scholarly journals RARE-34. UK CHILDREN’S CANCER AND LEUKAEMIA GROUP (CCLG): GUIDELINES FOR THE MANAGEMENT OF MENINGIOMA IN CHILDREN, TEENAGERS AND YOUNG ADULTS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii449-iii449
Author(s):  
Elwira Szychot ◽  
John Goodden ◽  
Whitfield Gillian ◽  
Sarah Curry
Keyword(s):  
Clinical Status ◽  
Treatment Recommendations ◽  
Management Approach ◽  
Intracranial Meningioma ◽  
Paediatric Tumours ◽  
Molecular Alterations ◽  
Long Term Follow Up ◽  
Teenagers And Young Adults ◽  
The Central Nervous System ◽  
Paediatric Practice

Abstract Primary tumours of the meninges are rare accounting for only 0.4–4.6% of all paediatric tumours of the central nervous system. Due to the rarity of these tumours in children, and the consequent absence of collaborative prospective trials, there is no clear consensus on how the unique characteristics of paediatric meningiomas impact clinical status, management approach, and survival. Much of the evidence and treatment recommendations for paediatric meningiomas are extrapolated from adult data. Translating and adapting adult treatment recommendations into paediatric practice can be challenging and might inadvertently lead to inappropriate management. In 2009 Traunecker et al. published guidelines for the management of intracranial meningioma in children and young people on behalf of UK Children’s Cancer and Leukaemia Group (CCLG). Ten years later we have developed the updated guidelines following a comprehensive appraisal of the literature. Complete surgical resection is the treatment of choice for symptomatic meningiomas, while radiotherapy remains the only available adjuvant therapy and may be necessary for those tumours that cannot be completely removed. However, significant advances have been made in the identification of the genetic and molecular alterations of meningioma, which has not only a potential value in development of therapeutic agents but in surveillance of childhood meningioma survivors. This guideline builds upon the CCLG 2009 guideline. We summarise recommendations for the diagnosis, treatment, surveillance and long-term follow up of children and adolescents with meningioma.

scholarly journals COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Myriam Calle Rubio ◽  
◽  
Juan Luis Rodriguez Hermosa ◽  
Juan P. de Torres ◽  
José María Marín ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Clinical Status ◽  
Airflow Limitation ◽  
Psychological Status ◽  
Prognostic Information ◽  
Clinical Control ◽  
All Cause Mortality ◽  
Long Term Follow Up

Abstract Background Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences. Methods We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis. Results 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5.5% versus 19.1%, p = 0.001). The hazard ratio for all-cause mortality was 2.274 (95% CI 1.394–3.708; p = 0.001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72.2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern. Conclusions The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results. Trial registration: Clinical Trials.gov: identifier NCT01122758.

Spinal metastases of malignant intracranial meningioma through the central nervous system

Chirurgia ◽  
2018 ◽  
Vol 31 (3) ◽  
Author(s):  
Tonko Marinović ◽  
Marina Raguž ◽  
Domagoj Dlaka ◽  
Vesna Marinović ◽  
Andrea Blažević ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Spinal Metastases ◽  
Intracranial Meningioma ◽  
The Central Nervous System

scholarly journals Sexual Abuse in Irritable Bowel Syndrome: To Ask or Not to Ask – That Is the Question

2002 ◽  
Vol 16 (11) ◽  
pp. 801-805 ◽  
Author(s):  
Alexandra Ilnyckyj ◽  
Charles N Bernstein
Keyword(s):  
Irritable Bowel Syndrome ◽  
Current Practice ◽  
Treatment Recommendations ◽  
Opinion Leaders ◽  
Management Approach ◽  
Abuse History ◽  
Ethical Context ◽  
Canadian Association ◽  
Male Patients ◽  
Irritable Bowel

