Object The role of radiosurgery in the treatment of cavernous malformations (CMs) remains controversial. It is frequently recommended only for inoperable lesions that have bled at least twice. Rehemorrhage can carry a substantial risk of morbidity, however. The authors reviewed their practice of treating deep-seated inoperable CMs to assess the complication rate of radiosurgery, the impact that radiosurgery might have on rebleeding, and whether a more active, earlier intervention is justified in managing this condition. Methods The authors performed a retrospective analysis of 113 patients with 79 brainstem and 39 thalamic/basal ganglia CMs treated with Gamma Knife surgery. Lesions were stratified into 2 groups: those that might be lower risk with no more than 1 symptomatic bleed before radiosurgical treatment and those deemed high risk with multiple symptomatic hemorrhages before treatment. Results Forty-one CMs had multiple symptomatic hemorrhages before radiosurgery with a first-ever bleed rate of 2.9% per lesion per year, a rebleed rate of 30.5% per lesion per year, and a median time of 1.5 years between the first and second bleeds. In this group the rebleed rate decreased to 15% for the first 2 years after radiosurgery and declined further to 2.4% thereafter. Pretreatment multiple bleeds led to persistent deficits in 72% of the patients. Seventy-seven CMs had no more than 1 symptomatic bleed before radiosurgery, making for a lifetime bleed rate of 2.2% per lesion per year. The short period between the presenting bleed and treatment (median 1 year) makes the natural history in this group uncertain. The rate of hemorrhage in the first 2 years after treatment was 5.1%, and 1.3% thereafter. Pretreatment hemorrhages resulted in permanent deficits in 43% of the patients in this group, a rate significantly lower than in the multiple-bleeds group (p < 0.001). Posttreatment hemorrhages led to persistent deficits in only 7.3% of the patients. Permanent adverse radiation effects were rare (7.3%) and minor in both groups. Conclusions Stereotactic radiosurgery is a safe management strategy for CMs in eloquent sites with the marked advantage of reducing rebleed risks in patients with repeated pretreatment hemorrhages. The benefit in treating CMs with a single bleed is less clear. Note, however, that repeated hemorrhage carries a significant risk of increased morbidity far in excess of any radiosurgery-related morbidity, and the authors assert that this finding justifies the early active management of deep-seated CMs.

-A number of reports have suggested that academic medicine within the UK may be in decline. This article assesses the number and outcome of abstracts presented at consecutive British Society of Gastroenterology (BSG) meetings. All abstracts presented at the BSG between 1994 and 2002 were assessed (n=4,096). Full publication rates of abstracts were then compared between meetings. Other abstract characteristics were also analysed. There was a significant downward trend demonstrated for the percentage of abstracts going onto full publication (p=0.02). In 1994, 57.6% of abstracts were subsequently fully published but by 2002 this number had fallen to 30.7%. The results show that the number of abstracts at the BSG which are then fully published has fallen with a significant trend. This observation could be taken as an indicator that there is a decline in research activity within the UK gastroenterology community. KEY WORDS: British Society of Gastroenterology, research IntroductionThe presentation of abstracts at national and international scientific meetings provides a unique opportunity to rapidly convey the results of novel research. It also allows the researcher a chance to receive informal peer review from other researchers in the field. This may help to clarify aspects of the work particularly in the identification and correction of potential weaknesses prior to submission for full publication. Although abstracts submitted to conferences are peer reviewed, this process may not be as rigorous as that of an indexed journal considering publication of the full manuscript. 1 Presentation of an abstract at a prestigious meeting may suggest to the researcher that full publication is probable. Certainly, acceptance as opposed to rejection increases the likelihood of subsequent publication, but this is not absolute. 2 The percentage of abstracts published from different medical specialty meetings has been reported to range from 11-78%. [3][4][5][6][7] A recent Cochrane review of 79 papers where the investigators had assessed the percentage of abstracts that were subsequently published, reported a mean publication rate of 44.5%. 5 This meta-analysis included all medical subspecialties and encompassed any national or international meeting that had been evaluated in this manner. 5 It has been previously demonstrated that in 1994 (at a single annual meeting) there was a high 'full paper' publication rate for abstracts presented at the British Society of Gastroenterology (BSG). 8 However, recently within the UK a number of reports have suggested that academic medicine may be in decline and that research output is diminishing. 9,10 This is supported by evidence that between 1994 and 2002 the number of publications achieved by gastroenterology trainees (specialist registrars, SpRs) prior to starting consultant posts had fallen significantly from a median of 19 in 1993 to five by 2002. 11 This paper assesses if there was a change in the number of abstracts presented at consecutive BSG meetings that are subsequently pub...

Patients with lung cancer often have chronic obstructive pulmonary disease (COPD), but the impact of COPD on postresection survival of patients with lung cancer is unclear. This study evaluated the impact of COPD on survival of patients with lung cancer following pulmonary resection. Databases searched included PubMed, Cochrane, and Embase until March 2016. Study outcomes were overall survival and pulmonary complication rate (pneumonia, bronchial fistula, and prolonged mechanical ventilation). 6 studies with a total of 3761 patients were included. The presence of COPD was associated with lower overall survival, increased frequency of pneumonia, and prolonged mechanical ventilation (p values ≤0.001). COPD had no influence on bronchial fistula development (p=0.098). In summary, COPD was associated with poorer survival and an increased frequency of certain adverse events in patients with lung cancer following resection.

The Dex-CSDH trial is a randomised, double-blind, placebo-controlled trial of dexamethasone for patients with a symptomatic chronic subdural haematoma. The trial commenced with an internal pilot, whose primary objective was to assess the feasibility of multi-centre recruitment. Primary outcome data collection and safety were also assessed, whilst maintaining blinding. We aimed to recruit 100 patients from United Kingdom Neurosurgical Units within 12 months. Trial participants were randomised to a 2-week course of dexamethasone or placebo in addition to receiving standard care (which could include surgery). The primary outcome measure of the trial is the modified Rankin Scale at 6 months. This pilot recruited ahead of target; 100 patients were recruited within nine months of commencement. 47% of screened patients consented to recruitment. The primary outcome measure was collected in 98% of patients. No safety concerns were raised by the independent data monitoring and ethics committee and only five patients were withdrawn from drug treatment. Pilot trial data can inform on the design and resource provision for substantive trials. This internal pilot was successful in determining recruitment feasibility. Excellent follow-up rates were achieved and exploratory outcome measures were added to increase the scientific value of the trial.

Highlights Awake craniotomy in the COVID-19 era feasibility and safety. Techniques for awake craniotomy in the COVID-19 era. Use of COVID-19 personal protective equipment in awake craniotomy. Minimising the risk to patient and staff members performing awake craniotomy in the COVID-19 era.