Primary spinal glioblastoma multiforme. Single center experience and literature review

Abstract Objectives Spinal glioblastomas represent a rare entity accounting for ca 1–3% of all intramedullary tumors; data about survival, prognostic factors and therapeutic protocols are quite poor. Even with an aggressive multimodal management the spinal glioblastoma patients' survival remains poor, with rapid progression of the disease. This study reports our experience with the management of the primary intramedullary glioblastomas, also in regard to the current literature data. Patients and Methods We retrospectively analyzed the medical records of 5 patients treated at the Department for Neuro-oncology and Spine Surgery of the Clinical Center of Belgrade, Serbia, between January 2007 and December 2016 for a primary intramedullary glioblastoma. Demographic characteristics, pre-operative data and post-operative results were then compared with previous literature regarding spinal GBMs and attempt to identify potential prognostic factors. Results Gross total resection was achieved in two patients, while a subtotal resection was performed in the latter 3 cases; as per protocol, all patients underwent to surgery, followed by radio and chemotherapy. There were no intraoperative complications and no patients developed a new postoperative neurological defect; the median overall survival was 6 months. Progression or recurrence of disease was noted in all patients at the 3-months follow-up, despite the adjuvant treatments. Conclusions To the date, there is a lack of consensus on specific management of spinal glioblastomas: the extent of resection can play an important role, but it appears to be not preeminent. A shorter interval between symptoms onset and treatment and a smaller extension of the tumor seem to be correlated with better outcomes and a longer overall survival. However, there is not an adjunctive viable standardized postoperative therapy yet, which results in concrete and persistent improvement of overall survival and progression free survival

Production of lead metal by molten-salt electrolysis with energy-efficient electrodes

"The U.S. Bureau of Mines investigated electrode designs for electrowinning lead metal from a LiCl-KCl-PbCl2 electrolyte at 450 deg C. The major objective of this investigation was to decrease the energy requirement for lead electrowinning. Electrolysis was performed in a bench-scale cell using several graphite electrode assemblies. Such parameters as electrode spacing, current density, and chlorine gas removal from the anode were investigated in the bench-scale tests. An optimum electrode assembly, termed the sawtooth design, was scaled up and operated at 3,000 and 4,000 A. The sawtooth electrodes operating at 3,000 A produced lead for 0.66 Kw.H/kg. The electrodes were constructed by cutting large triangular grooves in the electrode surfaces. The electrodes were placed together such that the triangular peaks of one electrode projected into the triangular valleys of the other electrode. Chlorine did not build up on the anode with the sawtooth electrodes." - NIOSHTIC-2NIOSHTIC no. 10008548199

Season-long control of flea and tick infestations in a population of cats in the Aeolian archipelago using a collar containing 10% imidacloprid and 4.5% flumethrin

Cats that have outdoor access are highly exposed to ticks, fleas, mites and flying insects, though the risk to become infested by arthropods is less perceived in cats than in dogs. This has resulted in fewer treatment and prevention options being available for cats than for dogs. A collar containing a combination of 10% imidacloprid and 4.5% flumethrin (Seresto®, Bayer Animal Health) is available for cats and licensed with claims against ticks and fleas for 7â8 months. Following the assessment of the efficacy of the collar against Leishmania infantum infection in privately owned cats living in the Aeolian archipelago, herein we report the efficacy of the collar in the treatment and prevention of tick and flea infestations in the same population of cats over a period of one year of observation. At the inclusion day (Study Day 0, SD 0), cats were visited and examined for ectoparasites (i.e., flea combing and tick thumb counts) and allocated to group 1 (G1; n = 104; cats treated with Seresto® collar) or group 2 (G2; n = 100; untreated controls) and further checked at SDs 210, 270 and 360 (study closure). At SD 0, G1 and G2 had a comparable percentage of cats infested by fleas (45.2% and 49.0%; Ï2 = 0.164; P = 0.6859) and ticks (6.7% and 14.0%; Ï2 = 2.946; P = 0.0861). The number of cats infested by fleas was reduced in G1, being 8.3%, 0% and 3.8% on SDs 210, 270 and 360, respectively, resulting in efficacies against fleas of 79.4%, 100% and 93.6% on SDs 210, 270 and 360. None of the cats in G1 was found infested by ticks after the application of the collar, whereas in G2 ticks were observed on 15.7%, 4.8%, 17.5% of the cats at the different follow up visits, leading to an overall efficacy against ticks of 100%. A total of 375 ectoparasites were collected from cats, being 249 fleas (six Ctenocephalides canis, 240 Ctenocephalides felis and three Nosopsyllus fasciatus) and 126 ticks (87 Ixodes ventalloi and 39 Rhipicephalus pusillus). Field data gathered herein confirm a high efficacy of the collar in the prevention of tick and flea infestations on cats. This is of great importance both for the primary role of fleas and ticks as blood feeding parasites and, more importantly, because of their role as vectors of pathogens causing diseases of veterinary and medical importance

