Considerations on surgery invasiveness and response and toxicity patterns in classic palliative radiotherapy for acrometastases of the hand: a hint for a potential role of stereotactic body radiation therapy? A case report and literature review

BackgroundThe rarity of hand acrometastases hampers the consensus-building for their optimal management among the involved oncology professionals. In the current literature, demolitive surgery overcomes the use of palliative radiotherapy, which proved to be ineffective in more than 30% of cases treated with classic palliative dose schemes, carrying also a not negligible radiation-related adverse event rate. Against this background, stereotactic body radiation therapy (SBRT) could emerge as a well-balanced therapeutic option.Case summaryHere we describe the methods and outcomes of a SBRT treatment of a painful and function-limiting hand acrometastasis in a patient with a history of stage IIIB lung adenocarcinoma. We delivered a total dose of 30 Gy in five daily fractions to a soft-tissue metastasis abutting the fifth metacarpal bone through the SBRT protocol generally used for intracranial treatments. A few weeks later, the patient reported a clinical complete response with acrometastasis and pain disappearance, function recovery, and no significant toxicity. The acrometastasis was the first sign of an atypical cancer progression.ConclusionsSBRT for hand acrometastases is feasible and might have the best therapeutic profile among the currently available treatment options for this rare clinical scenario. Larger investigations are needed to confirm the present single-case experience

Primary Skull Base Chondrosarcomas: A Systematic Review

From MDPI via Jisc Publications RouterHistory: accepted 2021-11-25, pub-electronic 2021-11-26Publication status: PublishedBackground: Primary skull base chondrosarcomas (SBCs) can severely affect patients’ quality of life. Surgical-resection and radiotherapy are feasible but may cause debilitating complications. We systematically reviewed the literature on primary SBCs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, and Cochrane were searched following the PRISMA guidelines to include studies of patients with primary SBCs. Clinical characteristics, management strategies, and treatment outcomes were analyzed. Results: We included 33 studies comprising 1307 patients. Primary SBCs mostly involved the middle-fossa (72.7%), infiltrating the cavernous-sinus in 42.4% of patients. Cranial-neuropathies were reported in 810 patients (62%). Surgical-resection (93.3%) was preferred over biopsy (6.6%). The most frequent open surgical approaches were frontotemporal-orbitozygomatic (17.6%) and pterional (11.9%), and 111 patients (21.3%) underwent endoscopic-endonasal resection. Post-surgical cerebrospinal-fluid leaks occurred in 36 patients (6.5%). Radiotherapy was delivered in 1018 patients (77.9%): photon-based (41.4%), proton-based (64.2%), and carbon-based (13.1%). Severe post-radiotherapy complications, mostly hypopituitarism (15.4%) and hearing loss (7.1%) were experienced by 251 patients (30.7%). Post-treatment symptom-improvement (46.7%) and reduced/stable tumor volumes (85.4%) showed no differences based on radiotherapy-protocols (p = 0.165; p = 0.062). Median follow-up was 67-months (range, 0.1−376). SBCs recurrences were reported in 211 cases (16.1%). The 5-year and 10-year progression-free survival rates were 84.3% and 67.4%, and overall survival rates were 94% and 84%. Conclusion: Surgical-resection and radiotherapy are effective treatments in primary SBCs, with acceptable complication rates and favorable local tumor control

Annali storici di Principato Citra A. 4, n. 1.1 (2006)

A. 4, n. 1.1 (2006): G. Guardia, Editoriale, P. 3 ; D. Ienna, Menhir a "la Mannina". Un sito megalitico a San Nazario di San Mauro La Bruca? Materiali e ipotesi interpretative, P. 5 ; A. Tierno, Il Vaticano Borgiano gr 27: un rotolo liturgico in lingua greca prodotto a Salerno, P. 44 ; G. Palmisciano, Baronissi nei moti del 1848, P. 54 ; C. Cerone, L’'arrivo dell'illuminazione a Capaccio e Agropoli. Dalle lampade a gas alla nazionalizzazione dell'energia. La centrale idroelettrica Maida, P. 68 ; F. La Greca, Paestanae valles: un antico nome per il Cilento?, P. 104 ; A. Giudice, Da Capo Palinuro alla conca di Sapri: la romanizzazione di un territorio, P. 110 ; Pietro III Paleologo di Bisanzio, Note storiche sulla vita del Sacro Militare Ordine Costantiniano di S. Giorgio, con la Regola di S. Basilio, dalla sua fondazione al gran magistero della Imperiale Famiglia dei Paleologo di Bisanzio, P. 124 ; M. Cerrato – P. Zoccoli, Elementi per la gestione del marketing strategico del prodotto tipico. Il caso di un formaggio caprino, P. 140 ; E. Frescani, "Lò scritto meno del successo". I racconti di Antonio Sessa, un notaio salernitano del XVII secolo, P. 153 ; A. Capano, Sapri, note storiche e il suo Catasto "provvisorio" del 1815, P. 162 ; M. Di Pasquale, 1815 - San Martino Cilento. Un processo per tentato omicidio, P. 178 ; A. Tortorella Bracco, Da un cassettone dell'800 una romantica storia d'amore, P. 202

