RESUMO
Tumours of the quadrigeminal plate in adults are usually benign. Nevertheless, obstructive hydrocephalus due to compression of the Sylvian aqueduct is an almost invariable early finding. Whether or not direct excision is undertaken, temporary or permanent treatment of the hydrocephalus is warranted. Endoscopic third ventriculostomy is an alternative to insertion of a shunt and provides both acute and long-term relief of hydrocephalus-related symptoms. We chose a two-stage approach for treating a tectal ganglioglioma in an adult: endoscopic third ventriculostomy followed by surgical excision. The advantages and disadvantages of each therapeutic strategy are discussed.
Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Ganglioglioma/cirurgia , Hidrocefalia/cirurgia , Teto do Mesencéfalo/cirurgia , Terceiro Ventrículo/cirurgia , Ventriculostomia/métodos , Adulto , Neoplasias do Tronco Encefálico/complicações , Neoplasias do Tronco Encefálico/patologia , Aqueduto do Mesencéfalo/patologia , Aqueduto do Mesencéfalo/fisiopatologia , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Ganglioglioma/complicações , Ganglioglioma/patologia , Humanos , Hidrocefalia/patologia , Hidrocefalia/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Teto do Mesencéfalo/patologia , Teto do Mesencéfalo/fisiopatologia , Terceiro Ventrículo/patologia , Terceiro Ventrículo/fisiopatologia , Resultado do Tratamento , Ventriculostomia/instrumentaçãoRESUMO
Caveolin-1 (Cav-1) protein has been documented in several neoplasms with a controversial role in cell proliferation, tumour development and progression. The aim of the present study was to investigate the Cav-1 immunohistochemical expression in human meningiomas. Sixty-two cases, classified as 11 meningothelial (17%), 12 transitional (19%), 5 fibrous (8%), 3 microcystic (5%), 3 secretory (5%), 1 clear cell (2%), 1 chordoid (2%) and 26 (42%) atypical meningiomas, were selected from our pathological files. Clinico-pathological data, including Ki-67 values and survival data were also available. Ten leptomeningeal samples were utilized as normal tissue control. For each case, a polyclonal antibody against Cav-1 was applied and an intensity distribution (ID) score was determined. The Cav-1 immunoexpression was found in 95% of meningiomas with a variable ID score, while only minimal, not uniform, reactivity was noted in non-neoplastic meninges. Of note, higher Cav-1 ID score was significantly correlated with tumour site, Simpson's grade, histological type, higher histologic grade, Ki-67 labelling index > or = 4% and clinical course. Kaplan-Meier curves demonstrated a significantly worse survival in patients with higher Cav-1 ID score, Ki-67 > or = 4% and 2-3 Simpson grade. Multivariate analysis indicated that only Ki-67 was an independent prognostic factor. Increased immunoexpression of the Cav-1 seems to be associated with the biological aggressiveness of meningiomas, reflecting a worse prognosis.
Assuntos
Caveolina 1/metabolismo , Neoplasias Meníngeas/metabolismo , Neoplasias Meníngeas/patologia , Meningioma/metabolismo , Meningioma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Caveolina 1/genética , Proliferação de Células , Progressão da Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Estimativa de Kaplan-Meier , Antígeno Ki-67/metabolismo , Masculino , Neoplasias Meníngeas/genética , Meningioma/genética , Pessoa de Meia-Idade , Valor Preditivo dos Testes , PrognósticoRESUMO
Central neurocytomas are low-grade tumours of neuronal origin, affecting mainly young patients and usually located in the lateral or third ventricle. We report a rare case of central neurocytoma at the fourth ventricle level. Magnetic resonance imaging showed a homogeneously enhancing mass lesion at the fourth ventricle. Gross-total surgical removal was achieved. The histological diagnosis was of central neurocytoma but the lesion showed a fairly elevated Ki-67 index (6%). Given this finding, close neuroimaging monitoring was performed and at the moment the patient is free of recurrence.
