Athanasios Chatzisotiriou

The Importance of Tumor Volume in the Prognosis of Patients with Glioblastoma

Background and Purpose:The importance of tumor volume as a prognostic factor in high-grade gliomas is highly controversial and there are numerous methods estimating this parameter. In this study, a computer-based application was used in order to assess tumor volume from hard copies and a survival analysis was conducted in order to evaluate the prognostic significance of preoperative volumetric data in patients harboring glioblastomas.Patients and Methods:50 patients suffering from glioblastoma were analyzed retrospectively. Tumor volume was determined by the various geometric models as well as by an own specialized software (Volumio). Age, performance status, type of excision, and tumor location were also included in the multivariate analysis.Results:The spheroid and rectangular models overestimated tumor volume, while the ellipsoid model offered the best approximation. Volume failed to attain any statistical significance in prognosis, while age and performance status confirmed their importance in progression-free and overall survival of patients.Conclusion:Geometric models provide a rough approximation of tumor volume and should not be used, as accurate determination of size is of paramount importance in order to draw safe conclusions in oncology. Although the significance of volumetry was not disclosed, further studies are definitely required.Hintergrund und Ziel:Die Bedeutung des Tumorvolumens als prognostischer Faktor fur maligne Gliome ist nach wie vor umstritten. In dieser Studie wurden eine computerbasierte Methode zur Beurteilung des Tumorvolumens anhand von magnetresonanztomographischen Bildern bei Patienten mit Glioblastoma multiforme (GBM) durchgefuhrt und mittels einer Uberlebensanalyse die prognostische Bedeutung praoperativer volumetrischer Daten untersucht.Patienten und Methodik:50 Patienten mit GBM, welche zwei unterschiedliche Chemotherapieregime erhalten hatten, wurden retrospektiv analysiert und die Tumorvolumina durch verschiedene geometrische Modelle sowie eine spezielle Software (Volumio) gemessen. Alter, Performance-Status, Tumorlokalisation sowie Art der Exzision wurden in der multivariaten Uberlebensanalyse berucksichtigt.Ergebnisse:Die angewandten spharoiden und rektangularen geometrischen Modelle uberschatzten das Tumorvolumen, wohingegen die ellipsoiden Modelle die beste Annaherung im Vergleich zu Volumio ermoglichten. Das Tumorvolumen erwies sich nicht als statistisch signifikanter Prognosefaktor. In der multivariaten Analyse bestatigte sich die Bedeutung des Alters und des Performance-Status fur das progressionsfreie Uberleben und das Gesamtuberleben der Patienten.Schlussfolgerung:Geometrische Modelle bieten eine ungenaue Messung des Tumorvolumens und sollten in der klinischen Praxis nicht zur Anwendung kommen, zumal die prazise Erfassung der Tumorgrose von entscheidender onkologischer Bedeutung ist. Obwohl die vorgelegten Daten den Einfluss des Tumorvolumens als statistisch nicht signifikant zeigten, sind weitere Studien bezuglich der Bedeutung dieses Parameters notwendig.

The importance of tumor volume in the prognosis of patients with glioblastoma: comparison of computerized volumetry and geometric models.

