Extensive androgen exposure and meningioma risk - A matched cohort study.

INTRODUCTION: Meningiomas frequently occur within the field of neuro-oncology, but it is unclear whether exogenous or imbalanced endogenous hormones are involved in the pathophysiology. A previous case-control study found an almost 20-fold increase in the risk of developing meningioma among users of androgenic anabolic steroids. We, therefore, investigated this hypothesis. METHODS: We compared the incidence rate of meningioma in a cohort of males sanctioned for the use of androgenic anabolic steroids with age- and sex-matched controls with an identical enrollment date. RESULTS: We followed 1189 males sanctioned for using androgenic anabolic steroids for a total of 13,305 person-years and found 0 cases of meningioma. The control cohort of 59,450 males was followed for a total of 654,938 person-years, and 16 were diagnosed with meningioma. Thus, the incidence rate ratio was 0 (95% CI: 0-12.8). CONCLUSION: We did not find any evidence supporting the hypothesis of an increased risk of meningioma development with the use of androgenic anabolic steroids. Due to the limited sample size, we cannot exclude androgenic anabolic steroids as a potential risk factor for meningioma development, despite the lack of apparent evidence in this study.

Postoperative de novo epilepsy after craniotomy: a nationwide register-based cohort study.

BACKGROUND AND OBJECTIVES: The risks of postoperative risk of epilepsy after a craniotomy is widely believed to be raised. A study is warranted to quantify the risks for any neurosurgical indication. In this unselected register-based nationwide cohort study with virtually complete follow-up, the short-term and long-term cumulative risks of postoperative de novo epilepsy for all major neurosurgical indications were estimated. METHODS: The study was based on 8948 first-time craniotomy patients in Denmark 1 January 2005 to 31 December 2015 with follow-up until 31 December 2016. The patients were classified according to their underlying neurosurgical pathology. Patients with preoperative epilepsy were excluded. The postcraniotomy risks of de novo epilepsy were estimated using the Aalen-Johansen estimator in a multistate model. RESULTS: The overall cumulative 1-year risk of postcraniotomy de novo epilepsy was 13.9% (95% CI 13.2 to 14.6). For patients with intracranial tumour the cumulative 1-year risk was 15.4% (95% CI 14.4 to 16.5), for spontaneous intracranial haemorrhage 11.3% (95% CI 10.1 to 12.6), for traumatic intracranial haemorrhage 11.1% (95% CI 9.6 to 12.9), for cerebral abscess 27.6% (95% CI 22.8 to 33.5) and for congenital malformations 3.8% (95% CI 1.3 to 11.7). The 6-month, 1-year and 5-year risks for all major indications by specific subtypes are provided. CONCLUSIONS: The cumulative risk of de novo epilepsy following craniotomy is high for patients with any indication for craniotomy, as compared with the background population. The results provide comprehensive data to support future recommendations regarding prophylactic antiepileptic treatment and driving restrictions.

Long-term postoperative health-related quality of life in patients with subfrontal meningiomas.

OBJECTIVE: Subfrontal meningiomas grow insidiously in areas with high cerebral compliance and a relative scarcity of eloquent function. Symptoms develop progressively, are nonspecific, and include anosmia, changes in personality and cognition, depressive symptoms, headaches, visual disturbances, and seizures. Patients with subfrontal meningiomas carry the highest risk of developing psychological symptoms, which makes patient-reported outcome in terms of long-term health-related quality of life (HRQOL), anxiety, and depression of particular importance. This observational study aimed to investigate long-term HRQOL, anxiety, and depression in patients with subfrontal meningiomas who underwent a bifrontal craniotomy (subfrontal) approach between 2008 and 2017 at a single tertiary center. Correlations between preoperative, perioperative, and postoperative factors and HRQOL, anxiety, and depression were analyzed to detect prognostic factors. METHODS: Seventy-seven consecutive patients who underwent operations at Rigshospitalet, Copenhagen, Denmark, between 2008 and 2017 were retrospectively analyzed. Patients were prospectively invited to respond to the Functional Assessment of Cancer Therapy-General, Functional Assessment of Cancer Therapy-Brain, and Hospital Anxiety and Depression Scale. Information regarding preoperative, perioperative, and postoperative factors were collected from the patients' medical records and scans. RESULTS: Patients with subfrontal meningiomas exhibited better HRQOL and lower levels of anxiety and depression than general populations and other meningioma and glioblastoma cohorts. The only statistically significant prognostic factors for long-term HRQOL were number of symptoms at diagnosis and whether patients were discharged home or to a local hospital postoperatively. Tumor and peritumoral brain edema volumes were not prognostic factors. CONCLUSIONS: Patients with subfrontal meningiomas exhibited better long-term postoperative HRQOL and were less likely to have anxiety or depression than the reference populations. This information on long-term prognosis is very valuable for patients, next of kin, and neurosurgeons and has not been previously studied in detail.

