| 1: J Neurosurg. 2004 Nov;101(5):874-7. |
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Secretion of high-molecular-weight adrenocorticotropic
hormone from a pituitary adenoma in a patient without Cushing stigmata. Case
report.
Matsuno A, Okazaki R, Oki Y, Nagashima T.
Department of Neurosurgery, Teikyo University Ichihara Hospital, Ichihara
City, Chiba, Japan. akirakun@med.teikyo-u.ac.jp
The authors report a case in which a patient harbored a corticotroph
macroadenoma that secreted biologically inactive high-molecular-weight
adrenocorticotropic hormone (ACTH) as well as authentic ACTH 1-39. The
secretion of the high-molecular-weight ACTH was determined using gel
chromatography. The authors believe that these two molecules competed with
each other at the ACTH receptor and, thus, the bioactivity of ACTH 1-39 was
masked and Cushing features were not manifested in the patient. This type of
silent corticotroph adenoma may be categorized as a clinically
nonfunctioning adenoma. Plasmas from patients with silent corticotroph
adenomas, which are identified by positive immunohistochemical staining of
ACTH, should be frozen, stored, and analyzed using gel chromatography to
examine whether the tumors produce and secrete high-molecular-weight ACTH.
Publication Types:
PMID: 15540932 [PubMed - indexed for MEDLINE]
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| 2: J Neurosurg. 2004 Nov;101(5):858-60. |
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A carcinoid tumor mimicking an isolated intracranial
meningioma. Case report.
Deshaies EM, Adamo MA, Qian J, DiRisio DA.
Department of Surgery, Division of Neurosurgery, Albany Medical Center,
Albany, New York 12208, USA. deshaie@mail.amc.edu
This 79-year-old woman presented with progressively worsening dementia,
abulia, flat affect, urinary incontinence, and profuse watery diarrhea.
Results of computerized tomography and magnetic resonance studies indicated
an extraaxial, dural-based mass compressing the right frontal lobe and
consistent with a convexity meningioma. A right frontal craniotomy was
performed and the dural-based mass was resected. Histopathological features
on immunostaining of the lesion were consistent with a carcinoid tumor
(low-grade neuroendocrine carcinoma). Further evaluation revealed no primary
carcinoid tumor in the foregut from which they typically originate. The
authors concluded that this intracranial carcinoid tumor was the primary
lesion despite its unusual location and that it should be included in the
differential diagnosis of dural-based, extraaxial brain lesions.
Publication Types:
PMID: 15540927 [PubMed - indexed for MEDLINE]
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| 3: J Neurosurg. 2004 Nov;101(5):762-6. |
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Continuous-flow shunt for treatment of hydrocephalus due
to lesions of the posterior fossa.
Arriada N, Sotelo J.
Research and Neurosurgical Divisions, National Institute of Neurology and
Neurosurgery of Mexico, Mexico City, Mexico.
OBJECT: Management of hydrocephalus caused by expansive lesions of the
posterior fossa is complicated by two main drawbacks of shunt devices:
sudden decompression and overdrainage. The ventriculoperitoneal (VP)
continuous-flow (CF) shunt is characterized by a peritoneal catheter with an
internal diameter of 0.51 mm that promotes continuous drainage of
cerebrospinal fluid (CSF) at its production rate. The authors have
previously demonstrated in adult patients with hydrocephalus that sudden
decompression and overdrainage are absent when this shunt is used; here they
report the findings of a prospective study in which the goal was to test the
performance of this shunt in patients with severe hydrocephalus due to
lesions of the posterior fossa. METHODS: During a 5-year period, 103
patients with severe hydrocephalus caused by lesions of the posterior fossa
were treated by placement of a VP shunt. In 53 of these patients (control
group) a shunt and valve system was surgically implanted and in 50 patients
a CF shunt was implanted. All patients were followed up for a minimum of 2
years after surgery. Shunt revision or change was necessary in 21 patients
(40%) with conventional shunts and in four patients (8%) with the CF shunt
(p < 0.003). Signs of overdrainage were observed in 18 patients (34%) in
the control group, four of whom had ascending transtentorial herniation;
this complication was not seen in patients with the CF shunt. CONCLUSIONS:
The CF shunt had a low rate of dysfunction and an absence of complications
caused by overdrainage, which were frequently associated with the control
shunts. The hydrodynamic properties of the CF shunt make it effective, even
in severe cases of hydrocephalus caused by lesions of the posterior fossa.
