Personal glimpses into the evolution of truncus arteriosus repair.

Truncus arteriosus (common arterial trunk) is an uncommon but complex congenital heart anomaly. Until the early 1970s, typically, patients died between the age of a few weeks to six months. Congestive heart failure owing to large pulmonary blood flow and truncal valve regurgitation was the major cause of death until innovative surgical techniques were discovered. In 1963, Herbert Sloan at the University of Michigan completed the first repair using a nonvalved conduit with long-term survival (not reported until 1974). At the Mayo Clinic, Rastelli and McGoon studied and completed the first repair with a valved homograft in 1967. In 1976, Ebert used the 12-mm Hancock valved conduit in infants under six months of age (University of California, San Francisco). In Boston (mid-1980s), Jonas and Castañeda used aortic homografts, which greatly reduced bleeding as a postoperative complication. In the early 1990s, Bove (University of Michigan) reported outstanding results with an approach based on primary repair within the first few days of life for patients with truncus arteriosus. Improved prognosis for patients with truncus arteriosus resulted from these corrective operations by analyzing the natural history of this condition while applying innovative ideas, improved technology, and perioperative care.

The lost art of localization: Franc Ingraham's legacy in pediatric neurosurgery.

The authors describe an 8-year-old girl who underwent emergency posterior fossa surgery for resection of a large cerebellar astrocytoma in November 1939. The surgery was carried out by Franc D. Ingraham at Boston Children's Hospital a decade after he established the first pediatric neurosurgical service in the world at the same institution. Four years later the tumor recurred and the patient underwent repeat resection followed by external-beam radiation therapy. The pathological diagnosis by Sidney Farber was fibrillary astrocytoma. The young girl is currently a healthy, functional 82-year-old woman. The authors believe that this 74-year follow-up represents one of the longest in history, if not the longest, of a patient undergoing resection of a brain tumor. A recent MRI study shows postoperative changes with no evidence of residual or recurrent tumor. The original block tissue specimen had been preserved. It was restained and examined, revealing the pathological diagnosis to be juvenile pilocytic astrocytoma. The case is analyzed in the context of Ingraham's powerful and lasting impact on the field of pediatric neurosurgery.

[Oncologic "second-look" today]. / Il "second look" oncologico oggi.

The Wangensteen's proposal of the SLL is far from us, not only chronologically but, what is more meaningful, technologically. Radiology, with its digestive tract barium meal or enema, was at his time the only mean entrusted for the instrumental study of the patient, and the medical oncology was at its very dawn. The Wangensteen's purpose was to discover with a SLL the recurrence (metastasis or relapse) of the neoplastic disease after a first demolitive surgical approach, not waiting its late clinical evidence. And this on the conviction that also the recurrent neoplastic disease can be again successfully treated by surgery when early detected. Many facts have happened since the 50's, and if it is by now demonstrated true that also the neoplastic recurrence can be successfully treated by surgery--naturally for particular neoplasms and in particular localization--it is equally true that diagnostic possibilities have widely evolved permitting the non invasive detection and localization of neoplastic recurrences with remarkable accuracy. Thence the renewed possibility of a reinterventional surgery.