Tumour progression or pseudoprogression?:A review of post-treatment radiological appearances of glioblastoma

Glioblastoma (GBM) is a common brain tumour in adults, which, despite multimodality treatment, has a poor median survival. Efficacy of therapy is assessed by clinical examination and magnetic resonance imaging (MRI) features. There is now a recognised subset of treated patients with imaging features that indicate "progressive disease" according to Macdonald's criteria, but subsequently, show stabilisation or resolution without a change in treatment. In these cases of "pseudoprogression", it is believed that non-tumoural causes lead to increased contrast enhancement and conventional MRI is inadequate in distinguishing this from true tumour progression. Incorrect diagnosis is important, as failure to identify pseudoprogression could lead to an inappropriate change of effective therapy. The purpose of this review is to outline the current research into radiological assessment with MRI and molecular imaging of post-treatment GBMs, specifically the differentiation between pseudoprogression and tumour progression

Radiological progression of cerebral metastases after radiosurgery: assessment of perfusion MRI for differentiating between necrosis and recurrence

To assess the capability of perfusion MRI to differentiate between necrosis and tumor recurrence in patients showing radiological progression of cerebral metastases treated with stereotactic radiosurgery (SRS). From 2004 to 2006 dynamic susceptibility-weighted contrast-enhanced perfusion MRI scans were performed on patients with cerebral metastasis showing radiological progression after SRS during follow-up. Several perfusion MRI characteristics were examined: a subjective visual score of the relative cerebral blood volume (rCBV) map and quantitative rCBV measurements of the contrast-enhanced areas of maximal perfusion. For a total of 34 lesions in 31 patients a perfusion MRI was performed. Diagnoses were based on histology, definite radiological decrease or a combination of radiological and clinical follow-up. The diagnosis of tumor recurrence was obtained in 20 of 34 lesions, and tumor necrosis in 14 of 34. Regression analyses for all measures proved statistically significant (χ2 = 11.6–21.6, P < 0.001–0.0001). Visual inspection of the rCBV map yielded a sensitivity and specificity of 70.0 respectively 92.9%. The optimal cutoff point for maximal tumor rCBV relative to white matter was 2.00 (improving the sensibility to 85.0%) and 1.85 relative to grey matter (GM), improving the specificity to 100%, with a corresponding sensitivity of 70.0%. Perfusion MRI seems to be a useful tool in the differentiation of necrosis and tumor recurrence after SRS. For the patients displaying a rCBV-GM greater than 1.85, the diagnosis of necrosis was excluded. Salvage treatment can be initiated for these patients in an attempt to prolong survival

Fragments of fiction: the myth in the minor Greek Tragedians of the 5th-4th C. BC

