Effects of glucagon as a neurohormone on the central nervous system and glucose homeostasis

OBJECTIVE

This study aimed to elucidate the possible effects of the acute/long-term infusion of glucagon in the brain as the regulatory role on the endocrine secretions of the pancreas.

MATERIALS AND METHODS

Ninety male Wistar albino rats were divided as Control, artificial Cerebrospinal Fluid (aCSF) (120 min), Glucagon (120 min), pancreatic denervation (PD)+aCSF (120 min), PD+Glucagon (120 min), aCSF (7 days), Glucagon (7 days), PD+aCSF (7 days) and PD+Glucagon (7 days). Glucagon and solvent (aCSF) were administered after pancreatic denervation (PD) by Hamilton syringe and osmotic mini pump (1 µg/10 µl/min) in the third ventricle of the brain.

RESULTS

Acute intracerebroventricular (icv) administration of glucagon resulted in an elevation of glucagon levels and a concurrent reduction in blood glucose levels. Furthermore, in both the PD+aCSF (7 days) and PD+Glucagon (7 days) groups, there was a notable decrease in propiomelanocortin (POMC) and agouti-related protein (AgRP). Significant changes were observed in feed consumption and body weight, as well as pancreatic glucagon levels, with a simultaneous decrease in insulin levels in the PD (7 days), Glucagon (7 days), and PD+Glucagon (7 days) groups. These alterations were statistically significant when compared to the control group (p<0.05).

CONCLUSIONS

The research outcomes established that pancreas-secreted glucagon functions as a neurohormone within the brain, activating central pathways linked to blood glucose regulation. The presence of glucagon led to a decrease in POMC levels. Surprisingly, this reduction in POMC resulted in the suppression of AgRP. Contrary to expectations, the suppression of AgRP led to an increase in food intake rather than a decrease. As already highlighted in the results section, it was emphasized that POMC may play a more significant role than AgRP in influencing feeding behavior.

A rare case of raoultella planticola peritonitis in a chronic ambulatory peritoneal dialysis patient and review of the literature

Peritonitis is a common and serious complication of peritoneal dialysis and often primary factor of change over to hemodialysis treatment. Raoultella planticola is known as as environmental bacterium and rarely causes infections in humans. We present a case of peritoneal dialysis related peritonitis due to Raoultella planticola and review the clinical manifestations and treatment options of this microorganism. As far as we know, this is the third case of Raoultella planticola peritonitis in the literature.

[COVID-19: neurological manifestations-update : What we know so far]

Beyond pulmonary presentation, COVID-19 infection can manifest with a variety of both acute and chronic neurologic and neuropsychiatric (concomitant) symptoms and diseases. Nonspecific symptoms such as headache, fatigue, olfactory and gustatory disturbance have been reported more frequently, and severe disease such as encephalopathy, encephalitis, and cerebrovascular events have been reported relatively rarely. The heterogeneity of neurologic and neuropsychiatric presentations is large, as well as the range of recorded prevalences. Older patients, pre-existing neurologic and non neurologic comorbidities and severe COVID-19 disease were associated with increased risk of severe neurologic complications and higher in-hospital mortality. Probable neurotropic pathomechanisms of SARS-CoV‑2 have been discussed, but a multifactorial genesis of neurologic/neuropsychiatric symptoms and disease beyond these is likely.

The role of miRNAs targeting K-ras and APC genes in colorectal cancer

OBJECTIVES

The occurrence of abnormal expression patterns in different types of cancer suggests that micro RNAs (miRNAs) may play an important role in tumorigenesis. The aim of this study was to examine the expression levels of miRNAs known to be associated with the regulation of the expression levels of the APC and K-ras, which are important in the development of colorectal cancer (CRC).

METHODS

The expression levels of miR-27, miR-663, miR-217, miR-181d, APC and K-ras in the serum, tumor and adjacent tumor-free (healthy) tissues of the patients and serum of the healthy controls were investigated with qRT-PCR.

RESULTS

Expression levels of miR-217, mR-181d, miR-663, miR-27 and K-ras were found to be higher in CRC tissues than in adjacent tumor-free tissues of the patients. In patient serum samples, miR-663 levels were statistically more elevated than in controls. In patient tumor tissues, miR-217, miR-181d and miR-27 expressions were found to be higher.

CONCLUSIONS

Increased miR-181d and miR-217 expression levels are associated with increased K-ras expression in the tumor tissues, and the expression of K-ras, which takes part as an oncogene in the CRC development, might be regulated by these miRNAs (Tab. 4, Ref. 33).

