scholarly journals Prognostic Value of Invasion, Markers of Proliferation, and Classification of Giant Pituitary Tumors, in a Georeferred Cohort in Brazil of 50 Patients, with a Long-Term Postoperative Follow-Up

2016 ◽  
Vol 2016 ◽  
pp. 1-14 ◽  
Author(s):  
Juliano Coelho de Oliveira Zakir ◽  
Luiz Augusto Casulari ◽  
José Wilson Corrêa Rosa ◽  
João Willy Corrêa Rosa ◽  
Paulo Andrade de Mello ◽  
...  
Keyword(s):  
Pituitary Tumors ◽  
Biological Behavior ◽  
Significant Relation ◽  
Ki 67 ◽  
Radiological Features ◽  
Current Classification ◽  
Geographical Cluster

Although some pituitary adenomas may have an aggressive behavior, the vast majority are benign. There are still controversies about predictive factors regarding the biological behavior of these particular tumors. This study evaluated potential markers of invasion and proliferation compared to current classification patterns and epidemiogeographical parameters. The study included 50 patients, operated on for tumors greater than 30 mm, with a mean postoperative follow-up of 15.2 ± 4.8 years. Pituitary magnetic resonance was used to evaluate regrowth, invasion, and extension to adjacent tissue. Three tissue biomarkers were analyzed: p53, Ki-67, and c-erbB2. Tumors were classified according to a combination of histological and radiological features, ranging from noninvasive and nonproliferative (grade 1A) to invasive-proliferative (grade 2B). Tumors grades 2A and 2B represented 42% and 52%, respectively. Ki-67 (p=0.23) and c-erbB2 (p=0.71) had no significant relation to tumor progression status. P53 (p=0.003), parasellar invasion (p=0.03), and classification, grade 2B (p=0.01), were associated with worse clinical outcome. Parasellar invasion prevails as strong predictive factor of tumor recurrence. Severe suprasellar extension should be considered as invasion parameter and could impact prognosis. No environmental factors or geographical cluster were associated with tumor behavior.

scholarly journals 10-Year Follow-Up of a Patient with Cerebral Amyloid Angiopathy

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 202-206
Author(s):  
Min Kyoung Kang ◽  
Byung-Woo Yoon
Keyword(s):  
Cerebral Amyloid Angiopathy ◽  
The Elderly ◽  
Amyloid Angiopathy ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Radiological Features ◽  
Magnetic Imaging ◽  
Long Term Follow Up ◽  
Cerebral Amyloid

We report the case of long-term follow-up of brain magnetic imaging of cerebral amyloid angiopathy. Cerebral amyloid angiopathy is often considered a major cause of spontaneous intracerebral hemorrhage in the elderly. This case illustrates the markedly progressive clinical and radiological features of the vasculopathic process in 10 years.

Classification of Fresh Fractures of the Lunate

1988 ◽  
Vol 13 (4) ◽  
pp. 458-462
Author(s):  
H. TEISEN ◽  
J. HJARBAEK
Keyword(s):  
Vascular Anatomy ◽  
X Rays ◽  
Lunate Bone ◽  
X Ray

The X-rays of 17 patients with fresh fractures of the lunate bone have been reviewed. The fractures were classified according to their radiological appearances and according to the vascular anatomy of the lunate. A long term X-ray follow-up examination was performed.

scholarly journals Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 182-186
Author(s):  
Manoj Bohara ◽  
Kosuke Teranishi ◽  
Kenji Yatomi ◽  
Takashi Fujii ◽  
Takayuki Kitamura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Flow Diversion ◽  
Total Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Radiological Features ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion

Background Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. Case description We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion. Conclusion Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

Clinical Course of Different Types of Immune Reactions following Keratoplasty

2021 ◽  
Author(s):  
Philip Keye ◽  
Thabo Lapp ◽  
Daniel Böhringer ◽  
Sonja Heinzelmann ◽  
Philip Maier ◽  
...  
Keyword(s):  
Clinical Course ◽  
Corneal Graft ◽  
Long Term Outcomes ◽  
Immune Mediated ◽  
Corneal Graft Rejection ◽  
Different Types ◽  
Lost To Follow Up

Abstract Background Immune-mediated corneal graft rejection (IR) is a leading cause of corneal graft failure. The endothelium, stroma, epithelium, or a combination can be affected. Little is known about the long-term outcomes of different types of IR. Methods We reviewed the medical records of all keratoplasties that had been performed at our eye centre between 2003 and 2016 (n = 3934) for any kind of IR that occurred between the surgery and 2019. All patients with a definite diagnosis of IR and sufficient clinical data were included in the analysis. IRs were grouped according to the affected part of the graft (endothelial, stromal, epithelial, and mixed). We analysed the dynamics of recovery and the clinical outcomes. Results We identified a total of 319 patients with IR. Twenty-seven of those were lost to follow-up and were excluded from further analysis. Of the IRs, 89% affected the endothelium. Endothelial IR resulted more frequently in a considerable loss of endothelial cell density than other forms of IR. Stromal IR showed a lower relapse rate and a better visual recovery than other types of IR and resulted less often in a failure of the graft. Conclusions We herein report comprehensive data about the prognosis regarding functional recovery after different types of IR following keratoplasty. Our data underline that timely recognition and correct classification of IR are important because they determine the clinical course and prognosis.

