Seoane: “Ha encontrado un talón de Aquiles en el glioblastoma, la forma más frecuente y grave de tumor cerebral”

Joan Seoane ha encontrado un talón de Aquiles en el glioblastoma, la forma más frecuente y grave de tumor cerebral. En una investigación presentada en diciembre, demostró que atacar las células madre del glioblastoma frena la progresión de la enfermedad en ratones. En paralelo a su investigación, el hospital Vall d’Hebron de Barcelona y el Johns Hopkins de Baltimore (Estados Unidos) han iniciado un ensayo clínico conjunto para ver si la misma estrategia funciona en personas.

¿Son más importantes las células madre que las otras células del tumor?
Las células madre son una minoría de todas las células del tumor. Pero son las
responsables del inicio de la enfermedad, de las recidivas, de las metástasis y
de la resistencia a los fármacos.

¿Basta con combatir las células madre para eliminar el tumor?
En una primera fase, el objetivo es eliminar las células más agresivas para que
se pueda convivir con el tumor. Se trata de convertir el glioblastoma en una
enfermedad crónica. A más largo plazo, el objetivo es erradicar todas las células del tumor.

¿Cómo atacan las células madre?
Hemos descubierto que tienen una actividad muy elevada de la hormona TGF beta. Y que, si inhibimos la actividad de esta hormona con un fármaco, las células madre del glioblastoma dejan de actuar como células madre y el
tumor deja de progresar.

¿Disponen ya de estos fármacos?
Varias compañías farmacéuticas han desarrollado inhibidores de TGF beta. En Vall d’Hebron hemos iniciado ensayos clínicos con dos de ellos.

¿Estos fármacos pueden sustituir a la quimioterapia clásica?
Si se demuestra que son eficaces y seguros, como esperamos, creo que complementarán a otros tratamientos. El tratamiento de los tumores cerebrales seguirá haciéndose con cirugía cuando sea posible, con radioterapia y con quimioterapia.

¿Qué le llevó a especializarse en tumores cerebrales?
Quería que mis investigaciones pudieran aplicarse en beneficio de los  pacientes. Pensé que tenía que focalizarme en algo concreto, más que investigar el cáncer en general, aunque con el objetivo de extrapolar los descubrimientos a otros tipos de tumor. Me atrajo el glioblastoma porque
es un tumor agresivo para el que hay una gran necesidad de encontrar
tratamientos eficaces.

Leer más: http://www.lavanguardia.com/vanguardia-de-la-ciencia/20110205/54111137148/seoane-el-objetivo-es-erradicar-el-tumor.html#ixzz3r6GJxglN
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Craniosynostosis: Developing Parameters for Diagnosis, Treatment, and Management

A multidisciplinary meeting was held from March 4 to 6, 2010, in Atlanta, Georgia, entitled “Craniosynostosis: Developing Parameters for Diagnosis, Treatment, and Management.” The goal of this meeting was to create parameters of care for individuals with craniosynostosis.

Fifty-two conference attendees represented a broad range of expertise, including anesthesiology, craniofacial surgery, dentistry, genetics, hand surgery, neurosurgery, nursing, ophthalmology, oral and maxillofacial surgery, orthodontics, otolaryngology, pediatrics, psychology, public health, radiology, and speech-language pathology. These attendees also represented 16 professional societies and peer-reviewed journals. The current state of knowledge related to each discipline was reviewed. Based on areas of expertise, four breakout groups were created to reach a consensus and draft specialty-specific parameters of care based on the literature or, in the absence of literature, broad clinical experience. In an iterative manner, the specialty-specific draft recommendations were presented to all conference attendees. Participants discussed the recommendations in multidisciplinary groups to facilitate exchange and consensus across disciplines. After the conference, a pediatric intensivist and social worker reviewed the recommendations.

Consensus was reached among the 52 conference attendees and two post hoc reviewers. Longitudinal parameters of care were developed for the diagnosis, treatment, and management of craniosynostosis in each of the 18 specialty areas of care from prenatal evaluation to adulthood.

