Gamma Knife: An Alternative Treatment for Acoustic Neurinomas

1988 ◽  
Vol 97 (6) ◽  
pp. 631-635 ◽  
Author(s):  
Donald B. Kamerer ◽  
L. Dade Lunsford ◽  
Margareta Møller
Keyword(s):  
Gamma Knife ◽  
The Elderly ◽  
The United States ◽  
Alternative Methods ◽  
Long Term Results ◽  
Major Surgery ◽  
Karolinska Institute ◽  
University Of Pittsburgh ◽  
Early Results ◽  
World Center

Despite surgical advances and technologic means of better monitoring seventh and eighth nerve function intraoperatively, there remains a group of patients for whom alternative methods of treatment are desirable. These include the elderly, those with bilateral tumors or tumors in only hearing ears, individuals with medical contraindications to major surgery, and those who refuse surgical resection. The University of Pittsburgh became the fifth world center and the first in the United States to install the “gamma knife” for stereotactic radiosurgery. On the basis of the pioneering work done at the Karolinska Institute in Stockholm, acoustic tumor patients who fulfill the above criteria are being treated. A tumoricidal single treatment closed-skull radiation dose is given through 201 sharply focused cobalt 60 sources, minimizing the effects on surrounding brain or other tissues. Our early results are discussed and compared to those from more than 200 cases in Stockholm. Complications and expected long-term results are presented.

Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment

2008 ◽  
Vol 109 (5) ◽  
pp. 804-810 ◽  
Author(s):  
Yoshiyasu Iwai ◽  
Kazuhiro Yamanaka ◽  
Hidetoshi Ikeda
Keyword(s):  
Malignant Transformation ◽  
Gamma Knife ◽  
Low Dose ◽  
Gamma Knife Radiosurgery ◽  
Cranial Base ◽  
Local Failure ◽  
Long Term Results ◽  
Early Results

Object In this study, the authors evaluate the long-term results after Gamma Knife radiosurgery of cranial base meningiomas. This study is a follow-up to their previously published report on the early results. Methods Between January 1994 and December 2001, the authors treated benign cranial base meningiomas in 108 patients using low-dose Gamma Knife radiosurgery. The tumor volumes ranged from 1.7 to 55.3 cm3 (median 8.1 cm3), and the radiosurgery doses ranged from 8 to 12 Gy (median 12 Gy) to the tumor margin. Results The mean duration of follow-up was 86.1 months (range 20–144 months). Tumor volume decreased in 50 patients (46%), remained stable in 51 patients (47%), and increased (local failure) in 7 patients (6%). Eleven patients experienced tumor recurrence outside the treatment field. Among these patients, marginal failure was seen in 5 and distant recurrence was seen in 6. Seven patients were thought to have malignant transformation based on histological or radiological characteristics of the lesion. The actuarial progression-free survival rate, including malignant transformation and outside recurrence, was 93% at 5 years and 83% at 10 years. Neurological status improved in 16 patients (15%). Permanent radiation injury occurred in 7 patients (6%). Conclusions Gamma Knife radiosurgery is a safe and effective treatment for cranial base meningiomas as demonstrated with a long-term follow-up period of > 7 years. Surgeons must be aware of the possibility of treatment failure, defined as local failure, marginal failure, and malignant transformation; however, this may be the natural course of meningiomas and not related to radiosurgery.

Functional MRI Studies of Cognitive Evaluation in the Elderly

2018 ◽  
pp. 119-139
Keyword(s):  
The Elderly ◽  
The United States ◽  
Global Perspective ◽  
Major Surgery ◽  
Medical Illness ◽  
Mental Function ◽  
Cognitive Changes ◽  
Compensatory Response ◽  
Age Related ◽  
The Brain

Over the last century, life expectancy has improved significantly in the United States—from 47 years for men and 49 years for women in 1900 to 76 years and 81 years, respectively, in 2017. Older people have altered mental function that can vary from subtle cognitive changes to dementia. Additionally in elderly patients cognitive function seems to worsen after a medical illness, hospital admission or major surgery. The cognitive neuroscience of aging is an emerging field of research. Clinically, older patients can show alteration in working memory, executive function, multitasking, speed of response, etc. Anatomically, age-related changes in the brain are primarily in the frontal lobe. However, in neuropathological diseases affecting cognition in elderly (Alzheimer’s disease, Huntington’s disease, etc.), the changes are primarily in the temporal lobe. fMRI activation studies have revealed consistent changes in activation pattern with age. In younger persons, many activation-induced responses are lateralized—verbal activation is lateralized to the left and spatial memory activation is right lateralized. In the elderly, these activations induce a bilateral response. This is an age-related compensatory response. fMRI connectivity studies give a global perspective on mental function. The default mode network (DMN) is active in the resting “no task” state of the brain; with a task, activity decreases in the DMN. The elderly have less resting DMN activity than younger people, and their ability to decrease DMN activity during a task (which is essential for shifting attention and focusing on a task) is also less.

