Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

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Operative Versus Non-operative Treatment of Grade III Acromioclavicular Joint Dislocations and the Use of SurgiLig: a Retrospective Review

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0010.8043 ◽

2017 ◽

Vol 19 (6) ◽

pp. 523-530 ◽

Cited By ~ 3

Author(s):

Fizan Younis ◽

Sanil Ajwani ◽

Asia Bibi ◽

Eleanor Riley ◽

Peter J. Hughes

Keyword(s):

Operative Treatment ◽

Retrospective Review ◽

Acromioclavicular Joint ◽

Shoulder Girdle ◽

Joint Dislocations ◽

Significant Difference ◽

Synthetic Ligament ◽

The Mean ◽

Grade Iii

Background. Acromioclavicular joint dislocations are common shoulder girdle injuries. The treatment of grade III acromioclavicular joint dislocations is controversial. Furthermore, the literature on the use of the SurgiligTM synthetic ligament for reconstruction of dislocations is sparse. Materials and methods. This retrospective review aimed to establish whether operative treatment was superior to non-operative treatment in grade III acromioclavicular joint dislocations treated at our institute over a 5-year period. We also reviewed the effectiveness of reconstruction with SurgiligTM after acute and chronic dislocations across all grades of acromioclavicular joint dislocations. Results. Twenty-five patients completed full follow-up with grade III dislocations. The mean follow-up in the operated group was 3.56 years and in the non-operated group this was 3.29 years. The mean Oxford Shoulder Score (OSS) in the operated group was 39.8, whereas the mean OSS in the non-operated group was 45.9 (p=0.01). The mean pain score in the operated group was 2.2, and in the non-operated group this was 1.6. The mean satisfaction score in the operated group was 8.2 and that in the non-operated group was 7.8. There was no statistically significant difference in pain or satisfaction scores. In respect to the cohort treated with SurgiligTM synthetic ligament, 22 patients across all grades of dislocations had this procedure performed. The mean post-operative Oxford Shoulder Score (OSS) was 40. Conclusions. 1. Non-operative treatment is not inferior to operative treatment for grade III acromioclavicular joint dislocations. The data from this study demonstrated that the non-operated group had superior Oxford Shoulder Scores that were statistically significant. 2. Additionally, the use of the SurgiligTM ligament appears to be effective in treating both chronic and acute acromioclavicular joint dislocations.

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Nonoperative Management of Femoroacetabular Impingement: Clinical Outcomes at 5-Years--A Prospective Study (143)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00282 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0028

Author(s):

Andrew Zogby ◽

James Bomar ◽

Kristina Johnson ◽

Kelly Randich ◽

Vidyadhar Upasani ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Patient Reported Outcomes ◽

