Interstitial brachytherapy for low-grade cerebral gliomas: analysis of results in a series of 36 cases.

The results obtained with interstitial brachytherapy in thirty-six low-grade cerebral gliomas (2 pilocytic astrocytomas, 23 astrocytomas and 11 oligodendrogliomas) are reported (mean follow-up: 75 months, range 37-159). All tumours were situated in locations which did not call for surgical removal as the treatment of choice. Their volume ranged from 4 to 82 cc (m = 32); the Karnofsky performance status (KPS) of the treated patients lay between 0.60 and 0.90. The sources utilized (Iridium-192 in 32 cases and Iodine-125 in 4) were implanted permanently in 22 patients and temporarily in 14, using the Talairach stereotactic apparatus. The mean peripheral dose was 89.7 Gy for the permanent implants and and 42.8 Gy with a rate of 32.05 cGy/h for the temporary implants. External beam irradiation was added for tumour volumes greater than 35 cc (19 cases) on a second target volume extending 2 cm beyond the tumoural borders treated with interstitial irradiation. The survival estimates for the entire group showed a probability of 82.9\% at 60 months, of 56.8\% at 96, 39.4\% at 120 (m.s.t.: 112 months). The quality of life in the treated patients was satisfactory, KPS never falling below a mean score of 0.70. The extent of the target volume turned out to be the most significant factor influencing survival at the multivariate analysis. Severe neurological impairment due to radionecrosis occurred in 4 patients (11\%), three of them requiring surgical decompression.(ABSTRACT TRUNCATED AT 250 WORDS

New perspectives in brachycurietherapy of malignant brain tumors. Preliminary report.

Between 1980 and 1988, 16 patients (9 females, 7 males) with malignant neuroepithelial tumors of the brain were treated by brachycurietherapy (BCT) and external radiation therapy (ERT) in a phase II nonrandomized study. There were 13 grade III and 3 grade IV tumors according to the WHO classification. Five patients in the grade III group who showed anaplastic foci in a generally grade II background were separately examined. Six patients received only BCT whereas 10 patients were treated by a combination of BCT and ERT, according to the tumor volume. We utilized as radioactive sources 192Ir in 14 cases and 125I in 2. Thirteen patients underwent permanent implant, 3 others received temporary irradiation with removable afterloaded catheters. The target volume was less than 50 cc in 8 cases, between 50 and 100 cc in 7, and larger than 100 cc in 1 patient. The total dose at the periphery of these volume ranged between 70 and 144 Gy. The result were analyzed referring to the following aspects: performance status, survival, side effects, grading. The impact of BCT was analyzed especially in a grade III with anaplastic foci group which showed a median survival of 6 years compared with only 2 years median survival of the pure grade III group

Interstitial irradiation for newly diagnosed or recurrent malignant gliomas: preliminary results.

The preliminary results obtained in 19 patients treated with interstitial irradiation for malignant gliomas are reported. Three different groups are included in the study: I Newly diagnosed tumours not suitable for surgery: 13 cases (10 anaplastic astrocytomas (AA) and 3 glioblastomas (GBM), mean volume 46.56 cc, source Ir 192) were implanted permanently (n = 11, mean peripheral dose 93.54 Gy) or temporarily (n = 2, 50 Gy = 0.5 Gy/hr). External beam irradiation was additionally applied in all cases. II Residual or recurrent tumours: 5 patients (2 AA and 3 GBM, mean volume 7.2 cc, source Ir 192) received temporary implants (150 Gy peripheral dose = 1.5 Gy/hr) after surgery and conventional radiotherapy. III Newly diagnosed surgically removable tumours: only one patient with AA (15 cc volume, source Ir 192) received temporary implantation with the same dose regimen used in Group II before surgery and external beam irradiation. A median survival time of 26.75 mos (34.62 mos for AA, with 3 long-term survivors) was observed in the patients of Group I. Three patients of Group II are still alive after 8, 12 and 12 mos after brachytherapy, the other 2 (GBM) survived 7 and 12 mos. The single patient so far included in Group III is still alive after 6 mos. Although the study is still in progress, these preliminary data seem to indicate that interstitial radiotherapy can be effective in prolonging survival of patients with malignant gliomas

