bluuebunny/crossref_metadata_2025 huggingface dataset:
Familial Risks for Cancer as the Basis for Evidence-Based Clinical Referral and Counseling
Authors: Hemminki Kari , Sundquist Jan , Lorenzo Bermejo Justo
Published: March 2008

Learning Objectives

After completing this course, the reader will be able to: Describe the relative risk (using the standardized incidence ratio) of various familial cancers defined by the affected family member.Evaluate family history as a risk factor for all cancers, not only the ones for which mutation or PSA testing is recommended.Critically assess the accuracy of reported family histories.

CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com

Objective.

Reliable, clinically useful data on familial risks have not been available for all types of cancer, and familial aggregations of cancers, which are not known to belong to an inherited cancer syndrome, are often overlooked by medical referral systems. We provide uniform data on familial risks in all common cancers.

Methods.

The nationwide Swedish Family-Cancer Database includes 11.5 million individuals, born in 1932 and later, along with their parents. Standardized incidence ratios (SIRs) were calculated for age-specific familial risks in offspring.

Results.

The familial risks for offspring cancer were increased at 24 of 25 sites when a parent was diagnosed with concordant cancer, at 20 of 24 sites when a sibling was affected, and at 14 of 16 sites when a parent and at least one other sibling were affected. Among the offspring of affected parents, testicular cancer showed the highest risk, 4.52, followed by Hodgkin's disease (3.95) and esophageal cancer (3.36). At many sites, the risks between siblings were higher than those between offspring and affected parents, probably in part because of childhood environmental effects.

Conclusions.

The data show convincingly that familial clustering is a common feature for all cancer sites. The results will be helpful in implementing evidence-based guidelines for clinical genetic counseling and in facilitating the recognition of familial risk at all levels of the general medical referral system.
Commentary: How Serious Is Getting a Diagnosis of Prostate Cancer?
Authors: Barry Michael J.
Published: March 2008

This commentary discusses the downside of implementing a more aggressive PSA screening strategy as suggested by Loeb and Catalona.
Fracture properties of normal and lightweight high-strength concrete
Authors: Tang W. C. , Lo T. Y. , Chan W. K.
Published: March 2008

This paper presents the results of a comparative study on the fracture properties of high-strength concrete (HSC) with normal aggregate (crushed limestone) and lightweight aggregate (sintered fly ash). The compressive strengths of the normal and lightweight HSC were about 115 and 90 MPa respectively. The fracture properties, namely the critical stress intensity factor [Formula: see text] and critical crack tip opening displacement (CTODC) for the two-parameter model, and the fracture energy (GF) for the fictitious crack model were examined. A three-point bending test on notched beams was carried out on specimens of varying sizes to examine the size effect on the measured properties and flexural behaviour. The experimental findings indicated that the [Formula: see text] and GF values of normal aggregate HSC were more size-sensitive than that of lightweight HSC while the CTODC of both types of HSC seemed to be size-independent. Compared with the normal aggregate HSC, the lightweight HSC had a considerably lower [Formula: see text] but had a similar GF and more ductile flexural behaviour.
Performance of concrete in XS1, XS2 and XS3 environments
Authors: McCarter W. J. , Linfoot B. T. , Chrisp T. M. , Starrs G.
Published: March 2008

An extensive chloride-profiling programme was undertaken over an eight-year period on nine concrete pier-stems placed at a marine location to represent XS1, XS2 and XS3 environmental exposure conditions as defined in European Standard EN 206-1. The pier-stems were 2·0 m high and octagonal in plan with each vertical face 0·66 m wide and were constructed in groups of three (one each placed at the locations defined above): one group, which was used as a benchmark, represented plain Portland cement concrete; the second group had a waterproofing agent (Caltite) added at the time of mixing; and the third was treated with silane. Chloride concentration profiles were taken at a number of locations on each pier-stem, which were subsequently used to evaluate the temporal change in effective diffusion coefficient and surface chloride concentration for the different exposure conditions. In addition, it allowed assessment of the relative performance of the plain concrete, Caltite concrete and silaned concrete pier-stems with regard to chloride ingress.
Dynamic behaviour and constitutive model of concrete at different strain rates
Authors: Xiao S. , Li H. , Lin G.
Published: March 2008

Dynamic tensile and compressive tests are carried out to investigate the effect of strain rates on the dynamic tensile and compressive behaviour of concrete. Results of tests indicate that the tensile and compressive strengths of concrete increase with the loading rate. The initial tangential modulus and the critical strain of concrete in tension are independent of strain rate but those in compression slightly increase with the strain rate. Poisson's ratio of concrete in both tension and compression is not obviously dependent of loading rate. The static Drucker–Prager model is modified to the consistency viscoplastic Drucker–Prager model by considering the effect of strain rate. The simulation results using the proposed model show that the present model can simulate the uniaxial dynamic tension and compression behaviour of concrete well. Finally, the dynamic responses of a concrete beam under impact loading are analysed to investigate the influence of strain rates on dynamic responses of concrete structures.
THE DIFFERENTIATION OF RESPONSE NUMEROSITIES IN THE PIGEON
Authors: Machado Armando , Rodrigues Paulo
Published: March 2008

