Psychiatric symptoms are frequent in idiopathic intracranial hypertension patients.

Idiopathic intracranial hypertension (IIH) is a rare disease with an incidence rate of 0.5-2.0/100,000/year. Characteristic symptoms are headache and several degrees of visual impairment. Psychiatric symptoms in association with IIH are usually poorly described and underestimated. In this study, we evaluated IIH subjects to determine the association with psychiatric symptoms. We evaluated thirty consecutive patients with IIH submitted to neurosurgery from January 2017 to January 2020 in two Brazilian tertiary hospitals. They underwent clinical evaluation, obtaining medical history, comorbidities, body mass index (BMI-kg/m2), and applying Neuropsychiatric Inventory Questionnaire (NPI-Q). There were 28 females and 2 males. Ages ranged from 18 to 66 years old, with mean age of 37.97 ± 12.78. Twenty-five (83%) presented comorbidities, being obese and having arterial hypertension the most frequent. Body mass index ranged from 25 to 35 kg/m2 and mean value was 31 ± 3.42. After application of Neuropsychiatric Interview, 26 of 30 presented psychiatric symptoms (86%). Depression-anxiety syndromes were reported in 25 patients (83%). Nighttime disturbances were reported by 14 subjects (46%). Appetite and eating disorders were described by 23 (76%). Psychiatric symptoms in association with IIH are usually poorly described and underestimated. In our sample, twenty-six out of 30 (86%) reported psychiatric symptoms. We highlight the high prevalence of psychiatric symptoms among IIH patients and the need of managing these patients with a multidisciplinary team, including psychiatrists.

Long term follow-up of shunted idiopathic normal pressure hydrocephalus patients: a single center experience.

Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence and enlarged ventricular system due to disturbance of cerebrospinal fluid (CSF). This study aims to describe the long-term experience with patients with iNPH submitted to ventriculoperitoneal shunt (VPS) with the programmable valve STRATA® (Medtronic). We prospectively selected a cohort of patients with a diagnosis of iNPH from January 2010 to April 2013 in a Brazilian tertiary hospital. All patients underwent clinical evaluation, which consists of the Mini-Mental State Examination and Time Up and Go tests and the application of Japanese Scale for Idiopathic Normal Pressure Hydrocephalus in three stages: prior to the TT, 3 h after the TT and 72 h after the TT. Fifty patients were submitted to VPS and followed. There were 32 men and 18 women. Mean age was 77.1 with standard deviation of 10.9. Follow-up time ranged from 96 to 120 months, with mean of 106 months. After 1 year of follow-up, 42 (83%) patients presented with clinical improvement, decreasing to 62% of patients at mid-term follow-up and 38% of patients at late follow-up. Complications occurred in 18% of subjects, needing reoperation in 16%. Our results show relevant clinical impact of shunting in iNPH patients, decreasing over time. Complications should not be underestimated, reaching up to 18% and demanding reoperation in 16% of cases. Thus, although much has been improved with current shunt technology, it is still important to consider the drawbacks of treatment.

Biological properties of cell wall mucopeptide of hemolytic streptococci.

Several of the toxic properties of streptococcal mucopeptide have been studied in detail. Intravenous injection of as little as 1 microg of mucopeptide, solubilized by ultrasonic treatment, elicits a reproducible febrile response. Rabbits which are made tolerant to Escherichia coli endotoxin are only partially tolerant to the subsequent injection of streptococcal mucopeptide. Soluble mucopeptide was successfully employed to prepare and provoke the localized Shwartzman reaction. Intravenous injection of 80 microg of solubilized mucopeptide leads to diffuse cellular infiltration as well as focal areas of myocardial necrosis, surrounded by inflammatory cells.

New approaches for the laboratory recognition of M types of group A streptococci.

The successful classification of Group A streptococci by the capillary precipitin technique requires a complete series of M type antisera which are sufficiently potent and specific to give unequivocal type-specific reactions with all the serotypes. Specific antisera for this purpose have been prepared by absorption with heterologous streptococci. Unabsorbed antisera have been employed here in the Ouchterlony double-diffusion agar-gel test to identify the M type of streptococci. Techniques have been developed for making this method of M typing fully reliable. The results reported here confirm and amplify the original findings of Michael and Massell (3). With crude HCl extracts and unabsorbed M type antisera, a precipitin line due to the M protein and another to the group-specific carbohydrate are the two major reactions observed. These reactions, however, are usually readily distinguishable. There was a surprising lack of cross-reactive precipitin lines due to non-type-specific protein antigens in the extracts. Although many of the unabsorbed M type antisera can be employed in the double-diffusion tests, the group-specific antibody must be removed from some of the unabsorbed antisera to avoid confusing cross-reactions. Absorption of these antibodies has been achieved by means of a specific immunoabsorbent column prepared from para-aminophenyl-beta-N-acetylglucosamine and cyanogen bromide-activated Sepharose. Excellent agreement was observed between the M typing results obtained on 117 field strains by the conventional capillary precipitin method and the Ouchterlony double-diffusion method.