Background and Purpose:The importance of tumor volume as a prognostic factor in high-grade gliomas is highly controversial and there are numerous methods estimating this parameter. In this study, a computer-based application was used in order to assess tumor volume from hard copies and a survival analysis was conducted in order to evaluate the prognostic significance of preoperative volumetric data in patients harboring glioblastomas.Patients and Methods:50 patients suffering from glioblastoma were analyzed retrospectively. Tumor volume was determined by the various geometric models as well as by an own specialized software (Volumio). Age, performance status, type of excision, and tumor location were also included in the multivariate analysis.Results:The spheroid and rectangular models overestimated tumor volume, while the ellipsoid model offered the best approximation. Volume failed to attain any statistical significance in prognosis, while age and performance status confirmed their importance in progression-free and overall survival of patients.Conclusion:Geometric models provide a rough approximation of tumor volume and should not be used, as accurate determination of size is of paramount importance in order to draw safe conclusions in oncology. Although the significance of volumetry was not disclosed, further studies are definitely required.Hintergrund und Ziel:Die Bedeutung des Tumorvolumens als prognostischer Faktor fur maligne Gliome ist nach wie vor umstritten. In dieser Studie wurden eine computerbasierte Methode zur Beurteilung des Tumorvolumens anhand von magnetresonanztomographischen Bildern bei Patienten mit Glioblastoma multiforme (GBM) durchgefuhrt und mittels einer Uberlebensanalyse die prognostische Bedeutung praoperativer volumetrischer Daten untersucht.Patienten und Methodik:50 Patienten mit GBM, welche zwei unterschiedliche Chemotherapieregime erhalten hatten, wurden retrospektiv analysiert und die Tumorvolumina durch verschiedene geometrische Modelle sowie eine spezielle Software (Volumio) gemessen. Alter, Performance-Status, Tumorlokalisation sowie Art der Exzision wurden in der multivariaten Uberlebensanalyse berucksichtigt.Ergebnisse:Die angewandten spharoiden und rektangularen geometrischen Modelle uberschatzten das Tumorvolumen, wohingegen die ellipsoiden Modelle die beste Annaherung im Vergleich zu Volumio ermoglichten. Das Tumorvolumen erwies sich nicht als statistisch signifikanter Prognosefaktor. In der multivariaten Analyse bestatigte sich die Bedeutung des Alters und des Performance-Status fur das progressionsfreie Uberleben und das Gesamtuberleben der Patienten.Schlussfolgerung:Geometrische Modelle bieten eine ungenaue Messung des Tumorvolumens und sollten in der klinischen Praxis nicht zur Anwendung kommen, zumal die prazise Erfassung der Tumorgrose von entscheidender onkologischer Bedeutung ist. Obwohl die vorgelegten Daten den Einfluss des Tumorvolumens als statistisch nicht signifikant zeigten, sind weitere Studien bezuglich der Bedeutung dieses Parameters notwendig.

Contractile properties and movement behaviour in neonatal rats with axotomy, treated with the NMDA antagonist DAP5

BackgroundIt is well known that axotomy in the neonatal period causes massive loss of motoneurons, which is reflected in the reduction of the number of motor units and the alteration in muscle properties. This type of neuronal death is attributed to the excessive activation of the ionotropic glutamate receptors (glutamate excitotoxicity). In the present study we investigated the effect of the NMDA antagonist DAP5 [D-2-amino-5-phosphonopentanoic acid] in systemic administration, on muscle properties and on behavioural aspects following peripheral nerve injury.MethodsWistar rats were subjected to sciatic nerve crush on the second postnatal day. Four experimental groups were included in this study: a) controls (injection of 0.9% NaCl solution) b) crush c) DAP5 treated and d) crush and DAP5 treated. Animals were examined with isometric tension recordings of the fast extensor digitorum longus and the slow soleus muscles, as well as with locomotor tests at four time points, at P14, P21, P28 and adulthood (2 months).Results1. Administration of DAP5 alone provoked no apparent adverse effects. 2. In all age groups, animals with crush developed significantly less tension than the controls in both muscles and had a worse performance in locomotor tests (p<0.01). Crush animals injected with DAP5 were definitely improved as their tension recordings and their locomotor behaviour were significantly improved compared to axotomized ones (p<0.01). 3. The time course of soleus contraction was not altered by axotomy and the muscle remained slow-contracting in all developmental stages in all experimental groups. EDL, on the other hand, became slower after the crush (p<0.05). DAP5 administration restored the contraction velocity, even up to the level of control animals 4. Following crush, EDL becomes fatigue resistant after P21 (p<0.01). Soleus, on the other hand, becomes less fatigue resistant. DAP5 restored the profile in both muscles.ConclusionsOur results confirm that contractile properties and locomotor behaviour of animals are severely affected by axotomy, with a differential impact on fast contracting muscles. Administration of DAP5 reverses these devastating effects, without any observable side-effects. This agent could possibly show a therapeutic potential in other models of excitotoxic injury as well.

