Context: The prognosis of medulloblastoma is better in patients who underwent complete treatment consisting of surgery, radiotherapy, and chemotherapy. However, the realization of such multidiscipline management is quite challenging in developing countries, including Indonesia. Until now, no study on the management of medulloblastoma has ever been conducted in Indonesia. Aims: The authors aimed to study the characteristics, management, and mortality outcome of medulloblastoma patients in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia. Subjects and Methods: This study was based on medical record and registry of 44 medulloblastoma patients who underwent tumor removal in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, between 2011 and 2018. Statistical Analysis Used: Cox regression analysis was utilized to determine the relationship between patients' demography, tumor characteristics, and treatment, with mortality. Results: The incidence of mortality was 84.1% and median months' survival time (95% confidence interval [CI]) was 13 (8.67–17.32). Gross total removal (GTR) was performed in 43.2% of all tumor removal surgery. Only 50% of all patients completed radiotherapy, and 6.8% concluded multimodalities treatment (surgery, radiotherapy, and chemotherapy). Significant statistical association between age, gender, and extent of resection with mortality was identified (HR [95% CI] for age: 0.44 [0.22–0.88], gender: 0.001 [0.000–0.27; REF: female], and biopsy: 31.52 [1.09–910.56; REF: GTR]). Conclusions: The survival rate of medulloblastoma in Indonesia is inferior to that previously reported in other studies. There is no unusual characteristic contributing to neoteric risk factor. The authors surmise that insufficient multidisciplinary management for the disease, consisting of suboptimal tumor resection, the absence of risk stratification, and incomplete postsurgical treatment (radiotherapy and chemotherapy) resulted in such outcome.
Meningiomas are primary central nervous system tumor with the highest prevalence. Meningiomas have a high recurrence rate in the same location. One of the factors thought to be associated with the frequency of meningiomas is hormonal status. However, research on this subject is still controversial. This review aims to discuss the effect of sex hormones on meningiomas. Sex hormones, especially progesterone, have been shown to play a role in tumorigenesis and meningioma recurrence. Progesterone receptors also play a role in meningioma recurrence where a low number of receptors indicates a poor prognosis. However, the molecular relationship between meningiomas at low progesterone receptor expression is still unknown. Further research is still needed to determine the role of sex hormones, especially progesterone, and their receptors, in both tumorigenesis and meningioma progression. This research ensures that new science in the field of endocrinology can be utilized for both primary preventive, secondary preventive, and therapeutic strategies for meningiomas.
Gamma Knife Stereotactic Radiosurgery (GKSRS) treatment requires the high accuracy of delivering single high dose without negative impact on the surrounding tissue. During radiosurgery treatments using GKSRS, the surrounding tissue will receive high scatter radiation because the single dose treatment will employed long irradiation time. Therefore, radiation doses in critical organs of patients during GKSRS treatment is important to be evaluated. In this study, we investigated the radiation dose to the lens, thyroid, breast, uterine fundus, ovaries and testes during treatment using Leksell Gamma Knife Perfexion (LGK; Elekta AB, Stockholm, Sweden). The dose was simulated using the variation of tumour target from 5 to 20 cc. The measurement were performed using variation of collimator size of 4 mm, 8 mm, 16 mm and employed thermoluminescent dosimeters (TLDs) to be placed at the surface of Rando anthropomorphic phantom. TLDs reader Harshaw model 3500 were employed to evaluate the measurement result. The result of this study explains that the dose of organs at risk decrease linearly depend on the distance of the target, target volume and the size of collimator.
MYELUM INTENSITY ON MRI CERVICAL AS PROGNOSTIC FACTORS IN CERVICAL SPONDYLOSIS MYELOPATHY PATIENTSABSTRACTIntroduction: Cervical spondylosis myelopathy (CSM) is a stenosis condition in cervical canal due to the cervical structural changes that compress the myelum, thus causing spinal medulla ischemia. Other than clinical factors, myelum intensity changes on MRI T1-weighted images (T1W1) and T2W1 might be useful to predict the pos-operative outcome.Aims: Identify prognostic factors in post-operative patients with CSM based on clinical symptoms and myelum intensity on cervical MRI.Methods: Retrospective study on CSM patients who underwent surgery in Neurosurgery Department, Cipto Mangunkusumo hospital, Jakarta, from January 2013 to December 2016. Magnetic resonance imaging data was obtained before the surgery, while clinical symptoms were assessed by Nurick scale before and 1 year after the surgery to evaluate outcome.Results: There were 50 subjects included in this study with mean age 51.98±9.64 years, majority male (76%), have