scholarly journals Plasticity of the Primary Motor Cortex in Patients with Primary Brain Tumors

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Nathan W. Kong ◽  
William R. Gibb ◽  
Suvarna Badhe ◽  
Benjamin P. Liu ◽  
Matthew C. Tate
Keyword(s):  
Motor Cortex ◽  
Brain Tumors ◽  
Growth Kinetics ◽  
Neural Plasticity ◽  
Primary Motor Cortex ◽  
Brain Injuries ◽  
Treatment Strategies ◽  
Case Series ◽  
Retrospective Case ◽  
Motor Region

There are two neuron-level mechanisms proposed to underlie neural plasticity: recruiting neurons nearby to support the lost function (ipsilesional plasticity) and uncovering latent pathways that can assume the function that was lost (contralesional plasticity). While both patterns have been demonstrated in patient groups following injury, the specific mechanisms underlying each mode of plasticity are poorly understood. In a retrospective case series of 13 patients, we utilize a novel paradigm that analyzes serial fMRI scans in patients harboring intrinsic brain tumors that vary in location and growth kinetics to better understand the mechanisms underlying these two modes of plasticity in the human primary motor cortex. Twelve patients in our series had some degree of primary motor cortex plasticity, an area previously thought to have limited plasticity. Patients harboring smaller lesions with slower growth kinetics and increasing distance from the primary motor region demonstrated recruitment of ipsilateral motor regions. Conversely, larger, faster-growing lesions in close proximity to the primary motor region were associated with activation of the contralesional primary motor cortex, along with increased activation of the supplementary motor area. These data increase our understanding of the adaptive abilities of the brain and may lead to improved treatment strategies for those suffering from motor loss secondary to brain injuries.

scholarly journals Deferiprone as adjunctive treatment for patients with invasive mucormycosis: A retrospective case series

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Maria N. Chitasombat ◽  
Pimjai Niparuck
Keyword(s):  
Mortality Rate ◽  
Treatment Strategies ◽  
Case Series ◽  
Hematologic Malignancies ◽  
Adjunctive Treatment ◽  
Combination Regimen ◽  
Retrospective Case ◽  
Day Range

Mucormycosis is a life-threatening disease requiring multimodal treatment with antifungals and surgery. The mortality rate remains high, prompting consideration of alternative treatment strategies. Deferiprone has in vitro activity against Mucorales, but its efficacy has never been evaluated in humans. Here, we retrospectively analyzed patients with confirmed mucormycosis who received deferiprone from 2011 to 2017. Five patients had hematologic malignancies and one was diabetic. The sites of infection included sinus-orbit-cerebral (67%), lung (17%), and disseminated infection (17%). Surgery was performed in 83% of cases and achieved local control for 33% of patients. A combination regimen of polyenes plus echinocandins was administered with stepdown treatment using posaconazole. The median duration of antifungal treatment was 86 days (range: 46-435 days) days. Deferiprone was given as adjunctive treatment with a median dose and duration of 100 mg/kd/day (range: 86.2-100 mg/kg/day) and 25 days (range: 15-215 days), respectively. Overall, deferiprone was well-tolerated. Successful outcomes were observed at 12-week follow-up for 67% of patients. The mortality rate at 180- day follow-up was 50%. Adjunctive therapy with deferiprone showed safety and tolerability.

Risk factors for corneal epithelial wound healing: Can sex play a role?

2021 ◽  
pp. 112067212110667
Author(s):  
Giulia Coco ◽  
Kevin J. Hamill ◽  
Lee D. Troughton ◽  
Stephen B. Kaye ◽  
Vito Romano
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Treatment Strategies ◽  
Case Series ◽  
Healing Time ◽  
Retrospective Case ◽  
Corneal Epithelial ◽  
Female Patients ◽  
Epithelial Wound Healing ◽  
Wound Healing Time

Purpose To determine if sex is associated with corneal epithelial wound healing time in patients with persistent corneal epithelial defects (PCEDs). Methods Retrospective case series on patients with PCED from November 2014 to January 2019. Records of 127 patients with diagnosis of PCED were reviewed. Patients with an epithelial defect that lasted more than two weeks in the absence of an active corneal infection were included. Main outcome was corneal epithelial wound healing time. Results 55 patients (29 males) with a mean age of 65.3 ± 16.5 years were included. No difference was found between female and male patients in terms of risk factors, age, treatment strategies or intervals between visits (median of 15 days in females and 12 days in males; p = 0.24). Median duration of the PCED was 51 days (IQR 32-130), with a median number of 5 clinical visits (IQR 4-8). Female patients had significantly longer healing times (p = 0.004) and a corresponding increase in the number of clinical visits (median of 7 visits vs. 5 clinical visits in males, p = 0.012). Conclusion Results from this study suggest female patients with PCED might have a longer corneal epithelial wound healing duration and may therefore require earlier intervention.

