MICROSURGICAL ANATOMY OF THE TEMPORAL LOBE: PART 2-SYLVIAN FISSURE REGION AND ITS CLINICAL APPLICATION

OBJECTIVE: We present observations of the anatomy of the sylvian fissure region and their clinical application in neuroimaging, microsurgery for middle cerebral artery aneurysms and insular lesions, frontobasal resections, and epilepsy Surgery. METHODS: Sixty adult cadaveric hemispheres and 12 adult cadaveric heads were studied after perfusion of the arteries and veins with colored latex. The anatomic information was applied in more than 200 microsurgeries in and around the sylvian fissure region in the past 15 years. RESULTS: The sylvian fissure extends from the basal to the lateral surface of the brain and presents 2 compartments on each surface, I superficial (temporal stem and its ramii) and 1 deep (anterior and lateral operculoinsular compartments). The temporal operculum is in opposition to the frontal and parietal opercula (planum polare versus inferior frontal and precentral gyri, Heschl`s versus postcentral gyri, planum temporale versus supramarginal gyrus). The inferior frontal, precentral, and postcentral gyri cover the anterior, middle, and posterior thirds of the lateral surface of the insula, respectively. The pars triangularis covers the apex of the insula, located immediately distal to the genu of the middle cerebral artery. The clinical application of the anatomic information presented in this article is in angiography, middle cerebral artery aneurysm surgery, insular resection, frontobasal resection, and amygdalohippocampectomy, and hemispherotomy. CONCLUSION: The anatomic relationships of the sylvian fissure region can be helpful in preoperative planning and can serve as reliable intraoperative navigation landmarks in microsurgery involving that region.

Lymphatic Vessel Density and VEGF-C Expression are Significantly Different Among Benign and Malignant Thyroid Lesions

Thyroid cancer is the most frequent endocrine neoplasia worldwide. The route for metastasis and loco-regional invasion preferentially occurs by lymphatic vessels. For this reason, the assessment of lymphatic vessel density (LVD) is supposed to represent both a prognostic parameter and also a potential therapeutic target. In order to evaluate the value of LVD in benign and malignant thyroid lesions, we analyzed 110 thyroidectomy specimens using D2-40, a specific marker for lymphatic vessels and vascular endothelial growth factor C (VEGF-C), the most potent molecule of lymphatic proliferation. LVD was significantly different between papillary and follicular carcinomas in total (p = 0.045) and peritumoral area (p = 0.042). Follicular adenoma and follicular carcinoma showed an important difference of intra- (p = 0.019) and peritumoral (p = 0.033) LVD. VEGF-C was more markedly expressed in malignancies than in benignant lesions (p = 0.0001). Almost all cancers with high positive VEGF-C expression also exhibited increased peritumoral LVD (p = 0.049) when compared with the benignant lesions. Indeed, the high peritumoral LVD of malignant thyroid lesions is an important finding for surgery planning and supports the practice of total thyroidectomy in malignant thyroid neoplasm`s since the lymphatic peritumoral vessels definitely are an escape path for tumor cells.

The effect of the number of biopsy cores on the concordance between prostate biopsy and prostatectomy Gleason score - A prostate volume-controlled study

Context.-Studies analyzing the concordance of biopsy and radical prostatectomy (RP) Gleason scores have limitations. Some included 2 or more centers, used historical controls from the early prostate specific antigen era or lacked a clear definition of the biopsy schemes. Furthermore, most did not control the results for prostate volume. Objective.-To confirm whether prediction of RP Gleason score can be optimized by taking more biopsy cores in a contemporary series of patients, with pathologic samples analyzed by the same pathologist, and controlling these results for prostate volume. Design.-The study comprised a retrospective case-control analysis of 393 patients with prostate cancer treated with RP. Patients were divided into 3 groups: those in group 1 underwent a 6-core biopsy; group 2, an 8-core biopsy; and group 3, a 10 or more-core biopsy. Concordance rates between biopsy and RP Gleason scores, as well as the rates of undergrading and overgrading, were determined for each biopsy scheme. Results.-Concordance rates were 60.9%, 58.3%, and 64.6% for patients from groups 1, 2, and 3, respectively (P = .18). When we analyzed patients with prostate volumes of less than 50 cm(3), concordance rates were 58.3%, 58.3%, and 65.1% for each group, respectively (P = .03). Among patients with prostate volumes of 50 cm3 or more, concordance rates were 70%, 58.1%, and 63.6%, respectively (P = .66). Conclusions.-Taking 10 or more cores can improve the prediction of RP Gleason score in patients with prostate volumes of less than 50 cm3. For patients with prostate volumes of 50 cm3 or more, increasing the biopsy cores to 10 or more did not improve prediction of RP Gleason score.

