Midgut Volvulus after Percutaneous Endoscopic Gastrostomy.

We report a 47-year-old man who underwent endoscopic gastrostomy placement due to feeding refusal and regurgitation. Procedure was unremarkable. Two days later, the patient presented signs of intestinal obstruction. Computed tomography imaging showed a well-positioned gastrostomy tube, small pneumoperitoneum, and small bowel volvulus (SBV) in the upper right abdomen with proximal small bowel dilated loops. Exploratory laparotomy revealed mesenteric torsion, leading to SBV, with no evidence of intestinal malrotation. Volvulus was successfully untwisted via surgery. This case highlights to the possible association between SBV and gastrostomy placement.

The main potentialities of resveratrol for drug delivery systems

Resveratrol (RSV), a natural polyphenol found in grapes, was found to be effective in the prevention and therapy of several diseases, however, it does have unfavourable physicochemical properties. In this context, an increasing number of studies have aimed at developing novel therapeutic systems for its delivery to overcome these disadvantages. This review focuses on the mechanisms of action and therapeutic applications. Finally, it also describes some tested formulations for RSV administration, controlled release and targeting, developed with the purpose of increasing RSV bioavailability.

O resveratrol (RSV) é um polifenol natural encontrado nas uvas, que se mostrou eficaz na prevenção e terapia de várias doenças. No entanto, apresenta propriedades físico-químicas desfavoráveis. Neste contexto, um número cada vez maior de estudos visando ao desenvolvimento de novos sistemas terapêuticos para a sua liberação vem sendo desenvolvido no sentido de ultrapassar estas desvantagens. Esta revisão discorre sobre os mecanismos de ação e aplicações terapêuticas do RSV. Finalmente, são abordadas algumas formulações de liberação controlada e vetorizada, testadas para administração do RSV, desenvolvidas com a finalidade de aumentar a biodisponibilidade do RSV.

Cone beam computed tomography, a low-dose imaging technique in the postoperative assessment of cochlear implantation.

BACKGROUND: Cone beam computed tomography (CBCT) has become an extremely useful technique for dentomaxillofacial imaging because it provides clear images of highly contrasted structures. Previous studies evaluating the applicability of this technique in otologic imaging were very encouraging but were only performed in vitro on temporal bone specimens. The intracochlear positioning of the individual electrodes after cochlear implantation by means of CBCT has not yet been shown in vivo. OBJECTIVE: We describe a protocol for in vivo postoperative imaging of cochlear implants by CBCT. Moreover, the effective dose was measured and compared with the effective dose used on 4- and 16-slice multislice computed tomography (MSCT) by using a RANDO-phantom. MAIN OUTCOME MEASURE: Developing a protocol for in vivo postoperative imaging of cochlear implants by CBCT. RESULTS: CBCT provides high-resolution and almost artifact-free multiplanar reconstruction images allowing assessment of the precise intracochlear position of the electrode and visualization of each of the individual contacts. The calculated effective dose of the used CBCT and MSCT acquisitions is 80 musv for the CBCT, 3,600 musv for the 16-slice computed tomography, and 4,800 musv for the 4-slice computed tomography. CONCLUSION: These preliminary results suggests that, for in vivo postoperative evaluation of cochlear implants, CBCT can provide at least the same information as conventional radiography, digital radiograph, and MSCT but in a more comfortable and a much more safer way.

Maffucci syndrome associated with a pituitary adenoma and a probable brainstem tumor.

Malignancies are a common feature of Maffucci syndrome, with chondrosarcomas being the most common tumor type. The authors present the first case of Maffucci syndrome associated with a pituitary adenoma and a probable brainstem glioma and review the literature concerning intracranial tumors related to this disease. They report the case of a 35-year-old woman with Marfucci syndrome (diagnosed when she was 22 years old) who presented with complaints of decreased visual acuity and visual field defect. Neuroimaging revealed a pituitary macroadenoma and a suspected brainstem tumor. The macroadenoma was partially removed. There were no postoperative complications and the patient experienced rapid improvement in visual acuity. On follow-up examination 2 years later, the lesion in the pons showed the same dimensions. No sarcomatous changes of enchondromas or hemangiomas occurred. To the authors' knowledge, including the present case, only 7 cases of Maffucci syndrome associated with glioma and 7 cases associated with pituitary adenoma have been reported in the literature. This report emphasizes that patients with this disease are at a higher risk for primary intracranial tumors and reinforces the concept of the multiplicity of tumors that may arise in this syndrome. It also underscores the importance of early diagnosis, regular clinical surveillance, and follow-up studies of these patients.

[Adult cerebellar medulloblastoma: imaging findings in eight cases]. / Meduloblastomas no adulto: aspectos imagiológicos em oito casos.

Medulloblastoma is a brain tumor of neuroepithelial origin, frequent in children but rare in adults. The imaging pattern is well studied in the pediatric group thought there is controversy about the imaging characteristics in adults. We report CT and MRI imaging findings of 8 adult patients with cerebellar medulloblastoma. The mean age was 29.6 years (16-65 years). The male: female rate was 5:3. Most were lateral, located in the cerebellar hemisphere (63%). They were hyperdense on CT (67%). On the MRI they were all hypointense on T1, hyperintense on T2, with gadolinium enhancement of variable pattern. In 7 cases there were cysts/intratumoral necrosis. It was seen calcifications in 2 cases. Four patients presented hydrocephalus. In 2 cases there was no perilesional edema. All had well defined margins and superficial extension. Dural involvement was seen in 7, one of which with lateral venous sinus compromise, and brainstem invasion was seen in 1 case. The imaging findings of medulloblastomas in adults are unspecific and different from those in child. They should be considered in the differential diagnosis of cerebellar tumor in adults, especially if they are hyperdense on CT, with well defined margins, with superficial extension and with dural involvement.

[The contribution of perfusion CT in stroke]. / O contributo da tomografia computorizada de perfusão no acidente vascular cerebral.

Multisection computed tomography (MSCT) was introduced in 1998 and improved neuroimaging quality, in particular concerning acute stroke. Previously, non-enhanced CT was used not only to detect early stroke signs, but also to exclude hemorrhage and non-vascular pathology responsible for the acute neurological deficit. Nowadays, using Perfusion CT (PCT) it is possible to obtain a functional study of the cerebral hemodinamics after injection of a fast bolus of contrast. Multi-voxel analysis of the time-attenuation curves delivers colour maps of Cerebral Blood Flow (CBF), Mean Time Transit (MTT) and Cerebral Blood Flow (CBF). Based on specific patterns of hemodinamic changes it is possible to differentiate between irreversible and reversible brain damage--"tissue at risk", which is essential for choosing an appropriate therapy. The authors will discuss data acquisition, post-processing and image interpretation and analysis starting from two clinical examples.