Operative Management ◽

Activity Level ◽

Treatment Groups ◽

Patient Reported ◽

The Mean ◽

Non Operative Management ◽

Fai Syndrome

Objectives: Mid-term and long-term outcomes data on non-operative management of femoroacetabular impingement (FAI) syndrome remains sparse despite expanding research on the topic. Our purpose is to present 5-year outcomes data utilizing a non-operative protocol on a consecutive series of patients with FAI syndrome. Methods: Between 2013 and 2016, patients were prospectively recruited in a non-operative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were offered arthroscopic treatment. Patient-reported outcomes including the modified Harris Hip Score (mHHS) and Non-arthritic Hip Score (NAHS) were collected 1-, 2-, and 5-years after enrollment. We present the 5-year data. Statistical analysis was performed to determine outcomes based on FAI type and treatment. Results: 133 hips in 100 patients were enrolled. Sixty-seven hips in 50 patients were available for 5-year follow up. At enrollment, the mean mHHS and NAHS were 69.6±13.1 and 76.3±14.7 respectively. In total, 73% of the cohort was managed non-operatively. Of the 11 patients requiring surgery, six (55%) converted to surgery within one year of enrollment, 4 (36%) converted to surgery between one and 2 years, and one patient converted to surgery between 2 and 5 years. At final follow up, the mean mHHS and NAHS were 89.6±10.7 and 88.0±12.1 respectively. At 1-year follow up, only the activity modification group made a significant increase in mHHS and NAHS (p<0.03), by two year follow up, all three treatment groups had made statistically significant improvements in mHHS and NAHS (p<0.05), by 5-years follow up, the activity modification group and the scope group had maintained their statistically significant improvement in mHHS and NAHS (p<0.03). There was no significant difference in mHHS or NAHS between treatment groups at 5-year follow-up (p>0.4)(Table 1), and no difference in proportion of hips meeting the MCID for mHHS based on treatment course (p=0.961). There was no difference in mHHS or NAHS between FAI types at any time point (p>0.06)(Table 2), or in the proportion of hips that met MCID among FAI types (p=0.511). 72% of patients returned to the same or similar sport/activity level, and there was no difference in the proportion of patients that returned to sports/activities among treatment type (p=0.095) or FAI type (p=0.273). Conclusions: Non-operative management of FAI syndrome is effective in a majority of adolescent patients, with robust improvements in patient-reported-outcomes persisting at 5-year follow-up.

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GENE-29. INCREASED COPY NUMBER BURDEN (CNB) IS ASSOCIATED WITH GRADE IN IDH-MUTANT, 1p/19q-CODELETED OLIGODENDROGLIOMAS.

Neuro-Oncology ◽

10.1093/neuonc/noz175.431 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi103-vi104

Author(s):

Desmond Brown ◽

Seiji Yamada ◽

Thomas Kollmeyer ◽

Paul Decker ◽

Matthew Kosel ◽

...

Keyword(s):

Copy Number ◽

Copy Number Variants ◽

Copy Number Alterations ◽

Software Suite ◽

Who Grade ◽

Grade Ii ◽

The Mean ◽

Grade Iii ◽

Array Analyses

Abstract BACKGROUND Oligodendrogliomas are classified as either WHO grade II or III depending on histologic features. Grade often influences treatment decisions. However, there is variability in patient outcome within tumors of similar grade. We hypothesized that copy number burden (CNB) and specific copy number variants (CNV) might be associated with oligodendroglioma grade and prognosis. METHODS Copy number array analyses were performed on 285 molecular oligodendrogliomas (IDH-mutant, 1p/19q-whole arm-codeleted) from the Mayo Clinic internal and consult neuropathology practice and 167 TCGA molecular oligodendrogliomas. CNB was defined as the total number of copy number alterations. The association of CNB and CNV with grade and overall survival (when available) was assessed. All Mayo and TCGA data were evaluated using the ChAS software suite (Thermo- Fisher) and blindly reviewed by a clinical cytogeneticist (RBJ). RESULTS The mean CNB was 5.0 and 10.4 in the Mayo WHO grade II and III oligodendrogliomas, respectively (p = 5.4 x 10–17). Among the TCGA WHO grade II and III oligodendrogliomas the mean CNB was 4.4 and 5.3, respectively (p = 0.034). Common CNVs (occurring in at least 5% of cases) were -4/4q-, +8/8q+, -9/9p-/cnLOH 9p, +11/11q+, -14/14q-, -15 and -18/18q-. Of these, -9/9p-/cnLOH 9p was significantly associated with higher grade in both the Mayo and TCGA cohorts (p = 8.3 x 10-10 and 0.018, respectively). In the TCGA cohort the presence of >10 CNVs or +11/11q+ was associated with a poorer survival (p = 0.016 and 0.006, respectively). CONCLUSIONS CNB is significantly associated with WHO grade in IDH-mutant, 1p/19q co-deleted oligodendrogliomas. The presence of a significantly elevated CNB in some WHO grade II tumors may be suspicious for the presence of unappreciated grade III histologic features. Longer follow-up will be necessary to determine if CNB or single CNVs are associated with survival.

