bluuebunny/crossref_metadata_2025 huggingface dataset:
Children having children: Outcome of extreme teenage pregnancies (13–15 years)
Authors: PAPAMICHEAL ESTHER , PILLAI REKHA , YOONG WAI
Published: December 2009

A case–control study was conducted to compare obstetric and fetal outcomes of teenage mothers ≤15 years (n=35) with those from older teenagers between 16 and19 years (n=35) and mothers between 20 and30 years (n = 35) matched for ethnicity and parity. Teenage mothers ≤15 years were significantly more likely to come from single‐parent families and twice as likely to have experienced childhood sexual or physical abuse compared to those over 16 years (both p <0.0001). They attended antenatal appointments later than older teenagers (23±7 weeks vs. 18±7 weeks, p <0.05), had fewer visits (p<0.05), were more likely to undergo emergency cesarean section (25.7% vs. 5.7% vs. 8.6%, p <0.05) and to have a higher rate of perineal trauma (45.7% vs. 20.0% vs. 25.7%, p<0.05). However, all three groups delivered babies of comparable birthweights (3.2±0.5 kg vs. 3.1±0.7 kg vs. 3.3±0.6 kg, p >0.05) at similar gestations (39±4 weeks vs. 39±2 weeks vs. 39±3 weeks, p >0.05).
Para‐aortic lymph node metastasis in malignant dysgerminoma of the ovary
Authors: KASENDA BENJAMIN , HARTER PHILIPP , HIRSCH TOBIAS , AST ALEXANDER , BUHRMANN CHRISTINE , GLASER FLORIAN , DU BOIS ANDREAS
Published: December 2009

Dysgerminomas comprise approximately 2–5% of all ovarian malignancies and mostly affect young adolescent women. Primary comprehensive surgery and adjuvant chemotherapy consisting of bleomycin, etoposide, and cisplatin (BEP) are the current recommended treatment options, the latter reserved for advanced stages (FIGO II–IV).

We report two patients aged 20 and 26 years who presented with an initial FIGO stage IA, but inadequately assessed. Both were subsequently diagnosed with recurrent malignant dysgerminoma and para‐aortic lymph node metastasis. Neither had received comprehensive staging at initial surgery nor adjuvant radio or chemotherapy. Both needed extensive surgery and multiagent chemotherapy for survival and belong to the small percentage of FIGO IA dysgerminoma patients showing a relapse. Comprehensive initial surgery including systematic para‐aortic lymphadenectomy and adjuvant chemotherapy at tertiary referral centers is needed to minimize the treatment burden.
Systematic review of progesterone for the prevention of preterm birth in singleton pregnancies
Authors: RODE LINE , LANGHOFF‐ROOS JENS , ANDERSSON CHARLOTTE , DINESEN JAKOB , HAMMERUM METTE SCHOU , MOHAPELOA HANNE , TABOR ANN
Published: December 2009

Background. A Cochrane review in 2006 concluded that further knowledge is required before recommendation can be made with regard to progesterone in the prevention of preterm birth. Objective. To provide an update on the preventive effect of progesterone on preterm birth in singleton pregnancies. Search strategy. A search in the PubMed, Embase, and Cochrane database was performed using the keywords: pregnancy, progesterone, preterm birth/preterm delivery, preterm labor, controlled trial, and randomized controlled trial. Selection criteria. Studies on singleton pregnancies. Data collection and analysis. A meta‐analysis was performed on randomized trials including singleton pregnancies with previous preterm birth. Main results. Two new randomized controlled trials of women with previous preterm birth were added to the four analyzed in the Cochrane review, and the meta‐analysis of all six studies now showed that progesterone supplementation was associated with a significant reduction of delivery before 32 weeks and of perinatal mortality. Furthermore, a third trial showed a positive effect on women with a short cervix at 23 weeks, and a fourth study showed that progesterone reduces the risk of preterm delivery in women with preterm labor. Conclusions. In women with a singleton pregnancy and previous preterm delivery, progesterone reduces the rates of preterm delivery before 32 weeks, perinatal death, as well as respiratory distress syndrome and necrotizing enterocolitis in the newborn. Women with a short cervix or preterm labor may also benefit from progesterone, but further evidence is needed to support such a recommendation. Follow‐up studies should focus on possible metabolic complications in the mother or the offspring.
The Dutch Perinatal Audit Project: a feasibility study for nationwide perinatal audit in the Netherlands
Authors: DE REU PAUL , VAN DIEM MARIET , ESKES MARTINE , OOSTERBAAN HERMAN , SMITS LUC , MERKUS HANS , NIJHUIS JAN
Published: December 2009

Objective. To investigate the feasibility of nationwide perinatal mortality audits in the Netherlands. Study design. Over a one‐year period, data for all cases of perinatal mortality were collected. Six perinatal audit panels of professionals within perinatal care investigated and classified causes of death and identified the presence of substandard care factors (SSF). Results. Out of 22,189 newborns, 228 cases of perinatal mortality were audited. Placental pathology, congenital anomalies and preterm birth were the main causes of perinatal death. SSF by caregivers were identified in 72 cases (32 %). Almost 20% of the cases were not reported. Conclusions. In the Netherlands, perinatal audit is well supported by all groups of caregivers. It reveals usable facts and findings for the quality assessment of perinatal care. This audit showed that in 9% of the cases perinatal death was related to SSF and potentially avoidable. However, immediate reporting of cases of perinatal death apart from regular registration in the perinatal database proved to be inaccurate. Once a nationwide audit program is realized, in which data from the different caregivers will be collected in a single database instead of collection by linkage afterwards, this problem should be solved. Local audits will start from 2009. These audits will assess mortality cases within their respective areas and may initiate adjustments for perinatal care and optimize the quality of care and inter‐professional collaboration. Yearly nationwide audits will focus on specific items (e.g. term or post‐term deliveries) and may well offer an opportunity for the development or adjustment of national guidelines.
Sex ratio and pregnancy complications according to mode of conception in women with polycystic ovary syndrome
Authors: VANKY ESZTER , BACKE BJØRN , CARLSEN SVEN M.
Published: December 2009