Neurosurgical Residency Training in Latin America: Current Status, Challenges, and Future Opportunities.

BACKGROUND: This analysis provides an overview of neurosurgery residency programs in Latin America; it evaluates strengths, weaknesses, and limitations within the Latin American Federation for Societies in Neurosurgery countries. Considering the shared cultural background between these neighboring countries and globalization of neurosurgical education, similarities in training characteristics and equal opportunities are expected. However, program differences are inevitable and should be investigated to promote collaboration and homogenization of training. METHODS: A 39-item survey was distributed to 970 neurosurgeons and residents in Latin America to assess aspects including working conditions, teaching, research, training, educational opportunities, and socioeconomics. RESULTS: In total, 276 neurosurgeons (28%) from 16 countries completed the survey. The average participant's age was 37 ± 7 years, and the average duration of residency programs was 5 ± 1 years. Trainees participated in around 5-10 cases during the typical 80-100 work hour week. Only 5% of survey respondents had a day off after a night shift, and 60% worked at least 3 night shifts per week. Only 34% had a mentorship program, Morbidity and mortality conferences were reported by 57% and research activities were compulsory in 45%. Satisfaction with evaluation methods was reported in 29%, although 96% reported satisfaction with their training programs overall. CONCLUSIONS: This study is the first of its kind to review neurosurgical training in Latin America's. Suggested areas of improvement include regulation of working hours, implementation of mentorship programs and standardized examinations, protected research time, increased support for conferences, and more opportunities for exchange rotations that will potentially bolster collaboration between programs.

Natural history study of pseudoachondroplasia.

Pseudoachondroplasia (PSACH) is a well-characterized autosomal dominant dwarfing condition. A great deal of information is available about orthopedic complications, but little is known about extraskeletal complications in adulthood. This study was undertaken to delineate the natural history of PSACH at all ages. Seventy-nine individuals responded to an extensive questionnaire that included information about deformities, operations, general health, chronic diseases, and reproduction. PSACH individuals were ascertained through the University of Texas Medical Genetics patient population, a genetic linkage study, and the social organization, Little People of America. The results show that PSACH individuals with a family history do not have a distinct or more severe phenotype than new mutation cases. There were not differences in the number of orthopedic complications, operations, or number of offspring between these two groups. Less than half of affected adults reported having total hip replacement surgery, which was less common than previously reported. Extraskeletal complications were generally uncommon. There were four cases of cancers in 41 individuals queried. Premature osteoarthritis was the major health problem for PSACH individuals. PSACH individuals are generally healthy but have problems associated with debilitating osteoarthritis.

Gonadal mosaicism in pseudoachondroplasia.

We report on a family in which a brother and sister have pseudoachondroplasia and normal parents. The brother married a normal woman, and they have 2 daughters; one of them has typical changes of pseudoachondroplasia, the other is normal. The most likely explanation in this family is gonadal (germinal cell) mosaicism in one of the grandparents. Other reports of possible autosomal recessive pseudoachondroplasia are reviewed. It is likely that gonadal mosaicism is responsible for a small percentage of cases with what appears to be a new mutation for pseudoachondroplasia.

Mosaicism in pseudoachondroplasia.

Pseudoachondroplasia (PSACH) is a spondylo-epi-metaphyseal dysplasia characterized by disproportionate short stature, generalized ligamentous laxity, and precocious osteoarthritis. PSACH is caused by mutations in the cartilage oligomeric matrix protein (COMP) gene, which codes for a noncollagenous protein expressed in the territorial matrix of chondrocytes. Autosomal dominant inheritance has been demonstrated in many families; however, autosomal recessive inheritance has been suggested in some severe familial cases. Alternatively, germline/somatic mosaicism has been proposed and is credible, since it has been shown that dominantly inherited and sporadic cases of PSACH are caused by the same genetic defect. Here, we present evidence demonstrating somatic mosaicism in two PSACH families that were originally considered to represent autosomal recessive inheritance. The results of this study suggest that autosomal recessive inheritance is unlikely and all cases of PSACH should be studied for mutations in COMP.

