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Lilja, Åsa. "Psychoneurooncology psychological dynamics in glioma patients /." Lund : Dept. of Psychology, Lund University, 1992. http://books.google.com/books?id=SnZrAAAAMAAJ.
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Lombardi, Giuseppe. "2-Hydroxyglutarate as a biomarker in glioma patients." Doctoral thesis, Università degli studi di Padova, 2014. http://hdl.handle.net/11577/3423791.
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Background: mutation of IDH1 gene is a prognostic factor and a diagnostic hallmark of gliomas. Mutant IDH1 enzyme can convert α-KG into 2-Hydroxyglutarate (2HG) and mutated gliomas have elevated amounts of intracellular 2HG. Since 2HG is a small molecule it seems possible that it could reach the systemic circulation and to be excreted by urine. And so, we analyzed 2HG concentration in plasma and urine in glioma patients to identify a surrogate biomarker of IDH1 gene mutation.
Materials and Methods: All patients had a prior histological confirmation of glioma, a recent brain MRI (within 2 weeks) showing the neoplastic lesions. The exclusion criteria were any chemotherapy performed within 28 days prior, other neoplastic and metabolic diseases. Plasma and urine samples were taken from all patients and 2HG concentrations determined by liquid chromatography tandem mass spectrometry; exon 4 of IDH1 genes were analyzed by Sanger sequencing; differences in metabolite concentrations between mutant and wild-type IDH1 patients were examined with the Mann-Whitney U test for non-parametric data; Student’s t-test was used to compare parametric data. ROC curve was used to evaluate the cut off value of the 2HG biomarker.
Results: 84 patients were enrolled: 38 with IDH1 mutated and 46 IDH1 wild-type.
All the mutations were R132H. Among patients with mutant IDH1 we had 21 highgrade gliomas (HGG) and 17 low-grade gliomas (LGG); among patients with IDH wild-type we had 35 HGG and 11 LGG.. In all patients we analyzed the mean 2HG concentration in plasma (P_2HG), in urine (U_2HG) and the ratio between P_2HG and U_2HG (R_2HG).
We found an important significant difference in R_2HG between glioma patients with and without IDH1 mutation (22.2 versus 15.6, respectively, p<0.0001). The optimal cut-off value of R_2HG to identify glioma patients with and without IDH mutation was 19 (sensitivity 63%, specificity 76%, accuracy 70%); in only PTS with HGG the optimal cut-off value was 20 (sensitivity 76%, specificity 89%, accuracy 84%, positive predictive value 80%, negative predictive value 86%). No associations between the grade or size of tumor and R_2HG were found. In 7 patients with highgrade gliomas we found a correlation between R_2HG value and response to treatment.
Conclusions: analyzing R_2HG derived from individual plasma and urine 2HG levels is possible discriminate glioma patients with and without IDH mutation, in particular in high grade gliomas. Moreover, a larger samples need to be analyzed to investigate this method in patients follow-up for recurrence detection and to monitor treatment efficacy.Background: la mutazione del gene IDH1 rappresenta un importante fattore prognostico e diagnostico per i tumori gliali. L’enzima IDH1 avente la mutazione ha la capacità di convertire α-KG in 2-Idrossiglutarato (2HG) e i gliomi mutati hanno una elevata concentrazione di 2HG all’interno delle cellule tumorali. Poichè 2HG è una piccola molecola, tale metabolita potrebbe raggiungere la circolazione sistemica ed essere escreta con le urine. Per tale ragione, nel nostro studio abbiamo analizzato la concentrazione di 2HG nel plasma e nelle urine nei pazienti con glioma per identificare un biomarcatore surrogato della presenza della mutazione IDH1. Materiali e Metodi: per l’arruolamento, tutti i pazienti dovevano avere avuto una precedente conferma istologica di glioma, una recente risonanza magnetica cerebrale (entro 2 settimane) mostrante la lesione tumorale. Qualsiasi chemioterapia eseguita nei 28 giorni precedenti l’analisi del metabolita, la presenza di altre malattie tumorali e malattie metaboliche escludevano l’arruolamento del paziente. Campioni plasmatici e urinari sono stati ottenuti da tutti i pazienti e le concentrazioni di 2HG ottenute mediante cromatografia liquida-spettrometria di massa; il test di Mann-Whitney è stato usato per calcolare le differenze di concentrazione dei metaboliti tra pazienti con IDH1 mutato e non-mutato, per dati non parametrici; il test di Student per comparare dati parametrici. La curva ROC è stata usata per calcolare il valore di cut-off del 2HG come biomarcatore. Risultati: sono stati arruolati 84 pazienti: 38 con IDH1 mutato e 46 con IDH1 wildtype. Tutte le mutazioni sono state R132H. Tra i pazienti con mutazione IDH1 abbiamo avuto 21 gliomi ad alto grado (HGG) e 17 gliomi a basso grado (LGG). Tra i pazienti con IDH1 wild-type abbiamo avuto 35 pazienti con HGG e 11 con LGG. In tutti i pazienti abbiamo analizzato la concentrazione media di 2HG nel plasma (P_2HG), nell’urina (U_2HG) e il rapporto tra la concentrazione plasmatica e urinaria (R_2HG). E’ emersa una importante differenza statisticamente significativa per l’R_2HG tra pazienti con e senza mutazione dell’IDH1 (22.2 verso 15.6, p<0.0001). Il cut-off ottimale di R_2HG per identificare lo stato mutazionale di IDH1 nei pazienti con glioma è risultato essere 19 (sensibilità 63%, specificità 76%, accuratezza 70%); nei soli pazienti con glioma ad alto grado il cut-off ottimale è risultato essere 20 (sensibilità 76%, specificità 89%, accuratezza 84%, valore predittivo positivo 80%, valore predittivo negativo 86%). Non è emersa nessuna associazione tra il grado o la dimensione del tumore con il valore di R_2HG. In 7 pazienti con glioma ad alto grado analizzati abbiamo, inoltre, trovato una correlazione tra il valore di R_2HG e la risposta al trattamento. Conclusioni: attraverso l’analisi di R_2HG, derivato dalla concentrazione plasmatica e urinaria di 2HG, è possibile discriminare gliomi con e senza mutazione IDH1, soprattutto in gliomi di alto grado. Occorrerà analizzare un campione più grande di pazienti con glioma per investigare tale metodica anche nel follow up allo scopo di individuare precocemente la recidiva di malattia e per monitorare l’efficacia del trattamento.
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Dan, Michael. "Human anti-glioma monoclonal antibodies from patients with neurological tumors." Thesis, McGill University, 1989. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=74367.
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The current management of malignant gliomas is unsatisfactory compared to other solid tumors. Expected median survival is less than one year with even the best of care. At some point in their illness, most patients with neurological tumors are capable of mounting an immune response to their disease. This study focused on the humoral immune response of brain tumor patients by preparing human-human B cell hybridomas from autologous peripheral blood lymphocytes and a human myeloma-like cell line, designated as TM-H2-SP2. Eighteen fusions were successfully performed, and 15.8% of all microwells screened contained human immunoglobulin with anti-tumor activity. Five hybridomas, designated as BT27/1A2, BT27/2A3, BT32/A6, BT34/A5, and BT54/B8 were selected for detailed study. All five produced monoclonal IgM in a range of 2.4-44 $ mu$g/ml, had a similar (but not identical) pattern of reactivity against a panel of human tumor cell lines, and did not react with normal human astrocytes. All five human monoclonal antibodies (HmAbs) recognized a subpopulation of tumor cells based on multiparameter flow cytometric studies. Cell sorting experiments suggested that the identified subpopulation may share certain properties with hypothetical tumor stem cells. Preliminary antigen characterization indicated that the HmAbs are directed to cell surface glycolipids. These HmAbs possess certain properties of reactivity that suggest potential roles for them in the future diagnosis and clinical management of human malignant gliomas.
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Gittleman, Haley Rebecca. "Nomograms and Sex Differences in Survival for Patients with Glioma." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1562341173580061.
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van, Ierschot Fleur Céline. "Monitoring of reading and spelling in glioma patients undergoing awake surgery." Doctoral thesis, Università degli studi di Trento, 2018. https://hdl.handle.net/11572/367937.
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One of the main aims of awake surgery for glioma patients is to preserve quality of life, while maximizing tumor resection. Focusing on an important yet understudied aspect of quality of life, this thesis investigates to what extent written language may be affected by a glioma or glioma surgery. By reviewing current assessments of reading and spelling in awake surgery studies, we aimed to provide a better understanding of how neuroanatomical theories may guide neurosurgical practice, and to evaluate how examinations of written language in glioma patients can be improved. To provide a direct clinical application for this knowledge, we developed a theory-driven written language battery specifically for glioma patients. Lastly, we tested its efficacy and evaluated reading and spelling performance in neurosurgical practice. The studies in this thesis have provided a better understanding of written language in neurosurgical practice. In particular, it has contributed to prediction and prevention of written language disorders in glioma patients undergoing awake surgery, and it has resulted in a valid examination tool to carefully monitor reading and spelling in this patient group.
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van, Ierschot Fleur Céline. "Monitoring of reading and spelling in glioma patients undergoing awake surgery." Doctoral thesis, University of Trento, 2018. http://eprints-phd.biblio.unitn.it/2834/1/FvI_PhD_thesis.pdf.
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One of the main aims of awake surgery for glioma patients is to preserve quality of life, while maximizing tumor resection. Focusing on an important yet understudied aspect of quality of life, this thesis investigates to what extent written language may be affected by a glioma or glioma surgery. By reviewing current assessments of reading and spelling in awake surgery studies, we aimed to provide a better understanding of how neuroanatomical theories may guide neurosurgical practice, and to evaluate how examinations of written language in glioma patients can be improved. To provide a direct clinical application for this knowledge, we developed a theory-driven written language battery specifically for glioma patients. Lastly, we tested its efficacy and evaluated reading and spelling performance in neurosurgical practice. The studies in this thesis have provided a better understanding of written language in neurosurgical practice. In particular, it has contributed to prediction and prevention of written language disorders in glioma patients undergoing awake surgery, and it has resulted in a valid examination tool to carefully monitor reading and spelling in this patient group.
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Davies, Elizabeth. "The quality of survival of patients with malignant cerebal glioma following radiotherapy." Thesis, Queen Mary, University of London, 1998. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1664.
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Objective- To describe survival, disability and morbidity after radiotherapy for malignant glioma and explore patient and relative experience. Design - Home follow-up of patients and relative over up to 24 months and of relatives after bereavement. Setting - Six London hospitals Subjects- 92 patients receiving radiotherapy (83 recruited at diagnosis; 9 after radiotherapy) and 85 relatives. 56 bereaved relatives. Main outcome measures- Survival, time free from disability, and changes in disability after treatment assessed, or deduced retrospectively, using interviewer observation, patient and relative reports, case note review and discussion with medical staff. A semi-structured interview designed for the study assessed awareness of the likely prognosis, distress, dissatisfaction with radiotherapy and perception of severe problems in everyday life. Results - 6,12 and 24 month survivals were 70%, 39% and 10%. Age, World Health Organisation clinical performance status, extent of surgery, and epilepsy each influenced survival. The Medical Research Council prognostic index was also significantly related to survival. Multivariate analysis showed that initial clinical performance status was the most important aspect of the index. Most (80%;4 9/61) patients with a clinical performance status of 0,1 or 2 lived at least 6 months before becoming permanently disabled. Of those with an initial good clinical performance status( 0-2) who survived 6 months after radiotherapy 69% (36/52) experienced either clinical deterioration or severe tiredness after treatment. Severely disabled patients (clinical performance status 3 or 4) gained little benefit. 75 patients and 66 relatives were interviewed at diagnosis, 59 patients after radiotherapy and 27 after deterioration. As they began radiotherapy most patients understood that they suffered from a brain tumour (95% ;7 1/75), but only one quarter (19/75) seemed fully aware of the poor prognosis. Others were unaware (43%; 32/75) or only partly aware (32%; 24/75). The more aware patients were more distressed. Relatives were three times more likely to be aware of the prognosis (67%; 44/66) and were more distressed. Although 39% (29/75) of patients initially made negative comments about radiotherapy, only 17% (13/75) were completely dissatisfied. The decision to accept radiotherapy could be discussed directly with 19 fully aware patients. Twelve found radiotherapy acceptable if it were medically advised or if it improved survival. Assessed by their own reports of symptoms only 40% of patients improved or achieved a period of stability, yet dissatisfaction with treatment did not increase. Bereaved relatives' judgements about quality of life and the value of radiotherapy were strongly related to the patient's initial disability and distress. Short periods of survival between six and 12 months were felt worthwhile. Conclusions- Severely disabled patients gain little benefit from radiotherapy and those not so disabled may experience considerable adverse effects. The lack of awareness of the prognosis, however, makes it difficult to explore with patients directly the possible trade off between quality and length of life. Relatives were more aware, more distressed and often concerned to protect patients from full awareness. However most aware patients accepted radiotherapy for the chance of improved survival and bereaved relatives valued relatively small periods of survival free from disability and distress. Conceptualising these questions as rational choices ignores therefore the social and emotional context of life threatening disease.