Objective. To investigate pregnancy complications and offspring sex ratio according to mode of conception in women with polycystic ovary syndrome (PCOS). Design. Retrospective, descriptive study. Setting. Tertiary, university hospital. Population. A total of 176 women with PCOS diagnosed according to the Rotterdam criteria. Methods. Women with PCOS who have participated in one or more clinical studies were invited to answer a questionnaire on the mode of conception, pregnancy complications, gestational length and offspring gender. A total of 139 women responded. Data were quality checked against hospital files. Main outcome measures. Fertility, mode of conception, offspring gender and pregnancy complications. Results. More than half (54%) of the singleton pregnancies were conceived spontaneously. More complications were seen in pregnancies achieved while using metformin than without (p = 0.02). Compared to spontaneous conception, more boys than girls were born in singleton pregnancies after in vitro fertilization/intracytoplasmatic sperm injection treatment (p = 0.004). Conclusions. In women with PCOS the mode of conception may influence both the rate of pregnancy complications and the offspring sex ratio.
Personality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment
Authors: VOLGSTEN HELENA , EKSELIUS LISA , POROMAA INGER SUNDSTRÖM , SVANBERG AGNETA SKOOG
Published: December 2009

Objective. To assess which personality traits are associated with depressive and/or anxiety disorders in infertile women and men undergoing in vitro fertilization (IVF). Design. Prospective study. Setting. A university hospital in Sweden. Population. A total of 856 eligible women and men, 428 couples, were approached to participate. Overall 643 (75.1%) subjects filled out the Swedish Universities Scales of Personality (SSP) questionnaire. The response rates were 323 women (75.5%) and 320 men (74.8%). Methods. The SSP, a self‐rating personality trait questionnaire, was used for evaluation. Main outcome measures. Personality traits associated with depression and/or anxiety disorders. Results. Higher mean scores on all neuroticism‐related personality traits were found in women and men with depressive and/or anxiety disorders compared to women and men with no diagnosis. High scores of neuroticism and a negative pregnancy test after IVF were associated with depressive and/or anxiety disorders among women. Among men, high scores of neuroticism and unexplained or male infertility factor were associated with depressive and/or anxiety disorders. High neuroticism scores were negatively associated with live birth (p < 0.05). Conclusion. High scores on neuroticism‐related personality traits were associated with depressive and/or anxiety disorders in women and men undergoing IVF.
Characterizing breast cancer xenograft epidermal growth factor receptor expression by using near-infrared optical imaging
Authors: Wang Kezheng , Wang Kai , Li Weihual , Huang Tao , Li Renfei , Wang Dan , Shen Baozhong , Chen Xiaoyuan
Published: December 2009

Background: Epidermal growth factor receptor (EGFR) overexpression is associated with several key features of cancer development and growth. Therefore, EGFR is a very promising biological target for tumor diagnosis and anticancer therapy. Characterization of EGFR expression is important for clinicians to select patients for EGFR-targeted therapy and evaluate therapeutic effects.

Purpose: To investigate whether near-infrared (NIR) fluorescent dye Cy5.5-labeled anti-EGFR monoclonal antibody Erbitux can characterize EGFR expression level in MDA-MB-231 and MCF-7 breast cancer xenografts using an in vivo NIR imaging method.

Material and Methods: A fluorochrome probe was designed by coupling Cy5.5 to Erbitux through acidylation, and the fluorescence property of the Erbitux-Cy5.5 conjugate was characterized by fluorospectroscopy. Flow cytometry and laser confocal microscopy were used to test the EGFR specificity of the antibody probe in vitro. Erbitux-Cy5.5 was also injected intravenously into immune-deficient mice bearing MDA-MB-231 or MCF-7 tumors. Whole-body and region-of-interest fluorescence images were acquired and analyzed. The EGFR expression was also analyzed and confirmed by immunohistochemical assay.

Results: The maximum excitation/emission wavelength for the Erbitux-Cy5.5 probe was 674/697 nm, similar to that of free Cy5.5 (674/712 nm). Confocal microscopy confirmed receptor-specific uptake in MDA-MB-231 and MCF-7 cells. In flow cytometry probe specificity assay, Erbitux-Cy5.5 showed a 9.32-fold higher affinity for MDA-MB-231 than MCF-7 cells. In vivo NIR imaging also indicated specific uptake in EGFR-positive tumors. Probe uptake rate and maximum intake dose in MDA-MB-231 were significantly higher than those in MCF-7 xenografts ( P < 0.001). Immunohistochemical staining confirmed the in vivo imaging results, showing differentiated EGFR expression in MDA-MB-231 (+ + +) and MCF-7 (+) tumor tissues.

