Optimum Treatment Protocol Research Articles

Resveratrol Promotes Proliferation, Antioxidant Properties, and Progesterone Production in Yak (Bos grunniens) Granulosa Cells.

Resveratrol (RES) is a class of natural polyphenolic compounds known for its strong anti-apoptotic and antioxidant properties. Granulosa cells (GCs) are one of the important components of ovarian follicles and play crucial roles in follicular development of follicles in the ovary. Here, we explored the effects of RES on the proliferation and functions of yak GCs. Firstly, we evaluated the effect of RES dose and time in culture on the viability of GCs, and then the optimum treatment protocol (10 μM RES, 36 h) was selected to analyze the effects of RES on the proliferation, cell cycle, apoptosis, malondialdehyde (MDA), glutathione (GSH), reactive oxygen species (ROS) accumulation, lipid droplet content, ATP production, and steroidogenesis of GCs, as well as the expression of related genes. The results show that RES treatment significantly (1) increased cell viability and proliferation and inhibited cell apoptosis by upregulating BCL-2 and SIRT1 genes and downregulating BAX, CASP3, P53, and KU70 genes; (2) increased the proportion of GCs in the S phase and upregulated CCND1, PCNA, CDK4, and CDK5 genes; (3) reduced ROS accumulation and MDA content and increased GSH content, as well as upregulating the relative expression levels of CAT, SOD2, and GPX1 genes; (4) decreased lipid droplet content and increased ATP production; (5) promoted progesterone (P4) secretion and the expression of P4 synthesis-related genes (StAR, HSD3B1, and CYP11A1); and (6) inhibited E2 secretion and CYP19A1 expression. These findings suggest that RES at 10 μM increases the proliferation and antioxidant properties, inhibits apoptosis, and promotes ATP production, lipid droplet consumption, and P4 secretion of yak GCs.

Do small for gestational age infants have less severe neonatal abstinence syndrome?

Small for gestational age (SGA) infants are likely to have decreased placental transfer of opioids and other substances and lower amounts of fat deposition, hence less severe neonatal abstinence syndrome (NAS). The goal of this study is to correlate SGA status and severity of NAS in infants admitted to the neonatal intensive care unit (NICU). This is a retrospective analysis of term and late-preterm infants (≥35 weeks gestation) exposed to in-utero substances, born between September 2006 and May 2021, and admitted to an inner-city NICU for medical therapy for NAS. Indicators of the severity of NAS (duration of medical treatment, duration of hospitalization, use of phenobarbital, and use of clonidine) were compared between infants characterized as SGA (birth weight <10th percentile for gestational age) to those not categorized as SGA (non-SGA). A total of 992 infants met the study criteria; 205 (20.7%) in the SGA group and 787 (79.3%) in the non-SGA group. The median duration of medical treatment was significantly lower in infants in the SGA group (22 days vs. 26 days, p = 0.04) and they were less likely to be treated with phenobarbital (19% vs. 26.8%, p = 0.02). SGA infants displayed less severe NAS symptoms as indicated by shorter a duration of medical treatment and decreased need for phenobarbital. Our findings may impact decisions around identifying the optimum treatment protocols catered to SGA infants with NAS.

The Effectiveness of Extracorporeal Shockwave Therapy for Midportion Achilles Tendinopathy: A Systematic Review.

Achilles tendinopathy is one of the most common lower limb injuries in both athletes and the general population. Despite the plethora of conservative treatment options available for the management of Achilles tendinopathy, as many as one in four patients will go on to require surgery. Extracorporeal shockwave therapy (ESWT) has emerged as a promising treatment option and has been successful in the management of other common musculoskeletal injuries such as plantar fasciitis. However, the evidence for ESWT in the management of Achilles tendinopathy remains inconclusive. Therefore, the aim of this systematic review was to evaluate the current evidence for the use of ESWT in the management of midportion Achilles tendinopathy.A comprehensive literature search was conducted using the databases MEDLINE (Pubmed), AMED, EMBASE, CINAHL, and CENTRAL. The databases were searched from their inception to December 2021. This was conducted to identify randomised control trials (RCTs) evaluating the effectiveness of ESWT versus control treatment in the management of midportion Achilles tendinopathy.Following a comprehensive search of the literature, a total of 283 articles were identified. Following the screening of titles and abstracts, 236 articles were excluded. The main reasons for exclusion were the identification of duplicates, non-randomised studies, and the use of ESWT on other pathology. Following the exclusion of 236 articles, 47 articles were retrieved for full-text review. Of these 47 articles, 40 were excluded leaving a total of 7 RCTs eligible for inclusion in this review. There was consistent evidence from 4 RCTs that ESWT is effective in the management of midportion Achilles tendinopathy.This review suggests that ESWT is a safe and effective modality for treating midportion Achilles tendinopathy as it reduces pain and improves function. The best available evidence suggests that a combination of ESWT with eccentric exercises and stretching may be even more effective than ESWT alone. Further research is required to confirm this and to determine the optimum ESWT treatment protocol.

