Outcome of peroneal neuropathies in patients with systemic malignant disease.
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Humans↗
Biomedical subjects
A Twijnstra
Publications and source records attributed to A Twijnstra.
The role of chemotherapy in intracranial germinoma: a case report.
BACKGROUND: The case of a 29-year-old man with histologically proven simultaneous germinoma (seminoma) of the pineal gland and a stage I embryonal carcinoma of the testis is reported. An intradural metastatic lesion from the pineal germinoma was diagnosed at the level of the first thoracic vertebra. Treatment, after inguinal orchiectomy, was chemotherapy only, rather than conventional radiotherapy for the pineal germinoma. METHODS: Therapy consisted of bleomycin (B), etoposide (E) and cisplatin (P). MRI was used to assess the effectiveness of BEP chemotherapy. RESULTS: A complete remission of the pineal gland germinoma and the epidural metastasis was documented after two cycles of BEP chemotherapy and after 15 months of follow-up the patient remains free of relapse. DISCUSSION: The pathogenesis of simultaneously occurring germinoma of the pineal gland and embryonal cell carcinoma of the testis is discussed. The choice of therapy in these circumstances is a matter of debate and the good result of chemotherapy alone in this patient suggest that primary chemotherapy may be the therapy of choice in patients with pineal germinomas.
Adult↗
Anti-Hu antibody titre and brain metastases before and after treatment for small cell lung cancer.
OBJECTIVES: To follow up the level of anti-Hu antibody titres during chemotherapy and to compare the pattern of metastases and other neurological complications before and after chemotherapy in patients with small cell lung cancer (SCLC) with and without low titre anti-Hu antibodies. Seventeen per cent of patients with SCLC without paraneoplastic syndromes have a low titre of anti-Hu antibodies in their serum. Previous studies suggested that these antibodies correlate with a more indolent tumour growth. METHODS: The serum of 52 consecutive patients with SCLC were studied before and during chemotherapy, and the correlation with stage of disease and pattern of metastases was examined. All serum samples were investigated using western blot and enzyme linked immunosorbent assay (ELISA) with HuD recombinant protein. All patients with SCLC were investigated using MRI of the brain, CSF, bone marrow aspiration, ultrasound of the abdomen, and radionuclide bone scan. RESULTS: Nine (17%) of 52 SCLC serum samples were positive by western blot. At the time of diagnosis none of the anti-Hu positive patients had either CNS (brain or leptomeningeal), epidural, adrenal, or bone marrow metastases and 56% had limited disease. In eight of 43 anti-Hu negative patients CNS metastases were found at the time of diagnosis, and only 30% had limited disease. The prevalence of bone and liver metastases was similar in both groups. Survival was 11 (SD ) months for the 43 anti-Hu negative and 10 (SD 6) months for the nine anti-Hu positive patients. Male:female ratio in the anti-Hu negative group was 4.4:1, and in the anti-Hu positive group 2:1. CONCLUSIONS: No anti-Hu antibody positive serum, as tested by western blot, became negative during chemotherapy. Anti-Hu positive and anti-Hu negative patients had similar survival, but anti-Hu positive patients tended to be women, had limited disease at the time of tumour diagnosis, and initially metastases seemed to spare the nervous system.
Aged↗
The value of interphase cytogenetics in cytology for the diagnosis of leptomeningeal metastases.
We studied the use of fluorescence in situ hybridization (FISH) in CSF to enhance the diagnostic yield for the detection of malignancy on the first lumbar puncture in patients clinically suspected of having leptomeningeal metastases (LMM). Although repeated lumbar punctures were still needed in some patients, the use of FISH did speed up the diagnosis in approximately one-third of the patients clinically suspected of having LMM with atypical cells at first cytology. This eliminates the need for repeated lumbar punctures in these patients and enables an earlier start of treatment.
Cerebrospinal Fluid↗
Response rate and prognostic factors of recurrent oligodendroglioma treated with procarbazine, CCNU, and vincristine chemotherapy. Dutch Neuro-oncology Group.
