جستجوی مقالات مرتبط با کلیدواژه « brain neoplasms » در نشریات گروه « پزشکی »

Whole Brain Radiation Therapy (WBRT) has been effective in the management of brain metastases, giving good local control but has shown to have potential neurocognitive effects. Assessing its effect on neurocognitive function is decisive assessing quality of life and therapeutic decision-making.  

This is an observational study at R. G. Kar Medical College and Hospital from May 2022 to April 2023 involving 60 biopsy proven carcinoma patients with brain metastases fulfilling inclusion and exclusion criteria. All received 30Gray (Gy)/10# WBRT over 2 weeks. Neurocognitive function assessment using Mini Mental State Examination (MMSE) were conducted before and at 2nd, 3rd, and 6th months post WBRT.  

The study, encompassing a median age of 58, revealed 43.3% had lung primary and 35% breast primary. Mean MMSE score was 27 pre radiation. Following WBRT, a more than equals to 3-point MMSE decrease occurred in 6.6%, 11.6%, and 18.3% at 2nd, 3rd, and 6th months post radiation respectively. Neurocognitive decline was 36% for those above 50 years and 64% for those below 50 years by the 6th month. At 2nd months 88.3% patients had controlled disease having a decrease in MMSE score by 1.6, while 11.6% with uncontrolled disease showed 3.1 MMSE change and the same trend continued at 3rd and 6th month observations.  

WBRT is crucial for local control of brain metastases, but neurocognitive decline, especially under 50, is of major concern. Study results offers awareness for pre-treatment counseling on WBRT benefits, risks and consideration for Hippocampal Avoidance WBRT or WBRT with memantine, and requires further extensive research.

Papillary tumor of the pineal region (PTPR) is an infrequent neoplasm arising from the ependymal cells of the sub-commissural organ. This tumor entity was incorporated into the World Health Organization (WHO) classification of central nervous system tumors in 2007. Given the propensity for local recurrence observed in PTPR cases and the documented instances of leptomeningeal seeding in previous case reports, it presents a substantial risk of significant morbidity. Due to its rarity, there is no established standard for its management. Surgical intervention constitutes the primary treatment modality, while the role of adjuvant radiotherapy remains ambiguous. In this case report, we present the clinical course of a 46-year-old male diagnosed with PTPR who underwent surgical resection followed by adjuvant radiotherapy. 14 months post-initial treatment, the patient manifested intracranial and spinal metastases in the form of leptomeningeal dissemination. Subsequently, systemic chemotherapy utilizing vincristine and carboplatin was initiated, and the patient exhibited no evidence of disease progression over the last six months.

To study the possible dosimetric benefits of a Hybrid planning technique that consists of combining intensity modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) for whole brain radiation therapy hippocampal-sparing (WBRT-HS).

Three types of plans were made for 15 patients, namely Hybrid, pure IMRT, and pure VMAT and retrospectively compared. Each plan was made using contoured structures on computed tomographic (CT) images fused with magnetic resonance imaging (MRI). The homogeneity (HI) and conformity (CI) indices of the planning target volumes (PTVs) were calculated to establish the dosimetric quality in all plans. The dose received to organs at risk (OARs), number of monitor units (MUs) and treatment time were evaluated for each type of planning technique.

Hybrid plans showed superior homogeneity (p = 0.04) and conformity (p = 0.01) indices compared to IMRT and VMAT plans. In terms of hippocampus sparing, the Hybrid technique showed almost equal D100% and maximum dose (Dmax) values compared to the other techniques, but without statistical significance (p> 0.05); however, there was a significant difference for the left hippocampus, where the IMRT technique obtained the best result (p <0.001). Hybrid plan values for dose delivered to the remaining OARs, MUs and treatment times were intermediate between those of IMRT and VMAT.

Compared to the IMRT and VMAT plans, the hybrid plan showed improved dosimetric plan quality along with intermediate dose values to the OARs.