Pathologic Characteristics of Pregnancy-Related Meningiomas.

Meningiomas are the most common intracranial tumor. During pregnancy, explosive growth of a known meningioma occasionally occurs, but the underlying reasons remain unknown. Prolactin has been suggested as a possible key contributor to pregnancy-related meningioma growth. This study sets out to investigate prolactin and prolactin receptor status in 29 patients with pregnancy-related meningiomas in Denmark, from January 1972 to December 2016, as compared to 68 controls aged 20-45 years, also undergoing resection of a meningioma. Furthermore, we investigated potential differences in the progesterone and estrogen receptor statuses, WHO grade, Ki-67 labeling indices, and locations of the resected meningiomas between the cases and controls. Immunohistochemical analyses were performed, and histopathology and intracranial location were assessed with the investigator blinded for the case-control status. None of the samples stained positive for prolactin and very few samples stained positive for prolactin receptors, equally distributed among cases and controls. Estrogen and progesterone receptors generally followed the same distributional pattern between groups, whereas above cut-point Ki-67 labeling indices for both groups were observed. In conclusion, our results did not support the notion of prolactin as a key contributor to pregnancy-related meningioma growth. Rather, the similarities between the cases and controls suggest that meningiomas early in life may comprise a distinct biological entity.

Sexual dysfunction and mental health in patients with multiple sclerosis and epilepsy.

BACKGROUND: Epilepsy and multiple sclerosis (MS) are two neurological diseases known to greatly influence a patient's life. The primary aim of this study was to describe the prevalence of sexual dysfunction in patients with epilepsy and MS and investigate whether there is an association between disease, sexual function, and physical and mental health. A secondary aim was to investigate whether there is a difference in sexual function between patients with MS and epilepsy. METHODS: A total of 414 patients were included in this descriptive cross-sectional study. Three patient report questionnaires were used for measurements: the Changes in Sexual Function Questionnaire (CSFQ) cut-off score; the Short Form 36 Health Survey (SF-36) divided into the Physical Component Summary (PCS) and Mental Component Summary (MCS), and the Life Satisfaction-11 (LiSat-11). RESULTS: Patients with MS constituted 62% (n = 258) of the participants and patients with epilepsy 38% (n = 156). The prevalence of sexual dysfunction was 68% in women and 77% in men. No differences were found between patients with MS and epilepsy (p = 0.184), except for the CSFQ desire domain, as patients with epilepsy more often had a desire problem (p = 0.029). On the SF-36, patients with MS scored significantly worse on the PCS (p = 0.000). Patients with epilepsy scored significantly worse on the MCS (p = 0.002). No significant differences were found on the LiSat-11. Regression analysis with CSFQ as the dependent variable showed an association with the PCS in men and an association with both PCS and MCS in women. CONCLUSIONS: In this study, the cohort of patients with MS and epilepsy had negatively affected sexual function. The only significant difference between patients with MS and epilepsy in sexual function measured by the CSFQ-14, was found in the frequency of desire, in which a larger number of patients with epilepsy reported sexual dysfunction. In the studied cohort, sexual function in women is associated with both physical and mental health, and in men with physical health. These results should be considered when caring for patients with epilepsy and MS.

