Prospective, randomized, double-blind study, comparing botulinum toxins type a botox and prosigne for blepharospasm and hemifacial spasm treatment.

Botulinum toxin A (BTA) is considered an effective treatment of blepharospasm and hemifacial spasm, but there are few studies to permit a comparison of its different formulations. This prospective, randomized, double-blind study compared Prosigne, a BTA of Chinese origin, with Botox to establish safety, efficacy, and equivalence of doses between those 2 formulations in blepharospasm and hemifacial spasm treatment. Fifty-seven patients participated in this study: 21 blepharospasm (from whom 11 were treated with Botox; and 10, with Prosigne) and 36 hemifacial spasm patients (17 were treated with Botox; and 19, with Prosigne). All patients were similar in age, disease time span, number of previous shots, and time elapsed since the last BTA application. Pain and burning during the injection and the result of the treatment were similar in both groups. There were no systemic adverse events, and the local ones were observed with similar intensity and frequency for both groups. The mean effect time length was similar for both blepharospasm (11.3 weeks for both toxins) and hemifacial spasm patients (12.8 weeks for Botox and 12.9 weeks for Prosigne). In both blepharospasm groups, only the 36-Item Short-Form Health Survey emotional aspects domain showed improvement from baseline after 16 weeks. There were no differences between the 36-Item Short-Form Health Survey scores before and after the treatment of all hemifacial spasm patients. Therefore, it has been concluded that Botox and Prosigne have similar efficacy, safety, and tolerability profiles, so that a dose equivalence of 1:1 may be considered for blepharospasm and hemifacial spasm treatments.

A prospective, randomized, double-blind study comparing the efficacy and safety of type a botulinum toxins botox and prosigne in the treatment of cervical dystonia.

Botulinum toxin A (BTA) is considered an effective treatment of cervical dystonia. The aim of this prospective, randomized, double-blind study was to compare Botox and Prosigne, a BTA of Chinese origin, with a view to establish the safety, the efficacy, and the equivalence of doses of the 2 formulations in the treatment of cervical dystonia. Twenty-four patients were randomized to receive 300 U of Botox or Prosigne (12 patients in each group). The patients were assessed before the injection and after 4 and 16 weeks by the Toronto Western Spasmodic Torticollis Rating Scale and the Short-Form 36 for quality of life before and 16 weeks after the injection. All patients were comparable in age, time since onset, number of previous injections, and time since last BTA application. According to the Toronto Western Spasmodic Torticollis Rating Scale scores, the patients improved after injection and the scores increased after 16 weeks, without returning to baseline values. Both pain and burning during the injection and the treatment outcomes were similar in both groups. No systemic adverse events occurred, and the severity and frequency of local events were comparable in both groups. Average duration of effect was similar in both groups (11 weeks). The quality-of-life evaluations before and after the injections were comparable in both groups. Social aspects, pain, and vitality improved after 16 weeks in both groups. In conclusion, Botox and Prosigne were determined to have equivalent efficacy, safety, and tolerability profiles and dose equivalence for cervical dystonia treatment is 1:1.

Nonfunctional abdominal complications of the distal catheter on the treatment of hydrocephalus: an inflammatory hypothesis? Experience with six cases.

INTRODUCTION: The peritoneal cavity is the most common site of cerebrospinal fluid absorption in hydrocephalus treatment. Many distal catheter complications are the result of this type of treatment, and these have been extensively described in the neurosurgical literature. MATERIALS AND METHODS: In our study, six cases of distal catheter migration with visceral perforation and/or extrusion are presented: three through the umbilicus, two through the scrotum, and one through the anus. An extensive review of the literature was performed. RESULTS: The studies of peritoneal dialysis models for the treatment of chronic renal failure patients provide important data about solute absorption in the peritoneal cavity and reactivity of the peritoneal membrane. CONCLUSION: This model, when compared to distal catheter complications on a ventriculoperitoneal (VP) shunt, presents similarities that could help understand the mechanism of the nonfunctional complications of the distal VP catheter (complication with functional shunt), providing valuable data to support an inflammatory mechanism.

