Signo de "doble corteza" visualizado en corregistro 18F-FDG PET/RM en un paciente con heterotopia subcortical en banda / "Double Cortex" Sign Visualized in 18F-FDG PET / MRI Coregistration in a Patient with Band Subcortical Heterotopia

Resumen La heterotopia subcortical en banda (HSB) se refiere a la presencia de bandas lisas bilaterales de sustancia gris cerebral ubicadas en la sustancia blanca subcortical. La presentación clínica es variable, con cuadros que incluyen discapacidad intelectual, crisis epilépticas y trastornos de conducta muy variados, lo que hace complejo su diagnóstico. Presentamos el caso de un varón de 20 años con largo historial de epilepsia refractaria a tratamiento, remitido a nuestra unidad para un estudio de tomografía por emisión de positrones/tomografía computada (PET/CT) con 18F-fluorodesoxiglucos (18F-FDG) para la búsqueda del foco epileptógeno. Adicionalmente, se realizó un corregistro de PET con un estudio de resonancia magnética (RM) de otra institución, observando el signo de doble corteza cerebral por RM y PET/CT, visualizando característicamente un patrón hipermetabólico en las zonas de heterotopia subcortical en banda.

Abstract Subcortical band heterotopia (HSB) refers to the presence of smooth bilateral bands of gray matter located in the subcortical white matter. Clinical presentation is widely variable, the presentation includes intellectual disability, epileptic seizures and varied conduct disorders, making a complex diagnosis. We present a case of a 20-year-old male with a long history of treatment-refractory epilepsy referred to our center for a 18F-FDG (18F-fluorodeoxyglucose) PET/CT (Positron Emission Tomography/Computed Tomography), to search for the epileptogenic focus. Additionally, a registration was carried out with another magnetic resonance imaging study (MRI), where the sign of double cerebral cortex was documented by MRI and PET/CT, visualized as a hypermetabolic pattern in subcortical band heterotopia.

An action-concept processing advantage in a patient with a double motor cortex.

Patients with atrophy in motor brain regions exhibit selective deficits in processing action-related meanings, suggesting a link between movement conceptualization and the amount of regional tissue. Here we examine such a relation in a unique opposite model: a rare patient with a double cortex (due to subcortical band heterotopia) in primary/supplementary motor regions, and no double cortex in multimodal semantic regions. We measured behavioral performance in action- and object-concept processing as well and resting-state functional connectivity. Both dimensions involved comparisons with healthy controls. Results revealed preserved accuracy in action and object categories for the patient. However, unlike controls, the patient exhibited faster performance for action than object concepts, a difference that was uninfluenced by general cognitive abilities. Moreover, this pattern was accompanied by heightened functional connectivity between the bilateral primary motor cortices. This suggests that a functionally active double motor cortex may entail action-processing advantages. Our findings offer new constraints for models of action semantics and motor-region function at large.

Heterotopic Adipose Tissue in the Placental Parenchyma: Case Report.

Objective. Reports of heterotopic tissue in the placenta are few and mainly include liver and adrenal cells. We report on adipose tissue found in the placenta. Case report. We present the case of a microscopic finding in a 25-year-old's placenta who suffered from hypertensive disorder in pregnancy. During routine microscopic study, we observed a heterotopic, benign, circumscribed and intervillous nodule of adipose tissue. Conclusion. To our knowledge, there is no other reported case of adipocytes among chorionic villi. Why foreign tissues show up in the placenta remains unknown; however, several new theories offer explanations.

Heterotopías sexuales, una localización epistemológica / Sexual heterotopies, an epistemological localization / Heterotopias sexuais, uma localização epistemológica

Resumen El presente ensayo analiza el concepto de «heterotopía¼ propuesto por Michel Foucault como una localización epistemológica a propósito de las imbricaciones existentes entre las dimensiones espaciales y sexuales. Así, el objetivo de este ensayo es trazar una asociación entre la vida urbana y aquellas libertades singulares que se pretender obtener en el imaginario de una ciudad. Para tales cometidos el texto reúne una serie de entrevistas etnográficas que engloban, por un lado, la caracterización de un desplazamiento localizado por varones homosexuales y, por el otro, un recurso epistemológico para pensar dichos movimientos espaciales.

Abstract The present essay analyzes the concept of "heterotopía" proposed by Michel Foucault as an epistemological location with regard to the imbrications existing between the spatial and sexual dimensions. Thus, the aim of this essay is to draw an association between urban life and those singular freedoms that are intended to obtain in the imaginary of a city. For such tasks the text brings together a series of ethnographic interviews that include, on the one hand, the characterization of a displacement located by homosexual men and, on the other, an epistemological resource to think about these spatial movements.