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The role of angioembolization in the management of blunt renal injuries: a systematic review

BMC Urology ◽

10.1186/s12894-021-00873-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giovanni Liguori ◽

Giacomo Rebez ◽

Alessandro Larcher ◽

Michele Rizzo ◽

Tommaso Cai ◽

...

Keyword(s):

Operative Management ◽

Renal Trauma ◽

High Grade ◽

Contrast Extravasation ◽

Newcastle Ottawa Scale ◽

Grade Ii ◽

Non Operative Management ◽

Grade Iii ◽

Renal Injuries

Abstract Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma.

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Congenital Hydronephrosis: Disease or Condition?

PRILOZI ◽

10.2478/prilozi-2014-0016 ◽

2014 ◽

Vol 35 (2) ◽

pp. 123-129 ◽

Cited By ~ 2

Author(s):

Mile Petrovski ◽

Risto Simeonov ◽

Lazar Todorovikj ◽

Vladimir Chadikovski ◽

Shaban Memeti ◽

...

Keyword(s):

Mean Value ◽

Initial Evaluation ◽

Benign Condition ◽

Congenital Hydronephrosis ◽

Grade Ii ◽

The Mean ◽

Strategic Options ◽

Timely Treatment ◽

Grade Iii

Abstract The aim of this paper is to address the dilemmas of the paediatric surgeon when facing an isolated, unilateral, congenital hydronephrosis and discuss the strategic options for the management of this condition. Congenital hydronephrosis, the most commonly diagnosed uropathy in children, is usually a benign and self-resolving condition. Nonobstructive hydronephrosis does not require operative treatment, while timely treatment is imperative for obstructive hydronephrosis before significant renal damage ensues. Managing congenital hydronephrosis is a challenging task. Thirty-two children with unilateral, isolated hydronephrosis and nonobstructed renography curves were followed up for 3 years. On the initial evaluation according to the grade of hydronephrosis: 22.6% were grade I, 54.8% grade II and 22.6% grade III. After 12 months of follow-up: 30% were grade I, 51.5% grade II and 18.5% grade III, respectively. After the three-year follow-up, there were no hydroneproses greater than grade II. The mean value of the separate GFR of the affected kidney at initial evaluation was 42.83%, and 40.33% after three years. In three children the treatment was converted from conservative to surgical. Nonobstructive, congenital hydronephrosis is a benign condition not requiring any medical treatment, but aggressive observation is indicated.

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Dynamic and Stabilometric Analysis After Syndesmosis Injuries

Journal of the American Podiatric Medical Association ◽

10.7547/18-174 ◽

2020 ◽

Vol 110 (4) ◽

Author(s):

Anil Taskesen ◽

Mustafa Caner Okkaoglu ◽

Ismail Demirkale ◽

Bahtiyar Haberal ◽

Ugur Yaradilmis ◽

...

Keyword(s):

