Brain tumors in children. I. Advances in diagnosis

This article emphasizes the contributions that new diagnostic techniques have made toward the management of children with brain tumors. The development of computerized tomographic (CT) scanning has revolutionized both the diagnosis and management of patients with brain tumors and has obviated the previously inevitable delays in diagnosis. The development of magnetic resonance imaging (MRI) has certainly facilitated diagnosis of brain tumors in certain locations with the brain, but it remains unproven in other locations. It is clear that at least some of the early promise of MRI scanning has not been realized. Neither CT nor MRI are able to provide functional detail within the brain, nor are they able to differentiate tumor from peritumoral edema to better delineate the tumor margins. It is hoped that the currently experimental techniques of Positron Emission Tomography (PET) scanning and contrast-enhanced MRI scanning will provide such information in the near future. Neurophysiologic methods of assessing brain tumors merit greater consideration than has been afforded to date. Sensory evoked-potential monitoring provides information about nervous system function. This information is useful both in diagnosis and in monitoring of brain tumors, since the functional information can be localized to discrete regions within the brain. The value of cerebrospinal fluid (CSF) evaluation, both for cytology and tumor markers, cannot be overstated. A significant proportion of childhood brain tumors tend to seed throughout the neuraxis by the CSF pathways. Thus, evaluation of CSF cytology prior to surgical perturbation of the primary tumor should be undertaken whenever safely feasible, in order to avoid the dilemma of postoperative positive CSF cytology and its questionable significance.     

In-vivo comparison of four absorbable sutures: Vicryl, Dexon Plus, Maxon and PDS

Absorbable sutures are initially equal or superior to nonabsorbable sutures in terms of tensile strength but are absorbed at variable rates by the action of hydrolysis. This study demonstrated that the in-vivo half-life tensile strength of the braided absorbable sutures polyglycolic acid (Dexon Plus) and polyglactin 910 (Vicryl) is 2 weeks, whereas those of the monofilament absorbable sutures polyglyconate (Maxon) and polydioxanone (PDS) are 3 and 6 weeks respectively. The addition of a single hitch or six knots reduced the in-vitro tensile strength by 30% to 35%. Polyglyconate (Maxon) suture demonstrated the best in-vitro knot security.     

Stability of the original Hoffmann and AO tubular external fixation devices

Detailed data of the stability of external fixation devices are needed by the orthopaedic surgeon to predict successful healing of a fracture. The stability (rigidity, yield and failure criteria) of four half-frame configurations (single, stacked, double and delta) of the original Hoffmann and AO tubular frame have been analysed under four loading conditions: axial compression, torsion, and both AP- and ML-bending. Overall the two systems' rigidities were the same between similar configurations. Both systems' single half-frames were particularly weak; however, as the number of components (rods, pins, clamps, couplings) on the frame increased, the rigidity of the frame increased. The difference in performance between the two systems lies in their yield and failure characteristics. The AO system exhibited excellent failure criteria in all modes of loading, i.e. no configuration failed within the test limits, whereas most Hoffman frames yielded and failed at low loads.     

Cytokinetic factors in drug resistance of Lewis lung carcinoma: comparison of cells freshly isolated from tumours with cells from exponential and plateau-phase cultures.

The cytotoxic effects of chemotherapeutic drugs on quiescent and actively proliferating cells of a Lewis lung carcinoma (LLTC) cell line have been examined. The sensitivities of cells in plateau-phase and exponentially growing cultures were compared with those of cells recovered from large subcutaneous tumours both immediately after tumour disaggregation and after one or 4 days in culture. Flow cytometric analysis indicated that when cells freshly prepared from tumours were placed into culture, they underwent extensive recruitment into S-phase. Several drugs were less cytotoxic towards both plateau-phase cultured cells and cells freshly isolated from tumours than they were against exponentially growing cells. These included amsacrine, its 4-methyl-5-(N-methyl)carboxamide derivative CI-921, doxorubicin, and nitrogen mustard. In contrast to these drugs, chlorambucil and plasma from cyclophosphamide-treated mice did not show decreased activity against slowly proliferating cells from cultures or tumours relative to cells in an actively proliferating state. The similar sensitivities of plateau-phase cultured cells and cells taken directly from large growing tumours is direct evidence that plateau-phase cultures are a useful approximation to the state of cytokinetic resistance to chemotherapeutic drugs that prevails in solid tumours, although they may not fully reflect the cytokinetic heterogeneity present in tumours.     

Challenging the world: patient safety and health care-associated infection.

Improving the safety of patient care is an issue which affects health systems in both developed and developing countries. To co-ordinate and accelerate improvements in patient safety, the World Health Organization (WHO) has supported the creation of the World Alliance for Patient Safety which was launched in October 2004. The six action areas of the Alliance are Patients for Patient Safety, Taxonomy, Research, Solutions for Patient Safety, Reporting and Learning, and a biennial Global Patient Safety Challenge. The first Challenge covering 2005-2006 was launched in October 2005 under the banner 'Clean Care is Safer Care'. The Challenge addresses health care-associated infection, a major, patient safety problem affecting hundreds of millions of people worldwide.