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

Impact of infestation by parasitic weeds on rice farmers' productivity and technical efficiency in sub-Saharan Africa

Rice production is crucial for food security and income generation in sub-Saharan Africa. However, productivity and technical efficiency levels in rice production systems are severely constrained by biotic constraints such as parasitic weeds. This paper assesses the impact of infestation by parasitic weeds on rice farmers’ technical efficiency and examines the potential role of managerial factors in improving technical efficiency. Household and field survey data were collected from rice farmers in Cote d’Ivoire and Benin in West Africa. A stochastic frontier production function was estimated, which allows for identifying the levels of exogenous factors that prevent farmers from improving technical efficiency levels. The results suggest that farmers cope with parasitic weeds through learning from experiencing infestations by parasitic weed. The results will assist national extension in designing segmented training programmes that are better tailored to rice farmers’ needs and preventing food security from being jeopardized by parasitic weeds

Hidradenitis suppurativa:The third cause of vulva carcinoma

The development of squamous cell carcinoma (SCC) is a severe complication of chronic HS (HS). HS associated SCC can present as a painful, persistent tumour or ulcer without typical HS characteristics such as sinus formation and inflammation. Especially male patients with prolonged HS in extra-axillary areas are at risk for this complication. This case of HS associated vulvar SCC emphasizes that also women can develop this complication. In addition to lichen sclerosus vulvae (via dVIN) and high risk HPV (via uVIN) there is a third disease that can lead to vulvar cancer; chronic HS. The clinician should be vigilant for the development of malignant transformation in cases of severe, chronic HS, and should have a low threshold for biopsy. Staging, therapy and follow-up should be performed by gynecologic oncologists in an academic center.</p

Feasibility of endometrial sampling by vaginal tampons in women with Lynch syndrome

Background: Endometrial sampling for the surveillance of women with Lynch syndrome is an invasive and painful procedure. The aim of this study was to evaluate the feasibility of a less invasive procedure of collecting vital cells by vaginal tampons. Methods: This was a prospective feasibility study of women scheduled to undergo annual gynecological surveillance, including endometrial sampling. We included consecutive asymptomatic women with Lynch syndrome or first-degree relatives and asked them to insert a vaginal tampon 2-4 h before attending their outpatient appointment. Feasibility was evaluated by the following metrics: Patient acceptance, pain intensity of each procedure (assessed by visual analog scale; range 0-10), and the presence of vital cells obtained by tampon-based or endometrial sampling methods. Two pathologists independently evaluated all samples. Results: In total, 25 of 32 approached women completed the tampon-based procedure, with 23 of these subsequently undergoing invasive endometrial sampling. The median visual analog scale scores for tampon use and invasive endometrial sampling were 0 (range, 0-10) and 5.5 (range, 1-10) (p < 0.001). None of the tampon samples analyzed by cytology showed endometrial cells, but they did contain vital squamous cells and granulocytes. By contrast, 18 (78%) of the invasive endometrial samples contained enough endometrial tissue for analysis. No endometrial abnormalities were found by endometrial sampling. Conclusions: Tampon-based endometrial surveillance was a well-accepted and non-painful procedure, and although tampons contained vital cells, they did not provide endometrial cells. However, this study was limited to asymptomatic women with Lynch syndrome (no endometrial pathology), indicating that research is needed to evaluate whether the tampon method has any utility for endometrial surveillance in women with Lynch syndrome