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Object. To determine the efficacy and accuracy of surgically-assisted systems including endoscopy combined with neuronavigation in the treatment of pineal region tumours through the occipital transtentorial approach, an evaluation of thirty-one patients undergoing surgery was performed over a 10-year period. Method. The study was performed in 2 parts. The surgical approach to the pineal region was the same in the two parts, but in part 2 a smaller craniotomy window was used. Part 1 (from March 1989 to March 1997) included 15 patients who underwent surgical removal of pineal region tumours without using assisted systems; four out of the fifteen patients had surgery-related complications, including seizure and hemianopsia. Part 2 (from April 1997 to February 1999) included 16 patients who underwent surgical treatment by the same surgical team and with assisted systems; all 16 patients had excellent outcomes, with no complications. Conclusions. Although this study was the first specifically to examine the efficacy of endoscopy combined with neuronavigation in the treatment of pineal region tumours, our findings suggest that these systems are very useful, safe, and accurate in evaluating the primary tumour and surrounding anatomy as well as in determining operative strategy, such as the location and size of the scalp incision, craniotomy, and the extent of surgical removal. Therefore, we conclude that the addition of endoscopy combined with neuronavigation to standard surgical procedures can improve the outcome of surgical treatment of pineal region tumours. [ABSTRACT FROM AUTHOR]

We describe three men with parkinsonian syndromes caused or aggravated by chronic subdural haematomas. A 63-year-old man developed tremor at rest, rigidity and bradykinesia one week after he fell and hit his head. A 70-year-old patient suffering from tardive dyskinesia and drug-induced parkinsonism experienced deterioration of his bradykinetic symptoms over two weeks. There was no history of trauma. The third patient, a 82-year-old man with idiopathic Parkinson's disease had a marked increase of his leftsided parkinsonian symptoms. Again, there was no history of trauma. In all three patients chronic subdural haematomas were demonstrated by computed tomography. Evacuation of the chronic subdural haematoma resulted in disappearance respectively improvement of the movement disorder. Diagnostic evaluations appear to be delayed and initial misinterpretations are frequent. The findings of our report and review of the literature point out that a favourable outcome after appropriate surgical treatment is achieved in most instances. [ABSTRACT FROM AUTHOR]

Objective and Method. Most of the literature about cranial aneurysmal bone cyst represents case reports, the aim of this paper is to gather information in solid clear statements about this disease in the region of the skull. This is a retrospective analysis of all available case reports on aneurysmal bone cyst involving the skull between 1960 and June 1998. The jaw was excluded. Results. Sixty one cases of aneurysmal bone cyst involving the skull were found. 33 were males and 28 were females. The average age at presentation was 17.5 years. A painless enlarging mass was the most common mode of presentation. Features of pressure on intracranial structures with increased intracranial pressure were present in some patients. Most patients were managed by total excision of the lesion when feasable. Partial resection resulted in recurrence in some patients. Endovascular embolization has been used as a single mode of therapy or as pre-operative to decrease the intra-operative bleeding. Conclusion. Aneurysmal bone cysts not uncommonly affect the skull. The pathological changes are similar to those affecting other parts of the body. Clinical presentation varies and depends on the part of the skull involved. Endovascular embolization plays a very important role in the managment either as pre-operative or as the only method of treatment. [ABSTRACT FROM AUTHOR]

Surgical outcome of intramedullary spinal cord ependymoma was investigated in order to define the treatment strategy. We have operated on 18 cases of intramedullary spinal cord ependymoma based on the principle of radical resection. The follow-up periods ranged from 10 months to 249 months with an average of 86.2 months. Postoperative neurological status in the long follow-up periods was compared to the pre-operative status and was correlated with the histological grade of malignancy. Total removal of the tumour was achieved in 17 cases, and subtotal removal followed by radiation therapy was conducted in 1 case. There was neither surgical mortality nor radiological evidence of recurrence in the long-term follow-up periods. The final outcome of the neurological condition was improved in 1 case, unchanged in 15 cases (including a case of subtotal removal) and deteriorated in 2 cases. The deterioration was in the form of gait disturbance due to the worsening of proprioception in 2 cases and dysaethesia in 1 case. Histological examination showed no evidence of anaplasia in 6 cases, evidence of early anaplasia in 10 cases, and moderate evidence of anaplasia in 2 cases. No relationship between the histological malignancy and clinical course was found. Intramedullary spinal cord ependymoma should be removed radically as early as possible while taking great care to avoid posterior column injury. Histologically malignant ependymoma might be a clinical exception. [ABSTRACT FROM AUTHOR]

