Effects of Postoperative Intravenous Cyclosporine Treatment on the Survival and Functional Performance Status of Patients With Glioblastoma: A Randomized, Triple-Blinded, Placebo-Controlled Clinical Trial.

BACKGROUND: Glioblastoma is associated with low median survival time irrespective of maximal treatment. Previous in vitro studies have revealed tumor inhibitory effect of cyclosporine A. However, whether the addition of cyclosporine could improve survival among patients with glioblastoma is unknown. This study aimed to determine the impact of postoperation treatment with cyclosporine on the survival and performance status. METHODS: In this randomized, triple-blinded, placebo-controlled trial, 118 patients with glioblastoma who underwent surgery were treated with standard chemoradiotherapy regimen. Patients were randomized to receive intravenous cyclosporine for 3 days postoperatively or placebo during the same period. The primary endpoint was the short-term effect of intravenous cyclosporine on survival and Karnofsky performance scores. Secondary endpoints were chemoradiotherapy toxicity and neuroimaging features. RESULTS: The overall survival (OS) in the cyclosporine (17.03 ± 5.8, 95% confidence interval: 11-17.37 months) group was statistically lower than in the placebo (30.53 ± 4.9, 95% confidence interval: 8-32.3 months) groups (P = 0.049). However, compared to the placebo group, a statistically higher percentage of patients in the cyclosporine group were alive at 12 months follow-up. Also, progression-free survival in the cyclosporine group was significantly prolonged than in the placebo group (6.3 ± 4.07 months vs. 3.4 ± 2.98 months, P < 0.001). In the multivariate analysis, age <50 years (P = 0.022) and gross total resection (P = 0.03) were significantly associated with OS. CONCLUSIONS: Our study results demonstrated that administering postoperative cyclosporine does not improve OS and functional performance status. Notably, the survival rate was significantly dependent on the patient age and the extent of glioblastoma resection.

Surgical management of a thoracic extradural arachnoid cyst with communication to subarachnoid space through nerve root: a case report.

Spinal extradural cysts are uncommon and may cause cord and nerve root compression. The cysts usually appear in thoracic spine. We report a 29-year-old man with an extradural arachnoid cyst from T4 to T6. The cyst was communicated to the subarachnoid space through a fistula at the left T6 nerve root. To access the fistula, we had to unroof the foramen of left T6 nerve root which could lead to spinal instability. We decided to save the bony and soft tissue elements of the foramen at the mentioned thoracic spine level. Therefore, the cyst walls were excised and then the ostia of the cyst at the cystic side of the fistula was tightly closed.

Contralateral Radiculopathy: A Kernohan-Woltman Notch-like Phenomenon.

Lumbar disc herniation is the most common cause of radiculopathy. In most cases, the chief complaint is associated with radicular pain due to nerve compression on the herniated side. However, a radicular pain contralateral to the herniation side is an unusual finding rarely reported in the literature. Here, a case of right lower limb radicular pain in the presence of left extruded L4-L5 disc herniation is reported. Management of the patient is discussed in addition to a review of the literature regarding hypotheses on the mechanism of this unusual situation.

Cerebral abscess complicating embolization of an arteriovenous malformation: Case report and review of litera.

Central nervous system infection is a rare complication of endovascular procedures. We report a 21-year-old woman presented with headache, nausea, vomiting, and right-sided hemiparesis 4 months after endovascular embolization of cerebral arteriovenous malformation. Investigations led to the diagnosis of multiple brain abscesses. This is the sixth case report of brain abscess following endovascular interventions.

Prevalence of hepatitis B and C seromarkers and abnormal liver function tests among hemophiliacs in Guilan (northern province of Iran).

BACKGROUND: The aim of this study was to determine the seroprevalence of hepatitis B and C viruses and abnormal liver function tests among hemophiliacs in Guilan province, Iran. MATERIAL/METHODS: Patients registered with Guilan Hemophilia Society (GHS) were enrolled in this study, and evaluated for the presence of hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (HCV-Ab) and liver function tests. RESULTS: One hundred and one patients (100 males, 1 female, mean age 19.7 years, range 3-71 years) from 110 registered hemophiliacs were enrolled in this study. 29 patients (28.7%) had elevated Alanine aminotransferase (ALT), 27 (26.7%) and 72 (71.3%) were positive for HBsAg and HCV-Ab, respectively. Seropositivity for HCV-Ab correlated with the duration of treatment with clotting factor until 1997 (P=0.01). There was also an inverse correlation between factor VIII & IX activity and seropositivity for HCV-Ab (P<0.001) and HBsAg (P<0.04). HCV-Ab was more likely to be positive among those received lyophilized factor VIII and cryoprecipitate than lyophilized factor VIII alone (P<0.01). In addition HCV-Ab seropositivity was more common among those received factor IX concentrate and fresh frozen plasma (FFP) than those received only FFP (P<0.01). CONCLUSIONS: Based upon our finding, prevalence of HBsAg positive cases in Guilan province was higher than other studies. Although frequency of HCV-Ab was similar to other studies, frequency of increased ALT was less. Upon the results emerged from this study, we recommend that all hemophiliacs should be vaccinated against HBV and should have regular program for checking HCV.