Avaliação de questionário sobre sintomas e estado funcional de pacientes com síndrome do túnel do carpo / Evaluation of a questionnaire on symptom severity and functional status of patients with carpal tunnel syndrome

Este estudo consistiu na avaliação do questionário de Levine et al. (1993) Boston Carpal Tunnel Questionnaire, de avaliação da gravidade dos sintomas - em domínios críticos na STC, como dor, parestesias, adormecimento, fraqueza, sintomas noturnos - e uma escala de estado funcional.

This study aimed at assessing the Boston Carpal Tunnel Questionnaire by Levine et. al. (1993), a self administered instrument for evaluating severity of symptoms and functional status in patients with carpal tunnel syndrome (CTS)...

Central neurocytoma: report of two cases

INTRODUÇÃO: Neurocitoma central é um tumor neuroectodérmico raro, geralmente localizado nos ventrículos laterais. RELATO DE CASOS: Uma mulher de 26 anos e um homem de 33 anos apresentaram-se com hipertensão intracraniana. Exames de imagem revelaram tumor intraventricular heterogêneo, que impregnava por contraste, ocupando os ventrículos laterais e causando hidrocefalia. A mulher faleceu no pós-operatório e o homem está livre de recidiva após três anos. HISTOPATOLOGIA: Ambos os tumores eram sólidos, com células arredondadas, lembrando oligodendroglia, positivas para sinaptofisina, cromogranina e NSE e algumas para GFAP, vimentina e proteína S-100. Microscopia eletrônica mostrou neurópilo entre os corpos celulares, mas sinapses eram raras.

Central neurocytoma: report of two cases.

INTRODUCTION: Central neurocytomas are rare neuroectodermal tumors believed to arise from the subependymal matrix of the lateral ventricles. CASE REPORTS: A 26-year-old woman and a 33-year-old man each had a large, heterogeneous, contrast enhancing mass in the lateral ventricles at the foramen of Monro causing bilateral hydrocephalus. The woman died after surgery, but the man is asymptomatic after three years. HISTOPATHOLOGY: Both tumors were composed of isomorphic rounded cells positive for synaptophysin, chromogranin and NSE, while some reacted for GFAP, vimentin and S-100 protein. Electron microscopy revealed neuropil-like tissue between cells, but synapses were rare.

Long term follow-up in a patient with papillary glioneuronal tumor.

We report a case of a young female patient with a rare and recently described form of brain tumor. This patient had a history of headache, hemiparesis and motor simple partial seizures. Her investigation revealed a brain tumor involving the left frontal and parietal lobes. The radiological images showed a cystic mass with multiple nodular masses and a rim of contrast enhancement extending from the right parietal cortex to the ipsilateral ventricle and corpus callosum. The patient underwent gross resection of the lesion and the histological analysis of the surgical specimen revealed a pseudopapillary structure formed by delicate vessels intermixed with a fibrillary pattern and bordered by intense astrocytic reaction with Rosenthal fibers. These features correspond to the recently described mixed neuronal-glial neoplasm, the papillary glioneuronal tumor. The patient has been followed for five years since the surgical treatment, without evidence of tumor recurrence, confirming the indolent behavior of this type of tumor.

Long term follow-up in a patient with papillary glioneuronal tumor

Relatamos o caso de uma jovem paciente com um tumor cerebral raro e recentemente descrito. Essa paciente apresentou-se com queixas de cefaléia, hemiparesia e crises epiléticas parciais simples. Sua investigação revelou um tumor cerebral envolvendo os lobos frontal e parietal esquerdos. As imagens radiológicas mostraram uma massa cística com massas nodulares múltiplas e reforço anelar de contraste estendendo do córtex parietal direito aos ventrículo lateral e corpo caloso ipsilaterais. A paciente se submeteu à ressecção do tumor e a análise histológica da lesão revelou uma estrutura pseudopapilar formada por vasos delicados entremeados com um padrão fibrilar e emoldurada por intensa reação astrocítica com fibras de Rosenthal. Essas características correspondem a uma forma de neoplasia mista glial-neuronal recentemente descrita, o tumor papilar glioneuronal. A paciente está em seguimento desde a cirurgia sem evidência de recorrência tumoral, confirmando o comportamento benigno desse tipo de tumor.

