphotrapezium-trapezoid ligament. None of the scaphoid ligaments other than the scaphocapitate ligament have been described consistently. Future research is required to verify the ligament attachments that currently have the most controversial descriptions, while addressing the interindividual variability of ligament insertions and morphology. Thorough knowledge of the anatomy will enhance our understanding of the kinematics of the scaphoid.

A Head and Neck Lymph Node Classification Using an Anatomical Grid System While Maintaining Clinical Relevance

The current classification of head and neck lymph nodes lacks a standardized system that integrates basic anatomy and clinical relevance. Currently, anatomy texts, atlases, and journals used to educate future health care professionals use a classification system that differs from the commonly used clinical nomenclature. As a result, student trainees entering the professional world are confused by lymph node terminology. The purpose of this study was to suggest a lymph node classification system that accurately reflected anatomy and clinical applications. A literature search was conducted on anatomic and clinical texts, atlases, journals, and Web sites. Two recurring classification themes were found from anatomic texts and atlases: superficial and deep chains, and local anatomic structures. Since 1988 the clinical specialties have used a Roman numeral "level" system. The differences between anatomic and clinical classification systems have led to academic frustration. After analysis, a functional classification system was developed that integrated anatomic and clinical terminology from the current classification systems. This suggested system revised the clinically accepted level system approved in 1988 and replaced the terminology with an anatomically derived naming system. This system satisfies the need for a classification that unifies anatomic and clinical applications.

A Review of Prognostic Factors in Thymic Malignancies

Prognosis is a central piece of information we would like to know when someone is diagnosed with a disease. Prognosis is affected by many factors. For a cancer, one important aspect is the anatomic extent of the tumor, typically described by a stage classification. Nevertheless, a stage classification system should not be confused with a system to predict prognosis—tumor stage is only one aspect. Prognosis is affected by the treatment given, by patient-specific factors (i.e., comorbidities), tumor-related factors, and others, collectively known as prognostic factors. The International Thymic Malignancy Interest Group (ITMIG) is currently engaged in the development of a validated formal stage classification system for thymic malignancies, together with the International Association for the Study of Lung Cancer and under the auspices of the Union International Contre le Cancer (UICC) and American Joint Commission on Cancer (AJCC). Assessment of prognostic factors is an important corollary to development of an anatomic stage classification system. A review of the current literature identifying prognostic factors is an important baseline to have for this initiative. The study and classification of prognostic factors, in general, is very rudimentary. Often there is confusion because people are not clear about the outcome in question: a factor may be prognostic relative to overall survival, to cure from the disease, to response to treatment, etc. Prognostic factors are often specific to a subgroup of patients and a particular setting: factors associated with prognosis for a patient with thymoma undergoing surgery may be different from that of a patient with thymic carcinoma undergoing chemotherapy and radiation. Prognostic factors can be divided into “domains” of tumor-related factors, host factors (i.e., that would be present in the patient even if there was no tumor), and environmental factors (including things such as access to optimal care). Furthermore, once we identify a prognostic factor, we immediately begin trying to change the outcome to be what we want to see (i.e., to undermine the predictive value of the prognostic factor). Finally, there are many statistical pitfalls and errors in the definition of prognostic factors, as discussed in another article in this issue.1 Despite deficiencies in our level of sophistication about the science of prognostic factors, the need to estimate future outcomes for patients is great. This article sets out to provide a review of the current state of affairs in the area of thymic malignancies.

SS23. Contemporary Results of Open Complex Abdominal Aortic Aneurysm Repair Using a Standardized Classification for Comparison with Fenestrated Endografts

