Surgery and Radiosurgery in Autism: A Retrospective Study in 10 Patients.

INTRODUCTION: A subgroup of patients with autism spectrum disorder (ASD) show self or heteroaggression, dyscontrol episodes, and others are of obsessive-compulsive disorder (OCD) profile; some of them are resistant to medical and behavioural treatment. We describe the long-term outcome in a group of these patients, treated with radiofrequency brain lesions or combined stereotactic surgery and Gamma Knife (GK) radiosurgery. METHODS: We reviewed the medical records of 10 ASD patients with pathological aggressiveness and OCD, who had undergone radiofrequency lesions and/or radiosurgery with GK in our institution. RESULTS: The 10 patients had a significant reduction of their symptoms (PCQ 39.9 and 33, OAS 11.8 and 5, CYBOCS-ASD 30.4 and 20), preoperatively and in the last follow-up, respectively; p < 0.005 (in all cases), although all but 2 needed more than 1 treatment to maintain this improvement. CONCLUSIONS: We observed a marked improvement in behaviour, quality of life, and relationship with the environment in all our 10 patients after the lesioning treatments, without long-lasting side effects.

Results of Gamma Knife anterior capsulotomy for refractory obsessive-compulsive disorder: results in a series of 10 consecutive patients.

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a severe psychiatric condition. The authors present their experience with Gamma Knife radiosurgery (GKRS) in the treatment of patients with OCD resistant to any medical therapy. METHODS: Patients with severe OCD resistant to all pharmacological and psychiatric treatments who were treated with anterior GKRS capsulotomy were retrospectively reviewed. These patients were submitted to a physical, neurological, and neuropsychological examination together with structural and functional MRI before and after GKRS treatment. Strict study inclusion criteria were applied. Radiosurgical capsulotomy was performed using two 4-mm isocenters targeted at the midputaminal point of the anterior limb of the capsule. A maximal dose of 120 Gy was prescribed for each side. Clinical global changes were assessed using the Clinical Global Impression (CGI) scale, Global Assessment of Functioning (GAF) scale, EQ-5D, Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). OCD symptoms were determined by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). RESULTS: Ten patients with medically refractory OCD (5 women and 5 men) treated between 2006 and 2015 were included in this study. Median age at diagnosis was 22 years, median duration of illness at the time of radiosurgery was 14.5 years, and median age at treatment was 38.8 years. Before GKRS, the median Y-BOCS score was 34.5 with a median obsession score of 18 and compulsion score of 17. Seven (70%) of 10 patients achieved a full response at their last follow-up, 2 patients were nonresponders, and 1 patient was a partial responder. Evaluation of the Y-BOCS, BDI, STAI-Trait, STAI-State, GAF, and EQ-5D showed statistically significant improvement at the last follow-up after GKRS. Neurological examinations were normal in all patients at each visit. At last follow-up, none of the patients had experienced any significant adverse neuropsychological effects or personality changes. CONCLUSIONS: GKRS anterior capsulotomy is effective and well tolerated with a maximal dose of 120 Gy. It reduces both obsessions and compulsions, improves quality of life, and diminishes depression and anxiety.

Relación entre la flexibilidad de los isquiotibiales y la fuerza del soleo con el salto y la velocidad en jugadores de ultimate frisbee / Relationship between the flexibility of the hamstring and the strength of soleus muscle with jump and speed in ultimate frisbee players / Relação entre a flexibilidade dos isquiotibiais, a força do sóleo com o salto e a velocidade emjogadores de ultimate frisbee

Problema: la reducción de la flexibilidad de los isquiotibiales es común en adolescentes, asociándose con dolor lumbar, hernia de disco y riesgo de lesiones musculares. El ultimate frisbee implica aceleraciones y desaceleraciones en cortas distancias. Los antecedentes reportan lesiones en miembros inferiores, sin correlacionarlas con patrones de movimiento como fuerza, velocidad o salto. Objetivo: determinar la relación entre la flexibilidad de los isquiotibiales y la fuerza del soleo, con el salto y la velocidad en jugadores de ultimate frisbee. Método: estudio descriptivo, correlacional, con 103 deportistas universitarios de Medellín, Colombia. La información se recolectó mediante encuesta y observación. Se evaluó la flexibilidad, la velocidad y el salto. Los datos se analizaron con SPSS, versión 24.0. Resultados: la flexibilidad de los isquiotibiales se correlacionó positivamente con la velocidad, pero inversamente con el salto. Conclusión: a mayor flexibilidad de los isquiotibiales, mayor desarrollo de velocidad, pero menor capacidad de salto.

