1
|
Zadnik PL, Goodwin CR, Karami KJ, Mehta AI, Amin AG, Groves ML, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL, Sciubba DM. Outcomes following surgical intervention for impending and gross instability caused by multiple myeloma in the spinal column. J Neurosurg Spine 2015; 22:301-9. [DOI: 10.3171/2014.9.spine14554] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECT
Multiple myeloma is the most common primary tumor of the spine and is the most common primary malignant tumor of bone. Although spinal myeloma is classically a radiosensitive lesion, clinical or radiographic signs of instability merit surgical intervention. The authors present the epidemiology, surgical indications, and outcome data of a series of consecutive cases involving 31 surgically treated patients with diagnoses of multiple myeloma and plasmacytoma of the spine (the largest such series reported to date).
METHODS
Surgical instability was the criterion for operative intervention in this patient cohort. The Spinal Instability Neoplastic Score (SINS) was used to make this assessment of instability. The cases were analyzed using location of the lesion, spinal levels involved, Frankel score, adjuvant therapy, functional outcome, and patient survival.
RESULTS
All patients undergoing surgical intervention were determined to have indeterminate or gross spinal column instability according to SINS criteria. The median survival was 78.9 months. No significant difference in survival was seen for patients with higher SINS scores or for older patients (> 55 years). There was a statistically significant difference in survival benefit observed for patients receiving chemotherapy and radiation versus radiation alone as an adjuvant to surgery (p = 0.02).
CONCLUSIONS
In this 10-year analysis, the authors report outcomes of surgical intervention for patients with indeterminate or gross spinal instability due to multiple myeloma and plasmacytoma of the spine with improved neurological function following surgery and low rates of instrumentation failure.
Collapse
|
2
|
Karami KJ, Kelkar PS, Verdon MP, Grills IS, Bojrab DI, Pieper DR. Malignant Peripheral Nerve Sheath Tumor of the Vestibulocochlear Nerve and Brainstem. Neurosurgery 2011; 69:E1152-65; discussion E1165. [DOI: 10.1227/neu.0b013e318223bc2a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Malignant peripheral nerve sheath tumors are the most common malignant mesenchymal tumors of soft tissues, but they are very rare when found to arise from a cranial nerve and when not in association with neurofibromatosis. These tumors are highly malignant and carry a poor prognosis with survival usually less than 6 months.
CLINICAL PRESENTATION
The authors report the case of a 23-year-old female with no history of phakomatoses, previous irradiation, or known genetic disorders, who presented with a malignant peripheral nerve sheath tumor of the vestibulocochlear nerve and brainstem. Multiple staged skull base approaches were carried out with maximal possible resection. Adjunctive therapies including standard radiation therapy, intensity-modulated radiation therapy, and stereotactic gamma knife radiosurgery were used with an ultimate patient survival of 27 months.
CONCLUSION
To our knowledge, this is the first report describing a patient with a malignant peripheral nerve sheath tumor of the vestibulocochlear nerve and brainstem treated with staged surgical approaches in conjunction with multiple forms of radiotherapy and having a significant survival of more than 2 years.
Collapse
Affiliation(s)
- Kristophe J. Karami
- Department of Neurosurgery, St John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan
| | - Prashant S. Kelkar
- Department of Neurosurgery, St John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan
| | - Michael P. Verdon
- Department of Neurosurgery, St John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan
| | - Inga S. Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Dennis I. Bojrab
- Department of Otolaryngology, Michigan Ear Institute, Farmington Hills, Michigan
| | - Daniel R. Pieper
- Department of Neurosurgery, St John Providence Hospital and Medical Centers, Michigan State University, Southfield, Michigan
- Department of Neurosurgery, Michigan Head & Spine Institute, William Beaumont Hospital, Royal Oak, Michigan
| |
Collapse
|
3
|
Abstract
Simultaneous primary brain tumors in pediatric patients without prior chemotherapy or radiotherapy, phacomatosis, or known familial history are a rare occurrence. The authors report the case of a 4-year-old boy with simultaneous choroid plexus carcinoma and pilocytic astrocytoma with features of oligodendroglioma. Magnetic resonance imaging studies revealed diffuse heterogeneously enhancing left intraventricular and posterior fossa tumors initially believed most consistent with multicentric choroid plexus carcinomas. A multiple staged resection was carried out for each tumor and gross-total resection was achieved. Upon gross inspection intraoperatively as well as postoperative histological analysis, 2 distinct simultaneous tumors were identified: choroid plexus carcinoma and pilocytic astrocytoma. To the authors' knowledge this is the first case report published identifying 2 distinct tumor types with similar radiological appearances in a pediatric patient with no prior history of radiotherapy, chemotherapy, or phacomatosis.
