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1.
ACM arq. catarin. med ; 47(4): 168-174, out.-dez. 2018.
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1023290

RESUMO

Os quistos mesentéricos são tumores intra-abdominais raros, com uma incidência descrita de 1/100 000 a 1/250 000 admissões hospitalares por dor abdominal. Localizam-se no mesentério do duodeno ao reto, principalmente no íleo. Os sintomas associados a estas massas não são específicos e a maioria dos casos são assintomáticos, sendo descobertos incidentalmente por exames de imagem ou durante exploração cirúrgica abdominal. O tratamento consiste na excisão cirúrgica e o diagnóstico é histológico. Apresenta-se o caso de um homem de 92 anos, internado num Serviço de Medicina Interna, que realizou uma angiotomografia axial computorizada abdominal que permitiu visualizar em localização sub-hepática uma lesão quística compatível com um quisto entérico de grandes dimensões constituído por 2 locas, sem comunicação, separadas pela vesícula biliar.


Mesenteric cysts are rare intra-abdominal tumors, with a reported incidence of 1/100 000 to 1/250 000 hospital admissions. They are located in the mesentery from duodenum to rectum, mainly in the ileum. The symptoms associated aren't specific and most cases are asymptomatic, being discovered incidentally during imaging tests or abdominal surgery. The treatment is the xcision of the cyst and the diagnosis is histological. We describe a case of a 92 years old man, admitted to the internal medicine service, which performed a computed tomography angiography that showed an infra hepatic cyst lesion compatible with an enteric multi-locular cyst, divided by the gallbladder.

2.
PLoS One ; 13(6): e0197922, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29856786

RESUMO

BACKGROUND: Autopsy studies reveal that atherosclerosis lesions can be found as early as two years of age. To slow the development of this early pathology, obesity and dyslipidemia prevention should start from childhood making it urgent to explore new ways to evaluate dyslipidemia risk in children that can be applied widely, such as the non-invasive anthropometric evaluation. OBJECTIVE: Assess the metabolic profile of a pediatric population at a specific age to describe the association between anthropometric and biochemical cardiovascular disease risk factors; and evaluate selected anthropometric variables as potential predictors for dyslipidemic cardiovascular risk. DESIGN AND METHODS: Anthropometric features, bioimpedance parameters and fasting clinical profile were assessed in Lisbon and the Tagus Valley region pre-pubertal nine-year-old children (n = 1.496) from 2009-2013 in a descriptive, cross-sectional study. Anthropometric variables predictive power was evaluated through regression analysis. RESULTS: At least one abnormal lipid parameter was found in 65% of "normal weight", 73% of "overweight" and 81% of "obese" children according to the International Obesity Task Force (IOTF) standards. Dyslipidemia was present in 67.8% of children. Waist-hip ratio (WHR) explained 0.4% of total cholesterol (TC) variance. Waist circumference (WC) explained 2.8% of apolipoprotein (APO) A1 variance. Waist-circumference-to-height-ratio (WHtR) explained 2.7%, 2.8% and 1.9% of low-density lipoprotein cholesterol (LDL-c), APO B, and N_HDL-c variance, respectively. Children with abnormally high WHR levels had an increase in risk of 4.49, 3.40 and 5.30 times, respectively, for developing cardiovascular disease risk factors measured as high-risk levels of TC, LDL-c and non-HDL-c (N_HDL-c) (p<0.05). Only 29.9% of "normal weight" children had no anthropometric, bioimpedance or biochemical parameters associated with CV risk. CONCLUSION: A large proportion of school age children have at least one lipid profile abnormality. BMI, zBMI, calf circumference (CC), hip circumference (HC), WC, and WHR are directly associated with dyslipidemia, whereas HC and calf circumference (CC) adjusted to WC, and mid-upper arm circumference (MUAC), are all inversely associated with dyslipidemia. Selected anthropometric variables are likely to help predict increased odds of having CV risk factors.