Reticulocytes can represent an early indicator of erythropoietic response to Darbepoetin alfa in the anemia by chemotherapy

Background: Darbepoetin is a new drug active in anemia from chemotherapy and 2-to 3- times longer serum half life then recombinant-human Epo (rHuEPO). Reticulocytes can constitute an useful parameter to check the medullar reserve and give an indication of the erythropoietic answer. Methods: 42 patients in chemotherapy were randomised in 3 groups: the first two reported severe asthenia and have been deal respective with (I) darbepoetin 2.25μg/kg once weekly or (II) rHuEPO 150 U/Kg three times weekly; the third group (III), used like control, did not report relevant asthenic symptoms. The study evaluated time zero, after 4 and 8 weeks hemoglobin, reticulocyte count,serum ferritin, transferrin and iron. Results: The group treated with darbepoetin reported an increase of Hb after 4 weeks of approximately 2 g/dl if the starting value were >10 g/dl (8pts), instead patients with values of Hb <10g/dl evidenced a lower improvement of Hb (approximately 1 g/dl after 8 weeks). In the same group 13/15 pts reported an important improvement of reticulocytes. The mean value increased from 12,3 to 30,4μl (range 19–66); five patients exceeded the 14,5 g/dl of Hb. Group treated with rHuEPO showed a lower increase of reticulocytes after 8 weeks, the mean value increase from 17,2 to 22,6μl (range 13 - 34). In the control group reticulocytes moved by 15,0 to 12,0μl (range 2–16) and hemoglobin value decreased during chemotherapy from 10,5 to 9,7 g/dl. Conclusions: We reported a significantly increase of reticulocytes after four and eight weeks in the group treated with darbepoetin, higher than the group with rHuEPO and much more than the control group. Therefore our study show that darbepoetin is the sooner effective drug in the improvement of anemia. We besides suggest that reticulocyte count is a very important parameter in the prediction of response to the erythropoietic agents

Is primary meningococcal arthritis in children more frequent than we expect? Two pediatric case reports revealed by molecular test

Abstract Background Primary meningococcal arthritis is a rare infectious disease that occurs in less than 3% of meningococcal infections and is characterized by arthritis without meningitis, fever, rash, or hemodynamic instability Barahona [Case Rep Orthop 4696014:2017 ]. There are no validated clinical criteria that can be used for the diagnosis. We present two pediatric cases of atypical presentation of meningococcal disease revealed by molecular tests. Case presentation The clinical presentation of the two children (6- and 9-years-old) was characterized by signs of arthritis. By Real Time Polymerase Chain Reaction (RT-PCR), we identified N. meningitidis serogroup Y in the joint fluid in both cases. After specific antimicrobial treatment, the clinical conditions of the two patients quickly improved during hospitalization. Conclusions. We believe that the incidence of meningococcal arthritis could be underestimated in those settings where the use of RT-PCR is limited. Clearer data on the incidence of meningococcal disease would help to design specific treatments and the best possible national vaccine strategies [Fiji Sci Rep 23:39784, 2016, J Infect 67:385-90, 2013]

Comments on brachycurie therapy of cerebral tumours.

Between 1980 and 1987 thirty patients harbouring cerebral neuroepithelial tumours have been treated with stereotactic brachycurie therapy (18 males, 12 females), either alone (n = 16) or combined with surgery (n = 7) and/or external radiotherapy (n = 10). There were 25 slowly growing tumours (grade I n = 1; grade II n = 24). The remaining 5 were malignant tumours (grade III n = 3; grade IV n = 2). The radioactive sources utilized were 192Ir in 26 cases and 125I in 4. Twenty-eight patients underwent permanent implantation, the other two received temporary irradiation with removable after-loaded catheters. Target volume was less than 15 cm3 in 6 cases, between 16-60 cm3 in 17 and more than 60 cm3 in 7. Tumour dose at the periphery of the target volume was: 70-100 Gy in 19 and 100-130 Gy in 9 of the cases treated with permanent implantation; the patients irradiated with removable implants received 40-60 Gy in 5-7 days. General follow-up ranged between 0.3 and 6.9 years (mean = 2.5 years). The results are analyzed with reference to the following aspects: 1) natural history of the disease; 2) modalities and goal of the treatment; 3) place of brachy therapy as sole treatment and combined with the other available therapeutical means