To identify the optimal time for imaging following stereotactic radiosurgery (SRS) in patients with vestibular schwannomas (VS).
Retrospective case series.
Tertiary, university center.
Patients with ...VS treated with SRS.
Pre- and post-SRS surveillance with magnetic resonance imaging (MRI); patients should have at least two pre- and two post-SRS scans available to be included.
Patient demographics, tumor size, and growth per month ratio pre- and post-SRS and time interval between serial MRI.
Forty-two patients fulfilled the inclusion criteria. The average tumor size before the treatment was 16.9 mm (range, 10-28 mm) while 2 years posttreatment it was 16 mm (range, 7-25 mm) (p = 0.5). Average time of the first MRI post-SRS was 11 months (range, 5-14) with an average change in tumor size at that time of +0.53 mm (range, -5-8). Average time to second MRI was 22.3 months (range, 12-33) with an average change in tumor size at second scan of -1.14 (range, -5-2) mm (p = 0.117). The average growth/mo ratio before SRS was 0.26 mm/mo (range, 0-1), while post-SRS 0.05 mm/mo (range, -0.3-0.5) and -0.16 mm/mo (range, -18-0.25) at the time of the first and second scan, respectively (p < 0.001).
Given the initial increase in size following SRS, unless clinically indicated, MRI post-SRS at less than 1 year has no clinical value. The growth per month ratio provides more meaningful values for response to treatment than tumor size measurements.
Although the natural history of vestibular schwannomas (VS) has been previously studied, few studies have investigated associated epidemiological factors, primarily because of the lack of large ...available cohorts.
The objective of this study was to perform a multi-scale geographical analysis of the period prevalence of VS in West Scotland from 2000 to 2015.
Adults diagnosed with sporadic VS were identified through the National Health Services of West Scotland database and geocoded to the unit postcode. To assess whether the cohort of VS cases could be pooled into a period prevalence measure, the locations of VS cases were analyzed by sex using Cross-L and Difference-K functions. VS period prevalence was examined at two aggregate spatial scales: the postcode district and a coarser scale of NHS Health Boards. The spatial structure of period prevalence within each level of spatial aggregation was measured using univariate global and local Moran's I. Bivariate local Moran's I was used to examine the between-scale variability in period prevalence from the postcode district level to the NHS Health Boards levels. Prior to spatial autocorrelation analyses, the period prevalence at the postcode district was tested for stratified spatial heterogeneity within the NHS Health Boards using Wang's q-Statistic.
A total of 512 sporadic VS were identified in a population of over 3.1 million. Between 2000 and 2015, VS period prevalence was highest within the NHS Health Boards of Greater Glasgow and Clyde, Ayrshire and Arran and the Western Isles. However, at the NHS scale, period prevalence exhibited no spatial autocorrelation globally or locally. At the district scale, Highland exhibited the most unusual local spatial autocorrelation. Bivariate local Moran's I results indicated general stability of period prevalence across the postcode district to Health Boards scales. However, locally, some postcode districts in Greater Glasgow and Clyde, Ayrshire and Arran exhibited unusually low district to zone spatial autocorrelation in period prevalence, as did the southern parts of the Western Isles. Some unusually high period prevalence values between the postcode district to Health Board scale were found in Tayside, Forth Valley and Dumfries and Galloway.
Geographic variability in VS in West Scotland was identified in this patient population, showing that there are areas, even remote, with unusually high or low period prevalence. This can be partially attributed to links between primary and tertiary care. Potential genetic or environmental risk factors that may contribute to geographic variation in this disease within Scotland are also a possibility but require further investigation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Objective
The aim of this study is to present our experience in dealing with middle ear adenomas (MEAs), very rare tumors of the middle ear.
Methods
The medical notes of individuals with ...MEAs treated in tertiary referral; academic settings were retrospectively reviewed. We recorded the presenting symptoms, imaging findings, and pathology results. We additionally examined our surgical outcomes, follow-up period, recurrence, and morbidity.
Results
We identified four patients with MEAs: two males and two females with an average age of 36.25 years (range = 27–51 years). Despite the detailed imaging studies, including computed tomography and magnetic resonance imaging with intravenous contrast administration, a biopsy was essential in setting the diagnosis. Total surgical resection was achieved in all patients without any recurrence over an average of 6 years (range = 3–10 years). Complete ipsilateral deafness was the commonest surgical morbidity due to footplate infiltration by the tumor.
Conclusion
Total surgical resection is the treatment of choice in MEAs to minimize the risk for recurrence; this can come with morbidity, mostly sensorineural deafness. Given the very limited literature, long-term follow-up is recommended.
To examine the predictive value of neutrophil to lymphocyte ratio (NLR) for vestibular schwannoma (VS) growth.
Retrospective case-control study.
Tertiary, referral center.
Patients with sporadic VS ...and available NLR obtained within 1 year from the diagnosis were divided into two groups with growing or non-growing tumor. Patients with known conditions affecting NLR were excluded.
NLR and tumor growth as determined by linear measurements on serial magnetic resonance imaging.
VS growth, demographic factors, and NLR were compared using multi-variant logistic regression and Receiver Operating Characteristic (ROC) curve analysis.
A total of 161 patients fulfilled the inclusion criteria, 79 with growing VS (men:women ratio = 43:36, mean age, 61.8 years) and 82 with non-growing tumors (men:women ratio = 37:45, mean age, 64.9 years). Mean NLR for the group with growing VS was 3.34 (SD standard deviation = 1.5) and 2.31 (SD = 0.76) for the group with non-growing VS (p = 0.001; 0.03 when adjusted for all parameters). The optimal cut-off point was NLR = 3.05 with positive predictive value 83.8% and 100% for NLR greater than 5.3. ROC analysis of the adjusted data for age, sex, and side, gave an area under the curve of 0.768, indicating NLR as a good independent predictive marker. Interestingly, the size of tumor was statistically significantly higher for the growing VS group (p = 0.001).
Despite the low specificity of low NLR, our results indicate high NLR as a good predictive marker for VS growth. Confirmation by prospective studies will have a significant impact on patients' management.
Natural, unburnt topsoil samples from the Cotswolds region of England and samples from archaeological contexts in the UK and Hungary, some of which are known to have been affected by burning, have ...been used to identify a distinctive magnetic ‘signature’ linked to the effects of fire on magnetic properties. A combination of bulk, low field (
χ
lf) and frequency dependent (
χ
fd) magnetic susceptibility and normalized anhysteretic remanent magnetization (
χ
ARM) measurements have been used on both unburnt and experimentally burnt samples from the Cotswolds and on the archaeological samples. Complementary determinations were made for both sets of samples of the maximum potential susceptibility (
χ
max) and, hence, percentage fractional conversion (
χ
conv), which provides independent evidence of burning. The results show that the ferrimagnetic mineral assemblages produced as a result of fire have a significantly finer grain size than those arising from weathering and soil formation alone. Burning thus gives rise to a distinctive envelope of values on a bilogarithmic plot of
χ
ARM/
χ
fd versus
χ
ARM/
χ
lf. Such a diagram provides a convenient basis for identifying magnetic signatures in soils, archaeological materials and palaeosols that have arisen mainly through burning.
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