Neuroimaging of Peptide-based Vaccine Therapy in Pediatric Brain Tumors: Initial Experience.

The potential benefits of peptide-based immunotherapy for pediatric brain tumors are under investigation. Treatment-related heterogeneity has resulted in radiographic challenges, including pseudoprogression. Conventional MR imaging has limitations in assessment of different forms of treatment-related heterogeneity, particularly regarding distinguishing true tumor progression from efficacious treatment responses. Advanced neuroimaging techniques, including diffusion magnetic resonance (MR), perfusion MR, and MR spectroscopy, may add value in the assessment of treatment-related heterogeneity. Observations suggest that recent delineation of specific response criteria for immunotherapy of adult brain tumors is likely relevant to the pediatric population and further validation in multicenter pediatric brain tumor peptide-based vaccine studies is warranted.

The Burden of Ionizing Radiation Studies in Children with Ventricular Shunts.

OBJECTIVES: To quantify the number of shunt-related imaging studies that patients with ventricular shunts undergo and to calculate the proportion of computed tomography (CT) scans associated with a surgical intervention. STUDY DESIGN: Retrospective longitudinal cohort analysis of patients up to age 22 years with a shunt placed January 2002 through December 2003 at a pediatric hospital. Primary outcome was the number of head CT scans, shunt series radiograph, skull radiographs, nuclear medicine, and brain magnetic resonance imaging studies for 10 years following shunt placement. Secondary outcome was surgical interventions performed within 7 days of a head CT. Descriptive statistics were used for analysis. RESULTS: Patients (n = 130) followed over 10 years comprised the study cohort. The most common reasons for shunt placement were congenital hydrocephalus (30%), obstructive hydrocephalus (19%), and atraumatic hemorrhage (18%), and 97% of shunts were ventriculoperitoneal. Patients underwent a median of 8.5 head CTs, 3.0 shunt series radiographs, 1.0 skull radiographs, 0 nuclear medicine studies, and 1.0 brain magnetic resonance imaging scans over the 10 years following shunt placement. The frequency of head CT scans was greatest in the first year after shunt placement (median 2.0 CTs). Of 1411 head CTs in the cohort, 237 resulted in surgical intervention within 7 days (17%, 95% CI 15%-19%). CONCLUSIONS: Children with ventricular shunts have been exposed to large numbers of imaging studies that deliver radiation and most do not result in a surgical procedure. This suggests a need to improve the process of evaluating for ventricular shunt malfunction and minimize radiation exposure.

CNS and spinal tumors.

Primary CNS tumors consist of a diverse group of neoplasms originating from various cell types in the CNS. Brain tumors are the most common solid malignancy in children under the age of 15 years and the second leading cause of cancer death after leukemia. The most common brain neoplasms in children differ consistently from those in older age groups. Pediatric brain tumors demonstrate distinct patterns of occurrence and biologic behavior according to sex, age, and race. This chapter highlights the imaging features of the most common tumors that affect the child's CNS (brain and spinal cord).

Implicações do fumo na gustação e na olfação: revisando o tema / Implications of Smoke Habit in Gustation and in Olfaction: reviewing the theme

Entre os diversos malefícios causados pelo tabagismo, os efeitos na gustação e na olfação não têm sido abordados pela literatura especializada nacional. Realizou-se um estudo de revisão sobre o tema. Há um predomínio de estudos que se dedicam à investigação da gustação. A exposição ao fumo parece alterar significativamente os dois sistemas quimiorreceptores. A capacidade gustativa está comprometida, quanto à percepção de substâncias salgadas, amargas e doces-principalmente as duas últimas -, bem como à impressão hedônica global (prazer). Dessa forma, a preferência alimentar pode variar. Já na olfação, há alterações ultraestruturais no epitélio, perda na habilidade de identificação de odores (hiposmia) e sensação de queimação e dor na mucosa. Talvez com o esclarecimento da importância desses dois sistemas sensórios e de suas patologias, possam ser efetuados novas revisões e estudos sobre o tema em nosso meio.

Among the variety of general health smoking habit consequences, the effects on gustation and on olfacion have not been reported in the national specialized literature. We did a review study about the issue. There is a predominance of study inquirements on gustation. The smoking habit seems to affect both sensory systems. The gustatory capacity is compromised by a reduction in taste sensibility to salty, bitter and sweet substances (specially the last two), as well by a diminish global hedonic impression (pleasure). Therefore, alimentary preferences may change in smokers. The olfaction is compromised by ultra-estrucutral epithelial alterations. The smell identification ability is reduced (hyposmia), and a sensation of burn and pain on the mucosa is also established. The importance of understanding both sensory systems and their pathology suggests new study requirements among our academic staff.

Drogas antiiflamatórias näo esteroidais e hemorragia digestiva alta / Non steroidal antininflamatory drugs(NSAIDs) and upper gastrointestinal bleeding

Pesquisas têm mostrado os efeitos adversos no sistema gastrintestinal, principalmente nos idosos, entre os usuários de antiinflamatórios, que, por sua vez, têm sido utilizados indiscriminadamente e de maneira crescente. No presente estudo observa-se que em 30 por cento das hemorragias digestivas altas existe referência ao antiinflamatório prévio, geralmente em uso regular, ou seja, maior que duas vezes na semana (79,4 por cento dos casos). Lesoes gástricas (erosoes e/ou úlceras) e erosoes duodenais foram as alteraçoes mais freqüentemente encontradas nos usuários de antiinflamatórios, assim como a presença de mais de uma lesao à endoscopia, enquanto varizes de esôfago foram mais freqüentes no grupo nao-usuário de antiinflamatórios. Variáveis como fumo e álcool foram significativamente mais freqüentes entre os usuários de antiinflamatórios com 60 anos ou menos.