Single Institution Research Articles

Retrospective analysis of external pin fixation of mandibular fractures: A 25-year single institution experience.

Retrospective analysis of external pin fixation of mandibular fractures: A 25-year single institution experience.

Implementation of a Multi-Disciplinary Geriatric Oncology Clinic in Toronto, Canada

Older adults with cancer tend to face more complex health needs than their younger counterparts. Patients > 65 years of age are recommended for comprehensive geriatric assessment (CGA) to capture and address age-related vulnerabilities. Access to geriatrics services is limited, and our baseline audit of geriatric referrals in 2019 from the cancer program revealed that only 30% of patients referred received a CGA. The aim of this study was to assess the implementation of a geriatric oncology (GO) clinic that employs CGA and determine patient outcomes. We conducted a retrospective cohort study at a single institution. Data collection included baseline characteristics, GO clinic findings and characteristics, recommendations/referrals, and emergency room (ER) visits/hospitalizations within 6 months of CGA. Descriptive statistics were used for analysis. A total of 100 patients were included, with a median (range) age of 80 (63–97) years; 70% were female, and the most common cancer type was breast (31%). Through the GO clinic, patients were seen in a timely manner, with a median of 3 weeks, compared to our historical baseline of 11 weeks. Cognitive decline (32%) and pre-treatment CGA (22%) were the most common reasons for referral, and the most common new diagnosis was cognitive impairment (65%). For pre-treatment CGA, 16 (48%) patients were deemed suitable for treatment and 10 (30%) were recommended for modified treatment; 34 (94%) referring physicians followed the recommendation. In addition, most (68%) patients received an allied health referral. One third of patients visited the ER and 30 (30%) patients were hospitalized. Overall, the GO clinic resulted in greater access to CGA in a timely manner, enhanced access to allied health, and assisted in treatment decision-making.

Impact on Sexual Function of Protective Coil Embolization of Penile Collaterals During Prostatic Artery Embolization.

This study aims to evaluate the erectile and ejaculatory function of patients undergoing prostate artery embolization with coil embolization of penile collaterals (cPAE) compared to traditional PAE (tPAE) for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). 878 patients who underwent PAE for LUTS secondary to BPH at a single institution from September 2014 to September 2022 were assessed. 828 (94%) underwent tPAE, and 50 (6%) underwent cPAE. Sexual Health Inventory for Men (SHIM) and Ejaculatory Function Questionnaire (EJQ) scores were reviewed pre-procedure and at subsequent follow-ups. In tPAE, the median (interquartile range (IQR), p-value compared to baseline) SHIM scores were 19(14-24, p = < 0.001), 19(13-18, p = 0.22), 19(16-23, p = 0.005), and 18(15-22, p = 0.52) at 3, 6, 12, and 24months, respectively, from a baseline of 17(10-21). In cPAE, median-(IQR, p-value compared to baseline) SHIM scores were 16(6.5-22.5, p = 0.03), 13(6.8-16.3, p = 0.04), 8.5(5-1.5, p = 0.46), and 18(15-18, p = 1) at 3, 6, 12, and 24months, respectively, from baseline of 13 (8-20). There was no significant difference in SHIM score change from baseline between cPAE and tPAE groups at 3(p = 0.60), 6(p = 0.31), 12(p = 0.09), and 24months(p = 1) post-PAE. In tPAE, median(IQR, p-value compared to baseline)-EJQ scores were 16(13-18, p = 0.42), 16(13-18, p = 0.22), 17(12-19, p = 0.09), and 16(12.5-19, p = 1) at 3, 6, 12, and 24months, respectively, from baseline of 14 (11-18). In cPAE group, median EJQ scores were 14(10.5-20, p = 0.11), 18(17-18), 16.5(3.5-19.7, p = 1) at 3, 6, and 12months, respectively, from baseline of 15(12-18). There was no significant difference in EJQ score change from baseline between cPAE and tPAE groups at 3(p = 0.26), 6(p = 0.38), and 12(p = 0.88) months. Adjunct coil embolization of penile collaterals during PAE for preventing nontarget embolization has no adverse effect on erectile or ejaculatory function.

