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First Time Portable CT Used for Skull Base Endoscopic Transnasal Surgery

By MedImaging International staff writers
Posted on 09 Apr 2009

Image: The CereTom portable CT with a technologist (Photo courtesy of NeuroLogica).

During a relatively rare endoscopic surgery on a woman with severe neck pain, doctors used a portable computed tomography (CT) system intraoperatively to check for guidance and assessment throughout the procedure. This is the first time in the United States that this type of imaging was used in the operating room for this surgery.

Suspecting a complex neurologic problem in a 58-year-old woman complaining of severe neck pains, her physician referred her to Mark Eisenberg, M.D., chief of neurosurgery at Long Island Jewish (LIJ) Medical Center (New Hyde Park, NY, USA), and B. Todd Schaeffer, M.D., associate chairman of otolaryngology and communicative disorders at North Shore University Hospital (NSUH; Great Neck, NY, USA).

After a thorough evaluation, including magnetic resonance imaging (MRI) and CT scans, Drs. Eisenberg and Schaeffer determined that the patient was in need of a delicate, highly specialized surgery to remove a tooth-shaped bone called the odontoid located at the top of the cervical spine. Due to settling of her skull onto the top of her spine, the bone (odontoid) was pressing into the brainstem at the base of the skull and causing her symptoms. The imaging scans revealed that the problem stemmed most likely from an old, healed fracture from the tonsillectomy performed on her during the 1950s.

The surgery for the patient consisted of two stages lasting a total of approximately 10 hours at NSUH designed to decompress her brainstem known as an endoscopic transnasal odontoidectomy a procedure where surgeons use normal nasal pathways to reach the odontoid bone resting on the base of the neck instead of going through the mouth. After the odontoid bone was removed, a fusion was performed from the back of the skull to the top of the spine to stabilize the spine. "Traditionally, the odontoid removal is done through the mouth, which is followed by at least a week of tube feeding," said Dr. Eisenberg. "The procedure also runs a high risk of complications related to the healing of the back of the throat."

For the minimally invasive endoscopic skull base surgery, Dr. Eisenberg partnered with Dr. Schaeffer, who specializes in endoscopic sinus and skull base surgery. "Using an endoscope through the nostrils to reach the odontoid bone, located about two inches below the pituitary gland, does not require any external or facial incisions, reducing healing and recovery time," said Dr. Schaeffer. The use of the endoscope, which has a camera on the end of the tip, allows the surgeons to visualize structures more closely and at angles that would otherwise be hidden from view. The images are projected on several monitors and a large flat-screen TV in the operating room.

The system used in the procedure, the CereTom portable CT, is equipped with wireless imaging capabilities and was developed by NeuroLogica (Danvers, MA, USA). "The intra-operative portable CT scanner enables us to ensure and confirm that we have done a complete resection and adequate decompression of the brainstem before we finish the surgery and before we leave the operation," explained Dr. Eisenberg. "This is a major advantage. Typically with this procedure, a CT scan would be taken the next day." The surgeons also used a stereotactic neuro-navigation system, which allows three-dimensional views of the skull in real time.

Throughout the high-tech surgery, Drs. Eisenberg and Schaeffer relied on the expertise of a multidisciplinary team comprised of various departments at NSUH, including operative services, neuroscience nursing, radiology, neuro-anesthesia and neuro-monitoring. About six weeks after the surgery, the patient, who loves to walk on the beach, said, "I feel great. My neck feels good and walking is fine. I'm very grateful to Dr. Eisenberg and Dr. Schaeffer. I never thought I'd be able to do these simple things again."

Related Links:
Long Island Jewish Medical Center
North Shore University Hospital
NeuroLogica

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56 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

57 (244.8558807373): SELECT name FROM jos_deeppockets WHERE id=294722744 LIMIT 1

58 (157.83309936523): SELECT name FROM jos_deeppockets_archive WHERE id=294722744 LIMIT 1

59 (47.922134399414): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

60 (69.141387939453): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722744 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

61 (387.90702819824): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722744 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

62 (!!!!! 1576.1852264404): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

63 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

64 (143.05114746094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

65 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

66 (129.93812561035): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

67 (629.90188598633): SELECT fid FROM jos_deeppockets WHERE id=294722744 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722744 AND published='1' LIMIT 1

68 (64.13459777832): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

69 (75.101852416992): select jos_twitters.link from jos_twitters where cat=10

70 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

71 (42.200088500977): select jos_google_plus.link from jos_google_plus where cat=10

72 (39.815902709961): select jos_linkedin.link from jos_linkedin where cat=10

73 (62.942504882812): SELECT fid FROM jos_deeppockets WHERE id=294722744 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722744 AND published='1' LIMIT 1

74 (50.067901611328): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

75 (437.97492980957): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722744 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

76 (329.01763916016): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722744 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

77 (61.988830566406): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

78 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (77.962875366211): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722744 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

93 (41.961669921875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722744 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

94 (46.014785766602): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

95 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

108 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

109 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

110 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

111 (124.21607971191): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722744 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (72.002410888672): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722744 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

114 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

115 (586.03286743164): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294722744 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (527.14347839355): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294722744 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

117 (128.03077697754): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294722743 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

118 (485.89706420898): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294722743 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

119 (813.00735473633): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

120 (543.83277893066): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

121 (159.02519226074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

122 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

123 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

124 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

125 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

126 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

127 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

128 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

129 (404.83474731445): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

130 (!!!!! 26703.834533691): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

131 (627.99453735352): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722744 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722744 AND type='deeppockets_item' AND published='1' LIMIT 1

132 (!!!!! 9251.8329620361): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

133 (102.99682617188): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

134 (67.949295043945): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

135 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

136 (74.148178100586): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

137 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

138 (407.21893310547): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

139 (50.067901611328): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

140 (49.114227294922): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

141 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

142 (566.95938110352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

143 (444.88906860352): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

144 (58.174133300781): SELECT name FROM jos_deeppockets WHERE id=211

145 (37.908554077148): SELECT name FROM jos_deeppockets WHERE id=211

146 (751.01852416992): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

147 (651.12113952637): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

148 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

149 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

150 (!!!!! 10485.887527466): TRUNCATE TABLE jos_trademed_module

151 (138.99803161621): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722744 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

152 (79.870223999023): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294722744 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

153 (!!!!! 2749.9198913574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

154 (120.16296386719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

155 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

156 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

157 (!!!!! 1636.9819641113): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

158 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

159 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

160 (83.92333984375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722744 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722744 AND type='deeppockets_item' AND published='1' LIMIT 1

161 (89.883804321289): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

162 (86.069107055664): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

163 (67.949295043945): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

164 (522.85194396973): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

165 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722744 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722744 AND published='1' LIMIT 1

166 (83.208084106445): select jos_twitters.link from jos_twitters where cat=10

167 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

168 (39.815902709961): select jos_google_plus.link from jos_google_plus where cat=10

169 (42.200088500977): select jos_linkedin.link from jos_linkedin where cat=10

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