bluuebunny/crossref_metadata_2025_split huggingface dataset:
Capsule of parotid gland tumor: evaluation by 3.0 T magnetic resonance imaging using surface coils
Authors: Ishibashi Mana , Fujii Shinya , Kawamoto Katsuyuki , Nishihara Keisuke , Matsusue Eiji , Kodani Kazuhiko , Kaminou Toshio , Ogawa Toshihide 
Published: October 2010

Background: Magnetic resonance (MR) imaging of parotid gland tumors has been widely reported, although few reports have evaluated the capsule of parotid gland tumors in detail. Purpose: To evaluate the diagnostic usefulness of 3.0 T MR imaging with surface coils for detection of the parotid gland tumor capsule, and to clarify the characteristics of the capsules. Material and Methods: Seventy-eight patients with parotid gland tumors (63 benign and 15 malignant) were evaluated. Axial and coronal T2-weighted and contrast-enhanced T1-weighted images were obtained using a 3.0 T MR scanner with 70 mm surface coils. It was retrospectively assessed whether each parotid gland tumor was completely surrounded by a capsule. The capsule was classified as regular or irregular in terms of capsular thickness, and as none, mildly, or strongly enhancing in terms of contrast enhancement. Visual interpretations were compared with histopathological findings to evaluate the diagnostic ability of MR imaging to detect parotid gland tumor capsules. Statistical evaluation was conducted concerning the presence of capsules, capsular irregularity, and the difference in contrast enhancement between benign and malignant tumors, and that between pleomorphic adenomas and Warthin's tumors. Results: Capsules completely surrounding the tumor on MR imaging yielded a sensitivity of 87.7% (50/57), specificity of 90.5% (19/21), and accuracy of 88.5% (69/78). Benign tumors had a capsule completely surrounding the tumor significantly more often than malignant tumors ( P = 0.009). Concerning capsular irregularity, malignant tumors tended to have more irregular capsules than benign tumors, although there were no significant differences. The capsules of malignant tumors enhanced significantly more strongly than those of benign tumors ( P = 0.018). Conclusion: 3.0 T MR imaging using surface coils could correctly depict parotid gland tumor capsules in most cases. Most benign and some malignant tumors had capsules completely surrounding the tumors. Malignancy should be considered in tumors with irregular and strongly enhancing capsules.
Computer-aided detection system applied to full-field digital mammograms
Authors: Bolivar Alfonso Vega , Gomez Sonia Sánchez , Merino Paula , Alonso-Bartolomé Pilar , Garcia Estrella Ortega , Cacho Pedro Muñoz , Hoffmeister Jeffrey W. 
Published: October 2010

Background: Although mammography remains the mainstay for breast cancer screening, it is an imperfect examination with a sensitivity of 75–92% for breast cancer. Computer-aided detection (CAD) has been developed to improve mammographic detection of breast cancer. Purpose: To retrospectively estimate CAD sensitivity and false-positive rate with full-field digital mammograms (FFDMs). Material and Methods: CAD was used to evaluate 151 cases of ductal carcinoma in situ (DCIS) ( n=48) and invasive breast cancer ( n=103) detected with FFDM. Retrospectively, CAD sensitivity was estimated based on breast density, mammographic presentation, histopathology type, and lesion size. CAD false-positive rate was estimated with screening FFDMs from 200 women. Results: CAD detected 93% (141/151) of cancer cases: 97% (28/29) in fatty breasts, 94% (81/86) in breasts containing scattered fibroglandular densities, 90% (28/31) in heterogeneously dense breasts, and 80% (4/5) in extremely dense breasts. CAD detected 98% (54/55) of cancers manifesting as calcifications, 89% (74/83) as masses, and 100% (13/13) as mixed masses and calcifications. CAD detected 92% (73/79) of invasive ductal carcinomas, 89% (8/9) of invasive lobular carcinomas, 93% (14/15) of other invasive carcinomas, and 96% (46/48) of DCIS. CAD sensitivity for cancers 1–10 mm was 87% (47/54); 11–20 mm, 99% (70/71); 21–30 mm, 86% (12/14); and larger than 30 mm, 100% (12/12). The CAD false-positive rate was 2.5 marks per case. Conclusion: CAD with FFDM showed a high sensitivity in identifying cancers manifesting as calcifications or masses. CAD sensitivity was maintained in small lesions (1–20 mm) and invasive lobular carcinomas, which have lower mammographic sensitivity.
Subaxial sagittal alignment and adjacent-segment degeneration after atlantoaxial fixation performed using C-1 lateral mass and C-2 pedicle screws or transarticular screws
Authors: Yoshida Go , Kamiya Mituhiro , Yoshihara Hisatake , Kanemura Tokumi , Kato Fumihiko , Yukawa Yasutugu , Ito Keigo , Matsuyama Yukihiro , Sakai Yoshihito 
Published: October 2010

