A job-activity analysis and follow-up study of 1945-1949 business department graduates of Vermont Junior College, Montpelier, Vermont

Thesis (M.A.)--Boston University, 1950

Trigeminal neuralgia treatment outcomes following Gamma Knife radiosurgery with a minimum 3-year follow-up

OBJECTIVE: Effective short-term outcomes have been well documented for trigeminal neuralgia (TN) patients treated with Gamma Knife radiosurgery (GKRS) with reported success rates of 70–90 % with median follow-up intervals of 19–75 months. Fewer series, however, have described uniform long-term follow-up data. In this study, we report our long-term institutional outcomes in patients treated with GKRS after a minimum follow-up of 36 months. METHODS: Thirty-six consecutive patients with medically intractable TN received a median radiation dose of 45 Gy applied with a single 4-mm isocenter to the affected trigeminal nerve. Follow-up data were obtained by clinical examination and telephone questionnaire. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale with BNI I–III considered to be good outcomes and BNI IV–V considered as treatment failure. BNI facial numbness score was used to assess treatment complications. RESULTS: The incidence of early pain relief was high (80.5 %) and relief was noted in an average of 1.6 months after treatment. At minimum follow-up of 3 years, 67 % were pain free (BNI I) and 75 % had good treatment outcome. At a mean last follow-up of 69 months, 32 % were free from any pain and 63 % were free from severe pain. Bothersome posttreatment facial numbness was reported in 11 % of the patients. A statistically significant correlation was found between age and recurrence of any pain with age >70 predicting a more favorable outcome after radiosurgery. CONCLUSION: The success rate of GKRS for treatment of medically intractable TN declines over time with 32 % reporting ideal outcome and 63 % reporting good outcome. Patients older than age 70 are good candidates for radiosurgery. This data should help in setting realistic expectations for weighing the various available treatment options

Assessment of depression in Alzheimer's disease: symptoms, syndrome, and computed tomography findings

The Hamilton Rating Scale for Depression (HAM-D) and DSM-III-R criteria were simultaneously employed to assess the prevalence of depression in 26 outpatients with dementia of the Alzheimer type and 26 age-matched normal control subjects. Both assessment methods evidenced a higher frequency of depression during the severe stages of Alzheimer's disease. Among the Alzheimer patients, the prevalence rate of depression produced by the HAM-D (38%) was higher than the rate produced by DSM-III-R criteria (23%). Such a difference was due to the weight given by the HAM-D to the vegetative symptoms reported by the Alzheimer patients with more severe dementia. In a subgroup of 14 Alzheimer patients who underwent computed tomography, the volumetric measurement of CSF spaces did not reveal any difference between the depressed and nondepressed patients. On the basis of these results, the clinical problems related to the assessment of depression in Alzheimer's disease are discussed

Assessment of depression in Alzheimer's disease: symptoms, syndrome, and computed tomography findings

The Hamilton Rating Scale for Depression (HAM-D) and DSM-III-R criteria were simultaneously employed to assess the prevalence of depression in 26 outpatients with dementia of the Alzheimer type and 26 age-matched normal control subjects. Both assessment methods evidenced a higher frequency of depression during the severe stages of Alzheimer's disease. Among the Alzheimer patients, the prevalence rate of depression produced by the HAM-D (38%) was higher than the rate produced by DSM-III-R criteria (23%). Such a difference was due to the weight given by the HAM-D to the vegetative symptoms reported by the Alzheimer patients with more severe dementia. In a subgroup of 14 Alzheimer patients who underwent computed tomography, the volumetric measurement of CSF spaces did not reveal any difference between the depressed and nondepressed patients. On the basis of these results, the clinical problems related to the assessment of depression in Alzheimer's disease are discussed

Risk factors for posttreatment edema in patients treated with stereotactic radiosurgery for meningiomas.

BACKGROUND: Peritumoral edema is a recognized complication following stereotactic radiosurgery (SRS). OBJECTIVE: To evaluate the risk of posttreatment peritumoral edema following SRS for intracranial meningiomas and determine predictive factors. METHODS: Between 2002 and 2008, 173 evaluable patients underwent CyberKnife or Gamma Knife SRS for meningiomas. Eighty-four patients (49%) had prior surgical resections, 13 patients had World Health Organization grade II (atypical) meningiomas, and 117 patients had a neurological deficit before SRS. Sixty-two tumors were in parasagittal, parafalcine, and convexity locations. The median tumor volume was 4.7 mL (range, 0.1-231.8 mL). The median prescribed dose and median prescribed biologically equivalent dose were 15 Gy (range, 9-40 Gy) and 67 Gy (range, 14-116 Gy), respectively. Ninety-seven patients were treated with single-fraction SRS, 74 received 2 to 5 fractions, and 2 received \u3e5 fractions. RESULTS: The median follow-up was 21.0 months. Thirteen patients (8%) developed symptomatic peritumoral edema, with a median onset time of 4.5 months (range, 0.2-9.5 months). The 3-, 6-, 12-, and 24-month actuarial symptomatic edema rates were 2.9%, 4.9%, 7.7%, and 8.5%, respectively. The crude tumor control rate was 94%. On univariate analysis, large tumor volume (P = .01) and single-fraction SRS (P = .04) were predictive for development of posttreatment edema. CONCLUSION: SRS meningioma treatment demonstrated a low incidence of toxicity; however, large tumor volumes and single-fraction SRS treatment had an increased risk for posttreatment edema. Risk factors for edema should be considered in meningiomas treatment