Two experiments examined how pigeons differentiate response patterns along the dimension of number. In Experiment 1, 5 pigeons received food after pecking the left key at least N times and then switching to the right key (Mechner's Fixed Consecutive Number schedule). Parameter N varied across conditions from 4 to 32. Results showed that run length on the left key followed a normal distribution whose mean and standard deviation increased linearly with N; the coefficient of variation approached a constant value (the scalar property). In Experiment 2, 4 pigeons received food with probability p for pecking the left key exactly four times and then switching. If that did not happen, the pigeons still could receive food by returning to the left key and pecking it for a total of at least 16 times and then switching. Parameter p varied across conditions from 1.0 to .25. Results showed that when p=1.0 or p=.5, pigeons learned two response numerosities within the same condition. When p=.25, each pigeon adapted to the schedule differently. Two of them emitted first runs well described by a mixture of two normal distributions, one with mean close to 4 and the other with mean close to 16 pecks. A mathematical model for the differentiation of response numerosity in Fixed Consecutive Number schedules is proposed.
Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma
Authors: Barnholtz-Sloan Jill S. , Williams Vonetta L. , Maldonado John L. , Shahani Dilip , Stockwell Heather G. , Chamberlain Marc , Sloan Andrew E.
Published: March 2008

Object

This study was undertaken to evaluate the association between age at diagnosis, patterns of care, and outcome among elderly individuals with anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM).

Methods

Using the Surveillance, Epidemiology and End Results database, the authors identified 1753 individuals with primary GBM and 205 individuals with primary AA (diagnosed between June 1991 and December 1999) who were 66 years and older and whose records were linked to Medicare information. To facilitate gathering of prediagnosis comorbidity and postdiagnosis treatment information, only those individuals were included who had the same Medicare coverage for 6 months before and 12 months after diagnosis. The odds of undergoing various combinations of treatments and the associations with outcome were calculated by tumor type and age and adjusted by various predictors.

Results

Age was not associated with treatment differences in individuals with AA. Very elderly individuals (≥ 75 years old) with GBM were more likely to have biopsy only (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78–3.59), surgery only (OR 1.47, 95% CI 1.15–1.87), or biopsy and radiation (OR 1.39, 95% CI 1.07–1.82) and were less likely to receive multimodal therapy. Regardless of patient age or lesion histological characteristics, survival was decreased in patients treated with biopsy only. Individuals with GBM who had surgery only or biopsy and radiation had worse outcomes than individuals treated with surgery and radiation. There were no differences in survival by lesion histological characteristics. Very elderly individuals with malignant astrocytomas were more likely to receive limited treatment (most pronounced in individuals with GBM). Survival variation correlated with treatment combinations.

Conclusions

These findings suggest that in clinical neurooncology patient age is associated with not receiving effective therapies and hence worse prognosis.
Outpatient brain tumor surgery: innovation in surgical neurooncology
Authors: Boulton Mel , Bernstein Mark
Published: March 2008

Object

Recent studies of conventional craniotomies and image-guided biopsies have afforded a solid characterization of surgical morbidity and the timing of its occurrence. This report outlines a novel 11-year experience with outpatient image-guided biopsy and outpatient craniotomy for supratentorial intraaxial brain tumors.

Methods

During the period between August 1996 and May 2007, 117 awake image-guided biopsies and 145 elective craniotomies for tumor resection were prospectively selected to be performed as outpatient procedures. Data were recorded for each patient regarding tumor histological type, reasons for admission if planned early discharge failed, and surgical complications.

Results

Successful discharge from the Day Surgery Unit was possible in 109 (93%) of 117 biopsy cases and 136 (94%) of 145 craniotomy cases (only 2 of which [1.5%] required unplanned readmission after discharge). Neurological worsening occurred in 5.1% of the patients who underwent image-guided biopsies, and in 5.5% of those who underwent outpatient craniotomies (based on intent-to-treat group analysis). No patient suffered an adverse event with alteration in outcome because of planned outpatient discharge.

Conclusions

Outpatient image-guided brain biopsy and outpatient craniotomy for tumor resection are safe and effective procedures in selected patients.
Identification of the optimal cortical target point for extracranial–intracranial bypass surgery in patients with hemodynamic cerebrovascular insufficiency
Authors: Peña-Tapia Pablo Gerardo , Kemmling Andre , Czabanka Marcus , Vajkoczy Peter , Schmiedek Peter
Published: March 2008

Object

The objective of this report is to describe a new approach to identify the optimal cortical target point for extracranial–intracranial (EC–IC) bypass surgery, to reliably find suitable recipient vessels for the anastomosis.