Assuntos
Neoplasias do Ventrículo Cerebral/patologia , Quarto Ventrículo/patologia , Neurocitoma/patologia , Adulto , Neoplasias do Ventrículo Cerebral/cirurgia , Diagnóstico Diferencial , Ependimoma/patologia , Quarto Ventrículo/cirurgia , Humanos , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Imageamento por Ressonância Magnética , Masculino , Microscopia Eletrônica de Transmissão , Neurocitoma/cirurgiaRESUMO
A Phase I radioimmunotherapy trial was conducted in which radioconjugated monoclonal antibody (MAb) was directly infused into the tumor or postoperative tumoral bed in patients with high-grade malignant glioma. BC-4, a murine MAb that recognizes tenascin, was used in these studies. The MAb was labeled with 90Y, a pure beta emitter with maximum energy of 2.284 MeV, which can penetrate into tissue up to 0.5-0.7 cm. Stable 90Y-labeled MAb conjugates were prepared using the chelator p-isothiocyanatobenzyl derivative of diethylenetriaminepentaacetic acid (ITC-Bz-DTPA), obtaining >95% labeling efficiency and conserving the antibodies' immunoreactivity (>85%). Twenty patients, 2 with anaplastic astrocytoma and 18 with glioblastoma, were included in the study. All of the patients had been treated previously with conventional therapies (surgery, external radiotherapy, and chemotherapy) and presented with progressive disease not amenable to further treatment. A dose-escalation study was performed using doses ranging from 5-30 mCi (185-1110 MBq) of 90Y-labeled MAb BC-4. The protein dose of MAb was always 1 mg. Three patients were treated at the 5, 10, 15, and 20 mCi levels, and the 25- and 30-mCi doses were each administered to 4 patients. Systemic toxicity was completely absent in all of the patients. The maximum tolerated dose to the brain was 25 mCi (925 MBq). The average dose to the tumor was 3200 cGy/mCi. Doses to the liver, bone marrow, and kidneys were below 10 cGy/mCi in all of the cases. Biodistribution studies demonstrated that the 90Y-labeled MAb accreted exclusively in the neoplastic area without any diffusion into the normal brain or other normal organs. No clinical responses were recorded because of the very advanced stage of disease at the time of radioimmunotherapy.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Glioma/radioterapia , Radioimunoterapia , Radioisótopos de Ítrio/uso terapêutico , Adolescente , Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Radioimunoterapia/efeitos adversos , Dosagem Radioterapêutica , Distribuição TecidualRESUMO
Locoregional radioimmunotherapy (LR-RIT) was administered to 111 patients (20 were recruited in a phase I and 91 in a phase II study) with malignant gliomas: 1 patient with oligodendroglioma, 7 patients with anaplastic oligodendroglioma, 2 with grade II astrocytoma, 10 with anaplastic astrocytoma and 91 with glioblastoma, amounting to 58 newly diagnosed and 53 recurrent tumours. The 131I-labelled monoclonal antibodies BC-2 and BC-4 were used in order to recognize stromal and intracellular glycoprotein tenascin, an antigen present particularly in glioblastoma. The patients were enrolled between February 1990 and December 1997 after conventional therapy. The radiopharmaceutical was injected directly into the tumour site. Sequential scintigraphies demonstrated a high and enduring uptake in the tumour. The mean irradiation dose in the tumour was 300 Gy per cycle. In the group of 74 phase II glioblastoma patients the clinical responses were as follows: 10 patients with stable disease (SD), 9 with partial responses (PR), 23 with no evidence of disease (NED) and 1 patient with complete response (CR). The median survival was 19 months. The response rate (CR + PR + NED) was 17.8% for those patients with bulky lesions, with a median survival of 17 months, but 66.6% for patients with small lesions, with a median survival of 25 months. Better outcomes were recorded in cases with less aggressive diseases: oligodendroglioma, anaplastic oligodendroglioma and anaplastic astrocytoma. We conclude that fractionated LR-RIT can be safely performed, with promising results especially in patients with minimal disease.
Assuntos
Glioma/radioterapia , Imunoconjugados , Radioimunoterapia/métodos , Adulto , Idoso , Relação Dose-Resposta à Radiação , Glioblastoma/radioterapia , Glioma/mortalidade , Glioma/patologia , Humanos , Radioisótopos do Iodo , Masculino , Pessoa de Meia-Idade , Oligodendroglioma/radioterapia , Qualidade de Vida , Taxa de Sobrevida , Distribuição TecidualRESUMO
The maintenance of the mechanical properties of the vessels results from the correct arrangement of smooth muscle cells and extracellular fibrous proteins (elastin and collagen) in their wall. The morphology of extracellular matrix modifications, particularly of elastin, was investigated in inflammatory (IA) and non specific (NSA) abdominal aortic aneurysms by scanning (SEM), transmission (TEM) and immunoelectron microscopy. Both NSAs and IAs were significantly characterized by extensive extracellular matrix remodelling, including different patterns of elastin degradation. Elastic and collagen fibres distribution appeared to be extensively altered in IAs, while it conformed more to a normal pattern in NSAs. With respect to NSAs, the morphology of elastic fibres in IAs was modified to such an extent that their identification by TEM had a rely on immunocytochemical methods and by SEM on back-scattered electron analysis. The observed ultrastructural changes are indicative of the central role of extracellular matrix modifications in the pathogenesis of IAs and NSAs.
