A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology

Factors determining the response to treatment in patients with vestibular migraine

Purpose To find out clinical features associated with poor response to treatment in vestibular migraine (VM) Methods VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. >= 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. Results The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 +/- 12.2 years (range: 17-74 years), were analyzed. Conclusion Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives

Can vestibular migraine development be predicted in patients with new onset migraine headaches?

Objective: This study aims to determine the clinical features associated with the development of vestibular migraine (VM) in patients with migraine headaches. Methods: A cross-sectional, multicenter study was performed in nine tertiary neurology clinics. Patients with migraine without vestibular symptoms were classified as having migraine only (MO) and compared with patients with VM to determine any differences in clinical features, associated disorders, past medical history, and family history of migraine headaches. Moreover, we investigated the features that might predict the development of VM. Results: Two hundred forty-four patients with MO and 461 patients with VM were included. The age of onset of headache attacks was later in life for patients with VM (p<0.001). Migraine without aura (MwoA) was significantly more common than migraine with aura (MwA) in patients with VM (p=0.016). All associated features of migraine headaches were significantly more frequent in patients with MO than patients with VM (p<0.005). The same was true for all triggers, including fasting, sleep disturbances, menstruation, stress, flickering lights, and smartphones/computer games (p<0.005). A family history of migraine headaches was more common in MO patients (p=0.002). However, a previous history of motion sickness was significantly more common in patients with VM (p<0.001), as was aural fullness/tinnitus accompanying attacks (p<0.001). Logistic regression analysis indicated that aural fullness/tinnitus accompanying attacks and a previous history of motion sickness were risk factors for the development of VM. Conclusion: Patients with migraine reporting aural symptoms accompanying attacks and motion sickness in their past medical history are at increased risk of vestibular attacks fulfilling the diagnosis of VM later in life