Necrosis and glioblastoma: a friend or a foe? A review and a hypothesis

OBJECTIVE: Two main forms of cell death are encountered in biology: apoptosis (i.e., programmed cell death) and necrosis (i.e., accidental cell death). Because necrosis and apoptosis can lead to cell removal, one might intuit that they are both desirable in cancer treatment. However, in the setting of glioblastoma multiforme, a malignant brain tumor for which the presence of necrosis is an important diagnostic feature, clinical studies indicate that as the degree of necrosis advances, the patient's prognosis worsens. Despite the apparent importance of this form of cell death, the mechanism of development of necrosis in glioblastomas remains unelucidated. The purpose of this article is to try to resolve this dilemma by hypothesizing the mechanism of necrosis formation in these tumors. METHODS: On the basis of an extensive review of the literature, we present a hypothesis for the mechanism of necrosis formation in glioblastoma multiforme. RESULTS: One of the many possible pathways leading to necrosis formation may involve increased tumor cell secretion of tumor necrosis factor. Procoagulation and antiapoptotic mechanisms resulting from certain pathways could prevent the completion of tumor necrosis factor-induced apoptosis and could promote necrosis as the final mode of cell death. Such a hypothesis would explain the inverse correlation that exists between tumor necrosis and the survival of patients with glioblastomas, because the hypoxia that results from procoagulation selects for tumor cells that are more aggressive and more resistant to apoptosis-inducing therapies. CONCLUSION: A complete understanding of the series of events surrounding necrosis development in glioblastomas that is evidence-based is likely to provide targets for future therapies. On the basis of the potential mechanisms of development of necrosis described in this article, we postulate that effective therapies may have to be directed against the pathways that result in the formation of necrosis.     

Concurrent rhinoplasty and endoscopic sinus surgery: a review of the pros and cons and a template for success

Historically concurrent FESS/rhinoplasty was avoided due to concerns of increased risk of complication. Recent studies have shown that FESS/rhinoplasty can be performed simultaneously with good outcomes and no significant increase in complications. A thorough and effective approach to the patient with sinonasal obstruction requires attention to aesthetic, functional, and inflammatory issues. Medical treatment is an important adjuvant to surgery in order to optimize outcomes by improving patient symptoms long-term. Surgery for these patients should be performed in a careful, stepwise approach to address the nasal septum, inferior turbinates, paranasal sinuses, and external nasal structures.     

Iron and acetaminophen a fatal combination?

Intentional iron overdose in adults is uncommon. Clinical consequences are variable and depend on the quantity of iron ingested and the delay to treatment. Severe iron overdose can lead to multi-organ failure and acute hepatic necrosis. Here, we report three cases of polypharmacy overdose including iron resulting in acute liver failure. Despite maximum supportive care including liver transplantation in two cases, all patients died. Iron poisoning may have an additive toxic effect in drug-induced acute liver failure and worsen outcome.     

Blister-like aneurysms—a diagnostic and therapeutic challenge

Blister-like internal carotid artery (ICA) aneurysms are known for their fragile and thin-walled morphology associated with a high risk of intraprocedural rupture. Neurosurgical and endovascular options are illustrated on three exemplary cases reviewing the diagnostic and therapeutic implications of these special aneurysms. A 49-year-old woman was admitted with subarachnoid hemorrhage (SAH) in which angiography showed a broad-based, small bulging ectasy of the terminal ICA segment. On the attempt of surgical clipping, the aneurysm ruptured leaving a tear in the ICA. After temporary clipping, the rims of the tear were approximated by sutures. Sufficient closure of the remaining leakage was achieved by circumferential wrapping which was secured by two clips. Postoperative angiography confirmed stenosis of the tightened ICA and patient recovered without neurological deficit. Surgical attempt on a second case with bulging of the C4-segment topped by a small aneurysm was fatal due to extensive laceration of the basal ICA intraoperatively. Endovascular stenting was the choice of treatment in a third SAH patient in which angiography was suspicious of a blister-like ICA aneurysm. Six-month follow-up was uneventful; the patient recovered well and further growth of bulging was not seen. Reviewing the literature, blister-like aneurysms tend to arise at uncommon sites not located at the arterial branches. Small and broad-based bulges with or without true saccular aneurysms have to be assessed as characteristic features of blister-like aneurysms. Rupture of the aneurysm involving the carrying artery has to be considered during therapeutic attempts, in which urgent strategies have to be kept in reserve preventing fatal outcome. Blister-like aneurysms is a hazardous affair for neurosurgeons and neuroradiologists as their fragile structure most likely will lead to intraoperative rupture. If endovascular treatment is not promising, wrapping and revascularization techniques come true to still be an important part of the neurosurgeons toolbox for reconstructing a vessel lumen and preserving a sufficient cerebral blood flow.     

