Diagnosis, treatment, and survival in spinal dissemination of primary intracranial glioblastoma: systematic literature review

2019 ◽  
Vol 31 (5) ◽  
pp. 723-732 ◽  
Author(s):  
Christina Huang Wright ◽  
James Wright ◽  
Louisa Onyewadume ◽  
Alankrita Raghavan ◽  
Isaac Lapite ◽  
...  
Keyword(s):  
Median Survival ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Brain Lesion ◽  
Spinal Metastases ◽  
Leptomeningeal Disease ◽  
Anatomical Location ◽  
Common Symptom ◽  
Rank Analysis ◽  
Spinal Axis

OBJECTIVESpinal metastases from primary intracranial glioblastoma (GBM) are infrequently reported, and the disease has yet to be well characterized. A more accurate description of its clinical presentation and patient survival may improve understanding of this pathology, guide patient care, and advocate for increased inclusion in GBM research. The authors sought to describe the clinical presentation, treatment patterns, and survival in patients with drop metastases secondary to primary intracranial GBM.METHODSA systematic review was performed using the PRISMA guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases were queried for abstracts that included patients with primary intracranial GBM and metastases to the spinal axis. Descriptive statistics were used to evaluate characteristics of the primary brain lesion, timing of spinal metastases, clinical symptoms, anatomical location of the metastases, and survival and treatment parameters. Kaplan-Meier analysis and log-rank analysis of the survival curves were performed for selected subgroups.RESULTSOf 1225 abstracts that resulted from the search, 51 articles were selected, yielding 86 subjects. The patients’ mean age was 46.78 years and 59.74% were male. The most common symptom was lumbago or cervicalgia (90.24%), and this was followed by paraparesis (86.00%). The actuarial median survival after the detection of spinal metastases was 2.8 months and the mean survival was 2.72 months (95% CI 2.59–4.85), with a 1-year cumulative survival probability of 2.7% (95% CI 0.51%–8.33%). A diagnosis of leptomeningeal disease, present in 53.54% of the patients, was correlated, and significantly worse survival was on log-rank analysis in patients with leptomeningeal disease (p = 0.0046; median survival 2.5 months [95% CI 2–3] vs 4.0 months [95% CI 2–6]).CONCLUSIONSThis study established baseline characteristics of GBMs metastatic to the spinal axis. The prognosis is poor, though these results will provide patients and clinicians with more accurate survival estimates. The quality of studies reporting on this disease pathology is still limited. There is significant need for improved reporting methods for spinal metastases, either through enrollment of these patients in clinical trials or through increased granularity of coding for metastatic central nervous system diseases in cancer databases.

scholarly journals Clinical profiling of patients with Acid Peptic Disorders (APD) in India: a cross-sectional survey of clinicians

2016 ◽  
Vol 6 (1) ◽  
pp. 194 ◽  
Author(s):  
Ramesh Roop Rai ◽  
A. Gangadhar ◽  
Mayur M. Mayabhate
Keyword(s):  
Peptic Ulcer ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Epigastric Pain ◽  
Ph Monitoring ◽  
Common Symptom ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Ulcer Disease ◽  
Presenting Symptoms