This is the first multidisciplinary effort to develop parameters of care for craniosynostosis. These parameters were designed to help facilitate the development of educational programs for the patient, families, and health-care professionals; stimulate the creation of a national database and registry to promote research, especially in the area of outcome studies; improve credentialing of interdisciplinary craniofacial clinical teams; and improve the availability of health insurance coverage for all individuals with craniosynostosis.

Book: Handbook of Neurosurgery

Handbook of Neurosurgery

By Mark S. Greenberg

Handbook of Neurosurgery

List Price: $99.99

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A ‘must-have’…[a] low-cost, highly portable, and extremely useful reference volume, which will undoubtedly enjoy continued longevity into the foreseeable future. –Journal of Neurosurgery

A vital resource…For rapid access to the diagnosis and management of all neurosurgical things, there is no substitute.–The Journal of TRAUMA Injury, Infection, and Critical Care

For two decades, Handbook of Neurosurgery — now in a fully updated seventh edition — has been an invaluable companion for every neurosurgery resident and nurse, as well as neurologists and others involved in the care of patients with brain and spine disorders. Dr. Greenberg’s classic text covers the breadth of neurosurgery and its allied specialties and provides the latest information on anatomy and physiology, differential diagnosis, and currently accepted principles of clinical management. Renowned for its scope and accessibility, this portable, single-volume guide is packed with more than 1,300 pages of practical information, including thousands of literature citations, handy cross-references, and a thorough index.

Features:

  • New to the seventh edition: detailed coverage of blunt cervical arterial injuries; awake craniotomies; brain mapping; new grading systems for cervical and thoracolumbar fractures; radiation safety for neurosurgeons; organ donation after cardiac death; and expanded discussion of endovascular techniques
  • Numerous updates, including information on dural arteriovenous malformations; tumors and molecular biology; and new neuromonitoring modalities such as brain oxygen tension, cerebral microdialysis, and regional cerebral blood flow
  • The return of basic surgical material to acquaint readers with the operating room
  • A practical new feature called Booking the Case supplies helpful information about scheduling surgery and obtaining informed consent
  • Highly valuable section on hot topics in neurocritical care
  • Color highlights and full-color inserts to enhance readability

Comprehensive and conveniently compact, this book is a must-have reference for neurosurgery residents and a useful tool for anyone working in the clinical neurosciences.


Product Details

  • Published on: 2010-02-22
  • Original language: English
  • Number of items: 1
  • Dimensions: 7.75″ h x 5.00″ w x 1.75″ l, 1.81 pounds
  • Binding: Paperback
  • 1352 pages

Editorial Reviews

Review

A must-have…[a] low-cost, highly portable, and extremely useful reference volume, which will undoubtedly enjoy continued longevity into the foreseeable future.–Journal of NeurosurgeryA vital resource…the Handbook is a comprehensive quick reference compilation spanning the breadth of neurosurgical disease and practice…the seventh edition marks a significant update…so accessible…For rapid access to the diagnosis and management of all neurosurgical things, there is no substitute.–The Journal of TRAUMA Injury, Infection, and Critical CareComprehensive and highly useful and readable…review of neurosurgery…Well indexed, convenient, well written…and light weight. This should be on all our bookshelves. — American Journal of NeuroradiologyOffers new material on new prodcedures such as awake craniotomies, brain mapping, and endovascular techniques, and reveals the latest understanding of conditions such as dural arteriovenous malformations and new monitoring modalities.–SciTech Book NewsComprehensive and conveniently compact, this book is a must-have reference for neurosurgery…and a useful tool for anyone working in the clinical neurosciences…Superb and…up to date. — Doody’sPraise for the previous edition:Jam-packed with information vital to every practicing neuroradiologist. It serves best to tuck this paperback book into a laboratory coat, so that quick consultation on patient evaluation, clinical management, and surgical approach is readily at hand…a comprehensive companion for all those in the clinical neurosciences.–American Journal of NeuroradiologyThe Handbook of Neurosurgery has been a kind of bible for neurosurgical residents. This book is an invaluable companion for the neurosurgical resident from internship through completion. It is a reference for quick up-to-date information on anatomical and physiological facts, differential diagnosis, and currently accepted principles of clinical management. The sixth edition has new features that distinguish it from prior editions. The most important of these is the incorporation of the concepts of evidence-based medicine. ..Highlighted areas…signal a condensed summary, key point, or clinical pearl…very helpful for quick reference. This new edition is the best there is for quick referencing. Its broad, yet detailed coverage of the most commonly encountered neurosurgical problems makes this book keep the title’s promise–this is truly a handbook of neurosurgery. The Handbook of Neurosurgery is a must-have for all neurosurgical resident.–Journal of Neurosurgery Up-to-date.. The information is presented in a very clear, condensed and comprehensive manner and can therfore be understood quickly if necessary. This handbook is a good must buy for every neurosurgeon, not only the resident, because it helps us to have a quick and reliable reference, especially in cases that we usually do not treat in our daily routine.–Neurosurgical Review