scholarly journals Nivolumab and Ipilimumab in the Treatment of Metastatic Uveal Melanoma: A Single-Center Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Vidhya Karivedu ◽  
Ihab Eldessouki ◽  
Ahmad Taftaf ◽  
Zheng Zhu ◽  
Abouelmagd Makramalla ◽  
...  
Keyword(s):  
Partial Response ◽  
Clinical Outcome ◽  
Uveal Melanoma ◽  
Stable Disease ◽  
Checkpoint Inhibitors ◽  
Evaluation Criteria ◽  
Treatment Strategies ◽  
Case Series ◽  
Retrospective Case ◽  
Study Results

Background. Metastatic uveal melanoma (MUM) is associated with a poor prognosis, with a median overall survival (OS) of 4–15 months. Despite new insights into the genetic and molecular background of MUM, satisfactory systemic treatment approaches are currently lacking. The study results of innovative treatment strategies are urgently needed. Patients and Methods. This was a retrospective case series of 8 patients with MUM managed at the University of Cincinnati between January 2015 and January 2018. The immune-related Response Evaluation Criteria in Solid Tumors (irRECIST) 1.1 criteria were used for patient evaluation, and magnetic resonance imaging was used for evaluation at treatment checkpoints. Objective. To assess the clinical outcome of patients with MUM treated with a combination of checkpoint inhibitors. Results. The series included eight patients, six men and two women, with MUM. Their median age at MUM diagnosis was 69 (range, 55–77) years. All patients were treated with ipilimumab and nivolumab combination along with transarterial chemoembolization (TACE), followed by nivolumab maintenance and monthly TACE procedures. The majority of patients had a partial response or stable disease. Two of the patients had partial response, while four others had stable disease. Two other patients experienced disease progression. Conclusion. We report the outcomes of eight patients with MUM treated with the combination of ipilimumab and nivolumab. We report the clinical outcome and toxicity associated with this treatment approach. Further studies are warranted to explore immunotherapy in MUM. These findings support the consideration of immunotherapy in MUM.

scholarly journals STMO-10 SURGICAL RESECTION FOR PRIMARY MOTOR CORTEX GLIOMA, TWO CASE REPORTS

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii19-ii20
Author(s):  
Noriyuki Kijima ◽  
Manabu Kinoshita ◽  
Ryuichi Hirayama ◽  
Tohru Umehara ◽  
Chisato Yokota ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Motor Cortex ◽  
Neural Plasticity ◽  
Primary Motor Cortex ◽  
Case Reports ◽  
Neurological Complication ◽  
Awake Surgery ◽  
Motor Deficit ◽  
Initial Surgery ◽  
Second Surgery

Abstract Primary motor cortex glioma is usually considered unresectable because of its high risk for motor deficit. However recent reports suggest that surgical resections for primary motor cortex brain tumor is feasible for selected patients. In this case report, we report two cases we can successfully resected primary motor cortex glioma by awake surgery without neurological worsening. Case1 was 32 year-old woman with right primary motor cortex oligodendroglioma. We could only perform biopsy at initial surgery, however the patient got worsening of left hemiparesis which were gradually improved by rehabilitation. The patient underwent 50 Gy of radiation therapy and 6 courses of PCV chemotherapy. 60 months after the initial surgery, the tumor recurred and the she underwent 12 courses of temozolomide chemotherapy, but tumor continued to grow. She underwent second surgery 13 years after the initial biopsy. We resected primary motor cortex tumor by awake surgery without neurological complication. Case2 was 31 year-old woman with left primary motor cortex oligodendroglioma. We could only perform biopsy at initial surgery, however the patient got mild right hemiparesis which were improved by rehabilitation. The patient underwent 4 courses of PAV chemotherapy and 54 Gy of Intensity Modulated Radiation Therapy (IMRT). 21 months after IMRT, the tumor recurred and the she underwent second surgery. We resected primary motor cortex tumor by awake motor mapping without severe neurological complication. In conclusion, surgical resections for primary motor cortex glioma is feasible in selected patients without severe neurological complication. Neural plasticity is the reason for this, but careful intraoperative awake mapping is necessary to achieve maximum resections.

