RESUMO
INTRODUCTION: Delayed vasospasm has traditionally been considered the most important determinant of poor outcome after subarachnoid haemorrhage (SAH). Consequently, most of the research and therapies are directed towards reducing the incidence of vasospasm (VSP). To date, however, clinical trials based on this strategy have not delivered a definitive treatment for preventing or reducing brain injury after SAH. This fact has caused a paradigm shift in research, which now focuses on early brain injury (EBI) occurring in the first 72 hours after SAH. It has also changed the idea of VSP's role in brain damage, and suggests the need for re-evaluating the pathophysiological process of SAH. DEVELOPMENT: This review examines the current state of knowledge on the pathophysiological mechanisms associated with EBI and summarises the diagnostic options currently available. CONCLUSION: It seems that the research approach needs to be changed so that investigators will focus on prevention of EBI, reduction of secondary brain complications and ultimately, the optimisation neurological outcome.
Assuntos
Encéfalo/patologia , Hemorragia Subaracnóidea/patologia , Vasoespasmo Intracraniano/patologia , Biomarcadores , Progressão da Doença , Humanos , Neuroimagem , Prognóstico , Hemorragia Subaracnóidea/complicações , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologiaRESUMO
INTRODUCTION: Primary cardiac tumours are very rare in the paediatric age, their incidence varies from 0.0017 % to 0.28 %. More than 90 % are benign in nature. The most common variety is the rhabdomyoma, present in over 60 % of cases with tuberous sclerosis. MATERIAL AND METHODS: We performed a retrospective analysis of medical records with a diagnosis of primary cardiac tumor between March 1977 and March 2007, finding a total of 27 patients. RESULTS: The age of initial diagnosis is more prevalent in the neonatal period, beginning with the discovery of a heart murmur (11 cases). There was no difference in gender distribution. In 14 patients were found cardiomegaly on chest radiograph. According to the echocardiography characteristics there were diagnosed 20 rhabdomyomas, 2 fibromas, 2 pericardial teratomas and 3 non classifiable tumours. Most were located in the left ventricle. Echocardiography, cardiac catheterization was also performed in 3 cases and angioresonance in 5 cases. During their evolution, episodes of arrhythmias were observed in 11 patients, 5 patients required some sort of surgical procedure, which confirmed the histopathology diagnosis. In 3 patients the initial cause of death was cardiological. The 75 % of cases with rhabdomyomas presented or developed tuberous sclerosis. In most of the rhabdomyomas (13 cases), there was a spontaneous regression. CONCLUSIONS: Firstly, there is shown to be a low prevalence of this disorder in children. Rhabdomyoma is the most common primary cardiac tumour in our study and it was associated in 75 % of cases with tuberous sclerosis. The diagnosis is more common in the early neonatal period after auscultation of a cardiac murmur and echocardiography, the diagnostic technique of choice, other imaging techniques, such as angioMRI not being of much for diagnosis in children. The emergence of foetal echocardiography allows early detection. The course is benign in most tumours, rhabdomyomas tending to regress spontaneously. It must be monitored as the occurrence of arrhythmias during its evolution will require medical treatment. Surgery is needed in cases with severe symptoms, due to obstruction in the ventricular output tracts. One option is the surgical cardiac transplant in non-resectable life-threatening tumours.
Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/epidemiologia , Rabdomioma/diagnóstico por imagem , Rabdomioma/epidemiologia , Adolescente , Pré-Escolar , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Radiografia Torácica , Estudos RetrospectivosRESUMO
INTRODUCTION: Persistent patent ductus arteriosus (PDA) is a common entity in preterm infants. The most commonly used pharmacological treatment to close the ductus is indomethacin but it can affect cerebral, renal and mesenteric blood flow. Ibuprofen has recently been shown to be effective in closing PDA with fewer hemodynamic effects. In this study we compared the safety and efficacy of ibuprofen and indomethacin in the treatment of PDA in preterm infants. MATERIAL AND METHODS: A randomized trial was performed. Premature infants with symptomatic PDA confirmed by echocardiography in the first week of life and who required respiratory support were included. The patients were randomly assigned to receive either intravenous indomethacin or ibuprofen. The rate of ductal closure, need for additional treatment, complications, and clinical course were evaluated. RESULTS: Twenty-four patients were treated with indomethacin and 23 with ibuprofen. The clinical characteristics before treatment were similar in both groups. Both treatments were effective in closing PDA (87.5% in the indomethacin group and 82.6% in the ibuprofen group). The two cohorts did not differ in the rate of reopening, need for a second pharmacologic treatment, or surgical ductal ligation. No patient in the ibuprofen group developed gastrointestinal adverse effects, but two infants in the indomethacin group had isolated bowel perforation and one had necrotizing enterocolitis. Transient renal dysfunction developed in seven patients (29%) in the indomethacin group versus two (9%) in the ibuprofen group. Transient renal insufficiency was found in one patient in the indomethacin group and in none in the ibuprofen group. The rate of other complications was similar in both groups. CONCLUSIONS: In our trial ibuprofen was as effective as indomethacin in closing PDA. No significant differences were found in the incidence of complications but fewer renal complications and no gastrointestinal complications were found in the ibuprofen group.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Permeabilidade do Canal Arterial/tratamento farmacológico , Ibuprofeno/uso terapêutico , Indometacina/uso terapêutico , Doenças do Prematuro/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , MasculinoRESUMO
An immunoradiometric assay was used to determine the presence of p29 protein in 68 breast cancer cyTOSOLS. The p29 values ranged from 0 to 1123 U/mg, with a mean value of 127 +/- 28.7 U/mg. Using a cutoff point of 20 U/mg the frequency of p29 positive tumors was about 55%. A quantitative and qualitative relation was found between p29 and estrogen receptor (ER), but not between p29 and progesterone receptor (PR). Discordance between p29 and ER status was found in 13 out of 68 tumors. Both the frequency of p29 positive tumors and the p29 values were significantly higher in postmenopausal than in premenopausal women, in a similar way to ER but different from PR. There was no difference in p29 content between primary tumor and metastasis. We did not find any relation among p29 primary tumors content and axillary lymph nodes involvement or tumor size.
Assuntos
Neoplasias da Mama/análise , Fosfoproteínas/análise , Receptores de Estrogênio/análise , Receptores de Progesterona/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática , Menopausa , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Dissection of the internal carotid artery (DIC) is a known cause of cerebral infarct, especially in young patients. The classical clinical syndrome consists of unilateral pain of the head or neck, homolateral oculo-sympathetic paresis and ischaemic symptoms of the cerebral hemisphere involved. Presentation as paralysis of cranial nerves is rare and occurs in less than 12% of cases. The neurological involvement seems to be due to compression caused by the increased diameter of the artery involved. CASE REPORTS: Two patients are reported with paralysis of the lower cranial nerves secondary to DIC. In the first case there was paralysis of the left cranial nerves IX, X, and XII which was diagnosed on angiography using computerized tomography with spiral acquisition. The second patient had clinical involvement of cranial nerves IX, X, XI and XII and magnetic resonance angiography showed the dissection. Both cases were confirmed after digital subtraction angiography. CONCLUSION: Diagnosis of DIC requires a high level of suspicion in cases with atypical onset. The use of new techniques of non invasive imaging diagnosis such as computerized tomography and magnetic resonance angiography permit effective diagnosis of this disorder.
Assuntos
Dissecação da Artéria Carótida Interna/complicações , Dissecação da Artéria Carótida Interna/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Paralisia/etiologia , Adulto , Dissecação da Artéria Carótida Interna/patologia , Doenças dos Nervos Cranianos/patologia , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
Varicella is a disease in childhood. When it affects adults, serious complications can develop, the most frequent and most dangerous being pneumonia. Acute renal failure is an exceptional complication which infrequently is reported in relevant current literature. The association of pneumonia with acute renal failure in a patient with varicella is unusual. We report a varicella case in an adult patient who suffered from pneumonia with respiratory distress syndrome and acute renal failure, both of them had a favourable clinical course.
Assuntos
Injúria Renal Aguda/etiologia , Varicela/complicações , Pneumonia Viral/etiologia , Adulto , Humanos , MasculinoRESUMO
185 cases of bacteremia admitted at the internal medicine department of "C.S. Virgen de la Arrixaga" in Murcia from 1977 to 1986, were studied retrospectively. The common infection was significantly associated to Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus A group and Neisseria meningitidis and the nosocomial infection was associated to Klebsiella Pneumoniae, Serratia Marcescens y Pseudomonas aeruginosa, Staphylococcus epidermidis and Enterobacter. We did not find significant differences between the common and nosocomial infection caused by E. Coli and Proteus mirabilis. These factors were associated to an increase of mortality: age greater than 40 years, nosocomial infection, Pseudomonas aeruginosa, other associated rapidly lethal diseases, acute clinical state at the beginning of bacteremia, shock and non-correct antibiotic therapy.
