Patients Underwent Tumor Resection Research Articles

Pilomyxoid astrocytoma of the cerebellum with Williams syndrome: a case report

A 3-year-old boy with Williams syndrome associated with supravalvular aortic stenosis was admitted to our hospital with disturbance of consciousness and a 2-month history of truncal ataxia. T1-weighted magnetic resonance imaging with contrast medium showed a heterogeneously enhanced tumor in the right cerebellum with severe hydrocephalus. The patient underwent tumor resection via suboccipital craniotomy. At the end of resection of the tumor, sudden cardiac arrest occurred after ST segment elevation. Despite immediate cardiopulmonary resuscitation, the patient died. Histological examination of the cerebellar tumor revealed that the tumor consisted of monomorphous bipolar spindle cells on a background of myxoid matrix, and angiocentric arrangement without Rosenthal fibers or eosinophilic granular body. The final diagnosis was pilomyxoid astrocytoma. This case of Williams syndrome with cerebellar pilomyxoid astrocytoma suggests the importance of investigation of the development of brain tumors and occurrence of intraoperative cardiac arrest associated with Williams syndrome.

Clinical characteristics and strategy for treatment of functional carotid body tumours

Functional carotid body tumours are rare, but linked to malignant hypertension, postoperative persistent hypotension, cranial nerve injury and stroke. The aim of this study is to analyze the treatment options for functional carotid body tumours. Six patients with functional carotid body tumours who underwent surgical procedures were studied retrospectively. They all had abnormal levels of preoperative catecholamine (norepinephrine, 721±452.2ng/l). One patient presented preoperative hypertension. Preoperative alpha- and beta-adrenergic blockade was carried out. Surgical methods included complete resection (6), saphenous vein interposition (3) and carotid shunt (1). With thorough supervision and treatment, the 6 patients underwent tumour resection. They all experienced intraoperative hypertension while the tumours were being resected. Postoperative problems included endurance hypotension (3/6, 50%), coughing when drinking (3/6, 50%) and deviation of the tongue on protrusion (3/6, 50%). The clinical highlights of functional carotid body tumour include preoperative abnormal catecholamine, peroperative fluctuations of blood pressure level, and regime issues. Operative resection could be the best option for functional carotid body tumours. Careful preoperative evaluation, measurement of serum catecholamine, treatment for alpha- and beta-adrenergic blockade, and gentle intraoperative manipulation are essential to avoid life-threatening complications.

Undifferentiated Pleomorphic Sarcoma of the Cheek with Surface Ulceration: Mimicking Spindle Cell Squamous Cell Carcinoma

Undifferentiated pleomorphic sarcoma (UPS), also called malignant fibrous histiocytoma (MFH), belongs to the soft tissue tumors and is more likely in elder patients. UPS currently accounts for approximately 18% of cutaneous soft tissue sarcoma except Kaposi sarcoma. The most common sites are the extremities and head and neck. UPS is rapidly enlarging, and easily invades subcutaneous tissue and muscle without overlying skin changes. UPS tumors, which are confined to subcutaneous tissue, have been reported to be less than 10%. On the other hand, the involvement of the epidermis, occasionally with ulceration, is rare. Here, we describe a case of UPS of the cheek with surface ulceration. An 83-year-old man presented with a 1-year history of a red nodule on his left cheek. The size of the nodule gradually increased. Clinical examination revealed a 55 × 45 mm red, hard mass in the center of his left cheek with a large cratershaped ulcer involving the subcutaneous tissue. The bottom of the ulcer contained necrotic tissue. No cervical lymph nodes were palpable. A biopsy revealed a high-grade, pleomorphic spindle cell neoplasm and frequent abnormal mitotic figures within the dermis. We temporarily diagnosed and suspected a soft tissue sarcoma, but we could not rule out spindle cell squamous cell carcinoma (SCSCC). The patient underwent tumor resection and skin grafting. The tumor had reached the muscle layer of his left cheek with invasion and ulceration of the overlying skin. Histopathological examination of the totally resected tumor revealed a neoplasm of mesenchymal origin, rich in cells with morphology and immunohistochemical characteristics compatible with UPS. Malignant cells were not found in the epidermis. Immunohistochemical analyses were positive for vimentin, α-anti-trypsin, α-smooth muscle actin (α-SMA), and CD10, and negative for cytokeratins (CAM5.2 and AE1/AE3), lysozyme, epithelial membrane antigen (EMA), CD34, S-100, desmin, and caldesmon. Two months after total resection, the tumor recurred, and the patient was treated with radiation therapy. However, he died 2 months later from multiple lung metastases. We thought that the metastases were from the UPS, because his prostatic carcinoma had not progressed. According to published literatures, the UPS rarely accompanies with surface ulceration. On the other hand, SCC commonly occurs on sun-exposed sites of the head and neck with surface changes including scaling, ulceration, crusting, and the presence of a cutaneous horn. In our case, it was very difficult to distinguish UPS from SCSCC by clinical examination and conventional histopathological staining (e.g. hematoxylin and eosin). Therefore, the immunohistochemistry was required to obtain the final diagnosis.