Collapse
Affiliation(s)
- Kristophe J Karami
- Department of Neurosurgery, Providence Hospital and Medical Center, Michigan State University, Southfield, Michigan 48075, USA.
| | | | | | | | | |
Collapse
|
4
|
Karami KJ, Coppola JE, Krishnamurthy K, Llanos DJ, Venkatachalam K. Effect of Food Deprivation and Hormonal Regulation on Acetyl CoA Carboxylase Activity in Mouse Brain. FASEB J 2006. [DOI: 10.1096/fasebj.20.5.a956-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kristophe J Karami
- BiochemistryNova Southeastern University3200 South University Dr.Ft. LauderdaleFL33328‐2018
| | - John E Coppola
- BiochemistryNova Southeastern University3200 South University Dr.Ft. LauderdaleFL33328‐2018
| | - Karthik Krishnamurthy
- BiochemistryNova Southeastern University3200 South University Dr.Ft. LauderdaleFL33328‐2018
| | - Domingo J Llanos
- BiochemistryNova Southeastern University3200 South University Dr.Ft. LauderdaleFL33328‐2018
| | - K.V. Venkatachalam
- BiochemistryNova Southeastern University3200 South University Dr.Ft. LauderdaleFL33328‐2018
| |
Collapse
|
5
|
Karami KJ, Coppola J, Krishnamurthy K, Llanos DJ, Mukherjee A, Venkatachalam KV. Effect of food deprivation and hormones of glucose homeostasis on the acetyl CoA carboxylase activity in mouse brain: a potential role of acc in the regulation of energy balance. Nutr Metab (Lond) 2006; 3:15. [PMID: 16483370 PMCID: PMC1386674 DOI: 10.1186/1743-7075-3-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 02/16/2006] [Indexed: 12/02/2022] Open
Abstract
We studied the regulation of brain acetyl CoA carboxylase (ACC) activity during food deprivation and under the influence of hormones of glucose homeostasis: glucagon and insulin. Mice were deprived of food and water for time periods of 1, 3, 6, 9, 12 and 24 hours and were then allowed to re-feed for 5, 30 and 60 minutes. Mice that were deprived for up to 6 h, and then re-fed for 60 min, consumed the same amount of food compared to the ad libitum (control) animals. However, after 9 h of deprivation, mice consumed only 50% of food present even after 1 h of re-feeding, compared to the controls. The ACC activity was measured in the whole mouse brain of controls and after 1, 3, 6, 9, 12, and 24 h of food deprivation. Brain extracts assayed from control mice expressed an ACC activity of 0.988 ± 0.158 fmol/min/mg tissue without citrate and 0.941 ± 0.175 fmol/min/mg tissue with citrate. After 1 h of food deprivation, the total ACC activity without citrate decreased to 0.575 ± 0.087 fmol/min/mg and in the presence of citrate, 0.703 ± 0.036 fmol/min/mg activity was measured. The citrate-dependent ACC activity decreased over time, with only 0.478 ± 0.117 fmol/min/mg of activity remaining after 24 h. Intraperitoneal (i.p.) injections of insulin, glucagon and phosphate buffered saline (PBS) were performed and whole brain ACC activity measured. After hormone administration, there were no significant differences in ACC activity in the presence of citrate. However, in the absence of citrate, there was a significant 20% decrease in ACC activity with glucagon (1.36 ± 0.09 fmol/min/mg) and a 33% increase with insulin (2.49 ± 0.11 fmol/min/mg) injections compared to PBS controls (1.67 ± 0.08 fmol/min/mg). Neuropeptide Y (NPY) levels of corresponding brain extracts were measured by ELISA (OD) using anti-NPY antibody and showed an 18% decrease upon insulin injection (0.093 ± 0.019) and a 50% increase upon glucagon injection (0.226 ± 0.084) as compared to controls injected with PBS (0.114 ± 0.040). Thus, we postulate that the changes in ACC levels under metabolic conditions would result in a fluctuation of malonyl CoA levels, and subsequent modulation of NPY levels and downstream signaling.
