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1.
《Neuro-Chirurgie》2022,68(3):262-266
BackgroundThe prognosis for patients with recurrent glioblastoma (GBM) is dismal, and the question of repeat surgery at time of recurrence is common. Re-operation in the management of these patients remains controversial, as there is no randomized evidence of benefit. An all-inclusive pragmatic care trial is needed to evaluate the role of repeat resection.Methods3rGBM is a multicenter, pragmatic, prospective, parallel-group randomized care trial, with 1:1 allocation to repeat resection or standard care with no repeat resection. To test the hypothesis that repeat resection can improve overall survival by at least 3 months (from 6 to 9 months), 250 adult patients with prior resection of pathology-proven glioblastoma for whom the attending surgeon believes repeat resection may improve quality survival will be enrolled. A surrogate measure of quality of life, the number of days outside of hospital/nursing/palliative care facility, will also be compared. Centers are invited to participate without financial compensation and without contracts. Clinicians may apply to local authorities to approve an investigator-led in-house trial, using a common protocol, web-based randomization platform, and simple standardized case report forms.DiscussionThe 3rGBM trial is a modern transparent care research framework with no additional risks, tests, or visits other than what patients would encounter in normal care. The burden of proof remains on repeat surgical management of recurrent GBM, because this management has yet to be shown beneficial. The trial is designed to help patients and surgeons manage the uncertainty regarding optimal care.Clinical Trial Registrationhttp://www.clinicaltrials.gov. Unique identifier: NCT04838782. 相似文献
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Sathiyavelavan Gopalan Jagadesh Chandra Bose S. Periasamy 《The Indian journal of surgery》2015,77(3):232-236
The aim of this study is to review the literature to find out the exact etiology of anastomotic cancers of colon post resection and differentiate them between a recurrence, second primary, and metastatic disease (local manifestation of systemic disease). Web-based literature search was done, and datas collected. We searched PubMed for papers using the keywords colon cancer recurrence, anastomotic recurrence, and recurrent colon carcinoma. We also searched for systematic review in the same topic. In addition, we used our personal referrence archive. Anastomotic recurrences of colon are postulated to arise due to inadequate margins, tumor implantation by exfoliated cells, altered biological properties of bowel anastomosis, and missed synchronous lesions. Some tumors are unique with repeated recurrence after repeated resection. Duration after primary surgery plays a major role in differentiating recurrent and second primary lesions. Repeated recurrences after repeated resections have to be considered a manifestation of systemic disease or metastatic disease due to the virulence of the disease. A detailed analysis and study of patients with colonic anastomotic lesion are required to differentiate it between a recurrent, a second primary lesion, and a metastatic disease (local manifestation of a systemic disease). The nomenclature is significant to study the survival of these patients, as a second primary lesion will have different survival compared to that of recurrent lesions. 相似文献
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When immunomodulation is used on an unselected population with recurrent miscarriage (RM), there is no improvement in the live birth rate. However, when the population is selected for a poor prognosis, or immune phenomena, immunotherapy has been shown to be effective. This review discusses four immunomodulatory agents, namely, paternal leukocyte immunization, intravenous immunoglobulin (IVIg), intralipid, and filgrastim. The presence of embryonic aneuploidy may confound the results of treatment, therefore creating an impression of futility when treatment may be highly effective in saving pregnancies that can be saved. Additionally, in an unselected population with RM, there is a relatively good prognosis of 60–80% for a subsequent live birth depending on whether the definition of ≥2 or ≥3 miscarriages is used. Hence, spontaneous prognosis must be taken into account, which has not been the case in previous trials.This review discusses the possible immune-mediated mechanisms of pregnancy loss and the means whereby immunotherapy may modulate these mechanisms. 相似文献