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Chikada, Ai. "A descriptive analysis of end-of-life discussions for high-grade glioma patients." Doctoral thesis, Kyoto University, 2021. http://hdl.handle.net/2433/264666.
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京都大学新制・課程博士
博士(人間健康科学)
甲第23385号
人健博第92号
新制||人健||6(附属図書館)
京都大学大学院医学研究科人間健康科学系専攻
(主査)教授 田村 恵子, 教授 稲富 宏之, 教授 溝脇 尚志
学位規則第4条第1項該当
Doctor of Human Health Sciences
Kyoto University
DFAM
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Cavers, Debbie Grant. "Understanding the supportive care needs of glioma patients and their relatives : a qualitative longitudinal study." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/10630.
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Background: Malignant cerebral glioma is a rare cancer but has a devastating impact on patients and their families. In Scotland each year, around 450 people are diagnosed with glioma. Prognosis is generally poor and treatment is essentially palliative. There is a growing recognition that non-clinical aspects of care for both patients and their families need to be acknowledged and integrated into health care provision in line with a patient-focused ethos of care. Currently, there is relatively little research exploring the psychosocial issues and needs of this patient group. Aims: To give patients being investigated for malignant cerebral glioma and their families the opportunity to describe their shared experiences of their illness journey and voice their concerns and unmet needs. To examine how these experiences and needs change over time as the patient progresses through the illness journey. To ascertain the extent to which these needs are recognised and supported, taking into accounts professionals’ views and making suggestions for steps forward in improving patients’ psychosocial care. Methods: A total of 80 qualitative prospective longitudinal interviews (30 paired and 50 separate) were conducted with 26 people with a suspected or confirmed diagnosis of malignant cerebral glioma being treated at a regional hospital and 24 primary relative/informal carers. Patients and carers were interviewed at the following five times: leading up to diagnosis; following a formal diagnosis; around the end of initial treatment (radiotherapy); at a designated six-month follow-up stage; and bereavement interviews with carers. One-off interviews were carried out with 66 health professionals (19 case-linked GPs and 47 other health, health-related and social care professionals involved in patients' care). Interviews were recorded and transcribed verbatim and analysed using the constant comparative method from a grounded theory approach assisted by QSR NVivo Version 7. Findings: Distress, anxiety and shock were overwhelming reactions in the period leading up to a diagnosis of glioma, making it difficult for participants to make sense of their experience. Over time, participants employed a range of strategies in order to cope with their diagnosis. Social and emotional support from professionals and friends, family and other patients were vital in many cases but support often felt inadequate. The role of information and the manner in which it was communicated was closely linked to participants’ ability to cope. Information needs were variable but on the whole patients and carers did not feel well informed. Dealing with cognitive and physical symptoms of their illness and side effects of treatment inhibited patients’ ability to resume their everyday activities. The lives of relatives were also affected as they struggled to care for their loved ones. People with a diagnosis of glioma were faced with the possibility of death from an early point in their illness trajectory and awareness of this, coupled with ability to make sense of existential issues, varied across participants. Issues around support, communication, information and palliative care were considered to be important among health professionals involved in the care of people with a diagnosis of glioma but provision fell short. Conclusions: Concerns regarding information, communication and support reported elsewhere in the literature are enduring in glioma patients and their relatives. Reporting of unmet psychosocial and supportive care issues by patients and recognition by professionals of the need to improve these dimensions of care for people affected by glioma emphasises previous recommendations yet to be fully implemented into patient care.
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Coget, Arthur. "Etude et modélisation de la plasticité cérébrale chez des patients porteurs de lésions gliales de bas grade opérés en chirurgie éveillée." Thesis, Montpellier, 2020. http://www.theses.fr/2020MONTS053.
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Introduction Les gliomes de bas grade sont des tumeurs cérébrales de progression lente qui affectent l’adulte jeune. Ce mode d’évolution laisse le temps aux réseaux neuraux de se réorganiser de façon massive ce qui permet d’expliquer pourquoi les patients ne présentent habituellement aucun déficit neurologique au diagnostic bien que la tumeur concerne des zones dites «éloquentes». Ces lésions sont donc un sujet d’étude particulièrement intéressant dans la compréhension des mécanismes de plasticité cérébrale.Ces patients bénéficient, comme traitement optimal, d’une chirurgie en condition éveillée permettant une résection la plus importante possible tout en préservant les fonctions neurologiques du patient pour qu’il conserve la meilleure qualité de vie possible.L'imagerie fonctionnelle de repos est un outil robuste en IRM pour étudier la connectivité fonctionnelle et la plasticité cérébrale. Elle est basée sur l’analyse du signal BOLD et présente plusieurs avantages : 1) la possibilité d’être réalisée chez des patients non coopérants 2) la possibilité d’analyser l’ensemble des réseaux neuraux simultanément.Dans ce travail nous souhaitions mesurer les fluctuations de connectivité fonctionnelle durant la période péri-opératoire d’une chirurgie éveillée pour gliome diffus de bas grade afin d’évaluer la plasticité fonctionnelle engendrée par la résection de la tumeur.Dans un second temps, nous avons tenté d'expliquer ces données fonctionnelles péri-opératoires à l’aide de l’imagerie multimodale en analysant l’évolution péri-opératoire de la connectivité anatomique et des paramètres hémodynamiques.Méthodes L’analyse principale portait sur une cohorte de 82 patients porteurs de gliomes diffus de bas grade et opérés en chirurgie éveillée. Pour chaque patient une IRM avec séquences fonctionnelles de repos était réalisée à trois temps : pré-opératoire, post-opératoire immédiat et lors du suivi à 3 mois. Toutes les IRM étaient effectuées pour chaque patient sur la même machine au cours du suivi, soit un système IRM 3.0 Tesla (Skyra, Siemens), soit un système IRM 1.5 Tesla (Avanto, Siemens). Après des étapes classiques de prétraitement, les données fonctionnelles étaient traitées à l’aide du logiciel CONN v16.a.La connectivité anatomique a secondairement été analysée par imagerie de diffusion anisotropique en IRM en se concentrant sur le corps calleux.Enfin les conséquences hémodynamiques de la chirurgie étaient évaluées d’une part via des séquences de perfusion en IRM et d’autre part par une analyse innovante du signal BOLD.RésultatsNous avons constaté de façon surprenante, durant la période post-opératoire immédiate, une altération significative transitoire globale quasi-exclusive de la connectivité interhémisphérique entre régions miroirs, nommée connectivité homotopique.Des modifications de connectivité anatomique concernant le corps calleux et des modifications hémodynamiques régionales et globales ont également été constatées de façon concomitante en période post-opératoire immédiate et à plus long terme après la chirurgie sans qu’un lien direct avec nos données fonctionnelles n’ait pu être mis en évidence.L’analyse des données hémodynamiques a enfin mis une lumière une région intéressante : le striatum. Cette structure pourrait être une région centrale dans le maintien de la connectivité homotopique et son atteinte alors mener aux modifications fonctionnelles observées.Conclusion La rupture d’homotopie fonctionnelle transitoire que nous constatons en période post-opératoire immédiate est probablement d’origine multifactorielle. La prise en compte des données anatomiques et hémodynamiques, dans l’interprétation des résultats fonctionnelles en IRM, est indispensable tant en période post-opératoire immédiate que à plus long terme après la chirurgie. Des travaux d’analyse de la vasoréactivité cérébrale d’une part et de modélisation d’autre part pourraient aider à mieux comprendre les différents phénomènes intriquésIntroductionDiffuse low-grade gliomas (DLGG) are slow-growing brain tumors occurring in young adults. This slow progression induces extensive neuroplasticity and explains why patients most of the time do not show any obvious neurological deficit at the time of diagnosis although tumors are located in ‘eloquent’ areas. Therefore DLGG provide an interesting model in understanding mechanisms of neuroplasticity.Awake surgery with direct cortical and subcortical electrostimulation mapping is recommended as first-line treatment of DLGG, allowing to maximize tumoral resection and limiting postoperative neurological deficit, maintaining patients quality of life.Resting-state fMRI, based on BOLD signal analysis, is used to study functional connectivity and neural plasticity. This technique allows robust evaluation of neural networks without performing a task. Consequently, it bypasses the impact of confusion, sedation or neurological deficits on task execution. In this thesis, we aimed to investigate perioperative functional connectivity modifications in order to evaluate neural plasticity after awake surgery.Subsequently we explained the functional results using multimodal MRI imaging to analyze anatomic connectivity and hemodynamic parameters.Methods82 patients with DLGG who underwent awake surgical resection were included in the principal study. MRI acquisitions were performed successively before, within 36 h after and three months post-surgery. All scans were executed on the same MRI magnet for each patient, i.e. either a 3.0 T magnet (Skyra, Siemens) or a 1.5 T magnet (Avanto, Siemens). First, data were preprossed using a standardized classical pipeline and analyzed with the CONN toolbox v16.a.Second, anatomic connectivity was evaluated using diffusion tensor imaging of the corpus callosum.Finally hemodynamic changes induced by surgery were assessed with traditional perfusion imaging as well as using an innovative analysis of the BOLD signal’ s temporal shift.ResultsSurprisingly, it was found that specifically a diffuse transient postoperative interhemispheric disconnectivity occurred between homologous regions, known as homotopic connectivity.In parallel, immediate and long-term postoperative alterations in the anatomic connectivity of the corpus callosum were observed. Immediate and long-term postoperative modifications were also found regarding both regional and global hemodynamics characteristics. Yet, no significant link between the homotopic connectivity findings and the anatomical and hemodynamic changes could have been established at this point.Nevertheless, the hemodynamic analysis allowed the identification of a a specific brain region : the striatum. It was hypothesized that it acts as a central region for the maintenance of homotopic connectivity, explaining simultaneously the decreased post-surgical homotopic connectivity observed.ConclusionThe highlighted transient postoperative functional homotopy is probably due to multifactorial causes To start entangling these causes, the use of anatomic and hemodynamic imaging data analyses seems crucial to interpret functional connectivity data both immediate and long-term postoperative.Cerebral vasoreactivity and modelling studies provide thereby a very promising tool to better understand the interrelated processes underlying postoperative functional connectivity modifications
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Kilbride, Lynn. "An examination of the period between surgery and radiotherapy for patients with malignant glioma and their families." Thesis, University of Edinburgh, 2006. http://hdl.handle.net/1842/24774.
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Study Aim: To examine the practical and emotional issues that patients with a malignant glioma and their carers experience between the surgery and radiotherapy. Study Design: Using a comparative descriptive design, this study prospectively examined 51 patients and their carers between their surgery and radiotherapy. The study explored changes in neurological functional status, frequency and severity of anxiety and depressive levels, prevalence of side effects of dexamethasone therapy and level of disruption to lives and life quality of patients and their carers. Study Findings: Lack of information and appropriate support, initiate a maladaptive emotional and physical response to the diagnosis of malignant glioma. The age, past medical history and familial commitments of patients are factors, which influence the physical and emotional response exhibited. Recommendations: If nurses and/or other health care professionals; consider the age, past medical history and family commitments of patients, undertake regular assessment of the patients neurological functional state and closely monitor the dosage and effectiveness of dexamethasone therapy, they could anticipate and predict the physical and emotional response of patients and their carers to the diagnosis of malignant glioma between surgery and radiotherapy. Overall implementation of these recommendations would ensure that the support needs of patients and carers could be met between surgery and radiotherapy. Consequently during this time the quality of the lives of these individuals could be optimised.
