Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study.

Background: The decision about whether to treat an unruptured brain arteriovenous malformation (AVM) depends on a comparison of the estimated lifetime risk of intracranial haemorrhage with the risks of interventional treatment. We aimed to test whether outcome differs between adults who had interventional AVM treatment and those who did not.

Methods: All adults in Scotland who were first diagnosed with an unruptured AVM during 1999-2003 (n=114) entered our prospective, population-based study.

Infantile clivus chordoma without clivus involvement: case report and review of the literature.

Background: We present a giant clival chordoma with disseminated disease but without involvement of the clivus. To our knowledge, this is the youngest child and only the second case, presenting without base of skull involvement, in paediatric literature and the fourth reported case of a chordoma in a patient with tuberous sclerosis.

Discussion: We discuss the subtle presentation, difficulties in diagnosis and management and also review the literature.

Perceptions of migrant doctors joining the New Zealand medical workforce.

New Zealand, like many first World countries, has become increasingly dependent on overseas-trained doctors (OTDs). This qualitative study identifies and explores issues of concern to OTDs when first integrating into the New Zealand medical system through the New Zealand Registration Examination (NZREX) pathway. The data were collected using semistructured interviews and focus groups involving 10 OTDs who were working in a New Zealand hospital.

Effect of relationship factors on safer sex decisions in older inner-city women.

Objectives: Heterosexual transmission of the human immunodeficiency virus (HIV) in older women is on the rise, yet little is known about safer sex practices in these women. We sought to determine the prevalence of and effect of relationship factors on safer sex practices among older women living in a high HIV incidence region.

Methods: In a cross-sectional study at an ambulatory medicine clinic of a large inner-city hospital, participants were women over age 50 seeking medical services at the study site.

Familial Dandy-Walker syndrome: a case report supporting an autosomal inheritance.

Introduction: We report an isolated pedigree in which a consanguineous couple had twin sons with Dandy-Walker malformation (DWM). The mother is similarly affected with the disorder.

Discussion: DWM is an abnormality of the central nervous system, which leads to hydrocephalus and is associated with other abnormalities.

Radiation doses in interventional radiology procedures: the RAD-IR Study. Part III: Dosimetric performance of the interventional fluoroscopy units.

Purpose: To present the physics data supporting the validity of the clinical dose data from the RAD-IR study and to document the performance of dosimetry-components of these systems over time.

Materials And Methods: Sites at seven academic medical centers in the United States prospectively contributed data for each of 12 fluoroscopic units. All units were compatible with International Electrotechnical Commission (IEC) standard 60601-2-43.

Changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy.

Objective: The objective was to investigate the changes in ventricular volume in hydrocephalic children following successful endoscopic third ventriculostomy (ETV).

Materials And Methods: Using segmentation techniques, serial measurements of ventricular volume were performed using the MRI scans of 13 hydrocephalic children who had successful ETV between 1999 and 2002 to monitor ventricular response. All patients remained asymptomatic, did not require shunting and demonstrated radiological evidence of stoma patency on phase contrast cine MR, throughout the follow-up period extending from 1 to 3.

Echocardiography and pulmonary function as screening tests for pulmonary arterial hypertension in systemic sclerosis.

Objective: A prospective study to evaluate echocardiography and gas transfer (DLCO) by comparison with cardiac catheterization in discriminating between patients with and without systemic sclerosis-associated pulmonary arterial hypertension (SScPAH).

Method: A total of 137 (52 with and 85 without pulmonary fibrosis) had echocardiography and lung function tests within 3 months of their definitive invasive study.

Results: At cardiac catheterization 99 of these patients were found to have PAH, while PAH was excluded in 38.

Nutritional effects on host response to lung infections with mucoid Pseudomonas aeruginosa in mice.

In cystic fibrosis, a recessive genetic disease caused by defects in the cystic fibrosis conductance regulator (CFTR), the main cause of death is lung infection and inflammation. Nutritional deficits have been proposed to contribute to the excessive host inflammatory response in both humans and Cftr-knockout mice. Cftr-knockout mice and gut-corrected Cftr-knockout mice expressing human CFTR primarily in the gut were challenged with Pseudomonas aeruginosa-laden agarose beads; they responded similarly with respect to bronchoalveolar lavage cell counts and levels of the acute-phase cytokines tumor necrosis factor alpha, interleukin-1beta (IL-1beta), and IL-6.

Stereotactic biopsy of brain tumours in the paediatric population.

Objective: Our objective was to establish the role of stereotactic neurosurgical techniques in the management of brain tumours in children.

Materials And Methods: A retrospective analysis was conducted of all stereotactic procedures performed in a single centre between 1996 and 2001. The success rates of achieving histologic diagnosis and a correlation between radiologic and histologic diagnosis were examined.

Stereotactic radiosurgery XVI: Isodosimetric comparison of photon stereotactic radiosurgery techniques (gamma knife vs. micromultileaf collimator linear accelerator) for acoustic neuroma--and potential clinical importance.