Recurrent Solitary Fibrous Tumor of the Pleura With Malignant Transformation

2004 ◽  
Vol 128 (4) ◽  
pp. 460-462
Author(s):  
Rani Kanthan ◽  
Bahman Torkian
Keyword(s):  
Malignant Transformation ◽  
Solitary Fibrous Tumor ◽  
Immunohistochemical Staining ◽  
White Woman ◽  
Accurate Diagnosis ◽  
Malignant Progression ◽  
Biological Behavior ◽  
Fibrous Tumor

Abstract Recurrent solitary fibrous tumor of the pleura with malignant progression occurs rarely. We report a case of solitary fibrous tumor of the pleura in an 85-year-old white woman that recurred 4 times during a span of 10 years and subsequently underwent malignant transformation. The accurate diagnosis of solitary fibrous tumor is aided by ancillary techniques, such as immunohistochemical staining; however, with malignant transformation, such tools may be of limited value. Long-term clinical follow-up is recommended for all patients with solitary fibrous tumor because of the potential adverse biological behavior of this tumor, which may lead to repeated recurrences and/or malignant transformation.

scholarly journals Readmission after discharge from a medium secure unit

2013 ◽  
Vol 37 (4) ◽  
pp. 124-129 ◽  
Author(s):  
Martin Clarke ◽  
Conor Duggan ◽  
Clive R. Hollin ◽  
Nick Huband ◽  
Lucy McCarthy ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychiatric Hospital ◽  
Psychiatric Hospitals ◽  
Patient Treatment ◽  
Multiple Sources ◽  
Long Term Follow Up ◽  
Secure Unit

Aims and methodWe examined readmission to psychiatric hospital of 550 patients discharged from one medium secure unit over 20 years. Multiple sources were used to obtain readmission data.ResultsReadmission was common, particularly to non-secure psychiatric hospitals. At least 339 patients (61.6%) were readmitted to any psychiatric hospital (mean follow-up 9.5 years), with over a third (37.6%) subsequently being readmitted to medium- or high-security or both. Of those discharged directly to the community, having previous in-patient treatment and a Mental Health Act classification of mental illness were associated with shorter time to first readmission.Clinical implicationsThe long-standing nature of disorders is evident in the high rates of readmission overall and the need for readmission to medium and high secure services, suggesting that these patients require long-term follow-up and support from mental health services.

scholarly journals Treatment of unstable hips with the Tübingen splint in early postnatal period: radiological mid-term results of 75 hips with mean follow-up of 5.5 years

2020 ◽  
Vol 14 (4) ◽  
pp. 252-258
Author(s):  
Hannes Kubo ◽  
David Latz ◽  
Martin Hufeland ◽  
Erik Schiffner ◽  
Ruediger Krauspe
Keyword(s):  
Postnatal Period ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Type D ◽  
Further Development ◽  
Mid Term Results

Purpose For treatment of unstable hips, the Tübingen splint is a treatment option. After the initial treatment, regular radiological follow-up examinations are recommended but there is a lack of long-term outcome studies. Therefore, the further development of unstable hips treated with the Tübingen splint were evaluated. Methods From 2004 to 2015 116 patients with 161 unstable hips treated with the Tübingen splint were evaluated. Inclusion criteria were: 1) successfully treated unstable hip (type D, III and IV); 2) pelvic radiographs at the age of one to ≤ two, two to ≤ four and four to ≤ eight years. The acetabular index (ACI) of all and the centre-edge angle (CEA) of the third radiograph were measured and classified according to the Tönnis classification. Results A total of 53 patients with 75 unstable hips (type D 34 (45.3%), III 33 (44.0%), IV 8 (10.7%)) were included. In comparison of the first, second and third radiograph, an increase of normal findings was seen in 31 (41.3%) to 53 (70.7%) and 60 (80.0%) hips, respectively. However, a decrease of slightly dysplastic hips from 31 (41.3%) to 19 (25.3%) and 14 (18.7%) respectively and severely dysplastic hips from 13 (17.3%) to three (4.0%) and one (1.3%) hip respectively was detected. In comparison of first to second radiograph, 32 hips improved and five hips deteriorated and of second to third radiograph 16 hips improved and six hips deteriorated. The Tönnis classification of ACI compared with CEA showed no significant differences (p = 0.442). Conclusion This study shows a good development of unstable hips treated with the Tübingen splint with mean follow-up 5.5 years. Nevertheless, unexpected deteriorations could be identified. The CEA is an alternative to the ACI. Level of evidence IV

scholarly journals Pharmacokinetics and pharmacodynamics of natalizumab in pediatric patients with RRMS

