Impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas: a single-institution retrospective study.

Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas. Between 1990 and 2002, 76 adult patients with pathologically confirmed malignant astrocytomas underwent craniotomy and removal of the tumors at the Toyama Medical and Pharmaceutical University Hospital. Of these 76 patients, 42 were treated using neuronavigation with conventional microneurosurgery and the other 34 were treated with conventional microneurosurgery alone. Postoperative early MRI with contrast enhancement was done, and gross total resection was defined as the complete absence of residual tumor. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model. In univariate analysis, age (< 65), grade 3, preoperative KPS (>/= 80), use of neuronavigation, and gross total resection were significantly associated with longer survival. However, when the data were submitted to multivariate analysis, grade 3, preoperative KPS (>/= 80), and gross total resection were independent prognostic factors. The median survival periods of patients receiving gross total resection (vs. partial resection) and neuronavigation (vs. no neuronavigation) were 16 (vs. 9) months and 16 (vs. 10) months, respectively. The percentage of a gross total resection was significantly higher in the neuronavigation group compared to that in the no-navigation group (64.3 % vs. 38.2 %, p < 0.05). Neurological deterioration occurred in 4 of 42 (9.5 %) and in 6 of 34 (17.6 %) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant. Our results showed that neuronavigation increases the radicality in the resection of malignant astrocytomas and is objectively useful for improving survival time.     

Contraception and abortion attitudes and practices of Western Ukraine women.

OBJECTIVES: To assess the attitudes and practices of contraceptive behaviors of Western Ukraine women. METHODS: A survey of 500 women in the Oblast was conducted to assess their knowledge, attitudes and practices on a variety of health topics. Convenience sampling was used to access the subjects in 16 different towns/villages in nine rayons throughout the Oblast. Respondents were asked more than 100 questions pertaining to their knowledge, attitudes and practices on a variety of health topics, including stress, contraception, breast health, sexually transmitted diseases, parity, abortion, nutrition, alcohol and tobacco use, domestic violence, and depression and mental health. RESULTS: Of married women, 44% (112/256) would terminate their pregnancy while 56% (144/256) said they would keep their baby. Of unmarried women, 35% (31/88) would abort while 65% (57/88) would keep their baby. A large proportion of married women (82%; 222/271) and unmarried women (70%; 52/74) did not use condoms at all. CONCLUSION: These results suggest lack of birth control education and contribution to poor protection from sexually transmitted infections. Higher abortion practices may also play a role in the infertility issues that Ukrainian women currently face.