Purpose: Two stereotactic photon radiation therapy methods are currently in practice for the treatment of acoustic neuroma. In the 1990s, our data and those of others demonstrated isodosimetric advantages for gamma knife technology over linear accelerator methodology. Since then, the introduction of micromultileaf collimator technology has improved the conformity of the linear accelerator method such that the isodosimetric differences between the two techniques have narrowed.

Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach.

Objective: To determine the prevalence of systemic sclerosis associated pulmonary arterial hypertension (SScPAH), evaluate outcome, and identify predictors of mortality in a large patient cohort.

Methods: A prospective four year follow up study of 794 patients (722 from our own unit and 72 referrals). All patients screened for PAH using a combination of echocardiography, lung function testing, and clinical assessment.

Glioma after cerebral hydatid disease.

Background: The authors present the case of a 31-year-old man with a malignant glioma. He had been treated for cerebral hydatid as a child, and 22 years later he developed a glioma at the site of his previous disease.

Discussion: Could chronic inflammatory change following intracranial hydatid disease have induced neoplastic transformation of glial cells?

A telephone advice line does not decrease the number of presentations to Christchurch Emergency Department, but does decrease the number of phone callers seeking advice.

Aim: To describe the effect of a pilot national telephone advice service (Healthline) on a public hospital emergency department.

Methods: We prospectively gathered information from the Christchurch Hospital Emergency Department (ED) computer- and non-computer-based information systems, for a six-month period during the operation of Healthline. We compared the data with five earlier periods when Healthline was not running.

Stereotactic radiosurgery. XVII: Recurrent intrasellar craniopharyngioma.

Stereotactic radiosurgery for craniopharyngioma is usually a high risk procedure due to the intimate relationship of the tumour to the optic chiasm and conservative dosing has been advocated to reduce complication rates. In 2002, in a publication from Karolinska Hospital, Sweden, 13 out of 21 patients received only a marginal dose of 6 Gy (not considered a radical dose) and 11 out of 13 tumours progressed. This recent report must argue against single dose stereotactic radiosurgery as the primary radiation therapy modality in most cases.

Acute symptoms after gamma knife radiosurgery.

Object: The purpose of this study was to examine the widely held assumption that early-onset symptoms after gamma knife radiosurgery (GKS) are uncommon. The study was designed to include all types of morbidity and not just those that lead to neurological dysfunction. It was hoped that the results of the study could lead to a more rational follow-up protocol.

An investigation into the spatial relationship between prostate intraepithelial neoplasia and cancer.

The distribution of high grade prostate intraepithelial neoplasia (PIN) and cancer was analysed in 18 separate areas from 89 radical prostatectomy specimens that had been sectioned and digitally imaged. When the occurrence of each type of pathology was summated a predilection was demonstrated for both pathologies in the apex of the prostate and a linear relationship was found between the frequency of cancer and high grade PIN (r(2)=0.744, P<0.

Resin-retained bridges re-visited. Part 2. Clinical considerations.

Resin-retained bridges have been used clinically since the 1970s, and offer a more conservative approach to the restoration of edentulous spaces than conventional bridgework. They are easy to place, cheap to fabricate and have been shown to be cost-effective. Despite this, they are not frequently used in general dental practice and they have an undeserved reputation for failure.

Stereotactic radiosurgery XIV: The role of the haemosiderin 'ring' in the development of adverse reactions following radiosurgery for intracranial cavernous malformations: a sustainable hypothesis.

There are strong data supporting the clinical efficacy of ionizing radiation therapy in the treatment of extracranial cavernous angiomas; no unusual complications occur. There is no a priori reason to anticipate a high rate of complications following radiosurgery for brain cavernous angiomas and yet equivalent dose prescriptions (site, size and target volume) to those used for AVM are associated with a considerably higher complication rate. The observed sub-acute reactions sometimes recover with steroid therapy.

Case report: orthodontic separators as periodontal ligatures in periodontal bone loss.

Periodontal destruction due to subgingival elastic bands was first reported in the dental literature nearly 130 years ago, and has involved over 20 cases. Destruction due to orthodontic separators used during fixed appliance therapy is a less common occurrence. A case report is presented which illustrates the severe periodontal destruction, which can occur when separators are misused.

Resin-retained bridges re-visited. Part 1. History and indications.

Resin-retained bridges have been used clinically since the 1970s, and offer a more conservative approach to the restoration of edentulous spaces than conventional bridgework. They are easy to place, cheap to fabricate and have been shown to be cost effective. Despite this, they are not frequently used in general dental practice and they have an undeserved reputation for failure.

Sex hormone-binding globulin in the human prostate is locally synthesized and may act as an autocrine/paracrine effector.

Sex hormone-binding globulin (SHBG) is a plasma protein synthesized and secreted by the liver. Its initial description stemmed from its ability to bind estrogens and androgens and its capacity to regulate the free concentration of the steroids that bind to it. Additionally, it participates in signal transduction for certain steroid hormones at the cell membrane.