The efficacy of percutaneous Achilles tenotomy alone (AT) was compared to combined posterior capsulotomy of the ankle joint together with open Achilles tenotomy (PC+AT) in 167 children with 260 clubfeet as a method to correct equinus after Ponseti serial casts. 189 idiopathic, and 71 non-idiopathic clubfeet were reviewed (20 with spina bifida, 12 with Arthrogryposis) with a minimum follow-up of two years (Mean 4.8±2.4 years). 73 idiopathic and 12 non-idiopathic clubfeet underwent AT, while 116 idiopathic and 59 non-idiopathic clubfeet underwent PC+AT. Mean age at surgery was 4.5±4.5 months. Mean dorsiflexion improved from -32.5º to 24.3º postoperatively and to 11.7º at the latest follow up in both groups (p0.001). Immediate postoperative improvement was significantly higher in the non-idiopathic group than the idiopathic (p0.005), but this was not sustained until latest follow up (p=0.405). Recurrence rate was significantly higher in non-idiopathic clubfeet (62%) than idiopathic clubfeet (37%), p0.005, regardless of type of surgery. There was no difference in the mean dorsiflexion range (p=0.333) at final follow-up or recurrence rate (p=0.545) between PC+AT and AT groups in idiopathic and non-idiopathic clubfeet. It might therefore be advisable to perform percutaneous Achilles tenotomy alone without the need for posterior capsulotomy of the ankle joint for equinus in idiopathic as well as non-idiopathic clubfeet. It is also worth mentioning, that in this follow up period of 4.8±2.4 years, more extensive surgery with capsulotomy did not lead to excessive scarring or reduced ankle dorsiflexion compared to percutaneous Achilles tenotomy alone.

Purpose: The purpose of this study is to compare the efficacyof percutaneous Achilles tenotomy (AT) to combined open Achilles tenotomy and posterior capsulotomy (PC+AT) in the correction of residual equinus deformity in congenital talipes equinovarus after Ponseti serial casting in both idiopathic and non-idiopathic clubfeet. Methods: The authors retrospectively reviewed 591 patients treated for congenital talipes equinovarus between January 1, 2001 and January 1, 2011. Available medical and operative records were reviewed for basic demographic data as well as ankle dorsiflexion pre-operatively, postoperatively and at latest follow up. Results: A total of 167 children with 260 discrete clubfeet that met our inclusion criteria were identified. Of them, 189/260clubfeet (72.7 %) were idiopathic and 71/260 clubfeet (27.3 %) were non-idiopathic with a mean total follow up of 4.8±2.4 years (minimum follow-up of two years). At latest follow up, there was no statistically significant difference in the mean ankle dorsiflexion (p=0.333) or recurrence rate (p=0.545) between PC+AT and AT groups in both idiopathic and non-idiopathic clubfeet. Conclusion: In our series, the addition of posterior capsulotomy to Achilles tenotomy did not improve the mean dorsiflexion at latest follow up or decrease the rate of recurrence of equinus deformity in both idiopathic and non idiopathic clubfeet. It is therefore advisable that percutaneous Achilles tenotomy alone be used in the correction of equinus deformity in both idiopathic and non-idiopathic congenital talipes equinovarus after successful Ponseti serial casting.

