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1.
Nature ; 622(7984): 842-849, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37821699

RESUMO

Central nervous system tumours represent one of the most lethal cancer types, particularly among children1. Primary treatment includes neurosurgical resection of the tumour, in which a delicate balance must be struck between maximizing the extent of resection and minimizing risk of neurological damage and comorbidity2,3. However, surgeons have limited knowledge of the precise tumour type prior to surgery. Current standard practice relies on preoperative imaging and intraoperative histological analysis, but these are not always conclusive and occasionally wrong. Using rapid nanopore sequencing, a sparse methylation profile can be obtained during surgery4. Here we developed Sturgeon, a patient-agnostic transfer-learned neural network, to enable molecular subclassification of central nervous system tumours based on such sparse profiles. Sturgeon delivered an accurate diagnosis within 40 minutes after starting sequencing in 45 out of 50 retrospectively sequenced samples (abstaining from diagnosis of the other 5 samples). Furthermore, we demonstrated its applicability in real time during 25 surgeries, achieving a diagnostic turnaround time of less than 90 min. Of these, 18 (72%) diagnoses were correct and 7 did not reach the required confidence threshold. We conclude that machine-learned diagnosis based on low-cost intraoperative sequencing can assist neurosurgical decision-making, potentially preventing neurological comorbidity and avoiding additional surgeries.


Assuntos
Neoplasias do Sistema Nervoso Central , Tomada de Decisão Clínica , Aprendizado Profundo , Cuidados Intraoperatórios , Análise de Sequência de DNA , Criança , Humanos , Neoplasias do Sistema Nervoso Central/classificação , Neoplasias do Sistema Nervoso Central/diagnóstico , Neoplasias do Sistema Nervoso Central/genética , Neoplasias do Sistema Nervoso Central/cirurgia , Tomada de Decisão Clínica/métodos , Aprendizado Profundo/normas , Cuidados Intraoperatórios/métodos , Metilação , Estudos Retrospectivos , Análise de Sequência de DNA/métodos , Fatores de Tempo
2.
J Neurooncol ; 163(2): 345-354, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37266846

RESUMO

BACKGROUND: The multidisciplinary management of patients with brain metastases consists of surgical resection, radiation treatment and systemic treatment. Tailoring and timing these treatment modalities is challenging. This study presents real-world data from consecutively treated patients and assesses the impact of all treatment strategies and their relation with survival. The aim is to provide new insights to improve multidisciplinary decisions towards individualized treatment strategies in patients with brain metastases. METHODS: A retrospective consecutive cohort study was performed. Patients with brain metastases were included between June 2018 and May 2020. Brain metastases of small cell lung carcinoma were excluded. Overall survival was analyzed in multivariable models. RESULTS: 676 patients were included in the study, 596 (88%) received radiotherapy, 41 (6%) awaited the effect of newly started or switched systemic treatment and 39 (6%) received best supportive care. Overall survival in the stereotactic radiotherapy group was 14 months (IQR 5-32) and 32 months (IQR 11-43) in patients who started or switched systemic treatment and initially did not receive radiotherapy. In patients with brain metastases without options for local or systemic treatment best supportive care was provided, these patients had an overall survival of 0 months (IQR 0-1). Options for systemic treatment, Karnofsky Performance Score ≥ 70 and breast cancer were prognostic for a longer overall survival, while progressive extracranial metastases and whole-brain-radiotherapy were prognostic for shorter overall survival. CONCLUSIONS: Assessing prognosis in light of systemic treatment options is crucial after the diagnosis of brain metastasis for the consideration of radiotherapy versus best supportive care.


Assuntos
Neoplasias Encefálicas , Neoplasias Pulmonares , Radiocirurgia , Humanos , Estudos Retrospectivos , Estudos de Coortes , Prognóstico , Neoplasias Encefálicas/cirurgia , Neoplasias Pulmonares/patologia , Resultado do Tratamento
3.
Cereb Cortex ; 32(11): 2343-2357, 2022 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34550325

RESUMO

The left temporal lobe is an integral part of the language system and its cortical structure and function associate with general intelligence. However, whether cortical laminar architecture and cellular properties of this brain area relate to verbal intelligence is unknown. Here, we addressed this using histological analysis and cellular recordings of neurosurgically resected temporal cortex in combination with presurgical IQ scores. We find that subjects with higher general and verbal IQ scores have thicker left (but not right) temporal cortex (Brodmann area 21, BA21). The increased thickness is due to the selective increase in layers 2 and 3 thickness, accompanied by lower neuron densities, and larger dendrites and cell body size of pyramidal neurons in these layers. Furthermore, these neurons sustain faster action potential kinetics, which improves information processing. Our results indicate that verbal mental ability associates with selective adaptations of supragranular layers and their cellular micro-architecture and function in left, but not right temporal cortex.