Collapse
Affiliation(s)
- Kristophe J Karami
- College of Osteopathic Medicine, Health Professions Division, Nova Southeastern University, 3200 South University Drive, Ft. Lauderdale, Florida 33328-2018, USA
| | - John Coppola
- College of Osteopathic Medicine, Health Professions Division, Nova Southeastern University, 3200 South University Drive, Ft. Lauderdale, Florida 33328-2018, USA
| | - Karthik Krishnamurthy
- College of Osteopathic Medicine, Health Professions Division, Nova Southeastern University, 3200 South University Drive, Ft. Lauderdale, Florida 33328-2018, USA
| | - Domingo J Llanos
- Department of Biochemistry, College of Medical Sciences, Health Professions Division, Nova Southeastern University, 3200 South University Drive, Ft. Lauderdale, Florida 33328-2018, USA
| | - Amrita Mukherjee
- College of Osteopathic Medicine, Health Professions Division, Nova Southeastern University, 3200 South University Drive, Ft. Lauderdale, Florida 33328-2018, USA
| | - K V Venkatachalam
- Department of Biochemistry, College of Medical Sciences, Health Professions Division, Nova Southeastern University, 3200 South University Drive, Ft. Lauderdale, Florida 33328-2018, USA
| |
Collapse
|
6
|
Venkatachalam KV, Llanos DE, Karami KJ, Malinovskii VA. Isolation, partial purification, and characterization of a novel petromyzonol sulfotransferase from Petromyzon marinus (lamprey) larval liver. J Lipid Res 2004; 45:486-95. [PMID: 14657197 DOI: 10.1194/jlr.m300346-jlr200] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have isolated, partially purified, and characterized the 5 alpha-petromyzonol (5 alpha-PZ), (5 alpha-cholan- 3 alpha, 7 alpha, 12 alpha, 24-tetrahydroxy-) sulfotransferase (PZ-SULT) from larval lamprey liver. Crude liver extracts exhibited a PZ-SULT activity of 0.9120 pmol/min/mg in juvenile and 12.62 pmol/min/mg in larvae. Using crude larval liver extracts and various 5 beta-cholan substrates and allocholic acid there was negligible activity, however, with 5 alpha-PZ and 3-keto-5 alpha-PZ the SULT activity was 231.5 pmol/min/mg and 180.8 pmol/min/mg respectively. This established that the sulfotransferase of lamprey larval liver extracts prefers (5 alpha) substrates and it is selective for hydroxyl at C-24. PZ-SULT was purified through various chromatography procedures. Partially purified PZ-SULT exhibited a pH optimum of 8.0, a temperature optimum of 22 degrees C, and activity was linear for 1h. PZ-SULT exhibited a K(m) of 2.5 microM for PAPS and a K(m) of 8 microM for PZ. The affinity purified peak PZ-SULT exhibited a specific activity of 2,038 pmol/min/mg. The peak protein upon SDS-PAGE, correlated to an Mw 47 kDa. Photoaffinity labeling with PAP(35)S, specifically crosslinked the 47 kDa protein, further confirming the identity of PZ-SULT. Partial amino acid sequencing of the putative 47 kDa PZ-SULT protein yielded a peptide sequence (M)SISQAVDAAFXEI, which possessed an overall (approximately 35-40%) homology with mammalian SULT2B1a.
Collapse
Affiliation(s)
- K V Venkatachalam
- Department of Biochemistry, College of Medical Sciences, Health Profession Division, Nova Southeastern University, Ft. Lauderdale, FL 33328-2018, USA.
| | | | | | | |
Collapse
|