RESUMO
Only two aneurysm formations in the internal carotid artery after gamma knife radiosurgery (GKRS) for pituitary adenomas are reported so far. Here, out of the 482 patients who underwent GKRS for pituitary adenomas at our institute, at least five developed aneurysms within the area of high single-dose irradiation. Three patients presented with epistaxis due to aneurysmal rupture and one presented with abducens paralysis due to nerve compression, while one was asymptomatic. The interval between irradiation and aneurysmal detection ranged from 14 to 21 years. Aneurysm formation in those conditions may be higher than previously thought.
Assuntos
Adenoma , Aneurisma Roto , Doenças das Artérias Carótidas , Neoplasias Hipofisárias , Radiocirurgia , Humanos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Radiocirurgia/efeitos adversos , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Aneurisma Roto/cirurgia , Doenças das Artérias Carótidas/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , SeguimentosRESUMO
Palbociclib(PAL), which is a small molecule with inhibitory activity against cyclin-dependent kinase 4/6, is used in endocrine combined therapy for the treatment of estrogen receptor(ER)-positive and HER2-negative inoperable and recurrent breast cancer. We retrospectively investigated the factors associated with prolonged treatment in inoperable and recurrent breast cancer in a multicenter study. The median time-to-treatment failure(TTF)after PAL was 5.6 months(0.2-22.5). A total of 28 patients in the fulvestrant(FUL)group and 21 patients in the aromatase inhibitor(AI)group received concomitant endocrine therapy. The median TTF was 2.6 vs 6.7 months(p=0.015)for white blood cell(WBC), 3.7 vs 6.6 months (p=0.021)for neutrophils(Neu), and 2.8 vs 7.5 months(p=0.007)for lymphocytes(Lym). The treatment period tended to be prolonged in the group with higher WBC, Neu, and Lym levels than that of the standard values. The median treatment duration of the FUL group was 7.5 months vs 4.2 months(p=0.162); however, the difference was not statistically significant. The WBC, Neu, and Lym levels upon PAL introduction may be factors affecting the prolonged treatment. Further analysis of the data and further investigation of the prolongation-related factors of PAL treatment period are necessary.
Assuntos
Neoplasias da Mama , Duração da Terapia , Humanos , Feminino , Estudos Retrospectivos , Recidiva Local de Neoplasia , Neoplasias da Mama/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica , Receptor ErbB-2/análiseRESUMO
BACKGROUND: Treating chordoma through surgery alone is often ineffective. Thus, surgery often performed with irradiation, with a reported 5-year survival rate of 60-75%. The clinical course varies, and disease rarity prevents larger number of clinical investigations. METHODS: In total, 19 patients with clival chordomas were retrospectively extracted from our institutional database. They were initially treated with maximal tumor removal using the extended transsphenoidal approach between March 2006 and January 2021. When total tumor removal was achieved, prophylactic irradiation was not performed. If tumor remnants or recurrence were confirmed, Gamma Knife (GK) radiosurgery was performed. The mean follow-up period was 106.7 months (ranged 27-224 months). The clinical course and prognostic factors were investigated. RESULTS: Total removal was achieved in 10 patients, whereas 4 patients suffered recurrence and required GK. GK was applied to 11 patients with a 50% isodose of 13-18 Gy (mean: 15.4 Gy), and eight patients remained progression free, whereas three patients suffered repeated local recurrence and died of tumor-related complications. The mean overall progression-free interval was 57.2 months (range: 6-169 months). One male patient died of tumor un-related lung cancer 36 months after the initial treatment, and other patients survived throughout the observational periods. The mean overall survival was 106.7 months (range: 27-224 months). Thus, the 5-year survival rate was 94.7%. Statistical analysis indicated that sex (men), > 15 Gy of 50% isodose by GK, and screening brain examinations as prophylactic medicine were significant favorable prognostic factors. CONCLUSIONS: The favorable outcomes in this investigation suggest the importance of early detection and treatment. Surgery may enable better conditions for sufficient GK doses.