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Jena, Rajesh. "Optimisation of radiotherapy for patients with high-grade glioma using diffusion tensor imaging and intensity modulated radiotherapy." Thesis, University of Cambridge, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.614124.
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Ali, Dulfikar A. "The feasibility of exercise in low and high grade glioma patients during radiation with or without adjuvant chemotherapy." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/233465/1/Dulfikar_Ali_Thesis.pdf.
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This research was a longitudinal mixed methods study that involved the delivery of an exercise intervention in brain cancer patients undergoing treatment. Three studies were conducted to examine post-surgical functioning, feasibility and safety, and a qualitative review of patients’ acceptability and experiences.
This research highlighted functional deficits after surgery, limiting independence. The delivery of an exercise intervention during treatment is both feasible and safe. Clinically important improvements in aerobic functioning, lower-body strength and mobility were observed after cancer treatment. Participating in the exercise intervention provided patients with respite from their cancer journey and promoted positive coping ability towards future outlook.
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Shepherd, S. C. "Longitudinal evaluation of 'Navigation', a decision support intervention for patients with colorectal cancer and high grade glioma : a mixed methods study." Thesis, Coventry University, 2016. http://curve.coventry.ac.uk/open/items/970f3ffe-da3b-4838-b05a-2e9faa43a7d3/1.
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Introduction: At the core of UK policy for improving outcomes in cancer are goals for a healthcare where patients are empowered through information enabling engagement in shared care decisions with clinicians. Interventions to support patients’ engagement in shared decision making are lacking within colorectal cancer and high grade glioma care despite intensive treatment regimens with uncertain outcomes. Navigation, a communication and decision support intervention, has been successfully piloted with prostate and breast cancer patients who demonstrated significantly more confidence and less uncertainty in their treatment decisions. With healthcare policy advocating patients be educated and engaged in their care, the applicability of this intervention to other cancer settings is required. The Navigation intervention includes: consultation planning with a Navigator, formulation of a consultation plan and recording (summary and CD) of the medical consultation. Objectives: To determine the effectiveness of the Navigation intervention in enhancing decision-making quality over time when compared with usual care, in patients with colorectal cancer. To explore repeated experiences of the Navigation intervention from the perspective of colorectal cancer (CRC) patients, patients with high grade glioma (HGG), and consulting clinicians. Design and Studies: A mixed methods study using a pragmatic randomised controlled trial and qualitative evaluation was undertaken during November 2010 – December 2013. The intervention was trialled separately with two cohorts of cancer patients (CRC and HGG). A longitudinal parallel-group pragmatic randomised controlled trial was conducted. Study 1 consisted of a longitudinal parallel-group pragmatic randomised control trial. Participants with colorectal cancer were openly randomised after completion of baseline measures to receive the intervention or usual care (no intervention). The intervention was administered to patients at three particular time points during first line cancer treatment. Participants completed tools collecting primary outcome (decision self-efficacy) and secondary outcomes (decision conflict, decision regret, anxiety and depression) measured prior to baseline, post consultation and at follow-up. Mean change in scores overtime and between groups were compared using Mixed ANOVAS. Study two was a prospective qualitative study undertaking serial in-depth semi-structured evaluation interviews with patients with High Grade Glioma. Study three undertook interviews with the consulting HGG and CRC clinicians. Framework analysis was undertaken. Setting: Two oncology settings within a tertiary cancer centre in Scotland. Participants: 132 patients with colorectal cancer (65 intervention, 67 control) participated in the randomised controlled trial. For the qualitative study, 17 colorectal trial participants (8 intervention, 9 control), 11 high grade glioma patients and 7 clinicians were interviewed. Evaluation Results: No significant difference was found between the control and Navigation intervention participants over time in the primary outcome of decision self-efficacy, or in the following secondary outcomes; decision conflict or anxiety and depression scores. At follow-up, the intervention group reported significantly less decision regret than the controls (p=0.039). In the qualitative data, Navigated participants reported being well prepared for medical consultations, able to actively engage in information exchange during consultation and enabled to recall and understand information provided. This was in contrast to participants receiving usual care who described being less prepared for medical consultations and experienced barriers to gathering information, such as time pressures, forgetting questions, and gaps in understanding. Clinicians identified that patients benefitted from preparing for, and having a written summary of, the consultation. Whereas neuro-oncology clinicians were supportive of Navigation as a tool to tailor information to patients; colorectal clinicians felt Navigation was a disruption to their normal consultation routine. Concern was expressed regarding the extra resource required by Navigated patients and therefore about the feasibility and sustainability of the intervention. Conclusions: Whilst models of shared decision making remain highly profiled in cancer strategies, information exchange and use of interventions in context is problematic. This evaluation of Navigation has demonstrated more impact on the process of decision making, rather than outcome per se, and has raised questions about its sustainability in clinical practice. A more nuanced understanding of different cancer pathways and the specific decisions to be made, may inform a more targeted use of decision support in cancer care.
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Sagberg, Lisa Millgård. "Quality of life assessed with EQ-5D 3L in patients undergoing glioma surgery; What is the responsiveness and minimal clinically important difference?" Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for samfunnsmedisin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-21706.
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Background: There are few studies on the impact of glioma surgery on health-related quality of life (HRQoL). The generic instrument EQ-5D 3L has been utilized in this context, but several questions concerning use and interpretation are unanswered. Objective: To evaluate the responsiveness of EQ-5D 3L in patients undergoing glioma surgery and estimate the minimal clinically important difference (MID). Materials and methods: EQ-5D 3L index values from 164 patients who underwent glioma surgery in the period 2007-2012 were analysed. Responsiveness and MID were estimated by using a combination of distribution-based and anchor-based methods. Karnofsky Performance Status (KPS) served as an anchor. Results: Patients who improved functionally did not report significantly higher EQ-5D 3L scores postoperatively with a Standardized Response Mean (SRM) of 0.04 (p=0.13). Patients who deteriorated functionally reported significantly lower EQ-5D 3L scores postoperative with a SRM of 0.72 (p <0.001). With different approaches we determined a range of MID-values from 0.07 to 0.15. Conclusions: EQ-5D 3L is responsive to changes when glioma patients are deteriorating functionally after surgery but not responsive when the patients are improving. The MID-values for EQ-5D 3L in glioma surgery are in the upper range of reported MID-values for other conditions.
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Herbet, Guillaume. "Vers un modèle à double voie dynamique et hodotopique de l'organisation anatomo-fonctionnelle de la mentalisation : étude par cartographie cérébrale multimodale chez les patients porteurs d'un gliome diffus de bas-grade." Thesis, Montpellier 1, 2014. http://www.theses.fr/2014MON1T004/document.
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Comprendre comment le cerveau humain engendre les formes les plus élaborées de comportements est profondément lié à nos connaissances générales sur son organisation anatomique et fonctionnelle. Jusqu'à récemment encore, on pensait que les fonctions cognitives n'étaient rien d'autre que le sous-produit de l'activité neurale de régions corticales discrètes et hyper-fonctionnalisées. Les découvertes majeures obtenues ces dix dernières années dans le champ de la neuro-imagerie, et plus particulièrement de la connectomique, invitent cependant à complexifier nos représentations sur les liens qu'entretiennent structures et fonctions cérébrales. Le cerveau semble en effet être organisé en systèmes neurocognitifs complexes, hautement distribués et plastiques. C'est dans cet esprit qu'a été réalisé ce travail de thèse dont l'ambition première a été de repenser les modèles actuels de la cognition sociale, et en particulier ceux ayant trait à la fonction de mentalisation, à travers l'étude comportementale des patients porteurs d'un gliome diffus de bas-grade. Cette tumeur neurologique rare constitue un excellent modèle physiopathologique en vue du démasquage des structures maîtresses des systèmes cognitifs complexes, en ce qu'elle induit des phénomènes majeurs de réorganisation fonctionnelle, et s'infiltre préférentiellement le long de la connectivité axonale associative. Des corrélations anatomo-cliniques ont été réalisées suivant une approche topologique classique (analyse de groupe en régions d'intérêt, cartographie voxel-based lesion-symptom, stimulation électrique corticale intra-opératoire) mais également hodologique (degré de déconnection des faisceaux d'association, stimulation électrique de la connectivité axonale). Les résultats principaux de nos différents travaux nous permettent de jeter les premières bases d'un modèle à double voie dynamique (plastique) et hodotopique (contraint par la réalité anatomique) de l'organisation anatomo-fonctionnelle des processus de mentalisation. Spécifiquement, une voie dorsale, interconnectant le aires corticales fronto-pariétales « miroirs » via le système périsylvien de substance blanche associative (faisceau arqué et faisceau longitudinal supérieur latéral), sous-tendrait les processus perceptifs de « bas-niveau » nécessaires à l'identification préréflexive des états mentaux ; une voie cingulo-médiane, interconnectant les régions préfrontales médiales et rostro-cingulaires aux régions pariétales postérieures médiales via le faisceau cingulaire, sous-tendrait les processus de «haut-niveau » nécessaires aux inférences mentalistiques conscientes. Ces découvertes constituent une avancée substantielle en neurosciences sociales, ont des implications importantes pour la prise en charge clinique des patients, et peuvent permettre de mieux comprendre certaines psychopathologies caractérisées à la fois par un trouble de la mentalisation et des anomalies structurales de la connectivité associative (troubles du spectre autistique)Understanding how the brain produces sophisticated behaviours strongly depends of our knowledge on its anatomical and functional organization. Until recently, it was believed that high-level cognition was merely the by-product of the neural activity of discrete and highly specialized cortical areas. Major findings obtained in the past decade from neuroimaging, particularly from the field of connectomics, prompt now researchers to revise drastically their conceptions about the links between brain structures and functions. The brain seems indeed organized in complex, highly distributed and plastic neurocognitive networks. This is in this state of mind that our work has been carried out. Its foremost ambition was to rethink actuals models of social cognition, especially mentalizing, through the behavioural study of patients harbouring a diffuse low-grade glioma. Because this rare neurological tumour induces major functional reorganization phenomena and migrates preferentially along axonal associative connectivity, it constitutes an excellent pathophysiological model for unmasking the core structures subserving complex cognitive systems. Anatomo-clinical correlations were conducted according to both a classical topological approach (region of interest analyses, voxel-based lesion-symptom mapping, intraoperative cortical electrostimulation) and a hodological approach (degree of disconnection of associative white matter fasciculi, intraoperative axonal connectivity mapping). The main results of our different studies enable us to lay the foundation of a dynamic (plastic) and hodotopical (connectivity) dual-stream model of mentalizing. Specifically, a dorsal stream, interconnecting mirror frontoparietal areas via the perisylvian network (arcuate fasciculus and lateral superior longitudinal fasciculus), may subserve low-level perceptual processes required in rapid and pre-reflective identification of mental states; a cingulo-medial stream, interconnecting medial prefrontal and rostro-cingulated areas with medial posterior parietal areas via the cingulum, may subserve higher-level processes required in reflective mentalistic inferences. These original findings represents a great step in social neuroscience, have major implications in clinical practice, and opens new opportunities in understanding certain pathological conditions characterized by both mentalizing deficits and aberrant structural connectivity (e.g. autism spectrum disorders)
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Lemaitre, Anne-Laure. "Métacognition et personnalité chez des patients porteurs d'un gliome diffus de bas grade : un eclairage nouveau sur le potentiel plastique du cerveau humain." Thesis, Lille 3, 2019. http://www.theses.fr/2019LIL3H059.