We describe a rare case of polyostotic fibrous dysplasia with craniofacial localization associated with involvement of the spine and extremities. A 14-year-old girl presented with progressive headache, left frontal swelling, exophthalmos of the left eye, deformity and palpable mass in the left frontal area. Cranial computerized tomography revealed extensive involvement of all cranial bones except right frontal and right parietal bones. Most of the facial bones were invaded. Especially, there was the involvement of ethmoidal air sinuses and frontal sinus also. Computerized tomography showed left frontal lobe compression. In addition, the spine and bones of the extremities were involved in the patient. Craniofacial approach was planned. Cranial surgery was performed by an extradural frontal approach. Firstly, the frontal cyst was excised. For left frontal lobe decompression, we removed successfully all the abnormal bones causing mass effect and frontal deformity. Secondly, facial surgery was performed with external approach. An attempt to remove all of the involved bone is necessary, as the lesion may recur and grow if a portion of dysplastic bone is left in place. However, the present case suggests that removal of all the involved bones in the polyostotic fibrous dysplasia may be possible in spite of extensive involvement. In this situation, it may be removal of only abnormal bones responsible for compression of affected neural elements is indicated. [ABSTRACT FROM AUTHOR]

Background: The purpose of this report is to describe the radiologic appearances of laparoscopic adjustable silicone gastric banding (LASGB), a new surgical treatment for morbid obesity. In this procedure, a silicone band is fastened around the fundus, delimitating a small proximal gastric pouch and stoma. The inner surface of the band is inflatable and connected by a thin silicone tube to an access port. This allows postoperative stoma size adjustment by puncturing the port and injecting or withdrawing saline solution.Methods: One hundred eighty patients underwent LASGB. A radiologic study protocol was established and performed in all patients, including preoperative double-contrast upper gastrointestinal (GI) series and single-contrast upper GI series on the first postoperative day and 1 month after surgery. Radiologic evaluation was also performed at each band adjustment and in case of persistent vomiting or inadequate weight loss.Results: Postoperative stoma adjustment was performed in all patients. The optimal volume of saline was 1-4.5 mL. Percutaneous puncture of the port was impossible in three patients because of an inverted port. We observed 15 cases of pouch dilatation with stomal obstruction requiring reoperation. There were also nine cases of spontaneous band deflation caused by leaking reservoir in five cases and by disconnection between the connecting tube and the port in the other four cases.Conclusions: Because radiologic evaluation is necessary after surgery and for band adjustments, radiologists are involved in the postoperative follow-up and may be asked to perform those adjustments themselves. [ABSTRACT FROM AUTHOR]

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study was undertaken to evaluate freeze-dried cross-linked human type I collagen when used as a barrier membrane for guided tissue regeneration (GTR) in periodontal surgery. 14 patients with radiographic evidence of bone loss and residual pocketing of > mm on bilaterally matched sites were given preliminary scaling, polishing and oral hygiene instruction before undergoing contralateral flap surgery. At the experimental sites, a collagen membrane was adapted to the root surface, extending from 2 mm apical to the bone crest to just subgingival, before replacing the flap and closing with sutures. The control sites underwent a similar procedure but without the placement of the collagen barrier. The experimental sites were selected at random. Plaque index (PLI), gingival index (GI), bleeding index (BI), probing pocket depth (PPD) and probing attachment level (PAL) were recorded at baseline, 6, 12 and 26 weeks postoperatively. The bony defects were classified and furcation involvement noted. The clinical parameters were recorded by an examiner, assessed for accurate reproducibility of measurement , who was not he surgeon and unaware of the experimental sites. PPD and PAL were measured using a constant pressure probe localised by a soft stent. There was significant improvement in the PLI, GI and BI at both test and control sites at 6,12 and 26 weeks compared to baseline (P<0.001 for PLI; P<0.0001 for GI and BI) but no significant difference between these sites. Probing pocket depths were significantly reduced in both test and control sites at 6, 12 and 26 weeks post-operatively (P<0.00001). Furthermore, the test sites demonstrated a greater reduction in PPD than the control sites. There was a gradual reduction in PAL reaching significant levels by 26 weeks (P<0.001 for both test and control sites). There was a significantly greater gain in PAL at the test sites compared to the controls at 26 weeks (P<0.05). This investigation shows that human collagen as a GTR membrane is beneficial in reducing PPD and producing a gain in PAL. [ABSTRACT FROM AUTHOR]