Assuntos
Antropometria , Aterosclerose/complicações , Dislipidemias/complicações , Dislipidemias/epidemiologia , Instituições Acadêmicas , Criança , Feminino , Humanos , Masculino , Medição de Risco
3.
Endocrine ; 60(3): 466-478, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29679223

RESUMO

PURPOSE: Evaluate the relationship of leptin receptor (LEPR) rs1137101, fat mass obesity-associated (FTO) receptors 9939609, melanocortin-4 receptors (MC4R) rs2229616 and rs17782313, and proliferator-activated receptor-gamma (PPARG) rs1801282 with clinical and metabolic phenotypes in prepubertal children. RESEARCH QUESTION: What is the effect of polymorphisms on clinical and metabolic phenotypes in prepubertal children? METHODS: A cross-sectional descriptive study was performed to evaluate anthropometric features, percentage body fat (%BF), biochemical parameters, and genotype in 773 prepubertal children. RESULTS: FTO rs9939609 was associated with an increase in body mass index (BMI) and BMI z-score (zBMI). MC4R rs17782313 was associated with a decrease in BMI and +0.06 units in zBMI. LEPR, and PPARG-2 polymorphisms were associated with decreases in BMI and an increase and decrease units in zBMI, respectively. The homozygous SNPs demonstrated increases (FTO rs993609 and MC4R rs17782313) and decreases (LEPR rs1137101, PPARG rs1801282) in zBMI than the homozygous form of the major allele. In the overweight/obese group, the MC4R rs17782313 CC genotype showed higher average weight, zBMI, waist circumference, waist-circumference-to-height ratio, and waist-hip ratio, and lower BMI, mid-upper arm circumference, calf circumference, and %BF (P< 0.05). FTO rs9939609 AT and AA genotypes were associated with lower triglycerides (P < 0.05). CONCLUSIONS: We showed that MC4R rs17782313 and FTO rs9939609 were positively associated with zBMI, with weak and very weak effects, respectively, suggesting a very scarce contribution to childhood obesity. LEPR rs1137101 and PPARG-2 rs1801282 had weak and medium negative effects on zBMI, respectively, and may slightly protect against childhood obesity.


Assuntos
Dioxigenase FTO Dependente de alfa-Cetoglutarato/genética , Predisposição Genética para Doença , Obesidade/genética , PPAR gama/genética , Polimorfismo de Nucleotídeo Único , Receptor Tipo 4 de Melanocortina/genética , Receptores para Leptina/genética , Adiposidade/genética , Alelos , Índice de Massa Corporal , Peso Corporal/genética , Criança , Estudos Transversais , Feminino , Frequência do Gene , Estudos de Associação Genética , Genótipo , Humanos , Masculino , Circunferência da Cintura/genética
4.
Obes Sci Pract ; 2(3): 272-281, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27708844

RESUMO

OBJECTIVE: To develop and cross-validate predictive models for percentage body fat (%BF) from anthropometric measurements [including BMI z-score (zBMI) and calf circumference (CC)] excluding skinfold thickness. METHODS: A descriptive study was carried out in 3,084 pre-pubertal children. Regression models and neural network were developed with %BF measured by Bioelectrical Impedance Analysis (BIA) as the dependent variables and age, sex and anthropometric measurements as independent predictors. RESULTS: All %BF grade predictive models presented a good global accuracy (≥91.3%) for obesity discrimination. Both overfat/obese and obese prediction models presented respectively good sensitivity (78.6% and 71.0%), specificity (98.0% and 99.2%) and reliability for positive or negative test results (≥82% and ≥96%). For boys, the order of parameters, by relative weight in the predictive model, was zBMI, height, waist-circumference-to-height-ratio (WHtR) squared variable (_Q), age, weight, CC_Q and hip circumference (HC)_Q (adjusted r2 = 0.847 and RMSE = 2.852); for girls it was zBMI, WHtR_Q, height, age, HC_Q and CC_Q (adjusted r2 = 0.872 and RMSE = 2.171). CONCLUSION: %BF can be graded and predicted with relative accuracy from anthropometric measurements excluding skinfold thickness. Fitness and cross-validation results showed that our multivariable regression model performed better in this population than did some previously published models.