Background: Acid peptic disorders (APD) which include GERD and peptic ulcer disease (PUD) are common conditions reported in daily clinical practice. This survey aimed to understand the epidemiology, clinical presentation and associated overlapping comorbidities in Indian patients with APD.Methods: This was an interview based cross-sectional survey of 1000 clinicians (specialist gastroenterologists and non-specialists) across India who treated patients of APD in their practice. Information related to patient demographics, diagnosis and clinical presentation (common symptoms and their duration, alarming, lower GI and extra-esophageal symptoms) were assessed. Indications for upper GI endoscopy, esophageal pH monitoring and esophageal manometry were also collected. Descriptive analyses were done.Results: About 39.2% and 37.1% patients had reported GERD and PUD respectively (duodenal ulcer: 10.5%, gastric ulcer: 9.9% and peptic ulcer-non-specified: 16.7%); 25.2% patients were reported to have non-ulcer dyspepsia. Heartburn was the most common symptom in GERD (60.5%); epigastric pain was common in PUD (72.3%); 49% GERD patients presented with alarming symptoms, mainly dysphagia (67%), whereas for PUD, GI bleeding was the most common alarming symptom (47.6%). Profiles of patients visiting clinicians were similar with respect to the presenting symptoms and associated conditions. Functional dyspepsia (25.9%), constipation (23.4%) and irritable bowel syndrome (23.4%) were the most common overlapping conditions associated with both GERD and PUD.Conclusions: APD (GERD and PUD) was more common in 18-59 yrs. age group with heart burn as the common symptom for GERD and epigastric pain for PUD. Diagnosis was mostly based on clinical symptoms; nearly 50% patients of APD presenting with alarming symptoms needed prompt endoscopy. Thus, there is need to focus on these overlapping disorders while managing patients of APD.

scholarly journals Temporal gliosarcoma: case report and review of literature

2015 ◽  
Vol 22 (1) ◽  
pp. 112-116
Author(s):  
Amit Agrawal ◽  
Vissa Shanthi ◽  
Baddukonda Appala Ramakrishna ◽  
Kuppili Venkata Murali Mohan
Keyword(s):  
Case Report ◽  
Median Survival ◽  
Glial Cells ◽  
Primary Tumor ◽  
Clinical Presentation ◽  
Spindle Cell ◽  
Review Of Literature ◽  
Future Studies ◽  
Aggressive Tumor ◽  
The Brain

Abstract First characterized by Stroebe, the gliosarcomas are highly malignant and rare primary tumor of the brain composed of neoplastic glial cells in association with spindle cell sarcomatous elements (biphasic tissue patterns). In spite of being recognized as two different pathologies studies have not shown any significant differences between gliosarcoma and glioblastoma with regard to age, sex, size, clinical presentation, and median survival. In summary, gliosarcoma is an aggressive tumor with a propensity to recur and re-grow with poor outcome. Future studies are needed to understand the true pathology of these biphasic tumors.

scholarly journals Clinical study of ectopic pregnancy

2017 ◽  
Vol 6 (8) ◽  
pp. 3498
Author(s):  
Meenakshi T. Chate ◽  
Bhagyashree Chate ◽  
Kranti Chate
Keyword(s):  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Public Health Issue ◽  
Common Symptom ◽  
Age Group ◽  
Common Site ◽  
Common Risk Factor ◽  
Medical College ◽  
Endometrial Cavity ◽  
Rising Incidence

Background: Ectopic pregnancy is pregnancy that develops following implantation anywhere other than the endometrial cavity of uterus. Objective of present study was to investigate the risk factors, clinical presentation and sites of ectopic pregnancy along with management and assessment of risk of maternal mortality and morbidity.Methods: The study was undertaken at Dr. Shankar Rao Chavhan Government Medical College and Guru Govind singhji hospital, Nanded between December 2012 and May 2014 after obtaining clearance from the Hospital Ethical Committee.Results: Maximum incidence of tubal gestation occurred between the age group of 21-25 years. Greater incidence was noted in multiparous woman. Tubectomy was the most common risk factor seen in 23.65% cases. The most common symptom observed is abdominal pain seen in 92.47% cases. The most common site of ectopic was ampulla seen in 51.61% cases. The most common mode of presentation was rupture seen in 71 cases about 76.35% cases. Unilateral salpingectomy was done in 70 cases about 75.26% cases.Conclusions: Since ectopic pregnancy remains a gynecological catastrophe in countries and a major challenge to the reproductive performance of women worldwide, it should be considered a relevant public health issue. With its rising incidence, which is likely to continue increasing because of the various factors discussed, it is necessary to devise means of early detection and treatment.

