Normal Pressure Hydrocephalus Following Cranial Radiation: Identification of Shunting Responders

BACKGROUND

We examined cognitive, brain MRI, and lumbar infusion test (LIT) features to identify predictors of response to ventriculoperitoneal shunting (VPS) in long-term cancer survivors with suspected normal pressure hydrocephalus (NPH) following cranial radiotherapy (RT).

METHODS

Patients who completed cranial RT at least 2 years before with clinically suspected NPH and an Evans' index (EI) ≥ 0.30 underwent a cognitive and a cerebrospinal fluid (CSF) volumetric (MRI) analysis (n = 36). For those in whom VPS was placed (n = 14), we explored whether adding a CSF volumetric analysis to classical MRI and LIT (Tap Test) features would better identify VPS responders.

RESULTS

Nearly 80% exhibited cognitive impairment. The CSF volume at NPH diagnoses was significantly larger in the group of VPS responders (p = 0.04). The addition of CSF volume to NPH diagnoses increased accuracy to 93%, with a positive and negative predictive value of 91% and 100%, respectively.

CONCLUSION

The addition of a quantitative MRI analysis of CSF volume to classical MRI and LIT NPH criteria, along with a high clinical suspicion of NPH, may help to identify VPS responders, thus improving the clinical management and prognosis of long-term survivors.

Oral self-administration of buprenorphine in the diet for analgesia in mice

Postsurgical oral self-administration of analgesics in rodents is an interesting technique of providing analgesia, avoiding the negative effects of manipulation. Several strategies, using gelatin or nutella, have already been described. However, rodents require some habituation period to reach a good intake because of their neophobic behavior. The current study aimed to explore whether buprenorphine when mixed with an extruded diet offers a potential treatment option in the pain management of mice using a triple approach: by measuring the spontaneous intake in healthy animals; by using the hot-plate test; and finally by assessing the drug’s ability to provide postoperative analgesia in a surgical intervention of moderate severity (intra-utero electroporation). Mice consumed during 20 hours, similar amounts of extruded diet alone, mixed with glucosaline, and mixed with buprenorphine (0.03 mg per pellet) or meloxicam (0.25 mg per pellet) both of which were diluted in glucosaline, showing that no neophobia was associated with these administrations. Relative increase from baseline latency (% maximal possible effect) in the hot-plate test at 20 h of administration was significantly higher for oral buprenorphine in diet 0.03 mg/pellet, and diet 0.15 mg/pellet, compared with placebo and no differences were found between those oral administrations and subcutaneous buprenorphine 0.1 mg/kg measured 3 h later. The treatment was also effective in attenuating the reductions in food consumption and body weight that occur after surgery. These data suggest that providing buprenorphine with the diet is a feasible and effective way of self-administration of analgesia in mice and does not cause neophobia and may easily contribute to the refinement of surgical procedures.

Value of 99mTc-MIBI scintimammography in women with impalpable breast lesions seen on mammography

OBJECTIVE

To find out if 99mTc-methoxyisobutylisonitrile scintimammography (MIBI) is useful in the evaluation of impalpable breast lesions in women referred for biopsy after mammography screening.

DESIGN

Observational and prospective study.

SETTING

Radiological screening campaign in Spain.

PATIENTS

36 patients referred between September 1997 and June 1998 (37 biopsies) with impalpable breast lesions referred consecutively from a screening campaign. Ages ranged from 50 to 64 years.

INTERVENTIONS

Mammography, ultrasound, MIBI, and wire-guided biopsy.

MAIN OUTCOME MEASURES AND RESULTS

Mean values for sensitivity, specificity, positive predictive value, and negative predictive value for scintimammography were 78.9, 72.2, 75, and 76.5 respectively (p = 0.002). The logistic regression analysis showed that 99mTc-MIBI scintimammography result predicted (p = 0.003) the risk of breast cancer in this group of patients (odds ratio: 9.75), particularly infiltrating ductal carcinoma.

CONCLUSIONS

MIBI scintimammography in patients referred for biopsy after mammography screening does not so much rule out cancer as confirm the diagnosis. Its practical benefit would be not so much avoiding biopsy for these patients as aiding in planning the radicality of their excision.

Treatment of primary and secondary spontaneous pneumothorax using videothoracoscopy

Our aim is to assess the results of surgical treatment for spontaneous pneumothorax (SP) using video-assisted thoracoscopic surgery (VATS) and to determine whether this technique is equally effective for primary SP (PSP) and secondary SP (SSP). A prospective study was performed on 54 patients with persistent and recurrent SP (42 PSPs and 12 SSPs). Mean operating time, time before drainage removal, and hospital stay were significantly longer with SSP (67.1 vs. 48.1 minutes; 5.4 vs. 3.6 days; and 7.7 vs. 5.3 days; p < 0.01, respectively). There was one conversion due to bleeding (PSP). Postoperative complications were greater with SSP (33% vs. 12%; p = 0.09). Although these were mild in all cases, the most common was air leak (25 vs. 5%; p = 0.06). The SP persisted in three cases [2 (5%) with PSP, and 1 (8%) with SSP] and recurred in 2 (1 in each group; 2% and 8%, respectively). Follow-up averaged 24 months. VATS is effective in the surgical treatment of PSP and SSP, although the technical difficulty, morbidity rate, hospital stay, and incidence of persistences and recurrences are greater in the latter than in the former.

Quantification of duodenogastric reflux in Barrett's esophagus

OBJECTIVES

Our objective was to assess the role of reflux of duodenal contents in the genesis of Barrett's esophagus. Therefore, we performed a study to quantify duodenogastric reflux, using 99mTc-HIDA quantification in gastric juice after continuous intravenous infusion of the same.

METHODS

The study contained 20 patients with Barrett's esophagus (10 uncomplicated and 10 complicated by ulcers and/or stenosis), 10 patients with peptic esophagitis without Barrett's esophagus (two grade I, four grade II, and four grade III, according to Savary-Miller), and 10 healthy volunteers who made up the control group. Comparisons were made between the groups.

RESULTS

When we considered the groups overall, we observed that the 20 patients with Barrett's esophagus had higher reflux rates (p < 0.01) than either the 10 patients with peptic esophagitis without Barrett's esophagus, or the 10 controls. Complicated Barrett's esophagus presented higher reflux rates than uncomplicated Barrett's esophagus, although the differences were not statistically significant. However, on analyzing the results after considering the groups case by case, we see that the mean reflux rate in the Barrett's esophagus groups is due to five patients presenting much higher rates than the rest.

CONCLUSIONS

Our results suggest that duodenogastric reflux might be involved in the appearance of Barrett's esophagus and its related complications, although only in certain cases. The pathogenesis of Barrett's esophagus is probably multifactorial, and other factors must be involved.