Effects of hypothalamic knife cuts on the ingestive responses to glucose and insulin.

Parasagittal knife cuts through the perifornical hypothalamus either medial or lateral to the fornix produced hyperphagia and obesity and altered the rat's ingestive responses to dilute glucose solutions. The lateral knife cut rats drank less dilute glucose solution under both nondeprived and food deprived conditions and displayed less of a feeding suppressive response to glucose ingestion compared to controls. The lateral cut rats were also deficient in their feeding response to insulin-induced hypoglycemia, although their altered sensitivity to glucose and insulin did not appear to be causally related. The medial knife cuts decreased the responsivity to glucose, but less so than the lateral cuts, and did not alter the ingestive response to insulin. Both the medial and lateral knife cuts did not appear to change the rat's responsivity to concentrated blucose solutions. The neuroanatomical and functional nature of the disorder responsible for these effects and its relationship to the hyper-phagia-obesity syndrome are discussed.     

Hypothalamic obesity following knife cuts that minimize arterial damage

Parasagittal knife cuts that separate the medial hypothalamus from the lateral hypothalamus produce obesity. It has been assumed that the obesity results from the cutting of axons. However, these cuts also appear to sever arteries. The present study demonstrates that the severing of arteries is not necessary for the production of obesity. Knife cuts were placed at an angle so as to separate the medial hypothalamus from the lateral hypothalamus with minimal damage to arteries. These rats overate and became obese just as rapidly as rats with parasagittal cuts.     

伽玛刀治疗垂体腺瘤的效率及其作用地位探讨

目的：从一个侧面探讨伽玛刀的作用地位。方法：采取“伽玛刀”和“开颅手术”两治疗方法对垂体腺瘤治疗的住院日、治疗率、后续治疗率，以及病人收治数量的变化等方面进行对比分析。结果：在239例垂体腺瘤的治疗中，伽玛刀治疗的平均住院日只是开颅手术的31．40％，治疗率占64．85％，后续治疗率2、58％(开颅手术为38．10％)，病人收治数量明显增加。结论：伽玛刀在医疗绩效中的作用明显。     

针对性护理对脑肿瘤患者伽马刀术后颅内压的影响

目的:探究针对性护理对脑肿瘤患者伽马刀术后颅内压等不良反应指标的影响。方法:选取2011年1月至2013年12月来我院就诊的需行伽马刀治疗的脑肿瘤患者88例,依据分层随机分组法将患者分为治疗组及对照组,对照组44例术后给予常规护理方案及治疗策略进行治疗;治疗组44例术后给予针对性个体化护理方案进行治疗;观察比较两组患者治疗满意度、不良反应情况及治疗效果。结果:治疗前两组患者的颅内压比较差异无统计学意义(P>0.05);治疗后治疗组患者颅内压(196.75±37.14)mm H2O、住院时间(13.27±3.18)d、出现癫痫发病0(0.00%)例、头皮破溃5(11.63%)例及头皮感染例数2(4.65%)例明显低于对照组(217.68±42.59)mm H2O,(15.46±3.53)d,5例(11.36%),13例(29.55%),9例(20.45%),差异有统计学意义(P<0.05);治疗组患者治疗满意度高于对照组,差异有统计学意义(P<0.05);治疗组患者出现头痛、呕吐及视乳头水肿等脑水肿症状例数明显低于对照组,差异有统计学意义(P<0.05)。结论:针对性个体化护理可有效降低患者不良反应出现率及严重程度,提高患者生活质量并促进患者的早日康复。     

