Efficacy of gamma knife radiosurgery for small-volume recurrent malignant gliomas after initial radical resection.

Objective: To review the authors' experience with Gamma Knife radiosurgery (GKR) for small recurrent high-grade gliomas (HGGs) following prior radical resection, external-beam radiation therapy (EBRT), and chemotherapy with temozolomide (TMZ).

Methods: The authors retrospectively analyzed 26 consecutive adults (9 women and 17 men; median age 60.4 years; Karnofsky Performance Status [KPS]≥70) who underwent GKR for recurrent HGGs from 2004-2009.

Incidence, timing, and treatment of new brain metastases after Gamma Knife surgery for limited brain disease: the case for reducing the use of whole-brain radiation therapy.

Object: In this paper, the authors' goal was to analyze the incidence, timing, and treatment of new metastases following initial treatment with 20-Gy Gamma Knife surgery (GKS) alone in patients with limited brain metastases without whole-brain radiation therapy (WBRT).

Methods: A retrospective analysis of 114 consecutive adults (75 women and 34 men; median age 61 years) with KPS scores of 60 or higher who received GKS for 1-3 brain metastases ≤ 2 cm was performed (median lesion volume 0.35 cm(3)).

Radiographic outcomes of adult acquired flatfoot corrected by medial column arthrodesis with or without a medializing calcaneal osteotomy.

Medial column arthrodesis and calcaneal osteotomies are commonly used for adult acquired flatfoot surgical reconstruction. In this retrospective study, 41 patients (47 feet) with a mean age of 55 ± 13.5 years underwent a medial column arthrodesis, with or without calcaneal osteotomy, between 1999 and 2007.

Local control of newly diagnosed and distally recurrent, low-volume brain metastases with fixed-dose (20 gy) gamma knife radiosurgery.

Background: Metastases to the brain occur in 20% to 30% of patients with cancer and have been identified on autopsy in as many as 50% of patients.

Objective: To analyze the efficacy of 20-Gy Gamma Knife radiosurgery (GKR) as initial treatment in patients with 1 to 3 brain metastases ≤ 2 cm in greatest diameter.

Methods: A retrospective analysis of 114 consecutive adults with Karnofsky performance status ≥ 60 who received GKR for 1 to 3 brain metastases ≤ 2 cm in size was performed.

Neurological complications and symptom resolution following Gamma Knife surgery for brain metastases 2 cm or smaller in relation to eloquent cortices.

Object: Reports on resection of tumors in or near eloquent cortices have noted neurological complications in up to 30% of patients. This paper contains an analysis of symptom resolution and neurological morbidity following 20-Gy Gamma Knife surgery (GKS) for supratentorial brain metastases < or = 2 cm in greatest diameter.

Methods: The authors performed a retrospective analysis of 98 consecutively treated adults (33 men and 65 women with a median age of 61.

Comparison of femtosecond laser-assisted keratoplasty versus conventional penetrating keratoplasty.

Purpose: To compare postoperative outcomes for femtosecond laser-assisted keratoplasty (FLAK) with conventional penetrating keratoplasty (PK).

Design: Retrospective, comparative surgical series.

Participants: Fifty consecutive patients who underwent FLAK and 50 case-controlled patients that had PK at the Casey Eye Institute (Oregon Health & Science University, Portland, OR).

Isolated medial incisional approach to subtalar and talonavicular arthrodesis.

Triple arthrodesis is commonly used to correct complex deformity with hindfoot valgus. The authors use an isolated medial incisional approach for subtalar and talonavicular joint arthrodesis to correct hindfoot deformity, including high degrees of hindfoot valgus. To assess outcomes achieved with this approach, we reviewed the records of 45 patients from the practices of 5 surgeons.

Trinity Evolution.

Trinity Evolution Cryopreserved Cell Viable Bone Matrix is a minimally manipulated, human cellular, and tissue-based allograft containing adult mesenchymal stem cells, osteoprogenitor cells, and a demineralized cortical component. The cancellous bone used to produce Trinity Evolution is derived from freshly recovered donor tissue by Food and Drug Administration-registered facilities and processed under aseptic conditions. Preclinical in vivo and in vitro testing as well as strict donor screening has demonstrated the safety of Trinity Evolution as well as its osteoinductive and osteogenic potential contained within a natural osteoconductive matrix.

Trinity Evolution: mesenchymal stem cell allografting in foot and ankle surgery.

Biologic augmentation of orthopaedic procedures is a time-tested useful adjunct. The ability to predictably heal all fractures and arthrodesis procedures is still elusive because of multiple factors. The next frontier in musculoskeletal medicine and surgery will involve increasing biologic manipulation of the healing environment.

Geographic variation in sperm traits reflects predation risk and natural rates of multiple paternity in the guppy.

Guppies (Poecilia reticulata) are models for understanding the interplay between natural and sexual selection. In particular, predation has been implicated as a major force affecting female sexual preferences, male mating tactics and the level of sperm competition. When predation is high, females typically reduce their preferences for showy males and engage more in antipredator behaviours, whereas males exploit these changes by switching from sexual displays to forced matings.

Activation of the Hedgehog pathway in pilocytic astrocytomas.

