Delayed post-surgical development of dural arteriovenous fistula after cervical meningocele repair

A 34-year-old female patient presented with an intracranial subarachnoid hemorrhage and was found to have a dural arteriovenous fistula at the site of previous cervical meningocele repair. Subsequent occlusion was achieved with endovascular embolization. To our knowledge, the phenomenon of the development of a spinal dural fistula at the site of a meningocele repair has not been recorded before.

Does pre-operative estimation of oesophageal tumour metabolic length using F-18-fluorodeoxyglucose PET/CT images compare with surgical pathology length?

PURPOSE:
The aim of the study was to compare the pre-operative metabolic tumour length on FDG PET/CT with the resected pathological specimen in patients with oesophageal cancer.

METHODS:
All patients diagnosed with oesophageal carcinoma who had undergone staging PET/CT imaging between the period of June 2002 and May 2008 who were then suitable for curative surgery, either with or without neo-adjuvant chemotherapy, were included in this study. Metabolic tumour length was assessed using both visual analysis and a maximum standardised uptake value (SUV(max)) cutoff of 2.5.

RESULTS:
Thirty-nine patients proceeded directly to curative surgical resection, whereas 48 patients received neo-adjuvant chemotherapy, followed by curative surgery. The 95% limits of agreement in the surgical arm were more accurate when the metabolic tumour length was visually assessed with a mean difference of -0.05 cm (SD 2.16 cm) compared to a mean difference of +2.42 cm (SD 3.46 cm) when assessed with an SUV(max) cutoff of 2.5. In the neo-adjuvant group, the 95% limits of agreement were once again more accurate when assessed visually with a mean difference of -0.6 cm (SD 1.84 cm) compared to a mean difference of +1.58 cm (SD 3.1 cm) when assessed with an SUV(max) cutoff of 2.5.

CONCLUSION:
This study confirms the high accuracy of PET/CT in measuring gross target volume (GTV) length. A visual method for GTV length measurement was demonstrated to be superior and more accurate than when using an SUV(max) cutoff of 2.5. This has the potential of reducing the planning target volume with dose escalation to the tumour with a corresponding reduction in normal tissue complication probability.

Comparative validation of c-kit exon 11 mutation analysis on cytology samples and corresponding surgical resections of gastrointestinal stromal tumours

Objective:

The Implications of Bach's Introduction of New Fugal Techniques and Procedures in the Well-Tempered Clavier Book Two

Among the fugues of the WTC II, there are some fugal techniques and procedures that were not explored in the first book. Here, the ‘fugal techniques’ include parallel entries (as used in the fugues in D-sharp minor, G minor and B-flat minor) and double counterpoint at the tenth or twelfth as well as fifteenth (as used in the fugues in G minor and B major). The ‘fugal procedures’, on the other hand, refer to meticulously planned multi-exposition architecture (as seen in the fugues in F-sharp minor exploiting two subsidiary subjects, and B-flat minor exploiting inversion and stretto) and a form in which the appearance of the subsidiary subject is gradually predicted in the fugal discourse (viz. C-sharp minor, G-sharp minor and B major). All these new ideas helped Bach to write more dramatic, more profound fugues for WTC II. The paper will consider how Bach came to acquire the new techniques and to use them in such ways, and what motivated him to adopt these new compositional approaches. Do they offer any clues for our better understanding of why Bach compiled the WTC II?