Assuntos
Cordoma/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias da Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Radiocirurgia/métodos , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: Hepatitis B virus (HBV) infection is a major public health problem worldwide. More than 2 billion people have been exposed to HBV, and about 257 million individuals are chronic carriers of HBV. HBV reactivation has been increasingly reported in HBV carriers who have undergone immunosuppression or chemotherapy, resulting in mortality. Treatment of hypothalamic/pituitary tumors in HBV carriers requires extensive care to avoid HBV reactivation as steroid therapy is required after surgery for hypothalamic/pituitary tumors. CASE PRESENTATION: This retrospective review identified 5 patients, who were HBV carriers positive for hepatitis B surface antigen among 1352 patients with surgically treated hypothalamic/pituitary tumor in Kohnan Hospital between February 2007 and April 2017. Transsphenoidal surgery was performed with particular attention to prevent damage to the pituitary gland, with delicate manipulation to minimize postoperative steroid coverage. All patients received nucleot(s)ide analogue to control HBV-DNA levels before the surgery. As a result, all patients had a good clinical course. Blood examinations found a transient increase of liver enzymes and HBV-DNA levels in all patients, which started to decrease within 2 weeks after surgery. No specific treatment other than nucleot(s)ide analogues was needed to maintain liver function, and all patients returned to their previous activities including reinstatement. CONCLUSION: Initiation of nucleot(s)ide analogues administration prior to the surgery for hypothalamic/pituitary tumors can be an effective strategy for preventing reactivation in HBV carriers. Appropriate screening of the patient's HBV phase, optimal timing of nucleot(s)ide analogues -administration, and administration period of nucleot(s)ide analogues need to be established.
Assuntos
Antivirais/uso terapêutico , Hepatite B/tratamento farmacológico , Neoplasias Hipotalâmicas/cirurgia , Neoplasias Hipofisárias/cirurgia , Idoso , DNA Viral/sangue , Feminino , Guanina/análogos & derivados , Guanina/uso terapêutico , Hepatite B/virologia , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/patogenicidade , Vírus da Hepatite B/fisiologia , Humanos , Neoplasias Hipotalâmicas/virologia , Terapia de Imunossupressão , Lamivudina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/virologia , Estudos Retrospectivos , Esteroides/uso terapêutico , Ativação Viral/efeitos dos fármacosRESUMO
OBJECTIVE: In elderly patients, age-related, disease-related, and drug-related factors are associated with chronic kidney disease (CKD). Little is known about which factors are the best predictors for CKD in elderly patients. MATERIALS AND METHODS: The study was based on 784 patients aged 75 years or older for whom the clinical and serum creatinine on admission to our hospital were available. Impaired renal function, including CKD and transient renal insufficiency, was defined as a non-indexed glomerular filtration rate (GFR) below 60 mL/min. A logistic regression model was developed for predictors of CKD and was internally validated using bootstrapping. RESULTS: Approximately 61% of the patients, who had CKD (46%) and transient renal insufficiency (15%), had a non-indexed GFR < 60 mL/min. Synergistic use of 3 drugs potentially impairing renal function, diuretics, ACE-I/ARB, and NSAIDs (odds ratio (OR), 4.66; 95% confidence interval (CI), 1.48 - 17.7, p = 0.012) was a significantly associated factor for CKD in a multivariate logistic regression analysis. Age (OR 1.56, 95% CI 1.04 - 2.33, p = 0.03), female gender (OR 1.58, 95% CI 1.04 - 2.39, p = 0.03), any prescription ACE-I/ARB either alone or in combinations with diuretics or NSAIDs (OR 2.74, 95% CI 1.83 - 4.13, p = 0.0001), and proteinuria (OR 1.98, 95% CI 1.27 - 3.10, p = 0.003), were included as the best model for CKD. The area under the curve (AUC) of the best model and the bootstrapping validation were 0.68 and 0.71, respectively. CONCLUSION: Given the widespread use of ACE-I/ARB for elderly patients, our findings suggest that caution is needed when they are prescribed because of the possibility of the patient developing CKD.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Diuréticos/efeitos adversos , Prescrição Inadequada/estatística & dados numéricos , Insuficiência Renal Crônica/induzido quimicamente , Idoso , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Pacientes Internados , MasculinoRESUMO