und the following review helpful.

Update: Radiography in Spinal epidural metastases

Most of the spinal epidural metastases are osteolytic, but at least 50 % of the bone must be eroded before plain x ray abnormality 1).

Not very specific.

see Winking owl sign

Plain x-rays are quite good at evaluating bony metastases, but not good at evaluating the spinal cord and surrounding soft tissues. Metastatic epidural spinal cord compression most commonly occurs at the site of vertebral involvement on plain x-ray, especially where there is evidence of vertebral collapse. Most common findings on x-rays include pedicle erosion, paravertebral soft shadow, vertebral collapse, and pathologic fracture or dislocation 2).

In the past, if there was back pain or a localizing sign and spinal x-ray was abnormal, the probability of epidural disease was 0.9, but if the x-ray was normal, the probability was only 0.1 3) 4).

In 1990, x-rays were found to have a 10% to 17% false negative rate 5).

The rate of missed metastatic epidural spinal cord compression is unacceptable.

1) Gabriel K, Schiff D. Metastatic spinal cord compression by solid tumors. Semin Neurol. 2004 Dec;24(4):375-83. Review. PubMed PMID: 15637649.
2) Perrin RG. Metastatic tumors of the axial spine. Curr Opin Oncol 1992;4(3):525-32.
3) Rodichok LD, Harper GR, Ruckdeschel JC, et al. Early diagnosis of spinal epidural metastases. Am J Med 1981;70(6):1181-8.
4) Portenoy RK, Galer BS, Salamon O, et al. Identification of epidural neoplasms. Radiography and bone scintigraphy in the symptomatic and asymptomatic spine. Cancer 1989;64(11):2207-13.
5) Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien). 1990;107(1-2):37-43. PubMed PMID: 2096606.

Color Atlas of Neurology

Color Atlas of Neurology
By Reinhard Rohkamm

Color Atlas of Neurology (Clinical Sciences (Thieme))

Price: $32.53

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Highly Commended at the 2004 British Medical Awards Medical Book Competition!

Neurology – made visible

Every practitioner in modern medicine is confronted daily with neurologic symptoms, diagnoses, and clinical problems. Yet there is scarcely any other medical specialty that is so fraught with complexities and abstractions. This pocket atlas is designed to provide a better, easier-to-understand visual guide on what the reader needs to know about neurology. In a unique way, neurology is made visible in the truest sense of the word.

Coverage includes:

  • The basic principles of neuroanatomy and neurophysiology (structure of the CNS, peripheral nerves, stimulus transmission, nerve conduction velocity, etc.)
  • Diagnostic methods and procedures (clinical examinations, electrophysiologic techniques, imaging studies, etc.).
  • Neurologic disorders including their clinical manifestations, pathogenesis, and principles of treatment.

These topics and more are covered in elaborately drawn, meticulously labeled illustrations. The effective concept of placing the illustrations opposite the descriptive text for a particular subject has created word-and-picture units that combine maximum teaching impact with an optimum density of information. Neurologic relationships can be grasped literally at a glance. This pocket atlas is intended for medical students, physicians, and other medical professionals (nurses, physical therapists, occupational therapists, speech therapists) who could profit from a visual guide to neurology.