Resumo O presente ensaio analisa o conceito de "heterotopia" proposto por Michel Foucault como uma localização epistemológica em relação às imbricações existentes entre as dimensões espacial e sexual. Assim, o objetivo deste ensaio é traçar uma associação entre a vida urbana e as liberdades singulares que se pretende obter no imaginário de uma cidade. Para tais tarefas, o texto reúne uma série de entrevistas etnográficas que incluem, por um lado, a caracterização de um deslocamento localizado por homens homossexuais e, por outro, um recurso epistemológico para pensar sobre esses movimentos espaciais.

Hippocampal deep brain stimulation: a therapeutic option in patients with extensive bilateral periventricular nodular heterotopia: a case report.

A female adult patient with extensive bilateral periventricular nodular heterotopia (PNH), who was referred for bilateral hippocampal deep brain stimulation (Hip-DBS), was investigated. She presented with daily focal aware and impaired-awareness seizures with automatism and weekly generalized tonic-clonic seizures. Her EEG showed bilateral independent ictal and interictal neocortical temporal lobe discharges and her MRI showed extensive, symmetric PNH. She was treated with bilateral Hip-DBS which led to a major decrease in her seizure frequency (one seizure per trimester). The outcome was stable over three years, and there was no additional neuropsychological deficits or device-related adverse effects. This is the first reported patient to be undergo long-term continuous Hip-DBS to treat bilateral PNH. DBS, a non-lesional, reversible, neuromodulatory technique, may prove to be a good therapeutic option in patients with extensive bilateral epileptogenic networks who present with temporal lobe epilepsy and who are usually considered poor candidates for resective surgery.

Olhar e espaço como heterotopia na pintura de Manet: uma leitura de Michel Foucault / Glance and space as heterotopy in Manet's painting: a look on Foucault's interpretation / La Mirada y el espacio como heterotopía en lapintura de Manet: una lectura de Michel Foucault

O artigo demonstra a dimensão heterotópica do olhar e do espaço próprios à pintura de Manet. O espaço, tal como concebido por Foucault, se constitui como poder-saber, e o olhar, tal como erigido pela pintura de Manet, visibiliza as heterotopias. A metodologia consistiu na seleção e análise crítica dos textos de Foucault sobre a pintura de Manet e a heterotopia acrescida de bibliografia de comentadores voltados para a análise da pintura, da arte e da heterotopia na obra do pensador. A raridade da reflexão sistemática acerca das considerações foucaultianas sobre a pintura e o espaço concebido como "espaço outro" faz com que a demonstração do entrelaçamento entre o espaço produzido pelas pinturas de Manet e a heterotopia configure novidade na literatura dedicada ao pensador. Concluímos indicando como as discussões estéticas estão indissoluvelmente ligadas às análises do poder. Neste caminho, Foucault indica, por exemplo, que a experiência da transgressão batailliana do olhar evidencia a condição da visualidade pictórica das telas de Manet. A visibilização dos efeitos políticos do espaço e seus outros assim como da produção artística pavimenta um caminho possível para esboçar novas compreensões das relações dos corpos com os enraizamentos espaciais e seus desdobramentos subjetivos singulares...(AU)

This article demonstrates the heterotopic dimension of glance and space in Manet's painting. Space, as conceived by Foucault, is constituted as power-knowledge, and glance, as defined by Manet's painting, reveals heterotopies. The methodology consisted in the selection and critical analysis of Foucault's texts on Manet's painting and the heterotopia plus bibliography of Foucault readers focused on the analysis of painting, art and heterotopia. The rarity of the systematic reflection of the Foucauldian reflections on painting and the space conceived as different space makes the demonstration of the interweaving between the space produced by Manet's paintings and heterotopia configure novelty in the literature dedicated to the thinker. We conclude by indicating how the aesthetic discussions are inextricably linked to the analysis of power. This path that Foucault indicates, for example, that the experience of Bataillean`s transgression of gaze evidences the condition of the pictorial visuality of Manet's canvas. The visibility of the political effects of space and other effects as well as of artistic production paves the way to sketch new understandings of the relationships of bodies with spatial roots and their unique subjective unfoldings...(AU)