BACKGROUND: Irritable bowel syndrome (IBS) is a common and costly disorder in Canada. The paucity of medical treatment underscores the importance of examining every element of the management approach. Data exist supporting an increased prevalence of abuse among individuals with IBS. Importantly, the pathophysiology underlying the link between abuse and IBS is increasingly understood. Treatment recommendations by opinion leaders support an abuse inquiry. However, many clinicians view abuse inquiry as an ethical dilemma.METHOD: Canadian gastroenterologists were surveyed to determine current practice patterns and to identify barriers to inquiry. Barriers cited by clinicians were explored within an ethical context.RESULTS: Abuse inquiry is not universally practised in Canada. Fifty-four per cent of the membership of Canadian Association of Gastroenterologists responded to the survey. They reported inquiring into abuse histories in approximately 50% of patients with IBS. The frequency of inquiry declined when male patients were considered. The primal barriers cited were time constraints (25%), personal comfort with abuse issues (25%) and lack of resources for addressing the abuse (33%). Importantly, only a minority (10%), cited abuse history as irrelevant to the management of the patient.INTERPRETATION: Physicians identify significant barriers to pursuing an inquiry into abuse. However, a minority cited ‘clinical irrelevance’ as a primal barrier, the implicit statement being that the abuse history has clinical relevance. This view is consistent with opinion leaders and published treatment recommendations. Therefore, by not inquiring into the abuse history, physicians are not fulfilling their ethical responsibility to the patient. Physicians need to resolve their barriers to inquiry. Furthermore, they need to familiarize themselves with treatment recommendations and include this review in their consultation.

Neurotropic behaviour of Trichobilharzia regenti in ducks and mice

2002 ◽  
Vol 76 (2) ◽  
pp. 137-141 ◽  
Author(s):  
K. Hrádková ◽  
P. Horák
Keyword(s):  
Spinal Cord ◽  
Peripheral Nerves ◽  
Clinical Status ◽  
Inbred Strains ◽  
Blood Capillaries ◽  
The Central Nervous System ◽  
New Type ◽  
The Brain ◽  
Trichobilharzia Regenti

AbstractThe bird nasal schistosome Trichobilharzia regenti is a new agent of cercarial dermatitis. Cercariae are able to penetrate the skin of birds and mammals including man. The parasite then attacks the central nervous system. The present study has shown that schistosomula avoid penetration of blood capillaries and enter the peripheral nerves of the legs of mice and ducks as early as 1 day post-infection (p.i.) and 1.5 days p.i., respectively. These peripheral nerves are used as a route to the spinal cord. In the specific host (duck) schistosomula were found in the spinal cord from 2 days p.i. until 15 days p.i. and in the brain from 12 days p.i. until 18 days p.i. In non-specific hosts (mice; inbred strains BALB/c, hr/hr, SCID) living schistosomula were found in the spinal cord from 2 days p.i. until 21 or 24 days p.i. (depending on the mouse strain) and in the brain of two (BALB/c, SCID) of three inbred strains from 3 days p.i. until 24 days p.i. No correlation was found between the infection dose and clinical status of the experimental hosts. A high affinity of schistosomula for the peripheral nerves was also proved in vitro, suggesting a new type of migratory behaviour in schistosomatids.

scholarly journals Cerebellar Liponeurocytoma Mimicking Medulloblastoma: Case Report of a Childhood and Literature Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Changhui Dong ◽  
Yining Jiang ◽  
Liyan Zhao ◽  
Yubo Wang ◽  
Yang Bai ◽  
...  
Keyword(s):  
Postoperative Radiotherapy ◽  
Tumor Resection ◽  
Treatment Strategies ◽  
Benign Neoplasm ◽  
World Health ◽  
Pathological Examination ◽  
Long Term Follow Up ◽  
The Central Nervous System ◽  
Cerebellar Liponeurocytoma ◽  
Health Organization