Methods

Thirty consecutive patients (17 men and 13 women; mean age 54.6 ± 11.79 years [± standard deviation]) with hemodynamic cerebrovascular insufficiency due to stenoocclusive arterial disease underwent EC–IC bypass surgery. The end of the Sylvian fissure was identified preoperatively using a specially designed template and external landmarks. At surgery, a 3-cm trephination was made, centered over the target point as determined by the template. The number, diameter, and length of the exposed cortical arteries were assessed using photographs and indocyanine green (ICG) angiograms.

Results

At least 1 recipient artery appropriate for anastomosis (≥ 1 mm) was found in every craniectomy. The mean number of suitable recipient arteries per craniotomy was 2.09 ± 0.87, the mean diameter was 1.28 ± 0.24 mm, and the mean length 10.83 ± 4.87 mm. Bypass patency was confirmed by intraoperative ICG angiography, postoperative computed tomography angiography, and digital subtraction angiography, and reached 100%.

Conclusions

Performing a 3-cm craniectomy over the described target point, reliably allows access to suitable recipient arteries for EC–IC bypass surgery.
Cigarette smoking as a risk factor for recurrence of aneurysms treated by endosaccular occlusion
Authors: Ortiz Rafael , Stefanski Michael , Rosenwasser Robert , Veznedaroglu Erol
Published: March 2008

Object

Aneurysms treated by endovascular coil embolization have been associated with coil compaction, and the rate of recanalization has been reported to be as high as 40%. The authors report the first published evidence of a correlation between aneurysm recanalization correlated with a history of cigarette smoking.

Methods

The authors conducted a retrospective chart review of all cases involving patients admitted to their institution from January 1, 2003, to December 31, 2003, for treatment of a cerebral aneurysm. Cases in which patients were treated with coil embolization were reviewed for inclusion. Coil compaction was defined as change in the shape of the coil mass. Aneurysm recanalization was defined as an increase in inflow to the aneurysm in comparison with baseline. The incidence of coil compaction and the relationship with cigarette smoking history were compared in patients with and without recurrence.

Results

A total of 110 patients qualified for inclusion. The odds ratio (OR) for aneurysm recanalization after endosaccular occlusion with respect to history of cigarette smoking was significant for the entire cohort (OR 4.53, 95% confidence interval [CI] 1.95–10.52) and especially for the female cohort (OR 3.72, 95% CI 1.45–9.54). The male cohort demonstrated a trend toward a direct correlation, but the sample size was not large enough for statistical significance (OR 7.50, 95% CI 1.02–55.00).

Conclusions

There was an increased risk of recanalization especially in patients with low-grade subarachnoid hemorrhage who had a history of cigarette smoking. These data suggest a correlation between cigarette smoking and aneurysm recurrence.
Long-term outcome of extratemporal epilepsy surgery among 154 adult patients
Authors: Elsharkawy Alaa Eldin , Behne Friedrich , Oppel Falk , Pannek Heinz , Schulz Reinhard , Hoppe Mathias , Pahs Gerald , Gyimesi Csilla , Nayel Mohamed , Issa Ahmed , Ebner Alois
Published: March 2008

Object

The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome.

Methods

This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan–Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes.

Results

Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52–58% at 0.5 years), 54.5% (95% CI 50–58%) at 1 year, and 51.1% (95% CI 48–54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78–98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic–clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002).

Conclusions

Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.
Impact of surgical treatment on tremor due to posterior fossa tumors
Authors: Kinfe Thomas M. , Capelle Hans-Holger , Krauss Joachim K.
Published: March 2008

Object

The object of this study was to investigate the impact of surgical treatment on tremor caused by posterior fossa tumors.

Methods

The authors performed a retrospective evaluation of 6 cases involving patients with tremors due to posterior fossa tumors. Patients who had been treated with neuroleptic medication or had a family history of movement disorders were excluded. All patients had postural or kinetic tremors. Tremor was mainly unilateral. The study group included 5 women and 1 man. Mean age at surgery was 59 years. Five patients underwent total or subtotal tumor resection, and 1 patient underwent stereotactic biopsy only. The histological diagnosis was epidermoid tumor in 2 patients, metastasis in 2 others, and vestibular schwannoma and low-grade glioma in 1 each.

Results

Two patients had no improvement of tremor, postoperatively. In both of these patients the tumor (low-grade glioma in 1, metastasis in the other) involved the dentate nucleus directly. In the other patients, a compressive effect on the dentate nucleus or the dentatothalamic pathways was present without invasion of the cerebellar structures, and immediate or gradual amelioration of the tremor was observed postoperatively.

Conclusions

The prognosis of tremor due to posterior fossa tumors appears to depend mainly on the involvement of tremor-generating structures. The prognosis appears to be favorable in those patients with compression of these substrates, whereas primary invasion by tumor has a poor prognosis. Caution must be used in generalizing the findings of this study because of the small number of cases in the series.
Cortical stimulation for the rehabilitation of patients with hemiparetic stroke: a multicenter feasibility study of safety and efficacy
Authors: Levy Robert , Ruland Sean , Weinand Martin , Lowry David , Dafer Rima , Bakay Roy
Published: March 2008

Object

In this prospective multicenter study the authors hypothesized that investigational epidural cortical stimulation (CS) delivered concurrently with rehabilitation therapy may enhance motor recovery following stroke.

