Differential Diagnosis of Behavioral Variant and Semantic Variant of Frontotemporal Dementia Using Visual Rating Scales.

BACKGROUND: Frontotemporal dementia (FTD) represents the second most frequent early onset of dementia in people younger than 65 years. The main syndromes encompassed by the term FTD are behavioral variant of Frontotemporal dementia (bvFTD), non-fluent variant primary progressive aphasia (nfvPPA) and semantic variant (SD). AIMS: To assess the bvFTD and SD, which represent the most common subtypes of FTD, using visual rating scales. METHODS: Brain MRI exams of 77 patients either with bvFTD (n=43) or SD (n=34) were evaluated. The rating scales used were: Global cortical atrophy (GCA), Fazekas Scale: periventricular (PV) and white matter (WM) changes, Koedam rating scale and visual scales regarding specific cortical regions: dorsofrontal (DF), orbitofrontal (OF), anterior cingulate (AC), basal ganglia (BG), anterior- temporal (AT), insula, lateral-temporal (LT), entorhinal (ERC), perirhinal (PRC), anterior fusiform( AF), anterior hippocampus (AHIP) and posterior hippocampus (PHIP). Both Left (L) and Right (R) hemispheres were evaluated. RESULTS: R-OF (p=0.059), L-OF (p<0.0005), L-AT (p=0.047) and L-AHIP (p=0.007) have a statistically significant effect on the variable occurrence of SD compared to bvFTD. The indicators with the highest value of the area under the curve (AUC) were R-AC (0.829), L-OF (0.808), L-AC (0.791) and L-AF (0.778). Highest sensitivity was achieved by R-OF (97%) and L-AF (75%). Highest specificity was achieved by L-OF (95%), L-AT (91%) followed by R-AC (84%). Best combination of sensitivity and specificity was achieved by L-AF (74%-79%), L-OF (56%-95%) and R-OF (97%-42%). Best combination of PPV and NPV was achieved by L-OF (90%-73%), LAT (83%-72%) and R-AC (77%-77%). CONCLUSION: Visual rating scales can be a practical diagnostic tool in the characterization of patterns of atrophy in FTLD and may be used as an alternative to highly technical methods of quantification.

Correlation Between Contrast-enhanced Ultrasound Characteristics (Qualitative and Quantitative) and Pathological Prognostic Factors in Breast Cancer.

BACKGROUND/AIM: Little is known about the correlation between contrast-enhanced ultrasound (CEUS) characteristics and pathological prognostic factors in breast cancer. The aim of this study was to explore the correlation between CEUS characteristics and pathological prognostic factors. PATIENTS AND METHODS: A retrospective study with 34 malignant breast lesions was conducted. CEUS characteristics included qualitative characteristics (e.g. lesion's enhancement degree and order, internal lesion homogeneity etc.) and quantitative characteristics (e.g. peak intensity, time to peak etc.). Also, pathological prognostic factors were included (e.g. tumor grade, estrogen receptor status etc.). RESULTS: Blurred lesion margins were observed more often in tumors of high histological grade (p=0.01) and in estrogen receptor-negative tumors (p=0.049). Furthermore, perilesional enhancement was associated with positive Ki-67 expression (p=0.049), while heterogeneous internal sentinel lymph node enhancement was associated with malignant infiltration of the node (p=0.002). CONCLUSION: CEUS has the potential to provide a prevision of pathological prognostic factors in malignant breast lesions, helping in the better early patient management.

The Role of Virtual Cystoscopy, after Multidetector Computed Tomography Imaging Reconstruction without the Use of Contrast Medium, in the Diagnosis and Evaluations of Bladder Tumors: Preliminary Study.

Introduction. Although conventional cystoscopy is considered to be the gold standard for diagnosis and follow-up of bladder tumors, it remains an invasive and costly procedure. With the advent of the multidetector CT (MDCT) scanners supported by specialized software virtual cystoscopy (VC) is possible. We assess the role of VC in diagnosing and evaluating bladder lesions. Materials and Methods. Between September 2010 and October 2011, 25 consecutive patients with cystoscopically confirmed bladder tumor underwent VC. The radiologists involved in this prospective study were blinded to the exact findings. After draining any residual urine with a catheter, the bladder was retrogradely insufflated with 200-600 cc of air. No intravenous or intravesical contrast was used. MDCT scan was performed in supine and prone positions and three-dimensional reconstruction of the urinary bladder was performed. Results. The examination was well tolerated by all patients with no complications. In total, 43 lesions were detected both with conventional cystoscopy and VC. Tumor size measured by CT ranged from 3 to 80 mm in diameter. The pathological report revealed noninvasive transitional cell carcinomas in all cases. Conclusion. VC has promising results in detecting exophytic bladder lesions. In the future it could be part of the diagnostic algorithm for bladder tumors.

