SANS September 2013 Flashcards
Pada pasien dengan anaplastic oligodendrogliomas, manakah dari faktor berikut yang meningkatkan perbaikan survival ?
A. Kejang pra operative
B. Reseksi partial / biopsi
C. Reseksi gross-total
D. Umur > 50 tahun
C. Reseksi gross-total
Gross total resection (GTR) has been shown to confer improved overall survival for patients with anaplastic oligodendrogliomas. In a metaanalysis of the SEER database by Nuno et al., among AO patients, younger age and GTR rather than surgery (biopsy, partial resection) were the only factors significantly associated with survival. Younger patients (s cohort in patients with GTR (versus biopsy). Preoperative seizures are not a prognostic factor in anaplastic glioma patients.
Pasien dengan acromegaly dapat mengalami beberapa komplikasi klinis. Dibandingkan dengan pasien dengan terapi biokimia post-operative, pasien dengan delayed post-operative normalization dari kadar IGF-1 dapat memiliki resiko apakah dari komplikasi berikut ini ?
A. Diabetes tidak terkontrol
B. Hypertensi tidak terkontrol
C. Peningkatan resiko atas fraktur tulang
D. Tidak ada perbedaan dalam resiko komplikasi
D. Tidak ada perbedaan dalam resiko komplikasi
Patients with delayed postoperative normalization of IGF-1 levels do not display increased risk of clinical complications. Shin et al.indicate in their study that in patients in the “early-cure” group, there was a remission or decreased anti-diabetic medication requirements. In addition, they state that patients display a similar result in the “delayed-cure” group as well. This result is seen in other studies as well, with patients having persistently abnormal oral glucose tolerance tests after surgery, but not associated with worsened control requiring escalation of medications. Patients in the “delayed-cure” group also did not display worsening hypertension. Finally, no fractures were seen in the study participants in either groups.
Mutasi genetik apakah yang telah ditunjukkan berkorelasi secara independen dengan peningkatan survival pada tumor astrocytic anaplastic ?
A. CIC
B. 1p19q co-deletion
C. ATRX
D. FUPB1
B. 1p19q co-deletion
The 1p-19q co-deletion is most commonly associated with improved response to adjuvant therapy and hence survival in oligodendrogliomas. Survival estimates for AA and AO tumors vary widely and seem to be associated with age, Karnofsky performance status, extent of surgical resection, use of adjuvant radiotherapy, ki-67 immunohistochemical markers and sensitivity to chemotherapy as determined by genetic mutations such as IDH1, PTEN, EGFR amplification, and 1p19q co-deletion. Co-deletion of 1p19q among AO patients has been validated as an independent and significant predictor of improved survival. ATRX mutations are frequent among grade II-III adult astrocytic tumors. The association between ATRX mutations with IDH mutations, and the association between CIC/FUBP1 mutations and IDH mutations as well as 1p/19q loss have been defined by Jiao et al., however their role as independent prognostic factors has not been established yet.
Apakah akibat dari radioterapi post-operative pada survival dalam anaplastic astrocytomas (AA) dan anaplastic oligidendrogliomas (AO) ?
A. Lebih efektif pada AO
B. Lebih efektif pada AA
C. Sama efektifnya pada AA dan AO
D. Tidak efektif pada keduanya
B. Lebih efektif pada AA
Radiation has been shown to provide significant improvement in survival for AA patients in prior retrospective studies; however, the benefits associated with this treatment modality for AO patients have been inconclusive. Some studies have shown a moderately favorable median overall survival for patients with AA (7 months, inclusive of biopsies and partial resections) and AO (47 months, inclusive of biopsies and partial resections) after postoperative
radiotherapy, while others seem to suggest that AO tumors harboring 1p/19q deletion may be exclusively treated with chemotherapy. The study by Nuno et al. showed survivaladvantage in AA patients who undergo radiotherapy compared to those who are not irradiated. Moreover, their results indicate that post-operative radiotherapy trended towards conferring asurvival benefit in AO patients. This survival benefit, however, was not statistically significant
Manakah dari hal berikut yang merupakan indikasi terapi biokimia untuk acromegaly setelah reseksi bedah pada adenoma pituitary sekresi GH ?
A. Umur dan gender sesuai dengan normalisasi dari kadar serum GH, dan kadar IGF-1 makan pagi 100µg/L/hr, dibanding dengan kadar pra operative
D. Umur dan gender sesuai dengan normalisasi dari kadar serum IGF-1, dan kadar GH
D. Umur dan gender sesuai dengan normalisasi dari kadar serum IGF-1, dan kadar GH 3months after surgery. Rate of increase was not used to define biochemical cure. Random measurements of GH and IGF-1levels are not used to determine cure. IGF-1 must be compared to age- and sex- matched populations and growth hormone suppression is measured following standard glucose bolus.