Current status and future opportunities for controlling acromegaly

Growth-hormone (GH) secreting adenomas, including acromegaly, account for approximately one-sixth of all pituitary adenomas and are associated with mortality rates at least twice that of the general population. The ultimate goal of therapy for acromegaly is normalization of morbidity and mortality rates achieved through removal or reduction of the tumor mass and normalization of insulin-like growth factor I (IGF-I) levels. Previously published efficacy results of current treatment modalities (surgery, conventional radiation, and medical therapy with dopamine agonists and somatostatin analogs) are often difficult to compare because of the different criteria used to define cure (some of which are now considered inadequate). For each of these modalities, pooled data from a series of acromegaly studies were reviewed for rates of IGF-I normalization, a currently accepted definition of cure. The results showed overall cure rates of approximately 10% for bromocriptine, 34% for cabergoline, 36% for conventional radiation, 50–90% for surgery for microadenomas and less than 50% for macroadenomas, and 54–66% for octreotide. These cure rates based on IGF-I normalization are generally less than those reported for cure based solely on GH levels. Novel new therapies for acromegaly include the somatostatin analog, lanreotide, Gamma Knife radiosurgery, and pegvisomant, the first in its class of new GH receptor antagonists. Although it does not appear that Gamma Knife radiosurgery results in significantly higher cure rates or fewer complications, it does provide a notable improvement in delivery compared with conventional radiation. Early studies have reported IGF-I normalization in 48% of lanreotide-treated patients and up to 97% of pegvisomant-treated.     

黏膜刀辅助切除术治疗结直肠带蒂息肉的初步研究（含视频）

目的探讨黏膜刀辅助息肉切除术（knife assisted polypectomy,KAP）治疗结直肠带蒂息肉（巴黎分型0-Ⅰp型）的安全性和有效性。方法回顾性分析2019年5月—2019年9月在复旦大学附属中山医院和徐汇区中心医院内镜中心行KAP治疗的42例结直肠带蒂息肉患者的临床资料,统计手术切除操作时间和术后并发症发生情况等,初步分析KAP的治疗效果。结果对42例患者共48枚息肉完成切除,息肉中位直径2.0 cm（0.8~3.5 cm）,操作时间（11.3±1.1）min。所有患者术中无严重出血和穿孔发生,术后无迟发性出血、迟发性穿孔及电凝综合征发生。术后病理显示手术完整切除率为100%。结论KAP治疗结直肠带蒂息肉操作安全高效。     

Gamma Knife radiosurgery in the management of brainstem metastases

Background

Metastases to the brainstem portend a poor prognosis and present a challenge in clinical management. Surgical resection is rarely a viable option.

Methods

Post-treatment MRI scans of patients with brainstem metastases treated with radiosurgery were used to determine local control and disease progression. Median survival was calculated using Kaplan–Meier analysis. Univariate and multivariate analyses were performed using log-rank test and Cox proportional hazards model, respectively.

Results

Thirty-two consecutive patients with brainstem metastasis underwent Gamma Knife radiosurgery. Median age was 50 years. Median tumor volume was 0.71 cm³ and median tumor margin dose was 13 Gy. Seventeen of 32 patients received WBRT prior to stereotactic radiosurgery. Median survival was 5.2 months. There was a statistically significant difference in survival based on RTOG recursive partition analysis (RPA) class. Median survival of patients categorized as RPA class I was 19.2 months, RPA class II was 8.4 months, and RPA class III was 1.9 months. The overall local tumor control rate was 87.5%. There were no acute complications following stereotactic radiosurgery and no evidence of radiation necrosis noted on post-treatment MRI scans.

Conclusion

Stereotactic radiosurgery is an effective treatment for brainstem metastases and should be considered especially for patients with good performance status.     