Problem: Reduction of hamstring flexibility is common in adolescents, associating with low back pain, disc herniation, andrisk of muscle injuries. Ultimate frisbee implies accelerations and decelerations over short distances. The background reports injuries in thelower limbs, without correlating them with movement patterns such as strength, speed or jump. Objective: To determine the relationship between hamstring flexibility and the strength ofthe soleus muscle with jump and speed in ultimate frisbee players. Method: Descriptive and correlational study, with 103 university athletes from Medellin, Colombia. Information wascollected through survey and observation. Flexibility, speed and jump were evaluated. Data were analyzed with SPSS® version 24.0. Results: Hamstring flexibility was positively correlated with speed, but inversely with jump. Conclusion: A greater flexibility of the hamstrings, greater speed development, but lessjumping ability.

Problema: a redução da flexibilidade dos isquiotibiais é um quadro clínico comum emadolescentes, esta redução foi reportada como um fator associado à prevalência de dor lombar, hérnia de disco e alto risco de lesões musculares. O ultimatefrisbee combina padrões de movimento similares ao futebol e ao handebol, onde se realizam cortes, arremessos, saltos, velocidade, voos e aceleração ­desaceleração em curtas distâncias. Os antecedentes encontrados nesse esporte reportam índices de lesões em membros inferiores, mas não se constataramcorrelações entre padrões de movimento específico com o salto, a força e a velocidade. Objetivo: determinar a relação da flexibilidade dos isquiotibiais, a força do sóleo com o salto e avelocidade em jogadores de ultimate frisbee. Método: realizou-se um estudo descritivo com alcance correlacional e amostra de conveniência de 103 jogadoresuniversitários de ultimate frisbee da cidade de Medellin-Colômbia. Os esportistas cumpriram os critérios de inclusão e assinaram o consentimentoinformado. No que se refere às técnicas de coleta de informação, utilizou-se a pesquisa de opinião e a observação. Avaliou-se a flexibilidade, a velocidade eo salto. Os dados se analisaram com o programa estadístico SPSS versão 24.0. Realizou-se uma análise uni-variada de estadística descritiva, que confirmou asfrequências absolutas e relativas. Além disso, determinou-se a distribuição da normalidade de todas as variáveis através do teste Kolmogorov-Smirnov, queassinalou normalidade para as variáveis com um valor < 0,05. Resultados: estabeleceu-se que a flexibilidade dos isquiotibiais tem correlação positivacom a velocidade, mas inversa com o salto. Conclusão: quanto maior a flexibilidade dos isquiotibiais, maior o desenvolvimento da velocidade, porémmenor a capacidade de salto.

Results for a series of 697 arteriovenous malformations treated by gamma knife: influence of angiographic features on the obliteration rate.

BACKGROUND: Stereotactic radiosurgery (RS) is an effective tool in treating brain arteriovenous malformations (AVMs). Careful study of AVM angiographic characteristics may improve results. OBJECTIVE: To report the long-term outcomes of Gamma Knife RS (GKRS) in brain AVMs, focusing on how the angioarchitectural and hemodynamic parameters of AVMs affect the post-RS results. METHODS: This was a retrospective, longitudinal study of 697 consecutive GKRS treatments of brain AVMs in 662 patients performed at a single center between 1993 and 2005. The mean age of the patients was 37 years; the median AVM volume was 3.6 cm(3); and the mean follow-up was 11 years. Forty-five percent of patients presented with intracranial hemorrhage; 44% underwent embolization; and 7% had multiple RSs. AVM characteristics in the RS-planning angiograms were analyzed, and their relationship to the post-RS obliteration rate was determined by univariate and multivariate analyses. RESULTS: The obliteration rate after a single RS was 69.3%; after multiple RS, it was 75%. Positive predictors of obliteration included compact nidus (odds ratio = 3.16; 95% confidence interval, 1.92-5.22), undilated feeders (odds ratio = 0.36; 95% confidence interval, 0.23-0.57), smaller AVM volume (odds ratio = 0.95; 95% confidence interval, 0.92-0.99), and higher marginal dose (odds ratio = 1.16; 95% confidence interval, 1.06-1.27). Improvement or clinical stability was observed in 89.3% of patients; postprocedural bleeding was noted in 6.1%; and clinical worsening attributable to RS was seen in 3.8%. The annual risk of hemorrhage in the 4 years after RS was 1.2%. CONCLUSION: GKRS yielded a good long-term clinical outcome in most patients. Certain angiographic features of brain AVMs such as a well-defined nidus and undilated feeder arteries contribute to AVM occlusion by RS. GKRS can be regarded as the treatment of choice for AVMs <6 cm(3), even after bleeding.

