Voxel-based morphometry and diffusion tensor imaging of the optic pathway in primary open-angle glaucoma: a preliminary study.

BACKGROUND AND PURPOSE: Neuropathologic studies in experimental and human glaucoma have demonstrated degenerative changes in the optic pathway. The purpose of this study was to assess the optic pathway in POAG by using VBM and DTI. MATERIALS AND METHODS: Eighteen patients 57.05 ± 11.38 years of age with POAG of 8.30 ± 5.14 years' duration and 18 control subjects underwent a complete ophthalmologic examination, including quantification of the RNFLT by using Stratus OCT 3, and brain imaging. The imaging protocol consisted of a T1-weighted high-resolution 3D spoiled gradient-echo sequence and a multisection spin-echo- planar diffusion-weighted sequence. Data preprocessing and analysis were performed by using Matlab 7.0 and SPM 5. RESULTS: Left temporal and right nasal RNFLTs were significantly thinner than right temporal and left nasal RNFLTs. In patients, VBM revealed a significant reduction in the left visual cortex volume, the left lateral geniculate nucleus, and the intracranial part of the ONs and the chiasma. In addition, a significant decrease of FA was observed in the inferior fronto-occipital fasciculus, the longitudinal and inferior frontal fasciculi, the putamen, the caudate nucleus, the anterior and posterior thalamic radiations, and the anterior and posterior limbs of the internal capsule of the left hemisphere (P < .05). CONCLUSIONS: Neurodegenerative changes of the optic pathway and several brain areas associated with the visual system can be observed by using VBM and DTI in patients with POAG, suggesting that glaucoma is a complex neurologic disease.

Epidemiology of pediatric brain tumors in Greece (1991-2008). Experience from the Agia Sofia Children's Hospital.

BACKGROUND: We set out to determine the epidemiology of pediatric brain tumors in a single Greek institute. METHODS: We reviewed all cases of brain tumors in children, under the age of 15 years, that were treated surgically in the Neurosurgical Department of Children's Hospital "Agia Sofia", between January 1991 and December 2008. RESULTS: From January 1991 through December 2008, we encountered 335 cases of pediatric brain tumors. The mean age was 7.2 years and there was a slight male predominance. Astrocytomas made up the largest component, with pilocytic astrocytomas accounting for 25.6% of all tumors. The second most common entity was medulloblastoma, accounting for 18% of all tumors, whereas ependymomas were the third most frequent tumor. There was an increase in the total number of brain tumors during the last decade. Furthermore, examining low-grade astrocytoma, medulloblastoma and ependymoma trends over the last 2 decades, we found a trend for a decrease of low-grade astrocytomas and an increase of the more aggressive medulloblastomas and ependymomas. CONCLUSION: This study presents the first epidemiological data of pediatric brain tumors in Greece. Astrocytomas were the most common tumor followed by medulloblastomas and ependymomas. Furthermore, a trend for an increase of malignant tumors over the last decade has been observed.

Malignant progression of a pleomorphic xanthoastrocytoma in a child.

Pleomorphic xanthoastrocytoma (PXA) is a recently recognized rare cerebral neoplasm that predominantly affects young patients. We report on the case of a 3-year-old boy who presented with a 2-week history of headaches and seizures. Radiological investigation revealed a lesion in the right parietal-occipital lobe. The lesion was excised and histology disclosed the presence of a PXA with anaplastic features. 1 year later follow-up magnetic resonance imaging (MRI) revealed tumor relapse. An MRI of the spine was also performed and demonstrated leptomeningeal dissemination. The patient underwent a second operation. Histology revealed that the presence of a malignant PXA with anaplastic features. The patient received radiotherapy and 9 months later on follow-up MRI a new tumor recurrence was noted. A third craniotomy was performed and the tumor removed. Histological examination revealed dedifferentiation to glioblastoma multiforme. The patient was referred to the oncology department and received chemotherapy with temozolamide. 8 months later the patient was stable without tumor recurrence. PXAs require close follow-up because of their unpredictable biological behaviour.

Tratamiento quirúrgico de mal formaciones arteriovenosas grado V en una niña / Surgical treatment of grade 5 arteriovenous malformation in a girl

Presentamos el caso de una niña de 12 años que fue tratada en nuestro servicio, quejándose de cefalea prolongada acompañada de vómitos y diplopia durante los últimos 10 días. En examinación neurológica se notó tremor en la extremidad superior derecha y rigidez cervical. Lasometimos a TC craneal e IRM, cuyos resultados indicaron la existencia de una lesión frontotemporal gigante. La lesión era heterogénea con calcificaciones y hemosiderina, rodeada de edema y provocando desplazamiento de la media línea. Tras la administración de gadolinio se aumentó un poco la señal. El último hallazgo nos hizo concluir que había una anormalidad vascular. La paciente se operó mediante craneotomía frontotemporal izquierda. Logramos extirpar la lesión totalmente. La histopatología demostró la presencia de una MAV. En el posoperatorio, la paciente estaba neurológicamente intacta, pero se notó una colección subcutánea de líquido cefalorraquídeo que se trató con drenaje sin ningún problema. Aunque el tratamiento quirúrgico de una MAV gigante y situada profundamente en el hemisferio dominante del habla y de las destrezas motoras puede resultar peligroso provocando daño neurológico, una intervención quirúrgica cuidadosa es muy posible que tenga resultado favorable (AU)

We report on a case of a 12-year-old girl that was admitted under our care complaining of headache for over a month which was accompanied by vomiting and diplopia over the last 10 days. On neurological examination a right upper limb tremor and cervical rigidity were noted. CT and MRI scan was performed and revealed a giant left front temporal lesion. The lesion was heterogenous with calcifications and hemosidirin, surrounded by brain swelling and causing midline shift. There was little enhancement after gadolinium administration. The last finding led us to consider the presence of a vascular abnormality as a possible diagnosis. The patient was operated upon via a left fronto-temporal craniotomy. We managed to excise the lesion totally. Histopathology revealed the presence of an AVM. Postoperatively the patient was neurologically intact but a subcutaneous collection of CSF was noted that was successfully treated by drainage. Although surgical treatment of deeply seated giant AVM’s in the dominant hemisphere of speech and motor-sensory area have a relative high proportion of postoperative neurological deficit, careful surgical intervention can produce excellent outcome (AU)

[Surgical treatment of grade 5 arteriovenous malformation in a girl]. / Tratamiento quirúrgico de malformaciones arteriovenosas grado V en una niña.

