Neurosurgical applications of radiotherapy

The term ‘radiosurgery’ (RS) indicates a high precision localized technique of irradiation used as an alternative to surgical excision in patients with malignant or benign conditions, both in the brain and in the body. Brain RS has been historically identified with ‘stereotactic radiotherapy’. The term refers to the long-established neurosurgical technique of localizing the position of a lesion in the brain by using a system of external 3D co-ordinates coupled with rigid head immobilization device (often fixed to the skull). A high dose of radiation is delivered to the target stereotactically identified and a safe and accurate treatment is achieved, minimizing the dose of radiation to the surrounding brain. While for some techniques the traditional stereotactic localization has been replaced by the integration of modern imaging with non-invasive accurate immobilization, the term ‘stereotactic’ is still maintained in the clinical practice. Over the past 30 years, the implementation of powerful diagnostic imaging devices and of new radiotherapy equipment has contributed to the large diffusion of brain RS. RS plays an important role in the management of brain tumours, vascular and functional brain lesions and the expertise of the multidisciplinary treating team (clinical oncologists, neurosurgeons, neuro-radiologists and medical physics) contributes to the treatment success rate.     

Laryngeal papillomas: the epidemiology in a Danish subpopulation 1965–1984

The incidence rate of laryngeal papillomas in a Danish subpopulation (approximately 2.8 million inhabitants) was 3.84 × 10^-6 per year in the period 1968–1984. For juvenile papillomas the incidence rate was 3.62 × 10^-6, compared with 3.94 × 10^-6 for laryngeal papillomas of adult onset. When comparing different time periods a significantly low incidence was found in the time 1965–1968, while the incidence remained constant in 1969–1984. The low incidence rate in the early period may be real, but selectional bias may have played a part. It is in general anticipated that maternal genital HPV-infections may serve as an HPV-reservoir, and that juvenile laryngeal papilloma is a result of HPV transmission from the mother to the child during birth. In the period in question cervical HPV-infections have been recorded with increasing frequency in younger women, indicating that the prevalence is rising. However, this is not reflected in the incidence of laryngeal papillomas.     

Liver transplantation in tyrosinaemia type 1: the dilemma of timing the operation

Four children with tyrosinaemia type 1 received liver transplants. The metabolic disorder was corrected and all four had normal liver function on an unrestricted diet. Two children, transplanted at age five and seven years, proved to have occult hepatocellular carcinoma and both subsequently developed pulmonary metastases. One child was well 32 months after removal of a single pulmonary metastasis but the other child died with multiple metastases. The two younger children, transplanted at age 19 and 21 months, were well 28 and 44 months after operation, one after a second liver transplant. Our experience confirms the high risk of hepatocellular carcinoma in this disease and the potential value of early liver transplantation.     

Five-year outcome of infants of birthweight 500 to 1500 grams: relationship with neonatal ultrasound data

Of 154 consecutive survivors of birthweight 500 to 1500 gm, 139 (90.3%) were seen at 5 years of age, corrected for prematurity, and 137 (89%) were able to be fully assessed by both the psychologist and pediatrician. All but two children had had serial cranial ultrasonography with a linear array real-time scanner in the neonatal period. At 5 years, of 39 children with cerebral ultrasound abnormalities detected during their primary hospitalization, seven (17.9%) had cerebral palsy, but 32 (82.1%) did not. A further three children with cerebral palsy at 5 years had had no cerebral abnormalities on ultrasound. Of the cerebral abnormalities diagnosed by ultrasound, ventricular dilation, with or without cerebroventricular hemorrhage, had the highest positive predictive value (40%) for cerebral palsy at 5 years. In the 127 children free from cerebral palsy at 5 years, two (1.6%) had severe intellectual impairment, both of whom had had normal cerebral ultrasonography. Although neonatal cranial ultrasonography with a linear array was somewhat predictive of cerebral palsy at 5 years, the majority of infants with abnormal scans had no severe sensorineural impairments at 5 years.     

Muscular strength at 5 years of children with a birthweight under 1500g

Abstract The hand-grip strength was measured as part of the 5-year neurodevelopmental assessment of 24 very low birthweight (VLBW) and 18 normal birthweight (NBW) children. Hand-grip strength was significantly lower in the VLBW children for left and right hands tested individually and for both hands used concurrently. Increasing hand-grip strength was significantly related to 5-year weight percentiles and to being in the NBW group. More of the VLBW children weighed less than the 10th percentile. After adjusting for the 5-year weight percentile, the hand-grip strength of VLBW children was still significantly lower than that for NBW children. This is another aspect of development in which VLBW children are disadvantaged.     

Longitudinal study of very low birthweight infants: impairments, health and distance growth to 14 years of age

Of 456 consecutive infants born in a tertiary maternity centre in 1966-70 and of birthweight under 1501 g, 171 (37.5%) survived their primary hospitalization. Subsequently three children died and the outcome of 142 (90.5%) of the remaining children presumably still alive were reviewed at a mean age of 14.5 years. Four children had cerebral palsy although only one child was legally blind, 31.6% (48/152) had an existing or corrected visual impairment; visual impairments occurred significantly more frequently in those of birthweight under 1251 g or those born before 29 weeks gestation. Six children required hearing aids and three others were still epileptic. Four children were chronic asthmatics and one had rheumatoid arthritis. None had disabling malformations and there was no delay in pubertal changes. The distributions of weight, height and head circumference percentiles were not significantly different from a standard Australian population. For children in the cohort, weights and heights were under the 10th percentile in 13.4% and 14.1%, respectively. Of the 30 children with birthweights under the 10th percentile and who were reviewed as teenagers, only eight (26.7%) were still in this weight category.