Saturday, May 31, 2014

iBook: Após um Tumor Cerebral

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APÓS UM TUMOR CEREBRAL

Júlio Pereira

Medicina, Livros, Profissional e técnico

23/01/2010

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Esta obra narra a história de um médico neurocirurgião que descobre que tem um tumor cerebral, após essa descoberta ele resolveu escrever um livro sobre seu dia-dia lidando com doentes graves. O livro vai revelando o médico e seus pacientes, cada um deles com seus medos e suas preocupações.

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Wednesday, May 28, 2014

Neurosurgery App

Neurosurgery Blog App


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A Prospective Phase II Trial of Fractionated Stereotactic Intensity Modulated Radiotherapy With or Without Surgery in the Treatment of Patients With 1 to 3 Newly Diagnosed Symptomatic Brain Metastases

A Prospective Phase II Trial of Fractionated Stereotactic Intensity Modulated Radiotherapy With or Without Surgery in the Treatment of Patients With 1 to 3 Newly Diagnosed Symptomatic Brain Metastases
Neurosurgery - Most Popular Articles

imageBACKGROUND: Several studies have demonstrated that omitting the routine use of adjuvant whole-brain radiation therapy for patients with newly diagnosed brain metastases may be a reasonable first-line strategy. Retrospective evidence suggests that fractionated stereotactic radiotherapy (fSRT) may have a lower level of toxicity with equivalent efficacy in comparison with radiosurgery. OBJECTIVE: To study the phase II efficacy of using a focally directed treatment strategy for symptomatic brain metastases by the use of fSRT with or without surgery and omitting the routine use of adjuvant whole-brain radiation therapy. METHODS: We used a Fleming single-stage design of 40 patients. Patients were eligible if they presented with 1 to 3 newly diagnosed symptomatic brain metastases, Karnofsky performance scale (KPS) greater than 60, and histological confirmation of primary disease. Patients underwent fSRT with the use of a dose of 30 Gy in 5 intensity-modulated fractions as primary or adjuvant treatment after surgical resection. The primary end point was the proportion of patients who experienced neurological death. Secondary end points were overall survival, time to KPS <70, and progression-free survival. RESULTS: Of 40 patients accrued, 39 were eligible for analysis. The proportion of patients dying of neurological causes was 13% (5 patients), which includes 3 patients with an unknown cause of death. Median overall survival, time to KPS <70, and progression-free survival were 16 (95% confidence interval, 9-23), 14 (95% confidence interval, 7-20), and 11 (95% confidence interval, 4-21) months, respectively. CONCLUSION: A focally directed treatment strategy using fSRT with or without surgery appears to be an effective initial strategy. Based on the results of this phase II clinical trial, further study is warranted. ABBREVIATIONS: CI, confidence interval CTV, clinical target volume fSRT, fractionated stereotactic radiotherapy GTV, gross tumor volume KPS, Karnofsky performance status OS, overall survival PFS, progression-free survival PTV, planning target volume RPA, recursive partition analysis SRS, stereotactic radiosurgery WBRT, whole-brain radiation therapy

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/06000/A_Prospective_Phase_II_Trial_of_Fractionated.9.aspx
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[Correspondence] 18F-FDG PET/CT scans for children and adolescents – Authors' reply

[Correspondence] 18F-FDG PET/CT scans for children and adolescents – Authors' reply
The Lancet Oncology

In response to Michael Lassmann and colleagues, we agree that CT and PET/CT scans can save lives by providing the information needed to cure a child with a newly diagnosed tumour. However, the so-called as low as reasonably achievable principle—endorsed by the Alliance for Radiation Safety in Pediatric Imaging (Image Gently Campaign)—suggests dose adjustments for radiological staging procedures in children, and alternative ionising radiation-free imaging whenever practically feasible. Our Article provides some of the first evidence that radiation-free imaging for children with cancer is now available.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70222-0/fulltext?rss=yes
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[Correspondence] Stereotactic radiosurgery for patients with brain metastases – Authors' reply

[Correspondence] Stereotactic radiosurgery for patients with brain metastases – Authors' reply
The Lancet Oncology

We thank Filippo Alongi and colleagues for their interest in our work. We are aware that there has been a debate for more than 20 years as to whether it is meaningful to calculate survival after stereotactic radiosurgery in a cohort, because about 90% of patients died in our study due to extracerebral disease progression after stereotactic radiosurgery for brain metastases. However, overall survival is still the most certain endpoint, as reported by Korn and colleagues, and the majority of previous studies have used overall survival to assess results after stereotactic radiosurgery.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70221-9/fulltext?rss=yes
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[Correspondence] Stereotactic radiosurgery for patients with brain metastases – Authors' reply

