Clinical significance of the duplicated muscularis mucosae in Barrett esophagus-related superficial adenocarcinoma.

OBJECTIVE: The purpose of this study was to evaluate the relationship between the depth of invasion within the mucosal compartment, with particular attention to the duplicated muscularis mucosae, and survival after esophagectomy performed as treatment for Barrett esophagus-related superficial adenocarcinoma. METHODS: A total of 185 patients with pT1 esophageal adenocarcinoma treated by esophagectomy without induction therapy were identified. Depth of invasion was subdivided into invasion into the lamina propria (LP), into the inner muscularis mucosae, between the inner and outer muscularis mucosae, and into the outer muscularis mucosae (OMM), with comparison with tumors invading the inner one third of the submucosa (SM-1). Patient and tumor characteristics were compared among the 5 groups using the χ test or the Kruskal-Wallis test. Survival was estimated using the Kaplan-Meier method and compared using the log-rank test. The prognostic effect of depth of invasion on survival was assessed with Cox proportional hazards analysis. RESULTS: Depth of invasion was LP (n=68), inner muscularis mucosae (n=38), BMM (n=11), OMM (n=33), and SM-1 (n=35). There was no significant difference in sex or age among groups. One of 150 patients with intramucosal adenocarcinoma (0.7%; LP, pN2) and 3 of 35 patients with SM-1 (8.6%; all pN1) had nodal disease. There were no significant differences in survival among the groups. CONCLUSIONS: Depth of invasion relative to the duplicated muscularis mucosae for tumors restricted to the mucosal compartment does not affect survival in Barrett esophagus-related superficial adenocarcinoma. Patients with SM-1 tumor had survival similar to those patients with tumor invasion into the OMM.

Chromosome 1p and 19q deletions in glioblastoma multiforme.

CONTEXT: Deletions on chromosomes 1p and 19q have been shown to correlate with prognosis and chemosensitivity in anaplastic oligodendrogliomas. In glioblastoma multiforme (GBM), the impact on prognosis of these alterations in GBM is unclear. OBJECTIVE: The purpose of this study was to identify patients with GBM who had evidence of 1p or 19q deletions by fluorescence in situ hybridization, and correlate these results with clinical findings and survival. DESIGN: Three hundred thirty-seven GBM resected between 2001 and 2006 were evaluated using fluorescence in situ hybridization to identify deletions on chromosomes 1p and 19q. Cox regression was used to compare survival between these 2 groups and a control group of 1p and 19q intact tumors. RESULT: Seventeen (5.1%) patients (9 males; mean age at diagnosis=61 y, range: 35 to 84 y) were found to have 1p deletions; 8 patients (47.1%) received chemotherapy and 13 patients received radiation therapy. The mean survival for this group was 10.8 months (range: 1 to 50 mo). Eighteen (5.3%) patients (11 females; mean=56 y, range: 25 to 76 y) had 19q deletions; 9 patients (50%) received chemotherapy and 8 patients were known to have had radiation therapy. The mean survival of this group was 8.4 months (range: 1 to 17 mo). A control group of 20 patients (13 males; mean=60 y, range: 40 to 80 y) was selected, 8 patients (40%) of who received chemotherapy and 12 patients were known to have had radiation therapy. The mean survival in this group was found to be 16.4 months (1 to 59 mo). Nine (3.7%) tumors had codeletions of 1p and 19q and were not evaluated in this study. Isolated 1p and 19q deletions did not significantly correlate with survival. Adjusting for sex, age, and chemotherapy, the 19q-deleted group had a significantly lower survival (hazard ratio =2.8, P=0.025) than the other groups. CONCLUSIONS: The incidence of isolated 1p or 19q deletions among GBM in the current study was 6.2% and 5.3%, respectively. In contrast to anaplastic oligodendrogliomas, 1p and 19q deletions alone were not found to improve survival of patients with GBM; however, when adjusted for age, sex, and chemotherapy, 19q deletions seem to negatively impact survival.

Evolution of endovascular therapy for aneurysm treatment. Historical overview.

The endovascular treatment of intracranial aneurysms has recently become an established therapeutic option. The foundation of this treatment modality was laid by the work done in ground-breaking cases, combined with technological advances since the first half of the 19th century. In this historical overview the authors describe the steps taken by the early pioneers and the results of their work, which was often done under challenging circumstances. The work of these predecessors established the stepping-stones for constant development and refinement for those who have come after them, eventually evolving into the procedures used today. Endovascular treatment of intracranial aneurysms is only possible because of the work of these innovators.