Is it really advantageous to operate proximal femoral fractures within 48 h from diagnosis? – A multicentric retrospective study exploiting COVID pandemic-related delays in time to surgery

Objectives: Hip fractures in the elderly are common injuries that need timely surgical management. Since the beginning of the pandemic, patients with a proximal femoral fracture (PFF) experienced a delay in time to surgery. The primary aim of this study was to evaluate a possible variation in mortality in patients with PFF when comparing COVID-19 negative versus positive. Methods: This is a multicentric and retrospective study including 3232 patients with PFF who underwent surgical management. The variables taken into account were age, gender, the time elapsed between arrival at the emergency room and intervention, pre-operative American Society of Anesthesiology score, pre-operative cardiovascular and respiratory disease, and 10-day/1-month/6-month mortality. For 2020, we had an additional column, “COVID-19 swab positivity.” Results: COVID-19 infection represents an independent mortality risk factor in patients with PFFs. Despite the delay in time-to-surgery occurring in 2020, no statistically significant variation in terms of mortality was detected. Within our sample, a statistically significant difference was not detected in terms of mortality at 6 months, in patients operated within and beyond 48 h, as well as no difference between those operated within or after 12/24/72 h. The mortality rate among subjects with PFF who tested positive for COVID-19 was statistically significantly higher than in patients with PFF who tested. COVID-19 positivity resulted in an independent factor for mortality after PFF. Conclusion: Despite the most recent literature recommending operating PFF patients as soon as possible, no significant difference in mortality was found among patients operated before or after 48 h from diagnosis

Cerebrospinal fluid leaks after anterior skull base trauma: a systematic review of the literature

- BACKGROUND: Anterior skull base (ASB) fractures are reported in 4% of head injuries and represent 21% of all skull fractures. Cerebrospinal fluid (CSF) leaks may follow, severely exacerbating outcomes. We systematically reviewed the literature to analyze and compare the roles of endoscopic surgery, open surgery, and combined approaches in the management of CSF leak repair after posttraumatic ASB fractures. - METHODS: PubMed, Web of Science, and Scopus databases were searched in accordance with the PRISMA guidelines. Studies reporting clinical data of patients with CSF leaks after ASB fracture were reviewed, focusing on management strategies and posttreatment outcomes. - RESULTS: We included 29 articles comprising 888 patients. The average age at diagnosis was 34 years (range, 18e91 years), with a male predominance (54%) and a male/female ratio of 2.9:1 (647:241). Clinical data were available for 888 patients with CSF leaks after ASB fracture, reporting a median follow-up time of 33.5 months (standard deviation, 29; range, 0.5e330.0 months). Open surgical repair was the most common approach (67.9%), followed by endoscopic surgical repair (32.1%). The endoscopy cohort showed lower rates of complications (0.7% vs. 11.1%) and fistula recurrence (2.8% vs. 5.3%) compared with open surgery. - CONCLUSIONS: ASB fractures are frequently treated as late surgery, 24 hours from injury or later, especially for endoscopic surgery. Overall, the endoscopic approach is preferred, mostly because of its safety and effectiveness, offering lower failure rates than does open surgery

Rassegna storica salernitana. N.s. A.18, n.1(2001)