El artículo pretende demostrar la dimensión heterotópica de la mirada y del espacio en la pintura de Manet. El espacio concebido por Foucault se constituye un poder-saber, y la mirada erigida por la pintura de Manet visibiliza las heterotopías. La metodología consistió en la selección y análisis crítico de los textos de Foucault sobre la pintura de Manet y la heterotopía, y en la bibliografía de comentaristas dirigidos al análisis de la pintura, del arte y de la heterotopía en la obra del pensador. La rareza de la reflexión sistemática de las reflexiones foucaultianas sobre la pintura y el espacio considerado como "espacio otro" hace que la demostración del entrelazamiento entre el espacio producido por las pinturas de Manet y la heterotopía sea una novedad en la literatura dedicada al pensador. En la conclusión indicamos cómo las discusiones estéticas están indisolublemente vinculadas a los análisis del poder. En este marco, Foucault apunta, por ejemplo, que la experiencia de la transgresión batailliana de la mirada evidencia la condición de la visualidad pictórica de los lienzos de Manet. La viabilidad de los efectos políticos del espacio y sus otros, así como de la producción artística, pavimenta un camino posible para esbozar nuevas comprensiones de las relaciones de los cuerpos con los enraizamientos espaciales y sus desdoblamientos subjetivos singulares...(AU)

Heterotopia de mucosa gástrica en el intestino delgado, hallazgo en videocápsula endoscópica. Reporte de caso / An endoscopic videocapsule finding of heterotopia of the gastric mucosa of the small intestine

Resumen Introducción: la heterotopia de mucosa gástrica se refiere a la localización ectópica de mucosa gástrica en cualquier parte del tracto gastrointestinal. Es una causa poco frecuente de úlceras gastrointestinales y sangrado digestivo oculto. La videocápsula endoscópica se ha convertido en una herramienta fundamental para el estudio del intestino delgado. Métodos: estudio descriptivo de reporte de caso. La información de la historia clínica, reporte de patología y estudios endoscópicos, se extrajo de las bases de datos de la Fundación Valle del Lili. Resultados: paciente masculino de 71 años, en quien se realizó videocápsula endoscópica por un sangrado digestivo oculto y se encontraron segmentos de estenosis y úlceras en el yeyuno. La histopatología reveló la presencia de mucosa gástrica heterotópica. Conclusión: la heterotopia de mucosa gástrica debe considerarse como una causa posible de sangrado del intestino delgado.

Abstract Introduction: Heterotopia of the gastric mucosa refers to an ectopic location of gastric mucosa in any part of the gastrointestinal tract. It is a rare cause of gastrointestinal ulcers and occult digestive bleeding. Endoscopic videocapsules have become fundamental tools for study of the small intestine. Methods: This is a descriptive case study based on information from the medical history, pathology report and endoscopic studies extracted from the databases of the Fundación Valle del Lili in Cali, Colombia. Results: An endoscopic videocapsule was used to examine a 71-year-old male patient who suffered from occult digestive bleeding. Segments of stenosis and ulcers were found in the jejunum and histopathology revealed heterotopic gastric mucosa. Conclusion: Heterotopy of the gastric mucosa should be thought of as a possible cause of bleeding in the small intestine.

Malformations of cortical development: New surgical advances.

Epilepsy related to malformations of cortical development is frequently drug resistant or requires heavy medication, therefore surgery is key in their management. The role of stereotactic surgery has recently changed the diagnosis and treatment of focal cortical dysplasias (FCD), hypothalamic hamartomas (HH) and periventricular nodular heterotopias (PNH). In HH, radiosurgery using Gammaknife® leads to 60 % of seizure control and is associated with excellent neuropsychological results without significant endocrine function impairment. The seizure control rate is even higher (more than 80 %) with monopolar multiple stereotactic thermocoagulations and Laser interstitial Thermal Therapy (LiTT). While the first technique is associated with a 2 % complications rate (but with excellent neuropsychological outcomes), the latest has up to 22 % side effects in some series. All three of these techniques have encouraging results, but controlled studies are still lacking to provide evidence-based new therapeutic algorithms. With regard to the PNH, surgical management has long been limited by the depth of the lesions and their close anatomical relations with the functional brain connectome. Stereotactic approaches required to perform a SEEG, to locate the part of the PNH responsible for the seizure onset, are later followed by a stereotactic lesioning procedure, therefore doubling the bleeding risk. That is why SEEG-guided radiofrequency-thermocoagulation (SEEG guided-RF-TC), which makes it possible to perform these two steps in a single procedure, was considered as a promising option. A recent meta-analysis confirmed this intuition and reported 38 % of seizure-free patients and 81 % of responders with only 0.3 % of complications, making this approach the first treatment line, followed by LiTT. Among the multiple advances in the FCD identification by non-invasive investigations, a new modality of per-operative diagnostic procedure, the three-dimensional electrocorticography may lead to simplify the preoperative investigation and enhance the accuracy of FCD delineation. Evidence is nevertheless still insufficient to validate this promising concept. Conventional surgical resection has also been concerned by significant conceptual advances during the past few years, in particular with the development of the hodotopic approach, initially in oncologic surgery. Associated with a better understanding of neuroplasticity in epilepsy and the setting up of functional mapping during SEEG or during awake surgery, the possibility of surgical resections grew up. A short-term perspective in this field, when surgical resection remains impossible, would be to target crucial nodes of the epileptic network, distinct from the core functional connectome.

