Efficacy and Cognitive Outcomes of Gamma Knife Radiosurgery in Glioblastoma Management for Elderly Patients.

BACKGROUND: Gamma Knife Radiosurgery (GKRS), a specific type of Stereotactic Radiosurgery (SRS), has developed as a significant modality in the treatment of glioblastoma, particularly in conjunction with standard chemotherapy. The goal of this study is to evaluate the efficacy of combining GKRS with surgical resection and chemotherapy in enhancing therapeutic effects for glioblastoma patients aged 55 years and older. METHODS: This prospective clinical study, conducted in accordance with the STROBE guidelines, involved 49 glioblastoma patients aged 55 years and older, treated between January 2013 and January 2023. Data were collected prospectively, and strict adherence to the STUPP protocol was maintained. Only patients who conformed to the STUPP protocol were included in the analysis. Due to concerns regarding the cognitive impairment associated with conventional radiotherapy, and at the patients' request, a radiosurgery plan was offered. Radiosurgery was administered for 4-8 weeks following surgical resection. Any patients who had not received previous radiotherapy received open surgical tumor removal, followed by GKRS along with adjuvant chemotherapy. RESULTS: In this prospective clinical study of 49 glioblastoma patients aged 55 years and older, the average lifespan post-histopathological diagnosis was established at 22.3 months (95% CI: 12.0-28.0 months). The median time before disease progression was 14.3 months (95% CI: 13.0-29.7 months). The median duration until the first recurrence after treatment was 15.2 months, with documented cases varying between 4 and 33 months. The Gamma Knife Radiosurgery (GKRS) treatment involved a median marginal recommended dose of 12.5 Gy, targeting an average volume of 5.7 cm3 (range: 1.6-39 cm3). Local recurrence occurred in 21 patients, while distant recurrence was identified in 8 patients. Within the cohort, 34 patients were subjected to further therapeutic approaches, including reoperation, a second GKRS session, the administration of bevacizumab and irinotecan, and PCV chemotherapy. A cognitive function assessment revealed that the patients treated with GKRS experienced significantly less cognitive decline compared to the historical controls, who were treated with conventional radiotherapy. The median MMSE scores declined by 1.9 points over 12 months, and the median MoCA scores declined by 2.9 points. CONCLUSION: This study demonstrates that Gamma Knife Radiosurgery (GKRS), when integrated with surgical resection and adjuvant chemotherapy, offers a substantial benefit for glioblastoma patients aged 55 years and older. The data reveal that GKRS not only prolongs overall survival and progression-free survival but also significantly reduces cognitive decline compared to conventional radiotherapy. These findings underscore the efficacy and safety of GKRS, advocating for its incorporation into standard treatment protocols for older glioblastoma patients. The potential of GKRS to improve patient outcomes while preserving cognitive function is compelling and warrants further research to optimize and confirm its role in glioblastoma management.

Giant Neurocysticercosis: A Rare Medical Condition.

Neurocysticercosis is the most common parasitic infestation of the central nervous system and is often asymptomatic. A giant presentation, defined as a cyst measuring 4 cm or more in its largest dimension, is a rare entity. The mass effect of such lesions can lead to neurological deterioration, making surgical resection necessary. We present three cases of neurocysticercosis with giant cystic lesions located intracranially, which caused significant mass effects. The patients primarily exhibited impaired consciousness, motor deficits, and seizures. All three patients underwent craniotomy for the resection of the cystic lesions, resulting in favorable outcomes and recovery of neurological function. The management of giant intracranial neurocysticercosis with substantial mass effect should be surgical. Adequate surgical resection can lead to significant neurological recovery for the patient.

Giant Meningioma Diagnosis and Clinical Treatment: A Case Report.