[Correspondence] Stereotactic radiosurgery for patients with brain metastases – Authors' reply
The Lancet Oncology

We thank Filippo Alongi and colleagues for their interest in our work. We are aware that there has been a debate for more than 20 years as to whether it is meaningful to calculate survival after stereotactic radiosurgery in a cohort, because about 90% of patients died in our study due to extracerebral disease progression after stereotactic radiosurgery for brain metastases. However, overall survival is still the most certain endpoint, as reported by Korn and colleagues, and the majority of previous studies have used overall survival to assess results after stereotactic radiosurgery.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70221-9/fulltext?rss=yes
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[News] Organs from some cancer patients safe for transplantation

[News] Organs from some cancer patients safe for transplantation
The Lancet Oncology

Donor organs from patients with some cancers could be safely used for transplantation, a UK Government report has concluded.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70194-9/fulltext?rss=yes
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[Cancer and Society] Life, love, and loss: a tale of terminal cancer

[Cancer and Society] Life, love, and loss: a tale of terminal cancer
The Lancet Oncology

Mario has terminal cancer. With not much longer left to live, he sets out on a final delivery journey in his truck with his 10-year-old son, Lito, to give him an experience to remember him by. Meanwhile, his wife, Elena, remains at home, anxiously waiting for the pair to return and struggling to deal with her own grief and inner turmoil. Talking to Ourselves, the short novel by Spanish-Argentinian author Andres Neuman, is the story of one family's experience of a life cut short by cancer.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70258-X/fulltext?rss=yes
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Teaching NeuroImages: Leptomeningeal lung carcinoma

Teaching NeuroImages: Leptomeningeal lung carcinoma
Neurology current issue

A 55-year-old woman with lung cancer presented with leg numbness. Her systemic disease was well-controlled. MRI was precluded by a metallic cardiac device and spinal CT was unremarkable. On 2 occasions, examination of CSF demonstrated minimally elevated protein, but no abnormal cells. CT myelogram revealed bulky disease and CSF obtained a third time during the procedure confirmed the diagnosis (figure). To detect leptomeningeal carcinomatosis with 90%–98% sensitivity, 3 taps are needed. False-negatives can be minimized by withdrawal of 10.5 mL of CSF and immediate processing.1,2



Original Article: http://www.neurology.org/cgi/content/short/82/21/e183?rss=1
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Emerging Subspecialties in Neurology: Neuropalliative care

Emerging Subspecialties in Neurology: Neuropalliative care
Neurology recent issues

Palliative medicine, as defined by World Health Organization, is the specialty that recognizes and attempts to prevent or alleviate physical, social, psychological, and spiritual suffering.1 Understanding the principles of palliative care should be an essential component of neurologic training, as the trajectory of many neurologic illnesses is progressive and incurable.2 Given the delicate nature of many of the conversations that neurologists have with patients at the time of diagnosis or during acute illness and hospitalization, expertise in discussing a patient's wishes, handling difficult conversations, and providing adequate symptom-based management is critical. Neurologists are often viewed as consulting physicians; however, patients living with chronic neurologic diseases such as multiple sclerosis, dementia, Parkinson disease, amyotrophic lateral sclerosis (ALS), or sequelae of stroke often consider their neurologist as one of their primary physicians. Therefore, neurologists are positioned in both the outpatient and inpatient care settings not only to address symptoms referable to the disease but also to improve overall quality of life for patients and caregivers and to facilitate end-of-life care.



Original Article: http://www.neurology.org/cgi/content/short/82/21/e180?rss=1
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Wednesday, May 21, 2014

Management of brain metastases with stereotactic radiosurgery alone versus whole brain irradiation alone versus both

Management of brain metastases with stereotactic radiosurgery alone versus whole brain irradiation alone versus both
Radiation Oncology

IntroductionThis prospective randomized study aimed to evaluate the role of WBRT + SRS compared to SRS alone and to WBRT alone in improvement of overall survival, brain local control and neurologic manifestations.Patients and methods: The trial included 60 patients with 1 to 3 brain metastases treated at the Radiotherapy Department, National Cancer Institute. 21 patients received WBRT + SRS, 18 patients received SRS alone and 21 patients received WBRT alone. Results: Median local control was significantly better for WBRT + SRS compared to SRS alone &WBRT alone (10 vs 6 vs 5 months, respectively, P = 0.04). There was non significant survival benefit for WBRT + SRS compared to SRS alone & WBRT alone. Survival was significantly better for patients with controlled primary tumor who received WBRT + SRS compared to SRS alone & WBRT alone (median survival was 12 vs 5.5 vs 8 months, respectively. P = 0.027). Regardless of the treatment group, median survival and median local control were highly significantly better for single brain site involvement compared to multiple brain sites involvement (P = 0.003 & P = 0.001, respectively), and median brain local control was significantly better for single lesion compared to multiple lesions (P = 0.05). Conclusions: WBRT + SRS is an effective, safe tool in treatment of patients with 1 to 3 brain metastses improving the brain local control, but further studies with larger number of patients is recommended.

