Gamma knife radiosurgery for intracranial mature teratoma--long-term results and review of literature

BACKGROUND: The purpose of this report is to present long-term outcomes of gamma knife radiosurgery for intracranial mature teratoma after debulking surgery. METHODS: Three patients with intracranial mature teratoma had initial target volumes of 5.4, 18.7, and 5.1 cm(3), respectively, and were treated by gamma knife radiosurgery between 1993 and 2004. Marginal doses of 17, 12.5, and 13.5 Gy, respectively, were delivered to the tumors at isodose levels of 50%, 50%, and 62%, respectively. The first patient received radiosurgery after surgical removal and conventional radiotherapy. The second patient received similar management, including surgery and radiotherapy, with tumor recurrence. Two additional operations and subsequent radiosurgery were performed on this patient. Based on the favorable results of the first 2 patients, we performed radiosurgery instead of conventional radiotherapy after subtotal surgical removal in the last patient. By reviewing literatures concerning the therapeutic modalities and the long-term results of our 3 patients, we discuss the role of radiosurgery in treating intracranial mature teratoma. RESULTS: A follow-up period of 121, 89, and 31 months, respectively, demonstrated tumor volume reduction rates of 70%, 89%, and 48%, respectively. No evidence of further tumor progression and no radiosurgery-related complication or morbidity was noted. The school performances of the affected children are all above average. CONCLUSIONS: Gamma knife radiosurgery provides a safe and effective alternative as the adjuvant treatment of intracranial mature teratoma after surgical debulking. Previous conventional radiotherapy does not alter final tumor control. Radiosurgery should be considered when residual tumor growth continues with no related symptoms or evaluations of tumor markers during follow-up.     

Spinal fractures and pseudoarthrosis complicating ankylosing spondylitis: MRI manifestation and clinical significance

PURPOSE: To analyze magnetic resonance (MR) patterns of fractures and pseudoarthrosis of the ankylosing spondylitic spine, and related changes in the dura and adjacent soft tissue. MATERIALS AND METHODS: Sixteen patients with radiographically evident fractures or pseudoarthrosis of the spine were included. Each underwent MR studies. Ten patients among them underwent surgical operations. RESULTS: Both transdiscal (n = 12) and transvertebral (n = 4) fractures were identified. The levels were located from T9 to L3. Five of 16 patients had pseudoarthrosis. The fractures or pseudoarthrosis had two patterns: low signal on T1-and high signal on T2-weighted images, and low signal on both T1-and T2-weighted images. Disruption of anterior longitudinal ligament (ALL) was identified in 14 patients. Seven patients had vertebral translation, all had disruption of the ALL. Dural adhesions were noted in five patients and manifested as linear epidural enhancements with triangular blunt edges. CONCLUSION: MR patterns of ankylosing spondylitis are important in evaluating complications of fractures or pseudoarthrosis, as well as changes in dura, soft tissue, and ligaments.     

A Decrease in the Percentage of CD3+ Cells Is Correlated With Clinical Improvement During Plasmapheresis in Patients With Myasthenia Gravis

Plasmapheresis not only removes circulating antibodies but also modulates cellular immunity, including lymphocyte subsets. To investigate the effect of double‐filtration plasmapheresis (DFPP) on the ratio of lymphocyte subsets in patients with myasthenia gravis (MG), we examined the percentages of B‐cells, T‐cells, T helper (Th) cells, T suppressor (Ts) cells, natural killer (NK) cells, NKT cells, and Th/Ts ratio before and after a single DFPP session and after a course of DFPP. A total of 26 patients were recruited; their peripheral blood lymphocyte subsets were assayed using flow cytometry. After a single session of DFPP treatment, the percentages of T‐cells (P = 0.0200), Th cells (P = 0.0178), and the Th/Ts ratio (P = 0.0309) decreased significantly, whereas the percentage of NK cells (P = 0.0007) increased significantly. More importantly, after one course of DFPP treatment, the reduced clinical quantitative MG (QMG) score was correlated with the decrease of the percentage of T‐cells (r = 0.5005, P = 0.0092). Fourteen thymectomized MG patients had decreased percentages of T‐cells (P = 0.0304) and Th cells (P = 0.0444), whereas they had increased NK cells (P = 0.0197) after a single DFPP session. Here, transiently decreased percentages of T‐cells after the full DFPP course could enhance the effectiveness of plasmapheresis for MG patients.     

