O'Brien S, et al. J Gastric Cancer. 2018 Sep;18(3):242-252. https://doi.org/10.5230/jgc.2018.18.e25

Inflammatory bowel disease (IBD) is a relatively common disorder with significant associated morbidity. Sarcopenia and myosteatosis are associated with adverse postoperative outcomes. This study investigated outcomes in IBD patients undergoing surgical resection relative to the presence of sarcopenia and myosteatosis. A retrospective analysis of a prospectively maintained surgical database was conducted. All patients undergoing elective or emergency resection for IBD between 2011 and 2016, with a contemporaneous perioperative computed tomography (CT) scan, were included. Patient demographics, clinical and biochemical measurements were collected. Skeletal muscle index and attenuation were measured on perioperative CT scans using Osirix version 5.6.1. Univariate and multivariate regression analysis was used to identify risk factors for adverse postoperative outcomes. Seventy-seven patients (46 male, 31 female; mean age 42 years, range 20–80 years) were included. Thirty patients (30%) had sarcopenia and 26 (34%) had myosteatosis. Myosteatosis was significantly associated with increased hospital stay postoperatively (9 versus 13 days). Sarcopenia and myosteatosis were associated with hospital readmission within 30 days on univariate analysis. Multivariate regression analysis demonstrated an independent association between myosteatosis and hospital readmission. Sixteen patients (21%) had a clinically relevant postoperative complication, but an association with sarcopenia and myosteatosis was not observed. A neutrophil-lymphocyte ratio greater than 5 was predictive of clinically relevant postoperative complications on multivariate regression analysis. Myosteatosis was associated with increased hospital stay and increased 30-day hospital readmission rates on multivariate regression analysis. Sarcopenia and myosteatosis in IBD were not associated with clinically relevant postoperative complications.

The ATTUNE Knee by DePuy Synthes was introduced in 2013. It is designed to provide better range of motion and address patient-reported instability. The PFC Sigma Knee, an earlier prosthesis by DePuy Synthes, is a common knee replacement with a strong clinical track record. Our aim is to compare the outcomes after primary total knee replacement for end-stage knee osteoarthritis of the PFC and ATTUNE knee systems in 21 patients who each have prosthesis in opposite knees using WOMAC, Oxford Knee and SF-12 scores and evaluation of range of motion. A review was carried out on 21 patients who underwent primary total knee replacement with both the ATTUNE and PFC knee systems. These were staged operations performed in the same institution and by the same surgeon. All cases were followed up for a minimum of 6 months. WOMAC, Oxford Knee and SF-12 scores, as well as knee range of motion were recorded preoperatively and at 6 months postoperatively. There was a significant difference in pre- to 6-month post-operative outcomes in PFC and ATTUNE groups with regard to improvement in range of motion (10° ± 8 and 13° ± 11, respectively). There was also a significant improvement in WOMAC scores (PFC group) and Oxford Knee Scores (ATTUNE group) (8.9 ± 7.7 and 12.1 ± 8.4, respectively). There was a significant improvement in SF-12 Score in both groups (10.1 ± 9.3 for PFC and 15.8 ± 13.3 for ATTUNE). The minimum clinically important difference (MCID) in scoring systems at 6 months was reached by 6 patients in the PFC group and 12 in the ATTUNE group. A significant difference was demonstrated in clinical outcome at 6 months postoperatively between PFC and ATTUNE knee systems in patients who underwent total knee arthroplasty with both prostheses. Superior results were recorded for the ATTUNE knee system.

Review of the role of abdominal imaging in irritable bowel syndrome