Conclusion: Erbitux-Cy5.5 may be used as a specific NIR contrast agent for the noninvasive characterization of EGFR expression level in breast cancer xenografts.
Sonographic changes after removing all benign breast masses with sonographically guided vacuum-assisted biopsy
Authors: Ko Eun Sook , Han Heon , Lee Byung Hee , Choe Du Hwan
Published: December 2009

Background: Total removal of benign breast masses by vacuum-assisted biopsy (VAB) is now increasingly accepted as a treatment option. However, little is known about whether this procedure produces early changes on follow-up sonography and, if so, how often and what factors might influence them.

Purpose: To evaluate sonographic changes after total removal of benign breast masses using sonographically guided VAB and to determine the influencing factors.

Material and Methods: We evaluated sonographic changes prospectively 1 week, 1 month, and 6 months after biopsying 32 benign masses from which all sonographic evidence had been removed during sonographically guided directional VAB performed with 8- or 11-gauge needles. Procedural factors were documented and compared with sonographic findings.

Results: At 1-week follow-up, hematomas were observed in 84% (27/32) of the lesions. After 1 month, while the hematomas had resolved in all but five lesions, focal new architectural distortion had developed in 26 (90%) lesions; 11 lesions were graded as severe, mimicking malignancy. After 6 months, 23 lesions with various degrees of architectural distortion were observed. Six of the 32 lesions (19%) contained a residual lesion. No statistically significant association between sonographic findings and procedural variables was identified, except between the degree of hematoma and lesion size.

Conclusion: The total removal of benign breast masses using sonographically guided VAB frequently produces changes on follow-up sonography after 6 months. Although these changes failed to show statistical significance with procedural factors, a larger dedicated study is needed.
Multiple 18f-fdg, pet-ct for postoperative monitoring of breast cancer patients
Authors: Kurata A. , Murata Y. , Kubota K. , Osanai T. , Shibuya H.
Published: December 2009

Background: Positron emission tomography (PET)-computed tomography (CT) may be useful in the post-treatment follow-up of breast cancer patients.

Purpose: To assess the usefulness of 18F-fluorodeoxyglucose (FDG) PET-CT (PET-CT) for postoperative monitoring of breast cancer patients.

Material and Methods: One hundred twenty-nine PET-CT studies performed on 55 female postoperative breast cancer patients (median age 56 years, range 36–86 years) were analyzed. The median interval between the PET-CT studies was 6 months (range 1–15 months). In order to determine the usefulness of serial PET-CT examinations in the postoperative follow-up of breast cancer patients, the PET-CT findings were compared with the physical findings, findings obtained by other imaging modalities, and the 18F-FDG-PET (PET) findings.

Results: The PET findings were negative in 4 metastatic bone lesions with a positive bone scan. The PET findings were also negative in 6 of 9 osteogenic bone metastases and one of 64 osteolytic bone lesions. There were 5 cases with false-positive of PET, which were determined to be areas of soft-tissue hyperactivity. All false-positive/-negative findings were corrected by the addition of CT.

Conclusion: The results of this study lend support to the clinical role of PET-CT in the postoperative follow-up/monitoring of breast cancer patients.
Ictal spect using an attachable automated injector: clinical usefulness in the prediction of ictal onset zone
Authors: Lee Jung-Ju , Lee Sang Kun , Choi Jang Wuk , Kim Dong-Wook , Park Kyung Il , Kim Bom Sahn , Kang Hyejin , Lee Dong Soo , Lee Seo-Young , Kim Sung Hun , Chung Chun Kee , Nam Hyeon Woo , Kim Kwang Ki
Published: December 2009

Background: Ictal single-photon emission computed tomography (SPECT) is a valuable method for localizing the ictal onset zone in the presurgical evaluation of patients with intractable epilepsy. Conventional methods used to localize the ictal onset zone have problems with time lag from seizure onset to injection.

Purpose: To evaluate the clinical usefulness of a method that we developed, which involves an attachable automated injector (AAI), in reducing time lag and improving the ability to localize the zone of seizure onset.

Material and Methods: Patients admitted to the epilepsy monitoring unit (EMU) between January 1, 2003, and June 30, 2008, were included. The definition of ictal onset zone was made by comprehensive review of medical records, magnetic resonance imaging (MRI), data from video electroencephalography (EEG) monitoring, and invasive EEG monitoring if available. We comprehensively evaluated the time lag to injection and the image patterns of ictal SPECT using traditional visual analysis, statistical parametric mapping-assisted, and subtraction ictal SPECT coregistered to an MRI-assisted means of analysis. Image patterns were classified as localizing, lateralizing, and nonlateralizing. The whole number of patients was 99: 48 in the conventional group and 51 in the AAI group.

Results: The mean (SD) delay time to injection from seizure onset was 12.4±12.0 s in the group injected by our AAI method and 40.4±26.3 s in the group injected by the conventional method ( P=0.000). The mean delay time to injection from seizure detection was 3.2±2.5 s in the group injected by the AAI method and 21.4±9.7 s in the group injected by the conventional method ( P=0.000). The AAI method was superior to the conventional method in localizing the area of seizure onset (36 out of 51 with AAI method vs. 21 out of 48 with conventional method, P=0.009), especially in non-temporal lobe epilepsy (non-TLE) patients (17 out of 27 with AAI method vs. 3 out of 13 with conventional method, P=0.041), and in lateralizing the seizure onset hemisphere (47 out of 51 with AAI method vs. 33 out of 48 with conventional method, P=0.004).