Lung Transplantation for FLNA-Associated Progressive Lung Disease.

OBJECTIVE: To describe a series of patients with pathogenic variants in FLNA and progressive lung disease necessitating lung transplantation. STUDY DESIGN: We conducted a retrospective chart review of 6 female infants with heterozygous presumed loss-of-function pathogenic variants in FLNA whose initial presentation was early and progressive respiratory failure. RESULTS: Each patient received lung transplantation at an average age of 11 months (range, 5-15 months). All patients had pulmonary arterial hypertension and chronic respiratory failure requiring tracheostomy and escalating levels of ventilator support before transplantation. All 6 patients survived initial lung transplantation; however, 1 patient died after a subsequent heart-lung transplant. The remaining 5 patients are living unrestricted lives on chronic immunosuppression at most recent follow-up (range, 19 months to 11.3 years post-transplantation). However, in all patients, severe ascending aortic dilation has been observed with aortic regurgitation. CONCLUSIONS: Respiratory failure secondary to progressive obstructive lung disease during infancy may be the presenting phenotype of FLNA-associated periventricular nodular heterotopia. We describe a cohort of patients with progressive respiratory failure related to a pathogenic variant in FLNA and present lung transplantation as a viable therapeutic option for this group of patients.

Dispositivos penales juveniles: atravesamientos institucionales / Youth criminal devices: institutional traversal

El presente escrito se desprende del proyecto de beca de culminación de doctorado que se propone identificar la relación entre la cultura organizacional de los Centros Socioeducativos de Régimen Cerrado y el desgaste profesional de sus miembros. Estas instituciones son Dispositivos Penales Juveniles que alojan a los jóvenes que han infringido la ley penal. En esta oportunidad se presenta la indagación de los orígenes de las mismas. Se propone la consideración teórica de los Centros como heterotopías de desviación (Foucault, 1967). Asimismo se exponen los resultados obtenidos hasta el momento respecto al sentimiento de frustración encontrado en los trabajadores que conforman estas instituciones y se articulan con la noción de desgaste mental producido por la insatisfacción en el trabajo (Dejours, 1992). Por último se señala la incidencia de los atravesamientos jurídico e institucional en ésta particular institución concebida como la respuesta estatal para los jóvenes que han cometido un delito.

This letter follows the draft grant doctoral culmination aims to identify the relationship between organizational culture Socioeducativos closed centers and professional wear of its members. These institutions are hosting Youth Criminal Devices young people who have broken the law. This time the investigation of the origins of these presents. the theoretical consideration of the Centers as heterotopias of deviation (Foucault, 1967) is proposed. The results obtained so far regarding the feeling of frustration found in workers who make up these institutions also exposed, articulate with the notion of mental exhaustion caused by dissatisfaction at work (Dejours, 1992). Finally the impact of legal and institutional atravesamientos in this particular state institution designed as a response to young people who have committed a crime noted.

Tuta e a cidade: arquivos domésticos das infâmias urbanas / Tuta and the city: domestico´s archives of urban infamy

Resumo O presente ensaio utiliza estratégias biografemáticas para acontecimentalizar nossos arquivos domésticos da infâmia urbana. Não se busca juízo ou verossimilhança. Não se pretende dizer o que o personagem experienciou: seria sufocar mais uma vez sua voz. Pretende-se apenas experimentar ver que cidade se vê ao nos reinventarmos com o contágio-tuta. Que cidade se produz ao nos afundarmos nas heceidades da sua vida ao ponto de repensar as nossas? É deste modo que se busca acontecimentalizar nossa cidade com fragmentos infames em uma heterotopia doméstica que acontecimentalize os arranjos de subjetivação existentes em nossas cidades desde seu surgimento até a atualidade.(AU)

