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1.
Arq. ciências saúde UNIPAR ; 26(3): 315-327, set-dez. 2022.
Article in Portuguese | LILACS | ID: biblio-1399066

ABSTRACT

O objetivo deste estudo foi comparar os desfechos clínicos dos pacientes em suporte ventilatório invasivo por período curto e prolongado e correlacionar funcionalidade e tempo de ventilação mecânica (VM). Estudo documental retrospectivo, realizado na UTI neurocirúrgica de um hospital escola. Dos prontuários clínicos foram coletados: idade, sexo, hipótese diagnóstica de internação, tempo de internação e de VM em dias, o desfecho sucesso ou falha da extubação e o nível de funcionalidade. Os prontuários foram divididos em grupo um (GI): pacientes em VM por até três dias e grupo dois (GII): pacientes em VM por mais de três dias. Foram analisados 210 prontuários, 73% dos pacientes permaneceram menos de três dias em VM. A idade média de GI foi 51,8±15,5 anos e GII 48,7±16,3 anos (p=0,20), prevalência do sexo masculino em GI (59%) e GII (68%). O acidente vascular cerebral foi o diagnóstico mais prevalente no GI (18%) e o tumor cerebral no GII (21%) e hipertensão arterial, a comorbidade mais prevalente em GI (28%) e GII (25%). O GII permaneceu maior tempo (p<0,0001) em VM e internação na UTI que o GI e percentual de sucesso no desmame/extubação menor (p=0,01) que o GI. Não houve correlação significativa entre funcionalidade e tempo de VM em GI e GII (p>0,05). Os pacientes em suporte ventilatório invasivo por período prolongado evoluíram com maior permanência em VM, maior tempo de internação na UTI e menor taxa de sucesso no desmame/extubação. O tempo de permanência em suporte ventilatório invasivo não interferiu na funcionalidade desses pacientes.


The aim of this study was to compare the clinical outcomes of patients on short- and long-term invasive ventilatory support and to correlate functionality and duration of mechanical ventilation (MV). Retrospective documental study, carried out in the neurosurgical ICU of a teaching hospital. The following were collected from the clinical records: age, gender, diagnostic hypothesis of hospitalization, length of hospital stay and MV in days, the outcome of success or failure of extubation and the level of functionality. The medical records were divided into group one (GI): patients on MV for up to three days and group two (GII): patients on MV for more than three days. A total of 210 medical records were analyzed, 73% of the patients remained on MV for less than three days. The mean age of GI was 51.8±15.5 years and GII 48.7±16.3 years (p=0.20), male prevalence in GI (59%) and GII (68%). Stroke was the most prevalent diagnosis in GI (18%) and brain tumor in GII (21%) and hypertension was the most prevalent comorbidity in GI (28%) and GII (25%). GII remained longer (p<0.0001) in MV and ICU admission than GI and the percentage of success in weaning/extubation was lower (p=0.01) than GI. There was no significant correlation between functionality and time on MV in GI and GII (p>0.05). Patients on invasive ventilatory support for a long period evolved with longer MV stays, longer ICU stays and lower weaning/extubation success rates. The length of stay on invasive ventilatory support did not interfere with the functionality of these patients.


El objetivo de este estudio fue comparar los resultados clínicos de los pacientes con soporte ventilatorio invasivo a corto y largo plazo y correlacionar la funcionalidad y el tiempo de ventilación mecánica (VM). Se trata de un estudio documental retrospectivo, realizado en la UCI neuroquirúrgica de un hospital universitario. Se recogieron los siguientes datos de las historias clínicas: edad, sexo, hipótesis diagnóstica, duración de la estancia y tiempo de VM en días, el resultado éxito o fracaso de la extubación y el nivel de funcionalidad. Las historias clínicas se dividieron en el grupo uno (GI): pacientes bajo VM hasta tres días y el grupo dos (GII): pacientes bajo VM durante más de tres días. Se analizaron 210 historias clínicas, el 73% de los pacientes permanecieron menos de tres días con VM. La edad media de GI fue de 51,8±15,5 años y la de GII de 48,7±16,3 años (p=0,20), con prevalencia masculina en GI (59%) y GII (68%). El ictus fue el diagnóstico más prevalente en GI (18%) y el tumor cerebral en GII (21%) y la hipertensión, la comorbilidad más prevalente en GI (28%) y GII (25%). El GII permaneció más tiempo (p<0,0001) en la VM y la estancia en la UCI que el GI y el porcentaje de éxito en el destete/extubación fue menor (p=0,01) que el GI. No hubo correlación significativa entre la funcionalidad y el tiempo de VM en GI y GII (p>0,05). Los pacientes con soporte ventilatorio invasivo a largo plazo evolucionaron con una mayor estancia en la VM, una mayor estancia en la UCI y una menor tasa de éxito de destete/extubación. La duración de la estancia con soporte ventilatorio invasivo no interfirió en la funcionalidad de estos pacientes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Respiration, Artificial/instrumentation , Residence Time , Interactive Ventilatory Support/nursing , Interactive Ventilatory Support/instrumentation , Intensive Care Units , Length of Stay , Brain Neoplasms/complications , Ventilator Weaning/instrumentation , Comorbidity , Medical Records/statistics & numerical data , Physical Therapy Modalities/nursing , Stroke/complications , Airway Extubation/instrumentation , Hospitalization , Hospitals, Teaching , Hypertension/complications
2.
Rev. otorrinolaringol. cir. cabeza cuello ; 82(3): 328-332, sept. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1409941

