Intraoperative radiotherapy during awake craniotomies: preliminary results of a single-center case series

Awake craniotomies are performed to avoid postoperative neurological deficits when resecting lesions in the eloquent cortex, especially the speech area. Intraoperative radiotherapy (IORT) has recently focused on optimizing the oncological treatment of primary malignant brain tumors and metastases. Herein, for the first time, we present preliminary results of IORT in the setting of awake craniotomies. From 2021 to 2022, all patients undergoing awake craniotomies for tumor resection combined with IORT were analyzed retrospectively. Demographical and clinical data, operative procedure, and treatment-related complications were evaluated. Five patients were identified (age (mean ± standard deviation (SD): 65 ± 13.5 years (y)). A solid left frontal metastasis was detected in the first patient (female, 49 y). The second patient (male, 72 y) presented with a solid metastasis on the left parietal lobe. The third patient (male, 52 y) was diagnosed with a left temporoparietal metastasis. Patient four (male, 74 y) was diagnosed with a high-grade glioma on the left frontal lobe. A metastasis on the left temporooccipital lobe was detected in the fifth patient (male, 78 y). After awake craniotomy and macroscopic complete tumor resection, intraoperative tumor bed irradiation was carried out with 50 kV x-rays and a total of 20 Gy for 16.7 ± 2.5 min. During a mean follow-up of 6.3 ± 2.6 months, none of the patients developed any surgery- or IORT-related complications or disabling permanent neurological deficits. Intraoperative radiotherapy in combination with awake craniotomy seems to be feasible and safe.

HIV-positive men who have sex with men are at high risk of development of significant liver fibrosis after an episode of acute hepatitis C

Acute hepatitis C virus infection remains a major health concern in human immunodeficiency virus(HIV)-infected men who have sex with men (MSM). New direct-acting antiviral agent (DAA) combination therapy has not yet been approved for the treatment for acute hepatitis C virus(HCV), thereby potentially causing deferral of HCV treatment. Therefore, we aimed to study the course of liver disease after an episode of acute HCV. This study is a retrospective single-centre cohort of HIV-positive MSM with acute HCV infection. Liver fibrosis was estimated by Fibroscan^® and Fibrotest^® . Liver-related and non-liver-related outcomes were documented. Overall 213 episodes of acute HCV infection in 178 men were documented. Median follow-up for all included patients was 38.7 months. Spontaneous HCV clearance was found in 10.8% of patients, which was significantly associated with older age, lower HCV RNA levels, and higher ALT levels upon initial acute HCV diagnosis. Treatment with interferon-based therapy was initiated in 86.3% of cases, resulting in a sustained virological response(SVR) rate of 70.7%. After 3 years' follow-up, significant liver fibrosis of METAVIR F2 stage or higher was found in 39.4% of patients after first acute HCV diagnosis. Higher age, physician-declared alcoholism, and nonresponse to acute HCV therapy were independently associated with higher fibrosis stages. Ten patients died during the observation period (IR 1.4/100 patient-years) and four during interferon treatment. Significant liver fibrosis is a common finding in HIV-positive MSM following acute HCV infection despite high treatment uptake and cure rates, suggesting the need for close liver disease monitoring particularly if HCV treatment is deferred.

Ultrasonographic examination of the abdomen of the goat. I. Reticulum, rumen, omasum, abomasum and intestines