OBJECTIVES: To determine the response rate and factors correlated with response of oligodendroglial tumors to procarbazine, lomustine (CCNU), and vincristine (PCV) chemotherapy. DESIGN: Retrospective, observational multicenter study. METHODS: Patients treated with PCV or intensified PCV chemotherapy for a recurrent oligodendroglial tumor after surgery and radiation therapy with measurable disease were retrospectively evaluated for response. A 50% reduction in cross-sectional enhancing tumor area was considered a partial response. Stabilized or responding patients received six cycles of PCV unless unacceptable toxicity occurred. RESULTS: Fifty-two patients were included; median time to progression (MTP) for the entire group was 10 months. In 17% of patients a complete response (MTP, 25 months) was obtained, and in 46% a partial response (MTP, 12 months) was obtained. Median overall survival was 20 months. Although treatment was discontinued for toxicity in seven patients, it was generally well tolerated. The intensified PCV regimen was more toxic. Patients initially presenting with seizures and patients with tumor necrosis in histologic specimens had a better response rate in contrast to patients who had their first relapse within 1 year of first treatment (surgery and radiation therapy). CONCLUSIONS: Oligodendroglial tumors are chemosensitive, but most patients will have relapsed after 12 to 16 months. New studies must aim at improving initial treatment and second-line chemotherapy.
Adolescent↗
Peroneal nerve neuropathy in cancer patients: a paraneoplastic syndrome?
AIMS: To investigate the occurrence of symptomatic peroneal neuropathy (PN) in cancer patients, as well as that of cancer in PN patients and to seek possible factors in the aetiology of PN. METHODS: Clinical, neurographical, and myographical data of patients with PN, in two general neurology clinics during a 5-year period (1988-1992) were analysed retrospectively. A population-based cancer registry was consulted for epidemiological data in the area. RESULTS: The catchment population of the two clinics consisted of 433,142 people, and 8,766 new cancer patients were diagnosed. PN was diagnosed in 372 patients, of whom 74 suffered from cancer (in 56 PN was believed to be related to cancer). The crude relative risk of PN in patients with cancer compared with patients without cancer was 8.6. After correction for differences in age and sex between the compared groups, the relative risk dropped to 3.4 (2.8 for women and 3.6 for men). The crude relative risk of cancer for patients with PN relative to people without PN was 7.5. The relative risk, after correction for age and sex, was 2.8 (2.5 for women and 2.9 for men). All relative risks were significant (P < 0.001), but did not differ between the sexes (P > 0.4). Weight loss was established in 35/56 patients, but in 17/56 it was unknown. PN has not been found to be part of a polyneuropathy. Chemotherapy did not play a causal part. In some patients PN preceded the diagnosis of cancer. CONCLUSIONS: The occurrence of PN seems to be higher in patients with cancer than in people without cancer. Cancer was found in patients with PN more often, particularly in elderly men, than would be expected from the occurrence in the total population. PN in patients with cancer is supposed to be due to a combination of metabolic and mechanical factors. The findings justify a prospective study of the relation between PN and cancer.
Age Factors↗
A case of brain metastases from male breast cancer responding to tamoxifen.
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Adenocarcinoma↗
Efficacy and safety of prophylactic cranial irradiation in patients with small cell lung cancer.