Conclusion: The AAI method was superior to the conventional method in reducing the time lag of tracer injection and in localizing and lateralizing the ictal onset zone, especially in patients with non-TLE.
Computer-aided detection in digital mammography: false-positive marks and their reproducibility in negative mammograms
Authors: Kim Seung Ja , Moon Woo Kyung , Seong Min Hyun , Cho Nariya , Chang Jung Min
Published: December 2009

Background: There are relatively few studies reporting the frequency of false-positive computer-aided detection (CAD) marks and their reproducibility in normal cases.

Purpose: To evaluate retrospectively the false-positive mark rate of a CAD system and the reproducibility of false-positive marks in two sets of negative digital mammograms.

Material and Methods: Two sets of negative digital mammograms were obtained in 360 women (mean age 57 years, range 30–76 years) with an approximate interval of 1 year (mean time 343.7 days), and a CAD system was applied. False-positive CAD marks and the reproducibility were determined.

Results: Of the 360 patients, 252 (70.0%) and 240 (66.7%) patients had 1–7 CAD marks on the initial and second mammograms, respectively. The false-positive CAD mark rate was 1.5 (1.1 for masses and 0.4 for calcifications) and 1.4 (1.0 for masses and 0.4 for calcifications) per examination in the initial and second mammograms, respectively. The reproducibility of the false-positive CAD marks was 12.0% for both mass (81/680) and microcalcification (33/278) marks.

Conclusion: False-positive CAD marks were seen in approximately 70% of normal cases. However, the reproducibility was very low. Radiologists must be familiar with the findings of false-positive CAD marks, since they are very common and can increase the recall rate in screening.
Diagnostic value of multislice computed tomography and magnetic resonance imaging in the diagnosis of retroperitoneal spread of testicular cancer: a literature review
Authors: Hansen J. , Jurik A. G.
Published: December 2009

Testicular cancer is the most frequent malignant disorder in men aged 15–35 years. Generally, diagnosing and follow-up include computer tomography (CT) examinations to detect possible retroperitoneal spread (abdomen and pelvis), resulting in at least eight CT examinations. This patient group is thereby exposed to a non-neglectable radiation dose, increasing the risk of future radiation-induced secondary cancer. This is especially problematic in potentially surgically cured patients with stage 1 testicular cancer. Thus, it can be beneficial to substitute CT with magnetic resonance imaging (MRI), provided there is valid evidence that the diagnostic value of MRI is at least comparable to current multislice CT (MSCT). The purpose of this study was to analyze whether there is evidence to recommend a substitution of MSCT with MRI in the diagnosis of retroperitoneal spread of testicular cancer. A literature search on the diagnostic accuracy, specificity, and sensitivity of MSCT and MRI in the diagnosis of retroperitoneal spread of testicular cancer was performed in the following databases: PubMed, EmBase, and ISI Web of Science. The search was limited to include the period from 2000 to September 2008, and to human and English-language publications. Forty-four publications were obtained for formal review (27 from PubMed, 15 from EmBase, two from ISI Web of Science). None of the publications reviewed encompassed diagnostic specificity and sensitivity of MSCT, and they lacked systematic comparison of MSCT and MRI. Only one study included sensitivity and specificity of MRI compared to single-slice CT. Both methods had a sensitivity and a specificity of approximately 70%. The literature review did not reveal valid data regarding diagnostic accuracy of MRI compared with MSCT for diagnosing retroperitoneal spread of testicular cancer. A prospective blinded comparative study is needed to provide valid evidence.
Tears of the supraspinatus tendon: assessment with indirect magnetic resonance arthrography in 67 patients with arthroscopic correlation
Authors: Van Dyck P. , Gielen J. L. , Veryser J. , Weyler J. , Vanhoenacker F. M. , Van Glabbeek F. , De Weerdt W. , Maas M. , van der Woude H.-J. , Parizel P. M.
Published: December 2009

Background: Magnetic resonance (MR) arthrography is generally regarded as the gold standard for shoulder imaging. As an alternative to direct MR arthrography, the less invasive indirect MR arthrography technique was proposed, offering logistic advantages because fluoroscopic or ultrasonographic guidance for joint injection is not required.

Purpose: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population.

Material and Methods: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (κ) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement.

Results: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (κ = 0.910). For partial-thickness tears, sensitivities (38–50%) and accuracies (76–78%) were poor for both reviewers, and interobserver agreement was moderate (κ = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears.

Conclusion: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the basis of the above findings, we do not recommend indirect MR arthrography on patients for whom rotator cuff disease is suspected clinically.
Synchronous parenchymal renal tumors of different histology in the same kidney
Authors: Capaccio Enrico , Varca Virginia , Simonato Alchiede , Toncini Carlo , Carmignani Giorgio , Derchi Lorenzo E.
Published: December 2009

Background: Synchronous primary cortical tumors of different histology in the same kidney are rare. Preoperative awareness of this coexistence is important, since it can help in planning the surgical approach.

Purpose: To describe the imaging findings observed in five patients with two parenchymal malignant tumors of different histology in the same kidney.