Profile and Outcome of Children with Opsoclonus Myoclonus Ataxia: A Tertiary Care Hospital Experience from India

AbstractOpsoclonus myoclonus ataxia syndrome (OMAS) is a rare but treatable, often paraneoplastic neuroimmunologic condition. This is a retrospective chart review of 8 patients diagnosed in the past 11 years at a tertiary care hospital. The mean age of children with OMAS was 21.2 ± 8 months. There was a female preponderance (62.5%). Median symptom duration was 24.5 days (interquartile range [IQR] 12.7; 97.5). All patients had ataxia and irritability; 6 had opsoclonus.An underlying neurogenic tumor was identified in 87.5% (⅞) of the patients by computed tomography (CT)/magnetic resonance imaging. Neuroblastoma was detected in ⅘ with normal 24-hour urinary vanillylmandelic acid and 2 had negative metaiodobenzylguanidine scan.All patients received adrenocorticotropic hormone/steroids for a median of 9.5 months (IQR 5.3; 13.5) with clonazepam. Five received intravenous immunoglobulin (IVIG), including repeated cycles in ⅘. Two received rituximab. One child with relapsing-remitting course received pulse dexamethasone and cyclophosphamide, resulting in improvement. Clonazepam restored ambulation in one with delayed diagnosis and failure of response to steroids. Six patients underwent tumor resection and four needed chemotherapies.Median follow-up was 15 months (IQR 10.7; 23.2). Mean OMAS-severity scale reduced from 10 to 1.4 in the IVIG group and 10.6 to 5.3 in those who did not receive IVIG. Cognitive delay and behavioral issues were seen in 100% treated with steroids only; 50 and 25%, respectively, treated with multimodal immunotherapy. Five had relapses, one with tumor recurrence.Thorax and abdomen CT scan was found to be a sensitive tool for tumor detection. Better motor and cognitive behavioral outcome were noted in patients who received adjunctive IVIG.Future studies on optimum investigation and treatment protocol in various resource settings are needed.

Double-blind randomized N-of-1 trial of transcranial alternating current stimulation for mal de débarquement syndrome.

BackgroundMal de Débarquement Syndrome (MdDS) is a medically refractory neurotological disorder characterized by persistent oscillating vertigo that follows a period of entrainment to oscillating motion such as experienced during sea or air travel. Fronto-occipital hypersynchrony may correlate with MdDS symptom severity.Materials and methodsIndividuals with treatment refractory MdDS lasting at least 6 months received single administrations of three fronto-occipital transcranial alternating current stimulation (tACS) protocols in an “n-of-1” double-blind randomized design: alpha frequency anti-phase, alpha-frequency in-phase, and gamma frequency control. Baseline assessments were made on Day 1. The treatment protocol that led to the most acute reduction in symptoms during a test session on Day 2 was administered for 10–12 stacked sessions given on Days 3 through 5 (20-minutes at 2-4mA). Pre to post symptom changes were assessed on Day 1 and Day 5. Participants who could clearly choose a preferred protocol on Day 2 did better on Day 5 than those who could not make a short-term determination on Day 2 and either chose a protocol based on minimized side effects or were randomized to one of the three protocols. In addition, weekly symptom assessments were made for four baseline and seven post stimulation points for the Dizziness Handicap Inventory (DHI), MdDS Balance Rating Scale (MBRS), and Hospital Anxiety and Depression Scale (HADS).ResultsOf 24 participants, 13 chose anti-phase, 7 chose in-phase, and 4 chose control stimulation. Compared to baseline, 10/24 completers noted ≥ 25% reduction, 5/24 ≥50% reduction, and 2/24 ≥75% reduction in oscillating vertigo intensity from Day 1 to Day 5. Stimulating at a frequency slightly higher than the individual alpha frequency (IAF) was better than stimulating at exactly the IAF, and slightly better than stimulating with a strategy of standardized stimulation at 10Hz. A one-way repeated measures ANOVA of weekly DHI, MBRS, and HADS measurements showed significant reductions immediately after treatment with improvement increasing through post-treatment week 6.ConclusionFronto-occipital tACS may be effective in reducing the oscillating vertigo of MdDS and serve as a portable neuromodulation alternative for longer-term treatment. Stimulation frequency relative to the IAF may be important in determining the optimum treatment protocol [ClinicalTrials.gov study NCT02540616. https://clinicaltrials.gov/ct2/show/NCT02540616].

