Malignant gliomas of the brain. A retrospective study

A retrospective study of 72 consecutive and nonrandomized patients with malignant glial tumors is presented. The influence of age, sex, location of tumor, initial presenting symptoms, symptomatic preoperative interval, reoperation, extent of tumor removal, histological subtype of tumor, lymphocyte infiltration, and different treatments upon survival time has been evaluated and statistically analyzed. Age was inversely associated with survival with a strong statistical significance (p = 0.0001). Headache was the most common (67%) initial symptom; aphasia and seizure were both present in 45.3% of patients. Initial presenting symptoms had no effect upon survival. Parietal lobe and lymphocyte infiltration had marginally negative effects upon survival (p = 0.097 and p = 0.10 respectively). The amount of tumor removal was marginally associated with an improved survival (p = 0.07). Radiation therapy was strongly associated with an improved survival time (p = 0.0007). The addition of chemotherapy did not affect the survival (perhaps reflecting the small number of patients and inadequate chemotherapy). There was an obvious beneficial effect of reoperation upon survival time, if the patient lived and underwent reoperation later than 16 months after the initial operation (slow-growing tumor). Although median and mean survival times (10 and 20.34 months respectively, SD 7.45 months) were similar to most series reported, our rates of survival (20%, 12.5%, and 7.5% at 2, 3, and 5 years, respectively) were notably higher.     

Hemivertebra as a cause of scoliosis. A study of 104 patients

We studied 104 patients with a total of 154 hemivertebrae which had produced scoliotic curves. Of the hemivertebrae 65% were of a fully segmented (non-incarcerated) type, 22% were semi-segmented and 12% were incarcerated. We found that the degree of scoliosis produced depended on four factors: first, the type of the hemivertebra; secondly, its site; thirdly, the number of hemivertebrae and their relationship to each other; and finally, the age of the patient. Semi-segmented and incarcerated hemivertebrae usually do not require treatment. Fully segmented non-incarcerated hemivertebrae may require prophylactic treatment to prevent significant deformity.     

Formation and propagation of brain oedema fluid around human brain metastases. A CT study

Summary Computerized tomography (CT) was used to examine the timecourse of the propagation of extravasated contrast medium from small brain metastases into the peritumoural oedematous white matter, following infusion of 200 ml of meglumine amidtrizoate for 3 hours. Four patients with a metastatic brain tumour were examined. CT scans at identical levels were taken 1.5, 3, 6, 9, and 12 hours after start of contrast infusion. Following 4–7 days of dexamethasone treatment (8–12mg/day i.v.) the examination was repeated. A contrast-enhanced area was observed surrounding the clearly delineated tumours, expanding gradually in a circular fashion into the peritumoural white matter oedema. The expanding circular enhancement was measured planimetrically on the various scans. From these values, the increase in radius/hr respectively in volume/hr was calculated, assuming a spherical geometry. This enabled a determination of the rate of oedema fluid formation and of the speed of oedema fluid propagation. The formation rate of oedema fluid amounted to 0.5–3.2ml/hour and the speed of oedema fluid spreading to 1.9 mm/hour. Following treatment with dexamethasone the formation rate of oedema fluid is reduced by 30–50%. The important clinical implications of these new findings are discussed.     

Stress fractures around the knee in elderly patients. A cause of acute pain in the knee

A review of the cases of sixteen elderly patients who had eighteen stress fractures around the knee revealed that thirteen fractures had been misdiagnosed, which led to inappropriate management of six. The most frequent factor contributing to misdiagnosis was the presence of other abnormalities of the knee for which the patient had previously consulted the physician. Conservative treatment with rest, walking aids, and, for some patients, splinting of the extremity resulted in relief of pain and healing of the fracture. A careful clinical assessment that includes new radiographs and, if necessary, bone scans is essential for early diagnosis in patients who have acute, incapacitating pain in the knee.     

