SANS Agustus 2013 Flashcards
Manakah faktor terkait pasien yang merupakan prediktor signifikan dari ICH postoperative yang mengikuti biopsi otak ?
A. Fungsi renal B. Cardiac output C. Jumlah dan fungsi platelet D. Status performa Karnofsky E. Riwayat stroke
C. Jumlah dan fungsi platelet
The correct answer is platelet function and number. In the study by Hawasli et al (2013) the only factors predicting ICH to remain significant in multivariate analysis were age > 60 and history of aspirin use. In a study of needle biopsies, Field et al. (2001) found that platelet number less than 150,000 predicted an increased chance of ICH. The risk increased by a factor of 1.49 per 10,000 platelets below this value.
Sebuah lesi membesar dari penilitian memperlihatkan bahwa reseksi yang meluas mempengaruhi survival pada pasien dengan glioblastoma multiforme. Manakah dari faktor berikut yang dapat mempengaruhi perluasan dari reseksi ?
A. Komorbiditas medis
B. Gender
C. Umur
D. Lokasi tumor
D. Lokasi tumor
Tumor location may have significant impact on the extent of resection of glioblastoma multiforme. A guiding principle in modern glioblastoma surgery is to achieve maximal safe resection; however this can be influenced by several factors. Orringer et al. showed that patient-related factors such as age, sex and comorbidity status did not have a significant effect on extent of resection. The well-documented prognostic effects of age on survival in patients with glioblastoma multiforme are not related to the surgical results that can be achieved. In contrast, tumor-related factors (eloquent location, superficial vs deep location, and size) were found to have a significant effect on the extent of resection. Consequently, the risk of aggressive tumor resection within eloquent areas is rarely justified by the oncological benefits of cytoreduction
Karakteristik apakah yang membedakan cerebellar glioblastoma multiforme (cGBM) dari supratentorial glioblastoma multiforme (sGBM) ?
A. EGFR negatif
B. p53 positif
C. Umur yang lebih muda pada presentasi cGBM
D. Overall medial survival
C. Umur yang lebih muda pada presentasi cGBM
The age of diagnosis of cGBM patients seems to be younger than that seen in patients with sGBM. In a study by Jeswani et al., they demonstrated that age at diagnosis was significantly lower for the cerebellar group versus the supratentorial group possibly reflecting an underlying biological difference between these tumor locations. A histological analysis of four patients with cGBM by Utsuki et al. showed that these tumors had characteristics similar to secondary sGBM, including positivity for p53, negativity for EGFR, and the presence of scant low-grade glioma histology. Jeswani et al. showed median overall survival time to be identical between matched cerebellar and supratentorial glioblastoma cohorts, suggesting a similar prognosis between these two entities at least early on in the study. However, a benefit in survival was observed in the cGBM cohort as the study progressed.
Berapakah proporsi dari semua glioblastoma intracranial berasal dari cerebellum ?
A. 6-9 % B. 3-6 % C. 0-3 % D. 9-12 % E. 12-15 %
C. 0-3 %
Cerebellar glioblastomas account for 0.63% of all glioblastomas. Glioblastoma multiforme of the cerebellum is rare in adults compared to its supratentorial counterpart. Using the SEER database, Jeswani et al. were able to identify 132 patients with adult cerebellar glioblastoma among 20,980 patients with glioblastoma corresponding to an incidence of 0.63%. Other studies showed similar rates with cerebellar glioblastoma accounting for 0.4% to 3.4% of all glioblastoma cases.
Menurut study HUNT, berapakah overall annual rupture risk dari unruptured intracranial aneurysms dalam populasi umur antara 50 hingga 65 tahun ?
A. 0,9 % B. 0,5 % C. 0,2 % D. 1,5 % E. 3,0 %
A. 0,9 %
The overall rupture risk of unruptured intracranial aneurysms according to the HUNT study in population aged 50 to 65 years is 0.9% per year. Importantly, this is consistent with the second ISUIA study.
Menurut study HUNT, berapakah prevalensi dari unruptured intracranial aneurysms ?
A. 1 % B. 0,1 % C. 0,05 % D. 2 % E. 5 %
D. 2 %
The prevalence of unruprtured intracranial aneurysms is approximately 2%. This is consistent with the incidence described in a meta-analysis by Rinkel et al, 1998.
Resiko terjadinya aneurysmal subarachnoid hemorrhage dari unruptured intracranial aneurysms telah diperkirakan dalam beberapa study, dimana kebanyakan menjadi kontroversi. Apakah yang menjadi sumber utama terjadinya bias pada study-study tersebut ?
A. Response B. Selecetion C. Lead time D. Analytical E. Funding
B. Selecetion
The greatest source of bias is most studies of risk of hemorrhage from unruptured intracranial aneurysms is selection bias. Selection bias arises when certain groups of patients are more likely to participate in a study than others.
Lead time bias occurs when a test that diagnoses a disease appears to prolong survival, when instead all it has done is detected the disease earlier resulting in more time between diagnosis and death. Response bias is a psychological bias that occurs when respondents to surveys answer questions according to how they perceive the surveyor wants them to answer instead of according to what they actually think. Analytical bias is a misuse of statistical techniques. Funding bias is bias introduced by the financiers of a given study.
Faktor demografi apakah yang menjadi prediktor paling utama untuk biopsi otak diagnostic ?
A. Riwayat merokok tembakau B. Gender laki-laki C. Umur > 45 tahun D. Riwayat penyakit arteri coroner E. Status HIV
C. Umur > 45 tahun
The correct answer is age > 45. Hawasli et al. (2013) found that age > 45 was a significant predictor of diagnostic biopsy in multivariate analysis. The only other significant predictor was biopsy of a specific lesion on MRI. Field et al. (2001) also found that diagnostic yield increased with age by a 1.25 by every decade of life. Possible reasons for this effect include increased likelihood in the elderly of harboring (and therefore detecting) a high-grade neoplasm.
Ketika melakukan biopsi otak terbuka pada pasien dengan enhancing lesion pada MRI, berapakah kemungkinan akan mendapatkan hasil non diagnostic ?
A. 25-35 % B. 15-25 % C. 5-15 % D. 35-45 % E. 45-55 %
C. 5-15 %
The correct answer is 5-15%. Compared to the non-diagnostic rate of biopsies in patients with non-enhancing lesions or no lesion on MRI, the chance of a non-diagnositic biopsy of an enhancing lesion is significantly lower. In a study by Hawasli et al (2013), the rate of non-diagnostic open superficial biopsy dropped from 50% in non-enhancing or non-lesional cases to 15% in enhancing lesions. Field et al. (2001) observed a similar non-diagnostic rate of 6% in their series of stereotactic needle biopsies of MRI visible lesions