Changes in the body fluid and serum electrolyte status following major operations, such as brain tumor resection, are always expected. These changes can increase post-operation morbidity and mortality.

We aimed to evaluate the changes in serum electrolyte levels and renal function parameters in brain tumor patients after operation.

This cross-sectional study was performed on 168 patients with supratentorial tumors in Poursina Hospital, Rasht City, Iran, in 2020. The study parameters included patients’ demographics, hemodynamic stability, serum sodium, potassium, blood urea nitrogen (BUN) and creatinine levels, urine specific gravity, and urinary output, measured immediately and 12 hours after the operation.

This study revealed statistically significant increases in serum sodium level (from 139.70±5.60 meq/L to 140.34±6.23 meq/L, P=0.002), urinary output (from 1043.70±455.00 mL to 1967.50±661.10 mL, P=0.008), urine specific gravity (from 1.010±0.007 to 1.012±0.008, P=0.011), and in serum BUN level (from 17.46±6.92 to 18.41±6.40, P=0.001), but significant decrease in serum potassium level (from 3.88±0.49 meq/L to 3.78±0.28 meq/L, P=0.017) during the first 12 hours after operation. However, the change in serum creatinine level was not significant (from 1.18±2.08 mg/dL to 1.17±2.08 mg/dL, P=0.787).

Significant changes in serum electrolytes (sodium and potassium) and renal function indicators (urine output, specific gravity, and serum BUN) are expected within the first 12 hours after brain tumor operation.

Diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) present the ability to selectively protect functional regions and fiber tracts of the brain when brain tumors are treated with radiotherapy. This study aimed to assess whether the incorporation of fMRI and DTI data into the radiation treatment planning process of brain tumors could prevent the neurological parts of the brain from high doses of radiation. In this investigational theoretical study, the fMRI and DTI data were obtained from eight glioma patients. This patient-specific fMRI and DTI data were attained based on tumor location, the patient’s general conditions, and the importance of the functional and fiber tract areas. The functional regions, fiber tracts, anatomical organs at risk, and the tumor were contoured for radiation treatment planning. Finally, the radiation treatment planning with and without fMRI & DTI information was obtained and compared. The mean dose to the functional areas and the maximum doses were reduced by 25.36% and 18.57% on fMRI & DTI plans compared with the anatomical plans. In addition, 15.59% and 20.84% reductions were achieved in the mean and maximum doses of the fiber tracts, respectively.  This study demonstrated the feasibility of using fMRI and DTI data in radiation treatment planning to maximize radiation protection of the functional cortex and fiber tracts. The mean and maximum doses significantly decreased to neurologically relevant brain regions, resulting in reducing the neuro-cognitive complications and improving the patient’s quality of life.

Primary brain tumors, although not among the most common site of tumors, are considered an important pathology, due to their high mortality rate. Astrocytoma is a glial brain tumor with a high mortality rate. The predictors of the patients’ outcome is thus of great importance. In the present study, we investigated the results of 7–year follow–up of patients with astrocytoma in order to determine the prognostic factors associated with patients’ survival.

In this cross–sectional study, 115 patients suffering from astrocytoma grade II, who referred to radio–oncology department of Nemazee hospital between 2006 and 2013, were included. The patients’ overall survival (OS) and disease–free survival (DFS) were recorded and their difference according to demographic and clinical characteristics of patients, as well as the treatment used, was evaluated using SPSS v.25.

Mean age of patients was 35.34±15.17 years; most were younger than 40 years old (71%) and men (59%). Mean OS and DFS were 74.90±43.05 and 26.61±26.97 months, respectively. Patients younger than 40 had a significantly longer mean OS (84.04±37.93 vs. 53.04±47.41 months; P=0.004). Mean DFS was different according to chemotherapy and dose of radiotherapy (P=0.041 and 0.01, respectively), while OS was not (P>0.05).