Publication Types:
- Clinical Trial
- Controlled Clinical Trial
PMID: 15540913 [PubMed - indexed for MEDLINE]
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| 4: Oncology. 2004;67(2):174-8. |
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Brain metastasis responding to gefitinib alone.
Poon AN, Ho SS, Yeo W, Mok TS.
Department of Clinical Oncology, The Chinese University of Hong Kong, Hong
Kong, China.
A woman with stage IIIb non-small cell lung cancer (NSCLC) developed disease
progression with brain metastases during chemotherapy. Due to unusual
circumstances, the patient received gefitinib alone, without the use of
corticosteroid treatment or radiotherapy. There was a dramatic clinical
improvement within 1 week. Follow-up magnetic resonance imaging of the brain
1 month later showed decreases in both the size and number of brain
metastases. The patient remains well 9 months after initiation of gefitinib.
It is proposed that gefitinib may have a role in treatment of brain
metastases from NSCLC. 2004 S. Karger AG, Basel.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15539923 [PubMed - indexed for MEDLINE]
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| 5: Eur J Endocrinol. 2004 Nov;151(5):587-94. |
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Thyrotropin-producing pituitary adenoma associated with
Graves' disease.
Koriyama N, Nakazaki M, Hashiguchi H, Aso K, Ikeda Y, Kimura T, Eto H,
Hirano H, Nakano S, Tei C.
Department of Diabetes and Endocrine Medicine, Kagoshima University
Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
koriyama@m2.kufm.kagoshima-u.ac.jp
OBJECTIVES: The examination of potential associations between Graves'
disease and thyrotropin-producing pituitary adenoma (TSHoma) after treatment
using octreotide, and of the expression of peroxisome proliferator-activated
receptor gamma (PPAR gamma). DESIGN AND METHODS: A specimen of resected
TSHoma tissue from our case was immunohistochemically examined for
expression of somatostatin receptor 2A (SSTR2A) and PPAR gamma. Specimens of
thyroid tissue from two cases with Hashimoto's thyroiditis were
immunohistochemically examined for expression of SSTR2A. RESULTS: Expression
of SSTR2A and PPAR gamma was identified in TSHoma cells. SSTR2A was also
expressed in lymphocytes that had infiltrated thyroid tissue in Hashimoto's
thyroiditis. In previous reports, three of four patients with TSHoma
displayed Graves' disease after tumor resection, and TSH is also known to
play a major role in regulating immunomodulatory gene expression in
thyrocytes. CONCLUSIONS: Both the immunomodulatory effects of octreotide on
intrathyroidal lymphocytes and rapid reductions in TSH may contribute to the
onset of Graves' disease. Patients with TSHoma-associated autoimmune
thyroiditis should undergo careful follow-up for development of Graves'
disease after treatment. Both octreotide and the PPAR gamma
receptor-activating ligands, thiazolidinediones, may be effective for
patients with TSHoma.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15538937 [PubMed - indexed for MEDLINE]
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| 6: J Neurosurg. 2004 Nov;101 Suppl 3:406-12. |
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Long-term management of patients with multiple brain
metastases after shaped beam radiosurgery. Case report and review of the
literature.
Okunieff P, Schell MC, Ruo R, Hale ER, O'Dell WG, Pilcher W.