Suggestion for a new grading scale for radiation induced pneumonitis based on radiological findings of computerized tomography: correlation with clinical and radiotherapeutic parameters in lung cancer patients.

BACKGROUND: The objective of this research is the computed axial tomography (CT) imaging grading of radiation induced pneumonitis (RP) and its correlation with clinical and radiotherapeutic parameters. MATERIALS AND METHODS: The chest CT films of 20 patients with non-small cell lung cancer who have undergone three- dimensional conformal radiation therapy were reviewed. The proposed CT grading of RP is supported on solely radiological diagnosis criteria and distinguishes five grades. The manifestation of RP was also correlated with any positive pre-existing chronic obstructive pulmonary disease (COPD) history, smoking history, the FEV1 value, and the dosimetric variable V20. RESULTS: The CT grading of RP was as follows: 3 patients (15%) presented with ground glass opacity (grade 1), 9 patients (45%) were classified as grade 2, 7 patients (35%) presented with focal consolidation, with or without elements of fibrosis (grade 3), and only one patient (5%) presented with opacity with accompanying atelectasis and loss of pulmonary volume (grade 4). Both univariate and multivariate analysis revealed as prognostic factors for the radiological grading of RP the reduction of FEV1 and the V20 (P=0.026 and P=0.003, respectively). There was also a significant (P<0.001) correlation of radiological grading of RP with FEV1 and V20 (spearman rho 0.92 and 0.93, respectively). CONCLUSIONS: The high correlation of the proposed radiological grading with the FEV1 and the V20 is giving a satisfactory clinical validity. Although the proposed grading scale seems relevant to clinical practice, further studies are needed for the confirmation of its validity and reliability.

Radionuclide therapy of painful bone metastases--a comparative study between consecutive radionuclide infusions, combination with chemotherapy, and radionuclide infusions alone: an in vivo comparison of their effectiveness.

Radionuclides have been long used for the palliation of skeletal-related metastatic pain. They are almost invariably used as the last resource for pain palliation. Their use as single agents with dose escalations, in combination with biphosphonates or chemotherapy is well known in the peer-reviewed literature; however, little is known about the combination between different agents. In our study, we used consecutive administration of 2 different radionuclides such as (186)Re-1,1-hydroxyethylidenediphosphonate ((186)Re-HEDP) and (89)Strontium Chloride ((89)Sr-Cl) separated by adequate period of time to allow bone marrow recovery in patients with high chance of bone pain relapse and compared it with (89)Sr-Cl and chemotherapy group and (186)Re-HEDP with bisphosphonates. The end result was that treatment with consecutive radionuclides was much more effective and safe than the other 2 groups.

Activities of daily living in Greek cancer patients treated in a palliative care unit.

GOALS OF WORK: To assess the psychometric properties of the Activities of Daily Living (ADL) scale on a Greek sample of advanced cancer patients. PATIENTS AND METHODS: The scale was translated with the forward-backward procedure to Greek. The ADL scale was administered to 136 advanced cancer patients. It was administered twice, with a 3-day interval, to 40 (of the 136) eligible patients with advanced cancer to assess the scale's stability. For the assessment of treatment effect, the index was administered to 90 (of the 136) patients 15 days later. Together with the ADL scale, the patients also completed the Instrumental Activities of Daily Living (IADL) scale. Confirmatory factor analysis was carried out using the AMOS 7.0 analysis. The reliability was assessed by the internal consistency (Cronbach's alpha co-efficients), and test/retest (Spearman's r value) of the instrument. Validity was assessed with construct validity using the IADL scale, treatment-effect, known groups, and convergent validity. MAIN RESULTS: The homogeneity of the scale proved to be satisfactory (cronbach alpha = 0.88). Overall test-retest reliability was satisfactory. Construct validity has shown satisfactory correlations with IADL p < 0.0005. Convergent validity and treatment effect were satisfactory at p < 0.0005 and p < 0.05, respectively. Known groups validity detected differences according to patient's performance status (p < 0.0005). CONCLUSIONS: The results suggest that the Greek version of ADL administered in cancer patients treated in a palliative care unit is a reliable and valid clinical instrument.