Pituitary adenomas with high proliferation rate and rapid growth are well known, but the clinical characteristics, prognosis, and treatment algorithm remain unclear. The clinical characteristics and mid-term prognosis of patients with non-functioning pituitary adenomas with high proliferative potential were retrospectively investigated. This study identified 53 patients with Ki-67 labeling index of > 3% among 845 patients with non-functioning pituitary adenoma (6.3%) initially treated by surgery. Prophylactic treatment was not applied for patients with residual tumor, but salvage treatment was performed if tumor progression was identified within the follow-up period. Twenty-two patients remained progression-free, whereas 31 patients suffered tumor progression. Comparison of gross total removal (n = 22) and non-total removal (n = 31) groups showed significantly longer progression-free period in the former group (P < 0.001). As salvage treatment gamma knife radiosurgery was applied for 11 patients resulting in 10 patients remaining progression-free and regrowth in 1 patient. Fractionated irradiation was applied for 10 patients, resulting in 2 patients remaining progression-free, deaths in 5 patients including 3 of transformation to pituitary carcinoma, dementia in 1 patient caused by frontal lobe dysfunction, and progression in 2 patients requiring additional surgery and gamma knife radiosurgery. Temozolomide was administered in 2 patients, resulting in deaths in both patients including 1 transformation to pituitary carcinoma. Total removal and gamma knife radiosurgery can result in good outcome. However, the prognosis is extremely poor for patients inadequate for gamma knife radiosurgery. Development of new salvage treatments is essential.
Assuntos
Adenoma/diagnóstico , Adenoma/metabolismo , Antígeno Ki-67/metabolismo , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/metabolismo , Adenoma/terapia , Adulto , Idoso , Biomarcadores Tumorais/metabolismo , Proliferação de Células , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/terapia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
This study retrospectively reviewed our single institute experience to clarify the optimal indication and timing of salvage surgery. Retrospective analysis of 159 consecutive cases with germ cell tumors identified 20 cases with salvage surgery. These cases were classified based on the radiological response to neoadjuvant treatment before salvage surgery into increase (growing group, five cases), no change (stable group, seven cases), and decrease (shrinkage group, eight cases) in tumor size. Changes in tumor markers, histological findings, and the pattern of failure after salvage surgery were reviewed. Growing teratoma syndrome (GTS) is defined as enlargement of tumor consisting of mature teratoma after chemotherapy with normalization of tumor markers. In growing group, two cases presented GTS, whereas other three cases did not fulfill the criteria for GTS. All cases in stable and shrinkage group had elevated levels of tumor markers at presentation and decreased levels after neoadjuvant treatment. Histologically, sparse components of mature teratoma with extensive fibrosis were found in cases with GTS and seven of eight cases in shrinkage group, whereas mature teratoma without fibrosis was found in six of seven cases in stable group. Six cases recurred after salvage surgery. We identified three factors as risks for recurrence after salvage surgery, as follows: (1) growing lesion which did not fulfill the criteria for GTS, (2) non-normalized level of tumor marker before salvage surgery, and (3) residual germinoma component. In conclusion, salvage surgery is recommended for patients with GTS, or with normalized tumor markers in stable or shrinkage group.