Gait Cycle ◽

Stress Test ◽

Radiographic Evaluation ◽

Foot And Ankle ◽

Outcome Score ◽

Syndesmosis Injury ◽

Significant Difference ◽

Grade Ii ◽

The Mean ◽

Grade Iii

Background Distal tibiofibular syndesmosis contributes to dynamic stability of the ankle joint and thereby affects gait cycle. The purpose of this study was to evaluate the grade of syndesmosis injury on plantar pressure distribution and dynamic parameters of the foot. Methods Grade of syndesmosis injury was determined by preoperative plain radiographic evaluation, intraoperative hook test, or external rotation stress test under fluoroscopic examination, and two groups were created: group 1, patients with grade III syndesmosis injury (n = 17); and group 2, patients with grade II syndesmosis injury (n = 10). At the last visit, radiologic and clinical assessment using the Foot and Ankle Outcome Score was performed. Dynamic and stabilometric analysis was carried out at least 1 year after surgery. Results The mean age of the patients was 48.9 years (range, 17–80 years), and the mean follow-up was 16 months (range, 12–24 months). No statistically significant difference was noted between two groups regarding Foot and Ankle Outcome Score. The comparison of stabilometric and dynamic analysis revealed no significant difference between grade II and grade III injuries (P > .05). However, comparison of the data of patients with grade III syndesmosis injury between injured and healthy feet showed a significant difference for dynamic maximum and mean pressures (P = .035 and P = .49, respectively). Conclusions Syndesmosis injury does not affect stance phase but affects the gait cycle by generating increased pressures on the uninjured foot and decreased pressures on the injured foot. With the help of pedobarography, processing suitable orthopedic insoles for the injured foot and interceptive measures for overloading of the normal foot may prevent later consequences of ankle trauma.

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Comparative evaluation of efficacy of autogenous platelet rich plasma versus visco supplementation in treatment of early osteoarthritis of knee

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195584 ◽

2019 ◽

Vol 6 (1) ◽

pp. 19

Author(s):

Kumar Shantanu ◽

Shailendra Singh ◽

Mahesh Kumar Navadaya ◽

Brijmohan Patel

Keyword(s):

Platelet Rich Plasma ◽

Knee Joints ◽

Long Term Results ◽

Early Osteoarthritis ◽

Group I ◽

Significant Difference ◽

Grade Ii ◽

Group Ii ◽

Grade Iii

Background: Osteoarthritis is a very common chronic degenerative disease most commonly affecting the knee joints. In present study we compared the efficacy of autogenous platelet rich plasma (PRP) versus visco supplementation in treatment of early osteoarthritis of knees.Methods: 30 patients (56 knees) were registered and divided into two groups. Out of which PRP in 28 knees and visco supplementation in 28 knees injected during. Visual analogue scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were measured. These scores were measured at first visit, 6 weeks, 12 weeks and at 24 weeks.Results: All registered patients were randomized in two groups. Group I (total 16 patients and 28 knees) for intraarticular PRP injection and group II (total 14 patients and 28 knees) for intraarticular viscosupplement injection. Out of 28 knees of group I; 12 (42.85%) knees belonged to grade II and 16 (57.15%) of grade III. Out of 28 knees of group II; 15 (53.57%) knees of grade II and 13 (46.45%) of grade III. None of the knees belonged to grade I and grade 0. There was significant difference in outcome of two treatment groups (p<0.05) at 24 weeks.Conclusions: Treatment with PRP showed a significantly better clinical outcome compared with viscosupplemention at 24 weeks follow up. Although patients achieved lower WOMAC and VAS scores in PRP group at 6 and 12 weeks follow up that was statistically insignificant. We conclude that long term results of PRP are better than viscosupplementation.

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Ulnar Collateral Ligament Injury in Gymnasts: An Analysis of Return to Competition Rates and Patient Outcomes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00200 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0020

Author(s):

Somnath Rao ◽

Robert Jack ◽

Donald Willier ◽

Steven Cohen ◽

Christopher Dodson ◽

...

Keyword(s):