Geriatric depression in advanced cancer patients: the effect of cognitive and physical functioning.

AIM: The aims of the current study were to evaluate geriatric depression and its risk factors in advanced cancer patients. METHODS: A cross-sectional study was carried out in a palliative care unit in Greece. Patients completed the Geriatric Depression Scale, the M. D. Anderson Symptoms Instrument (MDASI), the Activities of Daily Living and the Mini-Mental State Examination. Patients were included if they were aged >65 years, if they had cancer, were able to communicate and had agreed to sign informed consent. The final sample consisted of 92 elderly advanced cancer patients. RESULTS: The prevalence of depression was found to be 67.4%. The univariate comparison between the depressed elderly and non-depressed group showed that patients with metastases were found to be 2.2-fold more likely to suffer from geriatric depression compared with those without metastases (P = 0.074). Patients with moderate or severe cognitive impairment were found to be 3.61-fold more likely to suffer from geriatric depression in comparison with those with normal cognitive function (P = 0.019). In the multiple logistic regression analysis, elderly with cognitive impairment were 3.3-fold more likely to have geriatric depression than those without (adjusted odds ratio = 3.3 [95% CI 0.99-10.74], P = 0.052) and MDASI factor 1 was consistently a significant risk factor for depression in the elderly; when MDASI factor 1 increased by 1 unit, the odds of being classified as depressed increased by 7.6%. CONCLUSIONS: The present study found that cognitive impairment and symptoms such as enjoyment of life, walking, relationship with people, general activity, sadness and pain (MDASI F1) are strong independent predictors of depression in the elderly.

Relationship of general self-efficacy with anxiety, symptom severity and quality of life in cancer patients before and after radiotherapy treatment.

PURPOSE: Treatment-related symptoms can increase psychological and physical distress and alter the patient's quality of life. The present study evaluates prospectively treatment-related symptoms, general self-efficacy, anxiety and quality of life (QoL) in patients with different types of cancer undergoing external beam radiotherapy (RT) and the relationship of patients' general self-efficacy with the assessed measures, at the baseline and their absolute change 1 month after the end of the treatment. METHODS: The sample consisted of 90 cancer patients. General self-efficacy was assessed using the General Perceived Self-efficacy (GSE). QoL was evaluated using the Linear Analogue Scale Assessment (LASA), anxiety with the Anxiety subscale of the Hospital Anxiety and Depression (HAD) scale, whereas symptom severity and interference were assessed using the MD Anderson Symptom Inventory (MDASI). The instruments were administered first at the beginning of the RT and then 1 month after the completion of the RT. RESULTS: At post-treatment, general self-efficacy was reduced (28.86 ± 6.42), anxiety scores were elevated (9.56 ± 4.42), QoL scores were reduced (6.74 ± 1.81) and symptoms severity were deteriorated (3.24 ± 2.62). Pre-treatment and post-treatment absolute change scores revealed statistically significant negative correlations between general self-efficacy absolute scores and anxiety (p < 0.0005). Moderate negative correlations between general self-efficacy absolute scores and symptoms (MDASI symptom severity: p = 0.003, symptom interference: p = 0.002), whereas a low positive correlation was found between general self-efficacy absolute scores and LASA energy scale (p = 0.048). CONCLUSIONS: A sense of self-efficacy and its relationship with anxiety, symptom distress and quality of life are important factors for patients receiving radiotherapy. Health care professionals need to be aware of anxiety, symptom severity and patient's quality of life prior to treatment initiation.

Three-dimensional conformal radiotherapy for hepatocellular carcinoma in patients unfit for resection, ablation, or chemotherapy: a retrospective study.

PURPOSE: The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensional conformal radiotherapy (3DCRT) in patients with advanced hepatocelluar carcinoma (HCC) and inferior vena cava tumor thrombosis (IVCTT). METHODS: Between 2007 and 2012, in a retrospective way, 9 patients (median age 69 years) with advanced HCC and IVCTT unfit for surgery, radiofrequency ablation, embolization, or chemotherapy were treated with three-dimensional conformal radiotherapy (3DCRT). The radiotherapy volume included both primary tumor and IVTT. The radiotherapy schedule was 50-52 Gy in 2 Gy fractions. Overall survival (OS), response to radiotherapy, visual analogue scale (VAS), and toxicity were assessed. RESULTS: All patients demonstrated a response rate up to 60%. During radiotherapy, 3 patients experienced grade 1 nausea/vomit toxicity. All patients demonstrated an elevation of the liver enzymes (3 patients with grade 1 and 6 patients with grade 2). The mean VAS-score was decreased from 6.11 to 3.11, while the median overall survival was 24 months. CONCLUSION: 3DCRT achieves a very high local control rate and is suitable for patients with HCC and IVTT, while the documented radiation induced toxicity is moderate. It can be recommended for palliation in patients unable to undergo curative therapies.

