Evaluating the prognostic factors effective on the outcome of patients with glioblastoma multiformis: does maximal resection of the tumor lengthen the median survival?

BACKGROUND: The ETR that should be undertaken in patients with GBM remains controversial. This study aims to reiterate some independent predicting factors and to underscore the role and the ETR in increasing the survival of patients in the situation of developing countries, that is, without preoperative MRI or tractography. The authors submit additional information to be added to the list of CTRs in the management of malignant brain tumors. METHODS: The authors prospectively analyzed a cohort of 35 consecutive patients with histologically proven GBM who underwent tumor resection in surgically amenable areas for the first time at Sina Hospital, Tehran, between 2003 and 2005. Demographic data, volumetric measurements, and other characteristics identified on preoperative and immediate postoperative MR imaging as well as intraoperative and postoperative clinical data were collectively analyzed by SPSS for Windows, version 11.5 (SPSS, Chicago, Ill). RESULTS: Cox proportional hazards model multivariate analysis identified the following independent predictors of survival: Karnofsky performance scale ≥80 (P = .01), ETR (P = .01), tumor location in functionally silent prefrontal area (P = .002) vs tumor location in corpus callosum (P = .001), postoperative RT (P = .004), and postoperative chemotherapy (P = .001) CONCLUSION: Maximal resection of the tumor volume is an independent variable associated with longer survival times in patient with GBM. Gross total resection should be performed whenever possible, although not at the expense of increased morbidity.

Spinal fractures resulting from traumatic injuries.

OBJECTIVE: To illustrate mechanisms of spine fractures and the pattern of spinal injuries characterized by the major mechanisms in urban population of Iran. METHODS: Data regarding spinal injuries including demographics, mechanism and level of spinal injury, abbreviated injury score, associated injuries and final fate of the patients were extracted from the Iranian national trauma registry database from 1999 to 2004. RESULTS: A total of 619 patients with traumatic spine fractures were identified, of whom 68.5% were males. The peak frequency of these injuries occurred in the 21-40 year age-group. Accidental falls and road traffic crashes (RTCs) were the most common mechanisms of spinal fractures (47.2% and 44.1%, respectively). RTCs tended to occur in younger patients compared with accidental falls. The most common spinal region for spinal fracture was the lumbar spine (53.63%). Cervical spine fractures were significantly more common in RTCs, while lumbar spine fractures were more common in accidental falls (P less than 0.001). A total of 171 (27.6%) patients had associated non-spinal injuries, of whom 127 had associated extremity injuries, and 55 had head injuries. Thirty-six (5.6%) patients had spinal cord injury (SCI).The injury severity score of the RTC group was significantly higher than that of accidental falls (P equal to 0.002). Fifteen (4%) patients died of traumatic injuries. The rate of death was significantly higher in RTCs compared with accidental falls (5.1% vs 2.1%, P equal to 0.039). CONCLUSIONS: The patterns of spinal fractures are similar to those reported from developed countries. RTCs tend to affect the younger age population and are associated with a higher degree of associated injuries and mortality than accidental falls. Therefore preventive strategies should be based on reduction of the number and severity of RTCs.