Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital.

OBJECTIVES: To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service. MATERIALS AND METHODS: We conducted a retrospective study on patients diagnosed with brain tumors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed. RESULTS: We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig <0.01), greater mean cost of stay (17097 €, sig<0.01), and longer length of stay (15.45 days, sig<0.01). We did not find a significant difference in mortality. CONCLUSIONS: We found significant association between the presence of HAIs and worse clinical outcomes, higher costs, and longer length of stay. The pathogens responsible and infection locations were similar to existing series in the literature. Although variability in study designs in the literature makes interpretation and comparison of results difficult, measures to prevent these complications.

[Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature]. / Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de la literatura.

INTRODUCTION: Spontaneous cerebrospinal fluid otorrhea is a relatively rare entity and can be easily missed in adults. Every adult older than 50 years with a negative history of otologic disease who has recurrent serous otitis media should be evaluated for this pathology. Meningitis is the most serious complication, so there is no doubt that the condition needs immediate attention and correction. OBJECTIVE: We present two patients who were diagnosed with spontaneous CSF otorrhea and make a review of what is reported about this topic. CONCLUSION: Surgical repair is mandatory to seal these nontraumatic CSF leaks. There are two main surgical approaches, the middle fossa craniotomy and the transmastoid approach. A multilayered closure technique in which autologous and artificial materials are combined is considered to result in the highest rate of success.

[Neuronal tumors: gangliocytoma]. / Tumores neuronales: gangliocitoma.

INTRODUCTION: Gangliocytomas are neuronal tumors of the central nervous system. They tend to appear in children and young adults. These tumors usually appear in the supratentorial compartment in the temporal lobe. Their clinical presentation is frequently as refractory epilepsy. CASE REPORTS: Three gangliocytoma cases in different locations are presented and a review is made. CONCLUSIONS: Immunochemistry is of great value in the pathological study of these lesions, using neuronal markers for the diagnosis. They are usually benign lesions. Therefore, surgical complete removal is the goal to pursue.

[Imidazoline I(2) receptors as a possible marker for malignancy in human glial cell tumours]. / Los receptores para imidazolinas I(2) como posible marcador de malignidad en tumores gliales humanos.

AIM: To present the experimental data that support the hypothesis that the imidazoline I(2) receptors may be assessed as a biological marker to establish diagnosis and grade of human gliomas. DEVELOPMENT: Gliomas constitute the most important group of brain neoplasm in humans. In these tumours accurate histopathologic diagnosis is a first crucial prerequisite for patient treatment. However, current grading schemes are still limited by subjective histologic criteria. Therefore, the search for new molecular and biological markers of gliomas represents a crucial step. In this context, it has been reported a significant increase in I(2) density in human gliomas when compared with normal brain tissue and other intracranial non-glial tumours. Moreover, this increase seems to fit well with the degree of malignancy in human gliomas. Thus, in glioblastomas multiformes the I(2) density is 1.4 times higher than in anaplastic astrocytomas and 2.2 higher than in low-grade astrocytomas. CONCLUSIONS: The present results demonstrate that the measurement of the I(2) density by positron emission tomography techniques could be used in the future for grading and prognosis of human gliomas. This could avoid the current need for tumour biopsies in order to obtain a histopathologic diagnosis.

Imidazoline I(2) receptor density increases with the malignancy of human gliomas.

BACKGROUND: Current glioma grading schemes are limited by subjective histological criteria. Imidazoline I(2) receptors are principally expressed on glial cells. OBJECTIVE: To investigate the feasibility of using the measurement of imidazoline I(2) receptor expression to differentiate glial tumours from other types of brain tumours and for grading the different gliomas. METHODS: The specific binding of [(3)H]idazoxan to imidazoline I(2) receptors was measured in homogenates from human gliomas of different grades. RESULTS: The density of imidazoline I(2) receptors was significantly greater in the three types of malignant glial tumours than in postmortem control brain or non-glial tumours. The increase in density correlated with the malignancy grade of the gliomas. No significant differences in affinity values were observed. CONCLUSION: These results suggest that the density of imidazoline I(2) receptors may be a useful radioligand parameter for the differentiation of glial tumours from other types of brain tumours and for grading the different gliomas.

[Prophylactic antiepileptic treatment of cerebral aggressions]. / Tratamiento antiepiléptico profiláctico de las agresiones cerebrales.

OBJECTIVE: On the occasion of the First Congress of the Spanish Anti Epilepsy League we had reviewed the use of antiepileptic drugs for preventing postoperative and posttraumatic seizures. DEVELOPMENT: Two specific causes of epilepsy are particularly relevant to neurosurgical practice; postoperative and posttraumatic epilepsy. After reviewing the seizures arising after craniotomy for supratentorial conditions such as vascular malformations (aneurysms and arteriovenous malformations), cerebral tumours and supratentorial abscesses and empyemas, we discuss the different types of posttraumatic epilepsy and the risk factors. The pathogenesis of tumour associated epilepsy and the pathophysiological events initiating posttraumatic epilepsy are described. The use of prophylactic antiepileptic drugs is only justified in cases with several risk factors capable to develop seizures. CONCLUSION: As no treatments have yet been shown to be effective in preventing the development of epileptic seizures, additional trials are likely to be necessary.

[The evaluation of cell proliferation in gliomas]. / Estimación de la proliferación celular en gliomas.