Treatment Options ◽

Ulnar Collateral Ligament ◽

Operative Management ◽

Return To Play ◽

Ligament Injury ◽

Collateral Ligament ◽

Operative Outcomes ◽

The Mean ◽

Non Operative Management

Objectives: While results following ulnar collateral ligament (UCL) injury in baseball players has been well documented, results following UCL injury in gymnasts are not well documented. As such, the purpose of this study was to report the operative and non-operative outcomes of UCL injury in gymnasts. Methods: Gymnasts who underwent UCL injury treatment whether non-operative or operative at a single institution were evaluated at a minimum of 2 years post-operatively. Patients were assessed with Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), Mayo Elbow Performance Score (MEPS), Andrews-Timmerman (A-T) Elbow score, Quick Disabilities of the Arm, Shoulder and Hand (qDASH) score and a custom return to play survey. Results: There were 11 patients who met inclusion criteria and complete follow-up was available in 9 patients. Overall, 6 patients were treated operatively (4 UCL reconstructions (UCLR) and 2 UCL repairs) and 3 patients were treated non-operatively. One UCLR was performed after 2 months of failed non-operative management. All patients were female with a mean age of 16.1 (range, 12-20) and mean BMI of 24.46 (range 19.2-34.1) at time of surgery or initial visit. Average follow-up was 4.04 years. Overall, 66.7% of operative versus 100% of non-operative were able to RTP at an average of 7.5 and 7 months, respectively. One re-injury was reported in the non-operative group, which was a re-dislocation of the elbow unrelated to gymnastics and was ultimately treated non-operatively. The mean KJOC, MEPS, A-T and qDASH scores for the operative group were 70.0 (range, 48.5-89), 97.5 (range, 95-100), 90.8 (range, 75-100) and 24.6 (range, 22.7-29.5), respectively. The mean scores for the non-operative group were 75.9 (range, 61-91.2), 71.7 (range, 65-75), 71.7 (range, 55-80) and 34.1 (range, 22.7-40.9), respectively. Conclusions: Both operative and non-operative treatments can be offered as successful treatment options for UCL injuries in gymnasts. Further investigation is needed to determine the optimal management of UCL injuries in gymnasts.

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THU0517 THE ROLE OF ULTRASOUND-DEFINED SYNOVITIS GRADE I IN PATIENTS PRESENTING WITH INFLAMMATORY ARTHRALGIA, A RETROSPECTIVE STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4886 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 497.2-497

Author(s):

J. Arroyo Palomo ◽

M. Arce Benavente ◽

C. Pijoan Moratalla ◽

B. A. Blanco Cáceres ◽

A. Rodriguez

Keyword(s):

Rheumatoid Arthritis ◽

Inflammatory Arthritis ◽

Statistical Tests ◽

Median Number ◽

Painful Joint ◽

Significant Difference ◽

The Mean ◽

Specialized Unit

Background:Musculoeskeletal ultrasound (MSUS) is frequently used in several rheumatology units to detect subclinical inflammation in patients with joint symptoms suspected for progression to inflammatory arthritis (IA). Synovitis grade I (EULAR-OMERACT combined score) is known to be a casual finding in healthy individuals, but studies headed to unravel its possible role on rheumatic diseases are sparse.Objectives:To investigate the correlation between synovitis grade I, and the diagnosis of IA made after a year follow-up period since MSUS findings, in patients of an MSUS-specialized unit of a Rheumatology Department.Methods:We conducted a descriptive, retrospective and unicentric study. 30 patients were selected from the MSUS-specialized unit of our Rheumatology Department from July-18 to January-19. Patients presenting synovitis grade 0 (exclusively), 2 and/or 3 on combined score were excluded. Data collection at baseline included age, sex, immunological profile and previous physical examination to the MSUS findings, as well as the diagnosis made by the rheumatologist in 1-year visit follow-up: dividing the patient sample into two groups: those who were diagnosed with IA and those not. Non-parametric statistical tests for comparing means were used.Results:The mean age was 51,6 years and 70% were females. 6 (20%) patients were diagnosed with inflammatory arthritis after a year follow-up: 2 (4,8%) psoriatic arthritis, 1 (3,3%) undifferentiated arthritis, 1 (3,3%) rheumatoid arthritis, 1 (3,3%) Sjögren’s syndrome. Non-inflammatory arthropathies were also found 24 (80%), of which, 12 (40%) were non-specific arthralgias and 8 (19%) osteoarthritis.In the group of patients who did not developed an IA the mean C-reactive protein (CPR) value was 3,12 mg/L and erythrocyte sedimentation rate (ESR) was 8,2 mm; all of them were rheumatoid factor (RF) positive and ACPA-negative except one patient. 5 (31,3%) patients presented low antinuclear antibodies (ANAs) levels. In those who HLA B-27 and Cw6 were tested (4,25%); both were negative except for one that was HLA B-27 positive. The median number of swollen and painful joint count was 0, and the mean of joints with MSUS involvement was 3,5; the mean involved metacarpophalangeal (MCP) joints was 1,83; proximal interphalangeal (PIP) joints was 1,48 and distal interphalangeal (DIP) joints 0,21.Among the group of patients that developed an IA the mean of CPR and ESR was 9,27 mg/L and 14,17 mm respectively; 2 (33%) patients were RF- positive, and 1 ACPA-positive. ANAs were positive in 3 cases (50%). The median of swollen joint count was 2 and for painful joint count was 0, the median of joints with MSUS involvement was 4,5. The mean of MSUS involvement was for MCP, PIP and DIP joints: 1,67, 2 and 0. Comparing the means of CPR values in the two groups with Student’s t-test we obtained a statistically significant difference (p=0,023). No other significant differences were found.Conclusion:Despite the limitations and possible statistical bias, the presence of MSUS-defined synovitis grade I and elevated CRP levels could be related to further diagnoses of inflammatory arthropathy. Besides, the absence of synovitis in DIP joints might have a diagnostic role. Normal physical exploration and normal levels of CRP might suggest low MSUS value. However, further research is needed to clarify the role of MSUS-defined synovitis grade I.References:[1]D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1):e000428.[2]Van den Berg R et al. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature review. Arthritis Research & Therapy (2018) 20:228.Disclosure of Interests:None declared