ABSTRACT

Resumen El plasmocitoma extramedular solitario (PES) es una neooplasia maligna infrecuente caracterizada por una proliferación aislada de células plasmáticas monoclonales en tejido extramedular. La localización más frecuente es en cabeza y cuello con predominio en el territorio rinosinusal, sin embargo, estas lesiones malignas representan menos del 1% de los tumores de esta región anatómica. El diagnostico requiere una alta sospecha clínica, análisis histopatológico acucioso, estudios serológicos y exámenes radiológicos sistémicos de acuerdo a los criterios diagnósticos establecidos en la literatura internacional. Se analiza el caso de un paciente masculino con un PES que se presentó como un tumor de fosa nasal derecha y obstrucción nasal de meses de evolución con hallazgos clínicos e imagenológicos inespecíficos. El diagnóstico definitivo se realizó mediante biopsia endoscópica nasal y estudio histopatológico. El tratamiento fue abordado de manera multidisciplinaria entre otorrinolaringología, hematología y radiooncología. De acuerdo a las guías internacionales, se decidió realizar radioterapia localizada con buen resultado clínico precoz. El PES requiere un abordaje multidisciplinario para lograr un diagnóstico y tratamiento oportuno, siendo imprescindible la exclusión del mieloma múltiple debido a las diferencias terapéuticas y en pronóstico clínico. El tratamiento puede realizarse con radioterapia y/o cirugía, siendo la radioterapia el pilar de tratamiento.


Abstract Solitary extramedullary plasmacytoma (SEP) is a rare malignant neoplasm characterized by isolated proliferation of monoclonal plasma cells in extramedullary tissue. The most frequent location is in the head and neck with a predominance in the rhinosinusal territory; however, these malignant lesions represent less than 1% of the tumors in this anatomical region. The diagnosis requires a high clinical suspicion, careful histopathological analysis, serological studies and systemic radiological examinations according to the diagnostic criteria established in the international literature. We analyze the case of a male patient with SEP that presented as a tumor of the right nostril and nasal obstruction of months of evolution with nonspecific clinical and imaging findings. The definitive diagnosis was made by nasal endoscopic biopsy and histopathological study. The treatment was approached by multidisciplinary teamwork. According to international guidelines, it was decided to perform localized radiotherapy with good early clinical results. SEP requires a multidisciplinary approach to achieve a timely diagnosis and treatment, being essential exclusion of multiple myeloma due to the therapeutic differences and prognosis. Treatment can be done with radiation therapy and/or surgery; radiation therapy is the mainstay of treatment.


Subject(s)
Humans , Male , Middle Aged , Plasmacytoma/surgery , Plasmacytoma/diagnosis , Brain Neoplasms/surgery , Brain Neoplasms/diagnosis , Paranasal Sinus Neoplasms/surgery , Paranasal Sinus Neoplasms/diagnosis , Nose Neoplasms/surgery , Nose Neoplasms/diagnosis , Plasmacytoma/radiotherapy , Biopsy , Brain Neoplasms/radiotherapy , Paranasal Sinus Neoplasms/radiotherapy , Tomography, X-Ray Computed , Nose Neoplasms/radiotherapy , Treatment Outcome
3.
Oncología (Ecuador) ; 32(2): 224-246, 2 de Agosto del 2022.
Article in Spanish | LILACS | ID: biblio-1391912

ABSTRACT

Introducción: Las metástasis cerebrales (MC) representan una problemática importante de la salud pública, en promedio el 30% de los pacientes oncológicos desarrollarán MC siendo importante causa de morbilidad, ansiedad y mortalidad. El tratamiento con radioterapia, cirugía y sistémico son los pilares para el tratamiento y han tenido una evolución importante en la última década. Propósito de la revisión: Se proporciona información actualizada en relación a epidemiología, diagnóstico, pronóstico y tratamiento de metástasis cerebrales desde un enfoque multidisciplinariopara lograr individualizar su abordaje con el objetivo de proporcionar control oncológico y calidad de vida. También se discuten el acceso a nuevas terapias sistémicas, técnicas quirúrgicas y disponibilidad de tecnología para ofrecer técnicas avanzadas de radioterapia.Men saje principal: Conocer mutaciones específicas y receptores diana de los tumores permite elegir quimio-inmunoterapia o terapias dirigidas actuales que ofrecen mejor potencial de control tanto a nivel sistémico como intracraneal. La secuenciación de los tratamientos sistémicos y locales (cirugía, radio-cirugía, radioterapia holocraneal) deben ser discutidos desde un enfoque multidisciplinario Conclusión: Es importante poder estimar el pronóstico de los pacientes con MC, esto determinarla conducta terapéutica que puede variar desde cuidados sintomáticos hasta tratamientos más agresivos como resección neuroquirúrgica o radiocirugía.


