Biomedical subjects

E Arbit

Publications and source records attributed to E Arbit.

At least 37 records · Page 2Linked to original sources

PubMed1996

Pituitary gland metastases.

BACKGROUND: Symptomatic pituitary metastasis is an uncommon clinical problem. It may be difficult to distinguish pituitary metastasis from pituitary adenomas both clinically and radiographically. We present our experience with these tumors and compare it with the findings in the literature. METHODS: Eight cases are reported here. The medical records were reviewed concerning clinical features, radiographic findings, treatment, and outcome. RESULTS: Diabetes insipidus is associated with each case and was the initial manifestation of systemic malignancy in two of our patients. Half of the patients had headaches as well. Panhypopituitarism and visual field defects were noted in 25% of the patients. In 50% of the patients metastasis was limited to the pituitary gland only. All patients received radiation treatment and exogenous vasopressin. Two patients underwent resection of the tumor. Five patients died within a few months of diagnosis of pituitary metastasis. One patient died 2 years after the diagnosis and two patients were lost to follow-up. CONCLUSIONS: When a patient with known metastatic cancer develops diabetes insipidus and has radiographic evidence of a pituitary mass, the diagnosis of metastasis is highly probable. Reasonable treatment is palliative with exogenous vasopressin and radiotherapy.

Adult↗

PubMed1996

Surgical resection of brain metastases from renal cell carcinoma in 50 patients.

OBJECTIVES: Metastases are frequently diagnosed among patients with renal cell carcinoma (RCC). Of 709 patients with brain metastases (BMET) who were operated on at our institution between 1974 and 1993, 50 (7%) were of renal origin. METHODS: Medical records were reviewed retrospectively. Survival time was calculated by the Kaplan-Meier method and Cox proportional hazards model. RESULTS: There were 38 men and 12 women. The median age was 60 years. The primary RCC was resected in 47 patients. Forty patients had a metachronous diagnosis of RCC and BMET. Median interval between the diagnosis of RCC and BMET was 17 months. In all 50 patients overall median survival (MS) from diagnosis of primary RCC was 31.4 months and from craniotomy was 12.6 months. Postoperative mortality was 10% (5 patients). In patients with primary RCC in the left kidney (n=25) versus right kidney (n=25) median survival from craniotomy was longer; 21.3 versus 7.4 months (P<0.014). Twenty-three patients (46%) had intratumoral hemorrhage. Eight patients had cerebellar metastasis (MS, 3.0 months) and 9 had multiple metastases resected (MS, 7.6 months). Thirty-eight patients had both brain and pulmonary metastases, and 16 of them had pulmonary resection (MS, 18.6 versus 8.0 months; P<0.03). Twenty-two patients received whole-brain radiation therapy (WBRT) after craniotomy and 18 did not receive WBRT (MS, 13.3 versus 14.5 months; P<0.62). The 1-year, 2-year, 3-year, and 5-year survival was 51%, 24%, 22%, and 8.5% respectively. CONCLUSIONS: Only the resection of lung metastasis, supratentorial location of BMET, left-sided localization of primary RCC, and lack of neurologic deficit before craniotomy were statistically significant prognostic factors in Cox regression analysis. In the absence of effective systemic treatment, we suggest that patients with BMET from RCC be considered for operative resection for treatment and palliation.

Adult↗

PubMed1996

Invasive techniques in the management of cancer pain.

Familiarity with potentially useful anesthetic and neurosurgical techniques is important in the management of patients who are unable to achieve a satisfactory balance between analgesia and side effects from systemic analgesic therapies. The ability to make specific recommendations is limited by the paucity of controlled data, incorporating details of pain syndromes, prior therapies, validated pain assessment, meticulous reporting of adverse effects, and longitudinal follow-up.

Analgesia, Epidural↗

PubMed1996

Clinical decision making in brain metastases.

