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Background Histologic and molecular subtyping have become increasingly important as predictors of treatment benefit in lung cancer. The objective of the present study was to determine whether current diagnostic approaches provide adequate tissue to allow for individualized treatment decisions. Methods Our retrospective cohort study of new lung cancer patients seen at an academic centre between July 2007 and June 2008 collected baseline demographic and diagnostic information, including mode of diagnosis, type of diagnostic material, and pathology diagnosis. Results Of the 431 study patients, 20% had stage I or II non-small-cell lung cancer (NSCLC), 24% stage III disease, and 39% stage IV NSCLC. Three quarters of the small-cell lung cancer (SCLC) cases were extensive stage. Diagnostically, 18% of patients had SCLC; 30%, adenocarcinoma; 27%, squamous-cell cancer; 2%, large-cell carcinoma; 1%, bronchoalveolar carcinoma; 1%, mixed histology; 18%, NSCLC not otherwise specified; 4%, other; and 2%, no pathology diagnosis. Surgical pathology material was available in 80% of cases, and cytology material alone in 20%. Surgical pathology material was more common in patients with early-stage than with advanced disease (89% for stages I and II vs. 74% for stages III and IV, p < 0.0001). The pathology report included ambiguous terms in 24% of cases: "consistent" (12%), "suspicious" (3%), "favour" (2%), "suggestive" (2%), "likely" (1%), "compatible" with malignancy (1%), "at least" (1%), "atypical" (0.5%), and "no pathology" (1.5%). Conclusions Current diagnostic approaches in most lung cancer patients appear adequate, but complete histopathologic identification is missing in nearly 20% of cases, and some uncertainty as to the final diagnosis is expressed in 24% of pathology reports. Some improvement in diagnostic sampling and pathology reporting are required to allow for implementation of current treatment approaches. [ABSTRACT FROM AUTHOR]

Background Recruitment to clinical trials remains poor, and patient knowledge of clinical trials is one barrier to recruitment. To identify knowledge deficits, we conducted and compared surveys measuring actual patient knowledge and clinical trialist priorities for patient knowledge. Methods Consenting patients at a tertiary cancer centre answered a survey that included • 2 opinion questions about their own knowledge and willingness to join a trial, and • 22 knowledge questions. Clinical researchers at the centre were asked 13 questions about the importance of various trials factors. Results Of 126 patients surveyed, 16% had joined a clinical trial, and 42% had a secondary school education or less. The mean correct response rate on the knowledge questions was 58%. Higher rates of correct responses were associated with lower age (p = 0.05), greater education (p = 0.006), prior trial participation (p < 0.001), agreement or strong agreement with perceived understanding of trials (p < 0.001), and willingness to join a clinical trial (p = 0.002). Trialists valued an understanding of the rationale for clinical trials and of randomization, placebo, and patient protection, but those particular topics were poorly understood by patients. Conclusions Patient knowledge about clinical trials is poor, including knowledge of several concepts ranked important by clinical trialists. The findings suggest that when developing education interventions, emphasis should be placed on the topics most directly related to patient care, and factors such as age and education level should be considered. [ABSTRACT FROM AUTHOR]

We performed a retrospective review of 78 consecutive neurosurgical procedures using Vicryl Collagen®, a resorbable mesh of polyglactin 910 coated with bovine collagen, for dural substitution. The complications we encountered were infrequent and mostly minor (5 cases of subcutaneous CSF collections, 2 cases of aseptic meningitis, 1 superficial wound infection), and not unusual for the surgical procedures studied. One patient, however, had a major infection, starting in the superficial tissues, and extending toward the brain. In this patient, the resorption of the dural substitute appeared to be the cause for the intracranial extension of the infection. Three patients were reoperated on for recurrent tumour after a longer interval. We found minimal adhesions and good fibrous incorporation of the Vicryl Collagen® into the surrounding normal dura. We conclude that Vicryl Collagen® is a valuable alternative to the patient’s own fibrous tissues when dural substitution is necessary. [ABSTRACT FROM AUTHOR]

We performed a retrospective follow-up study of 33 patients, with 34 ruptured aneurysms, treated by coating using bio-adhesive polymers. The rebleeding rate after a mean follow-up of 10 years was 18% (6 patients), with 4 cases of early haemorrhage and 2 late rebleedings (late rebleeding rate of 0.7% per year). All rebleedings proved fatal. Coating of the aneurysmal wall provides some protection in patients with 'unclippable' aneurysms, but is obviously inferior to clipping, and should be used only in very selected cases. [ABSTRACT FROM AUTHOR]

This study presents a series of 10 patients with anterior skull base tumours, treated by a team of neurosurgeons and head- and neck surgeons. The series included 7 malignant tumours of the nose and paranasal sinuses and 1 retinoblastoma, all with intracranial extension through the lamina cribrosa. There were also 2 patients with an anterior base meningioma, growing into the ethmoid sinus and the nasal cavity. 8 tumours were resected by a combined bifrontal craniotomy and uni- or bilateral rhinotomy. In 2 cases a bifrontal craniotomy alone without facial incision sufficed. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of wound infection, CSF-leakage or meningitis. Recurrent tumour growth or systemic metastasis occurred in 5 out of 7 patients with malignant tumours, 6 months to 2 years postoperatively. The related literature and especially questions of operative indications and technique, including different possibilities of closure and reconstruction of the skull base, are discussed. [ABSTRACT FROM AUTHOR]