Introduction: Gliomas account for 40% of the primary central nervous system tumors in western countries, and for about one-third (37.3%) in Egypt. Identification of the cellular origin of gliomas presents an opportunity for improving the treatment strategies. It has been postulated that astrocytomas may be originated from neural stem cells. Hypoxia-inducible factor-1[alpha] (HIF-1[alpha]) is considered one of the key hypoxia regulatory factors. Hypoxia may be a critical component of a stem cell niche and contributes to the tumor initiation and maintenance of cancer stem cells (CSCs). In the present study, we hypothesized that the expression of stem cell marker (nestin) and hypoxia marker (HIF-1[alpha]) may be upregulated with increasing grades of astrocytomas. In addition, there is a correlation between hypoxia and stem cell marker in all grades of astrocytomas in both tumor cells (TRCs) and vascular endothelial cells (VECs). To explore our hypothesis, this study was organized into specific aims: (a) analysis of the immunohistochemical expression of nestin and HIF-1[alpha] in different grades of astrocytomas and (b) analysis of the correlation between nestin and HIF-1[alpha] in different grades of astrocytomas. Materials and methods: Paraffin-embedded sections of 43 specimens of astrocytic tumors (nine pilocytic astrocytoma, 13 diffuse astrocytomas, seven anaplastic astrocytomas, and 14 glioblastoma multiforme) and six normal brain tissue (as a control) were stained with nestin and HIF-1[alpha] using standard immunohistochemical approaches. The immunoreactivity for nestin and HIF-1[alpha] in both TRCs and VECs was evaluated. Correlation between nestin and HIF-1[alpha] expression was also studied. Results: The expression of nestin in TRCs was present in 88.4% of patients. As compared with normal brain tissue, there was statistically significant (P0.01) gradual increase in the mean of nestin immunoreactivity score with increasing grade of the studied astrocytomas (I-IV) (0.0+/-0.0, 1.7+/-1.8, 2.5+/-1.6, 5.7+/-3.2, and 7.8+/-2.5, respectively). The expression of HIF-1[alpha] was seen in 65.1% of studied patients. The immunoreactivity score of HIF-1[alpha] showed significant (P0.001) difference between low-grade astrocytomas (pilocytic astrocytoma and diffuse astrocytomas) and high-grade astrocytomas (anaplastic astrocytomas and glioblastoma multiforme). There was statistically significant positive correlation between expression of nestin and HIF-1[alpha] in both TRCs and VECs (r=0.71 and 0.47, respectively, and P0.001 for both). Conclusion: Restricted oxygen conditions increase the CSC fraction. Determining the cross-talk between hypoxia and CSCs will enhance the understanding of tumorigenesis and may provide new therapeutic strategy. Intense expression of nestin in high-grade astrocytomas may be helpful in their diagnosis especially in small biopsy.

Introduction: Gliomas account for 40% of the primary central nervous system tumors in western countries, and for about one-third (37.3%) in Egypt. Identification of the cellular origin of gliomas presents an opportunity for improving the treatment strategies. It has been postulated that astrocytomas may be originated from neural stem cells. Hypoxia-inducible factor-1[alpha] (HIF-1[alpha]) is considered one of the key hypoxia regulatory factors. Hypoxia may be a critical component of a stem cell niche and contributes to the tumor initiation and maintenance of cancer stem cells (CSCs). In the present study, we hypothesized that the expression of stem cell marker (nestin) and hypoxia marker (HIF-1[alpha]) may be upregulated with increasing grades of astrocytomas. In addition, there is a correlation between hypoxia and stem cell marker in all grades of astrocytomas in both tumor cells (TRCs) and vascular endothelial cells (VECs). To explore our hypothesis, this study was organized into specific aims: (a) analysis of the immunohistochemical expression of nestin and HIF-1[alpha] in different grades of astrocytomas and (b) analysis of the correlation between nestin and HIF-1[alpha] in different grades of astrocytomas. Materials and methods: Paraffin-embedded sections of 43 specimens of astrocytic tumors (nine pilocytic astrocytoma, 13 diffuse astrocytomas, seven anaplastic astrocytomas, and 14 glioblastoma multiforme) and six normal brain tissue (as a control) were stained with nestin and HIF-1[alpha] using standard immunohistochemical approaches. The immunoreactivity for nestin and HIF-1[alpha] in both TRCs and VECs was evaluated. Correlation between nestin and HIF-1[alpha] expression was also studied. Results: The expression of nestin in TRCs was present in 88.4% of patients. As compared with normal brain tissue, there was statistically significant (P0.01) gradual increase in the mean of nestin immunoreactivity score with increasing grade of the studied astrocytomas (I-IV) (0.0+/-0.0, 1.7+/-1.8, 2.5+/-1.6, 5.7+/-3.2, and 7.8+/-2.5, respectively). The expression of HIF-1[alpha] was seen in 65.1% of studied patients. The immunoreactivity score of HIF-1[alpha] showed significant (P0.001) difference between low-grade astrocytomas (pilocytic astrocytoma and diffuse astrocytomas) and high-grade astrocytomas (anaplastic astrocytomas and glioblastoma multiforme). There was statistically significant positive correlation between expression of nestin and HIF-1[alpha] in both TRCs and VECs (r=0.71 and 0.47, respectively, and P0.001 for both). Conclusion: Restricted oxygen conditions increase the CSC fraction. Determining the cross-talk between hypoxia and CSCs will enhance the understanding of tumorigenesis and may provide new therapeutic strategy. Intense expression of nestin in high-grade astrocytomas may be helpful in their diagnosis especially in small biopsy.