Considering the difference in outcome of patients, specifically DFS, according to the performance of chemotherapy and the dose of radiotherapy, it is recommended to pay greater attention to appropriate choice of treatment strategy of patients with astrocytoma. Further randomized controlled studies are required to determine the predictors of patients’ outcome.

Posterior fossa tumors (PFTs) are prevalent in children, and about half of all childhood brain tumors arise from the structures of the posterior fossa. Studies on PFTs in Iranian children have mainly focused on epidemiological characteristics. This study aimed to evaluate surgical outcomes and predictive factors for survival in children with PFTs in Shiraz, Iran. A prospective cohort study was conducted from March 2014 to September 2019 in Namazi Hospital affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). A total of 87 pediatric patients under the age of 16 who were diagnosed with PFT and had undergone surgery were recruited. The children were followed up for postoperative outcomes such as mortality and neurological complications. Data were analyzed using SPSS software (version 20.0) and R software (version 3.3.1). P<0.05 was considered statistically significant. The mean age of the patients was 6.49±4.14 years and 64.4% were male. Sixteen patients were lost to follow-up, 31 died after surgery, and 40 were in remission during phone calls. The median survival time of the patients was four years. The most common type of PFT was medulloblastoma (n=46, 53%). The result of the multivariate Cox proportional hazards model showed that age (P=0.034) was correlated with postoperative survival, hazard ratio 0.90 (95% confidence interval 0.82 to 0.99). Among various predictive factors, lower age was associated with poor outcomes in pediatric children with PFTs.

Background and Importance: 

Distant extracranial metastasis of meningioma is rare, and the pathophysiology of metastasis in meningioma remains a topic of debate. This study aimed to describe a patient who suffered from multiple pulmonary metastases of meningioma.

This report introduced a rare case of a 47-year-old female who presented with right hemiparesis. Cranial Computed Tomography (CT) demonstrated a homogeneously enhanced tumor in the left temporal lobe. The patient underwent tumor resection; the pathological result was found to be World Health Organization (WHO) grade I meningothelial meningioma. Recurrence of the tumor transpired after two years and a second operation was performed. WHO grade II atypical meningioma was diagnosed.Subsequently, the patient developed a chronic cough and her chest x-ray showed multiple lung masses. CT-guided biopsy of the right lung mass was performed. Finally, pulmonary metastatic meningioma was diagnosed.

Distant extracranial metastasis and malignant transformation of meningioma involve the genetic alteration of a tumor, which should be studied further.

Insertion of an External Ventricular Drain (EVD) is a common and important lifesaving procedure that can lead to morbidity and mortality. This study was conducted to assess the infection rate, risk factors, causative organisms, and outcome of EVDs.

A prospective study was undertaken in a tertiary care centre from August 1st to October 30th, 2020. Over 192 patients had undergone insertion of EVDs in the neurosurgical intensive care unit. CSF samples were collected in sterile containers and transported to the laboratory.

A total of 214 EVDs were inserted in 192 patients for 691 days. The median duration for EVD in situ and the mean time between catheter insertion and onset of infection were 14.5 days and 8 days. EVD related infection rate was 19.4 for 1000 EVD days. The most common risk factor for EVD insertion were tumors (55%) followed by hydrocephalus (40%).We identified 25 patients out of 192 (12%) who had clinical signs and symptoms with deranged CSF counts. A total of 13/25 (52%) specimens were culture positives out of which 10 (76.9%) were Gram negative pathogens and 3 (23%) were Gram positive pathogens and 3/10 (30%) Gram negative pathogens were Multidrug resistant organisms (MDROs).