Assuntos
Neoplasias Encefálicas/terapia , Neoplasias Embrionárias de Células Germinativas/terapia , Procedimentos Neurocirúrgicos , Terapia de Salvação , Adolescente , Biomarcadores Tumorais/sangue , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Criança , Progressão da Doença , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/patologia , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Adulto JovemRESUMO
Giant pituitary adenomas carry higher surgical risks despite recent advances in microsurgical and/or endoscopic surgery. In particular, postoperative acute catastrophic changes without major vessel disturbance are still extremely difficult to predict, and may manifest as postoperative pituitary apoplexy with very poor outcomes. These changes are associated with injuries to the capillary intratumoral feeders and/or drainers, which frequently have diameters of less than 300µm, and result in drastic hemodynamic changes. A 43-year-old woman with severe visual disturbance and a giant pituitary adenoma was referred to our institute, The tumor had extended irregularly toward the suprasellar cistern and had compressed the optic chiasm upwards, and the bilateral frontal lobes were displaced laterally. Surgery was planned based on information regarding the fine angioarchitecture and feeding systems using a C-arm cone-beam CT scanner with a flat-panel detector(GE Healthcare;IL, USA)and 50%-diluted contrast medium, which disclosed the distinct feedings from the left meningohypophyseal trunk to the left lower part of the tumor and from the left superior hypophyseal artery to the upper posterior part, and absence of pial blood supply to the lateral pole of the tumor. Extended transsphenoidal surgery was performed and achieved total tumor removal. The patient was discharged without neurological or endocrinological deficits. Detailed preoperative examination of the feeding system and hemodynamics of giant pituitary adenomas is not a priority at present. However, we would like to emphasize the need for specific individual operative strategies to prevent devastating outcomes after surgery for this formidable tumor.
Assuntos
Adenoma , Apoplexia Hipofisária , Neoplasias Hipofisárias , Adenoma/cirurgia , Adulto , Feminino , Humanos , Neoplasias Hipofisárias/cirurgia , Resultado do Tratamento , Transtornos da VisãoRESUMO
BACKGROUND: Various metabolic diseases induced by eating disorders are some of the most serious and difficult problems for modern public healthcare. However, little is known about hyperphagia, partly because of the lack of a clear definition. Several basic studies have analyzed eating habits using endocrinological or neurophysiological approaches, which have suggested a controlled balance between the hunger and satiety centers in the central nervous system. However, more detailed neuro-radiologic evaluations have not been achieved for the hypothalamus, and evaluations were limited only to the floor of the third ventricles. METHODS: Fine structures of hypothalamic morphology were investigated using high-resolution magnetic resonance imaging in seven patients with hypothalamo-pituitary tumors, who suffered from preoperative hyperphagia-induced severe obesity and metabolic disorders. Body mass index (BMI) varied from 22.4 to 40.5 kg/m2 (mean 32.8 kg/m2). Clinical data were compared with the data of nine patients without hyperphagia and seven healthy volunteers. RESULTS: Morphological evaluation was possible in all patients and control subjects, and patients with hyperphagia had significantly shortened maximum distances between the ependymal layers of the lateral wall of the third ventricle and fornixes (hyperphagia group right side 0.30 mm, left side 0.23 mm vs. patients without hyperphagia group right side 1.60, left side 1.53 vs. healthy group right side 1.73 mm, left side 1.85 mm) (p < 0.01). Two patients achieved postoperative improvement in both clinical and neuro-radiological findings. CONCLUSION: Eating and metabolic disorders are related to strong dysfunction of the medial nuclei of the hypothalamus in patients with hypothalamo-pituitary tumors. We report the first case of dynamic improvement from hyperphagia, with both symptomatic and neuro-radiological findings.
Assuntos
Hiperfagia/diagnóstico por imagem , Hipotálamo/diagnóstico por imagem , Obesidade/patologia , Adolescente , Adulto , Animais , Estudos de Casos e Controles , Feminino , Humanos , Hiperfagia/complicações , Hiperfagia/patologia , Hipotálamo/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/etiologiaRESUMO
Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid(CSF)leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons. We reviewed the cases of patients with CSF leakage treated by using the bath plug closure method with an endoscopic endonasal approach at our institution. Three patients were treated using the bath plug closure method. CSF leakage was caused by a meningocele in two cases and trauma in one case. No postoperative intracranial complications or recurrence of CSF leakage were observed. The bath plug closure method is an effective treatment strategy and allows neurosurgeons to gain in-depth knowledge of the treatment options for CSF leakage by using an endoscopic endonasal approach.
Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Neuroendoscopia , Adulto , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Feminino , Humanos , Neuroendoscopia/métodos , Neurocirurgiões , Otorrinolaringologistas , Equipe de Assistência ao PacienteRESUMO
BACKGROUND: Craniopharyngioma is a slow-growing tumor classified as benign, but tight adhesion and significant local infiltration to the vital structures are common. In spite of improvement of modern microsurgery techniques and precise anatomical understanding not few cases of this tumor recur, and long-term tumor control and maintenance of quality of life are sometimes difficult. However, very little is known about the effects of the molecular characters of craniopharyngioma on the prognosis. METHODS: Ninety eight cases of craniopharyngioma surgically treated at the Department of Neurosurgery, Tohoku University Hospital and Kohnan Hospital from April 1996 to May 2014, 45 males and 53 females aged from 2 to 80 years (mean, 40.84 years) were retrospectively reviewed, and postoperative outcomes and the possible involvement of the autocrine/paracrine mechanism were investigated. The patients were followed up at intervals of 6 months to assess tumor recurrence, and clinical outcomes were correlated with the findings of immunohistochemical examinations used growth hormone receptor (GHR) and downstream hormones. The follow-up period ranged from 3 to 209 months. RESULTS: Hormone expression was examined in 88 patients, of which 46 specimens (52.3 %) showed high expression of GHR. The GHR high expression group had a significantly shorter duration of postoperative stable disease compared with the low expression group (logrank test, p = 0.007). Simultaneous high expression of growth hormone (GH) and GHR was found in 33 specimens (37.5 %), and the high expression group had a significantly shorter duration of postoperative stable disease compared with the low expression group (logrank test, p = 0.011). No other hormones showed statistically significant differences in outcomes. CONCLUSIONS: High expression of GHR is associated with shorter duration of postoperative stable disease in patients with craniopharyngioma. If the surgical specimens were craniopharyngiomas with high GHR expression, GH supplementation would be introduced quite prudently.
Assuntos
Biomarcadores Tumorais/metabolismo , Craniofaringioma/diagnóstico , Receptores da Somatotropina/metabolismo , Adolescente , Adulto , Idoso , Biomarcadores Tumorais/genética , Criança , Pré-Escolar , Craniofaringioma/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Comunicação Parácrina , Prognóstico , Receptores da Somatotropina/genéticaRESUMO
The flash visual evoked potential (VEP) is a useful diagnostic modality for visual preservation during surgery. Decreased VEP amplitude is recognized to indicate visual deterioration;however, whether intraoperative VEP can detect visual improvement remains unclear. We describe a craniopharyngioma case with a significant increase in VEP amplitude during surgery. A 67-year-old woman presented with progressive gait disturbance and impaired consciousness. Head magnetic resonance imaging demonstrated a sellar-suprasellar tumor compressing the optic chiasm upward with significant ventricular dilation. Her Glasgow Coma Scale was E3V3M5. Visual fields and acuity could not be examined because of impaired consciousness, and she could not see/recognize objects on a table. Preoperative VEP showed reproducible waveforms. Tumor removal by the extended transsphenoidal approach was performed with VEP monitoring. Increased VEP amplitude was observed after dural incision and persisted until the surgery ended. Postoperative VEP waveforms were also reproducible, but visual fields/acuity could not be examined because of cognitive dysfunction. Useful visual function was restored, and she became independent in daily life. The histological diagnosis was craniopharyngioma. The patient underwent ventriculo-peritoneal shunting for hydrocephalus 16 days after tumor removal. The postoperative course was uneventful and she was transferred to another hospital for rehabilitation. Intraoperative VEP may indicate visual improvement during surgery, which is a useful objective assessment for visual function in patients with impaired consciousness and cognitive dysfunction.