Assuntos
Infecção Hospitalar , Sepse , Adulto , Antibacterianos/uso terapêutico , Infecção Hospitalar/complicações , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Departamentos Hospitalares , Humanos , Incidência , Medicina Interna , Prognóstico , Estudos Retrospectivos , Sepse/complicações , Sepse/tratamento farmacológico , Sepse/epidemiologia , Sepse/microbiologiaRESUMO
We described for the first time an alkaline encrusting cystitis in a patient with the acquired immune deficiency. This is an entity characterized by severe dysuria and long standing urinary frequency, alkaline urine and radiographically visible calcification of the urinary bladder. It has been observed in patients with permanent Foley catheter, persistent infections due to microorganisms with urolytic activity, urinary bilharziosis or tuberculosis, or malignant bladder tumors. None of these entities were described and the patient had all conditions for this syndrome.
Assuntos
Cistite/microbiologia , Infecções por HIV/complicações , Infecções por Proteus/complicações , Proteus mirabilis , Adulto , Cistite/complicações , Humanos , MasculinoRESUMO
OBJECTIVES: To know HIV-AIDS patient's nutritional status in different infection's condition and their relation with the socioeconomic situation and, in that case, the nutritional condition improvement through the dietetic advice appropriated for each patient. METHODS: Prospective study of 79 patients with HIV-AIDS diagnostic in any illness's condition and recopilation of anthropometrics and biochemical variables. At the beginning of the study we got data about socioeconomic situation of patient with a scale of 1 to 5 points each variable and an score top of 35. In the survivors we checked, after dietetic advice, the variables at 6 and 12 months by sanitary personal (physician and nurse) who weren't implicated in direct assistance. The study was analyzed by Student "T" for matched data and the simple correlation test. RESULTS: We have objectivated a lost of initial weight over their habitual's with a progressive impairment in different stage of evolution that weren't modified by dietetic advice. We didn't observed significant variations in the biochemical variables included in advances states and in parameters which are usually affected in malnutrition. In the analysis of relation between nutritional condition and socioeconomic factors, it was estimated a lesser score, that was statistically significative, in patients who had a work, family situation and an affective upset positive. CONCLUSIONS: The results obtained induce to think that the nutritional advices appropriated for each patient are not related, in our series, with progressive deterioration of anthropometrics variables, neither biochemical parameters fluctuations at 6, 12 months of follow-up. The patient's socioeconomic situation is not influenced by nutritional condition except for the work, affectivity and family environment.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Infecções por HIV/complicações , Distúrbios Nutricionais/etiologia , Estado Nutricional , Adulto , Aconselhamento , Interpretação Estatística de Dados , Dieta , Feminino , Seguimentos , Infecções por HIV/metabolismo , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Distúrbios Nutricionais/metabolismo , Distúrbios Nutricionais/mortalidade , Distúrbios Nutricionais/prevenção & controle , Estudos Prospectivos , Fatores Socioeconômicos , Fatores de TempoRESUMO
OBJECTIVES: To present a series of eight cases of rare sacral tumors that represent a wide spectrum of the aggressive disease involving the sacrum and to discuss the efficacy of CT-guided biopsy in these cases. MATERIAL AND METHODS: We reviewed all cases of sacral tumors biopsied under CT guidance in the last two years. Prior CT and MR images were analyzed before biopsy, and 3 mm CT slices of the lesion were obtained to determine the location of the target area and the path of the needle. All biopsies were performed using 11 G needles and 15 G coaxial needles. RESULTS: Eight sacral lesions were biopsied under CT guidance, and a diagnosis was reached in four. In three of these, the diagnosis (chordoma, plasmocytoma, and metastasis from melanoma) was reached in a single session. In the fourth case, three sessions were necessary to reach the diagnosis of Ewing's sarcoma. For various reasons, the remaining four cases required surgical biopsy to reach the diagnoses of chondrosarcoma, eosinophilic granuloma, and primary bone lymphoma in two patients. The diagnostic efficacy of CT-guided biopsy was 36%. CONCLUSION: Our results suggest that CT-guided biopsy is less useful in the characterization of primary tumors than in metastases. The diagnosis of primary bone lymphomas is especially complicated. Repeating the procedure after inconclusive results probably will not provide additional information, and it is recommendable to perform surgical biopsy in these cases.
