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1.
World Neurosurg ; 2024 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-38857868

RESUMO

BACKGROUND: Malignant gliomas are the most prevalent primary malignant cerebral tumors. Preoperative imaging plays an important role, and the prognosis is closely related to surgical resection and histomolecular aspects. Our goal was to correlate Ki67 indexes with tumoral volumetry in semiautomatic segmentation on preoperative magnetic resonance images and residual fluorescence in a 5-ALA-assisted resection cohort. METHODS: We included 86 IDH-wildtype glioblastoma patients with complete preoperative imaging submitted to 5-ALA assisted resections. Clinical, surgical, and histomolecular findings were also obtained. Preoperative magnetic resonance studies were preprocessed and segmented semiautomatically on Visualization and Analysis for whole tumor (WT) on 3D FLAIR, enhancing tumor (ET), and necrotic core on 3D postgadolinium T1. We performed a linear regression analysis for Ki67 and a multivariate analysis for surgical outcomes. RESULTS: Higher Ki-67 indexes correlated positively with higher WT (P = 0.048) and ET (P = 0.002). Lower Ki67 correlated with 5-ALA free margins (P = 0.045). WT and ET volumes correlated with the extent of resection (EOR; P = 0.002 and 0.002, respectively). Eloquence did not impact EOR (P = 0.14). CONCLUSIONS: There is a correlation between Ki67, the metabolically active tumoral volumes (WT and ET), and 5-ALA residual fluorescence. Methodological inconsistencies are probably responsible for contradictory literature findings, and further prospective studies are needed to validate and reproduce these findings.

2.
Acta Neurochir (Wien) ; 166(1): 212, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38739282

RESUMO

PURPOSE: Glioblastoma is a malignant and aggressive brain tumour that, although there have been improvements in the first line treatment, there is still no consensus regarding the best standard of care (SOC) upon its inevitable recurrence. There are novel adjuvant therapies that aim to improve local disease control. Nowadays, the association of intraoperative photodynamic therapy (PDT) immediately after a 5-aminolevulinic acid (5-ALA) fluorescence-guided resection (FGR) in malignant gliomas surgery has emerged as a potential and feasible strategy to increase the extent of safe resection and destroy residual tumour in the surgical cavity borders, respectively. OBJECTIVES: To assess the survival rates and safety of the association of intraoperative PDT with 5-ALA FGR, in comparison with a 5-ALA FGR alone, in patients with recurrent glioblastoma. METHODS: This article describes a matched-pair cohort study with two groups of patients submitted to 5-ALA FGR for recurrent glioblastoma. Group 1 was a prospective series of 11 consecutive cases submitted to 5-ALA FGR plus intraoperative PDT; group 2 was a historical series of 11 consecutive cases submitted to 5-ALA FGR alone. Age, sex, Karnofsky performance scale (KPS), 5-ALA post-resection status, T1-contrast-enhanced extent of resection (EOR), previous and post pathology, IDH (Isocitrate dehydrogenase), Ki67, previous and post treatment, brain magnetic resonance imaging (MRI) controls and surgical complications were documented. RESULTS: The Mantel-Cox test showed a significant difference between the survival rates (p = 0.008) of both groups. 4 postoperative complications occurred (36.6%) in each group. As of the last follow-up (January 2024), 7/11 patients in group 1, and 0/11 patients in group 2 were still alive. 6- and 12-months post-treatment, a survival proportion of 71,59% and 57,27% is expected in group 1, versus 45,45% and 9,09% in group 2, respectively. 6 months post-treatment, a progression free survival (PFS) of 61,36% and 18,18% is expected in group 1 and group 2, respectively. CONCLUSION: The association of PDT immediately after 5-ALA FGR for recurrent malignant glioma seems to be associated with better survival without additional or severe morbidity. Despite the need for larger, randomized series, the proposed treatment is a feasible and safe addition to the reoperation.


