1,720,972 research outputs found
Microparticelle plasmatiche nei pazienti affetti da glioblastoma: ruolo nello sviluppo delle complicanze tromboemboliche venose e potenziale utilizzo come marcatori di progressione neoplastica
Full text linkBackground: The clinical course of patients with glioblastoma is burdened with a poor prognosis. Furthermore, the hypercoagulable state associated with this cancer and the possible thromboembolic complications (VTE) may significantly worsen the prognosis. Moreover, the absence of tumor markers in glioblastoma makes the follow-up of these patients strictly dependent on the neuroimaging examination that might be controversial. Circulating tumor-derived microparticles (MPs), that are present in various types of tumors, associated with prothrombotic activity, were also found in the plasma of patients with glioblastoma.
Objective: To evaluate the first postoperative thromboembolic complications after surgery for brain tumor in a sample of patients. To determine the relationship between circulating microparticles (MPs) and thromboembolism. To assess the relationship between MPs and progression of disease in patients treated for newly diagnosed glioblastoma in order to evaluate the possible use of MPs as markers of disease.
Materials and methods: In 57 patients, without TEV and subjected to neurosurgical intervention for glioblastoma and meningioma, blood levels of D-Dimer before surgery and III and VII days after surgery were assayed. All patients received the same antithrombotic prophylaxis and lower extremities ultrasonography before surgery and seven days after surgery.
We measured baselines levels of MPs and procoagulant activity in a second group of 25 patients treated for newly diagnosed GBM and we compared these data with a group of 75 healthy controls. We assayed MPs 1, 4 and 7 months after surgery, and we examined the possible occurrence of thromboembolic complications and disease progression. All patients underwent adjuvant treatment according to the protocol Stupp within 6 weeks after surgery.
Results: In the first group of patients, VTE complication occurred in 17.5 % of patients without clinical signs or symptoms. The D-dimer level significantly increased in the basal sample, in third and seventh postoperative days in patients who developed VTE compared to those who did not develop VTE.
In the second group of patients, circulating MPs and prothrombotic activity were significantly increased in patients compared to healthy controls. These counts were also significantly higher in patients who developed VTE compared to those who did not have this complication. Similarly, the circulating MPs were higher in patients who went against disease progression compared to stable controls.
Conclusions: In the first post-operative period, the D-Dimer plasmatic levels’ trend can help in the diagnosis of VTE in the absence of clinical signs or symptoms. The increase of circulating MPs correlates with VTE strengthening the hypothesis of a prothrombotic role of these particles. The increase of circulating MPs in patients with progression of the disease seems suggest their possible use as tumoral markers
Cervical myelomeningocele in adulthood: case report.
No full textOBJECTIVE: Cervical myelomeningocele is an extremely rare condition, accounting for only 1 to 5% of all neural tube defects. These lesions are usually diagnosed in childhood. Here, we report a case of a cervical myelomeningocele diagnosed and treated in adulthood.
CLINICAL PRESENTATION: A 52-year-old man presented with a 3-year history of progressing weakness and paresthesia in his upper limbs. Physical examination revealed a posterior midline neck mass covered with normal skin. Magnetic resonance imaging showed a soft-tissue mass tethering the cord by a stalk extending from the dorsal spinal cord to the dome of the lesion. Syrinx was evident cranially and caudally to the origin of the posterior stalk.
INTERVENTION: Surgical resection of the sac and intradural exploration were performed. The subdural space was explored, and the tethered structures were released. Histological examination showed small foci of meningothelial cells with psammoma bodies and rare thin fascicle of glial tissue dispersed in hyaline tissue. Immunohistochemical stains against glial fibrillary acidic protein and S100 confirmed the presence of bands of astrocytic tissue. The patient demonstrated early improvement of neurological deficits. Six months after surgery, he was asymptomatic and magnetic resonance imaging showed resolution of the syrinx.
