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PubMed2000

Phase II trial of gemcitabine/doxorubicin/paclitaxel administered every other week in patients with metastatic breast cancer.

The present trial was designed to determine the efficacy of the combination of gemcitabine/doxorubicin/paclitaxel (GAT) delivered every other week as first-line therapy in patients with metastatic breast cancer. From February 1998 to September 1999, 41 patients were included in this trial. Doses delivered were doxorubicin 30 mg/m2 on day 1 and paclitaxel 135 mg/m2 plus gemcitabine 2500 mg/m2 both given on day 2, every 14 days. Doses were selected from a previous phase I trial conducted at our institution. Eligibility criteria for the phase II trial included histologically confirmed metastatic breast cancer with bidimensionally measurable lesions; no prior therapy for metastatic disease; adjuvant or neoadjuvant chemotherapy was allowed if given more than 1 year before and cumulative doses of doxorubicin or epirubicin were less than 200 mg/m2 or 360 mg/m2, respectively; Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less; and adequate hematological, hepatic, and renal function. Prophylactic use of granulocyte colony-simulating factor (G-CSF) was allowed if patients were not fully recovered (absolute neutrophil count greater than 1500/microL) from chemotherapy administration before the next dose. Left ventricular ejection fraction was determined initially, at the end of the study, and every 6 months thereafter. The patients' median age was 55 years (range, 33-68 years), and their median ECOG performance status was 0 (range, 0-1). Twenty-eight patients had received adjuvant therapy, 17 with epirubicin (none with doxorubicin). Metastases were present in the bone (19 patients), lung (19 patients), liver (11 patients), and soft tissues (18 patients). Twenty patients had one metastatic site and 21 had two or more sites. Efficacy was assessed on an intent-to-treat basis. A total of 216 cycles of GAT were given. Twenty-two percent of the courses were delayed or given at reduced doses mostly due to neutropenia or thrombocytopenia. G-CSF was required in 58% of the cycles. Grade 3/4 neutropenia was the main toxicity and appeared in 17 patients, one of whom had an episode of febrile neutropenia. Nonhematological toxicities consisted mainly of neurotoxicity and myalgias. A drop of 10%-20% in the left ventricular ejection fraction was detected in two patients and another patient had a decrease greater than 20%, although none developed symptoms of heart failure. Overall response rate was 80.4% (95% confidence interval: 68.3-92.5), with 15 patients (36.6%) achieving a complete response. Median survival time was 27 months and median time to progression was 15 months. The GAT combination is feasible and very active in patients with metastatic breast cancer, with an encouraging response rate including a high rate of complete responses. No congestive heart failure was documented and other toxicities were mild, with the exception of neutropenia.

Adult↗

PubMed2005

Results of a phase II trial of gemcitabine in patients with non-small-cell lung cancer and a performance status of 2.

This trial was designed to determine the 1-year survival rate, efficacy, progression-free survival (PFS), and toxicity with gemcitabine in patients with stage IIIB (with pleural effusion) or stage IV non-small-cell lung cancer (NSCLC) with Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2. Gemcitabine 1250 mg/m2 was administered intravenously on days 1 and 8 of each 21-day cycle. Treatment consisted of 6 cycles; patients who responded with complete response or partial response received < or = 2 additional cycles. Forty-two patients were enrolled at 31 community-based centers between March and November 2002. Most patients had stage IV disease (74%). The median age was 73 years (range, 58-84 years), and 19% had received prior palliative radiation therapy. Patients received a median of 3 cycles (range, 1-8 cycles). The median survival was 4.8 months (range, < 1 to 19.2 months), and the estimated 1-year survival was 20%. Median PFS was 2.5 months (range, < 1 to 19.2 months), and PFS at 1 year was 11.1%. Thirty-one patients died of disease progression, and 1 each died of myocardial infarction, brain herniation, pneumonia, and respiratory failure. Seven patients were not evaluable for response; 4 refused or received no treatment, treatment in 2 failed (myocardial infarction and pneumonia), and 1 was lost to follow-up. Among 35 evaluable patients, there were 5 partial responses (14%), 10 with stable disease (29%), and 20 with disease progression (57%). Drug-related grade > or = 3 toxicities included neutropenia (18%), anemia (8%), and dyspnea (2.6%). These results suggest that patients with NSCLC with an ECOG PS of 2 may benefit from single-agent chemotherapy gemcitabine. General toxicity, including myelotoxicity, was relatively low. Further studies comparing single-agent chemotherapy with combination chemotherapy for patients with a PS of 2 are warranted.