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Les découvertes récentes en neuropsychologie ont permis de passer d’une conception localisationniste à une conception en réseaux dynamiques du fonctionnement cérébral. Cette révolution conceptuelle, d’un cerveau immuable à remodelable, a été étayée par l’étude des patients porteurs d’un gliome de bas grade, une tumeur primaire associée à des phénomènes majeurs de plasticité cérébrale. Toutefois, on ne sait pas actuellement si cette neuroplasticité peut s’étendre aux fonctions de haut-niveau, celles qui participent à la conscience qu’ont les individus d’eux-mêmes. L’objectif de ce travail de thèse était d’évaluer dans quelle mesure les résections chirurgicales de gliomes affectent les processus métacognitifs et les traits de personnalité, en utilisant des méthodes de corrélations anatomo-fonctionnelles qui s’appuient sur la localisation lésionnelle et les déconnexions cérébrales. Dans un premier temps, nous avons montré que des résections frontales, unilatérales et bilatérales, n’induisaient pas de trouble métaperceptif, alors que le cortex préfrontal est supposé être central dans la métacognition. De même, nos résultats suggèrent que des résections chirurgicales massives n’affectent que très peu les traits de personnalité. Néanmoins, quelques traits comme la schizotypie positive et des troubles du comportement, comme l’anosognosie, étaient associés à l’atteinte de certains faisceaux de substance blancheRecent findings in the field of neuropsychology have allowed to move from a localized to a dynamic network approach of brain functions. This paradigmatic shift, from a static to a reshaping brain, has been supported by the investigation of patients with low-grade glioma, a neurological tumor known to trigger processes of compensation and rescue of brain functions. However, it is currently unestablished whether this neuroplastic compensation may extend to higher-order cognitive functions, specifically those involved in self-consciousness. By using both anatomo-functional correlational methods based on lesions localization and structural disconnection approach, the purpose of this work was to assess the extent to which the neurosurgical resections of low-grade glioma affect metacognitive processes and personality traits. First, we showed that frontal lobectomies, both unilateral and bilateral, did not induce metaperceptive impairments despite the established role of the prefrontal cortex in metacognition. Likewise, our results suggest that massive surgical resections did not significantly affect personality traits. However, some of them such as positive schizotypy, and a few behavioral modifications, such as anosognosia, were found to be associated with the disruption of some white matter bundles
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Mainio, A. (Arja). "Depressive and anxious symptomatology in relation to a primary brain tumor:prospective study of neurosurgical patients in Northern Finland." Doctoral thesis, University of Oulu, 2005. http://urn.fi/urn:isbn:9514277163.
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Abstract
The findings on depression and anxiety among brain tumor patients have so far been based on case series and case samples. In Finland, psychiatric research in relation to psychiatric symptoms among patients with different types of brain tumors is lacking.
The study population of this thesis consisted of 101 patients (39 males and 62 females) aged between 20 and 82 years with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery, Oulu University Hospital between February 1990 and March 1992. The major histological subgroup consisted of gliomas (40%), and the rest were meningiomas (33%), acoustic neurinomas (13%), pituitary adenomas (8%) and other types (6%).
The psychiatric symptoms of the patients were assessed at three time points, namely before tumor operation as well as at three months and at one year after operation by two valid measurement instruments, the Beck Depression Inventory and the Crown Crisp Experiential Index. In addition, the patients' functional state was evaluated by the Karnofsky Performance Scale and their quality of life according to Sintonen 15 D.
Prevalence of at least mild depression before tumor operation was 30% for males and 38% for females. The mean depressive scores decreased significantly for up to one-year during follow-up for both males and females, but they remained notably high in all patients. Decreased functional status (KPS under 70) in the patients was significantly associated with high depressive scores at all measurement points. The decrease in the mean depressive scores was significant among patients with an anterior tumor and those with a pituitary adenoma.
Five-year survival of the brain tumor patients was found to be mainly associated with the histology of the tumor. Survival time in months (SD) of the patients with high-grade (III–IV) gliomas was shown to be 22.5 (21.4), while it was 50.2 (19.9) for the patients with low-grade (I–II) gliomas, and 58.2 (9.4) for the rest of the patients. Depression among low-grade glioma patients was significantly associated with worse survival at five years follow-up.
The level of anxiety was shown to be significantly higher among patients with a primary brain tumor in the right hemisphere compared to the anxiety scores among patients with left hemispheric tumors. A significant increase was found in the level of obsessionality over time in the female patients with a brain tumor in the left anterior location of the brain at three months after operation.
The level of quality of life (QOL) was significantly worse among female brain tumor patients compared to males. Depressive females had significantly lower quality of life compared to that of non-depressive females up to one-year follow-up after surgical operation of the tumor.
Depression, anxiety and obsessive-compulsive symptoms have to be recognized and be treated by psychotherapy and pharmacotherapy as soon as possible at every unit where brain tumor patients are followed and encountered.
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Wheeler, Lee Adam. "Multicenter Phase IB/II Study of AdV-Tk, a Gene-Mediated Cytotoxic Immunotherapy, Adjuvant to Surgical Resection for Patients With Newly Diagnosed High Grade Glioma." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:15821599.
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Purpose: The prognosis for malignant gliomas is poor, and overall survival remains less than 15 months despite improved diagnostic and treatment techniques, underscoring the need for novel therapeutic options. This multicenter, single-arm Phase Ib/II trial was conducted to assess the safety and efficacy of AdV-TK, an adenoviral vector containing the herpes simplex virus thymidine kinase gene, in patients newly diagnosed with high grade glioma.
Patients & Methods: Patients were recruited between 2005 and 2010 at four clinical sites. In addition to the standard of care (SOC), which included surgery, adjuvant XRT + temozolomide (TMZ), AdV-TK was administered to the tumor bed at the time of resection followed by valacyclovir prodrug. A total of 48 patients completed therapy per protocol, and were stratified based on extent of resection (total vs. subtotal) and pathological diagnosis (GBM vs. AA/AO). Data from 134 matched patients, who underwent similar SOC at a fifth clinical site during the same time period, were used for descriptive comparison.
Results: There were no dose-limiting toxicities or significant adverse events considered related to AdV-TK. Median overall survival (OS) was 17.05 months, with 67% and 35% at 1- and 2- years respectively. Median OS for patients with total resection was 25 months, compared with 13.5 months for patients with subtotal resection. This difference was more pronounced in patients with a pathological diagnosis of GBM (25.05 vs. 10.6 months). In the comparison group median OS was 13.5 months, with 57% and 22% at 1- and 2- years respectively. Median OS for those with total resection was 16.9 months and 12.47 months for subtotal resection. Progression free survival (PFS) was also improved in the AdV-TK group (8.3 vs. 6.43 months).
Conclusions: Results from this multicenter Phase Ib/II trial demonstrate that AdV-TK plus valacyclovir can be safely delivered at the time of surgical resection without added toxicity to patients with newly diagnosed high grade glioma. The median OS and the 1- and 2-year survival rates of AdV-TK study patients compare favorably to historical reports and a matched comparison set. Survival outcomes are significantly better in patients having undergone total resections versus subtotal resections. These data strongly support launching a statistically powered randomized clinical study of AdV-TK for the treatment of high grade glioma.
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Edvardsson, Tanja. "Consequences of brain tumours from the perspective of the patients and of their next of kin." Doctoral thesis, Örebro universitet, Hälsoakademin, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-1742.
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A disease has consequences not only for the afflicted person but also for those who interact with him or her. A low-grade glioma is a brain tumour whose regarding its psychosocial implications for adult patients and their next of kin has received little attention in the literature. In the light of this the overall aim of the present thesis was to provide increased knowledge about how patients with low-grade glioma and their next of kin experience and deal with everyday life. The methods of the studies were mainly qualitative. Thirty-nine patients and 28 next of kin were interviewed and all except one next of kin completed a quality of life questionnaire. The onset of low-grade glioma was described from the patients’ perspective as a process, either rapid (up to a few months) or prolonged over several years. This phase of low-grade glioma encompassed repeated visits to physicians and care institutions. The onset of low-grade glioma was accompanied by stress, anxiety and uncertainty in the case of both the patients and those nearest. The symptoms and problems the patients experienced covered a broad range of consequences, physical, psychological and social. The patients presented a wide range of ways to cope with illness-related problems. The next of kin were often deeply involved in the patients’ situation and many of them experienced extremely stressful emotions mainly in the early period of the illness. They had experience of positive encounters in health care but more often they had had a sense both of powerlessness and of being invisible and neglected. Relations and roles changed in ways that mostly were experienced as negative. Enabling strength in everyday life had to do with alleviation of strain and having a positive outlook upon life. By means of the questionnaire Subjective estimation of Quality of Life (SQoL) the patients and those nearest estimated their quality of life as being comparatively high. Only one variable, among the patients the absence of work/meaningful occupation and among the next of kin the absence of own children, being estimated at below 60% of the maximum score.
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Yordanova, Yordanka Nikolova. "Un éclairage nouveau sur les bases neurales de la mentalisation : une étude combinant cartographie multimodale et IRM fonctionnelle de repos chez des patients atteints d’un gliome diffus de bas grade." Thesis, Montpellier, 2018. http://www.theses.fr/2018MONTT052/document.
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La mentalisation, ou la capacité d’élaborer des hypothèses sur les états mentaux d’autrui, a fait l’objet de nombreuses études durant les 20 dernières années dans le champ des neurosciences sociales. Toutefois, les bases neurales de cette fonction particulièrement complexe restent mal comprises, notamment en termes de connectivité structurale. Récemment, une organisation anatomo-fonctionnelle en double voie a été proposée. Selon ce modèle, les aspects réflexifs, inférentiels, de la mentalisation seraient sous-tendus par le faisceau cingulaire. Les aspects préréflexifs, identificatoires, seraient médiés, quant à eux, par le complexe faisceau arqué/partie latérale du faisceau longitudinal supérieur (FLS). L’objectif général de ce travail est d’apporter des données originales sur l’organisation anatomo-fonctionnelle du réseau neural impliqué dans la mentalisation basée sur les visages. Pour ce faire, nous avons utilisé comme modèle physiopathologique d’étude le gliome diffus de bas grade. Cette tumeur cérébrale primitive s’avère particulièrement intéressante pour l’étude du rôle de la substance blanche dans la cognition et ce pour deux raisons : (i) les cellules tumorales se propagent préférentiellement le long des fibres blanches ; (ii) l’exérèse chirurgicale est souvent réalisée en condition éveillée avec cartographie fonctionnelle peropératoire pour permettre d’identifier, et ainsi de préserver, les structures fonctionnelles, notamment de substance blanche.Dans une première étude, grâce aux stimulations électriques peropératoires, nous avons pu identifier un vaste réseau cortico-sous-cortical impliqué dans la mentalisation. L’analyse des déconnexions induites par les stimulations de la substance blanche nous a permis de mettre clairement en évidence, et ce pour la première fois, le rôle du faisceau occipito-frontal inférieur (FOFI) tout en confirmant celui du FLS. Dans une deuxième étude, en utilisant des techniques de cartographie lésionnelle chez des patients ayant été opérés, nous avons démontré que les troubles permanents, non compensables, de la mentalisation étaient expliqués par l’atteinte du faisceau arqué. Enfin, dans une dernière étude, en combinant l’imagerie par résonance magnétique fonctionnelle de repos (IRMfr) et les sites corticaux démasqués pendant la chirurgie, nous avons pu générer de véritables cartographies fonctionnelles du réseau cortical de la mentalisation, très similaires à celles observées en imagerie fonctionnelle classique.De façon générale, nos découvertes suggèrent que la mentalisation basée sur les visages reposerait sur l’intégrité d’au moins deux faisceaux associatifs de substance blanche. Elles permettent également de valider l’utilisation combinée de l’IRMfr et des stimulations corticales en tant qu’approche originale pour cartographier les réseaux neurocognitifs.En plus de ces considérations fondamentales, nos résultats ont des implications cliniques, notamment pour la cartographie fonctionnelle peropératoire. Ils permettent en outre de mieux comprendre les pathologies cérébrales caractérisées par un trouble de la mentalisation et une atteinte des voies de substance blancheMentalizing, or the ability of human beings to make assumptions about other people’s mental states, has been the subject of many studies over the last 20 years. The neural bases and especially the white matter connectivity of this complex cognitive function is still poorly understood. Recently, an anatomo-functional organization into two neural pathways has been proposed. According to this model, it is assumed that the reflective, inferential aspects of mentalizing is underpinned by the cingulum. The reflexive, identificatory aspects of mentalizing are thought to be mediated, for their part, by the arcuate fascicle and the lateral part of the superior longitudinal fascicle. The main purpose of this scientific work is to provide original data on the anatomo-functional organization of the neural network involved in the face-based mentalizing. We used as a pathophysiological study model diffuse low-grade gliomas. These primary brain tumors are particularly interesting for the study of the functional role of the white matter for two reasons: (i) the tumor cells propagate preferentially along the white matter fibers; (ii) the surgical resection is often performed in awake condition with intraoperative functional mapping to identify, and thus to preserve functional structures, including the white matter.In our first study, using intraoperative electrical stimulation, we were able to identify a large cortico-subcortical mentalizing network. The analysis of the disconnections induced by the stimulation of the white matter allowed us to clearly highlight, for the first time, the role of the inferior fronto-occipital fascicle. We also confirmed the already established role of the superior longitudinal fascicle in mentalizing. In a second study, using lesion mapping analyses in patients operated on for a diffuse low-grade glioma, we demonstrated that the long-term, non-compensatory mentalizing deficit was explained by the involvement of the arcuate fascicle. Finally, in a third study combining resting-state functional MRI and the cortical sites unmasked during surgery, we were able to identify a large cortical mentalizing networks, which were very similar to those identified by classical task-based functional imaging.In general, our findings suggest that the face-based mentalizing would require the integrity of at least two associative white matter fascicles. They also validate the combined use of resting-state functional MRI and direct cortical stimulations as an original approach to map neurocognitive networks.In addition to these fundamental considerations, our results have also clinical implications, especially regarding the intraoperative functional mapping. They also provide a better understanding of brain pathologies characterized by both mentalizing deficit and white matter impairment
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Harrow, Stephen. "A phase 1 trial of the herpes simplex virus HSV1716 in patients with high grade glioma plus an in vitro investigation of the interaction between HSV1716 and ionising radiation." Thesis, University of Glasgow, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.437921.
