RESUMO
Amyloid beta (Aß) aggregation and oxidative stress are two of the central events in Alzheimer's Disease (AD). Both these phenomena can be caused by the interaction of Aß with metal ions. In the last years the interaction between ZnII , CuII , and Aß was much studied, but between iron and Aß it is still little known. In this work we determine how three Aß peptides, present in AD, interact with FeIII -citrate. The three Aß peptides are: full length Aß1-42, an isoform truncated at Glutamic acid in position three, Aß3-42, and its pyroglutamated form AßpE3-42. Conformation and morphology of the three peptides, aggregated with and without FeIII -citrate were studied. Besides, we have determined the strength of the interactions Aß/FeIII -citrate studying the effect of ethylenediaminetetraacetic acid as chelator. Results reported here demonstrate that FeIII -citrate promotes the aggregation in all the three peptides. Moreover, Aspartic acid 1, Glutamic acid 3, and Tyrosine 10 have an important role in the coordination with iron, generating a more stable complex for Aß1-42 compared to that for the truncated peptides.
Assuntos
Peptídeos beta-Amiloides/química , Compostos Férricos/farmacologia , Peptídeos beta-Amiloides/ultraestrutura , Benzotiazóis , Dicroísmo Circular , Ferro/farmacologia , Quelantes de Ferro/farmacologia , Transição de Fase , Espectrometria de Fluorescência , Tiazóis/metabolismo , Fatores de Tempo , Tirosina/químicaRESUMO
PURPOSE: The purpose of this study is to evaluate the kinematics changes of the knee after cutting of the ACL with or without injury of the anterolateral structures. METHODS: In this study, the role of the ACL and one of the secondary restraints in controlling knee stability using a navigation system was evaluated. The kinematics of the knee was evaluated in different conditions of instability: ACL intact, after dissection of the posterolateral (PL) bundle, after dissection of the anteromedial (AM) bundle, and after lesion of the lateral capsular ligament (LCL). Anterior tibial translation and rotation were measured with a computer navigation system in 10 fresh-frozen cadaveric knees by use of a manual maximum load. Anterior translation was evaluated at 30°, 60°, and 90° of flexion; rotation at 0°, 15°, 30°, 45°, 60°, and 90°. RESULTS: Cutting the PL bundle does not increase anterior translation and rotation of the knee. Cutting the AM bundle significantly increased the anteroposterior (AP) translation at 30° and 60° (P = 0.01), but does not increase rotation of the knee. Cutting the LCL increased anterior translation at 60° (P = 0.04) and rotation at 30°, 45°, and 60° (P = 0.03). CONCLUSIONS: Within the testing conditions of this study, the PL bundle does not affect anterior translation and rotation of the knee; the AM bundle is the primary restraint of the anterior translation but does not affect rotation of the knee while the lesion of the LCL increases tibial rotation and could be related to the pivot shift phenomenon, so it is more correct and biomechanical valid to assess and repair the associated lesion of the antero-lateral structure of the knee at the time of ACL surgery.
Assuntos
Lesões do Ligamento Cruzado Anterior , Instabilidade Articular/fisiopatologia , Traumatismos do Joelho/fisiopatologia , Ligamentos Articulares/lesões , Idoso , Idoso de 80 Anos ou mais , Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Ligamentos Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento ArticularRESUMO
AIM: Different surgical approaches are used in total hip arthroplasty. The present study confronted two surgical techniques, analysing functional recovery in terms of activities of daily living, and ambulation using gait analysis, after a standardized rehabilitation protocol. Our hypothesis was that the increased surgical damage could modify the gait pattern and functional recovery. METHODS: Thirty patients were randomly assigned to two homogeneous groups: Group A was treated with intermuscular minimally invasive surgery (MIS); Group B was treated with standard lateral transmuscular approach. Follow up was planned at 30 and 90 days. Instrumental evaluation using gait analysis and functional evaluation using validated scales were performed at follow up. RESULTS: No differences could be found as for functional scales. At the first follow up, the MIS approach proved to be the most favourable: data showed a longer duration of the swing phase, an improved range of motion of the non-treated hip, a reduced adduction (all P<0.005) and a correct timing of activation of the gluteus medium muscle on the treated side. At the second evaluation, gait analysis demonstrated some benefits of the intermuscular approach (a better flexion of both hips, and a minor obliquity of the pelvis during the terminal stance), but also advantages in the transmuscular group (better hip extension). CONCLUSION: Gait pattern after THA seems to be strictly dependent on surgical access and on the extent and location of surgical damage. It appears important to consider these elements in order to correctly manage the rehabilitation treatment after surgery.
