Her2neu amplification associates with Co-deletion 1p/14q in recurrent meningiomas.

Background: The current methods to predict recurrence and aggressive behaviour of meningiomas rely mainly on histological grading, histological subtype, proliferative index, as well as brain invasion. In many instances, histological grade alone fails to predict recurrence in the grade I and grade II meningiomas. Deletions of 1p and 14q have previously been reported to correlate with poor prognosis in terms of either recurrence or higher histological grades.

Revisiting right atrial isolation rationale for atrial fibrillation: functional anatomy of interatrial connections.

Introduction: Direct catheter ablation for atrial fibrillation does not yield reproducible permanent control as for other atrial arrhythmias. Therefore, there is a need for an alternative intervention, i.e.

Fibroblast growth factor-23 and calcium phosphate product in young chronic kidney disease patients: a cross-sectional study.

Background: Fibroblast growth factor-23 (FGF-23), a novel marker of bone disease in chronic kidney disease (CKD) has been shown to correlate with vascular calcifications. We aimed to describe the effect of the calcium phosphate product (Ca*P) on FGF-23 concentrations in children and young adults without confounding cardiovascular disease.

Methods: Pediatric and young adult patients with CKD stages I-V were recruited in this cross sectional study to measure FGF-23, cystatin C, vitamin D-metabolites and other serum markers of bone metabolism.

Image-guided techniques in renal and hepatic interventions.

Background: Development of new imaging technologies and advances in computing power have enabled the physicians to perform medical interventions on the basis of high-quality 3D and/or 4D visualization of the patient's organs. Preoperative imaging has been used for planning the surgery, whereas intraoperative imaging has been widely employed to provide visual feedback to a clinician when he or she is performing the procedure. In the past decade, such systems demonstrated great potential in image-guided minimally invasive procedures on different organs, such as brain, heart, liver and kidneys.

Reporting of the estimated glomerular filtration rate was associated with increased use of angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers in CKD.

Many guidelines suggest that angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists (collectively referred to as renin, angiotensin, aldosterone system blockers (RAAS blockers)) are the preferred treatment for hypertension in most patients with chronic kidney disease (CKD). Improving the recognition of CKD with the introduction of eGFR reporting was intended to have more patients recognized with and treated for this disease. To quantify this, we examined trends in RAAS-blocker use over an 88-month period before and after routine eGFR reporting in southwestern Ontario, Canada.

Acute cranial decompression in Meckel-Gruber syndrome and slit-ventricle syndrome with craniocephalic disproportion.

Slit-ventricle syndrome (SVS) is characterized by headaches associated with subnormal ventricular size in patients with shunt-treated hydrocephalus. It commonly occurs in children who have had shunts placed at an early age and is diagnosed when computed tomography scans are carried out to investigate suspected shunt obstruction with an accompanying rise in intracranial pressure (ICP). Overdrainage of cerebrospinal fluid may additionally result in craniocephalic disproportion, potentially by dampening the normal expansile pulsations of the dura against the skull, which leads to craniostenosis.

Results of cemented femoral revisions for periprosthetic femoral fractures in the elderly.

The treatment goals of Vancouver type B2 periprosthetic femoral fractures in elderly patients with a limited life expectancy are early weight bearing without compromising the fracture healing. Thirty-one patients with a mean age of 82 years were treated with a long cemented stem with additional allograft or plate fixation, followed by immediate full weight bearing. Seven major complications occurred within the first 3 months postoperatively.

Augmented reality image guidance during off-pump mitral valve replacement through the guiraudon universal cardiac introducer.

Objective: : We report our experience with ultrasound augmented reality (US-AR) guidance for mitral valve prosthesis (MVP) implantation in the pig using off-pump, closed, beating intracardiac access through the Guiraudon Universal Cardiac Introducer attached to the left atrial appendage.

Methods: : Before testing US-AR guidance, a feasibility pilot study on nine pigs was performed using US alone. US-AR guidance, tested on a heart phantom, was subsequently used in three pigs (∼65 kg) using a tracked transesophageal echocardiography probe, augmented with registration of a 3D computed tomography scan, and virtual representation of the MVP and clip-delivering tool (Clipper); three pigs were used to test feature-based registration.

Variability of the pediatric subspecialty workforce in Canada.

Objective: To assess the regional variability of the pediatric subspecialty workforce in the academic health science centers in Canada, because effective and efficient delivery of specialized pediatric health care depends on the pediatrician workforce.

Study Design: This was an analysis of the pediatric subspecialty workforce database of the Pediatric Chairs of Canada for the surveys obtained between 2003/04 and 2005/06.

Results: In 2003/2004, 960 pediatrician specialists who spent a majority of their time supporting clinical, educational, research, and administrative activities within the 16 Canadian medical schools were reported.

Sonographic findings in a patient with neurofibromatosis type 1 and a gastrointestinal stromal tumor.

Gastrointestinal stromal tumors (GIST) have been suggested to be the most common neurofibromatosis 1-associated gastrointestinal tumors. This case report describes and compares US and CT findings of both abdominal neurofibromas and a gastrointestinal stromal tumor. On US, the GIST appeared as a well-defined inhomogeneous lesion with a target-like pattern similar to CT.

Evidence for enhanced M3 muscarinic receptor function and sensitivity to atrial arrhythmia in the RGS2-deficient mouse.

Atrial fibrillation (AF) is the most common arrhythmia seen in general practice. Muscarinic ACh receptors (M2R, M3R) are involved in vagally induced AF. M2R and M3R activate the heterotrimeric G proteins, G(i) and G(q), respectively, by promoting GTP binding, and these in turn activate distinct K(+) channels.

