Laterally Extended Endopelvic Resection Versus Chemo or Targeted Therapy Alone for Pelvic Sidewall Recurrence of Cervical Cancer

BackgroundLaterally extended endopelvic resection (LEER) has been introduced for treatment of pelvic sidewall recurrence of cervical cancer (PSRCC), which occurs in only 8% of patients with relapsed cervical cancer. LEER can only be performed by a proficient surgeon due to the high risk of surgical morbidity and mortality, but there is no evidence as to whether LEER is may be more effective than chemo or targeted therapy alone for PSRCC. Thus, we aimed to compare the efficacy and safety between LEER and chemo or targeted therapy alone for treatment of PSRCC.MethodsWe prospectively recruited patients with PSRCC who underwent LEER between December 2016 and December 2019. Moreover, we retrospectively collected data on patients with PSRCC who received chemo or targeted therapy alone between January 2000 and December 2019. We compared treatment-free interval (TFI), progression-free survival (PFS), treatment-free survival (TFS), overall survival (OS), tumor response, neurologic disturbance of the low extremities, and pelvic pain severity in the different patient groups.ResultsAmong 1295 patients with cervical cancer, we included 28 (2.2%) and 31 (2.4%) in the prospective and retrospective cohorts, respectively. When we subdivided all patients into two groups based on the median value of prior TFI (PTFI, 9.2 months), LEER improved TFI, PFS, TRS and OS compared to chemo or targeted therapy alone (median, 2.8 vs. 0.9; 7.4 vs. 4.1; 30.1 vs. 16.9 months; P ≤ 0.05) in patients with PTFI < 9.2 months despite no difference in survival in those with PTFI ≥ 9.2 months, suggesting that LEER may lead to better TFI, PFS, TRS and OS in patients with PTFI < 9.2 months (adjusted hazard ratios, 0.28, 0.27, 0.44 and 0.37; 95% confidence intervals, 0.12-0.68, 0.11-0.66, 0.18-0.83 and 0.15-0.88). Furthermore, LEER markedly reduced the number of morphine milligram equivalents necessary to reduce pelvic pain when compared with chemo or targeted therapy alone.ConclusionCompared to chemo or targeted therapy alone, LEER improved survival in patients with PSRCC and PTFI < 9.2 months, and it was effective at controlling the pelvic pain associated with PSRCC.Trial RegistrationClinicalTrials.gov, identifier NCT02986568.

Epilepsi dan Attention-Deficit / Hyperactivity Disorder (ADHD) pada Anak

Attention-deficit / hyperactivity disorder (ADHD) has been associated with childhood epilepsy. Epilepsy are themost common neurologic disturbance in child age. Children with epilepsy tend to get one or more ADHD symptoms,its related to lack of norepinephrine neurotransmitter in brain, that cause attenuate the effect of GABA and disruptionto fronto-striatal brain networks, these same brain networks are disrupted by seizures or the structural brainabnormalities that can cause seizures. Children with epilepsy especially absance, tend to get inattentive type ofADHD more than other types. Abnormalities of electro-encephalography found in inattentive type of ADHD withhigh focus activities in all lobe area. No data published that methylphenidate can lower seizure threshold or act asproconvulsant. Children with epilepsy tend to get one or more symptoms of ADHD in the following days.

Normalization

This chapter on “Normalization” examines neurologic diseases due to rapid normalization of systemic medical problems. Hyperglycemia, acidosis, hyponatremia, hypernatremia, uremia, and arterial hypertension are considered. Rapid normalization of a systemic medical disorder can cause neurologic disturbance and disease. Treatment of diabetes, uremia, and certain electrolyte disorders are examples. Stopping regular use of a medication would seem to bring the body to a more normal (unmedicated) state, but, in some cases, there are neurologic complications to rapid cessation. Likewise, a withdrawal syndrome can follow sudden cessation of a regularly used nonmedicinal chemical, causing neurologic withdrawal phenomena. Not all normalization disorders are chemical or metabolic. Rapid correction of increased intracranial pressure or rapid lowering of severe arterial hypertension are examples.

Postcardiotomy Delirium: An Overview

Any one of a number of psychologic patterns may appear after cardiotomy: (1) Some patients may be elated and confident after awakening from anesthesia and have no severe changes of affect or neurologic deficit. Denial seems to be for them an adequate defense against anxiety. (2) Others are disoriented and manifest neurologic disturbance immediately after awakening, without a lucid interval. The sensorium begins to clear five days after surgery. (3) Some patients go into delirium after being lucid for as long as a week and have hallucinations, illusions, and motor excitation for a few days—or over several weeks. Pathologic brain changes that are apparently anatomical correlates of neurologic deficits in delirium include anoxic lesions of the hippocampus, and infarcted foci. Physiologic factors that contribute to this reaction include: long periods of extracorporeal circulation, arterial hypotension during surgery, emboli, and low postoperative cardiac output. Age, and the type and severity of heart impairment are also factors. Psychologic factors to be taken into account include preexisting psychopathology and the failure of denial under the stress of physical symptoms or hospitalization. Delirium is fostered by sensory overload (or deprivation) in the recovery room and intensive care unit, and by staff tension. Modification of the intensive care unit environment, the administration of antipsychotic drugs, and metabolic correctives are recommended. Preoperative psychologic evaluation, with therapy as needed, preliminary familiarization with perioperative procedures, as well as collaboration between psychiatrist and surgeon, can do much to prevent postcardiotomy delirium.

Family Studies of MZ Twins Discordant for Schizophrenia: Neurological Findings

Over the past six years the Section on Twin and Sibling Studies, NIMH, has conducted intensive studies of 16 families with MZ twins discordant for schizophrenia. In addition, 3 families in which both twins were schizophrenic and 4 with no known psychiatric illness have been similarly investigated.Each family is admitted to the Clinical Center, NIH, for two weeks of multi-disciplinary investigation. In the hope of shedding light on the question of neurologic findings in schizophrenic patients and their role in this disorder, detailed neurological examinations are performed on the twins by two neurologists. Patients with gross neurologic disturbance are screened out by our selection criteria. The examiners are therefore explicitly seeking minor deviations in neurologic status, rather than patterns of symptoms and signs leading to a specific neurologic diagnosis. Given this context, the neurologists recorded substantial numbers of signs. Yet, in none of the twins was there sufficient evidence to warrant a neurologic diagnosis.The pairs of neurologic reports were subjected to a variety of procedures, in an attempt to quantify the results. For example, 11 of the first 13 index schizophrenic twins, as compared with 1 of 13 cotwin controls, were rated as having “probable” or “definite” neurologic abnormality, based upon the senior author's analysis of the number and type of signs recorded and the degree of agreement between the examiners. Significant group differences on number of signs reported were found between schizophrenics and nonschizophrenics, schizophrenic indexes and their cotwin controls, and schizophrenics and normals. In contrast, there were no significant group differences in the number of signs found between the nonschizophrenic cotwin controls and the normal twins.