The aim of the present study was to compare periodontal healing after successive removal of periodontal tissue components, from the alveolar bone to the dentin surface. The prevailing tissue reaction when adhering PDM was left on the exposed roots was that most of the bone tissue that had been removed from the buccal surfaces had regenerated and the integrity of the PDM between the new alveolar bone and cementum surface had been reestablished. On exposed etched cementum surfaces, 2 prevailing healing results were recorded. In half the number of the roots, the root surfaces were covered by connective tissue with fibers running parallel to the root surfaces in a capsule-like arrangement. The other prevailing reaction was a thin epithelial cell-lining running parallel to the root surfaces in close contact or partly penetrating the adjacent connective tissue. On exposed denuded dentin surfaces, gingival retraction was a constant finding, associated with an epithelial cell-lining of varying thickness sometimes with rete pegs and cyst-like formations. Gingival retraction was also a constant finding on etched dentin surfaces. This was associated with pathological pockets outlined by epithelial cell-layers of varying thicknesses. The significance of these findings were discussed with special emphasis on dynamics of recurrent periodontitis. [ABSTRACT FROM AUTHOR]

• A research-based project was conducted to introduce structured pain assessment on a surgical ward at a general hospital in Kenya, East Africa. The aim was to improve pain control, and subsequently patients' recovery and satisfaction with care. • It was agreed that the ultimate aim was to develop and use a common tool for pain assessment throughout the hospital, thereby reducing disparity in various clinical areas, and raising standards of patient care. • The project was seen as a pilot, and planned introduction of the pain assessment took place over 1 month. • This paper describes the findings in relation to the patient sample, and perceptions of nurses taking part. It also contains reflections about action research, and how it may enter the scene as a way of understanding the whole picture retrospectively. [ABSTRACT FROM AUTHOR]

We evaluated referral patterns for the initial surgery in patients with suspected ovarian cancer and factors associated with that referral. Through a mailed survey we asked gynecologists: (i) to rate the importance of characteristics of the patient, the mass, the surgeon and the hospital on to their decision to operate on or to refer to a gynecologic oncologist a patient with a pelvic mass; (ii) to indicate whether they would operate on or refer five hypothetical patients with masses of increasing complexity; (iii) to estimate on what proportion of patients with suspected ovarian cancer in their practice they currently operate; and (iv) to estimate the residual tumor volume when they perform surgery for ovarian cancer. Gynecologists seeing fewer patients with suspected ovarian cancers, in a teaching vs community hospital, in full-time university vs private practice and working in specific geographical areas, referred more to an oncologist for the primary surgery. Not significant were the gender of the surgeon, number of years in practice and distance to a regional cancer center. A high probability of cancer and characteristics of the surgeon affected referral patterns. [ABSTRACT FROM AUTHOR]

The results of this retrospective case study indicate that a composite of tumor grade, pattern of spread and substage at the time of opening affects the outcome most in the treatment of stage III epithelial tumors of the ovary. The poorest prognosis was associated with grade 3 histology, a pattern of spread requiring extensive and often difficult surgery for removal and a high substage. The best prognosis was usually associated with grade 1, with either very easily removed, isolated spread or low substage.The extent of tumor defined the degree of primary cytoreduction possible. If the tumor was minimally extensive, primary cytoreduction results were excellent. The same conclusions were reached in the case of secondary cytoreduction at the time of second-look procedure. There was no statistically significant difference (z = 1.481, P = 0.069) in 5-year survival between patients with microscopic only disease (59%) at second-look, and patients with gross disease not cytoreduced (36%). [ABSTRACT FROM AUTHOR]