Assuntos
Ácido Aminolevulínico , Neoplasias Encefálicas , Glioblastoma , Recidiva Local de Neoplasia , Fotoquimioterapia , Cirurgia Assistida por Computador , Humanos , Glioblastoma/cirurgia , Glioblastoma/tratamento farmacológico , Glioblastoma/diagnóstico por imagem , Ácido Aminolevulínico/uso terapêutico , Masculino , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/diagnóstico por imagem , Feminino , Pessoa de Meia-Idade , Fotoquimioterapia/métodos , Recidiva Local de Neoplasia/cirurgia , Idoso , Estudos de Coortes , Cirurgia Assistida por Computador/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Adulto , Estudos Prospectivos , Procedimentos Neurocirúrgicos/métodos
3.
J Breast Cancer ; 27(2): 141-146, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38233339

RESUMO

Erdheim-Chester disease (ECD) is a rare multisystem disorder characterized by mitogen-activated protein kinase (MAPK) pathway mutations. Herein, we present a unique case of ECD in a 79-year-old female with predominant breast nodules. Comprehensive imaging and histopathological evaluations confirmed the diagnosis. Mammography and ultrasonography revealed multiple hyperdense circumscribed nodules with coalescing masses and blurred margins. Core biopsy revealed infiltrating foamy cluster of differentiation (CD) 68+ and CD1a+ histiocytes. Because the tumor was negative for the BRAF V600E mutation, treatment with interferon-α was initiated. This case highlights the diagnostic challenges associated with ECD, the rarity of breast involvement, and the importance of considering ECD in the differential diagnosis of atypical breast lesions. Comprehensive imaging, histopathology, and genetic testing are essential for accurate diagnosis and treatment decision-making in ECD. Further research and awareness are required to improve recognition and management of this rare disease.

4.
Artigo em Inglês | MEDLINE | ID: mdl-37362111

RESUMO

We report a case of a 30-year-old previously higid female presenting with dorsal pain and persistent fever after COVID-19 vaccine booster dose. CT and MR revealed a prevertebral heterogeneous and infiltrating mass, with spontaneous regression in control imaging which biopsy confirmed an inflammatory myofibroblastic tumor.

12.
Childs Nerv Syst ; 38(6): 1189-1193, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34586492

RESUMO

Delleman-Oorthuys or oculocerebrocutaneous syndrome (OCCS) is an extremely rare condition which relies on three pillars of manifestations: ophthalmological, neurological, and dermatological. It was first described by Delleman and Oorthuys in 1981, and since then, very few other cases have been reported. We report the case of a 13-month-old boy, referred to an ophthalmological tertiary service for investigation of a microglobe with a cystic retrobulbar mass on translucency test. MRI revealed a left microphthalmia, with extensive retrobulbar cystic lesions occupying the remaining orbit and protruding anteriorly the microglobe. Cerebral findings included polymicrogyria, subependymal nodular heterotopia at the level of the left occipital horn of the lateral ventricle, and an importantly enlarged mesencephalic tectum observed in association with an absent cerebellar vermis. The ensemble of malformations met the criteria for definite OCCS. Being a tremendously rare syndrome, OCCS will always represent a diagnostic challenge. However, its emblematic cutaneous manifestations might be an important part of the road map leading to its correct interpretation. Thus, when absent, diagnosis can be harder than usual, and, on these cases, neurologists, ophthalmologists, and radiologists play a crucial role.


Assuntos
Anormalidades Múltiplas , Cistos do Sistema Nervoso Central , Anormalidades do Olho , Anormalidades da Pele , Cistos do Sistema Nervoso Central/patologia , Anormalidades do Olho/complicações , Anormalidades do Olho/diagnóstico por imagem , Dedos/anormalidades , Humanos , Lactente , Masculino , Anormalidades da Pele/complicações , Anormalidades da Pele/diagnóstico por imagem
14.
Breast J ; 27(8): 675-677, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33982346

RESUMO

Cutaneous myiasis is an endemic infestation in Latin America and Africa. Many unusual sites of larval infection can cause diagnostic confusion, especially if the patient is not from an endemic area. In the breast, the furuncular aspect suggests some differential diagnosis. We report a case of an 84-year-old patient with an ulcerated lesion on the right breast, who was referred to the reference service to exclude malignancy. Considering the clinical aspects and after further evaluation with imaging methods, she was diagnosed with myiasis. This study reinforces the importance of differential diagnosis of myiasis in patients that come from endemic areas.


