Biopsy of low-grade astrocytomas.
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Astrocytoma↗
Biomedical subjects
M Bernstein
Publications and source records attributed to M Bernstein.
Complications of CT-guided stereotactic biopsy of intra-axial brain lesions.
A series of 300 consecutive stereotactic biopsies for intra-axial brain lesions performed by one neurosurgeon was critically analyzed regarding complications of the procedure. Complications were incurred by a total of 19 patients (6.3%). Five patients (1.7%) died following the procedure, all due to intracranial hypertension: one from subarachnoid hemorrhage, one from intracerebral hemorrhage, and three from increased edema without hemorrhage. The three patients who died without hemorrhage all had marked intracranial hypertension at the time of biopsy. All five patients who died harbored a glioblastoma multiforme. The surviving 14 patients (4.7%) with complications suffered increased neurological deficit due to hemorrhage. In 10 (3.3%), the deficit was mild and/or transient; in the other four (1.3%), a major deficit was incurred which markedly affected the remainder of the patient's life. Therefore, mortality or major morbidity was seen in 3.0% of patients and minor morbidity in 3.3%. Stereotactic biopsy is a very effective procedure with a complication rate significantly lower than that of craniotomy (particularly in the population of patients selected for stereotactic biopsy), but in a small number of patients the outcome is devastating.
Adolescent↗
Necrosis in a meningioma following systemic chemotherapy. Case report.
Radiological and clinical evidence of acute necrosis in a meningioma following one cycle of chemotherapy with 5-fluorouracil, folinic acid, and levamisole was observed in a patient being treated for invasive rectal carcinoma. The possible mechanisms and implications of this occurrence are discussed.
Adenocarcinoma↗
Absence of p53 gene mutations in primary neuroblastomas.
Neuroblastoma is a common childhood malignancy of the sympathetic nervous system. Mutations in p53, a tumor suppressor gene located on the short arm of chromosome 17, are one of the most common genetic lesions in human cancers. The evidence for trisomies of 17q with loss of 17p in some cases of neuroblastoma led us to consider whether p53 mutations might contribute to the onset and progression of this malignancy. In this study, primary tumors from 38 neuroblastoma patients were screened for mutations within the coding exons of the p53 gene by single-strand conformation polymorphism analysis, and potential mutations were further analyzed by nucleotide sequence analysis. Previously described sequence variations were detected in many of the tumors, including a silent polymorphism at codon 213 (CGA to CGG) and the nontransforming Pro to Arg substitution at codon 72 (CCC to CGC). However, no other sequence variations were detected within the coding portions of the p53 gene. This finding suggests that p53 mutations do not contribute to the etiology of neuroblastoma and that the chromosome 17 alterations observed in neuroblastoma involve genes which are distinct from the p53 locus.
Base Sequence↗
Isolated right ventricular myocardial infarction.
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Aged↗
Phase I trial of trimetrexate in pediatric solid tumors: a Pediatric Oncology Group study.
Trimetrexate (TMTX), a lipophilic antifol, was evaluated in a Pediatric Oncology Group (POG) Phase I trial in children with refractory solid tumors. TMTX was administered intravenously daily x 5 every three weeks. Starting dose was 6.4 mg/m2/day. Dose was escalated by 20% until the maximal tolerated dose was reached. A total of 75 courses were administered to 26 children. The major toxicity was myelosuppression, of which neutropenia and thrombocytopenia were most prominent. Rash, mucositis, and transient liver enzyme elevations were infrequently seen. Responses were observed in children with brainstem glioma, neuroblastoma, and renal cell carcinoma. The recommended Phase II dose using this schedule is 9.2-11 mg/m2/day depending on how heavily the patient has been treated prior to initiating this therapy.
Adolescent↗
Physical and genetic mapping of a human apical epithelial Na+/H+ exchanger (NHE3) isoform to chromosome 5p15.3.
