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There is no report of the application of intraoperative computed tomography to the extremities, and its usefulness is not mentioned. We present a case of a patient with the elbow pain and loss of the forearm rotation due to the prominent bicipital tuberosity of the radius, which was diagnosed as enthesopathy. Surgical treatment to excise the prominent part of the bicipital tuberosity of the radius was recommended. However, it is difficult to perform the appropriate excision of the abnormal prominent part because of complications such as bicipital tendon rupture. The patient was successfully treated by surgical resection under the control of intraoperative computed tomography. Intraoperative computed tomography scan is a useful tool to assess the remaining volume of the abnormal bones.

Context\ud \ud Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs).\ud \ud \ud \ud Objective\ud \ud To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients.\ud \ud \ud \ud Design\ud \ud 12-year prospective, observational study.\ud \ud \ud \ud Participants & Setting\ud \ud We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases.\ud \ud \ud \ud Interventions & Outcome\ud \ud AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310).\ud \ud \ud \ud Results\ud \ud Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650).\ud \ud \ud \ud Conclusions\ud \ud Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course.

Nobuhiro Hata,1,2 Koji Yoshimoto,1 Ryusuke Hatae,1 Daisuke Kuga,1 Yojiro Akagi,1 Yuhei Sangatsuda,1 Satoshi O Suzuki,3 Tadahisa Shono,1,4 Masahiro Mizoguchi,1,5 Koji Iihara1 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 2Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 3Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, 4Department of Neurosurgery, Harasanshin Hospital, Fukuoka, 5Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan Purpose: The AVAglio trial established the beneficial effect of add-on bevacizumab (BEV) for the treatment of newly diagnosed glioblastomas (nd-GBMs) that led to the approval of BEV for the treatment of these patients in Japan. However, the rationality of using BEV as a first-line treatment for nd-GBMs remains controversial. The purpose of this study was to analyze the outcomes of a case series of nd-GBM patients.Patients and methods: The outcomes of 69 nd-GBM patients treated after 2006 were retrospectively analyzed. Clinical and genetic analyses were performed, and estimates of progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Since add-on BEV therapy was only used for partially resected GBMs (pr-GBMs) after its approval in 2013, the patients were subdivided into 3 treatment groups: Type I, partial removal with temozolomide (TMZ)/BEV and concurrent radiotherapy (CCRT); Type II, partial removal with TMZ and CCRT; and Type III, gross total removal with TMZ and CCRT.Results: The PFS rate of Type I patients was significantly higher than that of Type II patients (P=0.014), but comparable to that of Type III patients. Differences in OS rates between Type I and Type II patients were less apparent (P=0.075), although the median OS of Type I patients was ~8months higher than that of Type II patients (17.4 vs 9.8months, respectively). The clinical deterioration rate during initial treatment was significantly (P=0.024) lower in TypeI than in Type II patients (7.7% vs 47.4%, respectively). Differences in OS rates between Type I and Type II patients with a poor performance status (PS) were significant (P=0.017).Conclusion: Our findings suggest that add-on BEV can prevent early clinical deterioration of pr-GBM patients and contribute to a prolonged survival, especially for those with a poor PS. Keywords: bevacizumab, glioblastoma, performance status, survival, unresectable

Nobuhiro Hata,1,2 Koji Yoshimoto,1 Ryusuke Hatae,1 Daisuke Kuga,1 Yojiro Akagi,1 Satoshi O Suzuki,3 Toru Iwaki,3 Tadahisa Shono,1,4 Masahiro Mizoguchi,1,5 Koji Iihara1 1Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 2Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 3Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, 4Department of Neurosurgery, Harasanshin Hospital, Fukuoka, 5Department of Neurosurgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan Abstract: Recently updated phase III trials revealed the favorable effect of add-on procarbazine-lomustine-vincristine chemotherapy (CT) to radiotherapy (RT) in treating anaplastic oligodendrogliomas with 1p19q codeletion (codel). However, the underlying rationality of deferring RT and upfront CT administration for these tumors is yet to be elucidated. Here, we retrospectively analyzed the long-term outcome of our case series with oligodendroglial tumors treated with deferred RT and upfront procarbazine+nimustine+vincristine (PAV) in the introduction administration. We enrolled 36 patients with newly diagnosed oligodendroglial tumors (17, grade II and 19, grade III) treated during 1999–2012 and followed up for a median period of 69.0months. Their clinical and genetic prognostic factors were analyzed, and progression-free survival, overall survival (OS), and deterioration-free survival (DFS) were evaluated. Regardless of the WHO grade, the 25 patients with 1p19q codel tumors never received RT initially, and of these 25, 23 received PAV treatment upfront. The 75% OS of patients with 1p19q codel tumor was 135.3months (did not reach the median OS), indicating a favorable outcome. Multivariate analysis revealed that IDH mutation and 1p19q, not WHO grade, are independent prognostic factors; furthermore, IDH and 1p19q status stratified the cohort into 3 groups with significantly different OS. The DFS explained the prolonged survival without declining performance in patients with both grade II and III 1p19q codel tumors. Deferred RT and upfront PAV treatment for 1p19q codel oligodendrogliomas were associated with favorable outcomes without compromising performance status, regardless of WHO grade. Keywords: oligodendroglioma, IDH, PAV, 1p19q codel

Purpose: To investigate the degree of any decreasing effects for excess relative risk (ERR) of radiation exposure caused by adjusting for smoking and years of education. Methods: In this cohort study, we assembled a cohort of 41,742 males who responded to a lifestyle questionnaire survey performed in 2003, were registered in the Radiation Dose Registry as Japanese nuclear workers by the end of March 1999. There were a total of 215,000 person-years, while the number of deaths for all cancers excluding leukemia was 978. Poisson regression was used to quantify ERR per Sv and a comparison of ERRs was performed before adjustment for smoking or years of education and after those adjustments. Findings: For all cancers excluding leukemia, the ERR/Sv was 0.78 (90%CI: -0.65, 2.20). However, it decreased to 0.31 (-1.03, 1.65) when adjusted for smoking and to 0.42 (-0.94, 1.79) when adjusted for years of education. When adjusting for both smoking and years of education, it decreased to 0.08 (-1.22, 1.39). Conclusion: Our results demonstrate the importance of collecting lifestyle data and adjusting for them when estimating radiation risk.