This case report shows the importance of semiology during a clinical examination not only to diagnose spine clinical symptoms but also to review the central nervous system tumor as a foot drop cause. We report a unique case of a patient who consulted for constant progressive numbness and motor symptoms in the right lower extremity. Lumbar CT and MRI were negative for acute or chronic lumbar pathology. This is a 41-year-old female patient with a history of eight-month progressive right leg weakness. The physical examination did not reveal neurological alterations besides foot drop. MRI and lumbar X-rays showed no significant findings. Electromyography (EMG) indicated right peroneal neuropathy. Based on these findings, surgical treatment was not indicated; therefore, physical therapy and a referral to neurology were indicated. However, symptoms increased, resulting in a right lower extremity hemiparesis. A brain MRI showed a left frontoparietal giant meningioma, which was surgically resected after embolization. The patient evolved with a full recovery of the right-sided hemiparesis after surgery. Our case highlights the foot drop's multiple etiologies. Initially, a lumbar disc hernia was suspected, but it was ruled out by imaging studies. Later, the EMG revealed peroneal neuropathy, leading to a neurology consult. Unexpectedly, a giant intracranial meningioma was found, a rare case of foot drop. A consideration of upper motor neuron (UMN) and lower motor neuron (LMN) syndromes aided diagnosis. Tumoral resection with embolization resulted in significant improvement, showcasing the complexities of such cases. Foot drop is a peculiar clinical manifestation that must have an integral assessment to rule out peripheral and central causes. Even rare, giant meningiomas can cause focalized symptoms such as foot drop. Therefore, the assessment of foot drop should include the CT and MRI of the central nervous system.

Systematic Review and Clinical Insights: The Role of the Ketogenic Diet in Managing Glioblastoma in Cancer Neuroscience.

Recent scientific research has shown that the ketogenic diet may have potential benefits in a variety of medical fields, which has led to the diet receiving a substantial amount of attention. Clinical and experimental research on brain tumors has shown that the ketogenic diet has a satisfactory safety profile. This safety profile has been established in a variety of applications, including the management of obesity and the treatment of drug-resistant epileptic cases. However, in human studies, the impact of ketogenic therapy on the growth of tumors and the life expectancy of patients has not provided results that are well characterized. Consequently, our purpose is to improve the comprehension of these features by succinctly presenting the developments and conclusions that have been gained from the most recent study that pertains to this non-pharmacological technique. According to the findings of our study, patients with brain tumors who stick to a ketogenic diet are more likely to experience improved survival rates. However, it is required to conduct additional research on humans in order to more accurately define the anti-tumor efficiency of this diet as well as the underlying processes that support the therapeutic effects of this dieting regimen.

5-Aminolevulinic Acid-A Biomarker for Worse Prognosis in IDH-Wildtype II Tumors? Evolution of a Fluorescence-Positive Diffuse Astrocytoma: A Case Report.

Introduction In 2017, the U.S. Food and Drug Administration (FDA) approved 5-aminolevulinic acid (5-ALA) as an intraoperative optical imaging agent in patients with suspected high-grade gliomas (HGGs). However, the application of 5-ALA for low-grade gliomas is still less accepted. Astrocytoma, isocitrate dehydrogenase (IDH) mutant tumors are diffuse infiltrating astrocytic tumors where there is no identifiable border between the tumor and normal brain tissue, even though the borders may appear relatively well-marginated on imaging. Generally, it is considered that 5-ALA cannot pass through a normal blood-brain barrier (BBB). Thus, 5-ALA fluorescence may mean disruption of BBB in grade II glioma. Case Report A 74-year-old male patient was diagnosed with a right parietal lesion suggestive of a low-grade brain tumor in a surgical resection using 5-ALA, which led to the detection of tiny fluorescence spots during the surgery. The frozen section was consistent with diffuse astrocytoma, IDH-wildtype (World Health Organization [WHO] grade II). The patient's postoperative magnetic resonance imaging (MRI) showed complete resection. Eight months after surgery, he began experiencing symptoms again and was admitted with a brain MRI finding consistent with recurrent infiltrating astrocytomas. This required reoperation of the brain tumor resection with 5-ALA. Unlike the first surgery, they observed a high fluorescence intensity; the pathological finding was glioblastoma, IDH-wildtype (WHO grade IV). Postsurgical brain MRI showed total resection of the tumor. The patient was discharged 4 weeks after surgery and continued with specialized clinical follow-up. Conclusion The use of 5-ALA continues to be a great contributor to the improvement in complete resection of primary brain tumors, especially HGG. Besides, fluorescence is increasingly approaching its use as a prognostic tool for aggressive clinical course, regardless of the initial grade of the tumor. This case report is an effort to expand knowledge for potentially using 5-ALA to help prognosticate brain tumors. Nevertheless, more clinical prospective studies must be conducted.