Fifty-two intestinal operations were performed during 45 laparatomies in 43 non-obstructed ovarian cancer patients. The histology of the tumor was serous in 29/43 cases (67.5%). The gross postoperative morbidity rate was 15.5% and postoperative mortality rate 6.9%. The 5-year survival was 28.3%, and was not affected by the time of intestinal surgery (during the first or following laparotomies). As a result, intestinal surgery in advanced ovarian cancer patients is feasible without an undue increase in morbidity. However, it must be carefully tailored because, though contributing to the quality of life of these patients, it does not seem to affect their survival, at least in this retrospective series. [ABSTRACT FROM AUTHOR]

From January 1975 to December 1991, 34 patients with a diagnosis of epithelial ovarian tumors of low malignant potential (LMP) were admitted to the Istituto Nazionale Tumori of Milan. Eighteen of them (group 1) underwent complete staging laparotomy and retroperitoneal para-aortic and pelvic lymphadenectomy, as for ovarian cancer. In the remaining 16 cases (group 2), the surgical treatment ranged from unilateral oophorectomy to incomplete staging procedure. In group 1, nine patients (50%) were found to have retroperitoneal nodal involvement. In group 2, all patients had stage I disease. Patients were followed up for 20-222 months (mean 108, median 86). There were two recurrences in group 2 (after 5 years) and none in group 1 (NS). Currently all patients are alive and disease free. Nine of 18 group 1 patients were upstaged to stage III on the basis of lymph node involvement only. However, at least in this retrospective series, lymph node metastases did not affect prognosis or survival. [ABSTRACT FROM AUTHOR]

Between 1970 and 1990, 160 patients with malignant non-dysgerminomatous ovarian germ cell tumors have been treated at our own institution. Primary therapy failed in 42 of these patients, who constitute the basis for this study. Seventeen patients had stage I disease, 5 stage II, 17 stage III, and 3 stage IV. Histologic type included 13 immature teratomas, 8 endodermal sinus tumors, and 21 mixed germ cell tumors. Primary therapy for 14 patients was surgery alone, for 23, surgery plus chemotherapy, for 2, surgery plus radiotherapy and for 3, all three modalities. Median progression-free survival from initial diagnosis lasted 6.8 months (range, 0.9-24 months). Thirty-four patients received chemotherapy as part of salvage; 5/11 (45%) who received VAC are disease-free, and 6/11 (55%) who received cisplatin combinations are disease-free. When primary VAC failed, 3/7 (43%) were salvaged with cisplatin combinations. When primary cisplatin combinations failed, 2/5 (40%) were salvaged. Twelve of the 42 patients (29%) are currently alive disease-free. Primary treatment failure was attributed to surgery alone for 14 patients (7 because of misdiagnosis), radiotherapy for 5, and toxicity for 1. Of the 22 patients who failed chemotherapy, 12 did so because of a suboptimal regimen, 3 because of possible dose-intensity problems, one because of non-compliance, and 6 for unexplained reasons. Patients with ovarian germ cell tumors have an excellent probability of cure with aggressive primary therapy, but successful salvage may be difficult when primary treatment fails. [ABSTRACT FROM AUTHOR]