Assuntos
Células Piramidais , Lobo Temporal , Potenciais de Ação , Humanos , Inteligência/fisiologia , Neurônios/fisiologia , Células Piramidais/fisiologia , Lobo Temporal/patologia
4.
Eur Radiol ; 30(2): 1062-1074, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31691120

RESUMO

BACKGROUND: Recent studies have created awareness that facial features can be reconstructed from high-resolution MRI. Therefore, data sharing in neuroimaging requires special attention to protect participants' privacy. Facial features removal (FFR) could alleviate these concerns. We assessed the impact of three FFR methods on subsequent automated image analysis to obtain clinically relevant outcome measurements in three clinical groups. METHODS: FFR was performed using QuickShear, FaceMasking, and Defacing. In 110 subjects of Alzheimer's Disease Neuroimaging Initiative, normalized brain volumes (NBV) were measured by SIENAX. In 70 multiple sclerosis patients of the MAGNIMS Study Group, lesion volumes (WMLV) were measured by lesion prediction algorithm in lesion segmentation toolbox. In 84 glioblastoma patients of the PICTURE Study Group, tumor volumes (GBV) were measured by BraTumIA. Failed analyses on FFR-processed images were recorded. Only cases in which all image analyses completed successfully were analyzed. Differences between outcomes obtained from FFR-processed and full images were assessed, by quantifying the intra-class correlation coefficient (ICC) for absolute agreement and by testing for systematic differences using paired t tests. RESULTS: Automated analysis methods failed in 0-19% of cases in FFR-processed images versus 0-2% of cases in full images. ICC for absolute agreement ranged from 0.312 (GBV after FaceMasking) to 0.998 (WMLV after Defacing). FaceMasking yielded higher NBV (p = 0.003) and WMLV (p ≤ 0.001). GBV was lower after QuickShear and Defacing (both p < 0.001). CONCLUSIONS: All three outcome measures were affected differently by FFR, including failure of analysis methods and both "random" variation and systematic differences. Further study is warranted to ensure high-quality neuroimaging research while protecting participants' privacy. KEY POINTS: • Protecting participants' privacy when sharing MRI data is important. • Impact of three facial features removal methods on subsequent analysis was assessed in three clinical groups. • Removing facial features degrades performance of image analysis methods.


Assuntos
Encéfalo/diagnóstico por imagem , Confidencialidade , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Neuroimagem/métodos , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Doença de Alzheimer/patologia , Encéfalo/patologia , Face , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/patologia , Humanos , Disseminação de Informação , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Reprodutibilidade dos Testes , Carga Tumoral
5.
Ann Oncol ; 26(9): 1994-1999, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26113646

