Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Mar 2016
ReviewSecond surgery for recurrent glioblastoma: A concise overview of the current literature.
Optimal treatment for recurrent glioblastoma continues to evolve. Currently, however, there is no consensus in the literature on the role of reoperation in the management of these patients, as several studies provide evidence for a longer overall survival in selected patients with recurrent glioblastoma who underwent second surgery and other studies report a limited impact of second surgery in the clinical course. In this paper, a review of the current literature was performed to analyze the role of reoperation in patients with recurrent glioblastoma and to report the overall survival from diagnosis, progression-free survival and quality of life. ⋯ The median overall survival from diagnosis and the median survival from second surgery were 18.5 months and 9.7 months, respectively. Extent of resection at reoperation improves overall survival, even in patients with subtotal resection at initial operation. Preoperative performance status and age are important predictors of a longer survival, reason why younger patients with a good preoperative performance status could benefit from reoperation.
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Clin Neurol Neurosurg · Mar 2016
Cost-effectiveness analysis of CTA and LP for evaluation of suspected SAH after negative non-contrast CT.
Diagnostic workup of patients presenting with thunderclap headache and negative initial head CT remains a challenge, with most commonly employed strategies being lumbar puncture (LP) and CT angiography (CTA). The objective of this study was to determine the cost-effectiveness of these options. ⋯ LP should remain the preferred strategy for evaluation of SAH in patients presenting with thunderclap headache and negative non-contrast head CT. CTA is not an effective replacement, from either a utility or cost perspective.
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Clin Neurol Neurosurg · Mar 2016
TBI prognosis calculator: A mobile application to estimate mortality and morbidity following traumatic brain injury.
Traumatic Brain Injury (TBI) is a significant public health problem and a leading cause of worldwide mortality and morbidity. Although effective evidence-based guidelines are available to help with management, the first question clinicians and family face is whether or not it is appropriate to intervene at all. To facilitate prognostic assessment and family counseling, we developed mobile application integrating validated TBI prognostic models. ⋯ Prompt and accurate prognosis estimation in TBI is promising. Mobile applications have the potential to enable easier and quicker point-of-care access to validated models, providing additional information to improve management and family counseling. We anticipate that clinicians will find "TBI Prognosis Calculator" useful as an adjunct in their prognostic assessment and family counseling.
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Clin Neurol Neurosurg · Feb 2016
Microparticle derived proteins as potential biomarkers for cerebral vasospasm post subarachnoid hemorrhage. A preliminary study.
Cerebral vasospasm (CV) and associated secondary brain injury are major contributors to death and disability after aneurysmal subarachnoid hemorrhage (aSAH). Microparticles (MP) are small vesicular micro-molecules released by red and white blood cells, platelets and endothelial cells that can change rapidly and specifically depending on the type of cellular insult. They may serve as useful tools to target a specific pool of proteins associated with the development of CV post aSAH. In these studies, our goal was to use targeted MP-derived protein isolation to find reliable biomarkers indicating increased risk for the development of CV. We hypothesize that there are specific early changes in MP-derived protein expression in CV patients. These proteins may be useful as biomarkers for CV and may help us to further understand the mechanism for the development of CV. Patients Adult male and female patients with angiographically confirmed aSAH and an external ventricular drain (EVD) placed for medical or surgical needs were included in this study. Patients were closely monitored for CV development. Cerebrospinal fluid (CSF) was collected daily until EVD was removed. ⋯ This is the first preliminary demonstration that there is differential protein expression in CSF microparticles from CV patients. Alone or in combination, these and other proteins may be useful as reliable biomarkers to guide in stratifying patients into categories of risk to develop CV post aSAH. These results will deepen our understanding of the mechanisms of cerebral vasospasm and potentially facilitate the development of safer and more effective therapies therapies for cerebral vasospasm.
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Clin Neurol Neurosurg · Feb 2016
Observational StudyDevelopment, validation and psychometric properties of a diagnostic/prognostic tool for breakthrough pain in mixed chronic-pain patients.
Breakthrough pain (BTP) shows variable prevalence in different clinical contexts of cancer and non-cancer patients. BTP diagnostic tools with demonstrated reliability, validation and prognostic capability are lacking. We report the development, psychometric and validation properties of a diagnostic/prognostic tool, the IQ-BTP, for BTP recognition, its likelihood and clinical features among chronic-pain (CP) patients. ⋯ The IQ-BTP showed satisfactory psychometric and validation properties. With adequate feasibility it enabled the allocating of cancer/non-cancer CP patients in three prognostic classes. Results are sufficient to warrant a subsequent impact study of the IQ-BTP as prognostic model and screening tool for BTP in both CP populations.