Klinischer Verlauf von supratentoriellen Meningeomen nach mikrochirurgischer Resektion

Einleitung: Meningeome sind die häufigsten intrakraniellen Tumoren. Supratentoriell, also an Falx oder Konvexität gelegen, haben sie, verglichen mit infratentoriellen Meningeomen, häufig einen höheren Malignitätsgrad nach WHO, sind aber lokalisationsbedingt meist besser resektabel. Die Komplettresektion, therapeutischer Goldstandard bei diesen Tumoren, führt zu einer effektiven Tumorkontrolle. Neben dem onkologischen ist das funktionelle Outcome ein für die individuelle Lebensqualität wichtiger Faktor. Methoden: Es erfolgte die retrospektive Analyse von 300 prospektiv eingeschlossenen Patienten, die zwischen 2003 und 2013 am Universitätsklinikum Regensburg (UKR) an einem supratentoriellen Meningeom operiert worden waren. Eine Morbiditäts- und Mortalitätsanalyse wurde durchgeführt, um die Behandlungsgüte am UKR widerzuspiegeln. Beurteilungsmaßstäbe für das funktionelle Patientenoutcome bildeten der Karnofsky-Performance-Index (KPI), der neurologische Performance Score MRC-NPS sowie die Besserungsraten von fokalen Defiziten und Krampfanfällen. Für die Analyse des onkologischen Outcomes wurden das Auftreten von Rezidiven, das progressionsfreie Überleben (PFS) und das Gesamtüberleben (OS) ermittelt. Zudem fand eine Prüfung verschiedener klinischer, biologischer und anatomischer Faktoren hinsichtlich ihrer prognostischen Bedeutung statt. Ergebnisse: 84,3 % der 300 supratentoriellen Meningeome wurden dem WHO-Grad I, 14,7 % WHO-Grad II und 1,0 % WHO-Grad III zugeordnet. Liquorfistel/-kissen war die häufigste chirurgische Komplikation (10,6 %). Die 30-Tages-Mortalität betrug 1 %. Sowohl der KPI als auch der MRC-NPS konnten durch die Operation signifikant verbessert werden. Hinsichtlich fokalneurologischer Defizite verbesserten sich v.a. Aphasie (89,3 %), Hemiparese (72,4 %) und Hirnnervendefekte (57,9 %). Besserung geringeren Ausmaßes zeigten Gesichtsfelddefekte (27,3 %). Bei Patienten mit präoperativer Gesichtsfeldeinschränkung oder Hemiparese gab es einen Vorteil der Gross Total Resektion (GTR) gegenüber der subtotalen Resektion (STR). 82,6 % der Patienten mit präoperativen Krampfanfällen waren nach der Operation dauerhaft anfallsfrei. Die Rezidivrate der Meningeome lag bei 14,0 %. Als unabhängige, signifikante Prognosefaktoren für ein erhöhtes Rezidivrisiko wurden mittels multivariater Analyse der WHO-Grad (p= 0,001), das Resektionsausmaß nach Simpson (p= 0,014) und ein Tumordurchmesser > 50 mm (p= 0,039) identifiziert. Das mediane PFS lag bei 45,9 Monaten (6,0 - 151,5 M). Ein höherer WHO-Grad (p= 0,001) sowie ein inkomplettes Resektionsergebnis (p= 0,029) korrelierten mit dem PFS negativ. Patienten, die am Tumor verstorben waren (n= 49; 16,3 %), zeigten in der multivariaten Analyse signifikant häufiger einen höheren WHO-Grad (p= 0,001) sowie ein inkomplettes Resektionsergebnis (p= 0,031). Ferner ließen sich Tumordurchmesser > 50 mm (p= 0,025), WHO-Grad (p= 0,001) und der Simpson-Grad (p= 0,013) als negativ prognostische Faktoren hinsichtlich des OS identifizieren. Fazit: Durch die Meningeomresektion konnten neurologische Defizite signifikant verbessert und die Alltagsfähigkeit und symptombezogene Lebensqualität der Patienten häufig wiederhergestellt werden. Neben den etablierten Parametern WHO- und Simpson-Grad beeinflusst auch ein Tumordurchmesser > 50 mm die Rezidiv- und Überlebensprognose

Distribution and clinical comparison of restrictive feeding and eating disorders using ICD-10 and ICD-11 criteria.