5.
Neuromodulation ; 17(2): 119-25, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24112662

RESUMO

INTRODUCTION/OBJECTIVES: Previous experiments suggest that the striatal sensorimotor territory in rats is located in its dorsolateral region, along the rostrocaudal axis, unlike what has been observed in primates. In the present study, electrical stimulation was performed to investigate the degree of participation of the posterior striatum in its motor territory, its somatotopic organization, and the motor responses evoked by stimulation. METHODS: Twenty-five rats were submitted to stereotactic stimulation of the posterior striatum under general anesthesia, receiving consecutively four different current intensities. The motor responses observed in the different body parts were registered for later comparison. We considered as threshold the smallest of these current intensities able to evoke a motor response. RESULTS: The observed motor responses were qualitatively different for each segment: forepaws: ipsilateral, adduction, and contralateral abduction; hindpaws: ipsilateral, flexion, and contralateral, extension/abduction; trunk, rotation/flexion; and tail, rotation/elevation. High-frequency, small-amplitude distal tremor occurred in the ipsilateral forepaw in 95% of the animals. Progressively larger current intensities were necessary for the induction of motor response in the forepaws, hindpaws, and trunk/tail, in that order. CONCLUSIONS: The results allowed us to infer the following posterior striatal somatotopic organization: forepaws, posterolaterally, being the contralateral medial to the ipsilateral; trunk/tail, anteromedially; and hindpaws, in an intermediate position, being the contralateral posterior to the ipsilateral. It is suggested that the tremor and the other observed motor responses derive from the excitation of striatal projection neurons and that the striatum may play an important role in the genesis of essential tremor.


Assuntos
Mapeamento Encefálico/métodos , Corpo Estriado/fisiologia , Potencial Evocado Motor/fisiologia , Movimento/fisiologia , Animais , Estimulação Elétrica/métodos , Masculino , Ratos , Ratos Wistar
6.
J Neurosci Res ; 91(10): 1328-37, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23873746

RESUMO

Although long known and the most prevalent movement disorder, pathophysiology of essential tremor (ET) remains controversial. The most accepted hypothesis is that it is caused by a dysfunction of the olivocerebellar system. Vilela Filho et al. [2001; Stereotact Funct Neurosurg 77:149-150], however, reported a patient with unilateral hand ET that was completely relieved after a stroke restricted to the contralateral posterior putamen and suggested that ET could be the clinical manifestation of posterior putamen hyperactivity. The present study was designed to evaluate this hypothesis in the most often used model of ET, harmaline-induced tremor in rats. Fifty-four male Wistar rats were randomly distributed into three groups: experimental (EG), surgical control (SCG), and pharmacological control (PCG) groups. EG animals underwent stereotactic unilateral posterior striatotomy. SCG rats underwent sham lesion at the same target. PCG served exclusively as controls for harmaline effects. All animals received, postoperatively, intraperitoneal harmaline, and the induced tremor was video-recorded for later evaluation by a blind observer. Thirteen animals were excluded from the study. Limb tremor was reduced ipsilaterally to the operation in 20 of 21 rats of EG and in two of nine of SCG, being asymmetric in one of 10 of PCG rats. Comparisons between EG × SCG and EG × PCG were statistically significant, but not between SCG × PCG. Limb tremor reduction was greater in anterior than in posterior paws. Lateral lesions yielded better results than medial lesions. These results suggest that the posterior striatum is involved with harmaline-induced tremor in rats and support the hypothesis presented.


Assuntos
Corpo Estriado/fisiopatologia , Tremor Essencial/fisiopatologia , Animais , Estimulantes do Sistema Nervoso Central/toxicidade , Corpo Estriado/cirurgia , Modelos Animais de Doenças , Tremor Essencial/induzido quimicamente , Tremor Essencial/cirurgia , Lateralidade Funcional/fisiologia , Harmalina/toxicidade , Masculino , Ratos , Ratos Wistar , Técnicas Estereotáxicas
7.
J. epilepsy clin. neurophysiol ; 15(4): 178-183, dez. 2009. ilus, tab
Artigo em Português | LILACS | ID: lil-545424