Abstract This essay utilizes biographematics strategies to eventualization ours domestic´s archives of the urban infamy. We do not search for judgment or verisimilitude. We want just an experimental act of assemblage. Which city we can produce when we are infect whit the singularities of other life? What we can see of our habits whit the life of an infamy? In this essay, we want to make an effort to reinvent ours domestic lives beyond the disciplinary and control strategies. Whit the heterotopia of an infamy life, we proposes an eventualization of ours domestic´s archives.(AU)

EscritaCom: heterotopias / Writewith: heterotopias / Escrituracon: heterotopías

Este artigo focaliza uma reflexão sobre a escritaCom a partir do conceito de heterotopia. O conceito de heterotopia permitiria uma zona de aproximação e de criação de um espaço outro, na medida em que se considerar que um exercício de escrita se faz em um espaço. A heterotopia torna-se fio condutor para um exercício de pensamento sobre a escritaCom. Afirma-se que a escritaCom constitui uma possibilidade heterotópica porque o escrever exclusivamente solitário constitui uma utopia. Isto porque nunca se escreve solitariamente: multiplicidades de vozes fazem-se presentes a cada pensamento e a cada palavra. A escritaCom é tomada como uma política de pesquisa e torna-se, ela mesma, a condição mediante a qual a pesquisa se encontra com a vida. Um vetor afetivo que permite perseguir desdobramentos éticos e políticos na pesquisa, a partir do qual se tornaria possível conciliar política e afetos.

This article focuses on the writeWith embodied methodology from the vantage point of the concept of heterotopia. Heterotopia would allow an approach zone and creation of an other-place, to the extent that one may consider that a writing exercise is conducted somewhere. Heterotopia becomes the conducting wire for a thought exercise that engages writingWith. We contend that to writeWith is a heterotopic possibility because to write alone, exclusively, is a utopia. One never writes alone: a multiplicity of voices make themselves present in each thought and in each word. When writeWith is adopted as a research policy it becomes a mediating condition for the encounter of research with life; it becomes an affective vector that allows one to follow ethical and political unfoldings in the research, and through which it would become possible to reconcile policies and affects.

El presente artículo objetiva ofrecer una reflexión sobre la escrituraCon, tomando como punto de partida el concepto de heteronomía. El concepto de herotonomía es una zona de aproximación y de creación de un espacio otro, en la medida en que se considera que el ejercicio de la escritura se hace en un espacio. La heteronomía tornase hilo conductor para un ejercicio de pensamiento sobre la escrituraCon. Se afirma que la escrituraCon constituye una posibilidad heterotópica, porque el escribir exclusivamente solitario constituye una utopía. Esto porque nunca se escribe solitariamente: multiplicidades de voces se hacen presentes en cada pensamiento y encada palabra. La escrituraCon, es tomada como un política de la investigación e se torna, ella misma, a condición mediante la cual la investigación se encuentra con la vida. Un vector afectivo que permite dar seguimiento a desdoblamientos éticos y políticos en la investigación, a partir de lo que se tornaría posible la conciliación de política y afectos.

EscritaCom: heterotopias / Writewith: heterotopias / Escrituracon: heterotopías

Este artigo focaliza uma reflexão sobre a escritaCom a partir do conceito de heterotopia. O conceito de heterotopia permitiria uma zona de aproximação e de criação de um espaço outro, na medida em que se considerar que um exercício de escrita se faz em um espaço. A heterotopia torna-se fio condutor para um exercício de pensamento sobre a escritaCom. Afirma-se que a escritaCom constitui uma possibilidade heterotópica porque o escrever exclusivamente solitário constitui uma utopia. Isto porque nunca se escreve solitariamente: multiplicidades de vozes fazem-se presentes a cada pensamento e a cada palavra. A escritaCom é tomada como uma política de pesquisa e torna-se, ela mesma, a condição mediante a qual a pesquisa se encontra com a vida. Um vetor afetivo que permite perseguir desdobramentos éticos e políticos na pesquisa, a partir do qual se tornaria possível conciliar política e afetos.

