Gamma knife radiosurgery as an efficacious treatment for paediatric central nervous system tumours: a retrospective study of 61 neoplasms.

PURPOSE: Brain tumours have an incidence of 1.15 to 5.14 cases per 100,000 children and are associated with significant morbidity and mortality. Radiosurgery has become a promising approach to manage these paediatric CNS tumours. The aim of the present study was to analyse the efficacy of radiosurgery in the treatment of a variety of paediatric tumours of CNS. METHODS: This retrospective study was conducted from 1997 to 2012 at a single Neurosurgery centre. All paediatric patients (≤ 18 years of age) with CNS tumours who were treated with gamma knife radiosurgery (GKRS) and had a minimum follow up of 6 months were included in the study. Patients with lesions other than tumours were excluded. Clinical, radiological and GKRS planning data was collected and analysed in all patients. RESULTS: A total of 76 children with brain tumours had GKRS during the study period. Of these, 40 children (with 61 neoplasms) had follow-up available and were included in the study. The mean age was 16 years (6-18 years). Seventeen patients received primary GKRS, 20 patients received secondary, and 3 patients received both. The median tumour volume was 3.3 cm3 (0.14-38.9 cm3). The mean dose was 12.56 Gy at 50% isodose line. The majority of the tumours were meningioma (n = 20) followed by acoustic schwannoma (n = 17). The mean treatment time was 67.04 min. Thirty-three tumours responded favourably to GKRS, 24 showed a stable size, 3 had no response while 1 progressed, requiring surgery. CONCLUSION: GKRS has the potential to become an indispensable tool in the management of paediatric brain neoplasms.

A Framework for Assessing Uncertainty Associated with Human Health Risks from MSW Landfill Leachate Contamination.

Landfilling is a cost-effective method, which makes it a widely used practice around the world, especially in developing countries. However, because of the improper management of landfills, high leachate leakage can have adverse impacts on soils, plants, groundwater, aquatic organisms, and, subsequently, human health. A comprehensive survey of the literature finds that the probabilistic quantification of uncertainty based on estimations of the human health risks due to landfill leachate contamination has rarely been reported. Hence, in the present study, the uncertainty about the human health risks from municipal solid waste landfill leachate contamination to children and adults was quantified to investigate its long-term risks by using a Monte Carlo simulation framework for selected heavy metals. The Turbhe sanitary landfill of Navi Mumbai, India, which was commissioned in the recent past, was selected to understand the fate and transport of heavy metals in leachate. A large residential area is located near the site, which makes the risk assessment problem both crucial and challenging. In this article, an integral approach in the form of a framework has been proposed to quantify the uncertainty that is intrinsic to human health risk estimation. A set of nonparametric cubic splines was fitted to identify the nonlinear seasonal trend in leachate quality parameters. LandSim 2.5, a landfill simulator, was used to simulate the landfill activities for various time slices, and further uncertainty in noncarcinogenic human health risk was estimated using a Monte Carlo simulation followed by univariate and multivariate sensitivity analyses.

A framework for assessment and characterisation of municipal solid waste landfill leachate: an application to the Turbhe landfill, Navi Mumbai, India.

Rapid industrialisation, growing population and changing lifestyles are the root causes for the generation of huge amounts of solid waste in developing countries. In India, disposal of municipal solid waste (MSW) through open dumping is the most common waste disposal method. Unfortunately, leachate generation from landfill is high due to the prolonged and prominent monsoon season in India. As leachate generation rate is high in most of the tropical countries, long-term and extensive monitoring efforts are expected to evaluate actual environmental pollution potential due to leachate contamination. However, the leachate characterisation involves a comprehensive process, which has numerous shortcomings and uncertainties possibly due to the complex nature of landfilling process, heterogeneous waste characteristics, widely varying hydrologic conditions and selection of analytes. In order to develop a sustainable MSW management strategy for protecting the surface and ground water resources, particularly from MSW landfill leachate contamination, assessment and characterisation of leachate are necessary. Numerous studies have been conducted in the past to characterise leachate quality from various municipal landfills; unfortunately, none of these propose a framework or protocol. The present study proposes a generic framework for municipal landfill leachate assessment and characterisation. The proposed framework can be applied to design any type of landfill leachate quality monitoring programme and also to facilitate improved leachate treatment activities. A landfill site located at Turbhe, Navi Mumbai, India, which had not been investigated earlier, has been selected as a case study. The proposed framework has been demonstrated on the Turbhe landfill site which is a comparatively new and the only sanitary landfill in Navi Mumbai.

An institutional study on accuracy of freehand cervical C1 C2 screws placement by knock and drill technique in craniovertebral anomalous bony anatomy: An evaluation of more than 600 screws based on SGPGI screw accuracy criteria.

Purpose: To assess the accuracy of freehand cervical C1 C2 screws placement by knock and drill (K and D) technique in craniovertebral anomalous bony anatomy. Materials and Methods: From January 2017 to December 2022, 682 consecutive C1 C2 screws in 215 patients with craniovertebral junction (CVJ) anomalies were enrolled. All patients underwent posterior fixation with K and D technique without any fluoroscopic guidance. The patient's demographic details, clinical details, radiological details, major intraoperative events, and postoperative complications were noted. The screws malposition grades and direction on CT images in the axial and sagittal plane were defined as new per proposed "SGPGI accuracy criteria." All patients had a clinical evaluation at 3-month follow-up. Results: Total 682 C1, C2 screws were placed in 215 patients for CVJ anomalies using K and D technique. The accuracy of screws placement by freehand technique was 84.46% (576/682). So with technique explained the rate of malplacement in simple (16.35%) and complex (15.19%) groups were almost comparable and comparison difference was not significant (P = 0.7005). Conclusion: The freehand technique, as described, is effective in cases of anomalous bony anatomy, and it is mandatory in complex CVJ anomalies. The accuracy of screw placement and VA injury is comparable with major studies. This technique is supposedly cost-effective and less hazardous to both health-care workers and patients.

