Unique Subspecialty Research Articles

Pituitary Neurologic Surgery: a Unique Subspecialty in Evolution

To review the evolving approaches to surgical management of pituitary tumors during the past century, which may predict future directions. We undertook a retrospective review of selected literature published during the past century and report the trends in the treatment of pituitary tumors. Harvey Cushing's extraordinary influence on American neurosurgery and remarkably successful pituitary surgical series were the foundation for the development of a highly subspecialized neurosurgical operative field. Continued evolution in the treatment of pituitary tumors has been historically based on the following: (1) the development of exogenous cortisone and vasopressin; (2) the development of high-voltage and nuclear radiation therapy; (3) the experience gained from total hypophysectomy for "endocrine" driven malignant lesions and diabetic retinopathy; (4) the development of the image intensifier and television intraoperative fluoroscopic control; (5) the use of endoscopes in pituitary surgical procedures; (6) the application of the operating microscope to transsphenoidal approaches; (7) the development of the imaging modalities of computed tomographic scanning and subsequent magnetic resonance imaging; and (8) the concepts surrounding "minimally invasive" surgical techniques. The pituitary surgical techniques of today have evolved primarily because of extraordinary past accomplishments. The approaches used continue to maximize tumor resection and preserve functioning pituitary tissue. New intraoperative imaging techniques will forge the future of the field of pituitary neurosurgery, and the expected outcomes will be improved surgical success and lower perioperative morbidity.)

Principles and clinical applications of positron emission tomography

The basics of positron emission tomography (PET) are presented, including the physics, instrumentation, and radiopharmaceuticals involved; the clinical and research applications; and the cost. In PET, organic molecules labeled with positron-emitting radionuclides are injected or inhaled, and the high-energy photons produced by annihilation events are detected by paired, integrated crystal detectors. A computer uses the lines of origin of these photons to reconstruct a three-dimensional map of a functioning organ system. The positron-emitting radionuclides most often used are carbon 11, oxygen 15, nitrogen 13, fluorine 18, and rubidium 82. PET imaging centers usually consist of a cyclotron facility, a radiochemistry facility, a PET scanner, and computers for image reconstruction. Radiopharmaceuticals used in PET may be divided into blood flow-imaging agents, metabolic imaging agents, and drug receptor-imaging agents. Although PET is still primarily a research tool, it has shown diagnostic potential in neurology, cardiology, and oncology. It has also shown promise as a tool for pharmacologic assessment, as in studies of the effects of the fluorinated quinolones on cerebral blood flow and glucose metabolism. PET may become important in drug development because it yields specific information relatively noninvasively. A single study carries an average break-even price tag of $1500-$2000; rigorous cost-benefit analyses should be conducted before society is asked to subsidize such costs. Positron emission tomography is a frontier technology for which valuable clinical applications are being discovered. Pharmacists can contribute enormously to PET applications and at the same time establish a unique subspecialty for the profession.

Rehabilitation psychologists in medical settings: A unique subspecialty or a redundant one?

Rehabilitation psychologists in medical settings: A unique subspecialty or a redundant one?

Rehabilitation psychologists in medical settings: A unique subspecialty or a redundant one?

Rehabilitation psychologists in medical settings: A unique subspecialty or a redundant one?

Aesthetic and Functional Thumb Reconstruction: Great Toe to Hand Transfer

“Turf toe,” originally described in literature by Bowers and Martin in 1976, is an injury to the capsuloligamentous complex of the first metatarsophalangeal joint. This injury is common in football players. Up to 45% of National Football League (NFL) players have suffered from turf toe during their professional career. Turf toe injuries have been attributed to playing on hard, artificial surfaces with soft, flexible cleats; 83% of the turf toe injuries occurred on artificial turf. For most turf toe injuries, nonoperative treatment is the preferred approach, even in some cases with associated fracture of the sesamoids. Operative intervention should be considered after nonoperative management has failed or in cases of clear instability or sesamoid retraction. Good functional outcomes with high rates of return to play can be expected with appropriate management. Despite this, persistent symptoms of stiffness and great toe pain are not uncommon following initial injury, surgery or both. Due to limited availability of high-level evidence regarding the outcomes of turf toe injuries, particularly for surgical management of high-level athletes, this article will combine what is available with level V evidence based on the senior author’s experience over 34 years and his discussions with other experts in the unique subspecialty of foot and ankle sports medicine.