Assuntos
Artroplastia de Quadril/reabilitação , Marcha/fisiologia , Complicações Pós-Operatórias/reabilitação , Recuperação de Função Fisiológica , Atividades Cotidianas , Artroplastia de Quadril/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Avaliação de Processos e Resultados em Cuidados de Saúde , CaminhadaRESUMO
BACKGROUND: A number of anterior cruciate ligament (ACL) fixation techniques are currently in use. Slippage or failure of the graft by excessive loading or aggressive rehabilitation may result in an unstable knee. Load and slippage of the ACL graft varies according to the fixation technique used. METHODS: Graft slippage, load to failure, and stiffness were evaluated using an animal model. Six soft tissue ACL fixation techniques and bone cement as a fixation device were tested: group A, Endo Button CL-Bio RCI; group B, Swing Bridge-Evolgate; group C, Rigidfix-Intrafix; group D, Bone Mulch-Washer Lock; group E, Transfix-Retroscrew; group F, Transfix-Deltascrew; group G, Kryptonite bone cement. Maximum failure load, stiffness, and slippage at the 1st and 1000th cycles and mode of failure were evaluated. RESULTS: The maximum failure load was significantly higher in group B (1030 N) and significantly lower in group E (483 N) than in the others. The stiffness of group B (270 N/mm) was significantly higher than the others. As for the mode of failure, group C showed failure in the femoral side in all tests (four device ruptures and two tendon ruptures on the femoral side). All failures of the other groups occurred on the tibial side except one test in group A. All failures in group G were due to slippage of the tendons. CONCLUSION: Load to failure and stiffness was significantly different between the ACL fixation techniques. All but one of the fixation techniques showed sufficient properties for adequate postoperative rehabilitation. Bone cement used as a fixation device in soft tissue grafts did not seem to provide adequate initial fixation suitable for early rehabilitation after ACL reconstruction.
Assuntos
Ligamento Cruzado Anterior/cirurgia , Parafusos Ósseos , Análise de Falha de Equipamento , Procedimentos Ortopédicos/efeitos adversos , Âncoras de Sutura , Tendões/transplante , Animais , Lesões do Ligamento Cruzado Anterior , Modelos Animais de Doenças , Sus scrofaRESUMO
Minimally invasive surgery has become a trend over the last few years in all aspects of orthopaedic surgery, including total hip arthroplasty. So-called mini-incision techniques involve limiting the length of the skin incision to 10 cm with use of either an anterior, lateral or posterior approach. Between March 2004 and December 2005 one hundred consecutive unilateral total hip replacements were performed by the same senior surgeon in our institute. All patients were randomly assigned to study group (group A) or control group (group B). In group A (50 patients) the skin incision was 8 cm; in group B (50 patients) the skin incision was standard (about 12-14 cm). Patient demographic data, including sex, age, height, weight, BMI, diagnosis and preoperative Harris hip score were recorded. Other criteria evaluated included the perioperative and postoperative complications, the surgical time, the blood loss, the length of the incision, the acetabular and stem positions, the length of hospital stay, Harris Hip Score (HHS) and the WOMAC osteoarthritis index at six months. No significant differences were found between the groups with respect to the average surgical time, the acetabular and stem position, the length of hospital stay and the Harris Hip Score (HHS) and the WOMAC osteoarthritis index at six months. A significant lower blood loss was found in the mini-incision group. A higher percentage of peri-operative complications was recorded in Group A (two stupor of sciatic nerve and one fracture of the greater trochanter). On the basis of our experience we could speculate that minimally invasive surgery should be directed to the new surgical approach with muscle sparing, instead of a shorter skin incision using standard approaches.