scholarly journals Psychiatric disorders in multiple sclerosis patients

2009 ◽  
Vol 67 (3a) ◽  
pp. 664-667 ◽  
Author(s):  
Mirella Martins Fazzito ◽  
Sérgio Semeraro Jordy ◽  
Charles Peter Tilbery
Keyword(s):  
Multiple Sclerosis ◽  
Psychiatric Disorder ◽  
Optic Neuritis ◽  
Psychiatric Disorders ◽  
Clinical Presentation ◽  
Demyelinating Disease ◽  
Common Symptom ◽  
Multiple Sclerosis Patients ◽  
Variable Clinical Presentation

Multiple sclerosis (MS) is a demyelinating disease showing variable clinical presentation. Optic neuritis is the most common symptom, followed by motor and sensitive manifestations. It is known that this disease may be related to several psychiatric disorders, especially depression. In this study we will discribe 5 cases of MS patients harboring psychiatric disorder related or unchained by the disease itself.

scholarly journals Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481877825 ◽  
Author(s):  
Luis Miguel Juárez-Salcedo ◽  
Lubomir Sokol ◽  
Julio C. Chavez ◽  
Samir Dalia
Keyword(s):  
Malt Lymphoma ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Wide Spectrum ◽  
Gastric Lymphoma ◽  
B Cell Lymphoma ◽  
Low Grade ◽  
Predisposing Factor ◽  
Primary Gastric Lymphoma ◽  
Non Hodgkin Lymphoma

Primary gastric lymphoma (PGL) is the most common extranodal non-Hodgkin lymphoma and represents a wide spectrum of disease, ranging from indolent low-grade marginal zone lymphoma or mucosa-associated lymphoid tissue (MALT) lymphoma to aggressive diffuse large B-cell lymphoma. The PGL is a relatively rare cancer and easily misdiagnosed due to its unspecific symptoms of the digestive tract. The medical literature and ongoing clinical trials were reviewed on the clinical presentation, diagnosis, prognosis, prevention, and treatment of PGL. Primary gastric lymphoma is an event in the course of cancer with a variable clinical presentation and a wide differential diagnosis. Chronic gastritis secondary to Helicobacter pylori ( H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Magnetic resonance imaging and endoscopic ultrasonography have helped in staging of these cancers. The clinical course and prognosis of this disease are dependent on histopathological subtype and stage at the time of diagnosis. A global therapeutic approach to the cure of PGL has completely changed over the past 10 years, including innovative and conservative options to reduce treatment toxicity. Due to the rarity of PGL, many aspects of this neoplasm are still controversial. The incidence of this disease is increasing, making it necessary for clinicians to understand the clinical symptoms, workup, and treatment of these lymphomas.

Maturity-Onset Diabetes of the Young (MODY): Genetic Causes, Clinical Characteristics, Considerations for Testing, and Treatment Options

Endocrines ◽  
2021 ◽  
Vol 2 (4) ◽  
pp. 485-501
Author(s):  
Zoltan Antal
Keyword(s):  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Maturity Onset Diabetes ◽  
Onset Diabetes ◽  
Inappropriate Treatment ◽  
Monogenic Forms Of Diabetes ◽  
Initial Description

Maturity Onset Diabetes of the Young (MODY) encompasses a group of rare monogenic forms of diabetes distinct in etiology and clinical presentation from the more common forms of Type 1 (autoimmune) and Type 2 diabetes. Since its initial description as a clinical entity nearly 50 years ago, the underlying genetic basis for the various forms of MODY has been increasingly better elucidated. Clinically, the diagnosis may be made in childhood or young adulthood and can present as overt hyperglycemia requiring insulin therapy or as a subtle form of slowly progressive glucose impairment. Due to the heterogeneity of clinical symptoms, patients with MODY may be misdiagnosed as possessing another form of diabetes, resulting in potentially inappropriate treatment and delays in screening of affected family members and associated comorbidities. In this review, we highlight the various known genetic mutations associated with MODY, clinical presentation, indications for testing, and the treatment options available.