Rompiendo el efecto ''techo de cristal'' en la generación de evidencia clínica de alto nivel en ortopedia y traumatología / Breaking the "glass ceiling" effect in the generation of high-level clinical evidence in orthopedics and traumatology

Introduction: In clinical studies involving common orthopedic problems and traumatic injuries, randomization methods are difficult to orchestrate. The lack of high-level clinical evidence based on prospective, randomized, double-blind studies is often cited as a major reason for rejecting proposed therapeutic advances in orthopedic surgery. Materials and methods: This opinion document summarizes the limitations of clinical trials in surgical subspecialties. A consensus is presented about how the practicing orthopedic surgeon can produce high-quality clinical evidence and thus make changes to their clinical practice protocols. Results: This literature review revealed that level of evidence classifications vary among surgical subspecialties. Research in orthopedics and traumatology is primarily directed toward diagnosis, preferred treatment, and economic decision analysis, while other prognostic classifications are preferred in other areas, such as plastic surgery. In orthopedics, double-blind controlled studies are rare and often impractical or even unethical. Crossover between randomized surgical trials of study groups is more common. Other difficulties in surgical trials range from: lack of organizational and financial support, institutional approval or ethics committee and registration requirements for clinical trials, and to insufficient time outside of an already busy clinical program to dedicate to this laborious task. uncompensated task. Conclusion: Orthopedic surgery is a subspecialty based on experience and skill. Many innovations begin with enterprising surgeons reporting opinion reports or retrospective cohort studies, many of which are biased. Prospective observational cohort studies with consistent results may offer higher grade clinical evidence than poorly executed randomized trials.

Gamma knife stereotactic radiosurgery as an effective tool in primary CNS lymphoma: Evaluation of stereotactic radiosurgery and methotrexate treatment in a prospective and observational clinical research study.

OBJECTIVE: The purpose of this study was to compare the progression of Primary Central Nervous System Lymphoma (PCNSL) in patients treated with methotrexate (MTX) versus those treated with a combination of Stereotactic Radiosurgery (SRS) and MTX. Progression was measured via brain lesion count and tumor volume. METHODS: This observational and prospective cohort study evaluated the outcome of SRS treatment of PCNSL in one hundred twenty-eight subjects. We analyzed baseline, prospective, and retrospective data of patients enrolled in the brain tumor registry between June 2010 and August 2017. Seventy-three patients were treated exclusively with MTX while the remaining fifty-five patients received a combination of SRS and MTX. Strict inclusion and exclusion criteria were established. RESULTS: Mean survival rate for patients receiving combined SRS and MTX treatment was significantly higher (52.6 months) compared to the MTX group (19.8 months); p = 0.0029. At the 36 months follow-up, patients treated with SRS and MTX also had a lower rate of tumor progression (32.7 %) than the MTX group (95.9 %); p = 0.00192. Local tumor control was achieved in all patients treated with SRS. No clinical toxicity was observed in this group. CONCLUSIONS: Clinical results obtained from this observational study highlight the potential effectiveness of SRS in the treatment of PCNSL. Although treatment outcomes have improved in the past years, additional evidence in the clinical design of randomized trials is needed to evaluate the strength of this treatment in specific situations.

Two viruses from Stylosanthes guianensis may represent a new genus within Potyviridae.