RESUMO

BACKGROUND: O(6)-methyl-guanine-methyl-transferase (MGMT) silencing by promoter methylation may identify cancer patients responding to the alkylating agents dacarbazine or temozolomide. PATIENTS AND METHODS: We evaluated the prognostic and predictive value of MGMT methylation testing both in tumor and cell-free circulating DNA (cfDNA) from plasma samples using an ultra-sensitive two-step digital PCR technique (methyl-BEAMing). Results were compared with two established techniques, methylation-specific PCR (MSP) and Bs-pyrosequencing. RESULTS: Thresholds for MGMT methylated status for each technique were established in a training set of 98 glioblastoma (GBM) patients. The prognostic and the predictive value of MGMT methylated status was validated in a second cohort of 66 GBM patients treated with temozolomide in which methyl-BEAMing displayed a better specificity than the other techniques. Cutoff values of MGMT methylation specific for metastatic colorectal cancer (mCRC) tissue samples were established in a cohort of 60 patients treated with dacarbazine. In mCRC, both quantitative assays methyl-BEAMing and Bs-pyrosequencing outperformed MSP, providing better prediction of treatment response and improvement in progression-free survival (PFS) (P < 0.001). Ability of methyl-BEAMing to identify responding patients was validated in a cohort of 23 mCRC patients treated with temozolomide and preselected for MGMT methylated status according to MSP. In mCRC patients treated with dacarbazine, exploratory analysis of cfDNA by methyl-BEAMing showed that MGMT methylation was associated with better response and improved median PFS (P = 0.008). CONCLUSIONS: Methyl-BEAMing showed high reproducibility, specificity and sensitivity and was applicable to formalin-fixed paraffin-embedded tissues and cfDNA. This study supports the quantitative assessment of MGMT methylation for clinical purposes since it could refine prediction of response to alkylating agents.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Metilação de DNA/genética , Metilases de Modificação do DNA/metabolismo , Enzimas Reparadoras do DNA/metabolismo , Glioblastoma/tratamento farmacológico , Proteínas Supressoras de Tumor/metabolismo , Neoplasias Encefálicas/mortalidade , Neoplasias Colorretais/mortalidade , DNA/sangue , DNA/metabolismo , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , Dacarbazina/análogos & derivados , Dacarbazina/uso terapêutico , Intervalo Livre de Doença , Glioblastoma/mortalidade , Humanos , Reação em Cadeia da Polimerase , Prognóstico , Regiões Promotoras Genéticas/genética , Temozolomida , Proteínas Supressoras de Tumor/genética
6.
J Cancer Surviv ; 2023 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-36922442

RESUMO

PURPOSE: To comprehend the complex relationship between symptoms and health-related quality of life (HRQoL) in patients with diffuse glioma, we applied symptom network analysis to identify patterns of associations between depression, cognition, brain tumor-related symptoms, and HRQoL. Additionally, we aimed to compare global strength between symptom networks to understand if symptoms are more tightly connected in different subgroups of patients. METHODS: We included 256 patients and stratified the sample based on disease status (preoperative vs. postoperative), tumor grade (grade II vs. III/IV), and fatigue status (non-fatigued vs. fatigued). For each subgroup of patients, we constructed a symptom network. In these six networks, each node represented a validated subscale of a questionnaire and an edge represented a partial correlation between two nodes. We statistically compared global strength between networks. RESULTS: Across the six networks, nodes were highly correlated: fatigue severity, depression, and social functioning in particular. We found no differences in GS between the networks based on disease characteristics. However, global strength was lower in the non-fatigued network compared to the fatigued network (5.51 vs. 7.49, p < 0.001). CONCLUSIONS: Symptoms and HRQoL are highly interrelated in patients with glioma. Interestingly, nodes in the network of fatigued patients were more tightly connected compared to non-fatigued patients. IMPLICATIONS FOR CANCER SURVIVORS: We introduce symptom networks as a method to understand the multidimensionality of symptoms in glioma. We find a clear association between multiple symptoms and HRQoL, which underlines the need for integrative symptom management targeting fatigue in particular.

7.
Sci Rep ; 11(1): 18990, 2021 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556701

RESUMO

Non-invasively measured brain activity is related to progression-free survival in glioma patients, suggesting its potential as a marker of glioma progression. We therefore assessed the relationship between brain activity and increasing tumor volumes on routine clinical magnetic resonance imaging (MRI) in glioma patients. Postoperative magnetoencephalography (MEG) was recorded in 45 diffuse glioma patients. Brain activity was estimated using three measures (absolute broadband power, offset and slope) calculated at three spatial levels: global average, averaged across the peritumoral areas, and averaged across the homologues of these peritumoral areas in the contralateral hemisphere. Tumors were segmented on MRI. Changes in tumor volume between the two scans surrounding the MEG were calculated and correlated with brain activity. Brain activity was compared between patient groups classified into having increasing or stable tumor volume. Results show that brain activity was significantly increased in the tumor hemisphere in general, and in peritumoral regions specifically. However, none of the measures and spatial levels of brain activity correlated with changes in tumor volume, nor did they differ between patients with increasing versus stable tumor volumes. Longitudinal studies in more homogeneous subgroups of glioma patients are necessary to further explore the clinical potential of non-invasively measured brain activity.


