Radiotherapy and CCNU in the treatment of high-grade supratentorial astrocytomas

✓ Forty-one consecutive patients with supratentorial primary brain tumors (38 Grade III and IV astrocytomas, one giant-cell astrocytoma, and two cases with insufficient tissue for diagnosis) were randomly allocated within 2 weeks of surgery to one of three therapeutic groups. Group 1 (15 patients) received radiation therapy totaling 4000 to 4500 rads in 4 to 5 weeks. Group 2 (13 patients) received 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) 130 mg/sq m orally every 6 weeks. Group 3 (13 patients) received radiation therapy plus CCNU as for Groups 1 and 2. When the disease progressed, patients in Groups 1 and 2 were crossed over to receive CCNU and irradiation respectively. The median survival time in these groups was 188, 259, and 252 days, and the mean survival 263, 262, and 329 days. The median time from diagnosis to crossover (Groups 1 and 2) or to progression (Group 3) was 163, 99, and 220 days, and the mean time was 172, 108, and 231 days. There was no statistically significant difference between the means or medians in any of these situations.

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Comparison of Changes in Number of Hyperreflective Dots After İntravitreal Ranibizumab or Dexamethasone İmplant in Patients with Branch Retinal Vein Occlusion

10.21203/rs.3.rs-736656/v1 ◽

2021 ◽

Author(s):

Aylin Karalezli ◽

Sema Kaderli ◽

Ahmet Kaderli ◽

Cansu Kaya ◽

Sabahattin Sul

Keyword(s):

First Year ◽

Intravitreal Ranibizumab ◽

Retinal Layers ◽

Vein Occlusion ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Group 1

Abstract Purpose: To compare the effect of intravitreal ranibizumab (IVR) or intravitreal dexamethasone implants (IVD) on regression of hyperreflective dots (HRDs) on optical coherence tomography (OCT) B-scan in patients with branch retinal vein occlusion (BRVO). Methods: 37 eyes of 37 patients with cystoid macular edema who received IVR or IVD and followed up for at least 12 months were included in this study. The patients were divided into three groups according to intravitreal treatment. Group 1 consisted of 12 eyes who received only IVD, group 2 consisted of 10 eyes who received only IVR on a pro re nata and group 3 consisted of 15 eyes who received both IVD and IVR. OCT parameters (CMT, number of HRDs, status of external limiting membrane (ELM) and ellipsoid zone (EZ)) and best-corrected visual acuity (BCVA) were compared between the groups over the follow-up time. HRDs were categorized as HRD in inner retinal layers (from the internal limiting membrane to the inner nuclear layer) or HRD in outer retinal layers (from the outer plexiform layer to the outer border of the photoreceptor layer).Results: There was no significant difference between groups in terms of BCVA, CMT, HRDs in the inner and the outer retinal layers at baseline visit. (p˃0.05 for all) Comparing the baseline values in all groups, a significant decrease was observed in CMT in the first year. (For group 1; p=0.013, group 2; p=0.010; group 3, p<0.001) The BCVA was significantly increased after 1 year in all groups. (p=0.001, p=0.006, p<0.001) The mean number of HRDs in inner and outer retinal layers were significantly decreased in group 1 and group 3. (For group 1; p<0.001, p=0.001, for group 3; p<0.001, p<0.001) However, there was no significant difference in terms of the mean number of HRDs in inner and outer retinal layers for group 2. (p=0.134, p=0.477) At the first year, the number of HRDs in inner and outer retinal layers was significantly lower in group 1 and group 3 than group 2. (For inner HRDs; group 1 vs. group 2 p=0.007, group 2 vs. group 3 p<0.001. For outer HRDs group 1 vs. group 2 p<0.001, group 2 vs. group 3 p<0.001.) The BCVA was higher in group 3 than group 2 at 1year. (p=0.048). There was no significant difference in terms of post-treatment CMT and the number of HRDs between group 1 and group3 in posthoc tests (p=0.621, p=0.876, and p=0.632).Conclusion: The reduction in HRDs at 12 months and better BCVA after IVD intimates that the HRDs should be considered as inflammatory markers in the follow-up of CME in BRVO. Thus, IVD injection could be more appropriate for patients with higher HRDs after BRVO.

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Effects of eliminating tension by means of epineural stitches: a comparative electrophysiological and histomorphometrical study using different suture techniques in an animal model

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000300019 ◽

2011 ◽

Vol 69 (2b) ◽

pp. 365-370 ◽

Cited By ~ 4

Author(s):

J Bustamante ◽

M Socolovsky ◽

R S Martins ◽

J Emmerich ◽

M G Pennini ◽

...