Forage crops occupy large areas of tropical pastures for cattle feeding in Brazil. The use of stylos (Stylosanthes spp.) in these pastures, which are leguminous shrubs, has increased in the country due to their outstanding nutritional value and for being an efficient and alternative source for nitrogen fixation in the soil. In recent years, virus-like mosaic symptoms on S.guianensis leaves have often been observed in the field, indicating possible virus-like pathogen infections. In an effort to identify the causal agent, virus semi-purification protocol was performed using symptomatic S. guianensis leaves collected at EMBRAPA Beef Cattle Research Center. Total RNA extracted from this semi-purified preparation was submitted to high-throughput sequencing, which revealed complete genome sequences of novel viruses of the family Potyviridae. These viruses, tentatively named stylo mosaic-associated virus 1 (StyMaV-1) and stylo mosaic-associated virus 2 (StyMaV-2), shared 73 % CP aa identity and 77 % polyprotein aa identity with each other and, after that, being closest related to blackberry virus Y, genus Brambyvirus (only 41 % CP aa identity). Based on ICTV genus demarcation criteria, StyMaV-1 and StyMaV-2 represent new species of a new genus within the family Potyviridae. StyMaV-1 and StyMaV-2 are also not efficiently transmitted to other plant species by mechanical inoculation.

First Occurrence and Population Dynamics of Blissus pulchellus (Hemiptera: Blissidae) in Brazil: a new pest of pastures in Roraima

ABSTRACT Cattle production is one of the main economic activities in the state of Roraima, and insect pest attacks in pastures have a negative effect on this sector in the region. Little is known about the species that cause damage to forage fields in the state. This study presents the first report of the occurrence of the chinch bug Blissus pulchellus Montandon (Hemiptera: Blissidae) in Roraima, Brazil and a description of the population dynamics of this pest in pasture areas in this state. Pasture areas were sampled in nine municipalities of Roraima to detect the insect. The population dynamics study was conducted for two years in Alto Alegre municipality, two of which have Brachiaria brizantha cv. Marandu and one of Megathrysus maximus cv. Mombaça (Poaceae) crops. Blissus pulchellus was found in all sampled areas, except in Rorainópolis and São João da Baliza. High densities of this bug were found in in Alto Alegre. This is the first report of B. pulchellus in Brazil. The factors that affect the population dynamics and the damage caused by this insect pest to pastures as well as the risk of dispersal of this pest in Brazil are discussed.

Corrigendum: Genetic Mapping With Allele Dosage Information in Tetraploid Urochloa decumbens (Stapf) R. D. Webster Reveals Insights Into Spittlebug (Notozulia entreriana Berg) Resistance.

[This corrects the article DOI: 10.3389/fpls.2019.00092.].

Genetic Mapping With Allele Dosage Information in Tetraploid Urochloa decumbens (Stapf) R. D. Webster Reveals Insights Into Spittlebug (Notozulia entreriana Berg) Resistance.

Urochloa decumbens (Stapf) R. D. Webster is one of the most important African forage grasses in Brazilian beef production. Currently available genetic-genomic resources for this species are restricted mainly due to polyploidy and apomixis. Therefore, crucial genomic-molecular studies such as the construction of genetic maps and the mapping of quantitative trait loci (QTLs) are very challenging and consequently affect the advancement of molecular breeding. The objectives of this work were to (i) construct an integrated U. decumbens genetic map for a full-sibling progeny using GBS-based markers with allele dosage information, (ii) detect QTLs for spittlebug (Notozulia entreriana) resistance, and (iii) seek putative candidate genes involved in defense against biotic stresses. We used the Setaria viridis genome a reference to align GBS reads and selected 4,240 high-quality SNP markers with allele dosage information. Of these markers, 1,000 were distributed throughout nine homologous groups with a cumulative map length of 1,335.09 cM and an average marker density of 1.33 cM. We detected QTLs for resistance to spittlebug, an important pasture insect pest, that explained between 4.66 and 6.24% of the phenotypic variation. These QTLs are in regions containing putative candidate genes related to defense against biotic stresses. Because this is the first genetic map with SNP autotetraploid dosage data and QTL detection in U. decumbens, it will be useful for future evolutionary studies, genome assembly, and other QTL analyses in Urochloa spp. Moreover, the results might facilitate the isolation of spittlebug-related candidate genes and help clarify the mechanism of spittlebug resistance. These approaches will improve selection efficiency and accuracy in U. decumbens molecular breeding and shorten the breeding cycle.

Highly Active Antiretroviral Therapy and Gamma Knife Radiosurgery for the Treatment of AIDS-Related Primary Central Nervous System Lymphoma.

