Biomedical subjects

Meic H Schmidt

Publications and source records attributed to Meic H Schmidt.

42 records · Page 3Linked to original sources

PubMed2002

Clinical trial participation among patients enrolled in the Glioma Outcomes Project.

BACKGROUND: Patient participation in well-designed and conducted clinical trials enables researchers to test new therapies. An understanding of the variables that possibly influence patient enrollment may help in patient recruitment for future trials. The authors evaluated factors that influenced patient enrollment in clinical trials using a prospective, large, multi-institutional registry of patients with malignant glioma. METHODS: Data were examined from 708 patients who underwent first or second surgery for a malignant glioma who were enrolled in the Glioma Outcomes Project, which is a prospective observational data base that captures clinical practice patterns. The frequency of clinical trial participation and the variables that may have been associated with trial participation were evaluated. These variables included age, gender, race, household income, educational level, first versus second craniotomy, histology, and whether the patient was treated at an academic institution. RESULTS: One hundred fifty-one of 708 patients (21.3%) participated in a clinical trial, which was higher than the participation reported typically for patients with other types of primary malignancies. In univariate analysis, race, histology, and first craniotomy were significant between the two groups, with Caucasian patients and patients with glioblastoma histology showing higher participation rates. In a multivariate logistic regression model, significant predictors included young age and glioblastoma multiforme histology. CONCLUSIONS: The authors present information on factors that may influence clinical trial participation among patients with malignant glioma and compare their data with information described previously on patients with other types of malignant disease. The percent of participation among the patients in the current study was greater than among patients with other primary tumor sites. Strategies should be implemented to improve recruitment to neuro-oncology trials, especially in elderly and minority populations.

Age Factors↗

PubMed2002

Cervical myelopathy associated with degenerative spine disease and ossification of the posterior longitudinal ligament.

Cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament are two of the leading etiologies of spinal cord damage in older patients. For most patients, the natural history is one of slow stepwise decline in function. With nonsurgical therapy only 30 to 50% of patients are expected to stabilize. Surgical options include anterior and posterior surgical decompression, spinal canal expansion, and spinal column stabilization. Prospective, randomized trials with standardized outcome measures are needed to clarify the benefit of surgery conclusively.

Cervical Vertebrae↗

PubMed2002

Lumbar spinal stenosis.

Lumbar spinal stenosis refers to a diversity of conditions that decrease the total area of the spinal canal, lateral recesses, or neural foramina. Lumbar stenosis is a common disorder that may be present in isolation, with or without associated disk bulge or herniation, or can be associated with degenerative spondylolisthesis or scoliosis. Symptomatic lumbar spinal stenosis is characterized by neurogenic claudication and/or lumbar or sacral radiculopathy. Sixty percent to 85% of properly selected patients have a satisfactory symptomatic improvement with surgical treatment.

Cauda Equina↗

PubMed2002

Rheumatoid arthritis of the cervical spine.

The cervical spine is commonly affected in patients with rheumatoid arthritis. Erosive synovitis of the joints of the cervical spine can result in various types of subluxations. Subluxations and pannus formation can cause significant pain and neurological compromise. Surgery is an important treatment modality for patients with intractable neck pain and neurological deficits. This article reviews the indications for surgery and surgical procedures of decompression and arthrodesis. New surgical fixation techniques have resulted in improved arthrodesis rates. However, long-term effects on adjacent motion segments is not known. The cornerstone of good surgical outcome remains careful selection of patients and appropriate choice of surgical decompression and fusion.

Arthritis, Rheumatoid↗

PubMed2002

Intrathecal saline infusion in the treatment of obtundation associated with spontaneous intracranial hypotension: technical case report.

OBJECTIVE AND IMPORTANCE: Spontaneous intracranial hypotension is an increasingly recognized cause of postural headache. However, appropriate management of obtundation caused by intracranial hypotension is not well defined. CLINICAL PRESENTATION: A 43-year-old man presented with postural headache followed by rapid decline in mental status. Imaging findings were consistent with the diagnosis of spontaneous intracranial hypotension, with bilateral subdural hematomas, pachymeningeal enhancement, and caudal displacement of posterior fossa structures and optic chiasm. INTERVENTION: Despite treatment with lumbar epidural blood patch, worsening stupor necessitated intubation and mechanical ventilation. Contrast-enhanced magnetic resonance imaging and computed tomographic myelography of the spine failed to demonstrate the site of cerebrospinal fluid fistula. The enlarging subdural fluid collections were drained, and a ventriculostomy was performed. Postoperatively, the patient remained semicomatose. To restore intraspinal and intracranial pressures, intrathecal infusion of saline was initiated. After several hours of lumbar saline infusion, lumbar and intracranial pressures normalized, and the patient's stupor resolved rapidly. Repeat computed tomographic myelography accomplished via C1-C2 puncture demonstrated a large ventrolateral T1-T3 leak, which was treated successfully with a thoracic epidural blood patch. Follow-up magnetic resonance imaging demonstrated resolution of intracranial hypotension, and the patient was discharged in excellent condition. CONCLUSION: Spontaneous intracranial hypotension may cause a decline of mental status and require lumbar intrathecal saline infusion to arrest or reverse impending central (transtentorial) herniation. This case demonstrates the use of simultaneous monitoring of lumbar and intracranial pressures to appropriately titrate the infusion and document resolution of intracranial hypotension. Maneuvers aimed at sealing the cerebrospinal fluid fistula then can be performed in a less emergent fashion after the patient's mental status has stabilized.

Adult↗

PubMedDate not supplied

Evaluation of photodynamic therapy near functional brain tissue in patients with recurrent brain tumors.

INTRODUCTION: Photodynamic therapy (PDT) involves the selective retention of a photosensitizer that upon activation with light mediates tumor cell destruction via the production of singlet oxygen. This study evaluates the toxicity of PDT and a new light-delivery device based on light-emitting diode (LED) technology in selected patients with brain tumors. METHODS: Twenty patients with recurrent malignant brain tumors received 22 treatments with PDT. Sixteen tumors were supratentorial and four tumors were infratentorial. Patients received IV Photofrin 24 h prior to light exposure starting at 0.75 mg kg(-1). Laser and LED arrays were used to deliver 100 J cm(-2) of light to the sensitized tumors. Fourteen patients received PDT with a laser-balloon adapter, two via interstitial optical fibers and five patients had LED based PDT. At the maximum Photofrin dose of 2.0 mg kg(-1) five patients received laser-balloon adapter light and five patients received LED light. In addition, three patients received LED light with 0.25 mg kg(-1) of Visudine, a benzoporphyrin derivative (BPD). Quantitative analysis of toxicity and time to progression was performed. RESULTS: Two patients had toxicity consisting of ataxia and facial weakness after treatment with interstitial fibers. Escalating doses of Photofrin were tolerated to the maximum dose of 2.0 mg kg(-1). BPD did not result in additional toxicity. PDT in the posterior fossa or near eloquent brain was tolerated using the LED or laser-balloon adapter. All patients had tumor responses as documented by MRI scan and the mean time to tumor progression after PDT was 67 weeks. CONCLUSION: PDT with LED balloon adapters (also tunable dye laser) has acceptable toxicity in brain tumor patients. Future studies using more effective photosensitizers could improve local recurrence control.

Adolescent↗