An experience with Goel-Harms C1-C2 fixation for type II odontoid fractures.

Objective: Type II odontoid fractures need surgical stabilization for disabling neck pain and instability. Anterior odontoid screw fixation is a well-known technique. However, certain patients require posterior fixation. We present our surgical results and experiences with nine cases managed by the Goel-Harms technique. Materials and Methods: This is a retrospective review of nine patients operated on between January 2019 and December 2021 for Type II odontoid fractures with posterior fixation technique. Their clinical profile was collected from case files. The radiological data were retrieved from radiology archives. The indications for surgery were instability and refractory neck pain. The surgical decision for posterior fixation was guided by fracture morphology. Results: The mean age of presentation was 37.22 ± 9.85 years. Seven patients had Type II, and two had Type IIa odontoid fracture. All patients presented with unbearable neck pain. One patient had a quadriparesis. The fracture line was anterior-inferior sloping in six, posterior-inferior sloping in two, and transverse in one case. The anterior-posterior displacement of fracture ranged from 0 to 7 mm (mean 2.44 ± 2.18 mm). Partial transverse ligament tear without the Atlanto Axial Dislocation was present in three patients. The C1-C2 joint distraction was required in five cases. C1-C2 joint spacer was required in two cases. Following surgery, neck pain was relieved in all cases. Complete fracture alignment was achieved in eight patients. There were no postoperative complications. At the mean follow-up of 16.22 ± 9.61 months, there was no implant failure. Conclusions: Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases.

An integrated approach for modeling uncertainty in human health risk assessment.

A human health risk assessment (HHRA) will not remain simple and straightforward when it involves multiple uncertain input variables. Uncertainties in HHRA result from the unavailability and subjectivity of input variables. Though several studies have performed HHRA, the quantification of uncertainty in HHRA under a situation of data scarcity and the simultaneous application of random and non-random input variables have rarely been reported. The present study proposes an integrated hybrid health risk modeling framework involving the concurrent treatment of random and non-random input variables and estimating the uncertainties linked to the input variables in HHRA. The proposed framework presents the flexibility to classify the input variables into fuzzy and probabilistic categories, based on their data availability and provenience nature. The framework is demonstrated over the Turbhe sanitary landfill in Navi Mumbai, India, where the fate and transport of heavy metals in leachate are investigated through LandSim modeling. The present study considers the LandSim-simulated heavy metal concentration and body weight as a random variable and water intake, exposure duration, frequency, bioavailability, and average time as fuzzy variables. Further, the uncertainties in the non-carcinogenic human health risk have been quantified using Monte Carlo simulations, followed by a comprehensive multivariate sensitivity analysis of the proposed framework. High health risk at Turbhe is estimated for the male and female population. This study presents the first effort to quantify the non-carcinogenic human health risks from leachate-contaminated groundwater considering the health risk input variables as non-deterministic. The proposed framework is generic and applicable to any landfill site and will remain unaltered when integrated health risk assessment and uncertainty assessment are performed for the landfill.

A long-term comparative assessment of human health risk to leachate-contaminated groundwater from heavy metal with different liner systems.

The handling and management of municipal solid waste (MSW) are major challenges for solid waste management in developing countries. Open dumping is still the most common waste disposal method in India. However, landfilling also causes various environmental, social, and human health impacts. The generation of heavily polluted leachate is a major concern to public health. Engineered barrier systems (EBSs) are commonly used to restrict potentially harmful wastes by preventing the leachate percolation to groundwater and overflow to surface water bodies. The EBSs are made of natural (e.g., soil, clay) and/or synthetic materials such as polymeric materials (e.g., geomembranes, geosynthetic clay liners) by arranging them in layers. Various studies have estimated the human health risk from leachate-contaminated groundwater. However, no studies have been reported to compare the human health risks, particularly due to the leachate contamination with different liner systems. The present study endeavors to quantify the human health risk to contamination from MSW landfill leachate using multiple simulations for various EBSs. To quantify the variation in health risks to groundwater consumption to the child and adult populations, the Turbhe landfill of Navi Mumbai in India has been selected. The leachate and groundwater samples were collected continuously throughout January-September in 2015 from the landfill site, and heavy metal concentrations were analyzed using an inductively coupled plasma system. The LandSim 2.5 Model, a landfill simulator, was used to simulate the landfill activities for various time slices, and non-carcinogenic human health risk was determined for selected heavy metals. Further, the uncertainties associated with multiple input parameters in the health risk model were quantified under a Monte Carlo simulation framework.

Breast hamartoma with intrathoracic extension in a 13-year-old boy.

Breast hamartoma is a rare tumor that has been reported only thrice in a male breast. The pediatric age group is seldom involved. We present a case of breast hamartoma in a 13-year-old boy, which interestingly, extended through but without definite involvement of the chest wall into the thoracic cavity. In view of occasional recurrence and documented malignancy in hamartomas, tumor was excised along with two ribs.