Voices of change: experiences of early women urology residents — a single institution qualitative research study

ObjectiveTo understand the experiences of early women urology residents at a single institution, as told in their own words.MethodsA convenience sample of women residents who trained at the Brady Urological Institute between 1980 and 2022 was chosen. During the investigated period, 15 women trained at the Brady; all 15 were invited to participate. Participants were provided written consent and assured of anonymity. In semi-structured interviews guided by a set of IRB-approved questions, participants discussed personal backgrounds, medical school experiences, and residency experiences. Participants provided advice to future women in urology. Interviews were recorded with Audacity 3.0.5 or Zoom, and audio files were transcribed using NVivo 14.23.0.ResultsA total of 10 interviews were conducted between July 2023 and February 2024. Childhood role models influenced many participants’ initial interest in medicine, although most discovered urology during medical school. Participants valued the quality of training, mentorship opportunities, proximity to family, and program ethos when selecting a residency program. During residency, participants faced gender-specific challenges due to patient resistance and difficulties balancing professional and personal commitments. Despite these challenges, participants expressed optimism about the future of women in urology.ConclusionsThis study provides insights into the professional development of women urology residents. The participants were part of an early cohort of women in urology and expressed excitement for the future of the field. While the study reflects the experiences of women at just one institution, it provides a foundation for more comprehensive research on women’s experiences in urology and in medicine more broadly.Clinical trial numberNot applicable.

Assessing Racial and Ethnic Health Disparities in a Diverse Cohort with Pediatric Inflammatory Bowel Disease.

To identify racial and ethnic disparities in disease phenotype, treatment, and outcome in an diverse cohort of children with pediatric inflammatory bowel disease (IBD). Patients aged 7 through 18 with IBD diagnosed at a single institution between March 2020 and June 2021 with self- or parent-identified race and ethnicity of non-Hispanic (NH) Black, NH-White, or Hispanic were included. Demographics, Centers for Disease Control/Agency for Toxic Substances and Disease Registry Social Vulnerability Index, Childhood Opportunity Index, disease phenotype, time to diagnosis, treatment, and healthcare utilization were compared between the racial and ethnic groups. Ninety-seven patients were included. 18.6% of the cohort self- or parent-identified as NH-Black, 53.6% as NH-White, and 27.8% as Hispanic. Ulcerative colitis was found to be significantly more common in Hispanic patients. Hispanic patients were also significantly more likely to be hospitalized at time of diagnosis and have more emergency department visits within 2 years of diagnosis compared with non-Hispanic White patients. Race and ethnicity may affect the diagnosis and treatment of pediatric IBD, and these findings should serve as a foundation for establishing equitable care. Larger cohorts are needed to validate these findings.

Hormone and HER2-receptor status in breast cancer: determination using sonographically guided core needle biopsy and correlation with excision specimen-a German single institution diagnostic accuracy study.

Sonographically guided core needle biopsy (CNB) is a well-established tool for diagnosing breast lesions. Preoperative estrogen receptor (ER), progesterone receptor (PR), and HER2-receptor status are essential for a personalized treatment approach. We evaluated the concordance of the hormone- and HER2-receptor status between the CNB and the surgical specimen to determine the accuracy of the CNB as a diagnostic method. This is a non-interventional retrospective study analyzing breast cancer patients treated at the breast care center of the University Medical Center Duesseldorf between January 2002 and December 2005. Patients with paired CNB and surgical specimens and a diagnosis of invasive breast cancer were included. ER, PR, and HER2 status were determined by immunohistochemistry (IHC). Patients with IHC 2+ results were further examined by fluorescence in situ hybridization (FISH). Concordance of receptor status was calculated using specificity, sensitivity, and negative and positive predictive values. We found a very good agreement between CNB and surgical specimens regarding receptor status. A total of 248 patients were analyzed. Concordance rates in cases of primary surgery for ER, PR, and HER2 were 92.9%, 92.9%, and 93%, respectively. In cases of neoadjuvant chemotherapy, the concordance rates for ER, PR, and HER2 were 100%, 87.5%, and 96%, respectively. CNB demonstrated high diagnostic accuracy compared with surgical specimens regarding ER, PR, and HER2-receptor status. Our findings support the recommendation to use sonographically guided CNB as the initial diagnostic method for guiding tailored treatment plans.