Aged↗

PubMedDate not supplied

Moderate dose-intensive chemotherapy for patients with non-small cell lung cancer: randomized trial, can it improve survival of patients with good performance status?

Advanced non-small cell lung cancer (NSCLC) has proven to be remarkably resistant to standard chemotherapy regimens. One potential alternative approach is the use of dose-intensive chemotherapy with supportive therapy such as granulocyte-colony stimulating factor (G-CSF). We conducted a randomized study of dose-intensive cisplatin/vindesine/mitomycin C chemotherapy (DI-PVM) and standard cisplatin/vindesine/mitomycin C chemotherapy (PVM). A total of one hundred patients with III-IV NSCLC was randomized. The DI-PVM consisted of 3 cycles of cisplatin: 80 mg/m2 (day 1), vindesine: 3 mg/m2 (days 1 and 8) and mitomycin C: 8 mg/m2 (day 1) in 3-week intervals with concurrent G-CSF. The PVM consisted of 2 cycles of the same chemotherapy in 4-week intervals. Blood cell counts were checked twice a week, and G-CSF (2 microgram/kg, SC) was administered when the count was </=2000/microliter. Eligibility criteria for this study were: no previous therapy, no active concomitant malignancy, ECOG PS </=1, age </=75 and adequate hematologic functions. The response rate for DI-PVM (26/50, 52%) was not significantly higher than that for PVM (22/50, 44%, chi2; p=0.423). However, progression-free survival for patients on DI-PVM was significantly longer than that of patients on PVM (23.7 versus 13.9 weeks, log-rank and generalized Wilcoxon test; p=0.006), as was overall median survival (57.0 versus 37.7 weeks, generalized Wilcoxon test; p=0.036). In addition, the difference in survival of patients with metastatic disease was significant (DI-PVM versus PVM; 48.9 weeks versus 23.9; p=0.032). Multivariate analysis showed that only ECOG PS was an independent prognostic variable in predicting response and survival on DI-PVM regimen. Hematological and non-hematological toxicities were equally frequent. The DI-PVM archived a longer survival than the PVM. The DI-PVM regimen should be considered a standard regimen for patients with metastatic NSCLC.

Adult↗

PubMed2000

Spontaneous spike-wave discharges in rat neocortex and their relation to behaviour.

A certain proportion of laboratory rats of various strains show spontaneous nonconvulsive ECoG seizures in the form of bursts of spike-and-wave discharges (SWD). Since in the majority of behavioural experiments the EEG is not controlled, the experimenter is usually unaware of this fact. The purpose of the present work was to find out whether the SWD trait is related to the rats behavioural performance in selected test situations. The experiment was performed on two groups of male Wistar rats, outbreds, aged six (group 6M, n = 17) and 24 months (group 24M, n = 14). First, in both groups the following forms of behaviour were assessed: (1) seeking water reward in an 8-arm radial maze, (2) exploration of a new object, (3) inhibition of a locomotor response (passive avoidance), and (4) paw-lick response to a thermal stimulus (54.5 degrees C) applied to the feet before and after intermittent footshock. The rats were then implanted with intrabrain electrodes and the level of SWD activity was assessed. Rats of the 24M group, compared with those of the 6M one, showed a significantly shorter exploratory response to a new object and diminished responsiveness to heat. The groups did not differ, however, in passive avoidance and radial maze performance. The analysis of 3-h ECoG sections revealed SWD bursts in 73% and nearly 93% of rats from groups 6M and 24M, respectively. The groups did not differ in the number of bursts or in the total duration of SWD activity. A correlation analysis of pooled data from both groups revealed that the exploration time of a new object was significantly (negatively) correlated with the number of SWD episodes. The total duration of SWD activity, and the number of perseveration errors in the radial maze, was significantly (positively) correlated with the total duration of SWD activity. The results suggest that SWD rats are behaviourally impaired in some test situations.

