Nutrition Support Team Intervention Improves Activities of Daily Living in Older Patients Undergoing In-Patient Rehabilitation in Japan: A Retrospective Cohort Study.

The effect of nutrition support on activities of daily living (ADL) in individuals aged ≥75 years requiring rehabilitation is unknown. This study aimed to investigate the effect of nutrition support on ADL improvement in older patients undergoing in-patient rehabilitation in Japan. This retrospective cohort study was performed in 175 patients aged ≥75 years. The nutrition support team (NST) intervened in 85 cases. ADL was evaluated by the functional independence measure (FIM). We analyzed the effects of NST intervention on FIM efficiency. Multiple linear regression analysis revealed that NST intervention (standard partial regression coefficient, ß = 0.164; 95% confidence interval [CI] 0.003-0.229; P = 0.044), energy intake at admission (ß = 0.179; 95% CI, 0.000-0.016; P = 0.043), body mass index (BMI) at admission (ß = 0.227; 95% CI, 0.005-0.046; P = 0.014), and cerebrovascular disease (ß = -0.238; 95% CI, -0.298 to -0.063; P = 0.003) were independently associated with FIM efficiency. NST intervention, energy intake, and BMI on admission may affect ADL improvement in older patients undergoing in-patient rehabilitation.

Repeat stereotactic radiosurgery in the management of brain metastases from non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) is characterized by brain metastases that occur in about 30 to 50% of patients. To control tumor growth potential with maintaining neurocognitive function is important in the recent radiotherapy against brain metastases. From this viewpoint, we investigated the utility of repeat stereotactic radiosurgery (SRS) with a linear accelerator in the management of brain metastases from NSCLC. Between October 1998 and May 2010, 28 patients harboring brain metastases received repeat SRS (20 men and 8 women, with the age ranged from 51 to 79). The total number of SRS sessions ranged from 2 to 5, and the total number of lesions in one patient ranged from 1 to 8. Neurological decline due to uncontrolled brain lesions was identified in 9 of 28 patients after the repeat SRS, while the remaining 19 patients showed no neurological decline. Out of the 28 patients, 18 patients died by July 1, 2010; 12 patients died of active extracranial disease and 6 patients died from progressive brain lesions, considered neurological death. The 2-year and 4-year overall survival rates were 51% and 23%, respectively, and the median survival time was 26 months. In conclusion, repeat SRS is a preferred option to manage brain metastases from NSCLC, leading to a long survival with a decreased neurological decline. Repeat SRS is promising to preserve neurocognition, because the convergent dose distribution decreases the unfavorable influences from radiation on germinal niches, thereby preserving neural stem cells that are responsible for the nervous system repair.

Outcome of stereotactic radiosurgery for patients with non-small cell lung cancer metastatic to the brain.

We evaluated the treatment outcome of stereotactic radiosurgery (SRS) alone, allowing for salvage with repeat SRS or fractionated radiotherapy, for managing patients with brain metastases from non-small cell lung cancer (NSCLC). From October 1998 through November 2008, 84 patients with NSCLC metastatic to the brain were treated with linac SRS. The marginal dose of SRS ranged from 12 to 20 Gy. Twenty-one patients underwent salvage radiotherapy and repeat SRS was used for 12. The 1- and 5-year overall survival rates were 38% and 11%, respectively, and the median survival time was 9 months. The 1- and 2-year local control rates were 77% and 52%, respectively, and the median time of local control was 9 months. The most common cause of death was active extracranial disease, and central nervous system (CNS) failure was determined in 16%. Chronic CNS toxicity of grade 4 was observed in 2 patients. Uni- and multivariate analyses revealed that factors significantly affecting overall survival were the presence of active extracranial disease (P < 0.0001 and P = 0.003, respectively), performance status (P = 0.001 and P = 0.009, respectively), and number of brain metastases (P = 0.0003 and P = 0.019, respectively). There were 15 long-term survivors, surviving more than 2 years. A large proportion (87%) had a single brain metastasis initially and few intracranial distant metastases afterwards (20%). SRS alone allowing for salvage radiotherapy was effective for managing brain metastases and avoiding CNS failure from NSCLC. In consideration of appropriate prognostic factors and the so-called oligometastases situation for patient selection, the use of upfront whole brain radiotherapy might improve outcome.

Pupil-sparing oculomotor nerve paresis as an early symptom of unruptured internal carotid-posterior communicating artery aneurysms: three case reports.

