Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report.

OBJECTIVE:: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS:: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS:: 17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION:: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report

OBJECTIVE: To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro. METHODS: Cross-sectional and retrospective study of thirty cases treated over a period of two decades. RESULTS: 17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels. CONCLUSION: The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

Traumatic extrusion of C5-C6 intervertebral disc associated to mielopathy without bone lesion: report of 2 cases and review

The authors reports two cases of cervical disc herniation caused by trauma without osseous lesions in articular facets, vertebral bodies or dislocations. It constitutes uncommon lesions in spinal cord injury. The literature is reviewed.

Perfeccionismo: Autoconhecimento e Desapego dos Ideais Perfeitos / Perfectionism: Self-Knowledge and Detachment from Perfect Ideals / Perfeccionismo: Autoconocimiento y Desapego de los Ideales Perfectos

O artigo trata sobre o perfeccionismo, suas manifestações e consequências soba ótica do paradigma consciencial. O objetivo é discorrer sobre os achados de pesquisano sentido de compreender melhor os processos relacionados ao perfeccionismono âmbito da inversão existencial. O método utilizado para se chegar às ideiasdiscorridas foi a autopesquisa com base em anotações diárias, debates e do estudobibliográfico no período decorrido entre 2006 e 2007 para a primeira escrita e 2014para a escrita final. É proposta uma análise que favorece a profilaxia e a superação do perfeccionismo pelas conscins interessadas(AU)

The article deals with perfectionism, its manifestations and consequences underthe optics of the consciential paradigm. The objective is to discourse on the researchdiscoveries in the sense of better understanding the processes related to perfectionismin the ambit of the existential inversion. The used method to arrive to thediscoursed ideas was the self-research based in daily annotations, debates and bibliographicalstudy in the period elapsed between 2006 and 2007 for the first writingand 2014 for the final writing. It is proposed an analysis that favors the prophylaxisand the surpassing of the perfectionism for the interested intraphysical consciousness(AU)

El artículo trata sobre el perfeccionismo, sus manifestaciones y consecuenciassobre la óptica del paradigma conciencial. El objetivo es discurrir sobre los descubrimientosinvestigativos en el sentido de compreender mejor los procesos relacionadosal perfeccionismo en el ámbito de la inversión existencial. El método utiliza -do para llegar a las ideas percorridas fue la autoinvestigación con base enanotaciones diarias, debates y del estudio bibliográfico en el período transcurridoentre 2006 y 2007 para la primera escrita y 2014 para la escrita final. Es propuestoun análisis que favorece la profilaxia y la superación del perfeccionismo por lasconcines interesadas(AU)

Thoraco-lumbar nondysraphic intramedullary spinal cord lipoma with an unusual aspect on MRI: case report and review / Lipoma intramedular tóraco não associado a disrafismo espinhal com aspecto pouco usual à RM: relato de caso e revisão

Lipomas intramedulares são tumores raquidianos muito raros, sendo a maioria associado a disrafismos espinhais. Neste artigo relatamos o caso de um paciente oligossintomático, apresentando um lipoma intramedular tóraco-lombar não associado a disrafismo espinhal, com um sinal bifásico pouco usual na RM ponderada em T1, e submetido a biópsia microcirúrgica. Aspectos de origem, evolução, diagnóstico e tratamento são discutidos.

Intramedullary spinal cord lipomas are very rare spinal tumors, most of them related to spinal dysraphism. We report the case of an oligosymptomatic patient, presenting with a thoraco-lumbar nondysraphic intramedullary spinal cord lipoma, with an unusual biphasic sign on T1-weighted MRI, and submitted to microsurgical biopsy. Features of origin, evolution, diagnosis and treatment are discussed.

Total septal preservation for sellar approach - paving the way for future flap reconstructions.

CONCLUSIONS: Despite being a single surgical channel this approach provides enough room and maneuverability for microscopic and endoscopic surgery of sellar lesions and the total septal preservation technique allows future reconstructions using the posterior nasoseptal flap. OBJECTIVES: To demonstrate the importance and feasibility of total nasal septum and anterior sphenoid preservation in transseptal approaches to the sella. METHODS: Retrospective evaluation of 15 transseptal approaches for sellar lesions with or without suprasellar extensions operated under general anesthesia with a total septal preservation technique. RESULTS: In all patients operated by this method a complete microscopic and endoscopic tumor removal was possible and an uneventful recovery was observed. Nasal congestion was mild and no episode of nasal bleeding, cerebrospinal leaks, visual loss, diabetes insipidus or death was observed. Breathing was considered normal or improved in all patients after removal of splints; this subjective sensation was confirmed at 1 month and 6 months follow-up visits. No external nose deformities or septal deviations were observed; nasal endoscopy demonstrated a preserved septum and anterior sphenoid wall anatomy on both sides of the nose at 1 month and 6 months follow-up visits. CT scans taken at 6 months after the procedure confirmed these clinical findings.