Evaluating Outcomes of Same Day Discharge After Minimally Invasive Colectomy: A Nationwide Analysis.

Advances in Enhanced Recovery After Colectomy protocols have enabled same day discharge (SDD) in some patients. Current literature is limited to single institutions limiting generalizability. We employed a nationally-representative dataset to compare outcomes between SDD patients and patients with a short-term hospital stay (discharged on postoperative day 1 or 2). We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) Targeted Colectomy Participant User Files (2017-2021). We included patients ≥18 years who underwent elective minimally invasive colectomy. We excluded patients with severe comorbid conditions or in-hospital complications. We performed a 1:1 propensity-match adjusting for patient, diagnosis, and procedure- type characteristics. Our primary outcome was 30-day readmission and secondary outcome was post-discharge complications. We identified 22,482 patients, 740 (3.3%) of which were SDD patients. A higher proportion of patients with SDD underwent right colectomy (76.4% vs36.4%, P < 0.001) and carried a diagnosis of a benign neoplasm (53.0% vs18.1%, P < 0.001). After propensity matching there was no significant difference in the rate of 30-day readmission between the 2 groups (3.4% vs4.7%; P = 0.23). Additionally, there was no significant difference in rates of anastomotic leak (0.7% vs0.8%; P = 0.58) or colonic ileus (1.4% vs1.8%; P = 0.58). Post-discharge bleeding complications were higher in SDD patients (0.5% vs0%; P = 0.045). SDD following minimally invasive colectomy is not associated with higher readmission, anastomotic leak, or SSI when compared to patients discharged on postoperative day 1/2. SDD after minimally invasive colectomy may be considered for patients without severe comorbid conditions.

Quantified MRI measurements show the significance of indirect decompression in the lumbar spine.

Although several studies have documented indirect decompression after oblique lateral interbody fusion (OLIF), limited research exists that directly quantifies the degree of decompression. This study seeks to quantify the degree of indirect decompression achieved by OLIF using magnetic resonance imaging (MRI). This is a retrospective study of consecutive adult patients at a single institution who underwent multistage lumbar interbody fusion via antepsoas (OLIF) retroperitoneal approach for spinal stenosis with radiculopathy. Pre and Postoperative MRI were used to measure the following radiologic parameters: anterior and posterior disc heights, bilateral foraminal height, bilateral foraminal area, bilateral subarticular recess width, and thecal sac area. Paired sample t-tests were performed to evaluate pre and postoperative changes in MRI measurements. A total of 24 patients (age 66.4 ± 5.98, BMI 29.3 ± 4.73) with a total of 63 operative levels were reviewed: L1-L2 (3), L2-L3 (17), L3-L4 (22), L4-L5 (22). Anterior disc height, posterior disc height, bilateral foraminal height, bilateral foraminal area, bilateral subarticular lateral recess, and thecal sac area all demonstrated a statistically significant improvement (p < 0.05) for all levels except L1-L2. OLIF provides a significant amount of indirect decompression from L2-L5 including increased anterior and posterior disc height, bilateral foraminal height, bilateral foraminal area, bilateral subarticular recess, and thecal sac area. The proximal adjacent level above an interbody level also shows increased foraminal height and area.

Long-term local control and cosmesis of perioperative interstitial brachytherapy for partial breast irradiation following breast-conserving surgery.