The hazard of sharp force injuries: Factors influencing outcome

The risk of dying from sharp force injury is difficult to ascertain. To the best of our knowledge, no study has been performed in Norway regarding mortality due to sharp force injury or factors that impact survival. Thus, the objective of the present study was to investigate and assess mortality in subjects with sharp force injury. This retrospective study comprises data on 136 subjects (34 female, 102 male) with suspected severe sharp force injury (self-inflicted or inflicted by others) admitted to Haukeland University Hospital between 2001 and 2010. The majority of subjects were intoxicated, and the injury was most often inflicted by a knife. The incidence of sharp force injury in Western Norway is similar to the incidence in other European countries. Almost half of the subjects with self-inflicted injury died. In cases with injury inflicted by another individual, one in five died. Mortality rates were higher in those with penetrating chest injuries than those with penetrating abdominal injuries and higher in cases with cardiac injury compared to pleural or lung injury. Sharp force injury can be fatal, but the overall mortality rate in this study was 29%. Factors influencing mortality rate were the number of injuries, the topographic regions of the body injured, the anatomical organs/structures inflicted, and emergency measures performed.     

Fatal glioblastoma after Gamma Knife radiosurgery for arteriovenous malformation in a child

We describe a fatal case of glioblastoma multiforme that was induced by Gamma Knife radiosurgery (GKS; Elekta AB, Stockholm, Sweden) for an arteriovenous malformation (AVM). A 4-year-old girl presented with repeated convulsions. Imaging studies revealed an AVM located in the right thalamus. One year after initial symptoms, GKS was performed to obliterate the nidus. The maximum and marginal radiation doses were 32 and 16 Gy, respectively. Seventy months after GKS, the patient represented with severe headache. MRI showed a poorly demarcated tumor with heterogeneous gadolinium enhancement in the right thalamus and adjacent to the white matter of the temporal lobe. After a generalised convulsion, the patient deteriorated into a deep coma. CT scans showed severe brain swelling with intratumoral hemorrhage. An emergency craniotomy was performed, and the hematoma was removed. During this surgery, a tumor mass, which was found adjacent to the hematoma, was resected. Microscopic examination revealed glioblastoma multiforme. Despite intensive treatment, the patient died 1 month after surgery. A GKS-induced secondary tumor is a rare but serious complication. It is important to be aware of the adverse effects of GKS, including secondary neoplasms, before its clinical application, especially in young patients.     

RapidArc与Novalis Knife在多发脑转移瘤SRS中的剂量学比较

目的:比较基于多叶准直器的RapidArc与基于圆形限光筒的Novalis Knife在多发脑转移瘤立体定向放射外科（SRS）中的剂量学差异。方法:选取10例已进行Novalis Knife治疗的多发脑转移瘤患者（转移瘤3~5个/人）,共37个转移瘤。重新设计单中心、非共面4弧的RapidArc SRS计划,靶区处方剂量统一为16 Gy。比较Novalis Knife计划和RapidArc SRS计划中靶区的剂量适形度指数和均匀性指数、靶区周围剂量梯度指数、正常脑组织等剂量线体积（V16、V12、V9、V6、V3）以及治疗所需的机器跳数。结果:RapidArc SRS计划相较于Novalis Knife计划,适形度指数更接近于1（0.79[±]0.10 vs 0.50[±]0.22, P=0.000）,均匀性指数更接近于0（0.07[±]0.01 vs 0.15[±]0.07, P=0.000）,但靶区周围剂量梯度指数较大（15.92[±]12.43 vs 5.05[±]3.53, P=0.000）。对于正常脑组织等剂量线体积,RapidArc SRS计划中V16明显小于Novalis Knife计划（P=0.005）;两计划的V12、V9无明显差异（P=0.445, 0.059）;而RapidArc SRS计划中V6、V3明显大于Novalis Knife计划（P=0.005, 0.005）。RapidArc SRS计划的机器跳数明显少于Novalis Knife计划（P=0.005）。结论:RapidArc SRS计划通过设置单一治疗等中心可实现颅内多个转移瘤的同步放射外科治疗,具有更高的靶区剂量适形度及均匀性;但靶区周边剂量跌落陡度不及Novalis Knife计划,正常脑组织低剂量受照范围较大。治疗依从性较差的多发脑转移患者可考虑选择治疗效率更高的RapidArc技术,并根据临床实际情况调整剂量分割模式,以减少放射损伤风险。