Animals↗

PubMed1999

Paclitaxel steady-state plasma concentration as a determinant of disease outcome and toxicity in lung cancer patients treated with paclitaxel and cisplatin.

The principal purpose of this study was to evaluate relationships between paclitaxel plasma steady-state concentration (Css) and both disease outcome and toxicity in patients with non-small cell lung cancer (NSCLC) treated with paclitaxel and cisplatin in an Eastern Cooperative Oncology Group (ECOG) Phase III study E5592. Chemotherapy-naive patients with stage IIIb and IV NSCLC were randomized to treatment with either 75 mg/m2 cisplatin i.v. on day 1 and 100 mg/m2 etoposide i.v. on days 1-3 (EC arm) or 75 mg/m2 cisplatin i.v. combined with either a low dose of paclitaxel (135 mg/m2, 24-h i.v. infusion; PC arm) or a higher dose of paclitaxel (250 mg/m2 i.v., 24-h i.v. infusion) with granulocyte colony-stimulating factor (PCG arm). End-of-24-h-infusion paclitaxel concentrations, which have been demonstrated to be nearly equal to CssS on this schedule, were obtained during the first and second courses in patients on the PC and PCG arms. Relationships between the average paclitaxel Css (Css,avg) and the best response to treatment, time to treatment failure (TTF), survival, and worst grade of leukopenia and neurotoxicity were evaluated by univariate analysis. A multivariate model was used to assess the influence of paclitaxel Css in conjunction with other potentially relevant patient variables that may affect disease outcome, including the paclitaxel treatment arm, age, sex, performance status, weight loss during the previous 6 months, and disease stage. Paclitaxel Css in both courses 1 and 2 were obtained in 71 patients treated with PC and 75 patients treated with PCG. Although Css,avgS in patients treated with PC and PCG were significantly different (median, 0.32 versus 0.81 micromol/liter; P < 0.0001), response rates were not (33.8 versus 26.7%; P = 0.3719). In addition, there were no differences between the PC and PCG arms in TTF (median, 5.1 versus 5.5 months, P = 0.6201) or survival (median, 11.6 versus 11.3 months, P = 0.7173). Combined analysis of paclitaxel concentrations from both treatment arms revealed no significant difference in paclitaxel Css,avg between responders and nonresponders [median, 0.40 (range, 0.16-1.6) micromol/liter versus 0.55 (range, 0.11-3.6)], and Css,avgS were similar in patients segregated according to whether they had a complete response, partial response, stable disease, or progressive disease as their best response to treatment (P = 0.7612). In addition, the relationship between Css,avg and TTF was weak (r2 = 0.00003, P = 0.94), as was the relationship between Css,avg and survival (P = 0.1267). With regard to the principal toxicities, neither the propensity to develop neuromuscular and neurosensory toxicity nor the worst grade of these adverse effects were related to Css,avg (P = 0.5000 and 0.2033, respectively); however, the relationship between Css,avg and the worst grade of leukopenia experienced was marginally significant (P = 0.0796). In a multivariate model, neither the combined effect of relevant demographic and stratification variables nor paclitaxel Css,avg predicted for either response (P = 0.1544) or TTF (P = 0.2574), whereas the combined effect of all covariates predicted for survival (P = 0.0249). With regard to individual covariates, a lower disease stage (stage IIIb) was the only significant positive determinant of response (P = 0.0173), female sex was the only significant favorable predictor for TTF (P = 0.0195), and a lower ECOG performance status (= 0) was the only significant positive determinant of survival (P = 0.0121) in the multivariate model. In summary, paclitaxel Css,avg was not a determinant of response, TTF, or survival in patients with advanced NSCLC treated with paclitaxel as a 24-h i.v. infusion combined with cisplatin. On the basis of both the clinical and pharmacodynamic results of E5592, there is no compelling reason to treat patients with advanced NSCLC with paclitaxel on a 24-h i.v. schedule at doses of > 135 mg/m2 in combination with cisplatin, although highe

Adult↗

PubMedDate not supplied

[Theory of the EEG potential in models of the leptomeninges of the brain. IV. Radial dipoles and their double layers in the depths and on the surface of the brain].