Material and Methods: We reviewed the pathology reports of 381 patients operated for renal tumors from January 2000 to March 2007. The medical records of all patients with multiple, synchronous, primary lesions of different histology in the same kidney were reviewed with special attention to imaging findings and indications on the nature of the disease process. Computed tomography (CT) examinations were retrospectively evaluated for tumor detection, size, location, and enhancement pattern.

Results: We found seven patients with synchronous tumors of different histology in the same kidney (1.8%). Among these, five (1.3%) had two malignancies of different subtypes and represent our study group. Four had preoperative ultrasound; all had CT. Imaging allowed identification of multifocality in 4/5 cases and, in 3/4 patients with visible double tumors, recognition of differences in lesion appearance. In only one patient did the two tumors have similar enhancement patterns.

Conclusion: It is possible to suspect preoperatively the presence of tumors of different histologic subtypes within the same kidney. Imaging findings may provide information regarding the presence of lesions with different aggressiveness within the kidney, which may be helpful in therapeutic planning.
Book Review
Authors: Vejtorp Mogens
Published: December 2009

Fibroids, Menstruation, Childbirth, and Evolution. The Fascinating Story of Uterine Blood Vessels. By F. Burbank. Tucson, Arizona: Wheatmark, 2009. 295 pages. ISBN: 9781604941708
Physical and clinical comparison between a screen-film system and a dual-side reading mammography-dedicated computed radiography system
Authors: Rivetti S. , Canossi B. , Battista R. , Lanconelli N. , Vetruccio E. , Danielli C. , Borasi G. , Torricelli P.
Published: December 2009

Background: Digital mammography systems, thanks to a physical performance better than conventional screen-film units, have the potential of reducing the dose to patients, without decreasing the diagnostic accuracy.

Purpose: To achieve a physical and clinical comparison between two systems: a screen-film plate and a dual-side computed radiography system (CRM; FUJIFILM FCR 5000 MA).

Material and Methods: A unique feature of the FCR 5000 MA system is that it has a clear support medium, allowing light emitted during the scanning process to be detected on the "back" of the storage phosphor plate, considerably improving the system's efficiency. The system's physical performance was tested by means of a quantitative analysis, with calculation of the modulation transfer function, detective quantum efficiency, and contrast-detail analysis; subsequently, the results were compared with those achieved using a screen-film system (SFM; Eastmann Kodak MinR-MinR 2000). A receiver operating characteristic (ROC) analysis was then performed on 120 paired clinical images obtained in a craniocaudal projection with the conventional SFM system under standard exposure conditions and also with the CRM system working with a dose reduced by 35% (average breast thickness: 4.3 cm; mean glandular dose: 1.45 mGy). CRM clinical images were interpreted both in hard copy and in soft copy.

Results: The ROC analysis revealed that the performances of the two systems (SFM and CRM with reduced dose) were similar ( P>0.05): the diagnostic accuracy of the two systems, when valued in terms of the area underneath the ROC curve, was found to be 0.74 for the SFM, 0.78 for the CRM (hard copy), and 0.79 for the CRM (soft copy).

Conclusion: The outcome obtained from our experiments shows that the use of the dual-side CRM system is a very good alternative to the screen-film system.
Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis
Authors: Kanamori Masayuki , Kumabe Toshihiro , Saito Ryuta , Yamashita Yoji , Sonoda Yukihiko , Ariga Hisanori , Takai Yoshihiro , Tominaga Teiji
Published: December 2009

Object

This study retrospectively analyzed the long-term outcomes of 108 consecutive patients to establish the classification and optimal treatment strategy for each subgroup of newly diagnosed germ cell tumors (GCTs).

Methods

A retrospective review of medical records from the authors' department between April 1989 and March 2007 identified 108 patients with newly diagnosed intracranial GCT. The diagnoses were germinoma in 83 patients, and nongerminomatous GCT (NGGCT) in 25 patients.

Results

In patients with germinoma, the 10-year overall and progression-free survival (PFS) rates at a median follow-up period of 99 months were 86 and 74%, respectively. Recurrences developed during a range of 6 to 153 months (median 26 months) after starting the initial therapy. Patients treated only with chemotherapy demonstrated a shorter PFS rate, and patients treated with chemotherapy followed by reduced-dose radiation therapy to the whole ventricle, whole brain, or craniospinal axis showed significantly better PFS than patients treated with only radiation or reduced-dose radiation therapy to the focal field. Nongerminomatous GCTs were divided into good, intermediate, and poor prognosis groups as proposed by the Japanese Pediatric Brain Tumor Study Group. In the good and intermediate prognosis groups, the 10-year overall and PFS rates were 100 and 93%, respectively. In the poor prognosis group, the 3-year overall and PFS rates were 56 and 29%, respectively. All patients with NGGCTs, in whom the lesions on MR imaging disappeared after combination therapies consisting of resection, radiation therapy, and chemotherapy, remained alive.

Conclusions

Chemotherapy followed by reduced-dose radiation therapy covering the whole ventricle improves the prognosis for patients with germinoma. Combined therapy of radiation therapy, chemotherapy, and radical resection as an initial or salvage treatment achieved excellent tumor control in the intermediate prognosis NGGCT group. The outcomes were still dismal in the poor prognosis NGGCT group, so initial therapy should target complete disappearance of all lesions on MR imaging.
Role of diffusion tensor imaging in resection of thalamic juvenile pilocytic astrocytoma
Authors: Moshel Yaron A. , Elliott Robert E. , Monoky David J. , Wisoff Jeffrey H.
Published: December 2009

Object

The choice of surgical approach during resection of a thalamic juvenile pilocytic astrocytoma (JPA) is dictated by the location of the displaced normal thalamus and posterior limb of the internal capsule (PLIC). Diffusion tensor (DT) imaging and white matter tractography can identify the location of the PLIC in relation to the tumor and may be useful in planning the operative trajectory.