A test of the psychometric properties of the cancer locus of control scale in Greek patients with advanced cancer.

OBJECTIVE: The study aimed to assess the psychometric properties of the Cancer Locus of Control (CLOC) scale on a Greek sample of advanced cancer patients. METHODS: The scale was translated with the forward-backward procedure to Greek. The CLOC scale was administered to 140 advanced cancer patients. It was administered twice, with a 3-day interval, to 100 (of the 140) eligible patients with advanced cancer. Together with the CLOC scale, the patients also completed the Greek Mental Adjustment to Cancer (G-MAC) scale. Confirmatory factor analysis was carried out using the AMOS 7.0 analysis. The reliability was assessed by the internal consistency (Cronbach's α coefficients), test-retest (Spearman's r value) of the instrument, and inter-item correlations. Construct validity was assessed using the G-MAC scale, interscale correlations, item-scale correlations, and scales-total correlations. RESULTS: The homogeneity of the subscales proved to be satisfactory (α coefficient ranged from 0.713 to 0.786). Overall test-retest reliability was satisfactory at p < 0.0005. Construct validity has shown moderate correlations with G-MAC p < 0.0005. Interscale and inter-item correlations were satisfactory at p < 0.05. CONCLUSIONS: The results suggest that the Greek version of CLOC administered in cancer patients treated in a palliative care unit is a reliable and valid clinical instrument.

Social factors influencing hospital arrival time in acute ischemic stroke patients.

INTRODUCTION: This is a multi-center, hospital-based study aiming to estimate social factors influencing pre-hospital times of arrival in acute ischemic stroke, with a perspective of finding ways to reduce arrival time and to augment the number of patients eligible for intra-arterial thrombolysis. METHODS: Acute ischemic stroke patients who presented at the emergency units of four major general public hospitals were registered. We assessed information concerning demographics, time of presentation, clinical situation, imaging, treatment, and socioeconomic factors. The sample was divided in two sub-samples, based on the time of arrival since onset of symptoms, and was statistically analyzed. RESULTS: During one calendar year (2005), 907 patients were registered. Among them 34.6% arrived in the first 6 h from symptom onset, 38.7% arrived between 6 and 24 h, 18.1% after 24 h and for 8.6% the time of onset was unknown. Younger age (P = 0.007), transfer with ambulatory service (Ρ = 0.002), living with a mate (Ρ = 0.004), and higher educational level (P < 0.005) were factors which correlated significantly with early arrival at the hospital. CONCLUSIONS: Instructing patients at high risk for stroke to live with a housemate appears beneficial for timely arrival at the hospital. The establishment of dedicated acute stroke call and transportation center should improve the percentage of early arrival. A national information campaign is needed to increase the level of awareness of the population concerning beneficial social behaviors and optimal reaction to symptoms of acute ischemic stroke.

Well-differentiated hand liposarcoma with bone metastases treated successfully with zoledronic Acid.

BACKGROUND: Well-differentiated liposarcomas of the upper extremities, such as the hand or forearm, are extremely rare and are commonly misdiagnosed and considered benign. They are frequently reported as having low metastatic potential. CASE REPORT: We report the case of a 58-year-old man with well-differentiated hand liposarcoma and diffuse bone metastases. The patient initially presented with a tumor of the thenar eminence and was treated with marginal surgical excision and external beam irradiation. 4 months after this treatment, soft tissue local recurrence and skeletal metastases were detected. Zoledronic acid treatment (4 mg per month) was initiated, and both the tumor and the metastases regressed. The patient remains cancer-free 3.5 years after diagnosis of the metastatic disease. CONCLUSION: Significant metastatic disease can develop in patients with well-differentiated liposarcomas. The beneficial effect of zoledronic acid observed in this case may be related to its anticancer properties, as described in phase III trials in various tumor types.