Retrospective analysis of 36 ameloblastoma cases in Laos

We conducted a retrospective study of 36 cases of ameloblastoma from the files of Mittaphap Hospital in Vientiane Capital, Laos. Clinical findings showed an average patient age of 31.0 ± 3.8 years, with a slight male preponderance. Radiographically, all of the lesions showed multicystic radiotranslucency. Twenty-four patients underwent tumor resection and 12 underwent tumor enucleation. Of those patients, four underwent additional surgery because of tumor recurrence. This is the first report in the English literature of ameloblastoma cases from Laos.

Development of an Integrated Subspecialist Multidisciplinary Neuro-oncology Service.

Traditionally, the poor outcome for patients with malignant brain tumours led to therapeutic nihilism. In turn, this resulted in lack of interest in neurosurgical oncology subspecialisation, and less than ideal patient pathways. One problem of concern was the low rate of tumour resection.Between 1997 and 2006, 685 treated glioblastomas were identified. In the first four years only 40% of patients underwent tumour resection, rising to 55% in the last four years. Before revision of the pathway, the median length of hospital stay was 8 days, and 35% of patients received the results of their histology outside of a clinic setting.A pathway of care was established, in which all patients were discussed pre-operatively in an MDT meeting and then directed into a new surgical neuro-oncology clinic providing first point of contact. This limited the number of surgeons operating on adult glioma patients and aided recruitment into research studies.Now, three consultant neurosurgeons run this service, easily fulfilling IOG requirement to spend >50% of programmed activities in neuro-oncology. Nursing support has been critical to provide an integrated service. This model has allowed increased recruitment to clinical trials.The introduction of this service led to an increase in patients discussed pre-operatively in an MDT (66% rising to 87%; P=0.027), an increase in the rate of surgical resection (from 40% to 80%) and more patients being admitted electively (from 25% to 80%; P<0.001). There was a reduction in the median length of stay (8 days reduced to 4.5 days; P<0.001). For the cohort of GBM patients that went on to have chemoradiotherapy we improved median survival to 18 months, with 35% of patients alive at two years, comparable to international outcomes.Implementing a specialist neurosurgical oncology service begins with understanding the patient care pathway. Our patients have benefitted from the culture of subspecialisation and the excellent inter-disciplinary working relationships that have been developed.

Neuroblastoma with a Solitary Intraventricular Brain Metastasis Visualized on I‐123 MIBG Scan

Although metastatic skull lesions of neuroblastoma are not uncommon, brain involvement is infrequent and prompt diagnosis is of utmost importance in such cases. Previous studies have shown that Meta-Iodo-Benzyl-Guanidine (MIBG) scans were not always reliable in detecting central nervous system metastases, however most published reports referred to the Iodine-131 ((131)I)-MIBG scans. Herein, we report an intraventricular metastasis of neuroblastoma diagnosed using an Iodine-123 ((123)I)-MIBG scan, which is increasingly being used in clinical practice and reported as a more accurate method for detecting metastatic lesions. An unusual case of metastatic neuroblastoma to the left lateral ventricle of the brain is presented. Planar (123)I-MIBG scintigraphy showed faint tracer activity close to the midline without asymmetric extensions or abnormal activity in the skull bones. A subsequent brain MR scan revealed an enhancing mass within the left frontal horn consistent with a metastatic lesion. The patient underwent tumor resection with pathology showing neuroblastoma. Our case shows that (123) I-MIBG scintigraphy can be useful in detecting intraventricular brain metastases of neuroblastoma. Although the (123)I-MIBG scintigraphy has been reported to have a significantly superior sensitivity in monitoring asymptomatic patients with neuroblastoma compared with (131)I-MIBG scans, bone marrow histology, bone scan, CT, and urinary catecholamine levels, further studies may be necessary to evaluate its sensitivity in detecting brain lesions.