Methods

Diffusion tensor imaging was used to localize the PLIC on preoperative MR imaging in 6 children undergoing resection of thalamic JPAs. After review of the standard T2-weighted MR imaging sequences, the anticipated position of the PLIC was determined. This result was compared with the location of the PLIC determined by a blinded radiologist with the use of DT imaging. The utility of DT imaging in determining the surgical approach to a thalamic JPA, degree of resection, and neurological outcomes were all evaluated.

Results

Diffusion tensor imaging confirmed the expected location of the PLIC as approximated on conventional T2-weighted images in all 6 cases. In 1 patient in particular, unexpected medial deviation of the PLIC was identified, and this proved useful in tailoring the approach to a more lateral trajectory. Gross-total resection of all cystic and solid tumor components was confirmed on postoperative imaging in all cases. All patients experienced mild to moderate worsening of neurological status immediately following resection, but 4 of 6 patients were back to their preoperative baseline at 6-month follow-up.

Conclusions

Diffusion tensor imaging and white matter tractography successfully identified the white matter fibers emanating from the precentral gyrus within the PLIC in children with thalamic JPAs prior to surgery. Diffusion tensor imaging served as a valuable tool for stereotactic planning of operative approaches to thalamic JPAs. Localizing the position of the PLIC helped minimize potential neurological morbidity and facilitated gross-total resection.
Cystic degeneration of the cerebellar tonsils in pediatric patients with Chiari Type I malformation
Authors: Stevenson Charles B. , Leach James L. , Gupta Anita , Crone Kerry R.
Published: December 2009

Object

The operative indications and treatment algorithms for pediatric patients with Chiari Type I malformation (CM-I) vary widely. When an intradural approach and duraplasty are thought necessary at the time of surgery, neurosurgeons may elect to fulgurate or resect a portion of the cerebellar tonsils. Histological analyses of cerebellar tonsils resected during decompression in pediatric patients with CM-I have revealed multiple abnormal findings including extensive ischemic and degenerative changes. The authors describe an interesting phenomenon of cystic degeneration in the distal ends of the cerebellar tonsils in children undergoing operative treatment of CM-I.

Methods

The authors reviewed the clinical database of 440 pediatric patients who underwent surgical decompression for CM-I performed by a single surgeon. The clinical course, preoperative MR imaging and intraoperative ultrasound characteristics, and histological findings in 3 children found to have tonsillar cystic degeneration were analyzed and detailed.

Results

Cystic changes were subtle but uniformly evident on preoperative MR imaging and were more readily apparent on intraoperative ultrasonography. In each patient, the tonsillar cyst was resected. Histological examination revealed areas of cystic degenerative change characterized by distortion of the normal cerebellar architecture with absent Purkinje and internal granular cell layers. All children experienced improvement in their symptoms, without complication, postoperatively.

Conclusions

Cystic degeneration of the tonsils in pediatric patients with CM-I is an uncommon pathological process most likely resulting from long-standing and excessive compression. Based on their experience, the authors advocate expeditious surgical treatment, including intradural exploration and capacious duraplasty, for patients in whom there is evidence of this phenomenon on preoperative imaging.
Longitudinal assessment of regional directed delivery in a rodent malignant glioma model
Authors: Kondo Akihide , Goldman Stewart , Lulla Rishi R. , Mania-Farnell Barbara , Vanin Elio F. , Sredni Simone T. , Rajaram Veena , Soares Marcelo B. , Tomita Tadanori
Published: December 2009

Object

Direct delivery of chemotherapeutic agents for the treatment of brain tumors is an area of focus in the development of therapeutic paradigms because this method of delivery circumvents the blood-brain barrier without causing adverse systemic side effects. Few studies have investigated longitudinal tumor response to this type of therapy. In this study, the authors examined the time course of tumor response to direct delivery of a chemotherapeutic agent in a rodent malignant glioma model.

Methods

To visualize tumor response to chemotherapy, the authors used bioluminescence imaging in a rodent model. Rat 9L gliosarcoma cells expressing a luciferase gene were inoculated into adult male rat striata. Ten days following surgery the animals were randomly divided into 4 groups. Groups 1 and 2 received 20 and 40 μl carboplatin (1 mg/ml), respectively, via convection-enhanced delivery (CED); Group 3 received 60 mg/kg carboplatin intraperitoneally; and Group 4 received no treatment. Tumor growth was correlated with luminescence levels twice weekly.

Results

Differential growth curves were observed for the 4 groups. Systemically treated rats showed decreasing photon flux emission at 15.0 ± 4.7 days; rats treated with 20- or 40-μl CED showed decreased emissions at 4.0 ± 2.0 and 3.2 ± 1.3 days after treatment, respectively. Histopathologically, 6 of 12 CED-treated animals exhibited no residual tumor at the end point of the study.