The medical records of 45- patients with intraoperative diagnosis of borderline or low malignant potential (LMP) ovarian tumor were reviewed to identify factors affecting intraoperative management. The correlation between gross and histologic staging was examined, as was the complication rate following surgery. Patient age and presence of qualifying pathologic terms on frozen section diagnosis were the only important factors relating to performance of surgical procedure. Surgical complications were closely associated with non-conservative surgery. Thirteen of 14 (92.8%) patients with significant complications had a hysterectomy. These 14 patients had staging procedures at essentially the same rate as the entire population. Thirteen of 45 patients (28.8%) thought to have LMP by frozen section had a different diagnosis on permanent review; 5 were benign and 8 were frankly malignant, confirming the limitations of frozen section in the diagnosis of LMP ovarian tumor. Of 40 with LMP or frankly malignant tumors 5(12.5%) were upstaged based on unsuspected histopathologic findings. These results indicate the need for a standard approach to staging in patients who are suspected to have an LMP ovarian tumor and should encourage the performance of conservative surgery when appropriate. [ABSTRACT FROM AUTHOR]

We investigated a female population prior to general anaesthesia, using skin prick tests with latex and muscle relaxants to appraise the validity and feasibility of a systematic preoperative screening for these substances. Anaesthetists performed skin tests, and positive and doubtful tests were checked in our allergy department. Of 114 patients, 42 had uninterpretable tests because of dermographism (28 patients) or suppression of skin reactivity (14 patients). Among the other 72, nine had a positive or doubtful test to latex, and seven a positive or doubtful test to one or more muscle relaxants. After checking, only four sensitizations to latex and one to muscle relaxant were confirmed. In conclusion, a systematic screening for latex and muscle relaxant allergy is not advisable. In contrast, screening for latex allergy in selected high-risk groups (spina bifida, health-care workers) is necessary. [ABSTRACT FROM AUTHOR]

A case of chronic gastrointestinal hemorrhage caused by a small jejunal arteriovenous malformation (AVM) is reported. Treatment by endovascular embolization was temporarily successful. Subsequently, the patient underwent laparoscopic resection, guided by intraoperative catheter localization with methylene blue. Histopathology confirmed a true AVM. Eighteen months after treatment, the patient is free of symptoms. Literature of jejunal AVMs is reviewed. [ABSTRACT FROM AUTHOR]

Office-based intraocular surgery has been carried out for three years and over 1400 procedures have been performed There have been no systemic complications or infections The establishment of an office-based facility is a complex venture Apart from medicolegal, ethical and financial considerations there are regulations relating to structural requirements, steritisation of instruments, air-conditioning, electrical hazards and other technical matters Office-based surgery is convenient for both the patient and the surgeon The patient remains calm and relaxed from the time of initial counselling to the end of postoperative convalescence We have borrowed systems used in the United States for management of ambulatory surgical patients, in particular the counselling techniques This. in our opinion, has been a significant factor for calm relaxed surgery Patient acceptance and preference for ambulatory surgery will ensure that it is here to stay A case can be made out for an economic and ethical obligation for this form of surgery to be implemented on a more widespread basis It is not, however, the universal solution to ocular surgery There are still specific indications and contraindications, in terms of both the doctor and the patient At a time when government involvement is being felt more and more in the practice of medicine, any proven alternative method of health care delivery, provided entirely by the private sector, must be worthy of serious consideration. [ABSTRACT FROM AUTHOR]

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Chirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

SUMMARY The records of four patients presenting with a histological diagnosis of haemangiopericytoma of the central nervous system, in Auckland, New Zealand, between 1970 and 1990 were reviewed retrospectively, with the aim of determining the natural history of the disease and response to various treatment modalities. Three out of the four patients reviewed presented with primary cerebral disease and the fourth with a primary spinal cord tumour. All three cerebral primary patients were initially treated with local surgical excision. All three patients received radical radiotherapy following local recurrence. The first two patients remained disease-free locally although one patient developed a solitary liver metastasis 5 years after radiotherapy. The third patient was referred with multiple cerebral metastases and failed to respond to radiotherapy. The patient with the primary lesion in the spinal cord was treated with local excision followed by postoperative radiotherapy and remains disease-free 17 years after treatment. One patient failed to respond to chemotherapy, prescribed to treat a local recurrence adjacent to the previous radiotherapy field. This was successfully excised subsequently. The patient presenting with multiple cerebral metastases was the only patient to die of this disease. Results suggest that local recurrence is avoidable with adequate wide excision of the primary tumour followed by local radical radiotherapy. The role of chemotherapy remains controversial and no conclusion could be drawn regarding the role of palliative radiotherapy from this study. Active treatment and long-term follow-up are necessary because of the relative aggressiveness of this disease and the propensity for late relapses. [ABSTRACT FROM AUTHOR]