We report on a case of a 12-year-old girl that was admitted under our care complaining of headache for over a month which was accompanied by vomiting and diplopia over the last 10 days. On neurological examination a right upper limb tremor and cervical rigidity were noted. CT and MRI scan was performed and revealed a giant left frontotemporal lesion. The lesion was heterogenous with calcifications and hemosidirin, surrounded by brain swelling and causing midline shift. There was little enhancement after gadolinium administration. The last finding led us to consider the presence of a vascular abnormality as a possible diagnosis. The patient was operated upon via a left fronto-temporal craniotomy. We managed to excise the lesion totally. Histopathology revealed the presence of an AVM. Postoperatively the patient was neurologically intact but a subcutaneous collection of CSF was noted that was successfully treated by drainage. Although surgical treatment of deeply seated giant AVM's in the dominant hemisphere of speech and motor-sensory area have a relative high proportion of postoperative neurological deficit, careful surgical intervention can produce excellent outcome.

Tumour marker prescriptions for cancer screening in the Hellenic primary care.

Tumour markers are neither sensitive nor specific enough for cancer screening. Despite established guidelines, tumour marker 'screening myth' may be alive among physicians, but no study has analysed the phenomenon. This study aims to investigate tumour marker recommendation for screening purposes in primary care setting. A total of 209 Hellenic physicians were surveyed for screening activities by a multiple-choice questionnaire. Data were abstracted for the following tumour marker recommendations: carcinoembryonic antigen (CEA); cancer antigens 19.9, 125 and 15.3; alpha-fetoprotein and beta-human chorionic gonadotropin (beta-HCG). A high rate of physicians advocate that tumour markers in cancer screening (range from 24% for beta-HCG to 46% for CEA). This phenomenon is not related to age, sex, type and level of physicians' specialization. In conclusion, many physicians recommend tumour markers for screening purposes. This may be harmful, since their prescriptions unnecessarily burden health economics, and further evaluation of false-positive findings might be associated with increased costs and risk from additional diagnostic/therapeutic interventions.

Is primidone the drug of choice for epileptic patients with QT-prolongation? A comprehensive analysis of literature.

Sudden unexplained/unexpected death (SUDEP) in epilepsy is a major cause of death accounting for 7-17% of the mortality among epileptic patients. Prolongation of QT-interval has been issued as a major mechanism in SUDEP since it is associated with fatal cardiac arrhythmias. This condition may be further precipitated by anti-epileptic treatment. Despite thorough literature research, we did not find any reports suggesting that primidone is responsible for QT-prolongation. On the contrary, all the retrieved reports addressed that the drug shortened QT-interval and corrected signs and symptoms of the underlying disease.

Anaerobic waste stabilization ponds: a low-cost contribution to a sustainable wastewater reuse cycle.

Waste stabilization ponds (WSP) have been used extensively all over Europe over the last 50 yr for the treatment of municipal and industrial wastewaters. Models presented in manuals should be used only for guidance, and local experience from pilot and full-scale plants of a particular pond type is extremely valuable. Anaerobic WSP are single-stage, continuous- flow, anaerobic reactors operating at ambient temperatures and low volumetric organic loading as a pretreatment method. This article presents a literature review on the different available operational parameters of anaerobic ponds and examples from full-scale plant performance worldwide. On a wastewater management scheme, involving reuse for agriculture, the zero-energy demand of a waste stabilization pond series for the effective removal of organic and microbiological loading under existing legislation and guidelines will remain a valuable tool for sustainable development.

Epithelioid angiosarcoma of the adrenal gland associated with chronic arsenical intoxication?

Epithelioid angiosarcoma is a rare tumor quite recently described. There is no accurate epidemiological study of this tumor. Among the internal organs, the liver is the one most frequently affected with angiosarcoma while there is no reference to the adrenal gland as a primary site. It is well known that the direct exposure to arsenicals (especially of vineyard cultivators) may be an important causative factor in the pathogenesis of the disease. A 59-year-old male vineyard cultivator with an epithelioid angiosarcoma of the right adrenal gland is described. The histologic characteristics as well as the immunohistochemical profile of the tumor are presented and the literature is briefly reviewed.

Early metastatic patterns and survival in malignant melanoma.

Two hundred fifty patients with distant metastasis from malignant melanoma were analyzed at the first appearance of systemic metastasis. Commonly involved sites were lung, subcutaneous tissue, brain, and liver. Frequency of liver metastasis was higher with eye and mucous membrane primary sites (P less than 0.01). Liver involvement had the worse survival compared to lung and brain. Patients with mucosal or unknown primary sites had decreased survival compared to other sites (P less than 0.01). Patients with primary melanomas thicker than 4 mm had significantly shorter survival (P less than 0.02). Single-organ involvement correlated with longer survival compared to multiple-organ involvement (P less than 0.04). Survival of metastatic disease was more favorable in patients with involvement of subcutaneous tissue only and in those with a disease-free interval of 2 years or longer. Five-year survival from first appearance of metastasis was 7% and median survival was 8 months.