INTRODUCTION: The homeostasis of tissues depends on a strict control of cell growth, differentiation and death. Several proteins, which are involved on the regulation of the cell cycle, can suffer diverse alterations and produce an uncontrolled cell proliferation and the genesis of a neoplastic process. The assessment of cell proliferation is an useful method applied to Neuro-oncology in order to know the behavior of gliomas. DEVELOPMENT: This work is focussed on the analysis of different methods, all of them employed to study the cell proliferation: immunostaining of proliferating cell nuclear antigen (PCNA) and Ki-67, DNA content and ploidy by flow cytometry, in vitro incorporation of bromodeoxyuridine (BrdU) and the identification of apoptotic cells. The study of the DNA by flow cytometry establishes a relationship between ploidy and the prognostic of gliomas. The assessment of PCNA provides us with objective data about the proliferative activity of gliomas. Both Ki-67 expression and BrdU incorporation are also useful methods in the study of gliomas. CONCLUSIONS: In short, the most malignant gliomas are characterized by a high frequency of aneuploidies and high PCNA, Ki-67 and BrdU labelling indexes. All of these described methods can be used as prognostic markers complementary to the classic criteria employed nowadays.

Biologic parameters that correlate with the prognosis of human gliomas.

Much clinical and biologic data have been processed in the search for useful objective parameters to predict brain tumor behavior. Seventy cases of astrocytic glioma collected by a single clinical team were studied using a full complement of clinical procedures: follow up (7 years), histologic analysis, DNA content estimation, and cell kinetics by flow cytometry. Proliferating cell nuclear antigen (PCNA) was determined by immunocytochemical-coupling flow cytometry (PFC) and also by counting under light microscopy (PIHC). A statistical evaluation was carried out to establish the usefulness of several parameters for glioma prognosis. The cases were histologically classified as 14 low-grade astrocytomas, 20 anaplastic astrocytomas, and 36 glioblastomas multiforme. The survival curve showed significant differences between histologic groups. Diploid populations were more frequent in low-grade astrocytomas, and aneuploid tumors often had increased S-phase and proliferative fractions. The PCNA-labeled index (PCNA-LI) increased with malignancy and correlated with histologic grading (P = 0.01). The PCNA-LI and age segregated low- from high-grade astrocytomas (including anaplastic astrocytoma and glioblastoma multiforme), but none of the variables considered differentiated anaplastic astrocytoma from glioblastoma multiforme. The Cox regression test displayed significant values for age, histologic diagnosis, and PCNA determinations when considered in tandem. Discriminant analysis obtained a function integrating age and specifically PIHC-LI to help in the prognosis of doubtful cases. The results emphasize the importance of parameters integrating different variables in an attempt to provide an accurate prognosis, the most significant being age, histopathologic diagnosis, and the proliferative fraction determined by PCNA.

Expression of vascular endothelial growth factor (VEGF) and platelet-derived growth factor receptor-beta (PDGFR-beta) in human gliomas.

The growth of solid tumors is highly dependent on vascular proliferation. Vascular endothelial growth factor (VEGF), the main mediator of angiogenesis, and platelet-derived growth factor receptor-beta (PDGFR-beta), receptor for the potent mitogen PDGF, are two indicators of the angiogenic potential of human gliomas. We studied a series of 57 surgical biopsies of astrocytic neoplasms by immunohistochemistry to elucidate the relationship between tumor proliferation, quantified as Ki67-LI, and the expression of these two proteins. Ki67-LI increases throughout histological malignancy, although staining in endothelial cells has rarely been recorded. Elevated amounts of VEGF-positive tumor cells (VEGF-LI) were found in anaplastic astrocytomas and glioblastomas, mainly around areas of necrosis, cysts, or edema. Endothelium of blood vessels was consistently stained. PDGFR-beta positivity was found in glomeruloid formations and in tumor cells, excluding pilocytic astrocytomas. Multinucleated giant cells and perivascular tumor cells were positive in glioblastomas. In addition, peritumoral microglia-like cells were also stained in some cases. Statistical correlation was only found between PDGFR-beta and Ki67 LIs. In conclusion, VEGF as permeability factor is involved in the development of secondary neoplastic changes, whereas PDGFR-beta is directly correlated to proliferation indexes. Strong expression of VEGF and PDGFR-beta found in endothelium and tumor cells would seem to support a combined role in tumoral neoangiogenesis.

Increased density of I2-imidazoline receptors in human glioblastomas.

A glial location has been proposed for the non-adrenoceptor [3H]idazoxan binding site termed the I2-imidazoline receptor. The specific binding of [3H]idazoxan in the presence of (-)adrenaline was measured in membranes from excised human glioblastomas (n = 6), meningiomas (n = 6) and normal brains (n = 6). The pharmacological profile of the [3H]idazoxan binding in astrocytic tumours was similar to that in normal brain, compatible with the presence of I2-imidazoline receptors. There was a higher density of I2-imidazoline receptors in astrocytic tumours (Bmax = 266 +/- 18 fmol mg-1 protein; p < 0.001) than in normal brain (Bmax = 54 +/- 4 fmol mg-1 protein), with no differences in affinity values. Almost no [3H]idazoxan-specific binding was shown in meningiomas. The results suggest that I2-imidazoline receptors may be a selective marker for glial tumours in the evaluation of intracranial neoplasms.