Assuntos
Craniofaringioma/cirurgia , Potenciais Evocados Visuais , Idoso , Craniofaringioma/fisiopatologia , Cardioversão Elétrica , Feminino , Humanos , Imageamento por Ressonância Magnética , Monitorização Intraoperatória , Neoplasias Hipofisárias , Resultado do TratamentoRESUMO
Here, we report about a 60-year-old woman with metastatic breast cancer who was successfully treated for paclitaxelinduced peripheral neuropathy with duloxetine. She was administered trastuzumab plus paclitaxel(PTX)combination therapy that was ultimately discontinued because of grade 3 peripheral neuropathy detected on day 15, according to the CTCAE (v4.0). She was administered duloxetine on day 90 after the end of the previous therapy because of the peripheral neuropathy. Thereafter, the peripheral neuropathy decreased to grade 1, which enabled PTX administration on her request. Further trials are required to confirm the efficacy of duloxetine.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Paclitaxel/efeitos adversos , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Tiofenos/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Neoplasias da Mama/patologia , Cloridrato de Duloxetina , Feminino , Humanos , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Doenças do Sistema Nervoso Periférico/induzido quimicamente , TrastuzumabRESUMO
A 25-year-old man complained of disorientation and gait disturbance during the past 2 weeks. The patient had been treated for cerebellar astrocytoma by open surgery thrice, at ages 3, 5, and 11. Ventriculo-peritoneal shunt was performed for postoperative hydrocephalus at the age of 11. Magnetic resonance imaging(MRI)showed enlargement of both lateral ventricles, ballooning of the third ventricle, and obstruction of the aqueduct of Sylvius. The patient was diagnosed with recurrent hydrocephalus due to shunt malfunction, and treated by endoscopic third ventriculostomy(ETV)using a flexible endoscopic system. He was relieved of the symptoms immediately after surgery, and postoperative MRI showed reduced hydrocephalus. However, the symptoms reoccurred 6 days after surgery. Computed tomography did not show recurrence of hydrocephalus. Laboratory tests revealed hyponatremia(117mEq/L)and low serum osmolality(240mOsm/kg). The patient gained 2.4 kg over the preoperative body weight. The syndrome of inappropriate secretion of antidiuretic hormone(SIADH)was considered to be the cause of the hyponatremia, which was successfully treated with 3 days of fluid restriction. The patient was discharged 24 days after surgery. Hyponatremia is a relatively rare complication of ETV. When a patient shows recurrence of hydrocephalus-related symptoms during the early postoperative period after ETV, hyponatremia caused by SIADH should be considered.
Assuntos
Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/complicações , Terceiro Ventrículo/cirurgia , Ventriculostomia , Adulto , Humanos , Síndrome de Secreção Inadequada de HAD/cirurgia , Masculino , Neuroendoscopia/métodos , Resultado do Tratamento , Derivação Ventriculoperitoneal/efeitos adversos , Ventriculostomia/métodosRESUMO
Epirubicin hydrochloride injection is indicated as a therapy for patients with primary breast cancer. This drug has been reclassified as a drug with high emetic potential according to the American Society of Clinical Oncology Guidelines for Antiemetics in Oncology. Therefore, patients who receive this agent should also receive fosaprepitant dimeglumine, an anti-emetic agent. However, it has been reported that fosaprepitant induces vascular pain when used in anthracycline-based regimens administered via the peripheral veins. In order to relieve the fosaprepitant and epirubicin-induced vascular pain associated with vasculitis, dexamethasone was administered at the onset of vascular pain. There is a possibility that the fosaprepitant and epirubicin-induced pain may improve owing to the administration of dexamethasone; however, further trials are required to confirm the effect of this method.
Assuntos
Antieméticos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Dexametasona/uso terapêutico , Dor/prevenção & controle , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Epirubicina/administração & dosagem , Epirubicina/efeitos adversos , Humanos , Pessoa de Meia-Idade , Morfolinas/administração & dosagem , Morfolinas/efeitos adversos , Dor/induzido quimicamente , Vômito/induzido quimicamente , Vômito/prevenção & controle , Adulto JovemRESUMO
Gefitinib anderlotinib, which are epidermal growth factor receptor(EGFR)tyrosine kinase inhibitors(TKIs), have been usedfor the treatment of inoperable andrecurrent non-small cell lung cancer(NSCLC)patients. These drugs are known to cause a skin rash, one of the major side effects, at a high frequency. Biotin is a water-soluble vitamin, andit belongs to the vitamin B family. It is well known that biotin deficiency increases the risk of skin dermatitis. We administered biotin to four patients with skin rash, all of whom were treatedwith either gefitinib or erlotinib andwere unable to be treatedby a steroid ointment alone. In all patients, administration of biotin reduced the skin rash. Surprisingly, in 2 patients in whom EGFR-TKI therapy was discontinued because of the skin rash, the administration of biotin allowed for long-term gefitinib or erlotinib treatment. Biotin may be considereduseful for the treatment of skin rash causedby EGFR-TKIs. Further trials may be needed to confirm the value of biotin in this setting.