This article focuses on the writeWith embodied methodology from the vantage point of the concept of heterotopia. Heterotopia would allow an approach zone and creation of an other-place, to the extent that one may consider that a writing exercise is conducted somewhere. Heterotopia becomes the conducting wire for a thought exercise that engages writingWith. We contend that to writeWith is a heterotopic possibility because to write alone, exclusively, is a utopia. One never writes alone: a multiplicity of voices make themselves present in each thought and in each word. When writeWith is adopted as a research policy it becomes a mediating condition for the encounter of research with life; it becomes an affective vector that allows one to follow ethical and political unfoldings in the research, and through which it would become possible to reconcile policies and affects.

El presente artículo objetiva ofrecer una reflexión sobre la escrituraCon, tomando como punto de partida el concepto de heteronomía. El concepto de herotonomía es una zona de aproximación y de creación de un espacio otro, en la medida en que se considera que el ejercicio de la escritura se hace en un espacio. La heteronomía tornase hilo conductor para un ejercicio de pensamiento sobre la escrituraCon. Se afirma que la escrituraCon constituye una posibilidad heterotópica, porque el escribir exclusivamente solitario constituye una utopía. Esto porque nunca se escribe solitariamente: multiplicidades de voces se hacen presentes en cada pensamiento y encada palabra. La escrituraCon, es tomada como un política de la investigación e se torna, ella misma, a condición mediante la cual la investigación se encuentra con la vida. Un vector afectivo que permite dar seguimiento a desdoblamientos éticos y políticos en la investigación, a partir de lo que se tornaría posible la conciliación de política y afectos.

Heterotopía nodular periventricular, objetivo quirúrgico en epilepsia refractaria al manejo farmacológico / Periventricular Nodular Heterotopia, Surgical Goal in Drug-Resistant Epilepsy / Heterotopia Nodular Periventricular, objetivo cirúrgico em epilepsia refratária ao manejo farmacológico

Introducción: La heterotopía neuronal es un defecto de la migración en el cual estas células no completan su desplazamiento hacia la corteza. La forma más comúnmente reportada es la heterotopía nodular periventricular, caracterizada por conglomerados neuronales que se ubican adyacentes a las paredes de los ventrículos laterales. Hasta el 90% de los pacientes con esta condición presentan epilepsia en algún momento de la vida y una gran proporción de ellos serán refractarios al manejo farmacológico. Esto hace necesario un adecuado abordaje diagnóstico que busque establecer qué pacientes se beneficiarían de resección quirúrgica de la lesión, que en la mayoría de los casos ofrece una alta tasa de control de crisis. Desarrollo: Se presenta un recorrido desde la práctica por los aspectos con mayor relevancia en cuanto a la fisiopatología, manifestaciones clínicas, abordaje diagnóstico y terapéutico de la heterotopía nodular periventricular, con el fin de explorar el rol de esta condición como causante de epilepsia refractaria. Conclusión: La epilepsia refractaria al tratamiento condiciona de manera significativa la calidad de vida de los pacientes. Una entidad frecuentemente asociada a esto es la heterotopía nodular periventricular, la cual debe ser correctamente abordada por el equipo médico tratante procurando un diagnóstico oportuno y definiendo qué pacientes se benefician del manejo quirúrgico. De esta manera, se impacta positivamente la calidad de vida de estos sujetos y de sus cuidadores.

Introduction: Neuronal heterotopia is a migration disorder in which these cells do not complete their movement toward the cerebral cortex. Periventricular nodular heterotopia is the most frequently reported form, characterized by neuronal conglomerates adjacent to the lateral ventricles walls.About 90 % of patients with this condition suffer epilepsy at some point in their lives and the major proportion of them will be resistant to pharmacologic treatment. This makes an appropriate diagnostic approach necessary in order to determine which patients would benefit from surgical resection of the lesion, which in most cases offers a high rate of crisis control. Development: This article presents a review of the most important topics approached from the practice of periventricular nodular heterotopia pathophysiology, clinical features, diagnosis and therapy. It is aimed at exploring the role of this condition as a cause of intractable epilepsy. Conclusion: Pharmacologic treatment for resistant epilepsy will have a severe impact on patient's quality of life. Periventricular nodular heterotopia is frequently associated to this condition, which must be successfully approached by the medical team attempting to an opportune diagnosis and defining which patients would benefit from surgical management. This positively impacts the quality of life of these patients and their caregivers.

