[show abstract][hide abstract] ABSTRACT: Corticosteroids have been effective in the management of cerebral oedema, in the context of brain tumours, for many decades. Though their effectiveness is well-established, this needs to be balanced against their potential to cause significant side effects. There is currently little consensus in the literature about how this should be done. This article reviews the literature, specifically in relation to the role of corticosteroids in primary and secondary brain tumour patients. Areas reviewed include corticosteroid pharmacology, indications, mechanism of action, toxicity profile, prescribing practices, and corticosteroid-sparing agents.
[show abstract][hide abstract] ABSTRACT: Background: the terminal decline hypothesis suggests an acceleration in the rate of loss of cognitive function before death. Evidence about the association of educational attainment and the onset of terminal decline is scarce.Objective: to investigate the association of education with the onset of terminal decline in global cognitive function measured by Mini Mental State Exam (MMSE) scores.Subjects: deceased participants of the Cambridge City over 75 Cohort Study who were interviewed at about 2, 7, 9, 13, 17 and 21 years after baseline.Methods: regular and Tobit random change point growth models were fitted to MMSE scores to identify the onset of terminal decline and assess the effect of education on this onset.Results: people who left school at an older age had a delayed onset of terminal decline. Thus better educated individuals experience a slightly shorter period of faster decline before death.Conclusion: an important finding emerging from our work is that education does appear to delay the onset of terminal decline, although only by a limited amount.
[show abstract][hide abstract] ABSTRACT: The efficacy of radiation therapy, the mainstay of treatment for malignant gliomas, is limited by our inability to accurately determine tumor margins. As a result, despite recent advances, the prognosis remains appalling. Because gliomas preferentially infiltrate along white matter tracks, methods that show white matter disruption should improve this delineation. In this study, results of histologic examination from samples obtained from image-guided brain biopsies were correlated with diffusion tensor images.
Twenty patients requiring image-guided biopsies for presumed gliomas were imaged preoperatively. Patients underwent image-guided biopsies with multiple biopsies taken along a single track that went into normal-appearing brain. Regions of interest were determined from the sites of the biopsies, and diffusion tensor imaging findings were compared with glioma histology.
Using diffusion tissue signatures, it was possible to differentiate gross tumor (reduction of the anisotropic component, q > 12% from contralateral region), from tumor infiltration (increase in the isotropic component, p > 10% from contralateral region). This technique has a sensitivity of 98% and specificity of 81%. T2-weighted abnormalities failed to identify the margin in half of all specimens.
Diffusion tensor imaging can better delineate the tumor margin in gliomas. Such techniques can improve the delineation of the radiation therapy target volume for gliomas and potentially can direct local therapies for tumor infiltration.
American Journal of Neuroradiology 11/2006; 27(9):1969-74.