Assessment of IGF-1 expression in the peripheral blood of women with recurrent breast cancer.

Breast cancer is the most common malignancy affecting women worldwide. The insulin-like growth factor 1 (IGF-1) gene encodes a protein responsible for a wide variety of physiological processes, including differentiation and cell proliferation. Despite several studies on tumor tissues, no study has evaluated IGF-1 expression in the peripheral blood of women with recurrent breast cancer.In this cross-sectional study, IGF-1 expression in the peripheral blood of 146 women with breast cancer treated approximately 5 years ago was quantified by quantitative reverse transcription polymerase chain. The women were divided into 2 groups: non-recurrence (n = 85) and recurrence (n = 61). Statistical analysis of the data was performed using ANOVA, Mann-Whitney, and Chi-squared tests (P < .05).The results showed no significant difference in IGF-1 expression between the non-recurrence and recurrence groups (P = .988). In the subgroups of patients with lymph node involvement, no statistically significant difference was observed in IGF-1 expression between women with recurrence and those non-recurrence (P = .113). In patients without lymph node metastases, IGF-1 messenger ribonucleic acid (mRNA) expression levels were significantly higher in the non-recurrence group than in the recurrence group (P = .019). Furthermore, using the median IGF-1 mRNA expression as the cutoff point, it was obtained a statistically significant difference in tumor histological grade among women with recurrent breast cancer (P = .042).These data showed significantly higher IGF-1 expression in women without lymph node metastases in the non-recurrence group compared with the recurrence group. In addition, a significant difference was observed in median IGF-1 mRNA expression in relation to tumor histological grade in women with recurrent breast cancer.

Cefaleia sentinela: um quadro presente, mas pouco lembrad / Sentinel headache: present, but poorly remembered

Esta revisão narrativa da literatura tratou da cefaleia sentinela. A cefaleia é um acometimento de alta prevalência mundial, sobretudo em mulheres. São várias as condições que podem levar à sua ocorrência, destacando-se, entre elas, a hemorragia subaracnóidea, que é sabidamente a terceira maior causa de acidente vascular encefálico. No âmbito da hemorragia subaracnóidea, existe um sintoma que, por vezes, é ignorado na investigação clÍnica do acidente vascular encefálico: é a cefaleia sentinela. Ela é conceituada como sendo cefaleia súbita, não usual, do tipo explosiva, persistente e de menor intensidade que a dor de cabeça da hemorragia subaracnóidea. Geralmente precede a hemorragia subaracnóidea por dias ou semanas. Este manuscrito traz uma revisão narrativa da literatura sobre cefaleia sentinela, usando as bases de dados PubMed® e Literatura Latino-Americana e do Caribe em Ciências da Saúde. A prevalência dessa condição é de 10% a 43% na hemorragia subaracnóidea, podendo ser fator preditor na identificação precoce do paciente com risco para sangramento aneurismático. Torna-se, então, necessária tanto a educação médica como a atuação precisa acerca do tema, a fim de mudar os desfechos da hemorragia subaracnóidea.

This narrative review of the literature addressed the sentinel headache. headaches are of high prevalence worldwide, especially in women. Several conditions can lead to its occurrence, such as the subarachnoid hemorrhage (known to be the third main cause of stroke). In the context of subarachnoid hemorrhage, there is a symptom that is sometimes overlooked in the clinical investigation of stroke: the sentinel headache. It is conceptualized as sudden, unusual, of explosive nature, persistent and of lesser intensity than the subarachnoid hemorrhage headache. It usually precedes the subarachnoid hemorrhage by days or weeks. This study provides a narrative review of the literature on sentinel headache, using the PubMed® and Latin American and Caribbean Health Sciences Literature databases. The prevalence of this condition in subarachnoid hemorrhage is 10 - 43%, and may be a predictive factor in the early identification of the patient with risk for aneurysmal bleeding. Both medical education and accurate action on this issue are necessary to change the outcomes of subarachnoid hemorrhage.

Endovascular Approach of a Proximal Anterior Inferior Cerebellar Artery Aneurysm: Case Report

Anterior inferior cerebellar artery (AICA) aneurysms are extremely rare, accounting for only 0.75% of all intracranial aneurysms. The average age of patients suffering from those aneurysms found in the literature was 44 years, with no significant difference between the sexes. These aneurysms can manifest clinically through expansive symptoms in cerebellopontine angle or through signs and symptoms of subarachnoid hemorrhage, such as nausea, vomiting, headache, nystagmus and paresis. The gold standard exam for diagnosis is cerebral angiography. The treatment of these lesions is controversial. The main difficulty of the surgical treatment of these aneurysms is the location of the AICA, which lies close to critical neurovascular structures. In this article, we describe a proximal AICA aneurysm embolization without occlusion of the parent artery, with excellent results in the postoperative period.