RESUMO
The transition of prion protein from a mainly alpha-structured isoform (PrPC) to a beta sheet-containing protein (PrPSc) represents a major pathogenetic mechanism in prion diseases. To study the role of PrP structural conformation in prion-dependent neurodegeneration, we analysed the neurotoxicity of PrP in alpha and beta conformations, using a recombinant protein encompassing amino acids 90-231 of the human PrP (hPrP90-231). Using controlled thermal denaturation (53 degrees C, 1h) we converted hPrP90-231 in a structural isoform displaying PrPSc-related characteristics: high beta sheet content, increased aggregability and a slight increase in the resistance to protease K. In virtue of these structural changes, hPrP90-231 powerfully affected the survival of SH-SY5Y cells, inducing a caspase-3 and p38- dependent apoptosis. Conversely, in the native alpha-helix-rich conformation, hPrP90-231 did not show significant cell toxicity. The relationship between the structural state of hPrP90-231 and its neurotoxicity was demonstrated, inducing the thermal denaturation of the peptide in the presence of Congo red that prevented both the transition of hPrP90-231 into a beta-rich isoform and the acquisition of toxic properties. In conclusion, we report that the toxicity of hPrP90-231 is dependent on its three-dimensional structure, as is supposed to occur for the pathogen PrP during TSE.
Assuntos
Apoptose/efeitos dos fármacos , Proteínas PrPC/química , Proteínas PrPC/farmacologia , Amiloide/biossíntese , Benzotiazóis , Caspase 3 , Caspase 7 , Caspases/metabolismo , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Dicroísmo Circular , Endopeptidase K/química , Corantes Fluorescentes , Humanos , Hidrólise , Immunoblotting , L-Lactato Desidrogenase/metabolismo , Microscopia Eletrônica , Necrose , Conformação Proteica , Desnaturação Proteica , Estrutura Secundária de Proteína , Proteínas Recombinantes/química , Proteínas Recombinantes/farmacologia , Relação Estrutura-Atividade , Sais de Tetrazólio , Tiazóis/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismoAssuntos
Biomarcadores Tumorais/genética , Neoplasias da Mama/patologia , Queratinas/genética , Células Neoplásicas Circulantes , RNA Mensageiro/genética , Axila , Biomarcadores Tumorais/metabolismo , Neoplasias da Mama/genética , Neoplasias da Mama/metabolismo , Feminino , Humanos , Queratinas/metabolismo , Prognóstico , RNA Mensageiro/metabolismo , Biópsia de Linfonodo SentinelaRESUMO
Our work is focused in the broad area of strategies and efforts to inhibit protein-protein interactions. The possible strategies in this field are definitely much more varied than in the case of ATP-pocket inhibitors. In our previous work (10), we reported that a retro-inverso (RI) form of Helix1 (H1) of c-Myc, linked to an RI-internalization sequence arising from the third alpha-helix of Antennapedia (Int) was endowed with an antiproliferative and proapoptotic activity toward the cancer cell lines MCF-7 and HCT-116. The activity apparently was dependent upon the presence of the Myc motif. In this work, by ala-scan mapping of the H1 portion of our molecules with D-aa, we found two amino acids necessary for antiproliferative activity: D-Lys in 4 and D-Arg in 5 (numbers refer to L-forms). In the natural hetero-dimer, these two side chains project to the outside of the four alpha-helix bundle. Moreover, we were able to obtain three peptides more active than the original lead. They strongly reduced cell proliferation and survival (RI-Int-VV-H1-E2A,S6A,F8A; RI-Int-VV-H1-S6A,F8A,R11A; RI-Int-VV-H1-S6A,F8A,Q13A): after 8 days at 10 muM total cell number was approximately 1% of the number of cells initially seeded. In these more potent molecules, the ablated side chains project to the inside in the corresponding natural four alpha-helix bundle. In the present work, we also investigated the behavior of our molecules at the biochemical level. Using both a circular dichroism (CD) and a fluorescence anisotropy approach, we noted that side chains projecting at the interior of the four alpha-helix bundle are needed for inducing the partial unfolding of Myc-H2, without an opening of the leucine zipper. Side chains projecting at the outside are not required for this biochemical effect. However, antiproliferative activity had the opposite requirements: side chains projecting at the outside of the bundle were essential, and, on the contrary, ablation of one side chain at a time projecting at the inside increased rather than decreased biological activity. We conclude that our active molecules probably interfere at the level of a protein-protein interaction between Myc-Max and a third protein of the transcription complex. Finally, CD and nuclear magnetic resonance (NMR) data, plus dynamic simulations, suggest a prevalent random coil conformation of the H1 portion of our molecules, at least in diluted solutions. The introduction of a kink (substitution with proline in positions 5 or 7) led to an important reduction of biological activity. We have also synthesized a longer peptido-mimetic molecule (RI-Int-H1-S6A,F8A-loop-H2) with the intent of obtaining a wider zone of interaction and a stronger interference at the level of the higher-order structure (enhanceosome). RI-Int-H1-S6A,F8A-loop-H2 was less active rather than more active in respect to RI-Int-VV-H1-S6A,F8A, apparently because it has a clear bent to form a beta-sheet (CD and NMR data).
Assuntos
Peptídeos/farmacologia , Estrutura Secundária de Proteína , Proteínas Proto-Oncogênicas c-myc/química , Sequência de Aminoácidos , Apoptose , Fatores de Transcrição de Zíper de Leucina Básica/química , Neoplasias da Mama , Divisão Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Dicroísmo Circular , Neoplasias do Colo , Dimerização , Estabilidade de Medicamentos , Fluoresceína , Polarização de Fluorescência , Corantes Fluorescentes , Temperatura Alta , Humanos , Espectroscopia de Ressonância Magnética , Dados de Sequência Molecular , Peptídeos/síntese química , Peptídeos/química , Desnaturação Proteica , Proteínas Proto-Oncogênicas c-myc/análise , Rodaminas/química , Relação Estrutura-AtividadeRESUMO
Based on its ability to inhibit the tyrosine kinase activity of ABL, as well as the c-kit and the Platelet Derived Growth Factor Receptor tyrosine kinases, the spectrum of diseases that may respond to STI571 is increasing. A recently recognized subgroup of myeloproliferative disorders/myelodysplastic syndromes (MPD/MDS) has a t(5;12)(q33;p13) with the activation of the gene for PDGFBR which encodes a receptor tyrosine kinase. Here, we present the case of a patient, with MPD/MDS, and eosinophilia, carrying a translocation t(5;12)(q33;p13) who achieved a complete remission following treatment with STI571, 400 mg daily. At the time of writing he still remains in complete remission with an excellent performance status. There is clearly a need for further studies of STI 571in MPD/MDS with chromosomal translocations involving PDGFBR to confirm this promising initial result.
