ABSTRACT
PURPOSE: The incidence of brainstem metastasis (BSM) accounts for 1-3% of brain metastases (BM). They are often associated with multiple BM and produce significant neurological symptoms. We retrospectively analyse the results of treatment with stereotactic radiosurgery (SRS). METHODS AND MATERIAL: We included the medical records of 28 patients aged 52.86+/-11.29 years; 17 (60.7%) were women. The most frequent primary tumours were breast (n=11), lung (n=9) and melanoma (n=4). A total of 30 BSM were treated with radiosurgery (SRS) with a linear accelerator (Linac Scalpel, University of Florida). The 3D planning was with image fusion. RESULTS: The mean time from the diagnosis of the primary tumour to the BM was 3+/-3.35 years; 5 cases were diagnosed simultaneously. Twenty-seven patients (96.4%) received whole brain radiotherapy, 19 before SRS and 8 after. The most usual dose was 30 Gy. Three patients underwent another SRS for other BM. The medium volume of BSM was 1.86+/-2.31 cc. The mean prescribed dose was 1114.33+/-315.6 cGy. The tumour volume did not change significantly with SRS but there was neurological improvement in 13 patients (41.9%). Twenty-four patients (85.7%) died, 22 (78.5%) due to the primary tumour: 12 cases (42.8%) due to progression of BM, 1 case due to progression of BSM and 10 due to local tumour progression or extra-cerebral metastases. Mean survival from diagnosis of BM was 22.8+/-32.4 months and from SRS of BSM, 16.8+/-31.56 months (1 month to 13.54 years). CONCLUSION: The combined treatment of SRS and whole brain radiotherapy treatment is effective in the control of BSM (only one patient died due to progression of BSM), improving the neurological symptoms in 41.9% of patients; therefore an early diagnosis and treatment is important. Many patients die due to causes other than the BSM (AU)
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Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Radiosurgery/methods , Radiosurgery , Prognosis , Retrospective Studies , Treatment Outcome , Survival RateABSTRACT
OBJECTIVES: To describe a new technique for Doppler waveform quantification of the fetal umbilical artery, the half peak systolic velocity (h-PSV) deceleration time, which measures the time that it takes a single flow velocity waveform to halve its maximum systolic velocity. As this measurement is independent of fetal heart rate, its role in the evaluation of placental vascular resistance in fetuses with bradycardia was also explored. METHODS: The umbilical artery impedance indices and the h-PSV deceleration time were measured in 532 normal singleton fetuses from 17 to 41 weeks of gestation. A nomogram was established and its usefulness in assessing fetuses with bradycardia was evaluated. RESULTS: The relationship between umbilical artery h-PSV deceleration time and gestational age was best described by a linear formula (y = 6.5523x + 12.41; R(2) = 0.6346), h-PSV deceleration time increasing by 6.6 ms per week. The correlation coefficients for the 95(th), 50(th) and 5(th) centiles were 0.97, 0.98 and 0.98, respectively. Measurement of h-PSV deceleration time was reproducible, with interobserver and intraobserver variabilities of 10.7% and 7.4%, respectively. Among fetuses with bradycardia (n = 7), the h-PSV deceleration time was above the 5(th) centile in all cases, suggesting normal placental function in spite of abnormally increased impedance indices obtained with traditional Doppler indices in six. CONCLUSIONS: The h-PSV deceleration time increases linearly during the second and third trimesters of pregnancy. As its measurement is reproducible and independent of heart rate, it may be useful in the assessment of well-being in fetuses with bradycardia.
Subject(s)
Bradycardia/diagnostic imaging , Ultrasonography, Doppler/methods , Ultrasonography, Prenatal/methods , Umbilical Arteries/diagnostic imaging , Blood Flow Velocity/physiology , Bradycardia/physiopathology , Female , Humans , Pregnancy , Pulsatile Flow/physiology , Systole/physiology , Umbilical Arteries/physiopathologyABSTRACT
Se presenta la experiencia de 5 años en el diagnóstico y manejo antenatal de malformaciones fetales con un equipo multidisciplinario de obstetras y cirujanos infantiles en el hospital San Juan de Dios, entre 1990 y 1995. Se encontraron 162 fetos malformados, con una sensibilidad de la ultrasonografía del 98,2 por ciento. el 19,8 por ciento de pacientes tuvo algún factor de riesgo; las malformaciones más comunes fueron: del Sistema Nervioso Central (SNC) el 39,5 por ciento, urinarias el 25,7 por ciento y un 21,7 por ciento de malformaciones múltiples. La mortalidad perinatal fue del 100 por ciento de las malformaciones anticipadas como incompatibles con la vida, 84 por ciento en las graves y de 27 por ciento en las menos severas
Subject(s)
Congenital Abnormalities/diagnosis , PerinatologyABSTRACT
Se presenta la experiencia de 5 años en el diagnóstico y manejo antenatal de malformaciones fetales con un equipo multidisciplinario de obstetras y cirujanos infantiles en el hospital San Juan de Dios, entre 1990 y 1995. Se encontraron 162 fetos malformados, con una sensibilidad de la ultrasonografía del 98,2 por ciento. el 19,8 por ciento de pacientes tuvo algún factor de riesgo; las malformaciones más comunes fueron: del Sistema Nervioso Central (SNC) el 39,5 por ciento, urinarias el 25,7 por ciento y un 21,7 por ciento de malformaciones múltiples. La mortalidad perinatal fue del 100 por ciento de las malformaciones anticipadas como incompatibles con la vida, 84 por ciento en las graves y de 27 por ciento en las menos severas
Subject(s)
Congenital Abnormalities/diagnosis , PerinatologyABSTRACT
Intraoperative radiation therapy (IORT) with high energy electron beams is a treatment modality that has been included in multimodal programs in oncology to improve local tumor control. From August 1991 to December 1993, 17 patients with primary (8) or recurrent (9) high grade malignant gliomas, anaplastic astrocytoma (4), anaplastic oligodendroglioma (6) and glioblastoma multiforme (7), underwent surgical resection and a single dose of 10-20 Gy intraoperative radiation therapy was delivered in tumor bed. Fourteen patients received either pre-operative (8) or post-operative (6) external beam radiation therapy. Primary gliomas: 18-months actuarial survival rate has been 56% (range: 1-21+ months) and the median survival time has not yet been achieved. Four patients developed tumor progression (median time to tumor progression: 9 months). Recurrent gliomas: 18-months actuarial survival rate and median survival time has been 47% and 13 months (range: 6-32+ months) respectively. The median time to tumor progression was 11 months. No IORT related mortality has been observed. IORT is an attractive, tolerable and feasible treatment modality as antitumoral intensification procedure in high grade malignant gliomas.
