RESUMO
INTRODUCTION: Perfusion computed tomography (PCT) allows to quantitatively assess haemodynamic characteristics of brain tissue. We investigated if different brain tumor types can be distinguished from each other using Patlak analysis of PCT data. METHODS: PCT data from 43 patients with brain tumours were analysed with a commercial implementation of the Patlak method. Four patients had low-grade glioma (WHO II), 31 patients had glioblastoma (WHO IV) and eight patients had intracerebral lymphoma. Tumour regions of interest (ROIs) were drawn in a morphological image and automatically transferred to maps of cerebral blood flow (CBF), cerebral blood volume (CBV) and permeability (K (Trans)). Mean values were calculated, group differences were tested using Wilcoxon and Mann Whitney U-tests. RESULTS: In comparison with normal parenchyma, low-grade gliomas showed no significant difference of perfusion parameters (p > 0.05) , whereas high-grade gliomas demonstrated significantly higher values (p < 0.0001 for K (Trans), p < 0.0001 for CBV and p = 0.0002 for CBF). Lymphomas displayed significantly increased mean K(Trans) values compared with unaffected cerebral parenchyma (p = 0.0078) but no elevation of CBV. High-grade gliomas show significant higher CBV values than lymphomas (p = 0.0078). DISCUSSION: PCT allows to reliably classify gliomas and lymphomas based on quantitative measurements of CBV and K (Trans).
Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias do Sistema Nervoso Central/diagnóstico , Neoplasias do Sistema Nervoso Central/patologia , Glioma/diagnóstico , Glioma/patologia , Linfoma/diagnóstico , Linfoma/patologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Biópsia , Encéfalo/patologia , Circulação Cerebrovascular , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PerfusãoRESUMO
BACKGROUND: We evaluated retrospectively early and midterm results of conventional redo surgery and carotid stent-assisted angioplasty (CAS) in the treatment of carotis restenosis (CR) after carotid endarterectomy (CEA). METHODS: From January 1989 to April 2007, 79 consecutive patients (61 male, median age 65 years, range 51-82) were treated for CR. Seven patients were treated for bilateral CR, accounting for 86 reconstructions, 41 CEAs, and 45 CAS procedures. Fifty (58.1%) CRs were asymptomatic, and 36 (41.9%) CRs were symptomatic. Treatment for CR was recommended for any stenosis >70% based on duplex ultrasound imaging with a peak systolic flow of >200 cm/sec. RESULTS: There was no difference in age in the two groups. The incidence of atherosclerotic risk factors and comorbidity was similar in the two groups. All patients received aspirin as basic medical treatment, and 53 patients (61.6%) were on statin therapy. The time period from primary CEA to reoperation or CAS was significantly shorter in the CAS group than in the CEA group (54.1 vs. 85.34 months, p=0.003). Correspondingly, the proportion of early CR was significantly higher in the CAS group as well (20 vs. 5, p=0.001). There was no perioperative mortality (30 days) in the two groups. In the CEA group, four neurological complications were seen versus one in the CAS group (p=0.13). Wound site and cardiac complication rates were significantly higher in the CEA group (p=0.029) with a median follow-up of 35 months (range 12-190). The overall actuarial survival after 60 months was 83% in the CEA group and 100% in the CAS group (p=0.87). Freedom from repeat intervention for re-recurrence was 89% in the CEA group and 95% in the CAS group (p=0.52). CONCLUSION: CAS is feasible and safe in treating CR. Furthermore, midterm overall survival and need for treatment of re-recurrence is equal to CEA. However, reoperation is an established option and remains the treatment of choice when contraindications for CAS are evident.
Assuntos
Angioplastia/instrumentação , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/efeitos adversos , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Angioplastia/mortalidade , Aspirina/uso terapêutico , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/mortalidade , Endarterectomia das Carótidas/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Recidiva , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler DuplaRESUMO
PURPOSE: The appropriate management of low-grade gliomas is still a matter of debate. So far, there are no randomized studies that analyze the impact of surgical resection on patient outcome. The value of the data obtained from the few retrospective reports available is often limited. PATIENTS AND METHODS: In the present study, we performed an analysis on data of 130 adult low-grade glioma patients. Extent of the resection was evaluated in correlation to the overall survival (OS) and progression-free survival (PFS) using Cox regression multivariate analysis. RESULTS: Extended surgery was shown to prolong OS and PFS significantly. Re-surgery in the case of a tumor relapse has a significant impact on OS and PFS, too. CONCLUSIONS: In summary, we could retrospectively evaluate a large case series of well-defined low-grade gliomas patients with a long follow-up period showing that extended surgery would be the most effective therapy for low-grade glioma patients even in recurrent diseases.