[Anatomy of the petrous portion of the temporal bone]

CLINICAL METHOD

The complexity of the anatomy of the petrous portion of the temporal bone with the crossing nerval, vascular, and muscular structures together with the important parts of the human vestibulocochlear organ poses challenges in clinical routine, especially in the preoperative diagnostic workup. In particular, the presence of standard anatomical variations bears a higher risk of intraoperative injuries.

STANDARD RADIOLOGICAL METHOD

MRI and CT examinations are important image-based diagnostic methods in the detection of neoplastic, traumatic and inflammatory lesions of the petrous part of the temporal bone. These kinds of methods are absolutely necessary for the identification of the entity of the lesion, the extent of the infiltration, possible bone involvement or the presence of standard anatomical variations.

[Metabolic induced changes of the central nervous system]

CLINICAL ISSUE

The diagnosis of metabolic disorders of the central nervous system (CNS) can be very challenging for radiologists because of the nonspecific white matter lesions of the brain, the rarity of these diseases, and the variety of possible differential diagnoses.

RADIOLOGICAL STANDARD METHODS

Standard for the evaluation of the metabolic disorders is cranial MRI. The MRI spectroscopy can additionally help to reduce the possible differential diagnoses.

[Fetal magnetic resonance imaging]

CLINICAL ISSUE

The most important prenatal screening method for the detailed assessment of the fetus is ultrasound, which is often combined with colour-coded Doppler sonography. In case of sonographically diagnosed fetal pathologies or technical limitations of the ultrasound, supplementary diagnostics may be necessary.

STANDARD RADIOLOGICAL METHODS

With fast MRI sequences, fetal MRI screening provides important additional information especially with regard to the most common congenital pathologies-central nervous system (CNS) pathologies (agenesis of the corpus callosum, ventriculomegaly, arachnoid cyst, pathologies of the posterior cranial fossa, dysfunction of the gyrification). Knowledge of the developmental stages of the CNS is very important for accurate clinical assessment and interpretation.

[Cervical spine trauma]

CLINICAL/METHODICAL ISSUE

In the emergency department 65 % of spinal injuries and 2-5 % of blunt force injuries involve the cervical spine. Of these injuries approximately 50 % involve C5 and/or C6 and 30 % involve C2. Older patients tend to have higher spinal injuries and younger patients tend to have lower injuries. The anatomical and development-related characteristics of the pediatric spine as well as degenerative and comorbid pathological changes of the spine in the elderly can make the radiological evaluation of spinal injuries difficult with respect to possible trauma sequelae in young and old patients.

METHODICAL INNOVATIONS

Two different North American studies have investigated clinical criteria to rule out cervical spine injuries with sufficient certainty and without using imaging.

PRACTICAL RECOMMENDATIONS

Imaging of cervical trauma should be performed when injuries cannot be clinically excluded according to evidence-based criteria. Degenerative changes and anatomical differences have to be taken into account in the evaluation of imaging of elderly and pediatric patients.

[Shaken baby syndrome]

The shaken baby syndrome (SBS) or shaking trauma describes the occurrence of subdural hematoma, retinal hemorrhage and diffuse injury to the brain by vigorous shaking of an infant that has a poor prognosis. Rapid cranial acceleration and deceleration leads to tearing of bridging veins, retinal hemorrhages and diffuse brain injuries. In addition to clinical symptoms, such as irritability, feeding difficulties, somnolence, apathy, seizures, apnea and temperature regulation disorders, vomiting also occurs due to increased intracranial pressure. Milder forms of SBS often go undiagnosed and the number of unreported cases (grey area) is probably much higher. Up to 20 % of patients die within days or weeks due to SBS and survivors often show cognitive deficits and clinical symptoms, such as physical disabilities, impaired hearing, impaired vision up to blindness, epilepsy and mental retardation as well as a combination of these conditions; therefore, prevention is very important.

Are serum leptin levels a prognostic factor in advanced lung cancer?

AIM

The aim of the present study was to evaluate pre-treatment concentrations of leptin in patients with advanced lung cancer and to investigate possible associations between their levels and clinicopathological variables, response to therapy and overall survival.

MATERIAL AND METHODS

There are 71 previously untreated patients with cytological or histological evidence of primary lung cancer who were admitted to the oncology department between November 2013 and August 2014. Forty-five healthy individuals with age, sex and BMI matching the lung cancer patients, were recruited to take part in the study as a control group. Leptin levels were measured quantitatively by using a microELISA kit.

RESULTS

The serum leptin levels at diagnosis were significantly lower in lung cancer patients than those in control subjects (4.75±4.91 ng/ml, 9.67±8.02 ng/ml; p<0.001). We did not find any significant difference in leptin values related to clinicopathological parameters such as ECOG PS, weight loss, histological type, disease stage and TNM classification. Nevertheless, we demonstrated a significant correlation between serum leptin levels and BMI in lung cancer patients (correlation coefficient: 0.303; p>0.010). The analysis of serum leptin values did not show any association with the overall survival of the patients.

