Primary radiotherapy in progressive optic nerve sheath meningiomas: a long-term follow-up study

Background/aims: To report the outcome of primary radiotherapy in patients with progressive optic nerve sheath meningioma (ONSM). Methods: The clinical records of all patients were reviewed in a retrospective, observational, multicentre study. Results: Thirty-four consecutive patients were included. Twenty-six women and eight men received conventional or stereotactic fractionated radiotherapy, and were followed for a median 58 (range 51–156) months. Fourteen eyes (41%) showed improved visual acuity of at least two lines on the Snellen chart. In 17 (50%) eyes, the vision stabilised, while deterioration was noted in three eyes (9%). The visual outcome was not associated with age at the time of radiotherapy (p=0.83), sex (p=0.43), visual acuity at the time of presentation (p=0.22) or type of radiotherapy (p=0.35). Optic disc swelling was associated with improved visual acuity (p<0.01) and 4/11 patients with optic atrophy also showed improvement. Long-term complications were dry eyes in five patients, cataracts in three, and mild radiation retinopathy in four. Conclusion: Primary radiotherapy for patients with ONSM is associated with long-term improvement of visual acuity and few adverse effects.Peerooz Saeed, Leo Blank, Dinesh Selva, John G. Wolbers, Peter J.C.M. Nowak, Ronald B. Geskus, Ezekiel Weis, Maarten P. Mourits, Jack Rootma

Efficacy of endoscopic sinus surgery for paranasal sinus mucocele including modified endoscopic Lothrop procedure for frontal sinus mucocele

This study evaluated the efficacy of the modified endoscopic Lothrop procedure (MELP) for complicated frontal mucoceles and endoscopic marsupialization for other paranasal sinus mucoceles. It was a retrospective, consecutive case review of sinus mucoceles treated endoscopically by a single surgeon over a four-year period (1998-2002). There were 41 mucoceles in 28 patients, including 24 frontal, eight frontoethmoidal, three ethmoidal, five maxillary and one frontal mucocele. Twenty-one patients underwent the modified Lothrop procedure for frontal mucoceles, and seven underwent simple drainage and marsupialization for frontoethmoidal, ethmoidal and maxillary mucoceles. At median follow-up of 16 months, all patients had a patent mucocele opening. Patients treated by drainage and marsupialization did not have any complications or mucocele recurrence. All patients treated by the modified endoscopic Lothrop procedure had improvement in symptoms and signs. Four patients had minor complications including epistaxis and adhesions and five required further surgery. The average hospital in-patient stay was 2 ± 1.4 days. Endoscopic techniques, including MELP are effective in the short term for the management of complex and simple paranasal sinus mucoceles. MELP has a useful place in the management of mucoceles with a significant bony partition from an adjacent sinus or nasal cavity. It is also indicated when the mucocele is associated with loss of lateral support in the sinus with risk of medial-wall collapse of the orbital contents obstructing drainage.Jwu Jin Khong, Raman Malhotra, Dinesh Selva and Peter John Wormal

Controversies in the management of primary sclerosing cholangitis

Primary sclerosing cholangitis (PSC) remains a rare but significant disease, which affects mainly young males in association with inflammatory bowel disease. There have been few advances in the understanding of the pathogenesis of the condition and no therapeutics with proven mortality benefit aside from liver transplantation. There remain areas of controversy in the management of PSC which include the differentiation from other cholangiopathies, in particular immunoglobulin G4 related sclerosing cholangitis, the management of dominant biliary strictures, and the role of ursodeoxycholic acid. In addition, the timing of liver transplantation in PSC remains difficult to predict with standard liver severity scores. In this review, we address these controversies and highlight the latest evidence base in the management of PSC

Tetra­aqua­bis[3-(2-pyridylsulfan­yl)propionato N-oxide]nickel(II)

In the centrosymmetric title compound, [Ni(C8H8NO3S)2(H2O)4], the NiII ion, which lies on an inversion centre, is six coordinated by four water mol­ecules and two propionate O atoms from two 2-pyridylsulfanylpropionate N-oxide ligands, forming a slightly distorted octa­hedral geometry. An intra­molecular O—H⋯O hydrogen bond stabilizes the mol­ecular conformation. The crystal packing is consolidated by inter­molecular O—H⋯O and C—H⋯O hydrogen bonding