Surgery for metastatic cancer of the brain parenchyma has been shown to increase length of survival, especially in patients with primary breast cancer, RCC, and lung cancer. The identification of prognostic variables common to patients with brain metastases has permitted development of therapeutic guidelines.

Adult↗

PubMed1996

Application of laser Doppler flowmetry in neurosurgery.

Experience with LDF has indicated that intraoperative estimation of cerebral blood flow can be very useful and that long-term recordings of cortical perfusion pressure are possible. The disadvantage of LDF is that measurements are extremely local and that the units of measurements are arbitrary. Moreover, the reliability of the technique depends to a large extent on probe position and on the avoidance of movement artifact. The disadvantages are, however, compensated by an excellent dynamic resolution with ultra-short time responses to sudden fluctuations in cerebral perfusion pressure. The high temporal resolution of LDF provides the opportunity to detect hemodynamic events and to monitor the microcirculatory effects of treatment that alters cerebral perfusion pressure in patients with raised intracranial pressure. At no point in the near future is LDF going to supercede continuous recording of intracranial pressure and mean arterial blood pressure and, hence, cerebral perfusion pressure. Rather, we envision LDF becoming an integral part of a multimodal patient monitoring system whereby time trends of monitored variables are combined with calculated variables to provide continuous assessment of cerebral hemodynamic and compensatory reserves.

Humans↗

PubMed1995

Spinal metastases from solid tumors. Analysis of factors affecting survival.

BACKGROUND: Factors affecting survival were determined for 109 patients with thoracic spine metastases and cord compression. Lung, prostate, and breast were the most common primary sites (78%). All patients had surgical decompression of the spinal cord, and 99% received radiotherapy. METHODS: Survival was determined based on anatomic site of primary carcinoma, preoperative neurologic deficit, extent of disease, number of vertebral bodies involved, tumor location (site of cord compression), and age. The respective compounding weight of the negative prognostic factors also was analyzed in terms of survival. RESULTS: The overall median survival was 10 months. Patients preoperatively ambulatory survived statistically significantly longer than nonambulatory patients or those with sphincter incontinence (P = 3.469 x 10(-6)). Patients with renal cell carcinoma survived the longest, followed by those with breast, prostate, lung, and colon cancer. Patients with breast cancer survived statistically longer than those with lung cancer (P = 0.039). Patients with one vertebral body involved survived statistically significantly longer than patients with multiple vertebral level involvement (P = 0.027). Extent of disease, age, and tumor location did not significantly influence survival. In patients with vertebral column disease, the presence of two or more poor prognostic indicators (leg strength 0/5-3/5, lung or colon cancer, multiple vertebral body involvement), had a compounding adverse effect on survival. CONCLUSIONS: For patients with spinal metastases and cord compression, the factors found to affect survival include preoperative neurological status, anatomic site of primary carcinoma, and number of vertebral bodies involved. Patients with vertebral column disease and two or more of the poor prognostic indicators have a short life expectancy, and, therefore, radical surgery is not recommended because the benefits may not be substantial.

Adult↗

PubMed1995

The treatment of patients with recurrent brain metastases. A retrospective analysis of 109 patients with nonsmall cell lung cancer.