CONCLUSION

Our results showed that the serum leptin level has no prognostic indications in advanced lung cancer patients. Leptin is decreased in lung cancer, and there is lack of correlation with tumour‑related factors including prognosis. Therefore, leptin is not a useful clinical marker in lung cancer (Tab. 2, Fig. 2, Ref. 22).

Assessment of Palliative Care in Lung Cancer in Turkey

OBJECTIVE

To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms.

SUBJECTS AND METHODS

This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis.

RESULTS

The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled.

CONCLUSION

In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

Superficial Siderosis after Germinal Matrix Hemorrhage

BACKGROUND AND PURPOSE

Germinal matrix hemorrhage is a frequent complication of prematurity and can be associated with adverse neurodevelopmental outcome, depending on its severity. In addition to parenchymal damage, intraventricular residues of hemorrhage and hydrocephalus MR imaging findings include superficial siderosis. The purpose of this study was to investigate the prevalence and location of superficial siderosis in patients with a history of germinal matrix hemorrhage.

MATERIALS AND METHODS

We retrospectively identified patients with a history of germinal matrix hemorrhage who underwent MR imaging in our institution between 2008 and 2016. Imaging was evaluated for the presence and location of superficial siderosis. The presence of subependymal siderosis and evidence of hydrocephalus were assessed.

RESULTS

Thirty-seven patients with a history of germinal matrix hemorrhage were included; 86.5% had preterm births. The mean age at the first MR imaging was 386 days (range 2-5140 days). The prevalence of superficial siderosis was 67.6%. Superficial siderosis was detected significantly more often when MR imaging was performed within the first year of life (82.8% versus 12.5%, P < .000). When present, superficial siderosis was located infratentorially in all cases, while additional supratentorial superficial siderosis was detectable in 27%.

CONCLUSIONS

Here we report that superficial siderosis is a common MR imaging finding in the first year of life of patients with a history of germinal matrix hemorrhage, but it dissolves and has a low prevalence thereafter. A prospective analysis of its initial severity and speed of dissolution during this first year might add to our understanding of the pathophysiology of neurodevelopmental impairment after germinal matrix hemorrhages.

[Alzheimer's disease]

Alzheimer's disease is a progressive neurodegenerative disorder with characteristic neuropathological changes. It is the most common form of dementia. As a definitive diagnosis requires a neuropathological examination, clinical criteria have been established for the diagnostics of a probable Alzheimer's disease. In addition to the articles in this issue that focus on the imaging of dementia, this article provides a brief overview of clinically relevant aspects of Alzheimer's disease.

[Mechanical thrombectomy - technique]

Mechanical thrombectomy with stent retrievers in acute stroke has emerged as the technique with the highest recanalization rate of therapeutic procedures available so far. Recently it was demonstrated that compared to intravenous rTPA alone, mechanical thrombectomy improves outcomes of patients with acute occlusions of intracranial arteries of the anterior circulation in several randomized clinical trials. In this article we will give an overview of the steps required for the thrombectomy procedure.

[Mechanical Thrombectomy - Recent Trials]

BACKGROUND

The publications of five prospective randomized trials have made 2015 a milestone in the development of stroke therapy. Up till then, IV rtPA had been the only evidence-based recanalizing treatment for ischemic stroke.

AIM

In this article we review the results of five trials: MR CLEAN, ESCAPE, EXTEND IA, SWIFT PRIME, and REVASCAT.

[Diffusion-weighted imaging in acute stroke]

Diffusion-weighted imaging (DWI) enables the early detection of acute ischemic stroke and with high sensitivity and specificity. The signal changes are based on decreased diffusion of water molecules that is caused by cytotoxic edema. Despite the possibility of early detection of ischemic changes magnetic resonance imaging (MRI) is not normally necessary for the therapy decision; however, under some conditions, such as unknown time from onset of symptoms, multiparametric MRI including DWI can provide useful information that will influence the therapy.

