A prospective study on the usefulness of high-resolution intraoperative infrared thermography in intracranial tumors.

Introduction: Infrared thermography (IT) is a non-invasive real-time imaging technique with potential application in different areas of neurosurgery. Despite technological advances in the field, intraoperative IT (IIT) has been an underestimated tool with scarce reports on its usefulness during intracranial tumor resection. We aimed to evaluate the usefulness of high-resolution IIT with static and dynamic thermographic maps for transdural lesion localization, and diagnosis, to assess the extent of resection, and the occurrence of perioperative acute ischemia. Methods: In a prospective study, 15 patients affected by intracranial tumors (six gliomas, four meningiomas, and five brain metastases) were examined with a high-resolution thermographic camera after craniotomy, after dural opening, and at the end of tumor resection. Results: Tumors were transdurally located with 93.3% sensitivity and 100% specificity (p < 0.00001), as well as cortical arteries and veins. Gliomas were consistently hypothermic, while metastases and meningiomas exhibited highly variable thermographic maps on static (p = 0.055) and dynamic (p = 0.015) imaging. Residual tumors revealed non-specific static but characteristic dynamic thermographic maps. Ischemic injuries were significantly hypothermic (p < 0.001). Conclusions: High-resolution IIT is a non-invasive alternative intraoperative imaging method for lesion localization, diagnosis, assessing the extent of tumor resection, and identifying acute ischemia changes with static and dynamic thermographic maps.

Volumetric measurement of intracranial meningiomas: a comparison between linear, planimetric, and machine learning with multiparametric voxel-based morphometry methods.

PURPOSE: To compare the accuracy of three volumetric methods in the radiological assessment of meningiomas: linear (ABC/2), planimetric, and multiparametric machine learning-based semiautomated voxel-based morphometry (VBM), and to investigate the relevance of tumor shape in volumetric error. METHODS: Retrospective imaging database analysis at the authors' institutions. We included patients with a confirmed diagnosis of meningioma and preoperative cranial magnetic resonance imaging eligible for volumetric analyses. After tumor segmentation, images underwent automated computation of shape properties such as sphericity, roundness, flatness, and elongation. RESULTS: Sixty-nine patients (85 tumors) were included. Tumor volumes were significantly different using linear (13.82 cm3 [range 0.13-163.74 cm3]), planimetric (11.66 cm3 [range 0.17-196.2 cm3]) and VBM methods (10.24 cm3 [range 0.17-190.32 cm3]) (p < 0.001). Median volume and percentage errors between the planimetric and linear methods and the VBM method were 1.08 cm3 and 11.61%, and 0.23 cm3 and 5.5%, respectively. Planimetry and linear methods overestimated the actual volume in 79% and 63% of the patients, respectively. Correlation studies showed excellent reliability and volumetric agreement between manual- and computer-based methods. Larger and flatter tumors had greater accuracy on planimetry, whereas less rounded tumors contributed negatively to the accuracy of the linear method. CONCLUSION: Semiautomated VBM volumetry for meningiomas is not influenced by tumor shape properties, whereas planimetry and linear methods tend to overestimate tumor volume. Furthermore, it is necessary to consider tumor roundness prior to linear measurement so as to choose the most appropriate method for each patient on an individual basis.

Central nervous system high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR)-case-based reviews.

INTRODUCTION: High-grade neuroepithelial tumor with BCOR alteration (HGNET BCOR) has been recently classified as a new category of tumors among those previously known as PNET. They are molecularly characterized by the mutation of the BCOR gene, a corepressor of BCL6 a gene (which has an important role in immune responses). Only case reports and very small series have been published so far; therefore, their behavior and management are still under investigation. The goal of the present case-based review is to provide a summary about the state of the art on these tumors. METHODS AND RESULTS: The pertinent review has been reviewed, and an exemplary case has been reported (15-month-old boy with large HGNET BCOR of the left cerebellopontine angle). So far, 24 cases have been described, with a 5.5 mean age at diagnosis and a 1.4 male/female ratio. The cerebellar hemisphere is the more frequently involved region. No metastases are usually detected at diagnosis, though they are common in case of tumor recurrence. There are no specific radiological or pathological features to differentiate HGNET BCOR from other brain malignant neuroepithelial tumors so that the differential diagnosis is obtained by DNA methylation profiling. The management possibly relies on surgery and (high dose) chemotherapy and radiotherapy but without a dedicated protocol yet. The overall survival after 48-month follow-up is 50%. A gross total resection, which is mandatory for a better outcome, is achievable in the majority of cases. CONCLUSIONS: The clinical research on HGNET BCOR is just at the beginning. New targets and wide-ranging clinical trials are needed to get an optimal management.