This study analyzed outcomes of open repair of complex abdominal aortic aneurysms (cAAA) based upon an anatomic and endovascular classification system, thereby providing a standard of comparison for fenestrated endovascular repair (FEVAR). We reviewed outcomes of 461 patients who underwent open cAAA repair (2000-2010). Pre-operative digital imaging was analyzed by a blinded investigator using centerline of flow to define aneurysm extent and the expected number of fenestrations that would be required to provide 2-cm of proximal seal for FEVAR. End-points were mortality, morbidity, renal function (RF) deterioration, re-interventions, and patient survival. There were 354 male and 107 female patients with mean age of 73±8 years. Operative mortality was 1.3% (6/461). Any morbidity occurred in 260 patients (57%), and was severe (SVS 3) in 91 (20%). Five-year patient survival, freedom from re-intervention, and freedom from RF deterioration were 72±3%, 90±2%, and 84±3%. Increasing level of aneurysm complexity (see table) was associated with greater mortality, severe morbidity and dialysis rates using either classification system (P<0.001).Tabled 1n (%)5-yr Kaplan-Meier Estimates (%±SD)ClassificationnOperative mortalitySevere morbidityDialysisFreedom RF deteriorationFreedom re-interventionPatient survivalAnatomic classificationJuxtarenal235030 (13)5 (2)89 ± 692 ± 276±4Suprarenal1752 (1.1)38 (22)9 (5)82 ± 588 ± 469 ± 5Type IV TAAA514 (7.8)22 (43)7 (14)64 ± 1181 ± 862 ± 10Expected Number of FenestrationsOne700075 ± 2110067 ± 3Two214031 (14)4 (2)92 ± 392 ± 376 ± 4Three1181 (0.8)20 (17)7 (6)72 ± 890 ± 563 ± 7Four745 (6.7)31 (42)8 (11)72 ± 984 ± 671 ± 8Total4616 (1.3)91 (20)21 (4.5)84 ± 390 ± 272 ± 3 Open table in a new tab Open cAAA repair can be performed safely with low mortality (1.3%) but high risk of complications. These data stratified by anatomic classification and the expected number of fenestrations provide a benchmark for comparison with results of FEVAR.

Blunt Abdominal Trauma Resulting in Gallbladder Injury: A Review With Emphasis On Pediatrics

Gallbladder injury in blunt abdominal trauma is a rare and difficult diagnosis. Gallbladder injury is reported to be between 1.9% and 2.1% of all abdominal traumas. It has vague symptoms usually with inconclusive investigation results; hence, it is often diagnosed at laparotomy. The patient typically has vague abdominal pain and occasionally a period of remission depending on the type of gallbladder injury. In pediatrics, blunt abdominal trauma presents additional challenges of difficult historians and compensating physiology. Any delay in diagnosis and definitive management will worsen the prognosis. Making the diagnosis requires astute clinical acumen and radiologic interpretation. The classification system of Losanoff has merit in guiding treatment. While cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ and these are discussed. Literature searches were performed using Pubmed and Medline with keywords "abdominal trauma," "gallbladder injury," and "gallbladder perforation." The authors highlight the incidence of associated visceral injuries in gallbladder trauma (>90%). Gallbladder perforation is more likely in cases when the gallbladder is distended and thin-walled at the time of injury. Therefore, we recommend that gallbladder perforation is suspected in those patients who have drunk alcohol or eaten recently. Despite the developments in modern computed tomography, identifying gallbladder perforation is difficult because of the subtlety and rarity of the condition. We draw attention to the proposed anatomic classification systems because they are of some use in guiding treatment. In the absence of a diagnosis after blunt abdominal trauma and with intra-abdominal free fluid, the clinician faces the difficult decision of whether surgery is indicated for a potential visceral injury. After discussing the available evidence, the authors advocate a low index of suspicion for performing diagnostic laparoscopy.

Multidisciplinary medication review: evaluation of a pharmaceutical care model for nursing homes

The objective of this study was to assess implementation of a pharmaceutical care model for the multidisciplinary care of elderly patients in nursing homes. Prospective study, medication review, from January 2007 to December 2009 in ten nursing homes affiliated to the Pharmacie interjurassienne (PIJ), Switzerland. Medication use data were collected and reviewed by a pharmacist, focusing on drug indication, dosing, side effects, renal/hepatic elimination and interactions. Drug-related problems (DRPs) were discussed face-to-face with the responsible physician and a nurse. The pharmaceutical care issues were formulated and medication interventions proposed during this meeting. DRPs and interventions were documented using the Pharmaceutical Care Network Europe scheme version 5.00 (PCNE V5.00). The economic impact of the service was estimated through a retrospective evaluation of annual drug costs. A satisfaction evaluation was conducted among practitioners and nurses. DRPs, interventions, treatment changes implemented. Drug therapy of 329 patients was reviewed. The number of medicines per patient ranged from 2 to 27 (mean 12.8). A total of 1,225 DRPs were detected and discussed with the physician and the nurse. Medication review led to 343 medical evaluations secondary to drug-drug interactions and 803 treatment adaptations: 373 drugs were stopped, 197 dosages changed, 95 instructions for use amended, 86 drug choices were altered, 35 drug formulations changed and 17 new drugs started. According to the Anatomical Classification System, the main classes involved in interventions were related to Alimentary tract and metabolism (n = 285), Nervous system (n = 189) and Cardiovascular system (n = 115). Since the outset of the PIJ, the annual drug costs decreased in nursing homes with medication review including a pharmacist, whereas it was stable in the other nursing homes. The satisfaction evaluation showed a very positive appreciation by practitioners and nurses. The study showed an efficient pharmaceutical care model, well accepted by physicians and nurses. It also indicated that for elderly patients, continuous drug review contributed to improved drug therapy, reduced unnecessary polypharmacy and reduced pharmaceutical costs.

