Background:Central neurocytoma is an uncommon benign tumor of the central nervous system. A section of these tumors have unusual aggressiveness and are termed as “atypical central neurocytomas,” the definition of which is debated. Many studies in the available literature define them as tumors with elevated MIB-1 labeling index (MIB-1 LI) >2%, while some associate them with higher values of MIB-1 LI or those with histological atypical features. Newer parameters also have been identified and correlated with MIB-1 LI to differentiate atypical from benign neurocytoma cases. A recent analysis of the atypical neurocytoma cases with malignant behavior revealed their increased tendency of spread through the cerebrospinal fluid causing craniospinal axis dissemination. However, limited studies document the appropriate indications and usefulness of additional therapeutic modalities, such as upfront craniospinal irradiation (CSI) or adjuvant chemotherapy, in countering the aggressive behavior of such tumors.Case Description:We present two such rare cases of atypical neurocytoma with elevated MIB-1 LI, of 3% and 4%, respectively, without histological atypia. Since there is insufficient evidence documenting advantages of any additional measures in the adjuvant management of atypical cases, both patients were treated with localized cranial radiotherapy alone, as per the evidence available in the literature currently.Conclusion:We propose that future studies must aptly redefine these atypical neurocytomas with malignant potential and provide guidance to identify aggressiveness of these tumors early in the course of management. Lastly, strong evidence to provide specific adjuvant therapy is also warranted.
Deconditioning and weakness are problems commonly experienced by ICU patients [1][2][3][4]. Bed rest and immobility contribute to the development of these neuromuscular complications, which can be severe and long lasting in ICU survivors [1][2][3]. The benefits of physical medicine and rehabilitation in patients with prolonged mechanical ventilation have been well recognized [5][6][7][8], and recently there has been growing interest in evaluating early initiation of mobilization activities in the acute ICU setting [4,9,10]. Existing studies have demonstrated that early mobilization is safe, feasible, and associated with short-term benefits in critically ill patients.In this chapter, we will briefly review the relevant epidemiology and pathophysiology of immobility and bed rest. Thereafter, we will discuss early mobilization of critically ill patients specifically addressing its safety, feasibility and potential benefits. EpidemiologyRoutine use of physical medicine and rehabilitation therapy in the ICU is relatively rare. In one study, physical therapy was given to only 8 of 135 (6%) patients receiving 'usual care' in the ICU [11]. In another study of 150 acute lung injury patients in the ICU, only 27% received physical therapy which occurred on only 6% of all ICU days [12]. Likewise, in a smaller study of 20 physiologically stable ICU patients, physical activity was observed over two separate 4-hour periods that were variably scheduled throughout the day. During a total of 156 h of observation, only two instances of sitting and one instance of standing were recorded. No patient ambulated, and all other activities consisted solely of a passive range of motion and turning the patient in bed [13].One systematic review included 24 studies which evaluated neuromuscular abnormalities in 1,421 adult ICU patients with sepsis, multiorgan dysfunction, or prolonged mechanical ventilation [14]. In this review, 46% of subjects had critical illness neuromuscular abnormalities diagnosed using electrophysiological testing, with or without associated physical examination. A separate study used physical examination to diagnose neuromuscular weakness in awake patients who required >7 days of mechanical ventilation. In this cohort, ICU-acquired weakness was clinically diagnosed in 25% of 95 patients [1]. Neuromuscular weakness acquired in the ICU can persist for months or years Section Title Pulmonary Rehabilitation and Technology
Vitiligo is a common depigmentation disorder of skin, etiology of which is poorly understood. It has been rarely reported as a consequence of radiation at the site of irradiation, more so in patients with prior history of vitiligo. We report a rare clinical vignette that documents radiation-induced skin depigmentation, which started at the irradiated site and later manifested as generalized vitiligo, in a breast cancer patient with no family history of vitiligo. Studies describing the relationship between skin depigmentation and radiotherapeutic dose are scanty. The possible etiopathological mechanisms of vitiligo and radiation as a potential triggering factor for its development, which has been described in the literature, have been highlighted in this article.
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