CONCLUSION: We believe the syrinx in this patient was caused by a blockade of flow in the central canal and around the spinal cord as a result of the tethered cord. The untethering procedure resulted in the collapse of the syrinx followed by resolution of neurological deficits
Intraventricular astroblastoma. Case report. J Neurosurg Pediatrics. 2008 Feb;1(2):152-5. Review. PMID: 18352788 [PubMed - indexed for MEDLINE]
No full textAstroblastoma is a rare primary brain neoplasm that accounts for 0.45-2.8% of brain gliomas. Intraventricular localization is extremely rare. The authors report a case of well-differentiated completely intraventricular astroblastoma in a 6-year-old girl and review the relevant literature. Their patient presented with a 5-week history of progressive nausea and vomiting. Magnetic resonance (MR) imaging revealed a large, well-demarcated, solid-cystic mass in the left temporooccipital ventricular horn. Macroscopic radical resection of the tumor was performed via the superior temporal sulcus. The postoperative course was uneventful and no adjuvant therapy was administered after surgery. No recurrence was detected at 9-months follow-up. Gross-total resection has the greatest impact on patient survival. In differentiated tumors, recurrence is usually local, and adjuvant therapy is recommended after repeated resection for the treatment of recurrence. In patients harboring anaplastic astroblastoma, gross-total resection and adjuvant therapy after the initial surgery seems to be the best choice. It is important to distinguish astroblastoma from ependymoma in clinical practice because of the differences in therapeutic approaches
Intraventricular astroblastoma. Case report.
No full textOBJECTIVE: We describe a minimally invasive echo-guided placement of the cardiac tube in a ventriculoatrial shunt in a young pregnant woman, in order to avoid any radiological procedure.
METHODS: We used a central venous catheter placement kit for percutaneous echo-guided right internal jugular vein puncture located by a 7.5 mHz microlinear probe. Through the catheter, the distal portion of the shunt device was positioned into the internal jugular vein to the right atrium using ultrasound control by a 2.5 to 3.5 mHz probe in a four-chamber transthoracic view.
RESULTS: Sonographic guidance in percutaneous placement of a vertebral artery shunt is a safe and fast minimally invasive technique that improves success rates and decreases complications such as incidental puncture of the carotid artery and pneumothorax. The use of a two-dimensional echocardiographic apparatus in a four-chamber transthoracic view is an accurate and simple method to verify the position of the distal tip of the shunt in the mid-right atrium with no risks for the patient.
CONCLUSION: The use of these two techniques allows a minimally invasive, safe, accurate, and complete x-ray-free procedure
Cervical myelomeningocele in adulthood: case report. Neurosurgery. 2008 May;62(5):E1169-71; discussion E1171. PMID: 18580788 [PubMed - indexed for MEDLINE]
No full textOBJECTIVE: Cervical myelomeningocele is an extremely rare condition, accounting for only 1 to 5% of all neural tube defects. These lesions are usually diagnosed in childhood. Here, we report a case of a cervical myelomeningocele diagnosed and treated in adulthood.
CLINICAL PRESENTATION: A 52-year-old man presented with a 3-year history of progressing weakness and paresthesia in his upper limbs. Physical examination revealed a posterior midline neck mass covered with normal skin. Magnetic resonance imaging showed a soft-tissue mass tethering the cord by a stalk extending from the dorsal spinal cord to the dome of the lesion. Syrinx was evident cranially and caudally to the origin of the posterior stalk.
INTERVENTION: Surgical resection of the sac and intradural exploration were performed. The subdural space was explored, and the tethered structures were released. Histological examination showed small foci of meningothelial cells with psammoma bodies and rare thin fascicle of glial tissue dispersed in hyaline tissue. Immunohistochemical stains against glial fibrillary acidic protein and S100 confirmed the presence of bands of astrocytic tissue. The patient demonstrated early improvement of neurological deficits. Six months after surgery, he was asymptomatic and magnetic resonance imaging showed resolution of the syrinx.
CONCLUSION: We believe the syrinx in this patient was caused by a blockade of flow in the central canal and around the spinal cord as a result of the tethered cord. The untethering procedure resulted in the collapse of the syrinx followed by resolution of neurological deficits
Carmustine wafer implantation when surgical cavity is communicating with cerebral ventricles: technical considerations on a clinical series.
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