BackgroundCerebellar liponeurocytoma is a rare benign neoplasm of the central nervous system, which arises mainly in adult patients with only 3 cases reported in children. Due to its rarity, the diagnosis and treatment strategies for cerebellar liponeurocytoma remain unclear. The purpose of this study was to explore the epidemiology, clinical features, imaging findings, pathological characteristics, different diagnoses, treatment, and prognosis of cerebellar liponeurocytoma in juveniles.Case DescriptionA 5-year-old boy was admitted to the department of neurosurgery due to a 5-month history of headaches, nausea, vomiting, dizziness, dysphoria, as well as visual blurring associated with the peak of the headache. Magnetic resonance imaging showed a 4.9×5.4×6.2 cm mass located in the fourth ventricle and cerebellar vermis combined with hydrocephalus and periventricular edema. The mass was completely removed, and pathological examination indicated a cerebellar liponeurocytoma of the World Health Organization Grade II classification.ConclusionThe present study was the first to report a cerebellar liponeurocytoma with total tumor resection and adjuvant radiotherapy in a pediatric patient. Total tumor resection and postoperative radiotherapy together with close and long-term follow-up seem to be the optimal treatment strategy for juvenile patients. However, the side-effect of radiation needs to be considered.

scholarly journals Adult Patient Presenting Rare Brain Tumour-Gliosarcoma

Pulse ◽  
2016 ◽  
Vol 8 (1) ◽  
pp. 85-88
Author(s):  
Syed Khalequezzaman ◽  
Jahangir Alam ◽  
Sania Ahsan ◽  
Biva Shrestha Khan
Keyword(s):  
Brain Tumour ◽  
Brain Mri ◽  
Clinical Status ◽  
High Grade Glioma ◽  
World Health ◽  
Primary Malignancy ◽  
The Central Nervous System ◽  
Health Organization ◽  
Biopsy Examination ◽  
Loss Of Appetite

Gliosarcoma is a rare primary malignancy of the central nervous system, classified by the World Health Organization as a high-grade glioma and a variant of glioblastoma multiforme. A 57-year-old gentleman presented with a history of left-sided weakness and loss of appetite. Brain MRI was suggestive of right frontal and thalamic mass lesion with contrast enhancement at the periphery. Open biopsy examination revealed a malignant brain tumour presenting a biphasic tissue pattern with gliomatous and mesenchymal components suggestive of gliosarcoma. Although the treatment of gliosarcomas is almost similar to glioblastomas (surgical resection and, depending on clinical status, radiotherapy and/or chemotherapy) the prognosis of gliosarcomas remains poorPulse Vol.8 January-December 2015 p.85-88

scholarly journals Progressive Multifocal Leukoencephalopathy (PML) – a Case Report.

Pulse ◽  
2014 ◽  
Vol 6 (1-2) ◽  
pp. 57-59
Author(s):  
BS Khan ◽  
J Alam
Keyword(s):  
Immune Deficiency ◽  
Central Nervous System ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Demyelinating Disease ◽  
Clinical Status ◽  
White Matter Lesions ◽  
Mass Effect ◽  
Viral Disease ◽  
Review Of Literature ◽  
The Central Nervous System

Progressive Multifocal Leukoencephalopathy (PML) is a rare and usually fatal viral disease occurring almost exclusively in people with severe immune deficiency. This is a demyelinating disease of the central nervous system (CNS) that usually leads to death or severe disability. Patients usually present with focal CNS abnormalities like; hemiparesis, apathy, and confusion. Multifocal white matter lesions without mass effect lead to the diagnosis of PML. In this article we present a review of literature and report of a case of PML in which the patient’s clinical status and MR findings are typical. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20355 Pulse Vol.6 January-December 2013 p.57-59

Surgical treatment of rostrotentorial meningioma complicated by foraminal herniation in the cat

2020 ◽  
Vol 22 (12) ◽  
pp. 1230-1237
Author(s):  
Shigenori Kouno ◽  
Masakazu Shimada ◽  
Asaka Sato ◽  
Nobuo Kanno ◽  
Shuji Suzuki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Signs ◽  
Volume Ratio ◽  
Tumour Volume ◽  
Foramen Magnum ◽  
Intracranial Meningioma ◽  
Personality Changes ◽  
Cerebral Herniation ◽  
Long Term Follow Up ◽  
Mri Scans