Assuntos
Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/cirurgia , Glioma/mortalidade , Glioma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Neoplasias Encefálicas/patologia , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Tratamento Farmacológico/métodos , Tratamento Farmacológico/estatística & dados numéricos , Feminino , Glioma/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Invasividade Neoplásica/fisiopatologia , Invasividade Neoplásica/prevenção & controle , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Recidiva Local de Neoplasia/cirurgia , Neuronavegação , Cuidados Pré-Operatórios , Prognóstico , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Estudos Retrospectivos , Técnicas Estereotáxicas , Taxa de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
The mammalian thioredoxin system, comprising the selenoenzyme thioredoxin reductase (TrxR) and the 12-kDa protein thioredoxin (Trx), is implicated in thiol-mediated antioxidant defense and redox regulatory processes including transcriptional control, DNA synthesis, and apoptosis. Cell proliferation supported by the thioredoxin system can be suppressed by TrxR inhibition. In this study, we assessed the effects of the potent hTrxR inhibitors 4-mercaptopyridine (4'-chloro-2,2':6',2"-terpyridine)platinum nitrate (I(23)2N) and 2-mercaptopyridine (4'-chloro-2,2':6',2"-terpyridine)platinum nitrate (I(25)2N) on glioblastoma in a rat model. These compounds show no or little cross-resistance with cisplatin and are thus of great clinical interest. Triple intravenous application of 25-35 mg/kg of the compounds led to a significant decrease of tumor growth as determined by magnetic resonance imaging. Metabolic as well as redox parameters in the blood of the animals were not altered. However, TrxR activity was significantly decreased in the tumor tissue, and redox parameters-including glutathione concentrations, total antioxidant status, and the activities of different antioxidant enzymes-showed tissue-specific variations. As indicated by different apoptotic markers, the antitumor activity of I(23)2N is not mediated by the induction of programmed cell death but rather by hTrxR inhibition and DNA intercalation leading to cell cycle arrest.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Glioma/tratamento farmacológico , Compostos Organoplatínicos/uso terapêutico , Oxirredutases/metabolismo , Animais , Apoptose , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/enzimologia , Proliferação de Células , Glioma/diagnóstico , Glioma/enzimologia , Imageamento por Ressonância Magnética , Masculino , Oxirredução , Oxirredutases/sangue , Ratos , Ratos Wistar , Selenoproteínas/análise , Selenoproteínas/metabolismo , Distribuição Tecidual , Células Tumorais Cultivadas , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
OBJECTIVE: To evaluate prospectively contrast-enhanced ultrasound (CEUS) in patients suspected of having dermatomyositis or polymyositis. METHODS: In 35 patients (23 women, 12 men; mean age, 51 years+/-16 years) who were suspected of having dermatomyositis or polymyositis, perfusion in clinically affected skeletal muscles was quantified with contrast-enhanced intermittent power Doppler ultrasound. By applying a modified model that analyzed the replenishment kinetics of microbubbles, the perfusion-related parameters blood flow, local blood volume and blood flow velocity were measured. Findings were compared with muscle biopsy appearances and with the results of MRI that was performed with a 1.5-Tesla unit. Receiver operating characteristic analysis was performed and optimum thresholds for diagnosis of myositis were determined. RESULTS: Eleven patients had histologically confirmed dermatomyositis or polymyositis and showed significantly higher blood flow velocity (P=.01 for dermato- and P<.001 for polymyositis), blood flow (P<.001 for dermato- and polymyositis), and blood volume (P=.007 for dermato- and P<.001 for polymyositis) on contrast-enhanced ultrasound than those who did not have myositis. An increase in signal intensity on T2-weighted MR images was found in all patients with myositis. MRI had a sensitivity, specificity, positive (PPV), and negative predicting values (NPV) of 100%, 88%, 77%, and 100% for diagnosis of myositis, respectively. CEUS blood flow was the best ultrasound measure for diagnosis of dermato- or polymyositis with sensitivity, specificity, PPV, and NPV of 73%, 91%, 80%, and 88%, respectively. CONCLUSIONS: Increased skeletal muscle perfusion measured by CEUS could serve as an additional measurer for the diagnosis of an inflammatory myopathy.