Oculomotor nerve paresis caused by internal carotid-posterior communicating artery (IC-PC) aneurysm usually manifests with pupillary dysfunction. Recently, we treated three patients with unruptured IC-PC aneurysms initially manifesting as pupil-sparing oculomotor nerve paresis, which resolved after clipping of the aneurysms. Review of the 56 patients admitted to our hospital with unruptured IC-PC aneurysms between January 2000 and December 2006 identified 6 patients with oculomotor nerve disturbances, and the 3 present cases with pupil sparing. The incidence of IC-PC aneurysms manifesting as pupil-sparing oculomotor nerve paresis may be increasing with improved accessibility to medical services and wider awareness of oculomotor nerve paresis as a symptom of cerebral aneurysms. Cerebral angiography should be performed in patients with pupil-sparing oculomotor nerve paresis.

Thyroid follicular carcinoma metastasized to the lung, skull, and brain 12 years after initial treatment for thyroid gland--case report.

A 65-year-old woman presented with multiple metastases from thyroid follicular carcinoma to the lung, skull, and brain. The skull and brain tumors had been successfully treated by surgery, thyroxine supplementation, and radiosurgery until she died of sudden intracerebral hemorrhage which had no connection with tumor treatment. The lung tumor was treated by conventional irradiation and radioactive ablation. Well-differentiated thyroid carcinoma is a slowly progressive tumor. Follicular carcinoma is thought to have the most optimistic prognosis even with metastases to the lymph nodes and lung. Radioactive ablation using iodine-131 is widely used to treat the primary and/or metastatic lesion. However, the prognosis for patients with brain metastases is poor. Intracranial metastasis of this tumor is rare, but has a mean posttreatment survival of around 12 months. Surgical excision of the metastatic intracranial lesion may be the only effective treatment.

Central neurocytomas with MIB-1 labeling index over 10% showing rapid tumor growth and dissemination.

OBJECTIVE AND IMPORTANCE: Central neurocytoma is recognized as a indolent intraventricular tumor arising from the ependyma around the foramen of Monro and anterior part of the lateral ventricles, and well demarcated from the brain parenchyma. Surgical removal can be curative without postoperative therapy. However, malignant central neurocytoma refractory to even aggressive treatment is known. CLINICAL PRESENTATION: We report two cases of extraventricular central neurocytomas with significant vascular proliferation, mitoses, and MIB-1 labeling index of more than 10%. INTERVENTION: Subtotal removal for the one patient and open biopsy for other followed by radiotherapy with chemotherapy were performed. However, the disease progressed and dissemination occurred. Both patients subsequently died 23 and 18 month after the histological diagnosis was established. CONCLUSION: Extraventricular central neurocytoma may present with frequent vascular proliferation and high MIB-1 labeling index. Even if they lack malignant histological findings like frequent mitosis and/or necrosis, the prognosis for such patients is very poor.

[A case of primary meningeal melanocytoma of the left middle fossa].

A 29-year-old woman presented with a primary meningeal melanocytoma of the left middle fossa manifesting as headache and nausea. Computed tomography (CT) with contrast medium demonstrated a clearly demarcated, homogeneously enhanced high density area surrounded by a cyst in the left temporal lobe. Magnetic resonance (MR) imaging showed the mass as a slightly high signal intensity area on the T1-weighted image and as a low signal intensity area on the T2-weighted image. Cerebral angiography revealed shift of the middle cerebral artery but no tumor stain. The solid part of the tumor had rapidly increased in size with reduction of the cyst 3 months later. Left frontotemporal craniotomy disclosed a clearly demarcated jet-black tumor attached to the dura. The black-colored lesion in the dura and the bone extended to the skull base, so malignant melanoma was a possibility. The solid part of the tumor was gross totally removed, and the dura and the skull bone were preserved. Histological examination of the tumor specimen revealed meningeal melanocytoma. Melanophages were present in the specimen of the black-colored lesion in the dura and the bone, but no neoplastic infiltration was present. The postoperative course was uneventful, and the patient's headache and nausea disappeared. CT and MR imaging taken 1 month later confirmed total removal of the tumor. No recurrence has been observed for 2.5 years after surgery. Preoperative differentiation of meningeal melanocytoma from malignant melanoma is difficult, but the primary goal of therapy is gross total resection of the solid part of the tumor irrespective of tumor type.