Endoscopic Endonasal Approach to Foramen Magnum Meningioma: Two-Dimensional Surgical Video.

Even for the most experienced neurosurgeons, foramen magnum meningiomas represent a surgical challenge owing to their delicate position surrounded by the brainstem, lower cranial nerves, and vertebral arteries. The treatment goal is gross total resection, but choosing the most appropriate approach is crucial. Basically, 3 surgical approaches are commonly used: posterolateral approach (far-lateral), anterolateral approach (extreme-lateral), and posterior midline approach. However, over the years, skull base surgery has evolved from standard open craniotomies to the use of microscopes and, more recently, to the development of endoscopic techniques. The endoscopic endonasal approach (EEA) permits a direct extradural route without brain retraction and shorter postoperative recovery. In contrast to the oral route, the soft palate and retropharyngeal soft tissues are preserved, allowing patients to resume a regular diet on the first postoperative day. Despite the advantages, the EEA is yet not widely used for treating foramen magnum meningiomas, even in cases where EEA use is possible. The EEA is feasible especially in cases with no vascular encasements and with a limited inferior extension allowing minimal manipulation of lower cranial nerves. Care must be taken with tumors with a more lateral and caudal extension (below the tip of the odontoid process), when a far lateral approach may be the best approach. In this surgical Video 1, we present the surgical details with a stepwise narrative of the EEA for ventrolateral foramen magnum meningiomas through an illustrative case of a 48-year-old woman. Institutional informed consent was obtained for surgery and publication of this video.

Assessment of Hg contamination by a Chlor-Alkali Plant in riverine and coastal sites combining Hg speciation and isotopic signature (Sagua la Grande River, Cuba).

Chlor-alkali plants (CAP) are recognized as major sources of mercury (Hg) in the environment. In this work, Hg concentration, speciation and isotopic signature were determined in sediments and biota (fish and oyster) from Sagua La Grande River (SG River) and the adjacent coastal zone in the vicinity of a CAP (Cuba). High Hg concentrations in surface sediments (up to 5072 ng g-1), mainly occurring as inorganic Hg, decrease with the distance from the CAP along the SG River and seaward. Meanwhile, Hg concentration and speciation in riverine catfish (Claria gariepinus) muscle (1093 ± 319 ng g-1, ˜70% as MeHg) and coastal oysters (Crassostrea rizophorae) (596 ± 233 ng g-1, ˜50% as MeHg) indicate a direct impact from CAP. Hg isotopic signature in sediments, following both mass dependent (MDF) and mass independent fractionation (MIF), exhibits a clear binary mixing between CAP pollution (+0.42‰, δ202Hg; -0.18‰, Δ201Hg) and regional background end-member (˜ -0.49‰, δ202Hg; +0.01‰, Δ201Hg). The combination of speciation and isotopic information in biota and sediments allows to trace Hg contamination pathways from contaminated sediments to the biota, establishing the importance of both methylation and demethylation extent in both river and coastal sites before Hg species bioaccumulation.

Occurrence and Source Appraisal of Polycyclic Aromatic Hydrocarbons (PAHs) in Surface Waters of the Almendares River, Cuba.

In this work, 14 polycyclic aromatic hydrocarbons (PAHs) included in the United States Environmental Protection Agency pollutant priority list were analyzed in the surface water of the upper urbanized part of Almendares River, the most important water course in Havana, Cuba. Surface water from five sampling sites was collected at the end of dry season and analyzed by high-performance liquid chromatography-fluorescence detection method after solid phase extraction procedure. Total PAHs concentrations varied from 836 to 15 811 ng L(-1) with a geometric mean value of 2512 ng L(-1). PAH typology was dominated by low molecular-weight PAHs (2- to 3-ring components). Pollutant source appraisal was determined by diagnostic ratios method in five sampling sites. Factor analysis of normalized samples was used to concentration identified two factors as the main significant pollutant sources and to cluster similar sampling sites corresponding to petrogenic and combustion inputs, respectively. Ecological risks were considered. For animal aquatic life, acute toxicity values exceed the permissible values in the more-polluted sampling sites.