Delayed Persistent Hyperthermia after Resection of a Craniopharyngioma

Objective and Importance: Disorders of thermoregulation are occasionally noticed after operations in the region of the third ventricle. Various factors are usually implicated, but the actual contribution of each of them is rather vague. Apart from the presumed derangement in the functional connections of the hypothalamic region, mechanical reasons of compression should be thoroughly considered. Clinical Presentation: An 8.5-year-old patient was subjected to a radical excision of a craniopharyngioma compressing the third ventricle. Three months after the operation, he presented with a febrile syndrome of unknown origin. All usual investigations proved negative. Intervention: A chronic subdural hygroma was evacuated, an encapsulated CSF cyst of the suprachiasmatic cistern was drained and the lamina terminalis incised resulting in a moderate control of pyrexia. The administration of chlorpromazine contributed to the final resolution of hyperthermia. Conclusion: Postoperative hyperthermia may result following resection of tumors of the hypothalamic floor. It should not be blindly attributed to hypothalamic dysfunction as surgical causes could be implicated as well. Chlorpromazine could be a useful adjunct to the correction of the disorder.

Demyelinating plaque imitates an intramedullary tumour

An isolated spinal demyelinating lesion is very rare and almost always associated with multiple sclerosis. There are only a few reports of biopsy or resection of MS-associated lesions. Sometimes the radiological and the histopathological findings can lead to a false diagnosis of a tumour. A 15-year-old girl presented with a progressive spastic tetraparesis and various associated clinical symptoms. Magnetic resonance imaging (MRI) suggested a possible intramedullary tumour extending from C4 to C7 and the need for surgical intervention. There was no previous neurological or other history and the brain MRI was normal. The performing surgeons based their procedures on oncological criteria. The extracted lesion was finally diagnosed as a demyelinating plaque. The postoperative course was uneventful without deterioration of the neurological status and the young patient improved completely after 4-months of rehabilitation. After an 8-year follow-up, the patient remains in remission and free of neurological defects. Apart from the radiological findings, the CSF exam as well as the evoked potentials does not suggest a diagnosis of MS. A demyelinating plaque in the cervical spinal cord can occasionally imitate a cervical intramedullary tumour leading to an operation. Such lesions underscore the sensitivity of present-day lesion detection procedures. An addition of a MS work up could be beneficial in some cases of intramedullary tumours without a typical history, although in the case presented this type of workup was negative.

Three-dimensional morphometric mapping of rat muscle fibers

Introduction: Quantitative descriptions of fiber type organization in hind limb muscles are incomplete or rare. Methods: Fiber morphometrics for both rat tibialis anterior (TA) muscles were measured in 3 dimensions. Results: Slow oxidative fiber area and perimeter varied in all zones. Fast oxidative glycolytic fibers (FOG) were predominant in the mediolateral and posterior zones, and fast glycolytic fibers (FG) predominated in the anterior zone. The mean area of FOG and succinate dehydrogenase intermediate fibers was lowest in the anterior zone. Mean area of FG was highest in the proximal and distal parts of the muscle. The area and perimeter of fast fibers differed significantly between the right and left limbs in the medial zone. In the middle and lateral zones, they differed at the proximal and distal parts. Conclusions: This detailed analysis in a high resolution, 3‐dimensional map provides an essential tool for understanding the structure and function of TA muscles. Muscle Nerve 48: 951–957, 2013

