Development of Methodologies and Tools—The HKKH Partnership Project

High mountains have sensitive social-ecological systems (SESs) characterized by fragility, complexity, and marginality. The local economies of these environments mainly rely on primary production, tourism, and leisure activities; thus human-ecosystem interactions are intricately linked. Many authors stress that this strict relationship must be assisted with a participatory approach involving interested stakeholders in the conceptualization, specification, and synthesis of knowledge and experience into useable information for the express purpose of addressing a problem complex. This paper presents experience garnered with a participatory modeling framework combining hard and soft methodology in 2 case studies: the Sagarmatha National Park and Buffer Zone (Nepal) and the Central Karakoram National Park (Pakistan). The modeling framework was developed based on local stakeholders' demands and needs; it consists of 5 modules, briefly presented here along with their conceptual background. In developing the framework, particular emphasis was given to considering the needs of decision-makers at the local level, rather than simply providing technical solutions to abstract problems. From the development of this modeling process, a need emerged to structure a management-oriented research module in order to generate management knowledge that is both stakeholderrelevant and evidence-based. The application of the framework in the 2 cases studies showed that the modeling can trigger valuable discussion among stakeholders as well as guidance for management-oriented research and feedback loops ensuring validation of knowledge. In addition, the resulting scenarios can help decision-makers in defining pathways for sustainable development in mountain areas, where people's livelihoods are closely dependent on ecosystems. The framework was developed in such a way that it can be replicated in other mountain areas with similar challenges

Experience With a Hard and Soft Participatory Modeling Framework for Social-ecological System Management in Mount Everest (Nepal) and K2 (Pakistan) Protected Areas

High mountains have sensitive social-ecological systems (SESs) characterized by fragility, complexity, and marginality. The local economies of these environments mainly rely on primary production, tourism, and leisure activities; thus human-ecosystem interactions are intricately linked. Many authors stress that this strict relationship must be assisted with a participatory approach involving interested stakeholders in the conceptualization, specification, and synthesis of knowledge and experience into useable information for the express purpose of addressing a problem complex. This paper presents experience garnered with a participatory modeling framework combining hard and soft methodology in 2 case studies: the Sagarmatha National Park and Buffer Zone (Nepal) and the Central Karakoram National Park (Pakistan). The modeling framework was developed based on local stakeholders' demands and needs; it consists of 5 modules, briefly presented here along with their conceptual background. In developing the framework, particular emphasis was given to considering the needs of decision-makers at the local level, rather than simply providing technical solutions to abstract problems. From the development of this modeling process, a need emerged to structure a management-oriented research module in order to generate management knowledge that is both stakeholder-relevant and evidence-based. The application of the framework in the 2 cases studies showed that the modeling can trigger valuable discussion among stakeholders as well as guidance for management-oriented research and feedback loops ensuring validation of knowledge. In addition, the resulting scenarios can help decision-makers in defining pathways for sustainable development in mountain areas, where people's livelihoods are closely dependent on ecosystems. The framework was developed in such a way that it can be replicated in other mountain areas with similar challenges

Spinal en plaque meningiomas: A contemporary experience

OBJECTIVE: Spinal en plaque meningiomas are rare and challenging lesions because of their tendency to induce spinal arachnoiditis. The surgical treatment of this type of meningioma is more complex than that of classic meningioma. METHODS: We report seven cases of spinal en plaque meningiomas and review all the cases reported in the literature accessible to us by a MEDLINE search. RESULTS: All patients underwent microsurgery. Complete tumor removal was achieved in three patients. Subtotal removal was performed in four patients. A permanent neurological worsening was observed in one patient. CONCLUSION: Spinal meningiomas en plaque bear a prognosis poorer than that of classic meningiomas with regard to the possibility of a definitive surgical cure because recurrence or postoperative arachnoiditis occurs frequently. Total surgical removal should be attempted only when a clear plane of cleavage between tumor and arachnoid exists

Single cerebral metastasis from colorectal adenocarcinoma

Single cases are described in 50% of reported intracranial metastases. Single cerebral metastasis from colorectal adenocarcinoma is not very common, with a frequency varying between 0.5% and 1%. In our institute between 1960 and 2000, 44 patients affected by single metastasis from colorectal carcinoma were surgically treated. Surgical treatment with postoperative radiant therapy is necessary. These patients show improved quality of life, above all in relation to the maintenance of functional autonomy during the survival period

Gliosarcomas: analysis of 11 cases do two subtypes exist?