Multicatheter interstitial brachytherapy (MIB) is an established technique of partial breast irradiation (PBI). However, postoperative catheter implant is an invasive, inconvenient, and skillful procedure. In this study, local control and cosmesis of perioperative interstitial brachytherapy (PIB) by intraoperative catheter implant were evaluated by comparing with those of whole breast irradiation (WBI) following breast-conserving surgery (BCS). Between October 2007 and August 2019, consequent patients who underwent either PIB or WBI following BCS were included. In general, additional indications for PIB to WBI included age ≥ 40years, tumor ≤ 3cm, and pN0 or pNmi. WBI was initiated with a total dose of 50Gy in 25 fractions, whereas PBI was delivered immediately following BCS at 32Gy in eight fractions. Local recurrence (LR) was the primary endpoint, and subjective and objective cosmetic outcomes at 5years using the Harvard Cosmesis Scale and BCCT.core software, respectively, were the secondary endpoints. During the 10-year follow-up, the crude rate of LR was 3.8% (95% confidence interval [CI] 2.3-5.4) in 577 patients receiving PIB and 3.3% (95% CI 1.1-5.6) in 241 patients receiving WBI (P = 0.73). The 5- and 10-year LR-free survival rates in the PBI and WBI cohorts were 97.9% versus 97.9% and 95.4% versus 96.8%, respectively (P = 0.64). Multivariate analysis selected age < 50years as an independent risk factor for LR. Excellent or good cosmesis in the PBI and WBI cohorts assessed by subjective and objective measures was 89.5% versus 84.5% (P = 0.26) and 83.7% versus 68.1% (P < 0.005), respectively. Although this study was based on a retrospective chart review in a single institution, the largest series of data with a long follow-up suggested that acceptable local tumor control and cosmesis were achieved following PIB compared with WBI.

Intracapsular and extracapsular fracture types and inpatient mortality in failed hemiarthroplasty

BackgroundIncreasing life expectancy has led to a rise in hip fractures and an associated increase in hemiarthroplasty procedures aimed at restoring mobility and preventing muscle loss. Despite the extensive literature on failed hemiarthroplasty, limited data address the influence of pre-operative fracture types—intracapsular versus extracapsular—on outcomes, including inpatient mortality. This study investigates the revisions of uncemented bipolar hemiarthroplasties concerning fracture type and identifies risk factors for inpatient mortality.MethodsThis retrospective cohort study included 68 patients (16 males and 52 females) who underwent revision of uncemented bipolar hemiarthroplasties at a single institution between 2017 and 2024. Data on demographics, comorbidities, fracture type, surgical details and outcomes were analysed. Statistical analyses included t tests, chi-square tests and logistic regression, with significance set at p < 0.05.ResultsOf 1,690 hemiarthroplasties performed, 68 required revision (revision rate: 4%). Revisions for extracapsular fractures were associated with a higher prevalence of diabetes mellitus (p = 0.01) and elevated Almelo Hip Fracture Score (AHFS; p = 0.01). The overall inpatient mortality rate was 19%, significantly higher in males (43.75%) than females (11.54%; p = 0.00). Deceased patients demonstrated higher AHFS and American Society of Anaesthesiologists scores but lower Parker Mobility Scores (p = 0.01). Prolonged intensive care unit (ICU) stays were also linked to increased mortality (p = 0.02). Logistic regression identified male sex as an independent predictor of mortality (odds ratio: 9.37; p < 0.05).ConclusionsPre-operative fracture type significantly influences revision outcomes in failed hemiarthroplasties. Moreover, extracapsular fractures are linked to diabetes mellitus and higher AHFS, whereas male sex, ICU stay duration and comorbidity scores predict inpatient mortality. These findings highlight the need for tailored perioperative care to mitigate risks.Trial registrationNot applicable.

Surgical Site Preparation Using Alcohol with Chlorhexidine Compared with Povidone Iodine with Chlorhexidine Results in Similar Rate of Infection After Primary Total Joint Arthroplasty