Alternative methods of pain management for the older adult population: Review of topical pain medications

2015 ◽  
Vol 5 (3) ◽  
pp. 109-122
Author(s):  
Candice Tavares
Keyword(s):  
Older Adults ◽  
Pain Management ◽  
Older Adult ◽  
Adult Population ◽  
The Elderly ◽  
The United States ◽  
Community Dwelling ◽  
Alternative Methods ◽  
Pain Medications ◽  
Older Adult Population

Abstract The older adult population is one of the fastest growing age groups in the United States. As this population continues to expand, determining the safest way to provide pain management has become increasingly important. More than 50% of community-dwelling older adults experience pain on a daily basis, and up to 83% of those in assisted living facilities experience persistent pain. Pain is exceedingly challenging to treat safely and effectively in the elderly because of the physiologic changes that occur as people age. In addition, many nonnarcotic medications with analgesic properties are listed in both the 2012 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults and the Pharmacy Quality Alliance high-risk medications lists. An approach to the growing challenge of managing pain in the elderly that is gaining popularity among community-dwelling patients is the use of topical pain medications. The goal of this article is to review some of the available literature regarding the use of various topical analgesics alone or in combination, and to discuss their known or theoretical mechanisms of peripheral pain modulation. Commercially available or compounded topical pain medications may be used to replace or augment doses of oral medications in an effort to decrease the risk of adverse drug events for older adult patients. When prescribing topical pain medications physicians should consider the nature of the pain targeted, the type of analgesia expected from each ingredient, the potential for systemic absorption, and related side effects.

Körperliche Beschwerden bei älteren Migranten in Deutschland 1Erstellt unter Mitwirkung der Arbeitsgruppe «Abuse of the Elderly in the European Region» (ABUEL): Joaquim F. J. Soares, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Francisco Torres-González, Departmental Section of Psychiatry and Psychological Medicine, University of Granada, Spain; Elisabeth Ioannidi-Kapolou, National School of Public Health, Department of Sociology, Athens, Greece; Giovanni Lamura, Italian National Research Centre on Ageing Department of Gerontological Research, Unit of Health Economics, Ancona, Italy; Mindaugas Stankunas, Kaunas University of Medicine, Department of Health Management, A. Mickeviciaus, Kaunas, Lithuania; Henrique Barros, Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.

2010 ◽  
Vol 58 (3) ◽  
pp. 199-206 ◽  
Author(s):  
Rosina-Martha Csöff ◽  
Gloria Macassa ◽  
Jutta Lindert
Keyword(s):  
Public Health ◽  
Health Management ◽  
The Elderly ◽  
Health Department ◽  
Research Unit ◽  
Research Centre ◽  
Public Health Department ◽  
Karolinska Institute ◽  
Psychological Medicine ◽  
Körperliche Beschwerden

Körperliche Beschwerden sind bei Älteren weit verbreitet; diese sind bei Migranten bislang in Deutschland und international noch wenig untersucht. Unsere multizentrische Querschnittstudie erfasste körperliche Beschwerden bei Menschen im Alter zwischen 60 und 84 Jahren mit Wohnsitz in Stuttgart anhand der Kurzversion des Gießener Beschwerdebogens (GBB-24). In Deutschland wurden 648 Personen untersucht, davon 13.4 % (n = 87) nicht in Deutschland geborene. Die Geschlechterverteilung war bei Migranten und Nichtmigranten gleich; der sozioökonomische Status lag bei den Migranten etwas niedriger: 8.0 % (n = 7) der Migranten und 2.5 % (n = 14) der Nichtmigranten verfügten über höchstens vier Jahre Schulbildung; 12.6 % (n = 11) der Migranten und 8.2 % (n = 46) der Nichtmigranten hatten ein monatliches Haushaltsnettoeinkommen von unter 1000€; 26.4 % der Migranten und 38.1 % (n = 214) der Nichtmigranten verfügten über mehr als 2000€ monatlich. Somatische Beschwerden lagen bei den Migranten bei 65.5 % (n = 57) und bei den Nichtmigranten bei 55.8 % (n = 313). Frauen wiesen häufiger somatische Beschwerden auf (61.8 %) als Männer (51.8 %). Mit steigendem Alter nahmen somatische Beschwerden zu. Mit Ausnahme der Altersgruppe der 70–74-Jährigen konnte kein signifikanter Unterschied zwischen Migranten und Nichtmigranten hinsichtlich der Häufigkeit körperlicher Beschwerden gezeigt werden. Ausblick: Es werden dringend bevölkerungsrepräsentative Studien zu körperlichen Beschwerden bei Migranten benötigt.

