Neurologic clinics
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Patients with cancer commonly suffer neurologic disabilities. These neurologic disorders can be either metastatic to the brain, spinal cord, leptomeninges, or peripheral nerves or nonmetastatic including infections, vascular problems, metabolic abnormalities, side effects of therapy, or paraneoplastic syndromes. Careful diagnostic evaluation of patients with cancer and neurologic symptoms often indicates effective therapy.
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Recent progress in brain tumor biology research has helped us to understand the causes of our failure to improve patient survival with current therapeutic approaches. Present combination regimens of surgery, radiotherapy, and chemotherapy fail to address adequately two inherent biologic properties of brain tumors: tumor-induced host immunosuppression and tumor cell heterogeneity. Future success in immunotherapy will depend on our ability to dissect the mechanisms involved in tumor-host interactions. ⋯ As brain tumors evade immunosurveillance through active participation in inducing tumor-specific immunosuppression, successful immunotherapy, either passive serotherapy or active immunization, will be best achieved in patients with a slight or moderate immunosuppressive state. Alteration of immune status with various biologic response modifiers to boost host reactivity against tumors will be an important adjunct in our arsenal against brain tumors. IFNs, with their direct tumoricidal activity, and lymphokines (such as interleukin-2) may be such reagents with a promising future.
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Review Comparative Study
The episodic dyscontrol syndrome and aggression.
This article concerns the syndrome of episodic dyscontrol, not psychopathic behavior. It is discussed as a symptom of many disorders, both psychologic and physical; organic causes and correlates, pathophysiology, and pharmacologic treatment are given.
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The neuroradiologist and the clinician are partners in the search for pathology; the clinician must help the radiologist tailor the study by indicating where pathology is likely to be. The orbit, the sellar and parasellar regions, and new imaging modalities and interventional techniques are discussed in this light.