Functional MRI: Primary Motor Cortex Localization in Patients with Brain Tumors

1996 ◽  
Vol 20 (5) ◽  
pp. 702-708 ◽  
Author(s):  
Andrea Righini ◽  
Oreste de Divitiis ◽  
Anna Prinster ◽  
Diego Spagnoli ◽  
Ildebrando Appollonio ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Brain Tumors ◽  
Functional Mri ◽  
Primary Motor Cortex

scholarly journals Clinical Characteristics of Severe COVID-19 in China: A Case Series and Meta-analysis

2021 ◽  
Author(s):  
Geling Teng ◽  
Hua Hu ◽  
Xia Wang ◽  
Junsheng Wang ◽  
Hongmei Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Bacterial Infections ◽  
Clinical Signs ◽  
Treatment Strategies ◽  
Case Series ◽  
Imaging Features ◽  
Chest Tightness ◽  
Retrospective Case

Abstract Background: There have been inconsistent reports regarding the unique manifestations of severe coronavirus disease 2019 (COVID-19) occurring in China. This study analyzed the clinical manifestation of 13 severe COVID-19 cases at a single institution and compared the data to previously reported characteristics of severe COVID-19 in China. Methods: This retrospective case study included patients with severe COVID-19 who were admitted to the isolation ward of the Shandong Chest Hospital from January 2020 to February 2020. The clinical signs and symptoms, laboratory examination results, imaging features, treatment strategies, and patient prognoses were summarized. A database search was then conducted for studies published through December 2020 documenting characteristics of severe COVID-19 cases in China. The pooled results for severe COVID-19 patients in China were calculated by using the random-effects model.Results: A total of 4 severe and 9 critical patients were included from Shandong Chest Hospital. The average patient age was 55.3 (range 23-88) years, and 61.5% of patients were male. Chest computed tomography for all patients showed multiple lesions as ground-glass shadows in both lungs. All patients presented bacterial infection and various degrees of liver and myocardial injury. The treatment strategies for patients included antibiotics, immunoglobulin, and glucocorticoids, and mechanical ventilation was used in all patients for respiratory failure. Two patients died, and 11 recovered. In the pooled data for severe COVID-19 patients, the most common comorbidities were hypertension, diabetes mellitus, and coronary heart disease. The common signs in these patients were fever, cough, fatigue, chest tightness, and a leukocyte count > 10. Conclusions: Older males with hypertension, diabetes mellitus, and coronary heart disease may be at higher risk of developing severe COVID-19. Patients should be assessed for concomitant bacterial infections. Cardiac and liver enzymes, fever, cough, fatigue, chest tightness, and leukocytosis should be monitored for signs of disease progression.

scholarly journals Attenuated androgen discontinuation in patients with hereditary angioedema: a commented case series

2022 ◽  
Vol 18 (1) ◽  
Author(s):  
Marcus Maurer ◽  
Markus Magerl ◽  
Emel Aygören-Pürsün ◽  
Konrad Bork ◽  
Henriette Farkas ◽  
...  
Keyword(s):  
Side Effects ◽  
Hereditary Angioedema ◽  
Treatment Strategies ◽  
Case Series ◽  
Additional Patient ◽  
Type I ◽  
Retrospective Case ◽  
Androgen Withdrawal ◽  
Life Threatening ◽  
Attenuated Androgen

Abstract Background Hereditary angioedema (HAE) is characterized by potentially severe and life-threatening attacks of localized swelling. Prophylactic therapies are available, including attenuated androgens. Efficacy of attenuated androgens has not been assessed in large, randomized, placebo-controlled trials and can be associated with frequent, and sometimes severe, side effects. As better tolerated targeted therapies become available, attenuated androgen withdrawal is increasingly considered by physicians and their patients with HAE. Attenuated androgens withdrawal has not been systematically studied in HAE, although examination of other disorders indicates that attenuated androgen withdrawal may result in mood disturbances and flu-like symptoms. Standardized protocols for attenuated androgen discontinuation that continue to provide control of attacks while limiting potential attenuated androgen withdrawal symptoms are not established as the outcomes of different withdrawal strategies have not been compared. We aim to describe the challenges of attenuated androgen discontinuation in patients with HAE and how these may continue into the post-androgen period. Case presentation We present a retrospective case series of 10 patients with confirmed type I HAE who have discontinued prophylactic treatment with attenuated androgens. The most common reason for attenuated androgen discontinuation was side effects. Attenuated androgens were either immediately withdrawn, tapered and/or overlapped with another treatment. The major challenge of discontinuation was the management of an increased frequency and severity of HAE attacks in some patients. Conclusions Healthcare teams need to undertake careful planning and monitoring after attenuated androgens discontinuation, and modify treatment strategies if HAE control is destabilized with an increased number of attacks. Discontinuation of attenuated androgens is definitively an option in an evolving HAE treatment landscape, and outcomes can be favourable with additional patient support and education.