BACKGROUND: The criterion standard for the treatment of newly diagnosed primary central nervous system lymphoma (PCNSL) remains high-dose chemotherapy in conjunction with palliative whole-brain radiotherapy; however, there may be a role for novel combined approaches in immunocompromised patients. CASE DESCRIPTION: A 66-year-old man presented with acute cephalalgia, disorientation, and lethargy. His condition was evaluated in the emergency department, and he was admitted with probable hydrocephalus. Magnetic resonance imaging (MRI) of the brain revealed multiple nonspecific brain lesions, predominantly involving the right temporal lobe, which on biopsy led to a diagnosis of PCNSL. Subsequent laboratory studies demonstrated active human immunodeficiency virus (HIV) infection, with a CD4 count of 21 cells/µL and an HIV viral load (VL) of >400,000 copies/mL. The patient was eventually given highly active antiretroviral therapy (HAART). He declined palliative whole-brain radiotherapy but was amenable to gamma knife radiosurgery (GKRS) for treatment of the right temporal brain lesions. Three months later, the patient's neurologic symptoms had improved; similarly, his CD4 count increased to 176 cells/mL, and his HIV viral load was <90 copies/mL. By the 12-month follow-up visit, the patient was asymptomatic, and at 36 months, MRI of the brain demonstrated total remission without new brain lesions. CONCLUSIONS: The criterion standard for treatment of newly diagnosed PCNSL remains high-dose chemotherapy in conjunction with palliative whole-brain radiotherapy; however, there may be a role for novel combined approaches using chemotherapy, HAART, and GKRS to have a positive impact on survival rates of PCNSL related to AIDS.

A case report and technical tip of chronic subdural hematoma treated by the placement of a subdural peritoneal shunt.

BACKGROUND: Chronic subdural hematomas (CSDH) tend to occur most commonly in the elderly population, usually resulting from minor or insignificant head trauma. The pathophysiology behind CSDH is often directly associated with cerebral atrophy, and other causes of cerebral atrophy such as alcoholism or dementia. Other predisposing factors include diabetes, coagulopathy, use of anticoagulants (including aspirin), seizure disorders, and CSF shunts. Considerable evidence supporting the use of external drainage after evacuation of primary CSDH is readily available in the literature. CASE REPORT: We report the case of a 72 year-old male with a history of recurrent left subdural hematoma presenting to the neurosurgical clinic with a two-day history of personality changes, difficulty speaking, urinary incontinence, and headaches. Burr hole evacuation was performed with the placement of a subdural peritoneal shunt. At the one-month follow-up appointment, the patient had complete resolution of symptoms and CT scan showed no new recurrence of the subdural hematoma. CONCLUSIONS: Although several treatment options are available for the management of CSDH, recurrence of hematoma is a major and very common complication that may result in re-injury due to mass effect caused by chronic hematoma. However, placement of subdural peritoneal shunt for the treatment of CSDH can reduce the recurrence rate of CSDH and therefore, reduce the risk of brain re-injury.

Comparison of Percutaneous Retrogasserian Balloon Compression and Gamma Knife Radiosurgery for the Treatment of Trigeminal Neuralgia in Multiple Sclerosis.

OBJECTIVE: We compared and evaluated percutaneous retrogasserian balloon compression (PBC) and Gamma Knife radiosurgery (GKRS) for treatment of trigeminal neuralgia (TN) in patients with multiple sclerosis (MS). METHODS: In this single-center, retrospective comparative study, 202 patients with MS and concomitant TN were evaluated. A minimum follow-up of 24 months was required. Patients with a history of microvascular decompression or previous intervention were excluded. Between February 2009 and December 2013, 78 PBC procedures and 124 first-dosage GKRS procedures were performed. PBC procedures were successfully completed in all cases. The 2 groups were compared with regard to initial effect, duration of effect, and complications including type and severity. RESULTS: Immediate pain relief occurred in 87% of patients treated with PBC and in 23% of patients treated with GKRS. Kaplan-Meier plots for the 2 treatment modalities were similar. The 50% recurrence rate was at 12 months for the PBC group and 18 months for the GKRS group. Complication (excluding numbness) rates were 3% for GKRS and 21% for PBC. The difference was statistically significant (χ2 test, P = 0.03). CONCLUSIONS: PBC and GKRS are effective techniques for treatment of TN in patients with MS. Fewer complications and superior long-term relief were associated with GKRS. We consider GKRS as the first option for the treatment of TN in patients with MS, reserving PBC for patients with acute, intractable pain.