Original Article: http://www.ro-journal.com/content/9/1/116
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Intraoperative Contrast-Enhanced Ultrasound for Brain Tumor Surgery

Intraoperative Contrast-Enhanced Ultrasound for Brain Tumor Surgery
Neurosurgery - Most Popular Articles

imageBACKGROUND: Contrast-enhanced ultrasound (CEUS) is a dynamic and continuous modality that offers a real-time, direct view of vascularization patterns and tissue resistance for many organs. Thanks to newer ultrasound contrast agents, CEUS has become a well-established, live-imaging technique in many contexts, but it has never been used extensively for brain imaging. The use of intraoperative CEUS (iCEUS) imaging in neurosurgery is limited. OBJECTIVE: To provide the first dynamic and continuous iCEUS evaluation of a variety of brain lesions. METHODS: We evaluated 71 patients undergoing iCEUS imaging in an off-label setting while being operated on for different brain lesions; iCEUS imaging was obtained before resecting each lesion, after intravenous injection of ultrasound contrast agent. A semiquantitative, offline interobserver analysis was performed to visualize each brain lesion and to characterize its perfusion features, correlated with histopathology. RESULTS: In all cases, the brain lesion was visualized intraoperatively with iCEUS. The afferent and efferent blood vessels were identified, allowing evaluation of the time and features of the arterial and venous phases and facilitating the surgical strategy. iCEUS also proved to be useful in highlighting the lesion compared with standard B-mode imaging and showing its perfusion patterns. No adverse effects were observed. CONCLUSION: Our study is the first large-scale implementation of iCEUS in neurosurgery as a dynamic and continuous real-time imaging tool for brain surgery and provides the first iCEUS characterization of different brain neoplasms. The ability of CEUS to highlight and characterize brain tumor will possibly provide the neurosurgeon with important information anytime during a surgical procedure. ABBREVIATIONS: CE, contrast enhancement CEUS, contrast-enhanced ultrasound EFSUMB, European Federation of Societies for Ultrasound in Medicine and Biology 5-ALA, 5-aminolevulinic acid iCEUS, intraoperative contrast-enhanced ultrasound UCA, ultrasound contrast agent; US, ultrasound

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/05000/Intraoperative_Contrast_Enhanced_Ultrasound_for.9.aspx
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Patterns of presentation and failure in patients with gliomatosis cerebri treated with partial-brain radiation therapy

Patterns of presentation and failure in patients with gliomatosis cerebri treated with partial-brain radiation therapy
Cancer

BACKGROUND

The patterns of lobar involvement, optimal treatment, and disease course among patients with gliomatosis cerebri (GC) have not been fully characterized. The current study evaluates the clinical presentations and outcomes for patients with GC treated with radiation therapy (RT) at our institution.

METHODS

A total of 26 patients (25 with follow-up) with GC were diagnosed and treated between January 2004 and June 2012. Inclusion criteria consisted of brain magnetic resonance imaging and neuroradiology confirmation of contiguous involvement of ≥ 3 lobes/lobar equivalents with preservation of neural architecture. Patients were treated with either partial-brain RT to involved tumor (25 patients) or whole-brain RT (1 patient). The median RT dose was 54.0 Gray. The median follow-up was 17.3 months.

RESULTS

The median age of the patients at the time of diagnosis was 57 years. Twenty-one patients (81%) and 5 patients (19%) had 3 to 6 and ≥ 7 involved lobes/lobar equivalents, respectively. The median progression-free survival and overall survival were 7.4 months and 14.9 months, respectively. Fifteen patients experienced radiographic disease progression after partial-brain RT, 14 of whom (93%) developed infield disease recurrence. On univariate analysis, higher tumor grade and type II GC (with focal mass) were associated with a poorer progression-free survival. The extent of lobar involvement and chemotherapy were not associated with overall survival.

CONCLUSIONS

Even with partial-brain RT, nearly all disease recurrences were infield and clinical outcomes were similar to previous GC series, thereby suggesting that whole-brain RT is not necessary for this patient population. A greater number of involved lobes did not correlate with inferior outcomes. Further studies are necessary to establish more uniform and optimal treatments for this rare disease. Cancer 2014. © 2014 American Cancer Society.



Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28785
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Incidence, Cost, and Mortality Associated With Hospital-Acquired Conditions After Resection of Cranial Neoplasms

Incidence, Cost, and Mortality Associated With Hospital-Acquired Conditions After Resection of Cranial Neoplasms
Neurosurgery - Current Issue

imageBACKGROUND: In 2007, the Centers for Medicare and Medicaid Services stopped reimbursing for treatment of specified hospital-acquired conditions (HACs), also known as "never events." OBJECTIVE: To establish benchmarks for HACs after common neurosurgical oncologic procedures. METHODS: We identified adults in the Nationwide Inpatient Sample between 2002 and 2009 who underwent resection of a benign or malignant brain tumor. Baseline demographics, medical comorbidities, and hospital-level variables were assessed. A generalized estimating equation, multivariable-logistic model was used to identify predictors of HACs, mortality, prolonged hospital length of stay, and increased hospital charges. RESULTS: We identified 310,133 patients undergoing surgical treatment of a cranial neoplasm; 5.4% experienced an HAC. More medical comorbidities and the presence of an immediate postoperative neurosurgical complication increased one's risk of having an HAC (odds ratios: 1.56 and 2.48, respectively; both P < .01). Patients who experienced an HAC faced increased in-hospital mortality (6.47% vs 1.53%; P < .01) and increased total hospital costs ($52,882.61 vs $25,569.45; P < .01). Patients at urban teaching hospitals and those with a high surgical volume were more likely to experience an HAC compared with those treated at rural nonteaching hospitals and those with a low surgical volume (odds ratios: 1.33 and 1.16, respectively; P < .01). CONCLUSION: We found a 5.4% incidence of HACs after neurosurgical oncologic procedures, which varied based on several patient and hospital-level factors. A thorough analysis of the relationship between patient, procedure, and HAC incidence will be important to developing fair compensation practices for physicians as well as payers. Additionally, further investigation may identify opportunities for future quality improvement initiatives. ABBREVIATIONS: CI, confidence interval CMS, Centers for Medicare and Medicaid Services DVT, deep venous thrombosis HAC, hospital-acquired condition NIS, Nationwide Inpatient Sample PE, pulmonary embolism

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/06000/Incidence,_Cost,_and_Mortality_Associated_With.14.aspx
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Magnetic Resonance-Guided Laser Ablation Improves Local Control for Postradiosurgery Recurrence and/or Radiation Necrosis

Magnetic Resonance-Guided Laser Ablation Improves Local Control for Postradiosurgery Recurrence and/or Radiation Necrosis
Neurosurgery - Current Issue

imageBACKGROUND: Enhancing lesions that progress after stereotactic radiosurgery are often tumor recurrence or radiation necrosis. Magnetic resonance-guided laser-induced thermal therapy (LITT) is currently being explored for minimally invasive treatment of intracranial neoplasms. OBJECTIVE: To report the largest series to date of local control with LITT for the treatment of recurrent enhancing lesions after stereotactic radiosurgery for brain metastases. METHODS: Patients with recurrent metastatic intracranial tumors or radiation necrosis who had previously undergone radiosurgery and had a Karnofsky performance status of >70 were eligible for LITT. Sixteen patients underwent a total of 17 procedures. The primary end point was local control using magnetic resonance imaging scans at intervals of >4 weeks. Radiographic outcomes were followed up prospectively until death or local recurrence (defined as >25% increase in volume compared with the 24-hour postprocedural scan). RESULTS: Fifteen patients (age, 46-82 years) were available for follow-up. Primary tumor histology was non–small-cell lung cancer (n = 12) and adenocarcinoma (n = 3). On average, the lesion size measured 3.66 cm3 (range, 0.46-25.45 cm3); there were 3.3 ablations per treatment (range, 2-6), with 7.73-cm depth to target (range, 5.5-14.1 cm), ablation dose of 9.85 W (range, 8.2-12.0 W), and total ablation time of 7.43 minutes (range, 2-15 minutes). At a median follow-up of 24 weeks (range, 4-84 weeks), local control was 75.8% (13 of 15 lesions), median progression-free survival was 37 weeks, and overall survival was 57% (8 of 14 patients). Two patients experience recurrence at 6 and 18 weeks after the procedure. Five patients died of extracranial disease progression; 1 patient died of neurological progression elsewhere in the brain. CONCLUSION: Magnetic resonance imaging-guided LITT is a well-tolerated procedure and may be effective in treating tumor recurrence/radiation necrosis. ABBREVIATIONS: FLAIR, fluid-attenuated inversion-recovery LITT, laser-induced thermal therapy RN, radiation-induced cerebral necrosis SRS, stereotactic radiosurgery

