Otitis media, mastoiditis or the pressure effect of tumorous lesions such as cholesteatoma can be the cause of facial canal dehiscence and facial nerve paralysis. The most common segment involved in dehiscence is the tympanic segment and the second most common is the lateral aspect of the facial canal in the oval window area. To determine the prevalence of the facial canal dehiscence and the relationship between the angle at the second genu of the facial nerve and facial canal dehiscence. We evaluated the surgical findings in 113 patients who underwent surgery for cholesteatoma. Facial canal dehiscence was detected in 62 of the 113 patients. Patients were divided into two groups: Group 1, with dehiscence of the facial canal and Group 2, without dehiscence of the facial canal. The mean angles at the second genu of the facial nerve in Groups 1 and 2 were 117.8◦ ± 9.63◦ and 114◦ ± 9.9◦, respectively. There was a statistically significant difference between the mean angles at the second genu for the two groups (p = 0.04).In patients with dehiscence of the facial canal, the angle at the second genu was found to be wider than those without dehiscence
Hodgkin lymphoma is a malignant proliferation of lymphatic system which when advanced can involve the bone marrow. It is usually indolent and responds to chemotherapy. However the prediction of rapidly progressive disease is often dependent on lot of clinicopathological parameters. Serum ferritin may act as a marker for disease activity in these patients. But the prior studies have failed to establish its role or group the patients into prognostic categories. To study the status of serum ferritin at time of admission and after completion of chemotherapy and also iron overload induced organ involvement in the form of hepatic, cardiovascular and thyroid dysfunction in nine patients admitted in our ward with Hodgkin lymphoma and receiving treatment in the form of chemotherapy. A spectrum of clinicopathological variables were tested at baseline and after treatment liver function test, thyroid function test, 2D echocardiography, Ultrasound abdomen, PET scan and serum ferritin level. Serum ferritin at baseline statistically correlated with disease activity however the final ferritin values reduced to significant values in patient that underwent remission, and hence grouping of patients based on serum ferritin values can serve as better outcome predictors. Although transfusion requirement was very rare in the patients the levels of serum ferritin correlated with disease activity. Serum ferritin level may act as a predictor of disease activity and remission.
As you know, cardiovascular diseases are a common cause of death and disability, among them a special place is occupied by stroke. To determine the quantitative parameters of blood flow of the main brain vessels in patients with left hemispheric ischemic stroke (HIS). Transcranial dopplerography (TD) of the middle cerebral artery (MCA) and middle cerebral vein (MCV), the Rosenthal’s vein, the Galena’s vein and Straight sinus (SS) was performed in 89 patients with HIS. The comparative group (CG) was organized from 52 patients without cardiovascular diseases. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), the resistance index (RI) in MCA, and the Vs of the main brain veins were determined. Sistolic blood flow velocity in the mid-cerebral artery in 85.4% of patients was below 70 cm/s and averaged, 54.9 ± 7.1 cm/s. In 9.2% of cases, the size of the affected area in the left hemisphere did not exceed 1 cm according to the results of tomography, and in 90.8% of cases it ranged from 1 cm to 2 cm According to the results of TD, MSA stenosis was detected in 78 (87.6%) cases, which was confirmed by MRI angiography. Among the patient with the Hemispheric ischemic stroke the Rosenthal’s vena was visualized in 81 (91,0%) cases, the Galen’s vena – in 83 (93,3%) cases, the median cerebral vein (MCV) - in 75 (84,3%) and the Straight sinus - in 79 (88,9%) cases, respectively. In a patients of the comparative group, visualization of this veins was successful in 42 (80.8%), 47 (90.4%), 31 (59.6%) and 32 (61.5%) cases, respectively. In a patients with HIS, all the main cerebral veins were visualized significantly (P <0.05 and P <0.001) more often than in the CG (with the exception of the Galen vein). In a patient with HIS Vs in the deep median cerebral vein was 25.3+3.6 cm/s; in the basal vein of the brain -24.9+2.6 cm/s; in the large vein of the brain -26.3+2.1 cm/s; in the direct sinus, 32.1 ± 2.6 cm/s, respectively. Stenosis of the middle cerebral artery, a decrease in systolic blood flow velocity less than 70 cm/s, an increase in resistance index more than 0.70 and in the pulsation index more than 1.35 is a frequent finding in ischemic stroke. The correspondence between the severity of the stroke and the value of the systolic blood flow velocity in the cerebral veins was revealed. Good visualization of the main cerebral veins is due to the increase in blood flow velocity in them
Astrocytes comprise the major non-neuronal cell population in the mammalian neurovascular unit. Traditionally, astrocytes are known to play broad roles in central nervous system (CNS) homeostasis, including the management of extracellular ion balance and pH, regulation of neurotransmission, and control of cerebral blood flow and metabolism. After CNS injury, cell–cell signaling between neuronal, glial, and vascular cells contribute to repair and recovery in the neurovascular unit. In this mini-review, we propose the idea that astrocytes play a central role in organizing these signals. During CNS recovery, reactive astrocytes communicate with almost all CNS cells and peripheral progenitors, resulting in the promotion of neurogenesis and angiogenesis, regulation of inflammatory response, and modulation of stem/progenitor response. Reciprocally, changes in neurons and vascular components of the remodeling brain should also influence astrocyte signaling. Therefore, understanding the complex and interdependent signaling pathways of reactive astrocytes after CNS injury may reveal fundamental mechanisms and targets for re-integrating the neurovascular unit and augmenting brain recovery.
Health utilities summarize a patient’s overall health status. This study estimated utilities based on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ-C30), a widely used measure of health-related quality-of-life (HRQoL) in oncology, using published mapping algorithms. Data were from the Anaplastic Lymphoma Kinase (ALK) in Lung Cancer Trial of brigatinib (ALTA; NCT02094573), an open-label, international, phase 2 study. ALTA evaluated the efficacy and safety of two randomized dosing regimens of brigatinib in patients with locally advanced or metastatic ALKþ non-small cell lung cancer (NSCLC) that had progressed on prior therapy with crizotinib. QLQ-C30 scores were mapped to European Quality-of-Life-5 Dimensions (EQ-5D) utility scores using two published algorithms (Khan et al. for EQ-5D-5L; Longworth et al. for EQ-5D-3L). The impact of brigatinib treatment on health utilities over time was assessed. The analysis included 208 subjects. Mean baseline utility scores for both algorithms ranged between 0.60 0.71 and increased to 0.78 by cycle 5. Utility improvements were sustained during most of the treatment, before disease progression. Minor variations were observed between utility scores; Khan et al. estimates were approximately 0.01 or 0.02 points lower than Longworth et al. estimates. Algorithms considered were limited to those available in the published literature at the time of the study. This utility analysis was exploratory, and the ALTA trial did not include an internal control group (i.e. standard of care) and was not powered to detect differences in QoL/utility outcomes between treatment arms. Converting QLQ-C30 scores into utilities in trials using established mapping algorithms can improve evaluation of medicines from the patient perspective. Both algorithms suggested that brigatinib improved health utility in crizotinib-refractory ALK þ NSCLC patients, and improvements were maintained during most of the treatment.