Thecaloscopy Reduces the Risk of Recurrent Perineural (Tarlov) Cysts after Microsurgical Resection.

Sacral Tarlov cysts (TCs), often asymptomatic, can cause significant pain and severe neurological dysfunction. Conventional treatments are generally associated with high recurrence and complication rates. Specifically, the substantial recurrence rates, which can reach as high as 50%, significantly impact long-term outcomes. Recent evidence increasingly supports the hypothesis that the formation of Tarlov cysts (TCs) may be associated with inflammatory processes within the nerve root sheath, further exacerbated by elevated cerebrospinal fluid (CSF) pressure. This retrospective study explores thecaloscopy, combined with surgical techniques, as a more effective alternative. We observed a total of 78 patients, 48 of whom underwent endoscopic fenestration of the arachnoid sheath in addition to microsurgical resection of the TC. We found that the fenestration of the arachnoid sheath at the level of lumbosacral spinal nerve root entry led to a significantly decreased risk of developing recurrent TCs (5/48 vs. 9/30). Only one of the patients suffered from a persistent new bladder dysfunction after microsurgical resection. This presented technique provides a promising treatment path for the future management of TCs, offering a safe and more effective treatment option compared to previous methods. Additionally, the advantages of the thecaloscopy provide pathophysiological implications regarding the development of perineural cysts.

Laser Polishing of Additive Manufactured Aluminium Parts by Modulated Laser Power.

In this study a new approach to laser polishing with periodic modulated laser power in the kilohertz regime is introduced. By varying the modulation frequency and modulation time, different periodic laser power curves with varying minimum, peak and average laser power can be created. The feasibility of the method is shown by polishing of vertical built AlSi10Mg L-PBF parts with an initial roughness of Ra = 12.22 µm. One polishing pass revealed a decreasing surface roughness with increasing energy density on the surface up to Ra = 0.145 µm. An increasing energy density results in a rising remelting depth between 50 and 255 µm and a rising relative porosity of 0.3% to 4.6%. Furthermore, the thermal process stability, analysed by the melt pool length in scanning direction, reveals a steadily increasing melt pool dimension due to component heating. Multiple laser polishing passes offers a further reduced surface roughness, especially at higher modulation frequencies and provides an improved orientation independent roughness homogeneity. The process stability regarding varying initial surface roughness revealed an almost constant relative roughness reduction rate with an achievable roughness variation after two polishing passes between Ra = 0.13-0.26 µm from an initial state of Ra = 8.0-19.2 µm.

Rapid and Sensitive Quantification of Osimertinib in Human Plasma Using a Fully Validated MALDI-IM-MS/MS Assay.

The third-generation tyrosine kinase inhibitor (TKI), osimertinib, has revolutionized the treatment of patients with non-small cell lung carcinoma with epidermal growth factor receptor (EGFR)-activating mutation, and resistant to first- and second-generation TKIs. Osimertinib is now also proposed as a first-line therapy, thus extending the scope of applications in lung oncology. Personalized medicine approaches are still necessary to monitor if patients are exposed to adequate concentrations of osimertinib during their treatment. It would also help to understand the appearance of new resistances in patients after several months of dosing with osimertinib. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is currently the gold standard for the quantification of drugs in plasma enabling pharmacokinetic analyses and patient monitoring. In the present study, we propose an alternative to LC-MS/MS methods for the rapid and sensitive quantification of osimertinib in plasma using matrix-assisted laser desorption/ionization (MALDI) -MS. The presented assay requires only 3 min per sample for their preparation, analysis, and data extraction, and less than 3 h for quantification. A lower limit of quantification (LLOQ) of 5 ng/mL in plasma was retrieved. The method was fully validated, following the guidelines of the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for bioanalytical method validation. The present developments prove the importance to consider alternative MS assays for time-efficient quantification of small molecule inhibitors in plasma in the context of personalized medicine for targeted therapies.

Repeat Surgery for Patients Operated in Childhood for Early-Onset Esotropia and Suffering from Persistent Residual, Recurrent or Consecutive Strabismus.

