We assessed the impact of frailty on surgical outcomes, survival, and functional dependency in elderly patients harboring a glioblastoma, isocitrate dehydrogenase (IDH)-wildtype.
We retrospectively ...reviewed records of old and frail patients surgical treated at a single neurosurgical institution between January 2018 to May 2021. Inclusion criteria were: (1) neuropathological diagnosis of glioblastoma, IDH-wildtype; (2) patient≥65years at the time of surgery; (3) available data to assess the frailty index according to the 5-modified Frailty Index (5-mFI).
A total of 47 patients were included. The 5-mFI was at 0 in 11 cases (23.4%), at 1 in 30 cases (63.8%), at 2 in two cases (4.2%), at 3 in two cases (4.2%), and at 4 in two cases (4.2%). A gross total resection was performed in 26 patients (55.3%), a subtotal resection was performed in 13 patients (27.6%), and a biopsy was performed in 8 patients (17.1%). The rate of 30-day postoperative complications was higher in the biopsy subgroup and in the 5-mFI=4 subgroup. Gross total resection and age≤70years were independent predictors of a longer overall survival. Sex, 5-mFI, postoperative complications, and preoperative Karnofsky Performance Status score did not influence overall survival and functional dependency.
In patients≥65years harboring a glioblastoma, IDH-wildtype, gross total resection remains an independent predictor of longer survival and good postoperative functional recovery. The frailty, assessed by the 5-mFI score, does not influence surgery and outcomes in this dataset. Further confirmatory analyses are required.
Unresectable or metastatic (advanced) primary pulmonary carcinoma (PPC) represents a therapeutic challenge where surgery may be contraindicated and the therapeutic role of maximum‐tolerated dose ...(MTD) chemotherapy remains uncertain. This study was undertaken to explore the impact of metronomic chemotherapy (MC) in dogs with advanced PPC. Previously untreated dogs with advanced (T3 or N1 or M1) PPC, with complete staging work‐up and follow‐up data, receiving MC (comprising low‐dose cyclophosphamide, piroxicam and thalidomide), surgery, MTD chemotherapy or no oncologic treatment were eligible for inclusion. For all patients, time to progression (TTP) and survival time (ST) were evaluated. Quality‐of‐life (QoL) was only evaluated in patients receiving MC. To assess QoL, owners of dogs receiving MC were asked to complete a questionnaire before and during treatment.
Ninety‐one dogs were included: 25 received MC, 36 were treated with surgery, 11 with MTD chemotherapy and 19 received no treatment. QoL was improved in dogs receiving MC. Median TTP was significantly longer in patients receiving MC (172 days) than patients undergoing surgery (87 days), receiving MTD chemotherapy (22 days), or no oncologic treatment (20 days). Median ST was similarly longer in patients receiving MC (139 days) than those undergoing surgery (92 days), MTD chemotherapy (61 days) and no oncologic treatment (60 days). In dogs with advanced PPC, MC achieved a measurable clinical benefit without significant risk or toxicity. This makes MC a potential alternative to other recognized management approaches.
Giant herniated thoracic disc (HTD) is a rare disease that, unlike other thoracic disc herniations of different size, need a different surgical management. The copresence of ''giant'' volume and ...calcification of the herniated disc heavily affects the surgical difficulty and is not elsewhere described.
Seven cases of surgically treated giant calcified HTDs were considered in this study. Five of them were females and two males, age range 18-63 years. Before and after surgery, all patients underwent computed tomography myelography, magnetic resonance imaging or both pre-and postoperatively. Functional outcomes were assessed using the Asia grading system preoperatively, immediately after surgery, and at long-term follow-up examination. The mean overall follow-up period was 36 months. All patients presented with various grades of myelopathy: according to the Asia impairment scale, two were grade B, four were grade C and one were grade D. Six patients underwent an anterior approach, i.e. thoracotomy, and one patients underwent a posterolateral approach, i.e. peduncolocostotrasversectomy.
Based on an analysis of the long-term follow-up data, the Asia grade improved in five patients (71.4%), stabilized (no grade change) in one (14.3%), and worsened in one (14.3%).
Giant calcified HTDs are particularly challenging surgical lesions and their volume and consistency are additional elements of difficulty. This article presents authors' personal experience on a small but extraordinary series of giant and calcified thoracic herniated discs and the problems encountered in the management of this peculiar pathology since an accurate surgical planning leads to better clinical results.
The authors analysed the case of a 53-years-old woman who presented with an C5-D1 intra-extradural mass. Following subtotal removal, the tumour was histologically classified as meningothelial ...meningioma and no radiotherapy was recommended. The neuroradiological workup demonstrated that the lesion was stable one year after the operation but, a few months later a tumour recurrence with huge bone destruction was detected. The tumour was totally resected and a circumferential stabilization was performed. Histology remained unchanged but radiotherapy was now recommended. One year after a new recurrence was detected and the patient died. The authors discuss the extremely malignant behaviour of a tumour classified as benign.
We present the case of a 67-year-old woman referred to our hospital with an eight week history of walking difficulties and nausea. On CT scans a tumour in the right cerebellopontine angle (CPA) was ...diagnosed. The tumour was resected and histopathological examination revealed an adenocarcinoma, suspected to be a metastasis from breast carcinoma treated surgically twelve years earlier.
Introduction
: The cochlear implant is the first-choice solution for severe and profound hearing loss. Skull base surgery procedures often require sacrificing the hearing function. An interesting and ...innovative application field for cochlear implants is to restore hearing function after this skull base surgery procedure.
Patients and Methods
: In our department from March, 2009 to January, 2013 16 patients affected by different pathology involving skull base was surgically treated plus cochlear implant insertion (in one single step or in the two stages modalities).
Results
: Overall 16 patients with 6 acoustic cochlear schwannoma, 3 Meniere syndrome, 2 petrous-apex giant cholesteatoma, 2 colesterinic granuloma, 1 facial schwannoma, 1 CPA vascular conflict, 1 glomus jugular tumor. Total 14 of them have hearing benefits from CI, even those cases with controlateral normal hearing or mild hearing loss. One (giant petrous apex cholesteatoma with partial erosion of cochlea apex) and one giant schwannoma had no hearing benefits.
Conclusion
: Those skull-base procedures, where the sacrifice of the auditory function is required represent, in our experience, an interesting application field for cochlear implants.
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•HTC positively affects the thermal stability of hydrochar.•Hydrochar from co-HTC of VP and EGM has lower devolatilization and combustion index.•Higher fixed carbon and lower volatile ...and ash contents improve combustion efficiency.•Hydrochar exhibited reduced activation energy for both pyrolysis and combustion.
Pyrolysis and combustion behavior of the hydrochar (HY) from co-hydrothermal carbonization (co-HTC) of vine pruning (VP) and exhausted grape marc (EGM) by using vinasse as wet catalytic vector was investigated through thermogravimetric analysis (TGA). For both raw- and co-HTC biomass, different iso-conversional methods were used for kinetic analysis, and the thermodynamic parameters were determined. Overall, even if HY exhibited a lower activation energy compared to EGM and VP during both pyrolysis and combustion, HTC has positive effects on the hydrochar’s structure, which achieved a more thermodynamically stable, structurally ordered, and energetically favorable state. The obtained kinetic and thermodynamic parameters would contribute to the development of biomass thermochemical conversion technologies and the application of hydrochar-based energy systems.
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