Therapeutic efficacy of milbemycin oxime/praziquantel oral formulation (Milbemax®) against Thelazia callipaeda in naturally infested dogs and cats

BACKGROUND: Over the last few decades, canine and feline thelaziosis caused by Thelazia callipaeda eye worms has gained the attention of the veterinary community due to the spread of this ocular infestation in geographical areas previously regarded as non endemic. The therapeutic efficacy of milbemycin oxime/praziquantel tablets (Milbemax®) against T. callipaeda was tested in naturally infested dogs and cats. METHODS: From January 2009 to July 2011 a placebo controlled and randomized field study was conducted in T. callipaeda endemic areas of Switzerland (CH) and Italy (ITA) involving client-owned animals. Dogs (n = 56) and cats (n = 31) were physically examined at enrolment Day 0 (D0) and twice afterwards (D7 and D14). Infested animals were orally treated with Milbemax® or with placebo tablets on D0 and, if an animal was found still infested with T. callipaeda, also on D7. On D14 nematodes were flushed from the conjunctiva, identified and counted. RESULTS: Out of 56 dogs, 43 were included in the statistical analysis, whereas 13 were excluded because the products under investigation were not administered with food, as required by the label. On D7 and D14, 72.7% and 90.9% of treated dogs were eye worm free, whereas in the placebo group 95.2% and 76.2% still harbored nematodes, resulting in a mean percentage worm count reduction for the Milbemax® group of 86.1% and 96.8%, respectively. Both results were significantly higher (p = 0.0001) than the placebo group. Out of the 31 cats included in the study at D7 and D14, 53.3% and 73.3% treated with Milbemax® were free of T. callipaeda, while 81.3% and 73.3 in the placebo group were still harbouring eye worms, resulting in a mean percentage worm count reduction for the treated group of 62.2% and 80.0%, respectively. Both results were significantly higher (p = 0.0106 and p = 0.0043) than the placebo group. CONCLUSIONS: The commercial formulation of milbemycin oxime at the minimal dose of 0.5 mg/kg and 2 mg/k in dogs and cats, respectively, showed a high therapeutic efficacy in curing T. callipaeda infestations. The advantages of an oral application are additionally increased by the large spectrum of activity of praziquantel and milbemycin oxime against Cestodes and Nematodes infesting dogs and cats

Endoscopic transorbital eyelid approach for the removal of an extraconal cavernous venous malformation: Case report

Cavernous venous malformations (CVMs) are one of the most common benign primary orbital lesions in adults and the second most frequent cause of unilateral proptosis. Extraconal location is extremely rare, representing a favorable condition as compared to intraconal, as lesions at this level often adhere to orbital muscles and optic nerve. Herein, we report the case of a 50-year-old patient, who came to our attention because of progressive painless right axial proptosis. Magnetic resonance images were consistent with an extraconal CVM, occupying the superior temporal compartment of the orbit. Successful removal of the lesion was achieved through an endoscopic transorbital eyelid approach. The present case confirms the safety and efficacy of the endoscopic transorbital eyelid approach

Use of equine pericardium sheet (lyomesh®) as dura mater substitute in endoscopic endonasal transsphenoidal surgery