Objectives This study was performed to evaluate retrospectively the clinical signs, complications and postoperative outcomes of feline intracranial meningioma (IM) with concurrent cingulate, transtentorial and foramen magnum herniations. Methods The medical records and MRI scans of cats with IM and cerebral herniation were reviewed. Cases involving concurrent cingulate, transtentorial and foramen magnum herniations were included. Owners were contacted to obtain long-term follow-up information. Results Seven cats (four castrated males and three spayed females) met the inclusion criteria. Median age was 13.0 years (range 9.9–16.1 years) and median duration of clinical signs was 35 days (range 21–163 days). The clinical signs of cats with cerebral herniation included visual impairment (n = 5 [71.4%]), ataxia (n = 4 [57.1%]), impaired consciousness (n = 2 [28.6%]), head pressing (n = 2 [28.6%]), paresis (n = 1 [14.3%]), torticollis (n = 1 [14.3%]) and personality changes (n = 1 [14.3%]). Median tumour volume, cranial cavity volume and tumour volume:intracranial volume ratio before surgery were 3.37 cm3 (range 3.23–11.5 cm3), 32.6 cm3 (range 29.8–78.3 cm3) and 10.4% (range 5.3–35.3%), respectively. Median overall tumour excision rate was 90.6%. Preoperative intracranial pressure (ICP) ranged from 15 to 32 mmHg (median 29 mmHg). In all cases, the ICP dropped to 0 mmHg immediately after tumour removal. No adjuvant therapy was required after surgery. The median survival period was 612 days (range 55–1453 days). Conclusions and relevance The results of this study indicate that surgical treatment of rostrotentorial IM is effective and allows prolonged survival, even in cats with concurrent cingulate, transtentorial and foramen magnum herniations.

scholarly journals Rescue extracorporeal membrane oxygenation therapy in methamphetamine toxicity

CJEM ◽  
2017 ◽  
Vol 20 (S2) ◽  
pp. S14-S19 ◽  
Author(s):  
Laura K. Morrison ◽  
J Kromm ◽  
J Gaudet ◽  
D Zuege ◽  
B Button ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Clinical Status ◽  
Cardiovascular Effects ◽  
Spontaneous Circulation ◽  
Left Ventricular ◽  
Methamphetamine Use ◽  
Membrane Oxygenation ◽  
Standard Management ◽  
Neurologic Sequelae ◽  
The Central Nervous System

AbstractComplications related to methamphetamine use and abuse are common presentations seen in the emergency department. Standard management focuses on addressing the central nervous system and cardiovascular effects with the use of sedation and hemodynamic support. We describe a case report of a patient with methamphetamine toxicity and subsequent severe cardiomyopathy refractory to conventional management that responded to cardiovascular support with extracorporeal membrane oxygenation therapy (ECMO). A 22-year-old female was admitted in severe cardiogenic shock following intravenous administration of methamphetamine and oral fentanyl use. Despite aggressive treatment with benzodiazepines, intravenous fluids, vasopressors, vasodilators, antibiotics and inotropes, the patient’s clinical status deteriorated, and she suffered a cardiac arrest. The patient was successfully resuscitated, and following the return of spontaneous circulation, ECMO was initiated. After 82 hours the patient was successfully weaned from ECMO with the recovery of her left ventricular function and no neurologic sequelae. The patient developed leg ischemia requiring embolectomy and open repair as a complication of ECMO cannulation. In our case, ECMO was used successfully in treating severe cardiac dysfunction from acute methamphetamine-induced cardiomyopathy and was used as a bridge to recovery. The complications seen in this patient emphasize the potential risks associated with this intervention and highlight the need for careful patient selection.

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