Group A streptococcal strains in Kuwait: a nine-year prospective study of prevalence and associations.

During a period of 9 years (December, 1980, through November, 1989), 407 Group A streptococcal strains were isolated from 294 children with acute rheumatic fever and 303 of their family contacts, 234 children with acute post-streptococcal glomerulonephritis and 242 of their family contacts and 219 children with uncomplicated Group A streptococcal pharyngitis. Of the 407 strains 216 (53%) were M and/or serum opacity factor typable, 143 (35%) were only T typable and 48 (12%) were nontypable. Throughout the period of study the M12 and M1 were the most prevalent strains; however, important changes among the prevalent strains were observed. Although the study started in 1980 the serotypes M18, M81, M3, M15 and M58 made their first appearance 7 to 9 years later. These findings show the value of long term studies in detecting the changes in the prevalence of streptococcal strains in the community. M18 was isolated from three children with nephritis but not from children with rheumatic fever; this association has not been reported before. M12 was isolated from 26% of the nephritic children and their families vs. 7% from the rheumatic children and their families (P less than 0.05) vs. 17% from children with uncomplicated streptococcal pharyngitis. M49 was isolated from 7% of the nephritic children and their families vs. none from rheumatic children and their families vs. 1.4% from children with uncomplicated streptococcal pharyngitis. These findings support the concept of nephritogenicity of some streptococcal strains.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of peptidoglycan, a pyrogenic constituent of gram-positive microorganisms, on the pharmacokinetics of rifampicin.

Pharmacokinetics of rifampicin (20 mg/kg orally or i.v.) was determined in calves and rabbits. Seven days later a model pyrogen was administered i.v. to the same animals and 1 hr later the rifampicin administration was repeated. The pharmacokinetic analysis of oral rifampicin was performed using a one-compartment open model with absorption. Intravenously administered rifampicin was analysed by a two-compartment intravascular model. Injection of peptidoglycan in pyrogenic doses led to a significant increase of orally applied rifampicin serum levels in both animal species. The i.v. administration of rifampicin had the same parameters in the control and peptidoglycan experiments. Daily pretreatment of rabbits with small doses of peptidoglycan induced tolerance to the pyrogenic effect. In tolerant animals we did not observe any changes of rifampicin serum levels. Elevated temperature alone was not responsible for observed pharmacokinetic changes leading to the increase of bioavailability of oral rifampicin since another pyrogenic substance (endotoxin) had an opposite effect on pharmacokinetics of previously tested drugs.

Pleomorphic xanthoastrocytoma of the cerebellum.

We report a clinicopathologic case of a pure cerebellar pleomorphic xanthoastrocytoma occurring in a 68-year-old male patient. The occurrence of pleomorphic xanthoastrocytoma outside the cerebral hemispheres is exceedingly rare. In the cerebellum only five cases have been reported so far, four of which are composite pleomorphic xanthoastrocytoma-gangliogliomas. This observation reinforces the argument that pleomorphic xanthoastrocytomas should be included in the differential diagnosis of cerebellar neoplasms.

Nitric oxide release from the S-nitrosothiol zinc phthalocyanine complex by flash photolysis.

The photogeneration of nitric oxide (NO) using laser flash photolysis was investigated for S-nitroso-glutathione (GSNO) and S-nitroso-N-acetylcysteine (NacySNO) at pH 6.4 (PBS/HCl) and 7.4 (PBS). Irradiation of S-nitrosothiol with light (lambda = 355 nm followed by absorption spectroscopy) resulted in the homolytic decomposition of NacySNO and GSNO to generate radicals (GS and NacyS ) and NO. The release of NO from donor compounds measured with an ISO-Nometer apparatus was larger at pH 7.4 than pH 6.4. NacySNO was also incorporated into dipalmitoyl-phosphatidylcholine liposomes in the presence and absence of zinc phthalocyanine (ZnPC), a well-known photosensitizer useful for photodynamic therapy. Liposomes are usually used as carriers for hydrophobic compounds such as ZnPC. Inclusion of ZnPC resulted in a decrease in NO liberation in liposomal medium. However, there was a synergistic action of both photosensitizers and S-nitrosothiols resulting in the formation of other reactive species such as peroxynitrite, which is a potent oxidizing agent. These data show that NO release depends on pH and the medium, as well as on the laser energy applied to the system. Changes in the absorption spectrum were monitored as a function of light exposure.