Assuntos
Dermatomiosite/diagnóstico por imagem , Polimiosite/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Adulto , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Dermatomiosite/patologia , Dermatomiosite/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Polimiosite/patologia , Polimiosite/fisiopatologia , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To prospectively determine whether contrast material-enhanced ultrasonography (US) can depict inflammation-induced changes in muscle perfusion for patients suspected of having dermatomyositis or polymyositis and to compare these findings with those of magnetic resonance (MR) imaging and muscle biopsy. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. Perfusion in skeletal muscles was quantified with contrast-enhanced intermittent power Doppler US by applying a modified model that analyzed the replenishment kinetics of microbubbles. In 22 patients (16 women, six men; mean age, 52 years +/- 17) who were suspected of having myositis and in 10 healthy volunteers (two women, eight men; mean age, 28 years +/- 4), contrast-enhanced US of the clinically affected right biceps muscle was performed to measure blood flow, blood volume, and blood flow velocity. Additionally, the right upper arm was examined with a 1.5-T unit by using three different MR imaging techniques. Findings were compared with the results of clinical examinations and muscle biopsy. Data for perfusion-related parameters obtained at contrast-enhanced US were analyzed by using a nonparametric Mann-Whitney U test. RESULTS: Eight patients had histologically confirmed myositis and showed significantly higher blood flow velocity (P = .01), blood flow (P = .001), and blood volume (P = .002) at contrast-enhanced US than did patients who did not have myositis. Blood flow velocity (P = .001) and blood flow (P = .002) were significantly higher in patients with myositis than in volunteers. An increase in signal intensity on T2-weighted MR images was found in all patients with myositis, while contrast material enhancement on fat-suppressed T1-weighted MR images was found in only four of seven patients with myositis. CONCLUSION: Initial results show that contrast-enhanced US is a feasible method for noninvasively demonstrating increased perfusion in the involved muscle groups in patients with myositis.
Assuntos
Meios de Contraste , Dermatomiosite/diagnóstico por imagem , Dermatomiosite/patologia , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Polimiosite/diagnóstico por imagem , Polimiosite/patologia , Biópsia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Estudos Prospectivos , Fluxo Sanguíneo Regional , UltrassonografiaRESUMO
PURPOSE: To describe the successful hormone treatment of noncircumscribed orbital leiomyoma. DESIGN: Case report. PARTICIPANT: A 66-year-old woman with histologically proven orbital leiomyoma. METHODS: Because surgical excision of the tumor was impossible, therapy with the gonadotropin-releasing hormone (GnRH) analog goserelin was performed. RESULTS: Hormone treatment was well tolerated and no side effects were noted. The tumor regressed significantly during treatment. No recurrence occurred during a 5-year follow-up period. CONCLUSIONS: This report describes for the first time successful hormone treatment of a noncircumscribed orbital leiomyoma. Goserelin may have an antiproliferative effect on leiomyoma cells via membrane receptors for GnRH.
Assuntos
Antineoplásicos Hormonais/uso terapêutico , Gosserrelina/uso terapêutico , Leiomioma/tratamento farmacológico , Neoplasias Orbitárias/tratamento farmacológico , Idoso , Biomarcadores Tumorais/análise , Feminino , Humanos , Leiomioma/química , Leiomioma/patologia , Imageamento por Ressonância Magnética , Neoplasias Orbitárias/química , Neoplasias Orbitárias/patologiaRESUMO
BACKGROUND AND PURPOSE: Serum levels of the cytokine interleukin-6 (IL-6) rise markedly in stroke. IL-6 is a key regulator of inflammatory mechanisms that play an important part in stroke pathophysiology. The action of IL-6 is modified by its soluble receptor subunits sgp130 and sIL-6R. The purpose of this study was to investigate whether serum levels of the receptor subunits are changed after ischemic stroke and to define the role of genetic influences on IL-6 expression in acute stroke. METHODS: In 48 patients with acute stroke and 48 age- and sex-matched control subjects, serum concentrations of IL-6, sgp130, and sIL-6R were measured by enzyme-linked immunosorbent assay. Furthermore, IL-6 promoter haplotypes comprising 4 different polymorphisms (-597G-->A, -572G-->C, -373A(n)T(n), -174G-->C) were determined by DNA sequencing and allele-specific oligonucleotide polymerase chain reaction. The effect of the common haplotypes on IL-6 gene transcription was tested by transfecting reporter fusion genes in the astrocytelike cell line U373. RESULTS: Whereas serum concentrations of IL-6 significantly rose (P<0.001), sgp130 levels were transiently reduced after stroke (P<0.05), and sIL-6R levels remained unchanged. IL-6 levels depended on the infarct size and the haplotype of the promoter region. The common haplotype A-G-8/12-C was associated with low IL-6 levels after stroke and a reduced induction of IL-6 transcription on stimulation with an adenosine analog in vitro. CONCLUSIONS: The data demonstrate genetic variation in the expression of IL-6 in stroke. Induction of the inflammatory response by IL-6 might be enhanced by a transient downregulation of the potential IL-6 antagonist sgp130.