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NIMG-53. GLUTAMATE/GABA RATIO ON MRS IS ELEVATED IN PATIENTS WITH LOWER GRADE GLIOMAS AND SEIZURES

Neuro-Oncology ◽

10.1093/neuonc/noaa215.666 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii159-ii160

Author(s):

Roberta Rudà ◽

Riccardo Pascuzzo ◽

Francesca Mo ◽

Alessia Pellerino ◽

Peter B Barker ◽

...

Keyword(s):

Tumor Location ◽

Resonance Spectroscopy ◽

Lower Grade ◽

Lack Of Information ◽

Baseline Evaluation ◽

Grade Ii ◽

Grade Iii

Abstract BACKGROUND There is lack of information on the role of excitatory and inhibitory neurotransmitters in the development of seizures in patients with lower grade gliomas. Increase of glutamate and downregulation of GABA have been suggested in preclinical models and human surgical samples to be associated with brain tumor-related epilepsy. MATERIAL AND METHODS We prospectively investigated with the use of magnetic resonance spectroscopy (MRS) the differences in the ratio of metabolites (glutamate/GABA, glutamate/creatine and GABA/creatine) in the peritumoral areas between patients with or without seizures in a series of lower grade gliomas. Tumors were classified according to WHO Classification of 2016 as follows:11 grade II IDH mutated and 1p/19q codeleted; 3 grade III IDH mutated and 1p/19q codeleted; 6 grade II IDH mutated and 1p/19q intact; 1 grade III IDH mutated and 1p/19q intact; 1 grade II IDH wild-type. Patients received surgery alone or followed by temozolomide chemotherapy according to the presence of risk factors. RESULTS At baseline evaluation, maximum glutamate/GABA values were significantly higher (p=0.023) in the peritumoral area of patients with seizures (1.008 ± 0.368) with respect to those without seizures (0.691 ± 0.170). No other metabolites ratio showed significant differences between the two groups. Similar results were obtained when analyzing the metabolites ratio in the examinations during the follow-up. In the cohort of patients with seizures (n.14) variations of metabolite ratios were not associated with tumor location, 1p/19q codeletion, use of AEDs, concomitant chemotherapy or seizure characteristics (type, duration, frequency). CONCLUSIONS The study is ongoing with the aim of analyzing further the correlations between ratio of metabolites and status of the tumor (stable vs progressive).

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