SUrface-PRojected FLuid-Attenuation-Inversion-Recovery Analysis: A Novel Tool for Advanced Imaging of Epilepsy.

OBJECTIVE: The objective of this pilot retrospective study is to describe the SUrface-PRojected FLuid-Attenuation-Inversion-Recovery (SUPR-FLAIR) analysis, a novel method mainly aimed at revealing cortical areas with subtle signal hyperintensity. METHODS: Images from 101 healthy controls and 10 patients suffering from drug-resistant partial epilepsy were retrospectively postprocessed. The brain surface was reconstructed from a 3-dimensional (3D) T1-weighted fast field echo (T1W-FFE) magnetic resonance imaging (MRI) scan. A turbo spin echo fluid attenuated inversion recovery axial scan was registered to the 3D T1W-FFE scan, and its intensity values were normalized. The cortical intensity signal was projected onto the brain surface, and surface-based analysis was performed, comparing each patient against the 101 controls. The localizations of the first positive lower P value cluster (PLPC) peak and the resection zone (RZ) were compared. We studied 5 patients with focal cortical dysplasia (3 of them with negative MRI) and 5 with hippocampal sclerosis. RESULTS: SUPR-FLAIR analysis localized the first PLPC peak in the RZ in all cases. Because all patients have been seizure free since surgery, it can be assumed that the epileptogenic zone (EZ) was included in the RZ. Therefore, SUPR-FLAIR analysis correctly aligned with the EZ, with 100% sensitivity. CONCLUSIONS: SUPR-FLAIR analysis is a noninvasive technique that could be helpful for the definition of the EZ, especially when MRI is negative. Its use could reduce the indications for invasive electroencephalography or could provide essential data to refine the strategy of intracerebral electrode implantation in the most challenging cases.

Cerebral Angiography for Multimodal Surgical Planning in Epilepsy Surgery: Description of a New Three-Dimensional Technique and Literature Review.

OBJECTIVE: Cerebrovascular imaging is critical for safe and accurate planning of Stereo-ElectroEncephaloGraphy (SEEG) electrode trajectory. We developed a new technique for Cone Beam Computed Tomography (CBCT) Three-Dimensional Digital Subtraction Angiography (3D DSA). METHODS: The workflow core is the acquisition of computed tomography datasets without (bone mask) and with selective injection of contrast medium in the main brain-feeding arteries, followed by dataset registration and subtraction. The images were acquired with the O-armTM 1000 System (Medtronic). Images were postprocessed with FSL software package. We retrospectively analyzed 191 3D DSA procedures and qualitatively analyzed the quality of each 3D DSA dataset. RESULTS: The quality of 3D DSA was good in 150 procedures, sufficient in 37, and poor in 4. 3D rendering of the vascular tree was helpful for both SEEG implantation and resective surgery planning. Angiography complications occurred in only one procedure that was aborted due to a major allergic reaction to contrast medium. No other complications directly related to 3D DSA occurred. Minor intracerebral hemorrhage occurred in 2/191 patients after SEEG implantation, with no permanent sequelae. CONCLUSIONS: CBCT 3D DSA is a safe diagnostic procedure for SEEG electrode trajectory planning and for 3D reconstructions of the vascular tree in multimodal scenes for resections. The high fidelity and geometric accuracy contribute to the safety of electrode implantation.

[Hypertension as predictive factor in renal cell cancer treated with antiangiogenic therapy]. / Hipertensión arterial como factor predictivo en pacientes con cáncer renal tratados con antiangiogénicos.

Knowledge of several pathways of oncogenesis has led to the development of novel therapies in the treatment of advanced kidney cancer in the last five years. These have targeted the vascular endothelium-derived factor (VEGF) (angiogenesis) and mammalian target of rapamycin (mTOR). Antiangiogenics are a group of active molecules with a peculiar spectrum of toxicity including the development of hypertension, thyroid dysfunction and hand-foot syndrome. The identification of molecular and clinical predictors would allow to identify those patients who would benefit from such treatment and saveguarding the rest from toxic exposure. The occurrence of hypertension has been correlated with treatment response and clinical efficacy. In our retrospective series, patients treated with antiangiogenic agents who developed high blood pressure showed a higher response rate and disease-free interval compared to those without increased blood pressure. Hypertension should be considered a clinical predictor in the treatment of these patients. These findings should be confirmed in a larger study population.