A gene family of Na+/H+ exchanger isoforms has been identified. Characterization of rabbit NHE3 suggests that it is the apical epithelial Na+/H+ exchanger isoform responsible for transepithelial, electroneutral Na+ absorption in intestinal and renal epithelial cells. We have previously isolated from a human kidney cortex library a partial human NHE3 cDNA, clone HKC-3. Using HKC-3 to probe human/rodent somatic cell hybrid mapping panels, the human NHE3 gene was physically mapped to the distal portion of chromosome 5p15.3. Southern analysis of EcoRI-digested human genomic DNAs of CEPH pedigrees probed with HKC-3 detected three polymorphic sites containing a total of nine alleles that segregate in a Mendelian fashion. The observed heterozygosity for the NHE3 locus in unrelated individuals was 71%. Linkage analysis between NHE3 and other markers known to map at 5p15 confirmed the localization of NHE3 to chromosome 5p15.3, making NHE3 the most telomeric gene identified on the short arm of chromosome 5.
Animals↗
Brain tumor protocols in North America.
A list of active investigative brain tumor protocols in North America is presented. The fact that there are 138 protocols (and certainly some have been missed) indicates the diversity and intensity of research into this difficult problem. The geographic diversity of institutions involved in brain tumor clinical trials also underscores the opportunity available to a large number of clinicians caring for patients with brain tumors to refer them for participation in such a study.
Brain Neoplasms↗
Intracranial arterial occlusion associated with high-activity iodine-125 brachytherapy for glioblastoma.
We describe two patients who developed devastating strokes due to intracranial arterial occlusion 15 weeks and 97 weeks following high dose stereotactic iodine-125 brachytherapy for glioblastoma multiforme. In both cases the occlusion was within the implant volume at points receiving 110-281 Gy and there was no other evidence of significant atherosclerosis in the patients. We therefore conclude that these complications were a direct result of the brachytherapy. The phenomenon of radiation-induced occlusion of large cerebral arteries is reviewed.
Arterial Occlusive Diseases↗
[Dietary intake of total lipids and saturated fatty acids of the Geneva population: an unexpected development].
Results of two dietary surveys performed 10 years apart suggest that the Geneva population has a lower caloric intake and a lower proportion of total fat and saturated fat in the total caloric intake. These changes are observed in all ages, sexes or nationalities. They may indicate that prevention campaigns promoting a healthier diet with a lower content of calories and fat have had some impact. However, because of methodological differences between the two surveys we cannot conclude that these dietary changes are real.
Adult↗
Pulsatile motion artifact reduction in 3D steady-state-free-precession-echo brain imaging.
An image can be made from the echo of a steady-state-free-precession and pulse sequences for this purpose have been implemented on various commercial systems under such names as "CE-FAST" and "SSFP" (herein generically termed SSFP-Echo). Such sequences can be employed to achieve strong T2-weighting with reduced T2* effects, but are limited by their sensitivity to flow and motion which produce artifacts. Simple considerations indicate that this sensitivity is primarily related to the (implementation-dependent) moments of the imaging gradients. In this work, MR imaging of the brain using a standard implementation of the sequence with large moment "crusher" gradients on the slice select axis (to dephase the FID of the SSFP) is compared to a modified implementation with reduced moment gradient pulses and different radiofrequency (RF) phase cycling. Asymmetric echo acquisition and narrowed bandwidth was used to further reduce gradient moments. The sensitivity of this sequence to flow and motion artifacts, especially for motion perpendicular to the slice, is thus expected to be significantly reduced. The modified sequence was found to have flow and motion artifacts reduced by a factor of five in the axial plane and a factor of two in the coronal plane. These modifications can thus significantly reduce the flow and motion artifacts commonly seen in conventional images of the SSFP echo with little or no penalty in scan time or signal-to-noise ratio.
Artifacts↗
Enzyme rate assay for 5-fluorocytosine.
Modification of an enzyme assay for 5-fluorocytosine, from an end point to a rate analysis, has resulted in a method that can provide results within 10 minutes. The modification also rendered the assay less susceptible to interference from bilirubin and triglycerides. This obviated the need to correct 5-fluorocytosine results for icteric or moderately lipemic samples. The performance history of the enzyme rate method has shown that it is reliable, quick, cost-effective, and suitable for use in a clinical laboratory.
Aminohydrolases↗
The value of reoperation for recurrent glioblastoma.