Barbed Sutures and Tendon Repair—a Review

Introduction

Traumatic tendon lacerations are a common problem encountered by hand surgeons worldwide. Although the use of barbed suture to repair tendon lacerations has gained theoretical popularity in recent years, there is little information available regarding the safety, efficacy, longevity, or complications encountered when used in tenorraphy. In this study, we review the available literature on the use of barbed suture in tendon repair.

Methods

Studies conducted between 1980 and 2014 were identified using several databases, including EMBASE, SCOPUS, MEDLINE, and Web of Science. Keywords used to search for appropriate studies included the following: barbed, v loc, quill, tendon, tendon injuries, suture, tenorraphy, injury, and laceration, in various combinations.

Results

Our initial literature search identified 47 articles, and 8 were deemed appropriate for review after applying our exclusion criteria. The data from each of the articles is reviewed for the following major categories:

1. Maximum load to failure
2. Mode of failure
3. Load to 2-mm gap
4. Change in cross-sectional area
5. Type of repair

Conclusions

Barbed suture tenorraphy has a myriad of theoretical advantages, supported by varying ex vivo studies, as compared to traditional techniques. However, due to the non-uniformity in current studies and the lack of available data in a live model, we are unable to argue for or against barbed suture tenorraphy. We believe our review provides the most in-depth analysis of barbed suture tenorraphy to date, illuminates the potential advantages of using barbed sutures, and highlights the need for further investigation into this technique.     

Prognostic and treatment-predictive factors-is there a difference?

The terms risk factor, prognostic factor and predictive factor are often imprecisely used. We defined a prognostic factor as a patient characteristic that identifies subgroups of untreated patients having different outcomes, and a factor predictive of treatment effect as a patient characteristic that identifies subgroups of treated patients having different (as a consequence of treatment) outcomes. To illustrate this, theoretical graphical examples were constructed and data from the literature on prostate cancer were used to substantiate the theoretical examples. In most situations, but not necessarily always, a prognostic factor is also pre- dictive of the effect of specific treatments. Whether a prognostic factor is also predictive of treatment effect or not can only be assessed in a valid comparative setting such as in a randomized trial. A factor that is predictive for treatment effect may not be predictive for another treatment. Prostate Cancer and Prostatic Diseases (2000) 3, 265-268     

Post-streptococcal glomerulonephritis and uveitis—a case report

We hereby present the first case report of a child with concomitant post-streptococcal glomerulonephritis (PSGN) and uveitis. Pediatricians should be familiar with this entity and recognize signs and symptoms of uveitis in children with PSGN.     

Mesenteric cystic lymphangioma: a congenital and an acquired anomaly? Two cases and a review of the literature

Mesenteric cystic lymphangioma is an uncommon benign abdominal mass. Two cases of mesenteric cystic lymphangioma are presented, both in combination with malrotation and intermittent volvulus. Both mesenteric cystic lymphangiomas were located near the duodenojejunal junction, the usual area of torsion in case of a volvulus. These findings suggest that mesenteric cystic lymphangioma could have evolved as a consequence of chronic intermittent volvulus. We hypothesize that in patients with malrotation and volvulus, mesenteric cystic lymphangioma may be regarded as an acquired anomaly.     

Fatigue and interleukin-6 – a multi-faceted relationship

Many connective tissue diseases are characterized by fatigue, which is described in the literature as prostration, weakness, lassitude or asthenia. In many other diseases (autoimmune, neurologic or metabolic) fatigue impinges on daily activities and thus influences the quality of life. Different molecular backgrounds are involved in the development of fatigue. Not only does the immunosuppressive treatment of autoimmune diseases reduce fatigue, but also selective nutritional components may have an effect on secretion of cytokines which are responsible for development of the sensation of tiredness (e.g. secretion of interleukin-6). The beneficial influence of selected food components (such as polyunsaturated omega-3 fatty acids, nutritional antioxidants or adequate fat intake with the diet) on proinflammatory cytokine secretion has been demonstrated in many studies. In this review, the biochemical, neurological and nutritional aspects of fatigue in autoimmune diseases are underlined.     

Potter sequence and consanguinity — a case report

The first child of first-cousin parents had Potter sequence, including rudimentary, dysplastic kidneys and pulmonary hypoplasia. The girl died after 5 h. During the next pregnancy, early fetal ultrasound was normal. In the 33rd week, however, ultrasound revealed oligohydramniosis and reduced renal size. After 40 weeks of gestation a healthy girl of normal weight without any stigmata was born. Her pulmonary function and X-ray were normal. Renal ultrasound demonstrated small kidneys with high echogenicity. There was a transient renal insufficiency with a peak serum creatinine of 160 mol/l. At 5 months of age the infant still has an increased serum creatinine concentration of 57 mol/l and an inulin clearance of 29 ml/min per 1.73 m². In this case there is a possibility of an autosomal recessive inheritance.