4 research outputs found
Portal-Mesenteric Venous Thrombosis
The importance of portal vein thrombosis (PVT) lies mainly in
the complications of prehepatic portal hypertension, which in
the chronic state causes bleeding through varices. Acute PVT is
the main cause of prehepatic portal hypertension in the Western
world1 and the primary cause of portal hypertension of any type
in noncirrhotic patients in developed countries. PVT accounts
for some 8% to 10% of all cases of portal hypertension
Endolymphatic hydrops severity in magnetic resonance imaging evidences disparate vestibular test results
Objectives: It has been suggested that in Ménière’s disease (MD) a dissociated result in the caloric
test (abnormal result) and video head-impulse test (normal result) probably indicates that hydrops
affects the membranous labyrinth in the horizontal semicircular canal (HSC). The hypothesis in this
study is that based on endolymphatic hydrops’ cochleocentric progression, hydrops should also be
more severe in the vestibule of these patients than in those for whom both tests are normal.
Methods: 22 consecutive patientswith unilateral definiteMDwere included and classified as NNif both
tests were normal or AN if the caloric test was abnormal. MRI evaluation of endolymphatic hydrops was
carried out with a T2-FLAIR sequence performed 4 h after intravenous gadolinium administration. The
laterality and degree of vestibular endolymphatic hydrops and the presence or absence of cochlear
endolymphatic hydrops were recorded. Demographic data, audiometric and vestibular evoked myogenic
potentials were collected, and video head-impulse and caloric tests were performed.
Results: Patients in both groups (NN and AN) were similar in terms of demographic data and
hearing loss. The interaural asymmetry ratio was significantly higher for ocular and cervical VEMP
in patients in the AN group. There was a significantly higher degree of hydrops in the vestibule of
the affected ear of AN patients (x2
; p = 0.028).
Conclusion: Significant canal paresis in the caloric test is associated with more severe
endolymphatic hydrops in the vestibule as detected with gadolinium-enhanced MRI and with a
more severe vestibular deficit
Repeated stereotactic radiosurgery for recurrent brain metastases: An effective strategy to control intracranial oligometastatic disease
Due to improvements in systemic therapies and longer survivals, cancer patients frequently present with re-
current brain metastases (BM). The optimal therapeutic strategies for limited brain relapse remain undefined.
We analyzed tumor control and survival in patients treated with salvage focal radiotherapy in our center. Thirty-
three patients with 112 BM received salvage stereotactic radiosurgery (SRS) or fractionated stereotactic radio-
therapy (FSRT) for local or regional recurrences. Local progression was observed in 11 BM (9.8 %). After 1 year,
72 % of patients were free of distant brain failure, and the 2-year overall survival (OS) was 37.7 %. No increase
in toxicity or neurologically related deaths were observed. The 2- and 3-year whole brain radiation therapy free
survival (WFS) rates were 92.9 % and 77.4 %, respectively. Hence, focal radiotherapy is a feasible salvage of
recurrent BM in selected group of patients with limited brain disease, achieving a maintained intracranial
control and less neurological toxicity
A phase II trial of autologous dendritic cell vaccination and radiochemotherapy following fuorescence-guided surgery in newly diagnosed glioblastoma patients
Background: Prognosis of patients with glioblastoma multiforme (GBM) remains dismal, with median overall survival
(OS) of about 15 months. It is therefore crucial to search alternative strategies that improve these results obtained with
conventional treatments. In this context, immunotherapy seems to be a promising therapeutic option. We hypoth‐
esized that the addition of tumor lysate-pulsed autologous dendritic cells (DCs) vaccination to maximal safe resection
followed by radiotherapy and concomitant and adjuvant temozolomide could improve patients’ survival.
Methods: We conducted a phase-II clinical trial of autologous DCs vaccination in patients with newly diagnosed
patients GBM who were candidates to complete or near complete resection. Candidates were fnally included if residual
tumor volume was lower than 1 cc on postoperative radiological examination. Autologous DCs were generated from
peripheral blood monocytes and pulsed with autologous whole tumor lysate. The vaccination calendar started before
radiotherapy and was continued during adjuvant chemotherapy. Progression free survival (PFS) and OS were analyzed
with the Kaplan–Meier method. Immune response were assessed in blood samples obtained before each vaccines.
Results: Thirty-two consecutive patients were screened, one of which was a screening failure due to insufcient
resection. Median age was 61 years (range 42–70). Karnofsky performance score (KPS) was 90–100 in 29%, 80 in 35.5%
and 60–70 in 35.5% of cases. MGMT (O6
-methylguanine-DNA-methyltransferase) promoter was methylated in 45.2%
of patients. No severe adverse efects related to immunotherapy were registered. Median PFS was 12.7 months (CI
95% 7–16) and median OS was 23.4 months (95% CI 16–33.1). Increase in post-vaccination tumor specifc immune
response after vaccines (proliferation or cytokine production) was detected in 11/27 evaluated patients. No correla‐
tion between immune response and survival was found.
Conclusions: Our results suggest that the addition of tumor lysate-pulsed autologous DCs vaccination to tumor
resection and combined radio-chemotherapy is feasible and safe. A multicenter randomized clinical trial is warranted
to evaluate the potential survival beneft of this therapeutic approach