RESUMO

INTRODUÇÃO: A estereoeletroencefalografia (E-EEG), conforme introduzida na década de 50 por Talairach, é um método invasivo de análise tridimensional da zona epilpeptogênica, baseado na técnica de implantação intracraniana de eletrodos de profundidade (EP). O advento das modernas técnicas de cirurgia guiadas por imagem revolucionaram a técnica de implantação dos EP. OBJETIVO: O objetivo deste artigo é discutir os princípios da E-EEG e sua evolução, desde a era Talairach até a era atual, da cirurgia guiada por imagem, e suas perspectivas futuras. CONCLUSÕES: Embora os princípios gerais da E-EEG tenham permanecidos intactos ao longo dos anos, a implantação de EP, que é a técnica cirúrgica que viabiliza este método, sofreu uma tremenda evolução ao longo das últimas três décadas devido ao advento das modernas técnicas de imagem, de sistemas de computação e das novas técnicas estereotáxicas. O uso de sistemas robotizados, a evolução constante das técnicas de imagem e computação e a utilização de EP com sondas para micro diálise associados a si, abre no futuro uma enorme perspectiva para a aplicação dos EP e da E-EEG, tanto para uso investigativo como terapêutico. A descoberta de novos alvos, em localizações profundas e a fabricação de eletrodos "inteligentes", poderá incrementar, num futuro próximo, a necessidade do uso deste método.


INTRODUCTION: The stereoelectroencephalography (SEEG), introduced by Talairach in 50', is an invasive method of tridimensional analysis of epileptogenic zone based on the intracranial placement of depth electrodes (DE). The advent of modern imaging guided surgery had a tremendous impact in DE implantation techniques. OBJETIVE: The aim of this article is to discuss the main principles of SEEG and its evolution along the years since Talairach era until the imaging guide surgery era, with its new perspectives. CONCLUSIONS: Although the main principles of SEEG have remained intact, the placement of depth electrodes (DE) which is the surgical technique that supports this method has suffered a tremendous evolution along the last three decades due the advent of the modern imaging, the computer systems and the new stereotactic techniques. The use of robotic, the new imaging and computed systems and the use of probes of micro dialise adaptated to EP opened a tremendous perspective to DE and SEEG application as an investigative and therapeutical method. The discovery of new targets in deep brain localization and the manufacturing of "smart" DE, can increment, in a near future, the number of indications to this method.


Assuntos
Humanos , Cirurgia Assistida por Computador , Eletrodos , Epilepsia/cirurgia
8.
J. epilepsy clin. neurophysiol ; 13(2): 65-69, June 2007. ilus
Artigo em Inglês | LILACS | ID: lil-458777

RESUMO

INTRODUCTION: In this study the authors review the outcomes of 22 patients with medically refractory epilepsy and slow growth brain tumors. OBJECTIVES: Evaluate the clinical, electrophysiological, operative, and histopathological features. PATIENTS AND RESULTS: The majority of the tumors were located in the temporal lobe (n = 20) and involved the cortical gray matter. The most frequent tumors were gangliogliomas (n = 9), astrocytomas grade I and II (n = 6), dysembryoplastic neuroepithelial tumors (n = 5) and ganglioneuroma (n = 2). The biological behavior of the tumors was strikingly indolent, as indicated by a long preoperative history of chronic seizures (mean, 14 years). Mean follow-up time after resection was 27 months, and according to EngelÆs classification, 85 percent were seizure-free, 10 percent showed a reduction of seizure frequency of at least 90 percent, and 5 percent had reduction in seizure frequency at least 75 percent. CONCLUSION: The data indicate that neoplasms associated with pharmacoresistent epilepsy constitute a distinct clinicopathological group of tumors that arise in young patients, involve the cortex, and exhibit indolent biological behavior for many years. Complete surgical removal of these tumors, including the epileptogenic area, can achieve excellent seizure control.


INTRODUÇÃO: Neste estudo os autores avaliaram retrospectivamente 22 pacientes tratados cirurgicamente com diagnóstico de epilepsia refratária e tumor cerebral de crescimento lento. OBJETIVOS: Avaliar os aspectos clínicos, eletrofisiológicos, cirúrgicos e histopatológicos. PACIENTES E RESULTADOS: A maioria dos tumores estava localizada no lobo temporal (n = 20) com envolvimento da substância cinzenta. Ganglioglioma foi o tumor mais frequente (n = 9), seguido do astrocitoma grau I e II OMS (n = 6), tumor neuroepitelial disembrioplástico (DNET) (n = 5) e ganglioneuroma (n = 2). O comportamento biológico dos tumores foi estritamente indolente como indicado pela longa história pré-operatória de (média, 14 anos). O tempo de acompanhamento pós-operatório médio foi de 27 meses e de acordo com a Classificacão de Engel, 85 por cento ficaram sem crises (Classe I), 10 por cento obtiveram redução maior de 90 por cento das crises (Classe II), e 5 por cento tiveram redução menor que 75 por cento (Classe III). CONCLUSÃO: Os dados indicam que neoplasias associadas à epilepsia crônica refratária constituem um grupo de tumores com características clinico-patológicas distintas que se iniciam em pacientes jovens, envolvem o córtex e apresentam comportamento biológico indolente. A ressecção cirúrgica completa destes tumores, incluindo a zona epileptogênica, levou ao controle total das crises na maior parte dos casos estudados.