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Aura, Karine. "Protocole d'évaluation du langage fondé sur le traitement de fonctions prosodiques : étude exploratoire de deux patients atteints de gliomes de bas grade en contexte péri-opératoire." Phd thesis, Université Toulouse le Mirail - Toulouse II, 2012. http://tel.archives-ouvertes.fr/tel-00798667.
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Notre étude est dédiée au développement d'un protocole d'évaluation du langage à visée clinique. Nous examinons les spécificités du traitement du langage oral à travers le filtre des fonctions langagières actualisées par la prosodie. Système composite par excellence, largement négligé tant dans l'étude du traitement du langage que dans les évaluations orthophoniques, la prosodie est cependant en étroite relation avec les composantes du langage et réalise par ce biais l'ensemble des fonctions structurantes du langage. Deux fonctions linguistiques de la prosodie sont ici testées en compréhension : une fonction syntaxique, sous-tendue par le marquage accentuel des frontières de syntagmes réalisé par un accent final et un accent initial, et une fonction pragmatique impliquant la fonction de focalisation initiée par un accent emphatique. Après avoir procédé à la normalisation de notre protocole auprès d'un groupe de sujets contrôles, notre évaluation a été intégrée à la prise en charge longitudinale de deux patients atteints de gliomes de grade II. Dans ce cadre spécifique, nous avons adapté nos épreuves au contexte de la chirurgie éveillée. Les capacités langagières des patients ont été testées en condition pré-opératoire afin d'observer l'impact cognitif de la tumeur et en condition post-opératoire afin d'évaluer les conséquences de l'exérèse. Les résultats soulèvent des questionnements concernant la spécialisation hémisphérique de la prosodie. Ils ont aussi permis de mesurer la sensibilité de notre protocole. L'étude exploratoire réalisée en condition peri-opératoire nous a permis de soulever les contraintes inhérentes à la méthode de stimulation électrique directe.
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Nguyen, Thanh Thao [Verfasser], and Irina [Akademischer Betreuer] Mader. "Functional MRI and DTI fiber tracking in patients with gliomas = Funktionelle MRT und DTI Fiber Tracking bei Patienten mit Gliomen." Freiburg : Universität, 2011. http://d-nb.info/1123461236/34.
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Lourenço, Blandine. "Monitorage des paramètres pressionnels et vasculaires cochléaires au moyen du potentiel microphonique cochléaire : Étude chez le patient." Thesis, Université Clermont Auvergne (2017-2020), 2017. http://www.theses.fr/2017CLFAS004/document.
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Les dernières années ont laissé place à de nombreuses avancées médicales, montrant de plus en plus d’intérêt à l’amélioration des modalités de soin et du cadre de vie des patients, en apportant plus d’efficacité et moins de risque. Dans ce contexte, trois études de recherche clinique ont été menées avec le potentiel microphonique cochléaire (PMC) pour évaluer les capacités de cette réponse cochléaire dans des applications médicales originales et proposer des outils de surveillance de grand intérêt pour la prise en charge des patients. La première étude s’est intéressée à la survenue de surdités suite aux exérèses de neurinome de l’acoustique, notamment les pertes auditives d’origine vasculaire. L’amplitude du PMC a détecté tous les événements chirurgicaux responsables de l’altération de la vascularisation cochléaire et a ainsi fourni une meilleure compréhension de l’origine des pertes auditives lors des chirurgies dans l’angle pontocérébelleux. Les deux autres études ont porté sur la fiabilité d’un monitorage non invasif de la pression intracrânienne (PIC) par la phase du PMC sur une longue période de suivi, chez des patients pour lesquels il est attendu une variation de la PIC. Le PMC a montré une bonne capacité à détecter les variations de la PIC au cours du temps, aussi bien lors d’une installation lente d’une PIC élevée (progression de gliome malin) que lors de l’apparition transitoire et aiguë d’une PIC augmentée (hypertension intracrânienne, hydrocéphalie).Plusieurs observations parfois inattendues ont été obtenues avec le PMC et ouvrent de nouvelles pistes d’intérêt et de réflexion sur les mécanismes de fonctionnement de la PIC ou de la cochlée. Parmi elles : une répercussion épisodique de l’embolisation des anévrysmes cérébraux sur la PIC, l’aptitude de la phase du PMC à prédire la survenue prochaine d’une crise de Menière et la possible prédiction préopératoire d’une fragilité cochléaire au fraisage du conduit auditif interne quand le signal IRM des fluides cochléaires du côté affecté (par le neurinome de l’acoustique) est hypointenseThe last years, healthcare and living conditions of patients have been of growing interest in medical advances with the goal to bring more efficiency and less risk. In this context, three clinical researches have been conducted with cochlear microphonic potential (CMP) to assess the abilities of this cochlear response in unusual medical applications and propose monitoring tools of major interests for patients’ management.The first study is interested in the occurrence of deafness following vestibular schwannoma resection, in particular hearing loss due to vascular origin. The CMP amplitude detected all the surgical events responsible for the alteration of the cochlear vascularization and thus provided a better understanding of the origin of the hearing losses during surgeries in the cerebellopontine angle.The other two studies examined the reliability of non-invasive intracranial pressure (ICP) monitoring, by the CMP phase, over a long period to follow patients for whom a change in ICP is expected. The CMP has shown good ability to detect changes in ICP over time, both in a slow installation of a high ICP (progression of malignant glioma) and in the transient and acute onset of increased ICP (intracranial hypertension, hydrocephalus).Several observations, sometimes unexpected, have been obtained with the CMP and open up new track of interest and reflections on the mechanisms of ICP and cochlea functioning. These discoveries included: episodic repercussion of cerebral aneurysm embolization on ICP, ability of CMP phase to predict the next occurrence of a Meniere crisis, and preoperative prediction of cochlear fragility during the drilling of the internal auditory meatus when the MRI signal of the cochlear fluids on the affected side (vestibular schwannoma) is hypointense
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RAVEAU, CHOPLAIN VERONIQUE. "Criteres d'admission des patients atteints de gliomes en unites de soins palliatifs." Lyon 1, 1991. http://www.theses.fr/1991LYO1M250.
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Knappitsch, Markus [Verfasser], and Christina [Akademischer Betreuer] Surulescu. "Patient specific multiscale modelling of glioma growth / Markus Knappitsch ; Betreuer: Christina Surulescu." Münster : Universitäts- und Landesbibliothek Münster, 2014. http://d-nb.info/1138282928/34.
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Stretton, Erin. "Simulation de modèles personnalisés de gliomes pour la planification de thérapies." Thesis, Paris, ENMP, 2014. http://www.theses.fr/2014ENMP0064/document.