Assuntos
Interleucina-6/genética , Interleucina-6/metabolismo , Acidente Vascular Cerebral/metabolismo , Doença Aguda , Antígenos CD/sangue , Astrócitos/citologia , Astrócitos/metabolismo , Biomarcadores/sangue , Proteína C-Reativa/análise , Linhagem Celular , Receptor gp130 de Citocina , Ensaio de Imunoadsorção Enzimática , Feminino , Frequência do Gene , Genes Reporter , Haplótipos , Humanos , Interleucina-6/sangue , Masculino , Glicoproteínas de Membrana/sangue , Pessoa de Meia-Idade , Polimorfismo Genético , Regiões Promotoras Genéticas , Estudos Prospectivos , Receptores de Interleucina-6/sangue , Acidente Vascular Cerebral/sangue , TransfecçãoRESUMO
A female child presenting with acute flaccid paraparesis at 18 months was found to have a dermal sinus in combination with a dermoid cyst and a myxopapillary ependymoma of the cauda equina and conus medullaris. A possible embryologic relation between these lesions is discussed.
Assuntos
Cauda Equina/patologia , Ependimoma/complicações , Ependimoma/patologia , Doenças Fetais , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/patologia , Paraplegia/etiologia , Neoplasias do Sistema Nervoso Periférico/complicações , Neoplasias do Sistema Nervoso Periférico/patologia , Espinha Bífida Oculta/complicações , Espinha Bífida Oculta/patologia , Cauda Equina/cirurgia , Ependimoma/cirurgia , Feminino , Humanos , Lactente , Síndromes de Compressão Nervosa/cirurgia , Paraplegia/diagnóstico , Neoplasias do Sistema Nervoso Periférico/cirurgia , Índice de Gravidade de Doença , Espinha Bífida Oculta/cirurgiaRESUMO
BACKGROUND AND PURPOSE: There is a lack of systematic data regarding local intra-arterial fibrinolysis (LIF) of thromboemboli occurring during neuroendovascular procedures with the use of recombinant tissue plasminogen activator (rtPA). We report our technique for treating LIF of intracerebral thromboemboli occurring during neuroendovascular procedures. METHODS: Nine of 723 patients (1.2%) who underwent neuroendovascular procedures during the period from January 1997 to September 2002 suffered thromboembolic complications. These patients were treated by LIF with a maximum dose of 0.9 mg rtPA per kilogram body weight. Recanalization was categorized as successful (Thrombolysis in Myocardial Infarction [TIMI] grade 2 or 3) versus unsuccessful (TIMI grade 0 or 1), and clinical outcome was categorized as independent (Rankin Scale score 0 to 2) versus dependent or dead (Rankin Scale score 3 to 6). RESULTS: The minimum time between thrombus detection and beginning of LIF was 10 minutes, and the maximum time was 90 minutes. Successful recanalization was achieved in 4 of 9 patients (44%). All 9 patients suffered cerebral ischemic infarctions, and none of the patients sustained intracerebral hemorrhage. Two patients (22%) died from malignant brain infarctions. Four patients (44%) remained moderately disabled, and 3 patients (33%) were severely disabled 3 months after LIF. CONCLUSIONS: Although we used relatively high doses of rtPA, the recanalization rates and clinical outcome of LIF in our patients were not satisfactory. Strategies for the prevention of thromboemboli during neuroendovascular procedures must be improved, and novel fibrinolytic or thrombolytic techniques should be developed.