Setelah reseksi total gross dari adenoma pituitary sekresi GH, manakah dari faktor berikut yang secara signifikan meningkatkan kemungkinan akan delayed normalization dari kadar IGF-1 ?
A. Gender wanita
B. Umur lebih muda dari 50 tahun
C. Peningkatan besar pada immediate post-op IGF-1
D. Peningkatan besar pada immediate post-op GH
C. Peningkatan besar pada immediate post-op IGF-1
Large increase in immediate post-op IGF-1 may increase the chances of delayed normalization of serum IGF-1 levels. Although it has been generally believed that IGF-1 levels may fall into normal ranges within a few days of surgical removal of GH-secreting pituitary adenomas, multiple studies have shown that serum IGF-1 levels slowly decline and many normalize up to a year post-operatively. In a recent retrospective observational study, it was found that a significant portion of patients considered surgically, biochemically, and radiographically cured by MRI and nadir GH of 3 months post-operatively. The overall mean duration taken to IGF-1 normalization in this study was 10 months post-surgery, consistent with another study which had a mean time to normalization of IGF-1 levels to be 11.6 months post-surgery. In the same study, high immediate post-operative IGF-1 levels, defined as increase in >100 μg/L, could predict a delayed normalization of IGF-1 levels (p = 0.024), defined as normalization after 3 months post-operatively. Probability of IGF-1 normalization after 3 months post-operatively was 8.8 fold higher in this group compared to those patients whose immediate-postoperative IGF-1 levels did not increase by greater than 100 μg/L. On the other hand, age at time of surgery, gender of the patient, and immediate post-operative GH level were not significantly different in patients whose IGF-1 normalized before versus after 3 months post-operatively. Trending IGF-1 post-operatively may need to be continued for years in order to track normalization in patients with higher IGF-1 levels in the immediate postoperative period.
Mengikuti aneurysmal subarachnoid hemorrhage, komplikasi cardiac manakah yang merupakan prediktor independen paling signifikan untuk kejadian mortalitas ?
A. Heart block B. Cardiac failure C. Myocardial infartion D. Tachyarrhythmias E. Myocardial stunning
B. Cardiac failure
Cardiac failure (CF) has been associated with increased mortality following aneurysmal subarachnoid hemorrhage (aSAH). Cardiac complications and abnormalities are common following aneurysmal subarachnoid hemorrhage (SAH). A recent study of the National Inpatient Sample found that patients experiencing cardiac failure (CF) were 1.6 times more likely to experience in-hospital mortality. In addition, aSAH patients with CF had longer in-hospital stay (LOS) compared to those without CF. Patients with CF may suffer from other medical complications, such as pulmonary complications, renal failure, and hepatic dysfunction, which may require observation in intensive care units and thus longer periods of hospitalization and higher charges. The mortality rate was increased in patients with myocardial infarction (MI), but did not reach statistical significance. Bradycardia, tachycardia, non-specific EKG alterations, troponin leak, and myocardial stunning are common abnormalities following aneurysmal SAH. Studies have found conflicting results concerning these effects on overall mortality as well as outcome.
Berapakah persentase untuk pasien dapat memiliki peningkatan serum troponon yang mengikuti aneurysmal subarachnoid hemorrhage ?
A. 40-60 % B. 20-40 % C. 0-20 % D. 60-80 % E. 80-100 %
B. 20-40 %
Following aneurysmal subarachnoid hemorrhage, troponin elevation is seen in 20% to 40%, electrocardiogram (ECG) changes such as T-wave inversion and QT-prolongation can be found in 50% to 100% of patients, regional wall-motion abnormalities occur in 10% of patients, cardiac failure in 6.7%, and myocardial infarction in 0.28%. Both cardiac failure and myocardial infarction significantly increase the risk of unfavorable outcome following aneurysmal subarachnoid hemorrhage.
Manakah dari hal berikut yang merupakan faktor resiko untuk terjadinya infark miokard yang mengikuti aneurysmal subarachnoid hemorrhage ?
A. Umur lebih tua B. Riwayat diabetes mellitus C. Riwayat merokok D. Gender pria E. Ras kulit putih
A. Umur lebih tua
Higher average age may be associated with higher risk for cardiac complications in patients with aneurysmal subarachnoid hemorrhage (aSAH). While conduction abnormalities and myocardial stunning are particularly common, cardiac failure (CF) and myocardial infarction (MI) occur in 6.7% and 0.28% of patients following aneurysmal subarachnoid hemorrhage and significantly increase the risk of unfavorable outcome. In a study by Kim et al., the following factors have been found to be independent predictors of cardiac failure: increasing age, male gender, black race, history of diabetes, history of smoking, history of cardiac disease, and no private payer status. The multivariate GEE model identified age, black race and primary payer status as significant predictors of MI. The odds of CF and MI are estimated to multiply by 1.03 (increase by 3%) and by 1.02 (increase by 2%) for each additional year of age, respectively.