Methods

Patients who had suffered their index stroke ≥ 4 months previously were randomized into 6 weeks of rehabilitation therapy with or without CS. Cortical stimulation, targeted by functional imaging, was delivered at ~ 50% of motor movement threshold. Primary outcome measures were Upper Extremity Fugl-Meyer (UEFM [a measure of neurological and motor function]) and Arm Motor Ability Test (AMAT [a measure of activities of daily living]) scores. The primary study end point was 4 weeks following rehabilitation therapy.

Results

A total of 24 patients, 12 per group, completed the treatment protocol. The mean interval since the patients' index stroke was 33 months (range 4–100 months). There were no deaths or cases of neurological deterioration; 1 acute postoperative seizure occurred unrelated to the device or treatment. Patients who underwent CS experienced improved hand/arm function more than control patients. The UEFM score improved 5.5 ± 4.4 points in patients in the CS group compared with 1.9 ± 4.4 points for controls (p = 0.03). A 3.5-point UEFM improvement is considered clinically meaningful. The AMAT scores for the CS group improved by 0.4 ± 0.6 points, whereas the scores in the control group improved by 0.2 ± 0.4 points (p = 0.2). A 0.21-point improvement in AMAT score is considered clinically meaningful. In the CS group, 67% of patients had clinically meaningful improvement in UEFM scores, compared with 25% of the control group (p = 0.05). Of patients in the CS group 50% had clinically meaningful improvement in UEFM as well as AMAT scores, compared with only 8% of those in the control group (p = 0.03).

Conclusions

These results suggest that subthreshold epidural CS is safe and effective during rehabilitation for recovery of arm and hand function following hemiparetic stroke. Further research in a larger cohort is needed to validate the therapeutic effect.
Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum
Authors: Kassam Amin B. , Gardner Paul A. , Snyderman Carl H. , Carrau Ricardo L. , Mintz Arlan H. , Prevedello Daniel M.
Published: March 2008

Object

Craniopharyngiomas are notoriously difficult to treat. Surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. Because of their parasellar location, often extending well beyond the sella, these tumors challenge vision and pituitary and hypothalamic function. New techniques are needed to improve outcomes in patients with these tumors while decreasing treatment morbidity. An endoscopic expanded endonasal approach (EEA) is one such technique that warrants understanding and evaluation. The authors explain the techniques and approach used for the endoscopic endonasal resection of suprasellar craniopharyngiomas and introduce a tumor classification scheme.

Methods

The techniques and approach used for the endoscopic, endonasal resection of suprasellar craniopharyngiomas is explained, including the introduction of a tumor classification scheme. This scheme is helpful for understanding both the appropriate expanded approach as well as relevant involved anatomy.

Results

The classification scheme divides tumors according to their suprasellar extension: Type I is preinfundibular; Type II is transinfundibular (extending into the stalk); Type III is retroinfundibular, extending behind the gland and stalk, and has 2 subdivisions (IIIa, extending into the third ventricle; and IIIb, extending into the interpeduncular cistern); and Type IV is isolated to the third ventricle and/or optic recess and is not accessible via an endonasal approach.

Conclusions

The endoscopic EEA requires a thorough understanding of both sinus and skull base anatomy. Moreover, in its application for craniopharyngiomas, an understanding of tumor growth and extension with respect to the optic chiasm and infundibulum is critical to safely approach the lesion via an endonasal route.
Endoscopic treatment of traumatic basal encephaloceles: a report of 8 cases
Authors: Lee Ta-Jen , Chang Po-Hung , Huang Chi-Che , Chuang Chi-Cheng
Published: March 2008

Object

Basal encephaloceles are rare entities that can present as congenital diseases; however, traumatic lesions due to head injuries or iatrogenic causes have been described in the literature. In this study the authors aimed to define placement techniques for free grafts in repairing traumatic basal encephaloceles and to describe the long-term effectiveness of endoscopic treatment.

Methods

Between September 1997 and December 2006, 8 patients with traumatic encephaloceles underwent endoscopic surgery. A free graft following an underlay (2 cribriform plate and 4 ethmoid fovea defects) or obliteration (2 sphenoid defects) procedure was used as the repair material.

Results

All traumatic basal encephaloceles with the associated skull base defects and cerebrospinal fluid (CSF) leakage were successfully treated via the endoscopic approach. There were no major complications or recurrence of meningitis or leakage of CSF encountered after an average follow-up of 77 months.