The estimaiton of ECoG-potentials is fulfilled by means of a simple model of the isolated sphere, which is exact enough, as it was proved earlier [1]. A simple limit formula for the qualitative estimation of ECoG-potentials of a source situated in the cerebral cortex is obtained. The EEG as in [2] is obtained using the transformation of the first 20 spheric harmonics. The experimental facts of registration of the evoked potentials of comparatively little subcortical sources were explained theoretically. Numerical results of the model are used to estimate the intensity of the field induced in the brain by two electrodes placed on the scalp.

Brain↗

PubMed1976

Cortical synchronization induced by thermal stimulation of the preoptic area in immobilized rats.

Cortical synchronization characterized by frontal spindles and occipital slow wave activity was induced by bilateral thermal stimulation of 2--4 degrees C of the preoptic area in unanaesthetized immobilized rats. The synchronization was demonstrated by ECoG and its power density spectra. The ECoG of the synchronization was similar to that of slow wave sleep. Switching off the thermal stimulation the original activity was recovered in most of the cases. Frontal spindle activity and slow wave activity recorded over the posterior cortex seemed to be dissociated to some degree. Low frequency stimulation at the points of thermal stimulation resulted in frequency following synchronization. In some cases electrical and thermal stimulation induced gradually developing seizure activity.

Animals↗

PubMed1999

The addition of interferon or high dose cyclophosphamide to standard chemotherapy in the treatment of patients with multiple myeloma: phase III Eastern Cooperative Oncology Group Clinical Trial EST 9486.

BACKGROUND: Interferon (IFN) has demonstrated activity in the treatment of patients with multiple myeloma. A previous Eastern Cooperative Oncology Group (ECOG) study suggested that the rates of complete response (CR) and survival were increased with a regimen that alternated IFN with chemotherapy. The current study was designed to evaluate the effect of adding alternating cycles of IFN or early intensification with high dose cyclophosphamide (HiCy) to the VBMCP regimen for the treatment of multiple myeloma patients. METHODS: From February 1988 to May 1992, the ECOG entered previously untreated patients with active multiple myeloma on a study in which they were randomized to VBMCP (vincristine 1.2 mg/m(2) administered intravenously [i.v.] on Day 1, BCNU 20 mg/m(2) i.v. on Day 1, melphalan 8 mg/m(2) administered orally [p.o.] on Days 1-4, cyclophosphamide 400 mg/m(2) i.v. on Day 1, and prednisone 40 mg/m(2) p.o. on Days 1-7; 5-week cycles) or VBMCP + rIFN(alpha2), the latter given at 5 Mu/m(2) 3 times a week starting on Day 22 of each 6-week cycle after 2 initial cycles of VBMCP. Patients younger than 70 years were also randomized to a third treatment that substituted cyclophosphamide 600 mg/m(2) i.v. on Days 1-4 and prednisone 100 mg/m(2) p.o. on Days 1-4 for cycles 3 and 5 of VBMCP (VBMCP + HiCy). Treatment was continued for 2 years. RESULTS: Of the 653 patients entered, 628 were eligible for the study. All were evaluated for response. With median follow-up for surviving patients of 54 months, the median survival duration was 42 months-1 year longer than usually reported for melphalan combined with prednisone. A comparison of the three regimens revealed no significant difference in the rates of survival or objective response (OR). However, CRs were increased among patients treated with VBMCP + rIFN(alpha2) compared with VBMCP alone (18% vs. 10%, P = 0.03). Patients treated with VBMCP + rIFN(alpha2) had a longer response duration than patients treated with VBMCP alone (30 vs. 25 months, P = 0.035). There was a greater response rate with the IFN regimen among elderly patients (OR and CR = 67% and 31%, respectively) and patients with immunoglobulin A (IgA) myeloma (OR and CR = 83% and 29%, respectively). Severe infections were seen as often with VBMCP as with VBMCP + rIFN(alpha2) (13% vs. 15%), but they were more frequent with VBMCP + HiCy (25%). CONCLUSIONS: VBMCP + rIFN(alpha2) yields a higher rate of CR and a longer response duration than VBMCP alone but appears to make no difference in the rates of overall response or survival compared with VBMCP or VBMCP + HiCy. The superior ability of VBMCP + rIFN(alpha2) induction therapy to produce CR and more durable responses, as well as its activity in older patients and in those with IgA myeloma, suggest that this therapy has important biologic activity in myeloma and merits further clinical investigation.