An analysis of psychotropic drug sales. Increasing sales of selective serotonin reuptake inhibitors are closely related to number of products

Prescribing of selective serotonin reuptake inhibitors (SSRIs) has increased dramatically. To compare the sales of benzodiazepines and SSRIs within the primary care sector in Denmark and relate changes in usage to number of indications and products on the market. We used data from various sources to establish the sales curves of psychotropic drugs in the period 1970 to 2007, based on the Anatomic Therapeutic Classification system and Defined Daily Doses. Fluctuations in sales of psychotropic drugs that cannot be explained by disease prevalence were caused by changes in sales of the benzodiazepines and SSRIs. We found a decline in the sales of benzodiazepines after a peak in 1986, likely due to the recognition that they cause dependence. From a low level in 1992, we found that the sales of SSRIs increased almost linearly by a factor of 18, up to 44 DDD per 1000 inhabitants, which was closely related to the number of products on the market that increased by a factor of 16. Sales of antidepressant drugs are mainly determined by market availability of products indicating that marketing pressures are playing an important role. Thus the current level of use of SSRIs may not be evidence-based, which is supported by studies showing that the effect of SSRIs has been overestimated.

RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy

• To assess the use of the RENAL Nephrometry Score (RNS), which has been proposed as an anatomical classification system for renal masses, aiming to predict surgical outcomes for patients undergoing laparoscopic partial nephrectomy (LPN). • In the present study, 159 consecutive patients who underwent LPN were reviewed and RNS was calculated for 141 patients with solitary renal masses who had complete radiographic data. • Renal tumours were categorized by RNS as low (nephrometry sum 4-6), intermediate (sum 7-9) and high (sum 10-12). • Of the 141 patients, there were 43 (30%) low, 91 (65%) intermediate and seven (5%) high score lesions. There was no statistically significant difference in the demographics of the three groups. • There was a significant difference in warm ischaemia time (16 vs 23 vs 31 min; P < 0.001), estimated blood loss (163 vs 312 vs 317 mL; P= 0.034) and length of hospital stay (1.2 vs 1.9 vs 2.3 days; P < 0.001) between the low, intermediate and high score groups, respectively. There was no difference in overall operative time (P= 0.862), transfusion rate (P= 0.665), complication rate (P= 0.419), preoperative creatinine clearance (P= 0.888) or postoperative creatinine clearance (P= 0.473) between the groups. • Sixty-one lesions (43%) were anterior and 80 (57%) were posterior. No difference was found among any intra-operative, pathological or postoperative outcomes when comparing anterior vs posterior lesions. • In patients undergoing LPN, a higher RNS was significantly associated with an increased estimated blood loss, warm ischaemia time and length of hospital stay. • The RNS may stratify tumours based on the technical difficulty of performing LPN.

624 APPLICATION OF R.E.N.A.L. NEPHROMETRY SCORE TO LAPAROSCOPIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Advanced II1 Apr 2010624 APPLICATION OF R.E.N.A.L. NEPHROMETRY SCORE TO LAPAROSCOPIC PARTIAL NEPHRECTOMY Matthew Hayn, Thomas Schwaab, Willie Underwood, and Hyung Kim Matthew HaynMatthew Hayn Buffalo, NY More articles by this author , Thomas SchwaabThomas Schwaab Buffalo, NY More articles by this author , Willie UnderwoodWillie Underwood Buffalo, NY More articles by this author , and Hyung KimHyung Kim Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.960AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The R.E.N.A.L. Nephrometry Score (NS) has been proposed as a standardized anatomical classification system for renal masses. The score is based on 5 anatomical characteristics of the tumor: Radius (maximal diameter), Exophytic/endophytic properties, Nearness to collecting system or renal sinus, Anterior versus posterior descriptor, and Location relative to polar line. The purpose of this study was to assess the utility of the R.E.N.A.L.-NS for patients undergoing laparoscopic partial nephrectomy (LPN). METHODS We reviewed 159 consecutive patients who underwent LPN by a single surgeon at one institution, and R.E.N.A.L. scores were calculated for 141 patients with solitary renal masses who had complete radiographic data. Patients were divided into low (nephrometry sum 4-6), moderate (sum 7-9), and high (sum 10-12) complexity lesions as well as anterior versus posterior. Preoperative, intraoperative, pathologic, and postoperative outcomes were compared for the groups. RESULTS Of the 141 patients, there were 43 (30%) low complexity, 91 (65%) moderate complexity, and 7 (5%) high complexity lesions. Sixty-one lesions (43%) were anterior and 80 (57%) were posterior. There was no statistically significant difference in the demographics of the three groups. No difference was found among any intraoperative, pathologic, or postoperative outcomes when comparing anterior versus posterior lesions. There was a significant difference in warm ischemia time (16 vs 23 vs 31 minutes, p<0.0001), estimated blood loss (163 vs 312 vs 317 mL, p=0.034), and hospital length of stay (1.2 vs 1.9 vs 2.3 days, p<0.0001) between the low, moderate, and high complexity groups, respectively. There was no difference in overall operative time (p=0.862), transfusion rate (p=0.665), complication rate (p=0.419), preoperative creatinine clearance (p=0.888), or postoperative creatinine clearance (p=0.473) between the groups. There was no statistically significant difference in pathologic characteristics between the groups. CONCLUSIONS In patients undergoing LPN, a higher R.E.N.A.L. Nephrometry Score was significantly associated with an increased estimated blood loss, warm ischemia time, and length of hospital stay. The R.E.N.A.L.-NS may be helpful in counseling patients and may stratify tumors based on the technical difficulty of performing LPN. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e245 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Hayn Buffalo, NY More articles by this author Thomas Schwaab Buffalo, NY More articles by this author Willie Underwood Buffalo, NY More articles by this author Hyung Kim Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retroperitoneal Fibrosis

