Expresión inmunohistoquímica de homólogo de fosfatasa y tensina en glioblastoma multiforme y su relación con sobrevida / Immunohistochemical expression of phosphatase and tensin homologue in glioblastoma multiforme and its relationship to survival

El glioblastoma multiforme es el subtipo de gliomas más frecuente en adultos, con una pobre sobrevida promedio posterior al diagnóstico incluso si se aplica el tratamiento óptimo. Se ha estudiado marcadores tumorales de buen pronóstico, siendo controversial la expresión del homólogo de fosfatasa y tensina. Se estudió muestras parafinadas obtenidas de pacientes con glioblastoma multiforme en el Hospital Carlos Van Buren de Valparaíso, Chile, entre 2010 y 2014. Se realizó análisis inmunohistoquímico para expresión de homólogo de fosfatasa y tensina, estudiándose la intensidad y el patrón de expresión en astrocitos y células epiteliales, además de revisión de datos clínicos. Análisis estadístico utilizando SPSS v20. Se estudió la expresión de PTEN en 21 pacientes. Un 52,4 % presentó una baja expresión en núcleos de astrocitos, con un promedio de sobrevida de 14,2 meses comparado con 10,2 meses del grupo con alta expresión (p=0,33). Se encontró una intensa expresión endotelial en tejido tumoral, comparado con tejido cerebral sin tumor. Se encontró una relación entre la expresión nuclear en astrocitos con diferencias en el tiempo de sobrevida, aunque no estadísticamente significativa, requiriéndose nuevos estudios para corroborarlo. La intensa expresión endotelial observada en tejido tumoral debe ser analizada de forma dirigida.

Glioblastoma multiforme is the most frequent glioma subtype in adults, with poor survival rate after diagnosis even applying the optimal treatment. Tumoural markers have been studied looking for good prognosis, being the phosphatase and tensin homologue controversial. Paraffined samples were used from Carlos Van Buren Hospital in Valparaíso, Chile, between 2010 and 2014. An immunohistochemical analysis was performed looking for phosphatase and tensing homologue expression, studying the intensity and expression pattern in astrocytes and epithelial cells, in addition to clinical data. Statistical analysis was performed using SPSS v20. It was studied the phosphatase and tensin homologue expression in 21 patients. In the study, 52,4 % presented low expression in astrocytic glial cell nuclei, with a survival mean of 14.2 months in comparison to 10.2 months in the high expression group (p=0.33). A very intense endothelial expression was found in tumoural tissue, in comparison to the tissue without tumor. A relation between nuclear expression in astrocytes and survival rate was found, although no statistically significant. The intense endothelial expression seen in tumoural tissue must be studied directly.

Quiste aracnoidal cervical anterior en edad pediátrica / Anterior cervical arachnoid cyst in pediatric age

Los quistes aracnoidales espinales son lesiones poco comunes en la población pediátrica. La mayor parte de ellos, se ubican en los segmentos dorsales y la posición anterior respecto a la médula es rara en todos los casos. Si bien su patogenia no está aclarada, se han asociado a defectos del tubo neural y traumas previos. Clínicamente, pueden presentarse con síndrome medular que en ocasiones pueden empeorar con cambios posturales. El tratamiento, puede ser conservador o quirúrgico, el que está indicado en presencia de síntomas neurológicos secundarios a compresión medular, siendo el abordaje posterior el más frecuentemente utilizado. El propósito de la cirugía es la resección total o en su defecto, la fenestración del quiste para comunicarlo al espacio subaracnoídeo. Una potencial complicación de la vía posterior, es la herniación medular durante la durotomía, secundaria al efecto compresivo del quiste, la cual podría aumentar la morbilidad neurológica en el período postoperatorio. Se presentan 2 casos consecutivos en edad pediátrica con quistes intradurales espinales anteriores, el primero en la región cervico-dorsal cuya cirugía se vio dificultada por la presencia de herniación medular transdural y un segundo caso con un quiste exclusivamente cervical, en que mediante una punción lateral del quiste guiada por ecografía previo a la durotomía, se logró resecar la lesión sin esta complicación.

Spinal arachnoid cysts are rare lesions in pediatric population. Most of them are located posteriorly in dorsal segments ananterior position is rare. Although its pathogenesis has not been elucidated, they have been associated with neural tube defects and the presence of previous spinal traumas. Clinically, they present with a spinal cord syndrome which can sometimes worsen with postural changes. Treatment may be conservative or surgical, the latter indicated by the presence of neurological symptoms secondary to spinal cord compression, with the posterior approach being the most frequently used. The purpose of surgery is total or partial resection, or fenestration of the cyst to subarachnoid space. A potential intra-surgical complication of posterior approach in anterior cyst is spinal cord herniation during durotomy, secondary to the compressive effect of the cyst, which could increase neurological morbidity in the postoperative period (1 case with mortality is described in the literature). We present 2 consecutive cases in pediatric patients with previous spinal intradural cysts. The first in the cervico-dorsal region whose surgery was hampered by the presence of medullary transdural herniation and second case with an exclusively cervical cyst that through a side puncture cyst guided by ultrasound prior to durotomy, it was possible to resect the lesion without this complication.

Delayed intracranial hypertension and cerebral edema in severe pediatric head injury: risk factor analysis.

INTRODUCTION: Diffuse brain edema has been described as a major cause of intracranial hypertension (IH) following traumatic brain injury (TBI), and several studies suggest that it may be more frequent in children than in adults. While most cases of IH following TBI are present from the beginning, several studies have described a subgroup of patients with delayed elevations in intracranial pressure (ICP). METHODS: Retrospective review of severe pediatric TBI cases admitted to a single institution during a 6-year period. Patients were classified into three groups, based on the temporal evolution of ICP: patients who evolved without IH, patients who had IH at admission and patients with delayed IH. A risk factor analysis was performed to find differences between these groups. RESULTS: 31 cases of severe pediatric TBI were analyzed. 13 patients were female and 18 male, with an average age of 8.9 years. 4 patients met the described criteria for delayed IH; the only significant risk factor was presence of edema at the initial brain CT (p = 0.008). 3 additional patients presented clinical deterioration after 48 h and signs of brain edema in the CT, after ICP monitoring had been discontinued. CONCLUSIONS: Late-onset IH is a relatively common clinical condition in the pediatric population with severe TBI (present in 13% of the cases in our series), and the presence of a Marshall III CT scan at admission is a significant risk factor for this condition. Pediatric patients may benefit from a more prolonged period of ICP monitoring than adults, and the lack of amelioration of brain edema at follow-up brain CT (even with normal ICP values) may be an indication that more prolonged monitoring is needed.

Aneurísmas cerebrales en menores de 20 años: experiencia del Hospital Carlos van Buren de Valparaíso / Cerebral aneurysm in minors of 20 years old: experience of the Carlos van Buren Hospital of Valparaíso

Se presentan una serie de 16 pacientes menores a 20 años portadores de aneurismas cerebrales intervenidos en el Hospital Carlos van Buren. En la muestra predominaron los pacientes de sexo femenino, los aneurismas de carótida interna y cerebral media fueron los más frecuentes. No hubo mortalidad y el estado de alta fue bueno en 15 de los 16 enfermos.