Exogenous Application of Polycationic Nanobactericide on Tomato Plants Reduces the Candidatus Liberibacter Solanacearum Infection.

Candidatus Liberibacter solanacearum (CaLso) is associated with diseases in tomato crops and transmitted by the tomato psyllid Bactericera cockerelli. A polymeric water-dispersible nanobactericide (PNB) was evaluated against CaLso as a different alternative. PNB is a well-defined polycationic diblock copolymer designed to permeate into the vascular system of plants. Its assessment under greenhouse conditions was carried out with tomato plants previously infected with CaLso. Using a concentration as low as 1.0 mg L−1, a small but significant reduction in the bacterial load was observed by real-time qPCR. Thus, to achieve an ecologically friendly dosage and set an optimum treatment protocol, we performed experiments to determine the effective concentration of PNB to reduce ~65% of the initial bacterial load. In a first bioassay, a 40- or 70-fold increase was used to reach that objective. At this concentration level, other bioassays were explored to determine the effect as a function of time. Surprisingly, a real reduction in the symptoms was observed after three weeks, and there was a significant decrease in the bacterial load level (~98%) compared to the untreated control plants. During this period, flowering and formation of tomato fruits were observed in plants treated with PNB.

All about cellulite: a review of the causes, treatments and new technologies

Cellulite is an aesthetic condition that affects the vast majority of post-pubescent females worldwide. It is difficult to treat, and any results are difficult to maintain. Subcutaneous fibrous septa, anchoring the skin to the underlying tissue and piercing the subcutaneous fat perpendicular to the dermis, lead to the dimpled or wavy topography of the surface. Treatment to improve cellulite must include release of these septa, as well as strengthening of the dermis. As the causes of cellulite are multifactorial, combination treatments, including surgical subcision, lasers, radiofrequency, microfocused ultrasound, acoustic wave therapy and collagenase, are the best option for significant and long-lasting cellulite improvement. Optimum treatment protocols are yet to be determined.

Methodology for enhancing the ionic conductivity of superionic halogen-rich argyrodites for all-solid-state lithium batteries

The development of high-performance all-solid-state lithium-ion batteries depends on the realization of solid-state electrolytes with high ionic conductivity. In this study, halogen-rich argyrodites with high ionic conductivities were fabricated, and their structural evolution was studied. In addition, the optimum heat treatment protocol for enhancing the ionic conductivity of halogen-rich argyrodites (Li5.3PS4.3Cl1.7) was determined by interpreting the reaction mechanism. Structural and thermal analyses revealed that fast heating results in the formation of intermediates containing PS43- units and Cl- ions, which remain in the material and decrease the ionic conductivity (~1.6 mS/cm at 25 °C). Surprisingly, slow heating, such as step heating, can promote the slow reaction that produces argyrodite from an intermediate, resulting in a high ionic conductivity (~5.0 mS/cm at 25 °C). Furthermore, we examined the performance of all-solid-state batteries assembled with Li5.3PS4.3Cl1.7 as a solid-state electrolyte and found that the batteries employing Li5.3PS4.3Cl1.7 treated by a slow heating protocol performs better than the batteries employing Li5.3PS4.3Cl1.7 treated by a fast heating protocol, with an impressive specific capacity of 151.8 mAh/g at 1.0 C. Herein, we assert that further developing halogen-rich argyrodites as glass-ceramics may provide a long-sought solution to realizing ASSBs capable of achieving a high rate.

Efficacy of Fractional CO2 Laser in Onychomycosis: A Clinical Evaluation.

Efficacy of Fractional CO2 Laser in Onychomycosis: A Clinical Evaluation.

PRESENTATION AND MANAGEMENT OF HIRSCHSPRUNG'S DISEASE IN INFANTS AT A TERTIARY CARE CENTRE AND OUTCOME OF PRIMARY PULL-THROUGH IN THESE PATIENTS.

