Unruptured aneurysms smaller than 1 cm can cause neurological symptoms of mass effect. We recommend timely surgery, preferably within 5 days, to avoid not only aneurysm rupture but also functional disability even in patients with unruptured aneurysms smaller than 1 cm.
Hypoxia-inducible factor (HIF)-1α and HIF-2α expression were investigated immunohistochemically as determinants of prognosis in 42 cases of astrocytic tumors associated with necrosis grade on magnetic resonance (MR) imaging. Expression of HIF-1α was determined immunohistologically. The degree of necrosis on MR images was divided into four grades. Kaplan-Meier analysis revealed a significant effect of necrosis grade on MR images on cumulative overall survival. Median survival times were 26, 14, and 13 months for patients with necrosis grades 1, 2, and 3, respectively (not defined for grade 0). Kaplan-Meier analysis revealed a significant effect of HIF-1α expression on cumulative overall survival. Median survival time of patients with HIF-1α expression was 17 months, whereas it was 80 months for patients without HIF-1α expression. However, overexpression of HIF-2α did not correlate with malignant features, for example angiogenesis or necrosis, and had no impact on overall survival of patients with glial tumors. In conclusion, HIF-1α, but not HIF-2α, is a useful prognostic factor in astrocytic tumor associated with necrosis on MR images.
An 18-year-old man presented with a rare spinal subdural hematoma (SSH) manifesting as headache, which developed following diving into the sea the day before. Computed tomography of the head revealed no abnormality. His headache persisted followed by neck stiffness and mild lumbago. He came to see us 6 days after the first visit. He underwent lumbar puncture to eliminate the possibility of meningitis. The cerebrospinal fluid showed xanthochromia. Cerebral angiography showed no abnormality. Magnetic resonance imaging of the spine revealed lumbosacral subdural hematoma. The hematoma and his symptoms regressed spontaneously during several weeks of conservative treatment. A sharp increase in intraabdominal and/or intrathoracic pressures following diving may have caused the bleeding. Headache may be an initial symptom associated with subarachnoid hemorrhage concomitant with SSH. Delayed progression of lumbosacral SSH must be considered if the patient complains of lumbago following minor trauma.
Irinotecan (CPT-11) has shown emerging promise in the treatment of malignant gliomas. It is believed the mechanism of action of irinotecan is to sensitize glioma cells to the cytotoxic action of radiation therapy and alkylating agents. However, clinical trials using weekly or three-weekly doses of CPT-11 have demonstrated imaging responses in only 10-15% of patients. In this study, we evaluated another mechanism of action, angiosuppression by CPT-11 of ACNU-resistant gliomas, using a metronomic administration schedule. Two different types of treatment, (1) conventional and (2) metronomic, were applied to the subcutaneous U87 model. We found that metronomic administration of CPT-11 significantly inhibited malignant glioma growth by inhibiting angiogenesis; this treatment procedure reduced the number of tumor vessels and the area of hypoxic lesions and reduced expression of VEGF and HIF-1alpha, the most important angiogenic factors in gliomas. Metronomic treatment was superior to conventional treatment with regard to the severe systemic side effect of body weight loss. The growth inhibitory effect was very similar for both low and high doses of CPT-11. These angiosuppressive effects of CPT-11 show promise for another use of CPT-11 in metronomic and scheduled angiosuppressive chemotherapy with low dose and long-term administration for malignant gliomas without systemic side effects.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.