Assuntos
Neoplasias Encefálicas/diagnóstico , Encéfalo/fisiopatologia , Glioma/diagnóstico , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Estudos Transversais , Feminino , Seguimentos , Glioma/mortalidade , Glioma/fisiopatologia , Glioma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Magnetoencefalografia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Intervalo Livre de Progressão , Estudos Retrospectivos , Carga Tumoral
8.
Neuroimage Clin ; 22: 101727, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30825711

RESUMO

BACKGROUND: Tumor segmentation of glioma on MRI is a technique to monitor, quantify and report disease progression. Manual MRI segmentation is the gold standard but very labor intensive. At present the quality of this gold standard is not known for different stages of the disease, and prior work has mainly focused on treatment-naive glioblastoma. In this paper we studied the inter-rater agreement of manual MRI segmentation of glioblastoma and WHO grade II-III glioma for novices and experts at three stages of disease. We also studied the impact of inter-observer variation on extent of resection and growth rate. METHODS: In 20 patients with WHO grade IV glioblastoma and 20 patients with WHO grade II-III glioma (defined as non-glioblastoma) both the enhancing and non-enhancing tumor elements were segmented on MRI, using specialized software, by four novices and four experts before surgery, after surgery and at time of tumor progression. We used the generalized conformity index (GCI) and the intra-class correlation coefficient (ICC) of tumor volume as main outcome measures for inter-rater agreement. RESULTS: For glioblastoma, segmentations by experts and novices were comparable. The inter-rater agreement of enhancing tumor elements was excellent before surgery (GCI 0.79, ICC 0.99) poor after surgery (GCI 0.32, ICC 0.92), and good at progression (GCI 0.65, ICC 0.91). For non-glioblastoma, the inter-rater agreement was generally higher between experts than between novices. The inter-rater agreement was excellent between experts before surgery (GCI 0.77, ICC 0.92), was reasonable after surgery (GCI 0.48, ICC 0.84), and good at progression (GCI 0.60, ICC 0.80). The inter-rater agreement was good between novices before surgery (GCI 0.66, ICC 0.73), was poor after surgery (GCI 0.33, ICC 0.55), and poor at progression (GCI 0.36, ICC 0.73). Further analysis showed that the lower inter-rater agreement of segmentation on postoperative MRI could only partly be explained by the smaller volumes and fragmentation of residual tumor. The median interquartile range of extent of resection between raters was 8.3% and of growth rate was 0.22 mm/year. CONCLUSION: Manual tumor segmentations on MRI have reasonable agreement for use in spatial and volumetric analysis. Agreement in spatial overlap is of concern with segmentation after surgery for glioblastoma and with segmentation of non-glioblastoma by non-experts.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Imageamento por Ressonância Magnética/normas , Adulto , Idoso , Neoplasias Encefálicas/epidemiologia , Estudos de Coortes , Feminino , Glioma/epidemiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Variações Dependentes do Observador , Distribuição Aleatória
11.
AJNR Am J Neuroradiol ; 38(10): 1884-1891, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28882867

RESUMO

BACKGROUND: Brain imaging in diffuse glioma is used for diagnosis, treatment planning, and follow-up. PURPOSE: In this meta-analysis, we address the diagnostic accuracy of imaging to delineate diffuse glioma. DATA SOURCES: We systematically searched studies of adults with diffuse gliomas and correlation of imaging with histopathology. STUDY SELECTION: Study inclusion was based on quality criteria. Individual patient data were used, if available. DATA ANALYSIS: A hierarchic summary receiver operating characteristic method was applied. Low- and high-grade gliomas were analyzed in subgroups. DATA SYNTHESIS: Sixty-one studies described 3532 samples in 1309 patients. The mean Standard for Reporting of Diagnostic Accuracy score (13/25) indicated suboptimal reporting quality. For diffuse gliomas as a whole, the diagnostic accuracy was best with T2-weighted imaging, measured as area under the curve, false-positive rate, true-positive rate, and diagnostic odds ratio of 95.6%, 3.3%, 82%, and 152. For low-grade gliomas, the diagnostic accuracy of T2-weighted imaging as a reference was 89.0%, 0.4%, 44.7%, and 205; and for high-grade gliomas, with T1-weighted gadolinium-enhanced MR imaging as a reference, it was 80.7%, 16.8%, 73.3%, and 14.8. In high-grade gliomas, MR spectroscopy (85.7%, 35.0%, 85.7%, and 12.4) and 11C methionine-PET (85.1%, 38.7%, 93.7%, and 26.6) performed better than the reference imaging. LIMITATIONS: True-negative samples were underrepresented in these data, so false-positive rates are probably less reliable than true-positive rates. Multimodality imaging data were unavailable. CONCLUSIONS: The diagnostic accuracy of commonly used imaging is better for delineation of low-grade gliomas than high-grade gliomas on the basis of limited evidence. Improvement is indicated from advanced techniques, such as MR spectroscopy and PET.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Neuroimagem/métodos , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Feminino , Glioma/patologia , Humanos , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Curva ROC
12.
J Emerg Med ; 29(1): 61-5, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15961011