Hirschsprung's disease is a common cause of neonatal intestinal obstruction. The treatment of Hirschsprung's disease has evolved to a single stage pull-through. . The aim of study was to evaluate the feasibility of performing the primary pull-through surgery and to develop an optimum treatment protocol for patients of Hirschsprung's disease (HD) presenting to our institution. It was a prospective cohort study of newborn and young infants with features of Hirschsprung's disease conducted in our department from Oct. 2014, till Oct. 2018. The diagnosis was based on history, clinical examination, water soluble contrast enema and a definitive rectal biopsy. Transition zone was confirmed by intra-operative frozen section. Patients with weight of more than 5kgs and absence of features of concurrent enterocolitis, were taken for surgery. Patients included in the study underwent primary pull-through by different methods were put on strict follow-up protocol for 24 months and results were evaluated. Out of 40 patients of Hirschsprung's disease presented to SKIMS from Oct. 2014 till Oct. 2017,only 25 patients underwent primary pull-through. Mean age of patients at the time of pull-through was6.9±7.12 months and mean weight was 8.76 ±2.67kg. Delayed passage of meconium was seen in23 patients (92%). Preoperative rectal biopsy was done for confirmation of diagnosis and intra-operative frozen section for delineation level of aganglionosis. Laparoscopic transanal pull-through was most common operation done in 13 (52%) patients. Anastomotic leak was seen in 2(8%) patients, wound infection occurred 2(8%) patients, enterocolitis in1(4%) and constipation in 2 (8%) patients. One patient who had undergone trans-anal pull-through underwent a redo for a retained cuff. Primary pull-through is feasible and safe option with excellent results in neonates and infants with Hirschsprungs disease.

Treatment of sialorrhoea with repeated ultrasound-guided injections of botulinum toxin A into the parotid and submandibular glands

Botulinum toxin injections are useful in patients with refractory sialorrhoea although the optimum treatment protocol and its efficacy over a long period of follow up are controversial. The aim of our prospective study was to examine the efficacy and complications of a protocol of repeated ultrasound-guided botulinum toxin injections of fixed doses at a tertiary children’s hospital. A total of 79 procedures were done in 34 patients who were followed up for two years. The overall complication rate was 3%. The outcome measures considered included the Drooling Frequency Severity Scale (DFSS), visual analogue scale (VAS), and carers’ assessments of the reduction in drooling. Our study highlighted two types on non-responders (primary and secondary) of which 3/34 required definitive surgical management. In summary, this study shows that a protocol of repeated injections of fixed doses of botulinum toxin A, while not beneficial in all cases, is a potentially valuable option for the safe and effective treatment of sialorrhoea in children.

A Compendium of Intralesional Therapies in Nail Disorders.

Nail unit is a complex skin appendage offering natural barrier to drug penetration by virtue of its unique anatomy. This is the reason why topical as well as oral therapies can be largely ineffective when dealing with nail diseases. Intralesional (injectable therapies) offer a practical solution in this scenario. This review aims to summarise the role of different injectable drugs in various nail unit disorders. Various types of intralesional therapies in the nail unit, their techniques of administration, appropriate drugs to be used and optimum treatment protocols are summarised.

Initial medical management of rotator cuff tears: a demographic analysis of surgical and nonsurgical treatment in the United States Medicare population

Rotator cuff tears have a lifetime incidence between 25% and 40% in the United States, but optimum treatment strategies and protocol have not yet been widely accepted. This study evaluated the proportions of patients treated with nonoperative and operative modalities and how this proportion has changed during an 8-year period (2005-2012) among patients with Medicare. Using the PearlDiver patient record database, we identified Medicare patients having been diagnosed with a rotator cuff tear. These patients were then stratified on the basis of treatment with physical therapy, subacromial/glenohumeral injection, or rotator cuff repair. We analyzed the data in regard to standard demographic information, comorbidities, and the Charlson Comorbidity Index. During the study period, 878,049 patients were identified and 397,116 patients had rotator cuff repair. The proportion of patients treated initially with physical therapy dropped from 30.0% in 2005 to 13.2% in 2012, and the subacromial/glenohumeral injection proportion decreased from 6.00% to 4.19% (P < .001). The proportion of patients who had rotator cuff repair increased from 33.8% to 40.4% from 2005 to 2012 (P < .001). Charlson Comorbidity Indexes were significantly lower in operative patients compared with each nonoperative treatment examined. This analysis demonstrates a significant decrease in the initial trial of nonoperative treatment and an increase in the rate of surgery. Patients undergoing rotator cuff repair had fewer comorbidities than those undergoing nonoperative treatments. It also demonstrates that patients who had a trial of injection had a higher incidence of eventual rotator cuff repair compared with the patients with an initial trial of physical therapy.