BACKGROUND: Prophylactic cranial irradiation (PCI) as part of the treatment regimen for patients with limited stage small cell lung cancer (SCLC) remains controversial. The present study was performed to analyze the efficacy and safety of PCI in patients with limited stage SCLC who achieved complete remission. PATIENTS AND METHODS: Between 1983 and 1993, thirty-nine patients with limited stage SCLC who had shown complete remission after chemotherapy were enrolled prospectively into the non-randomized study. Eighteen of them received PCI (PCI+), while 21 did not (PCI-). Pretreatment CT or MRI of the brain was performed in all patients. Patients were prospectively evaluated by a neurologist at regular intervals. RESULTS: Three PCI+ patients and seven PCI- patients developed brain metastases. The frequencies of brain metastases were not significantly different between the groups (Fisher's exact test, p = 0.207), but brain metastases in PCI+ patients tended to occur later (log rank, p = 0.008). Overall survival was significantly longer in PCI+ patients (log rank, p < 0.001). Early toxicity consisted of headache, nausea, fatigue, concentration problems and alopecia. These symptoms and signs were mild and usually reversible within a few months. Late toxicity was studied in patients whose survival exceeded two years. Seven PCI+ patients survived for more than two years, while no PCI- patients survived for more than two years. Memory problems were seen in six of the seven patients. These problems were non-disabling and, once established, remained stable for months to years. The most prominent radiologic abnormalities were cortical atrophy and leukoencephalopathy, found in four of the five patients who underwent radiologic follow-up examination. CONCLUSIONS: This non-randomized study suggests that PCI may be effective by decreasing the frequency of brain metastases and by increasing the brain metastasis-free survival and overall survival, with a minor risk of clinical and radiologic neurotoxicity.
Adult↗
Detection of malignant cells in cerebrospinal fluid using fluorescence in situ hybridization.
Cytologic examination of cerebrospinal fluid (CSF) is the diagnostic gold standard for leptomeningeal metastasis (LMM). However, this technique is only moderately sensitive when routine staining procedures are applied. The use of fluorescence in situ hybridization (FISH) to identify malignant cells may have an additional value in diagnosing LMM, since numerical chromosomal aberrations (NCA) can be detected at the single cell level. We tested the feasibility of FISH to detect tumor cells in CSF by analyzing 22 samples with proven LMM with a probe for chromosome 1 (1q12) to detect NCA in the cells. A control group consisted of samples from 10 patients with inflammatory neurologic disease. In 7 LMM samples no cells or only lysed cells were found, due to time delay before fixation. Of the other 15 LMM samples analyzed, 13 showed NCA (87%), while no NCA were found in the control group. Our results indicate that FISH may be a useful additional diagnostic tool to the cytodiagnosis of CSF in cases of LMM. We expect that FISH can become an additional marker for malignancy at the single cell level in patients with LMM, which may also be of use to determine the effect of therapy for LMM.
Arachnoid↗
[No uniformity in radiodiagnosis and advice by Dutch neurologists in patients with minor brain injuries].
OBJECTIVE: To determine diagnostic procedures and medical advice in cases of mild head injury in Dutch hospitals. DESIGN: Questionnaire. SETTING: Academic Medical Hospital, Maastricht, the Netherlands. METHOD: A questionnaire was sent to neurologists of 100 different Dutch hospitals. RESULTS: The response was 85%. X-rays of the skull were made by 73% of the respondents, of the cervical spine by 46%. CT scans of the brain were made only on indication. A waking advice for the first 12-24 hours following a mild head injury was given in 95%. Bed rest and work stoppage were prescribed in 37% and 80% respectively. The duration of this bed rest and work stoppage varied from 1 to 14 days and from 2 to 24 days respectively. In 59% pain medication was prescribed and 40% of the patients were seen at least once for a control visit. In 25% of the hospitals a protocol for the treatment of these patients was used, and 52% of the neurologists considered such a protocol desirable. CONCLUSION: This inquiry shows that no consensus exists regarding radiodiagnosis of patients with mild head injury in Dutch hospitals. Apart from the waking advice, the treatment also shows many discrepancies.
Bed Rest↗
Neurologic disorders in 203 consecutive patients with small cell lung cancer. Results of a longitudinal study.