Adult↗

PubMed1999

[The effect of peroperative transfusion on survival in resected lung carcinomas].

This paper analyzes the influence of perioperative transfusion on survival after lung cancer surgery. Between January 1991 and December 1995, we enrolled 405 patients, 196 of whom received transfusions and 209 of whom did not. Follow-up extended to December 1997. Excluded were patients undergoing exploratory thoracotomy (n = 92), those who died during the postoperative period (n = 19) and those lost to follow-up (n = 13). The final number of patients in the study was 281 (136 who received transfusions and 145 who did not). We analyzed age, sex, general clinical status measured on the Eastern Cooperative Oncology Group (ECOG) scale, histological type and TNM staging. Single and multiple variable analyses were performed. At the end of the study 158 patients were alive and 123 had died. Transfusions were used more often in pneumonectomies (p < 0.001) and in patients with an ECOG score of 2 (p < 0.01). Survival at 36 and 60 months, calculated using the Kaplan-Meier method was 52% and 30%, respectively, for those who had received transfusions, and 53% and 49%, respectively, for those who had not. The differences were not statistically significant (p > 0.1). Multivariant analysis failed to demonstrate an influence of transfusion on survival (relative risk of 1.08; 95% confidence interval 0.72-1.61; p > 0.1). We conclude that there is no negative prognostic effect of perioperative transfusion.

Adenocarcinoma↗

PubMed2000

Prognostic significance of survivin expression in diffuse large B-cell lymphomas.

Survivin is an inhibitor of apoptosis overexpressed in various human cancers but undetectable in normal differentiated tissues. A potential expression and prognostic significance of survivin was studied in 222 patients with diffuse large B-cell lymphomas (centroblastic, 96%; immunoblastic, 4%). All patients were enrolled between 1987 and 1993 (median follow-up, 7 years) in the LNH87 protocol of the Groupe d'Etudes des Lymphomes de l'Adulte (GELA) and treated either with the reference ACVBP arm (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone)[AU3A] (n = 79) or other experimental anthracycline-containing regimens (n = 143). The characteristics of these patients were median age of 56 years; serum lactate dehydrogenase (LDH) greater than 1N, 60%; stage III-IV, 55%; performance status, according to the Eastern Cooperative Oncology Group (ECOG) scale, more than 1, 23%; extranodal sites more than 1, 29%; mass more than 10 cm, 44%; bone marrow involvement, 15%. Of the 222 patients studied, 134 (60%) revealed survivin expression in virtually all tumor cells by immunohistochemistry. The overall 5-year survival rate was significantly lower in patients with survivin expression than in those without (40% vs 54%, P =.02). Multivariate analysis incorporating prognostic factors from the International Prognostic Index (IPI) identified survivin expression as an independent predictive parameter on survival (P =.03, relative risk [RR] = 1.6) in addition to LDH (P =.02, RR = 1.6), stage (P =.03, RR = 1.7), and ECOG scale (P =.05, RR = 1.6). A second analysis incorporating IPI as a unique parameter demonstrated that survivin expression (P =.02, RR = 1.6) remained a prognostic factor for survival independently of IPI (P =.001, RR = 1.5). Survivin expression may be considered a new unfavorable prognostic factor of diffuse large B-cell lymphoma. (Blood. 2000;96:1921-1925)

Adolescent↗

PubMed2000

Lung cancer highlights.