Background: Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. A skin antiseptic solution is used to reduce the bacterial count and prevent PJI. There is no consensus in the literature on the application of antiseptic solutions. This study aims to compare the rate of infection between patients who received alcohol wash with Chloraprep to those who received povidone iodine wash with Chloraprep. Methods: A total of 607 patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a single institution between January 2009 and July 2023 were reviewed. Perioperative variables were collected. The infection rate was used as a primary outcome. An odds ratio was calculated to compare infection and complication rates between the groups. Results: For patients who underwent THA, no difference in the rate of complications (alcohol wash: n = 6, 4.5%; povidone wash: n = 5, 3.6%; OR: 0.796; 95% CI: 0.237–2.673) or infection (alcohol wash: n = 1, 0.7%; povidone wash: n = 2, 1.4%; OR: 1.942; 95% CI: 0.174–21.667) was found. No difference in the rate of complications (alcohol wash: n = 3, 1.9%; povidone wash: n = 2, 1.2%; OR: 0.635; 95% CI: 0.105–3.849) or infection (alcohol wash: n = 0; povidone wash: n = 1, 0.6%; OR: 0.994; 95% CI: 0.983–1.006) was found in patients who underwent TKA. Conclusions: Surgical site preparation using alcohol wash with chlorhexidine offers similar short-term benefits in preventing postoperative infection to a povidone iodine wash with chlorhexidine in primary total joint arthroplasty. The use of alcohol wash and chlorhexidine is effective, while reducing the preparation time.

Long-Term Results of the Birmingham Hip Resurfacing Implant in the United States: An Updated Analysis of a Single Institution's Experience.

We previously reported the 5-year results of the Birmingham Hip Resurfacing (BHR) implant. This study evaluates BHR survivorship as well as radiographic and clinical outcomes at long-term follow-up. A total of 224 patients with contemporary indications, including 179 patients from the original study, were included in this analysis. Survivorship was calculated. Metal ion levels and radiographs were updated. Patient-reported outcomes (PROs) were compared with those for matched patients who had undergone total hip arthroplasty (THA). The mean follow-up was 14 years. Survivorship free from any revision and from aseptic revision was 96.0% and 97.4% at 15 years, respectively. Two patients had undergone revision since the original study. The median serum cobalt and chromium levels were 1.4 and 1.5 ppb, respectively. The PROs were similar to those for the THA cohort. Equal proportions of patients remained active; however, the BHR group trended toward more remaining highly active (p = 0.12). Although activity was similar to THA at long-term follow-up, the BHR implant remains an excellent option for the treatment of osteoarthritis in younger male patients. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Analysing the clinical outcomes between FIGO 2009 and 2023 staging for endometrial cancer—a single institution retrospective study

Analysing the clinical outcomes between FIGO 2009 and 2023 staging for endometrial cancer—a single institution retrospective study

Impact of early arterial-phase multidetector CT in blunt spleen injury: a clinical outcomes-oriented study.

Blunt spleen injuries (BSI) present significant diagnostic and management challenges in trauma care. Current guidelines recommend arterial-phase contrast-enhanced multidetector computed tomography (CT) for a detailed assessment. However, the direct impact of add-on arterial phase CT on clinical outcomes remains unclear. This study investigated the impact of early arterial-phase imaging via multidetector CT on the clinical outcomes of patients with blunt splenic injuries. A retrospective case-control study was conducted to analyze the data of adult patients with BSI treated at a single institution between 2019 and 2022. Patients were divided based on the CT phase performed: portal vein phase only or add-on arterial phase. Management methods were divided according to the initial treatment intent: nonoperative management observation (NOM-Obs), transarterial embolization (TAE), and splenectomy. NOM failure refers to either NOM-Obs or TAE failure leading to splenectomy. NOM-Obs failure refers to cases initially managed with observation only, but later requiring either TAE or splenectomy. Transarterial embolization (TAE) failure refers to cases initially treated with TAE, but subsequently requiring splenectomy. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences and compare outcomes between the two groups. Of 170 patients assessed, 147 met the inclusion criteria and were divided into two groups: those receiving portal vein phasic-only CT (N = 104) and those receiving add-on arterial phasic CT (N = 43). The overall NOM failure rate was 3.0% (4/132), the NOM-OBS failure rate was 6.7% (4/60), and the TAE failure rate was 4.1% (3/73). After adjusting for covariates using inverse probability of treatment weighting (IPTW), the comparison between the add-on arterial phase and portal phase CT groups revealed similar overall NOM failure rates (3.0% vs. 2.2%, p = 0.721), NOM-OBS failure rates (3.8% vs. 6.2%, p = 0.703), and intra-abdominal bleeding-related mortality rates (4.8% vs. 2.1%, p = 0.335). Among the 43 patients who underwent add-on arterial CT, only one was diagnosed with a tiny pseudoaneurysm (0.7cm) attributable to the inclusion of the arterial phase. Dual-phase CT within 24h of presentation offers no added value over single-phase CT in managing blunt splenic injuries in terms of clinical outcomes.