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/06000/Magnetic_Resonance_Guided_Laser_Ablation_Improves.16.aspx
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Critical appraisal of RapidArc radiosurgery with flattening filter free photon beams for benign brain lesions in comparison to GammaKnife: a treatment planning study

Critical appraisal of RapidArc radiosurgery with flattening filter free photon beams for benign brain lesions in comparison to GammaKnife: a treatment planning study
Radiation Oncology - Latest Articles

Background: To evaluate the role of RapidArc (RA) for stereotactic radiosurgery (SRS) of benign brain lesions in comparison to GammaKnife (GK) based technique. Methods: Twelve patients with vestibular schwannoma (VS, n = 6) or cavernous sinus meningioma (CSM, n = 6) were planned for both SRS using volumetric modulated arc therapy (VMAT) by RA. 10MV flattening filter free photon beams with a maximum dose rate of 2400MU/min were selected. Data were compared against plans optimised for GK. A single dose of 12.5Gy was prescribed. The primary objective was to assess treatment plan quality. Secondary aim was to appraise treatment efficiency. Results: For VS, comparing best GK vs. RA plans, homogeneity was 51.7 +/- 3.5 vs. 6.4 +/- 1.5%; Paddick conformity Index (PCI) resulted 0.81 +/- 0.03 vs. 0.84 +/- 0.04. Gradient index (PGI) was 2.7 +/- 0.2 vs. 3.8 +/- 0.6. Mean target dose was 17.1 +/- 0.9 vs. 12.9 +/- 0.1Gy. For the brain stem, D1cm3 was 5.1 +/- 2.0Gy vs 4.8 +/- 1.6Gy. For the ipsilateral cochlea, D0.1cm3 was 1.7 +/- 1.0Gy vs. 1.8 +/- 0.5Gy. For CSM, homogeneity was 52.3 +/- 2.4 vs. 12.4 +/- 0.6; PCI: 0.86 +/- 0.05 vs. 0.88 +/- 0.05; PGI: 2.6 +/- 0.1 vs. 3.8 +/- 0.5; D1cm3 to brain stem was 5.4 +/- 2.8Gy vs. 5.2 +/- 2.8Gy; D0.1cm3 to ipsi-lateral optic nerve was 4.2 +/- 2.1 vs. 2.1 +/- 1.5Gy; D0.1cm3 to optic chiasm was 5.9 +/- 3.1 vs. 4.5 +/- 2.1Gy. Treatment time was 53.7 +/- 5.8 (64.9 +/- 24.3) minutes for GK and 4.8 +/- 1.3 (5.0 +/- 0.7) minutes for RA for schwannomas (meningiomas). Conclusions: SRS with RA and FFF beams revealed to be adequate and comparable to GK in terms of target coverage, homogeneity, organs at risk sparing with some gain in terms of treatment efficiency.

Original Article: http://www.ro-journal.com/content/9/1/119
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Friday, May 16, 2014

Top 100 Most Prescribed, Top Selling Drugs

Top 100 Most Prescribed, Top Selling Drugs
Medscape Today- Medscape

The thyroid drug levothyroxine continues to be the most prescribed drug in the United States, and the antipsychotic aripiprazole continues to have the most sales, new data indicate.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/825053?src=rss
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Genetic factors identified that may aid survival from brain cancer

Genetic factors identified that may aid survival from brain cancer
Neurology News & Neuroscience News from Medical News Today

A Henry Ford Hospital research team has identified specific genes that may lead to improved survival of glioblastoma, the most common and deadly form of cancerous brain tumor.

Original Article: http://www.medicalnewstoday.com/releases/276772.php
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Twitter Opinion Quickly Stablizes

Twitter Opinion Quickly Stablizes
Scientific American: Mind and Brain

A study of millions of tweets found that public opinion quickly solidifies, even without an overwhelming concensus. Allie Wilkinson reports.  

-- Read more on ScientificAmerican.com


Original Article: http://www.scientificamerican.com/podcast/episode/twitter-opinion-quickly-solidifies/
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Tuesday, May 13, 2014

Radiation dose for pediatric brain CT reduced by iterative reconstruction techniques

Radiation dose for pediatric brain CT reduced by iterative reconstruction techniques
Neurology News & Neuroscience News from Medical News Today

A study conducted at Massachusetts General Hospital and Harvard Medical School found that estimated radiation doses are substantially lower for pediatric CT exams of the brain that used an adaptive...