Congenital dermoid inclusion cyst over the anterior fontanel: report of three cases.

Congenital dermoid inclusion cyst over the anterior fontanel (CDIC) is an uncommon cystic lesion located over the anterior fontanel. It is a benign and curative lesion and most of the time, can be diagnosed at birth. From 1994 to 2001, three patients were operated with this kind of lesion and after reviewing the literature we found 229 cases and only 6 cases described in Brazil. Our objective in this study is to report three more cases.

Congenital dermoid inclusion cyst over the anterior fontanel: report of three cases

Congenital dermoid inclusion cyst over the anterior fontanel (CDIC) is an uncommon cystic lesion located over the anterior fontanel. It is a benign and curative lesion and most of the time, can be diagnosed at birth. From 1994 to 2001, three patients were operated with this kind of lesion and after reviewing the literature we found 229 cases and only 6 cases described in Brazil. Our objective in this study is to report three more cases

Arachnoid cyst: adversity and plasticity

We report four cases of surgically treated intracranial arachnoid cysts, one with cyst-peritoneal shunt and three with craniotomy and arachnoid membrane resection. Their classification and etiopathogeny are discussed, and especially the different methods of treatment comparing the drastic complications (adversities) with the favorable solutions in severe clinical cases (plasticity) treated at our institution.

Pilonidal cyst on the vault: case report

Pilonidal cysts and sinuses are described as dermoid cysts which contain follicles of hairs and sebaceous glands. They clinically present as a classic case of inflammation which comes with pain, local infection and redness. The origin of pilonidal disease remains controverse. There are many hypothesis as lack of hygiene on the affected area and a penetration and growth of a hair in the subcutaneus tissue caused by constant friction or direct trauma on the damaged area. The option for clinical treatment is very frequent. However, taking into consideration the incidence and the possibility of recidive, surgical treatment is presently recommended. Complications include cellulitis and abscess formation. Pilonidal cysts are mostly found on the sacral region. In the literature is found description of pilonidal cysts on the penis, interdigital region on the hands as well as on the cervical region. We present a case of pilonidal cyst located on the vault biparietal region, without malignant degeneration.

Hematoma epidural espontâneo. Relato de dois casos / Spontaneous epidural hematoma. Report of two cases

Os hematomas epidurais espontâneos sao raramente descritos na literatura. Estao associados a doenças infecciosas do crânio, distúrbios da coagulaçao, malformaçoes vasculares da dura-máter e metástases na calota craniana. Os autores relatam dois casos de hematomas epidurais espontâneos de diferentes etiologias e discutem aspectos relacionados à hemostasia.

Hematoma intracerebral tardio pós-traumatismo craniencefálico por arma de fogo: relato de caso / Delayed intracerebral haematoma after gunshot head injury: case report

Os autores relatam o caso de uma paciente de 25 anos de idade, que foi admitida no Pronto-Socorro do H.C. da UNICAMP. O exame neurológico confirmou Glasgow de 15. Foi feita uma tomografia computadorizada de crânio, que mostrou uma pequena contusäo temporal direita. A paciente ficou internada durante dois dias e recebeu alta sem queixas e com o mesmo Glasgow inicial. Dezessete dias depois, retornou ao Hospital em coma. Uma nova tomografia demonstrou grande hematoma intraparenquimatoso. A mesma faleceu um dia após a internaçäo

Estudo de componentes da hemostasia em neurocirurgia de tumores primários intracranianos / Study of hemostasis components in neurosurgery of intracranial primary tumors