Identifying Risk Factors for Allogenic Blood Transfusion in Oral and Oropharyngeal Cancer Surgery With Free Flap Reconstruction

Several observational studies in head and neck cancer have reported that allogenic blood transfusion is associated with increased postoperative complications, increased risk of tumor recurrence, and worse prognosis. The aim of this study was to identify preoperative and intraoperative factors predicting blood transfusion in patients undergoing surgery for oral and oropharyngeal cancer. We conducted a retrospective cohort study of patients undergoing tumor resection and free flap reconstruction for locally advanced oral and oropharyngeal squamous cell carcinoma between 2000 and 2008. The primary outcome variable was perioperative exposure to allogenic blood transfusion. Univariate and multivariate logistic regression models were used to determine predictors of blood transfusion. A cohort of 142 participants was found eligible. In a multivariate model, Charlson score ≥ 1 (OR, 5.2; 95% CI, 1.4 to 19.3; P = .01), preoperative hemoglobin levels ≤ 12 g/dl (OR, 4.4; 95% CI, 1.2 to 16.2; P = .03), bone resection (OR, 5.1; 95% CI, 1.5 to 17.8; P = .01), and osseous free tissue transfer (OR, 8.8; 95% CI, 1.0 to 74.8; P = .046) were independently associated with an increased risk of blood transfusion. Our study identified patient- and surgery-related factors predicting a higher risk of exposure to allogenic blood transfusion. This readily available preoperative information could be used to better stratify patients according to their transfusion risk and may thereby guide blood conservation strategies in high-risk patients.

Total en bloc spondylectomy for thoracic and lumbar chondrosarcoma

Objective To investigate technique and clinical effect of total en bloc spondylectomy for thoracic and lumbar chondrosarcoma.Methods From January 2010 to March 2012,6 patients with thoracic or lumbar chondrosarcoma underwent total en bloc spondylectomy.There were 4 males and 2 females,aged from 25 to 54 years (average,38 years).The tumor ranged from T3 to L3; 1 located in T3 and T4,1 in T7,1in T11,1 in L1,1 in L2 and 1 in L3.According to Tomita surgical classification system,there was 1 case of type 2,1 case of type 4,3 cases of type 5 and 1 case of type 6.One patient underwent tumor resection through single posterior approach,while the other 5 patients underwent anterior dissection and posterior resection of tumor.All spines were reconstructed by posterior fixation with pedicle screws and anterior interbody fusion with titanium mesh cages or artificial vertebrae.Results The average amount of blood loss was 3200 ml (range,2100 to 6300 ml).The duration of operation ranged from 3.5 to 12 hours (average,5.5hours).Two patients obtained wide resection,3 obtained marginal resection,and 1 had intralesional margin.The complications included 2 cases of cerebrospinal leak,1 case of pleural effusion and 1 case of pulmonary infection.There was no wound infection and death during peroperative period.All patients were followed up for 6 to 32 months (average,19 months).The neurological function improved from preoperative Frankel C to postoperative Frankel E in 2 cases.All patients obtained bone union 6 to 12 months (average,8 months) after operation.At final follow-up,all patients could walk without aid,and there was no recurrence.Conclusion The total en bloc spondylectomy is an effective method for thoracolumbar chondrosarcoma,which could provide a satisfied tumor control and neurological function improvement. Key words: Thoracic vertebrae; Lumbar vertebrae; Chondrosarcoma; Treatment outcome