Fetal death: obstetric, placental and fetal necroscopic factors / Óbito fetal: fatores obstétricos, placentários e necroscópicos fetais

ABSTRACT Introduction: Fetal death is defined as the death of the product of conception, regardless of gestational age. Objectives: The objective of this study was to investigate the maternal (obstetrical and placental) risk factors and the necropsy findings associated with fetal death, based on data obtained from the Verification of Death Service [Serviço de Verificação de Óbito (SVO)] in Florianópolis, Santa Catarina, Brazil. Material and method: This is an observational, cross-sectional study using secondary data. Were included the reports released between 2010 and 2015, with a diagnosis of fetal deaths at gestational age of 20 weeks or more. Results: During the period evaluated, 210 autopsies were performed. From these, 15.2% (n = 32) presented umbilical cord abnormalities, 22.4% (n = 47) placental abnormalities, 49.5%(n = 104) maternal health problem related to pregnancy, and 10% (n = 21) previous maternal disease. Among the fetal characteristics involved, it was observed that 6.7% (n = 14) presented meconium aspiration and 5.2% (n = 11) fetal malformations. In this study, 21.9%(n = 46) did not have their causa mortis defined. Discussion: The findings of this study show a statistically significant association (p <0.05) between meconium aspiration and full term pregnancy, hospital origin and normal birth weight. Such information is in agreement with the literature, which shows signs of intrauterine hypoxia, such as the presence of meconium, which are more prevalent in full term pregnancy. Conclusion: Among the causes of fetal death, ascending infection was the most prevalent; the maternal death related to pregnancy were the ones that stood out the most.

RESUMEN Introducción: Muerte fetal se define como muerte del producto de la concepción independientemente de la duración del embarazo. Objetivos: El objetivo de este trabajo fue investigar los factores de riesgo maternos (obstétricos y placentarios) y los hallazgos de la autopsia asociados a muerte fetal con base en los datos obtenidos en el Servicio de Verificación de Muerte [Serviço de Verificação de óbitos (SVO)] de Florianópolis, Santa Catarina, Brasil. Materialy método: Este es un estudio observacional, de diseno transversal, que utilizó datos secundarios. Se incluyeron informes de autopsia de fetos con edadgestacional de 20 semanas o más, practicadas entre 2010 y 2015. Resultados: En el período evaluado se realizaron 210 autopsias. Entre estas, 15,2% (n = 32)presentaron alteraciones de cordón umbilical; 22,4% (n = 47), de placenta; 49,5% (n = 104), enfermedades maternas relacionadas con el embarazo; y 10% (n = 21), enfermedades maternas previas. Entre las características fetales implicadas, se encontróque 6,7% (n = 14) presentaron aspiración meconialy 5,2% (n = 11), malformaciones fetales. En este estudio, 21,9% (n = 46) no tuvieron sus causas de muerte determinadas. Discusión: Los hallazgos de esta investigación muestran una relación estadísticamente significativa (p < 0,05) entre aspiración meconial y gestación a término, procedencia hospitalaria y peso adecuado al nacimiento. Estas informaciones están de acuerdo con la literatura, que trae senales de hipoxia intrauterina, como la presencia de meconio, más frecuentes en los embarazos a término. Conclusión: Entre las causas de muerte fetal, infección ascendente fue la más común; las causas de muerte materna relacionadas con el embarazo fueron las que más se destacaron.