Is hypothermia indicated during cardiopulmonary resuscitation and after restoration of spontaneous circulation?

Targeted temperature management (TTM) after cardiac arrest has become a standard therapy in postresuscitation care. However, many questions addressing the optimum treatment protocol remain unanswered. The positive influence of intra-arrest cooling on survival and neurologic outcome, seen in animal studies, was not revealed in clinical trials so far. By contrast, the evidence of TTM after restoration of circulation is based on both experimental and clinical data. The mechanisms of cerebral injury unfold different time windows for cooling initiation. Immediate cooling and early achievement of a target temperature less than 34°C seems to be beneficial, although clinical data on preclinical cooling failed to detect a positive correlation. Despite previous beneficial experimental and clinical data, the benefit of a lower body temperature was recently called into question by a recent study. Regardless of the preferred temperature range, the main focus must lie in active cooling and prevention of hyperthermic conditions. There are many factors that influence the effect of TTM, which should therefore be tailored to the specific patient's needs. To maximize its beneficial potential, TTM should be customized to resuscitation covariates. Despite open questions on the optimum treatment protocol, active cooling should be started as soon as possible and hyperthermic conditions should be prevented in any case. To answer the question if intra-arrest cooling or prehospital cooling induction is indicated, additional studies are needed.

Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database

BackgroundExtracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system.Sources of dataThis systematic review used data derived from the Physiotherapy Evidence Database (PEDro; www.pedro.org.au, 23 October 2015, date last accessed).Areas of agreementESWT is effective and safe. An optimum treatment protocol for ESWT appears to be three treatment sessions at 1-week intervals, with 2000 impulses per session and the highest energy flux density the patient can tolerate.Areas of controversyThe distinction between radial ESWT as ‘low-energy ESWT’ and focused ESWT as ‘high-energy ESWT’ is not correct and should be abandoned.Growing pointsThere is no scientific evidence in favour of either radial ESWT or focused ESWT with respect to treatment outcome.Areas timely for developing researchFuture randomized controlled trials should primarily address systematic tests of the aforementioned optimum treatment protocol and direct comparisons between radial and focused ESWT.

Comparison of Body, Auricular, and Abdominal Acupuncture Treatments for Insomnia Differentiated as Internal Harassment of Phlegm-Heat Syndrome: An Orthogonal Design.

Objective. To identify the optimum treatment protocol for insomnia among auricular, body, and abdominal needling methods. Methods. A three-factor (3 needling protocols) and three-level experimental scheme was designed based on orthogonal method. 54 patients of insomnia differentiated as internal harassment of phlegm-heat syndrome were given two courses of acupuncture treatment (each with 20 times of acupuncture). The therapeutic effects were evaluated by comparing the Pittsburgh sleep quality index (PSQI), Hamilton Depression Scale (HAMD) scores, and Hamilton Anxiety Scale (HAMA) scores of patients before treatment, after one course of treatment, and after two courses of treatment as well as one month after treatment. Results. Body, auricular, and abdominal acupuncture treatments all alleviated symptoms of insomnia, depression, and anxiety, but body and auricular acupuncture had stronger therapeutic effects. Conclusions. Body acupuncture at basic points shall be given priority in protocol selection for insomnia. The second-best choice is auricular acupuncture with basic points combined with points based on Traditional Chinese Medicine (TCM) theories. Abdominal needling with very quick effect can be an alternative protocol with basic points combined with syndrome differentiation points.

The effectiveness of acupuncture or TENS for phantom limb syndrome. II: A narrative review of case studies