Nationwide Improvement of Only Short-Term Survival After Resection for Pancreatic Cancer in The Netherlands

Evaluation of incidence, treatment, and survival trends after resection of pancreatic cancer at a national level. Using data on patient and tumor characteristics from the nationwide Netherlands Cancer Registry trends were analyzed for the period 1989-2008. A total of 30,025 patients diagnosed with pancreatic cancer were included. The incidence remained stable over the 20-year study period at approximately 9 per 100,000 inhabitants. Resection rates increased from 8% in 1989 to 12% in 2008, adjuvant chemotherapy rates increased from 7% to 29%, and palliative chemotherapy rates increased from 5% to 19% (P < 0.0001 each). Relative survival proportions did not change over time; besides a minimal, nonsignificant increase at 3 months from 53% to 55%, these remained 34% at 6 months and 4.5% at 3 years. Among the patients undergoing tumor resection, relative survival increased from 82% to 93% at 3 months and from 51% to 63% at 1 year after diagnosis. However, no improvement was seen after 3 years (23%). The increased short-term survival among patients who underwent resection probably reflects decreased postoperative mortality driven by ongoing centralization efforts. However, longer-term survival remained poor irrespective of the changes in management in the past decades.

Surgical treatment of an interatrial septal paraganglioma

A 39-year-old man presented with chest pain. Chest radiography and echocardiography indicated a possible cardiac tumor. Echocardiography, computed tomography, and magnetic resonance imaging revealed a tumor in the interatrial septum. The patient underwent tumor resection under cardiopulmonary bypass. A paraganglioma was diagnosed on the basis of histopathological findings.

Immunohistochemical and molecular genetics study of a granular cell astrocytoma: A case report of malignant transformation to a glioblastoma

We treated a 56-year-old woman who had a right temporal lobe tumor found by chance after a traffic accident. MRI confirmed a heterogeneously enhanced tumor in the temporal lobe with large peritumoral edema extending to the superior parietal lobe. The patient underwent tumor resection. The tumor consisted largely of distinct cells with discrete borders and granular cytoplasm. In granular cells, the accumulation of PAS-positive granules was observed. Immunohistochemical analysis demonstrated positive staining for GFAP, S-100, and oligodendrocyte transcription factor 2 and negative staining for synaptophysin. CD68 was negative in granular cells, but positive in stromal cells. Ki-67 labeling index was quite low. The tumor was diagnosed as a granular cell astrocytoma (GCA). Postoperative radiotherapy combined with temozolomide was administered. One month after chemoradiotherapy, the tumor occurred in the parietal lobe, and a tumorectomy was performed. The tumor was composed of poorly differentiated astrocytic tumor cells with prominent microvascular proliferation and necrosis. A small number of granular cells were locally observed and the tumor was diagnosed as a glioblastoma. O6-methylguanine-DNA methyltransferase promoter methylation was detected in the GCA but not in the glioblastoma. Isocitrate dehydrogenase mutations were not detected in either tumor. Comparative genomic hybridization analysis demonstrated that no chromosomal abnormality was found in the GCA; however, a gain of chromosomes 7 and 19 and a loss of chromosomes 10 and 9p21 (CDKN2A) were found in the glioblastoma. p53 was strongly expressed in both the GCA and glioblastoma. The tumor progressed despite extensive chemotherapy, and the patient died 1 year after the initial treatment. Our immunohistochemical, genetic and chromosomal analyses indicate that the glioblastoma was transformed from the GCA.

