-
[show abstract]
[hide abstract]
ABSTRACT: Stereotactic radiosurgery has enabled the delivery of higher doses of radiation and decreased fractionation due to improved accuracy. Spinal radiosurgery has been increasingly utilized for the management of metastatic extradural spinal disease. However, surgical resection remains the primary treatment strategy for intradural spinal tumors. Preliminary evidence suggests that radiosurgical ablation with stereotactic radiation for intradural spinal lesions may be efficacious in certain clinical scenarios. Local tumor control, pain relief, and improvement in neurologic function with minimal morbidity have been reported in short-term follow-up. However, long-term efficacy of radiosurgery in the management of intradural spinal neoplasms necessitates further validation. As extracranial radiosurgery is a newly evolving modality, a continuative review of the current literature is appropriate. Until a standardized therapeutic window of safety and efficacy can be determined, the recommendation of radiosurgical applications for benign spinal tumors should be reserved for carefully selected cases.
Neurosurgical Review 02/2009; 32(2):133-40; discussion 140-1. · 2.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Spinal meningiomas are uncommon entities that fortunately burden only a small minority of patients. Notwithstanding their overwhelmingly benign propensity, the occurrence of extramedullary meningioma may nonetheless cause significant morbidity and possible mortality. The consideration therefore, of spinal meningioma in the differential of patients presenting with radiculopathy or complaints of chronic back or neck pain should not be disregarded. The rapidity of diagnosis and the first neurosurgical encounter are cornerstones in patient longevity and neurological preservation. The advent of microsurgical techniques and magnetic resonance imaging and surgical techniques has notably improved clinical outcomes over the past two decades. However, surgical candidacy may be limited, particularly in those patients with significant preexisting medical comorbidities, aggressive or recurring tumors, or multiple lesions. Alternative management strategies such as stereotactic radiosurgery or less invasive surgical techniques are currently underway in clinical practice. A review on neurosurgical diagnosis and treatment modalities in the management of spinal meningioma is therefore pertinent.
Clinical neurology and neurosurgery 01/2009; 111(3):221-6. · 1.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The experimental literature of the foregoing decade has furnished an assemblage of mechanisms explaining the metabolic perturbations and overall decline in cardiac performance implicated in the pathogenesis of diabetes mellitus. Particularly, the experimentally-induced diabetic rat model has been indispensable in the examination of diabetic cardiomyopathy, an entity distinctly separable from atherosclerosis, hypertension, coronary artery disease and valvular dysfunction, yet convincingly attributable to the increase in cardiac-associated mortality commonly observed in the diabetic patient. The widespread epidemic of diabetes mellitus in developed societies has elicited considerable attention and the role of exercise as an adjuvant therapy in diabetes management has been increasingly emphasized. However, the evidence endorsing the beneficial attributes of exercise in the diabetic state is indeterminate despite markedly observed increases in myocardial and skeletal muscle glucose homeostasis, endothelial and autonomic function, insulin sensitivity and amelioration of diabetes pathogenesis. As evidenced by review of the experimental literature, a mild to moderately intense exercise regime may be a reliably implicated insulin-sensitizing therapy for the experimentally-diabetic rat model as well as the human diabetic patient. Notably, the cardio-protective and metabolic benefits of aerobic exercise are seemingly more pronounced in those individuals most susceptible to diabetes progression.
Current Diabetes Reviews 03/2007; 3(1):75-84.
-
[show abstract]
[hide abstract]
ABSTRACT: Although the insulinotropic role of glucagon-like peptide-1 (GLP-1) in type 2 diabetes mellitus has been substantiated, its role in cardioprotection remains largely unknown. To ascertain the role of the cardiovascular actions of GLP-1 in health and disease states necessitates a review of the current evidence as well as ongoing investigation. Of cardiovascular significance, both positive inotropic and chronotropic effects, unmodifiable by beta-adrenergic blockers, have been reportedly attributed to GLP-1 actions on the myocardium. However, the potent role of GLP-1 and its analogues in eliciting tachycardic and pressor effects should be of some concern. Aside from its reported insulinotropic activity, GLP-1 impacts the myocardium directly. Highly specific GLP-1 receptors have been identified in the heart and within the central nervous system, particularly in the nucleus tractus solitarius, a neuromodulatory centre of cardiovascular control. The occurrence of GLP-1 receptors in cardiac tissue and autonomic regions of cardiovascular control has stimulated investigation, particularly as these sites may be suitable targets for the pharmacological action of GLP-1 and long-acting analogues. Discordance on the haemodynamic consequences of GLP-1 pharmacotherapy in experimental animals and human patients has been reported in the literature. However, long-term pharmacological doses of GLP-1 have shown prolonged and beneficial actions on cardiovascular homeostasis in the adjuvant treatment of metabolic disease.
Drugs in R & D 02/2007; 8(3):145-53. · 1.35 Impact Factor
