Matthew R. Naunheim

The quality of randomized controlled trial reporting in spine literature.

Study Design. Retrospective literature review. Objective. To assess the quality of randomized controlled trial reporting in spine surgery. Summary of Background Data. The use of the Consolidated Standards of Reporting Trials (CONSORT) criteria in clinical trials aims to improve adherence to a set of generally accepted practices in the reporting of randomized controlled trials. Randomized controlled trials in spine surgery are important sources of evidence-based practice, but the quality of their execution and reporting have not been reported adequately. Methods. All randomized controlled trials published in three selected dedicated spine journals from 2008 were reviewed with respect to the 40 criteria derived from CONSORT descriptors; 10 criteria applying to the abstract, and 30 to the body of the article. Each article was scored by three reviewers in group format for each criterion and was assigned a score. Reviewers always came to a consensus before assigning a score. Results. A total of 32 RCTs met the inclusion criteria for this review. The average modified CONSORT score was 65%. Disclosing certain criteria was associated with a higher overall score, including method of generation of random sequence (P < 0.000071), allocation concealment (P < 0.00014), inclusion of a flow chart or description of patient numbers at different stages (P < 0.00034), and identification of outcome measures (P < 0.00064). Conclusion. Conclusions drawn from current randomized controlled trials in the spine literature may thus be difficult to interpret. Greater effort must be put into compliance with these guidelines to improve data quality.

Arterial Tortuosity Syndrome With Multiple Intracranial Aneurysms: A Case Report

OBJECTIVE To report a new manifestation of the rare connective tissue disorder arterial tortuosity syndrome in the absence of skin and soft-tissue abnormalities and with bilateral, giant fusiform intracranial aneurysms. DESIGN Case report. SETTING University teaching hospital. PATIENT A 67-year-old man with a history of hypertension presented to medical attention after a syncopal episode. Imaging revealed incidental, bilateral, giant fusiform intracranial aneurysms of the internal carotid artery at their junction of the circle of Willis. There was also aneurysmal dilatation of the left main coronary artery ectasia and aneurysmal dilation of the aorta and bilateral iliac arteries, suggestive of arterial tortuosity syndrome. RESULTS The patients syncope was attributed to transient complete heart block for which a permanent pacemaker was placed. The patient started taking aspirin for stroke prevention and losartan potassium for blood pressure control. CONCLUSIONS To our knowledge, we present the first case of arterial tortuosity syndrome with marked bilateral intracranial artery dilation in the absence of concurrent skin and soft tissue abnormalities. Workup may include systemic vascular imaging to characterize the extent of disease. Antiplatelet therapy can be used for stroke prevention by reducing the risk of clot formation in ectatic vessels with altered hemodynamics and subsequent embolism. Losartan is known to inhibit transforming growth factor β signaling and may be a specific modulator of disease expression in this syndrome.

Cost analysis of conventional face reconstruction versus face transplantation for large tissue defects.

Background: Large facial tissue defects are traditionally treated with staged conventional reconstruction. Facial allograft transplantation has emerged as a treatment modality. Facial allografts are procured from a dead donor and transplanted to the recipient. Recipients are then subjected to lifelong global immunosuppression to prevent immunologic rejection. This study analyzes the cost of facial allograft transplantation in comparison with conventional reconstruction. Methods: Hospital billing records from facial allograft transplantation (2009 to 2011) and conventional reconstruction (2000 to 2010) patients were compiled. Comparative 1-year costs were calculated, segregated by physician, hospital, and hospital’s department costs. Because most conventional reconstruction patients had smaller facial deficits than their facial allograft transplantation counterparts, regression models were used to estimate costs of conventional reconstruction for full facial defects, mirroring the facial transplantation cohort. All costs were adjusted using the medical consumer price index. Results: One-year costs for facial allograft transplantation were significantly higher than those for conventional reconstruction (mean/median,

Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach:

337,360/

Diagnosis of acute lymphoblastic leukemia from intracerebral hemorrhage and blast crisis. A case report and review of the literature

313,068 versus

Intercalated Duct Lesion of the Parotid

70,230/

Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments.

64,451, respectively). One-year costs for a hypothetical full-face conventional reconstruction were

Contingent Valuation Analysis of an Otolaryngology and Ophthalmology Emergency Department: The Value of Acute Specialty Care

184,061 (95 percent CI,

Skull Base Surgery Training and Practice Patterns among Recent Otolaryngology Fellowship Graduates

89,358 to

Placement of a 16-French voice prosthesis at the time of secondary tracheoesophageal voice restoration.

278,763). The per-patient cost in a hypothetical cohort of conventional reconstruction patients with deficits identical to four facial allograft transplantation recipients was