Keyword(s):

Test Results ◽

Motor Action ◽

Nerve Suture ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Human Nerve ◽

Group 1

Epineural stitches are a means to avoid tension in a nerve suture. We evaluate this technique, relative to interposed grafts and simple neurorraphy, in a rat model. METHOD: Twenty rats were allocated to four groups. For Group 1, sectioning of the sciatic nerve was performed, a segment 4 mm long discarded, and epineural suture with distal anchoring stitches were placed resulting in slight tension neurorraphy. For Group 2, a simple neurorraphy was performed. For Group 3, a 4 mm long graft was employed and Group 4 served as control. Ninety days after, reoperation, latency of motor action potentials recording and axonal counts were performed. Inter-group comparison was done by means of ANOVA and the non-parametric Kruskal-Wallis test. RESULTS: The mean motor latency for the simple suture (2.27±0.77 ms) was lower than for the other two surgical groups, but lower than among controls (1.69±0.56 ms). Similar values were founding in both group 1 (2.66±0.71 ms) and group 3 (2.64±0.6 ms). When fibers diameters were compared a significant difference was identified between groups 2 and 3 (p=0.048). CONCLUSION: Good results can be obtained when suturing a nerve employ with epineural anchoring stitches. However, more studies are needed before extrapolating results to human nerve sutures.

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Radiation-induced changes in the inflammatory microenvironment composition of lung cancer brain metastases.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2528 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2528-2528

Author(s):

Ariane Steindl ◽

Maximilian Mair ◽

Angelika Martina Starzer ◽

Karin Dieckmann ◽

Georg Widhalm ◽

...

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Brain Metastases ◽

T Cell Subsets ◽

P Value ◽

Inflammatory Microenvironment ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Group 1

2528 Background: Radiotherapy was postulated to impact the inflammatory microenvironment composition in patients with lung cancer brain metastases (BM). Methods: Formalin fixed and paraffin embedded BM specimens from treatment naïve patients (group 1) and from patients treated with radiation therapy including whole brain radiotherapy and/or stereotactic radiosurgery (group 2) or prophylactic cranial irradiation (group 3) before BM resection were identified from the Vienna Brain Metastasis Registry. T cell subsets (CD3+,CD8+,CD45RO+,FOXP3+,PD-L1+) were investigated using the Ventana Benchmark Ultra system Definiens software. Results: Specimens from 41 patients (28/41;68.3% NSCLC, 13/41;31.7% SCLC) were included in the study. A significant difference in CD3+TIL density between group 1 (median: 964.5cells/mm2) and group 2 (median: 283.4cells/mm2; p-value=0.021; Mann-Whitney-U test), as well as group 3 (median: 168.8 cells/mm2; p-value= 0.028; Mann-Whitney-U test) were observed. Furthermore, CD8+ and FOXP3+TIL densities of group 2 (CD8+ median: 172.1cells/mm2; FOXP3+ median: 210.7cells/mm2) were numerically lower compared to group 1 (CD8+ median: 190.1 cells/mm2; FOXP3+ median: 221.2 cells/mm2). Of 10/41 (24.4%) patients further resected BM tissue specimens after initial resection were available. Here, the inflammatory microenvironment of BM treated with radiation therapy between the resections was significantly associated with lower densities of CD3+ (median: 105.1 cells/mm2) and CD8+ (median: 20.3cells/mm2) compared to radiation-naïve patients (CD3+ median: 825.4cells/mm2; CD8+median: 105.5cells/mm2; p=0.037; Mann-Whitney U-test). Conclusions: Radiation treatment was associated with lower densities of TIL subsets in our BM cohort. Although results have to be interpreted with caution due to the limited sample size, further studies investigating the sequencing of radiotherapy and immune modulating therapies might be of interest. [Table: see text]

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The effects of local nitroglycerin on the surgical delay procedure in prefabricated flaps by vascular implant in rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502012001200013 ◽

2012 ◽

Vol 27 (12) ◽

pp. 905-911 ◽

Cited By ~ 3

Author(s):

Jairo Zacchê de Sá ◽

José Lamartine de Andrade Aguiar ◽

Adriana Ferreira Cruz ◽

Alexandre Ricardo Pereira Schuler ◽

José Ricardo Alves de Lima ◽

...