Assuntos
Biópsia por Agulha/métodos , Radiografia Intervencionista , Sacro , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto JovemAssuntos
Hemangioma Cavernoso/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Vértebras Torácicas , Adulto , Espaço Epidural , Hemangioma Cavernoso/complicações , Hemangioma Cavernoso/patologia , Hemangioma Cavernoso/cirurgia , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgiaRESUMO
OBJECTIVE: To determine the interobserver agreement in the interpretation of MR angiography (MRA) studies for surveillance of embolized intracranial aneurysms. To determine whether contrast administration improves interobserver agreement. MATERIAL AND METHODS: Two experienced neuroradiologists independently reviewed all follow-up MRA studies performed between July 2004 and December 2006 of cerebral aneurysms embolized with coils. All MRA studies included both unenhanced 3D time-of-flight (3D TOF) and contrast-enhanced MRA (CE-MRA) images. Studies were classified as: a) not assessable; b) complete occlusion; c) residual aneurysm. Interobserver agreement for unenhanced and enhanced MRA studies was determined using the kappa statistic. Kappa values were considered insignificant when<0.2, low when between 0.21 and 0.4, and moderate when between 0.41-0.6; values >0.6 were considered good agreement and >0.8 excellent agreement. Significance was set at p<0.005. RESULTS: We reviewed a total of 200 MRA studies (100 3D TOF studies and 100 CE-MRA studies) performed in 48 patients (25 women, 23 men) at 6, 12, and/or 24 months after embolization. Interobserver agreement was good in both 3D TOF and CE-MRA studies, although it was better in CE-MRA studies (kappa=0.660, p<0.001 and kappa=0.779, p<0.001, respectively). CONCLUSIONS: Interobserver agreement is good for follow-up MRA studies of embolized intracranial aneurysms. Gadolinium administration improves interobserver agreement.
Assuntos
Embolização Terapêutica , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética/estatística & dados numéricos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do ObservadorRESUMO
OBJECTIVE: To show the role of magnetic resonance imaging in the early diagnosis of ankylosing spondylitis and discuss its possible usefulness in evaluating the response to treatment. MATERIAL AND METHODS: We describe the findings on magnetic resonance images using STIR and contrast-enhanced T1-weighted sequences in 13 patients diagnosed with ankylosing spondylitis receiving adalimumab treatment. Magnetic resonance images were acquired at baseline and after six months. We describe the findings obtained and the results of the quantitative analysis of vertebral affection (using the ASspiMRI-a score), and sacroiliac and hip joint affection. RESULTS: Inflammatory effects were demonstrated in 12 patients as signal hyperintensity in STIR sequences and as contrast enhancement in T1-weighted sequences. After treatment, 12 patients showed decreased ASspiMRI-a score and less affection in the sacroiliac and hip joints. No changes were observed in the remaining patient. Two patients showed posterior vertebral element involvement and disc involvement was seen in three. CONCLUSIONS: MRI opens up new possibilities for the management of patients with ankylosing spondylitis. On the one hand, it enables early diagnosis, saving the patient years of trial treatments and saving the healthcare system the cost of multiple diagnostic tests to try to explain the symptoms these patients present. On the other hand, it enables the rapid, objective evaluation of the response to therapy, thus making it possible to step up to a new, more aggressive therapy quickly and avoid treatments that are not very effective.
Assuntos
Imageamento por Ressonância Magnética , Espondilite Anquilosante/diagnóstico , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/tratamento farmacológicoRESUMO
Seventy-seven women with clinical suspect of microprolactinoma were studied by means of magnetic resonance of the pituitary gland. The homogeneity and signal intensity of the pituitary gland, presence of intraglandular nodule, height and gland morphology were evaluated. Radiological findings were correlated to prolactinemia values and the definite clinical diagnosis. The pituitary gland was normal in eleven out of the thirteen patients in whom the presence of hypophyseal endocrine pathology was not confirmed. In the remaining 64 women with hyperprolactinemia, 26 hypophyseal nodules were detected (40.6%), 3 questionable nodules (4.7%), 8 homogeneous glands (12.5%), 6 of empty sella turcica (9.4%) and 21 normal pituitary glands (32.8%). A correlation between radiological diagnosis, prolactinemia levels and definite clinical diagnosis was verified. The convexity degree of the pituitary gland was not useful for the diagnosis of microprolactinoma. In contrast, the height of the pituitary gland was indeed useful.
Assuntos
Imageamento por Ressonância Magnética , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/diagnóstico , Adolescente , Adulto , Distribuição de Qui-Quadrado , Síndrome da Sela Vazia/diagnóstico , Feminino , Humanos , Hiperprolactinemia/diagnóstico , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
We describe a 10 year old girl with ventricular septal defect in whom bidimensional echocardiogram disclosed a membrane in the outflow tract of the left ventricle. Color Doppler found the presence of fixed subaortic stenosis.