Department of Radiation Oncology, James P Wilmot Cancer Center at the
University of Rochester Medical Center, NY 14642, USA.
paul_okunieff@urmc.rochester.edu
The role of radiosurgery in the treatment of patients with advanced-stage
metastatic disease is currently under debate. Previous randomized studies
have not consistently supported the use of radiosurgery to treat patients
with numbers of brain metastases. In negative-results studies, however,
intracranial tumor control was high but extracranial disease progressed;
thus, patient survival was not greatly affected, although neurocognitive
function was generally maintained until death. Because the future promises
improved systemic (extracranial) therapy, the successful control of brain
disease is that much more crucial. Thus, for selected patients with multiple
metastases to the brain who remain in good neurological condition,
aggressive lesion-targeting radiosurgery should be very useful. Although a
major limitation to success of this therapy is the lack of control of
extracranial disease in most patients, it is clear that well-designed,
aggressive treatment substantially decreases the progression of brain
metastases and also improves neurocognitive survival. The authors present
the management and a methodology for rational treatment of a patient with
breast cancer who has harbored 24 brain metastases during a 3-year period.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15537197 [PubMed - indexed for MEDLINE]
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| 7: J Clin Endocrinol Metab. 2004 Nov;89(11):5649-54. |
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Extreme elevation of intrasellar pressure in patients
with pituitary tumor apoplexy: relation to pituitary function.
Zayour DH, Selman WR, Arafah BM.
Division of Clinical and Molecular Endocrinology, University Hospitals of
Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA.
The dominant mechanism for hypopituitarism and hyperprolactinemia commonly
observed in patients with pituitary macroadenomas was postulated to be
increased intrasellar pressure (ISP) caused by the slow and gradual
expansion of adenomas within the sella turcica. Hemorrhagic infarction of
adenomas (pituitary tumor apoplexy) is associated with a rapid, rather than
gradual, increase in intrasellar contents. The impacts of the sudden
increase in intrasellar contents on ISP and pituitary function are unknown.
ISP and pituitary function were determined in 13 patients with pituitary
tumor apoplexy who had surgical decompression within 1 wk of symptoms'
onset. ISP measurements were remarkably high (median, 47 mm Hg), whereas
serum prolactin (PRL) concentrations were generally low (median, 3.5
microg/liter). There was an inverse correlation (r = -0.76; P < 0.01)
between ISP measurements and serum PRL concentrations. Postoperatively,
partial recovery or maintenance of pituitary function was noted in seven of
13 patients. These seven patients had higher (P = 0.013) serum PRL levels
(9.3 +/- 7.4 microg/liter) and lower (P < 0.001) ISP measurements (35.9
+/- 7.3 mm Hg) than the respective values in the remaining six with
persistent postoperative hypopituitarism (1.6 +/- 0.6 microg/liter and 55.9
+/- 2.4 mm Hg, respectively). The low serum PRL levels in patients with
tumor apoplexy suggested that ischemic necrosis of the anterior pituitary
resulting from sudden and extreme elevation of ISP was commonly observed in
this setting. A normal or elevated serum PRL level in patients with
non-PRL-secreting macroadenomas indicates the presence of viable pituitary
cells and the high likelihood of postoperative recovery of pituitary
function.
PMID: 15531524 [PubMed - indexed for MEDLINE]
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| 8: Am J Ophthalmol. 2004 Nov;138(5):864-6. |
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Diagnosis of metastatic carcinoma to the cavernous sinus
by computed tomograpy-guided fine-needle aspiration.
Lin A, Foroozan R, Carrier D, Yen MT.
Cullen Eye Institute, Department of Ophthalmology, Baylor College of
Medicine, Houston, Texas, USA.
PURPOSE: To describe a case of metastatic lung carcinoma to the cavernous
sinus and orbital apex diagnosed by fine-needle aspiration guided by
computed tomography. DESIGN: Case report. METHOD: A 52-year-old man who
presented with right-sided ptosis and ophthalmoplegia was found to have an
enhancing mass of the right orbital apex and cavernous sinus extending into
the temporal fossa on magnetic resonance imaging. Chest computed tomography
revealed hilar adenopathy and a lesion of the right lower lobe of the lung.
