Progesterone-only contraception is associated with a shorter progression-free survival in premenopausal women with WHO Grade I meningioma.

The hormonally active nature of intracranial meningioma has prompted research examining the risk of tumorigenesis in patients using hormonal contraception. Studies exploring estrogen-only and estrogen/progesterone combination contraceptives have failed to demonstrate a consistent increased risk of meningioma. By contrast, the few trials examining progesterone-only contraceptives have shown higher odds ratios for risk of meningioma. With progesterone-only contraception on the rise, the risk of tumor recurrence with these specific medications warrants closer study. We sought to determine whether progesterone-only contraception increases recurrence rate and decreases progression-free survival in pre-menopausal women with surgically resected WHO Grade I meningioma. Comparative analysis of 67 pre-menopausal women taking hormone-based contraceptives (progesterone-only medication, n = 21; estrogen-only or estrogen/progesterone combination medication, n = 46) who underwent surgical resection of WHO Grade I intracranial meningioma was performed. Differences in demographics, degree of resection, adjuvant therapy and time to recurrence were compared between the two groups. Compared to patients taking combination or estrogen-only contraception, those taking progesterone-only contraception demonstrated a greater recurrence rate (33.3 vs. 19.6%) with a reduced time to recurrence (18 vs. 32 months, p = 0.038) despite a significantly shorter follow-up (p = 0.014). There were no significant demographic or treatment related differences. The results from this study suggest that exogenous progesterone-only medications may represent a specific contraceptive subgroup that should be avoided in patients with meningioma.

Phase I trial of dose-escalating metronomic temozolomide plus bevacizumab and bortezomib for patients with recurrent glioblastoma.

The average survival time for patients with recurrent glioblastoma is between 5 and 9 months. Phase I and II trials have shown a modest survival benefit with combination temozolomide and other chemotherapeutics. We conducted a phase I trial of dose-escalating temozolomide with bevacizumab and the proteasome inhibitor bortezomib for patients with recurrent disease. Three groups of three patients were scheduled to receive daily doses of temozolomide at 25, 50, and 75 mg/m2. Fixed doses of bortezomib and bevacizumab were given at standard intervals. Patients were monitored for dose-limiting toxicities (DLT) to determine the maximum-tolerated dose (MTD) of temozolomide with this regimen. No DLT were seen in the first two groups (25 and 50 mg/m2 temozolomide). One patient in the 75 mg/m2 group experienced a grade 4 elevation of ALT and three more patients were accrued for a total of six patients at that dose level. No other DLT occurred, thus making 75 mg/m2 the MTD. Progression-free survival was 3.27 months for all patients and mean overall survival was 20.75 months. The MTD of temozolomide was 75 mg/m2 in combination with bevacizumab and bortezomib for recurrent glioblastoma. Only one patient experienced a severe (Grade 4) elevation of ALT. This study will provide the framework for further studies to elicit effectiveness and better determine a safety profile for this drug combination.

Perception of passage through openings depends on the size of the body in motion.

Walkers need to modify their ongoing actions to meet the demands of everyday environments. Navigating through openings requires gait modifications if the size of the opening is too small relative to the body. Here we ask whether the spatial requirements for navigating horizontal and vertical openings differ, and, if so, whether walkers are sensitive to those requirements. To test walkers' sensitivity to demands for gait modification, we asked participants to judge whether they could walk through horizontal openings without shoulder rotation and through vertical openings without ducking. Afterward, participants walked through the openings, so that we could determine which opening sizes elicited gait modifications. Participants turned their shoulders with more space available than the space they left themselves for ducking. Larger buffers for horizontal openings may reflect different spatial requirements created by lateral sway of the body during walking compared to vertical bounce. In addition, greater variability of turning from trial to trial compared with ducking may lead walkers to adopt a more conservative buffer to avoid errors. Verbal judgments accurately predicted whether openings required gait modifications. For horizontal openings, participants' judgments were best predicted by the body's dynamic abilities, not static shoulder width. The differences between horizontal and vertical openings illustrate that walkers account for the dynamic properties of walking in addition to scaling decisions to body dimensions.

Cervical intradural disc herniation, case report and reflection on preoperative imaging.

Intradural disc herniation in the cervical spine is a rare condition that requires identification and modification of surgical technique to avoid postoperative complications. A 55-year-old male with a C4-5 intradural disc herniation who presented with radicular symptoms was treated via anterior cervical discectomy and fusion. The dural defect was identified at the time of surgery. On retrospective review of the patient's preoperative MRI, there were subtle findings of the intradural disc location, including a surrounding ring of hyperintensity on T2 and less deformation of the spinal cord than would be expected given its size.