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Elder JB. Recent experimental and clinical studies on the pharmacology of colloidal bismuth subcitrate. Scand J Gastroenterol 1986, 2l(suppl 122). 14-16Recent experimental and clinical pharmacological studies on colloidal bismuth subcitrate (CBS) are reviewed. CBS combines with mucus to produce a marked retardation of the movement of hydrogen ions. CBS has potent anti-ulcer and anti-erosive action in various experimental models in animals, and is able to stimulate the generation of gastric mucosal prostaglandins. CBS is thought to be a cytoprotective agent. The type of mucosal cell repair in the vicinity of the ulcer is favourably affected in man. CBS also exhibits anti-pepsin and bile acid-binding properties. Pyloric campylobacter are inhibited in vitro and in vivo. The recent pharmacological findings are discussed in the light of the clinical efficacy of CBS and new indications.Scand J Gastroenterol Downloaded from informahealthcare.com by York University Libraries on 12/27/14For personal use only.

The mainstay of therapy for patients harboring meningiomas, including atypical (WHO Grade II) meningiomas, is resection. The optimal initial treatment for all grades of meningioma is gross-total resection (GTR), although factors such as anatomical location and patient comorbidities may preclude aggressive surgical management, and the specific role and importance of resection for meningiomas continue to be evaluated. 19,20 Highergrade meningiomas (Grades II and III) are known to have a higher recurrence rate and poorer overall prognosis. Thus, optimization of adjuvant therapy is needed to minimize the risks of recurrence or progression after surgery.Recent literature has suggested that postoperative adjuvant radiation therapy immediately after GTR of atypical meningioma prolongs progression-free survival (PFS) and overall survival (OS) compared with resection without radiation therapy. 2,3,15 In their article, Komotar and colleagues 12 reinforce this treatment strategy with results from a focused retrospective review of 45 patients with atypical meningiomas, all of whom underwent GTR of their tumor. With a median follow-up of 44.1 months, only 1 (8%) of 13 patients who received postoperative radiation therapy demonstrated tumor recurrence, whereas 13 (41%) of 32 patients who did not receive postoperative radiotherapy experienced tumor recurrence. Thus, a trend toward increased PFS was observed in patients who received postoperative radiation therapy, although the results were not statistically significant (p = 0.085). Although the focus of this paper was patients with no residual tumor after surgery, not all meningiomas are amenable to GTR, and there are limits to the efficacy of surgery with recurrent or aggressive tumors.8 Furthermore, systemic chemotherapy and hormonal therapy have demonstrated minimal efficacy thus far. [10][11][12][13]21 Thus, radiotherapy will continue to be the primary adjuvant therapeutic modality, and data from studies such as this will have an important role in guiding therapy not only in high-grade tumors after GTR, as discussed in this manuscript, but also in subtotally resected tumors or those amenable only to biopsy procedures.Postoperative radiation therapy for atypical meningiomas is an important topic given the recent evolution of the WHO classification criteria.16,17 Currently, histological grade is the most powerful prognostic factor for patients with meningioma. Recognition of the subclassification of atypical meningioma was first made to distinguish these tumors from benign, WHO Grade I tumors and malignant/anaplastic, WHO Grade III tumors. Based on these initial WHO guidelines, the WHO Grade II tumor incidence rate was reported to be around 5% of meningiomas overall. 6 The WHO classification criteria for meningiomas changed significantly in 2000 based in part on retrospective reviews associating outcomes with histological grading criteria. These criteria broadened the definition of atypical meningioma, leading to a shift in observed incidence of atypical meningioma from roug...

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