Balloon cell melanoma metastasis to the temporal lobe

Editor, In recognition of the rarity of metastatic melanomas in the brain of the morphological variant of the balloon‐cell type,[1‐3] we report a new case of balloon cell melanoma (BCM) metastatic to the convexity of the left temporal lobe. A 54‐year‐old male presented with difficulty in speech comprehension. Νeurological examination disclosed mild sensory dysphasia, with no other localizing signs. Neuroimaging revealed a space‐occupying lesion of the left temporal lobe, showing strong enhancement with gadolinium in T1‐weighted images [Figure 1]. The patient was subjected to a left temporal craniotomy and total resection of the lesion, which was clearly visible in the cortex and with no connection to the meninges. Histopathological examination revealed diffuse infiltration of the brain tissue by large, tightly packed, pale neoplastic cells, occasionally of giant size, with an abundant, clear, foamy cytoplasm and relatively uniform nuclei with minimal‐to‐mild atypia, and few mitoses [Figure 2a and b]. These characteristic balloon cells were amelanotic. The neoplasm was arranged in a solid pattern infiltrating the brain matter. Immunohistochemically, the tumor cells were positive for Vimentin, S100, Melan‐A, and HMB‐45 [Figure 2c and d], but negative for cytokeratins AE1/AE3 and 8/18, PAX8, calretinin, and synaptophysin. The medical history of the patient included a surgically excised cutaneous melanoma without BCM features. He was initially subjected to resection of a lesion in the left forearm with complementary lymph node dissection in the left axilla. Metastasis was then

The Importance of Tumor Volume in the Prognosis of Patients with Glioblastoma@@@Tumorvolumen als prognostischer Faktor für Patienten mit Glioblastoma. Vergleich der computerbasierten Volumetrie mit geometrischen Modellen: Comparison of Computerized Volumetry and Geometric Models

Background and Purpose:The importance of tumor volume as a prognostic factor in high-grade gliomas is highly controversial and there are numerous methods estimating this parameter. In this study, a computer-based application was used in order to assess tumor volume from hard copies and a survival analysis was conducted in order to evaluate the prognostic significance of preoperative volumetric data in patients harboring glioblastomas.Patients and Methods:50 patients suffering from glioblastoma were analyzed retrospectively. Tumor volume was determined by the various geometric models as well as by an own specialized software (Volumio). Age, performance status, type of excision, and tumor location were also included in the multivariate analysis.Results:The spheroid and rectangular models overestimated tumor volume, while the ellipsoid model offered the best approximation. Volume failed to attain any statistical significance in prognosis, while age and performance status confirmed their importance in progression-free and overall survival of patients.Conclusion:Geometric models provide a rough approximation of tumor volume and should not be used, as accurate determination of size is of paramount importance in order to draw safe conclusions in oncology. Although the significance of volumetry was not disclosed, further studies are definitely required.Hintergrund und Ziel:Die Bedeutung des Tumorvolumens als prognostischer Faktor fur maligne Gliome ist nach wie vor umstritten. In dieser Studie wurden eine computerbasierte Methode zur Beurteilung des Tumorvolumens anhand von magnetresonanztomographischen Bildern bei Patienten mit Glioblastoma multiforme (GBM) durchgefuhrt und mittels einer Uberlebensanalyse die prognostische Bedeutung praoperativer volumetrischer Daten untersucht.Patienten und Methodik:50 Patienten mit GBM, welche zwei unterschiedliche Chemotherapieregime erhalten hatten, wurden retrospektiv analysiert und die Tumorvolumina durch verschiedene geometrische Modelle sowie eine spezielle Software (Volumio) gemessen. Alter, Performance-Status, Tumorlokalisation sowie Art der Exzision wurden in der multivariaten Uberlebensanalyse berucksichtigt.Ergebnisse:Die angewandten spharoiden und rektangularen geometrischen Modelle uberschatzten das Tumorvolumen, wohingegen die ellipsoiden Modelle die beste Annaherung im Vergleich zu Volumio ermoglichten. Das Tumorvolumen erwies sich nicht als statistisch signifikanter Prognosefaktor. In der multivariaten Analyse bestatigte sich die Bedeutung des Alters und des Performance-Status fur das progressionsfreie Uberleben und das Gesamtuberleben der Patienten.Schlussfolgerung:Geometrische Modelle bieten eine ungenaue Messung des Tumorvolumens und sollten in der klinischen Praxis nicht zur Anwendung kommen, zumal die prazise Erfassung der Tumorgrose von entscheidender onkologischer Bedeutung ist. Obwohl die vorgelegten Daten den Einfluss des Tumorvolumens als statistisch nicht signifikant zeigten, sind weitere Studien bezuglich der Bedeutung dieses Parameters notwendig.