Assuntos
Neoplasias da Mama , Dípteros , Miíase , Idoso de 80 Anos ou mais , Animais , Diagnóstico Diferencial , Feminino , Humanos , Larva , Miíase/diagnóstico
15.
World Neurosurg ; 147: 8-10, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33348100

RESUMO

Terminal myelocystocele is a rare type of neural tube malformation, consisting of a skin-covered lumbosacral mass, highly associated with other complex abdominal malformations within the OIES complex (omphalocele, imperforate anus, exstrophy of the cloaca and spinal defects). We present a case of a premature female with an extensive lumbosacral mass at birth, as well as an omphalocele, cloacal exstrophy, renal abnormalities, and sacral agenesis. Lumbar magnetic resonance imaging revealed a meningocele sac herniating through the bone defects and containing a syringocele sac. Advanced imaging techniques showed turbulent cerebrospinal fluid flow. At control, 4 weeks later, the defect doubled in size. The myelocystocele sac was evacuated and closed, and the patient persisted with paraparesis. The role of cerebrospinal fluid flow analysis is well established in Chiari-type malformations, in which turbulent flow within the syrinx is related to a better outcome after surgery. It is possible that the same principle could be applied to other spinal malformations, as shown in this case of terminal myelocystocele.


Assuntos
Anus Imperfurado/diagnóstico por imagem , Líquido Cefalorraquidiano/diagnóstico por imagem , Hérnia Umbilical/diagnóstico por imagem , Hidrodinâmica , Meningomielocele/diagnóstico por imagem , Escoliose/diagnóstico por imagem , Siringomielia/diagnóstico por imagem , Anormalidades Urogenitais/diagnóstico por imagem , Anus Imperfurado/fisiopatologia , Anus Imperfurado/cirurgia , Progressão da Doença , Feminino , Hérnia Umbilical/fisiopatologia , Hérnia Umbilical/cirurgia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Imageamento por Ressonância Magnética , Meningomielocele/fisiopatologia , Meningomielocele/cirurgia , Paraparesia/fisiopatologia , Escoliose/fisiopatologia , Escoliose/cirurgia , Siringomielia/fisiopatologia , Siringomielia/cirurgia , Anormalidades Urogenitais/fisiopatologia , Anormalidades Urogenitais/cirurgia
18.
J Fungi (Basel) ; 5(3)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31487828

RESUMO

Terbinafine has proved to treat numerous fungal infections, including onychomycosis, successfully. Due to its liver metabolization and dependency on the cytochrome P450 enzyme complex, undesirable drug interaction are highly probable. Additionally to drug interactions, the treatment is long, rising the chances of the appearance of side effects and abandonment. Pharmacokinetic data suggest that terbinafine maintains a fungicidal effect within the nail up to 30 weeks after its last administration, which has aroused the possibility of a pulse therapy to reduce the side effects while treating onychomycosis. This study's goal was to evaluate the effectiveness of three different oral terbinafine regimens in treating onychomycosis due to dermatophytes. Sixty-three patients with onychomycosis were sorted by convenience in three different groups. Patients from group 1 received the conventional terbinafine dose (250 mg per day for 3 months). Group 2 received a monthly week-long pulse-therapy dose (500 mg per day for 7 days a month, for 4 months) and group 3 received a 500 mg/day dose for 7 days every 3 months, totaling four treatments. There were no statistical differences regarding the effectiveness or side effects between the groups. Conclusion: A quarterly terbinafine pulse regimen can be a possible alternative for treating onychomycosis caused by dermatophytes.

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