Radiosurgery effects and adverse effects in symptomatic eloquent brain-located Cavernomas.

In this study, the dose schedule efficacy, safety and late adverse effects of stereotactic radiosurgery (SRS) were evaluated for patients with symptomatic cavernomas who were not eligible for surgery and treated with SRS. Between January 2013 and December 2018, 53 patients with cavernomas were treated using SRS with the CyberKnife® system. Patients' diseases were deeply located or were in subcortical functional brain regions. In addition to bleeding, 23 (43.4%) patients had epilepsy, 12 (22.6%) had neurologic symptoms and 16 patients (30.2%) had severe headaches. The median volume was 741 (range, 421-1351) mm3, and the median dose was 15 (range, 14-16) Gy in one fraction. After treatment, six (50%) of 12 patients with neurologic deficits still had deficits. Rebleeding after treatment developed in only two (3.8%) patients. The drug was completely stopped in 14 (60.9%) out of 23 patients who received epilepsy treatment, and the dose of levetiracetam decreased from 2000 mg to 1000 mg in four (17.3%) of nine patients. Radiologically, complete response (CR) was observed in 13 (24.5%) patients, and partial responses (PR) were observed in 32 (60.2%) patients. Clinical response of CR was observed in 30 (56.6%) patients, PR was observed in 16 (30.2%), stable disease (SD) was observed in three (5.7%) and four (7.5%) patients progressed. In conclusion, SRS applied in the appropriate dose schedule may be an effective and reliable method in terms of symptom control and prevention of rebleeding, especially in patients with inoperable cavernomas.

A case of an idiopathic massive osteolysis with skip lesions.

A patient with a 2-year history of pain in the left arm, and decreased strengths unrelieved by non-steroidal anti-inflammatory therapy, was being referred for repeating radiography. The radiologic examinations have demonstrated a unique pattern of non-contiguous osteolysis in the left elbow, proximal and distal radius, ulna, wrist, carpal bones, proximal and distal metacarpals and phalanges. Multi-site biopsies were being performed and confirmed the diagnosis of massive osteolysis. To our knowledge, this is the first case in which multifocal, non-contiguous osteolysis with skip lesions without associated nephropathy and without a hereditary pattern is being described in one extremity.

Normal diaphragmatic motion and the effects of body composition: determination with M-mode sonography.

OBJECTIVE: To evaluate the quantitative measurement of diaphragmatic motion in healthy subjects and to investigate the effects of different variables such as body mass index and waist circumference on the diaphragmatic motion. METHODS: The study included 164 healthy subjects. The subjects were grouped according to age, sex, body mass index, and waist circumference. Measurements of diaphragmatic motion were made by a 3.5-MHz sonographic unit in the M-mode of the system. The posterior diaphragm on both sides was identified, and measurements were performed during deep inspiration. RESULTS: The mean diaphragmatic motion measurements +/- SD were 49.23 +/- 10.98 and 50.17 +/- 11.73 mm on right and left sides, respectively. Female subjects had statistically significantly (P < .05) decreased diaphragmatic motion (right, 46.93 +/- 10.37 mm; left, 47.57 +/- 10.36 mm) than male subjects. The mean diaphragmatic motion (right, 40.90 +/- 8.89 mm; left, 39.37 +/- 9.15 mm) was less in subjects who were underweight (P < .05) when compared with subjects who were of normal weight, overweight, and obese. Subjects who had a waist circumference of less than 70 cm showed a statistically significant decrease (P < .05) in diaphragmatic motion (right, 42.55 +/- 9.12 mm; left, 42.24 +/- 9.73 mm) when compared with subjects who had a waist circumference of 70 to 85, 85 to 100, and greater than 100 cm. Also, subjects younger than 30 years had statistically significantly (P < .05) decreased diaphragmatic motion (right, 44.57 +/- 10.57 mm; left, 44.44 +/- 11.37 mm). CONCLUSIONS: Sex, body mass index, waist circumference, and age may affect the diaphragmatic motion to some extent. Healthy persons of younger age with a smaller body mass index and waist circumference may show a decreased amount of diaphragmatic motion.