Have we made any progress in the treatment of advanced non-small cell lung cancer (NSCLC) over the past 15 years? After hearing the Eastern Cooperative Oncology Group (ECOG) 1594 presented by Dr. Joan Schiller at the plenary session of the 36th Annual Meeting of ASCO, it is hard to be certain. SCHILLER: reported the results of one of the world's largest randomized trials in metastatic lung cancer comparing four platinum-based doublets. There were no differences in survival (primary endpoint) or response between these four regimens, although the cisplatin/gemcitabine arm had a superior time to progression. In her commentary on this study, Dr. Francis Shepherd concluded that progress in the treatment of metastatic lung cancer has occurred at "a snail's pace." Despite the disappointing results of ECOG 1594, there were notable trials describing new agents with novel mechanisms of action reported at this year's ASCO meeting. In small-cell lung cancer, the combination of cisplatin/ irinotecan was found to be superior to cisplatin/etoposide. For NSCLC, novel agents Iressa anti-epidermal growth factor receptor tyrosine kinase and anti-vascular endothelial growth factor monoclonal antibody appear promising.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1976

Spectral density analysis of the effects of barbiturates and benzodiazepines on the electrocorticogram of the squirrel monkey.

The effects of pentobarbital and diazepam were compared in a series of tests in squirrel monkeys; the effects of phenobarbital and flurazepam were compared in a second series. Observations were made of gross behavior and on the ECoG; the latter was analyzed by the spectral density technique. The two barbiturates induced sedation,which was occasionally so deep that the monkeys could not be readily aroused. The benzodiazepines induced sedation in some monkeys, but others showed signs of restlessness. The ECoG showed general slowing with the barbiturates, whereas the benzodiazepines produced mixed fast and slow patterns. Spectral density analysis showed that pentobarbital increased activity at frequencies below 40 Hz, with the largest increases occurring below 8 Hz. Phenobarbital increased activity below 8 Hz, but differed from pentobarbital by decreasing activity above 13 Hz. The benzodiazepines increased activity below 8 Hz, decreased it between 8 and 20 Hz, and increased it between 20 and 50 Hz.

Animals↗

PubMed2001

Influence of the critical EEG pattern on blood flow variations measured by single photon computed emission tomography.

Anatomo-electro-clinical correlation's using stereo-electro-encephalography (SEEG) or electro-cortico-graphy (EcoG) are the gold standard for delineating the epileptic zone (EZ) in patients with partial epilepsy. These two techniques reflect the temporal and spatial dimensions of the epileptic fit. More recently, ictal Single Photon Computed Tomography (SPECT) compared with interictal SPECT allows anatomo-clinical correlations. SPECT reflects variations of the regional cerebral blood flow (rCBF) during the seizure. These variations of the rCBF are linked with the electrical activity but the relations between electrical activity and rCBF have not been well studied and it is still difficult to compare ictal/interictal SPECT with the SEEG and EcoG data to delineate the EZ. From the few published studies, we know that, if the injection of the SPECT tracer is performed at the onset of the seizure, while the fast ictal discharge is still going on, we shall observe a local hyperperfusion in the region where the discharge started and in the region where it propagated secondarily. If the tracer injection is performed late during the seizure, or after the end of it, we shall observe a local hypoperfusion in these regions, this has also a good localizing value. Time of injection must be known, as it represents a key issue for SPECT interpretation.

Journal Article↗

PubMed2002

[A case of medial temporal lobe epilepsy associated with occult focal cortical dysplasia in the lateral temporal neocortex].

A 29-year-old male with medial temporal lobe epilepsy(MTLE) was revealed to have "occult" focal cortical dysplasia(FCD) in the lateral temporal neocortex. He had no history of febrile convulsion and developed complex partial seizure at the age of 14 year, which became intractable. Although MRI failed to reveal structural abnormality in the temporal lobe, even retrospectively, the findings of non-invasive preoperative examination, such as video-EEG monitoring and interictal ECD-SPECT and FDG-PET, were consistent with those of the left MTLE. Intraoperative electrocorticography(ECoG) demonstrated almost continuous paroxysmal activities on the anterior part of the inferior temporal gyrus(ITG). Anterior temporal lobectomy(ATL) with hippocampectomy was performed. Histological examination revealed FCD in the small area with 0.8 mm in diameter of the resected ITG. In the ATL without preoperative invasive examination such as chronic subdural electrode recording, intraoperative ECoG recording is mandatory.