2019 ◽  
Vol 6 (5) ◽  
pp. e591 ◽  
Author(s):  
Angelo Ghezzi ◽  
Giancarlo Comi ◽  
Luigi Maria Grimaldi ◽  
Lucia Moiola ◽  
Carlo Pozzilli ◽  
...  
Keyword(s):  
Safety Profile ◽  
Time Course ◽  
Pediatric Patients ◽  
Short Term ◽  
Elimination Phase ◽  
Relapsing Remitting ◽  
Distribution Phase

ObjectiveThis phase I study investigated pharmacokinetic (PK) and pharmacodynamic (PD) profiles of natalizumab in pediatric patients with relapsing-remitting MS (RRMS).MethodsPediatric patients with RRMS who were prescribed natalizumab 300 mg IV every 4 weeks were enrolled. Blood samples were collected on days 1, 2, 8, 15, and 22 and at weeks 4, 8, 12, and 16 to estimate PK parameters; PD properties were evaluated by measuring α4-integrin saturation and lymphocyte counts over time. Natalizumab's safety profile was also evaluated.ResultsPK parameters were similar to those reported in adult patients; natalizumab concentrations peaked approximately 1 day after infusion in most of the participants (Cmax 142.9 μg/mL, AUClast 47389.4 hr*μg/mL), followed by a biphasic decline with a rapid distribution phase and a slow elimination phase, with a terminal half-life of 215.1 hours. In terms of PD, both time course and magnitude of α4-integrin saturation and increase in lymphocyte counts were similar to those observed in adults. During the 16-week study follow-up, 3 adverse events attributed to natalizumab were observed; no unexpected safety events occurred.ConclusionsPK profile, α4-integrin saturation, lymphocyte counts, and safety observed in these pediatric patients are comparable to those reported in adults.Classification of evidenceThis study provides Class I evidence that natalizumab PK/PD parameters and safety profile are similar in adults and pediatric patients in the short term. Longer studies, also including a larger number of younger subjects (aged 10–12 years), are required to further inform about long-term PK and PD parameters in pediatric patients with MS.

scholarly journals A long-term prospective observational study in 31 patients with hemicrania continua

2019 ◽  
Vol 2 ◽  
pp. 251581631882469 ◽  
Author(s):  
Sanjay Prakash ◽  
Chaturbhuj Rathore ◽  
Kaushik Rana ◽  
Hemant Joshi ◽  
Jay Patel ◽  
...  
Keyword(s):  
Hemicrania Continua ◽  
Background Pain ◽  
Headache Diary ◽  
The Mean ◽  
Drug Leads ◽  
Observation Period ◽  
Structured Questionnaire

Introduction: Till date, there is no prospective study in patients with hemicrania continua (HC). Methods: Patients fulfilling the international classification of headache disorders criteria for HC were evaluated prospectively. All patients were subjected to a detailed clinical interview, based on a structured questionnaire. Before starting indomethacin, all patients were instructed to fill a headache diary for at least 5 days. Gradual tapering of indomethacin was done at regular intervals. Results: We enrolled 41 patients over 4.5 years, 31 of whom met the criteria after confirming the indomethacin response. The mean age was 41 years, and 55% were female. The mean duration of headache was 43.6 months. All patients had continuous strictly unilateral pain with episodic exacerbations. At least one cranial autonomic feature was noted in 81% of patients. Twenty-five patients (81%) felt a sense of restlessness during exacerbations. The mean follow-up was 2.5 years. Three-fourths of patients noted a reduction in indomethacin dose after an average 2.5 of years follow-up. The mean reduction of the dose in the follow-up was statistically significant (172 mg vs. 110 mg, p < 0.001). All patients missed the drug for various reasons over the observation period. The headache reappeared within 48 h in 97% of patients. Conclusion: Misdiagnosis of HC is still very common. Patients may not volunteer about the background pain and will focus only on the exacerbations. HC rarely remits, but indomethacin requirements may decrease over time. Skipping of the effective drug leads to the immediate reappearance of pain.

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