It was observed that longer duration of catheter in situ was an important risk factor for EVD-related infections (ERIs) and also higher frequency of CSF sampling. A proper EVD infection prevention and control protocol must be followed in the form of a checklist at the time of EVD insertion.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the development of hamartomatous tumors in multiple organs, including the skin. Most patients present early in life with seizures, intellectual disability, and cutaneous angiofibromas. However, patients may often not present these features until late adulthood. A 55-year-old female presented with complaints of sudden and florid appearance of multiple fibrokeratomas around all twenty of her nails, along with multiple hyperpigmented papules on her face. On examination, she also had gingival fibromas and a single skin-colored plaque on her lower back. Histopathology of lesions over the face, back, and fingernails were compatible with the diagnoses of angiofibroma, shagreen patch, and fibrokeratoma, respectively. She was advised laser ablation of the facial lesions and excision of the nail fibrokeratomas. MRI of the brain showed multiple cortical tubers and subependymal nodules. Late presentation of TSC during adulthood may delay the diagnosis and prevent the screening of early tumor formation, potentially increasing morbidity. This was exemplified in our clinical case, where asymptomatic cortical tubers were discovered on MRI only after the appearance of skin lesions and fibrokeratomas around the nails.

Context: 

Using various pesticides to control pests and vectors of diseases has a long history in households worldwide. However, most pesticides are considered toxic to and harmful to the environment. 

Evidence Acquisition:

 Electronic databases such as Google Scholar, PubMed, and Scopus were searched using the following search terms: “children”, “pesticide residues”, “risks”, “leukemia”, and “brain neoplasms”. This review was designed to identify the relevant electronic studies published from January 2000 to February 2020.

Children are more susceptible to pesticides because of their underdeveloped metabolic processes and disability to detoxify chemicals. Over 30% of the children’s diseases are due to environmental factors, including pesticides. The possibility of children’s pesticide exposure inside of urban houses is more than outside. In general, children can be exposed to pesticides in two ways: Direct and indirect contact. Direct contact refers to hand-to-mouth behavior in daily plays that absorbs household pesticides. Indirect contact refers to exposure via their parents’ work in hazardous environments and during pregnancy. There is a significant association between pesticide exposure via households and some cancers in children, such as leukemia and brain tumors.

Due to the positive association between pesticide residues in households and the risk of cancers in children, public health policies must be adopted to minimize children’s exposure to pesticides in the urban household.

Brain tumors such as glioma are among the most aggressive lesions, which result in a very short life expectancy in patients. Image segmentation is highly essential in medical image analysis with applications, particularly in clinical practices to treat brain tumors. Accurate segmentation of magnetic resonance data is crucial for diagnostic purposes, planning surgical treatments, and also follow-up evaluation. Manual segmentation of a large volume of MRI data is a time-consuming endeavor, and this necessitates employing automatic segmentation techniques that are both accurate and reliable. However, the vast spatial and structural diversity of brain tissue poses serious challenges for this procedure. The current study proposed an automatic segmentation method based on convolutional neural networks (CNN), where weights of a pre-trained network were used as initial weights of neurons to prevent possible overfitting in the training phase.

As tumors were diverse in their shape, size, location, and overlapping with other tissue, it was decided to exploit a flexible and extremely efficient architecture tailored to glioblastoma. To remove some of the overlapping difficulties, morphological operators as a pre-processing step were utilized to strip the skull.

The proposed CNN had a hierarchical architecture to exploit local and global contextual features to handle both high- and low-grade glioblastoma. To address biasing stem from the imbalance of tumor labels, dropout was employed and a stochastic pooling layer was proposed.

Experimental results reported on a dataset of 400 brain MR images suggested that the proposed method outperformed the currently published state-of-the-art approach in terms of various image quality assessment metrics and achieved magnitude fold speed-up.

Glioblastoma multiforme (GBM), the most frequent malignant and aggressive primary brain tumor, is characterized by genetically unstable heterogeneous cells, diffused growth pattern, microvascular proliferation, and resistance to chemotherapy. Extensive investigations are being carried out to identify the molecular origin of resistance to chemo- and radio-therapy in GBM and find novel targets for therapy to improve overall survival rate. Dimethyl fumarate (DMF) has been shown to be a safe drug with limited short and long-term side effects, and fumaric acid esters (FAEs), including DMF, present both anti-oxidative and anti-inflammatory activity in different cell types and tissues. DMF has also anti-tumoral and neuroprotective effects and so it could be repurposed in the treatment of this invasive tumor in the future. Here, we have reviewed DMF pharmacokinetics and different mechanisms by which DMF could have therapeutic effects on GBM.