The Unusual Cruelty of Nursing Homes Behind Bars

2020 ◽  
Vol 32 (5) ◽  
pp. 264-271
Author(s):  
Rachel E. López
Keyword(s):  
Nursing Homes ◽  
Human Dignity ◽  
Prison Population ◽  
Financial Burden ◽  
The Elderly ◽  
The United States ◽  
Term Care ◽  
Trained Staff ◽  
State Prisons ◽  
The Cost

The elderly prison population continues to rise along with higher rates of dementia behind bars. To maintain the detention of this elderly population, federal and state prisons are creating long-term care units, which in turn carry a heavy financial burden. Prisons are thus gearing up to become nursing homes, but without the proper trained staff and adequate financial support. The costs both to taxpayers and to human dignity are only now becoming clear. This article squarely addresses the second dimension of this carceral practice, that is the cost to human dignity. Namely, it sets out why indefinitely incarcerating someone with dementia or other neurocognitive disorders violates the Eighth Amendment of the United States Constitution’s prohibition on cruel and unusual punishment. This conclusion derives from the confluence of two lines of U.S. Supreme Court precedent. First, in Madison v. Alabama, the Court recently held that executing someone (in Madison’s case someone with dementia) who cannot rationally understand their sentence amounts to cruel and unusual punishment. Second, in line with Miller v. Alabama, which puts life without parole (LWOP) sentences in the same class as death sentences due to their irrevocability, this holding should be extended to LWOP sentences. Put another way, this article explains why being condemned to life is equivalent to death for someone whose neurodegenerative disease is so severe that they cannot rationally understand their punishment.

Combination of microsurgery and Gamma Knife surgery for the treatment of intracranial chondrosarcomas

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 18-25 ◽  
Author(s):  
Petter Förander ◽  
Tiit Rähn ◽  
Lars Kihlström ◽  
Elfar Ulfarsson ◽  
Tiit Mathiesen
Keyword(s):  
Gamma Knife ◽  
Cranial Nerve ◽  
Residual Tumor ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Tumor Control ◽  
Low Grade ◽  
Cranial Nerve Palsies ◽  
Tumor Volume Reduction

ObjectIntracranial chondrosarcomas have a high risk of recurrence after surgery. This retrospective study of patients with intracranial chondrosarcoma was conducted to determine the long-term results of microsurgery followed by Gamma Knife surgery (GKS) for residual tumor or recurrence.MethodsThe authors treated nine patients whose median age was 36 years. Seven patients had low-grade chondrosarcomas (LGCSs), whereas mesenchymal chondrosarcomas (MCSs) were diagnosed in two. Radiosurgery was performed in eight patients, whereas one patient declined further surgical intervention and tumor-volume reduction necessary for the GKS.The patients were followed up for 15 to 173 months (median 108 months) after diagnosis and 3 to 166 months (median 88 months) after GKS. Seven patients had residual tumor tissue after microsurgery, and two operations appeared radical. In the two latter cases, tumors recurred after 25 and 45 months. Thus, definite tumor control was not achieved after surgery alone in any patient, whereas the addition of radiosurgery allowed tumor control in all six patients with LGCSs. Two of these patients experienced an initial tumor regrowth after GKS; in both cases the recurrences were outside the prescribed radiation field. The patients underwent repeated GKS, and subsequent tumor control was observed. An MCS was diagnosed in the remaining two patients. Complications after microsurgery included diplopia, facial numbness, and paresis. After GKS, one patient had radiation necrosis, which required microsurgery, and two patients had new cranial nerve palsies.Conclusions Tumor control after microsurgery alone was not achieved in any patient, whereas adjuvant radiosurgery provided local tumor control in six of eight GKS-treated patients. Tumor control was not achieved in the two patients with MCS. Similar to other treatments for intracranial chondrosarcoma, morbidity after micro- and radiosurgical combination therapy was high and included severe cranial nerve palsies.

