Neurosurgical treatment of pediatric brain tumors - results from a single center multidisciplinary setup.

OBJECTIVE: The challenge of pediatric brain tumor surgery is given due to a relative low prevalence but high heterogeneity in age, localization, and pathology. Improvements of long-term overall survival rates were achieved during the past decades stressing the importance of a multidisciplinary decision process guided by a national treatment protocol. We reviewed the entire spectrum of pediatric brain tumor surgeries from the perspective of an interdisciplinary pediatric neuro-oncology center in Germany. METHODS: Every patient who underwent brain tumor surgery from January 2010 to June 2017 in our Pediatric Neurosurgery department was retrospectively included and evaluated regarding the course of treatment. Perioperative data such as tumor localization, timing of surgery, extent of resection, neuropathological diagnosis, transfusion rates, oncologic and radiation therapy, and neurological follow-up including morbidity and mortality were evaluated. RESULTS: Two hundred ninety-three pediatric brain tumor patients were applicable (age: 8.28 ± 5.62 years, 1.22:1.0 m:f). A total of 531 tumor surgical interventions was performed within these patients (457 tumor resections, 74 tumor biopsies; mean interventions per patient 1.8 ± 1.2). Due to a critical neurologic status, 32 operations (6%) were performed on the day of admission. In 65.2% of all cases, tumor were approached supratentorially. Most frequent diagnoses of the cases were glial tumors (47.8%) and embryonal tumors (17.6%). Preoperative planned extent of resection was achieved in 92.7%. Pre- and postoperative neurologic deficits resolved completely in 30.7%, whereas symptom regressed in 28.6% of surgical interventions. New postoperative neurologic deficit was observed in 10.7%, which resolved or improved in 80% of these cases during 30 days. The mortality rate was 1%. CONCLUSION: We outlined the center perspective of a specialized pediatric neuro-oncological center describing the heterogeneous distribution of cases regarding age-related prevalence, tumor localization, and biology, which requires a high multidisciplinary expertise. The study contributes to define challenges in treating pediatric brain tumors and to develop quality indicators for pediatric neuro-oncological surgery. We assume that an adequate volume load of patients within a interdisciplinary infrastructure is warranted to aim for effective treatment and decent quality of life for the majority of long-term surviving pediatric tumor patients.

Effect of omeprazole on the course of associated esophagitis and laryngitis.

Esophagitis has increasingly been implicated as a cause of chronic laryngitis and there is some evidence that gastro-esophageal reflux disease (GERD) is more common in patients with laryngitis. The aim of this study was to evaluate whether patients with esophagitis and laryngitis responded to treatment with omeprazole. Of 74 consecutive patients with endoscopically proven GERD, 21 had laryngitis. These 21 patients with associated esophagitis and chronic laryngitis were treated for 4 weeks with omeprazole 40 mg per day. After 2 weeks of treatment and at the conclusion of the study, 2 weeks later, esophagoscopy and laryngoscopy were performed and the patients responded to a questionnaire on their symptoms. The follow-up period was 1 year. Twenty-one of the 74 patients (28.4%) had esophagitis (grade I, n = 12; grade II, n = 9) and associated laryngitis (grade I, n = 14; grade II, n = 7). The severity of the esophagitis accorded with the severity of the laryngitis. After 2 weeks' treatment with omeprazole, both the esophageal and the laryngeal symptoms had improved in all 21 patients. Endoscopically, the healing rates were 62% for esophagitis and 33.3% for laryngitis. At the end of the study period, at 4 weeks, all patients were symptom-free and the esophagitis and laryngitis had healed completely. No patient suffered from drug-induced side effects. Patients with associated laryngitis and esophagitis should be given adequate anti-reflux therapy. Both the laryngeal and esophageal symptoms improved with the omeprazole treatment, suggesting that reflux was the underlying etiology.

Omeprazole-amoxycillin therapy for eradication of Helicobacter pylori in duodenal ulcer bleeding: preliminary results of a pilot study.