Object
The purpose of this study was to evaluate the effect of a fixed atlantoaxial angle on subaxial sagittal alignment, and that of atlantoaxial fixation on adjacent-segment motion and degeneration.

Methods
The authors retrospectively reviewed 65 patients in whom atlantoaxial instability was treated with atlantoaxial fixation by C-1 lateral mass and C-2 pedicle screw fixation (30 patients, Goel-Harms [GH] group) or a combination of transarticular screw fixation and posterior wiring (35 patients, Magerl-Brooks [MB] group). Angles of Oc–C1, C1–2, C2–3, and C2–7 were determined based on an upright lateral radiograph in flexion, neutral, and extension positions. The range of motion (ROM) at Oc–C1 and C2–3 was also determined. All patients were examined before and 2 years after surgery.

Results
The mean preoperative atlantoaxial angles in the GH and MB groups were 20.9 ± 8.3° and 18.3 ± 7.2°, respectively, and the mean postoperative atlantoaxial angles in the same groups were 23.5 ± 5.6° and 29.7 ± 6.3°, respectively, with a statistically significant difference between the 2 groups (p < 0.05). The mean preoperative angles of C2–7 in the GH and MB groups were 15.4 ± 7.8° and 13.7 ± 9.5°, respectively, and after surgery, the angles were 11.8 ± 12° and 2.48 ± 12°, respectively, with a statistically significant difference between the 2 groups (p < 0.05). The postoperative angle of C1–2 showed a negative correlation with the extent of change observed in the C2–7 angle preand postoperatively in each of these 2 surgical procedures. The Oc–C1 ROM increased after surgery in both groups, but the difference was not statistically significant (p = 0.38). The C2–3 ROM decreased after surgery in both groups, and the difference was statistically significant (p < 0.05).

Conclusions
Atlantoaxial fixation in a hyperlordotic position produced kyphotic sagittal alignment after surgery in both GH and MB groups. Reduction of the atlantoaxial joint can be easily achieved through screw fixation at an optimal angle, thereby ameliorating the risk for subsequent subaxial kyphosis. Degeneration of lower adjacent segments appeared to be less with this procedure compared with using a combination of transarticular screw fixation and posterior wiring.
Influence of low glucose supply on the regulation of gene expression by nucleus pulposus cells and their responsiveness to mechanical loading
Authors: Rinkler Christina , Heuer Frank , Pedro Maria Teresa , Mauer Uwe Max , Ignatius Anita , Neidlinger-Wilke Cornelia 
Published: October 2010