Conclusions

Long-term follow-up results demonstrated that endoscopic surgery was suitable for the treatment of traumatic basal encephaloceles. The underlay procedure is more appropriate than the overlay procedure in repairing large defects of the anterior skull base. Meticulous manipulations of the endoscope following precise autograft placement are mandatory for the successful repair of traumatic basal encephaloceles.
Bilateral malignant melanoma metastases to the internal auditory canal/cerebellopontine angle: surgical management and preservation of function
Authors: Gerganov Venelin M. , Hore Nirjhar , Herold Christian , Wrede Karsten , Stan Alexandru C. , Samii Amir , Samii Madjid
Published: March 2008

✓Although intracranial metastases of malignant melanomas are common, localization at the cerebellopontine angle (CPA) or in the internal auditory canal (IAC) is rare, and bilateral presentation especially so. We present the case of a 46-year-old Caucasian woman with bilateral IAC/CPA lesions and a prior history of malignant melanoma on the right leg. During preoperative investigations, the presence of the bilateral IAC/CPA lesions along with several radiologically identified lesions along the neural axis led to the suspicion that she had neurofibromatosis Type 2 despite her history of malignant melanoma and the lack of characteristic skin lesions and family history. Histopathological analysis of the resected lesion confirmed the intraoperative diagnosis of bilateral CPA malignant melanoma metastases. Surgical removal of the tumors via the retrosigmoid approach with preservation of normal bilateral facial nerve function and unilateral serviceable hearing, combined with control of the systemic disease, provided this patient with a near-normal quality of life for at least 42 months after the initial diagnosis of melanoma.
Surgical removal of intramuscular arteriovenous hemangioma of the upper left forearm compressing radial nerve branches
Authors: Nazzi Vittoria , Messina Giuseppe , Dones Ivano , Ferroli Paolo , Broggi Giovanni
Published: March 2008

✓The authors report on the case of a 32-year-old woman with an intramuscular arteriovenous hemangioma (AVH) of the left forearm with burning pain and paresthesias diffused to the radial nerve–related territories. The patient underwent coil embolization of the AVH and surgical removal of the remnant and regrown AVH. This case demonstrates the safety and efficacy of surgery when interventional radiology fails to achieve complete occlusion. En bloc removal of the lesion was performed through a left elbow cleft incision, and intraoperative electrophysiological monitoring and angiography with indocyanine green (ICG) were performed. The pathological diagnosis was intramuscular AVH. Postoperative follow-up examinations demonstrated the permanent disappearance of the subcutaneous mass and of the patient's sensory disturbances. Complete excision of the AVH was confirmed on postoperative magnetic resonance angiography, and no surgery-related complications or new neurological symptoms were detected.

Intramuscular AVHs are rare lesions that can be successfully treated with both coil endovascular embolization and surgery; the latter is indicated when endovascular procedures fail to occlude the AVH completely. Intraoperative angiography with ICG can be helpful in confirming the success of the procedure.
High-resolution depth electrode localization and imaging in patients with pharmacologically intractable epilepsy
Authors: Ekstrom Arne , Suthana Nanthia , Behnke Eric , B.S.E.  , Salamon Noriko , Bookheimer Susan , Fried Itzhak
Published: March 2008

✓Localization and targeting of depth electrodes in specific regions of the human brain is critical for accurate clinical diagnoses and treatment as well as for neuroscientific electrophysiological research. By using high-resolution magnetic resonance imaging combined with 2D computational unfolding, the authors present a method that improves electrode localization in the medial temporal lobe. This method permits visualization of electrode placements in subregions of the hippocampus and parahippocampal gyrus, allowing for greater specificity in relating electrophysiological and anatomical features in the human medial temporal lobe. Such methods may be extended to therapeutic procedures targeting specific neuronal circuitry in subfields of structures deep in the human brain.
Staple electrodes: an innovative alternative for intraoperative electrophysiological monitoring
Authors: Goto Tetsuya , Tanaka Yuichiro , Kodama Kunihiko , Yomo Shoji , Hara Yosuke , Sato Atsushi , Hongo Kazuhiro
Published: March 2008

✓ Intraoperative electrophysiological monitoring is essential for minimally invasive neurosurgery. The authors developed an innovative recording method using a staple electrode, consisting of a surgical skin staple and an integrated circuit (IC) test clip with a cable. The staple is put on the patient's skin after the induction of general anesthesia. After head fixation, the IC test clip is simply hooked to the staple. The authors used this method for recording in 158 consecutive cases. It took only a few minutes to set up 4–18 staple electrodes in each case. None of the staple electrodes became disconnected unintentionally, and the initial impedance was kept throughout the procedures. The authors conclude that the staple electrode is superior to conventional disc or needle electrodes in speed of setup, electrical stability, and cost-effectiveness and recommend its routine use for intraoperative electrophysiological monitoring.
Diffusion tensor imaging of brainstem tumors: axonal degeneration of motor and sensory tracts
Authors: Helton Kathleen J. , Weeks James K. , Phillips Nicholas S. , Zou Ping , Kun Larry E. , Khan Raja B. , Gajjar Amar , Fouladi Maryam , Broniscer Alberto , Boop Frederick , Li Chin-Shang , Ogg Robert J.
Published: March 2008

Object

Diffusion tensor (DT) imaging has been used to predict postoperative motor function in patients with supratentorial tumors. The authors sought to determine whether DT imaging and white matter tractography could detect axonal degeneration in patients with brainstem tumors.