Aeromedical Implications of Cerebral Cavernomas

2021 ◽  
Vol 92 (2) ◽  
pp. 120-123
Author(s):  
Tania Jagathesan ◽  
Michael OBrien
Keyword(s):  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Civil Aviation ◽  
Complication Rates ◽  
Cerebral Cavernous Malformations ◽  
Cavernous Malformations ◽  
Medical Certification ◽  
The Uk ◽  
Age Range ◽  
The Brain

BACKGROUND: Cavernomas, cavernous angiomas, or cerebral cavernous malformations are clusters of endothelium-lined blood vessels usually found in the brain. With the increasing use of radiological imaging, these are being detected incidentally in asymptomatic aircrew. The UK Civil Aviation Authority (CAA) experience of cavernomas is described and the aeromedical concerns, that is, the risk of epilepsy, hemorrhage, and the development of a neurological deficit, are considered.METHODS: A search of the CAA database between 1990 and 2020 was performed for the term cavernoma. The gender, age at diagnosis, class of certification held, clinical presentation, location, and size of the lesion were noted. A PubMed literature review for papers with complications of cavernoma was performed.RESULTS: Six cases of cavernoma have been declared to the CAA: five professional pilots and one private pilot. Five were men and one was a woman. The age range was between 38 and 60 yr, with a mean of 48 yr. Two cases presented with clinical symptoms and four were asymptomatic. Complication rates for seizure and hemorrhage were extracted from the published literature together with the significance of other factors such as cavernoma size, family history, multiplicity, and the development of new lesions.DISCUSSION: A policy for the medical certification of aircrew with cavernomas that have presented with clinical symptoms and those that are detected incidentally is proposed.Jagathesan T, OBrien M. Aeromedical implications of cerebral cavernomas. Aerosp Med Hum Perform. 2021; 92(2):120123.

A STUDY OF CLINICALAND MYCOLOGICAL PROFILE OF TINEA INFECTIONS

2021 ◽  
pp. 1-2
Author(s):  
Thappeta Deepak Tony Raj ◽  
Vennapusa Sravan Kumar Reddy ◽  
Chappidi Bhargavi
Keyword(s):  
Clinical Presentation ◽  
Skin Diseases ◽  
Fungal Infections ◽  
Geographic Location ◽  
Common Symptom ◽  
General Physical Examination ◽  
Direct Microscopic Examination ◽  
The World ◽  
General Physical ◽  
Dermatophyte Infection

INTRODUCTION: Dermatophytic infections, also known as ringworm, is one of the most common fungal infections of the skin around the world. The most common symptom seen with dermatophyte infection is pruritis. The varied presentation of tinea is often confusing with other skin diseases. It may be due to the irrational application of broad-spectrum steroid ointments and creams, leading to misdiagnosis and mismanagement. This study was begun to know the prevalence, clinical, and mycological prole of various dermatophytes OBJECTIVES OFTHE STUDY: 1.To study the prevalence of tinea infections. 2.To study the clinical presentation of patients with tinea infections. 3.To study the mycological prole of various tinea infections. METHODS: Clinical assessment was done, which include a detailed history, general physical examination, and examination of the lesion. After a complete review, the evaluation took place. Direct Microscopic Examination. Culture helps in the identication of species. CONCLUSION: To conclude, dermatophytosis is very common in India. It has been registered all over the world but with a different distribution, incidence, and epidemiology from location to location. Geographic location, climate, overcrowding, health care, immigration, personal and environmental hygiene, culture, and socioeconomic status have been attributed as major risk factors for these variations

A STUDY OF CLINICAL PRESENTATION AND MANAGEMENT OF PITUITARY TUMORS

2021 ◽  
pp. 58-60
Author(s):  
Manthan Patel ◽  
Naimish Patel
Keyword(s):  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Pituitary Tumors ◽  
Csf Leak ◽  
Total Removal ◽  
Diagnostic Investigation ◽  
Subtotal Removal ◽  
Visual Disturbances ◽  
Bitemporal Hemianopia