Meningiomas in Pregnancy

Abstract BACKGROUND: Dramatic growth of meningiomas is occasionally encountered during pregnancy. While cell proliferation is often assumed, hemodynamic changes have also been touted as a cause. OBJECTIVE: We identified 17 meningiomas resected during pregnancy or within 3 weeks post-partum and characterized them to determine the cause of occasional rapid growth in pregnancy. METHODS: Seventeen tumors were identified from searches at 4 university centers. All available clinical records, radiology images, and tissue specimens were reviewed, with immunohistochemical studies performed as needed. RESULTS: Sixteen patients underwent tumor resection and 1 died of complications prior to surgery. Average patient age was 32 years. Nine experienced onset of symptoms in the third trimester or within 8 days post-partum. Principle physical findings included visual complaints (59%) and cranial nerve palsies (29%). Ten tumors (59%) were located in the skull base region. The Ki-67 labeling index was low (0.5-3.6%) in 11 of 13 benign (grade I) tumors and elevated (11–23.2%) in 3 of 4 atypical (grade II) meningiomas. Eight (50%) tumors featured hypervascularity with at least focal CD34-positive hemangioma-like microvasculature. Fourteen (82%) showed evidence of intra- and/or extracellular edema, 1 so extensive that its meningothelial nature was not apparent. Five tumors (29%) exhibited intratumoral hemorrhage and/or necrosis. CONCLUSION: Our series suggests that pregnancy-associated meningiomas located in the skull base are likely to require surgical intervention for visual complaints and cranial nerve palsies. The rapid tumor growth is more often due to potentially reversible hemodynamic changes rather than hormone-induced cellular proliferation.

Predictive and prognostic roles of ribonucleotide reductase M1 in resectable pancreatic adenocarcinoma

Ribonucleotide reductase M1 (RRM1) is an important molecule in different types of cancer. The objective of this study was to evaluate the predictive roles of RRM1 in the survival of patients with resectable pancreatic adenocarcinoma who received treatment with gemcitabine or nongemcitabine adjuvant therapy. In total, 122 patients underwent tumor resection for pancreatic adenocarcinoma at the authors' institution from October 1999 to December 2007. Total RNA was isolated from microdissected, paraffin-embedded tumors. RRM1 expression levels were measured using quantitative reverse transcriptase-polymerase chain reaction (QRT-PCR) and were dichotomized using recursive partitioning analysis. The Kaplan-Meier method was used to estimate overall survival and progression-free survival, and the predictive value of RRM1 expression on survival was examined using Cox proportional hazards regression. RRM1 expression did not have significant prognostic value in the entire cohort regarding overall survival (P = .2) or progression-free survival (P = .7). In the subgroup of 44 patients who received adjuvant gemcitabine, patients who had low RRM1 expression had longer overall survival (median, 47.8 months vs 14.1 months; P = .005) and a trend toward longer progression-free survival (median not reached vs 12.9 months; P = .06). In contrast, in the subgroup of 35 patients who received nongemcitabine adjuvant therapy, patients who had high RRM1 expression had significantly longer overall survival (median, 41.9 months vs 19.8 months; P = .01) and progression-free survival (median, 70.0 months vs 11.8 months; P = .04). These results were confirmed in Cox proportional hazards multivariable analysis. In patients with resectable pancreatic adenocarcinoma, low RRM1 expression in the tumor predicted an overall survival benefit of adjuvant gemcitabine; and high RRM1 expression predicted the survival benefit of nongemcitabine adjuvant therapy.

Dorsal Column Mapping for Intramedullary Spinal Cord Tumor Resection Decreases Dorsal Column Dysfunction

Retrospective cohort study and technical report. To demonstrate, through our institutional series of intramedullary spinal tumor resection, the potential avoidance of dorsal column dysfunction after using dorsal column mapping. Surgical resection of intramedullary spinal cord tumors carries significant associated postoperative morbidity. Much of this morbidity is because of dorsal column dysfunction from the dorsal myelotomy. The inconsistency and distortion of anatomic landmarks for a midline myelotomy has posed a significant challenge for spine surgeons. Dorsal column mapping is a relative new technique that may decrease the morbidity associated with operative resection of intramedullary masses. A cohort of patients operated upon at our institution for intramedullary lesions were retrospectively reviewed. Neurologic examination changes were assessed through clinic notes and chart review. A total of 91 intramedullary tumors were assessed, with 80 patients without dorsal column mapping and 11 patients with dorsal column mapping. In our cohort of 91 patients with intramedullary tumors undergoing resection over the past decade, postoperative dorsal column dysfunction was observed in 45%. Dorsal column mapping decreased the frequency of new postoperative posterior column dysfunction. Patients with dorsal column mapping had a statistically significant decrease rate of new postoperative posterior column dysfunction of 9% compared with 50% for without mapping (P=0.01). Tumor histology was not found to correlate with worsening posterior column dysfunction in patients undergoing tumor resection. With our surgical cohort as an internal control, we found a decreased rate of postoperative posterior column dysfunction when using intraoperative dorsal column mapping. Our findings show the ability of this evolving technology to provide useful intraoperative information to localize the physiological midline and decrease the rate of posterior column dysfunction after intramedullary spinal cord tumor resection.