BACKGROUND: Patients operated in childhood for early esotropia may suffer from persistent strabismus, whether residual, recurrent, or consecutive, usually with a more complex oculomotor imbalance than in primitive strabismus. HISTORY AND SIGNS: The clinical data are fundamental, in particular, (1) the basic accommodation-free deviation, (2) the horizontal far/near incomitance, (3) the cyclovertical incomitances and/or A or V pattern, and (4) the motility restrictions. In complicated cases, magnetic resonance tomography of the orbits showed the anomalies of the eye and muscle position. The intraoperative findings have to be taken into account, such as (1) the position of the eyes and (2) the muscle extensibility in antagonistic muscle pairs. Twenty-seven patients, aged 16 to 62, were included in the present retrospective study. All of them had repeat surgery between 2013 to 2018, 15 for residual esotropia and 12 for consecutive exotropia. THERAPY AND OUTCOME: In five of the eight patients with posterior fixation sutures on the medial recti, the residual exo or estropia was moderate and could be corrected with a recession or tuck of the lateral recti. In the three other patients with pronounced esotropia, revision of the posterior fixation sutures was carried out. In 19 patients (11 esotropia and 8 exotropia) with only prior conventional surgery, the surgical choice for the residual deviation went electively to the muscles that were most responsible for the motor imbalance, without using posterior fixation sutures. In 4 of these 19 patients, the deviation was small due, in particular, to residual incomitances. For any persistent cyclovertical incomitance, the overacting oblique muscles were recessed, and, in four patients with an A or V pattern, the lateral rectus insertions shifted to the horizontal meridian in the same procedure. DISCUSSION: The two main difficulties are to assess (1) the imbalance of the active and passive muscle force and (2) the surgically induced incomitances.

Is endometrial cancer really a neurophobic tumor? A case report and review of the literature.

Brain metastases due to endometrial cancer are rare and usually occur in the context of widespread disease. We present a rare case of a 74-year-old woman with recurrent endometrial cancer in terms of a solitary brain lesion two years after initial diagnosis. She was treated with local resection of the brain metastasis and subsequent whole-brain radiotherapy. She then experienced relapse twice, presenting two solitary metastases at two different time points at the same location as at initial diagnosis, but never showed any signs of extracranial widespread disease. The patient has been alive for 13 months after detection of her initial brain metastasis. Despite the identification of some risk factors, there is still very limited knowledge why some patients develop brain metastases as the only sign of distant spread. Our review of the literature revealed that the combination of two treatment modalities yields higher survival rates than single treatment-alone, as was the case in the presented patient. Further case reports, as well as large and prospective studies, may contribute to a better understanding of the etiology and dynamics of this disease and allow better evaluation of treatment options.

Which Angle for which Surgical Strategy in Comitant Strabismus?

BACKGROUND: The fusion-free angle measured in the awake state was adopted as the angle of reference and the basis for conventional muscle surgery. The surgical effect is amount dependent. Further analysis: The basic angle does not, however, correspond to the fusion-free angle in all types of comitant strabismus. In infantile esotropia it corresponds to the minimum angle. The difference between the maximum and the minimum angle represents the angle of variability. Weakening-reinforcing techniques (conventional surgery) to correct the minimum angle should therefore be combined with a progressive lessening technique (posterior fixation suture) to reduce the variability. In normosensorial strabismus the prism adaptation test, or prismotherapy, allows accurate determination of the basic angle to be corrected. The imbalance of the passive forces in an antagonistic muscle pair can be assessed during surgery under general anaesthesia in two ways, the eye position and the measurement of muscle extensibility. These two parameters are partially independent from the minimum angle measured in the awake state. The intraoperative data can, therefore, be considered as valuable parameters for adjusting the amount of conventional surgery. Patients, method and results: A series of 80 children with infantile esotropia were operated on between 11 and 100 months of age. The surgical procedure consisted of bilateral posterior fixation sutures and uni- or bilateral medial rectus recessions. The intraoperative data were recorded in all cases. The amount of global recession was calculated on the minimum angle and adjusted if necessary during surgery according to the intraoperative data. The long-term results (follow-up of two years or more) show that the failures arose more often in the cases in which no adjustment was made. DISCUSSION AND CONCLUSION: An intraoperative adjustment of the amount of surgery is indicated according to the imbalance of passive muscle forces. Our long-term results, as yet uncompleted, suggest that the variance in results can be reduced by this strategy, along with taking into account the different angles of a deviation.