Assuntos
Fibrinólise , Procedimentos Neurocirúrgicos/métodos , Proteínas Recombinantes/uso terapêutico , Tromboembolia/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Estudos Retrospectivos , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversosRESUMO
In order to characterise primary central nervous system lymphomas (PCNSL) and to evaluate if 1H spectroscopy improves the preoperative differential diagnosis of PCNSL and glioma, seven immunocompetent patients with PCNSL and 21 patients with glioma were examined using single voxel, short echo time magnetic resonance spectroscopy (MRS; 1.5 T, STEAM 1500/20). All PCNSL demonstrated massively elevated lipid resonances and markedly elevated choline. Similarly increased lipid resonances were only found in seven necrotic glioblastomas, PCNSL differing from all solid astrocytomas by massively elevated lipid resonances. Additionally, PCNSL had higher Cho/Cr ratios than all grades of astrocytoma. In conclusion, we found that massively elevated lipid resonances are a hallmark of PCNSL in immunocompetent patients. Together with a markedly elevated Cho/Cr ratio, MRS provides metabolic information which may improve the preoperative differentiation of PCNSL and glioma.
Assuntos
Neoplasias do Sistema Nervoso Central/diagnóstico , Glioma/diagnóstico , Linfoma/diagnóstico , Espectroscopia de Ressonância Magnética/métodos , Neoplasias do Sistema Nervoso Central/metabolismo , Colina/análise , Diagnóstico Diferencial , Glioma/classificação , Glioma/metabolismo , Humanos , Imunocompetência/fisiologia , Lipídeos/análise , Linfoma/metabolismo , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/instrumentaçãoRESUMO
Pronounced forward flexion of the trunk, often termed camptocormia, is a typical symptom of patients with Parkinson's disease. In 4 parkinsonian patients with camptocormia, paraspinal muscles were studied by electromyography (EMG) and axial computerized tomography (CT) or magnetic resonance imaging (MRI) scans and muscle biopsy. EMG of the lumbar and thoracic paravertebral muscles showed abundant fibrillations, positive sharp waves, and bizarre high-frequency discharges. Spinal CT and MRI scans revealed variable degrees of atrophy and fatty replacement of the thoracolumbar paraspinal muscles on both sides. No other signs of neuromuscular disease were found. Biopsy of the paraspinal muscles revealed end-stage myopathy with autophagic vacuoles, chronic inflammatory myopathy, unspecific myopathic changes, or mitochondrial myopathy. In parkinsonian patients with pronounced forward flexion of the trunk, myopathy confined to the erector spinae muscles must be considered.
Assuntos
Eletromiografia , Imageamento por Ressonância Magnética , Atrofia de Múltiplos Sistemas/diagnóstico , Músculo Esquelético/inervação , Miosite/diagnóstico , Doença de Parkinson/diagnóstico , Postura , Tomografia Computadorizada por Raios X , Idoso , Potencial Evocado Motor/fisiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios Motores/patologia , Neurônios Motores/fisiologia , Atrofia de Múltiplos Sistemas/patologia , Atrofia de Múltiplos Sistemas/fisiopatologia , Músculo Esquelético/patologia , Atrofia Muscular/diagnóstico , Atrofia Muscular/patologia , Atrofia Muscular/fisiopatologia , Miosite/patologia , Miosite/fisiopatologia , Doença de Parkinson/patologia , Doença de Parkinson/fisiopatologia , Postura/fisiologiaRESUMO
To assess the usefulness of perfusion-weighted echo-planar magnetic resonance imaging in the differential diagnosis of primary supratentorial lymphoma (PCNSL) and glioblastoma (GBM), 12 patients with a PCNSL and 12 with a GBM were examined using a 1.5 T magnetic resonance (MR) imager. With dynamic-susceptibility contrast MR imaging the intensity-time curves of each tumor were analyzed, and we determined the relative regional cerebral blood volume ratios (rrCBV [tumor/contralateral white matter (WM)]) to find out whether these parameters could be used to separate PCNSL from GBM. The maximum rrCBV ratio in the PCNSL was significantly lower than that of the GBM (P<0.0001). Comparing the intensity-time curves for the two tumor groups, the PCNSL showed a characteristic type of curve with a significant increase in signal intensity above the baseline due to massive leakage of contrast media into the interstitial space. PCNSL tend to have low maximum CBV ratios and typical intensity-time curves. These two parameters may be useful in distinguishing PCNSL from GBM.