Intravenous Thrombolysis in Acute Ischemic Stroke. Acute ischemic stroke is a
major cause of mortality and morbidity in the world. Intravenous thrombolysis
with recombinant tissue plasminogen activator remains the standard treatment
for acute ischemic stroke for any patient presenting within 4.5 hours from
symptom onset. However, it is more effective and safe when treatment starts
early. This therapy for acute ischemic stroke has been administered in
Vojvodina since 2008. Various factors influence the outcome after intravenous
thrombolysis. Timely recanalization and reperfusion is associated with better
clinical outcomes. Mechanical Thrombectomy - a New Therapeutic Modality for
the Treatment of Acute Ischemic Stroke. Nevertheless, the rate of
recanalization and favorable outcomes for patients with acute ischemic stroke
due to large vessel occlusion are low after intravenous thrombolysis. In such
patients mechanical thrombectomy has demonstrated significantly higher rates
of recanalization and improved outcomes compared with intravenous
thrombolysis alone. This endovascular reperfusion therapy began to be
implemented in Vojvodina in 2016. Conclusion. Intravenous thrombolysis
continues to play a key role in the treatment of all acute ischemic stroke
patients, but mechanical thrombectomy should be the ?gold standard? in the
cases with large vessel occlusion.
Background/Aim. Although considered rare, gliomas cause morbidity and mortality disproportionate to their incidence. The aim of the study was to determine whether pre and post-therapeutic metric values, derived from the FDG PET/CT maximal standardized uptake value (SU-Vmax) and calculated ratios between tumor and normal brain tissue, may provide a predictive/prognostic biomarker information in estimating overall survival of glioblastoma patients. Methods. In 26 out of 31 patients with glioblastoma treated with standard Stupp protocol after maximal safe reductive surgery, we performed a baseline 18F-FDG PET/CT examination before commencing combined and concomitant chemotherapy/radiotherapy (pre-therapy FDG PET/CT) and a second examination three months after the therapy completion (post-therapy FDG PET/CT). Two-graded SUVmax values and a calculated ratio of uptake in tumor-to-normal-tissue (T/N ratio) value, divided into two grades by the calculated cut-off value, were measured in all patients at both pre- and post-therapy FDG PET/CT studies. Data sets were statistically analyzed by the Kaplan-Meier survival test and Log-rank was calculated, with the level of confidence determined at p < 0.05. Results. Pre-therapy FDG PET/CT two-grade T/N ratio value and both pre-and post-therapy FDG PET/CT derived two-grade SUVmax values had a strong predictive impact on overall survival of glioblastoma patients. Conclusion. Based on two-grade SUVmax and T/N ratio values assessment, FDG PET/CT could provide valuable predictive survival information in glioblastoma patients and serve as a selection tool for identifying patients at higher risk from worse outcomes and shorter survival time.
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