Traditionally, surgical therapy for tachydysrhythmias has been reserved for drug-refractory cases. Accordingly, there has been no study comparing medical with surgical therapy in similar groups of patients. Recent developments in surgical therapy for supraventricular and ventricular tachydysrhythmias have resulted in lower morbidity and mortality with good surgical success. In most patients with the Wolff-Parkinson-White syndrome, accessory pathway division can be performed with very low mortality and high chance for success, obviating the need for lifelong drug therapy. Similarly, in patients with life-threatening ventricular tachydysrhythmias, several operative techniques incuding the encircling endocardial ventriculotomy and subendocardial resection offer an alternative to therapy which often requires frequent dosing with one or more medications, each associated with a significant incidence of adverse effects. These newer operative techniques for both supraventricular and ventricular tachydysrhythmias are challenging the widely held concept that surgery should be reserved only for patients with drug-refractory tachydysrhythmias. [ABSTRACT FROM PUBLISHER]

Objectives: To study whether combining age and the Glasgow Coma Scale (GCS) with the shock index (SI) - SIA/G - during the initial care of polytraumatized patients can improve the ability of the SI alone to predict mortality. To compare the predictive performance of the SIA/G combination to other prognostic scales: the addition of points for the GCS, age and systolic blood pressure (GAP); the Revised Trauma Score (RTS); and the Injury Severity Score (ISS)., Material and Methods: Observational cohort study of patients with severe trauma admitted to the intensive care unit of a tertiary care hospital between 2015 and 2020. We calculated the SI (heart rate/systolic blood pressure), the SI/G ratio, the product of the SI and age SIA, and the combined index: SIA/G. The areas under the receiver operating characteristic curves (AUROCs) for hospital mortality and 24-hour mortality were calculated for the SIA/G combination and compared to the AUROCs for the GAP, the RTS, and the ISS., Results: We analyzed data for 433 patients, 47 of whom (10.9%) died. All the prognostic indexes were significantly related to mortality but the SIA/G was the best predictor of both hospital and 24-hour mortality, with AUROCs of 0.879 (95% CI, 0.83-0.93) and 0.875 (95% CI, 0.82-0.93), respectively. A score of 3.3 for the SIA/G showed 82% sensitivity and 80% specificity for hospital mortality (86% and 78%, respectively, for 24-hour mortality). The AUROCs for the GAP, RTS, and ISS indexes were lower for hospital mortality., Conclusion: The combined SIA/G score is a better predictor in hospital of mortality in patients with multiple injuries than the SI or the traditional GAP, RTS, and ISS indexes.

We report a case of a 48-year-old Indian male who presented with swelling and firmness in his leftupper part of the abdomen of one month duration with anorexia and weight loss. Initial examinationrevealed an intra abdominal mass of around 16.8x11.0x24.5cm with minimal left sided pleuraleffusion. A biopsy from the mass confirmed the diagnosis of gastrointestinal stromal tumour (GISTs)as supported by immmunohistochemistry results which showed strong positivity for c-kit while stainsfor smooth muscle actin, desmin, myoglobin, S100 Protein and cytokerstin remained negative. Thepatient was not suitable for surgical intervention in view of advanced tumor, and Imatinib Mesylate400mg daily was started with the aim of making the tumor operable. Such therapy lasted for twentymonths and was tolerated well by the patient. It then resulted in gradual tumor regression, followingwhich the patient underwent successful tumor resection. Post surgical resection patient had noradiological evidence of intra abdominal tumor but mild left sided pleural effusion with left lower lobeatelectasis. The patient had uneventful post operative recovery and he is currently on Imatinibmesylate and tolerating treatment well with mild skin rash. The experience with preoperative imatinibon surgical resection rates and post operative outcomes is limited especially with primary locallyadvanced GISTs. In our case successful surgical resection was possible for a huge locally advancedGIST with unusually prolonged treatment of twenty months with imatinib preoperatively.