Original Article: http://www.medicalnewstoday.com/releases/276574.php
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Bevacizumab for glioblastoma: What can we learn from patterns of progression?

Bevacizumab for glioblastoma: What can we learn from patterns of progression?
Neurology recent issues

Glioblastoma is the most common type of malignant primary brain tumor and has a median survival of only 14.6–16 months.1,2 For patients whose tumors progress after standard radiotherapy with concomitant and adjuvant temozolomide chemotherapy, the treatment options are limited. Because glioblastomas are highly vascular tumors, therapies that target angiogenesis have generated substantial interest. In 2009, bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor, received accelerated approval from the US Food and Drug Administration for treatment of recurrent glioblastomas based on 2 phase II trials showing improved response rates and 6-month progression-free survival (PFS) compared to historical controls.3,4 However, the benefits of bevacizumab are transient, and tumors progress after a median of only 3–5 months.3,4 Once tumors progress on bevacizumab, further treatments are of little or no benefit.5



Original Article: http://www.neurology.org/cgi/content/short/82/19/1670?rss=1
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Tumors shrank or disappeared in some pediatric patients with advanced neuroblastoma in a Phase I study

Tumors shrank or disappeared in some pediatric patients with advanced neuroblastoma in a Phase I study
Neurology News & Neuroscience News from Medical News Today

Tumors shrank or disappeared and disease progression was temporarily halted in 15 children with advanced neuroblastoma enrolled in a safety study of an experimental antibody produced at St.

Original Article: http://www.medicalnewstoday.com/releases/276627.php
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Monday, May 12, 2014

Livro Digital: Após um tumor cerebral

Sinopse - APÓS UM TUMOR CEREBRAL

Sempre quis escrever, mas sempre pensava no impacto disso. Tinha uma carreira boa pela frente que não podia destruir por um impulso, um desejo infundado. Queria escrever o que eu via, os diálogos, as impressões, mas poderia ser mal interpretado. Podia criar um nome fantasia e contar a história. Mas sempre esse pensamento era parado por que algo me reprimia. Tudo isso se mudou num dia que senti uma forte dor de cabeça...



Amazon: http://goo.gl/l7kYcT
Google Play: http://goo.gl/3mWSUU
iBook: http://goo.gl/4ug4uO
Cultura: http://goo.gl/54GYza
IBA - http://goo.gl/PnEVO6
Saraiva - http://goo.gl/zKprGU
Skoob: http://goo.gl/WpkpvU
Bertrant (Portugal): http://goo.gl/hEjdxU
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Saturday, May 10, 2014

Check out "Neurosurgery"

Neurosurgery App

https://play.google.com/store/apps/details?id=com.sodavirtual.neurosurgery
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Oncology Scan—Molecular Genotyping of Medulloblastoma: A New Treatment Era

Oncology Scan—Molecular Genotyping of Medulloblastoma: A New Treatment Era
International Journal of Radiation Oncology * Biology * Physics

Medulloblastoma is the most common malignant central nervous system tumor of childhood. The current classification schemes are based primarily on histopathology, with treatment dependent upon risk stratification incorporating clinical factors of age, extent of surgical resection, and metastatic disease. For children more than 3 years of age, the current mainstay of treatment involves maximal surgical resection followed by adjuvant craniospinal irradiation (CSI) and boost, in combination with concurrent and maintenance chemotherapy. Although the poor prognostic impact of additional histopathological factors, such as large-cell variant and diffuse anaplasia, have been recognized, the incorporation of molecular genetic features into treatment strategies has previously been elusive. With advances in molecular genetics, it has now been recognized that medulloblastoma comprises a heterogeneous group of tumors with distinct genomic signatures and associated prognostic implications . Four principal transcriptional subgroups of medulloblastoma are recognized, which include: Wnt, Shh (sonic hedgehog), Group 3, and Group 4 . The Wnt and Shh groups are associated with biomarkers of aberrant signaling pathways that drive tumor initiation, whereas Group 3 and Group 4 are more vaguely defined as the underlying genetic alterations driving clinical outcomes that are less well understood. The identification of underlying biology as a clinical driver provides tremendous opportunities for better therapeutic targeting (eg, Shh inhibitors) and allows re-stratification of prognostic groups beyond the clinical markers in use today.