BACKGROUND: Neurologic complications of small cell lung cancer (SCLC) are manifold. The incidence and course of the various metastatic and nonmetastatic neurologic disorders were studied prospectively in a cohort of SCLC patients. METHODS: The 203 patients underwent neurologic examinations on a regular basis, prior to therapy, during and after treatment, from 1983 through 1994. Routine computer tomography or magnetic resonance imaging of the brain was performed before therapy and after 2 years' survival. Other auxiliary diagnostic tests were performed as required. RESULTS: The majority of the 174 neurologic disorders, diagnosed in 132 patients, were associated with metastases. A total of 79 patients developed brain metastases. The cumulative risk of brain metastases reached 47% for limited and 69% for extensive disease patients at 2 years from diagnosis. Survival following the diagnosis of brain metastases was significantly longer for patients with brain metastases at the initial diagnosis of SCLC than for patients with delayed brain metastases (P < 0.01, long rank test). The most frequent paraneoplastic syndrome with neurologic symptoms was that of inappropriate secretion of antidiuretic hormone (SIADH), which was diagnosed in 11 patients. Antibody-mediated paraneoplastic neurologic syndromes were diagnosed in five patients. Chemotherapy for SCLC caused SIADH to subside in most patients. In contrast, the antibody-mediated syndromes did not respond to SCLC therapy. Adverse effects of treatment included peripheral neuropathy, encephalopathy, radiation plexopathy, and steroid myopathy. However, unlike the other complications, peripheral neuropathy was reversible. CONCLUSIONS: This clinical investigation confirmed the frequency of central nervous system metastatic involvement as well as the diversity of the neurologic complications in SCLC. The high frequency of brain metastases justifies a reappraisal of prophylactic cranial irradiation in this patient group.
Adult↗
Sequelae in long-term survivors of small cell lung cancer.
PURPOSE: Central nervous system (CNS) effects of chemotherapy and prophylactic cranial irradiation (PCI) are studied in long-term small cell lung cancer (SCLC) survivors. The exact significance and pathogenesis of the neurotoxicity is still unknown, as studies on this subject lack sufficient patient numbers and are performed in an extremely varied manner. METHODS AND MATERIALS: Fifty-nine survivors (> 2 years from diagnosis) were examined neurologically and neuropsychologically, and underwent a cranial computer tomography (CT) scan or magnetic resonance (MR). Eight patients were excluded from further analysis for various reasons (not SCLC-related CNS disease, n = 6; no chemotherapy nor PCI treatment, n = 2). The remaining 51 patients were divided into three groups; group 1 = chemotherapy alone (n = 21), group 2 = sequential PCI (n = 19), and group 3 = concurrent or sandwiched PCI (n = 11). Groups were neuropsychologically compared in matched controls. RESULTS: Performance status did not differ significantly between various treatment groups; all patients remained ambulatory and capable of self-care. Mental impairment (n = 20), motor abnormalities (n = 9), and visual complaints (n = 1), were found in five patients in group 1 (24%), eight patients in group 2 (42%), and eight patients in group 3 (73%). Analysis of brain atrophy revealed no significant results; however, white matter abnormalities were found more frequently in group 3. Neuropsychologically no significant group differences existed, although interference sensitivity and difficulties with divided attention tended to occur more frequently in patients treated with PCI. Mean neuropsychometric results of treatment groups were significantly worse than those of matched controls. CONCLUSIONS: Although more intensively treated patients showed more neurologic impairment and patients in group 3 had more white matter abnormalities, there was no statistic evidence for additional neurotoxicity of PCI. Marked neuropsychometric differences between patients and matched controls may indicate that cognitive impairment is partly disease related, probably due to emotional distress and deteriorated physical condition.
Atrophy↗
MRI in detection of brain metastases at initial staging of small-cell lung cancer.
We prospectively investigated 40 patients with small-cell carcinoma of the lung (SCLC) for signs of brain metastasis by neurological examination and MRI of the brain, to determine the significance of MRI for staging. MRI could not be completed in one patient, who was excluded from the study. The MRI studies of the remaining patients showed no abnormalities in 12, cerebral infarcts in 2 and brain metastases in 11 patients, of whom 3 no relevant symptoms. Nonenhancing white matter lesions were found in 14 patients. In 3 of the 4 patients with an abnormal neurological examination at diagnosis, nonenhancing white matter lesions later developed into contrast enhancing lesions compatible with brain metastases; in 2, this occurred during the course of the chemotherapy. MRI did not change the clinical staging in patients with asymptomatic brain metastases.