ObjectEnvironmental alterations resulting in a decrease in the nutrient supply have been associated with intervertebral disc (IVD) degeneration, particularly of the nucleus pulposus (NP). The goal of the present study was to examine the hypothesis that glucose deprivation alters the metabolism of NP cells and their responsiveness to mechanical loading. A possible interaction of glucose supply and hydrostatic pressure (HP) with gene expression by NP cells has not been investigated.MethodsThe influence of glucose supply (physiological concentration: 5 mM, reduction: 0 or 0.5 mM) and cyclic HP loading (2.5 MPa, 0.1 Hz, 30 minutes) on bovine and human NP cell matrix turnover was analyzed by quantitative real-time reverse transcriptase–polymerase chain reaction. Glucose-dependent effects on cell viability were determined by trypan blue exclusion. A glycosaminoglycan (GAG) assay was performed to determine nutritional effects on the protein level.ResultsGlucose reduction resulted in significant downregulations (p < 0.05) of aggrecan, collagen-I, and collagen-II gene expression by bovine NP cells. Exemplary human donors also displayed a similar trend for aggrecan and collagen-II, whereas matrix metalloproteinases (MMPs) tended to be upregulated under glucose deprivation. After HP loading, human NP cells showed individual upregulations of collagen-I and collagen-II expression, while MMP expression tended to be downregulated under glucose reduction relative to a normal glucose supply. Cell viability decreased with glucose deprivation. The GAG content was similar in all groups at Day 1, whereas at Day 3 there was a significant increase under physiological conditions.ConclusionsGlucose deprivation strongly affected NP cell metabolism. The effects of an altered glucose supply on gene expression were more pronounced than the mechanically induced effects. Data in this study demonstrate that the glucose environment is more critical for disc cell metabolism than mechanical loads. In individual human donors, however, adequate mechanical stimuli might have a beneficial effect on matrix turnover during IVD degeneration.
Anterior transsternal approach for a lesion in the upper thoracic vertebral body
Authors: Zengming Xiao , Maolin He , Xinli Zhan , Qianfen Chen 
Published: October 2010

Object
Access to the upper thoracic vertebrae has been hampered by numerous anatomical structures and is further impaired by the transition from cervical lordosis to thoracic kyphosis. Therefore, the authors endeavored to study an anterior transsternal approach for upper thoracic disease (T1–4).

Methods
Fifty-four patients with upper thoracic disease underwent anterior decompression and fusion with sternotomy. Ages in the 33 men and 21 women ranged from 37 to 69 years (average 49 years). Before surgery, there were 7 patients with Frankel Grade B function, 17 with Grade C, 21 with Grade D, and 9 with Grade E. For a T-1 and T-2 lesion, the authors used “inside window of the brachiocephalic artery”: the brachiocephalic artery and right arteria carotis communis were retracted to the right, and the tracheoesophageal sheath was retracted to left. For a T-3 and T-4 lesion, the authors used the “outside window of the brachiocephalic artery”: the trachea, esophagus, and brachiocephalic artery were retracted to the left, the proximal portion of the right innominate vein was retracted to the right, and the left innominate vein was retracted inferolaterally. The patients were followed up for 24–48 months.

Results
The surgery was successful. The operation time was 120–150 minutes, and bleeding during the operation was 300–800 ml. After surgery, pain resolved in all patients, and improvement in motor deficits was noted in those who had presented with radiculopathy or myelopathy. Postoperative histological examinations showed that 33 patients had tuberculosis, 14 had metastatic neoplasm, 5 had eosinophilic granuloma, and 2 had traumatic fracture. Four patients died of systemic metastatic cancer between 10 and 21 months after surgery. There was no serious approach-related postoperative complication and no breakage of screws or failure of the internal fixation during follow-up.

Conclusions
Upper thoracic vertebrae can be exposed with sternotomy. This approach can provide excellent access to a lesion.
Cordotomy for patients with thoracic malignant astrocytoma
Authors: Nakamura Masaya , Tsuji Osahiko , Fujiyoshi Kanehiro , Watanabe Kota , Tsuji Takashi , Ishii Ken , Matsumoto Morio , Toyama Yoshiaki , Chiba Kazuhiro 
Published: October 2010

Object
The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure.

Methods
Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined.

Results
Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted.

Conclusions
One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.
Immunogenicity of osteogenic protein 1: results from a prospective, randomized, controlled, multicenter pivotal study of uninstrumented lumbar posterolateral fusion
Authors: Hwang Chang Ju , Vaccaro Alexander R. , Hong Joseph , Lawrence James P. , Fischgrund Jeffrey S. , Alaoui-Ismaili Moulay Hicham , Falb Dean 
Published: October 2010

Object
The aim in this study was to detect and quantify antibody responses against recombinant human osteogenic protein 1 (OP-1) and to compare these responses to patient clinical outcomes and safety information.