Assuntos
Neoplasias Encefálicas/cirurgia , Epilepsia/cirurgia , Fenobarbital/efeitos adversos , Fenitoína/efeitos adversos , Carbamazepina/efeitos adversos , Estudos Retrospectivos
9.
Arq Neuropsiquiatr ; 64(3B): 774-80, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17057884

RESUMO

PURPOSE: To evaluate using transcription analysis the presence and importance of two genes: NM23-H1 and TIMP-1 on control of tumor cell invasion in diffuse astrocytomas (WHO II) and glioblastoma multiforme (WHO IV). METHOD: Northern blot analysis of NM23-H1 and TIMP-1 was performed. Eight diffuse astrocytomas and 19 glioblastomas (WHO IV) were analyzed to determine if TIMP-1 and NM23-H1 were candidates to inhibition of tumor cell invasion quantitated RNA levels. The samples were collected directly from operating room. Total cellular RNA was extracted from frozen tissue samples using guanidinium-isothiocyanate and cesium chloride gradients. Total RNA (10 mg per sample) from tumor tissue were size fractionated through 1% agarose-formaldehyde gel and transferred to nylon filters and then hybridized to 32P-labeled DNA probes and placed for autoradiography. Levels of specific RNAs were determined by computer-assisted laser densitometry. Blot filters were sequentially hybridized to nm23 and TIMP-1 probes in addition to GAPDH, as a control. Statistical analyses were carried out according to t-test for equality of means. RESULTS: NM23-H1 were detected in each sample, however it did not correlate with malignancy and invasiveness. On the other side TIMP-1 gene expression showed a clear correlation between low expression and invasiveness. CONCLUSION: The data suggest that TIMP-1 is an inhibitor of high grade gliomas invasion. NM23-H1 was present in the entire gliomas sample, but it did not vary in diffuse astrocytomas and glioblastomas.


Assuntos
Astrocitoma/genética , Neoplasias Encefálicas/genética , Glioblastoma/genética , Proteínas de Neoplasias/genética , Núcleosídeo-Difosfato Quinase/genética , Inibidor Tecidual de Metaloproteinase-1/genética , Northern Blotting , Regulação Neoplásica da Expressão Gênica , Marcadores Genéticos , Humanos , Nucleosídeo NM23 Difosfato Quinases , Invasividade Neoplásica , RNA Neoplásico/análise , Transcrição Genética
10.
Arq. neuropsiquiatr ; 64(3b): 774-780, set. 2006. graf, tab
Artigo em Inglês, Português | LILACS | ID: lil-437148

RESUMO

PURPOSE: To evaluate using transcription analysis the presence and importance of two genes: NM23-H1 and TIMP-1 on control of tumor cell invasion in diffuse astrocytomas (WHO II) and glioblastoma multiforme (WHO IV). METHOD: Northern blot analysis of NM23-H1 and TIMP-1 was performed. Eight diffuse astrocytomas and 19 glioblastomas (WHO IV) were analyzed to determine if TIMP-1 and NM23-H1 were candidates to inhibition of tumor cell invasion quantitated RNA levels. The samples were collected directly from operating room. Total cellular RNA was extracted from frozen tissue samples using guanidinium-isothiocyanate and cesium chloride gradients. Total RNA (10 mg per sample) from tumor tissue were size fractionated through 1 percent agarose-formaldehyde gel and transferred to nylon filters and then hybridized to 32P-labeled DNA probes and placed for autoradiography. Levels of specific RNAs were determined by computer-assisted laser densitometry. Blot filters were sequentially hybridized to nm23 and TIMP-1 probes in addition to GAPDH, as a control. Statistical analyses were carried out according to t-test for equality of means. RESULTS: NM23-H1 were detected in each sample, however it did not correlate with malignancy and invasiveness. On the other side TIMP-1 gene expression showed a clear correlation between low expression and invasiveness. CONCLUSION: The data suggest that TIMP-1 is an inhibitor of high grade gliomas invasion. NM23-H1 was present in the entire gliomas sample, but it did not vary in diffuse astrocytomas and glioblastomas.