Seasonal variations in antibiotic resistance gene transport in the almendares river, havana, cuba.

Numerous studies have quantified antibiotic resistance genes (ARG) in rivers and streams around the world, and significant relationships have been shown that relate different pollutant outputs and increased local ARG levels. However, most studies have not considered ambient flow conditions, which can vary dramatically especially in tropical countries. Here, ARG were quantified in water column and sediment samples during the dry- and wet-seasons to assess how seasonal and other factors influence ARG transport down the Almendares River (Havana, Cuba). Eight locations were sampled and stream flow estimated during both seasons; qPCR was used to quantify four tetracycline, two erythromycin, and three beta-lactam resistance genes. ARG concentrations were higher in wet-season versus dry-season samples, which combined with higher flows, indicated much greater ARG transport downstream during the wet-season. However, water column ARG levels were more spatially variable in the dry-season than the wet-season, with the proximity of waste outfalls strongly influencing local ARG levels. Results confirm that dry-season sampling provides a useful picture of the impact of individual waste inputs on local stream ARG levels, whereas the majority of ARGs in this tropical river were transported downstream during the wet-season, possibly due to re-entrainment of ARG from sediments.

Antibiotic resistance gene abundances associated with waste discharges to the Almendares River near Havana, Cuba.

Considerable debate exists over the primary cause of increased antibiotic resistance (AR) worldwide. Evidence suggests increasing AR results from overuse of antibiotics in medicine and therapeutic and nontherapeutic applications in agriculture. However, pollution also can influence environmental AR, particularly associated with heavy metal, pharmaceutical, and other waste releases, although the relative scale of the "pollution" contribution is poorly defined, which restricts targeted mitigation efforts. The question is "where to study and quantify AR from pollution versus other causes to best understand the pollution effect". One useful site is Cuba because industrial pollution broadly exists; antibiotics are used sparingly in medicine and agriculture; and multiresistant bacterial infections are increasing in clinical settings without explanation. Within this context, we quantified 13 antibiotic resistance genes (ARG; indicators of AR potential), 6 heavy metals, 3 antibiotics, and 17 other organic pollutants at 8 locations along the Almendares River in western Havana at sites bracketing known waste discharge points, including a large solid waste landfill and various pharmaceutical factories. Significant correlations (p < 0.05) were found between sediment ARG levels, especially for tetracyclines and ß-lactams (e.g., tet(M), tet(O), tet(Q), tet(W), bla(OXA)), and sediment Cu and water column ampicillin levels in the river. Further, sediment ARG levels increased by up to 3 orders of magnitude downstream of the pharmaceutical factories and were highest where human population densities also were high. Although explicit links are not shown, results suggest that pollution has increased background AR levels in a setting where other causes of AR are less prevalent.

Assessment of heavy metal levels in Almendares River sediments--Havana City, Cuba.

The Almendares River watershed covers a large portion of Havana, Cuba and is centrally important to both recreational and other activities in the region. In order to assess current water quality conditions prior to planned remediation efforts, the spatial distribution of six heavy metals and other compounds were determined in river sediments at fifteen sampling stations in the watershed. Metal concentrations in sediments ranged from 86.1 to 708.8 for Zn, 39.3 to 189.0 for Pb, 71.6 to 420.8 for Cu, 84.4 to 209.7 Cr, 1.5 to 23.4 for Co, and 1.0 to 4.3 for Cd microg/g dry weight sediment. Calculated enrichment factors (EF; measured metal versus background mineral conditions) were almost always greater than 1.0, suggesting significant anthropogenic impact on metal levels in the river. The highest EF values were seen immediately below Cotorro (EF>10 for Pb, Cu, and Cd), a suburban town that has an active secondary smelter, and below the largest municipal landfill in Havana (EF>10 for Pb, Cu, Cd, and Zn). Further, three sampling stations had multiple metals at concentrations higher than probable effects concentrations (PEC), implying possible local ecotoxicological impacts. Finally, sequential extractions of the sediments indicated that heavy metals were largely associated with the organic fraction, and it was estimated that up to 62% of metals in the sediments would be susceptible to release back into the water column if hydraulic or other changes occurred in the river. These data are being used to prioritize decisions related to the remediation of the river system.