Os aneurismas da artéria cerebelar anterior inferior (AICA) são extremamente raros, representando apenas 0,75% de todos os aneurismas intracranianos. A idade média de acometimento encontrada na literatura é de 44 anos, não havendo diferença significativa entre os sexos. A etiologia do aneurisma da AICA é controversa, porém, acreditase haver semelhanças com aneurismas em geral. Clinicamente, esses aneurismas podem manifestar sintomas expansivos no ângulo ponto-cerebelar, ou sinais e sintomas de hemorragia subaracnóidea (HSA), como náuseas, vômitos, cefaleia, nistagmo. O exame padrão-ouro para o diagnóstico é a angiografia cerebral. A maior controvérsia dos aneurismas da AICA é o tratamento. A principal dificuldade no tratamento cirúrgico desses aneurismas é a localização da AICA, perto de estruturas neurovasculares críticas. Neste artigo, descrevemos a embolização de um aneurisma proximal da AICA sem oclusão da artéria portadora, com excelentes resultados no pósoperatório.

Cervical Internal Carotid Artery Saccular Aneurysm Manifesting with Progressive Dysphonia / Aneurisma sacular da artéria carótida interna cervical manifestando-se por disfonia progressiva

Aneurysm of the cervical internal carotid artery is a rare condition, which can trigger severe neurologic complications. The authors report a case of a female patient of 54 years, presenting as a progressive dysphonia, which revealed it to be an aneurysmof the extracranial portion of the internal carotid artery. Endovascular treatment was used.

Aneurisma da artéria carótida interna cervical é uma patologia infrequente, podendo desencadear severas complicações neurológicas. Os autores relatam o caso de uma paciente feminina de 54 anos, apresentando-se por disfonia progressiva, que revelou tratar-se de um aneurisma da porção extracraniana da artéria carótida interna, tendo sido empregado o tratamento endovascular.

Dissecting aneurysm of the distal superior cerebellar artery ? Case report and assessment of endovascular treatment / Aneurisma dissecante da artéria cerebelar superior distal ? Relato de caso e avaliação do tratamento endovascular

Dissecting aneurysms located in peripheral regions of the cerebellar arteries are rare, and few cases have been described in the literature. Surgical treatment of these lesions may become difficult due to its relatively inaccessible location. Thus, the approach of these aneurysms through endovascular therapy may be an alternative treatment. We described a case of ruptured dissecting aneurysm located in the distal portion of the superior cerebellar artery, which was treated with endovascular embolization. We also discuss the results of endovascular therapy for this type of injury...

Aneurismas dissecantes localizados em regiões periféricas das artérias cerebelares são de ocorrência incomum e poucos casos têm sido descritos na literatura. O tratamento cirúrgico dessas lesões pode se tornar difícil por causa de sua localização relativamente inacessível. Assim, a abordagem desses aneurismas por terapia endovascular pode ser um método alternativo de tratamento. Descrevemos um caso de aneurisma dissecante roto localizado na porção distal da artéria cerebelar superior que foi tratado com embolização endovascular. Discutimos, também, os resultados da terapia endovascular para esse tipo de lesão...

Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position.

OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.

Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99 percent of the cases, with a mortality of 1.6 percent. The facial nerve function was preserved in 85 percent of cases and hearing in 40 percent of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8 percent and meningitis 2.9 percent. Venous air embolism was registered in 3 percent of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.

OBJETIVO: Avaliar o resultado do tratamento cirúrgico de pacientes portadores de schwannoma do vestibular (SV) operados em decúbito dorsal (posição de mastóide). MÉTODO: 240 pacientes foram submetidos a craniotomia retrosigmóide na posição de mastóide. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno foi realizada com retalho vascularizado de dura-mater, músculo e cola de fibrina. RESULTADOS: A exérese foi completa em 99 por cento dos casos, com mortalidade de 1,6 por cento. Houve preservação da função do nervo facial em 85 por cento dos casos e da audição em 40 por cento dos pacientes com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi 5,8 por cento e meningite 2,9 por cento. Embolia gasosa foi registrada em 3 por cento dos casos, não associada à mortalidade. CONCLUSÃO: O tratamento cirúrgico dos SV utilizando-se a posição de mastóide tem várias vantagens, com baixa morbidade e mortalidade.

Angioma cavernoso na cisterna magna / Cavernous angioma in the cisterna magna

É relatado um caso de angioma cavernoso na cisterna magna, afecçäo rara cujo diagnóstico é difícil de ser estabelecido, seja pelos achados clínicos como pelos radiológicos. Apesar dos avanços da imagem, o diagnóstico dos angiomas cavernosos permanece ainda restrito ao exame anatomopatológico da lesäo. Neste caso, foi realizada craniectomia suboccipital em um paciente de 21 anos de idade e extirpado totalmente um tumor vascularizado.