Abstract Background Malignant granular cell tumor (MGCT) is a rare disease entity. Forty-one well-documented MGCTs have been reported in the world literature. Case Report This report describes a patient who presented with a MGCT of the lung and reviews the preoperative evaluation, pathologic features and differential diagnosis of the disease. This case represents the first report of resected primary pulmonary MGCT. Conclusions Diagnosis of MGCT is based on histology of the primary tumor, immunohistochemistry, and exclusion of tumors that may mimic granular cell tumor.

Abstract Background Desmoid tumors are slow growing deep fibromatoses with aggressive infiltration of adjacent tissue but without any metastatic potential. Case Presentation We report on two female patients with desmoid tumor of the abdominal wall who underwent primary resection. Both patients had a history of an earlier abdominal surgery. Preoperative evaluation included abdominal ultrasound, magnetic resonance imaging and computed tomography. The histology in both cases revealed a desmoid tumor. Conclusion Complete surgical resection is the first line management of this tumor entity.

Dural arteriovenous fistulas presenting with ascending myelopathy are characterised by the presence of an abnormal retrograde drainage through spinal veins. The authors present a case of cranial dural arteriovenous fistula causing brainstem dysfunction secondary to venous hypertension, treated by surgical interruption of the pial venous drainage which resulted in complete clinical and radiological resolution of the brainstem lesion. [ABSTRACT FROM AUTHOR]

Spinal epidural abscess is a rare condition that can lead to irreversible complications and death if untreated. Rarely, Brucella melitensis may produce spondylodiscitis, which may be complicated by spinal epidural abscess. We report a case of lumbosacral spinal epidural abscess caused by Brucella melitensis. Spinal brucellosis should be kept in mind in the differential diagnosis of low back pain. [ABSTRACT FROM AUTHOR]

To assess the presentation, management and risk factors for mortality in necrotizing fasciitis at Middlemore Hospital in South Auckland, New Zealand.A retrospective review of the medical records of patients presenting to Middlemore Hospital over a 6-year period (1997−2002) with a diagnosis of necrotizing fasciitis.Forty eight patients were identified. There were 27 men and 21 women whose age ranged from 19 to 80 years (median 51 years) at presentation. Maori and Pacific Islanders accounted for 64% of total admissions despite making up only 31% of the referral population.Streptococcus Pyogeneswas the most common bacterial isolate (54%). 31% of patients had polymicrobial infections. Sixty-two per cent of cases involved extremities. The median number of operations and length of stay were 4 and 31 days, respectively. Overall mortality was 29%. In multivariate analysis, delay in surgical intervention (P = 0.015) and diabetes mellitus (P = 0.023) were found to be associated with increased mortality. Ethnicity, sex, type of pathogen, site of infection and increasing age did not affect mortality.Necrotizing fasciitis remains a significant problem in our community especially in the Maori and Pacific population. Early surgical debridement decreases mortality rates. [ABSTRACT FROM AUTHOR]

The results of patients operated on by Nepal Cleft Lip and Palate Association (NECLAPA) surgeons for congenital macrostomia were prospectively studied between January 2000 and December 2002. There were four males and three females with a median age of 10 years. Three had an associated branchial arch syndrome. In all patients an overlapping repair of orbicularis oris was done. Six patients had a straight line closure with excellent cosmetic results and one a Z-plasty with a more obvious scar. All had a normal appearing commissure. Overlapping orbicularis repair with straight line skin closure for this rare congenital anomaly is recommended. [ABSTRACT FROM AUTHOR]