OBJECTIVE Within the eleventh edition of the International Classification of Diseases (ICD-11), diagnostic criteria for feeding and eating disorders were revised and new diagnoses including avoidant/restrictive food intake disorder (ARFID) are classifiable; however, nothing is known about how these changes affect the prevalence of feeding and eating disorders. This study compared the distribution and clinical characteristics of restrictive feeding and eating disorders between ICD-10 and ICD-11. METHOD The Eating Disorder Examination (EDE), its child version, and the EDE ARFID module were administered to N = 82 patients (0-17 years) seeking treatment for restrictive feeding and eating disorders and their parents. Clinical characteristics were derived from medical records, questionnaires, and objective anthropometrics. RESULTS The number of residual restrictive eating disorders (rrED) significantly decreased from ICD-10 to ICD-11 due to a crossover to full-threshold disorders, especially anorexia nervosa (AN) or ARFID. Patients reclassified to ICD-11 ARFID were younger, had an earlier age of illness onset, more restrictive eating behaviors, and tended to have more somatic comorbidities compared to those reclassified to ICD-11 AN. Patients with rrED according to both ICD-10 and ICD-11 were younger, had an earlier age of illness onset, less shape concern, and more somatic comorbidities than patients who were reclassified from ICD-10 rrED to ICD-11 AN or ARFID. DISCUSSION This study highlights the inclusive approach of ICD-11 criteria, paving the way for more targeted treatment, and ARFID's high clinical relevance. Future studies considering nonrestrictive feeding and eating disorders across the life span may allow further analyses on diagnostic crossover. PUBLIC SIGNIFICANCE Changes in diagnostic criteria for restrictive eating disorders within the newly published ICD-11 led to an increase in full-threshold disorders, while the number of rrED was significantly lowered compared to ICD-10 criteria. The results thus highlight the diagnostic utility of ICD-11 criteria and may help providing adequate treatment to children and adolescents with rrED

Gustatory Function in Acute COVID‐19 ‐ Results From Home‐Based Psychophysical Testing

Objective Gustatory function during COVID-19 is self-reported by around 50% of patients. However, only a few studies assessed gustation using psychophysical testing during acute infection. The objective of this study is to test gustatory function on threshold tests in the very first days of COVID-19. Methods Psychophysical testing consisted of validated and blinded tests for olfaction (NHANES Pocket Smell Test) and gustation (Taste Strips Test). These test kits were sent to home-quarantined patients and self-administered using a detailed instruction sheet. Results A total of 51 patients were included in this study. Testing was performed 6.5 ± 2.7 days after sampling of respiratory swabs. At this time 37% of patients stated to currently experience a gustatory impairment. The mean Taste Strips score was 10.0 ± 3.4 with 28% scoring in the range of hypogeusia. Interestingly, no significant difference in the results of gustatory testing could be observed between the group with subjectively preserved gustation and the group with self-rated taste impairment. Conclusion During the very first days of COVID-19, psychophysical gustatory testing revealed hypogeusia in 28%. This is far lower than patients' self-reports. Different from previous studies, we did not find clear evidence for an impairment of only certain taste qualities

Symptom burden and surgical outcome in non-skull base meningiomas

Purpose: Non-skull base meningiomas (NSBM) are a distinct entity and frequently present with focal neurological deficits. This study was designed to analyze functional and oncological outcome following microsurgical tumor resection in patients with NSBM. Patients and methods: An analysis of 300 patients that underwent NSBM resection between 2003 and 2013 was performed. Assessment reasures for functional outcome were Karnofsky Performance Scale (KPS), Medical Research Council - Neurological Performance Scale (MRC-NPS), and improvement rates of focal deficits and seizures. The extent of resection; recurrence-free survival (RFS) and tumor-specific survival (TSS) were also determined. Results: Impaired KPS and MRC-NPS were present in 73.3% and 45.7%, respectively. Focal neurological deficits were recorded in 123 patients (41.0%), with hemiparesis (21.7%) and aphasia (9.3%) the most prevalent form of impairment. Most meningiomas were localized at the convexity (64.0%), followed by falcine tumors (20.3%). Both KPI and MRC-NPS scores were significantly improved by surgical resection. Postoperative improvement rates of 96.6%, 89.3%, 72.3%, 57.9%, and 27.3% were observed for aphasia, epilepsy, hemiparesis, cranial nerve, and visual field deficits, respectively. Long-term improvement was achieved in 83.2%, 89.3%, 80.0%, 68.4% and 54.6% of patients, respectively. Gross total resection (GTR) over subtotal resection (STR) significantly improved preoperative seizures and visual field deficits and correlated with reduced risk of new postoperative hemiparesis. Poor Simpson grade was the only significant prognostic factor in multivariate analysis for long-term functional deficit, which occurred in 7.3%. Median RFS was 45.9 months (6.0 - 151.5 months), while median TSS was 53.7 months (3.1 – 153.2 months). Both WHO grade (p= 0.001) and Simpson classification (p= 0.014 and p= 0.031) were independent significant prognostic factors for decreased RFS and TSS by multivariate analysis, respectively. Furthermore, tumor diameter > 50 mm (p= 0.039) significantly correlated with decreased TSS in multivariate analysis. Conclusion: Surgical resection significantly and stably improves neurological deficits in patients with NSBM