Lesões císticas não tumorais intraselares: cisto de Rathke ede aracnóide: relato de dois casos e revisão da literatura / Intraselar non neoplasic cystic lesions: Rathke cystic and arachnoidal cyst: report of two cases and literature review

São discutidos os aspectos clínicos, endocrinológicos, radiológicos e cirúrgicos de dois pacientes: um portador de cisto de bolsa de Rathke e outro de cisto aracnóide, ambos em localização intraselar, de uma série de 123 pacientes portadores de lesão intra e supraselar abordados por via transesfenoidal. Lesões císticas puras são raras e as dificuldades diagnósticas pré-operatórias assim como os aspectos neurocirúrgicos relativos a estas patologias são destacados. É feita uma revisão da literatura.

Selección de cepas de Shigella sonnei para el desarrollo de una vacuna efectiva contra la shigellosis / Selection of Shigella sonnei strains to develop an effective shigellosis vaccine

En el Instituto Finlay se desarrolló una metodología de trabajo que contribuyó a la selección de cepas de Shigellasonnei como posibles candidatos vacunales contra la shigellosis. Las cepas investigadas, donadas por el Centro Provincial de Higiene y Epidemiología de Ciudad de La Habana, se caracterizaron según los métodos convencionales. La identificación del serogrupo y serotipo se realizó por aglutinación en láminas portaobjetos con antisueros comerciales; mientras que para el estudio de la susceptibilidad antimicrobiana se utilizó el DIRAMIC 10, un equipo semiautomatizado que proporcionó los resultados 4 horas después de su realización. Se investigó también la presencia de plásmidos de virulencia, por el crecimiento de Shigella spp. en medio de agar Triptona Soya con Rojo Congo al 0,025 por ciento, así como la expresión de las proteínas de la membrana externa en SDS-PAGE; para las pruebas de virulencia y potencia se emplearon los modelos animales (modelo ratón-pulmón y Test de Sereny). Los resultados obtenidos conla metodología utilizada permitieron la selección de la cepa de S sonnei A-04 como la más adecuada para la obtencióndel posible candidato vacunal(AU)

A work methodology was developed at Finlay Institute that contributed to the selection of Shigella sonnei strains as possible vaccinal candidates against shigellosis. Strains under study , were donated by the provincial Centre of Hygiene and Epidemiology in the City of Havana and were characterized using traditional methods. The identification and of the serogroup and serotype was performed by agglutination in slides with commercial antisera. Whereas DIRAMIC 10, a semi automatedequipment was used to study antimicrobial susceptibility. Results were obtained four hours after. The presence of virulence plasmid for the growth of Shigella spp. In Agar Soy Triptone with Congo Red at 0,025 percent, as well as outer membrane protein expression in of SDS-PAGE. In addition, animal models mice-lung and the test of Sereny were used for virulence and potency tests. Results obtained allowed the selection of the strain S sonnei A-04 as the most adequate for the obtainment of a possible vaccinal candidate(AU)

Utilidad del modelo animal ratón-pulmón para evaluar la virulencia de posibles cepas vacunales de Shigella spp / Usefulness of lung-mouse animal model to evaluate the virulence of Shigella spp candidate vaccine straims

Shigella flexneri y Shigella sonnei, como cualquier otra especie del género Shigella, se sitúan entre los principalesagentes etiológicos de las enfermedades diarreicas agudas, sobre todo aquellas que ocurren en los países en vías dedesarrollo, aunque por la baja dosis infectante de este enteropatógeno no se excluyen los países desarrollados. Estasituación conlleva a la elaboración de vacunas para prevenir esta enfermedad y la necesidad de un modelo animal quepruebe la eficacia protectora e inmunogénica de posibles candidatos vacunales contra la shigellosis, situación que ha motivado numerosos estudios por la dificultad de demostrar la enteropatía intestinal en los monos y humanos. Lo anteriormente expuesto, más la capacidad de Shigella spp para mostrar resistencia a los ntimicrobianos, motivó la realización de este trabajo. En el mismo se constató la utilidad del modelo animal ratón-pulmón para evaluar la virulencia de candidatos vacunales a partir de este microorganismo. Se utilizó la técnica de inoculación intranasal con una concentración entre 107 y 109 UFC de cepas de Shigella flexneri y Shigella sonnei. Por todos los resultadosobtenidos con el modelo animal ratón-pulmón se concluyó que este modelo puede ser eficiente para los estudiospreclínicos de cualquier candidato vacunal a partir de Shigella spp(AU)