Primary Central Nervous System Lymphoma (PCNSL): Analysis of Treatment by Gamma Knife Radiosurgery and Chemotherapy in a Prospective, Observational Study.

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a rare cancer accounting for less than 3% of primary brain and central nervous system (CNS) tumors. Tissues involved include the brain parenchyma, leptomeninges, eyes, and spinal cord. High-dose methotrexate (MTX) is the gold standard for newly diagnosed PCNSL. However, Gamma Knife radiosurgery (GKRS) may be efficacious as a co-adjuvant treatment. The purpose of this prospective observational cohort study is to determine the effectiveness of MTX in combination with GKRS in the treatment of PCNSL. METHODS: This is a prospective, observational cohort study evaluating the treatment of histologically confirmed PCNSL with MTX as a single agent in a dose of 8 g/m2 (control) and treatment with MTX, plus GKRS. Strict inclusion and exclusion criteria were employed. Primary outcomes were measured by survival rate. Secondary outcomes were assessed by the tumor's responsiveness to treatment and reduction in size as noted on imaging. RESULTS: Between January 2007 and January 2012, 128 charts were evaluated. Included in this evaluation were 73 chemotherapy (control) and 55 chemotherapy, plus GKRS, patients (variable). The follow-up period was 24 to 49 months (mean: 36.9 months). There were no statistically significant differences in patient demographics or histology diagnosis. Patients were treated with GK doses ranging from 11 Gy to 16 Gy (median: 11 Gy). The median survival rate from initial diagnosis was 26.8 months in the chemotherapy group and 47.6 in the chemotherapy, plus GKRS, group (p-value: 0.0034). All lesions showed a complete response after GKRS when evaluated using magnetic resonance imaging after three to eight weeks (mean range: 6.3 weeks). CONCLUSIONS: The use of GKRS is non-invasive, safe, and shows rapid success, improving the prognosis of the patient. This noninvasive treatment modality should be considered as an option for patients with PCNSL. In our study, GKRS as a co-adjuvant therapy to high-dose methotrexate was statistically significant for greater tumor control, enhanced overall survival period, and a lesser number of complications.

Is Subdural Peritoneal Shunt Placement an Effective Tool for the Management of Recurrent/Chronic Subdural Hematoma?

UNLABELLED: OBJECTIVE : To describe a surgical technique and to report using a retrospective study the efficacy of peritoneal shunts for the treatment of recurrent/chronic subdural hematoma (CSDH). We describe the considerations, complications, and outcomes related to this technique. METHODS : In a retrospective cohort study, 125 charts with a diagnosis of subacute/chronic subdural hematoma were assigned for evaluation. Of the charts reviewed, 18 charts were found from subjects with a diagnosis of recurrent sub-acute or chronic subdural hematoma. All patients had undergone initial surgical treatment of their condition followed by peritoneal shunt placement to help alleviate intracranial pressure. Factors including the age, size of subdural hematoma, number of previous events, BMI, complications, survival, and clinical course were analyzed. RESULTS : After subdural peritoneal shunt placement all patients had full neurological recovery with no complaints of headaches, lethargy, weakness, confusion or seizures. None of the cases had new subdural hematoma episodes after placement for a minimum of a two-year period (mean 26.1 months) (range 24.3-48.6 months). No postoperative complications were reported. The rates of postoperative hemorrhage, infection, distal catheter revision, and perioperative seizures was found to be zero percent. Shunt drainage was successful in all cases, draining 85% of the blood in the first 48 hours. There was no significant relationship between complications and the use of anticoagulants four weeks after surgery. CONCLUSIONS: Peritoneal shunts, though rarely used, are a viable option in the treatment of sub-acute/chronic subdural hematomas. When pursuing this treatment, this technique is recommended to mitigate the risks of repeat surgical intervention and lessen perioperative time in high-risk patients.