RESUMO

Hangman's fractures are a rare finding in childhood. In case of suspected or proven child abuse, differentiation with a congenital defect of the posterior arch of C2 is essential. We present the case of a 5-month-old girl, who had a history of being physically abused by one of her caretakers. On the lateral view of the cervical spine, a defect of the posterior elements of C2 and an anterolisthesis of C2 on C3 was seen. CT scan showed a bilateral defect in the posterior elements of C2. No soft-tissue swelling of hematoma was noted. MRI showed a normal signal intensity of the intervertebral disc C2-C3. No haematoma was noted. Clinical examination revealed a slight head lag and local tenderness; there were no neurological deficits. This case shows that the differentiation between a congenital C2 arch defect and a hangman's fracture is precarious. In this case the findings on MRI and CT scan were interpreted as a congenital posterior arch defect (spondylolysis).


Assuntos
Vértebras Cervicais/anormalidades , Vértebras Cervicais/lesões , Maus-Tratos Infantis/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Cervicais/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Radiografia
13.
Obes Surg ; 8(3): 300-1, 1998 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9678198

RESUMO

A significant weight gain with a mean of 4.4 kg was found between the date of acceptance for bariatric surgery and the date of admission to hospital for the operation.


Assuntos
Obesidade Mórbida/cirurgia , Aumento de Peso , Gastroplastia , Humanos , Obesidade Mórbida/psicologia , Estudos Retrospectivos , Fatores de Tempo
14.
Neuroimage Clin ; 2: 1-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-24179752

RESUMO

PURPOSE: Low-grade glioma (LGG) patients often have cognitive deficits. Several disease- and treatment related factors affect cognitive processing. Cognitive outcome of resective surgery is unpredictable, both for improvement and deterioration, especially for complex domains such as attention and executive functioning. MEG analysis of resting-state networks (RSNs) is a good candidate for presurgical prediction of cognitive outcome. In this study, we explore the relation between alterations in connectivity of RSNs and changes in cognitive processing after resective surgery, as a stepping stone to ultimately predict postsurgical cognitive outcome. METHODS: Ten patients with LGG were included, who had no adjuvant therapy. MEG recording and neuropsychological assessment were obtained before and after resective surgery. MEG data were recorded during a no-task eyes-closed condition, and projected to the anatomical space of the AAL atlas. Alterations in functional connectivity, as characterized by the phase lag index (PLI), within the default mode network (DMN), executive control network (ECN), and left- and right-sided frontoparietal networks (FPN) were compared to cognitive changes. RESULTS: Lower alpha band DMN connectivity was increased after surgery, and this increase was related to improved verbal memory functioning. Similarly, right FPN connectivity was increased after resection in the upper alpha band, which correlated with improved attention, working memory and executive functioning. DISCUSSION: Increased alpha band RSN functional connectivity in MEG recordings correlates with improved cognitive outcome after resective surgery. The mechanisms resulting in functional connectivity alterations after resection remain to be elucidated. Importantly, our findings indicate that connectivity of MEG RSNs may be used for presurgical prediction of cognitive outcome in future studies.