Bronchial washings and transbronchial needle biopsies of the lung were
nondiagnostic. Computed tomography-guided fine-needle aspiration of the
temporal fossa portion of the mass was performed. RESULT: Biopsy of the mass
showed malignant cells consistent with metastatic non-small cell lung
carcinoma. CONCLUSION: Computed tomography-guided fine-needle aspiration can
be useful in the diagnosis and management of some masses involving the
cavernous sinus.
Publication Types:
PMID: 15531326 [PubMed - indexed for MEDLINE]
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| 9: J Neurooncol. 2004 Oct;70(1):91-5. |
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Phase II study of concurrent continuous Temozolomide
(TMZ) and Tamoxifen (TMX) for recurrent malignant astrocytic gliomas.
Spence AM, Peterson RA, Scharnhorst JD, Silbergeld DL, Rostomily RC.
Departments of Neurology, University of Washington School of Medicine,
Seattle, WA 98195, USA. aspence@u.washington.edu
PURPOSE AND BACKGROUND: The aim of this study was to assess the frequency of
response and toxicity in adults with recurrent anaplastic astrocytoma (AA)
or glioblastoma multiforme (GM) treated with concurrent continuous TMZ and
TMX. METHODS: In addition to histology, eligibility included age > 18
years, Karnovsky score > or = 60, normal laboratory parameters, no
radiotherapy (RT) for 4 weeks, measurable disease and normal EKG. The chief
exclusions were: previous TMZ, TMX or dacarbazine (DTIC); nitrosourea within
6 weeks; history of deep venous thrombosis or pulmonary emboli. All patients
(pts) had received prior RT. TMZ was given at 75 mg/M2/day for 6 weeks,
repeated every 10 weeks, maximum 5 cycles. Four pts received 60 mg/M2/day
for 6 weeks due to extensive prior chemotherapy exposure. TMX was started at
40 mg twice daily (b.i.d.) for 1 week and then was increased in three
successive weeks to 60, then 80, then 100 mg b.i.d. Response was assessed
before every cycle with MRI +/- gadolinium (Gd). RESULTS: Sixteen pts
enrolled: GM 10, AA 6; female 6, male 10; median age 48 (21-58); prior
chemotherapy 7. There was one partial response and one stable disease.
Eleven pts progressed by the end of cycle 1; three pts failed due to
toxicity before completing cycle 1. Median time to treatment failure was 10
weeks. The main toxicities were: transaminitis, pancytopenia, 1st division
herpes zoster, deep vein thrombosis and fatigue. The study was closed due to
the low response rate and frequency of toxicity.
Publication Types:
- Clinical Trial
- Clinical Trial, Phase II
PMID: 15527114 [PubMed - indexed for MEDLINE]
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| 10: Cancer. 2004 Dec 1;101(11):2614-21. |
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Expression of the pro-apoptotic protein ARTS in
astrocytic tumors: correlation with malignancy grade and survival rate.
Gottfried Y, Voldavsky E, Yodko L, Sabo E, Ben-Itzhak O, Larisch S.
Department of Pathology, Rambam Medical Center, Haifa, Israel.
BACKGROUND: Apoptosis (i.e., programmed cell death) plays a major role in
the development of astrocytic tumors, which are the most common tumors of
the central nervous system. ARTS, a proapoptotic protein that is localized
in the mitochondria, promotes apoptosis by functioning as an XIAP antagonist
and a caspase activator. METHODS: To investigate the role of ARTS in
astrocytoma, the authors examined protein expression and apoptotic activity
in 72 astrocytic tumors, which included low-grade astrocytomas, anaplastic
astrocytomas, and glioblastomas. RESULTS: Whereas normal astrocytes did not
express the ARTS protein, astrocytoma cells strongly expressed ARTS, and the
expression of this protein increased with increasing tumor grade.