To determine the value of reoperation alone (no further surgical procedures or radiotherapy), 43 patients (27 men, 16 women) with recurrent supratentorial glioblastomas who underwent a second craniotomy for recurrent tumour were reviewed retrospectively. The patients ranged in age from 27 to 66 years (median 53 years). All patients were treated initially by surgical resection and external radiation (50 Gy in 25 fractions through parallel opposed regional fields). In addition, 10 patients (23%) received chemotherapy, 3 patients (7%) received photodynamic therapy and 9 patients (21%) received interstitial brachytherapy postoperatively. Although none of the patients had further surgical procedures or radiotherapy after reoperation for tumour recurrence, 5 of the 43 did receive single-agent chemotherapy. The median survival after the first operation was 57 weeks. The median interval between first and second operations was 32 weeks. Median survival after reoperation was 19 weeks. An interval of more than 50 weeks between the two operations correlated with a significant (p < 0.05) increase in survival. The death rate for reoperation was 4.6%. The infection rate was 9.3%. The authors conclude that reoperation alone confers a modest but valuable increase in survival, especially if the interval between operations is greater than 50 weeks.
Adult↗
Seizure prophylaxis for brain tumour patients. Brief review and guide for family physicians.
Brain tumours are relatively uncommon, but family physicians are sometimes confronted with the somewhat unnerving task of carrying on the day-to-day management of these patients. The authors examine some of the problems encountered in preventing seizures among brain tumour patients. Using illustrative clinical cases and a review of the relevant literature, guidelines are provided for the institution, maintenance, and in some cases discontinuation of seizure prophylaxis for this group of patients.
Adult↗
Cold hard death, cold hard doctors.
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Family↗
[Salami and extrinsic allergic alveolitis: a new occupational disease in Switzerland].
The authors report a case of extrinsic allergic alveolitis in a patient working in an industrial butchery where she is involved in the preparation of dry sausages. The molds proliferating at the surface of these sausages, molds from the Penicillium family, are responsible for the disease. The respective value of laboratory tests such as the presence of precipitating antibodies and the analysis of the cellularity of the bronchoalveolar lavage are discussed. Whenever a patient presents with clinical symptoms suggestive of extrinsic allergic alveolitis a detailed search for any type of exposure linked to the professional milieu is required, so as to propose adequate modifications in work conditions or work place.
Alveolitis, Extrinsic Allergic↗
The psychological, social, and sexual consequences of gestational trophoblastic disease.
Seventy-six women diagnosed with gestational trophoblastic disease (GTD) from 1985 to 1989 completed questionnaires evaluating their status on mood disturbance, marital satisfaction, sexual functioning, psychosocial response to illness, and report of the most stressful event occurring within the past year. Multivariate analyses of variance (MANOVA) were conducted on dependent measures to examine differences between diagnostic groups (partial mole, complete mole, persistent disease), time from diagnosis (less than 1 year, 1-2 years, or 3-5 years from diagnosis), and follow-up status (active disease or remission). MANOVAs revealed no significant differences in the dependent measures based on time from diagnosis, type of medical treatment received, or type of molar disease. The metastatic disease group displayed significantly greater mood disturbance (F(1, 66) = 17.63, P less than 0.0001) and reported suffering clinically significant levels of distress and significantly greater levels of distress in response to the illness (F(33, 39) = 2.32, P less than 0.006). Women with active disease also reported significantly greater levels of distress in response to the illness (F(33, 39) = 2.76, P less than 0.001). Across disease types, GTD patients experience clinically significant levels of anxiety, anger, fatigue, confusion, and sexual problems and are significantly impacted by pregnancy concerns for protracted periods of time.
Adaptation, Psychological↗
Patterns of recurrence of malignant astrocytoma following stereotactic interstitial brachytherapy with iodine-125 implants.
The pattern of tumor recurrence was studied in a series of 68 patients who were treated with interstitial brachytherapy for malignant astrocytoma. Thirty-six patients had newly diagnosed tumors and were treated following surgery and external beam therapy, while 32 were treated for recurrent tumors. Recurrence pattern was determined using computed tomography at the time of clinical deterioration. Thirty-eight percent of tumor recurrence occurred within the original tumor margin and 50% occurred at the original site but extended beyond the initial margin. In all, 88.0% recurred at the initial tumor site, 71.4% being confined to within 2 cm of the pretreatment tumor borders while 6.0% recurred intracranially outside of the initial tumor margin. One patient recurred with spinal metastasis while two patients developed systemic metastases. The significance of these findings is discussed.
Adolescent↗