Adult↗
Brain metastases from an unknown primary tumour: which diagnostic procedures are indicated?
Seventy two patients presenting with symptomatic brain metastases from undiagnosed primary neoplasms were retrospectively reviewed. Primary malignancies were diagnosed before death in 54 patients and remained unknown in 18 patients. Lung cancer was the most common primary tumour (72%), followed by breast cancer, colon carcinoma, and melanoma. On physical examination, 51 patients had organ specific symptoms or signs providing guidelines to the diagnostic evaluation. In 24 of the 52 patients with a primary lung tumour, and in four of the 20 patients without, organ specific complaints or findings suggested this tumour type, resulting in a positive predictive value of 85%. Overall, radiography and CT of the chest were very useful in detection of primary lung tumours. This could partly be explained by the high prior probability of detecting such tumours. Other diagnostic procedures should be used on indication only. The prognosis of patients with confirmed primary tumour position did not differ from those with unidentified primary tumour.
Adolescent↗
Follow-up of cognitive functioning in patients with small cell lung cancer.
PURPOSE: Study of the course of possible treatment-related cognitive impairment in patients with small cell lung cancer. METHODS AND MATERIALS: Thirty-two consecutive patients with small cell lung cancer underwent successive neurologic and neuropsychologic examinations until 5 months after prophylactic cranial irradiation, and in their pretherapeutic condition were compared to matched controls. Patients with brain metastases were excluded from this study. RESULTS: Neurologic examination revealed central nervous system (CNS) abnormalities only in the 14 patients with brain metastases. In the remaining patients, neuropsychologic tests showed clear differences between the pretherapeutic performance of patients and that of matched controls (p < 0.001), but no significant deterioration either during or after therapy (0.1 < p < 0.8). CONCLUSION: The difference between the pretherapeutic performance of patients and that of matched controls may indicate disease-related cognitive impairment. Within the observation period, no adverse effects of the used therapy were found. Our observations underline the importance of a pretherapeutic assessment in neurotoxicity research.
Aged↗
Late neurobehavioural symptoms after mild head injury.
The present study examined whether patients (n = 11) with post-concussional symptoms (PCS) 12-34 months after mild head injury (MHI) performed less well on selected neuropsychological tests than patients with MHI without PCS (n = 11) and healthy controls (n = 11). Patients with PCS were individually matched with controls for the time elapsed after the injury, age, sex, education and IQ. There were no overall gross differences between the groups in cognitive functioning, except for an isolated deficit on a sustained attention task. Post-hoc analysis of results obtained with two behavioural rating scales showed that patients with higher ratings on a post-concussive/cognitive complaints scale performed less well on a sustained attention task than subjects with lower ratings.
Adolescent↗
Test characteristics of cerebrospinal fluid tumor markers.
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Biomarkers, Tumor↗
The value of skull radiography in patients with head trauma.
This study assesses the value of skull X-ray after a skull fracture for predicting intracranial hematoma. Patients with a skull injury were divided into three risk groups, based on the history and examination findings. The records of 1218 patients were studied. In the risk group, the existence of a skull fracture and the development of intracranial hematoma were determined. Not a single hematoma was found in the low-risk group. Hence, skull radiography had no significance in this group. In the moderate-risk group two patients had an intracranial hematoma; one patient had a skull fracture. Negative skull radiography therefore did not fully exclude intracranial complications. There were many patients with an intracranial hematoma in the high-risk group, in the presence or not of a skull fracture. CT imaging is the best method for obtaining the diagnosis of intracranial hematoma in this group. In conclusion, plain skull X-rays are of little value in patients with acute head trauma.
Adult↗