In troduction:Brain metastases (BMs) represent a significant public health problem. An average of 30% of cancer patients develop BM, which is a significant cause of morbidity, anxiety, and mortality. Radio-therapy, surgery, and systemic treatment are the mainstays of treatment and have evolved significantly in the last decade.Pu rpose of the review: Updated information on the epidemiology, diagnosis, prognosis, and treatment of brain metastases from a multidisciplinary approach is provided to enable an individualized approach aimed at cancer control and quality of life. Access to new systemic therapies, surgical techniques, and availability of technology for advanced radiotherapy techniques are also discussed.Mai n message: Knowledge of specific mutations and targets of tumor receptors allows the selection of chemoimmunotherapy or current targeted therapies that offer better control potential at the systemic and intracranial levels. The sequence of systemic and local treatments (surgery, radiosurgery, whole brain radiation therapy) should be discussed as part of a multidisciplinary approach.C o nclusion: It is essential to estimate the prognosis of patients with BM, given that this will determine the therapeuticbehavior that can range from symptomatic care to more aggressive treatments such as neurosurgical resection or radiosurgery


Subject(s)
General Surgery , Brain Neoplasms , Immunotherapy , Prognosis , Radiotherapy , Therapeutics , Radiosurgery
4.
Arq. bras. neurocir ; 41(1): 35-42, 07/03/2022.
Article in English | LILACS | ID: biblio-1362074

ABSTRACT

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.


Subject(s)
Brain Neoplasms/surgery , Surgery, Computer-Assisted/methods , Aminolevulinic Acid , Microscopy, Fluorescence/methods , Postoperative Care , Brain Neoplasms/pathology , Preoperative Care , Retrospective Studies , Neuronavigation/methods , Cerebrum/surgery , Cerebrum/pathology , Intraoperative Care , Latin America/epidemiology
5.
Article in Chinese | WPRIM | ID: wpr-936138

ABSTRACT

OBJECTIVE@#To summarize and analyze the clinical characteristics of children with basal ganglia germinoma and to improve the level of early clinical diagnosis.@*METHODS@#The clinical data of children diagnosed with basal ganglia germinoma admitted to the Pediatric Surgery Ward of Peking University First Hospital from January 2013 to December 2020 were retrospectively analyzed, and descriptive statistics were used to analyze the clinical characteristics of children with basal ganglia germinoma.@*RESULTS@#A total of 30 patients were included in the study, 28 were male, 2 were female, the mean age at onset was (9.7±2.2) years, the median disease duration was 7 months, 27 had unilateral disease, and 3 had bilateral disease. The clinical manifestations were decreased limb muscle strength, cognitive function disorders, polydipsia, precocious puberty, intracranial hypertension, dysphonia and swallowing dysfunction. The serum and cerebrospinal fluid tumor marker alpha-fetoprotein (AFP) were normal in the 30 patients, and the serum and cerebrospinal fluid tumor marker β-human chorionic gonadotropin (β-HCG) were normal in 8 patients.The serum β-HCG was normal in 11 patients but the cerebrospinal fluid β-HCG was slightly elevated, and the serum and cerebrospinal fluid β-HCG were slightly elevated in 11 patients. A total of 33 lesions with irregular shapes were found by imaging examination, including 15 (45.5%) patchy lesions, 10 (30.3%) patchy lesions, and 8 (24.2%) round-like high-density lesions. Tumors showed obvious high-density shadows on computed tomography (CT) scan. Magnetic resonance imaging (MRI) scan of the tumors showed low or isointensity on T1WI and isointensity on T2WI, accompanied by mild peritumoral edema, hemispheric atrophy, cerebral peduncle atrophy, calcification, cystic degeneration, ventricular dilatation and wallerian degeneration. On contrast-enhanced scans, the tumor showed no enhancement or heterogeneous enhancement.@*CONCLUSION@#The main age of onset of germ cell tumors in the basal ganglia in children is about 10 years old, and males are absolutely dominant. The clinical features and imaging manifestations have certain characteristics. With both combined, the early diagnosis of germ cell tumors in the basal ganglia can be improved.


Subject(s)
Atrophy/pathology , Basal Ganglia/pathology , Biomarkers, Tumor , Brain Neoplasms/diagnostic imaging , Child , Chorionic Gonadotropin, beta Subunit, Human , Female , Germinoma/pathology , Humans , Magnetic Resonance Imaging , Male , Neoplasms, Germ Cell and Embryonal , Retrospective Studies
6.
Chinese Journal of Lung Cancer ; (12): 193-200, 2022.
Article in Chinese | WPRIM | ID: wpr-928797

ABSTRACT

Brain metastasis of non-small cell lung cancer (NSCLC) is a common treatment failure mode, and the median survival time of NSCLC patients with brain metastasis is only 1 mon-2 mon. Prophylactic cranial irradiation (PCI) can delay the occurrence of brain metastasis, but the survival benefits of NSCLC patients are still controversial. It is particularly important to identify the patients who are most likely to benefit from PCI. This article reviews the high risk factors of brain metastasis in NSCLC.
.


Subject(s)
Brain Neoplasms/secondary , Carcinoma, Non-Small-Cell Lung/pathology , Cranial Irradiation , Humans , Lung Neoplasms/pathology , Risk Factors
7.
Chinese Journal of Pathology ; (12): 407-412, 2022.
Article in Chinese | WPRIM | ID: wpr-935554