Objective: The aim of this study was to describe the use of equine pericardium sheet (Lyomesh®) as dural substitute for sellar reconstruction after endoscopic endonasal transsphenoidal surgery for the removal of pituitary adenomas. Methods: We reviewed data of patients that underwent surgery by means of an endoscopic endonasal transsphenoidal approach for the removal of pituitary adenomas over a 12-months period, starting in May 2012, i.e. when we adopted Lyomesh® (Audio Technologies, Piacenza, Italy) an equine pericardium sheet, as dura mater substitute. Results: During the 12-months period evaluated, we performed an endoscopic endonasal transsphenoidal operation for a variety of pituitary lesions on 102 consecutive patients. Among these, in 12 patients (9.4%) harboring a pituitary adenoma, the implant of the pericardium sheet was used. Four patients (33.3%) presented a small intraoperative cerebrospinal fluid (CSF) leak; in these cases the Lyomesh® was placed intradurally with fibrin glue and, thereafter, several layers were positioned in extradural space. In 8 other subjects without any evidence of CSF leak, the dural substitute was placed intradurally and fibrin glue was injected intradurally to hold the material in place. Conclusions: Even if based on a relatively small patient series, our experience demonstrated that the use of equine pericardium sheet (Lyomesh®) as dura mater substitute in transsphenoidal surgery is safe and biocompatible, as compared with other dural substitutes

Novel concepts and strategies in skull base reconstruction after endoscopic endonasal surgery

Recently, a variety of craniofacial approaches has been adopted to enter the skull base, among those, the endonasal endoscopic technique. An effective watertight thereafter: the reconstruction can be performed using different materials, both autologous and non-autologous, individually or combined in a multilayer fashion. The current study was focused on the development of new advanced devices and techniques, aiding in reducing postoperative CSF leak rate. Additive manufacturing allows the design of devices with tailored structural and functional features and, as well, injectable semi-IPNs and composites; therefore specific mechanical/rheological and injectability studies are valuable. Accordingly, we propose new additive-manufactured and injectable devices

Anatomy and surgery of the endoscopic endonasal approach to the skull base

The midline skull base is an anatomical area, which extends from the anterior limit of the anterior cranial fossa down to the anterior border of the foramen magnum. For many lesions of this area, a variety of skull base approaches including anterior, antero-lateral, and postero-lateral routes, have been proposed over the last decades, either alone or in combination, often requiring extensive neurovascular manipulation. Recently the endoscopic endonasal approach to the skull base has been introduced to access the midline skull base. The major potential advantage of the endoscopic endonasal technique is to provide a direct anatomical route to the lesion since it does not traverse any major neurovascular structures, thereby obviating brain retraction. The potential disadvantages include the relatively restricted exposure and the higher risk of CSF leak. In the present study we report the endoscopic endonasal anatomy of different areas of the midline skull base from the olfactory groove to the cranio-vertebral junction and accordingly describe the main features of the surgical approaches to each of these regions

Bilateral hypertrophy of masseteric and temporalis muscles, our fifteen patients and review of literature

OBJECTIVE: The association of bilateral hypertrophy of temporalis and masseteric muscles is a rare clinical entity. The origin of the condition is unclear, causing cosmetic problems, pain, and functional impairment. PATIENTS AND METHODS: In this paper we analyzed 15 patients treated at the Department of Maxillo-Facial Surgery of the University of Naples Federico II, from 2000 to 2013, for temporalis and/or masseteric muscle hypertrophy, and in particular, a rare case of a patient with a marked bilateral swelling of the temporalis and masseteric region, in conjunction with a review of the literature. RESULTS: Fourteen patients have not any kind of postoperatively problems. The last patient had been aware of the swelling for many years and complained of recurrent headaches. We adopted a new protocol fort these patients and the patient was very pleased with the treatment resul ts, and reported a reduct ion in headaches and a continuation of his well-being, in addition to greater self-confidence. The last follow-up was performed three years after the first treatment, and the patient showed a complete resolution of his symptoms, and just a small increase of the swelling. CONCLUSIONS: The treatment of temporalis and masseteric hypertrophy with Botulin toxin could be an effective option compared to conservative treatment or surgical intervention although the review of the literature shows that this is only a temporary treatment. In fact, surgery still remains the best option. The treatment must be repeated every 4/6 months for 2-3 consecutive years before having stable benefits. To overcome this problem, an association with a bite treatment allowed us to achieve more lasting and more stable results over time without a recurrence of symptoms between the treatments. Furthermore, this association has enabled us to obtain a more rapid reduction of the hypertrophy