BACKGROUND: Brain metastases represent a major source of morbidity in patients with cancer. METHODS: Treatment outcomes were analyzed retrospectively in 214 patients with brain metastases from nonsmall cell lung cancer (NSCLC) who underwent resection at Memorial Hospital (New York, NY) between January, 1976, and December, 1990. RESULTS: The study group included 109 patients (51%) with symptomatic recurrent brain tumors (median, 5.0 months after complete resection). Recurrence in the brain was at the original site in 62% of patients and at other sites in 38%. The median survival (MS) was 11.3 months in the recurrence group compared with 9.5 months (P < 0.5) in the nonrecurrence group (N = 105). Thirty-two patients had further surgery after recurrence; their median relapse time was 5.2 months. In these patients, survival (MS, 15.0 months) calculated from the time of their first operation, was significantly different (P < 0.001) from that of patients who did not undergo a second procedure (N = 77) (MS, 10.0 months). In the 32 patients who underwent reoperation, MS from the time of the second operation was 10 months, whereas the median interval from the first operation was 5 months (average, 5.7 months). Eight of these 32 patients had a third operation, after a median relapse time of 4 months; their MS was 42 months. There was a significant difference (P < 0.02) between the MS of 39 patients synchronously diagnosed with lung cancer and brain metastasis (MS, 9.0 months) and 70 metachronously diagnosed patients (MS, 14.6 months). Women (N = 55) survived longer than men (N = 54) (14.4 months vs. 9.7 months, P < 0.01). Univariate analysis showed that histology, disease stage, and completeness of resection of the primary tumor also affected survival (P < 0.02, P < 0.014, and P < 0.001, respectively). Although no significant difference was found between survival of patients with recurrence in the supratentorial space and patients with recurrence in the posterior fossa (MS, 11.4 months vs. 11.2 months, P < 0.13), no one from the latter subgroup survived 3 years. CONCLUSIONS: If technically feasible, further surgery is effective in prolonging the survival of patients with NSCLC who have recurring brain metastases.

Adult↗

PubMed1995

The relationship between the technical accuracy of stereotactic interstitial implantation for high grade gliomas and the pattern of tumor recurrence.

PURPOSE: To correlate the pattern of failure and subsequent survival with the technical accuracy of stereotactic brain tumor implantation. METHODS AND MATERIALS: The patterns of failure of 47 consecutive patients with primary or recurrent gliomas after stereotactic implantation delivering 60 Gy via removable high activity 125I sources were reviewed. When the tumor was covered at all levels by the chosen isodose distribution, the implant was considered to be "ideal." If the coverage was not complete, a numerical description of the volume of tumor outside the isodose was assigned. Criteria for "adequate" and "inadequate" implants were defined. Standard radiographic criteria, with pathologic confirmation in 26 cases, were used to categorize the patterns of failure into the following components: central, peripheral, distant (within the brain parenchyma), leptomeningeal, and spinal. A peripheral failure was scored as being in the "direction of error" when the prescribed isodose did not cover the tumor volume and the subsequent tumor progression was in this region. Survival was calculated from the date of implantation. RESULTS: Of 47 cases examined, 72% had an element of central and/or peripheral failure and 23% had a component of distant or meningeal failure. Among the patients with "adequate" or "inadequate" ("nonideal") implants who had a component of peripheral failure, only 19% were in the "direction of error." All patients with technically "inadequate" implants progressed in both the central and peripheral region. Among the groups who had "ideal," "adequate," and "inadequate" implants; 37%, 70%, and 75%, respectively, underwent reoperation [p = not significant (NS)]. Patients who underwent reoperation had a longer median survival than those who did not; 521 days vs. 298 days, respectively (p = 0.035). For patients with "nonideal" implants, a median survival of 470 days was found for patients undergoing reoperation vs. 184 days for those who did not (p = 0.016). CONCLUSIONS: (a) Patients with "inadequate" implants failed in both the central and peripheral region in all cases. This pattern, while less common in those with "ideal" or "adequate" implants, occurred in the majority of cases. (b) The technical excellence of the implant had no impact on survival. (c) Patients with "nonideal" implants were more likely to have reoperation than those with "ideal" implants, and this intervention was associated with a significant survival advantage.

Adult↗

PubMed1995

Quantitative studies of monoclonal antibody targeting to disialoganglioside GD2 in human brain tumors.