RESUMO Introdução: Óbito fetal se define como morte do produto da concepção independente do tempo da gestação. Objetivos: O objetivo deste estudo foi investigar os fatores de risco maternos (obstétricos e placentários) e os achados de necropsia associados ao óbito fetal a partir de dados obtidos no Serviço de Verificação de Óbito (SVO) de Florianópolis, Santa Catarina, Brasil. Material e método: Trata-se de um estudo observacional, com delineamento transversal, que utilizou dados secundários. Foram incluídos laudos com diagnóstico de óbito fetal e idade gestacional de 20 semanas ou mais, realizados entre 2010 e 2015. Resultados: No período avaliado, foram realizadas 210 autópsias. Destas, 15,2% (n = 32) apresentaram alterações de cordão; 22,4% (n = 47), de placenta; 49,5% (n = 104), doenças maternas relacionadas com a gestação; e 10% (n = 21), doenças maternas prévias. Entre as características fetais implicadas, observou-se que 6,7% (n = 14) apresentaram aspiração meconial e 5,2% (n = 11), malformações fetais. Neste estudo, 21,9% (n = 46) não tiveram sua causa mortis definida. Discussão: Os achados desta pesquisa mostram associação estatisticamente significativa (p < 0,05) entre aspiração meconial e gestação a termo, procedência hospitalar e peso adequado ao nascer. Tais informações estão em concordância com a literatura, que traz sinais de hipóxia intraútero, como a presença de mecônio, mais prevalentes em gestação a termo. Conclusão: Entre as causas de óbito fetal, a infecção ascendente foi a maisprevalente; as causas de morte materna relacionadas com a gestação foram as que mais se destacaram.

Male hormone-interfering drugs and meningioma development.

BACKGROUND: Extremely strong associations between male hormone-interfering drugs and meningiomas have been reported in two previous studies, but these findings are limited by small size of the study populations and possibly by surveillance- and selection bias. Thus, such possible and indeed very interesting association must be investigated in a large, unselected cohort. Accordingly, the aim of this study was to determine whether patients exposed to male hormone-interfering drugs had a higher risk of meningioma development in a nationwide cohort study. METHODS: A retrospective Danish nationwide cohort study with follow-up from January 1, 1996 to December 31, 2016. Exposure was use of male hormone-interfering drugs (5-α-reductase-inhibitors, luteinizing hormone-releasing hormone agonist, steroidal antiandrogen, and nonsteroidal antiandrogen). Hazard ratio of first-time diagnosis of meningioma according to drug use was estimated using Cox proportional hazards model with adjustment for age and birth year. RESULTS: The cohort included 244,696 men of which 64,047 had used male hormone-interfering drugs. Overall 444 meningiomas occurred during follow-up. No significant association was observed between use of male hormone-interfering drugs and the occurrence of meningioma (hazard ratio 1.02, 95% confidence interval 0.82-1.27). Similar results were observed 0-1, 2-4, and 5+ years after first use. In explorative analyses, no elevated risk association was observed for specific drugs (5-α-reductase-inhibitors, luteinizing hormone-releasing hormone agonist, steroidal antiandrogen, and nonsteroidal antiandrogen). CONCLUSION: As opposed to previous studies, we found no evidence of an increased risk of meningioma in men treated with male hormone-interfering drugs.

[The impact of hormonal factors in meningioma development].

Meningioma is the most common extra-axial, intracranial tumour. The incidence is 5/100,000 persons per year with a female:male ratio of 2:1. Only two predisposing factors have been identified: neurofibromatosis type 2 and ionising radiation. It has been suggested, that hormones, especially female, may have an impact on development. The results from studies on this matter have been inconclusive, and there is a need for further and broader research in the field of meningioma development.

[Problems in the gastrointestinal and urinary tract system and sexual dysfunction in patients suffering from multiple sclerosis].

Patients suffering from multiple sclerosis (MS) often experience bothersome symptoms from the gastrointestinal system and the urinary tract, and they may suffer from sexual dysfunction. These problems can diminish quality of life, and therefore it is important that they are addressed and treated whenever possible. Unfortunately, a limited body of research in the area suggests that this is not always the case, possibly because neither patients nor medical professionals bring up the issues during consultations. More studies are needed to further elucidate the situation.

[Penile implants is a good last treatment option in erectile dysfunction]. / Penisimplantater er en god sidste behandlingsmulighedfor erektil dysfunktion

When other treatments fail, penile implants represent the last treatment option in erectile dysfunction. The most commonly used implant is the inflatable three-piece device, which allows the penis to be rigid for sexual intercourse and flaccid during the remaining time. Earlier penile implants were associated with high rates of infection and mechanical malfunction. However, technical improvements have greatly reduced these problems. This has resulted in a patient satisfaction rate of 80-90% in most studies. Thus, penile implants are a valid option in motivated patients with erectile dysfunction.