Neurolymphomatosis as primary presentation of extra-nodal NK/T-cell lymphoma, nasal type.

Neurolymphomatosis (NL) describes an infiltration of cranial and peripheral nerves by lymphoma cells, most frequently in non-Hodgkin B-cell lymphoma. This clinical entity is rare and poses a challenging diagnosis. We describe a case of a 64-year-old female patient with NL associated with extra-nodal NK/T-cell lymphoma (ENKTL), nasal type, presenting as a painful progressive mononeuropathy multiplex with an oral cavity lesion. ENKTL is usually associated with Epstein-Barr virus (EBV) infection and rarely affects the central and peripheral nervous system. Lumbar puncture, magnetic resonance imaging (MRI), nerve biopsy, and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) help to establish the diagnosis. Thereby, NL should be considered in the differential diagnosis of painful progressive multiple neuropathies, even in patients without previous history of cancer.

No reason to smile: giant internal carotid artery aneurysm.

Giant cerebral aneurysms account for approximately 5% of all intracranial aneurysms, affecting morecommonly women in the 5th to 7th decade. When untreated, giant intracranial aneurysms face a poor prognosis withan estimated 2-year mortality of 68%. We present the case of an 82-year-old woman admitted at the emergencydepartment due to two focal to bilateral tonic-clonic seizures with a giant aneurysm of the supraclinoid segment ofthe right internal carotid artery on the CT scan. We discuss different management approaches for giant internalcarotid artery aneurysms, including direct surgical clipping, reconstructive endovascular procedures (coiling, balloon-/stent-assisted coiling, and flow diversion), deconstructive endovascular techniques (parent artery occlusion), andconservative management.

Depression after stroke.

Stroke treatment has dramatically improved in recent decades. However, although new treatments have reduced its mortality and the severity of its physical and cognitive sequelae, many people still have incapacitating disabilities following a stroke. Depression is the most common psychiatric disorder following stroke; it is important to recognise and treat as it limits motor and cognitive rehabilitation. Antidepressant medication is an effective treatment and can improve adherence to clinically recommended physical and cognitive tasks, thereby enhancing functional remodelling of neuronal pathways and improving rehabilitation outcomes.

Myasthenia Gravis Induced by Ipilimumab in a Patient With Metastatic Melanoma.

In daily clinical practice, there is a growing number of patients receiving new biological agents used in the treatment of malignancies. Ipilimumab is a fully humanized monoclonal antibody approved for patients with melanoma. It acts as an immune checkpoint inhibitor, binding and blocking cytotoxic T-lymphocyte antigen-4 in order to increase the antitumor immune response. There are several reports of autoimmune responses after its use. A 74-year-old man developed a mild rash and pruritus a few hours after the second infusion of ipilimumab and 24 h after the third dose of ipilimumab, he presented with shortness of breath, proximal limb muscle weakness, and diplopia. Repetitive nerve stimulation was consistent with a postsynaptic neuromuscular junction disorder. He began therapy with corticosteroids and pyridostigmine and ipilimumab was discontinued. Following ipilimumab suspension, the patient started to improve gradually. Here, we describe a rare case of myasthenia gravis presumably related with ipilimumab's therapy. A better knowledge of these agents is necessary, in order to identify characteristics or biomarkers that may be associated with the development of potentially serious autoimmune responses.

Recurrent Stroke in a Young Woman with a Single Pulmonary Arteriovenous Fistula: An Unusual Association.

INTRODUCTION: Cryptogenic stroke is present in about 40% of ischemic stroke patients. Extracardiac shunt related to pulmonary arteriovenous fistula (PAVF) could be a rare potential risk factor for embolic stroke. Most PAVFs are multiple, congenital, and associated with hereditary conditions. On the other hand, isolated PAVFs are rare conditions and an uncommon cause of cryptogenic stoke. CASE REPORT: We describe a case of a young woman without history of respiratory diseases or vascular risk factors, who presented with acute onset of transitory aphasia and right hemiplegia. She had a history of a transient ischemic attack, 3 years before, and migraine headaches. Brain MRI showed an acute cortical ischemic lesion and a chronic ischemic lesion. Diagnostic workup with transcranial Doppler ultrasonography revealed a significant right-to-left shunt with curtain pattern, and echocardiogram did not show structural abnormalities. An isolated small PAVF was diagnosed on pulmonary angiogram. Despite the rare association between isolated small PAVF and stroke, we decided to treat it with coil embolization because of recurrence of stroke, cortical lesions suggestive of embolic source, significant right-left shunt, and risk of future complications. CONCLUSIONS: This case highlights the importance of search, identification, and interpretation of causes of cryptogenic strokes to better choose therapy to reduce the stroke recurrence risk. Although unusual, PAVF detection is a treatable cause of stroke and the therapeutic decisions should take into account the characteristics of the PAVF and the degree of suspicion regarding the cause-effect relationship between PAVF and stroke.