The present study aimed to assess the factors associated with the mortality of patints with brain tumor surgery at Be’sat Hospital in Sanandaj, Kurdistan, Iran. In this prospectively cross-sectional study, 108 patients diagnosed with brain tumor and followed by a surgery during April to December of 2014 were recruited. Eighteen cases were excluded from the study due to lack of information about their treatment outcomes. Patients’ information including age, gender, tumor type, tumor location, type of treatment, and extent of resection was collected by a checklist. Clinical outcome of the patients in six months after surgery was determined through phone calling to patients. All analyses conducted in SPSS software using logistic regression. Forty-seven (52.2%) of the studied subjects were women. The age of cases ranged from 3 to 83 years with total mean of 43.4 ± 21.9 years. In six months after treatment, 41 (45.6%) of the treated patients died. After excluding 9 children from final analysis and modeling the data by logistic regression, statistically significant associations were observed between death from central nervous system (CNS) tumor and male gender [odds ratio (OR): 5.25, 95% confidence interval (CI): 1.38–21.99], higher age (OR: 1.07, 95% CI: 1.02–1.13), partial vs. total resection (OR: 20.24, 95% CI: 1.21–337.51), and high malignant potential tumors (OR: 14.77, 95% CI: 4.85–45.02). The results showed that both demographic (advanced age and male gender) and clinical factors (high malignant potential tumors and partial removal of tumor) related to the worse outcome in patients with primary CNS tumors during six months after surgery.

Psychotic manifestations and other psychiatric presentations may be eventually secondary to involvement and disassemble of anatomy and brain structures. Glioma of corpus callosum is a rare tumor. We report a case of psychotic-like symptoms presumably due to tumor invasion to corpus callosum. A 53-year-old woman from north of Iran was referred because of a severe headache. She hadn’t a previous history of psychiatric or psychotic disorders and organic problems. The onset of headache was from 2 months ago. From 13 days ago, the headache was very severe with vomiting, decrease of visual acuity, dyspnea, talkativeness, aggression, disorganized behavior, disorientation, cognitive impairment, incontinency, insomnia, dysphoric mood, disorganized speech as incoherency, auditory, and visual hallucination. The brain MRI showed bilateral parasagital and posterior Corpus callosum lesions. The surgery was high risk for her and radiotherapy was suggested. The physicians should be alert for clinical manifestations suggestive reversible and organic cause of psychotic disorders. It is important to be alert to the possibility of an organic cause to psychosis.

Previous studies on Brain and other Nervous System Cancers (BNSC) and aircrew have shown inconsistent results, possibly due to their relatively small sample sizes; therefore, the current study aimed to increase the precision of risk estimates. Systematic searches of PubMed and Embase for pertinent studies up to August 2016 were performed and supplemented by manual reviews of bibliographies. The pooled standard incidence ratio (SIR) and corresponding 95% CIs were estimated with random effects models. Among the 903 studies retrieved, 7 studies (5 cohort studies and 2 pooled analyses) were included in the current meta-analysis. The pooled SIR (95% CI) of BNSC incidence in aircrew was 1.01 (0.77, 1.31) with no significant heterogeneity (I2 = 36.1%, P = .199). The null association persisted when the analysis was stratified by geographic area (Europe or America), publication year (before or after 2001), air population (pilots or cabin crew), cancer site (brain, nervous system, or brain/nervous system), and gender (male or female). The current evidence is not sufficient to support a significant positive association between aircrew employment and BNSC risk. However, the interpretation and extrapolation of this meta-analysis are restricted by the possible impact exerted by health worker effect and potential clinical heterogeneity. More studies based on other populations, including Asian aircrews, are warranted.