Usefulness of image guidance in the surgical treatment of petrous apex cholesterol granuloma

The petrous apex is a pyramid-shaped structure, located medial to the inner ear and the intrapetrous segment of the internal carotid artery. Lesions of the petrous apex can be surgically treated through different surgical routes. Because of the important neurovascular structures located inside the temporal bone, anatomical 3D knowledge is paramount. For this reason, image-guided surgery could represent a useful tool. We report the case of a young woman who came to our observation for a trigeminal neuralgia due to a petrous apex cholesterol granuloma. The lesion was treated through the placement of a drainage tube via an infracochlear approach, with the aid of neuronavigation and intraoperative MRI. Preoperative CT scan images and intraoperative MRI images were fused for surgical planning. The accuracy of the neuronavigation system has proved to be good, and the safety of the procedure was enhanced. Therefore, neuronavigation and intraoperative MRI, though not available in all neurootological centres, should be considered useful tools in these challenging procedures

INSPIRE PROJECT: INTEGRATED TECHNOLOGIES FOR SMART BUILDINGS AND PREDICTIVE MAINTENANCE

Abstract. Applying integrated digital technologies for the management and maintenance of the existing built heritage appears to be one of the main current challenges for the definition and application of digitisation protocols for the construction supply chain. Key enabling technologies, collaborative platforms, Big Data management and information integration in a BIM environment are areas of increasing experimentation. In the field of intervention on the built heritage, it is the boundaries and opportunities offered by the integration of many different information sources that constitutes the main challenge. Furthermore, the study of the accessibility and usability of data and information from sources such as the three-dimensional terrestrial survey, existing databases, sensor networks, and satellite technologies make it possible to investigate both different ways of data modelling, even with a view to the development of predictive algorithms, and of visualisation and information management. The study illustrates part of the results of the InSPiRE project, an industrial research project financed with European structural funds and carried out in a public-private partnership by four universities and public research bodies, an innovation centre and six companies, SMEs, large enterprises, and start-ups. Specifically, the project highlights the growing importance of BIM-based modelling as a tool to lead users, both experts and non-experts, through the multiple information paths resulting from the relation between data and metadata

COVID-19 pandemic: an update on the reaction attitude of the spine societies and their members worldwide

BACKGROUND All surgical specialties have been influenced by the coronavirus disease 2019 (COVID-19) pandemic, and substantial changes have been determined in medical assistance, especially in elective surgery. Several spine societies have published recommendations to provide optimal care during this unique situation. AIM To discuss the recommendations by many spine societies for the management of spinal diseases during the COVID-19 pandemic. METHODS The present study was performed according to the PRISMA guidelines. A review of the MEDLINE database (PubMed – National Library of Medicine), Google, and Google Scholar was performed from March 2020 to date for articles published in the English Language. RESULTS Spine associations and societies worldwide were divided into three groups: Continental, specialty and country-based societies. A total of 27 spine associations were included in this review. There were eight major continental associations, but only one-third of these had published guidelines and recommendations on this topic. On the other hand, the specialty-based societies have not addressed the topic, except in two cases. CONCLUSION The national spine societies showed the deepest concern on this topic with several publications in scientific journals influenced by the local epidemiological severity. Contrarily, continental and specialty-based societies showed less interest in this topic

Anterior corpectomy and plating with carbon-peek instrumentation for cervical spinal metastases: clinical and radiological outcomes

Background: Anterior cervical corpectomy and plating has been recognized as a valuable approach for the surgical treatment of cervical spinal metastases. This study aimed to report the surgical, clinical and radiological outcomes of anterior carbon-PEEK instrumentations for cervical spinal metastases. Methods: Demographical, clinical, surgical and radiological data were collected from 2017 to 2020. The Neck Disability Index (NDI) questionnaire for neck pain, EORTC QLQ-C30 questionnaire for quality of life, Nurick scale for myelopathy and radiological parameters (segmental Cobb angle and cervical lordosis) were collected before surgery, at 6 weeks postoperatively and follow-up. Results: Seventeen patients met inclusion criteria. Mean age was 60.9 ± 7.6 years and mean follow-up was 12.9 ± 4.0 months. The NDI (55.4 ± 11.7 to 25.1 ± 5.4, p < 0.001) scores and the EORTC QLQ-C30 global health/QoL significantly improved postoperatively and at the last follow-up. The segmental Cobb angle (10.7◦ ± 5.6 to 3.1◦ ± 2.2, p < 0.001) and cervical lordosis (0.9◦ ± 6.7 to −6.2 ± 7.8, p = 0.002) significantly improved postoperatively. Only one minor com-plication (5.9%) was recorded. Conclusions: Carbon/PEEK implants represent a safe alternative to commonly used titanium ones and should be considered in cervical spinal metastases management due to their lower artifacts in postoperative imaging and radiation planning. Further larger comparative and cost-effectiveness studies are needed to confirm these results

