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Background: Optic nerve schwannomas are an extremely rare pathology in neurosurgery. Their origin is rather debatable given the structure of the optic nerve, which does not typically have Schwann cells therein. However, a number of clinical cases of optic nerve tumors classified as schwannomas have been described in the literature. At present, there is no fundamental understanding of the etiology and pathogenesis of these tumors or treatment due to their rare incidence., Observations: The authors describe the clinical case of a 40-year-old female patient with blurred vision in the left eye for 6 months who was operated on for an optic nerve tumor via a minimally invasive supraorbital approach. Complete resection of the tumor was achieved. Histopathological examination revealed a schwannoma. The patient had no postoperative complaints or neurological deficits. The authors also performed a detailed review of the literature for cases with optic nerve schwannomas. Only 18 patient outcomes have been published so far. There are significant differences in the structure, localization, size, and surgical treatment of optic nerve schwannomas., Lessons: Optic nerve schwannomas are extremely rare lesions. Hence, there is a need to accumulate knowledge in order to study the etiology, pathogenesis, and treatment of these tumors. The minimally invasive supraorbital approach can be successfully used in the surgical treatment of optic nerve schwannomas located in the optic canal. https://thejns.org/doi/10.3171/CASE24638.

Background and Purpose: Duchenne muscular dystrophy (DMD) is the most frequent skeletal muscle myopathy. Nearly all patients develop cardiomyopathy in their second decade of life. The purpose of this study was to evaluate the frequency, cause, and outcome of stroke in a German cohort of patients with DMD., Methods: Retrospective analysis of medical records of 54 DMD patients, who lived in a regional facility for handicapped people (Wichernhaus Altdorf, Germany) between 1963 and 2013., Results: Fifty-four DMD patients were followed up for 7.4 years on average. Mean age at admission and discharge from the long-term care facility or death were 11.4 and 18.8 years, respectively. Covering a total observation period of 400 patient-years, we identified 4 DMD patients with juvenile arterial ischemic strokes. Off-label systemic thrombolysis in 2 patients resulted in a nearly complete regression of stroke-related symptoms, but 1 patient died of septic pneumonia and cardiac failure 24 days after thrombolysis therapy. In the other 2 patients, who had their ischemic strokes in 1994 and 1998, severe infarction-related symptoms persisted, and 1 patient died 13 days later. DMD-associated cardiomyopathy without evidence of atrial fibrillation was the only risk factor for ischemic stroke in all patients., Conclusions: This study indicates an increased risk for ischemic strokes in DMD patients. Regular cardiological assessment of all DMD patients is mandatory to evaluate the individual risk profile for cardioembolic events and to adapt therapeutic strategies., (© 2016 American Heart Association, Inc.)

Background: Recent clinical trials have demonstrated the benefit and feasibility of perioperative chemotherapy for treatment of gastroesophageal adenocarcinoma (GEA). Despite convincing results, patients entering such trials usually represent only a fraction of those who are candidates for treatment. Confirmation of trial-reported effects and tolerability in unselected cohorts is therefore required. The aims of this study were to confirm the safety and efficacy of perioperative chemotherapy for resectable GEA and to delineate risks of treatment failure., Methods: We conducted a national retrospective cohort analysis of patients admitted for perioperative chemotherapy for resectable GEA. Regimens were epirubicin and capecitabine combined with oxaliplatin or cisplatin., Results: The intention-to-treat analysis included 271 patients. Eighty-seven percent of patients completed preoperative chemotherapy, and 63 % received radical resection. Age >70 years (odds ratio 2.58) and hypoalbuminemia (odds ratio 4.10) were independent predictors of not undergoing scheduled surgery (P = 0.033). Grade 3 or higher febrile neutropenia, fatigue, and diarrhea were common in the oxaliplatin group (n = 128), but hypomagnesaemia and tinnitus/hearing loss were more common in the cisplatin group (n = 135). The median overall survival was 26.4 months, and the 1- and 2-year survival rates were 76 and 53 %, respectively. Performance status >0 (hazard ratio 1.64) and elevated serum lactate dehydrogenase (hazard ratio 3.03) were independent predictors of poor prognosis (P ≤ 0.05)., Conclusions: Perioperative chemotherapy is feasible and well tolerated in patients with good performance status and low incidence of comorbidities.

Aim: To determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of concurrent chemoradiotherapy and cetuximab in patients with non-resectable locally advanced esophageal cancer., Patients and Methods: Escalating doses of oxaliplatin every second week and daily tegafur/uracil were given concurrently with radiotherapy, 59.4 Gy in 33 fractions. Cetuximab was given on day 15 (400 mg/m(2)) and weekly (250 mg/m(2)) during radiotherapy. Fixed doses of oxaliplatin (130 mg/m(2)) and tegafur/uracil (300 mg/m(2)) were administered before, and after radiotherapy., Results: Eleven patients were included in the study; two were excluded due to allergic reactions to cetuximab. In DL2 (tegafur/uracil 300 mg/m(2), oxaliplatin 30 mg/m(2)) two grade 3/4 fistula and one grade 3 neuropathy were observed. Six patients were enrolled in DL1 (tegafur/uracil 150 mg/m(2)/, oxaliplatin 30 mg/m(2)) with no DLTs. Four out of 9 patients had complete response., Conclusion: Concomitant chemoradiotherapy and cetuximab had significant activity. DL1 was established as the MTD.

Introduction: This study was conducted to determine the degree to which the clinical practice concerning computed tomographies (CTs) with iodinated contrast media in patients with lung cancer was in accordance with ESUR international guidelines. Lung cancer is treatable with platinum-based cytostatic drugs, which can be nephrotoxic. According to the ESUR s guidelines this adds to the risk of developing contrast-induced nephropathy., Material and Methods: A retrospective study of lung cancer patients at Hillerød Hospital., Inclusion Criteria: Patients in current treatment with platinum-based cytostatic drugs up to and including 20 Sept. 06 who had undergone an elective CT with iodinated contrast media. A total of 51 patients where included. P-creatinine and other potential risk factors for development of contrast-induced nephropathy were collected., Results: In 31.4% of the patients included, P-creatinine was measured no earlier than seven days prior to their CT. 43.1% of the patients included had received a platinum-based cytostatic drug after the latest measurement of their P-creatinine prior to their CT scan. 45.1% of the patients received a platinum-based cytostatic 14 days or less before CT scan. 66.7% had additional risk factors. None needed nephrologic assistance., Conclusion: Significant deviations were found between the clinical practice and ESUR international guidelines covering prevention of contrast-induced nephropathy. This study has led to changes in the guidelines and clinical practice regarding contrast-induced nephropathy at Hillerød Hosipital. Now all elective patients have P-creatinine measured no more than seven days prior to CT with iodinated contrast media.