A hemostasia é um importante fator na neurocirurgia. Está alterada frequentemente nos grandes procedimentos cirúrgicos abdominais e toráxicos. Nestes, há uma ativaçäo da coagulaçäo e fibrinólise no intra-operatório. Esse estudo, na hemostasia, verificadas na neurocirurgia. Além disso, foram avaliados os níveis plasmáticos da Proteina C e S, na neurocirurgia de tumores, anteriormente, näo analisados. Para tanto, foi delineado um estudo, composto de 3 grupos: um grupo dom 13 pacientes com diversos tumores primários intracranianos; um grupo controle com 9 pacientes com aneurisma cerebral e um grupo de indivíduos normais. Os pacientes com tumor foram comparados aos pacientes com aneurisma e controle normal no pré, intra e pós-operatório imediato e tardio (30 dias após a cirurgia). Além da comparaçäo entre os grupos, foi feita análise pareada dos tempos cirúrgicos de cada grupo...

Estudo da fibrinólise em meningeomas / Study of fibrinolysis in meningiomas

Neste trabalho apresentamos os parâmetros da hemostasia em 3 pacientes com diagnóstico de meningeomas intracranianos, submetidos a craniotomia e exérese completa do tumor. A análise foi feita antes da cirurgia, durante a exérese do tumor, no primeiro dia do pós-operatório e após o trigésimo dia da cirurgia. Foram dosados os seguintes parâmetros: Tempo de Protrombina (TP), Tempo de Tromboplastina Parcial Ativado (TTPA), Tempo de Trombina (TT), Plaquetas (PQ), Alfa-2-Macroglobulina (A2MC), C 1 inibidor (C1), Antitrombina III (AT III), Fator V (FV), Fibrinogênio (FIBR), Plasminogênio (PLASM), area de Lise em Placa de Fibrina (ALPF), Produto de Degradaçäo da Fibrina e Fibrinogênio (PDF), Procalicreina Plasmática (PK) e Pr'e-Albumina (PRE ALB). Este estudo demonstrou a ocorrência de fibrinólise no intraoperatório e primeiro dia do pós-operatório de intensidade variável para cada paciente. Sugerimos, com base neste trabalho e revisäo da literatura que, durante o manuseio dos meningeomas, ocorrendo grande sangramento que näo se justifique por lesöes de grandes vasos, se deva fazer uso de drogas inibidoras da plasmina (Acido tranexâmico, Gabaxate, Acido Epsilon Amino Caproico)

Glioblastose cerebral difusa: relato de caso / Diffuse cerebral glioblastosis: report of a case

Relatamos o caso de um paciente do sexo masculino, cor branca, de 29 anos de idade, que apresentou uma única crise convulsiva focal com generalizaçäo secundária 10 dias antes do atendimento. Confirmamos o diagnóstico de glioblastose cerebral difusa através de biópsia. No seguimento por tomografia computadorizada e ressonância nuclear magnética, confirmamos a evoluçäo do processo cerebral de glioblastose, com comprometimento bilateral. Discutimos a ocorrência de glioblastose cerebral difusa como entidade nosológica distinta dos gliomas

Apresentaçäo de um caso raro de amaurose por chordoma / An uncommon case of blindeness by chordoma

Paciente de 57 anos, homem, branco, examinado em maio/83 com a queixa de há 2 anos de dor cervical intermitente, irradiando-se para o crânio. Há um ano com embaçamento visual maior em olho esquerdo. Ao exame oftalmológico: Acuidade Visual: olho direito: 20:100; olho esquerdo: percepçäo de luz. Fundoscopia: olho direito - palidez acentuada temporal de papila; olho esquerdo - atrofia de papila. Reflexos: olho direito - fotomotor e consencual normais. olho esquerdo - fotomotor lento. Biomicroscopia e tonometria: normais. Campimetria - diâmetro pupilar: 3mm; cor: incoclor; olho direito - index usado 4mm2 com hemianoscopia temporal; olho esquerdo - näo vê index maior que 64 mm2