16.
Oncogene ; 27(14): 2091-6, 2008 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-17934519

RESUMO

Screening of therapeutics relies on representative cancer models. The representation of human glioblastoma by in vitro cell culture models is questionable. We obtained genomic profiles by array comparative genomic hybridization of both short- and long-term primary cell and spheroid cultures, derived from seven glioblastomas and one anaplastic oligodendroglioma. Chromosomal copy numbers were compared between cell cultures and spheroids and related to the parental gliomas using unsupervised hierarchical clustering and correlation coefficient. In seven out of eight short-term cell cultures, the genomic profiles clustered further apart from their parental tumors than spheroid cultures. In four out of eight samples, the genetic changes in cell culture were substantial. The average correlation coefficient between parental tumors and spheroid profiles was 0.89 (range: 0.79-0.97), whereas that between parental tumors and cell cultures was 0.62 (range: 0.10-0.96). In two out of three long-term cell cultures progressive genetic changes had developed, whereas the spheroid cultures were genetically stable. It is concluded that genomic profiles of primary cell cultures from glioblastoma are frequently deviant from parental tumor profiles, whereas spheroids are genetically more representative of the glioblastoma. This implies that glioma cell culture data have to be handled with the highest caution.


Assuntos
Neoplasias Encefálicas/genética , Aberrações Cromossômicas , Glioblastoma/genética , Esferoides Celulares/metabolismo , Técnicas de Cultura de Células , Genômica , Humanos , Análise de Sequência com Séries de Oligonucleotídeos , Células Tumorais Cultivadas
17.
Eur J Surg ; 165(9): 855-60, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10533761

RESUMO

OBJECTIVE: To evaluate the long term results of Mason's vertical banded gastroplasty (VBG) using accepted criteria, and to find out which factors predicted success. DESIGN: Retrospective survey of a cohort of 40 severely obese patients (mean initial body mass index (BMI in kg/m2): 43, range 34-62). SETTING: General teaching hospital, The Netherlands. MAIN OUTCOME MEASURES: Success according to three definitions: weight loss of more than 25%; percentage of excess weight 50% or less; and BMI < 30. RESULTS: Mean follow-up was 7.4 years (range 0.5-10) or 85%. The distribution over MacLean and Reinhold criteria shows a shift towards unfavourable categories. The consecutive percentages of success at five years were 35%, 62%, and 35%. Logistic regression analysis of success at 5 years shows that the following factors significantly predicted success: Definition I: age odds ratio (95% confidence interval): 0.88 (0.78 to 0.99). Definition II: age: 0.84 (0.69-1.01), outlet > or = 5 cm: 176 (2.4 to 12774), percentage of ideal weight > or = 100%: 0.03 (0.002 to 0.48). Definition III: age: 0.86 (0.75 to 0.99), pouch size > or = 15 ml: 10.64 (1.48 to 76.6). CONCLUSION: The long term results of VBG are disappointing when assessed by the standard criteria.


Assuntos
Gastroplastia , Adulto , Índice de Massa Corporal , Peso Corporal , Estudos de Coortes , Feminino , Seguimentos , Gastroplastia/métodos , Gastroplastia/estatística & dados numéricos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Redução de Peso
18.
J Neurooncol ; 53(3): 267-71, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11718259

RESUMO

The value of chemotherapy in patients with malignant astrocytoma remains controversial. In our laboratories in vitro experiments with organotypic spheroid cultures showed superior effectiveness of anthracyclines. Systemic administration did not provide in therapeutic concentrations so far. Because recent studies on Daunorubicin in liposomes in the treatment of Kaposi sarcoma have shown effectiveness with diminished systemic toxicity, we administered intravenously a single dose of Daunorubicin in liposomes in eight patients at different intervals prior to surgery (12-50 h). In samples taken from tumor, tumor-edge and where possible from adjacent brain, the levels of Daunorubicin and its active metabolite Daunorubicinol were assessed with high performance liquid chromatography. Here we report that high concentrations of Daunorubicin and Daunorubicinol were found in malignant gliomas after systemic administration of liposomal Daunorubicin.


Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/farmacocinética , Astrocitoma/metabolismo , Daunorrubicina/análogos & derivados , Daunorrubicina/administração & dosagem , Daunorrubicina/farmacocinética , Adulto , Idoso , Feminino , Humanos , Injeções Intravenosas , Lipossomos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Fatores de Tempo
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