Resultados de biopsia guiada por tomografía axial computarizada en el síndrome de destrucción vertebral, evaluados en dos instituciones distintas / Resultados de biópsia guiada por tomografia computadorizada axial na síndrome de destruição vertebral, avaliados em duas instituições distintas / Results of computerized axial tomography-guided biopsy in the vertebral destruction syndrome, evaluated at two different institutions

OBJETIVO: Comparar resultados de biopsias vertebrales guiadas por tomografía axial computarizada, reportados por dos servicios de Anatomía Patológica distintos en pacientes con síndrome de destrucción vertebral para confirmar confiabilidad y utilidad en el diagnóstico. MÉTODOS: Se obtuvieron muestras de tejido de 21 pacientes en el periodo comprendido del 1 de marzo al 15 de julio del 2011 con el diagnóstico del síndrome de destrucción vertebral y a quienes se les realizó biopsia guiada por tomografía axial computarizada. Las muestras se enviaron en forma cegada a dos servicios de patología distintos. Los resultados fueron analizados con el método de comparación de dos proporciones. RESULTADOS: 14 pacientes fueron del género masculino (67%) y 7 del femenino (23%), edades de 28-82, con afección principalmente lumbar (48%) y torácica (38%); afectados en una vértebra en 62%, en dos en un 33% y en 3 o más niveles en 5%. Las vértebras más afectadas fueron L1, L2 y L3 (12/30 [40%]), T4 (3/30 [10%]) y T9 (3/30 [10%]). Los resultados se agruparon en categorías: 1. Osteomielitis (9/21 [43%]), 2. Tumores (7/21 [33%]), 3. Metástasis (3/21 [14%]), 4. Tejido normal (2/21 [10%]), 5. Inflamación (0/21 [0%]), 6. Muestra inadecuada (0/21 [0%]), 7. Mal de Pott (0/21 [0%]). CONCLUSIONES: De acuerdo a los valores de Z obtenidos mediante la prueba de comparación de dos proporciones no se encontró diferencia significativa entre los resultados reportados por dos los dos servicios de patología en el síndrome estudiado, determinándose que esta parte del proceso es confiable y útil en un 90%.

OBJETIVO: Comparar resultados de biópsias vertebrais guiadas por tomografia axial computadorizada, relatados por dois serviços de Anatomia Patológica distintos em pacientes com síndrome de destruição vertebral para confirmar a confiabilidade e a utilidade no diagnóstico. MÉTODOS: Foram obtidas amostras de tecido de 21 pacientes no período de 1 de março a 15 de julho de 2011, com diagnóstico de síndrome de destruição vertebral, que foram submetidos a biópsia guiada por tomografia axial computadorizada. As amostras foram enviadas de modo cego a dois serviços de patologia distintos. Os resultados foram analisados pelo método de comparação de duas proporções. RESULTADOS: 14 pacientes eram do sexo masculino (67%) e 7 do feminino (23%), com idades entre 28 e 82 e afecção predominantemente lombar (48%) e torácica (38%); 62% tinham comprometimento em uma vértebra, 33% em duas e 5% em três ou mais níveis. As vértebras mais afetadas foram L1, L2 e L3 (12/30 [40%]), T4 (3/30 [10%]) e T9 (3/30 [10%]). Os resultados foram agrupados em categorias: 1. Osteomielite (9/21 [43%]), 2. Tumores (7/21 [33%]), 3. Metástases (3/21 [14%]), 4. Tecido normal (2/21 [10%]), 5. Inflamação (0/21 [0%]), 6. Amostra inadequada (0/21 [0%]), 7. Mal de Pott (0/21 [0%]). CONCLUSÕES: De acordo com os valores de Z obtidos pela prova de comparação de duas proporções, não se encontrou diferença significante entre os resultados relatados pelos dois serviços de patologia na síndrome estudada, ficando determinado que essa parte do processo tem confiabilidade e utilidade de 90%.