Assuntos
Antineoplásicos/efeitos adversos , Biotina/uso terapêutico , Eritema/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Quinazolinas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Cloridrato de Erlotinib , Eritema/induzido quimicamente , Feminino , Gefitinibe , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Estudos Prospectivos , Inibidores de Proteínas Quinases/uso terapêutico , Quinazolinas/uso terapêuticoRESUMO
OBJECTIVE: Transsphenoidal surgery for lactotroph pituitary neuroendocrine tumor (PitNET) lowers serum prolactin concentrations, occasionally below the normal range. However, the clinical significance of postoperative hypoprolactinemia is still unclear. In this study, we retrospectively reviewed the female patients with lactotroph PitNET who were treated with transsphenoidal surgery to elucidate the influence of postoperative hypoprolactinemia on regular menstruation restoration and endocrinological remission. RESULTS: The serum prolactin levels in all thirty three participating females had decreased following surgery. Serum prolactin levels in seven patients had decreased below the lower limit of normal ranges (hypoproactinemia group) and in the remaining twenty six patients, it was within the normal range (non-hypoproractinemia group). In hypoprolactinemia group, regular menstruation was restored in all patients with only lactotroph axis deficiency. Nine patients from the non-hypoprolactinemia group experienced re-elevation of serum prolactin concentration (27%). No patient in hypoprolactinemia group experienced the relapse of hyperprolactinemia. These data suggest that early postoperative hypoprolactinemia after transsphenoidal surgery for lactotroph PitNET is not only a good predictive factor for endocrinological remission but also no unfavorable effects on regular menstruation restoration.
Assuntos
Menstruação , Neoplasias Hipofisárias , Prolactina , Humanos , Feminino , Neoplasias Hipofisárias/cirurgia , Prolactina/sangue , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Menstruação/fisiologia , Tumores Neuroendócrinos/cirurgia , Tumores Neuroendócrinos/sangue , Complicações Pós-Operatórias/etiologia , Lactotrofos , Hiperprolactinemia/sangue , Hiperprolactinemia/etiologia , Hiperprolactinemia/cirurgia , Hiperprolactinemia/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: Rathke's cleft cyst (RCC) with significant squamous and/or stratified epithelium including smooth transition from single cuboidal to squamous epithelium (tRCC) is rare and possibly represents an intermediate form to craniopharyngioma. METHODS: Twelve patients with histologically confirmed tRCC were retrospectively investigated from a series of 167 cases of RCC and 96 cases of craniopharyngiomas. Clinical data were reviewed, and immunohistochemistry findings for cytokeratins and ß-catenin were examined. RESULTS: All lesions were located in the sella turcica with marked extension to suprasellar cistern. Six of the 12 patients had suffered postoperative re-enlargement, and three of these six patients required more than two additional operations and irradiation. CAM5.2 was positive in the glandular epithelium in all tRCCs and focally positive in the squamous epithelium of all these tRCCs. 34ßE12 was positive in the squamous epithelium in all tRCCs and focally positive in the glandular epithelium in all but one tRCC. The findings of cytokeratin expression of tRCCs were very similar to those of craniopharyngioma. ß-Catenin showed nuclear translocation in five cases. All patients with nuclear translocation of ß-catenin suffered postoperative re-enlargement. CONCLUSIONS: tRCC carries an extremely high risk of re-enlargement. Cytokeratin expression resembles that in craniopharyngioma, which might indicate a very close origin of these pathologies. Nuclear translocation of ß-catenin may be related to the aggressive clinical course.