Hipertensión arterial como factor predictivo en pacientes con cáncer renal tratados con antiangiogénicos / Hypertension as predictive factor in renal cell cancer treated with antiangiogenic therapy

El conocimiento de las diversas vías de oncogénesis ha llevado al desarrollo en los últimos cinco años de nuevas terapias para el tratamiento del cáncer renal avanzado, las que poseen como blanco al factor derivado del endotelio vascular (VEGF) y sus receptores (antiangiogénicos) y al blanco mamífero de la rapamicina (mTOR). Los antiangiogénicos constituyen un grupo de moléculas activas con un espectro de toxicidad peculiar que comprende el desarrollo de hipertensión arterial, disfunción tiroidea y síndrome de mano-pie. La identificación de factores predictivos clínicos y moleculares lograría identificar aquellos pacientes que se beneficiarían con dicho tratamiento, evitando exposición y toxicidad innecesaria al resto. La aparición de hipertensión arterial se ha correlacionado con respuesta al tratamiento y eficacia clínica. En nuestra serie retrospectiva, los pacientes tratados con antiangiogénicos que desarrollaron hipertensión arterial tuvieron aumento de la tasa de respuestas e intervalo libre de enfermedad en comparación con aquellos que, tratados de la misma manera, no manifestaron hipertensión. La hipertensión arterial debería considerarse como un factor predictor clínico en su tratamiento. Dichos hallazgos deberían ser corroborados en forma prospectiva y con un mayor número de pacientes.

Knowledge of several pathways of oncogenesis has led to the development of novel therapies in the treatment of advanced kidney cancer in the last five years. These have targeted the vascular endothelium-derived factor (VEGF) (angiogenesis) and mammalian target of rapamycin (mTOR). Antiangiogenics are a group of active molecules with a peculiar spectrum of toxicity including the development of hypertension, thyroid dysfunction and hand-foot syndrome. The identification of molecular and clinical predictors would allow to identify those patients who would benefit from such treatment and saveguarding the rest from toxic exposure. The occurrence of hypertension has been correlated with treatment response and clinical efficacy. In our retrospective series, patients treated with antiangiogenic agents who developed high blood pressure showed a higher response rate and disease-free interval compared to those without increased blood pressure. Hypertension should be considered a clinical predictor in the treatment of these patients. These findings should be confirmed in a larger study population.

CePAD Casa Joven de Flores: Respetar la singularidad para construir un conocimiento compartido / CePAD Casa Joven, Flores: Respecting the singularity to build a shared knowledge

El Centro de prevención, asesoramiento y diagnóstico en VIH-SIDA, que funciona desde Octubre de 2001 en la Casa Joven del barrio de Flores, es el primero de estos centros ubicado fuera del sistema de salud, y cuenta con un equipo interdisciplinario que le permite tener una visión integral de esta problemática. Se reseñan las actividades desarrolladas en sus casi dos años de trabajo, enfatizando la alta efectividad lograda en tareas de aconsejamiento y testeo

CePAD Casa Joven de Flores: Respetar la singularidad para construir un conocimiento compartido / CePAD Casa Joven, Flores: Respecting the singularity to build a shared knowledge

El Centro de prevención, asesoramiento y diagnóstico en VIH-SIDA, que funciona desde Octubre de 2001 en la Casa Joven del barrio de Flores, es el primero de estos centros ubicado fuera del sistema de salud, y cuenta con un equipo interdisciplinario que le permite tener una visión integral de esta problemática. Se reseñan las actividades desarrolladas en sus casi dos años de trabajo, enfatizando la alta efectividad lograda en tareas de aconsejamiento y testeo