Intra-arterial cisplatin for the treatment of malignant gliomas

Cisplatin (DDP) is a chemotherapeutic agent that has shown efficacy against primary CNS malignancies. Intraarterial (IA) administration of DDP to patients with brain tumors should produce higher peak levels of drug than intravenous (IV) administration of an identical dose and reduce systemic toxicity. Twelve patients with malignant glioma were entered into the study. All had failed irradiation, 11 had failed IA BCNU. Each patient received IA DDP, 58–100 mg/m 2 , into the internal carotid artery at four to six week intervals. One of 12 patients had a partial response of 6 months. The remaining 11 patients had progressive disease [10] or severe complications [1]. Toxicity included seizures in four patients, weakness and/or aphasia in four patients, coma in two patients, and visual deterioration in two patients. IA DDP has very limited efficacy in patients with malignant gliomas after failure of nitrosoureas and is associated with an unacceptable level of toxicity. IA DDP may be more effective when used as initial chemotherapy of malignant gliomas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45394/1/11060_2004_Article_BF00149377.pd

Intravoxel water diffusion heterogeneity imaging of human high-grade gliomas

This study aimed to determine the potential value of intravoxel water diffusion heterogeneity imaging for brain tumor characterization and evaluation of high-grade gliomas, by comparing an established heterogeneity index ( Α value) measured in human high-grade gliomas to those of normal appearing white and grey matter landmarks. Twenty patients with high-grade gliomas prospectively underwent diffusion-weighted magnetic resonance imaging using multiple b-values. The stretched-exponential model was used to generate Α and distributed diffusion coefficient (DDC) maps. The Α values and DDCs of the tumor and contralateral anatomic landmarks were measured in each patient. Differences between Α values of tumors and landmark tissues were assessed using paired t- tests. Correlation between tumor Α and tumor DDC was assessed using Pearson's correlation coefficient. Mean Α of tumors was significantly lower than that of contralateral frontal white matter ( p  = 0.0249), basal ganglia ( p  < 0.0001), cortical grey matter ( p  < 0.0001), and centrum semiovale ( p  = 0.0497). Correlation between tumor Α and tumor DDC was strongly negative (Pearson correlation coefficient, −0.8493; p  < 0.0001). The heterogeneity index Α of human high-grade gliomas is significantly different from those of normal brain structures, which potentially offers a new method for evaluating brain tumors. The observed negative correlation between tumor Α and tumor DDC requires further investigation. Copyright © 2009 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65045/1/1441_ftp.pd

Reply

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34892/1/20273_ftp.pd

Comparison between BCNU and procarbazine chemotherapy for treatment of gliomas

We compared sequential single-agent BCNU and procarbazine (PCB) chemotherapy in 31 patients with gliomas [grade IV (10), grade III (15), grade II (6)]. Patients had failed surgical biopsy ± resection and radiation therapy. All patients were treated initially with BCNU 150-300mg/m 2 by intra-arterial or intravenous route every 6 weeks. After CT evidence of tumor progression, all patients received PCB 150mg/m 2 /day for 28 days every 8 weeks. Patient responses to BCNU were CR (0), PR (7), SD (12), progression (12), and to PCB CR (2), PR (9), SD (6), and progression (14). Kaplan-Meier estimates of median time to failure for all patients were shorter for BCNU, 5.0 months (range 1.5–20), than for PCB, 6.0 months (range 2–50+). There was a statistically significant difference (Mantel-Cox test, p=0.02) in the distribution of time to disease progression between the two drugs, especially for grade III tumors (p= 0.02). The cumulative proportion of patients without disease progression at 6 months was 26% while on BCNU, compared to 48% while on PCB; at 12 months the cumulative proportions were 3% for BCNU compared to 35% for PCB. Although there was no formal washout period between administration of the two drugs, no carryover effect was evident. These data provide further evidence that PCB has significant activity against malignant glioma and may, in fact, be more effective than BCNU.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45377/1/11060_2005_Article_BF01050072.pd

Relationship between neuropsychological and emotional functioning in severe chronic alcoholism

Previous studies of patients with severe chronic alcoholism have shown a high prevalence of emotional distress such as anxiety and depression, and neuropsychological impairments such as executive deficits, but few have examined the relationship between these disorders. We addressed this issue in 51 abstinent patients with histories of severe chronic alcoholism utilizing the Minnesota Multiphasic Personality Inventory (MMPI) and the Halstead-Reitan Neuropsychological Test Battery (HRNTB). Applying factor analysis to the MMPI clinical and validity scales, we derived four dimensions accounting for 78% of the available variance. We found that Factor 1, which loaded on most clinical scales of the MMPI, was significantly correlated (p <.01) with performance on the Halstead Category Test (HCT), a measure of executive functioning. Further, group analysis with MANOVA using HCT (impaired and nonimpaired) as the independent variable revealed a significant main effect for Factor 1 (p <.004), which was maintained and strengthened when age and education were controlled as covariates (p <.001). The results suggest a relationship between emotional distress and executive functioning as measured by the HCT, reflecting differing facets of frontal lobe dysfunction common to cognitive and affective domains in patients with severe chronic alcoholism

Differentiating Alzheimer’s disease from dementia with Lewy bodies and Parkinson’s disease with (+)‐[11C]dihydrotetrabenazine positron emission tomography

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152813/1/alzjjalz200711016.pd