Introdução: A heterotopia neuronal é um defeito da migração no qual estas células não completam seu deslocamento ao córtex. A forma mais comunmente reportada é a heterotopia nodular periventricular, caracterizada por conglomerados neuronais que se localizam adjacentes às paredes dos ventrículos laterais. Até o 90% dos pacientes com esta condição apresentam epilepsia em algum momento da vida e uma grande proporção deles, serão refratários ao manejo farmacológico. Isto faz necessária uma adequada abordagem diagnóstica, buscando estabelecer quais pacientes se beneficiariam de ressecção cirúrgica da lesão, que na maioria dos casos oferece uma alta taxa de controle de crises. Desenvolvimento: Se apresenta um recorrido desde a prática pelos aspectos com maior relevância em quanto à fisiopatologia, manifestações clínicas, abordagem diagnóstica e terapêutica da heterotopia nodular periventricular. Com o fim de explorar o rol desta condição como causador de epilepsia refratária. Conclusão: A epilepsia refratária ao tratamento condiciona de maneira significativa à qualidade de vida dos pacientes. Uma entidade frequentemente associada a isto é a heterotopia nodular periventricular, a qual deve ser corretamente abordada pela equipe médica tratante procurando um diagnóstico oportuno e definindo quais pacientes se beneficiam de manejo cirúrgico. Desta forma impacta-se positivamente a qualidade de vida destes sujeitos e de seus cuidadores.

Diffuse heterotopic hair in a canine uterus: case report / Heterotopia de pelo difusa no útero de uma cadela: relato de caso

The present report describes the clinical and pathological findings related to diffuse heterotopic hairs associated with pseudo-placentational endometrial hyperplasia in a canine uterus. Macroscopically, the uterus was intensely enlarged and thicker, and the endometrial surface was irregular and covered with black hairs similar to the hairs of the bitch. Histologically, heterotopic hairs associated with pseudo-placentational endometrial hyperplasia were observed.

O presente relato descreve os achados clínicos e patológicos de uma heterotopia de pelos difusa associada com hiperplasia endometrial pseudo-placentacional em um útero de uma cadela. Macroscopicamente, o útero estava intensamente aumentado de volume e espesso, a superfície do endométrio estava irregular e recoberta com pelos pretos semelhantes aos pelos da cadela. Histologicamente, heterotopia de pelos associada com hiperplasia endometrial pseudoplacentacional foi observada.

Diffuse heterotopic hair in a canine uterus: case report / Heterotopia de pelo difusa no útero de uma cadela: relato de caso

The present report describes the clinical and pathological findings related to diffuse heterotopic hairs associated with pseudo-placentational endometrial hyperplasia in a canine uterus. Macroscopically, the uterus was intensely enlarged and thicker, and the endometrial surface was irregular and covered with black hairs similar to the hairs of the bitch. Histologically, heterotopic hairs associated with pseudo-placentational endometrial hyperplasia were observed.(AU)

O presente relato descreve os achados clínicos e patológicos de uma heterotopia de pelos difusa associada com hiperplasia endometrial pseudo-placentacional em um útero de uma cadela. Macroscopicamente, o útero estava intensamente aumentado de volume e espesso, a superfície do endométrio estava irregular e recoberta com pelos pretos semelhantes aos pelos da cadela. Histologicamente, heterotopia de pelos associada com hiperplasia endometrial pseudoplacentacional foi observada.(AU)

Heterotopia pancreática yeyuna yuxtahepática y en quiste de conducto colédoco / Jejunal juxtahepatic and common bile duct (ductus choledochus) cystic pancreatic heterotopia

Se exponen 3 casos con hallazgo incidental de páncreas heterotópico, en autopsia y 2 piezas quirúrgicas para hacer una breve revisión del tema. Casos: 1. Mujer de 53 años de edad fallecida por neumonía de focos múltiples. Durante el estudio post mortem se encontró, a nivel del segmento yeyunal, un nódulo constituido histológicamente por múltiples conductos con epitelio columnar y fibras anchas desorganizadas de músculo liso. 2. Preescolar varón de 2 años 11 meses de edad con diagnóstico de quiste de colédoco y resección del mismo. En uno de los cortes de pared se observó una banda de tejido que a la microscopía de luz correspondía a tejido pancreático sin alteraciones. 3. Escolar mujer de 6 años 10 meses de edad con diagnóstico de síndrome de Byler candidata a transplante hepático. Los cortes histológicos del explante en la región del hilio revelaron grupos multifocales de conductos y acinos pancreáticos sin presencia de islotes. Conclusión: La heterotopia pancreática es un hallazgo infrecuente que se puede observar a cualquier nivel del tracto gastrointestinal e inclusive fuera del mismo, por lo que la caracterización histopatológica de esta alteración permite distinguirla de otras lesiones. Pese a su conducta habitualmente benigna y asintomática, ocasionalmente puede dar origen a cuadros obstructivos, hemorrágicos, inflamatorios o neoplásicos.