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Les modèles de croissance tumorale fondés sur l'équation de réaction-diffusion Fisher Kolmogorov FK ont montré des résultats probants dans la reproduction et la prédiction de l'invasion de cellules tumorales du cerveau pour les gliomes. Nous utilisons différentes formulations du modèle FK pour évaluer la nécessité de l’imagerie de diffusion pour construire des modèles spécifiques de Gliomes de Bas Grade GBG, l'étude de l'infiltration de cellules tumorales après une résection chirurgicale de la tumeur, et définir une métrique pour quantifier l’évolution de GBG. L'imagerie en tenseur de diffusion ITD a été suggérée pour modéliser la diffusion anisotrope des cellules tumorales dans la matière blanche du cerveau. Les ITD acquises en basse résolution impactent la précision des résultats des modèles de croissance. Nous utilisons une formulation FK pour décrire l'évolution de la frontière visible de la tumeur pour étudier l'impact du remplacement de l'ITD patient par une hypothèse de diffusion isotrope ou une ITD de référence anisotrope en haute résolution formée par la moyenne des ITD de plusieurs patients. Nous quantifions l'impact du remplacement de l'ITD acquise sur un patient à aide de simulations de croissance tumorales synthétiques et des prévisions d'évolution de la tumeur d'un cas clinique. Cette étude suggère que la modélisation de la croissance du gliome à base de motilité différentielle de tissus donne des résultats un peu moins précis qu'à l'aide d'une ITD. S'abstenir d'utiliser une ITD serait suffisant lors de la modélisation de GBG. Par conséquent, toutes ces options d'ITD sont valides dans une formulation FK pour modéliser la croissance de GBG dans le but d'aider les cliniciens dans la planification du traitement. Après la résection d’une tumeur cérébrale, ils veulent savoir quel serait le meilleur traitement de suivi pour chaque patient : une chimiothérapie pour des tumeurs diffuses ou bien une deuxième résection après un laps de temps donné pour les tumeurs massives. Nous proposons une méthode pour tirer profit de modèles de croissance de gliome FK sur les cas post-opératoires montrant des distorsions du cerveau pour estimer l'infiltration des cellules tumorales au-delà des frontières visibles dans les IRM FLAIR. Notre méthode répond à 2 défis de modélisation : celui du mouvement du parenchyme cérébral après la chirurgie avec une technique de recalage non-linéaire et celui de la segmentation incomplète de la tumeur post-opératoire en combinant 2 cartes d'infiltration : une ayant été simulée à partir d'une image pré-opératoire et l’autre à partir d'une image post-opératoire. Nous avons utilisé les données de 2 patients ayant des GBG afin de démontrer l'efficacité de la méthode. Celle-ci pourrait aider les cliniciens à anticiper la récurrence de la tumeur après une résection et à caractériser l’étendue de l'infiltration non visible par la radiologie pour planifier la thérapie. Pour les GBG visibles par une IRM FLAIR/T2, il y a un débat important au sein du groupe de travail RANO Response Assessment in Neuro-Oncology sur la sélection d'un seuil pertinent des métriques basées sur l’évolution de la taille de la tumeur pour déterminer si la maladie est évolutive ME. Nous proposons une approche pour évaluer la ME du GBG en utilisant des estimations de la vitesse de croissance de la tumeur à partir d'une formulation FK qui prend en compte les irrégularités de forme de la tumeur, les différences de vitesse de croissance entre la matière grise et la matière blanche, et les changements volumétriques. En utilisant les IRM FLAIR de 9 patients, nous comparons les estimations de ME de notre approche proposée avec celles calculées en utilisant les estimations manuelles de la vitesse de croissance tumorale 1D, 2D et 3D et celles calculées en utilisant un ensemble de critères basés sur la taille critères RECIST, Macdonald et RANO. Notre approche est prometteuse pour évaluer la ME du GBG à partir d'un nombre limité d'examens par IRMTumor growth models based on the Fisher Kolmogorov (FK) reaction-diffusion equation have shown convincing results in reproducing and predicting the invasion patterns of glioma brain tumors. In this thesis we use different FK model formulations to i) assess the need of patient-specific DTIs when modeling LGGs, ii) study cancer cell infiltration after tumor resections, and iii) define a metric to determine progressive disease for low-grade glimoas (LGG).Diffusion tensor images (DTIs) have been suggested to model the anisotropic diffusion of tumor cells in brain white matter. However, patient specific DTIs are expensive and often acquired with low resolution, which compromises the accuracy of the tumor growth models' results. We used a FK formulation to describe the evolution of the visible boundary of the tumor to investigate the impact of replacing the patient DTI by i) an isotropic diffusion map or ii) an anisotropic high-resolution DTI atlas formed by averaging the DTIs of multiple patients. We quantify the impact of replacing the patient DTI using synthetic tumor growth simulations and tumor evolution predictions on a clinical case. This study suggests that modeling glioma growth with tissue based differential motility (not using a DTI) yields slightly less accurate results than using a DTI. However, refraining from using a DTI would be sufficient in situations when modeling LGGs. Therefore, any of these DTI options are valid to use in a FK formulation to model LGG growth with the purpose of aiding clinicians in therapy planning.After a brain resection medical professionals want to know what the best type of follow-up treatment would be for a particular patient, i.e., chemotherapy for diffuse tumors or a second resection after a given amount of time for bulky tumors. We propose a thorough method to leverage FK reaction-diffusion glioma growth models on post-operative cases showing brain distortions to estimate tumor cell infiltration beyond the visible boundaries in FLAIR MRIs. Our method addresses two modeling challenges: i) the challenge of brain parenchyma movement after surgery with a non-linear registration technique and ii) the challenge of incomplete post-operative tumor segmentations by combining two infiltration maps, where one was simulated from a pre-operative image and one estimated from a post-operative image. We used the data of two patients with LGG to demonstrate the effectiveness of the proposed three-step method. We believe that our proposed method could help clinicians anticipate tumor regrowth after a resection and better characterize the radiological non-visible infiltrative extent of a tumor to plan therapy.For LGGs captured on FLAIR/T2 MRIs, there is a substantial amount debate on selecting a definite threshold for size-based metrics to determine progressive disease (PD) and it is still an open item for the Response Assessment in Neuro-Oncology (RANO) Working Group. We propose an approach to assess PD of LGG using tumor growth speed estimates from a FK formulation that takes into consideration irregularities in tumor shape, differences in growth speed between gray matter and white matter, and volumetric changes. Using the FLAIR MRIs of nine patients we compare the PD estimates of our proposed approach to i) the ones calculated using 1D, 2D, and 3D manual tumor growth speed estimates and ii) the ones calculated using a set of well-established size-based criteria (RECIST, Macdonald, and RANO). We conclude from our comparison results that our proposed approach is promising for assessing PD of LGG from a limited number of MRI scans. It is our hope that this model's tumor growth speed estimates could one day be used as another parameter in clinical therapy planning
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Touat, Mahdi. "Mécanismes et implications thérapeutiques de l'hypermutation dans les gliomes Mechanisms and Therapeutic Implications of Hypermutation in Gliomas Mismatch Repair Deficiency in High-Grade Meningioma: A Rare but Recurrent Event Associated With Dramatic Immune Activation and Clinical Response to PD-1 Blockade Buparlisib in Patients With Recurrent Glioblastoma Harboring Phosphatidylinositol 3-Kinase Pathway Activation: An Open-Label, Multicenter, Multi-Arm, Phase II Trial Hyman DM. BRAF Inhibition in BRAFV600-Mutant Gliomas: Results From the VE-BASKET Study Glioblastoma Targeted Therapy: Updated Approaches From Recent Biology Successful Targeting of an ATG7-RAF1 Gene Fusion in Anaplastic Pleomorphic Xanthoastrocytoma With Leptomeningeal Dissemination Ivosidenib in IDH1-Mutated Advanced Glioma." Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASL071.
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Une élévation majeure de la charge mutationnelle (hypermutation) est observée dans certains gliomes. Néanmoins, les mécanismes de ce phénomène et ses implications thérapeutiques notamment concernant la réponse à la chimiothérapie ou à l'immunothérapie sont encore mal connus. Sur le plan du mécanisme, une association entre hypermutation et mutations des gènes de la voie de réparation des mésappariements de l'ADN (MMR) a été rapportée dans les gliomes, cependant la plupart des mutations MMR observées dans ce contexte n'étaient pas fonctionnellement caractérisées, et leur rôle dans le développement d’hypermutation restait de ce fait incertain. De plus, l'impact de l'hypermutation sur l'immunogénicité des cellules gliales et sur leur sensibilité au blocage des points de contrôles immunitaires (par exemple par traitement anti-PD-1) n’est pas connu. Dans cette étude, nous analysons de manière exhaustive les déterminants cliniques et moléculaires de la charge et des signatures mutationnelle dans 10 294 gliomes, dont 558 (5,4%) tumeurs hypermutées. Nous identifions deux principales voies responsables d'hypermutation dans les gliomes : une voie "de novo" associée à des déficits constitutionnels du système MMR et de la polymérase epsilon (POLE), ainsi qu'une voie "post-traitement", plus fréquente, associée à l'acquisition de déficits MMR et de résistance secondaire dans les gliomes récidivant après chimiothérapie par temozolomide. Expérimentalement, la signature mutationnelle des gliomes hypermutés post-traitement (signature COSMIC 11) était reproduite par les dommages induits par le témozolomide dans les cellules MMR déficientes. Alors que le déficit MMR s'associe à l'acquisition de résistance au témozolomide, des données cliniques et expérimentales suggèrent que les cellules MMR déficientes conservent une sensibilité à la nitrosourée lomustine. De façon inattendue, les gliomes MMR déficients présentaient des caractéristiques uniques, notamment l'absence d'infiltrats lymphocytaires T marqués, une hétérogénéité intratumorale importante, une survie diminuée ainsi qu’un faible taux de réponse aux traitements anti-PD-1. De plus, alors que l'instabilité des microsatellites n'etait pas détectée par des analyses en bulk dans les gliomes MMR déficients, le séquençage du génome entier à l'échelle de la cellule unique de gliome hypermuté post-traitement permettait de démontrer la presence de mutations des microsatellites. Collectivement, ces résultats supportent un modèle dans lequel des spécificités dans le profil mutationnel des gliomes hypermutés pourraient expliquer l’absence de reconnaissance par le système immunitaire ainsi que l’absence de réponse aux traitements par anti-PD-1 dans les gliomes MMR déficients. Nos données suggèrent un changement de pratique selon lequel la recherche d’hypermutation par séquençage tumoral lors de la récidive après traitement pourrait informer le pronostic et guider la prise en charge thérapeutique des patientsHigh tumor mutational burden (hypermutation) is observed in some gliomas; however, the mechanisms by which hypermutation develops and whether it predicts chemotherapy or immunotherapy response are poorly understood. Mechanistically, an association between hypermutation and mutations in the DNA mismatch-repair (MMR) genes has been reported in gliomas, but most MMR mutations observed in this context were not functionally characterized, and their role in causing hypermutation remains unclear. Furthermore, whether hypermutation enhances tumor immunogenicity and renders gliomas responsive to immune checkpoint blockade (e.g. PD-1 blockade) is not known. Here, we comprehensively analyze the clinical and molecular determinants of mutational burden and signatures in 10,294 gliomas, including 558 (5.4%) hypermutated tumors. We delineate two main pathways to hypermutation: a de novo pathway associated with constitutional defects in DNA polymerase and MMR genes, and a more common, post-treatment pathway, associated with acquired resistance driven by MMR defects in chemotherapy-sensitive gliomas recurring after temozolomide. Experimentally, the mutational signature of post-treatment hypermutated gliomas (COSMIC signature 11) was recapitulated by temozolomide-induced damage in MMR-deficient cells. While MMR deficiency was associated with acquired temozolomide resistance in glioma models, clinical and experimental evidence suggest that MMR-deficient cells retain sensitivity to the chloroethylating nitrosourea lomustine. MMR-deficient gliomas exhibited unique features including the lack of prominent T-cell infiltrates, extensive intratumoral heterogeneity, poor survival and low response rate to PD-1 blockade. Moreover, while microsatellite instability in MMR-deficient gliomas was not detected by bulk analyses, single-cell whole-genome sequencing of post-treatment hypermutated glioma cells demonstrated microsatellite mutations. Collectively, these results support a model where differences in the mutation landscape and antigen clonality of MMR-deficient gliomas relative to other MMR-deficient cancers may explain the lack of both immune recognition and response to PD-1 blockade in gliomas. Our data suggest a change in practice whereby tumor re-sequencing at relapse to identify progression and hypermutation could inform prognosis and guide therapeutic management
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Tellier, Anaïs. "Fonctions cognitives de patients atteints d'un gliome de haut grade avant tout traitement." Mémoire, Université de Sherbrooke, 2016. http://hdl.handle.net/11143/9539.
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En plus d’être associé à une espérance de vie précaire, les gliomes de haut grade (GHG) s’accompagnent de déficits cognitifs ayant le potentiel d’avoir un impact majeur sur la qualité de vie. Il demeure une compréhension limitée de l’étendue et de la nature des déficits cognitifs des patients en début de parcours de soins, de l’effet de la tumeur elle-même sur les fonctions cognitives tout comme de son lien avec la qualité de vie. L’objectif général de la présente étude était d’effectuer une évaluation cognitive de patients atteints de GHG avant tout traitement afin de décrire leur profil cognitif. Plus précisément, on visait à décrire l’étendue et la nature des déficits cognitifs des patients et explorer la relation entre les fonctions cognitives des patients et les caractéristiques tumorales (volume tumoral et de l’atteinte parenchymateuse) et le niveau de qualité de vie. Une seconde partie de l’étude visait à explorer l’utilité du Montreal Cognitive Assessment (MOCA), un test de dépistage, pour détecter des déficits cognitifs chez des patients atteints d’un GHG. Une étude descriptive transversale exploratoire, comportant un échantillon de 14 patients atteints de GHG nouvellement diagnostiqués et recrutés au Centre Hospitalier Universitaire de Sherbrooke, a été conduite. Les évaluations cognitives ont été effectuées à l’aide d’une batterie de six tests neuropsychologiques et du MOCA. Les volumes tumoraux provenant des imageries par résonance magnétique ont été obtenus grâce à une méthode volumétrique rigoureuse alors que la qualité de vie a été évaluée à l’aide du Sherbrooke Neuro-oncology Assessment Scale. Les résultats ont démontré que des déficits cognitifs sont bien présents en début de parcours de soins chez ces patients. En ce qui à trait aux caractéristiques tumorales, notre étude n’a pu démontrer de corrélation entre les déficits cognitifs et le volume tumoral, soulevant la possibilité d’une absence de lien entre ces deux variables. L’atteinte parenchymateuse créée par la tumeur corrèle avec un test d’évaluation de la vitesse de traitement de l’information (⍴ = -0,784, p = 0,01). Il semblerait par ailleurs que les fonctions cognitives ne soit pas corrélées avec le niveau de qualité de vie. Finalement, le MOCA semble être un outil prometteur pour l’évaluation cognitive des patients présentant des GHG, alors qu’il semble présenter une valeur prédictive positive satisfaisante malgré une sensibilité plus modeste.