Re-Irradiation for the Progressive Pediatric Diffuse Intrinsic Pontine Glioma: A Report on 109 Children From a Single Center.

Diffuse intrinsic pontine glioma (DIPG) is a challenging pediatric tumor that frequently progresses within the first year following local radiotherapy. However, several small studies have suggested that re-irradiation may improve quality of life and extend overall survival. This retrospective study included 109 children who experienced disease progression ≥3months after their initial radiotherapy, and subsequently received re-irradiation at a single institution. These patients were compared with a cohort of 60 children, meeting the same criteria, who were treated before adopting the re-irradiation policy and received only the best supportive care (BSC). Most of the re-irradiated children (94%) received first radiation dose as hypofractionation (39Gy/13 fractions). The re-irradiation group demonstrated significantly higher overall survival (OS) rates after the first progression, with a 6-month OS of 42% (95% CI: 34%-53%) compared to 16% (95% CI: 8.9%-32%) in the BSC group (p < 0.001). Re-irradiation reduced the hazard of death by more than half (HR = 0.45, p < 0.001). Clinical response (p < 0.001) and radiological response (p = 0.016) were significant predictors of improved survival. While the time from initial radiotherapy to progression (p = 0.059) and higher re-irradiation doses (p = 0.074) were associated with improved OS, these factors did not reach statistical significance but may represent potential prognostic indicators. Re-irradiation improved the OS in children with progression of DIPG and alleviated their signs and symptoms.

Robot-Assisted Thoracoscopic Surgery Can Be Safely Performed in Patients With Obesity from the Early Stages of Implementation.

This study aimed to compare the perioperative outcomes of robot-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) for lung cancer in patients with obesity. Anatomical pulmonary lobectomy or segmentectomy performed at a single institution from April 2018 to September 2023 in patients with obesity (body mass index ≥25 kg/m2) were statistically compared in terms of perioperative clinical factors including operative time, blood loss, chest tube duration, pain score, intraoperative events, and early postoperative complications between RATS and VATS. In all, 89 patients were evaluated; 43 underwent RATS and 46 underwent VATS. All RATS procedures were performed using the da Vinci Xi system. Patient characteristics were comparable between the 2 groups. The operative time, blood loss, number of dissected lymph nodes, intraoperative events, and conversion rate to open thoracotomy were similar between the 2 groups. The frequencies of postoperative complications and chest tube placement duration between the groups were also similar. The median pain scores were slightly higher in the RATS group on postoperative day 1 but were equivalent between the 2 groups on postoperative day 7. The RATS group had a shorter postoperative hospital stay than the VATS group (P < 0.01). A surgical team proficient in conventional VATS can safely introduce RATS in patients with obesity and lung cancer with equivalent perioperative outcomes.

Prognostic Factors in Squamous Cell Carcinoma of the Maxillary Gingiva and Hard Palate: A Retrospective Analysis From a Single Institution

Prognostic Factors in Squamous Cell Carcinoma of the Maxillary Gingiva and Hard Palate: A Retrospective Analysis From a Single Institution

Long-Term Durability of Tunneled Hemodialysis Catheters: Outcomes from a Single Institution 22-Year Experience.

