1,721,010 research outputs found
The role of PD-L1 in biological behavior of intracranial meningiomas
No full textMeningiomas are considered a substantially benign disease that can be treated surgically in the vast majority of patients. However, there are forms of meningioma characterized by greater aggressiveness and/or tendency to recurrence.
To date, grading is the only known factor that provides some information about the biological behavior of meningiomas. As a matter of fact, patients with high grade meningiomas (WHO grade 2 and 3) have a significant higher risk to develop local recurrence after treatment and, consequently, they tend to have a shorter survival compared to patients with WHO grade 1 meningiomas .However, even grade 1 meningiomas can recur even if with less frequency.
Given that to date there are no approved pharmacological treatments for meningiomas and that the use of treatments such as hormone-therapy and chemotherapy have not shown any substantial benefit, it seems appropriate to hypothesize new innovative therapeutic strategies and verify their biological plausibility.
To our knowledge, this is the first report of increased PD-L1 expression in meningioma recurrences compared to their primary presentation, regardless of their grade. The high prevalence of PD-L1 expression in the meningioma population and its correlation with grade and clinical behavior may be an important tool to tailor therapeutical strategies and follow up, in particular in high grade and recurrent cases.
Moreover, the results obtained contribute to build a rational basis for designing therapeutic trials that use immunotherapy in the treatment of meningiomas
Carpal tunnel syndrome: Epidemiology and risk factors
No full textCarpal tunnel syndrome (CTS) is the most frequent mononeuropathy seen in the general population. Defined as median nerve compression at the level of the wrist, CTS causes numbness and tingling in the hand and fingers. The first introduction of the term "carpal tunnel syndrome" is attributed to Brain in 1947 and the popularization of its diagnosis and treatment to Phalen in 1950. Since then, there has been continued debate over the optimal management of this disease. CTS is the most expensive upper-extremity musculoskeletal disorder at an estimated cost of medical care in the US exceeding $2 billion annually, primarily due to surgical releases. The extra-medical costs are substantially greater. In fact, during 2006 in the US, surgeons performed 580,000 outpatient carpal tunnel releases [6] and the median lost worktime from work-related CTS is 27days, which is longer than any other work-related disorder except fractures. Although CTS is a strong driver of workers compensation costs, lost wages, lost productivity, and disability, there is still an incomplete understanding of its frequency and causes in working populations. Prevalent CTS in general populations range from 1-5% and among manufacturing and meat-packing workers has ranged from 5- 21%. Incidence rates from many studies on workers of CTS ranged from 1-15 per 1000 person-years and varied by industrial and occupational. In the general population, the emphasis on possibly risk factors is focused on demographic characteristics (female gender, older age) and on comorbid conditions (higher BMI, rheumatoid arthritis, diabetes mellitus and thyroid disease. Associations between CTS and other risk factors, such as gout, smoking status are uncertain as well as personal and workplace psychosocial possible involvement. However, general population studies do not take workplace exposures into account. The prevalence of CTS in working populations is generally higher than in the general population. Occupation-related CTS represents one of the major health problems among workers in various occupations throughout the world including Sweden, Italy, France, Japan, Taiwan. Recognized occupational risk factors are identify manual loadings with a significantly higher risk or association with CTS, comprise the use of handheld vibrating machinery, forceful gripping of objects with hands, repetitive and frequent manual tasks and forced postures of the wrist (flexion/extension). These loadings are usually combined during occupational work
Carpal tunnel syndrome: Carpal tunnel release - mini-open technique
No full textCarpal tunnel syndrome (CTS) is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized for the carpal tunnel syndrome, although certain indications would specifically indicate the need for surgery. Conservative management is typically preferred for transient cases of CTS such as those associated with pregnancy, short-term overuse or where other exacerbating phenomena are expected to be corrected. In other cases conservative management might be used for partial relief of symptoms while awaiting surgery or for diagnostic purposes in determining patient response [1].The surgical intervention for CTS is recommended in remaining case, in which is common to find out these characteristics: constant numbness, symptoms > 1 year durations, sensory loss, thenar weakness/atrophy. The first popularization of diagnosis and treatment of "carpal tunnel syndrome" is attributed to Phalen in 1950. Since then, there has been continued debate over the optimal management of this disease [2]. Currently, surgical options include these techniques: carpal tunnel release with a standard open, carpal tunnel release using various incision techniques (such as mini-open), endoscopic carpal tunnel release, open carpal tunnel release with additional procedures such as internal neurolysis, epineurotomy or tenosynovectomy. From August 2004 to November 2013, 780 procedures of carpal tunnel release using a mini open incision technique have been performed in our department. The procedure starts with an accurate skin detersion and disinfection. The intervention has been performed under local anesthesia and exsanguination with pneumatic tourniquet at the limb. The wrist extended approximately 30°. 2 cm long scalpel incision on Taleisnik line. Retraction of skin edges, incision of palmar aponeurosis, exposition and complete opening of flexor retinaculum to perform an external neurolysis of median nerve from fibro/adherential tissue. Before the wound closure a water dissection is performed to complete the procedure and to evaluate the decompression within the carpal tunnel. Postoperative bulky dressing and skin sutures are kept for 10 days and then removed. No complications like nerve, vascular or tendon damage, nor infection, relapse or failed treatment occurred. The one exception was a case of postoperative wound infection in a patient who dirtied the dressing during activities in a farm. In all cases patients referred a fast total regression of preoperatively symptoms. No painful and hypertrophic scars were observed
Percutaneous radiofrequency thermocoagulation of dorsal ramus branches as a treatment of âlumbar facet syndromeâ - How I do it
No full textBackground: Low back pain is an extremely common and often chronic condition. In some cases, this is due to an irritative arthropathy of zygapophyseal joint involving the medial branch of the dorsal ramus of the spinal nerve. Percutaneous radiofrequency thermocoagulation appears to be the most effective treatment to date, among a range of different treatments. In this paper, the technique is described as performed at out institution. Methods: In supine position and under fluoroscopic control, a radiofrequency electrode is inserted into different articular zygapophyseal complexes to thermocoagulate ramifications of the medial branch of the dorsal primary ramus of the spinal nerve. Conclusions: Fluoroscopic-guided percutaneous radiofrequency thermocoagulation of dorsal rami branches is a safe and reliable technique for the treatment of lumbar facet syndrome. Careful selection of patients based on clinical presentation and positive anesthetic block test are key points for an optimum outcome
A giant calcific aneurysm of an aplastic middle cerebral artery in an infant: pathophysiological description with embryological hypothesis
No full textCavernous angioma within the context of anaplastic oligodendroglioma: case report and review of the literature
No full textTranscranial approach for surgical-combined-endovascular treatment of a cavernous dural arteriovenous fistula: the superficial sylvian vein route
No full text
- …