The use of strategic visioning to enhance local tourism planning in periphery communities

Tourism has had a profound impact upon destinations worldwide, and although this impact has been positive for many destinations, there are numerous examples where tourism has adversely impacted upon the environment and social fabric of the destination community (Coccossis 1996; Murphy 1985). The negative impacts of tourism have been attributed, among other things, to inadequate or non-existent planning for development (Gunn 1994; Hall2000). This has led to increased calls for tourism planning to offset some of the negative impacts that tourism can have on the destination community. While a number of approaches have been advocated, a collaborative philosophy, based on the principles of sustainability, is more likely to result in acceptable and successful policies and programmes for tourism destinations (Farrell1986; Jamal & Getz 1995; Maitland 2002; Minca & Getz 1995). Such an approach focuses on cooperation and broader based participation in tourism planning and decision-making between stakeholders to lead to agreement on planning directions and goals, with one of the primary objectives of collaborative arrangements being to develop a strategic vision for a destination (Bramwell & Lane 2000). [Extract from introduction]

Communicating trustworthiness and building trust in interorganizational virtual organizations

We propose a theory of trust in interorganizational virtual organizations that focuses on how trustworthiness can be communicated and trust built in this environment. The theory highlights three issues that must be dealt with if the potential obstacles to the development of trust in the virtual context are to be overcome. These are communication of trustworthiness facilitated by reliable Information and Communication Technology (ICT), establishment of a common business understanding, and strong business ethics. We propose four specific propositions relating to these issues, and suggest topics to be explored in future research. (C) 2001 Elsevier Science Inc. All rights reserved.

Contrasting models of land use regulation: Community, government and tourism development

This paper assesses the capacity of local communities and sub-national governments to influence patterns of tourism development, within the context of a globalizing economy. Through a comparison of the contrasting examples of Hawaii and Queensland, the paper indicates the consequences of different approaches to land use regulation. It points to the importance of planning and policy processes that integrate community interests, in order to achieve long-term, sustainable tourism development. Effective regulation of development can minimize the social and environmental impacts of tourism. The paper illustrates how community organizations and sub-national governments can articulate local interests, despite the global demands of investors for more deregulated markets in land.

Development, reliability, and concurrent validity of the modified inventory of potential reconstructive needs

Documentation of burn sequelae can be a difficult and time-consuming task. To date a reliable and systematic format for recording postburn trauma is lacking. The purpose of this research was two-fold: first, to develop a Modified Inventory of Potential Reconstructive Needs from the original Inventory of Potential Reconstructive Needs to allow methodical documentation of functional and cosmetic burn sequelae in all body surface areas of children with burns and, second, to establish interrater reliability and concurrent validity of the instrument, thus allowing its clinical application. Two raters scored the Modified Inventory of Potential Reconstructive Needs on 41 children with a range of burns types and severity. Excellent interrater reliability was demonstrated for both total (intraclass correlation coefficient = 0.996) and subsection inventory scores. Concurrent validity was also established with total scores showing strong positive correlations (0.73-0.76) with three indicators of burn severity. These findings provide initial support for the tool's clinical applicability, particularly in relation to rehabilitative planning and documentation.

Organizational actions in response to threats and opportunities

In this study, we tested a model in which threats and opportunities lead directly to different organizational actions and compared it to a model in which organizational characteristics moderate organizational actions taken in response to threats and opportunities. To better understand these effects, we differentiated the dimensions of threat and opportunity associated with the threat-rigidity hypothesis from the dimensions associated with prospect theory. In this study, threats had the main and moderated effects predicted from the literature, but opportunities did not.

Reasoning about real-time repetitions: terminating and nonterminating

It is common for a real-time system to contain a nonterminating process monitoring an input and controlling an output. Hence, a real-time program development method needs to support nonterminating repetitions. In this paper we develop a general proof rule for reasoning about possibly nonterminating repetitions. The rule makes use of a Floyd-Hoare-style loop invariant that is maintained by each iteration of the repetition, a Jones-style relation between the pre- and post-states on each iteration, and a deadline specifying an upper bound on the starting time of each iteration. The general rule is proved correct with respect to a predicative semantics. In the case of a terminating repetition the rule reduces to the standard rule extended to handle real time. Other special cases include repetitions whose bodies are guaranteed to terminate, nonterminating repetitions with the constant true as a guard, and repetitions whose termination is guaranteed by the inclusion of a fixed deadline. (C) 2002 Elsevier Science B.V. All rights reserved.

On-line analysis of froth surface in coal and mineral flotation using JKFrothCam

The personal computer revolution has resulted in the widespread availability of low-cost image analysis hardware. At the same time, new graphic file formats have made it possible to handle and display images at resolutions beyond the capability of the human eye. Consequently, there has been a significant research effort in recent years aimed at making use of these hardware and software technologies for flotation plant monitoring. Computer-based vision technology is now moving out of the research laboratory and into the plant to become a useful means of monitoring and controlling flotation performance at the cell level. This paper discusses the metallurgical parameters that influence surface froth appearance and examines the progress that has been made in image analysis of flotation froths. The texture spectrum and pixel tracing techniques developed at the Julius Kruttschnitt Mineral Research Centre are described in detail. The commercial implementation, JKFrothCam, is one of a number of froth image analysis systems now reaching maturity. In plants where it is installed, JKFrothCam has shown a number of performance benefits. Flotation runs more consistently, meeting product specifications while maintaining high recoveries. The system has also shown secondary benefits in that reagent costs have been significantly reduced as a result of improved flotation control. (C) 2002 Elsevier Science B.V. All rights reserved.