Estudio endoscópico de 500 pacientes con hemoptisis / Endoscopic study of 500 patients with hemoptysis

Se revisó la base de datos del Departamento de Broncoscopia del Servicio de Neumología del Hospital "Hermanos Ameijeiras" y se escogió las 500 broncoscopias que se realizaron al mismo número de pacientes con hemoptisis en el período comprendido entre enero de 1996 y enero del 2001. Los resultados fueron los siguientes: 330 (66 por ciento) pacientes eran masculinos y 170 (34 por ciento), femeninos. El promedio de edad fue de 60 años con un rango de 18 a 85 años, 440 (88 por ciento) tenían el hábito de fumar. El diagnóstico final fue: neoplasia de pulmón 290 (58 por ciento), bronquitis crónica 95 (19 por ciento), bronquiectasias 70 (14 por ciento), en 25 (5 por ciento) la causa de hemoptisis no se pudo determinar y hay 20 (4 por ciento) con otros diagnósticos. Se relacionó la magnitud de la hemoptisis con el diagnóstico en 453 (90,6 por ciento) tuvieron sangrado entre ligero y moderado y sólo en 47 (9,4 por ciento) fue severo, independientemente de la causa. Al realizar la broncoscopia se detectó sangre en vías aéreas en 280 (56 por ciento) de los casos; sin restos de sangre, 220 (44 por ciento). La prueba sirvió para saber de dónde venía el sangrado en 300 (60 por ciento). En total se llegó a la etiología de la hemoptisis con la broncoscopia y sus procederes en 336 (67,2 por ciento). Se puso de manifiesto una vez más que el estudio endoscópico de las vías aéreas en pacientes con hemoptisis es de vital importancia

Eficacia diagnóstica de la biopsia endobronquial y correspondencia entre diagnóstico macroscópico y microscópico en 1 000 broncoscopias / Diagnostic efficacy of the endobronchial biopsy and correspondence between the macroscopic and microscopic diagnosis in 1 000 bronchoscopies

Se comprobó la eficacia diagnóstica de la biopsia endobronquial en las lesiones tumorales, visibles endoscópicamente, en 1 000 broncoscopias realizadas en un período de 2 años en nuestro centro, para ello se revisó la base de datos del Departamento de Broncoscopia. Los resultados fueron: de 402 lesiones tumorales encontradas, el diagnóstico macroscópico se confirmó histológicamente en 393 (97,8 porciento). Se constató que la biopsia fue diagnóstica en 390 pacientes (97 porciento). Hubo diagnóstico macroscópico falso positivo en 5 pacientes (1 porciento ) y falso negativo, en 4 (0,9 porciento). Del total de tumores, 387 (96,2 porciento) eran malignos y 11 (2,73 porciento), benignos o de bajo grado de malignidad; en 10 (90,9 porciento) de los cuales coincidió la impresión del endoscopista con la estirpe histológica. Se describieron otras características de los tumores

Valor diagnóstico del cepillado bronquial bajo control fluoroscópico y a ciegas en lesiones tumorales periféricas del árbol bronquial no visibles endoscópicamente / Diagnostic value of the blind bronchial brushing and under fluoroscopic control in non endoscopically visible peripheral tumors of the bronchial arbor

Se analizó el rendimiento diagnóstico en nuestro servicio del cepillado bronquial bajo control fluoroscópico y a ciegas en lesiones tumorales del árbol bronquial no visibles endoscópicamente y de localización periférica por estudios radiológicos. Se tomó como base las 503 broncoscopias realizadas en el último año. Se llevó a cabo el estudio en 52 pacientes, en 48 (92,3 porciento) de estos la muestra obtenida fue útil para diagnóstico. En 24 se hizo bajo control fluoroscópico y se llegó a diagnóstico en 13 (54,1 porciento), en 28 pacientes se hizo a ciegas y se diagnosticaron 12 (42,8 porciento). Con este proceder se logró el diagnóstico con fluoroscopia o sin ella, en 25 casos (48 porciento). Se reafirmó la utilidad de esta variante diagnóstica en el estudio del carcinoma broncógeno de localización periférica

Tratamiento de la neumonía extrahospitalaria / Treatment of out-of-hospital pneumonia

Se revisaron algunos aspectos novedosos acerca de la neumonía extrahospitalaria, diagnóstico relativamente frecuente en la práctica medica. Se consideraron la causa, los criterios de ingreso y de cómo abordarla desde el punto de vista terapéutico, de forma empírica o específica