This review article summarizes the ultrasonographic findings of the reticulum, rumen, omasum, abomasum and intestines of goats. Ultrasonographic examination is done on both sides with the goat in a standing position using a linear array or convex transducer with a frequency of 5.0 to 7.5 MHz. The shape, contour and motility of the reticulum are assessed; this organ appears as a crescent-shaped structure with a smooth contour immediately adjacent to the diaphragm. There are 0.8 to 2.1 reticular contractions per minute, which may be mono-, bi- and triphasic. The rumen is examined from the 8th to 12th intercostal spaces (ICSs) and flank on the left, and from the 12th ICS and flank on the right. The ruminal wall appears as a thick echoic line. The dorsal and ventral sacs of the rumen are differentiated based on the longitudinal groove, which forms an echoic notch. Differentiation of the dorsal gas cap, fibre mat and fluid layer is not always straightforward and varies among goats. The omasum is examined from the 6th to 11th ICSs on the right. Only the wall closest to the transducer can be imaged and it appears as a crescent-shaped echoic line medial to the liver. The omasal folds and the wall furthest from the transducer cannot be seen. In about two thirds of goats, active omasal motility is apparent as a transient reduction in size of several centimetres, followed by relaxation and return to its original size. There is an average of 1.1 contractions per minute. The abomasum is examined from the ventral midline and the left and right paramedian regions and can always be seen from the ventral midline. In all but a few goats the abomasum is also visible from the left and right paramedian areas. It appears as a heterogeneous, moderately echoic structure with echogenic stippling. The abomasal folds appear as prominent echoic bands in about two thirds of all goats. The small and large intestines are examined on the right from the 8th to the 12th ICSs. Loops of jejunum and ileum are seen mainly in cross-section and have a strong motility. The intestinal content is usually homogeneous and echoic and the diameter of the intestinal loops varies from 0.8 and 2.7 cm. The spiral colon and in many cases also the caecum can be imaged. The former is recognized by its garland-like appearance brought about by the centripetal and centrifugal coils of the intestine. In the spiral colon and the caecum, only the wall closest to the transducer can be imaged because of intraluminal gas. The wall appears as a thick echoic and slightly undulating line 5.6 to 8.0 cm in length. Ultrasonography is an imaging technique that is very well suited for the examination of the gastrointestinal tract of goats.

Sonographic findings in an alpaca with Mycobacterium kansasii infection

This case report describes the clinical, ultrasonographic and postmortem findings in an alpaca with Mycobacterium kansasii infection. The alpaca was referred because of chronic weight loss and weakness. The results of clinical examination, haematology and serum biochemistry were not diagnostic. Ultrasonography of the liver revealed multiple, hyperechogenic lesions with a diameter of 1 to 3 cm. Histological evaluation of a liver biopsy sample showed acute, multifocal, suppurative, necrotising hepatitis. Despite treatment with antibiotics, the alpaca died. Postmortem examination revealed nodular to coalescing lesions in the liver, lungs, mediastinum, pleura and greater omentum, which could not be differentiated macroscopically or histologically from lesions caused by tuberculosis. Ziehl-Neelsen staining showed massive numbers of rods within epithelioid macrophages, which were identified as Mycobacterium kansasii by polymerase chain reaction analysis.

[Ultrasonographic and computed tomographic findings in a goat with mediastinal lymphocytic thymoma]

This case report describes the clinical, sonographic, computed tomographic and pathological findings in a 9-year-old goat with mediastinal lymphocytic thymoma. The goat was referred to the Department of Farm Animals because of weight loss and dyspnoea. The lead clinical findings were increased heart rate, increased respiratory rate and heart sounds heard only on the right side. Ultrasonographic examination revealed a massive amount of fluid and an echogenic corrugated mass ventral to the lungs in the thoracic cavity on the left side. Computed tomography showed that the mass was very large and diffusely mineralised. A tentative diagnosis of mediastinal neoplasia was made, and the goat was euthanized. Postmortem examination revealed a cauliflower-like, pedunculated tumour, which occupied the entire left thoracic cavity and displaced the left lung. Based on histological evaluation, the tumour was diagnosed as a lymphocytic thymoma.

An unusual cause of traumatic reticulitis/reticuloperitonitis in a herd of Swiss dairy cows nearby an airport

This report describes the findings in five cows from one dairy herd, in which all 31 cows were slaughtered or euthanised because of traumatic reticuloperitonitis. All the cows had numerous thin sharp pieces of metal attached to a magnet in the reticulum, giving the magnet a hedgehog-like appearance. Investigation revealed that the cattle had eaten forage harvested from a field immediately adjacent to an airport. The snow was cleared from the airport runways with a machine that had a wire-bristle brush attachment. Mechanical wear resulted in numerous wire bristles breaking and these were blown with the snow onto the field in question. The wire then became accidentally incorporated into the hay and grass silage at harvest the next summer and was ingested by the cattle in the fall and winter. To prevent further cases, approximately 200 tonnes of hay and grass silage contaminated with wire were discarded and 30 hectares of the 50-hectare field were cultivated and re-sown. The wire-bristles of the snow plow were replaced with plastic bristles. The cost of this and the livestock loss was several hundred thousand Swiss Francs.