ABSTRACT

Objective: To investigate immunohistochemical patterns of CXorf67 and H3K27me3 proteins in central nervous system germ cell tumors (GCTs) and to assess their values in both diagnosis and differential diagnosis. Methods: A total of 370 cases of central nervous system GCTs were collected from 2013 to 2020 at Huashan Hospital of Fudan University, Shanghai, China. The expression of CXorf67, H3K27me3 and commonly-used GCT markers including OCT4, PLAP, CD117, D2-40, and CD30 by immunohistochemistry (EnVision method) was examined in different subtypes of central nervous system GCTs. The sensitivity and specificity of each marker were compared by contingency table and area under receiver operating characteristic (ROC) curve. Results: Of the 370 cases there were 282 males and 88 females with a mean age of 19 years and a median age of 17 years (range, 2-57 years). Among the GCTs with germinoma, the proportions of male patients and the patients with GCT located in sellar region were both higher than those of GCTs without germinoma (P<0.05), respectively. CXorf67 was present in the nuclei of germinoma and normal germ cells, but not in other subtypes of GCT. H3K27me3 was negative in germinoma, but positive in the nuclei of surrounding normal cells and GCTs other than germinoma. In the 283 GCTs with germinoma components, the expression rate of CXorf67 was 90.5% (256/283), but no cases were positive for H3K27me3. There was also an inverse correlation between them (r2=-0.831, P<0.01). The expression rates of PLAP, OCT4, CD117 and D2-40 were 81.2% (231/283), 89.4% (253/283), 73.9% (209/283) and 88.3% (250/283), respectively. In 63 mixed GCTs with germinoma components, the expression rate of CXorf67 was 84.1% (53/63), while all cases were negative for H3K27me3. The expression rates of PLAP, OCT4, CD117 and D2-40 were 79.4% (50/63), 79.4% (50/63), 66.7% (42/63) and 87.3% (55/63), respectively. The 6 markers with largest area under ROC curve in ranking order were H3K27me3, CXorf67, D2-40, OCT4, PLAP and CD117 (P<0.05). Conclusions: CXorf67 and H3K27me3 have high sensitivity and high specificity in diagnosing germinoma. There is a significant inverse correlation between them. Therefore, they can both be used as new specific immunohistochemical markers for the diagnosis of GCTs.


Subject(s)
Adolescent , Adult , Brain Neoplasms/pathology , Central Nervous System/pathology , Central Nervous System Neoplasms/metabolism , Child , Child, Preschool , China , Female , Germinoma/pathology , Histones , Humans , Male , Middle Aged , Neoplasms, Germ Cell and Embryonal/diagnosis , Oncogene Proteins , Transcription Factors/metabolism , Young Adult
8.
Chinese Journal of Pathology ; (12): 319-325, 2022.
Article in Chinese | WPRIM | ID: wpr-935533

ABSTRACT

Objective: To investigate the clinicopathological features of pediatric diffuse midline glioma with H3K27 alteration and to analyze their relationship with prognosis. Methods: Forty-one cases of childhood diffuse midline glioma with H3K27 alteration were collected at Children's Hospital of Fudan University (39 cases) and Xi'an Children's Hospital (2 cases), from July 2016 to July 2020. The clinical manifestations, imaging data, histopathology, immunohistochemical phenotype and molecular genetics features, tumor size, site and histological grading were evaluated. Results: Among the 41 cases, 21 were males and 20 females, the age of onset was 3-14 years, the average and median age was 7.6 years and 7.0 years, respectively. The tumor sites were brain stem (n=36) and other locations (n=5). The clinical manifestations were dizziness, gait disturbance, and limb weakness, etc. The MRI features were variable. The histology varied from low-grade to high-grade glioma with neuron differentiation. Immunohistochemistry showed that the tumor cells expressed H3K27M, GFAP, and Olig2. Genetic study showed that 76% (16/21) of tumors had H3F3A gene mutation, mostly accompanied by TP53 (62%, 13/21) missense mutation; five tumors (24%, 5/21) had HIST1H3B gene mutation, accompanied by missense mutations in ACVR1 and PI3K pathway-related gene PIK3CA (4/5) and PIK3R1 (1/5) mutations. The prognosis was dismal with only one alive and others died. The average and median overall survival time was 7 months and 4 months, respectively. Cox multivariate regression analysis showed that age, tumor location, radiologically maximum tumor diameter, histologic grading, and surgical methods were not significantly associated with overall survival rate (P>0.05). Conclusions: Pediatric diffuse midline gliomas with H3K27 alteration have unique clinicopathological and genetic characteristics. The prognosis is poor. The tumor location and histopathologic grading are not related to prognosis. New specific drugs and comprehensive treatment are needed to improve the prognosis.


Subject(s)
Adolescent , Brain Neoplasms/genetics , Child , Child, Preschool , Female , Glioma/pathology , Histones/genetics , Humans , Male , Phosphatidylinositol 3-Kinases/genetics , Prognosis
9.
Chinese Journal of Oncology ; (12): 416-424, 2022.
Article in Chinese | WPRIM | ID: wpr-935230