OBJECTIVE: To compare results of vertebral biopsy guided by computerized axial tomography scan, reported by two different Departments of Pathology in patients with vertebral destruction syndrome to confirm the reliability and utility in the diagnosis. METHODS: Tissue samples from 21 patients were obtained March 1 to July 15, 2011, with a diagnosis of the vertebral destruction syndrome and who underwent computerized axial tomography-guided biopsy. The samples were blindly sent to two different pathology services. The results were analyzed using the two-proportion z-test. RESULTS: 14 patients were male (67%) and 7 females (23%), aged between 28 and 82, with condition predominantly lumbar (48%) and thoracic (38%); 62% had one vertebra affected, 33% ha two and 5% had three or more levels involved. The most affected vertebrae were L1, L2 and L3 (12/30 [40%]) and T9 (3/30 [10%]). The results were grouped into categories: 1. Osteomyelitis (9/21 [43%]), 2. Tumors (7/21 [33%]), 3. Metastases (3/21 [14%]), 4. Normal tissue (2/21 [10%]), 5. Inflammation (0/21 [0%]), 6. Inadequate sample (0/21 [0%]), 7. Pott's disease (0/21 [0%]). CONCLUSIONS: According to the values obtained by the two-proportion z-test, there was no significant difference between the results reported by the two departments of pathology for the syndrome studied, being determined that this part of the process has reliability and usefulness of 90%.

Laser interstitial thermal therapy for focal cerebral radiation necrosis: a case report and literature review.

Whole-brain radiotherapy and stereotactic radiosurgery (SRS) play a central role in the treatment of metastatic brain tumors. Radiation necrosis occurs in 5% of patients and can be very difficult to treat. The available treatment options for radiation necrosis include prolonged high-dose corticosteroids, hyperbaric oxygen, anticoagulation, bevacizumab, and surgical resection. We present the first report and results using laser-interstitial thermal therapy (LITT) for medically refractory radionecrosis. A 74-year-old diabetic patient who had a history of non-small cell lung cancer with brain metastases and subsequent treatment with SRS, presented with a focal lesion in the left centrum semiovale with progressively worsening edema. Image findings were consistent with radiation necrosis that was refractory despite prolonged, high-dose steroid therapy. His associated comorbidities obviated alternative interventions and the lesion was not in a location amenable to surgical resection. We used laser thermal ablation to treat the biopsy-proven radionecrosis. The procedure was tolerated well and the patient was discharged 48 hours postoperatively. Imaging at 7-week follow-up showed near complete resolution of the edema and associated mass effect. Additionally, the patient was completely weaned off steroids. To our knowledge this is the first report using LITT for the treatment of focal radiation necrosis. LITT may be an effective treatment modality for patients with medically refractory radiation necrosis with lesions not amenable to surgical decompression.

Meiotic chromosomes and nucleolar behavior in testicular cells of the grassland spittlebugs Deois flavopicta, Mahanarva fimbriolata and Notozulia entreriana (Hemiptera, Auchenorrhyncha).

Spittlebugs annually infest pastures and cause severe damage, representing a serious problem for the tropical American beef cattle industry. Spittlebugs are an important biotic constraint to forage production and there is a lack of cytogenetic data for this group of insects. For these reasons, we conducted this work, in which the spermatogenesis and nucleolar behavior of Deois flavopicta, Mahanarva fimbriolata and Notozulia entreriana were studied. The males possessed testes in the shape of a "bunch of grapes"; a variable number of testicular lobes per individual and polyploid nuclei composed of several heteropycnotic bodies. A heteropycnotic area was located in the periphery of the nucleus (prophase I); the chiasmata were terminal or interstitial; metaphases I were circular or linear and anaphase showed late migration of the sex chromosome. The chromosome complement had 2n = 19, except for N. entreriana (2n = 15); the spermatids were round with heteropycnotic material in the center and elongated with conspicuos chromatin. The analysis of testes after silver nitrate staining showed polyploid nuclei with three large and three smaller nucleolar bodies. Early prophase cells had an intensely stained nucleolar body located close to the chromatin and another less evident body located away from the chromatin. The nucleolar bodies disintegrated during diplotene. Silver staining occurred in two autosomes, in terminal and subterminal locations, the latter probably corresponding to the nucleolus organizer regions (NORs). The spermatids were round with a round nucleolar body and silver staining was observed in the medial and posterior region of the elongated part of the spermatid head.