Original Article: http://www.redjournal.org/article/S0360-3016(13)03677-8/abstract?rss=yes
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Risk Factors for Brain Metastases in Locally Advanced Non-Small Cell Lung Cancer With Definitive Chest Radiation

Risk Factors for Brain Metastases in Locally Advanced Non-Small Cell Lung Cancer With Definitive Chest Radiation
International Journal of Radiation Oncology * Biology * Physics

Purpose: We intended to identify risk factors that affect brain metastases (BM) in patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving definitive radiation therapy, which may guide the choice of selective prevention strategies.Methods and Materials: The characteristics of 346 patients with stage III NSCLC treated with thoracic radiation therapy from January 2008 to December 2010 in our institution were retrospectively reviewed. BM rates were analyzed by the Kaplan-Meier method. Multivariate Cox regression analysis was performed to determine independent risk factors for BM.Results: The median follow-up time was 48.3 months in surviving patients. A total of 74 patients (21.4%) experienced BM at the time of analysis, and for 40 (11.7%) of them, the brain was the first site of failure. The 1-year and 3-year brain metastasis rates were 15% and 28.1%, respectively. In univariate analysis, female sex, age ≤60 years, non-squamous cell carcinoma, T3-4, N3, >3 areas of lymph node metastasis, high lactate dehydrogenase and serum levels of tumor markers (CEA, NSE, CA125) before treatment were significantly associated with BM (P 18 ng/mL (P=.008, HR=1.968) and CA125 ≥ 35 U/mL (P=.002, HR=2.129) were independent risk factors for BM. For patients with 0, 1, 2, and 3 to 4 risk factors, the 3-year BM rates were 7.3%, 18.9%, 35.8%, and 70.3%, respectively (P 18 ng/mL, and CA125 ≥ 35 U/mL were independent risk factors for brain metastasis. The possibilities of selectively using prophylactic cranial irradiation in higher-risk patients with LA-NSCLC should be further explored in the future.

Original Article: http://www.redjournal.org/article/S0360-3016(14)00210-7/abstract?rss=yes
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Fractionated stereotactic radiosurgery for patients with skull base metastases from systemic cancer involving the anterior visual pathway

Fractionated stereotactic radiosurgery for patients with skull base metastases from systemic cancer involving the anterior visual pathway
Radiation Oncology - Latest Articles

Background: To analyze the tumor control, survival outcomes, and toxicity after stereotactic radiosurgery (SRS) for skull base metastases from systemic cancer involving the anterior visual pathway.Patients and methods: We have analyzed 34 patients (23 females and 11 males, median age 59 years) who underwent multi-fraction SRS for a skull base metastasis compressing or in close proximity of optic nerves and chiasm. All metastases were treated with frameless LINAC-based multi-fraction SRS in 5 daily fractions of 5 Gy each. Local control, distant failure, and overall survival were estimated using the Kaplan-Meier method calculated from the time of SRS. Prognostic variables were assessed using log-rank and Cox regression analyses. Results: At a median follow-up of 13 months (range, 2-36.5 months), twenty-five patients had died and 9 were alive. The 1-year and 2-year local control rates were 89% and 72%, and respective actuarial survival rates were 63% and 30%. Four patients recurred with a median time to progression of 12 months (range, 6-27 months), and 17 patients had new brain metastases at distant brain sites. The 1-year and 2-year distant failure rates were 50% and 77%, respectively. On multivariate analysis, a Karnofsky performance status (KPS) >70 and the absence of extracranial metastases were prognostic factors associated with lower distant failure rates and longer survival. After multi-fraction SRS, 15 (51%) out of 29 patients had a clinical improvement of their preexisting cranial deficits. No patients developed radiation-induced optic neuropathy during the follow-up. Conclusions: Multi-fraction SRS (5 x 5 Gy) is a safe treatment option associated with good local control and improved cranial nerve symptoms for patients with a skull base metastasis involving the anterior visual pathway.

Original Article: http://www.ro-journal.com/content/9/1/110
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A randomized controlled trial of a multiple health behavior change intervention delivered to colorectal cancer survivors

A randomized controlled trial of a multiple health behavior change intervention delivered to colorectal cancer survivors
Cancer

BACKGROUND

Sedentary behavior may independently contribute to morbidity and mortality among survivors of colorectal cancer. In the current study, the authors assessed whether a telephone-delivered multiple health behavior change intervention had an effect on the sedentary behavior of recently diagnosed colorectal cancer survivors.

METHODS

A total of 410 participants were recruited through the Queensland Cancer Registry and randomized to the health coaching (intervention) or usual-care (control) group. Eleven health coaching sessions addressing multiple health behaviors, including sedentary behavior, were delivered over a period of 6 months. Data were collected at baseline (before randomization), at 6 months, and at 12 months via a telephone interview.