[Germ cell and embryonal tumors]

Germ cell tumors, which constitute approximately 3-5% of tumors of the central nervous system (CNS), can be subdivided into germinomas, embryonal carcinomas, yolk sac tumors, choriocarcinomas, teratomas and mixed germ cell tumors. The diagnosis of intracranial germ cell tumor is based on the clinical symptoms, detection of tumor markers, such as alpha fetoprotein (AFP) and the beta subunit of human chorionic gonadotropin (beta-hCG) in blood and cerebrospinal fluid (CSF), magnetic resonance imaging (MRI) of the brain and spinal cord, CSF cytology and histology. The diagnosis of a secreting germ cell tumor, i.e. a non-germinoma, can be made by the determination of AFP and hCG as tumor markers. Germinomas are radiosensitive but are equally as sensitive to chemotherapy. Teratomas of the CNS are mostly diagnosed in newborns and infants. The most decisive role in the treatment of teratomas is played by as complete a resection as possible. Chemotherapy and irradiation play a subordinate role.Embryonal tumors, which constitute approximately 15-20% of CNS tumors, include medulloblastomas, primitive neuroectodermal tumors (PNET) of the CNS and the atypical teratoid rhabdoid tumor of the CNS. Medulloblastoma is the most common malignant brain tumor in childhood and adolescence. The incidence peak is the fifth year of life with a male predisposition in a ratio of 1.5:1. Medulloblastomas constitute 12-25% of all pediatric CNS tumors and 30-40% of pediatric tumors of the posterior cranial fossa. At the time of diagnosis evidence of dissemination in the CSF cavity is found in approximately 40% of patients. The extreme cell density makes medulloblastomas hyperdense in computed tomography (CT) and can therefore be differentiated from hypodense astrocytomas. The PNETs are histologically related to medulloblastomas, pineoblastomas, atypical teratoid rhabdoid tumors and peripheral neuroblastomas. They are relatively rare in children constituting less than 5% of supratentorial neoplasms. Patients are mostly clinically conspicuous due to macrocephalus and signs of brain pressure and/or seizures. In native CT the solid components of PNETs show a hyperdensity compared to the surrounding brain parenchyma probably due to the high cell density. Cysts and calcification are often detectable. The survival rate of children with CNS tumors has continuously increased in recent years. When corresponding clinical symptoms appear, such as headache, nausea or vomiting when fasting, all of which are evidence of increased intracranial pressure, MRI should be carried out as quickly as possible. Children should be treated in centers with departments of pediatric oncology and hematology and within the framework of studies.

[Pediatric intracranial tumors : Principles of diagnostics and treatment]

Pediatric intracranial tumors account for approximately 24% of childhood malignancies. Pathological entities and their frequencies differ significantly from adult intracranial tumors and have age-specific differences in the pediatric population itself. In Germany treatment and diagnosis must be carried out according to ongoing multicenter trials for therapy optimization and registers of the Gesellschaft für pädiatrische Onkologie und Hämatologie (GPOH, Society of Pediatric Oncology and Hematology) in specialized centers for pediatric oncology. In addition to the articles in this issue which focus on the radiological aspects of the different entities, this article provides an overview of the principles of diagnostics and treatment of pediatric intracranial tumors.

[Anatomy of the petrous portion of the temporal bone]

The petrous portion of the temporal bone is an important location of traumatic injuries as well as inflammatory and neoplastic diseases in the clinical daily routine. In addition to the articles in this issue that focus on these diseases, this article provides a short overview of the clinically relevant anatomy of the petrous portion of the temporal bone.

[Sturge-Weber syndrome]

Sturge-Weber syndrome (SWS) is a rare congenital disease which affects the brain, the skin and the eyes. It is a sporadically occurring neurocutaneous syndrome affecting the intracerebral veins (venous angiomatosis). The frequency is estimated to be 1 in 50,000 births [1]. The main symptom is intracranial leptomeningeal angiomatosis which mostly affects the occipital and posterior parietal lobes and can occur unilaterally and also bilaterally. Facial cutaneous vascular alterations occur ipsilaterally in the form of port wine stains (nevus flammeus) which are normally found in the catchment area of the trigeminal branch VI. Other clinical symptoms associated with SWS are seizures, glaucoma, headaches, transient neurological stroke-like episodes and cognitive impairment. Neurological cortical symptoms often include hemiparesis, hemiatrophy and hemianopsia.

[Tuberous sclerosis complex]

Tuberous sclerosis complex is an autosomal dominant disorder with variable affection of the central nervous system (CNS) and many other organ systems. Radiological features include various lesions of the brain as well as lesions of the lungs, kidneys and the heart. Imaging is important for the early detection of complications. This article provides an overview of the clinical features and therapy as well as the specific imaging of tuberous sclerosis complex.

[Malformations and abnormalities of the petrous portion of the temporal bone]

High-resolution computed tomography (HRCT) is the procedure of choice in the diagnostics of abnormalities of the middle and inner ear. It allows a detailed presentation of anatomical features and achieves the prerequisites for selection of the various therapeutic options. The highly diverse abnormalities can be described using detailed imaging analyses. Malformations with an abnormally developed modiolus are assumed to be early embryological defects, such as the classical Mondini dysplasia. The essential therapeutic option for middle ear deformities is still a cochlear implant. The domain of magnetic resonance imaging (MRI) is not only in the analysis of the cochlear nerve and for exclusion of fibrosis or ossification of the labyrinth but is also able to visualize details of isolated malformations, such as an extended vestibular aqueduct or subtle alterations to the vestibule or can visualize them better in comparison to CT. Radiological diagnostics are used not only for classification but also to recognize typical clinical problem situations and play a key role in the diagnostics of hearing disorders and selection of the optimal therapeutic procedure.