Thirty-five patients with duodenal ulcer bleeding and Helicobacter pylori-colonization were assigned to receive 2 x 20 mg omeprazole and 3 x 750 mg amoxycillin daily for 2 weeks. Eradication was defined as no evidence of H. pylori infection by urease test and by histology 4 weeks after completion of therapy. Two patients were lost to follow up. All ulcers healed completely (100% ulcer healing rate). Twenty-nine out of the 33 patients were H. pylori-negative (87.9% eradication rate). Three patients complained of typical side effects of amoxycillin (9.1% side effect rate). The patients were prospectively followed for 12 months. After ulcer healing, no maintenance therapy was given. One of the 29 patients in whom H. pylori eradication had been successful suffered a second ulcer hemorrhage with H. pylori reinfection (3.4% relapse rate of ulcer bleeding), and this was managed endoscopically. Recurrent ulcer hemorrhage occurred in 2 out of 4 H. pylori-resistant patients. At the end of the follow-up period, of the patients in whom H. pylori eradication had been initially successful, only the patient with re-bleeding remained reinfected. The 4 H. pylori-resistant patients showed persistent H. pylori colonization. In conclusion, omeprazole plus amoxycillin is a safe and effective treatment for eradicating H. pylori; this treatment reduces the relapse rate of duodenal ulcer bleeding.

[Fatal soccer injury as an unfortunate sequela of collision]. / Ein tödlicher Fussballunfall als unglückliche Kollisionsfolge.

The tragic death of a 26-year old hobby soccer player is described, who had a collision with the opposing goalie and suffered from a fracture of the left lateral process of the atlas, an extensive subarachnoid haemorrhage, tamponade of the third and fourth cerebral ventricles, bleeding into both lateral cerebral ventricles, infratentorial and supratentorial cerebral oedema. Furthermore, a survey of the literature concerning acute death in soccer is presented.

A novel gel electrophoretic extraction and fractionation technique in comparative analysis of functional differences and alterations in cellular metabolism.

A novel gel electrophoretic extraction and fractionation technique is described. The technique enables extraction of aqueous sample components (nonamphoteric and amphoteric) into polar and water-miscible organic solvents. The three major fractions obtained are acidic, basic, and neutral/nonextractable. In the acidic and basic fractions, the extractable compounds form a pH gradient in which they are further separated by the difference in their dissociation constants. Selective separation of acidic and basic ampholytes from other sample components is possible by modifying experimental conditions. The workup technique is particularly suitable for sample profiling because of quantitative extraction yields. Applications of the technique are shown by gas chromatographic profiles of extracellular fluids from cultured and biopsied intact cells. Differences in metabolic consumption and excretion in various cell lines and in normal and diseased cells (biopsies) as reflected in the extracellular environment are demonstrated. Profiles of extracellular fluids bathing approximately 1500 cells indicate the potential of this approach and methodology.

The formation of cyclized silyl derivatives of beta-hydroxyamines and their analyses by means of gas chromatography mass spectrometry.

A generally applicable silylation method for beta-hydroxylated primary, secondary, tertiary and even quaternary amines is presented. These aminoalcohols form 6-membered heterocycles under the influence of a reagent mixture consisting of 1,3-bis-(chloromethyl)-1,1,3,3-tetramethyldisilazane and chloromethyldimethyl-chlorosilane. Examples of analogue ring closures with a gamma-hydroxyamine and an alpha-amino acid are also given. The formation of the derivatives and their properties, are discussed, mainly from the viewpoint mass spectrometry.

[Cerebellar ataxia due to hypothyroidism in adults (case report)]. / Zerebellare Ataxie infolge Hypothyreose beim Erwachsenen

Cerebellar ataxia was diagnosed in a 62-year-old woman, its signs regressing almost completely within six weeks during treatment with thyroxine and triiodothyronine. The cause of cerebellar ataxia in association with hypothyroidism remains unknown. No typical morphological changes in the cerebellum have been described. It is assumed that a thyrogenic, specific metabolic factor is responsible which aggravates already existing non-specific cerebellar changes. The prognosis is very good. On the other hand, cerebellar ataxia resulting from congenital hypothyroidism has typical histological cerebellar changes and prognosis is very poor unless thyroid treatment is started soon after birth.