The evolving role of antiangiogenic therapies in glioblastoma multiforme: current clinical significance and future potential.

Introduction: Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults, but its prognosis remains poor despite significant advances in our understanding of its molecular biology and investigation of numerous treatment modalities. Despite conventional treatment consisting of surgical resection, radiotherapy, and temozolomide marginally prolonging survival, most GBM patients die within 2 years of initial diagnosis. Bevacizumab (Bev) is the best-studied antiangiogenic agent for GBM and currently the only FDA-approved second-line treatment. Areas covered: Areas covered in this review include the molecular pathways of angiogenesis in glioblastoma, specifically the overexpression of vascular endothelial growth factor (VEGF) and robust formation of tumor neovasculature. In addition, this review covers pharmacological targeting of this process as a longstanding attractive clinical strategy, specifically by Bev. Expert opinion: This review attempts to discuss the history of early studies of antiangiogenic treatment for GBM that eventually failed in subsequent studies and the evolving modern role of Bev in the course of treatment for a variety of indications, including symptom control, reduced glucocorticoid use, and improved quality of life.

Comparative study of color Doppler voiding urosonography without contrast enhancement and direct radionuclide voiding cystography for diagnosis of vesicoureteric reflux in children.

OBJECTIVES: Most available studies investigating the diagnostic accuracy of color Doppler voiding urosonography in the detection of vesicoureteric reflux used an echo contrast agent. It is unknown whether echo contrast agents are necessary for diagnosis or follow-up of vesicoureteric reflux. We compared color Doppler voiding urosonography without contrast enhancement and direct radionuclide voiding cystography in the detection and grading of vesicoureteric reflux with respect to the sex and age of patients as well as the severity of reflux. METHODS: In the 66 patients enrolled (56 girls and 10 boys), 132 renoureteral units were investigated. All patients under went Doppler voiding urosonography and direct radionuclide voiding cystography within 3 hours. Direct radionuclide voiding cystography was used as the reference standard. RESULTS: Our results indicate good overall sensitivity (83%) and specificity (77%) for color Doppler voiding urosonography without contrast enhancement in comparison with direct radionuclide voiding cystography. As the age of the patients decreased, the sensitivity of urosonography increased, reaching 100% among patients younger than 1 year. In the comparison of different grades of reflux severity, we found that the sensitivity and specificity were elevated as the grade increased (both parameters reaching 100% in the most severe cases). Severity grading was equal between the two methods. CONCLUSIONS: We have shown that Doppler voiding urosonography without contrast enhancement is a comparably reliable method versus direct radionuclide voiding cystography in the detection and grading of vesicoureteric reflux, especially at higher grades of reflux and in children younger than 1 year.

Correlation between the severity of carpal tunnel syndrome and color Doppler sonography findings.

OBJECTIVE: Carpal tunnel syndrome (CTS) represents one of the most prevalent peripheral entrapment mononeuropathies. The purpose of our study was to assess the potential correlation between intraneural hypervascularization, flexor retinaculum bowing, and median nerve cross-sectional area and the severity of CTS in cases confirmed by nerve conduction study. SUBJECTS AND METHODS: Sixty consecutive patients with classic or probable symptoms of CTS were enrolled in the study. A control group consisting of 27 healthy volunteers who were never diagnosed with CTS or had any symptoms of CTS was recruited among institution employees. All symptomatic patients were initially examined by a hand surgeon and subsequently referred for sonographic and electrophysiologic examinations. RESULTS: A total of 90 wrists (in 60 patients) were included in the study. Twenty-eight (31.1%) had mild CTS, 33 had moderate disease, and 29 had severe disease. We detected significant correlation between median nerve hypervascularization and the severity of CTS (p = 0.01, logistic regression) for moderate CTS and (p = 0.04) for severe disease. We also detected a significant correlation in flexor retinaculum bowing and median nerve cross-sectional area with increase in the severity of CTS (p < 0.001 and < 0.008; chi-square test and analysis of variance, respectively). CONCLUSION: Our study suggests that the severity of CTS strongly correlates with color Doppler sonography findings, and this technique may represent a reliable complementary tool in CTS examination.