Conclusions

Direct and systemic delivery of carboplatin was examined to determine how the method of drug delivery affects tumor growth. The present report is one of the first in vivo studies to examine the time course of tumor response to direct drug delivery. The results indicate that direct drug delivery may be a promising option for treating gliomas.
Solitary juvenile xanthogranuloma of the temporal muscle and bone penetrating the dura mater in a 2-month-old boy
Authors: Cornips Erwin M. J. , Cox Kimberly E. M. , Creytens David H. K. V. , Granzen Bernd , Weber Jacobiene W. , Ter Laak–Poort Mariel P.
Published: December 2009

Juvenile xanthogranuloma (JXG) is a rare histiocytic disorder primarily observed during the first 2 years of life. Most patients present with a solitary cutaneous lesion; however, others present with extracutaneous manifestations or even with systemic involvement. The authors describe a 2-month-old boy in whom was diagnosed a unifocal extracutaneous JXG involving the temporal bone. Unlike 3 other cases of solitary JXGs of the temporal bone in the literature, the present case involved destruction of the dura mater and leptomeningeal enhancement surrounding the entire temporal lobe. The lesion did not regress after an initial biopsy procedure and had to be removed more radically because of progressive mass effect on the brain. The child recently underwent a reconstructive skull procedure and is doing well almost 2 years postoperatively without evidence of disease. This case demonstrates that even in instances of extensive disease a favorable outcome is possible without chemotherapy.
Radiobiology of vestibular schwannomas: mechanisms of radioresistance and potential targets for therapeutic sensitization
Authors: Yeung Andrea H. , Sughrue Michael E. , Kane Ari J. , Tihan Tarik , Cheung Steven W. , Parsa Andrew T.
Published: December 2009

Vestibular schwannomas (VS) are benign tumors arising from the Schwann cells of cranial nerve VIII. Historically the prevailing therapy for patients with VS has been microsurgical resection. More recently, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy have gained acceptance as effective alternatives. Although the side effect profile and rates of tumor control appear to be favorable for SRS, there is a subset of radioresistant tumors that continue to progress despite properly administered radiation treatment. In this review, the authors summarize what is known about the mechanism of radioresistance in VS at the clinical and molecular level. An improved understanding of the radiobiological behavior of VS may help guide appropriate patient selection for SRS and potentially aid in the design of novel therapies to treat radioresistant tumors.
Radiosurgery for glomus jugulare: history and recent progress
Authors: Guss Zachary D. , Batra Sachin , Li Gordon , Chang Steven D. , Parsa Andrew T. , Rigamonti Daniele , Kleinberg Lawrence , Lim Michael
Published: December 2009

In this article the authors review the literature for recent studies of radiosurgical treatment for glomus jugulare. These studies demonstrate that radiosurgery results in similar glomus jugulare tumor control and a superior morbidity profile compared with surgical treatment. In addition, patients treated with radiosurgery usually remain stable clinically or improve. Given the indolent nature of these tumors, however, more follow-up is required to ensure that the immediate benefits are lasting. These preliminary reports demonstrate that the use of radiosurgery as a primary treatment for glomus jugulare should be extended to encompass more of the patients who are currently assigned to microsurgical treatment.
Ring strain and total syntheses of modified macrocycles of the isoplagiochin type
Authors: Speicher Andreas , Backes Timo , Hesidens Kerstin , Kolz Jürgen
Published: December 2009

Macrocycles of the bisbibenzyl-type are natural products that are found exclusively in bryophytes (liverworts). The molecular framework of the subtype “isoplagiochin” is of substantial structural interest because of the chirality of the entire molecule, which arises from two biaryl axes in combination with two helical two-carbon units in a cyclic arrangement. From a structural as well as a synthetic point of view we report on the total synthesis of compounds which possess more rigid two-carbon biaryl bridges like stilbene (E or Z) or even tolane moieties which were introduced starting with a Sonogashira protocol. The McMurry method proved to be a powerful tool for the cyclization to these considerably ring-strained macrocycles.
Impact of Age, Sex, Physical Function, Health-related Quality of Life, and Treatment with Adalimumab on Work Status and Work Productivity of Patients with Ankylosing Spondylitis
Authors: MAKSYMOWYCH WALTER P. , GOOCH KATHERINE L. , WONG ROBERT L. , KUPPER HARTMUT , VAN DER HEIJDE DÉSIRÉE
Published: December 2009

Objective.

To determine factors associated with work in patients with ankylosing spondylitis (AS).

Methods.

Three hundred fifteen patients with AS were enrolled in a 24-week, randomized controlled study of adalimumab with a longterm, open-label, adalimumab extension phase. Patient-reported outcome (PRO) measures included the Medical Outcome Study Short Form 36 Health Survey (SF-36), AS Quality of Life Questionnaire (ASQOL), Health Utilities Index Mark 3 (HUI-3), and Work Productivity and Activity Impairment-Specific Health Problem Questionnaire (WPAI-SHP). Multivariate logistic regression was used to analyze differences between working and nonworking patients. The relationships between PRO and WPAI-SHP scores were assessed using Pearson correlation coefficients. Multivariate modeling was applied to determine factors associated with productivity while at work. WPAI-SHP was assessed through 3 years of adalimumab exposure.

Results.