Changes of pharmacokinetics of trimethoprim after pretreatment with streptococcal peptidoglycan.

Trimethoprim (TMP) 10 mg.kg-1 was given orally to calves and rabbits. Two to three weeks later the animals were pretreated by i.v. Peptidoglycan (Pt) 20 micrograms.kg-1. One hour later TMP was administered as above. To other animals under otherwise identical conditions TMP was injected intravenously. The pretreatment with Peptidoglycan induced in both species a significant increase of TMP serum levels positively correlated with temperature elevation. Peptidoglycan pretreatment increased the bioavailability of TMP.

[Unusual cause for bilateral trigeminal neuralgia: unilateral racemous cysticercus of cerebellopontine angle. Case report]. / Neuralgia do trigêmeo bilateral por cisticerco racemoso unilateral no ângulo-ponto cerebelar: relato de caso.

We report the case of a 42-year-old woman with a racemous cystecercus in the right cerebellopontine angle (CPA), who presented with bilateral trigeminal neuralgia. The parasite was completly removed via a right suboccipital craniotomy. On the first postoperative day, the patient indicated that the pain disappeared. The neuralgia was caused by two probable mechanisms: a distortion of the brain stem and compression of the nerve against an arterial loop at the entry zone or arachnoiditis caused by the parasite in the both CPA cisternae. This case demonstrates the advisability of obtaining imaging studies in all patients with trigeminal neuralgia before starting any management. We must always remind that the cysticercus may be a differential diagnosis of CPA lesions.

[Supratentorial meningiomas. Diagnosis, surgical results and complications]. / Meningiomas supratentoriais. Diagnóstico, resultados cirúrgicos e complicações.

Meningiomas are benign tumors arisising from arachnoid cells and represent the commonest asymptomatic intracranial tumors. We analysed 69 supratentorial meningiomas managed by the Neurosurgical Tumor Group of the Clinics Hospital of Medicine School of São Paulo University (September 1995 to September 1997). Age, sex, edema degree, tumor site, surgical complications and mortality were studied. Edema degree was defined by radiological methods (CT and MRI). Forty-seven patients were women and average age was 58 years. Type II of edema degree was predominant (38.7%). Twenty-nine patients had parasagital meningiomas and 40 presented convexity tumors. Simpson I resection was obtained in 48 procedures, II in 18 and III in two surgical removals. Nine cases complicated (transitory deficits, 6; permanent deficit, 1; and infection, 2). Death occurred in two patients. Morbity and mortality had relation with age, falx tumors and attempt of radical surgical removal. Edema degree did not modify mortality and morbidity rates.

[Medulloblastoma in adults: analysis of a casuistics and surgical results]. / Meduloblastoma em adultos. Análise de uma casuística e resultados cirúrgicos.

We report on 15 cases of medulloblastoma of adult onset (8 male and 7 female) operated upon posterior fossa approach from February 1988 to October 1995. Tumors were localized in cerebellar hemisphere in 7 cases (one with extension to supratentorial notch and another case reaching the cerebello-pontine angle cistern), in vermis and hemisphere in four, only in vermis in another four. Resection was total in seven patients, subtotal in other seven, and partial in one. There was no operative mortality. Aspects regarding biological behavior, diagnosis, pathological findings, surgery and survival are discussed as well as prognostic factors.

The group specific polysaccharide antibody in children with non-suppurative sequelae of group A streptococcal infection.

The kinetics of the group A specific polysaccharide antibody were studied in children with acute rheumatic fever who had no carditis, children with acute rheumatic fever who had carditis and developed rheumatic heard disease and in children with acute poststreptococcal glomerulonephritis. The children with rheumatic fever who had carditis and those who did not, were kept on continuous antistreptococcal prophylaxis. In the group of children who developed rheumatic heart disease the titer of the antibody at onset was significantly higher than those who had rheumatic fever but no carditis (P = 0.01). After a mean follow-up period of three years, a high titer was maintained in children who developed rheumatic heart disease only and was significantly higher than that found in children with rheumatic fever who had no carditis (P = 0.001) and in children with poststerptococcal nephritis (P = 0.001).