Meningiomas

neurological symptoms and deficits, requiring surgical removal. When patients were unable to undergo surgery because of their advanced age, failing health or "inoperable" tumor location, most were treated with radiation and/or not amenable to a long-term "natural" follow-up. Therefore, data on patients diagnosed with a meningioma that were followed clinically, without surgical or radiation treatment, have been very limited and mainly anecdotal.

Autopsy data have revealed that there are a significant number of meningiomas that remain asymptomatic and are undetected during life [3,4]. With recent advances and availability of neuroimaging, asymptomatic meningiomas have been increasingly diagnosed over the past two decades, providing an ample opportunity now to study and understand better the natural history of meningiomas. Patients with asymptomatic meningiomas may not, however, represent a cross-section of all meningioma patients because of a possible selection bias toward tumors that have an inherently more benign course. Nevertheless, important information that is currently unavailable may be derived from such studies. Olivero et al. reported 45 females and 15 males, aged 38-84, who were diagnosed with asymptomatic meningiomas. Forty-five of their patients underwent serial clinical and imaging follow-up. Thirty-five patients (78%) had no change in the tumor size (average follow-up 29 months; range 3-72 months), while 10 patients (22%) showed tumor growth (average follow-up 47 months; range 6 months to 15 years). Among the latter group, tumor growth ranged from 0.2 cm/180 months to 1.0 cm/12 months (average growth rate of 0.24 cm/year). Kuratsu et al. [15] reported on 196 asymptomatic meningiomas out of a total of 504 meningiomas diagnosed in a 6-year period. Sixty-three of the asymptomatic menin-giomas were followed conservatively with serial imaging studies. Two-thirds of their patients had no change in the tumor size (average follow-up 36.6 months; range 12-96 months), while one-third of them revealed tumor growth (average follow-up 27.8 months; range 12-87 months). Rates of tumor growth were not included in their report. Although the overall incidence of asymptomatic meningiomas was significantly higher among patients older than 70 years compared with younger patients, there were no significant differences in age, sex or initial tumor size between the group with meningiomas that progressed and the group that did not. Conclusions from both of these studies, in addition to the possible selection bias mentioned above, are certainly limited owing to the short length of follow-up. An update of these cohorts in future years is essential and will be more revealing.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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