Methods
A controlled, open-label, randomized, prospective, multicenter pivotal study was performed in which patients with single-level Grade I or II degenerative lumbar spondylolisthesis (Meyerding classification) and spinal stenosis underwent decompression and uninstrumented posterolateral spinal arthrodesis. Three hundred thirty-six patients were randomized in a 2:1 fashion to receive either OP-1 Putty or autogenous iliac crest bone graft. Patients were evaluated at regular postoperative intervals for radiographic results, clinical outcomes, and safety parameters for more than 36 months. Serum samples were collected over this period and evaluated for the presence of anti–OP-1 antibodies and neutralizing activity by using a battery of in vitro binding assays (including enzyme-linked immunosorbent assay [ELISA]) and cell-based bioassays, respectively.

Results
Antibodies were predominantly seen in the OP-1–treated patients, although some responses were recorded preoperatively and in patients receiving autograft alone. Antibody production peaked in the 6-week to 3-month postoperative time frame and diminished thereafter. Neutralizing antibodies (Nabs) were detected at 1 time point at least in 25.6% of the patients treated with OP-1 Putty, but were not found in any patient following the 24-month postoperative time period. A single autograft patient (1.2%) also presented with OP-1 Nabs. An anti–OP-1 antibody status did not correlate with any measure of patient outcomes or adverse events.

Conclusions
Recombinant human OP-1 (bone morphogenetic protein 7), like many recombinant human proteins, induces an immune response following its use as a bone graft alternative. This response was transient and diminished over time, and there was no statistical evidence to suggest an association between Nab status and any of the efficacy or safety criteria that were examined.
Effectiveness of a clinical pathway for patients with cerebrospinal fluid shunt malfunction
Authors: Chern Joshua J. , Macias Charles G. , Jea Andrew , Curry Daniel J. , Luerssen Thomas G. , Whitehead William E. 
Published: October 2010

Object
Patients with CSF shunts often present to the emergency department (ED) with suspected shunt malfunction. Timely assessment and treatment are important factors affecting patient outcomes. A protocol was implemented at a tertiary children's hospital ED to expedite the care of these patients. This study evaluated the effectiveness of this protocol.

Methods
The protocol assigned all patients with CSF shunts into 1 of 3 pathways. If a patient presented with altered mental status, the Cushing triad, acute focal neurological deficit, ongoing seizure activity, or severe dehydration due to emesis, an ED physician was immediately notified (emergency pathway). If a patient presented with emesis, headache, increasing frequency of seizure, or parental concern for shunt malfunction, the patient entered the expedited pathway, and imaging studies were ordered prior to physician evaluation. All other patients entered the default pathway, in which a physician would evaluate the patient before deciding on further workup. Outcomes of interest included measures of timeliness in the ED and clinical outcomes. Comparisons were made between preprotocol and protocol periods and among the 3 pathways.

Results
The total time to complete both ED physician evaluation and to initiate imaging studies was significantly shorter in the protocol period than in the preprotocol period (104 vs 147 minutes). Similar time saving over the 2 processes was demonstrated comparing expedited and default pathways during the protocol period (95 vs 134 minutes, a 29% difference). Clinically, more patients underwent surgery in the expedited pathway than the default pathway (36% vs 17%), and patients in the expedited pathway had a shorter hospital stay (3.4 ± 0.9 days vs 5.7 ± 4.0 days; p = 0.02).

Conclusions
An ED-based protocol helped identify patients at risk for shunt failure early in the triage process and shortened the assessment process prior to neurosurgical intervention. Improving the timeliness of care for patients with shunt failure is important because morbidity and mortality associated with shunt failure are time dependent.
Postoperative imaging surveillance in pediatric pilocytic astrocytomas
Authors: Dorward Ian G. , Luo Jingqin , Perry Arie , Gutmann David H. , Mansur David B. , Rubin Joshua B. , Leonard Jeffrey R. 
Published: October 2010

Object
Currently there is no consensus regarding the frequency of neuroimaging following gross-total resection (GTR) of pilocytic astrocytoma (PA) in children. Whereas several reports recommend no postoperative imaging, one study proposed surveillance MR imaging studies to detect delayed recurrences.