There are conflicting reports regarding gliosarcomas. The goal of this study is to examine clinical, radiological, surgical and therapeutic aspects of 11 patients with gliosarcoma. Between 1993 and 2001, 11 patients with cerebral gliosarcoma were treated at our Institute. Ten patients underwent surgery and one patient had stereotactic biopsy. Four patients received whole brain radiotherapy with Co-60, five underwent radiotherapy with LINAC extended 2 cm beyond the edema margins. One patient refused any additional treatment after surgery and one patient was not treated postoperatively for poor clinical conditions (KPS 40). Chemotherapy (temozolomide) was administered to four patients. Four patients had a prevalence of sarcomatous component that corresponded to surgical and radiological aspects similar to meningioma while six patients showed a prevalence of gliomatous component and radiological and surgical aspects similar to those of glioblastomas. Surgical resection was total in six and subtotal in four patients. Patients with prevalent sarcomatous component showed median survival time more prolonged than patients with prevalent gliomatous component (71 +/- 6 weeks vs. 63 +/- 6; P=0.0417). Moreover, the survival rate differed in relation to the therapy: patients treated with multimodality therapy (surgery, radiotherapy and chemotherapy) had a longer survival time than patients treated in single or bimodality. Despite prognosis of gliosarcomas remains poor, a multidisciplinary approach (surgery, radiotherapy and chemotherapy) seems to be associated with slight more prolonged survival times

Platinum-iridium subdermal magnetic resonance imaging-compatible needle electrodes are suitable for intraoperative neurophysiological monitoring during image-guided surgery with high-field intraoperative magnetic resonance imaging: an experimental study.

Neurosurgery aims to achieve maximal tumor resection while preserving neurological function. Tools such as neuronavigation, high-field intraoperative magnetic resonance imaging (iMRI), and intraoperative neurophysiological monitoring (IOM) have consistently helped to achieve this goal, but integration has often been difficult. Surgery of eloquent areas requires IOM, which in an operating theater equipped with high-field (1.5-T) iMRI could present several issues. To identify the electrodes types more suitable for IOM in a high-field iMRI operating theater by performing an experimental study on phantoms, to report our experience with platinum-iridium (Pt/Ir) electrodes during surgery, and to prove that integration between IOM with Pt/Ir electrodes and high-field iMRI is safe and reliable. Electrodes of different materials (gold, Pt/Ir, and stainless steel) were tested on jelly phantom and apples to evaluate their safety and compatibility. Subsequently, electrodes were tested on 5 healthy volunteers before being used on patients. None of the different electrodes presented thermal instability, and no damage to the volunteers' skin occurred. Stainless steel electrodes caused severe imaging distortion. Gold electrodes had no distortion, but their high cost makes their use in routine surgery unaffordable. Pt/Ir electrodes are significantly less expensive than gold electrodes and were completely safe, compatible, and suitable for use in an operating theater with high-field iMRI, providing excellent IOM and mild interference that did not affect the quality of intraoperative imaging. We suggest the use of Pt/Ir electrodes for IOM in 1.5-T iMRI suites. DTI, diffusion tensor imagingiMRI, intraoperative magnetic resonance imagingIOM, intraoperative neurophysiological monitoring

Retroperitoneal mesenchymal chondrosarcoma mimicking a large retroperitoneal sacral schwannoma

We report a case of retroperitoneal chondrosarcoma in which preoperative radiological study induced to a possible diagnosis of sacral schwannoma. A 25-year-old woman was admitted to our neurosurgical institute for a progressive sciatic pain with gait difficulties with a sudden radicular deficit with right positive Lasegue's sign at 30 degrees, loss of Achilles reflex, sensory deficit on right S1 dermatome, and complete motor deficit of right plantar flexion. We performed an en bloc removal of the lesion via an anterior retroperitoneal approach. We believe that the treatment of choice is radical surgical excision of the tumor with complete en-bloc removal of the lesion; postoperative radiotherapy and chemotherapy should be valuated case by case

Accuracy of Transthoracic Ultrasound for the Prediction of Chest Wall Infiltration by Lung Cancer and of Lung Infiltration by Chest Wall Tumours

Background: We wanted to determine the accuracy of transthoracic ultrasound in the prediction of chest wall infiltration by lung cancer or lung infiltration by chest wall tumours. Methods: Patients having preoperative CT-scan suspect for lung/chest wall infiltration were prospectively enrolled. Inclusion criteria for lung cancer were: obliteration of extrapleural fat, obtuse angle between tumour and chest wall, associated pleural thickening. The criteria for chest wall tumours were: rib destruction and intercostal muscles infiltration with extrapleural fat obliteration and intrathoracic extension. Lung cancer patients with evident chest wall infiltration were excluded.Transthoracic ultrasound was preoperatively performed. Predictions were checked during surgical intervention. Results: Twenty-three patients were preoperatively examined.Sensitivity, specificity, positive and negative predictive values of transthoracic ultrasound were 88.89%, 100%, 100% and 93.3%, respectively. Youden index was used to determine the best cut-off for tumour size in predicting lung/chest wall infiltration: 4.5. cm.At univariate logistic regression, tumour size (<4.5 vs 65 4.5. cm) (p=0.0072) was significantly associated with infiltration. Conclusions: Transthoracic ultrasound is a useful instrument for predicting neoplastic lung or chest wall infiltration in cases of suspect CT-scans and could be used as part of the preoperative workup to assess tumour staging and to plan the best surgical approach