Charlson Co‐morbidity Index and albumin significantly associated with fracture risk in peritoneal dialysis patients

Published literature on fracture in dialysis patients seldom addressed the effect of co‐morbidity and malnutrition. In this study, we reported the incidence and risk factors for fracture in peritoneal dialysis patients. Peritoneal dialysis patients who had fractures between 2006 and 2011 were recruited. Demographic data, details of fracture, Charlson Co‐morbidity Index (CCI) and biochemical parameters were also collected. Non‐fracture controls, matched for age, gender and duration of dialysis, were also recruited at ratio 1:1 for fracture risk analysis. The incidence of fracture was 1 in 37 patient‐years. The commonest site of fracture was neck of femur (n = 16, 55.2%). Twenty‐four patients (82.8%) developed fracture after slip and fall injury. Eight out of 17 self‐ambulatory patients (47.1%) became non‐ambulatory after fracture. Infection was the commonest complication during hospitalization. Univariant analysis demonstrated high CCI (P = 0.001), hypoalbuminaemia (P < 0.001), loss of self autonomy (P = 0.006) and non‐ambulatory state (P = 0.011) significantly associated with increased fracture risk. However, only CCI (odds ratio (OR) 1.373, P = 0.028) and albumin (OR 0.893, P = 0.025) increased fracture risk significantly on multivariant analysis. Bone profile and parathyroid hormone were not significant risk factors. To conclude, fracture associated with adverse outcome in peritoneal dialysis patients. High CCI score and hypoalbuminaemia significantly increase risk of fracture.     

假细锥香茶菜新二萜成分——假细锥甲素的结构

从假细锥香茶菜(Rabdosia coetsoides C.Y.Wu)叶分离得到新二萜成分,根据紫外光谱、红外光谱、质谱、核磁共振氢谱及碳谱等分析,推定了化学结构,并经X-射线衍射确证,命名为假细锥甲素。     

A community-based study of the relationship between insulin resistance/beta-cell dysfunction and diabetic retinopathy among type II diabetics in Kinmen, Taiwan

PURPOSE: To explore whether insulin resistance and beta-cell dysfunction are both related to diabetic retinopathy (DR) in type II diabetics by using a community-based study in Kinmen, Taiwan. METHODS: A screening program for DR was performed by a panel of ophthalmologists who used ophthalmoscopy and 45 degrees color retinal photographs on dilated pupils to determine a consensus grade of diabetic retinopathy. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type II diabetes. The Homeostatis Model Assessment (HOMA) method was used to determine insulin resistance and beta-cell dysfunction. RESULTS: Seven hundred twenty-five diabetics who attended ophthalmological fundus checkups were studied. The overall response rate was 75%. After excluding 10 insulin-treated diabetics, diabetic retinopathy at first eye screening among the remaining 715 diabetics was 18.5%. Based on the multiple logistic regression, DR was found to be strongly related to both baseline insulin resistance (IR) and beta-cell dysfunction regardless of duration of diabetes. The strength of the relationships was maintained after adjustment for confounders. Those who were in the 2nd, 3rd, and 4th quartile of HOMA IR had 1.38 times (95% CI: 0.62-3.05), 2.37 times (95% CI: 1.19-4.69), and 4.16 times (95% CI: 2.15-8.06) the risk for DR compared to that in the 1st quartile, respectively. A reduced risk for DR in relation to HOMA beta-cell dysfunction for the 2nd, 3rd, and 4th quartile were 64% (95% CI: 27%-82%), 82% (95% CI: 58%-92%), and 82% (95% CI: 60%-92%) compared to that in the 1st quartile, respectively. CONCLUSIONS: Insulin resistance and beta-cell dysfunction are both associated with diabetic retinopathy in type II diabetes.     

Atypical MRI features of intraorbital metastatic melanoma

A 78-year-old man with a history of melanoma presented with a 2-week history of diplopia, pain, and intermittent blurriness in his right eye. Imaging showed a multicystic mass within the right lateral rectus muscle that was biopsy-proven metastatic melanoma. To our knowledge, this is the first case report of orbital metastasis from melanoma presenting as a multicystic mass intrinsic to the extraocular muscle with layering fluid-fluid levels.