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Uptake of Adriamycin in tumour and surrounding brain tissue in patients with malignant gliomas 总被引:1,自引:0,他引:1
H. von Holst E. Knochenhauer H. Blomgren V. P. Collins L. Ehn M. Lindquist G. Norén C. Peterson 《Acta neurochirurgica》1990,104(1-2):13-16
Summary Eight patients with malignant gliomas verified on CT scan, received an intravenous injection of 50 mg of Adriamycin R, 24 hours prior to surgical removal of the tumour. Peroperatively, both tumour and surrounding tissue specimens were obtained for determination of the tissue concentrations of Adriamycin and its reduced metabolite Adriamycinol. It was found that Adriamycin could be detected in tumour tissue from all patients. The concentration varied between 0,9 and 4,6 nmol/g tissue. In contrast, Adriamycin could only be detected in surrounding brain tissue from one patient.In anin vitro study a human malignant glioma cell line (U-251 MG) was exposed to various concentrations of Adriamycin for 24 hours. It was found that an intracellular drug concentration above 30 nmol/g cells caused a concentration dependent inhibition of cell growth. Thus, it is likely that the poor effect of Adriamycin on patients with malignant gliomas is due to an ineffective drug accumulation in the tumour tissue. 相似文献
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Heubner回返动脉显微外科解剖及其临床应用 总被引:2,自引:0,他引:2
目的 :为前交通动脉复合体部位显微手术避免损伤Heubner回返动脉提供相关的应用解剖学资料。方法 :对经双侧椎动脉 (VA)、颈内动脉 (ICA)乳胶灌注的尸头标本 2 2例 ,按翼点入路方向 ,在手术显微镜下解剖观测 2 0例Heubner回返动脉的起点、管径、行径及其毗邻关系。 2例模拟手术操作。结果 :(1)本组观测到 4 3支回返动脉 ,其中 39支Heubher回返动脉 ;4支副Heubner回返动脉。 (2 )Heubner回返动脉 4 6 .5 % (2 0 / 4 3)起于A2 段 ,2 5 .6 % (11/ 4 3)起于A1段 ,2 7.9% (12 /4 3)起于前交通动脉 (ACOA)水平的大脑前动脉 (ACA)。 (3)Heubner回返动脉起点管径 :左侧 0 .81± 0 .2 1mm(0 .35~ 1.17mm) ;右侧 0 .84± 0 .2 6mm(0 .37~ 1.2 1mm)。 (4 )回返动脉发出后 ,与ACA反方向成锐角 ,沿A1上壁、外侧及后内侧 ,越过ICA两分叉 ,经大脑中动脉 (MCA)始段前面穿通入脑 ,少数回返动脉行走于前穿质 (APS)的后部。A1近端 3~ 5mm或中 1/ 3段穿通支少。结论 :在前交通动脉复合体部位手术时 ,A1近端 3~ 5mm或中 1/ 3段夹闭 ,并解剖寻找、剥离Heubner回返动脉 ,可避免损伤Heubner回返动脉及其它穿通支 ,最大限度减少术后并发症 相似文献
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目的研究创伤性复发性腓骨肌腱脱位的手术方法. 方法回顾分析1986年1月~2003年12月手术治疗的21例创伤性复发性腓骨肌腱脱位的病例,所有病例均应用Watson Jones手术. 结果 15例得到随访,随访时间1~15年,平均4.9年.1例因外伤再次脱位,其余14例未再出现脱位,均恢复正常运动或训练,比赛. 结论 Watson Jones手术治疗复发性脱位操作简单,损伤小,效果满意. 相似文献
10.
D. McCormick 《Neuropathology and applied neurobiology》1993,19(2):146-151
There is evidence from investigations of non-CNS neoplasms that secreted proteolytic enzymes may facilitate tumour invasion by partially degrading extracellular matrix (ECM). Among the enzymes which may be involved are members of the cysteine proteinase superfamily and especially cathepsin B (CB). In the present investigation we have studied CB in human gliomas in vitro , concentrating particularly on CB secretion, as extracellular enzyme is of prime importance in this context. We have found that CB is secreted by gliomas in vitro as a latent zymogen, requiring activation. This has been confirmed by gel chromatography which indicated that CB is secreted as a 42 kDa proenzyme which may be proteolytically processed to an enzymatically active 29 kDa molecule. The inactive, high molecular weight, latent CB is stable at extracellular pH in contrast to the activated low molecular weight form which rapidly loses activity at this pH. We have also measured secretion of cysteine proteinase inhibitors (CPI), as their presence would have a direct influence on the effective activity of CB, and found that all of the gliomas secreted significant amounts of a CPI as assessed by papain inhibition. Our experiments suggest that a number of factors are involved in the regulation of extracellular glioma-derived CB activity. These include: rate of secretion of pro-CB, rate of CB activation, destabilization of CB at neutral pH and the presence of cysteine proteinase inhibitors. 相似文献