Evaluation of changes in the attitudes and behaviors of relatives of lung cancer patients toward cancer prevention and screening

BACKGROUND

Cancer diagnosis affects all the relatives living with the patient; however, whether the behavior of family members changes or not is unknown. To end this we evaluated the relatives of lung cancer patients.

MATERIALS AND METHODS

Forty-one questions were used to collect data from the relatives of lung cancer patients who had been living with them for at least one year, to evaluate changes in their attitudes and behaviors related to cancer prevention.

RESULTS

The study included 246 lung cancer patients' relatives, of them 172 (69.9%) were women and 74 (30.1%) were men. The median age was 46 years (range: 20-83 years). Patients and their relatives had been living together for an average of 28 years (range: 1-68 years), and 88 (35.7%) of the patients' relatives were their children. We found changes in the attitudes and behaviors toward prevention and screening for cancer in 92 (37.4%) of the relatives. Fifty-two (21.1%) of them changed their smoking habits, 34 (13.8%) altered their eating habits, 25 (10.2%) changed their exercise habits, 13 (5.3%) visited a doctor due to a suspicion of having cancer, 12 (4.9%) changed their lifestyles, seven (2.8%) underwent cancer screening tests, three (1.2%) started using alternative medicines, and three (1.2%) started using vitamins for cancer prevention.

CONCLUSIONS

Important changes occur in the attitudes and behaviors of patients' relatives toward cancer prevention and screening after the patients are diagnosed with lung cancer. Being aware of how patients' relatives react to a family member's cancer diagnosis may provide healthcare professionals with more incentive to address the relatives' special needs.

Peri-interventional Subarachnoid Hemorrhage During Mechanical Thrombectomy with stent retrievers in Acute Stroke: A Retrospective Case-Control Study

BACKGROUND

Mechanical thrombectomy with stent retrievers in acute stroke has emerged as a promising new technique with the highest recanalization rate of the therapeutic procedures available so far. However, endovascular treatment is also associated with the risk of specific complications. One of those is the occurrence of peri-interventional subarachnoid hemorrhage (SAH), which has been reported in 5-16 % of the cases. Interestingly, this rate is higher than that of angiographically detectable perforations (0-3 %), leaving the majority of peri-interventional SAH to be due to angiographically occult perforations. Little is known about the influence of this finding on clinical outcome. The purpose of this study was to investigate the clinical relevance of SAH due to occult perforations during thrombectomy with stent retrievers.

METHODS

Postinterventional computed tomography (CT) scans of 217 consecutive patients with acute occlusions of intracerebral arteries who were treated with stent retrievers in our department between October 2009 and October 2012 were retrospectively analyzed.

RESULTS

SAH was found on postinterventional CT scans in 5.5 % of the cases. Seven cases were included for further analysis and matched to controls by the following characteristics: (1) site of occlusion, (2) result of the recanalization procedure according to the modified thrombolysis in cerebral infarction score, (3) administration of intravenous recombinant tissue plasminogen activator, (4) presence of proximal extracranial occlusion, (5) age, and (6) sex. Comparison of the angiographic data of the two cohorts showed no significant difference in the length of the procedures or the number of maneuvers needed for recanalization, nor were there significant differences in clinical outcomes as measured by NIHSS and mRS scores. Secondary symptomatic ICH occurred in one case in either cohort and led to death in both cases. The rate of asymptomatic ICH within the first 24 h after recanalization was significantly higher in the group with peri-interventional SAH (57 vs. 0 %, P = 0.018).

CONCLUSIONS

This small retrospective case-control study did not reveal a significant influence of peri-interventional SAH due to angiographically occult perforations on neurologic outcome of patients treated with stent retrievers.

Multifocal Signal Loss at Bridging Veins on Susceptibility-Weighted Imaging in Abusive Head Trauma

Identifying abusive head trauma (AHT) in infants is difficult because often there are no externally visible injuries and symptoms are nonspecific. The radiological finding that usually raises suspicion of AHT--especially when found with retinal hemorrhage and inappropriate history--is subdural hematoma (SDH). In addition to that, bridging vein thrombosis, assessed by imaging or autopsy, has been reported as a sign of the traumatic cause of SDH. Here we present two cases of AHT-associated SDH in infants, in which multifocal signal loss at bridging veins was present on susceptibility-weighted imaging without signs of venous infarction. As susceptibility-weighted imaging has been reported to be more sensitive for blood products than gradient-echo T2-weighted imaging, we propose that it might help to identify clot formation on injured bridging veins and therefore increase the sensitivity of imaging studies for a traumatic cause of SDH, helping to identify AHT that is considered to be caused by violent shaking.