ABSTRACT

Objective: To describe the actual efficacy of programmed death-1 (PD-1)/ programmed-death ligand 1 (PD-L1) inhibitors in patients with metastatic non-small cell lung cancer (NSCLC) and explore potential prognostic predictive biomarkers. Methods: Patients with metastatic NSCLC who were treated with PD-1/PD-L1 inhibitors at Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to December 2019, either as monotherapy or in combination with other agents, were consecutively enrolled into this study. We retrospectively collected the data of demographics, clinical information and pathologic assessment to evaluate the therapeutic efficacy and conduct the survival analysis. Major endpoint of our study is progression-free survival (PFS). Secondary endpoints include objective response rate (ORR), disease control rate (DCR) and overall survival (OS). Results: The ORR of 174 patients who underwent PD-1/PD-L1 inhibitor was 28.7%, and the DCR was 79.3%. Immune-related adverse events (irAEs) occurred in 23 patients (13.2%). Brain metastasis, line of treatment, and treatment patterns were associated with the ORR of metastatic NSCLC patients who underwent immunotherapy (P<0.05). After a median follow-up duration of 18.8 months, the median PFS was 10.5 months (ranged from 1.5 to 40.8 months) while the median OS was not reached. The 2-year survival rate was estimated to be 63.0%. The pathologic type was related with the PFS of metastatic NSCLC patients who underwent immunotherapy (P=0.028). Sex, age, brain metastasis and autoimmune diseases were associated with OS (P<0.05). Analysis of the receptor characteristic curve (ROC) of neutrophil/lymphocyte ratio (NLR) predicting ORR of immunotherapy in metastatic NSCLC showed that the areas under the curve of NLR before immunotherapy (NLR(C0)), NLR after one cycle of immunotherapy (NLR(C1)) and ΔNLR were 0.600, 0.706 and 0.628, respectively. Multivariate logistic regression analysis showed that NLR(C1) was an independent factor of the ORR of metastatic NSCLC patients who underwent immunotherapy (OR=0.161, 95% CI: 0.062-0.422), and the efficacy of combination therapy was better than that of single agent (OR=0.395, 95% CI: 0.174-0.896). The immunotherapy efficacy in patients without brain metastasis was better than those with metastasis (OR=0.291, 95% CI: 0.095-0.887). Multivariate Cox regression analysis showed that NLR(C1) was an independent influencing factor of PFS of metastatic NSCLC patients after immunotherapy (HR=0.480, 95% CI: 0.303-0.759). Sex (HR=0.399, 95% CI: 0.161-0.991, P=0.048), age (HR=0.356, 95% CI: 0.170-0.745, P=0.006) were independent influencing factors of OS of metastatic NSCLC patients after immunotherapy. Conclusions: PD-1/PD-L1 inhibitors are proved to be efficacious and have tolerable toxicities for patients with metastatic NSCLC. Patients at advanced age could still benefit from immunotherapy. Brain metastasis is related to compromised response. Earlier application of immunotherapy in combination with other modalities enhances the efficacy without elevating risk of irAEs. NLR(C1) is an early predictor of clinical outcome. The OS of patients younger than 75 years may be improved when treated with immunotherapy.


Subject(s)
B7-H1 Antigen/metabolism , Brain Neoplasms/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Humans , Immune Checkpoint Inhibitors , Lung Neoplasms/pathology , Prognosis , Programmed Cell Death 1 Receptor , Retrospective Studies
10.
Article in English | WPRIM | ID: wpr-928481

ABSTRACT

Wide-awake local anesthesia has many advantages. We describe a new method to use wide-awake local anesthesia with more flexibility. A 32-year-old man with a severe right-hand contracture after an iatrogenic tourniquet accident during an anterolateral thigh flap for a partial hand amputation underwent contracture release using external fixation after proximal row carpectomy and subsequent tenolysis. We performed most of the tenolysis procedure under general anesthesia and the final stage with an intraoperative assessment of active finger movement and dissection under local anesthesia. He regained his grip strength 2.5 years post-injury. General anesthesia is useful to treat a surgical site with extensive hard scars, whereas local anesthesia is useful for adjusting tension in an awake patient. The indication for wide-awake surgery is yet to be established; our method of combining general and local anesthesia in the tenolysis procedure illustrates the possibilities in expanding this method.


Subject(s)
Adult , Anesthesia, General , Anesthesia, Local , Brain Neoplasms , Contracture/surgery , Dissection , External Fixators , Fracture Fixation , Humans , Male , Wakefulness
11.
Article in Chinese | WPRIM | ID: wpr-927876

ABSTRACT

Objective To investigate the relationship between the expression of glutathione peroxidase(GPX)genes and the clinical prognosis in glioma patients,and to construct and evaluate the model for predicting the prognosis of glioma. Methods The clinical information and GPX expression of 663 patients,including 153 patients of glioblastoma(GBM)and 510 patients of low-grade glioma(LGG),were obtained from The Cancer Genome Atlas(TCGA)database.The relationship between GPX expression and patient survival was analyzed.The key GPX affecting the prognosis of glioma was screened out by single- and multi-factor Cox's proportional-hazards regression models and validated by least absolute shrinkage and selection operator(Lasso)regression.Finally,we constructed the model for predicting the prognosis of glioma with the screening results and then used concordance index and calibration curve respectively to evaluate the discrimination and calibration of model. Results Compared with those in the control group,the expression levels of GPX1,GPX3,GPX4,GPX7,and GPX8 were up-regulated in glioma patients(all P<0.001).Moreover,the expression levels of other GPX except GPX3 were higher in GBM patients than in LGG patients(all P<0.001).The Kaplan-Meier curves showed that the progression-free survival of GBM with high expression of GPX1(P=0.013)and GPX4(P=0.040),as well as the overall survival,disease-specific survival,and progression-free survival of LGG with high expression of GPX1,GPX7,and GPX8,was shortened(all P<0.001).GPX7 and GPX8 were screened out as the key factors affecting the prognosis of LGG.The results were further used to construct a nomogram model,which suggested GPX7 was the most important variable.The concordance index of the model was 0.843(95%CI=0.809-0.853),and the calibration curve showed that the predicted and actual results had good consistency. Conclusion GPX7 is an independent risk factor affecting the prognosis of LGG,and the nomogram model constructed with it can be used to predict the survival rate of LGG.