Long-term clinical and radiographic analysis of platform matching and platform switching implants in the esthetic zone: a retrospective cohort study

Background: The aims of this study are to retrospectively compare the clinical, radiographic and esthetic outcomes of platform switching (PS) and platform matching (PM) dental implants in the anterior maxilla after ≥ 10 years of functional loading. Methods: Marginal bone loss (MBL) levels were recorded; furthermore, peri-implant clinical parameters (PPD, BOP, PI) were collected and the Pink and White Esthetic scores (PES/WES) were used to evaluate the esthetic outcomes. Wilcoxon signed rank tests were performed to compare collected parameters among the two groups, with a p-value < 0.05. Results: A final sample of 58 patients was enrolled in this study (PM implants = 29; PS implants = 29). PS implants showed lower MBL levels (1.02 ± 0.81 mm vs. 1.67 ± 0.99 mm, p = 0.028) and PPD values (3.69 ± 1.1 vs. 5.16 ± 1.09 mm, p < 0.001) compared to PM implants. Mean PES values were higher in the PS group compared to the PM group (8.46 ± 0.69 vs. 7.89 ± 0.78, p < 0.005), while there were no differences for WES values (7.82 ± 1.09 vs. 7.71 ± 0.85, p > 0.05) and peri-implant diseases’ prevalence (p > 0.05). Conclusions: After 10 years, PS implants showed statistically significant lower MBL and PPD values and higher PES values compared to PM implants

Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus. A Multicenter Prospective Observational Study

Background: Normal pressure hydrocephalus (NPH) is characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventricu-loperitoneal shunt (VPS). This study aims to evaluate the clinical outcomes of shunting in normal pressure hydrocephalus following a new standardized protocol. Methods: This study is designed according to the STROBE guidelines. Demographical, clinical, surgical and radiological data were collected from May 2015 to November 2019. Gait, balance and incontinence data based on the NPH European scale were collected before and after one, six and twelve months of treatment with a VPS. Clinical symptoms and changes of the stoke volume, measured on phase-contrast MRI, were used to evaluate improvement after VPS surgery. Results: One hundred and eighty-one consecutive patients met the inclusion criteria. The mean age was 73.1 years (59–86) and mean follow-up was 38.3 months (13–50). The gait (58.5 ± 14.3 to 70.1 ± 13.4, p < 0.001), the balance (66.7 ± 21.5 to 71.7 ± 22.1, p = 0.001), continence domain (69.9 ± 20.5 to 76 ± 20, p = 0.002) scores and neuropsychological scales showed a statistically significant improvement over the follow-up. The overall improvement after 12 months was present in 91.2% of patients. An overall complication rate of 8.8% and a reoperation rate of 9.4% were recorded, respectively. Conclusions: Surgical treatment by VPS for NPH improves symptoms in most patients, when accurately selected. A standardized protocol and a multidisciplinary team dedicated to this disorder is needed to achieve an early and correct diagnosis of NPH. Follow-up with stroke volume measurement is a valuable tool for the early diagnosis of shunt malfunction or the need for valve adjustment

Carmustine Wafers Implantation in Patients With Newly Diagnosed High Grade Glioma: Is It Still an Option?