Keyword(s):

Wistar Rats ◽

Delay Procedure ◽

Surgical Delay ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Prefabricated Flap ◽

Group 1

PURPOSE: To evaluate the effect of local nitroglycerin on the viable area of a prefabricated flap for vascular implant in rats, and to investigate the surgical delay procedure. METHODS: A femoral pedicle was implanted under the skin of the abdominal wall in forty Wistar rats. The animals were divided into four groups of ten: group 1 - without surgical delay procedure and local nitroglycerin; group 2 - with surgical delay procedure, but without local nitroglycerin; group 3 - without surgical delay procedure, but with local nitroglycerin; and group 4 - with simultaneous surgical delay procedure and local nitroglycerin. The percentages of the viable areas, in relation to the total flap, were calculated using AutoCAD R 14. RESULTS: The mean percentage value of the viable area was 8.9% in the group 1. 49.4% in the group 2; 8.4% in the group 3 and 1.1% in the group 4. There was significant difference between groups 1 and 2 (p=0.005), 1 and 4 (p=0.024), 2 and 3 (p=0.003), 2 and 4 (p=0.001). These results support the hypothesis that the closure of the arterial venous channels is responsible for the phenomenon of surgical delay procedure. CONCLUSION: Local nitroglycerin did not cause an increase in the prefabricated viable flap area by vascular implantation and decreased the viable flap area that underwent delay procedures.

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Results of trimethoprim-sulfamethoxazole prophylaxis in ventriculostomy and shunting procedures

Journal of Neurosurgery ◽

10.3171/jns.1985.62.5.0694 ◽

1985 ◽

Vol 62 (5) ◽

pp. 694-697 ◽

Cited By ~ 86

Author(s):

Göran C. Blomstedt

Keyword(s):

Placebo Group ◽

Infection Rates ◽

Group 14 ◽

Content Type ◽

Group 4 ◽

Antibiotic Group ◽

Group 3 ◽

Group 2 ◽

To Receive ◽

Group 1

✓ The author reports the results of a study to assess the effectiveness of a trimethoprim-sulfamethoxazole combination as prophylaxis in ventriculostomy or shunting operations. Between 1980 and 1983, 122 patients undergoing shunting procedures were randomly assigned to receive trimethoprim-sulfamethoxazole (Group 1, 62 cases) or a placebo (Group 2, 60 cases). The same regimen was followed at each operation, and the patients were followed for a minimum of 6 months. There was a higher infection rate in the placebo group (14 of 60 patients compared with 4 of 62 patients in the antibiotic group, p < 0.01). The antibiotic protected against early infections (nine of the 60 patients in Group 2 against none of the patients in Group 1), but not against late infections (four of the 62 in Group 1 compared with five of the 60 in Group 2). During the same period, 52 patients undergoing ventriculostomy only were also randomly assigned to receive trimethoprim-sulfamethoxazole (Group 3) or placebo (Group 4). There were no differences in the infection rates between these groups (one of 25 in Group 3 as against one of 27 in Group 4).

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Topographic Analysis of the Distal Femoral Condyle Articular Cartilage Surface: Adequacy of the Graft from Opposite Condyles of the Same or Different Size for the Osteochondral Allograft Transplantation

Cartilage ◽

10.1177/1947603517752056 ◽

2018 ◽

Vol 10 (2) ◽

pp. 205-213 ◽

Cited By ~ 5

Author(s):

Adam B. Yanke ◽

Atsushi Urita ◽

Jason J. Shin ◽

Greg L. Cvetanovich ◽

Erin K. Moran ◽

...

Keyword(s):

Femoral Condyle ◽

Weight Bearing ◽

Osteochondral Allograft ◽

Topographic Analysis ◽

Cloud Models ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Group 1

Objective To analyze the topography of the opposite condyle to treat focal femoral condyle articular defects with an osteochondral allograft (OCA). Design Three groups were created: Group 1, same condyle with same width; Group 2, opposite condyle with same width; Group 3, opposite condyle with different width. Computed tomography (CT) of 22 cadaveric femoral hemi-condyles was used to create 3-dimensional CT models that were exported into point-cloud models. Three zones of the donor condyle (anterior, middle, and posterior) were quantified. Four defect sizes were created (15, 18, 23, 25 mm) at the weight-bearing region. The defect was moved throughout each donor condyle zone and the least distance was calculated, defined as the shortest distance between the defect and the donor condyle. Results The mean least distance increased with larger defect size in all groups, yet there was a less than 0.2 mm difference in the least distance among defect sizes. The 15, 18, and 23 mm defect models in Group 1 exhibited greater least distances at the anterior than middle and posterior zones. The 15 mm defect model exhibited greater least distance at the anterior zone than posterior zone in Group 3. However, there was a less than 0.05 mm difference in the mean least distance between zones. There was no significant difference in the least distance between groups. Conclusion OCAs from opposite condyles yield similar topographic matching to OCAs from the same condyles, suggesting that opposite condyles can be utilized. Clinical correlation and outcomes are necessary.