Subject(s)
Brain Neoplasms , Glioblastoma , Glioma/diagnosis , Glutathione Peroxidase/metabolism , Humans , Peroxidases , Prognosis , Proportional Hazards Models
12.
Article in Chinese | WPRIM | ID: wpr-927842

ABSTRACT

Objective To analyze the disease spectrum and clinicopathological characteristics of central nervous system(CNS)diseases diagnosed based on pathological findings in Tibet. Methods We collected the data of all the cases with CNS lesions in Tibet Autonomous Region People's Hospital from January 2013 to December 2020.The clinicopathological features were analyzed via light microscopy,immunohistochemical staining,and special staining. Results A total of 383 CNS cases confirmed by pathological diagnosis were enrolled in this study,with a male-to-female ratio of 188∶195 and an average age of(40.03±17.39)years(0-74 years).Among them,127(33.2%)cases had non-neoplastic diseases,with a male-to-female ratio of 82∶45 and an average age of(31.99±19.29)years;256(66.8%)cases had neoplastic diseases,with a male-to-female ratio of 106∶150 and an average age of(44.01±14.87)years.The main non-neoplastic diseases were nervous system infectious diseases,cerebral vascular diseases,meningocele,cerebral cyst,and brain trauma.Among the infectious diseases,brain abscess,granulomatous inflammation,cysticercosis,and hydatidosis were common.The main neoplastic diseases included meningioma,pituitary adenoma,neuroepithelial tumor,schwannoma,metastatic tumor,and hemangioblastoma.The meningioma cases consisted of 95.4%(103/108)cases of grade Ⅰ,3.7%(4/108)cases of grade Ⅱ,and only 1(1/108,0.9%)case of grade Ⅲ.Among the neuroepithelial tumor cases,the top three were glioblastoma,grade Ⅲ diffuse glioma,and ependymoma. Conclusions There are diverse CNS diseases confirmed by pathological diagnosis in Tibet,among which non-neoplastic diseases account for 1/3 of all the cases.Infectious and vascular diseases are the most common non-neoplastic diseases in Tibet,and tuberculosis and parasitic infections are relatively common.The types and proportion of brain tumors in Tibet are different from those in other regions of China,and meningioma is the most common in Tibet,with higher proportion than neuroepithelial tumor.


Subject(s)
Adolescent , Adult , Aged , Brain Neoplasms/diagnosis , Central Nervous System Diseases/pathology , Child , Child, Preschool , Ependymoma , Female , Humans , Infant , Infant, Newborn , Male , Meningeal Neoplasms , Middle Aged , Retrospective Studies , Tibet/epidemiology , Young Adult
13.
Article in English | WPRIM | ID: wpr-927681

ABSTRACT

Objective@#To investigate the function of primary cilia in regulating the cellular response to temozolomide (TMZ) and ionizing radiation (IR) in glioblastoma (GBM).@*Methods@#GBM cells were treated with TMZ or X-ray/carbon ion. The primary cilia were examined by immunostaining with Arl13b and γ-tubulin, and the cellular resistance ability was measured by cell viability assay or survival fraction assay. Combining with cilia ablation by IFT88 depletion or chloral hydrate and induction by lithium chloride, the autophagy was measured by acridine orange staining assay. The DNA damage repair ability was estimated by the kinetic curve of γH2AX foci, and the DNA-dependent protein kinase (DNA-PK) activation was detected by immunostaining assay.@*Results@#Primary cilia were frequently preserved in GBM, and the induction of ciliogenesis decreased cell proliferation. TMZ and IR promoted ciliogenesis in dose- and time-dependent manners, and the suppression of ciliogenesis significantly enhanced the cellular sensitivity to TMZ and IR. The inhibition of ciliogenesis elevated the lethal effects of TMZ and IR via the impairment of autophagy and DNA damage repair. The interference of ciliogenesis reduced DNA-PK activation, and the knockdown of DNA-PK led to cilium formation and elongation.@*Conclusion@#Primary cilia play a vital role in regulating the cellular sensitivity to TMZ and IR in GBM cells through mediating autophagy and DNA damage repair.


Subject(s)
Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/metabolism , Cell Line, Tumor , DNA/therapeutic use , Glioblastoma/metabolism , Humans , Radiation, Ionizing , Temozolomide/therapeutic use
15.
Arq. bras. neurocir ; 40(4): 368-373, 26/11/2021.
Article in English | LILACS | ID: biblio-1362105

ABSTRACT

Glioblastoma multiforme (GBM) is the most frequent and most aggressive primary brain tumor in adults,mainly located in the cerebral hemispheres. In the literature, few cases of primary GBM have been reported to have radiographic and intraoperative features of extra-axial lesions, leading to a diagnostic dilemma. Despite the advances in imaging modalities, the diagnosis of GBM can be challenging, and it is mainly based on the histopathologic confirmation of the excised tumor. We describe the case of a 76- year-old previously healthy female patient who presented to our hospital due to speech disturbances and cognitive impairment. The diagnosis of the tumor type on magnetic resonance imaging (MRI) was difficult, as the findings were suggestive of a malignant meningioma due to the heterogeneous enhancement of a dural-based mass with a dural tail sign. Moreover, the intraoperative findings revealed an extra-axial mass attached to the dura. A histological examination confirmed the diagnosis of glioblastoma with arachnoid infiltration. The patient underwent adjuvant radiotherapy and concomitant temozolomide treatment, she had clinical improvement postoperatively, and was stable during the six months of follow-up. Glioblastoma should be considered in the differential diagnosis of primary extra-axial mass with atypical and malignant features, especially in elderly patients.