IntroductionPhantom limb pain and phantom limb sensation are extremely prevalent, affecting up to 85% of amputees, but with limited positive solutions available. Previous systematic reviews of complementary therapies suggested the use of acupuncture and transcutaneous electrical nerve stimulation. However, there is a lack of randomized controlled trials and inadequate information to guide clinical practice and future definitive research. This narrative review aims to provide guidance for using acupuncture or TENS and to identify potential outcome measures and optimum treatment protocols for clinical practice and future research. MethodsCase studies identified in a previous systematic review were included, with clinical characteristics extracted to provide narrative description. ResultsThirty-six case studies (257 individuals) were included. Acupuncture usually involved body needling and was most frequently reported on the contralateral limb. Chinese papers tended to use body and scalp acupuncture together; studies reported in English language journals tended to use one style. Acupoints along Yang Ming meridians, Liv 3, and LI 4 were commonly used. Needle retention time varied but was usually 30–40min. Most Chinese studies reported daily treatment for 10–30 sessions, English studies tended to treat less frequently (weekly) and provide a smaller number of treatments (4–7 treatments). Contralateral stimulation in the upper fifth and middle 2/5 of sensory area were frequently used to activate lower limbs and body with scalp acupuncture. TENS treatment tended to be administered at the stump, the contralateral side and in relation to dermatomal pain patterns and innervating peripheral nerves. High frequency TENS was the most frequently used treatment, usually administered more than once daily. Both acupuncture and TENS recorded positive outcomes. Visual analogue scales, numerical pain rating scales, pain rating indices and present pain intensity were common outcome measures. ConclusionTreatment protocols can be drawn from the case studies for clinical practice but information is variable. Differences in clinical practice between studies published in Chinese and English may be due to different educational background, qualifications, cultural expectations, and differences in healthcare systems and policy. Further studies are recommended to develop standard treatment protocols for further randomized controlled trials.

Comparison of the effect of reduced-fluence photodynamic therapy with intravitreal bevacizumab and standard-fluence alone for polypoidal choroidal vasculopathy

BackgroundPhotodynamic therapy (PDT) has previously been reported to be effective in treating polypoidal choroidal vasculopathy (PCV), with satisfactory polyp regression. However, the optimum treatment protocol remains controversial. This study compared the effect of reduced-fluence PDT combined with intravitreal bevacizumab (rPDT/IVB) and standard-fluence PDT (sPDT) alone for treating symptomatic PCV in Chinese patients. MethodsA retrospective review was carried out of the medical records of patients with PCV who were treated with rPDT/IVB (14 eyes of 13 patients) or sPDT (12 eyes of 12 patients) with at least 6 months of follow-up. ResultsThe mean best-corrected visual acuity of the rPDT/IVB group improved significantly at the 6-month follow-up (p = 0.041). Only one eye (7.1%) in the rPDT/IVB group showed a decrease in visual acuity, compared with four eyes (33.3%) in the sPDT group. A total of 40.0% of eyes in the sPDT group showed increased lipid exudate at follow-up 1 month after treatment, whereas no increase in lipid exudate was observed in the rPDT/IVB group (p = 0.015). The mean maximum area of post-treatment hemorrhage in the rPDT/IVB group was smaller than that in the sPDT group (2.57 ± 2.74 mm2 vs. 12.69 ± 10.28 mm2, p = 0.042). ConclusionCombination therapy with rPDT/IVB for patients with PCV showed encouraging results in vision improvement, a lower decrease in visual acuity, significantly less post-treatment lipid exudate and a smaller area of post-treatment hemorrhage at the 6-month follow-up than patients treated with sPDT.

Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare, clinically aggressive cutaneous neuroendocrine neoplasm with a high mortality rate. Though the etiology is not precisely known, Merkel cell polyomavirus DNA has been found recently in a large percentage of MCC tumors. Other suggested risk factors include sun exposure, immunosuppression, and a history of prior malignancy. Work up of patients with MCC most notably includes nodal staging via clinical examination or sentinel lymph node biopsy. The prognosis for most patients with MCC is poor, and the rarity of MCC precludes the prospective, randomized clinical trials necessary to elucidate optimum treatment protocols. Most published data support the use of a multimodality approach centered around surgical excision with negative margins, sentinel lymph node biopsy to establish the presence or absence of nodal metastases, adjuvant radiothearpy to decrease the risk of recurrence, and systemic chemotherapy in the case of widespread disease.

Primary Cerebral Lymphoma Causing Remitting and Relapsing Neurological Symptoms

Primary CNS lymphoma is a rare variant of non-Hodgkin’s lymphoma. Incidence has increased over the past 3 decades, but the optimum treatment protocol is yet to be established. We report a 44-year old man who presented with left-sided numbness. Magnetic resonance imaging of the brain revealed a right hemisphere ill-defined mass. Within four months the patient experienced a spontaneous near-full recovery. From this time the patient deteriorated with increasing left hemiparesis. After several months, the patient developed lethargy and dyspnoea, with episodes of epistaxis and per rectal bleeding. Full blood count revealed a pancytopaenia. Trephine biopsy demonstrated evidence of marrow involvement by diffuse large B-cell lymphoma. The patient was diagnosed with primary CNS lymphoma with systemic involvement. We conclude that the spontaneous remission of symptoms should not discourage a diagnosis of PCNSL if consistent with clinical and radiological findings. doi: http://dx.doi.org/10.4021/jmc1159e