Coagulation dysfunction of severe burn patients: A potential cause of death

BackgroundResearch on coagulation dysfunction following burns is controversial. This study aimed to describe the coagulation changes in severe burn patients by examining coagulation parameters.MethodsPatients with third-degree total body surface area (TBSA) burns of ≥30% were enrolled between 2017 and 2020. Platelet (PLT) count and coagulation indexes (including APTT, INR, FIB, DD, and AT Ⅲ) were measured at admission and once weekly for 8 weeks, and statistical analysis was performed. The patient medical profiles were reviewed to extract demographic and clinical data, including TBSA, third-degree TBSA, and inhalation injury. The total intravenous fluids and transfusions of crystalloids, fresh frozen plasma (FFP), and red blood cells (RBC) were calculated during the forty-eight-hour period. The number of sepsis cases was recorded.ResultsWe enrolled 104 patients , and while the overall coagulation trend fluctuated, inflection points appeared around one week and demonstrated hypercoagulability. INR was significantly higher in the non-survival group than in the survivors' group from admission to three weeks after burn (all p<0.01). From post-injury week 1 to post-injury week 3, the APTT in the non-survival group was greater than in the survival group, but the non-survival group's PLT count was lower than that in the survival group (all p<0.05). At two and three weeks after burns, the FIB levels in the non-survival group were significantly lower than those of the survival group (both p<0.01). The prevalence of inhalation injury and the proportion of sepsis cases were significantly higher in the non-survival group than in the survival group ( p ＜ 0.05, p ＜ 0.001, respectively). At the time of death, APTT, INR, and FDP levels were significantly higher in the non-survival group in the survivor group, and FIB, ATIII, and PLT were significantly lower than in the survivor group (all p<0.01). On the day of death, nine of the 12 dead patients had disseminated intravascular coagulation (DIC).ConclusionsCoagulation dysfunction was most prominent in severe burn patients 1 week after injury and presented as hypercoagulability. Large-area burn injury, large amounts of fluid resuscitation, inhalation injury, and sepsis may all contribute to coagulation dysfunction, which can further develop into DIC and even death in severe burns patients.     

The pyruvate kinase isoenzyme shift in human gliomas: a potential marker in the treatment of gliomas

In primary human brain tumours a shift occurs in the synthesis of isoenzymes of pyruvate kinase from the M towards the K-type. In astrocytomas, oligodendrogliomas and glioblastomas, which were localised in the cerebral hemispheres of adult patients over 20 years of age, the shift correlated well with histological grading and growth rate as observed in postoperative survival. Gliomas of adults, localised in midline structures, as well as childrens gliomas were characterised too by a strong shift from M towards the K type. However, in these tumours, less correlation with histological grading and growth rate was found. The isoenzyme shift can be rapidly demonstrated with an alanine inhibition test. The application of this assay may have a diagnostic value during operation for gliomas in grading of malignancy in adults as well as demarcation of the resection of gliomas in all age groups. The test can be performed within 10-15 min and can thus fit easily into a surgical procedure. A case report is presented for illustration.     

A descriptive study of the centralization phenomenon. A prospective analysis

STUDY DESIGN: Occurrence and treatment responses associated with the centralization phenomenon were analyzed prospectively in 289 patients with acute neck and back pain with or without referred spinal symptoms. OBJECTIVES: To document symptom changes to mechanical assessment during initial evaluation and during consecutive visits. Using standard operational definitions, patients were categorized reliably into three inclusive and mutually exclusive pain pattern groups: centralization, noncentralization, and partial reduction. It was hypothesized that the occurrence of centralization would be less than previously reported and that the centralization group would have better treatment results. SUMMARY OF BACKGROUND DATA: Centralization has been reported to occur with high frequency during mechanical assessments of patients with acute spinal syndromes. When centralization is observed, a favorable treatment result is expected. Because centralization has not been defined consistently in the literature, the true prevalence and treatment responses associated with centralization have not been confirmed. METHODS: Consecutive patients with neck or back pain syndromes and referred to outpatient physical therapy services were categorized into three pain pattern groups by experienced therapists trained in the McKenzie system. Changes in distal pain location were scored and documented before and after each visit. Maximal pain intensity over 24 hours, perceived functional status, and number of treatment visits were compared between groups. RESULTS: Patients could be categorized reliably according to movement signs and symptoms. The centralization pain pattern group had significantly fewer visits than the other two groups (P < 0.001). Pain intensity rating and perceived function were different between the centralization and noncentralization groups (P < 0.001). There was no difference in treatment response between the centralization and partial-reduction groups (P = 0.306). Prevalence of patients assigned to the three groups was 30.8% in the centralization group, 23.2% in noncentralization, and 46% in the partial-reduction group. CONCLUSION: Categorization by changes in pain location to mechanical assessment and treatment allowed identification of patients with improved treatment outcomes and facilitated planning of conservative treatment of patients with acute spinal pain syndromes. If a proximal change in pain location is not observed by the seventh treatment visit, the results of this study support additional medical evaluation for physical or nonphysical factors that could be delaying quick resolution of the acute episode.     