Depression and anxiety in cancer patients and their relatives

PURPOSE

To investigate the depression and anxiety levels and the factors that affect patients receiving chemotherapy and their relatives with the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) scoring system.

METHODS

330 patients and 330 relatives of these patients were enrolled in this study. The study forms including the questions regarding the patient demographic characteristics, BDI, and STAI were completed during face-to-face interviews by trained interviewers for the determination of the psychological status of the patients and their relatives. BDI and STAI were validated for Turkish population by studies made before.

RESULTS

According to BDI scale, 96 (29.1%) patients had mild and 60 (18.2%) had severe depression. Seventy-one (21.5%) relatives had mild and 24 (7.3%) had severe depression. Anxiety evaluation was made by STAI scale and a statistical difference emerged between patients and relatives (patients: 44.93±8.8 vs relatives: 43.27±8.5, p=0.015). The depression and anxiety levels were higher in women, in people with low socio-economic level, in people having a time period between diagnosis and participation in the study longer than 6 months, and in people having relapsing disease.

CONCLUSION

Since there are many emotional and psychological disorders in patients and their relatives, much attention should be paid in order to diagnose and treat their psychiatric disorders and enough information about their disease should be given.

Thrombus attenuation does not predict angiographic results of mechanical thrombectomy with stent retrievers

BACKGROUND AND PURPOSE

Mechanical thrombectomy with stent retrievers in acute stroke has emerged as a promising new technique, with the highest recanalization rate of the therapeutic procedures available thus far. However, in up to 20% of the cases, mechanical thrombectomy with stent retrievers results in poor angiographic outcomes, with Thrombolysis in Cerebral Infarction scores ≤2a. The purpose of this study was to investigate whether thrombus attenuation on the initial CT scan can predict the angiographic outcome of the recanalization procedure in MCA occlusions.

MATERIALS AND METHODS

The data of 70 patients with acute MCA occlusions who underwent endovascular treatment with stent retrievers in our department were included. We analyzed thrombus attenuations, angiographic outcome, and periprocedural thrombus fragmentation.

RESULTS

The mean thrombus attenuation was 49.8 ± 7.8 HU and the mean difference from the attenuation of the contralateral MCA was 9.9 ± 8.0 HU. There were no significant differences in the thrombus attenuations of occlusions that were successfully recanalized (modified Thrombolysis in Cerebral Infarction ≥2b) and those that were not. Neither were there significant correlations of thrombus attenuations and periprocedural thrombus fragmentations that occurred in 64.3%. We found a nonsignificantly higher rate of recanalizations with modified Thrombolysis in Cerebral Infarction ≥2b when the difference from the attenuation of the contralateral MCA was between 1-20 HU.

CONCLUSIONS

In contrast to results of other revascularization procedures as published in a recent study, the angiographic result of mechanical thrombectomy with stent retrievers is not predicted by thrombus attenuation.

[Clinical appearance and differential diagnosis of intracranial arterial stenoses]

Intracranial arterial stenoses clinically present as acute, fluctuating or recurrent neurological deficits which are caused by hemodynamically impaired perfusion of the corresponding area of the brain. The type and the extent of the deficit, however, are not only determined by the location of the stenosis but also depend on the individual anatomical conditions of the patient, such as the degree of collateralization and variants of the circle of Willis.

[Hydrocephalus and intracranial hypotension]

Ventricular enlargement due to a imbalance of the production of cerebrospinal fluid and its absorption can be a symptom of a variety of diseases. The causes are increased production or decreased absorption of cerebrospinal fluid and obstructions to cerebrospinal fluid flow. Treatment requires thorough neuroradiological imaging with high-resolution thin-section magnetic resonance imaging (MRI) and cerebrospinal fluid flow measurements. Thus, for instance even small membranes causing aqueductal obstruction can be detected and their influence on cerebrospinal fluid flow can be analyzed. The results of neurosurgical therapy, such as ventriculostomy can also be evaluated. This article provides an overview about imaging features as well as clinical and therapeutic aspects of hydrocephalus.

[Spinal vascular malformations]

Spinal vascular malformations are a group of rare diseases with different clinical presentations ranging from incidental asymptomatic findings to progressive tetraplegia. This article provides an overview about imaging features as well as clinical and therapeutic aspects of spinal arteriovenous malformations, cavernomas and capillary telangiectasia.