Retroperitoneal fibrosis (RPF) is an inflammatory disorder that affects the infrarenal great vessels and surrounding structures. Although first described in 1948 by Ormond, much of the information currently available on this disease is conflicting and results from multiple definitions used by different investigators. We conducted the current study to describe the clinical, laboratory, and radiographic presentation of RPF from a single center using data collected in a prospective fashion.Data on all patients who were referred to our RPF clinic were prospectively collected. We obtained information on presenting signs and symptoms, and on the presence or absence of "traditional risk factors," comorbidities, and family histories. All patients underwent the same battery of laboratory testing, including complete blood count, renal function profile, erythrocyte sedimentation rate (ESR), thyroid-stimulating hormone, and antinuclear antibodies (ANA). All patients had contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen and pelvis. The extent of disease was classified based on the anatomic location of the soft-tissue density.Forty-eight patients (26 male and 22 female) met the criteria for RPF and were included in the study. The mean age was 54.25 years. Few patients had traditional risk factors for RPF. Pain and weight loss were the most common presenting symptoms. The mean hemoglobin was 11.6 g/dL. The mean ESR was 40.5 mm/h. Nine patients had positive ANA, all with negative antibodies to dsDNA. CT or MRI revealed the presence of a periaortic soft-tissue density in all (100%) patients; 69% had pericaval involvement, 62% had obstruction of 1 or both ureters, and 35% of patients had involvement of the renal artery or renal vein.In the current report we present the demographics and laboratory and radiographic presentation of a homogenous group of patients with RPF. We attempt to solidify a proper scheme of classification for the disease, and suggest an anatomic classification system that may be used for future studies.

A Clinical Classification System for Aberrant Internal Carotid Arteries

Pronounced anatomic variations of the extracranial internal carotid artery (ICA) can be found in 5% to 6% of the general population. An aberrant ICA is at risk of injury during routine pharyngeal procedures if the vessel is placed into close relationship with the pharyngeal wall. The objective was to highlight the impact of parapharyngeal ICA aberrations and to analyze the clinical usefulness of the current anatomic classification system of these anomalies. Prospective quality assessment study in an academic tertiary care medical center. A systematic clinicoradiological follow-up study was performed over a period of 18 months. The ICA's course was classified according to Weibel and Fields in 21 consecutive patients with 35 pronounced parapharyngeal ICA aberrations. The vessels' minimum distance to the pharyngeal wall and the corresponding pharyngeal level was analyzed. Tortuosity was found in 13, kinking in 18, and coiling in 4 aberrant ICAs. The vessel's minimum distance to the pharyngeal wall ranged from 0.8 to 17.9 mm (mean, 7.0 mm), but the currently used anatomic classification was inadequate to determine the risk potential for ICA injury in the given cases. We propose a clinicoradiological classification system, which considers the vessel's relation to the pharyngeal wall. Parapharyngeal ICA aberrations are common and probably under-appreciated anatomic variations. The awareness of these anomalies is essential for clinicians. Since the current anatomic classification is insufficient to outline patients with an increased risk of ICA injury, a clinicoradiological graduation of cervical ICA aberrations may be of practical benefit.