Off-pump positioning of a conventional aortic valve prosthesis through the left ventricular apex with the universal cardiac introducer under sole ultrasound guidance, in the pig.

Objective: : To test an alternative to catheter and open-heart techniques, by documenting the feasibility of implanting an unmodified mechanical aortic valve (AoV) in the off pump, beating heart using the universal cardiac introducer (UCI) attached to the left ventricular (LV) apex.

Methods: : In six pigs, the LV apex was exposed by a median sternotomy. The UCI was attached to the apex.

Off-pump atrial septal defect closure using the universal cardiac introducer®: creation of models of atrial septal defects in the pig access and surgical technique.

Objective: : Optimal atrial septal defect (ASD) closure should combine off-pump techniques with the effectiveness and versatility of open-heart techniques. We report our experience with off-pump ASD closure using the Universal Cardiac Introducer (UCI) in a porcine model. The goal was to create an ASD over the fossa ovale (FO) and position a patch over the ASD under ultrasound (US) imaging and augmented virtual reality guidance.

Kaplan-Meier analysis on seizure outcome after epilepsy surgery: do gender and race influence it?

Objective: To evaluate seizure outcome following epilepsy surgery for patients with temporal lobe epilepsy and evaluate is gender and race/ethnicity influence it.

Methods: Data were obtained from the discharge database of the University of Alabama at Birmingham, Epilepsy Center, between 1985 and 2001. The sample consisted of all patients with a primary diagnosis of medically intractable temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy.

Salivary duct carcinoma presenting with vaginal metastasis: case report.

Vaginal cancer represents about 1-2% of the genital tract malignancies. Most cases represent metastasis from the cervix, endometrium or colon. Metastasis of salivary duct carcinoma to the vagina has not been previously reported.

Cold-induced sweating syndrome: a report of two cases and demonstration of genetic heterogeneity.

Objectives: To characterize the specific autonomic disturbances underlying the cold-induced sweating syndrome (CISS), and to describe a novel genetic variant of this rare recessive disorder. The two not previously reported patients had similar dysmorphic features: abnormal facial appearance, high arched palate, low set rotated ears, flexion deformities of elbows and fingers and scoliosis. Most noticeable were their paradoxical sweat responses: cold ambient temperature induced a profuse sweating over the face, arms and trunk but not over the lower limbs; while in the heat very little sweating occurred primarily on the legs.

Prospective angiographic comparison of direct, endoscopic, and telesurgical approaches to harvesting the internal thoracic artery.

Background: The purpose of this study was to compare the quality of left internal thoracic arteries harvested by the conventional open approach versus minimally invasive videoscopic and robotic-assisted telesurgical techniques.

Methods: One hundred and fifty consecutive patients with single vessel coronary artery disease were prospectively studied. The left internal thoracic artery was harvested using three different approaches, with 50 patients consecutively assigned to each group.

Concurrent robotic hybrid revascularization using an enhanced operative suite.

Hybrid myocardial revascularization combines coronary surgery with percutaneous intervention as an alternative therapy for ischemic heart disease. The order and sequence of the hybrid approach is not yet clearly defined. We report on the benefits of an enhanced surgical suite equipped with a carbon fiber operating table and digital C-arm for robotic-assisted hybrid revascularization in a single operative sequence.

Predictors of major neurologic improvement after thrombolysis in acute stroke.

Background: Major neurologic improvement at 24 hours after administration of recombinant tissue plasminogen activator (rt-PA) in acute stroke may predict good outcome at 3 months.

Objective: To identify predictors of major neurologic improvement at 24 hours after IV rt-PA administration and its relationship with outcome at 3 months.

Methods: The authors analyzed patients with acute stroke treated with IV rt-PA from two academic centers in London, Ontario, and 33 affiliated hospitals between 1999 and 2003.

Drotrecogin alfa (activated) treatment in a neonate with sepsis and multi organ failure.

The administration of drotrecogin alfa (activated) improves outcome in adult patients with severe sepsis. Since the published pediatric experience with this drug is limited, the role of drotrecogin alfa (activated) in children, and especially in newborns is not well established. We describe a 3-day-old neonate with septic shock and multiorgan system failure, including circulatory, respiratory, renal failure, and disseminated intravascular coagulation, refractory to intensive fluid resuscitation and inotrope support.

Optimizing discharge planning: clinical predictors of longer stay after recombinant tissue plasminogen activator for acute stroke.

Background And Purpose: The length of stay (LOS) is the main cost-determining factor for inpatients with acute stroke. Although studies have identified variables associated with LOS, few have analyzed predictors of longer stay after receiving thrombolytic therapy for acute stroke.

Methods: We studied all consecutive acute stroke patients receiving intravenous recombinant tissue plasminogen activator (rtPA) admitted to the London Health Sciences Center, in London, Ontario, Canada, from 1999 to 2003.

Biomechanical analysis of hydroxyapatite cement cranioplasty.

A recent review of the authors' experience with hydroxyapatite (HA) cement cranioplasties revealed a high infection rate. During removal of these implants, all were loose and fractured. Forty percent of these patients had a history of minor trauma at the site of cranioplasty before experiencing infection.

Renal tubular epithelial cell apoptosis by Fas-FasL-dependent self-injury can augment renal allograft injury.

The role of Fas-FasL interactions in kidney allograft injury may be complex as renal tubular epithelial cells (TEC) express both Fas and FasL. The role and regulation of TEC self-injury has not been investigated. In co-cultures of TEC, FasL-bearing, Fas-null TEC was demonstrated to induce apoptosis of TEC-bearing Fas.