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Polo A.,Ramon jal University Hospital
Journal of Contemporary Brachytherapy | Year: 2010

Over the last twenty years major software and hardware developments in brachytherapy treatment planning, intraoperative navigation and dose delivery have been made. Image-guided brachytherapy has emerged as the ultimate conformal radiation therapy, allowing precise dose deposition on small volumes under direct image visualization. In this process imaging plays a central role and novel imaging techniques are being developed (PET, MRI-MRS and power Doppler US imaging are among them), creating a new paradigm (dose-guided brachytherapy), where imaging is used to map the exact coordinates of the tumour cells, and to guide applicator insertion to the correct position. Each of these modalities has limitations providing all of the physical and geometric information required for the brachytherapy workflow. Therefore, image fusion can be used as a solution in order to take full advantage of the information from each modality in treatment planning, intraoperative navigation, dose delivery, verification and follow-up of interstitial irradiation. Image fusion, understood as the visualization of any morphological volume (i.e. US, CT, MRI) together with an additional second morphological volume (i.e. CT, MRI) or functional dataset (functional MRI, SPECT, PET), is a well known method for treatment planning, verification and follow-up of interstitial irradiation. The term image fusion is used when multiple patient image datasets are registered and overlaid or merged to provide additional information. Fused images may be created from multiple images from the same imaging modality taken at different moments (multi-temporal approach), or by combining information from multiple modalities. Quality means that the fused images should provide additional information to the brachytherapy process (diagnosis and staging, treatment planning, intraoperative imaging, treatment delivery and follow-up) that cannot be obtained in other ways. In this review I will focus on the role of image fusion for permanent seed implantation.

Carrasco R.,Ramon jal University Hospital | Pascual J.M.,La Princesa University Hospital | Navas M.,La Princesa University Hospital | Fraga J.,La Princesa University Hospital | And 2 more authors.
Neurocirugia | Year: 2010

Introduction. Subependymomas are benign neoplasms intimately related to the ventricular system which only exceptionally associate hemorrhagic events. We present neuroradiological and pathological evidences of intratumoral hemorrhage within a single case of subependymoma operated on at our institution. Additionally we analyze retrospectively the well-defined reports of similar cases published in the scientific literature. Case report. A 71-year-old man on anticoagulant therapy presented with abrupt and progressive deterioration of his level of consciousness. Emergent computed tomography and magnetic resonance imaging evidenced signs of acute bleeding within a mass located at the frontal horn of the left lateral ventricle, producing obstructive biventricular hydrocephalus. The lesion was immediately and completely removed through a left frontal transcortical approach. Pathological diagnosis was consistent with subependymoma displaying areas of microhemorrhage. After surgery the patient developed global anterograde and retrograde amnesia. Conclusions. A spontaneous hemorrhagic event within an asymptomatic lateral ventricle subependymoma can result in a surgical emergence as a consequence of sudden obstruction of cerebrospinal fluid pathways. Prompt and radical surgical removal of the mass, which allows a rapid resolution of hydrocephalus and prevents the risk of rebleeding, may constitute the safest management strategy.

Chaudhuri K.R.,Kings College | Prieto-Jurcynska C.,Carlos III Institute of Health | Naidu Y.,University of London | Frades-Payo B.,National Health Research Institute | And 10 more authors.
Movement Disorders | Year: 2010

The nonmotor symptoms (NMS) of Parkinson's disease (PD) are less well recognised and can be more troublesome to patients and carers than classical motor features. NMS are frequently missed during routine consultations and such under-recognition may have implications on quality of care given that many NMS are treatable. To determine the proportion of patients not declaring NMS to healthcare professional (HCP) as assessed by self completion of the NMS questionnaire (NMSQuest), a validated, self-completing questionnaire with 30 items. Multicentre international study. The data was collected from PD patients across all age groups and stages attending outpatient clinics in specialist and care of the elderly settings. 242 patients recruited and undeclared NMS ranged from 31.8% (diplopia) to 65.2% (delusions). The most frequently nondeclared symptoms were delusions, daytime sleepiness, intense and vivid dreams, and dizziness. In many, appropriate treatments for undeclared NMS were started only after these were recognised following completion of NMSQuest. NMS of PD are frequently undeclared at routine hospital consultation and may be related to the fact that patients often do not link these symptoms with PD or may be too embarrassed to discuss these. Use of NMSQuest allows patients to flag symptoms which may be otherwise undeclared and remain untreated when potential treatments exist. © 2010 Movement Disorder Society.

Riaza Bermudo-Soriano C.,Ramon jal University Hospital | Perez-Rodriguez M.M.,Mount Sinai School of Medicine | Vaquero-Lorenzo C.,Autonomous University of Madrid | Baca-Garcia E.,Fundacion Jimenez Diaz University Hospital | And 2 more authors.
Pharmacology Biochemistry and Behavior | Year: 2012

Anxiety and stress-related disorders, namely posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), obsessive-compulsive disorder (ODC), social and specific phobias, and panic disorder, are a major public health issue. A growing body of evidence suggests that glutamatergic neurotransmission may be involved in the biological mechanisms underlying stress response and anxiety-related disorders. The glutamatergic system mediates the acquisition and extinction of fear-conditioning. Thus, new drugs targeting glutamatergic neurotransmission may be promising candidates for new pharmacological treatments. In particular, N-methyl-d-aspartate receptors (NMDAR) antagonists (AP5, AP7, CGP37849, CGP39551, LY235959, NPC17742, and MK-801), NMDAR partial agonists (DCS, ACPC), α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors (AMPARs) antagonists (topiramate), and several allosteric modulators targeting metabotropic glutamate receptors (mGluRs) mGluR1, mGluR2/3, and mGluR5, have shown anxiolytic-like effects in several animal and human studies. Several studies have suggested that polyamines (agmatine, putrescine, spermidine, and spermine) may be involved in the neurobiological mechanisms underlying stress-response and anxiety-related disorders. This could mainly be attributed to their ability to modulate ionotropic glutamate receptors, especially NR2B subunits. The aim of this review is to establish that glutamate neurotransmission and polyaminergic system play a fundamental role in the onset of anxiety-related disorders. This may open the way for new drugs that may help to treat these conditions. © 2011 Elsevier Inc. All rights reserved.

Fortunately, the landscape of the systemic treatment for grade 1 and 2 pancreatic neuroendocrine tumors has changed in the last decade with at least four different alternatives approved in the field. Chemotherapy, somatostatin analogues, sunitinib and everolimus remind valid options according to the most referenced international guidelines. However, and although this is something done in the routine practice, there is a lack of evidence for the use of any of these strategies after failure to the others. Moreover, further sequential alternatives in third or fourth line have never been tested prospectively. The need for a better understanding of the rationale to sequence different systemic options is even greater in non-pancreatic neuroendocrine tumors since available therapies are scarce. Sequential strategies in other solid tumors have led to a clear improvement in overall survival. This is also believed to occur in neuroendocrine tumors but no clear data on it has been delivered yet. We postulate that the different mode of action of the systemic options available for the treatment of neuroendocrine tumors may avoid the complete resistance of one option after the other and that sequential use of these agents will be translated into a longer overall survival of patients. Prospective and randomized trials that seek for the activity of drugs after failure to another systemic alternatives are highly needed in this field of neuroendocrine tumors. ©2016 Baishideng Publishing Group Inc. All rights reserved.

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