Mobile stroke unit for diagnosis-based triage of persons with suspected stroke

BACKGROUND

In this feasibility study, we tested whether prehospital diagnostic stroke workup enables rational decision-making regarding treatment and the target hospital in persons with suspected stroke.

METHODS

A mobile stroke unit that delivers imaging (including multimodal brain imaging with CT angiography and CT perfusion), point-of-care-laboratory analysis, and neurologic expertise directly at the emergency site was analyzed for its use in prehospital diagnosis-based triage of suspected stroke patients.

RESULTS

We present 4 complementary cases with suspected stroke who underwent prehospital diagnostic workup that enabled direct diagnosis-based treatment decisions and reliable triage regarding the most appropriate medical facility for that individual, e.g., a primary hospital vs specialized centers of a tertiary hospital.

CONCLUSIONS

This preliminary report demonstrates the feasibility of prehospital diagnostic stroke workup for immediate etiology-specific decision-making regarding the necessary time-sensitive stroke treatment and the most appropriate target hospital.

[Spinal angiography : Anatomy, technique and indications]

Spinal angiography is a diagnostic modality requiring detailed knowledge of spinal vascular anatomy. The cervical spinal cord is supplied by the vertebral arteries while segmental arteries which are preserved from fetal anatomy, supply the thoracic and lumbar regions. As spinal angiography carries the risk of paraplegia the indications have to be considered very carefully. Nevertheless, spinal angiography should be performed if there is reason to suspect a spinal vascular malformation from magnetic resonance imaging (MRI).

[Extradural tumors]

Approximately 50-60% of spinal tumors are extradural and depending on the origin and location are classified into tumors of the vertebrae, tumors of the epidural space and primarily extraspinal tumors growing into the spine. Presenting complaints include back pain and weakness as well as myelopathy and radiculopathy due to compression of the spinal cord or the nerve roots, respectively. Imaging of extradural tumors mostly requires both magnetic resonance imaging (MRI) and computed tomography (CT). Extradural masses and infiltration of the cord can be depicted by MRI and CT depicts osteolytic and osteosclerotic lesions and the extent of osseous involvement. Bone scintigraphy is often helpful in detecting metastases and characterizing osteoid osteomas.

Prognostic factors affecting recurrence and survival in patients with locally advanced rectal cancer

PURPOSE

This study aimed at investigating the factors that are likely to affect recurrence and survival in patients with locally advanced rectal cancer.

METHODS

The study included patients treated and followed- up between January 1999 and August 2009. Patient and disease data were retrieved from the patients' hospital charts.

RESULTS

A total of 221 patients were evaluated. Their median age was 58 years (range 18-83); 69 (31.2%) patients had clinical stage II and 152 (68.8%) clinical stage III. Median follow-up was 40 months (range 8-136). Median disease free survival (DFS) was 77 months and median overall survival (OS) 95 months. The factors affecting local recurrence were pathological lymph node involvement (pN+), pathological T4 (pT4) tumors, and postoperative high serum level of carcinoembryonic antigen (CEA). pN (+) tumors, postoperative high serum CEA level, and perineural invasion increased the risk of both local and distant metastasis. The factors affecting mortality were pN+ tumors, pT4 tumors, poor tumor differentiation, high postoperative CEA level, age > 60 years, and no postoperative adjuvant chemotherapy (CT). The factors affecting DFS were pN+ tumors, pT4 tumors, poor tumor differentiation, postoperative high serum CEA level, perineural invasion, and surgical margin positivity. The factors affecting OS were pN+ tumors, postoperative high serum CEA level, poor tumor differentiation, perineural invasion and no adjuvant CT.

CONCLUSION

Some prognostic factors are important in the assessment of prognosis of locally advanced rectal cancer.

[Spondylodiscitis]

Despite highly sensitive imaging techniques, the diagnosis and treatment of spondylodiscitis are often delayed due to a lack of specific symptoms with back pain as the presenting complaint. Late diagnosis and neurological involvement at the time of diagnosis are risk factors for long-term neurological deficits. Unremitting back pain with signs of inflammation should give reason to suspect spondylodiscitis and to rule it out by imaging, especially if risk factors such as diabetes mellitus, malignant neoplasms or immunosuppression are present. Magnetic resonance imaging (MRI) is the imaging procedure of choice with high sensitivity and specificity and typically shows hypointense adjacent vertebrae on T1-weighted images with hyperintense signal on short tau inversion recovery (STIR) sequences and hyperintense disc spaces on T2-weighted images.