Iodine-131 3F8, a murine IgG3 monoclonal antibody that targets to GD2-bearing tumors, was administered intravenously to 12 patients with brain tumors. Six patients received 2 mCi (0.74 Bq) of 131I-3F8, five patients 10 mCi (3.7 Bq)/1.73 m2 of 131I-3F8, and one patient 2.6 mCi (0.96 Bq) of 124I-3F8, with no side-effects. Nine of 11 malignant gliomas and the single metastatic melanoma showed antibody localization, with the best tumor delineation on single-photon emission tomography (SPET) following 10 mCi (3.7 Bq)/1.73 m2 dose. No nonspecific uptake in the normal craniospinal axis was detected. There was no difference in the pharmacokinetics of low-dose versus the higher-dose antibody groups; plasma and total-body half-lives were 18 h and 49 h, respectively. Surgical sampling and time-activity curves based on quantitative imaging showed peak uptake in high-grade glioma at 39 h, with a half-life of 62 h. Tumor uptake at time of surgery averaged 3.5 x 10(-3) %ID/g and peak activity by the conjugate view method averaged 9.2 x 10(-3) %ID/g (3.5-17.8). Mean radiation absorption dose was 3.9 rad per mCi injected (range 0.7-9.6) or 10.5 cGy/Bq (range 1.9-26). There was agreement on positive sites when immunoscintigraphy was compared with technetium-99m glucoheptonate/diethylene triamine penta-acetic acid planar imaging, thallium-201 SPET, and fluorine-18 fluorodeoxyglucose positron emission tomography. Taken together, these data suggest that quantitative estimates of antibody targeting to intracranial tumors can be made using the modified conjugate view method.

Adolescent↗

PubMed1995

Resection of brain metastases from sarcoma.

BACKGROUND: Brain metastases from sarcoma are rare, and data concerning the treatment and results of therapy are sparse. METHODS: We retrospectively reviewed 25 patients with brain metastases from sarcoma of skeletal or soft-tissue origin, surgically treated in a single institution during 20 years. RESULTS: In 18 patients the brain lesion was located supratentorially, and in 7 patients infratentorially. Median age at brain metastasis diagnosis was 25 years. Median time from primary diagnosis to diagnosis of brain metastasis was 26.7 months. Lung metastases were present in 19 patients and in 8 patients they were synchronous with the brain lesion. Pulmonary metastases were resected in 12 patients (48% of total, and 63% of those with pulmonary lesions). The overall median survival from diagnosis of the primary sarcoma was 38 months and from craniotomy was 7 months. The presence or absence of lung lesions did not alter the median survival as calculated from diagnosis of brain metastasis. Overall percent survival was 40% at 1 year and 16% at 2 years. CONCLUSIONS: Because brain metastases from sarcoma are refractory to alternative treatment, surgical excision is indicated when feasible. Brain metastases from sarcoma are uncommon, usually occurring with or after lung metastasis. Long-term survival is possible in some patients.

Adolescent↗

PubMed1995

Brain tumors do not affect thiopental dosing requirements.

We used the biphasic electroencephalographic (EEG) response to increasing concentrations of thiopental to measure regional brain responses to thiopental. Eight patients with cortical parietal brain tumors, 3.3 (SD 1.3) cm in diameter, and eight control patients with lung cancer and normal brain computed tomography scans received thiopental by infusion (50-75 mg/min) until burst suppression (50% isoelectric activity) on the EEG occurred. Infusion lasted 10.7 (SD 2.4) min, and the average dose of thiopental administered was 810 (SD 170) mg [11.2 (SD 1.9) mg/kg]. During infusion the EEG was continuously recorded from the F3, F4, P3, and P4 electrodes. On-line power spectral analysis was performed, and data were saved for later analysis. Four EEG parameters [log beta (15-30 Hz) power, percent beta power, spectral edge 95% and spectral edge 70%] were plotted against calculated brain concentration of thiopental [using an assumed plasma-effect site rate constant (ke0) of 0.58] for each individual. Three points were measured on each curve (50% upslope, peak, and zero intercept) to quantitate the EEG response. Statistical comparisons were performed between the following sets of data: EEG response at electrode closest to brain tumor versus electrode farthest from tumor (in the same patient); and electrodes closest to brain tumors (parietal P3 and P4) versus same electrode pair in control patients (patients with thoracic tumors) using analysis. No differences were found in any comparison. Thus, the presence of a brain tumor does not affect the response of the brain in this region to thiopental as measured using EEG.

