Post-traumatic hydrocephalus is a contraindication for endoscopic third-ventriculostomy: isn't it?

OBJECTIVES: Post-traumatic hydrocephalus (PTH) is commonly considered as a relative contraindication for endoscopic third-ventriculostomy (ETV). However, few studies are available on this topic. METHODS: An analysis of the papers published in the last ten years has been performed, in order to assess the level of evidence on which the current indication for ETV for PTH is based. References were identified by PubMed searches of clinical articles relating to both PTH and ETV. Laboratory investigations were excluded. RESULTS: Only 5 articles were selected, for a total of 15 patients with PTH treated with ETV. All these patients were described by the authors to have a communicating hydrocephalus. No complications of surgery were reported. Outcome data were not available for one patient. Thirteen out of the remaining 14 patients had a clinical improvement after the surgical procedure (93%). Direct or indirect information on pre-operative ICP was available for 11 cases. Eight of them had an elevated ICP and presented a clinical improvement after ETV. CONCLUSIONS: There is no current evidence to support that PTH is a contraindication for ETV. Our data suggest that we could reconsider ETV for the treatment of PTH, especially for patients with elevated ICP. Prospective clinical trials (involving several centers, due to the difficulty of recruiting patients with PTH) are needed

Quality of Life after Invasive or Breast-Conserving Surgery for Breast Cancer

Breast surgery and its side effects can compromise the ability to perform daily functional activities resulting in impaired quality of life (QoL). Treatment‐related factors, including fatigue, pain, loss of upper extremity range of motion (ROM) and strength, anxiety, weight changes, unemployment, and neuropathy, have also been suggested to compromise functioning and QoL 1. For this reasons surgery is currently moving towards methods that are more conservative. Many studies investigated about cancer response, recovery and survival rate, which is improving in last years. So in the present study we focus on patient well‐being, even if it is very difficult to define QoL because it is a multidimensional measure, involving many different factors such as pain, fear’ and fatigue 2, among others. Breast‐specific concerns, such as altered sense of femininity, feelings of decreased attractiveness, and changes in body image and sexuality could affect general QoL. For the evaluation of QoL, we used the Short Form Health Survey Questionnaire (SF‐36). This questionnaire is composed by 36 items, gathered into eight scales: Physical Activity, Physical Role Limitation, General Health, Bodily Pain, Vitality, Social Activity, Emotional Role Limitation, and Mental Health. The first three scales evaluate physical wellness, whereas the last three are related to psychological wellness. The score for every scale ranges from 0 to 100, with 100 representing health 3. SF‐36 is one of the most used instrument in clinical investigations. We assessed SF‐36 in 63 consecutive unselected patients, followed up between January 2013 and January 2015. All patients underwent surgery for unilateral breast cancer (Breast Surgery Unit and Plastic Surgery Unit). 26 patients who received only sentinel lymph node dissection were excluded. Among the remaining 37 patients (Surgical Group) who received axillary lymphnodes dissection 16 underwent lumpectomy (Lumpectomy Group) and 21 mastectomy (Mastectomy Group) with reconstruction in the same surgery session. After surgery, patients were instructed on how to position their shoulder and arm in bed and how to carry out exercises for upper limbs after discharge. During hospitalization, the same physiotherapist treated all patients. Those who underwent lumpectomy, physical therapy started on the first postoperative day, while those who had mastectomy and immediate reconstruction started on the third postoperative day. All the patients received a brochure with home based exercises, consisting in active, active‐assisted and passive ROM exercises, stretching and upper‐limb strengthening exercises, with the aim of restoring muscular length and joint mobility 4. Evaluations were performed before (T0) and 1 (T1), 3 (T2), 6 (T3), 12 (T4) months after surgery. SF‐36 scores were compared with those of a control group age‐matched to the patients but without a diagnosis of breast cancer. We also aim to assess the impact of different tags as different surgery approach, conservative and demolitive, treatment related conditions, shoulder articular limitation, pain, lymphedema, and chemotherapy on QoL (Table 1)

Defocused Shock Wave Therapy for Chronic Soft Tissue Wounds in the Lower Limbs. A Pilot Study

Chronic soft tissue wounds of the lower limbs are debilitating, painful and often unresponsive to advanced dressing treatments. Extracorporeal shock wave therapy (ESWT) could represent an alternative treatment. Ten patients with chronic soft tissue wounds of the legs, unresponsive to advanced dressing treatments for more than 3 mo, underwent three defocused ESWT sessions at 72-h intervals. In every session, the sum of 300 standard pulses + 100 pulses per square centimeter was applied at 0.15 mJ/mm2 and 4 Hz over the edge of the wound. The wound size in square centimeters, Bates-Jensen Wound Assessment Tool and visual analogue scale were used as outcome measures. A significant reduction in wound size and Bates-Jensen Wound Assessment Tool and visual analogue scale values from pre-treatment to 90 d was observed. Seven of ten ulcers healed completely and nine of ten patients reported complete pain relief. Defocused ESWT represents a non-invasive, feasible strategy for difficult-to-treat soft tissue wounds of the lower limbs

High-grade glioma: elderly patients, older treatments

Patients aged 65 years or older represent half of all patients with glioblastoma. Nonetheless, this older cohort is often excluded from trials. The NOA-08 Phase III trial compared radiotherapy (RT) (60 Gy) versus temozolomide (TMZ; 100 mg/m(2)) in the elderly patients (65 years and older) with high-grade glioma. Median overall survival was comparable between the two groups (8.6-RT- and 9.6-TMZ-months). Resection extent was the only independent prognostic factor for overall survival. Several concerns arise: the inclusion of patients with a very low Karnofsky Performance Status (KPS; KPS = 20), the lack of an analysis of the impact of KPS and comorbidities on outcome, the salvage therapy administered at tumor progression (RT in the TMZ group and TMZ in the RT group), which could have balanced the effects of primary treatments, the absence of information on spread of disease/tumor site, the mixture of grade III and grade IV histologies. Ongoing trials evaluating RT plus TMZ, RT plus bevacizumab and other treatment modalities in the elderly population are going to change clinical practice in the near future