moderate myelopathy (Nurick scale pre-operative ≤2), and time between onset and surgery mostly ≤1 year (80%). Most subject (88%) had improvement clinically, but mostly without hypointensity on cervical T1W1 MRI.Discussion: Myelum hypointensity in cervical MRI is associated with poor outcome in CSM post-surgery patients.Keywords: Cervical spondylosis myelopathy, MRI, myelum hypointensity, Nurick scaleABSTRAKPendahuluan: Cervical spondylosis myelopathy (CSM) merupakan suatu kondisi stenosis kanal servikal akibat adanya perubahan struktur servikal yang menyebabkan kompresi mielum, sehingga timbul iskemia medula spinalis. Selain faktor-faktor klinis, perubahan intensitas mielum pada MRI T1-weighted images (T1W1) dan T2W1 dapat dijadikan modalitas untuk memprediksi luaran pascaoperasi.Tujuan: Mengidentifikasi faktor prognosis luaran pasien CSM pascaoperasi berdasarkan gejala klinis dan intensitas mielum pada gambaran MRI servikal.Metode: Penelitian retrospektif terhadap penderita CSM yang dilakukan operasi di Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo, Jakarta, pada bulan Januari 2013 hingga Desember 2016. Dilakukan penilaian klinis dan gambaran MRI awal, serta luaran 1 tahun pascaoperasi menggunakan skor Nurick.Hasil: Terdapat 50 subjek dengan rerata usia 51,98±9,64 tahun, terutama laki-laki (76%), memiliki derajat mielopati ringan (skor Nurick preoperasi ≤2), dan jarak antara onset dengan waktu operasi ≤1 tahun (80%). Sebagian besar subjek (88%) mengalami perbaikan skor pascaoperasi yang mayoritas (95,4%) tidak didapatkan gambaran hipointesintas pada T1W1 MRI servikal.Diskusi: Hipointensitas mielum pada MRI servikal merupakan faktor prognosis luaran buruk pascaoperasi pada pasien CSM.Kata kunci: Cervical spondylosis myelopathy, hipointens, mielum, MRI, skala Nurick
FIBRINOGEN VALUE AS PROGNOSTIC FACTOR IN SPONTANEOUS INTRACEREBRAL HEMORRHAGEABSTRACTIntroduction: Spontaneous intracerebral haemorrhage (SIH) refers as spontaneous bleeding in the brain paren- chyma due to injury of blood vessels. Thus causing tissue inflammatory and coagulation reaction, activating the release of fibrinogen. Fibrinogen, an active substrate of coagulation cascade, also considered as the most powerful indicator of acute inflammatory response in SIH. Elevated levels of fibrinogen may be the marker for the increasing degree of brain tissue damage.Aims: Determine the correlation of fibrinogen levels with outcomes of patients with SIH who went on operative procedures.Methods: The study was conducted in Dr. Cipto Mangunkusumo hospital and its affiliation hospitals from January until August 2017. Total sampling was conducted. Preoperative Glasgow Coma Scale (GCS), blood volume, preoperative and postoperative serum fibrinogen values, and modified Rankin Scale (mRS) data were obtained and analyzed using the Spearman correlation test.Results: Significant correlation were found between the preoperative and postoperative fibrinogen with mRS score. Positive correlation coefficients were shown in both parameters, whereas the increase of preoperative and postoperative fibrinogen would increase the mRS score.Discussion: Pre and postoperative fibrinogen value showed significant association with mRS score, thereby they could be considered as prognostic predictive factors. However, because of the limited number of subject of this study to fulfill the criteria of validity study, a future study with a larger scale should be carried out.Keyword: Fibrinogen, mRS, outcome, spontaneous intracerebral haemorrhageABSTRAKPendahuluan: Perdarahan intraserebral spontan (PISS) adalah perdarahan spontan pada parenkim otak akibat kerusakan pembuluh darah pada jaringan otak. Kerusakan tersebut menimbulkan reaksi inflamasi jaringan dan koagulasi yang mengaktivasi pelepasan fibrinogen. Fibrinogen merupakan substrat aktif kaskade koagulasi yang juga merupakan penanda paling kuat respons akut inflamasi pada PISS. Adanya peningkatan kadar fibrinogen dapat menggambarkan peningkatan derajat kerusakan jaringan otak.Tujuan: Mengetahui korelasi kadar fibrinogen dengan luaran pasien dengan PISS yang dilakukan tindakan operatif.Metode: Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dan rumah sakit jejaring pendidikan dalam periode Januari–Agustus 2017. Sampel diambil dengan total sampling, data yang diambil adalah, Glasgow Coma Scale (GCS) preoperasi, volume perdarahan, kadar fibrinogen serum preoperasi dan pascaoperasi, dan modified Rankin Scale(mRS), kemudian dianalisis dengan tes Spearman correlation.Hasil: Dari uji statistik didapatkan hasil bermakna antara fibrinogen preoperasi mau pun pascaoperasi dengan skor mRS. Koefisien korelasi, menunjukkan korelasi positif pada keduanya, dimana peningkatan fibrinogen preoperasi dan pascaoperasi akan meningkatkan skor mRS.Diskusi: Fibrinogen pre dan pascaoperasi sebagai faktor prediksi prognostik memiliki hubungan bermakna dengan skor mRS. Namun dengan jumlah sampel penelitian yang masih belum mencukupi untuk memenuhi kriteria validitas untuk dapat diajukan sebagai faktor yang bersifat pasti, diperlukan penelitian lebih lanjut dengan sampel yang lebih besar.Kata kunci: Fibrinogen, luaran, mRS, perdarahan intraserebral spontan
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