Pre- and post-operative assessment of visuo-spatial functions in right hemisphere tumour patients: a pilot study

Patients with neglect fail to report, respond to, or orient to stimuli presented on the opposite side of the brain lesion. Spatial neglect is a multi-componential syndrome and many of its symptoms and signs need specific testing to detect their different clinical manifestations. Given that neglect has a dramatic effect on the outcome of these patients, it is of paramount importance for accurate assessment all its manifestations. Thus, the purpose of this study is to assess visuo-spatial functions with a newly-built neuropsychological battery to determine the incidence of visuo-spatial disorders and spatial neglect in patients with right brain tumour. We tested 14 patients undergoing tumour resection, both pre-operatively and post-operatively. Pre-operatively, we found an incidence of 42.86% for visuo-spatial deficits and of 14.29% specifically for spatial neglect. This incidence increases post-operatively to 57.14% for visuo-spatial deficits and to 42.86% specifically for spatial neglect. The present study has important implications for a better knowledge of the spatial disorders in patients with right-brain tumour, thus providing a clearer picture on the everyday life problems faced by these patients, both within the family and in working contexts.

Metastatic myxofibrosarcoma of the spermatic cord responding to mesna, adriamycin, ifosfamide, and dacarbazine combination therapy

Myxofibrosarcoma is common in the extremities of elderly people and is characterized by a high frequency of local recurrence. We report herein a case of a 72-year-old male who presented with a 5-year history of right scrotal swelling and a month history of painful swelling in the scrotal area. Computed tomography scan revealed a scrotal tumor 5 cm in size and a tumor in the rectum. He subsequently underwent right high orchiectomy and rectal dissection with colostomy. The scrotal tumor was histopathologically diagnosed as a myxofibrosarcoma; the rectal tumor was a leiomyosarcoma. The patient underwent tumor resection for recurrence and left inguinal metastasis, but soon developed local recurrences and lymph node metastasis of the left iliac area. Chemotherapy with mesna, adriamycin, ifosfamide, and dacarbazine (MAID) resulted in partial remission. We report the rare case of myxofibrosarcoma in the spermatic cord for which chemotherapy with MAID was an effective treatment.

Glioblastoma without Remarkable Contrast Enhancement on Magnetic Resonance Imaging

This is the report of a histological and clinical investigation of 4 cases of glioblastoma, a rare tumor, in whom poor contrast enhancement of the tumor was visualized on magnetic resonance imaging (MRI). Among the 94 patients with first-occurrence glioblastoma treated between January 2000 and August 2011, 4 were enrolled in this retrospective study. There were 2 men and 2 women, ranging in age from 41 to 70 years (mean, 57 years). All the patients underwent tumor resection, postoperative irradiation, and chemotherapy. One died of local tumor recurrence after 36 months; the remaining three remain alive as of 25 to 72 months after the initial treatment. The histopathology was glioblastoma with nuclear pleomorphism and pseudopalisading necrosis in all cases. However, the typical vascular endothelial proliferation was not found in 3 cases. All glioblastomas were immunopositive for p53 and immunonegative for epidermal growth factor receptor (EGFR) and isocitrate dehydrogenase 1 (IDH1). These glioblastomas showing unclear contrast enhancement on MRI had similar clinical and pathological characteristics, but differed in characteristics from glioblastoma patients showing marked contrast enhancement of the tumor on MRI.