Heterotopic ossification around the hip in spinal cord-injured patients. A long-term follow-up study.

Twenty patients with spinal cord injury complicated by ossification around the hip were followed for eighteen months or more. The bone scan, roentgenogram, level of alkaline phosphatase, and range of hip motion of each patient were analyzed. The average follow-up was forty months. The heterotopic ossification usually did not mature until after one and one-half years. The roentgenograms were of no value in judging its maturity. The bone scan correlated well with the results of the alkaline phosphatase testing in judging maturity of the ossification. We concluded that before operative resection, a patient should have a normal level of alkaline phosphatase, decreasing activity on the bone scans, and a restriction of motion to less than 50 degrees of hip flexion.     

Chemotherapy for malignant gliomas of the brain: a review of ten-years experience

Summary In recent years, there has been a great improvement in the knowledge of the biological aspects of malignant gliomas of the brain. Conversely, there has been an increase of interest in the multimodal treatment of these tumours.In this review, we have analyzed the results of the several reports which have appeared in the literature that deal with the chemotherapeutic treatment of malignant gliomas. Furthermore, some areas of biological investigation that could have an impact on pharmacological therapy are discussed.Abbreviations AA anaplastic astrocytoma - ACNU (l-4-amino-2methil-5pyrimidinyl)-methyl-3-(2-chloroethyl)-3-nitrosourea - AraC cytosine arabinoside - AZQ aziridinylbenzoquinone - BCNU 1,3-bis(2-chloroetyl)-1-nitrosourea - BTSG Brain Tumor Study Group (USA) - BTCG Brain Tumor Cooperative Group (USA) - BUdR 5-bromodeoxyuridine - CCNU 1-(2-chloroethyl)-3cyclohexyl-1 -nitrosourea - CDDP cisplatin - DAG dianhydrogalacticol - DBD dibromodulcitol - DTIC imidazolcarboxamide - EORTC European Organization for Research on Treatment of Cancer - 5-FU fluorouracil - GBM glioblastoma - HU hydroxyurea - MeCCNU methyl-CCNU - Miso misonidazole - MP 6-mercaptopurine - MST median survival time - MTTP median time to tumor progression - PCNU 1-(2-chloroethyl)-3-(2,6-dioxo-3-piperidyl)-1-nitrosourea - PCZ procarbazine - RT radiotherapy - VCR vincristine - VM26 teniposide - VP16 etoposide     

Hsp72 induction: a potential molecular mediator of the delay phenomenon

The molecular basis of enhanced ischemic tissue survival in flaps preconditioned by surgical delay is poorly understood. Because elevated expression of so-called heat shock or stress proteins has been shown to protect tissues/organs against ischemic injury, the authors examined whether the levels of the most highly induced stress protein-hsp72-were elevated in delayed muscle flaps using a rat muscle flap model. Bilateral latissimus dorsi muscle flaps based on the thoracodorsal vessels were elevated in 16 male Sprague-Dawley rats. For each animal, one side was selected randomly to undergo preconditioning by surgical delay for a 7-day period prior to elevation. Delay was accomplished by preserving the thoracodorsal pedicle and a single large distal intercostal perforating vessel. After bilateral flap elevation, latissimus dorsi tissue was harvested from proximal, central, and distal flap segments 0, 1, 3, and 7 days postoperatively (N = 4 for each group), and was analyzed for the expression of hsp72 via Western blot analysis. At the time of harvest, flap viability was assessed by staining with nitroblue tetrazolium. Flap perfusion was measured prior to muscle elevation and harvest using laser Doppler flowmetry. The results demonstrate that delayed muscle flaps had significantly greater total perfusion (p < 0.05) and survival (p < 0.03) 1, 3, and 7 days after elevation compared with the acutely elevated control tissue. Western blot analysis revealed that tissues harvested from the delayed flaps expressed substantially higher levels of hsp72 compared with the acutely elevated control samples. Segmental analysis also revealed a proximal > middle > distal expression of hsp72 in the delayed flaps (p < 0.05). Flap preconditioning by surgical delay increases the expression of hsp72. Moreover, regional differences in hsp72 gene expression are associated with differences in perfusion and survival of delayed muscle flaps. These results indicate that hsp72 may play a substantial role in mediating the delay phenomenon.     

