Clinical outcomes and natural history of pediatric brainstem tumors: with 33 cases follow-ups

2012 ◽  
Vol 36 (2) ◽  
pp. 311-320 ◽  
Author(s):  
Tao Sun ◽  
Weiqing Wan ◽  
Zhen Wu ◽  
Junting Zhang ◽  
Liwei Zhang
2020 ◽  
Author(s):  
Paul Briaud ◽  
Sylvère Bastien ◽  
Laura Camus ◽  
Marie Boyadjian ◽  
Philippe Reix ◽  
...  

AbstractStaphylococcus aureus (SA) is the major colonizer of the lung of cystic fibrosis (CF) patient during childhood and adolescence. As patient aged, the prevalence of SA decreases and Pseudomonas aeruginosa (PA) becomes the major pathogen infecting adult lungs. Nonetheless, SA remains significant and patients harbouring both SA and PA are frequently found in worldwide cohort. Impact of coinfection remains controversial. Furthermore, co-infecting isolates may compete or coexist. The aim of this study was to analyse if co-infection and coexistence of SA and PA could lead to worse clinical outcomes. The clinical and bacteriological data of 212 Lyon CF patients were collected retrospectively, and patients were ranked into three groups, SA only (n=112), PA only (n=48) or SA plus PA (n=52). In addition, SA and PA isolates from co-infecting patients were tested in vitro to define their interaction profile. Sixty five percent (n=34) of SA/PA pairs coexist. Using univariate and multivariate analysis, we confirm that SA patients have a clinical condition less severe than others, and PA induce a poor outcome independently of the presence of SA. FEV1 is lower in patients infected by competition strain pairs than in those infected by coexisting strain pairs compared to SA mono-infection. Coexistence between SA and PA may be an important step in the natural history of lung bacterial colonization within CF patients.


2003 ◽  
Vol 98 (1) ◽  
pp. 82-94 ◽  
Author(s):  
John E. Wanebo ◽  
Russell R. Lonser ◽  
Gladys M. Glenn ◽  
Edward H. Oldfield

Object. The goals of this study were to define the natural history and growth pattern of hemangioblastomas of the central nervous system (CNS) that are associated with von Hippel—Lindau (VHL) disease and to correlate features of hemangioblastomas that are associated with the development of symptoms and the need for treatment. Methods. The authors reviewed serial magnetic resonance images and clinical histories of 160 consecutive patients with VHL disease who harbored CNS hemangioblastomas and serially measured the volumes of tumors and associated cysts. Six hundred fifty-five hemangioblastomas were identified in the cerebellum (250 tumors), brainstem (64 tumors, all of which were located in the posterior medulla oblongata), spinal cord (331 tumors, 96% of which were located in the posterior half of spinal cord), and the supratentorial brain (10 tumors). The symptoms were related to a mass effect. A serial increase in hemangioblastoma size was observed in cerebellar, brainstem, and spinal cord tumors as patients progressed from being asymptomatic to symptomatic and requiring surgery (p < 0.0001). Twenty-one (72%) of 29 symptom-producing cerebellar tumors had an associated cyst, whereas only 28 (13%) of 221 nonsymptomatic cerebellar tumors had tumor-associated cysts (p < 0.0001). Nine (75%) of 12 symptomatic brainstem tumors had associated cysts, compared with only four (8%) of 52 nonsymptomatic brainstem lesions (p < 0.0001). By the time the symptoms appeared and surgery was required, the cyst was larger than the causative tumor; cerebellar and brainstem cysts measured 34 and 19 times the size of their associated tumors at surgery, respectively. Ninety-five percent of symptom-producing spinal hemangioblastomas were associated with syringomyelia. The clinical circumstance was dynamic. Among the 88 patients who had undergone serial imaging for 6 months or longer (median 32 months), 164 (44%) of 373 hemangioblastomas and 37 (67%) of 55 tumor-associated cysts enlarged. No tumors or cysts spontaneously diminished in size. Symptomatic cerebellar and brainstem tumors grew at rates six and nine times greater, respectively, than asymptomatic tumors in the same regions. Cysts enlarged seven (cerebellum) and 15 (brainstem) times faster than the hemangioblastomas causing them. Hemangioblastomas frequently demonstrated a pattern of growth in which they would enlarge for a period of time (growth phase) and then stabilize in a period of arrested growth (quiescent phase). Of 69 patients with documented tumor growth, 18 (26%) harbored tumors with at least two growth phases. Of 160 patients with hemangioblastomas, 34 patients (median follow up 51 months) were found to have 115 new hemangioblastomas and 15 patients new tumor-associated cysts. Conclusions. In this study the authors define the natural history of CNS hemangioblastomas associated with VHL disease. Not only were cysts commonly associated with cerebellar, brainstem, and spinal hemangioblastomas, the pace of enlargement was much faster for cysts than for hemangioblastomas. By the time symptoms appeared, the majority of mass effect—producing symptoms derived from the cyst, rather than from the tumor causing the cyst. These tumors often have multiple periods of tumor growth separated by periods of arrested growth, and many untreated tumors may remain the same size for several years. These characteristics must be considered when determining the optimal timing of screening for individual patients and for evaluating the timing and results of treatment.


