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Biomedical subjects

H R Djalilian

Publications and source records attributed to H R Djalilian.

7 recordsLinked to original sources
PubMed2001

Securing cochlear implants to the skull: two alternate methods.

In view of the various problems encountered with the traditional methods of securing cochlear implants--including dural tear and suture dissolution following infection--we devised two alternate methods of performing this procedure. We use a titanium mesh or a Gore-Tex patch secured with two 4-mm screws to fix the receiver to the skull. No patient who has undergone either of these procedures at our institution has experienced any of the complications that are associated with the older silk, nylon, and Dacron sutures. Moreover, our two alternate methods are less technically difficult and can be performed in a shorter period of time.

Cochlear Implantation↗
PubMed2000

Long-term survival with metastatic cancer to the brain.

Metastatic cancer to the brain has a poor prognosis. The focus of this work was to determine the incidence of long-term (> or = 2y) survival for patients with brain metastases from different primary cancers and to identify prognostic variables associated with prolonged survival. A retrospective review of 740 patients with brain metastases treated over a 20 y period identified 51 that survived 2 or more years from the time of diagnosis of the brain metastasis. Prognostic variables that were examined included age, sex, histology, tumor number and location, and treatment. In the 51 patients, 35 (69%) had single lesions and 16 (31%) had multiple tumors. For all tumor types (740 patients), the actuarial survival rate was 8.1% at 2 y, 4.8% at 3 y, and 2.4% at 5 y. At 2 y, patients with ovarian carcinoma had the highest survival rate (23.9%) and patients with small cell lung cancer (SCLC) had the lowest survival rate (1.7%). At 5y, survival rates were 7.8% for ovarian carcinoma, 2.9% for non-SCLC, 2.3% for melanoma and renal cell carcinoma, 1.3% for breast carcinoma and there were no survivors with SCLC, gastrointestinal, bladder, unknown primary, or prostate cancer. Age, sex, histology, location for single tumors, systemic chemotherapy, and stereotactic radiosurgery did not significantly influence survival. The presence of a single lesion (P = 0.001, chi-square test), surgical resection (P= 0.001), and WBRT (P = 0.009) were favorable prognostic variables for extended survival. Multiple bilateral metastases was a poor prognostic indicator (P= 0.001). Multivariate analysis showed younger age (P< 0.05), single metastasis (P < 0.0001), surgical resection (P < 0.0001), whole brain radiation therapy (P < 0.0001), and chemotherapy (P = 0.0288) were associated with prolonged survival. 29 patients (57%) died of systemic disease progression, 9 (18%) died of central nervous system progression, and the cause of death was unknown in 3 (6%). Patients with a single non-SCLC, breast, melanoma, renal cell, and ovarian carcinoma brain metastasis have the best chance for long-term survival if treated with surgical resection and WBRT.

Adult↗
PubMed1999

Radiographic incidence of multicentric malignant gliomas.

BACKGROUND: Multicentric malignant gliomas are interesting yet uncommon clinical entities with an unknown rate of occurrence. METHODS: We reviewed the computed tomography (CT) and magnetic resonance (MR) images of 100 consecutive patients with malignant gliomas to determine the incidence of multicentricity in malignant glial neoplasms. RESULTS: Five patients had multiple lesions on their initial radiographic study (synchronous lesions) and in four patients multiplicity developed after initial diagnosis (metachronous lesions). MR imaging demonstrated one lesion not seen on CT. CONCLUSIONS: Because synchronous or metachronous multicentricity was found in 9% of patients with malignant gliomas, treatment delivery should not be based on radiographic imaging without attempting to obtain an accurate diagnosis of the ongoing intracranial process.

Adult↗
PubMed1998

Malignant gliomas of the cerebellum: an analytic review.