Big Data Driven Clinical Informatics & Surveillance (BDD_CIS) – A Multimodal Database Focused Clinical, Community, and Multi-Omics Surveillance Plan for COVID-19: A study Protocol (Preprint)

2020 ◽  
Author(s):  
Bankole Olatosi ◽  
Jiajia Zhang ◽  
Sharon Weissman ◽  
Zhenlong Li ◽  
Jianjun Hu ◽  
...  
Keyword(s):  
Big Data ◽  
South Carolina ◽  
Data Science ◽  
Age Groups ◽  
The Elderly ◽  
The United States ◽  
Data Sources ◽  
Patient Registries ◽  
Multiple Partner ◽  
Multimodal Data

BACKGROUND The Coronavirus Disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) remains a serious global pandemic. Currently, all age groups are at risk for infection but the elderly and persons with underlying health conditions are at higher risk of severe complications. In the United States (US), the pandemic curve is rapidly changing with over 6,786,352 cases and 199,024 deaths reported. South Carolina (SC) as of 9/21/2020 reported 138,624 cases and 3,212 deaths across the state. OBJECTIVE The growing availability of COVID-19 data provides a basis for deploying Big Data science to leverage multitudinal and multimodal data sources for incremental learning. Doing this requires the acquisition and collation of multiple data sources at the individual and county level. METHODS The population for the comprehensive database comes from statewide COVID-19 testing surveillance data (March 2020- till present) for all SC COVID-19 patients (N≈140,000). This project will 1) connect multiple partner data sources for prediction and intelligence gathering, 2) build a REDCap database that links de-identified multitudinal and multimodal data sources useful for machine learning and deep learning algorithms to enable further studies. Additional data will include hospital based COVID-19 patient registries, Health Sciences South Carolina (HSSC) data, data from the office of Revenue and Fiscal Affairs (RFA), and Area Health Resource Files (AHRF). RESULTS The project was funded as of June 2020 by the National Institutes for Health. CONCLUSIONS The development of such a linked and integrated database will allow for the identification of important predictors of short- and long-term clinical outcomes for SC COVID-19 patients using data science.

scholarly journals Bariatric Surgery vs Lifestyle Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial

2020 ◽  
Vol 105 (3) ◽  
pp. 866-876 ◽  
Author(s):  
Anita P Courcoulas ◽  
James W Gallagher ◽  
Rebecca H Neiberg ◽  
Emily B Eagleton ◽  
James P DeLany ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Controlled Trial ◽  
The United States ◽  
Diabetes Remission ◽  
University Of Pittsburgh ◽  
Lifestyle Treatment ◽  
Surgical Treatments ◽  
The University

Abstract Context Questions remain about bariatric surgery for type 2 diabetes mellitus (T2DM) treatment. Objective Compare the remission of T2DM following surgical or nonsurgical treatments. Design, setting, and participants Randomized controlled trial at the University of Pittsburgh, in the United States. Five-year follow-up from February 2015 until June 2016. Interventions 61 participants with obesity and T2DM who were initially randomized to either bariatric surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) or an intensive lifestyle weight loss intervention (LWLI) program for 1 year. Lower level lifestyle weight loss interventions (LLLIs) were then delivered for 4 years. Main Outcomes and Measures Diabetes remission assessed at 5 years. Results The mean age of the patients was 47 ± 6.6 years, 82% were women, and 21% African American. Mean hemoglobin A1c level 7.8% ± 1.9%, body mass index (BMI) 35.7 ± 3.1 kg/m2, and 26 participants (43%) had BMI < 35 kg/m2. Partial or complete T2DM remission was achieved by 30% (n = 6) of RYGB, 19% (n = 4) of LAGB, and no LWLI participants (P = .0208). At 5 years those in the RYGB group had the largest percentage of individuals (56%) not requiring any medications for T2DM compared with those in the LAGB (45%) and LWLI (0%) groups (P = .0065). Mean reductions in percent body weight at 5 years was the greatest after RYGB 25.2% ± 2.1%, followed by LAGB 12.7% ± 2.0% and lifestyle treatment 5.1% ± 2.5% (all pairwise P < .01). Conclusions Surgical treatments are more effective than lifestyle intervention alone for T2DM treatment.

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