The results of a recently concluded phase III study have shown that Gliadel therapy (biodegradable polymer impregnated with 3.85% BCNU placed into the surgical cavity) significantly prolongs survival and time to relapse in patients having initial resective surgery for malignant glioma followed by radiotherapy. The indications and exclusion criteria for patients in this study were well defined. To determine the relative frequencies of Gliadel `eligible' and `ineligible' patients, and differences in prognostic variables between these two cohorts, we conducted a review of all Edinburgh patients with an initial diagnosis of malignant glioma managed throughout the period of patient accrual into the phase III Gliadel study (Edinburgh was one of 38 contributing centres). Independent predictors of outcome were taken from the MRC prognostic index. Analysis was done on an intention to treat basis. Only 25% of patients (14/56) with malignant glioma managed over this period were eligible for the Gliadel study and all were recruited. The patients in the study group were younger (median 51 v. 59 years, p =0.085); in better clinical grade (median Karnofsky score 85 v. 80, p = 0.038); more likely to have resective surgery (86% v. 38%, p = 0.0001); more likely to have postoperative radiotherapy (93% v. 55%, p =0.0001) and more likely to survive longer, even though one half of the Gliadel cohort received placebo, (66 v. 19 weeks, p= 0.06) than those not eligible. If the future use of Gliadel is limited to the eligibility criteria used in the phase III trial about 20% (95% confidence intervals 13 -34%) of patients with newly diagnosed malignant glioma will receive this therapy. [ABSTRACT FROM AUTHOR]

Background: Ependymomas are the third most common pediatric central nervous system (CNS) tumors, accounting for 6-12% of brain tumors in children. Management of these tumors remains challenging and recurrence occurs in over 50% of cases, mainly when complete resection is not achieved before radiotherapy. The 5-year overall survival (OS) ranges from 39 to 64%, with a 5-year progression-free survival (PFS) rate of 23-45%. The study aimed to describe the OS and PFS rates of cases of pediatric ependymoma. It also aimed to evaluate the effects of different variables on disease outcomes. Variables examined included patient age, the extent of surgical resection, radiotherapy and chemotherapy delivered, the histopathological subtype of the tumor, primary tumor location, and extent of the disease at presentation. Last, the challenges that potentially compromise treatment outcomes in resource-limited countries were to be highlighted., Methods: This is a retrospective cohort study, representing a single-center experience that included 47 pediatric patients treated at the National Cancer Institute, Cairo University, between January 2009 and December 2014., Results: Median follow-up stood at 23.5 months (range: 2-77 months). The average 3-year OS and PFS rates were 43.7 and 43.3%, respectively., Conclusion: The extent of surgical excision (maximal resection) and the adequacy of postoperative radiotherapy were the only two factors that had significantly affected the outcome. Understandably, treatment outcomes for ependymomas in developing countries still lag behind best reported outcomes, mainly due to inadequate surgical excision and postoperative radiotherapy., Competing Interests: None

Background: Consolation behaviors toward the sick are common in humans. Anxiety in the relatives of the sick is also common. Anxiety can cause detrimental effects on multiple systems. However, our understanding on the neural mechanisms of these behaviors is limited because of the lack of small animal models. Methods: Five of 6- to 8-week-old CD-1 male mice were housed in a cage. Among them, 2 mice had right common artery exposure (surgery) and the rest were without surgery. Allo-grooming and performance in light and dark box and elevated plus maze tests of the mice were determined. Results: Mice without surgery had increased allo-grooming toward mice with surgery but decreased allo-grooming toward non-surgery intruders. This increased allo-grooming toward surgery mice was higher in familiar observers of surgery mice than that of mice that were not cage-mates of surgery mice before the surgery. Familiar observers developed anxious behavior after being with surgery mice. Surgery mice with familiar observers had less anxious behavior than surgery mice without interacting with familiar observers. Multiple brain regions including paraventricular thalamic nucleus (PVT) were activated in familiar observers. The activated cells in PVT contained orexin receptors. Injuring the neurons with ibotenic acid, antagonizing orexin signaling with an anti-orexin antibody or inhibiting neurons by chemogenetic approach in PVT abolished the consolation and anxious behaviors of familiar observers. Conclusions: Mice show consolation behavior toward the sick. This behavior attenuates the anxious behavior of surgery mice. The orexin signaling in the PVT neurons play a critical role in the consolation of familiar observers toward surgery mice and their anxious behavior. Considering that about 50 million patients have surgery annually in the United States, our study represents the initial attempt to understand neural mechanisms for consolation and anxiety of a large number of people., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)