RESULTS

At 12 months, there was a significant decrease noted in the hours per day of sedentary time in both the health coaching (−1.21; 95% confidence interval [95% CI], −1.71 to −0.70) and usual-care groups (−0.55; 95% CI, −1.06 to −0.05), but the between-group difference was not found to be statistically significant (−0.65; 95% CI, −1.37 to 0.06 [P = .07]). In stratified subgroup analyses, the multiple health behavior change intervention was found to have a significant effect on total sedentary time (hours/day) at 12 months in survivors of colorectal cancer who were aged > 60 years (−0.90; 95% CI, −1.80 to −0.01 [P = .05]), male (−1.33; 95% CI, −2.44 to −0.21 [P = .02]), and nonobese (−1.10; 95% CI, −1.96 to −0.25; [P = .01]).

CONCLUSIONS

Incorporating simple messages about limiting sedentary behaviors into a multiple health behavior change intervention was found to have modest effects on sedentary behavior. A sedentary behavior-specific intervention strategy may be required to achieve substantial changes in sedentary behavior among colorectal cancer survivors. Cancer 2014. © 2014 American Cancer Society.



Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28773
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Wednesday, May 7, 2014

[Cancer and Society] Hyperthermia in cancer: is it coming of age?

[Cancer and Society] Hyperthermia in cancer: is it coming of age?
The Lancet Oncology

Interest in hyperthermia as an adjunct to conventional oncology treatments has increased over the past two decades. Hyperthermia now refers to heating tumours, tissues, or systems to temperatures of up to 42°C, either to sensitise tissue to conventional treatments, or to induce tumour regression. However, hyperthermia as therapy dates back millennia: liquids heated to vapour on stones or bricks were used to treat what was probably breast cancer by the Egyptians, Greeks and Romans.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70207-4/fulltext?rss=yes
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Teaching NeuroImages: Brain mass with hilar adenopathy: The importance of histologic diagnosis

Teaching NeuroImages: Brain mass with hilar adenopathy: The importance of histologic diagnosis
Neurology recent issues

A 30-year-old man presented with weeks of progressive headaches, imbalance, and aphasia. Brain MRI revealed an enhancing left frontal mass (figure 1, A and B). Chest imaging revealed mediastinal and hilar adenopathy (figure 1, C and D). Metastatic cancer was initially suspected, but pulmonary lymph node aspiration revealed sarcoidosis (figure 2A). Subsequent brain biopsy revealed glioblastoma (figure 2B).



Original Article: http://www.neurology.org/cgi/content/short/82/18/e161?rss=1
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Feasibility and Economic Impact of Dedicated Hospice Inpatient Units for Terminally Ill ICU Patients*

Feasibility and Economic Impact of Dedicated Hospice Inpatient Units for Terminally Ill ICU Patients*
Critical Care Medicine - Most Popular Articles

imageObjectives:End-of-life care is frequently provided in the ICU because patients receiving life-sustaining treatments are often unsuitable for transfer to home or community hospices. In-hospital dedicated hospice inpatient units are a novel option. This study was designed to 1) demonstrate the feasibility of ICU to dedicated hospice inpatient unit transfer in critically ill terminal patients; 2) describe the clinical characteristics of those transferred and compare them to similar patients who were not transferred; and 3) assess the operational and economic impact of dedicated hospice inpatient units. Design:Retrospective chart review. Setting:ICUs and dedicated hospice inpatient units at two southeast urban university hospitals. Interventions:Charts of ICU and dedicated hospice inpatient unit deaths over a 6-month period were reviewed. Patients:Dedicated hospice inpatient unit transfers were identified from hospice administrator records. Missed opportunities were patients admitted to the hospital for more than 48 hours who either adopted a comfort care course or had a planned termination of life-sustaining therapy. Patients were excluded if they were declared brain dead, were organ donors, required high-frequency ventilation, or if there was insufficient information in the medical record to make a determination. Measurements and Main Results:We identified 167 transfers and 99 missed opportunities; 37% of appropriate patients were not transferred. Transfers were older (66.9 vs 60.4 yr; p < 0.05), less likely to use mechanical ventilation (71.9% vs 90.9%) and vasopressors (70.9% vs 95.0%; p < 0.05), and less likely to receive a palliative care consult (70.4% vs 43.4%; p < 0.05) than missed opportunities. Transfers saved 585 ICU bed days. Conclusions:Dedicated hospice inpatient units are a feasible way to provide care for terminal ICU patients, but barriers including lack of knowledge of the units and provider or family comfort with leaving the ICU remain. Dedicated hospice inpatient units are potentially significant sources of bed days and cost savings for hospitals and the healthcare system overall.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/05000/Feasibility_and_Economic_Impact_of_Dedicated.7.aspx
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