Natural history and management of brainstem gliomas in adults. A retrospective Italian study.

Brainstem gliomas in adults are rare tumors, with heterogeneous clinical course; only a few studies in the MRI era describe the features in consistent groups of patients. In this retrospective study, we report clinical features at onset, imaging characteristics and subsequent course in a group of 34 adult patients with either histologically proven or clinico-radiologically diagnosed brainstem gliomas followed at two centers in Northern Italy. Of the patients 18 were male, 14 female, with a median age of 31. In 21 of the patients histology was obtained and in 20 it was informative (2 pilocytic astrocytoma, 9 low-grade astrocytoma, 8 anaplastic astrocytoma and 1 glioblastoma). Contrast enhancement at MRI was present in 14 patients. In all of the 9 patients who were investigated with MR spectroscopy, the Cho/NAA ratio was elevated at diagnosis. In 8 of the patients, an initial watch and wait policy was adopted, while 24 were treated shortly after diagnosis with either radiotherapy alone [4] or radiotherapy and chemotherapy [20] (mostly temozolomide). Only minor radiological responses were observed after treatments; in a significant proportion of patients (9 out of 15) clinical improvement during therapy occurred in the context of radiologically (MRI) stable disease. Grade III or IV myelotoxicity was observed in 6 patients. After a follow-up ranging from 9 to 180 months, all but 2 patients have progressed and 14 have died (12 for disease progression, 2 for pulmonary embolism). Median overall survival time was of 59 months. Investigation of putative prognostically relevant parameters showed that a short time between disease onset and diagnosis was related to a shorter survival. Compared with literature data, our study confirms the clinical and radiological heterogeneity of adult brainstem gliomas and underscores the need for multicenter trials in order to assess the efficacy of treatments in these tumors.

Radiotherapy and chemotherapy of brain metastases.

The authors have reviewed the results, the indications and the controversies regarding radiotherapy and chemotherapy of patients with newly diagnosed and recurrent brain metastases. Whole-brain radiotherapy, radiosurgery, hypofractionated stereotactic radiotherapy, brachytherapy and chemotherapy are the available options. New radiosensitizers and cytotoxic or cytostatic agents are being investigated. Adjuvant whole brain radiotherapy, either after surgery or radiosurgery, and prophylactic cranial irradiation in small-cell lung cancer are discussed, taking into account local control, survival, and risk of late neurotoxicity. Increasingly, the different treatments are tailored to the different prognostic subgroups, as defined by Radiation Therapy Oncology Group RPA Classes.

Role of H2-receptor antagonists in the treatment of duodenitis.

Non-erosive duodenitis is an ulcer-independent disorder, the pathogenesis of which is still unclear but apparently unrelated to gastric hyperacidity. However, antisecretory agents such as H2-blockers can be effective not only in relieving dyspeptic symptoms but also in promoting endoscopic healing or improvement. In this respect conflicting data are reported with cimetidine while promising, although preliminary, results were obtained with ranitidine and with nizatidine. Nizatidine seems especially effective when administered at a dose of 150 mg b.i.d., a regimen providing moderate, but continuous acid inhibition throughout a 24 hour period.

[Cinoxacin in infections of the lower urinary tract]. / La cinoxacina nelle infezioni delle basse vie urinarie.

The results obtained in 15 patients with infections of the lower urinary tract given 500 mg cinoxacin in two daily doses for 10 days are reported. A positive response was obtained in 13 of the 15 cases. Cinoxacin is easily managed, produces no side effects and can be administered orally, all of which makes it a drug of first choice in the treatment of prophylaxis of lower urinary infections.