Younger age (p = 0.002) and male sex (p < 0.001) were significantly and independently associated with working patients with AS. The SF-36 Physical Component Summary score (p < 0.001), ASQOL score (p < 0.001), HUI-3 scores (p < 0.001), and both patient’s global assessment of disease activity (p < 0.001) and nocturnal pain (p < 0.001) scores were independently associated with working status. Work absenteeism due to AS was weakly correlated with all PRO scores. WPAI-SHP components of work presenteeism (lack of productivity at work), activity impairment, and overall work productivity loss due to AS were moderately correlated with quality of life as measured by the ASQOL, the SF-36 Physical Component Summary score, and the SF-36 Bodily Pain domain. Linear multivariate analyses indicated that work presenteeism was significantly associated with pain, functioning, and disease activity. Longterm adalimumab treatment was associated with sustained improvements in WPAI-SHP scores.

Conclusions.

Quality of life and the physical consequences associated with AS have a direct relationship with a patient’s ability to work. Adalimumab sustains improvements in work outcomes in patients with AS.
Echocardiography as an Outcome Measure in Scleroderma-related Pulmonary Arterial Hypertension: A Systematic Literature Analysis by the EPOSS Group
Authors: KOWAL-BIELECKA OTYLIA , AVOUAC JEROME , PITTROW DAVID , HUSCHER DOERTE , BEHRENS FRANK , DENTON CHRISTOPHER P. , FOELDVARI IVAN , HUMBERT MARC , MATUCCI-CERINIC MARCO , NASH PETER , OPITZ CHRISTIAN F. , RUBIN LEWIS J. , SEIBOLD JAMES R. , STRAND VIBEKE , FURST DANIEL E. , DISTLER OLIVER
Published: December 2009

Objective.

To assess the validation status of echocardiography with continuous Doppler (echo-Doppler) as an outcome measure in pulmonary arterial hypertension associated with systemic sclerosis (PAH-SSc).

Methods.

Structured literature review on full-text English articles was performed using the PubMed and Cochrane databases. Assessment of validation of echo-Doppler was based on the OMERACT filter criteria with the domains truth (face, content, construct, and criterion validity), discrimination, and feasibility.

Results.

Out of 35 studies eligible for analysis, only 5 included well defined PAH-SSc subgroups (World Health Organization criteria). Echo was considered as having face validity based on expert opinion and high number of studies using echo for evaluation of patients with SSc. Echo was considered partially validated with respect to criterion validity based on significant correlations between echo measures and right-heart catheterization in patients with SSc at risk of PAH/PH. However, echo was found to lack specificity (lack of content validity), since measurements of echo pulmonary pressure may be influenced by left-heart disease and interstitial lung disease. Data from general populations of patients with scleroderma indicate that evaluation of pulmonary artery pressure by echo might not be available in all PAH-SSc patients because of technical factors. No studies enabling evaluation of the discriminant capacity over time and treatment of echo in PAH-SSc could be identified.

Conclusion.

Further studies are needed to fully validate echo-Doppler as an outcome measure in PAH-SSc. These studies would include cross-sectional analysis of baseline measures and longitudinal data of placebo and verum groups in randomized controlled trials of patients with PAH-SSc.
Signs of Accelerated Preclinical Atherosclerosis in Patients with Ankylosing Spondylitis
Authors: PETERS MIKE J.L. , van EIJK IZHAR C. , SMULDERS YVO M. , SERNE ERIK , DIJKMANS BEN A.C. , van der HORST-BRUINSMA IRENE E. , NURMOHAMED MICHAEL T.
Published: December 2009

Objective.

Preliminary evidence suggests that ankylosing spondylitis (AS) is associated with an increased cardiovascular (CV) risk. We investigated subclinical atherosclerosis and arterial stiffness in patients with AS compared with controls, and identified CV and AS related risk factors for atherosclerotic disease.

Methods.

A total of 59 patients with AS who were scheduled for etanercept treatment according to the ASsessments in Ankylosing Spondylitis guidelines and 30 healthy controls were recruited. Subclinical atherosclerosis was assessed as the average intima-media thickness (IMT) of the common carotid artery. Arterial stiffness was determined by distensibility, compliance, and Young’s elastic modulus of the carotid artery.

Results.

AS patients had a greater IMT (0.62 ± 0.09 mm vs 0.57 ± 0.09 mm in controls; p = 0.02), a difference that remained after adjustment for traditional CV risk factors. AS was associated with higher carotid pulse pressure (47 ± 7 mm Hg vs 44 ± 8 mm Hg in controls; p = 0.04), but this was not due to local vessel wall properties. Among AS patients, age and body mass index (BMI) were determinants of IMT. Age, BMI, total cholesterol, triglycerides, and disease duration were identified as determinants of stiffness indices. No relationship was found between large-vessel properties and higher Bath AS disease indices or C-reactive protein values.

Conclusion.

AS was associated with subclinical atherosclerosis and arterial stiffness, supporting epidemiological evidence of an increased CV risk in these patients. Whether these differences are due to AS or to a higher prevalence of CV risk factors in patients with AS remains to be determined.
THE ULTRA STRUCTURE OF INSECT SURFACES BY SCANNING ELECTRON MICROSCOPY
Authors: Salkeld E. H. , Wilkes A.
Published: December 2009

A recent development in microscopy certain to be of great interest to entomologists is the Scanning Electron Microscope. This machine overcomes the difficulties of studying solid surfaces with a standard light microscope and the problems of the extremely small limits of penetration of the electron microscope. This new microscope focuses a stream of electrons into a beam as small as 1 μ in diameter which moves over the surface of the specimen in a regular pattern, causing secondary radiations to emerge from the surface of the specimen. These are collected by a very sensitive detector and converted to an image similar to that produced by a television tube.