Adult↗

PubMed2001

Surgical strategy and outcomes for epileptic patients with focal cortical dysplasia or dysembryoplastic neuroepithelial tumor.

PURPOSE: The purpose of this study was to clarify and compare the influence of surgical strategy on relief from seizures in patients with focal cortical dysplasia (FCD) and those with dysembryoplastic neuroepithelial tumor (DNT). METHODS: Six patients with FCD and five patients with DNT, all of whom underwent surgical resection for medically intractable epilepsy, were compared in terms of presurgical seizure types and frequency, location of lesions, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) with 99mTc-ECD, scalp electroencephalogram (EEG), and long-term video-EEG recording. Prolonged subdural recordings and intraoperative electrocorticograms (ECoG) were analyzed. The influences of surgical strategies on seizure outcomes were retrospectively analyzed. RESULTS: In all the FCD patients, ictal SPECT revealed hyperperfusion in the regions where MRI showed FCD. Interictal epileptiform activity and ictal seizure onset on ECoG performed with subdural electrodes were localized on the FCD itself. In contrast, the tumors of all the DNT patients were depicted as hypoperfuse areas on interictal SPECT scans. Ictal SPECT in one DNT patient showed hyperperfusion in the area enclosing the tumor. Interictal spiking in all DNT patients and ictal seizure onset in two DNT patients were not in the lesions themselves but in an area enclosing the lesion. All but one patient with FCD who underwent total lesionectomy became seizure free. All DNT patients who underwent resection of the epileptogenic cortex associated with lesionectomy became seizure free or achieved a 90% reduction in seizures. CONCLUSIONS: FCD has intrinsic epileptogenicity, whereas DNT is encompassed by epileptogenic cortical areas. Therefore, total lesionectomy is an essential strategy for FCD, whereas resection of the epileptic focus associated with lesionectomy of a DNT lesion is necessary to control seizures.

Adolescent↗

PubMed2003

[Correlation between the mode of presentation of renal tumors and patient survival].

OBJECTIVES: To establish a symptom score and to test its prognostic value in comparison with the usual histological prognostic criteria. MATERIAL AND METHODS: 388 renal tumours were classified into three symptomatic grades according to the circumstances of discovery: S1: incidental discovery, S2; patient presenting with haematuria or low back pain, S3: patient presenting with alteration of general state or symptomatic metastasis. The following prognostic criteria were studied: age, gender, tumour volume, symptom score, ECOG (0 vs 1 or more), stage (TNM 1997), Fuhrman grade, venous and adrenal invasion. Survival rates were compared by the Kaplan-Meier method (Log rank test). Multivariate analysis was performed according to the Cox model. RESULTS: Tumours were classified as T1, T2, T3, T4 in 140 (36.1%), 73 (18.80%), 162 (41.8%) and 13 (3.4%) cases, respectively. 31 tumours were graded as G1 (8%), 167 as G2 (43%), 152 as G3 (39.2%) and 38 as G4 (9.8%), 143 tumours were classified as S1 (36.9%), 159 as S2 (41%) and 86 as S3 (22.10%). 45 patients were N+ (11.6%) and 54 were M+ (13.9%), The mean follow-up was 73 months. The significant parameters on univariate analysis were: ECOG, symptom score, TNM stage, grade, venous and adrenal invasion and tumour volume (p < 0.001), while symptom score, TNM stage and Fuhrman grade were significant on multivariate analysis (p < 0.001). CONCLUSION: The symptom score is an independent prognostic factor in the same way as tumour stage and grade. This score could be used in a mathematical algorithm predictive of survival of patients with renal cancer.

Carcinoma, Renal Cell↗

PubMed2003

Psychometric testing of the translated McGill Quality of Life Questionnaire-Taiwan version in patients with terminal cancer.

