Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group.

Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper.

The costs of skull base surgery in the pediatric population.

Objectives To determine the costs of endoscopic endonasal surgery (EES) for pediatric skull base lesions. Methods Retrospective chart review of pediatric patients (ages 1 month to 19 years) treated for skull base lesions with EES from 1999 to 2013. Demographic and operative data were recorded. The cost of care for the surgical day, intensive care unit (ICU), floor, and total overall cost of inpatient stay were acquired from the finance department. Results A total of 160 pediatric patients undergoing EES for skull base lesions were identified. Of these, 55 patients had complete financial data available. The average total inpatient and surgical costs of care were $34, 056 per patient. Angiofibromas were the most costly: $59,051 per patient. Fibro-osseous lesions had the lowest costs: $10,931 per patient. The average ICU stay was 1.8 days at $4,577 per ICU day. The average acute care stay was 3.4 days at $1,961 per day. Overall length of stay was 4.5 days. Three cerebrospinal fluid leaks (4%) and two cases of meningitis (3%) occurred. One tracheostomy was required (1.5%). Conclusions EES is a cost-effective model for removal of skull base lesions in the pediatric population. Costs of care vary according to pathology, staged surgeries, length of ICU stay, and need for second operations.

Animal model for endoscopic neurosurgical training: technical note.

OBJECTIVE: The learning curve for endonasal endoscopic and neuroendoscopic port surgery is long and often associated with an increase in complication rates as surgeons gain experience. We present an animal model for laboratory training aiming to encourage the young generation of neurosurgeons to pursue proficiency in endoscopic neurosurgical techniques. METHODS: 20 Wistar rats were used as models. The animals were introduced into a physical trainer with multiple ports to carry out fully endoscopic microsurgical procedures. The vertical and horizontal dimensions of the paired ports (simulated nostrils) were: 35×20 mm, 35×15 mm, 25×15 mm, and 25×10 mm. 2 additional single 11.5 mm endoscopic ports were added. Surgical depth varied as desired between 8 and 15 cm. The cervical and abdominal regions were the focus of the endoscopic microsurgical exercises. RESULTS: The different endoscopic neurosurgical techniques were effectively trained at the millimetric dimension. Levels of progressive surgical difficulty depending upon the endoneurosurgical skills set needed for a particular surgical exercise were distinguished. LEVEL 1 is soft-tissue microdissection (exposure of cervical muscular plane and retroperitoneal space); LEVEL 2 is soft-tissue-vascular and vascular-capsule microdissection (aorto-cava exposure, carotid sheath opening, external jugular vein isolation); LEVEL 3 is artery-nerve microdissection (carotid-vagal separation); LEVEL 4 is artery-vein microdissection (aorto-cava separation); LEVEL 5 is vascular repair and microsuturing (aortic rupture), which verified the lack of current proper instrumentation. CONCLUSION: The animal training model presented here has the potential to shorten the length of the learning curve in endonasal endoscopic and neuroendoscopic port surgery and reduce the incidence of training-related surgical complications.

A brief history of the rise and fall of the School Medical Service in England.

The paper tracks the history of the School Medical Service over 150 years. The service has changed markedly during this period, with some cyclical recurrence of practice and policy. By 2006, the health of schoolchildren is of major concern, particularly the rise in nutrition-related problems including obesity: the demise of the School Health Service may well be a matter for serious regret to future generations.

Rapidly expanding brain mass.

Amebic encephalitis is an uncommon central nervous system infection, usually caused by Acanthamoeba spp., which generally occurs in immunocompromised individuals. The infection might start from a minor, slowly progressive, skin ulceration that can be present for weeks to months before neurologic changes occur. We present a 40-year-old male with multiple visceral allografts, on immunosuppression, 9 months after transplantation. He had an active skin rash previously diagnosed as graft-versus-host disease by biopsy. The condition of the patient declined rapidly.

The society of public health: 1957-1997.

History of the Period 1957-1997 The Society of Public Health: 1957-1997 is in two parts that are complementary but may be read independently of each other. Part 1: A History of the Period 1957-1997 This account details the progress and activity of the last forty years of the Society of Public Health (previously The Society of Community Medicine: Originally The Society of Medical Officers of Health) before its ammalgamation with the Royal Institute of Public Health and Hygiene to form The Royal Institute of Public Health and Hygiene and Society of Public Health. The appendices to this account cover the Presidents of The Society and Its Branches (Home And Overseas) and Special Interest Groups, Editors, its Faculty, Awards and Conferences since the Society's establishment in 1856 or their own beginning, as appropriate. Published in Public Health (2000) 114, 73-107 Part 2: Profiles of Some Fellows of the Society of Public Health To be published in Public Health (2000) 114, (3) This consists of profiles of eminent people active within the Society and the wider discipline of public health during the period 1957-1997. As it is based on availability of information the series cannot be all inclusive and readers are invited to consult the history in Part 1 and the listings in its appendices for additional information regarding members of the Society of Public Health.

Knife blade as a facial foreign body.

This case demonstrates the unpredictability of foreign bodies in the face. The retained knife blade eluded detection on two separate examinations. The essential components to making a correct diagnosis of a foreign body following a stabbing to the face include a thorough review of the mechanism of injury, a complete head and neck examination, a high index of suspicion, and plain radiographs of the face.

Sensitivity of mouse Skh:HR-2 to ultraviolet radiation: melanocyte inactivation.

The hairless mouse, Skh:HR-2, was exposed to doses of ultraviolet (UV) radiation known to induce skin pigmentation. Three parameters associated with perturbations in skin pigmentation were monitored following UV exposure. These include spectroscopy (skin darkness), histology (melanocyte density), and biochemistry (melanin). Within 90 min of UV exposure, the skin became lighter. This was associated with a reduction of quantifiable melanin and the inactivation of epidermal melanocytes.

A technique for renal preservation during suprarenal abdominal aortic operations.

Preservation of renal parenchyma during operative cross clamping of the suprarenal aorta is desirable. A simple method to perfuse the kidneys with a hypothermic solution is described.

Comparative toxicity of 226Ra, 239Pu, 241Am, 249Cf, and 252Cf in C57BL/Do black and albino mice.

Groups of C57BL/Do (black and albino) mice were injected with graded activities of 226Ra, 239Pu, 241Am, 249Cf, or 252Cf and were followed throughout life. Bone sarcoma was the principal radiation-induced end point, and the risks associated with average skeletal doses of the four transuranium radionuclides, relative to radium, were determined. The relative biological effectiveness (RBE) was calculated for each emitter by dividing its risk coefficient (bone sarcomas per 10(6) mouse-rad) by the risk coefficient for 226Ra. Combined data for males and females in both black and albino mice gave the following values +/- SD for the RBE relative to 226Ra = 1.0: 239Pu = 15.3 +/- 3.9, 241Am = 4.9 +/- 1.4, 249Cf = 5.0 +/- 1.4, and 252Cf = 2.6 +/- 0.8. About 70% of the tumors occurred in the axial skeleton, and the risk coefficient for females averaged about four times higher than for males when all five nuclides were included. The RBE of fission fragment irradiation from 252Cf for cancer induction, relative to alpha irradiation, for the combined data in all of the animals given 252Cf and 249Cf, was 0.02 +/- 0.28, in agreement with the calculated theoretical value of 0.03, based on the ratio of summed track lengths in tissue.