OBJETIVO: Comparar através da análise da expressão dos níveis de RNA, a presença e a relevância dos genes NM23-H1 e TIMP-1 no controle da invasão celular tumoral dentro do tecido cerebral normal em: astrocitoma difuso (OMS II) e glioblastoma multiforme (OMS:IV). MÉTODO: Análise em "Northern blot" dos genes NM23-H1 e TIMP-1. Oito astrocitomas fibrilares difusos (OMS II) e 19 glioblastomas multiformes foram analisados para determinar se TIMP-1 e NM23-H1 estavam relacinados à inibição da invasão tumoral nas neoplasias do sistema nervoso central, quantificando os níveis de RNA dos respectivos genes extraídos diretamente dos tumores. 10 mg por amostra de RNA total foram fracionados de gel de formaldeído e transferidos para os filmes de hibridação. Níveis específicos de RNAs foram determinados na espectrofotometria. Valores das razões entre NM23-H1/GAPDH e TIMP-1/GAPDH foram submetidos à análise de variabilidade das médias. RESULTADOS: A análise da expressão do gene TIMP-1 mostrou supressão em tumores gliais malignos. CONCLUSÃO: Os resultados indicam que existe relação direta entre níveis baixos de TIMP-1 e malignidade dos gliomas. O gene NM23-H1 foi detectado em todas as amostras, mas não foi possível relacionar sua subexpressão ou superexpressão com algum fenótipo de invasividade.


Assuntos
Humanos , Astrocitoma/genética , Neoplasias Encefálicas/genética , Glioblastoma/genética , Proteínas de Neoplasias/genética , Núcleosídeo-Difosfato Quinase/genética , Inibidor Tecidual de Metaloproteinase-1/genética , Northern Blotting , Regulação Neoplásica da Expressão Gênica , Marcadores Genéticos , Invasividade Neoplásica , RNA Neoplásico/análise , Transcrição Genética
11.
Neurosurg Focus ; 21(1): e11, 2006 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-16859249

RESUMO

OBJECT: The aim of this study was to analyze cerebellar cavernous malformations (CMs) with respect to epidemiological, clinical, radiological, and therapeutic aspects. METHODS: Between 1984 and 2004, 100 patients were surgically treated for intracranial CMs at the Division of Neurosurgery of Federal University of Sao Paulo. The authors reviewed the records of 10 patients whose lesions were located in the cerebellum. There were four male and six female patients (ratio 1:1.5) whose ages ranged from 14 to 45 years (mean age 33 years). Clinical presentation was sudden or acute in all cases, and neuroimaging examinations performed in all patients demonstrated signs of bleeding. The mean size of the malformations was 4.6 cm, and in all but one patient the lesions were totally removed without complications. After a mean follow-up period of 70 months, all patients were considered to be in good or excellent clinical condition. CONCLUSIONS: Cerebellar CMs should be analyzed separately from other posterior fossa CMs. These lesions can reach large sizes and cause massive hemorrhages, resulting in acute or sudden presentation. Surgery is a safe and effective option that provides a curative treatment when a complete removal is achieved.


Assuntos
Neoplasias Cerebelares/cirurgia , Cerebelo/cirurgia , Veias Cerebrais/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda/terapia , Adolescente , Adulto , Distribuição por Idade , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/fisiopatologia , Cerebelo/irrigação sanguínea , Cerebelo/fisiopatologia , Veias Cerebrais/anormalidades , Veias Cerebrais/patologia , Fossa Craniana Posterior/anatomia & histologia , Fossa Craniana Posterior/cirurgia , Diagnóstico por Imagem/normas , Progressão da Doença , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico , Hemangioma Cavernoso do Sistema Nervoso Central/fisiopatologia , Humanos , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/prevenção & controle , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/normas
12.
Arq Neuropsiquiatr ; 63(1): 20-5, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15830059