Fentanyl nasal spray for the treatment of cancer pain.

INTRODUCTION: Breakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated. AREAS COVERED: Oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients. EXPERT OPINION: The aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation.

Degenerative endplate changes of the lumbosacral spine: dynamic contrast-enhanced MRI profiles related to age, sex, and spinal level.

PURPOSE: To investigate differences in perfusion profiles between degenerative endplate marrow changes and normal vertebral marrow in relation to spinal level, age, and sex with dynamic contrast-enhanced magnetic resonance imaging (DCE MRI). MATERIALS AND METHODS: Ninety-two consecutive patients referred for evaluation of low back pain or sciatica, without history of malignant or chronic disease, underwent conventional and DCE MRI of the lumbosacral spine. Fifty-two of them demonstrated degenerative endplate marrow changes. Regions of interest were placed on sites of normal marrow (group A) and degenerative changes (group B) on subtracted images. Fitted time-intensity curves (fTICs) were generated and evaluated for curve pattern. Both groups were stratified into upper (L1-L2) and lower (L3-I1) levels, males and females younger or older than 50 years. Perfusion parameters were calculated and statistically compared for both groups and subgroups. Receiver operator curve (ROC) analysis was also performed. RESULTS: Two fTIC patterns were identified. Perfusion parameters of degenerative changes and normal marrow differed significantly, even when groups were stratified for spinal level, age, and sex (P < 0.05). A time to peak value >108 seconds was characteristic for degenerative changes with sensitivity 69.5% and specificity 84.6%. CONCLUSION: DCE MRI profiles of degenerative endplate marrow changes of the lumbosacral spine differ significantly from normal marrow regardless of spinal level, age, or sex.

The mediation effect of anxiety between post-traumatic stress symptoms and preparatory grief in advanced cancer patients.

CONTEXT: The relationship between anxiety and preparatory grief is complex and poorly understood. OBJECTIVES: To investigate the relationship between anxiety, post-traumatic stress symptoms, and preparatory grief in a sample of patients with advanced cancer. METHODS: Ninety-four patients with advanced cancer completed the Greek version of the Impact of Events Scale-Revised (IES-R-Gr), the Anxiety subscale of the Greek Hospital Anxiety and Depression Scale, and the Preparatory Grief in Advanced Cancer Patients (PGAC) scale. RESULTS: Statistically significant associations were found between IES-R-Gr subscales, anxiety (P<0.0005), and PGAC (P<0.0005). CONCLUSION: Some of the effect of post-traumatic stress symptoms on preparatory grief is mediated by anxiety.

Self-efficacy, depression, and physical distress in males and females with cancer.

AIMS: to examine the relationship between self-efficacy with depression and physical distressing symptoms in males and females with cancer. METHODS: a total of 41 males and 49 females with cancer completed the General Perceived Self-Efficacy Scale (GSE), depression scale, from the Hospital Anxiety and Depression Scale (HAD-D), and the MD Anderson Symptom Inventory (MDASI). RESULTS: correlations were found between depression and self-efficacy in males (r = -.501, P = .001) and females (r = -.588, P < .0005). The multivariate regression analysis revealed that education and depression could influence self-efficacy in male population. Urogenital versus breast cancer as well as depression seemed to influence females' self-efficacy. CONCLUSIONS: patients who had higher self-efficacy had lower depressive symptoms. Men with depressive symptoms and women with breast cancer and depression are more likely to have low self-efficacy than patients with other cancer types.

Attitudes of health care professionals, relatives of advanced cancer patients and public towards euthanasia and physician assisted suicide.

OBJECTIVES: Nowadays, euthanasia has the meaning of the direct administration of a lethal agent to the patient by another party with a merciful intent after patients' request. Physician assisted suicide refers to the patient intentionally and wilfully ending his or her own life with the assistance of a physician. The objectives of the manuscript were to investigate the opinions of Greek physicians, nurses, lay people and relatives of advanced cancer patients on euthanasia and physician assisted suicide. METHODS: The final sample consisted of 215 physicians, 250 nurses, 218 relatives and 246 lay people. A survey questionnaire was used concerning issues such as euthanasia and physician assisted suicide. The survey instrument included 13 questions and described issues such as religious and spiritual beliefs, euthanasia, physician assisted suicide and decision-making situations. RESULTS: 43.3% physicians and 41.3% relatives would agree in advance that in case of heart and/or respiratory arrest there would not be an effort to revive a terminally ill cancer patient. 20.5% physicians had a request for euthanasia. Significant associations were found between physicians (9.3%), relatives (1.8%, p=0.001) and lay people (3.7%, p=0.020) on their opinions regarding withdrawing treatment. CONCLUSIONS: The majority of the participants were opposed to euthanasia and physician assisted suicide. However many would agree to the legalization of an advanced cancer patient's hastened death.