Assuntos
Antineoplásicos/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Leucemia Mielomonocítica Crônica/tratamento farmacológico , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Receptor beta de Fator de Crescimento Derivado de Plaquetas/genética , Idoso , Benzamidas , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Humanos , Mesilato de Imatinib , Leucemia Mielomonocítica Crônica/diagnóstico , Masculino , Síndromes Mielodisplásicas/diagnóstico , Síndromes Mielodisplásicas/tratamento farmacológico , Transtornos Mieloproliferativos/diagnóstico , Transtornos Mieloproliferativos/tratamento farmacológico , Receptor beta de Fator de Crescimento Derivado de Plaquetas/antagonistas & inibidores , Translocação GenéticaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Mieloma Múltiplo/tratamento farmacológico , Terapia de Salvação/métodos , Talidomida/uso terapêutico , Antineoplásicos/uso terapêutico , Dexametasona , Doxorrubicina , Mobilização de Células-Tronco Hematopoéticas/métodos , Humanos , Melfalan/uso terapêutico , Mieloma Múltiplo/terapia , VincristinaRESUMO
OBJECTIVE: Pituitary adenomas rarely occur in childhood and adolescence, but their mass effect and endocrine abnormalities can compromise both quality and length of life. In this study we evaluated the symptoms at onset and the long-term consequences induced in teenagers by functioning or nonfunctioning pituitary adenomas. DESIGN AND PATIENTS: Clinical, biochemical and neuroradiological data of 44 young patients (12 males and 32 females, aged 16.3 +/- 1.9 years at diagnosis) with pituitary adenomas were evaluated retrospectively at baseline and after therapy. Patients underwent surgery, radiotherapy and/or medical treatment depending on clinical history and endocrine secretion of the tumour. Follow-up ranged from 8 to 252 months (median 55 months). MEASUREMENTS: Baseline and dynamic pituitary function were evaluated in all cases at diagnosis and after treatments. Magnetic resonance imaging (MRI) or computed tomography (CT) scan were performed before therapy and during follow-up. Hormone levels were measured using commercial radioimmunologic or immunoradiometric methods. RESULTS: Pituitary macroadenomas (group 1) or microadenomas (group 2) were found in 61% and 39% of cases, respectively. Overall, 68% were PRL-secreting, 7% GH-secreting, 5% ACTH-secreting and 20% nonfunctioning. The most frequent symptoms at onset were oligoamenorrhoea (62%) and galactorrhoea (59%) in the girls, and headache (58%) in the boys. Pubertal development was delayed in 12/27 (44%) cases with macroadenoma. Growth failure was observed in 4/44 (9%) patients (3 in group 1 and 1 in group 2). At diagnosis, hypopituitarism was detected in 10/27 (37%) patients with macroadenoma. Surgery alone cured 4/18 (22%) and 4/9 (44%) patients in group 1 and group 2, respectively. Adjuvant therapies (second surgery and/or radiotherapy and/or medical treatment) cured the disease in 2/13 (15%) patients with macroadenoma and allowed a persistent normalization in other 4/13 (31%) and 2/4 (50%) cases in group 1 and group 2, respectively. Medical treatment alone cured 2/9 (22%) patients with PRL-secreting macroadenoma and normalized PRL levels in another six (66%) with macroprolactinoma and in 2/7 (28%) patients with microprolactinoma. CONCLUSION: Delay of growth was rarely observed in teenagers with pituitary adenomas. At the onset of the disease, many girls complained of oligoamenorrhoea and galactorrhoea, while headache and delay of pubertal development were the symptoms more frequently referred by boys. Surgery alone was effective in a minority of patients and adjuvant therapies were helpful to obtain the remission of the disease in many cases. In patients with PRL-secreting pituitary adenoma, medical treatment, both as first choice or as adjuvant therapy, normalizes serum PRL levels in 14/27 (52%) cases.
