Pilot study to define criteria for Pituitary Tumors Centers of Excellence (PTCOE):results of an audit of leading international centers

Purpose: The Pituitary Society established the concept and mostly qualitative parameters for defining uniform criteria for Pituitary Tumor Centers of Excellence (PTCOEs) based on expert consensus. Aim of the study was to validate those previously proposed criteria through collection and evaluation of self-reported activity of several internationally-recognized tertiary pituitary centers, thereby transforming the qualitative 2017 definition into a validated quantitative one, which could serve as the basis for future objective PTCOE accreditation. Methods: An ad hoc prepared database was distributed to nine Pituitary Centers chosen by the Project Scientific Committee and comprising Centers of worldwide repute, which agreed to provide activity information derived from registries related to the years 2018–2020 and completing the database within 60 days. The database, provided by each center and composed of Excel® spreadsheets with requested specific information on leading and supporting teams, was reviewed by two blinded referees and all 9 candidate centers satisfied the overall PTCOE definition, according to referees’ evaluations. To obtain objective numerical criteria, median values for each activity/parameter were considered as the preferred PTCOE definition target, whereas the low limit of the range was selected as the acceptable target for each respective parameter. Results: Three dedicated pituitary neurosurgeons are preferred, whereas one dedicated surgeon is acceptable. Moreover, 100 surgical procedures per center per year are preferred, while the results indicated that 50 surgeries per year are acceptable. Acute post-surgery complications, including mortality and readmission rates, should preferably be negligible or nonexistent, but acceptable criterion is a rate lower than 10% of patients with complications requiring readmission within 30 days after surgery. Four endocrinologists devoted to pituitary diseases are requested in a PTCOE and the total population of patients followed in a PTCOE should not be less than 850. It appears acceptable that at least one dedicated/expert in pituitary diseases is present in neuroradiology, pathology, and ophthalmology groups, whereas at least two expert radiation oncologists are needed. Conclusion: This is, to our knowledge, the first study to survey and evaluate the activity of a relevant number of high-volume centers in the pituitary field. This effort, internally validated by ad hoc reviewers, allowed for transformation of previously formulated theoretical criteria for the definition of a PTCOE to precise numerical definitions based on real-life evidence. The application of a derived synopsis of criteria could be used by independent bodies for accreditation of pituitary centers as PTCOEs.</p

Reverse flow digital artery pedicle flap for closure of diabetic forefoot ulceration

Digital artery pedicle flap is a useful surgical technique for coverage of plantar foot defects. For diabetic forefoot ulcers that are subject to recurrence despite consistent care, this flap can provide long-term durable closure. The authors provide a case report and overview of this innovative reconstructive procedure

Communication Research

Contains reports on six research projects.Rand Corporatio

Recommendations for the diagnosis of pediatric tuberculosis

Tuberculosis (TB) is still the world's second most frequent cause of death due to infectious diseases after HIV infection, and this has aroused greater interest in identifying and managing exposed subjects, whether they are simply infected or have developed one of the clinical variants of the disease. Unfortunately, not even the latest laboratory techniques are always successful in identifying affected children because they are more likely to have negative cultures and tuberculin skin test results, equivocal chest X-ray findings, and atypical clinical manifestations than adults. Furthermore, they are at greater risk of progressing from infection to active disease, particularly if they are very young. Consequently, pediatricians have to use different diagnostic strategies that specifically address the needs of children. This document describes the recommendations of a group of scientific societies concerning the signs and symptoms suggesting pediatric TB, and the diagnostic approach towards children with suspected disease

Broomrape (Orobanche spp.) problem in the eastern mediterranean region of Turkey

Broomrapes (Orobanche spp.) which belong to the famly Orobanchaceae are obligate parasitic flowering plants. The main center of distribution is the Mediterranean basin, where large areas are heavily infested. Yield losses due to Orobanche range from 5 to 100% depending on the region and the crop. Orobanche species infesting crops in the eastern Mediterranean region of Turkey are: O. aegyptiaca, O. ramosa and O. crenata. O. aegypttaca / O. ramosa were present in 27.72% of the tomato greenhouses and 80% of the tomato fields, O. crenata and O. aegyptiaca / O. ramosa were present in 57.89% of the faba bean fields and 75.51% of the lentil fields. Sunflower cultivation has gradually increased in the eastern Mediterranean region since 2004. In 2005, sunflower acreage and production in the region were tripled compared with 2004. There has not been any record on broomrapes m sunflower fields m eastern Mediterranean region yet, but broomrapes are considered a possible threat for sunflower fields in this area. Orobanche cernua Loef. causes considerable damage in sunflower fields m other regions of Turkey where sunflower has been sown for years and it may spread from those regions to the eastern Mediterranean region. In addition, sunflower is also a host plant of Orobanche ramosa L. and Orobanche aegyptiaca Pers. which were already found in some crops m the eastern Mediterrean region. Since the magnitude of the broomrape problem increases each year in Turkey, a "National Broomrape Project" has been organized in collaboration of some govermental institues and universities in 2006. The Project includes extension activities too. Because growers are not carefull about dispersal of broomrape, they should be trained how to apply preventive measures as soon as possible

Comparison of connective tissue massage and spray-and-stretch technique in the treatment of chronic cervical myofascial pain syndrome

The aim of this study was to investigate whether ischemic pain tolerance changed in patients who had successfully undergone treatment for chronic cervical myofascial pain syndrome (MPS). In a controlled study, patients with the diagnosis of MPS were assessed for pain intensity using a visual analogue scale (VAS), number of trigger points, range of motion (ROM) in cervical region, and ischemic pain threshold and tolerance using a modified tourniquet technique. Patients were randomly allocated into two groups. The first group was treated with connective tissue massage and the second with vapocoolant spray and stretch technique. No difference was found between the groups as regards to the assessed parameters except VAS, which was higher in the group treated with the spray and stretch technique. Following treatment, although there was a significant decrease in pain intensity and number of trigger points, and an increase in ROM in both groups, there was no difference in ischemic pain threshold or tolerance, when compared with pre-treatment values