Combined cervicosternotomy and cervicotomy for true retrosternal goiters : a surgical cohort study

Objective Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy. Methods In a prospectively gathered cohort undergoing thyroid surgery (2010-2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a 'standard' thyroidectomy (N = 1500). Results An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%). Conclusion In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy

ENSAT registry-based randomized clinical trials for adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is an orphan disease lacking effective systemic treatment options. The low incidence of the disease and high cost of clinical trials are major obstacles in the search for improved treatment strategies. As a novel approach, registry-based clinical trials have been introduced in clinical research, so allowing for significant cost reduction, but without compromising scientific benefit. Herein, we describe how the European Network for the Study of Adrenal Tumours (ENSAT) could transform its current registry into one fit for a clinical trial infrastructure. The rationale to perform randomized registry-based trials in ACC is outlined including an analysis of relevant limitations and challenges. We summarize a survey on this concept among ENSAT members who expressed a strong interest in the concept and rated its scientific potential as high. Legal aspects, including ethical approval of registry-based randomization were identified as potential obstacles. Finally, we describe three potential randomized registry-based clinical trials in an adjuvant setting and for advanced disease with a high potential to be executed within the framework of an advanced ENSAT registry. Thus we, therefore, provide the basis for future registry-based trials for ACC patients. This could ultimately provide proof-of-principle of how to perform more effective randomized trials for an orphan disease

Bewegingsvolgsysteem

Bewegingsvolgsysteem voor het volgen van een uit objectdelen samengesteld object in een driedimensionale ruimte

SENSOR FUSION FOR AUGMENTED REALITY

Abstract: In Augmented Reality, the position and orientation of the camera have to be estimated very accurately. This paper proposes a model to fuse inertial and vision measurements in a Kalman filter framework. The resulting filter has good tracking performance, even for fast movements

A portable magnetic position and orientation tracker

This paper presents the design and testing of a portable magnetic system for human motion tracking. Three essential components comprise this system (1) 3D source, consisting of three orthogonal coils, placed on the body; (2) a compatible 3D sensor, which is fixed at a remote body segment and measures the fields generated by the source; (3) a processor whose function is to relate the signals from source and sensor. Given the signals from the source and sensor, the position and orientation of the sensor in 6 degrees of freedom (DOF) with respect to the position of the transmitter can be estimated. Coil parameters, such as the radius are optimized for tracking the distance between the lower back and the shoulder of a person. The electronics are designed to run on battery supply, making it suitable for body mounting and ambulatory measurements. The system is tested with functional body movements such as flexion of the back, arm movement and walking. The accuracy of measurements is approximately 8 mm in position and 5° in orientation with 6 DOF movements. Results are less accurate during relatively high velocities of the source or sensor due to under sampling. The magnetic tracker will be used as an aiding system for fusion with inertial sensors, therefore, the update rate requirements can be relatively low