We report three cases of pancreatic heterotopia incidentally found (one in autopsy and two in surgical pieces) with a brief review of the literature. Cases: 1. A fifty-three-year-old woman who died of bronchopneumonia. During post-mortem examination, a nodule (hystologically formed by multiple ducts lined by columnar epithelium and broad disarranged smooth muscle fibers) was found at the level of jejune. 2. 5-year, 11-month-old male with diagnosis ofcholedochal cyst. In the resected specimen, one of the mural slices showed a tissue stripe that under light-microscope examination corresponded to normal pancreatic tissue. 3. 6-year, 10-month-old female diagnosed with Byler syndrome who was recipient of liver transplant. Slices taken from the hilum in the resected specimen revealed multiple clusters of pancreatic acini and ducts without evidence of endocrine islets. Conclusion: Pancreatic heterotopia is an uncommon finding, which may be found at any level of the gastrointestinal tract, and even outside it. Histopathologic studies allow to distinguish this disorder from other lesions. Despite its commonly benign and asymptomatic behaviour, it may sometimes produce obstruction, hemorrhage, inflammation or neoplasms.

Heterotopia gástrica como causa de sangrado del tubo digestivo bajo / Gastric heterotopia as a cause of lower gastrointestinal bleeding

Se comunica un caso de heterotopia gástrica en rectosigmoides con sangrado rectal como manifestación clínica, por lo que se efectuó la revisión bibliográfica del tema. Caso: Varón de 21 años de edad con rectorragia de una semana de evolución. Durante el estudio del caso se tomaron biopsias de lesiones ulceradas en mucosa rectal, que fueron enviadas para su estudio histopatológico. Resultados: En la muestra recibida se observaron fragmentos entremezclados de mucosa de colon y mucosa gástrica de tipo oxíntico (fúndica) cuyos adenómeros se hallaban en estrecha relación con las criptas de Lieberkühn. Conclusión: La heterotopia gástrica es un hallazgo infrecuente, más aún cuando se observa en segmentos muy apartados en el colon distal. Suele acarrear un curso indolente y benigno, sin embargo, en ocasiones conlleva ciertas malformaciones asociadas o complicaciones derivadas de la misma actividad secretora fisiológica del tejido ectópico. Raramente puede experimentar malignización.

We report a case of gastric heterotopia in the rectum and sigmoid colon clinically presented as rectal bleeding; a review of the literature on the topic is also presented. Case: Twenty-one-year-old male who had experienced rectal bleeding for one week. biopsies from ulcerated lesions in the rectum were taken and sent forward for histopathological assessment. Results: In the sample received, fragments of colon mucosa and oxyntic (fundus) gastric mucosa, which adenomeres were closely related to the crypts of Lieberkuhn. Conclusion: Gastric heterotopia is an unusual finding, even less common when it is located in distant segments of the distal colon. Although usually being a condition with an indolent and benign evolution, it may also produce certain malformations o complications, consequence of the same secretory activity of the ectopic tissue. It rarely becomes a malignant disease.

Heterotopia nodular difusa y focal como malformación del sistema nervioso central / Focal and diffuse nodular heterotopy as a malformation of the central nervous system

Se presenta el caso clínico de una adolescente de 16 años de edad, con 37,8 semanas de embarazo, quien ingresó en el Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, por presentar manifestaciones neurológicas. Mediante la resonancia magnética efectuada se observó una imagen de posible aspecto tumoral en la zona temporoparietooccipital derecha, lo cual obligó a realizarle cesárea de urgencia. Luego se efectuó resonancia magnética contrastada, cuyos resultados confirmaron que se trataba de una heterotopia nodular difusa subependimaria y focal, asociada a hipoplasia de los hemisferios cerebral y cerebeloso derechos y del cuerpo calloso(AU)

The case report of a 16 year-old adolescent, with 37.8 weeks of pregnancy who was admitted to Dr Juan Bruno Zayas Alfonso Teaching General Hospital from Santiago de Cuba is presented, due to neurological manifestations. By means of magnetic resonance an image of possible tumoral aspect was observed in the right temporoparietooccipital area, which forced to carry out an emergent caesarean section. Then a contrasted magnetic resonance was made, which results confirmed that it was a focal and diffuse nodular subependymal heterotopy, associated with an hypoplasia of the right cerebral and cerebelous hemispheres and from the callous body(AU)