Assuntos
Adenoma/fisiopatologia , Neoplasias Hipofisárias/fisiopatologia , Adenoma/complicações , Adenoma/diagnóstico , Adolescente , Hormônio Adrenocorticotrópico/metabolismo , Adulto , Criança , Feminino , Hormônio do Crescimento/metabolismo , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Distúrbios Menstruais/etiologia , Testes de Função Hipofisária , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/complicações , Prolactinoma/diagnóstico , Prolactinoma/fisiopatologia , Puberdade Tardia/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XAssuntos
Inibidores da Angiogênese/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Talidomida/uso terapêutico , Fatores de Crescimento Endotelial/sangue , Fator 2 de Crescimento de Fibroblastos/sangue , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Linfocinas/sangue , Recidiva , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio VascularAssuntos
Inibidores da Angiogênese/efeitos adversos , Pé Diabético/etiologia , Mieloma Múltiplo/tratamento farmacológico , Talidomida/efeitos adversos , Inibidores da Angiogênese/uso terapêutico , Circulação Colateral/efeitos dos fármacos , Terapia Combinada , Diabetes Mellitus Tipo 1/complicações , Pé Diabético/induzido quimicamente , Neuropatias Diabéticas/fisiopatologia , Fatores de Crescimento Endotelial/fisiologia , Feminino , Pé/irrigação sanguínea , Transplante de Células-Tronco Hematopoéticas , Humanos , Isquemia/induzido quimicamente , Linfocinas/fisiologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/terapia , Recidiva , Terapia de Salvação , Talidomida/uso terapêutico , Trombofilia/induzido quimicamente , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio VascularAssuntos
Antimetabólitos Antineoplásicos/toxicidade , Fluoruracila/toxicidade , Leucemia Mieloide Aguda/induzido quimicamente , Síndromes Mielodisplásicas/induzido quimicamente , Quimioterapia Adjuvante/efeitos adversos , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Humanos , Segunda Neoplasia Primária/induzido quimicamenteRESUMO
PURPOSE: to determine whether the QOLIE-10, an abbreviated quality of life questionnaire, provides results similar to the more detailed QOLIE-31 instrument when the ten items are derived from the QOLIE-31. METHODS: the QOLIE-31 was completed by 246 patients participating in UCB protocol N132 at baseline and after 18 weeks of treatment with levetiracetam (LEV 1000 or 3000 mg) or placebo added to standard therapy. QOLIE-10 components and total scores were calculated from the QOLIE-31 data. RESULTS: baseline QOLIE-10 components and total score correlated highly with corresponding QOLIE-31 scores, both at baseline and follow-up (range 0.70-0.95). Changes from baseline to follow-up were significantly different (ANCOVA) among treatment groups for both the QOLIE-10 and QOLIE-31 for the total score (P = 0.02, P = 0.009, respectively), seizure worry (P = 0.005, P = 0.0003) and cognitive functioning (P = 0.01, P = 0.01). One subscale (overall QOL) showed significant change with the QOLIE-31 (P = 0.04), but not with the QOLIE-10 (P = 0.07). Differences in QOLIE-10 scores were found between responders (> or = 50% partial onset seizure reduction) and non-responders for the total score (P = 0.0001) and two components (overall QOL P = 0.002, social function P = 0.0003). In the QOLIE-31, the total score and six subscale scores (all except medication effects) were significantly different. Both instruments were able to detect change over time. Responsiveness assessed by effect sizes (- 0.1 for non-responders, 0.4 for responders, 0.8 for seizure-free patients) and the Guyatt statistic (0.1, 0.6 and 1.0, respectively) was similar for both instruments. CONCLUSIONS: although the QOLIE-10 was designed as a screening tool, it can be scored and used in research. The total score did discern differences among treatments in a clinical trial. Nonetheless, questionnaires with multiple, multi-item subscales provide more detailed information than abbreviated forms. The QOLIE-31 is preferred where time and resources are available.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsias Parciais/tratamento farmacológico , Epilepsias Parciais/psicologia , Piracetam/análogos & derivados , Qualidade de Vida , Adolescente , Adulto , Idoso , Análise de Variância , Ansiedade , Quimioterapia Combinada , Emoções , Seguimentos , Humanos , Levetiracetam , Pessoa de Meia-Idade , Piracetam/uso terapêutico , Placebos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: "Central neurocytoma" is classically considered as an intraventricular benign tumor, largely based on data from small retrospective series. The authors present prospective data on 12 patients with tumors diagnosed as central neurocytoma, to highlight the diverse nature of this tumor and challenge the classic notion. METHODS: Between 1991 and 1997, 12 patients had tumors diagnosed prospectively as "central neurocytoma". Clinical, radiologic, and histologic data were collected, and Karnofsky performance score was evaluated for each patient. Proliferation marker studies were performed using Ki-67 labeling index. RESULTS: In two patients, the tumors were located in atypical locations, namely, the parietal lobe and the spine. Aggressive behavior characterized by clinical and radiologic evidence of tumor progression was noted in two additional patients. In both these cases, unusually high proliferation rates of 5.3% and 11.2% were noted. Total excision of the tumor, when possible, was the treatment of choice. Postoperative radiotherapy to the residual tumor may be of benefit in patients with clinically aggressive tumors, or those with high proliferation rates. CONCLUSIONS: Given the findings of this study, it is suggested that the traditional concept of central neurocytoma as a benign intraventricular tumor warrants reconsideration.