Extensive tumoral calcinosis in a patient with systemic sclerosis.

Tumoral calcinosis, a rare disease manifesting with periarticular, calcified masses in soft tissues, can be either primary or secondary to a disease, such as systemic sclerosis. In the case reported here, a patient diagnosed with systemic sclerosis presented with hard calcified masses that involved the shoulders and hips.

Predictive implications of bone turnover markers after palliative treatment with (186)Re-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases.

PURPOSE: To prospectively evaluate the predictive value of various bone formation and resorption markers in patients with bone metastases from prostate cancer after palliative treatment with (186)Re-1,1-hydroxyethylidene diphosphonate ((186)Re-HEDP). METHODS: Included in the study were 36 men with prostate cancer, suffering from painful osseous metastases and treated with (186)Re-HEDP. None had received any treatment that would have interfered with bone metabolism before (186)Re-HEDP treatment or throughout the follow-up period. For each patient, pretreatment and posttreatment serum levels of osteocalcin (OC), bone alkaline phosphatase (BALP), aminoterminal (PINP) and carboxyterminal (PICP) propeptides of type I collagen, amino-terminal (NTx) and carboxyterminal (CTx) telopeptides of type I collagen and their combinations were compared with the level and duration of pain response to radionuclide treatment. RESULTS: Pain response was correlated only with pretreatment NuTaux/PINP, PICP/PINP and NTx/CTx ratios and posttreatment decrease in baseline NTx and PICP values (p = 0.0025-0.035). According to multivariate and ROC analyses, the best marker-derived predictors of better and longer duration of response to (186)Re-HEDP treatment were a posttreatment decrease in NTx of > or = 20% (RR = 3.44, p = 0.0005) and a pretreatment NTx/PINP ratio of > or = 1.2 (RR = 3.04, p = 0.036) CONCLUSION: NTx, a potent collagenous marker of bone resorption, along with the novel NTx/PINP ratio provide useful cut-off values for identifying a group of patients suffering from painful osseous metastases from hormone-refractory prostatic carcinoma who do not respond to palliative treatment with (186)Re-HEDP. This information could help avoid an inefficient and expensive radionuclide treatment. Also, in the cohort of patients who will eventually undergo such treatment, the medium-term posttreatment changes in NTx offer valuable predictive information regarding long-term palliative response.

Anterior cruciate ligament deficiency causes brain plasticity: a functional MRI study.

BACKGROUND: The mechanoreceptors located in anterior cruciate ligament (ACL) constitute an afferent source of information toward the central nervous system. It has been proposed that ACL deficiency causes a disturbance in neuromuscular control, affects central programs and consequently the motor response resulting in serious dysfunction of the injured limb. PURPOSE: The objective of this study was to investigate whether chronic anterior cruciate ligament injury causes plastic changes in brain activation patterns. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Seventeen right leg-dominant male participants with chronic anterior cruciate ligament deficiency and 18 matched healthy male participants with no special sport or habitual physical activity participated in this study. Patient selection criteria comprised a complete right unilateral anterior cruciate ligament rupture > or = 6 months before testing. Brain activation was examined by using functional magnetic resonance imaging technique (1.5-T scanner). RESULTS: Results show that patients with anterior cruciate ligament deficiency had diminished activation in several sensorimotor cortical areas and increased activation in 3 areas compared with controls: presupplementary motor area, posterior secondary somatosensory area, and posterior inferior temporal gyrus. CONCLUSION: The current study reveals that anterior cruciate ligament deficiency can cause reorganization of the central nervous system, suggesting that such an injury might be regarded as a neurophysiologic dysfunction, not a simple peripheral musculoskeletal injury. This evidence could explain clinical symptoms that accompany this type of injury and lead to severe dysfunction. Understanding the pattern of brain activation after a peripheral joint injury such as anterior cruciate ligament injury lead to new standards in rehabilitation and motor control learning with a wide application in a number of clinical and research areas (eg, surgical procedures, patient re-education, athletic training, etc).