Sarcoma of the breast: an update on a rare entity

2016 ◽  
Vol 69 (5) ◽  
pp. 373-381 ◽  
Author(s):  
Sue Zann Lim ◽  
Kong Wee Ong ◽  
Benita Kiat Tee Tan ◽  
Sathiyamoorthy Selvarajan ◽  
Puay Hoon Tan
Keyword(s):  
Case Reports ◽  
Treatment Strategies ◽  
Case Series ◽  
Soft Tissue Sarcomas ◽  
Rare Condition ◽  
Diagnostic Approach ◽  
Retrospective Case ◽  
Breast Sarcoma ◽  
Randomised Control Trials ◽  
Epithelial Tumours

Breast sarcoma is a rare condition. It consists of a heterogeneous group of non-epithelial tumours arising from the mesenchymal tissue of the breast. It has a distinctly different natural history, treatment response and prognosis as compared with carcinoma of the breast. A different diagnostic approach and treatment strategy have to be defined for this group of tumours. Due to its rarity, the current understanding on breast sarcoma is limited and is mostly based on small retrospective case series or case reports. Hence, the management generally follows the algorithms derived from randomised control trials of soft tissue sarcomas in the extremities and chest wall. Through this review, we discuss the results of major retrospective studies on breast sarcomas including data on epidemiology, aetiology, diagnostic approach, treatment strategies and outcomes of this challenging and potentially aggressive condition.

Shock and Myocardial Injury in Children With Multisystem Inflammatory Syndrome Associated With SARS-CoV-2 Infection: What We Know. Case Series and Review of the Literature

2020 ◽  
pp. 088506662096935
Author(s):  
Gema de Lama Caro-Patón ◽  
Amelia Martínez de Azagra-Garde ◽  
Alberto García-Salido ◽  
Marta Cabrero-Hernández ◽  
Amalia Tamariz ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Cardiogenic Shock ◽  
Myocardial Injury ◽  
Treatment Strategies ◽  
Case Series ◽  
Empirical Therapy ◽  
Extensive Literature ◽  
Retrospective Case ◽  
Laboratory Findings ◽  
Inflammatory Syndrome

Background: Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease. Objective: To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided. Methods: Retrospective case series including all children (age 1 month–18 years) admitted to a pediatric intensive care unit in Madrid, Spain, between March 15 and April 30, 2020 with suspected or confirmed SARS-CoV-2 infection and shock. Results: Twelve previously healthy patients with shock, age 5 to 14 years, were included. All required volume resuscitation and 75% required vasoactive/inotropic support. Distributive shock was present on admission in 67% (n = 8), and 4 patients (33%) showed features of cardiogenic shock. Myocardial injury was diagnosed in 67% (n = 8) and ventricular dysfunction in 33% (n = 4). The most common symptoms on presentation were fever (100%), anorexia (100%), diarrhea (75%), and vomiting (75%). Five patients showed signs of Kawasaki disease but none met the criteria for the classic form. Laboratory findings revealed lymphopenia (83%), thrombocytopenia (83%), and increased inflammatory markers (100%). Respiratory status was not significantly impacted. Chest X-ray showed bilateral alveolar infiltrates in 7 (58%) and bilateral pneumonia in 3 (25%). COVID-19 was confirmed in 11 cases (92%). All received empirical therapy against COVID-19, thromboprophylaxis and immunomodulation. Median stay in the PICU and inpatient ward was 4.5 and 10 days, respectively. No patients died. Conclusion: Multisystem inflammatory syndrome in children with COVID-19 can mimic Kawasaki disease and lead to a combination of distributive and cardiogenic shock, probably secondary to a hyperinflammatory state that remains to be precisely defined. Treatment strategies include hemodynamic support, empirical therapies against COVID-19, thromboprophylaxis, and immunomodulation.

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