Background: The implantation protocol for Carmustine Wafers (CWs) in high grade glioma (HGG) was developed to offer a bridge between surgical resection and adjuvant treatments, such as radio- and chemotherapy. In the last years, however, a widespread use of CWs has been limited due to uncertainties regarding efficacy, in addition to increased risk of infection and elevated costs of treatment. Objective: The aims of our study were to investigate the epidemiology of patients that underwent surgery for HGG with CW implantation, in addition to the assessment of related complications, long-term overall survival (OS), and associated prognostic factors. Methods: Three different medical databases were screened for conducting a systematic review of the literature, according to the PRISMA statement guidelines, evaluating the role of BCNU wafer implantation in patients with newly diagnosed HGG. The search query was based on a combination of medical subject headings (MeSH): “high grade glioma” [MeSH] AND “Carmustine” [MeSH] and free text terms: “surgery” OR “BCNU wafer” OR “Gliadel” OR “systemic treatment options” OR “overall survival.” Results: The analysis of the meta-data demonstrated that there was a significant advantage in using CWs in newly diagnosed GBM in terms of OS, and a very low heterogeneity among the included studies [mean difference 2.64 (95% CI 0.85, 4.44); p = 0.004; I2149 = 0%]. Conversely, no significant difference between the two treatment groups in terms of PFS wad detected (p = 0.55). The analysis of complications showed a relatively higher rate in Carmustine implanted patients, although this difference was not significant (p = 0.53). Conclusions: This meta-analysis seems to suggest that CWs implantation plays a significant role in improving the OS, when used in patients with newly diagnosed HGG. To minimize the risk of side effects, however, a carful patient selection based mainly on patient age and tumor volume should be desirable

KINERJA PERSIMPANGAN TAK BERSINYAL PADA PERSIMPANGAN JALAN DOTULOLONG LASUT – JALAN SUDIRMAN – JALAN SARAPUNG – JALAN SUDIRMAN KOTA MANADO

Persimpangan Jl. Sarapung – Jl. Sudirman – Jl. Dotulong Lasut – Jl. Sudirman adalah salah satu persimpangan yang selalu ramai karena melayani arus lalu lintas yang cukup tinggi, karena merupakan persimpangan yang terletak di tengah pusat kota Manado dan sangat sering terjadi kemacetan dan antrian panjang. Kondisi ini terjadi pada jam-jam sibuk di pagi, siang dan sore hari. Penelitian mengenai kinerja persimpangan jalan Jl. Sarapung – Jl. Sudirman – Jl. Dotulong Lasut – Jl. Sudirman simpang tipe 422, bertujuan untuk mengkaji kinerja persimpangan pada kondisi eksisting sampai kondisi 5 tahun ke depan, dengan menggunakan MKJI 1997. Pengumpulan data volume lalulintas dilakukan pada hari Senin, Jumat dan Sabtu di minggu ke empat Bulan Oktober 2014. Berdasarkan hasil analisis kondisi eksisting mengenai kinerja simpang Jl. Sarapung – Jl. Sudirman – Jl. Dotulong Lasut – Jl. Sudirman menunjukkan bahwa, derajat kejenuhan (DS) rata-rata simpang  telah melebihi nilai 0,75 selama 2/3 hari di siang hari. Dan DS tertinggi terjadi di sekitar pukul 17.00 sebesar 0,87 dengan nilai kapasitas (C) 3879 smp/jam, tundaan simpang 14,16 det/smp dan peluang terjadinya antrian (QP) sebesar 31 % - 98 %. Berarti sudah terjadi antrian kendaraan di persimpangan saat ini. Dengan data survey volume lalulintas dihitung nilai LHR dan dengan menggunakan data pertumbuhan lalulintas yang ada di Sulawesi Utara dihitung nilai LHR sampai 5 tahun kedepan. Volume jam puncak diambil sebagai volume rencana yang dihitung dengan mengalikan faktor k pada nilai LHR dan ditetapkan sebagai dasar perhitungan Kinerja Persimpangan saat sekarang dan 5 tahun ke depan. Volume jam puncak ditetapkan berdasarkan volume LV+HV yang paling besar pada tiap-tiap pendekat. Selanjutnya dilakukan perhitungan kembali dengan memperhatikan proporsi volume MC untuk dilakukan penyesuaian pada geometrik persimpangan. Penyesuaian pertama untuk memenuhi kriteria yang di isyaratkan, dengan penyesuaian pertama menghilangkan parkir di ruas jalan Dotulolong Lasut serta memperbesar lebar persimpangan ini dari 12 m menjadi 13 m dengan tetap mempertahankan  tipe persimpangan yaitu tipe 422. Hasil perhitungan menunjukkan bahwa nilai DS ditahun ke 2 sudah diatas 1. Kemudian dilakukan penyesuaian berikutnya yaitu dirubah ke tipe simpang 424 dan hasil perhitungan DS di tahun ini sampai 3 tahun ke depan adalah di bawah 1, dan di tahun ke 4 dan ke 5 sudah di atas 1. Berdasarkan hasil dari beberapa penyesuaian, persimpangan di perlukan pengaturan lebih lanjut lagi untuk memberikan hasil yang lebih baik. Kata Kunci : Simpang tak bersinyal, Kapasitas, Derajat Kejenuhan, Tundaan Simpang, Peluang Antria