Assuntos
Cistos do Sistema Nervoso Central/patologia , Craniofaringioma/patologia , Neoplasias Hipofisárias/patologia , Adolescente , Adulto , Idoso , Cistos do Sistema Nervoso Central/metabolismo , Cistos do Sistema Nervoso Central/cirurgia , Criança , Craniofaringioma/metabolismo , Craniofaringioma/cirurgia , Feminino , Humanos , Queratinas/metabolismo , Masculino , Metaplasia/metabolismo , Pessoa de Meia-Idade , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem , beta Catenina/metabolismoRESUMO
BACKGROUND: Most difficulties in skull base tumor removal are generally caused by adhesion of feeding arteries to the vital structures and cranial nerves. Water jet technology provides tissue dissectability with preservation of fine blood vessels both in experimental and clinical situations. However problems still remain regarding whether tumor removal with preservation of peripheral nerve function is possible or not. This clinical investigation evaluated functional preservation of peripheral nerves and dissectability with a newly developed pulsed laser-induced liquid jet (LILJ) system under intraoperative electrophysiological monitoring. METHODS: The LILJ system was used to treat 21 patients with skull base tumors manifesting as severe visual disturbance through the extended transsphenoidal approach. The LILJ system consists of a bayonet-shaped catheter incorporating a jet generator, and total weight is around 7 g. Intraoperative visual evoked potential (VEP), and pre/postoperative conventional visual assessments were investigated. RESULTS: Precise dissections of the tumor were obtained, resulting in gross total removal in 19 of 21 patients. Two patients with meningiomas with tight adhesion to the origin of the lenticulostriate arteries had small remnants. Of the 21 patients, 16 showed immediate improvement on intraoperative VEP, 2 had no change, and 3 had prolonged latency, which required intermittent suspension of procedure. A total of 20 patients and 40 eyes showed good recovery at discharge, and all patients evaluated had recovered good visual status. CONCLUSIONS: The LILJ system can achieve safe and optimal removal with functional preservation of optic nerves, probably because of the high resistance of the arachnoidal sheath and fine vascular tissue.
Assuntos
Lasers , Nervo Óptico/cirurgia , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dissecação/instrumentação , Dissecação/métodos , Potenciais Evocados Visuais/fisiologia , Feminino , Humanos , Masculino , Neoplasias Meníngeas/irrigação sanguínea , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meningioma/tratamento farmacológico , Meningioma/patologia , Meningioma/cirurgia , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/métodos , Nervo Óptico/patologia , Nervo Óptico/fisiopatologia , Base do Crânio/irrigação sanguínea , Base do Crânio/patologia , Neoplasias da Base do Crânio/irrigação sanguínea , Neoplasias da Base do Crânio/patologiaRESUMO
OBJECTIVES: Immunohistochemically negative pituitary adenoma is known to be relatively indolent, but a few aggressive and highly vascular cases have been reported, which sometimes show high expression of vascular endothelial growth factor (VEGF). METHODS: The present study investigated the relationship between high expression of VEGF and the clinical character of pituitary adenomas in 30 cases of immunohistochemically negative pituitary adenomas using immunohistochemical staining with monoclonal VEGF antibody and related upstream factors, including von Hippel-Lindau gene-related protein (pVHL). Correlations between the histological findings and the clinical characteristics were investigated. RESULTS: Immunohistochemical staining using VEGF antibody showed high expression in 7 (23.3%) and low expression in 23 (76.7%) cases, and pVHL staining showed high expression in 24 (80%) and low expression in 6 (20%) cases. The pVHL low expression group showed significantly higher expression of VEGF (p = 0.005019), and significantly higher recurrence or regrowth rate (p = 0.04535) than the pVHL high expression group, whereas Ki-67 labeling index of >3% also showed significant correlation with recurrence or regrowth rate (p = 0.01745). However, there was no significant correlation between pVHL staining and Ki-67 labeling index (p = 0.49978). CONCLUSION: Low expression of pVHL with high expression of VEGF may be involved in the unusual aggressive clinical course in some pituitary adenomas.