Product Details

  • Published on: 2003-12-10
  • Original language: English
  • Number of items: 1
  • Dimensions: .80″ h x 5.50″ w x 7.60″ l, 1.10 pounds
  • Binding: Paperback
  • 440 pages

Editorial Reviews

Review

Easily readable, with subheadings, informative summaries and key references, which allow rapid orientation in the comprehensive subject matter. Logical and easy-to-understand text is placed opposite beautifully drawn and labeled illustrations, thus enhancing the book’s didactic utility. This small atlas is a precious and unique visual guide to neurology’s most difficult concepts, a book that should always be close at hand. It is a ‘must have’ for all who are interested and engaged in the open and inspiring field of clinical neuroscience and practice. –Acta Clinica Croatica

From the Back Cover

Highly Commended at the 2004 British Medical Awards Medical Book Competition!

Neurology – made visible

Every practitioner in modern medicine is confronted daily with neurologic symptoms, diagnoses, and clinical problems. Yet there is scarcely any other medical specialty that is so fraught with complexities and abstractions. This pocket atlas is designed to provide a better, easier-to-understand visual guide on what the reader needs to know about neurology. In a unique way, neurology is made visible in the truest sense of the word.

Coverage includes:

  • The basic principles of neuroanatomy and neurophysiology (structure of the CNS, peripheral nerves, stimulus transmission, nerve conduction velocity, etc.)
  • Diagnostic methods and procedures (clinical examinations, electrophysiologic techniques, imaging studies, etc.).
  • Neurologic disorders including their clinical manifestations, pathogenesis, and principles of treatment.

These topics and more are covered in elaborately drawn, meticulously labeled illustrations. The effective concept of placing the illustrations opposite the descriptive text for a particular subject has created word-and-picture units that combine maximum teaching impact with an optimum density of information. Neurologic relationships can be grasped literally at a glance. This pocket atlas is intended for medical students, physicians, and other medical professionals (nurses, physical therapists, occupational therapists, speech therapists) who could profit from a visual guide to neurology.

About the Author

Director, Neurological Clinic, Friesland Hospital, Sande, Germany


Color Atlas of Neurology, Second Edition is a well-organized and illustrated text with anatomic and physiological information pertinent to physicians, advanced practice providers, medical students, and nursing students. While nonboard certified neurologists will be the greatest beneficiaries of the information in this book, board-certified neurologists and neurosurgeons can focus on a number of pages of this book for reminders of pertinent information that will help them treat their patients.

The text is divided into 4 sections. It starts with fundamentals that explain basic central and peripheral nervous system anatomy. For learners, neuroanatomy and its clinical relevance are elusive concepts; Rokhamm’s text facilitates acquisition of information in digestible portions that do not require hours of reading and synthesizing of plain text. Novice learners will benefit from explanations and illustrations of the nervous system. The illustrations allow the reader to visualize both physiology and pathophysiology. For the more experienced provider, this section is a good reference to review when questioning a finding on physical exam, trying to better understand a certain condition, or determining if an abnormal finding is peripheral or central in origin.

The text then explores functional system pathways more deeply. This second section provides a review of pain, memory, autonomics, and other functional pathways. Normal physiological findings are described, and explanations of why the findings are normal are included. Illustrations clearly show the origin and termination of pathways that generate normal physical findings, such as muscle stretch reflexes. The undergraduate, medical student, and advanced practice provider learners will likely spend extensive time in this section, as the functional pathways covered are essential to practicing good neurology.

The third section focuses on abnormal findings, syndromes, and the effect of disease on target organs and systems. The authors explain the pathophysiology of abnormal findings and where they are occurring within neurological pathways. Relevant physical finding illustrations are reminiscent but distinct from Netter’s work, picturesquely describing the major points. In particular, we enjoyed the pages devoted to describing gait and its associated disorders.

The fourth and final section is the most extensive section of the book, as the authors synthesize information skillfully, again using in-text illustrations to provide complete explanations of the manifestations of neurology disease processes that are inclusive of neuroanatomy and pathophysiology. Numerous diseases are reviewed, and it is the most useful section for active providers and more experienced practitioners. Diseases that are particularly well described are various types of stroke and spinal cord injury.

In conclusion, Color Atlas of Neurology, Second Edition, by Reinhard Rohkamm, is an excellent text for providers at every level. Its organization, illustrations, and depth make it a text that we would recommend to students, residents, and colleagues alike. This is not a text that will gather dust on a shelf; its place is in the pockets of white coats of learners who are on rotations, or on the desk of nurse practitioners who care for patients with neurological diseases, non-neurologists who encounter patients with neurological disease, and neurologists and neurosurgeons who require a quick reminder for specific questions related to their patients.