Author(s):  
Md Faisal Talukder

Degenerative Mitral Valve Disease (DMVD) is common in developed countries that frequently causes mitral regurgitation (MR). The natural history of DMVD is not well demonstrated. Therefore, timely and suitable interventions are the determinant of post-intervention clinical outcomes, life quality, and life expectancy of patients. The severity of MR can be precisely assessed by doppler-echocardiographic imaging. However, no medical management has been proven to be effective in averting the volume overload related sequel of asymptomatic degenerative MR. Therefore, mitral valve surgery (MVS) is the gold standard treatment strategy for DMVD. Notwithstanding, MVS is the only sorts of treatment strategy which provides long term natural and complication-free clinical outcome to otherwise healthy DMVD patients. However, mitral valve (MV) repair provides better clinical outcomes compared to MV replacement, along with the significant reduction of postoperative mortality rate about 70%. Currently, MVS is carried out using minimally invasive techniques or robotic-assisted techniques. Nonetheless, MVS using percutaneous techniques is evolving in the treatment for DMVD patients. This state-of-the-art-review is aimed to delineate the recent knowledge of DMVD, which includes the natural history of the disease, diagnostic modalities, recent treatment strategies, and clinical follow-up results.


2019 ◽  
Vol 55 (1) ◽  
pp. 78-85 ◽  
Author(s):  
Ryunosuke Hakuta ◽  
Tsuyoshi Hamada ◽  
Yousuke Nakai ◽  
Hiroki Oyama ◽  
Sachiko Kanai ◽  
...  

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Glenda M. Delgado-Ramos ◽  
Fridtjof Thomas ◽  
Ari VanderWalde ◽  
Benjamin King ◽  
Matthew Wilson ◽  
...  

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e21631-e21631
Author(s):  
Glenda Maria Delgado Ramos ◽  
Fridtjof Thomas ◽  
Ari M. Vanderwalde ◽  
Matthew W. Wilson ◽  
Arnel M. Pallera

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S156-S156
Author(s):  
Amit T Vahia ◽  
Chandrika Chitturi ◽  
Olivia Rizzo ◽  
Nihn Lwin ◽  
Sandeep Soman ◽  
...  

Abstract Background Occult Hepatitis B (OHB) is defined as hepatitis B core antibody (HBcAb) positivity in the absence of surface antibody (HBsAb) or surface antigen (HBsAg) positivity. The reported incidence ranges from 0.3% to 58% in the hemodialysis (HD) population. Our study is among the first in the United States to examine the natural history of OHB patients (patients). This work is of interest in HD patients to estimate Hepatitis B transmission risk. Methods We performed a retrospective analysis of 352 Hep B cAb positive HD patients between 2010 and 2017 in the Henry Ford Health System and Greenfield Dialysis Centers in SE Michigan. This system contains 5 hospitals including a 900-bed tertiary referral center in Detroit, serving a high-risk, medically complex population. Our primary outcomes were the development of HBsAb positivity, considered protective, or development of HBsAg positivity or new Hepatitis B viremia, considered adverse events. Univariate and multivariate logistic regression analysis was performed to study pertinent risk factors for the clinical outcomes comparing OHB and Non-OHB patients. Statistical analysis was performed using SAS 9.4. Results Of the 352 HBcAb patients studied, 98 (27%) were OHB patients. Each group shared similar baseline demographics apart from OHB patients having higher ALT and a greater proportion of drug use and Hepatitis C (Hep C) compared with non-OHB patients (Table 1). There were 15 adverse events in the non-OHB group, including 10 viremias. Only 1 adverse event was seen in the OHB group, a patient who developed viremia of 19 copies/mL (Table 2). Conversely, OHB status was a statistically significant predictor of protective HBsAb development in follow-up (P < 0.01), occurring at a 7-fold increased rate compared with non-OHB patients. Univariate analysis showed that a history of liver disease, Hep C, and drug use predicted HBsAb development (Table 3). When studying adverse outcomes, history of liver disease raises the risk of adverse events in unadjusted models (P < 0.05) (Table 4). Conclusion OHB patients in our center tend to develop protective HBsAb titers over time rather than develop viremia or antigenemia in contrast to non-OHB patients. Our study finds that OHB confers minimal risk of potential transmission of Hepatitis B among HD patients. Disclosures All authors: No reported disclosures.


2020 ◽  
Vol 43 ◽  
Author(s):  
Hannes Rakoczy

Abstract The natural history of our moral stance told here in this commentary reveals the close nexus of morality and basic social-cognitive capacities. Big mysteries about morality thus transform into smaller and more manageable ones. Here, I raise questions regarding the conceptual, ontogenetic, and evolutionary relations of the moral stance to the intentional and group stances and to shared intentionality.


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