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Pulmonary Excretion of Carbon Monoxide in the Human Infant as an Index of Bilirubin Production IV. Effects of Breast-feeding and Caloric Intake in the First Postnatal Week

PEDIATRICS ◽

10.1542/peds.65.6.1170 ◽

1980 ◽

Vol 65 (6) ◽

pp. 1170-1172 ◽

Cited By ~ 1

Author(s):

David K. Stevenson ◽

Albert L. Bartoletti ◽

Clinton R. Ostrander ◽

John D. Johnson

Keyword(s):

Carbon Monoxide ◽

Caloric Intake ◽

Human Infant ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Breast Fed ◽

Pulmonary Excretion ◽

Group 1

Measurements of the pulmonary excretion rate of carbon monoxide (VEco) as an index of bilirubin production in the first several days of life were taken from 64 breast-fed or bottle-fed infants. Twenty-one infants (≥37 weeks of gestation) were breast-fed; 43 infants (28 to 42 weeks of gestation) were bottle-fed a commercially prepared formula. Information pertaining to their caloric intake during the 24-hour period preceding VECO determination was taken from 38 of the 43 infants who were bottle-fed and they were placed into three groups based on their caloric intake: (1) ≤60 kcal/kg/day (19 infants); (2) 61 to 100 kcal/kg/day (7 infants); and (3) > 100 kcal/kg/day (12 infants). There was no significant difference in bilirubin production between bottle-fed and breast-fed infants. No effect of caloric deprivation on bilirubin production was demonstrated. The mean VECO values were 18.5 ± 0.9 (SE) for group 1, 17.7 ± 1.8 (SE) for group 2, and 16.2 ± 1.1 (SE) µl/kg/hr for group 3.

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Intergroup Rhabdomyosarcoma Study-IV: Results for Patients With Nonmetastatic Disease

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.12.3091 ◽

2001 ◽

Vol 19 (12) ◽

pp. 3091-3102 ◽

Cited By ~ 690

Author(s):

William M. Crist ◽

James R. Anderson ◽

Jane L. Meza ◽

Christopher Fryer ◽

R. Beverly Raney ◽

...

Keyword(s):

Stage I ◽

Embryonal Tumors ◽

Primary Tumor Site ◽

Free Survival ◽

Eyelid Tumors ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

To Receive ◽

Group 1

PURPOSE: The study goal was to improve outcome in children with rhabdomyosarcoma by comparing risk-based regimens of surgery, radiotherapy (RT) and chemotherapy. PATIENTS AND METHODS: Eight hundred eighty-three previously untreated eligible patients with nonmetastatic rhabdomyosarcoma entered the Intergroup Rhabdomyosarcoma Study-IV (IRS-IV) (1991 to 1997) after surgery and were randomized treatment by primary tumor site, group (1 to 3), and stage (I to III). Failure-free survival (FFS) rates and survival were the end points used in comparisons between randomized groups and between patient subgroups treated on IRS-III and IRS-IV. Most patients were randomized to receive vincristine and dactinomycin (VA) and cyclophosphamide (VAC, n = 235), or VA and ifosfamide (VAI, n = 222), or vincristine, ifosfamide, and etoposide (VIE, n = 236). Patients with group 3 tumors were randomized to receive conventional RT (C-RT) versus hyperfractionated RT (HF-RT). RESULTS: Overall 3-year FFS and survival were 77% and 86%, respectively. Three-year FFS rates with VAC, VAI, and VIE were 75%, 77%, and 77%, respectively (P = .42). No significant difference in outcome was noted with HF-RT versus C-RT (P = .85 and P = .90, respectively). Overall, patients with embryonal tumors benefited from intensive three-drug chemotherapy in IRS-IV (3-year FFS, 83%). The improvement was seen for patients with stage I or stage II/III, group 1/2 disease, many of whom received VA chemotherapy on IRS-III. Patients with stage 2/3, group 3 disease had similar outcomes on IRS-III and IRS-IV. Three-year FFS for the nonrandomized patient subsets was 75% with renal abnormalities; 81% for paratesticular, group 1 cases; and 91% for group 1/2 orbit or eyelid tumors. Patients with paratesticular primaries had poorer outcomes if they were more than 10 years old (3-year FFS, 63% v 90%). Myelosuppression occurred in most patients, but toxic deaths occurred in less than 1%. CONCLUSION: VAC and VAI or VIE with surgery (with or without RT), are equally effective for patients with local or regional rhabdomyosarcoma and are more effective for embryonal tumors than therapies used previously. Younger patients with group 1 paratesticular embryonal tumors and all patients with group 1/2 orbit or eyelid tumors can usually be cured with VA chemotherapy along with postoperative RT for group 2 disease.