Methods

A cross-sectional, retrospective study of 7 patients with brainstem tumors and 8 healthy volunteers was performed. The DT imaging data were normalized and regions of interest (ROIs) with the highest probability of sensory and motor connections were selected using the Talairach Atlas to identify the 3D millimetric coordinates of white matter tracts. An iterative process involving fractional anisotropy (FA), apparent diffusion coefficients (ADCs), and color maps was developed to precisely select ROIs in the bilateral sensory and motor tracts. The FA and ADC values were calculated for each ROI.

Results

The FA values of sensory and motor tracts significantly differed between the patient and healthy volunteer groups (p < 0.05), whereas no significant changes were found in the splenium or genu of the corpus callosum. The FA values were altered proximal and distal to the brainstem tumors with a bimodal peak of antegrade decreased FA involving second- and third-order sensory axons and retrograde decreased FA of motor axons.

Conclusions

This study demonstrates changes in diffusion properties of sensory and motor tracts consistent with degeneration to further characterize brainstem tumors in children, and the results warrant the planning of prospective trials. The rigorous methods the authors describe may provide valuable information when planning biopsies or debulking of unusual brainstem tumors, as well as improve prognostication of the possible functional tract recovery following therapy.
Epilepsy surgery in children: outcomes and complications
Authors: Kim Seung-Ki , Wang Kyu-Chang , Hwang Yong-Seung , Kim Ki Joong , Chae Jong Hee , Kim In-One , Cho Byung-Kyu
Published: March 2008

Object

Ideal epilepsy surgery would eliminate seizures without causing any functional deficits. The aim of the present study was to assess seizure outcomes and complications after epilepsy surgery in children with intractable epilepsy.

Methods

Data obtained in 134 children (75 boys and 59 girls) age 17 years or younger who underwent epilepsy surgery at Seoul National University Children's Hospital between 1993 and 2005 were retrospectively reviewed. Epilepsy surgery included temporal resection (59 cases), extratemporal resection (56 cases), functional hemispherectomy (7 cases), callosotomy (9 cases), multiple subpial transection (1 case), and disconnection of a hamartoma (2 cases). The mean follow-up duration was 62.3 months (range 12–168 months).

Results

The overall seizure-free rate was 69% (93 of 134 cases). The seizure-free rate was significantly higher in children who underwent temporal resection than in those in whom extratemporal resection was performed (88 vs 55%, p < 0.05). The most frequent causes of treatment failure were related to the absence of structural abnormality demonstrated on magnetic resonance imaging, development-associated disease, widespread disease documented by postoperative electroencephalography, and limited resection due to the presence of functional cortex. There were no postoperative deaths. Visual field defects were the most common complication after temporal resection (22% [13 of 59 cases]), whereas hemiparesis (mostly transient) was the most common morbidity after extratemporal resection (18% [10 of 56 cases]).

Conclusions

Epilepsy surgery is an effective and safe therapeutic modality in childhood. In children with extratemporal epilepsy, more careful interpretation of clinical and investigative data is needed to achieve favorable seizure outcome.
Cerebrospinal fluid eosinophilia in children with ventricular shunts
Authors: Fulkerson Daniel H. , Boaz Joel C.
Published: March 2008

Object

Eosinophils have been reported in children with cerebrospinal fluid (CSF) shunts. The goal of this study was to describe the risk factors, relationship to infection, and clinical significance of CSF eosinophilia in a large group of shunt-treated patients.

Methods

The authors performed a retrospective review of data obtained in all patients who underwent ventricular shunt placement or revision at the James Whitcomb Riley Hospital for Children between 2000 and 2004.

Results

Eosinophils were identified during a follow-up shunt evaluation in 93 (31%) of 300 patients after initial shunt placement. Eosinophilia was statistically related to CSF extravasation (p < 0.0001), shunt infection (p = 0.031), blood in CSF (p < 0.0001), younger age at shunt insertion (p = 0.030), and the diagnosis of posthemorrhagic hydrocephalus (p < 0.0001). Patients with CSF eosinophilia had a higher risk of subsequent shunt failure (p < 0.0001).

Analysis was performed using data obtained in a cohort of patients with a total of 130 shunt infections. Cerebrospinal fluid eosinophils were identified in 118 infections (90.8%). The leukocytic and eosinophilic reactions were dependent on the infecting organism. Propionibacterium acnes had a statistically lower CSF leukocyte count but higher differential percentage of eosinophils than the other common pathogens.