Pilocytic astrocytoma is commonly viewed as a benign lesion. However, disease onset is most prevalent in the first two decades of life, and children are often left with residual or recurrent disease and significant morbidity. The Hedgehog (Hh) pathway regulates the growth of higher WHO grade gliomas, and in this study, we have evaluated the activation and operational status of this regulatory pathway in pilocytic astrocytomas.

Targeted inhibition of the Hedgehog pathway in established malignant glioma xenografts enhances survival.

Hedgehog pathway activity has been demonstrated in malignant glioma. However, its role in tumor growth has not been determined. Here we demonstrate that pharmacological inhibition of the Hedgehog pathway in established orthotopic malignant glioma xenografts confers a survival advantage.

Supramalleolar osteotomy.

Supramalleolar osteotomy for posttraumatic malunion, developmental or physeal deformities, congenital malalignment, or focal articular degenerative problems in the ankle is a useful surgical technique. Accurate evaluation of the distal tibial deformity, weight-bearing radiographs, and soft tissue examination for contractures and instability ensure proper decision making. Osteotomy planning must involve all components of the deformity, including the foot, and respect osteotomy principles.

Mesenchymal stem cell allograft in revision foot and ankle surgery: a clinical and radiographic analysis.

Unlabelled: A review was conducted of 23 patients who underwent implantation of mesenchymal stem cell allograft for revision foot or ankle surgery. Composed of viable mesenchymal stem cells derived from cadaveric donor tissue, the graft had osteogenic, osteoinductive, and osteoconductive properties, and was capable of direct new bone formation at the site of implantation. In all of the cases, radiographic new bone formation was observed at the area of implantation and a 91.

Talus fractures: surgical principles.

Surgical treatment of talus fractures can challenge even the most skilled foot and ankle surgeon. Complicated fracture patterns combined with joint dislocation of variable degrees require accurate assessment, sound understanding of principles of fracture care, and broad command of internal fixation techniques needed for successful surgical care. Elimination of unnecessary soft tissue dissection, a low threshold for surgical reduction, liberal use of malleolar osteotomy to expose body fracture, and detailed attention to fracture reduction and joint alignment are critical to the success of treatment.

Small vestibular schwannomas with no hearing: comparison of functional outcomes in stereotactic radiosurgery and microsurgery.

Objectives: To date, numerous studies have compared functional outcomes between stereotactic radiosurgery (SRS) and microsurgery (MS) in the treatment of vestibular schwannomas (VS). However, most of them involve tumors of difference sizes, radiation dosages, and surgical approaches. Few have systematically compared issues of dysequilibrium.

Rates of revision surgery using Chevron-Austin osteotomy, Lapidus arthrodesis, and closing base wedge osteotomy for correction of hallux valgus deformity.

To identify complications that necessitated revision surgery after the primary operation, a multicenter retrospective chart review was conducted for 646 patients who received either a modified chevron-Austin osteotomy (270 patients), modified Lapidus arthrodesis (342 patients), or closing base wedge osteotomy (34 patients) to correct hallux valgus deformity. Revision surgery for complications was calculated and compared. All surgery was performed by 1 of 5 staff foot and ankle surgeons at Kaiser Permanente medical centers.

Clinical outcomes of postmastectomy radiation therapy after immediate breast reconstruction.

Purpose: To determine the long-term complication rates and cosmetic results for patients undergoing postmastectomy radiation therapy (PMRT) after immediate reconstruction (IR).

Methods And Materials: Between January 1998 and December 2005, 92 patients underwent modified radical mastectomy, IR, and PMRT in our practice. A total of 69 patients underwent tissue expander and implant reconstruction (TE/I), and 23 underwent autologous tissue reconstruction (ATR).

Bilateral single-stage middle facet talocalcaneal coalition resection combined with flatfoot reconstruction: a report of 3 cases and review of the literature. Investigations involving middle facet coalitions--part 1.

Unlabelled: Talocalcaneal middle facet coalitions are associated with rigid pes planovalgus that often requires surgical intervention. Simple resection of the coalition is preferred for symptomatic cases in the absence of rearfoot arthritis. While resection of the coalition will remove the osseous restriction of motion and may eliminate pain, the procedure does not specifically correct the concomitant pes planovalgus.

Revision lapidus arthrodesis: rate of union in 17 cases.

This multicenter study retrospectively reviewed the medical records and radiographs of 15 consecutive patients (17 feet; mean patient age, 54.1 years), who underwent revision "bone-block" Lapidus arthrodesis for a symptomatic nonunion. In all cases but one, the procedure was performed with ipsilateral autogenous bone grafting.

Geographic distribution of selected elements in the livers of polar bears from Greenland, Canada and the United States.

To assess geographic distributions of elements in the Arctic we compared essential and non-essential elements in the livers of polar bears (Ursus maritimus) collected from five regions within Canada in 2002, in Alaska between 1994 and 1999 and from the northwest and east coasts of Greenland between 1988 and 2000. As, Hg, Pb and Se varied with age, and Co and Zn with gender, which limited spatial comparisons across all populations to Cd, which was highest in Greenland bears. Collectively, geographic relationships appeared similar to past studies with little change in concentration over time in Canada and Greenland for most elements; Hg and Se were higher in some Canadian populations in 2002 as compared to 1982 and 1984.