Sport specific fitness testing of elite badminton players

There is a scarcity of descriptive data on the performance capacity of elite badminton players, whose fitness requirements are quite specific. The purpose of this paper is to investigate the physiological response of elite badminton players in a sport-specific fitness test. Twelve Hong Kong national badminton team players performed a field test on a badminton court. Six light bulbs were connected to a programming device causing individual bulbs to light up in a given sequence. The players were instructed to react to the flashes by running towards them, and striking shuttles mounted in the vicinity of the bulbs. Exercise intensity was controlled by altering the interval between successive lightings. A low correlation (r = 0.65) was found between the results of the field test and the rank-order list of subjects, based on an objective on-field physiological assessment and subjective ranking. This may be explained by the requirements of other factors besides physical fitness which contribute to success in elite level badminton competition. These factors may include, for example, technical skill, mental power, and aesthetic judgements on the court. Maximum mean (s.d.) heart rate data (187(8) beats.min-1) and blood lactate values (10.4(2.9) mmol.l-1) in this study showed that players were under maximal load during the field test. From the testing data, it seems reasonable to speculate that the intensity of level 3 (20 light pulses.min-1; 3.0 s.pulse-1) and level 4 (22 light pulses.min-1; 2.7 s.pulse-1) simulates the requirement of actual games energy expenditure of the Hong Kong badminton players exercising at close to their anaerobic threshold. The results also show that an estimate of fitness can be derived from measurements involving exercise closely resembling that which is specific for the sports activity in question. Improved training advice and guidance may result from such studies.

Physiological profiles and sport specific fitness of Asian elite squash players

There is a scarcity of descriptive data on the physiological characteristics of elite Asian squash players. The purpose of this study was to evaluate the physiological profile and sports specific fitness of Hong Kong elite squash players. It was conducted before the selection of the Hong Kong national squash team for the 1992 Asian Squash Championship. Ten elite squash players were selected as subjects for the study. Maximum oxygen uptake was measured using a continuous treadmill running test. A sports specific field test was performed in a squash court. The following means (s.d.) were observed: height 172.6(4.3) cm; weight 67.7(6.9) kg; body fat 7.4(3.4)%; forced vital capacity (FVC) 5.13(0.26) litres; maximum oxygen uptake (VO2max) 61.7(3.4) ml.kg-1.min-1; anaerobic threshold (AT) 80.2(3.3)% of VO2max; alactic power index 15.5(1.8) W.kg-1; lactic work index 323.5(29.4) J.kg-1, peak isokinetic dominant knee extensor and flexor strengths 3.11(0.29) Nm.kg-1 and 1.87(0.18) Nm.kg-1. The results show that the Hong Kong squash players have relatively high cardiorespiratory sports specific fitness and muscle strength which may be one of the key factors that contributed to the success of the Hong Kong team in the Asian Championship.

[Chondropathia patellae--study of the femoropatellar joints of healthy, athletic children]

155 children, aged 8 to 13 years, who trained regularly, were examined clinically for signs of chondropathy patellae. As control group, 200 children of the same age were included who did not take part in any sports activities except in school. 32% of the training group children showed signs suggestive of chondropathy. With increasing training age, the part of children with these signs increased from 16% in the first to 45% in the third to fourth training year. Non-training children showed in 17% positive signs of chondropathy.

Sports-specific fitness testing in squash

Maximum oxygen uptake and the running speed at the anaerobic threshold were determined during treadmill running. Performance in these laboratory tests and performance on a squash-specific field test were compared and examined with respect to subjective ratings of squash fitness. The field test was performed in a squash court. Six light bulbs were connected to a programming device causing individual bulbs to light up in a given sequence. The players were instructed to react to the flashes by running towards and striking balloons mounted in the vicinity of the bulbs. By altering the interval between the lighting of the bulbs the intensity of exercise could be varied. The test consisted of a series of 3 min periods of exercise at increasing intensities (increased number of runs per unit of time). The results showed a low correlation (r = 0.52) between treadmill ergometry data and a rank-order list based on an independent, partly subjective estimate of fitness. A higher correlation (r = 0.90) was found for the results of the field test and the rank-order list. Maximum oxygen uptake values and anaerobic threshold values derived from laboratory measurements were thus not sufficient for a valid estimate of competition fitness in these players. The results show that a valid estimate of fitness can be derived from measurements involving exercise closely resembling that which is specific for the sports activity in question. Improved training advice and guidance may result from such studies.