Context.— Decisions to perform hip arthroplasty rely on both radiographic and clinical findings. Radiologists estimate degree of osteoarthritis (OA) and document other findings. Arthroplasty specimens are sometimes evaluated by pathology. Objective.— To determine the frequency of pathologic changes not recognized clinically. Design.— Nine hundred fifty-three consecutive femoral head resections performed between January 2015 and June 2018, with recent radiologic and histologic study, were reviewed. We compared severity of OA reported by radiology and pathology. Findings unrecognized radiographically but recorded pathologically, and discrepancies between clinical diagnosis and pathology diagnosis, were tabulated. Results.— Twenty-one cases of osteomyelitis were diagnosed radiographically or pathologically. Eight discrepancies were present. Fourteen osteomyelitis cases were recognized clinically. Pathology recognized 2 neoplasms missed radiographically. Avascular necrosis was diagnosed on pathology but not radiology in 25 cases, and 35 cases of avascular necrosis were seen radiographically but not pathologically. Osteoarthritis was graded both radiographically and pathologically from 0 to 3. Five hundred ninety-one of 953 cases (62%) were grade 3. Pathologists and radiologists had perfect agreement in 696 of 953 cases (73%). When grade of OA seen at pathology was correlated with surgeon, 2 groups of surgeons were detected: one with a low threshold for performance of hip arthroplasty (23%–28% low-severity OA) and the second with a high threshold (2%–5% low-severity OA). Conclusions.— Correlation between radiology and pathology diagnoses is high. Degree of OA present varies significantly between surgeons. Pathology discloses findings not recognized clinically.
INTRODUCTION AND OBJECTIVE: Our current study aims to determine the correlation between controlling nutritional status (CONUT) and prognostic nutritional index (PNI) and long term outcomes in bladder cancer patients.METHODS: A total of 302 bladder cancer patients who received a cystectomy from University Hospitals Cleveland Medical Center between 2007-2019 were evaluated. CONUT score was obtained based on total cholesterol, albumin, and lymphocyte count. PNI was calculated by utilizing the following formula: 10 Â the serum albumin value (g/dl) þ 0.005 Â the total lymphocyte count in peripheral blood (per mm3). Using inclusion/exclusion criteria, a total of 179 patients were included. We utilized Kaplan-Meier survival analyses to determine the correlation between CONUT and PNI and survival. PNI and CONUT association with upstaging was performed via multivariable regression analysis after adjusting for age, gender, chemotherapy status (y/n), smoking, Charlson Comorbidity Index.RESULTS: Patients with a PNI >50 (no evidence of malnourishment) had an Odds-Ratio (OR) of 0.416 (95% CI: 0.196-0.884, p[0.023) for upstaging of disease compared to patients with PNI <50, suggesting a protective effect against upstaging. When adjusted for age (OR[ 1.026.95%
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