A controlled trial of hepatitis B vaccination with recombinant antigen was undertaken in 18 hemodialysed end-stage renal failure (ESRD) patients (P) and 16 members of our staff (controls, C). In order to identify expected nonresponders (NR), we monitored T lymphocyte (Tc) subsets, peripheral blood mononuclear cells (PBMC), total leukocytes (WBC) and IgG. After 3 vaccine doses of 40 and 20 IU, respectively, for P and C, at 0,1 and 6 months, 11 P (61.1%) and all C (100%) responded, as in previous reports [1-3]. The 7 NR presented lower CD4 + Tc fraction, compared to responders (R) and C (p < 0.05), and higher monocyte (p < 0.00001) and WBC (p < 0.002) counts, with lower lymphocyte fraction (p < 0.001), compared to R. We suggest that NR could represent a selected group of ESRD patients, screenable by these easily detectable features, probably markers of a specific immune dysfunction.
BackgroundBoth surgery and conservative management are well established treatments for compression fractures of the thoraco-lumbar spine without neurological compromise. This article aims to compare the outcomes of conservative management to those of vertebroplasty, a relatively safe and simple procedure.Methods102 patients were admitted to our neurosurgical unit between January 2012 and February 2016, presenting with a single-level, post-traumatic A1 or A2 Mager l type fracture, affecting the thoracic-lumbar spine without any neurological deficits. After description of both treatment options, the patients were asked to choose between vertebroplasty or conservative treatment. Accordingly, the patients were allocated into two groups and a prospective non-randomized controlled trial was carried out. The first group (Group A) included 52 patients, treated with bed rest and an orthosis. The second group (Group B) of 50 patients underwent a percutaneous vertebroplasty. Pain intensity (assessed via visual analog scale (VAS)), disability degree (assessed via Oswestry Disability Index), ability to resume work (assessed via Denis work Scale), vertebral body height loss rate, regional kyphosis angle (Cobb’s angle), duration of hospitalization and treatment-associated complications, were prospectively recorded in a database and analyzed. Follow ups were planned at 1, 6, and 12 months after the injury.ResultsGroup B, compared with group A, showed a faster improvement in VAS score as well as functional ability and return to work. Cobb’s angle progression was significantly less in the surgical group. Morbidity, mortality, and complication rate were similar and comparable in both groups without a statistical difference (P<0.05)ConclusionsVertebroplasty is a safe and effective treatment in post-traumatic thoracic-lumbar fractures compared with conservative management.
Purpose. For recurrent high-grade gliomas (HGG), no standard therapeutic approach has been reported; thus, surgery, chemotherapy, and re-irradiation (re-RT) may all be proposed. The aim of the study was to evaluate safety and efficacy of re-RT by radiosurgery or fractionated stereotactic radiotherapy (SRS/FSRT) in association to chemotherapy in patients with recurrent HGG. Material/Methods: All patients with histological diagnosis of HGG that suffered by recurrent disease diagnosed by magnetic resonance imaging (MRI), according to Response Assessment in Neuro-Oncology (RANO) criteria, after primary/adjuvant chemo-radiotherapy treatment and underwent to re-RT by SRS/FSRT were included in the analysis. Second-line chemotherapy was administered. Outcomes were evaluated by neurological examination and brain MRI performed 1 month after re-RT and then every 2–3 months. Results: From November 2019 to September 2021, 30 patients presenting recurrent HGG underwent re-RT. Median dose was 24 Gy (range 15–36 Gy), and median fractions was 5 (range 1–6). Twenty-one patients (70%) had RPA class ≤ IV. One patient had a histological diagnosis of anaplastic oligodendroglioma, 24 patients (80%) were affected by glioblastoma (GBM) including 3 cases of multifocal form, and 5 patients (17%) by anaplastic astrocytoma. Median time between primary/adjuvant RT and disease recurrence was 8 months. In six cases (20%) re-operation was performed, and in most cases (87%), a second line of systemic therapy was administrated. At a median follow-up time from recurrence of 13 months (range 6–56 months), 10 patients (33%) were alive: 2 patients with partial response disease, 7 patients with stable disease, and 1 patient with out-field progression disease. Of the 20 patients who died (67%), 15 (75%) died for progression disease and 5 (25%) for other causes (3 due to septic event, 1 due to thrombo-embolic event, and 1 due to car accident). Median OS and PFS after recurrence were 12.1 and 11.2 months. Six-month and one-year OS were, respectively, 81% and 51%. No acute or late neurological side effects grade ≥ 2 and no case of radio-necrosis were reported. One patient experienced, after reintervention and during Regorafenib treatment (administered 40 days after surgery), dehiscence of the surgical wound. In three cases, grade 2 distal paresthesia was reported. Grade 3–4 hematologic toxicity occurred in seven cases. Three case of grade 5 toxicities during chemotherapy were reported: three septic events and one thrombo-embolic event. Conclusion. Re-RT with SRT/FSRT in association with second-line systemic therapy is a safe and feasible treatment for patients with HGG recurrence. Validation of these results by prospective studies is needed.
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