Subject(s)
Humans , Female , Aged , Brain Neoplasms/therapy , Glioblastoma/radiotherapy , Glioblastoma/therapy , Arachnoid , Brain Neoplasms/diagnostic imaging , Glioblastoma/pathology , Glioblastoma/diagnostic imaging , Diagnosis, Differential , Temozolomide/therapeutic use
16.
An. bras. dermatol ; 96(6): 765-767, Nov.-Dec. 2021. graf
Article in English | LILACS | ID: biblio-1355638

ABSTRACT

Abstract Glomus tumors are rare benign neoplasms arising from the neuromyoarterial structure called glomus body. They present as angiomatous papules, soft and painful, especially to cold and pressure. In general, they are solitary and affect the extremities, located mainly the subungual bed. Extradigital lesions are rare and can constitute a diagnostic challenge. This is the report of a patient with an extradigital lesion on the left arm, and its dermoscopic aspects, including angiomatous lagoons circumscribed by a pale halo, a structure not previously described in the two reports of extradigital glomus tumor with dermoscopic features, found in the literature.


Subject(s)
Humans , Brain Neoplasms , Neoplasms/diagnostic imaging , Pain , Extremities
17.
MedUNAB ; 24(3): 359-364, 202112.
Article in Spanish | LILACS | ID: biblio-1353578

ABSTRACT

Introducción. El xantoastrocitoma pleomórfico es una lesión glial de bajo grado de malignidad (grado II), puede presentar transformación maligna progresando a xantoastrocitoma pleomórfico anaplásico o glioblastoma multiforme, clasificados en grado III y IV, respectivamente, de acuerdo con la OMS. El glioblastoma epitelioide es un subtipo morfológico poco común del glioblastoma, de comportamiento agresivo, asociado a recurrencia temprana y compromiso leptomeníngeo. Presentación del caso. Se describe un reporte de caso de paciente femenina de 13 años con hallazgos de xantoastrocitoma pleomórfico anaplásico asociado a glioblastoma epitelioide, neoplasia poco frecuente que suele presentarse en la población pediátrica y en los adultos jóvenes. Discusión. El diagnóstico de glioblastoma epitelioide constituye un desafío, solo se han reportado unas pocas series pequeñas en la población adulta y pediátrica. Conclusión. Los hallazgos imagenológicos en las dos entidades son similares y comparten características histopatológicas e incluso algunos hallazgos moleculares superpuestos, lo cual dificulta su diferenciación, por lo que continúa siendo de gran controversia si se presentan conjuntamente o si el xantoastrocitoma pleomórfico anaplásico es un precursor del glioblastoma epitelioide.


Introduction. Pleomorphic xanthoastrocytoma is a glial lesion with low grade of malignancy (grade II), it can present malignant transformation progressing to anaplastic pleomorphic xanthoastrocytoma or glioblastoma multiforme, classified as grade III and IV, respectively, according to the WHO. Epithelioid glioblastoma is a rare morphological subtype of glioblastoma, with aggressive behavior, associated with early recurrence and leptomeningeal compromise. Case Presentation. Case report of a 13-year-old female patient with findings of anaplastic pleomorphic xanthoastrocytoma associated with epithelioid glioblastoma, a rare neoplasm that usually occurs in the pediatric population and in young adults. Discussion. The diagnosis of epithelioid glioblastoma is challenging, only a few small series have been reported in the adult and pediatric population. Conclusion. The imaging findings in the two entities are similar and share histopathological characteristics and even some overlapping molecular findings, which makes their differentiation difficult. For this reason, there is still a great controversy whether these entities are present continuously or whether the anaplastic pleomorphic xanthoastrocytoma is a precursor of epithelioid glioblastoma.


Introdução. O xantoastrocitoma pleomórfico é uma lesão glial de baixo grau de malignidade (grau II), pode apresentar transformação maligna progredindo para xantoastrocitoma pleomórfico anaplásico ou glioblastoma multiforme, classificados como grau III e IV, respectivamente, de acordo com a OMS. O glioblastoma epitelióide é um subtipo morfológico raro de glioblastoma, com comportamento agressivo, associado a recorrência precoce e envolvimento leptomeníngeo. Apresentação do caso. É descrito um relatório de caso de uma paciente feminina de 13 anos com achados de xantoastrocitoma pleomórfico anaplásico associado ao glioblastoma epitelióide, uma neoplasia rara que geralmente ocorre na população pediátrica e em adultos jovens. Discussão. O diagnóstico do glioblastoma epitélioide é desafiador, apenas algumas pequenas séries foram reportadas na população adulta e pediátrica. Conclusão. As descobertas imagiológicas nas duas entidades são semelhantes e compartilham características histopatológicas e, até mesmo, algumas descobertas moleculares sobrepostas, o que dificulta sua diferenciação, portanto permanece controverso se ocorrem juntas ou se o xantoastrocitoma pleomórfico anaplásico é um precursor do glioblastoma epitélioide.