Pharmacoepidemiology and Health in a Brazilian Older Population

Many health concerns, such as cardiovascular diseases, metabolic disorders, falls and inadequate drug use, can affect the vulnerable older population. The objectives of this study were to verify the use of prescription drugs in an older population, as well as their morbidities and the occurrence of falls. The study comprised 300 older people from the town of Barra do Garças, Mato Grosso State, Brazil. Data were collected during leisure sessions using a 23-item questionnaire. Statistical analysis was performed using Mantel-Haenszel Chi-squared test, Student's t test and odds ratio calculation. Drugs were classified according to the Anatomical Therapeutical Chemical Classification System, and diseases were classified following the 10 th Review of the International Classification of Diseases and Health Problems. The majority of the subjects were women aged 60–70. Circulatory health problems were the most prevalent diseases. There was a significant positive association between bone and skeletal muscle diseases and falls (odds ratio, 2.27). Overall, 82.3% of the subjects had used at least one medicinal drug in the last 15 days. During this time interval, 554 drugs were consumed, leading to an average of 2.4 remedies per subject. Cardiovascular drugs were the most prevalent therapeutic indications (39%). Although 87% of drugs used by the subjects were prescribed by a physician, 56.7% of the subjects had not been examined by a physician in the last 30 days. In this older population, the presence of morbidities and frequent use of drug use were commonly observed. Special care should be taken for older subjects with bone and skeletal muscle diseases to reduce the risk of falls. The high proportion of older people using drugs without a recent medical prescription indicated irrational medicinal drug use.

An analysis of the clinical development of drugs in Norway for the years 2000 and 2004: the influence of the pharmaceutical industry

Little has been published either concerning the total number of research projects in connection with clinical development of drugs or the number of projects financially supported by the industry. From the archives of the five regional Norwegian Research Ethical Committees (REC), all research projects in connection with clinical development of drugs for the years 2000 and 2004 were analysed with the intention of finding the number of projects financially supported by the industry, the type of research institution, the industrial company, the topic of the research as classified in the international Anatomic Therapeutic Classification system (ATC), the research phase and the approval status of the drug by the Norwegian Medicines Agency (NMA). The total number of research projects for the clinical development of drugs for the years 2000 and 2004 was 489, and 75.7% were financially supported by the industry. More than two-thirds of the projects were done in academic institutions and about one-third were equally divided between public health hospitals and private health service/hospitals. Eight of the 88 drug companies involved were among the world's largest and supported 38% of the projects. Fifty-nine percent of all the projects were within four therapeutic groups: antineoplastic/immunomodulating agents, nervous system, cardiovascular system and alimentary tract/metabolism. The distribution of research phases was as follows: phase I 1.2%, phase II 16.4%, phase III 26.6% and phase IV 55.8%. In the phase IV drug trials, drugs had been approved for sale by the NMA. The share of research projects related to the development of drugs supported by the industry is high. Research independent of the industry is of importance to avoid bias and selective publications and to prevent research as a means of marketing. Independent research should be encouraged and financially supported by sources with no connection to the drug industry.

Maximum Standardized Uptake Values on Positron Emission Tomography of Esophageal Cancer Predicts Stage, Tumor Biology, and Survival

The stage of esophageal cancer is currently determined by the anatomic TNM classification system as opposed to information about tumor biology. A retrospective review was made of a prospective electronic database. Patients had esophageal cancer, dedicated positron emission tomography (PET) using F-18-fluorodeoxyglucose (FDG-PET) and maximum standardized uptake value (maxSUV) measured. Biopsies were obtained from suspicious nodal and systemic locations, and when indicated, resection with complete lymphadenectomy was performed. There were 89 patients (53 men). The median maxSUV for patients with high grade dysplasia, stage I, IIa, IIb, III, and IVa esophageal cancer was 1.7, 2.9, 8.9, 7.7, 9.5, and 12, respectively. Multivariate analysis showed patients with a high maxSUV were more likely to have poorly differentiated tumors (risk ratio 1.89, p = 0.032) and advanced stage (risk ratio 2.6, p < 0.001). The maxSUV correlated better (r(2) = 0.85) than the current TNM staging system for survival (r(2) = 0.68). Receiving operator characteristics curve demonstrated a maxSUV of 6.6 to be the optimal cut-off point. The 4-year survival of patients with a maxSUV of 6.6 or less was 89%, whereas it was only 31% for those patients with values greater than 6.6 (p < 0.001). The maxSUV of an esophageal cancer on dedicated FDG-PET scan is an independent predictor of stage, tumor characteristics, and survival. It predicts survival better than the current TNM staging system. This information may help guide treatment strategies.