GEOCHEMICAL INVESTIGATION OF AQUIFER POLLUTION FROM WASTE MANAGEMENT. THE CASE OF KOMOTINI LANDFILL (GREECE)

According to European legislation, environmental control and monitoring of landfills has become of crucial importance. This study includes a thorough geochemical approach aiming to evaluate the environmental impact of the landfill of Komotini, N. Greece. Samples of waters were taken from inside the working landfill as well as from the area of the neighbouring old landfill. The waters were analyzed chemically (major elements and heavy metals) and isotopically (D and 18O). Also, biogas flow was measured and the ratio CH4/CO2. Based on the geomorphological, hydrogeological and land use data of the area, we proceeded to analyses of waters both from the area of the landfill and from the wider region (drainage basin). The obtained results were used to construct digital maps (GIS) in order to determine the special dispersion of the polluted aquifers. The biogas flow in the old and new garbage burial sites was measured by accumulation chamber device for methane and carbon dioxide ratio determination. The obtained results show an important agent of pollution in the water samples downstream from the landfill and in a distance more than 2km, along the dispersion of the leachate. The land use of the area was taken into account to evaluate the importance and the criticality of the situation

PENGARUH PASANG SURUT TERHADAP TINGGI MUKA AIR DI MUARA SUNGAI BAILANG

Sungai Bailang merupakan salah satu sungai di Kota Manado yang pernah meluap dan membanjiri beberapa daerah yang dilewati oleh sungai Bailang. Terkait hal tersebut maka penelitian ini dilakukan untuk mengetahui apakah pada saat banjir bersamaan dengan air pasang yang tinggi terjadi kenaikan muka air banjir di penampang sungai Bailang.Analisis dilakukan dengan mencari frekuensi hujan dengan metode Log Pearson III. Adapun data hujan yang digunakan berasal dari 3 pos hujan yaitu: pos hujan Tikala-Sawangan, pos hujan Talawaan, dan pos hujan Tikala. Data curah hujan yang digunakan adalah data curah hujan harian maksimum dari tahun 2008 s/d 2017. Dilakukan kalibrasi parameter HSS SCS sebelum melakukan simulasi debit banjir dengan menggunakan program komputer HEC-HMS. Untuk batasan setiap parameter disesuaikan dengan nilai standar pada program komputer HEC-HMS. Hasil kalibrasi menunjukan nilai Nash Sutchliffe Efficiency yang memenuhi yaitu 0,707. Kemudian dilakukan analisis debit banjir dengan parameter terkalibrasi menggunakan program komputer HEC-HMS. Dalam penelitian ini digunakan perangkat lunak HEC-RAS untuk melakukan penelusuran aliran dengan pemodelan aliran permanen (steady flow) dengan menggunakan debit banjir kala ulang 5, 10, 25, 50 dan 100 tahun sebagai Boundary condition di sebelah hulu dan Boundary condition sebelah hilir adalah tinggi muka air pasang tertinggi.Hasil simulasi menunjukkan bahwa penampang sungai Bailang yang ditinjau pada kondisi tanpa pasang surut kala ulang 5 tahun, 10 tahun dan 25 tahun penampang STA 0+0, STA 0+25, STA 0+50, STA 0+75, STA 0+95, STA 0+125 dan STA 0+200 sudah tidak mampu menampung debit banjir yang terjadi. Sedangkan untuk kala ulang 50 tahun dan 100 tahun semua penampang sudah tidak mampu menampung debit banjir yang terjadi. Hasil simulasi pada kondisi dengan pasang surut kala ulang kala ulang 5 tahun, 10 tahun, 25 tahun, 50 tahun dan 100 tahun semua penampang sudah tidak mampu menampung debit banjir yang terjadi. Tinggi muka air tertinggi dengan kenaikan muka air banjir (luapan) berkisar 0.71-1.25 m untuk kondisi dengan pengaruh pasang surut.Kata kunci: Banjir, Tinggi Muka Air, Pasang Surut, HEC-HMS, HEC-RAS