[Analgesic interventions for spinal diseases]

As a rule vertebroplasty and kyphoplasty can prevent further collapse of a previously broken vertebra. Pain is probably caused by collapse of the porous bone resulting in instability of the vertebra. Stabilization of the vertebra by injecting cement results in a clear improvement in the complaint and a clear reduction in pain resulting in better mobilization. Recent results have, however, cast doubt on the effectiveness of this therapy. Diagnostic nerve blocks on the spinal column are important because the pain is mostly clinically uncharacteristic, the innervation is complex and the pain is subjective. An exact classification can be made using special nerve blocks. Prerequisites for the use of diagnostic nerve blocks are an extensive clinical history and examination of the patient before nerve blocks are carried out. In approximately 15-45% of patients the zygapophyseal joint is the cause of the back pain. Anesthesia of the zygapophyseal joint can be carried out by direct intra-articular application of a local anesthetic or by a block of the medial branch of the posterior branch of each of two spinal nerves. The simplest method is by computed tomography-guided zygapophyseal block.

Quality of life of physicians and nurses working in an oncology clinic

PURPOSE

The objective of this study was to determine possible differences in the perception of quality of life (QoL) between physicians and nurses working in an oncology clinic in Turkey.

METHODS

Seventy-seven physicians and 67 nurses participated in this study. All participants provided information such as the working hours per day and the number of years working in an oncology clinic. The European Organization for Research and Treatment of Cancer (EORTC) QLQC30 questionnaire was used during face-to-face interviews by trained interviewers.

RESULTS

The mean age of physicians and nurses were 32±0.8 and 29,9±0.9 years, respectively (p>0.05). Forty-four percent of physicians and all nurses were women. Fifty-three percent of physicians and 57% of nurses were single. Mean working hours per day and number of working years were similar between physicians and nurses. The physical, emotional, and cognitive function scales of physicians were better and statistically significant compared with nurses (p<0.0001, p<0.0006, and p<0.0127, respectively). Global health score was also better in physicians but without statistical significance. In physicians, a significant negative correlation with working hours and emotional, cognitive, role, and social function scales was found. A significant positive correlation with the number of working years and emotional function scale and also with age and role, emotional, cognitive, and social scales was found. Global health showed significant negative correlation with working hours, and positive correlation with age, number of working years, physical, role, emotional, cognitive, and social function scales.

CONCLUSION

It is important to recognize that oncology workers, particularly nurses, have poor QoL. There are many factors adversely affecting the QoL of oncology workers in Turkey, therefore systems should be developed to provide better support and conditions for them.

A randomized, multicenter phase III trial of bevacizumab plus capecitabine as maintenance treatment after initial treatment with bevacizumab plus XELOX in previously untreated metastatic colorectal cancer

474

Background: Colorectal cancer is one of the most frequent malignancies, second to breast cancer in women and third to lung cancer and prostate cancer in men. The aim of this study in first-line metastatic colorectal cancer (mCRC) was to achieve a better progression-free survival (PFS) and less risk of toxicity by administrating bevacizumab (BEV) + capecitabine + oxaliplatin (XELOX) for 6 cycles, stop oxaliplatin and go with maintenance therapy (BEV + capecitabine) until progression.

Methods: BEV (7.5 mg/kg) + XELOX (capecitabine 1,000 mg/m2 bid d1–14 + oxaliplatin 130 mg/m2 d1 q3w) were administered until progression (Arm A) or 6 cycles of BEV + XELOX followed by BEV + capecitabine were administered until progression (Arm B). PFS was the primary endpoint; secondary endpoints included overall survival (OS), objective response rate (ORR), and safety. A sample size of 118 patients (pts) was calculated to achieve 80% power to detect an increase of 1.5 months in median PFS between Arm A (9.5 months) and Arm B (11.0 months) with a standard deviation of 3.9 months and significance level of 0.05 using a 10% drop-out rate.

Results: A total of 122 pts were randomized. No significant differences were found in demographic characteristics between the two arms. Median treatment period was 6.1 (range 0.7–13.4) and 6.8 (range 0.7–12.4) months in Arms A and B, respectively. Interim analysis showed no statistically significant differences in median PFS and ORR between arms (see table). Tolerability was also acceptable in both arms with grade 3/4 diarrhoea in 7.7% vs. 8.2%, weakness in 15.2% vs. 8.4%, hand-foot syndrome in 6.3% vs. 9.4%, and neuropathy in 2.8% vs. 4.6% of pts in Arms A and B, respectively.

Conclusions: BEV + capecitabine as maintenance therapy following induction BEV + XELOX is non-inferior to continuous BEV + XELOX until progression. While this study is ongoing, these interim findings suggest that maintenance therapy with BEV + capecitabine is an appropriate option following induction BEV + XELOX in pts with mCRC.

[Table: see text]

[Table: see text]