Prolonged Therapy with Imatinib Mesylate before Surgery for Advanced Gastrointestinal Stromal Tumor Results of a Phase II Trial

Purpose. Proven efficacy of imatinib mesylate in gastrointestinal stromal tumour (GIST) has led to its use in advanced disease and, more recently, in adjuvant and neoadjuvant settings. The purpose of this study was to evaluate the optimal neoadjuvant imatinib duration to reduce the morbidity of surgery and increase the possibility of resection completeness in advanced tumours. Patients and Method. Patients with advanced GIST were enrolled into a registered open-label multicenter trial and received imatinib daily for a maximum of 12 months, followed by en bloc resection. Data were prospectively collected regarding tumour assessment, response rate, surgical characteristics, recurrence, and survival. Results. Fourteen patients with advanced GIST were enrolled. According to RECIST criteria, 6 patients had partial response and 8 had stable disease. The overall tumour size reduction was 25% (0–62.5%), and there was no tumour progression. Eleven patients underwent tumour resection, and all had R0 resection. After a median followup of 48 months, 4-year OS and DFS were 100% and 64%, respectively. Conclusion. This prospective trial showed that one year of neoadjuvant imatinib in advanced GIST is safe and associated with high rate of complete microscopic resection. It is not associated with increased resistance, progression, or complication rates.

Preoperative alpha blockade for normotensive pheochromocytoma

To compare the intraoperative hemodynamics in normotensive pheochromocytoma patients undergoing tumor resection between those with α-blockade preparation, preoperatively, and those without it. From January 2003 to July 2011, patients with adrenal incidentaloma, which was highly suspected as normotensive pheochromocytoma, were divided into two groups. Group 1 recieved α1-blockade doxazosin before adrenalectomy. Group 2 received no α-adrenoceptor, preoperatively. Data regarding the intraoperative hemodynamics was collected. These include peak/nadir blood pressure (BP) and heart rate, vasoactive medication and fluid infusion. Fifty-nine cases of pheochromocytoma were confirmed by histopathology examination: 38 in group 1 and 21 in group 2. No differences were found in the preoperative demographics, comorbidities, BP and anesthesia. Intraoperative BP and heart rate showed no difference between these two groups. Intraoperative use of nitroglycerin (P < 0.001), norepinephrine (P < 0.001), phentolamine (P < 0.001) and colloid fluid (P = 0.008) was significantly greater in group 1 with doxazosin. Preoperative α1-adrenoceptor antagonist has no benefit in maintaining intraoperative hemodynamic stability in patients with normotensive pheochromocytoma. It may increase the use of vasoactive drugs and colloid infusion.

Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age

The objective of this study was to analyze whether age influences the outcome of patients with glioblastoma and whether elderly patients with glioblastoma can tolerate the same aggressive treatment as younger patients. Data from 361 consecutive patients with newly diagnosed cerebral glioblastoma (2000-2006) who underwent regular follow-up evaluation from initial diagnosis until death were prospectively entered into a database. Patients underwent resection (complete, subtotal, or partial) or biopsy, depending on tumor size, location, and Karnofsky Performance Scale score. Following surgery, all patients underwent adjuvant treatment consisting of radiotherapy, chemotherapy, or combined treatment. Patients older than 65 years of age were defined as elderly (146 total). Two hundred thirty-four patients underwent tumor resection (complete 26%, subtotal 29%, and partial 45%). One hundred twenty-seven underwent biopsy. Mean patient age was 61 years, and overall survival was 11.6 ± 12.1 months. The overall survival of elderly patients (9.1 ± 11.6 months) was significantly lower than that of younger patients (14.9 ± 16.7 months; p = 0.0001). Stratifying between resection or biopsy, age was a negative prognostic factor in patients undergoing biopsy (4.0 ± 7.1 vs 7.9 ± 8.7 months; p = 0.007), but not in patients undergoing tumor resection (13.0 ± 8.5 vs 13.3 ± 14.5 months; p = 0.86). Survival of elderly patients undergoing complete tumor resection was 17.7 ± 8.1 months. In this series of patients with glioblastoma, age was a prognostic factor in patients undergoing biopsy, but not in patients undergoing resection. Tumor location and patient clinical status may prohibit extensive resection, but resection should not be withheld from patients only on the basis of age. In elderly patients with glioblastoma, undergoing resection to the extent feasible, followed by adjuvant therapies, is warranted.