La Società Salernitana di Storia Patria aderisce al progetto EleA e autorizza la pubblicazione del fascicoloN.s. A.18, n.1(2001): Amodio, M., La tomba di Enrico Sanseverino a Teggiano, P. 7 ; Noto, M. A., L'applicazione dei decreti tridentini nella Benevento pontificia: potere, istituzioni, giurisdizione vescovile, P. 29 ; Mancini, T., Il tardo manierismo, una dimenticata pagina della storia della pittura salernitana, P. 63 ; Cirillo, G., Tra funzioni ed identità urbana: il patriziato amalfitano nell'età moderna, P. 75 ; Capuano, P., Libertà e liberismo nel dibattito politico della Napoli di fine Settecento, P. 129 ; Palmisciano, G., Gli studenti universitari nell'Ottocento borbonico: fonti e indirizzi di ricerca, P. 143 ; Fulgione, G., Il servizio postale nel regno delle due Sicilie nell'Ottocento, P. 163 ; D'Urso, D., Prosopografia di alcuni protagonisti del brigantaggio postunitario salernitano, P. 179 ; Noto, M.A., I banchi pubblici napoletani nella cultura e nella società del loro tempo (1540-1650), Napoli, Convegno Internazionale 4-5 dicembre 2000, P. 267 ; Viscido, L., Un appunto sull'etimologia del toponimo "Calabritto", P. 209 ; D'Ovidio, S., La raffigurazione della Croce, P. 213 ; Incarnato, G., A proposito di una "mina" … vagante , P. 219 ; Cacciatore, G., Nuove ipotesi storiografiche sul brigantaggio, P. 225 ; Ferraro, S., Nel centenario della nascita di Paola Zancani Montuoro, P. 231 ; Pinto, C., Il "Campo dei prigionieri Certosa di Padula" nella prima guerra, P. 233 ; Gallo, I., Matteo Rossi, primo sindaco eletto di Salerno postfascista, P. 245 ; Galante, M., Tre nuove carte del IX secolo conservate nell'archivio cavense, P. 251 ; Rassegne, P. 267 ; Recensioni e schede bibliografiche, P. 275-344.Sul recto del frontespizio: fasc. 35 della Nuova Serie (Annata LXI dalla fondazione

Introducing Mixed Reality for Clinical Uses

The advent of mixed reality (MR) has revolutionized human activities on a daily basis, striving for augmenting professional and social interactions at all levels. In medicine, MR tools have been developed and tested at an increasing rate over the years, playing a promising role in assisting physicians while improving patient care. In this chapter, the authors present their initial experience in introducing different MR algorithms in routine clinical practice from their implementation in several neurosurgical procedures to their use during the COVID-19 pandemic. A general summary of the current literature on MR in medicine has also been reported

Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Background: Brain metastases (BMs) carry a high morbidity and mortality burden. Neoadjuvant stereotactic radiotherapy (NaSRT) has shown promising results. We systematically reviewed the literature on NaSRT for BMs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, Cochrane, and ClinicalTrial.gov were searched following the PRISMA guidelines to include studies and ongoing trials reporting NaSRT for BMs. Indications, protocols, and outcomes were analyzed using indirect random-effect meta-analyses. Results: We included 7 studies comprising 460 patients with 483 BMs, and 13 ongoing trials. Most BMs originated from non-small lung cell carcinoma (41.4%), breast cancer (18.7%) and melanoma (43.6%). Most patients had single-BM (69.8%) located supratentorial (77.8%). Patients were eligible if they had histologically-proven primary tumors and ≤4 synchronous BMs candidate for non-urgent surgery and radiation. Patients with primary tumors clinically responsive to radiotherapy, prior brain radiation, and leptomeningeal metastases were deemed non-eligible. Median planning target volume was 9.9 cm3 (range, 2.9–57.1), and NaSRT was delivered in 1-fraction (90.9%), 5-fraction (4.8%), or 3-fraction (4.3%), with a median biological effective dose of 39.6 Gy10 (range, 35.7–60). Most patients received piecemeal (76.3%) and gross-total (94%) resection after a median of 1-day (range, 1–10) post-NaSRT. Median follow-up was 19.2-months (range, 1–41.3). Actuarial post-treatment rates were 4% (95%CI: 2–6%) for symptomatic radiation necrosis, 15% (95%CI: 12–18%) and 47% (95%CI: 42–52%) for local and distant recurrences, 6% (95%CI: 3–8%) for leptomeningeal metastases, 81% (95%CI: 75–87%) and 59% (95%CI: 54–63%) for 1-year local tumor control and overall survival. Conclusion: NaSRT is effective and safe for BMs. Ongoing trials will provide high-level evidence on long-term post-treatment outcomes, further compared to adjuvant stereotactic radiotherapy

Contralateral Interhemispheric Transfalcine Approach for Supratentorial Extraventricular Ependymoma Resection

Extraventricular supratentorial ependymomas are rare entities. Most ependymomas are located at the infratentorial and intraventricular level, and only in a small group of cases they do not present continuity with the ventricular system. This is a case report of a patient with an atypical location of a cerebral ependymoma, which required the implementation of a complex and infrequent approach for its complete microsurgical removal