To describe long-term physical durability of tunneled hemodialysis catheters, highlighted in the 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines as a specific area for future research. Tunneled hemodialysis catheters with known outcomes and dwell times > 1year were entered into this retrospective study. Data includes demographics, complications, catheter type, dwell time, reason for removal, access site, and placement via exchange or de novo. Catheter durability < 1year dwell was analyzed as a secondary aim. 272 catheters in 229 patients were included. Dwell times ranged from 366 to 3,802days (median 504), totaling 162,439 catheter days. 17 (6%) catheters > 1year dwell had broken external components. For these, dwell times until breaking ranged from 377 to 1,436days (median 489), totaling 10,434 catheter days. 5 had a broken hub, 11 had a broken clamp, and 1 had broken hub and clamp. 12 were Ash Split Cath (n = 240) and 5 were Arrow-Clark VectorFlow (n = 32). In the durability < 1year sub-analysis, 6,515 catheters with dwell times < 1year in 3,693 patients were included, totaling 425,018 catheter days. 48 were damaged, with 24 broken hubs, 17 broken clamps, and 7 holes. Median time to breakage was 110days. 38 were Ash Split Cath (n = 5,636) and 10 Arrow-Clark VectorFlow (n = 812). In both analyses, breakage was limited to hubs, clamps, and extensions. Tunneled hemodialysis catheters are exceptionally durable, rarely requiring removal for hub-related issues after one year. Breakdown was not observed as a long-term durability issue. Further, broken external components can be replaced using external repair kits. Level 2b, Retrospective Study.

A Twenty-Year Study of a Single Institution Examining Age, Gender, and Demographic Differences Between Subcapital and Peritrochanteric Hip Fractures

A Twenty-Year Study of a Single Institution Examining Age, Gender, and Demographic Differences Between Subcapital and Peritrochanteric Hip Fractures

Fractionated robotic radiosurgery for unfavorable nonfunctioning pituitary macroadenoma: 5-year outcomes from a single institution protocol

ObjectiveNonfunctioning macroadenoma is a commonly diagnosed pituitary tumor. Resection is the favored treatment, with radiosurgery often utilized for residual or progressing disease. Long-term outcomes are established in the literature for single-fraction frame-based radiosurgery, but mature outcomes are lacking for fractionated frameless radiosurgery. We report our institution’s 5-year efficacy and toxicity results for unfavorable nonfunctioning pituitary macroadenoma patients treated with 5-fraction robotic radiosurgery.MethodsBetween 2010 and 2020, patients who completed 5-fraction robotic radiosurgery for the treatment of unfavorable nonfunctioning pituitary macroadenomas were included. A tumor was considered unfavorable if the gross tumor volume (GTV) was larger than 5 cc or if it closely approached a critical structure (optic apparatus, brainstem, or pituitary gland). Local control was calculated using the Kaplan–Meier method.ResultsTwenty predominantly female patients (60%), ages 21–77 (median: 53 years), were included in this study. All underwent primary resection at the time of diagnosis. The indication for radiosurgery was tumor progression (n = 14, 70%) or residual tumor after subtotal resection (n = 6, 30%). Eighty-five percent of patients treated with radiosurgery (n = 17) had cavernous sinus involvement. Median GTV was 3.4 cm3 (range: 0.3–20.8 cm3), and 40% of the tumors had suprasellar extension. A mean dose of 28.8 Gy (range: 25–30 Gy) was delivered to a median isodose line of 80% (range: 75%–89%). The median optic chiasm maximum point dose was 21.8 Gy (range: 12.0–25.0 Gy). Acute toxicity was minimal with eight patients (40%) developing short-lived headaches and one patient (5%) developing a brief ipsilateral sixth nerve palsy. There was no late radiation-induced neurologic or optic dysfunction identified in this cohort. At a median follow-up of 5 years, local control was 94%. There was one in-field failure pathologically confirmed following surgery for pituitary hemorrhage and two radiographically confirmed out-of-field failures in patients with larger tumors (&amp;gt;20 cc).ConclusionsThe treatment of unfavorable nonfunctioning pituitary macroadenoma with 5-fraction robotic radiosurgery provides excellent local control to date, with acceptable toxicity. However, tumors with GTVs greater than 20 cc may still require conventionally fractionated treatment with a margin to optimize local control.