Methods
The records of 40 consecutive pediatric patients who underwent GTR of infratentorial PAs were examined. All had follow-up duration of ≥ 2 years. Patients underwent early (< 48 hours) postoperative MR imaging, followed by surveillance imaging at 3–6 months, 1 year, and variably thereafter. The classification of GTR was based on a lack of nodular enhancement on early postoperative MR imaging. Demographic, clinical, and pathological variables were analyzed with respect to recurrence status. Univariate and multivariate analyses were performed to evaluate the association between pathological variables and recurrence-free survival (RFS).

Results
Of 13 patients demonstrating new nodular enhancement on MR imaging at 3–6 months, the disease progressed in 10, with a median time to recurrence of 6.4 months (range 2–48.2 months). At last follow-up, 29 patients had no recurrence, whereas in 1 additional patient the tumor recurred at 48 months, despite the absence of a new contrast-enhancing nodule at 3–6 months (for a total of 11 patients with recurrence). No demographic variable was associated with recurrence. Nodular enhancement on MR imaging at 3–6 months was significantly associated with recurrence in both univariate (p < 0.0001) and multivariate (p = 0.0015) analyses. Among the pathological variables, a high Ki 67 labeling index (LI) was similarly significantly associated with RFS in both univariate (p = 0.0016) and multivariate (p = 0.034) analyses. Multivariate models that significantly predicted RFS included a risk score incorporating Ki 67 LI and CD68 positivity (p = 0.0022), and a similar risk score combining high Ki 67 LI with the presence of nodular enhancement on initial surveillance MR imaging (p < 0.0001).

Conclusions
Surveillance MR imaging at 3–6 months after resection predicts tumor recurrence following GTR. One patient suffered delayed recurrence, arguing against a “no imaging” philosophy. The data also highlight the pathological variables that can help categorize patients into groups with high or low risk for recurrence. Larger series are needed to confirm these associations.
Microfibrillar collagen hemostat–induced necrotizing granulomatous inflammation developing after craniotomy: a pediatric case series
Authors: Apel-Sarid Liat , Cochrane Doug D. , Steinbok Paul , Byrne Angela T. , Dunham Christopher 
Published: October 2010

Object
Microfibrillar collagen hemostat (MCH; trade name Avitene) is a partially water-insoluble acid salt of purified bovine corium collagen. This agent has been widely used to control hemorrhage at surgery, and especially during pediatric neurosurgeries at the authors' institution. Despite its effectiveness, rare case reports detailing adverse inflammatory reactions to MCH have been documented. Based primarily on MR imaging, postoperative reactions have most commonly elicited clinical differential diagnoses of tumor recurrence or abscess. According to the literature, MCH induces a very characteristic mixed inflammatory response that is rich in eosinophils; in light of these observations, many authors have suggested an allergy-based pathogenesis.

Methods
The authors retrospectively reviewed 3 pediatric neurosurgical cases treated at their institution, wherein a common histomorphological inflammatory reaction to MCH was elicited at the site of prior craniotomy.

Results
Case 1 is that of a 10-year-old girl whose diagnosis was a right temporal lobe ganglioglioma, classified as WHO Grade I. Case 2 is that of a 9-year-old boy whose diagnosis was a left parietal lobe anaplastic ependymoma, classified as WHO Grade III. Finally, Case 3 is that of a 15-year-old girl whose diagnosis was focal cortical dysplasia Type IIA affecting the left occipital lobe. Each patient presented with new or recurrent seizures 5–6 weeks after the initial resection. The postsurgical reactions incited by MCH mimicked the radiological appearance of either an abscess (Cases 2 and 3) or recurrent tumor (Case 1). Histologically, the mixed inflammatory infiltrate was typified by the presence of MCH-centric necrotizing granulomas that were surrounded by a palisade of macrophages and often several eosinophils.

Conclusions
The findings are in keeping with previous case reports describing the clinicopathological features of adverse reactions occurring due to MCH. Based on the authors' observations, the possibility of an idiopathic inflammatory reaction to MCH should be considered when either seizures, a typical radiological appearance (that is, consistent with tumor recurrence or abscess formation), or both arise shortly after initial surgery. A conservative treatment approach to this type of inflammatory lesion appears to be the most appropriate management strategy.