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Becker, Juliane [Verfasser]. "Establishing valid neuropsychological assessments in patients with gliomas undergoing awake surgery / Juliane Becker." Kiel : Universitätsbibliothek Kiel, 2017. http://d-nb.info/1130656659/34.
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Salander, Pär. "Qualities in the short life : psychological studies relevant to patient and spouse in malignant glioma." Doctoral thesis, Umeå universitet, Onkologi, 1996. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96905.
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This thesis deals with psychological issues concerning patients with malignant gliomas, and their spouses. There is no known medical cure, and the patients have a limited survival expectancy. Therefore studies evaluating new treatment modes, an overall supportive atmosphere, and attempts to avoid imposing unnessesary strain are necessary. Thirty consecutive patients with astrocytomas, grade III-IV, were included in a clinical trial with estramustine phosphate in addition to conventional treatment with surgery and radiotherapy. Both the patients and their spouses participated in the present study which aimed at a deeper understanding of the psychological processes relevant to their situation. By means of repeated thematically structured interviews, patients and spouses were followed separately during the entire course of the disease process. In addition to these interviews, all patients were assessed with a mini-mental examination, and five-month survivors were tested with a comprehensive neuropsychological battery. Questionnaires on reaction to the diagnosis and assessing psychosocial well-being were also administered to the patients. The interviews were analysed with grounded theory methodology and the findings were juxtaposed to concepts in psychoanalysis and coping theory. The main finding was that the patients, despite or owing to their severe medical situations, showed a marked capacity to create protection and hope. By means of biased perception they created an 'illusion' that palliated their strain. This finding is related to object-relational psychoanalysis with obvious implications for the crucial discussion on telling bad news. Another finding was that the spouses displayed different crisis trajectories depending on the overall status of their partners. Different senses of the relationship were related to different modes of coping. Especially spouses to patients with personality changes were put under severe strain and ought to be acknowledged by medical staff. Patients with no obvious deficits five months after termination of primary treatment nevertheless evidenced, at neuropsychological testing, a pronounced deficiancy in long-term memory, but no clear impairment in global intellectual capacities. Estramustine phosphate was found to have a negative impact on sexuality and might be one causative agent behind the decline in long-term memory, but these adversive effects did not seem to affect psychosocial well-being. The selective reminding technique proved to be sensitive in detecting deficits and is recommended in future clinical trials affecting the CNS.Diss. (sammanfattning) Umeå : Umeå universitet, 1996, härtill 5 uppsatser.
digitalisering@umu
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Alaraj, Mimoza, and Emma Andreasson. "Information och stöd till vuxna med gliom och deras anhöriga." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-25434.
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Alaraj, M & Andréasson, E. Information och stöd till vuxna med gliom och deras anhöriga. Examensarbete i omvårdnad 15 högskolepoäng. Malmö högskola: Fa-kulteten för Hälsa och Samhälle, Institutionen för vårdvetenskap, 2012.Gliom är en allvarlig tumörsjukdom där möjligheten till tillfrisknande är be-gränsad. Sjukdomen har en djup inverkan både på patient och anhöriga i var-dagen. Information och stöd är omvårdnadsåtgärder som kan påverka patient och närstående att hantera sin situation och öka deras välbefinnande. Syftet med den här systematiska litteraturstudien var att beskriva de behov av information och stöd som patienter med gliom och deras anhöriga upplever. Metoden var en sys-tematisk litteraturstudie där medicinska och omvårdnadsdatabaser genomsöktes. Resultatet bygger på tretton bearbetade kvalitativa studier. Två huvudkategorier och sju subkategorier framkom efter analysen. Resultatet visade att information och stöd var viktigt för både patienter och anhöriga under hela sjukdomsförloppet. Behoven skiljde sig åt under sjukdomsprogressen och både patienter och anhöriga uttryckte ett behov av individuell anpassning av dessa åtgärder. Information och stödåtgärder vid insjuknande, diagnos och kirurgi var betydelsefullt. Stöd att han-tera rollförändringar och existentiella frågor upplevdes också som viktigt. Slutsat-ser: Rätt information och rätt stödåtgärder bidrar till att patient och anhöriga får möjlighet att bibehålla hoppet och finna mening i den emotionellt stressande situ-ationen. Nyckelord: Anhörig, Gliom, Information, Patient, Stöd, TravelbeeAlaraj, M & Andréasson, E. Information and support for adults with Glioma and their relatives. Degree Project, 15 credits. Malmo University: Faculty of Health and Society, School of Health Sciences, 2012.Glioma is a serious malignancy where the possibility of recovery is limited. The disease has a profound impact on both the patient and family in everyday life. Information and support are nursing interventions that may affect the patient and families cope with their situation and improve their wellbeing. The aim of this systematic literature review was to describe the needs for information and support that patients with glioma and their caregivers are experiencing. The method was a systematic literature review in which medical and nursing databases were searched. The results were based on thirteen processed qualitative studies. Two major categories and seven sub-themes emerged after the analysis. The results showed that information and support measures were demanded by both patients and families throughout the course of the disease. The needs differed during the disease trajectory and both patients and families expressed a need for individual adaptation of these measures. Information and support operations at the onset and at diagnosis and surgery were valuable. Support to cope with existential issues and role of changes were also seen as important. Conclusions: The right information and the right support interventions contribute to patient and relatives are able to maintain hope and find meaning in the emotionally stressful situation.Keywords: Family, Glioma, Information, Patient, Support, Travelbee
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Chinot, Olivier. "Gliomes malins : etude retrospective des patients traites de 1980 a 1988 avec chimiotherapie selon le protocole vm26-belustine." Aix-Marseille 2, 1992. http://www.theses.fr/1992AIX20816.
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Graubner, Sebastian. "Klinischer Verlauf und Analyse des Rezidivmusters von 111 Patienten mit anaplastischem Astrozytom oder Glioblastoma multiforme nach Operation und lokaler Strahlentherapie." Doctoral thesis, [S.l.] : [s.n.], 2005. http://deposit.ddb.de/cgi-bin/dokserv?idn=975294784.
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BAZILLE-BORNEQUE, ANNE. "I. R. M des gliomes cerebraux, correlation anatomo-pathologique : a propos de 14 patients biopsies en condition stereotaxique." Lille 2, 1989. http://www.theses.fr/1989LIL2M294.
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Ekström, Linda, and Lena Hultgren. "Upplevelser av symtom och livskvalité hos patienter med maligna gliom : litteraturöversikt." Thesis, Sophiahemmet Högskola, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2676.
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Maligna hjärntumörer delas in i primära eller sekundära hjärntumörer. Primära hjärntumörer drabbar cirka 1300 personer varje år och ungefär hälften av dessa hjärntumörer hos vuxna är gliom. Gliomen kan därefter delas in i olika undergrupper beroende på om de är låg- eller högmaligna utifrån hur aggressiva de är. Kirurgi är den viktigaste behandlingsmetoden vid de flesta hjärntumörer där syftet är att försöka ta bort så mycket som möjligt av tumören. Andra viktiga behandlingsmetoder är strålbehandling och cytostatika. Tumören i sig och/eller behandlingen kan ge symtom som kan ha påverkan på livskvalitén. Syftet var att belysa hur patienter med maligna gliom upplever sina symtom och sin livskvalitet. Metoden som valdes var litteraturöversikt. Artiklarna valdes utifrån författarnas syfte och frågeställning. Sökning av vetenskapliga artiklar gjordes i databaserna PubMed och CINAHL. De artiklar som valdes ut var publicerade mellan åren 2006 - 2017. Artiklarna sammanställdes och presenterades i en matris. Resultatet visade att patienter med stort fysiskt hjälpbehov kan skatta sin livskvalité lägre och att funktionell status kan skapa osäkerhet om sjukdom, symtom, behandling och prognos. Det fanns samband mellan mental trötthet, kognitiva och emotionella svårigheter samt låg skattning av övergripande hälsorelaterad livskvalité. Studierna visade att patienter med maligna gliom upplevde lägre livskvalitet än den friska befolkningen. Trötthet var det svåraste symtomet att hantera och tröttheten påverkade patientens psykiska, fysiska och sociala liv. Patienter som kände hoppfullhet hade högre livskvalitet. Vårdpersonal kan hjälpa patienten att upprätthålla känslan av hopp genom sin stödjande relation till patienten. På så vis kan patientens förmåga att hantera lidande öka.
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Goranci-Buzhala, Gladiola [Verfasser], Mrika [Gutachter] Uhlirova, Bernhard [Gutachter] Schermer, and Jay [Gutachter] Gopalakrishnan. "Characterization of primary cilia in patient-derived glioma stem cells / Gladiola Goranci-Buzhala ; Gutachter: Mrika Uhlirova, Bernhard Schermer, Jay Gopalakrishnan." Köln : Universitäts- und Stadtbibliothek Köln, 2020. http://d-nb.info/1220422703/34.
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Hopkins, K. "The feasibility and toxicity of direct intratumoral injections of yttrium-90 ('9'0Y) radioimmunoconjugates in the treatment of patients with malignant gliomas." Thesis, University of Bristol, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337623.
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Freitag, Benjamin [Verfasser], Matthias [Gutachter] Eyrich, and Mario [Gutachter] Löhr. "Prognostischer Einfluss der systemischen Immunsuppression bei Patienten mit hochgradigem Gliom / Benjamin Freitag ; Gutachter: Matthias Eyrich, Mario Löhr." Würzburg : Universität Würzburg, 2018. http://d-nb.info/1166054853/34.
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Rolhion, Christine. "Etude de l'expression de genes impliques dans l'agressivite et la chimioresistance des gliomes humains : relation avec les caracteristiques anatomo-cliniques des patients (doctorat : biologie cellulaire et moleculaire)." Clermont-Ferrand 1, 1999. http://www.theses.fr/1999CLF1MM06.
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Pietschmann, Sophie. "Charakteristika, Therapie und Prognose von Patienten mit metastasierten WHO Grad IV Gliomen - Eine Metaanalyse individueller Patientendaten." Doctoral thesis, Universitätsbibliothek Leipzig, 2016. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-216728.
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Da hochgradige Gliome nur eine geringe Tendenz zur Metastasierung aufweisen, beschränkte sich das klinische Wissen über diesen seltenen Krankheitsverlauf bisher im Wesentlichen auf die Erkenntnisse aus Einzelfallberichten und kleineren Fallserien. Eine detaillierte Analyse der beschriebenen Fälle war bisher nicht verfügbar. Die vorliegende Arbeit stellt eine systematische Auswertung der wissenschaftlichen Literatur über Patienten mit metastasierten Glioblastomen oder Gliosarkomen dar. Unser Ziel war es, sämtliche Publikationen zu berücksichtigen, welche bis April 2013 veröffentlicht worden sind.
Mit Hilfe einer systematischen Literaturrecherche in den beiden Datenbanken PubMed und Web of Science konnten 215 Arbeiten identifiziert werden, welche insgesamt 357 Fallberichte enthielten.
Die Prognose nach Diagnose einer Metastasierung ist infaust. In der untersuchten Patientenkohorte betrug die mediane Überlebenszeit lediglich 3.0 ± 0.4 Monate. Eine univariate Datenanalyse ergab, dass Geschlecht, Alter, der histologische Subtyp und das Zeitintervall zwischen der Diagnose des Primärtumors und der Metastasen die Überlebenszeit nicht beeinflussten. Im Gegensatz dazu war eine Metastasierung, die ausschließlich außerhalb des zentralen Nervensystems (ZNS) auftrat, mit längeren Überlebenszeiten verbunden. In den letzten Jahrzehnten wurden offenbar keine entscheidenden therapeutischen Fortschritte erzielt. Fälle, die in Publikationen bis zum Jahr 2000 Erwähnung fanden, wiesen keine schlechteren Überlebenszeiten auf als die nach der Jahrtausendwende publizierten Fälle. Aktuell gibt es keinen Datensatz, der geeignet wäre, die vielfältigen Therapieansätze systematisch auf ihre Wirksamkeit hin zu überprüfen. Wir sehen hier die Notwendigkeit, ein zentrales Register zu etablieren.