Using an analytical review, the demographic data on malignant cerebellar gliomas such as length of survival, and those factors associated with prolonged survival were examined. Seventy-one cases of malignant cerebellar glioma reported since 1975 were combined and reviewed with the seven cases treated at our institution since that time. Thirty-seven patients (47%) had grade III tumors and 41 (53%) had grade IV tumors. Fifty-nine percent of the tumors were located in the hemispheres and 41% were found in the vermis. Median survival for patients with grade III anaplastic astrocytomas was 32 months compared to 11 months for those with grade IV glioblastomas multiforme (P = 0.0257). For the entire cohort, patients with grade III tumors, those who had a surgical resection, and those that had received radiation therapy for treatment of their tumor had prolonged survival on multivariable analysis. Radiation therapy was associated with extended survival for patients with grade III tumors by uni- and multivariate analysis. For grade IV tumors, univariate analysis revealed prolonged survival for those patients who had surgical resection compared to those who had biopsy alone (P = 0.0036) and for those who received external beam radiation therapy (P = 0.0001). Patients with malignant gliomas of the cerebellum had length of survival comparable to their supratentorial counterparts. Prompt diagnosis and treatment may explain the similarity in survival found between supra- and infratentorial malignant gliomas despite an expected shorter survival because of treatment limitations. Surgical resection followed by radiation therapy is recommended for patients with malignant gliomas of the cerebellum.

Adolescent↗
PubMed1996

Brain metastases. Histology, multiplicity, surgery, and survival.

BACKGROUND: With the advent of new therapies for metastatic carcinoma to the brain, patterns of intracranial disease and factors influencing survival become important considerations when examining potential treatment options. METHODS: The records of 729 patients with metastases to the brain treated during the period between 1973 to 1993 were reviewed. RESULTS: Primary tumor histologic type in order of descending frequency included nonsmall cell lung carcinoma (NSCLC), breast carcinoma, small cell lung carcinoma (SCLC), malignant melanoma, renal cell carcinoma, gastrointestinal carcinoma, uterine/vulvar carcinoma, and unknown primary carcinoma. There were 384 patients (53%) with a single brain metastasis, which was encountered most commonly in patients with prostate carcinoma and least often in patients with SCLC. Multiple metastases were present in 345 patients (47%). The median duration from diagnosis to presentation with a brain metastasis was 12 months, ranging from 3 months for patients with NSCLC to 53 months for patients with breast carcinoma. The median duration from presentation with brain metastases to death was 4 months, ranging from 3 months for patients with SCLC to 13 months for patients with prostate carcinoma. Median survival from presentation with brain metastases to death was 5 months for patients with single lesions and 3 months for patients with multifocal disease (P = 0.0001). Median survival for patients with a single lesion was 11 months with surgery and 3 months without surgery (P = 0.0001). Surgery did not significantly influence survival in patients with multiple metastases. CONCLUSIONS: Dissemination of systemic carcinoma to the brain continues to carry a poor prognosis. Knowledge of the metastatic patterns and limited survival associated with specific tumor types may be useful for guiding future therapeutic intervention.

Brain Neoplasms↗
PubMed1995

Stereotactic radiosurgery for recurrent malignant gliomas.

PURPOSE: To evaluate the role of stereotactic radiosurgery in the management of recurrent malignant gliomas. PATIENTS AND METHODS: We treated 35 patients with large (median treatment volume, 28 cm3) recurrent tumors that had failed to respond to conventional treatment. Twenty-six patients (74%) had glioblastomas multiforme (GBM) and nine (26%) had anaplastic astrocytomas (AA). RESULTS: The mean time from diagnosis to radiosurgery was 10 months (range, 1 to 36), from radiosurgery to death, 8.0 months (range, 1 to 23). Twenty-one GBM (81%) and six AA (67%) patients have died. The actuarial survival time for all patients was 21 months from diagnosis and 8 months from radiosurgery. Twenty-two of 26 patients (85%) died of local or marginal failure, three (12%) of noncontiguous failure, and one (4%) of CSF dissemination. Age (P = .0405) was associated with improved survival on multivariate analysis, and age (P = .0110) and Karnofsky performance status (KPS) (P = .0285) on univariate analysis. Histology, treatment volume, and treatment dose were not significant variables by univariate analysis. Seven patients required surgical resection for increasing mass effect a mean of 4.0 months after radiosurgery, for an actuarial reoperation rate of 31%. Surgery did not significantly influence survival. At surgery, four patients had recurrent tumor, two had radiation necrosis, and one had both tumor and necrosis. The actuarial necrosis rate was 14% and the pathologic findings could have been predicted by the integrated logistic formula for developing symptomatic brain injury. CONCLUSION: Stereotactic radiosurgery appears to prolong survival for recurrent malignant gliomas and has a lower reoperative rate for symptomatic necrosis than does brachytherapy. Patterns of failure are similar for both of these techniques.

Actuarial Analysis↗