Conclusions

Cerebrospinal fluid eosinophilia is a relatively common finding in children with shunts. Patients with CSF eosinophilia had an increased risk of shunt malfunction in the present series. Eosinophilia is associated with infection, CSF extravasation, and blood in the CSF. Patients with P. acnes–induced shunt infections have higher eosinophil percentages than are found in infections associated with other common organisms. Therefore, in patients with eosinophilia, extended anaerobic culture studies should be performed with particular attention paid to searching for this pathogen.
Expression of MAGE and GAGE genes in medulloblastoma and modulation of resistance to chemotherapy
Authors: Kasuga Chinatsu , Nakahara Yukiko , Ueda Shigeo , Hawkins Cynthia , Taylor Michael D. , Smith Christian A. , Rutka James T.
Published: March 2008

Object

Cancer testis antigens (CTAs) were initially identified by their ability to elicit autologous T-cell–mediated immune responses in patients with melanoma. The CTA genes are widely expressed in a variety of human cancers, such as melanoma, breast cancer, lung cancer, esophageal cancer, and hepatocellular carcinoma; however, their expression in pediatric brain tumors, such as medulloblastoma (MB), has not been the subject of in-depth analysis. The MAGE proteins are members of the CTA family and have been shown to correlate with tumor development, aggressive clinical course, or resistance to chemotherapeutic agents. The authors undertook this study to examine the expression and role of MAGE proteins in human MB cell lines and specimens.

Methods

From a transcriptional profiling study in which 47,000 genes in MB cell lines were examined, the authors identified members of the MAGE and GAGE families as being highly expressed. A series of MB tumors was examined using both immunohistochemistry and Western blot analysis with antibodies to the MAGE-A family, MAGE-A1, and GAGE proteins.

Results

Western blot analysis showed expression of these 3 proteins (MAGE-A family, MAGE-A1, and GAGE) in 62, 46, and 84%, respectively, of MB specimens examined. In addition, a correlation was observed between the expression of MAGE and GAGE genes and resistance of MB cells to chemotherapeutic agents. The functional significance of this correlation was examined in MAGE knockdown studies, and increased drug-induced cytotoxicity was observed in UW426 MB cells following treatment with chemotherapeutic drugs. Cleaved caspase-3 was found in UW426/MAGE small interfering (si)RNA–inhibited cells treated with cisplatin, but not in UW426 cells treated with cisplatin alone at the same concentration.

Conclusions

These data show that MAGE and GAGE family members are expressed in MB cell lines and specimens, and that inhibition of MAGE and GAGE genes by siRNA increases apoptosis of MB cells and sensitizes them to certain chemotherapeutic agents such as cisplatin and etoposide.
Management of severe cervical kyphosis in a patient with Larsen syndrome
Authors: Madera Marci , Crawford Alvin , Mangano Francesco T.
Published: March 2008

✓ Larsen syndrome is a rare genetic disorder of the connective tissue that is characterized by multiple joint dislocations, distinctive deformities of the hands and feet, characteristic facial features, kyphoscoliosis, and segmentation anomalies of the vertebrae. Diverse treatment options, including conservative observation and surgical correction, have been reported for patients who present with cervical spine pathophysiology. Differences in surgical approaches, timing of the correction, and pre- or postoperative bracing have been reported. According to the authors, the present case is the first report of a pediatric patient with Larsen syndrome in whom an asymptomatic cervical instability was treated before neurological deterioration with synchronous anterior decompression and fixation, posterior fusion and fixation, and halo placement. A review of the literature on similar patients reveals the variety of practices associated with a diagnosis of Larsen syndrome.
Primary meningeal osteosarcoma of the brain during childhood
Authors: Dagcinar Adnan , Bayrakli Fatih , Yapicier Ozlem , Ozek Memet
Published: March 2008

✓ Primary meningeal osteosarcomas are rare tumors, with only 19 reported cases in the literature; only 4 of these, including the present case, are in pediatric patients. In this report, the authors present the case of an 8-year-old boy with a history of generalized tonic–clonic seizures who was found to harbor a meningeal osteosarcoma within the sylvian fissure. Initial working diagnoses included meningioma and glioma. After tumor enlargement and progressive symptoms, the patient underwent a large frontotemporal craniotomy and complete resection of the lesion, which recurred 6 and 12 months after the initial surgery and was surgically treated after each recurrence. The rarity of primary meningeal osteosarcomas can make their diagnosis difficult, and histopathological evaluation is mandatory for diagnosis. Because of their fast progression, they must be treated aggressively by means of surgery, chemotherapy, and radiotherapy.
Postoperative hemicerebellar inflammation mimicking recurrent tumor after resection of a medulloblastoma
Authors: Luijnenburg Saskia E. , Hanlo Patrick W. , Han K. Sen , Kors Wijnanda A. , Witkamp Theo D. , Verbeke Jonathan I. M. L.
Published: March 2008

✓ The authors present the case of a 4-year-old boy in whom a medulloblastoma in the left cerebellar hemisphere was successfully resected with no signs of residual tumor on the postoperative magnetic resonance (MR) images. A second MR imaging study performed 1 month after surgery demonstrated an extensive, contrast-enhancing lesion in the left cerebellar hemisphere, which simulated massive recurrent tumor, and repeated surgery was considered. A third postoperative MR imaging study, performed for evaluation of the craniospinal axis 10 days after the second postoperative study, still showed some contrast enhancement in the left cerebellar hemisphere, but the lesion had almost disappeared. Postoperative hemicerebellar inflammation seemed to be the most likely explanation.