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Bartz, Isabell [Verfasser]. "Nutzung von komplementären Therapien und unterstützende Maßnahmen von Patienten mit malignen Gliomen im klinischen Alltag / Isabell Bartz." Mainz : Universitätsbibliothek der Johannes Gutenberg-Universität Mainz, 2021. http://d-nb.info/1238223834/34.
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Nickel, Katrin [Verfasser]. "Einfluss des Resektionsausmaßes, der intraoperativen Bildgebung und der Wachoperationen auf die Lebensqualität von Patienten mit höhergradigen Gliomen / Katrin Nickel." Ulm : Universität Ulm, 2019. http://d-nb.info/1183099371/34.
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Pietschmann, Sophie [Verfasser], Rolf-Dieter [Akademischer Betreuer] Kortmann, Klaus [Akademischer Betreuer] Müller, Johannes [Gutachter] Lutterbach, and Jürgen [Gutachter] Meixensberger. "Charakteristika, Therapie und Prognose von Patienten mit metastasierten WHO Grad IV Gliomen - Eine Metaanalyse individueller Patientendaten : Charakteristika, Therapie und Prognose von Patienten mit metastasierten WHO Grad IV Gliomen-Eine Metaanalyse individueller Patientendaten / Sophie Pietschmann ; Gutachter: Johannes Lutterbach, Jürgen Meixensberger ; Rolf-Dieter Kortmann, Klaus Müller." Leipzig : Universitätsbibliothek Leipzig, 2016. http://d-nb.info/1240696353/34.
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Leroch, Barbara. "Erfassung der gesundheitsbezogenen Lebensqualität und kognitiver Funktionen bei erwachsenen Patienten mit supratentoriellen WHO GradII Gliomen: Erstmals vor und nach Therapie." Diss., lmu, 2006. http://nbn-resolving.de/urn:nbn:de:bvb:19-54822.
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Cuno, Peter Martin [Verfasser], D. [Akademischer Betreuer] Vordermark, Ch [Akademischer Betreuer] Strauß, and C. [Akademischer Betreuer] Petersen. "Osteopontin als Plasmamarker der Tumorhypoxie bei Patienten mit malignen Gliomen / Peter Martin Cuno. Betreuer: D. Vordermark ; Ch. Strauß ; C. Petersen." Halle, Saale : Universitäts- und Landesbibliothek Sachsen-Anhalt, 2013. http://d-nb.info/1047796414/34.
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Martens, Corentin. "Patient-Derived Tumour Growth Modelling from Multi-Parametric Analysis of Combined Dynamic PET/MR Data." Doctoral thesis, Universite Libre de Bruxelles, 2021. https://dipot.ulb.ac.be/dspace/bitstream/2013/320127/5/contratCM.pdf.
Full textAbstract:
Gliomas are the most common primary brain tumours and are associated with poor prognosis. Among them, diffuse gliomas – which include their most aggressive form glioblastoma (GBM) – are known to be highly infiltrative. The diagnosis and follow-up of gliomas rely on positron emission tomography (PET) and magnetic resonance imaging (MRI). However, these imaging techniques do not currently allow to assess the whole extent of such infiltrative tumours nor to anticipate their preferred invasion patterns, leading to sub-optimal treatment planning. Mathematical tumour growth modelling has been proposed to address this problem. Reaction-diffusion tumour growth models, which are probably the most commonly used for diffuse gliomas growth modelling, propose to capture the proliferation and migration of glioma cells by means of a partial differential equation. Although the potential of such models has been shown in many works for patient follow-up and therapy planning, only few limited clinical applications have seemed to emerge from these works. This thesis aims at revisiting reaction-diffusion tumour growth models using state-of-the-art medical imaging and data processing technologies, with the objective of integrating multi-parametric PET/MRI data to further personalise the model. Brain tissue segmentation on MR images is first addressed with the aim of defining a patient-specific domain to solve the model. A previously proposed method to derive a tumour cell diffusion tensor from the water diffusion tensor assessed by diffusion-tensor imaging (DTI) is then implemented to guide the anisotropic migration of tumour cells along white matter tracts. The use of dynamic [S-methyl-11C]methionine ([11C]MET) PET is also investigated to derive patient-specific proliferation potential maps for the model. These investigations lead to the development of a microscopic compartmental model for amino acid PET tracer transport in gliomas. Based on the compartmental model results, a novel methodology is proposed to extract parametric maps from dynamic [11C]MET PET data using principal component analysis (PCA). The problem of estimating the initial conditions of the model from MR images is then addressed by means of a translational MRI/histology study in a case of non-operated GBM. Numerical solving strategies based on the widely used finite difference and finite element methods are finally implemented and compared. All these developments are embedded within a common framework allowing to study glioma growth in silico and providing a solid basis for further research in this field. However, commonly accepted hypothesis relating the outlines of abnormalities visible on MRI to tumour cell density iso-contours have been invalidated by the translational study carried out, leaving opened the questions of the initialisation and the validation of the model. Furthermore, the analysis of the temporal evolution of real multi-treated glioma patients demonstrates the limitations of the formulated model. These latter statements highlight current obstacles to the clinical application of reaction-diffusion tumour growth models and pave the way to further improvements.Les gliomes sont les tumeurs cérébrales primitives les plus communes et sont associés à un mauvais pronostic. Parmi ces derniers, les gliomes diffus – qui incluent la forme la plus agressive, le glioblastome (GBM) – sont connus pour être hautement infiltrants. Le diagnostic et le suivi des gliomes s'appuient sur la tomographie par émission de positons (TEP) ainsi que l'imagerie par résonance magnétique (IRM). Cependant, ces techniques d'imagerie ne permettent actuellement pas d'évaluer l'étendue totale de tumeurs aussi infiltrantes ni d'anticiper leurs schémas d'invasion préférentiels, conduisant à une planification sous-optimale du traitement. La modélisation mathématique de la croissance tumorale a été proposée pour répondre à ce problème. Les modèles de croissance tumorale de type réaction-diffusion, qui sont probablement les plus communément utilisés pour la modélisation de la croissance des gliomes diffus, proposent de capturer la prolifération et la migration des cellules tumorales au moyen d'une équation aux dérivées partielles. Bien que le potentiel de tels modèles ait été démontré dans de nombreux travaux pour le suivi des patients et la planification de thérapies, seules quelques applications cliniques restreintes semblent avoir émergé de ces derniers. Ce travail de thèse a pour but de revisiter les modèles de croissance tumorale de type réaction-diffusion en utilisant des technologies de pointe en imagerie médicale et traitement de données, avec pour objectif d'y intégrer des données TEP/IRM multi-paramétriques pour personnaliser davantage le modèle. Le problème de la segmentation des tissus cérébraux dans les images IRM est d'abord adressé, avec pour but de définir un domaine propre au patient pour la résolution du modèle. Une méthode proposée précédemment permettant de dériver un tenseur de diffusion tumoral à partir du tenseur de diffusion de l'eau évalué par imagerie DTI a ensuite été implémentée afin de guider la migration anisotrope des cellules tumorales le long des fibres de matière blanche. L'utilisation de l'imagerie TEP dynamique à la [S-méthyl-11C]méthionine ([11C]MET) est également investiguée pour la génération de cartes de potentiel prolifératif propre au patient afin de nourrir le modèle. Ces investigations ont mené au développement d'un modèle compartimental pour le transport des traceurs TEP dérivés des acides aminés dans les gliomes. Sur base des résultats du modèle compartimental, une nouvelle méthodologie est proposée utilisant l'analyse en composantes principales pour extraire des cartes paramétriques à partir de données TEP dynamiques à la [11C]MET. Le problème de l'estimation des conditions initiales du modèle à partir d'images IRM est ensuite adressé par le biais d'une étude translationelle combinant IRM et histologie menée sur un cas de GBM non-opéré. Différentes stratégies de résolution numérique basées sur les méthodes des différences et éléments finis sont finalement implémentées et comparées. Tous ces développements sont embarqués dans un framework commun permettant d'étudier in silico la croissance des gliomes et fournissant une base solide pour de futures recherches dans le domaine. Cependant, certaines hypothèses communément admises reliant les délimitations des anormalités visibles en IRM à des iso-contours de densité de cellules tumorales ont été invalidée par l'étude translationelle menée, laissant ouverte les questions de l'initialisation et de la validation du modèle. Par ailleurs, l'analyse de l'évolution temporelle de cas réels de gliomes multi-traités démontre les limitations du modèle. Ces dernières affirmations mettent en évidence les obstacles actuels à l'application clinique de tels modèles et ouvrent la voie à de nouvelles possibilités d'amélioration.
Doctorat en Sciences de l'ingénieur et technologie
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Glimm, Anne-Marie [Verfasser]. "Analysis of distribution and severity of inflammation in patients with osteoarthritis and rheumatoid arthritis by ICG-enhanced fluorescence optical imaging and musculoskeletal ultrasound / Anne-Marie Glimm." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2017. http://d-nb.info/1139255304/34.
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Lanfroy, de Belly Rénald. "Clinique interactionnelle de la consultation d’annonce de diagnostic de cancer en neuro-oncologie : analyse critique des consultations d’annonce et post-annonce des gliomes malins de l’adulte." Thesis, Université de Lorraine, 2015. http://www.theses.fr/2015LORR0229/document.
Full textAbstract:
L'objectif de cette thèse est de décrire et comprendre les processus interactionnels qui gouvernent les consultations d'annonce de diagnostic de glioblastome par une équipe pluridisciplinaire à une personne adulte. Le glioblastome est une tumeur cérébrale grave qui engage le pronostic vital à court et moyen terme. L’annonce de son diagnostic constitue un acte interlocutoire fondateur dans le processus de soin qui va sceller une relation entre deux individus, un qui sait mais qui a du mal à dire, et l’autre qui veut savoir tout en redoutant de découvrir et comprendre une réalité sombre qui le concerne. Cette révélation faite au patient et à son entourage est un acte engageant pour celui qui annonce la mauvaise nouvelle, ce dernier ne pouvant se détacher ni des émotions qu’il va provoquer en l’autre ni des siennes propres. Pour ce travail de recherche, un dispositif original a été mis en place pour l’annonce du diagnostic faite à quatre patients entourés de leur famille et personne de confiance. Deux équipes de professionnels étaient composées de médecins, psychologue et infirmiers. Les analyses de quatre consultations d’annonce constituées chacune de cinq entretiens polylogiques ont mis en évidence les attentes parfois surprenantes des patients vis-à-vis des médecins quant à la manière d’annoncer, ainsi que les effets psychiques de cette annonce. Les stratégies discursives utilisées par les interlocuteurs en présence, dans une visée inconsciente probablement protectrice pour la plupart, sont également dévoilées et permettent de donner des repères précis, notamment en ce qui concerne la formation des médecins mais également des autres acteurs impliqués dans l’annonce de diagnosticThis thesis aims at describing and understanding the processes of interaction that are at stake during the announcement of the diagnosis of glioblastoma to an adult by a team encompassing various fields of action. Glioblastoma is a serious brain tumor that can be life-threatening in a short or mid- term. The announcement of the diagnosis is of paramount importance in the healing process that is going to seal a relationship between two persons, one who knows but who has some troubles telling it and another one who wants to know while fearing to discover and understand a dark reality about himself. This revelation that is said to the patient and his/her relatives is an engaging act for the person announcing the bad news, the latter being unable not to feel concerned with the impact of his words or to deny his own emotions. For this research, an original scheme was put into practice to announce this diagnosis to four patients who were surrounded by their families and friends. Two teams of professionals were composed of doctors, psychologists and nurses. The analyses, resulting from four consultations of announcement, each one constituted of five philological interviews, showcased the sometimes surprising expectations of the patients concerning the doctors as for their way of announcing as well as the psychic effects of this revelation. The discursive strategies used by the persons present, in an unconscious perspective and even protective for most of them, are also unveiled and enable to give thorough landmarks, especially about the training of the doctors but also the other actors involved in the announcement of the diagnosis