Furthermore, increased levels of ARTS were significantly associated with
higher rates of apoptosis (as measured using the terminal
deoxynucleotidyltransferase-mediated deoxyuridine triphosphate nick
end-labeling [TUNEL] assay as well as an immunohistochemical staining assay
for active caspase-3) in these tumors. Levels of two other apoptosis-related
proteins, p53 and Bcl-2, also were examined using immunohistochemical
methods; ARTS expression was found to be positively correlated with
expression of the former and negatively correlated with expression of the
latter, which is known to possess antiapoptotic activity. CONCLUSIONS: The
results of the current study suggest that ARTS levels reliably reflect the
ability of cells to undergo apoptosis, which serves as a defense mechanism
against the development and progression of astrocytoma. Furthermore, ARTS
expression, when taken into consideration in combination with tumor grade,
was the only independent predictor of survival identified in the current
analysis. Thus, the authors conclude that ARTS may possess utility as a
prognostic marker, as well as a therapeutic tool, for patients with
astrocytoma. (c) 2004 American Cancer Society
PMID: 15517578 [PubMed - indexed for MEDLINE]
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| 11: J Clin Oncol. 2004 Nov 1;22(21):4282-9. |
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Phase II study of fenretinide (NSC 374551) in adults with
recurrent malignant gliomas: A North American Brain Tumor Consortium study.
Puduvalli VK, Yung WK, Hess KR, Kuhn JG, Groves MD, Levin VA, Zwiebel J,
Chang SM, Cloughesy TF, Junck L, Wen P, Lieberman F, Conrad CA, Gilbert MR,
Meyers CA, Liu V, Mehta MP, Nicholas MK, Prados M; North American Brain
Tumor Consortium.
Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer
Center, 1515 Holcombe Blvd., Unit 431, Houston TX 77030, USA.
vpuduval@mdanderson.org
PURPOSE: Fenretinide induces apoptosis in malignant gliomas in vitro. This
two-stage phase II trial was conducted to determine the efficacy of
fenretinide in adults with recurrent malignant gliomas. PATIENTS AND
METHODS: Twenty-two patients with anaplastic gliomas (AG) and 23 patients
with glioblastoma (GBM) whose tumors had recurred after radiotherapy and no
more than two chemotherapy regimens were enrolled. Fenretinide was given
orally on days 1 to 7 and 22 to 28 in 6-week cycles in doses of 600 or 900
mg/m(2) bid. RESULTS: Six of 21 (29%) patients in the AG arm and two of 23
(9%) patients in the GBM arm had stable disease at 6 months. One patient
with AG treated at 900 mg/m(2) bid dosage had a partial radiologic response.
Median progression-free survival (PFS) was 6 weeks for the AG arm and 6
weeks for the GBM arm. PFS at 6 months was 10% for the AG arm and 0% for the
GBM arm. Grade 1 or 2 fatigue, dryness of skin, anemia, and hypoalbuminemia
were the most frequent toxicities reported. The trial was closed after the
first stage because of the inadequate activity at the fenretinide doses
used. The first-administration mean plasma C(max) for fenretinide was 832
+/- 360 ng/mL at the 600 mg/m(2) bid dosage and 1,213 +/- 261 ng/mL at the
900 mg/m(2) bid dosage. CONCLUSION: Fenretinide was inactive against
recurrent malignant gliomas at the dosage used in this trial. However,
additional studies using higher doses of the agent are warranted based on
the tolerability of the agent and the potential for activity of a higher
fenretinide dosage, as suggested in this trial.
Publication Types:
- Clinical Trial
- Clinical Trial, Phase II
PMID: 15514370 [PubMed - indexed for MEDLINE]
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Volume 4, Number
1 - 1 January 2005