Separation of plastics by froth flotation. The role of size, shape and density of the particles.

Over the last few years, new methods for plastic separation in mining have been developed. Froth flotation is one of these techniques, which is based on hydrophobicity differences between particles. Unlike minerals, most of the plastics are naturally hydrophobic, thus requiring the addition of chemicals that promote the selective wettability of one of its components, for a flotation separation. The floatability of six granulated post-consumer plastic - Polystyrene (PS), Polymethyl methacrylate (PMMA), Polyethylene Terephthalate (PET-S, PET-D) and Polyvinyl Chloride (PVC-M, PVC-D) - in the presence of tannic acid (wetting agent), and the performance of the flotation separation of five bi-component plastic mixtures - PS/PMMA, PS/PET-S, PS/PET-D, PS/PVC-M and PS/PVC-D - were evaluated. Moreover, the effect of the contact angle, density, size and shape of the particles was also analysed. Results showed that all plastics were naturally hydrophobic, with PS exhibiting the highest floatability. The contact angle and the flotation recovery of six plastics decreased with increasing tannic acid concentration, occurring depression of plastics at very low concentrations. Floatability differed also with the size and shape of plastic particles. For regular-shaped plastics (PS, PMMA and PVC-D) floatability decreased with the increase of particle size, while for lamellar-shaped particles (PET-D) floatability was slightly greater for coarser particles. Thus, plastic particles with small size, lamellar shape and low density present a greater floatability. The quality of separation varied with the mixture type, depending not only on the plastics hydrophobicity, but also on the size, density and shape of the particles, i.e. the particle weight. Flotation separation of plastics can be enhanced by differences in hydrophobicity. In addition, flotation separation improves if the most hydrophobic plastic, that floats, has a lamellar shape and lower density and if the most hydrophilic plastic, that sinks, has a regular shape and higher density. The results obtained show that froth flotation is a potential method for plastics separation, in particular for plastics with particle size greater than 2.0mm.

Influence of shape and size of the particles on jigging separation of plastics mixture.

Plastics are popular for numerous applications due to their high versatility and favourable properties such as endurance, lightness and cheapness. Therefore the generation of plastic waste is constantly increasing, becoming one of the larger categories in municipal solid waste. Almost all plastic materials are recyclable, but for the recycling to be possible it is necessary to separate the different types of plastics. The aim of this research was to evaluate the performance of the jig separation of bi-component plastic mixtures. For this study six granulated plastics had been used: Polystyrene (PS), Polymethyl methacrylate (PMMA), Polyethylene Terephthalate (PET-S, PET-D) and Polyvinyl Chloride (PVC-M, PVC-D). Plastics mixtures were subjected to jigging in a laboratorial Denver mineral jig. The results showed that the quality of the jigging separation varies with the mixture, the density differences and with the size and shape of the particles. In the case of particles with more regular shapes the quality of separation of bi-component plastic mixtures improved with the increase of the particle size. For lamellar particles the influence of particle size was minimal. In general, the beneficiation of plastics with similar densities was not effective, since the separation efficiency was lower than 25%. However, in bi-component plastic mixtures that join a low density plastic (PS) with a high density one (PMMA, PET-S, PET-D, PVC-M and PVC-D), the quality of the jigging separation was greatly improved. The PS grade in the sunk was less than 1% for all the plastic mixtures. Jigging proved to be an effective method for the separation of bi-component plastic mixtures. Jigging separation will be enhanced if the less dense plastic, that overflows, has a lamellar shape and if the denser plastic, that sinks, has a regular one.

[Cerebral death: from the fear of premature burial to the myth of the living donor]. / Morte cerebral: do medo de ser enterrado vivo ao mito do dador vivo.

OBJECTIVE: To analyse the historical evolution of the clinical concept "brain death", and discuss the concepts: whole-brain death and brainstem death in clinical perspective. BACKGROUND: Taphophobia means the fear of premature burial. Its modern equivalent is the fear of organs harvested from a still living patient. The debate remains concerning the advantages and disadvantages of whole-brain death and brainstem death concepts. METHODS: We have made a Pubmed-medline and Google search and identified published articles dealing with brain death, brainstem death, whole-brain death, death diagnosis, concept and definition. RESULTS: From the classical cardio-respiratory concept, it was a long way to emerge the centralist brain concept. Brain Death is a technical, ethical and legal concept, it appears: 1. For economic reasons and shortage of technical resources, to remove futile care in patients already death. 2. To permit the provision of organs to transplantation. The clinical criteria demonstrating irreversibility are identical for both, whole-brain death and brainstem death. CONCLUSIONS: The concept of brain death appears by technical need, when we have technological substitutions of other organs. Neurological criteria for determination of brain death are well settled, rigorous and reliable. Brainstem death and whole-brain death are both legal and philosophical concepts, without any difference in technical execution.