Subject(s)
Brain Neoplasms/therapy , Glioma/therapy , Intraoperative Care/methods , Adolescent , Adult , Aged , Brain Neoplasms/radiotherapy , Brain Neoplasms/surgery , Female , Follow-Up Studies , Glioma/radiotherapy , Glioma/surgery , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/therapy , Radiotherapy, Adjuvant/adverse effectsABSTRACT
A modification of the stereotactic radiosurgical procedure to permit treatment of lesions in the foramen magnum and upper cervical regions is described. The modification consists of placing the frontal pins of the stereotactic head ring in the zigoma bone, with no changes in the position of the occipital pins, so the final BRW head ring is oblique to the orbito-meatal plane. In this new position there is room enough in the posterior part of the guide for the support scrubs. This is unhampered by the patient's shoulders and the lesion is far enough to permit setting the axial coordinate sufficiently above the head ring plane.
Subject(s)
Foramen Magnum/surgery , Head and Neck Neoplasms/surgery , Radiosurgery/methods , Humans , Particle AcceleratorsABSTRACT
The biophysical profile is an excellent test for assessment of the fetoplacental unit, for analyze is value in twin gestation, we study prospectively 81 multiple gestations. The fetuses were examined weekly antepartum. We use the modified profile of Manning which include only the sonographic criteria: the figures for predict stillborn were: sensitivity of 66.7%, specificity of 98.8%, positive predictive value of 50% and negative predictive value of 99.4% and predict between distressed and healthy fetus of a pair; 94.6% of fetus perform good biophysical profile score twenty minutes. We conclude that the fetal biophysical profile is the elective tool in the assessment of twin gestations.
Subject(s)
Fetal Viability , Pregnancy, Multiple , Adolescent , Adult , Female , Fetal Death , Humans , Maternal Age , Parity , Pregnancy , Pregnancy, High-Risk , Prospective Studies , Risk Factors , Sensitivity and Specificity , Ultrasonography, PrenatalABSTRACT
A new method for management of the umbilical cord prolapse is presented: the bladder of the patient is filled with 500 to 700 ml of saline solution through a catheter, the bladder produce the upward displacement of the fetal head and soon proceed to cesarean section, this method reduce the maternal risks and the perinatal mortality. Four case reports are presented with good results.
Subject(s)
Pregnancy Complications/therapy , Umbilical Cord , Urinary Bladder , Urinary Catheterization/methods , Adult , Apgar Score , Female , Fetal Death/prevention & control , Humans , Infant, Newborn , Pregnancy , ProlapseABSTRACT
A facial malformation was diagnosed by ultrasonography, the case correspond to First Arch syndrome, the findings are micrognathia, polyhydramnios, low-set ears and absence of stomach bubble. The heterogeneity of this syndrome and his relationship with environmental agents is analyzed.
Subject(s)
Branchial Region/abnormalities , Craniofacial Dysostosis/diagnostic imaging , Mandibulofacial Dysostosis/diagnostic imaging , Polyhydramnios/diagnostic imaging , Abnormalities, Drug-Induced/etiology , Adult , Female , Humans , Pregnancy , Pregnancy Complications, Infectious , Prenatal Diagnosis , Syndrome , Ultrasonography , Urinary Tract InfectionsABSTRACT
We studied the effect of intracerebroventricular infusion of dopamine and dopamine agonists in rat and primate models of Parkinson's disease as an experimental approach to the treatment of levodopa-induced fluctuations. The infusion of dopamine, lisuride, and pergolide into the ventricle ipsilateral to the lesion, by 6-hydroxydopamine, of the nigrostriatal pathway induced a contralateral rotation which was maximal 24-48 h after infusion and whose intensity progressively decreased over the period of 1 week. [3H]Spiperone binding was decreased by the infusion of dopamine but the responses to subcutaneous apomomorphine were unchanged. The infusion of dopamine also restored the levels of monoamines in the rat brain. In chronic reserpized rats, the infusion of dopamine restored brain levels of dopamine but did not reverse akinesia unless monoamine oxidase inhibitors were simultaneously administered, either systemically or intracerebroventricularly. Lisuride and pergolide proved much weaker than dopamine in reversing the effects of reserpine. Intracerebroventricular infusion of dopamine plus deprenyl reversed MPTP induced akinesia in monkeys but the pump used for the delivery was not well tolerated, because of its size, by the animals.