We compared magnetic resonance angiography (MRA) and intra-arterial digital subtraction angiography (IADSA) in the study of brain tumours and assessed the utility of gadolinium-enhanced MRA. We studied 17 patients with supratentorial brain tumors. The entire brain was imaged with multiple overlapping thin volume acquisitions. After IV injection of gadolinium-DTPA, a single thick-slab MRA acquisition was performed. Standard three-dimensional (3D-TOF) acquisitions (in six patients) and 3D-TOF with magnetization transfer prepulse and tilted optimisation nonsaturing radiofrequency excitation pulses (in 11 patients) were used. Displacement of the anterior cerebral artery, main stem and insular branches of the middle cerebral artery was seen well on unenhanced and contrast-enhanced MRA. Displacement of the lenticulostriate and anterior choroidal arteries was seen only once, after Gadolinium. Tumour encasement of the middle cerebral artery was demonstrated in one patient. Tumour vessels were seen in 2 of 8 cases before and 3 of 8 after gadolinium; Tumour hypervascularity was seen only after gadolinium, in 3 of 8 cases. Study of the veins was possible only on gadolinium-enhanced MRA. Displacement of the venous angle was seen in 4 of 7 patients in the frontal, and in all of 8 patients on the lateral projections. Early venous drainage was not seen. Patency of the dural venous sinuses was demonstrated in all patients, but in one neoplastic occlusion of a cortical vein was recognised. [ABSTRACT FROM AUTHOR]

In a retrospective study of 72 patients with developmental venous anomalies (DVA) diagnosed by MRI and/or angiography, 33 associated lesions were found in 32 patients (44%). Study of the clinical files allowed classification of the patient population into three groups. In group 1 (11 patients: 34%) the symptoms were attributed with certainty to the associated lesions (1 brain infarction, 2 multiple sclerosis patients, 1 case of meningitis, and 7 patients with tumors). In group 2 (9 patients: 28%) the symptoms were probably caused by the associated lesion and not by the associated DVA (1 contusion, 1 Sturge-Weber angiomatosis, and 7 hemorrhagic DVA). In group 3 (12 patients: 38%) the symptoms were nonspecific (10 cavernous angiomas, 1 varix with sinus pericranii, and 1 ectasia of the middle cerebral artery. These findings sustain the theory that DVA is a congenital anomaly of the venous drainage of the brain, without pathological significance, and must be considered as an incidental finding. [ABSTRACT FROM AUTHOR]

Two cases of Lhermitte-Duclos of the cerebellum are presented. MRI was essential in the radiological diagnosis of both lesions by the demonstration, both on T1- and T2 weighted images of thickened cerebellar folia. [ABSTRACT FROM AUTHOR]

A method for multiparametric quantitative cerebral angioscintigraphy is described. For the evaluation of the symmetry of hemispherical bolus transit the following parameters were used: the cumulative L/R hemispheric ratios expressed in arctangent values and the sequential hemispheric activity difference. Both the sensitivity and specificity of this technique for detection of proven stenosis of carotid or cerebral arteries (25 cases) were 80%, in comparison with 60% for computerized axial tomography. A few clinical examples illustrate the diagnostic utility of quantitative cerebral angioscintigraphy. The value of the different quantitative parameters is discussed and compared with other similar studies. With regard to the complementary role of computerized axial tomography and serial cerebral scintigraphy the results of other authors were confirmed. Considering the broad field of application for dynamic brain scintigraphy and the fact that both sensitivity and specificity of this exploration are comparable to, or even better than, CT, it is our opinion that isotopic exploration remains a reliable detection method for cerebrovascular discase. [ABSTRACT FROM AUTHOR]

The concept of a circular economy has been proposed as a key component of a solution for the finiteness of earth's resources. As one path, the research on the direct reuse of construction components focusses on strategies for designing buildings for disassembly in the end-of-life stage. This is of particular importance because it can reduce the environmental impact of the construction industry. The recently published ISO 20887 also advocates to design buildings for disassembly and to use standard-sized components. However, to the authors' knowledge the role of standardisation in this process remains unexplored. Therefore, in this paper the evolution of standardisation is studied in order to identify the drivers for standardisation and currently available standards that aid and support the claims of the ISO 20887. This study concludes that most standards are introduced from an economic, rather than an environmental point of view. Also, ISO 20887 seems to be the first actual standard addressing the idea of reusing building components. Through an integrative discussion of the available types of construction standards, the problem areas obstructing the required further standardisation are identified: protectionism of contractors whom perceive standardisation as a threat, protectionism of manufacturers whom are reluctant to change the organisation structure, and designers whom seem least aware of the need to implement the circular economy in the construction sector. Finally, a corresponding trajectory is proposed for future standardisation to tackle these problem areas and to actually perform its role as an essential enabler for circular Reuse in the construction sector. • No written standards aiding the circular reuse of building components are available. • Standards are introduced from an economic, rather than an environmental perspective. • The development of standards for circular Reuse concerns all construction stakeholders. • Standardisation can enable circular Reuse and effectuate a cleaner construction industry. [ABSTRACT FROM AUTHOR]

Studies a significant response to neoadjuvant chemotherapy in breast cancer related to the BRCA1 and BRCA2 genes. Key issues of interest; Analysis of pertinent topics and relevant issues; Theoretical significance to medical genetics.

Presents a letter to the editor of the periodical "Journal of Medical Genetics," concerning the penetrance of breast cancer in BRCA1/2 mutation carriers.