Magnetic resonance assessment of the double-crush phenomenon in patients with carpal tunnel syndrome: a bilateral quantitative study.

Our main goal was to assess the coexistence of narrowed cervical foramens and cervical canal stenosis in patients with carpal tunnel syndrome (CTS). We took magnetic resonance (MR) images of 120 wrists and 480 foramens in 60 age and sex matched subjects (30 patients with CTS and 30 controls). All patients had nerve conduction velocity tests before MR examination. We measured the volume of the carpal canal in all participants bilaterally. We also quantified the cross-sectional areas of the cervical foramens on both sides from C4 to T1 and measured the diameter of the cervical canal in all participants. We searched for the prevalence and location of cervical spondylosis and disc prolapse on the side of the symptomatic wrist(s). All patients had CTS-related neurophysiological findings. There was no correlation between the symptoms and the reduced carpal canal volume. The mean (SD) area of the foramens was 109.5 (12.8) mm2 in the patients compared with the controls 126.4 (28.7) mm2 (p = 0.007). Cervical spondylosis and disc prolapse were more common in the patients than the controls at the C5-C6 and C6-C7 levels, and their locations were on the same side as the symptoms in the wrist(s) in 50% of cases. There was no difference in the size of the cervical canal between the two groups. The higher incidence of narrowed cervical foramens in the patients and its concordance with affected nerve roots on the same side as the CTS symptoms support the hypothesis of a double-crush phenomenon.     

Lonidamine in the combined treatment of malignant gliomas. A randomized study

Lonidamine (LND) is a drug that interferes with energy metabolism of cancer cells, principally inhibiting aerobic glycolytic activity, by its effect on mitochondrially-bound hexokinase (HK). In such way LND could impair energy-requiring processes, as recovery from potentially lethal damage, induced by radiation treatment and by some cytotoxic drugs. A randomized study started in November 1983, to evaluate the efficacy of LND in association with radiotherapy as first line treatment in malignant gliomas, after surgical procedure. LND was also used in association with Lomustine (CCNU) at the moment of documented clinical and neuroradiological recurrence. At the present time 60 patients entered the study, and 47 are evaluable. Present preliminary results are not statistically significant, however indicate that LND tends to prolong the median survival time and the rate of one year survivors.     

胆管内乳头状黏液性肿瘤21例临床分析

目的 探讨胆管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm of the bile tract, IPMN-B）的临床特点及诊治方法。方法 回顾性分析郴州市第一人民医院2012年1月至2019年6月收治 的21例IPMN-B患者临床资料。结果 21例患者中男4例,女17例,平均年龄（63.0±7.5）岁。临床表现： 腹痛19例,黄疸10例,畏寒发热7例;既往有胆道手术史13例;合并胆管结石14例。患者CA19-9阳性率 38.1%（8/21）, CEA阳性率28.6%（6/21）;术前诊断率33.3%（7/21）。肿瘤位置：位于左肝19例,右肝及胆 总管各1例。手术方式：肝部分切除+胆道探查术18例,肿瘤活检+胆道探查术2例,胰十二指肠切除术1例。 术后病理诊断：腺癌11例,腺瘤10例。本组死亡4例,其中1例因术后1个月并发肝功能衰竭死亡; 2例术 后病情进展,分别于术后8个月及10个月死亡; 1例术后2年复发并发消化道出血死亡。术后复发3例,其 中1例再次手术,2例保守治疗,其余患者顺利康复。结论 IPMN-B患者以老年女性为主,多数合并有胆 道手术史、胆管结石,好发于左肝,术前诊断率低,手术切除是主要治疗手段,预后较好。     

High dose chemotherapy with autologous bone marrow rescue for high grade gliomas of the brain: a potential for improvement in therapeutic results

Improvements in the therapy of high grade gliomas have not been achieved since the addition of single agent chemotherapy to operation and radiation therapy in the mid-1970s. The dosages of nitrosourea compounds commonly used as chemotherapeutic agents for malignant gliomas have been limited by the myelotoxicity of the drugs. Autologous bone marrow transplantation offers a means to escalate chemotherapeutic dosages by reversing marrow toxicity. Early studies indicated that complete responses, partial responses, and clinical responses are possible using high dose chemotherapy and autologous marrow rescue. The exact role that this technique will play in the management of malignant gliomas has not yet been determined.