The study includes 25 cases of pituitary adenomas. Most common age group by pituitary tumors falls between 41-50 years of age. Male: Female incidence of these tumors is 1: 2.12. Most common clinical symptoms in our series are visual disturbances followed by headache. Optic nerve involvement is other common clinical nding presenting in form of decreased vision or loss of vision, eld defect or fundus changes. Commonest eld defect is bitemporal hemianopia. MRI is the diagnostic investigation of choice in pituitary tumors to dene extent, invasion and relationship to major vessels and nerves. Approximately half (44%) of the patients exhibited normal preoperative pituitary function in form of baseline hormone prole. Increased GH level (32%) followed by hyperprolactinemia (20%) are the most common endocrinologic abnormalities. Total/near total removal was done in 21 patients (84%) and subtotal removal done in 4 patients (16%). Adjuvant therapies were given in 5 patients. Two patients were given radiotherapy and 3 were given pharmacotherapy. Post operative complications were CSF leak, diabetes insipidus and meningitis. 20 patients (80%) had improvement in their symptoms including relief from headache, improvement in vision and endocrinal dysfunction. Post operatively visual functions improved in 13 patients (52%) and it remained stationary in 11 (44%) patients. Only one patient (4%) complained of worsening of his visual function and it was improved in follow up period

BIOM-02. LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA: UPDATES ON THE VALIDITY OF THE VERIDEX CELLSEARCH SYSTEM

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi10-vi10
Author(s):  
yolanda Pina ◽  
Sepideh Mokhtari ◽  
Youngchul Kim ◽  
Brittany Evernden ◽  
Nam Tran ◽  
...  
Keyword(s):  
Median Survival ◽  
Gold Standard ◽  
Retrospective Chart Review ◽  
Standard Test ◽  
Diagnostic Tools ◽  
Cancer Center ◽  
Leptomeningeal Disease ◽  
Csf Cytology ◽  
Cellsearch System ◽  
Additional Tool

Abstract BACKGROUND Leptomeningeal disease (LMD) is devastating with a median survival of 8-10 weeks without treatment. LMD affects approximately 5% to 25% of melanoma patients. Its pathophysiology remains unknown and effective treatments are virtually non-existent. The primary aim of this study was to evaluate the validity of Veridex CellSearch® System (VCS) compared to Gold Standard test (i.e., CSF cytology). MATERIALS AND METHODS A retrospective chart review was performed of subjects with suspected LMD from melanoma enrolled in the MCC 19332/19648 at Moffitt Cancer Center. Patients underwent standard of care with different treatments as deemed appropriate by treating physician. CSF samples were obtained from lumbar punctures, surgeries, and Ommaya reservoir. CSF was evaluated for quantification of CSF circulating tumor cells (CTCs) with the Veridex CellSearch® System (VCS). RESULTS Forty-eight patients were identified with melanoma as primary tumor, ages 29-80. Twenty-seven had LMD (median age 62) with median KPS 70. N=19 (70%) were diagnosed radiographically and n=5 (19%) with CSF cytology; n=14 (54%) had positive cytology on first LP. From 24 patients with LMD who underwent VCS, n=22 (92% patients had positive CSF CTCs. Number of CTCs/mL CSF was significantly higher in patients with LMD versus in patients without LMD (mean SD 227.6 vs. 0.07, p < 0.001). VCS sensitivity and specificity was analyzed. AUC was 0.515, with TPR 0.250 and FPR 0.286. CSF analysis and treatments were described. The median survival of those with LMD was 2.7 months. CONCLUSION These results indicate the potential value of the VCS as an additional tool to the gold standard in the diagnosis of LMD in patients with high suspicion of the disease. Future directions involve doing prospective studies to further validate this method, and to better understand this patient population to enhance diagnostic tools and management of LMD.

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