Zervikofaziale Aktinomykose

Actinomycosis is an infectious disease caused by gram-positive, facultative anaerobic bacteria, which in most cases manifests itself in the cervicofacial area and often has a dentogenic focus. The clinical presentation ranges from acute abscess to chronically fistulating soft tissue processes. Early diagnosis and an appropriate therapeutic approach including a combination of extensive antibiotic treatment and, if necessary, surgical intervention are critical. This article presents five cases of actinomycete infections, which are intended to illustrate the variety of clinical presentations, the problems on the way to the correct diagnosis and possible therapeutic courses

Birth-related, medical, and diagnostic characteristics in younger versus older children with avoidant/restrictive food intake disorder (ARFID)

Abstract Background Although avoidant/restrictive food intake disorder (ARFID) presents the replacement and extension of feeding disorders of infancy and childhood, previous research into ARFID concentrated mainly on older patients. While birth-related characteristics play an etiologic role in feeding disorders, virtually nothing is known so far in ARFID. Therefore, the first aim of the study was to identify differences in birth-related characteristics in younger vs. older children with ARFID. Second, differences in physical and mental comorbidities, and third, diagnostic features between age groups were analysed. Methods Among N = 51 in- and outpatient treatment-seeking patients, n = 23 patients aged 0–5 years (30% girls) and n = 28 patients aged 6–17 years (57% girls), with an interview-based diagnosis of ARFID were included. Data on the pre- and perinatal period and mental and physical comorbidities were derived from patients’ medical records, while diagnostic criteria, main ARFID presentation, and sociodemographic variables were collected through diagnostic interview. Results Significantly, younger patients with ARFID were born more often preterm and had more pre- and perinatal complications and a higher incidence of postnatal invasive procedures. Patients with ARFID aged 0–5 years presented significantly more physical comorbidities and conditions, especially congenital anomalies, while mental comorbidities, especially mood disorders, were significantly more common in patients with ARFID aged 6–17 years. No age differences were found for the distribution of diagnostic criteria and main ARFID presentation. Conclusion This is the first study which aimed to identify age-specific characteristics in patients with ARFID with potential relevance for diagnosis and treatment. Especially birth-related complications, including invasive procedures postnatally, may be associated with developing ARFID, highlighting the importance of a closer view on these potential risk factors of the disorder. Future research with longitudinal design and larger samples may allow more detailed information on further age-specific associations, symptom trajectories, and age-specific risk factors for ARFID

Granulocyte transfusions made with modified fluid gelatin in pediatric and adolescent patients with prolonged neutropenia

Background Granulocyte transfusions (GT) are used to treat progressive systemic or local infections in prolonged neutropenic patients with antibiotic or antifungal resistance. Granulocytes are most commonly collected from whole blood by apheresis using hydroxyethyl starch (HES) as the red blood cell (RBC) sedimentation agent. This is the first study on the safety and efficacy of transfusing granulocytes collected with modified fluid gelatin (MFG) instead of HES to pediatric patients. Methods Clinical data from 46 pediatric and adolescent patients receiving at least one MFG-based granulocyte transfusion and in total 295 granulocyte concentrates from July 2013 to August 2019 at our local university medical center were evaluated retrospectively. Results Forty-one patients (89%) survived at least 21 days after their last granulocyte transfusion. These survivors had lower CRP values and higher leukocyte counts after GT than non-survivors (mean delta of −5.34 mg/dl vs. –11.99 mg/dl and + 0.62 × 103/μl vs. +0.18 × 103/μl of all GT, respectively). The neutrophil corrected count increment (CCI) was 68.72 mm2/ml in survivors versus 28.00 mm2/ml in non-survivors. There were no major or severe adverse events. Conclusion This study suggests that modified fluid gelatin is a safe and effective alternative to hydroxyethyl starch for the collection of granulocytes for transfusion to prolonged neutropenic patients with progressive systemic or local infections refractory to antibiotic or antifungal therapy

Feasibility of peripheral blood stem cell collection from sickle cell trait donors with an intensified G‐CSF regimen

Objectives Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative treatment for SCD and bone marrow from an HLA-matched sibling is currently the standard of care. Haploidentical HSCT from a family donor with a TCR αβ/CD19 depleted graft (T-haplo) is an increasingly successful alternative, which requires the generation of G-CSF stimulated peripheral stem cell (PBSC) from haploidentical relatives. These sickle cell trait (SCT) donors reported to develop SCD-related complications in conditions of severe stress. Methods In this retrospective analysis, we compared the safety and efficacy of PBSC mobilization with a G-CSF intensified mobilization regimen in SCT donors with a conventional G-CSF mobilization regimen in healthy donors. Results The reported adverse events were similar during intensified G-CSF mobilization, apheresis, and shortly after stem cell apheresis in SCT and control donors. In SCT and control donors, we were able to mobilize high yields of CD34+ stem cells and the harvested CD34+ cell count was comparable with control donors. Conclusions Peripheral stem cell mobilization using an intensified G-CSF regimen is safe, and well tolerated among SCT donors. SCT donors are a valid alternative for collection of peripheral CD34+ stem cells for T-cell-depleted haploidentical stem cell transplantation