Aged↗

PubMed1995

Survival after surgical treatment of brain metastases from lung cancer: a follow-up study of 231 patients treated between 1976 and 1991.

The authors reviewed the records of 231 patients who underwent resection of brain metastases from nonsmall-cell lung cancer between 1976 and 1991. Data regarding the primary disease and the characteristics of brain metastasis were retrospectively collected. Median survival in the group from the time of first craniotomy was 11 months; post-operative mortality was 3%. Survival rates of 1, 2, 3, and 5 years were 46.3%, 24.2%, 14.7%, and 12.5%, respectively. One hundred twelve women survived significantly longer than 119 men (13.8 vs. 9.5 months, p < 0.02). Patients with single metastatic lesions (200 patients) survived longer than those (31 patients) with multiple metastases (11.1 vs. 8.5 months, p < 0.02). Patients with supratentorial tumors survived longer than patients with cerebellar lesions. A high Karnofsky performance scale score before surgery also indicated increased survival. In multivariate analyses, incomplete resection or no resection of primary lung tumor, male gender, infratentorial location, presence of systemic metastases, and age older than 60 years were significantly correlated with shorter survival. Approximately one-third of the patients died of neurological causes, one-third of systemic disease, and one-third of a combination of both. The results of this series confirm that the overall prognosis for patients with even a single resectable brain metastasis is poor, but that aggressive therapy can prolong life with quality of life preserved and can occasionally permit long-term survival.

Adult↗

PubMed1995

Vertebral body reconstruction with a modified Harrington rod distraction system for stabilization of the spine affected with metastatic disease.

Anterior spinal decompression has become widely used for neoplasia arising from the vertebral bodies. Replacement for the resected vertebral body must achieve spinal stability, restitution of lost height, correction of kyphotic deformities, and allow for early ambulation. A spinal fixator based on the Harrington ratchet locking system was found to fulfill this requirement. The fixator, its technique of implementation, and surgical results in 10 patients are described.

Adult↗

PubMed1994

Leiomyosarcoma of the uterus metastatic to brain: a case report and a review of the literature.

Central nervous system metastases are an unusual sequela of uterine sarcomas. A single brain metastasis from a leiomyosarcoma occurred in a 60-year-old woman, 6.5 years after hysterectomy and more than 2 years following the diagnosis of bilateral lung metastases, treated by combination chemotherapy. After resection of the cerebral metastasis, she was treated with brain radiation therapy and survived 2.5 years. Only seven other cases of uterus leiomyosarcoma metastatic to the brain have been published.

Brain Neoplasms↗

PubMed1994

Hemostatic changes in patients with brain tumors.

Abnormal hemostasis is a functional property of cancer. Hemostatic abnormalities are common in patients with systemic malignant disease and brain tumors. However, the incidence of thromboembolism is higher in patients with brain tumors than in those with systemic disease. This raises the question of whether or not hemostatic abnormalities found in the blood of the two groups of patients differs, suggesting different pathogeneses. The purpose of this report is to review abnormalities in blood and clinical manifestations of abnormal hemostasis found in brain tumors and cancer patients in an attempt to answer this question. Normal hemostasis, as currently understood, will be considered with an emphasis on features unique to the central nervous system.

Blood Coagulation↗

PubMed1994

Importance of image-guided stereotactic biopsy to confirm diagnosis in an oncological setting.