Subject(s)
Brain Neoplasms , Astrocytoma , Glioblastoma , Diagnosis, Differential , Glioma
18.
Rev. chil. neuro-psiquiatr ; 59(4): 321-333, dic. 2021. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388402

ABSTRACT

Resumen Los tumores cerebrales son una causa importante de las epilepsias de difícil manejo, corresponden a un 20-30 % de los casos de cirugía de epilepsia refractaria. En este grupo de pacientes los tumores neuroepiteliales de bajo grado asociados a epilepsia (LEAT) son la principal causa, siendo los más frecuentes los tumores neuroepiteliales disembrioplásticos (DNT) y ganglioglioma (GG). En el presente artículo revisamos los cambios en la definición de epilepsia refractaria, avances en el diagnóstico por imágenes y el diagnóstico histopatológico con los nuevos marcadores moleculares, que han permitido un diagnóstico cada vez más precoz y certero. Se revisa también la cirugía resectiva que permite en estos casos una libertad de crisis cercana un 70-90% de los pacientes. Los mejores resultados en términos de control de crisis, se pueden alcanzar cuando la cirugía es precoz.


Brain tumors are an important cause of epilepsy that is difficult to manage, accounting for 20-30% of cases of refractory epilepsy surgery. In this group of patients, low-grade epilepsy-associated neuroepithelial tumors (LEAT) are the main cause and the most frequent being dysembryoplastic neuroepithelial tumors (DNT) and ganglioglioma (GG). In this article, we review the changes in the definition of refractory epilepsy, advances in diagnostic imaging, and histopathological diagnosis with new molecular markers, which have allowed for an increasingly early and accurate diagnosis. Resective surgery is also reviewed, allowing in these cases a seizure freedom close to 70-90% of patients. The best outcome in terms of seizure control can be achieved when early surgery is performed.


Subject(s)
Humans , Therapeutics , Brain Neoplasms , Epilepsy
19.
J. health med. sci. (Print) ; 7(3): 177-182, jul.-sept. 2021. ilus, tab, graf
Article in English | LILACS | ID: biblio-1381661

ABSTRACT

Radiosurgery is a high-precision technique for delivering, in most cases, a single highly conformal dose to a stereotactically localized target. It can be indicated for small intracranial injury treatment, using either multiple sources of 60Co (γ rays) or high energy photon beams produced by linear accelerators. In order to minimize the impact of inaccurate localization of the target or dose delivery, a rigorous Quality Assurance (QA) program must be enforced, which should include an independent auditing system. This work proposes a simple and reliable postal QA phantom to be used as an independent evaluation. In it two important parameters were verified such as, the dosimetric precision of the planning system, by comparing the absorbed doses measured in the target volume using different dosimeters (ionization chamber, films, thermoluminescent dosimeters and L-alanine dosimeters) all calibrated against a small volume ion chamber. The exact positioning of the target volume was localized using air spaces and small steel spheres to find the appropriate target coordinates. The head phantom and the instruction sheets were extensively tested and sent by mail to selected institutions. The overall results were very encouraging and suggest that the proposed phantom may be used as a postal system as part of an independent QA tool in radiosurgery.


La radiocirugía es una técnica de alta precisión para administrar, en la mayoría de los casos, una sola dosis altamente conformada en un objetivo localizado estereotípicamente. Puede estar indicado para el tratamiento de pequeñas lesiones intracraneales, utilizando múltiples fuentes de 60Co (rayos γ) o haces de fotones de alta energía producidos por aceleradores lineales. Con el fin de minimizar el impacto de la ubicación inexacta de la administración de la meta o de la dosis, se debe aplicar un riguroso programa de control de calidad (QA), que debe incluir un sistema de auditoría independiente. Este documento propone un fantoma postal de control de calidad simple y fiable que se utilizará como evaluación independiente. Se verificó dos parámetros importantes, como la precisión dosimétrica del sistema de planificación, comparando las dosis absorbidas medidas en el volumen objetivo mediante diferentes dosis (cámara de ionización, películas, dosímetros Termoluminiscentes y dosímetros de L-alanina) todos calibrados con una pequeña cámara de iones de volumen. El posicionamiento exacto del volumen objetivo se localizó utilizando espacios aéreos y pequeñas esferas de acero para encontrar las coordenadas de destino adecuadas. El fantoma principal y las hojas de instrucciones fueron ampliamente probados y enviados por correo a instituciones seleccionadas. Los resultados generales fueron muy alentadores y sugieren que el fantoma propuesto puede utilizarse como sistema postal como parte de una herramienta independiente de control de calidad en radiocirugía.


Subject(s)
Humans , Brain Neoplasms/therapy , Intracranial Arteriovenous Malformations/therapy , Radiosurgery/methods , Postal Service , Quality Control , Radiometry , Radiosurgery/adverse effects
20.
Arq. bras. neurocir ; 40(3): 284-287, 15/09/2021.
Article in English | LILACS | ID: biblio-1362168

ABSTRACT

The COVID-19 pandemic has affected a large number of patients in all countries, overwhelming healthcare systems worldwide. In this scenario, surgical procedures became restricted, causing unacceptable delays in the treatment of certain pathologies, such as glioblastoma. Regarding this tumor with high morbidity and mortality, early surgical treatment is essential to increase the survival and quality of life of these patients. Association between COVID-19 and neurosurgical procedures is quite scarce in the literature, with a few reported cases. In the present study, we present a rare case of a patient undergoing surgical resection of glioblastoma with COVID-19.


Subject(s)
Humans , Male , Aged , Brain Neoplasms/surgery , Glioblastoma/surgery , COVID-19/drug therapy , Brain Neoplasms/diagnostic imaging , Treatment Outcome , Glioblastoma/pathology , Glioblastoma/diagnostic imaging , Neurosurgical Procedures/methods
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