BACKGROUND AND PURPOSE: Quality of life (QOL) is the paramount goal of end-of-life care. However, there is no Chinese language instrument for measuring QOL that has been shown to have adequate psychometric properties for Taiwanese patients with terminal cancer. The purpose of this study was to examine the psychometric properties of a Chinese language version of the McGill Quality of Life questionnaire (MQOL-Taiwan version) in this population. METHODS: The original English version of the MQOL questionnaire was translated into Chinese, and administered to 64 Taiwanese patients with terminal cancer for psychometric testing (factor structures and various types of reliability and validity). The cultural equivalence of the translation was tested by content validity index. Statistical analysis included exploratory factor analysis, Pearson's product moment correlation coefficient, and the calculation of Cronbach's alpha (alpha). RESULTS: Findings on the validity and reliability of the MQOL-Taiwan version were as follows. The value of content validity was 0.98. The range of the correlations between an item and its domain was 0.59 to 0.96 (all p < 0.05), and for inter-domain was 0.28 to 0.52 (all p < 0.05). The 4 domains of the original MQOL emerged as the 4 dominant factors (64% total variance explained) in the MQOL-Taiwan version, namely the domains of physical symptoms, psychological symptoms, existential well-being, and support. The internal consistency (Cronbach's alpha) coefficient of the whole MQOL-Taiwan version was 0.83, and those for the 4 domains ranged from 0.69 to 0.90. For the convergent and divergent validity, the MQOL-Taiwan version physical domain was moderately and significantly (r = -0.44, p < 0.05) correlated with the performance status rating of the Eastern Cooperative Oncology Group-Performance Status Rating (ECOG-PSR). The MQOL-Taiwan version psychological, existential, and support domains were not significantly correlated to the ECOG-PSR. CONCLUSIONS: The MQOL-Taiwan version demonstrated an acceptable level of reliability, validity and equivalency in the initial cross-cultural validation. These findings indicate the suitability of this QOL measure for clinical and research use in Taiwanese patients with terminal cancer.

Adult↗

PubMed1976

[The effect of low-frequency electric stimulation of the caudate nucleus on the electrical activity of the cortex and on the sleep-wakefulness cycle].

In cats, the effect of low-frequency electric stimulation of the caudate nucleus on electric activity of neo- and archipaleocortex and on wakefulness-sleep cycle, was studied. The data obtained suggest: 1) at threshold and suprathreshold single electric shocks applied to the caudate nucleus they evoked potential occurs more readily in the sensorimotor area of the neocortex than in the dorsal hippocampus. At 2-6/sec stimulation the evoked potentials in the hippocampus are facilitated and become very stable, whereas in the sensorimotor cortex the most obvious responses occur at the 6-8/sec frequency. However, the evoked potentials are variable in the sensorimotor cortex, and at prolonged 8-12/sec stimulation spindle activity soon develops; 2) behavioral correlate of the synchronized activity in the neo- and archipaleocortical structures during low-frequency stimulation of the caudate nucleus, may involve development of drowsiness with the cessation of stimulation, however, both the EEG and behavioral signs of the drowsiness disappear. The onset of drowsiness following withdrawal of the caudate stimulation, is a rare phenomenon only occurring because of an occasional coincidence of the stimulation with the spontaneous onset of natural sleep; 3) low-frequency caudate stimulation entailing the ECoG synchronization does not cause the transition of paradoxical phase into the slow-wave phase of sleep, and as soon as the stimulation ceases its normal structure recovers. However, if the stimulation of the caudate nucleus is repeated several times in one paradoxical phase, this would shorten the subsequent slow-wave phase and accelerate the onset of the next paradoxical phase; 4) prolonged low-frequency stimulation of the caudate nucleus causing the ECoG synchronization results in a considerable change of wakefulness-sleep cycle in the post-stimulation period: a decrease in the total time of slow-wave sleep due to shortening of its different phases, and an increase in the total amount of paradoxical sleep because of the onset of its phases is rendered more frequent. This effect is more obvious in the first half of the 8-hr cycle.

Animals↗