Assuntos
Neoplasias Encefálicas/diagnóstico , Neurocitoma/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Adolescente , Adulto , Agressão , Neoplasias Encefálicas/etiologia , Criança , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Imageamento por Ressonância Magnética , Masculino , Microscopia , Pessoa de Meia-Idade , Neurocitoma/metabolismo , Neurocitoma/fisiopatologia , Neurocitoma/cirurgia , Lobo Parietal/patologia , Estudos Prospectivos , Neoplasias da Coluna Vertebral/etiologia , Coluna Vertebral/patologiaRESUMO
PURPOSE: To evaluate the short-term effect of levetiracetam (LEV; UCB L059) as add-on therapy on health-related quality of life in the treatment of refractory partial-onset seizures. METHODS: Patients were enrolled in protocol UCB N132 if they had >/=12 partial-onset seizures with or without secondary generalization during the 12-week baseline period with a minimum of two seizures every 4 weeks. Randomization was made to placebo, LEV 1,000 mg, or LEV 3,000 mg, with sample size based on seizure frequency reduction. The 31-item Quality of Life in Epilepsy (QOLIE-31) questionnaire was completed by 246 patients at the end of baseline and at 18-week follow-up, or earlier if withdrawn. RESULTS: Significant differences were found among the three treatment groups for Seizure Worry (p = 0. 0003), Overall Quality of Life (p = 0.04), and Cognitive Functioning domains (p = 0.01), as well as the Total Score (p = 0.009). Responders (>/=50% partial onset seizure reduction) had significant improvements in all areas, except Medication Effect, compared with nonresponders (all p > 0.006). Clinically noticeable improvement (>/=10% change from baseline to follow-up) was perceived by LEV 3, 000 mg responders in all areas, except Emotional Well-Being, by LEV 1,000 mg responders in 5 of 9 areas, and by placebo responders in 2 of 9 areas. CONCLUSIONS: Addition of LEV to standard medication seems to have a positive impact on health-related quality of life, particularly among responders in this short-term study. These exploratory analyses require additional studies to evaluate long-term changes in a larger population.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsias Parciais/tratamento farmacológico , Indicadores Básicos de Saúde , Piracetam/análogos & derivados , Qualidade de Vida , Adulto , Anticonvulsivantes/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada , Epilepsias Parciais/diagnóstico , Epilepsias Parciais/psicologia , Feminino , Seguimentos , Humanos , Levetiracetam , Masculino , Piracetam/efeitos adversos , Piracetam/uso terapêutico , Placebos , Perfil de Impacto da Doença , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Microdysgenesis is a microscopic cortical malformation reported to occur with varying incidence in surgical lobectomies from patients with temporal lobe epilepsy (TLE). It may act as a substrate for the seizures. Four patients are reported with TLE, hippocampal sclerosis and cortical microdysgenesis which was also characterized by the presence of abnormal myelinated fibres running tangentially in the superficial cortical laminae and closely associated with abnormal clusters of neurones. Similar abnormal cortical fibres have been described in other malformations of cortical development including polymicrogyria and focal cortical dysplasia and it is therefore likely that these fibres represent part of the microdysgenetic malformation not hitherto reported. The possibility is discussed that they may also be of functional significance in terms of influencing local seizure propagation and the secondary cortical neuronal loss observed, predominantly affecting layer II. Studies of calbindin interneuronal populations showed preservation of these cells in the microdysgenetic cortex, when compared with non-malformed temporal lobes, despite an overall reduction in cortical neuronal density. In addition, prominent numbers of neurogliaform calbindin-positive nerve cells were observed in the microdysgenesis cases and the nature of these cells is speculated upon.