This case illustrates that early postoperative inflammation can mimic recurrent tumor on MR images obtained after resection of a medulloblastoma and caution should be taken in interpreting such images. Clinical history, neurological examination, laboratory findings, and repeated MR imaging studies can be helpful in evaluating the patient accurately.
Aortocarotid bypass for hemispheric hypoperfusion in a child
Authors: Sanai Nader , Fullerton Heather , Karl Tom R. , Lawton Michael T.
Published: March 2008

✓ Large-vessel vasculitis syndromes in the pediatric population are rare and highly morbid. The authors here report on the microsurgical revascularization of a unique case of presumed vasculitis with aortitis and severe obliterative arteriopathy in a 10-month-old child with symptomatic hemispheric hypoperfusion. Using a cryopreserved saphenous vein, this unilateral aortocarotid bypass restored normal intracranial perfusion bilaterally and led to a resolution of the patient's ischemic symptoms. The aortocarotid bypass is clinically effective and technically feasible in young children when a saphenous vein allograft is used. The bypass graft is amenable to angioplasty with or without stenting if delayed stenosis becomes an issue later in life.
Influence of Dural Opening on Syringomyelia and Scoliosis in Patients with Chiari I Malformations
Authors: Feldstein Neil
Published: March 2008

Introduction

The choice of surgical procedure for decompression of Chiari I malformations is often influenced by the presence of syringomyelia. The goal of this study was to determine if syringomyelia and/or scoliosis are influenced by dural opening versus nondural opening suboccipital decompressive (SOD) procedures.

Methods

A retrospective review of 54 pediatric patients over a 13-year period presenting with Chiari I malformation and syringomyelia at time of diagnosis is presented. Between 1994 and 2002 nearly all patients underwent SOD with duraplasty (n = 26), while between 2003 and 2007 nearly all patients underwent SOD without dural opening (n = 28). Sixteen of 26 patients who underwent duraplasty presented with scoliosis while 8 of 28 patients without duraplasty had scoliosis. All of the patients had a complete spinal cord MRI before and after surgery.

Results

MRI studies clearly demonstrated a greater degree of resolution of the syrinx in the duraplasty group. However, the degree of resolution of the syrinx did not correlate with clinical outcome (that is, improvement of symptoms or progression of scoliosis). Progression of scoliosis was rare in either group.

Conclusion

While much controversy exists as to the best method of decompression in patients with Chiari I malformations, it does not appear from this study that dural opening influences the clinical progression of syringomyelia or scoliosis.
Network Comparison of Epileptogenic Human Cortex and Excited Rat Cortex
Authors: Smith Jodi L. , Hobbs Jon , Tang Aonan , Jackson David , Chen Wei , Patel Hema , Prieto Anita , Sher Alexander , Litke Alan , Beggs John M.
Published: March 2008

Introduction

Epileptogenicity of neuronal tissues requires both altered excitability and altered synchronization of neurons. However, the network-level mechanisms responsible for neuronal hyperexcitability and synchronization remain unknown, and there is much to learn regarding how even small networks of neurons interact. The present study examines local and network properties of cortical neurons from epileptogenic human and excited (“epileptic”) rat cortex.

Methods

Epileptogenic cortex was harvested from pediatric patients with medically refractory seizures undergoing resective surgery. Local field potential signals (LFPs) were recorded continuously for up to several hours with a 60-channel microelectrode array. We also recorded LFPs from slices and organotypic and dissociated cultures of rat cortex bathed in high K+ and low Mg++. We then compared the human and rat data, applied a second-order maximum entropy model (MEM) to the data, and explored how well the MEM predicted sequences of correlated states over time.

Results

Both human and rat cortex produced LFP signals in the form of interictal spikes on almost all electrodes. However, only human cortex demonstrated spontaneous activity in normal cerebrospinal fluid, and the LFPs from human cortex showed greater synchrony across electrodes than the rat LFPs. Moreover, when a second-order MEM was applied to human and rat data, the model accounted for roughly 88% of network correlations. However, in 8/13 preparations the observed sequences of correlated states were significantly longer than predicted by independently concatenating states from the model, suggesting that temporal dependencies are a common feature of cortical network activity.

Conclusion

Excited slices of rat cortex fail to capture some important features of network activity found in epileptogenic human cortex. Furthermore, a second-order MEM successfully predicts correlated states in cortical networks, but not their evolution over time. Thus, higher-order MEMs are necessary to account for temporal correlations observed between states.