Assuntos
Aneurisma da Aorta Abdominal/patologia , Elastina/ultraestrutura , Músculo Liso Vascular/ultraestrutura , Aneurisma da Aorta Abdominal/metabolismo , Elastina/análise , Matriz Extracelular/ultraestrutura , Humanos , Imuno-Histoquímica , Inflamação/patologia , Microscopia Eletrônica de VarreduraRESUMO
Inflammatory aneurysms (IAs) have peculiar macroscopic and histological aspects which make them very different from nonspecific aneurysms (NSAs). These morphological differences seem to be determined by significant modifications of the extracellular matrix. Extracellular matrix protein component concentrations were determined biochemically in infrarenal aortic biopsies from 10 NSAs, five IAs and five non-aneurysmal aortic controls. The concentration of each wall component was expressed in % w/w (relative concentration) and in mg/wall longitudinal cm (absolute concentration) with reference to total protein recovered after hydrolysis and amino acid analysis. The biochemical results were correlated with the histological and ultrastructural features of the specimens. A significant increase in total collagen was observed in the two groups of aneurysms, with respect to the controls (NSA = 285%, IA = 382%). In contrast the 80-90% decrease in the relative concentration of elastin observed in both types of aneurysm was less marked (NSA = 55%, IA = 39%). This fall was not significant when expressed in mg/cm, although elastin derived peptide (EDP) levels in the plasma of these patients was significantly higher than in age-matched controls. The concentration of the soluble collagen fraction appeared significantly higher (Mann-Whitney, p < 0.05) in the IAs with respect to the NSAs, whilst no differences were observed between the two groups regarding the concentration of insoluble elastin and of wall and plasma EDPs. As well as providing evidence of increased elastin turnover, this study emphasises the conspicuous modifications of collagen deposition in the wall of abdominal aortic aneurysms which appeared more marked in the inflammatory group.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Aneurisma da Aorta Abdominal/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Idoso , Aorta Abdominal/metabolismo , Aorta Abdominal/ultraestrutura , Aneurisma da Aorta Abdominal/patologia , Colágeno/metabolismo , Elastina/metabolismo , Humanos , Inflamação , Microscopia Eletrônica , Microscopia Eletrônica de Varredura , Pessoa de Meia-IdadeRESUMO
One of the most important aspects of Behçet's disease is aneurysmal arteriopathy. The major problem of this complication is its tendency to develop recurrent false aneurysms at anastomotic and traumatic sites, such as angiographic punctures. We present a clinical case in which five aneurysms, some true, some false, were operated on during a period of 6 years, with the aid of ultrastructural observations of the wall of a true and a false aneurysm. One of the true aneurysms, localized in the aorta, was treated by direct aneurysmorrhaphy, and the 6-year follow-up demonstrated the absence of recurrences. Based on both this experience and the data in the literature, we suggest that the most appropriate surgical approach would, when possible, be direct aneurysmorrhaphy.
Assuntos
Falso Aneurisma/patologia , Aneurisma/patologia , Aorta Abdominal/ultraestrutura , Aneurisma da Aorta Abdominal/patologia , Síndrome de Behçet/patologia , Artéria Femoral/ultraestrutura , Adulto , Aneurisma/cirurgia , Falso Aneurisma/cirurgia , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Síndrome de Behçet/cirurgia , Endotélio Vascular/ultraestrutura , Artéria Femoral/cirurgia , Humanos , MasculinoRESUMO
The case of a 35 years old woman affected by endometriosis located inside the spinal canal in the extradural space at the level of the third left lumbar root, and developing through the corresponding foramen into the paraspinal muscles, is presented. The clinical aspect, radiological picture and surgical treatment are described. Pathogenesis is discussed on the basis of the literature. Furthermore it is stressed that only the histopathological examination gave the correct diagnosis and permitted the definitive hormonal treatment. To our best knowledge no comparable case has been published in the literature.
Assuntos
Endometriose/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adulto , Diagnóstico Diferencial , Endometriose/patologia , Feminino , Humanos , Laminectomia , Imageamento por Ressonância Magnética , Síndromes de Compressão Nervosa/patologia , Neoplasias da Coluna Vertebral/patologia , Raízes Nervosas Espinhais/patologia , Tomografia Computadorizada por Raios XRESUMO
Real-time ultrasound was used to assist localization and surgical removal of ten cases of tumours of pineal region and third ventricle. Two illustrative cases are reported in which intraoperative ultrasound greatly facilitates the surgical procedure.
Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias do Ventrículo Cerebral/diagnóstico , Ependimoma/diagnóstico , Pinealoma/diagnóstico , Ultrassonografia , Adulto , Neoplasias Encefálicas/cirurgia , Neoplasias do Ventrículo Cerebral/cirurgia , Ependimoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pinealoma/cirurgiaRESUMO
Fifty eight adult patients suffering from different intracranial lesions and scheduled for cerebral angiography were given propofol. In the first group (38 patients) brief periods of anaesthesia were induced and reinduced by means of 1.5 mg/kg of propofol iv and sometimes extended with boluses of 25-50 mg of this anesthetic. The patients were premedicated with 0.5 mg atropine im 30-40 min before the induction. Fentanyl, droperidol and diazepam in various combinations and doses were injected, im together with the atropine and iv 1-2 min before the induction, to obtain long-lasting sedations. In the second group (20 patients) the induction of the anaesthesia started 20-35 min after 0.5 mg of atropine im and 1 min after 0.1 mg of fentanyl iv. The induction was based on a bolus of 2.5 mg/kg of propofol and it was followed by suxamethonium, tracheal intubation and mechanical ventilation with N2O 70% in O2. An adequate depth of anaesthesia was maintained with supplemental doses of 50 mg of propofol, frequently associated with 25 mg of suxamethonium. Both methods proved to be reliable and safe. Nevertheless, the second method provided a better stability as far as a number of physiologic variables is concerned.
Assuntos
Anestesia Geral/métodos , Angiografia Cerebral/efeitos dos fármacos , Propofol/administração & dosagem , Adulto , Idoso , Estudos de Avaliação como Assunto , Humanos , Injeções Intravenosas , Pessoa de Meia-IdadeRESUMO
A woman 38-year-old, suffering for about ten years from multiple sclerosis and treated with repeated therapy cycles of intrathecal Depo-Medrol, developed a spastic paraparesis at the lower limbs. A lumbar myelography was carried out, and a dorsal block was demonstrated. The patient underwent a dorsal laminectomy, and arachnoidal calcification and ossification was find, but the removal of the bone plaques was ineffectual in order to the subsequent course of the neurological troubles. The results of the histological study and chemical tests are reported, and the etiology and the pathogenesis are discussed on the basis of the pertinent literature.
Assuntos
Anti-Inflamatórios/efeitos adversos , Aracnoide-Máter/efeitos dos fármacos , Calcinose/induzido quimicamente , Metilprednisolona/análogos & derivados , Esclerose Múltipla/tratamento farmacológico , Ossificação Heterotópica/induzido quimicamente , Adulto , Anti-Inflamatórios/administração & dosagem , Feminino , Humanos , Injeções Espinhais , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Acetato de MetilprednisolonaRESUMO
An unusual case of hematomyelia during anticoagulant therapy is reported in a patient after cardiac surgery. A review of the pertinent literature is presented. After medical and surgical treatment, the transverse symptoms largely subsided with rehabilitation of the patient.
Assuntos
Hemorragia/induzido quimicamente , Doenças da Medula Espinal/induzido quimicamente , Varfarina/efeitos adversos , Hemorragia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal/diagnósticoRESUMO
Os traumas cranio-cervicais, algumas vezes associados a fratura de mandibula, podem causar trombose da porcao cervical da carotida interna. No presenta trabalho, os autores referem 5 casos de trombose da arteria carotida interna ao nivel do pescoco
Assuntos
Humanos , Masculino , Feminino , Traumatismos da Coluna Vertebral , Lesões Encefálicas , Trombose das Artérias Carótidas , Artéria Carótida InternaRESUMO
Several cases of supratentorial gliomas and meningiomas were operated on since May 1977 with the help of CO2 laser infrared beam, generated by the Sharplan 791 He unit, with an adjustable output up to 50 Watts. Defocused laser beam has been found to be useful in direct attack on the tumour, through a vaporization of the neoplastic tissue. So the tumour could be progressively excavate with a loss of blood comparatively lower than with classical method. Haemostasis was quite good on diffuse capillary bleeding, but not on arterial or venous haemorragies, where the use of electrocoagulation was necessary. Extirpation especially, of meningiomas, was easier and less traumatic with the laser beam, and the destruction of infiltrating glial tumours was facilitated too.
Assuntos
Neoplasias Encefálicas/cirurgia , Terapia a Laser , Lasers/métodos , Astrocitoma/cirurgia , Ependimoma/cirurgia , Glioblastoma/cirurgia , Humanos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Oligodendroglioma/cirurgiaRESUMO
The Authors reviewed 52 cases of unilateral chronic subdural hematoma (c.s.h.) of the convexity from the clinical and angiographic point of view. They stated that it is possible to subdivide the c.s.h. into three main clinico-angiographic types: type 1: with focal symptoms and with almost always "biconvex" shape; type 2: with signs of intracranial hypertension and with "transitional or "biconvex" shape; type 3: with prevalent consciousness alterations and with "transitional" or "crescentic" shape. The shifting of the medial structure in relationship with the size of the hematoma is also discussed.