Update: Spinal arachnoid cyst

Spinal arachnoid cyst

Epidemiology

Almost always dorsal, most common in the thoracic spine.

Most are extradural and these are sometimes referred to as arachnoid diverticula – these may be associated with kyphoscoliosis in juveniles or with spinal dysraphism.

Etiology

Intradural arachnoid cysts may be congenital or may follow infection or trauma.

Clinical features

Usually asymptomatic, even if large.

Differential diagnosis

Vith a ventral cyst, consider a neurenteric cyst.

Treatment

When indicated, treatment options include:

1. percutaneous procedures: may be done under MRI 1). or CT guidance. CT guidance usually requires use of intrathecal contrast to delineate the cyst

A. needle aspiration.

B. needle fenestration.

2. open surgical resection or fenestration

Case report

Takahashi et al. describe the case of a high cervical, intradural extramedullary cyst located anterior to the spinal cord in a 13-year-old boy. The lesion was fenestrated percutaneously by using real-time magnetic resonance (MR) imaging guidance and a local anesthetic agent. The patient’s symptom, severe exercise-induced headache, immediately resolved after treatment. Nine months later, complete disappearance of the cyst was confirmed on MR imaging and computerized tomography myelography. Magnetic resonance imageing-guided fenestration can be considered a minimally invasive option for intradural cystic lesions 2).

1) , 2) Takahashi S, Morikawa S, Egawa M, Saruhashi Y, Matsusue Y. Magnetic resonance imaging-guided percutaneous fenestration of a cervical intradural cyst. Case report. J Neurosurg. 2003 Oct;99(3 Suppl):313-5. PubMed PMID: 14563151.

Update: Pallidotomy

Pallidotomy

Indications

Pallidotomy is an alternative to deep brain stimulation for the treatment of the involuntary movements known as dyskinesias which can become a problem in people with Parkinson disease after long-term treatment with levodopa — a condition known as levodopa-induced dyskinesia.

It is also sometimes used in alternative to deep brain stimulation to treat difficult cases of essential tremor.

Unilateral posteroventral pallidotomy can be effective at reducing Parkinsonism, but is associated with impaired language learning (if performed on the dominant hemisphere) or impaired visuospatial contructional ability (if performed on the non-dominant hemisphere). It can also impair executive functions.

Bilateral pallidotomy will not reduce Parkisonistic symptoms but will cause severe apathy and depression along with slurred unintelligable speech, drooling, and pseudobulbar palsy.

Pallidotomy has long been an accepted procedure and the indications for this surgery, in the opinion of the responding centers of a survey of current practice in North America (1996), were rated on a scale of 1 (poor) to 4 (excellent) and demonstrated dyskinesia as the best indication (median = 4); on-off fluctuations, dystonia, rigidity, and bradykinesia as good indications (median = 3); and freezing, tremor and gait disturbance as fair indications (median = 2). Most centers used MRI alone (50%) or in combination with CT scan (n = 6) or ventriculopathy (n = 5) to localize the target. The median values of pallidal coordinates were: 2 mm anterior to the midcommissural point 21 mm lateral to the midsagittal plane and 5 mm below the intercommissural line. Microrecording was performed by half of the centers (n = 14) and half of the remaining centers were considering starting it (n = 7). Main criteria used to define the target included the firing pattern of spontaneous neuronal discharges (n = 13) and the response to joint movement (n = 10). Most centers performed motor (n = 26) and visual (n = 23) macrostimulation. Twenty four centers performed test lesions using median values of 55 degrees C temperatures for 30 s. Final lesions consisted of 3 permanent lesions placed 2 mm apart, each lesion created with median values of 75 degrees C temperatures for 1 minute. Median hospital stay was 2 days 1).

1) Favre J, Taha JM, Nguyen TT, Gildenberg PL, Burchiel KJ. Pallidotomy: a survey of current practice in North America. Neurosurgery. 1996 Oct;39(4):883-90; discussion 890-2. PubMed PMID: 8880789.