The study evaluates the usefulness of some commonly used screening investigations in the management of elderly acutely ill medical patients. It was performed on 50 consecutive admissions to one ward and all patients received a full blood count, ESR, urea and electrolyte estimation, liver function tests, thyroid function tests, examination of a mid-stream urine specimen and P-A chest X-ray examination. When performed in the absence of clinical indication these tests were considered to be screening tests. On assessing the tests performed prospectively, it was shown that only a full blood count, urea and electrolyte estimation, ward testing of urine, and, possibly, a P-A chest X-ray examination are worthwhile screening investigations in this patient population. The ESR and liver function tests and mid-stream urine specimens seem to be of little value in the absence of clinical indication.

Background/Aim: Gliomas present a uniquely challenging clinical situation in the context of pregnancy, with no standard recommendations. This case series aimed to describe the treatment regimen and outcomes of five pregnant patients with gliomas. Patients and Methods: This is a retrospective study. A patient database from electronic medical records was evaluated to identify pregnant patients with gliomas treated at our institution between 2008-2018. Results: Five study patients who were pregnant with gliomas were identified. Of these, 4 were diagnosed during pregnancy, while 1 was diagnosed prior to her pregnancy. One patient had grade 2 astrocytoma, 1 had grade 3 anaplastic astrocytoma, and 3 had grade 4 glioblastomas (GBM). All patients received surgery, and one patient received radiation therapy without concurrent chemotherapy during her pregnancy. All delivered healthy babies. Three of the 5 patients remain alive, and 2 of the 5 were progressionfree at the last follow-up. Conclusion: Treatment plans must be specifically tailored to the individual patient based on the glioma grade, the mother's desire to continue the pregnancy, and the risks of delaying treatment until after pregnancy. Additional studies need to be performed to definitively establish uniform guidelines for the treatment of pregnant patients with glioma.

Objective: To report three cases of refractory prolactinomas treated with Temozolomide (TMZ). Background: Prolactinomas account for 40% of pituitary adenomas. Dopamine agonists (DA) are the first line of treatment followed by surgical resection and radiation. TMZ is an oral chemotherapeutic agent used in gliomas, which has been given to patients with prolactinomas refractory to conventional treatments. Methods: Retrospective chart review was conducted for refractory prolactinoma patients treated between 2008 and 2018 at UT Southwestern Medical Center (UTSW). Three patients with refractory prolactinomas received oral TMZ at UTSW. Results: All three patients demonstrated improvement in symptoms upon TMZ treatment, markedly decreased serum prolactin levels (SPRL), as well as radiographic decrease in tumor size.

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Glioblastoma (GBM)-induced breakdown of the blood brain barrier is revealed by contrast enhancement (CE) on MRI and corresponds to the presence of bulk tumor tissue. However, vascular function in the CE area and the surrounding, non-enhancing (NE) area of infiltrating glioma cells is less defined. Resting-state BOLD (Blood Oxygen Level Dependent) fMRI has been shown to be sensitive to alterations in neurovascular coupling both within and outside the region of CE in GBM. However, the mechanism by which the tumor disrupts vascular control in these areas is not known. We hypothesize that the alterations in neurovascular coupling seen in GBM are due to the local effects of infiltrating glioma cells. To test this hypothesis, we took 25 radiographically-localized biopsies from CE (n=16) and NE (n=9) regions during open surgical resection of primary GBM in patients with preoperative resting-state BOLD fMRI. The BOLD scan was co-registered to the volumetric T1-weighted + gadolinium scan used for intraoperative stereotactic guidance and the BOLD signal intensity was calculated from a spherical region of interest (radius=2 mm) at each biopsy site. Cellularity of each sample was calculated by averaging cell counts from three high powered fields of highest cellularity on H&E stained sections. Linear robust regression was used to evaluate the relationship between mean signal intensity and cellularity. The BOLD signal intensity was positively correlated to tissue cellularity (correlation coefficient = 0.42, p<0.01), indicating that the neurovascular coupling mechanism is disrupted by local effects of glioma cells. Moreover, this result suggests that BOLD fMRI could serve as a clinically useful biomarker for glioma infiltration into non-contrast-enhancing brain regions.