In our doctoral thesis we attempt to study the ways in which the considered minor poets of the 5th and 4th c. B.C. utilized in their tragic creations the myths related to the mythical houses of Cadmus, Minyas, Oineas and Pyleas. In other words, we explore the mythological background revealed by the study of the subject matter of the fragmentarily extant tragedies of the minor poets, drawing information from the relevant mythological tradition as reflected in epic, lyric poetry, and the major tragic poets, so that to understand the way of their reconstruction by the minor tragedians in their poetic compositions. Despite the wealth of recent research on the various problems arising from the study of the fragmentary work of the minor tragedians, works which we will present in our introduction, the thorough presentation and investigation of the way in which the minor tragedians of the 5th and 4th c. B.C. handled the tragic myths, is still a question of research.The introduction presents the overview of previous research, the structure and objectives of the thesis. In the first part of the study, which occupies the largest area, the mythological background of the surviving tragic fragments, whose possible plot is inspired by Theban myths, is investigated. In the second part, the method of reconstruction of the myth is examined in the only two surviving fragments, the possible plot of which is related to the myths of Orchomenos. The third part explores the use of the myth by the minor dramatists in the plot of the surviving fragments, who draw their inspiration from the myths of Aetolia. The fourth part examines the reconstruction of the myth by the minor poets in the surviving tragic fragments, whose possible plot is inspired by the myths of the region of Phthia. In the fifth part, based on the findings of our research, we formulate some partial conclusions and explore the possible way in which the minor dramatists in the postclassical period dealt with the four aforementioned mythological cycles. The general conclusions and the appendix follow, where a brief consideration of the mythological cycles is carried out, so that the reader has a more complete picture. In the appendix, citations are limited to primary sources only. However, an indicative bibliography of secondary sources is listed in each chapter of the appendix. The thesis concludes with the bibliography tables and the chronological tables of the examined tragic authors and their works.Στη διδακτορική μας διατριβή επιχειρούμε να μελετήσουμε τους τρόπους, με τους οποίους οι θεωρούμενοι ως ελάσσονες ποιητές του 5ου και 4ου αι. π.Χ. αξιοποίησαν στις τραγικές τους δημιουργίες τους μύθους, που σχετίζονται με τους μυθικούς οίκους του Κάδμου, του Μινύα, του Οινέως και του Πηλέως. Με άλλα λόγια, διευρευνούμε το μυθολογικό υπόβαθρο, που αποκαλύπτεται από τη μελέτη του περιεχομένου των υποθέσεων των αποσπασματικά διασωζόμενων τραγωδιών των ελασσόνων ποιητών, αντλώντας πληροφορίες από τη σχετική μυθολογική παράδοση, όπως αυτή αποτυπώνεται στο έπος, τη λυρική ποίηση και τους μείζονες τραγικούς ποιητές, ώστε να κατανοήσουμε τον τρόπο ανάπλασής τους από τους ελάσσονες τραγικούς στις ποιητικές τους συνθέσεις. Παρά τον πλούτο των πρόσφατων ερευνών πάνω στα ποικίλα προβλήματα, που ανακύπτουν από τη μελέτη του διασωθέντος έργου των ελασσόνων τραγικών, εργασίες τις οποίες θα παρουσιάσουμε στην εισαγωγή μας, η διεξοδική παρουσίαση και διερεύνηση του τρόπου, με τον οποίο οι ελάσσονες τραγικοί του 5ου και του 4ου αι. π.Χ. χειρίστηκαν τους τραγικούς μύθους, αποτελεί ακόμη ζητούμενο της έρευνας. Στην εισαγωγή παρουσιάζεται η επισκόπηση της προηγούμενης έρευνας, η δομή και οι στόχοι της διατριβής. Στο πρώτο μέρος της μελέτης, το οποίο καταλαμβάνει και τη μεγαλύτερη έκταση, διερευνάται το μυθολογικό υπόβαθρο των διασωθέντων τραγικών αποσπασμάτων, των οποίων η πιθανή υπόθεση είναι εμπνευσμένη από τους θηβαϊκούς μύθους. Στο δεύτερο μέρος εξετάζεται ο τρόπος ανασύνθεσης του μύθου στα μοναδικά δύο διασωθέντα απόσπασματα, η πιθανή υπόθεση των οποίων σχετίζεται με τους μύθους του Ορχομενού. Στο τρίτο μέρος διερευνάται η αξιοποίηση του μύθου από τους ελάσσονες δραματουργούς στην πλοκή των διασωζόμενων αποσπασμάτων, που αντλούν την έμπνευσή τους από τους μύθους της Αιτωλίας. Στο τέταρτο μέρος εξετάζεται η ανάπλαση του μύθου από τους ελάσσονες ποιητές στα διασωθέντα τραγικά αποσπάσματα, των οποίων η πιθανή πλοκή είναι εμπνευσμένη από τους μύθους της περιοχής της Φθίας. Στο πέμπτο μέρος με βάση τα πορίσματα, που προκύπτουν από την έρευνά μας, διατυπώνουμε ορισμένα επιμέρους συμπεράσματα και διερευνούμε τον πιθανό τρόπο, με τον οποίο οι ελάσσονες δραματουργοί πραγματεύτηκαν στη μετακλασική περίοδο τους τέσσερις προαναφερθέντες μυθολογικούς κύκλους. Έπονται τα γενικά συμπεράσματα και το επίμετρο, όπου πραγματοποιείται μια συνοπτική θεώρηση των μυθολογικών κύκλων, ώστε ο αναγνώστης να έχει πληρέστερη εικόνα. Στο επίμετρο, οι παραπομπές περιορίζονται μόνο στις πρωτογενείς πηγές. Ωστόσο, σε κάθε κεφάλαιο του επιμέτρου παρατίθεται ενδεικτική βιβλιογραφία δευτερογενών πηγών. Η διατριβή ολοκληρώνεται με τους πίνακες βιβλιογραφίας και τους χρονολογικούς πίνακες των υπό εξέταση τραγικών συγγραφέων και των έργων τους

The surgical management of cerebral cavernous angiomas

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Atropine administration in experimental electromechanical dissociation

Atropine can have a place during cardiopulmonary resuscitation (CPR) in the management of asystole, where parasympathetic influence might be excessive. However, the beneficial effects of atropine in electromechanical dissociation (EMD) have not been clearly demonstrated. The authors studied the effects of atropine in combination with epinephrine on an experimental model of EMD in the closed-chested dog. In 15 pentobarbital-anesthetized, mechanically ventilated dogs (mean weight 20 kg), EMD was induced by ventricular fibrillation followed by an external countershock, and was observed for 2 minutes before CPR was started. After 5 minutes of chest compression using a CPR thumper, either atropine 0.5 mg or D5W was administered, and the same injection was repeated every 5 minutes until recovery. Epinephrine 1 mg was administered in alternans. Each dog was submitted to two successive episodes of CPR, using either atropine or D5W, in a randomized order. Of a total of 28 CPRs, five were successful with chest compression alone. In the treatment groups, 10 of 11 were successful with atropine, but only eight of 12 with D5W (P < .01). The duration of CPR was also significantly shorter when atropine was used (9 minutes 56 seconds ± 14 seconds versus 12 minutes 08 seconds ± 43 seconds, P < .001). During the recovery period, atropine-treated animals had higher arterial pressure, heart rate, cardiac output and stroke volume. On this experimental model, the administration of high doses of atropine together with epinephrine enhances the recovery from EMD and results in a better cardiac function during recovery.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

One level cotrel-dubousset instrumentation in lumbar spondylolisthesis

info:eu-repo/semantics/nonPublishe

Parenchymal Anaplastic Astrocytoma Presenting With Visual Symptoms Due to Bilateral Optic Nerve Sheath Involvement

A 23 year old man presented with transient visual obscurations and was found to have optic nerve edema and a thalamic lesion that did not enhance on magnetic resonance imaging. Lumbar puncture opening pressure was normal. Subsequent magnetic resonance images demonstrated optic nerve sheath enhancement. Pathological diagnosis of the thalamic mass was anaplastic astrocytoma (WHO grade III). Visual symptoms were attributed to spread of high grade parenchymal glioma to the optic nerve sheaths causing intraorbital optic nerve compression

Cervical Spondylotic myelopathy: 150 cases, result of Surgery

info:eu-repo/semantics/nonPublishe