Prognostic impact of meningeal dissemination in primary CNS lymphoma (PCNSL): experience from the G-PCNSL-SG1 trial.

BACKGROUND: We evaluated the frequency and prognostic impact of meningeal dissemination (MD) in immunocompetent adult patients with primary central nervous system lymphoma treated in a randomized phase III trial. PATIENTS AND METHODS: MD was evaluated at study entry and defined by lymphoma proof in the meningeal compartment detected by at least one of the following methods: cerebrospinal fluid (CSF) cytomorphology, detection of clonal B cells by IgH PCR in CSF or contrast enhancement of the leptomeninges on magnetic resonance imaging (MRI). RESULTS: Data on MD were available in 415 patients, of those, MD was detected in 65 (15.7%): in 44/361 (12.2%) by CSF cytomorphology, in 16/152 (10.5%) by PCR and in 17/415 (4.1%) by MRI. Major patients' characteristics and therapy did not significantly differ between patients with MD (MD+) versus those without MD (MD-). There was a significant correlation of MD with CSF pleocytosis (>5/µl; P < 0.0001), but no correlation with CSF protein elevation (>45 mg/dl). Median progression-free survival was 6.7 months [95% confidence interval (CI) 0-14.5] in MD+ and 8.3 months (5.7-10.8) in MD- patients (P = 0.95); median overall survival was 21.5 months (95% CI 16.8-26.1) and 24.9 months (17.5-32.3), respectively (P = 0.98). CONCLUSION: MD was detected infrequently and had no impact on outcome in this trial.

The crossed leg sign indicates a favorable outcome after severe stroke.

OBJECTIVE: We investigated whether crossed legs are a prognostic marker in patients with severe stroke. METHODS: In this controlled prospective observational study, we observed patients with severe stroke who crossed their legs during their hospital stay and matched them with randomly selected severe stroke patients who did not cross their legs. The patients were evaluated upon admission, on the day of leg crossing, upon discharge, and at 1 year after discharge. The Glasgow Coma Scale, the NIH Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel Index (BI) were obtained. RESULTS: Patients who crossed their legs (n = 34) and matched controls (n = 34) did not differ in any scale upon admission. At the time of discharge, the GCS did not differ, but the NIHSS was better in crossed legs patients (6.5 vs 10.6; p = 0.0026), as was the mRS (3.4 vs 5.1, p < 0.001), and the BI (34.0 vs 21.1; p = 0.0073). At 1-year follow-up, mRS (2.9 vs 5.1, p < 0.001) and the BI (71.3 vs 49.2; p = 0.045) were also better in the crossed leg group. The mortality between the groups differed grossly; only 1 patient died in the crossing group compared to 18 in the noncrossing group (p < 0.001). CONCLUSION: Leg crossing is an easily obtained clinical sign and is independent of additional technical examinations. Leg crossing within the first 15 days after severe stroke indicates a favorable outcome which includes less neurologic deficits, better independence in daily life, and lower rates of death.

[Pain and neuroborreliosis: significance, diagnosis and treatment]. / Schmerzen bei Neuroborreliose: Bedeutung, Diagnostik und Therapie.

Lyme neuroborreliosis is a tick-borne infection of the central nervous system caused by the spirochete Borrelia burgdorferi. The most frequent manifestation of neuroborreliosis in Europe is meningoradiculitis or Bannwarth's syndrome. One of its hallmarks is intense, lancinating, radicular pain, especially at night. Its characteristics are rather different to other forms of neuropathic pain in respect to the dynamics, localisation and therapeutic responses. This review therefore summarises not only the general symptoms, diagnostic procedures and therapy of Lyme neuroborreliosis, but also revises the characteristics and therapeutic options of painful meningoradiculitis in Bannwarth's syndrome.

Characteristics of brain tumour-associated headache.

Eighty-five brain tumour patients were examined for further characteristics of brain tumour-associated headache. The overall prevalence of headache in this population was 60%, but headache was the sole symptom in only 2%. Pain was generally dull, of moderate intensity, and not specifically localized. Nearly 40% met the criteria of tension-type headache. An alteration of the pain with the occurrence of the tumour was experienced by 82.5%, implying that the pre-existing and the brain tumour headaches were different. The classic characteristics mentioned in the International Classification of Headache Disorders (worsening in the morning or during coughing) were not found; this might be explained by the patients not having elevated intracranial pressure. Univariate analysis revealed that a positive family history of headache and the presence of meningiomas are risk factors for tumour-associated headache, and the use of beta-blockers is prophylactic. Pre-existing headache was the only risk factor according to logistic regression, suggesting that patients with pre-existing (primary) headache have a greater predisposition to develop secondary headache. Dull headache occurs significantly more often in patients with glioblastoma multiforme, and pulsating headache in patients with meningioma. In our study, only infratentorial tumours were associated with headache location, and predominantly with occipital but rarely frontal pain.

Hepatocyte growth-factor-scatter factor can stimulate post-operative tumor-cell proliferation in childhood hepatoblastoma.

Rapid growth of residual tumor after partial hepatectomy has been observed during the period of liver regeneration in children with malignant embryonal hepatoblastoma. The aim of this study was to elucidate the role of hepatocyte growth-factor-scatter factor (HGF-SF) in this phenomenon. Markedly increased serum levels of HGF-SF up to 15 ng/ml were found in 13/18 patients after liver resection and in 6/16 patients with regressive tumors after chemotherapy, in comparison with 15 patients with non-pre-treated hepatoblastoma and 20 healthy children of the same age group. In the tumors, epithelial tumor cells highly expressed the HGF-SF receptor c-met, as shown by immunohistochemistry and m-RNA RT-PCR. The hepatoblastoma cell lines HepT1, HepT3 and HUH6 reacted with significantly increased proliferation to rhHGF-SF in these concentrations (1-15 ng/ml). In the tumors, HGF-SF was found to be expressed in the stromal fibroblasts. In culture, hepatoblastoma cells (HepT3, HUH6) stimulated secretion of the factor by human fibroblasts, indicating the paracrine fashion of intratumoral HGF-SF production. Cultured hepatoblastoma cells ceased to proliferate at 20-50 ng/ml HGF-SF, and they underwent cell death at >/=100 ng/ml. In contrast, the hepatocellular-carcinoma cell line HepG2 decreased growth under HGF-SF in a dose-dependent manner. We conclude that post-operatively secreted and intratumorally produced HGF-SF can function as a growth factor for hepatoblastoma, while the same agent has a cytostatic effect in unphysiologically high concentrations.