Thomas Jefferson University Hospital

About: Thomas Jefferson University Hospital is a healthcare organization based out in Philadelphia, Pennsylvania, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 6173 authors who have published 7631 publications receiving 197620 citations.

A randomized phase III protocol for the evaluation of misonidazole combined with radiation in the treatment of patients with brain metastases (RTOG-7916).

Abstract: From 1979 through July 1983, 859 patients were enrolled in a Phase III RTOG Protocol (7916) evaluating the role of Misonidazole combined with radiation in the treatment of brain metastasis. Patients were randomized to one of four treatment arms 3.0 Gy × 10 fractions with or without 1 g/m 2 of Misonidazole [total 10 g/m2] versus 5.0 Gy × 6 fractions with or without 2 g/m 2 of Misonidazole) [total 12 g/m 2 ]. Among the 779 analyzable cases, 63% had a lung primary and 12% had breast. Of the histologic types, 43% were adenocarcinoma and 24% were squamous cell. Seventy-eight percent had a Karnofsky of greater than 70. Of the 779 cases, 773 are dead (99%). Median survival is 3.9 months, with 60% alive at 3 months, 35% at 6 months, and 15% at 1 year. Survival was evaluated by treatment arm, Misonidazole status, and fractionation scheme; none showed any statistical significance. Favorable prognostic factors were assessed (age less than 60, Karnofsky of 70–100, controlled primary and brain metastasis only) in each treatment arm and no difference was found. Brain metastasis was cause of death in 13, and 19–33% of patients were retreated. Because up to 13 of the patients in this study died secondary to uncontrolled brain metastasis, improvement in local control remains an important goal. Until proven otherwise, the treatment of choice for the majority of patients still remains a conventional palliative course of 3.0 Gy × 10 fractions.

Diagnosis of osteomyelitis: utility of fat-suppressed contrast-enhanced MR imaging.

Abstract: PURPOSE: To assess the value of fat-suppressed contrast material-enhanced magnetic resonance (MR) imaging in the diagnosis of osteomyelitis. MATERIALS AND METHODS: T1- and T2-weighted MR imaging was performed in 51 cases of suspected osteomyelitis. Nonenhanced and contrast-enhanced T1-weighted fat-suppressed MR images were also obtained. Three-phase bone scan results were available for 30 cases. Complicating clinical factors, including chronic osteomyelitis (n = 26), postoperative state (n = 17), and neuropathic disease of the foot (n = 5), were identified in 73% of cases. RESULTS: In the diagnosis of osteomyelitis, scintigraphy demonstrated a sensitivity of 61% and specificity of 33%. For nonenhanced MR imaging, sensitivity was 79% and specificity was 53%. For fat-suppressed contrast-enhanced imaging, sensitivity was 88% and specificity was 93%. CONCLUSION: In diagnosing osteomyelitis in patients with complicating clinical factors, fat-suppressed contrast-enhanced MR imaging was significantly more sensit...

MR Imaging of Disorders of the Achilles Tendon

Abstract: he Achilles tendon is among the most frequently injured tendons of the body with a variety of types of traumatic and overuse conditions affecting it. These conditions are common, often come to clinical attention, and are frequently imaged. The pathophysiology of Achilles disorders is complex, and the nomenclature is irregularly applied; this leads to miscommunication between clinicians and radiologists and inconsistencies in the literature. Therefore, we review the anatomy, MR imaging findings, and pathologic findings in an attempt to develop a systematic nomenclature. Gross Anatomy The Achilles tendon originates in the mid leg and is formed by the junction of the two heads of the gastrocnemius muscles and the soleus muscle [1, 2]. The bulk of the Achilles is formed from the gastrocnemius muscle. The larger medial head originates almost entirely from just proximal to the medial femoral condyle, and the smaller lateral head arises from both the posterior and lateral surfaces of the lateral femoral condyle. At the junction of the proximal and mid calf, the two heads of the gastrocnemius muscles and their tendons approximate midline. The gastrocnemius tendon origin is gradual, occurring over approximately 3‐4 cm. The fibers of the medial head originate slightly lower than those of the lateral head. The Achilles tendon is not formed until the soleus muscle inserts onto the gastrocnemius tendon, approximately 3‐4 cm more distally [2]. The plantaris muscle originates from the lateral meniscus and the lateral femoral epicondyle in close association with the lateral head of the gastrocnemius muscle. The plantaris tendon then crosses obliquely between the soleus and gastrocnemius muscles and continues just medial to the Achilles. Various plantaris insertions are seen, but most fibers insert on the medial aspect of the superior calcaneal tuberosity or 1 cm anterior and medial to the Achilles on the calcaneus, a distinct insertion point separate from that of the Achilles. The Achilles‐plantaris complex is termed the “triceps‐surae complex” [3].

Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors.

Abstract: Background: There has been a major and alarming increase in readmission rates following total joint arthroplasty. With proposed changes in reimbursement policy, increased rates of unplanned readmission following arthroplasty will penalize providers. In particular, it has been proposed that specific complications—so-called “zero-tolerance” complications—are unacceptable and that their treatment will not qualify for reimbursement. The purpose of this study was to identify the incidence, causes, and risk factors for readmission following total joint arthroplasty. Methods: An institutional arthroplasty database was utilized to identify those patients undergoing total knee or hip arthroplasty from January 2004 through December 2008. A total of 10,633 admissions for primary arthroplasty (5207 knees and 5426 hips) were identified. The same database was used to identify patients requiring an unplanned readmission within ninety days of discharge. Multivariate logistic regression was utilized to determine the independent predictors of readmission within ninety days. Results: There were 591 unplanned readmissions within ninety days of discharge following 564 (5.3%) of the 10,633 admissions for total joint arthroplasty. The most common cause of readmission was joint-related infection, followed by stiffness. Black race, male sex, discharge to inpatient rehabilitation, increased duration of hospital stay, unilateral replacement, decreased age, decreased distance between home and the hospital, and total knee replacement were independent predictors of readmission within ninety days. Conclusions: The high incidence of readmissions secondary to potential “zero-tolerance” events suggests that these are not easily preventable complications. In addition, longer hospitalization and discharge to an inpatient continued-care facility increased the risk of readmission. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.