The use of bevacizumab is increasingly reported in neuro-oncology. The most common schedule is 10 mg/kg every 2 weeks. We retrospectively investigated the efficacy of a 3-week schedule of 5 mg/kg bevacizumab in patients with recurrent glioblastomas. Fourteen patients (median age, 46 years) were included in the study. The median number of bevacizumab cycles was 4 (range, 2-8). Five patients (36%) had a partial response, 7 (50%) had stable disease, and 2 (14%) had progressive disease. No grade III-IV toxicities were observed. The median progression-free and overall survival were 3.6 months and 6.4 months, respectively. Every-3-week low-dose single-agent bevacizumab showed substantial activity and a safe profile in patients with recurrent glioblastoma.

Introduction:To investigate the efficacy of platinum-based chemotherapy in patients with recurrent high-grade glioma (HGG) who had received previous alkylating line of chemotherapy.Material and methods:Case notes of patients who had received chemotherapy with carboplatin or cysplatin for recurrent HGG between June 2006 and July 2012 were reviewed. Baseline characteristics and outcomes after treatment were recorded.Results:Forty-eight patients received carboplatin/cysplatin as second line chemotherapy for recurrent HGG (grade III n=6; grade IV n=42). The median number of cycles completed was 4. Fifteen patients (28%) had at least minor response, 22 (49%) had stable disease and 11 (23%) had progressive disease. Six month progression-free survival was 30% (52% in patients with grade III glioma and 18% in patients with grade IV glioma). The median time to disease progression from the first treatment with platinum drug was 3.2 months. The median survival was 8 months (10 months for patients with grade III glioma and 7 months for patients with grade IV glioma). Among patients with either stable disease or a partial response, the median survival was 12 months compared with 3 months in patients with progressive disease. No survival or response rate differences were noted regarding the type of previous chemotherapy, nitrosoureas or temozolomide.Conclusions:Single-agent carboplatin/cysplatin has modest activity in patients with recurrent HGG previously treated with one line of chemotherapy, nitrosoureas or temozolomide. Despite the improvement of median survival of patients achieving stable disease or a partial response to treatment, more effective regimens are required for this patient population.

Background: Shotgun injuries of the peripheral nerves are presented frequently during the last decades at the Service of Neurosurgery of UHC “Mother Theresa” in Tirana. In such cases the surgical repair of brachial plexus and peripheral nerves constitutes a challenge with relation to difficulties related with mechanism of injury, coexistence of other vascular damage, bone, soft tissue and visceral lesions. Materials and methods: A retrospective study of operated cases with shotgun injuries treated in our Department from 1997 to 2012 was conducted getting information from clinical charts, surgical registries, intraoperative photos and videos of the surgical repair of peripheral nerves. We performed a thorough analysis of the most influencing factors of surgical outcome such as: age, severity of injury, site of injury with relation to the innervated muscles, type of necessary nerve repair, presence of causalgia before operation, concomitant compromise of vascularization and/or locomotor apparatus. Follow-up of the patient was conducted through out-patient visits and phone interviews going back 10 years from surgical repair. Results: 68 cases operated for shotgun injury of brachial plexus or peripheral nerves were revised. There were different ages and both sexes involved. The type of nerve repair went from interfascicular neurolysis to direct end-to-end microsuture and nerve grafting. Timely repair of the nerve injury proved to be yielding better result than late repair in terms of pain relief and sensory motor improvement of the preoperative neurological deficit. The degree and the quality of improvement after surgery is related to the type of repair (neurolysis improves better and faster than grafting), the distance from site of injury to the effector muscle (the longer the distance more time it takes for the function to recover). The recovery of the brachial plexus was followed up for many years and further surgery proved to be necessary and of further improvement. Conclusions: From our long term experience dealing with surgical repair of shotgun injury of peripheral nerves we have learnt that early surgical repair is more efficacious in treating pain and gives better results in terms of motor and sensitive recovery than six months after injury as it was usually done. Long term follow-up is necessary to help with further surgery in case of distal decompressive surgery in anatomical tunnels.

The combination of BEV and CBDCA is associated with improved response rates and survival compared with CBDCA alone. These results highlight the value of BEV in recurrent GBM. However, the clinical benefit of this interesting approach needs validation in a larger patient cohort.

Traumatic injury of the peripheral nerves should be treated in specialized centres. This study presents the epidemiological data of 1368 consecutive patients operated for peripheral nerve injuries beside the Service of neurosurgery, Department of Neurosciences, UHC "Mother Theresa", Tirana. In order to obtain the necessary data for this study we revised the clinical records, surgical registers and pre, intra and postoperative photo/video of the cases operated for peripheral nervous system injuries. A data recording program of the surgery cases was built ad hoc, categorizing the cases according to several variables. The data collected from the operated cases were manually inserted to be processed by the program. Results of informatics elaboration of the data were obtained, reviewed and categorized by: age, gender, type of trauma, localization of injury and type of nerve repair. Future studies to be conducted in this field will focus in determining the level of nerve injury, time from the injury to intervention, distance from the site of trauma to the effector organ. The data will build necessary information for data mining, which based on these important factors that influence the result of nerve repair, will be useful for the prediction of the result in new patients harbouring peripheral nerve injury before undergoing surgery.