Shigella flexneri and Shigella sonnei, as other species of Shigella, are among the main etiological agents of acute diarrhoeal diseases worldwide, specially in developing countries, although we do not exclude developed ones, because of their low infective dose, between 10 and 100 colonies. This leads to the preparation of vaccines to prevent this illness and the need for an animal model to demonstrate the protective and immunogenic effectiveness of the shigellosis candidate vaccines. Many studies have been carried out since the intestinal enteropathy is difficult to demonstrate in monkeys and humans. The aforementioned and the capacity of Shigella sp to become resistant to antibiotic treatments motivated our study. In it we demonstrated theusefulness of the mouse-lung animal model to evaluate the virulence of vaccine candidates. Intranasal inoculation with Shigella flexneri and Shigella sonnei in concentration on between 107 and 109 CFU was used. The conclusion was that the lung-mouseanimal model can result efficient for preclinical studies of any Shigella spp vaccine candidate(AU)

Avaliaçäo da atividade secretora, proliferaçäo celular e expressäo da proteína p27 em tumores hipofisários / Evaluation of secretory activity, cell proliferation and expression of p27 protein in hypophyseal tumors

A finalidade deste estudo foi avaliar a atividade secretora, proliferaçäo celular e inibiçäo do ciclo celular das neoplasias hipofisárias. Os tecidos foram obtidos de 13 pacientes incluindo acromegalia (n=5), adenomas näo-secretores (n=4), hiperprolactinemia (n=3) e doença de Cushing (n=1). Os espécimes foram examinados por técnica imuno-histoquímicacom anticorpos anti-ACTH, anti-TSH, anti-LH, anti-FSH, anti-PRL, anti-hGH, anti MIB-1 (análise da proliferaçäo celular)e anti-p27(análise da inibiçäo do ciclo celular). A expressäo imunohistoquímica quanto à atividade secretora nos tumores hipofisários demonstrou que todos produziam mais que um hormôni. As células positivas para o marcador de proliferaçäo celular MIB-1 mostraram-se presentes em aproximadamente 46 por cento dos casos. A maior taxa proliferativa foi encontrada nos tumores com com quadro clínico de acromegalia (80 por cento dos casos). A taxa d positividade para a proteína p27 foi de aproximadamente 38 por cento, sendo, em média, maior no tumor responsável pela doença de Cushing. Esses resultados demonstram que os adenomas multisecretores säo relativamente comuns. Os índices de proliferaçäo celular baixos e os nveis de p27 próximos àqueles observados em tecidos normais expressam o baixo nível de proliferaçäo celulas destes tumores.

Estereotaxia no tratamento dos tumores cerebrais: experiência inicial com 40 casos / Stereotaxic techniques in the treatment of brain tumors: experience with 40 cases

Os autores relatam sua experiência com 40 pacientes portadores de lesöes expansivas intracranianas operados consecutivamente no período de setembro de 1993 até abril de 1996, utilizando estereotaxia guiada por tomografia computadorizada. Foram realizadas 33 biøpsias cerebrais e 7 craniotomias estereotaxicamente localizadas para lesöes superficiais e profundas. Säo discutidas as dificuldades encontradas, complicaçöes e resultados.

Formas císticas da neurocisticercose: consideraçöes sobre o tratamento cirúrgico / Cystic lesions due to neurocysticercosis: considerations by surgical treatment

Neste trabalho os autores discutem o tratamento cirúrgico das formas císticas da neurocisticercose: parenquimatosa, intraventricular, subaracnóide e intrarraquiana. Aspectos de diagnóstico, tipos de abordagem utilizadas e complicaçöes säo analisadas. Destaca-se a baixa incidência destas formas considerando-se que a hidrocefalia é a complicaçäo mais frequente desta doença

Lesäo axonal difusa: aspectos clínicos e tomográficos / Diffuse axonal injury: clinical and tomography aspects

Neste trabalho säo estudados os aspectos clínicos e tomográficos de 24 pacientes com lesäo axonal difusa. Os pacientes foram divididos em 2 grupos: com lesäo axonal grave e moderada; säo analisados aspectos relativos às sequelas e diagnóstico por neuroimagem

Condroma parassagital intracraniano / Parasagital intracranial chondroma

Apesar da reconhecida capacidade de diferenciaçäo mesenquimal das meninges, a ocorrência de condromas intracranianos em localizaçäo parassagital é bastante rara. É relatado o caso de uma menina de 13 anos e as dificuldades encontradas no diagnóstico e no tratamento cirúrgico. Estas lesöes, em geral, säo de bom prognóstico

Forma cistica gigante da neurocisticercose: relato de caso. / Giant cystic form of neurocysticercosis: a case report

E apresentado 1 paciente, portador de 2 cistos gigantes na regiao frontal, que apresentou sintomatologia clinica de hipertensao intracraniana e sinal neurologico focal. Justifica-se a apresentacao do caso pelo fato de, contrariamente ao tratamento cirurgico empregado na literatura (craniotomia + exerese), ter sido utilizada drenagem atraves de sistema valvular de baixa pressao (cisto-cavidade peritoneal) e a seguir tratamento com praziquantel com o que desapareceram os cistos