2-(2,3,5,6-Tetra­methyl­benzyl­sulfan­yl)pyridine N-oxide

In the title compound, C16H19NOS, the durene ring and the oxopyridyl ring form a dihedral angle of 82.26 (7)°. The crystal structure is stabilized by inter­molecular C—H⋯O hydrogen bonds, weak C—H⋯π inter­actions and π–π inter­actions [centroid–centroid distance of 3.4432 (19) Å], together with intra­molecular S⋯O [2.657 (2) Å] short contacts

catena-Poly[[aqua­sodium(I)]-μ-[2,2′-(disulfanedi­yl)bis­(pyridine N-oxide)]-μ-(pyridine-2-thiol­ato 1-oxide)]

There are two monomeric units in the asymmetric unit of the polymeric title compound, [Na(C5H4NOS)(C10H8N2O2S2)(H2O)]n. The NaI ions are six coordinated by four O atoms, one S atom and one water mol­ecule, forming a slightly distorted octa­hedral geometry. An intra­molecular O—H⋯O hydrogen bond stabilizes the conformation of the mol­ecule. The crystal packing is consolidated by inter­molecular O—H⋯O, O—H⋯N and O—H⋯S hydrogen bonds, π–π inter­actions [with centroid–centroid distances of 3.587 (2) Å] together with weak C—H⋯π inter­actions. The mol­ecules are linked into polymeric chains along the b-axis direction

2-(Mesitylmethyl­sulfan­yl)pyridine N-oxide–18-crown-6 (2/1)

In the title compound, 2C15H17NOS·C12H24O6, the asymmetric unit consists of one N-oxide derivative and one-half of the 18-crown-6 ether, which lies on an inversion centre. In the crown ether, the O—C—C—O torsion angles indicate a gauche conformation of the ethyl­eneoxy units, while the C—O—C—C torsion angles indicate planarity of these segments. In the N-oxide unit, the dihedral angle between the pyridine and benzene rings is 85.88 (12)°. The crystal packing is stabilized by weak C—H⋯O hydrogen bonds and C—H⋯π inter­actions

Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory

Objective: To investigate whether Indigenous Australians with cancer have more advanced disease at diagnosis than other Australians, and whether late diagnosis explains lower Indigenous cancer survival rates. Design: Retrospective cohort study. Setting and participants: Indigenous and non-Indigenous people diagnosed with cancers of the colon and rectum, lung, breast or cervix and non-Hodgkin lymphoma in the Northern Territory of Australia in 1991–2000. Main outcome measures: SEER summary stage of cancer at diagnosis (local, regional or distant spread), cause-specific cancer survival rates and relative risk of cancer death. Results: Diagnosis with advanced disease (regional or distant spread) was more common for Indigenous people (70%; 95% CI, 62%–78%) than for non-Indigenous people (51%; 95% CI, 53%–59%) with cancers of the colon and rectum, breast, cervix and non-Hodgkin lymphoma, but for lung cancer the opposite was found (Indigenous, 56% [95% CI, 46%–65%] v non-Indigenous, 69% [95% CI, 64%–75%]). Stage-adjusted survival rates were lower for Indigenous people for each cancer site. With few exceptions, the relative risk of cancer death was higher for Indigenous people for each category of stage at diagnosis for each cancer site. Conclusions: Health services apparently could, and should, be performing better for Indigenous people with cancer in the Northern Territory, and probably elsewhere in Australia. This study has demonstrated that data from cancer registers, enhanced with data on stage at diagnosis, can be used to monitor health service performance for Indigenous Australians in the Northern Territory; similar data is available in other States, and could be used to monitor health service performance for Indigenous people throughout Australia

catena-Poly[[(18-crown-6-κ6 O)potassium]-μ-chlorido-[(1H-benzotriazol-1-ol-κN 3)chloridoplatinum(II)]-μ-(benzotriazol-1-olato-κ2 N 3:O)]

In the structure of the title compound, [KPt(C6H4N3O)Cl2(C6H5N3O)(C12H24O6)], the PtII atom is in a distorted square-planar geometry. The crystal structure is consolidated by O—H⋯O hydrogen bonds. The measured crystal was a non-merohedral twin with four components

1-Mesitylmethyl-1Hbenzotriazole 3-oxide

In the title compound, C16H17N3O, the benzotriazole ring forms a dihedral angle of 77.25 (6)° with the phenyl ring. The benzotriazole ring is essentially planar with a maximum deviation of 0.012 (19) Å. Weak inter­molecular C—H⋯O hydrogen bonds form R 2 2(10) motifs. The crystal packing is consolidated by π—π inter­actions with centroid–centroid distances of 3.5994 (12) Å together with very weak C—H⋯π inter­actions