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A Comparison of Various Types of Patient Instruction in the Proper Administration of Metered Inhalers

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808201600107 ◽

1982 ◽

Vol 16 (1) ◽

pp. 53-59 ◽

Cited By ~ 17

Author(s):

Richard J. Roberts ◽

J. Daniel Robinson ◽

Paul L. Doering ◽

John J. Dallman ◽

Roy A. Steeves

Keyword(s):

Patient Compliance ◽

Patient Instruction ◽

Instruction Sheet ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Pharmacist Counseling ◽

Group 2 ◽

Proper Performance ◽

Group 1

The administration technique employed by 42 inpatients using metered inhalers was observed. Proper performance of the six steps recommended by the manufacturer provided the guidelines for correct administration. The degree of compliance with proper technique was defined as the number of steps correctly executed by the patient. The mean number of steps correctly performed was 2.9 out of the possible six (48.3 percent). Twenty-four patients were then randomized into one of three groups. Group 1 received the manufacturer's instruction sheet, Group 2 received counseling from a pharmacist, and Group 3 received both the manufacturer's instruction sheet and counseling from a pharmacist. There was a significant improvement in the postinstruction technique in Groups 2 and 3, while Group 1 failed to demonstrate any significant improvement. Comparisons were then made among the three groups. No significant difference was found between Group 2 and Group 3. However, both Groups 2 and 3 were found to be significantly different ( p < 0.05) from Group 1. This study shows that pharmacist counseling can significantly improve the degree of patient compliance in the administration of metered inhalers.

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Retrospective Analysis of the Effect of Three-Dimensional Preformed Titanium Mesh on Peri-Implant Non-Contained Horizontal Defects in 100 Consecutive Cases

Applied Sciences ◽

10.3390/app11020872 ◽

2021 ◽

Vol 11 (2) ◽

pp. 872

Author(s):

In-Oh Choi ◽

Ji-Su Oh ◽

Sang-Joun Yu ◽

Byung-Ock Kim ◽

Won-Pyo Lee

Keyword(s):

Three Dimensional ◽

Collagen Membrane ◽

Mesh Exposure ◽

Titanium Mesh ◽

Hard Tissue ◽

Significant Difference ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Group 1

This study aimed to clinically and radiographically evaluate the results of guided bone regeneration (GBR) using three-dimensional preformed titanium mesh (3-D-PFTM) for non-contained horizontal defects in 100 consecutive cases. This study involved 100 patients (129 implants) with peri-implant non-contained horizontal defects. The patients were divided into three groups: 3-D-PFTM alone (Group 1), 3-D-PFTM plus cross-linked collagen membrane (Group 2), and 3-D-PFTM plus non-cross-linked collagen membrane (Group 3). Each implant was evaluated radiographically using CBCT at baseline and 6 months postoperatively. At the platform level, the mean horizontal hard tissue gain of all the sites was 3.1 ± 1.3 mm at 6 months postoperatively. The mean rate of mesh exposure was 11.8% in Group 1, 4.2% in Group 2, and 5.0% in Group 3. The mean hard tissue gain rate was 71.0 ± 23.0% in group 1, 84.2 ± 21.5% in group 2, and 84.0 ± 22.9% in group 3. Groups 2 and 3 showed significantly higher hard tissue gain rates than group 1. However, there was no significant difference between the rates in groups 2 and 3. Within the limitations of this study, 3-D-PFTM should be considered as a valuable option for GBR for peri-implant non-contained horizontal defects. The use of an additional resorbable collagen membrane provides additional advantages.

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