BACKGROUND: In current practice, the neurosurgical community relies heavily on computed tomography (CT) and magnetic resonance imaging (MRI) for making the diagnosis of brain lesions, especially when surgically inaccessible. However, the specificity of these neuroimaging modalities remains limited, and errors in diagnosis are frequent. In an attempt to ascertain how often the diagnosis based on imaging studies is proved wrong by biopsy, we reviewed the findings from 100 consecutive stereotactic biopsies performed in an oncological setting. METHOD: The records of 100 consecutive stereotactic biopsies were postoperatively reviewed. The preoperative clinical and radiologic differential diagnoses were compared with diagnosis made on tissue retrieved by biopsy. RESULTS: In 19% of patients, the preoperative clinical and radiological diagnoses and postoperative diagnosis were different, and reliance on brain imaging data alone would have led to an incorrect tentative diagnosis and the wrong choice of treatment. CONCLUSIONS: The high rate of discrepancy between clinical and radiological diagnoses on the one hand and biopsy-proven diagnosis on the other hand is a compelling reason to establish tissue diagnosis. Stereotactic biopsies of brain lesions are relatively safe and should be performed in cases where tissue characteristics affect prognosis, where therapy carries an inherent risk, and in those patients under treatment for cancer or immune deficiencies in whom there is an unusually broad differential diagnosis.

Adolescent↗

PubMed1994

Postoperative radiation for lung cancer metastatic to the brain.

PURPOSE: Although resection of single brain metastases and postoperative whole-brain radiation therapy (WBRT) improves survival, compared with treatment using WBRT alone, the value of postoperative WBRT after resection of brain metastases is controversial. We analyzed the largest reported series of lung cancer patients with resected brain metastases to evaluate the impact of postoperative WBRT. MATERIALS AND METHODS: Between 1974 and 1989, 185 patients with non-small-cell lung cancer (NSCLC) underwent resection of brain metastases. Patients who had received preoperative WBRT (23%, 42 of 185) were excluded. The remaining patients were divided into group A (no WBRT; n = 32), group B (patients received WBRT and were prognostically matched to group A; n = 32), and group C (all other WBRT patients; n = 79). Most patients received postoperative doses of 30 Gy in 10 fractions. Higher doses were used in 16% of group B and 18% of group C patients. RESULTS: Overall 5-year survival rates were as follows: group A, 12%; B, 8%; C, 16%. Overall brain failures occurred in 38% of patients in group A, 47% in group B, and 42% in group C. The use of WBRT (group A v groups B plus C) had no apparent impact on survival or on overall brain failure rates. In particular, no improvement in either of these parameters could be demonstrated when group B was compared with group A. Focal failure (defined as failure within the brain adjacent to the site of the resected brain metastases) occurred as follows: group A, 34% (11 of 32); groups B plus C, 23% (25 of 111) (P = .07). WBRT significantly reduced focal failure for patients with adenocarcinoma (group A, 33% [eight of 24]; groups B plus C, 14% [11 of 79]; P = .05). Nonfocal failure (anatomically distinct from the resected metastasis) occurred in 9% of patients in group A (three of 32), 21% in groups B plus C (23 of 111) (P = .07). CONCLUSION: Long-term survival is possible when NSCLC brain metastases are resected. Postoperative WBRT as used in this series only had an impact on the focal control of brain metastases and this effect was of borderline significance. The lack of conclusive benefit supports the need for ongoing randomized trials to test the value of adjuvant postoperative WBRT. Brain failures were relatively common in all three groups of patients, which suggests that doses greater than 30 Gy need to be studied.

Adenocarcinoma↗

PubMed1994

"Trap door" exposure of the cervicothoracic junction. Technical note.

This report describes a "trap door" exposure of the cervicothoracic junction. The method combines a standard anterior approach to the spine along the medial border of the sternocleidomastoid muscle with both a partial median sternotomy and an anterolateral thoracotomy. Transection of the clavicle is not required and the sternoclavicular joint is preserved. With this method, all important ventral paravertebral vessels, nerves, and associated soft tissue are fully identified and readily mobilized as needed. The method provides full bilateral anterior exposure from the C-4 through at least the T-3 vertebral levels, as well as unilateral anterolateral access to the upper thoracic spine.

Cervical Vertebrae↗