Jugulotympanic paragangliomas treated with Gamma Knife radiosurgery: a single-center review of 58 cases.

OBJECT: Jugulotympanic paragangliomas (JTPs) are rare benign tumors whose surgical treatment is usually associated with partial resection of the lesion, high morbidity, and even death. Gamma Knife radiosurgery (GKRS) has been reported as a useful treatment option. The goal of this retrospective study is to analyze the role of GKRS in tumor volume control and clinical outcomes of these patients. METHODS: A total of 75 patients with JTPs were treated with GKRS at the authors' center from 1995 to 2012. The authors analyzed those treated during this period to allow for a minimal observation time of 2 years. The MR images and clinical reports of these patients were reviewed to assess clinical and volumetric outcomes of the tumors. The radiological and clinical assessments, along with a group of prognostic factors measured, were analyzed using descriptive methods. The time to volumetric and clinical progression was analyzed using the Kaplan-Meier method. Prognostic factors were identified using log-rank statistics and multivariate Cox regression models. RESULTS: The mean follow-up was 86.4 months. The authors observed volumetric tumor control in 94.8% of cases. In 67.2% of cases, tumor volume decreased by a mean of 40.1% from the original size. Of patients with previous tinnitus, 54% reported complete recovery. Improvement of other symptoms was observed in 34.5% of cases. Overall, clinical control was achieved in 91.4% of cases. Previous embolization and familial history of paraganglioma were selected as significant prognostic factors for volumetric response to GKRS treatment in the univariate analysis. In multivariate analysis, no factors were significantly correlated with progression-free survival. No patient died of side effects related to GKRS treatment or tumor progression. CONCLUSIONS: Gamma Knife radiosurgery is an effective, safe, and efficient therapeutic option for the treatment of these tumors as a first-line treatment or in conjunction with traditional surgery, endovascular treatment, or conventional fractionated radiotherapy.

Buen control local y sobrevida post resección curativa de cáncer de recto medio e inferior: protocolo terapéutico multimodal, selectivo / Good local control and survival post curative resection for middle and lower rectal cancer: therapeutic, multimodal, selective protocol

Objetivo: Evaluar protocolo multimodal, selectivo, midiendo resultados alejados en una serie de cáncer de recto medio e inferior, operada con intención curativa, por un solo cirujano. Material y Método: Entre 1991 y 2000 se atienden 112 cánceres restales. Se resecan 107. Resección paliativa: 27, sin mortalidad; curativa: 80. Esta serie incluye 73 pacientes: recto medio (23) y recto inferior (50). Operaciones: Sin resección total del mesorrecto (RTM): Resección local: 9, Resección anterior baja: 11. Con RTM: Resección anterior ultrabaja: 33, Resección abdominoperineal: 18 y Hartmann: 2. Radioterapia: En 54,8 por ciento. Incluye radioquimioterapia preoperatoria (26 por ciento), especialmente en T3-T4, N+ y/o recto inferior. Seguimiento: Asiduo en 72 pacientes. Promedio 57,4 meses. Resultados: Mortalidad operatoria: 1,4 por ciento. Preservación esfínter funcionante 68,5 por ciento. Recidiva local 5 años: 11 por ciento. Sobrevida a 5 años: Cáncer específica: 73,3 por ciento. Libre de enfermedad: 68,2 por ciento. Conclusión: Estos resultados avalan la aplicación de este protocolo terapéutico multimodal, selectivo, con cifras similares a buenas series extranjeras.