RESUMO

UNLABELLED: Long-term complications in levodopa treated Parkinson's disease (PD) patients caused a resurgence of interest in pallidotomy as an option of treatment. However, postoperative complications such as speech disorders can occur. PURPOSE: The aim of this study is to evaluate the acoustic voice in PD patients, before and after posteroventral pallidotomy. METHOD: Twelve patients with PD were submitted to neurological and voice assessments during the off and on phases, in the pre-operative, 1st and 3rd post-operative months. The patients were evaluated with the UPDRS and the vocal acoustic parameters -- f0, NHR, jitter, PPQ, Shimmer, APQ (using the software MultiSpeech-Kay Elemetrics-3700). RESULTS: The off phase UPDRS scores revealed a tendency to improvement at the 1st month and the off phase worsened. The shimmer and APQ improved. CONCLUSION: This study shows that pallidotomy has little improvement on functional use of communication of PD patients.


Assuntos
Disartria/etiologia , Globo Pálido/cirurgia , Doença de Parkinson/cirurgia , Distúrbios da Voz/etiologia , Qualidade da Voz , Idoso , Antiparkinsonianos/efeitos adversos , Antiparkinsonianos/uso terapêutico , Disartria/cirurgia , Feminino , Humanos , Levodopa/efeitos adversos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Índice de Gravidade de Doença , Acústica da Fala , Resultado do Tratamento , Distúrbios da Voz/cirurgia
13.
AJNR Am J Neuroradiol ; 26(4): 777-83, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15814920

RESUMO

BACKGROUND AND PURPOSE: Relative cerebral blood volume (rCBV) measurements derived from perfusion-weighted imaging (PWI) may be useful to evaluate angiogenesis and preoperatively estimate the grade of a glioma. We hypothesized that rCBV is correlated with vascular endothelial growth factor (VEGF) expression as marker of the angiogenic stimulus in presumed supratentorial low-grade gliomas (LGGs). METHODS: From February 2001 to February 2004, we examined 20 adults (16 men, four women; mean age 36 years; range, 23-60 years) with suspected (nonenhancing) supratentorial LGG on conventional MR imaging. Preoperative MR imaging used a dynamic first-pass gadolinium-enhanced, spin-echo echo-planar PWI. In heterogeneous tumors, we performed stereotactic biopsy in the high-perfusion areas before surgical resection. Semiquantitative grading of VEGF immunoreactivity was applied. RESULTS: Nine patients had diffuse astrocytomas (World Health Organization grade II), and 11 had other LGG and anaplastic gliomas. In patients with heterogeneous tumors on PWI, the high-rCBV focus had areas of oligodendroglioma or anaplastic astrocytoma on stereotactic biopsy, whereas the surgical specimens were predominantly astrocytomas. Anaplastic gliomas had high rCBV ratios and positive VEGF immunoreactivity. Diffuse astrocytomas had negative VEGF expression and mean rCBV values significantly lower than those of the other two groups. Three diffuse astrocytomas had positive VEGF immunoreactivity and high rCBV values. CONCLUSION: Our results confirmed the correlation among rCBV measurements, VEGF expression, and histopathologic grade in nonenhancing gliomas. PWI may add useful data to the preoperative assessment of nonenhancing gliomas. Its contribution in predicting tumor behavior and patient prognosis remains to be determined.


Assuntos
Volume Sanguíneo , Glioma/metabolismo , Glioma/fisiopatologia , Imagem por Ressonância Magnética , Neoplasias Supratentoriais/metabolismo , Neoplasias Supratentoriais/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/biossíntese , Adulto , Feminino , Glioma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Supratentoriais/patologia
14.
Arq. neuropsiquiatr ; 63(1): 20-25, Mar. 2005. tab, graf
Artigo em Inglês | LILACS | ID: lil-398784

RESUMO

O uso prolongado da levodopa na doença de Parkinson (DP) pode ocasionar alterações em seu rendimento e possibilitou o interesse no ressurgimento da palidotomia. Contudo, complicações pós-operatórias podem ocorrer. OBJETIVO: O presente estudo tem por objetivo avaliar alguns parâmetros acústicos da voz de pacientes com DP pré e pós a realização da palidotomia posteroventral METODO: foram avaliados 12 pacientes com PD submetidos a avaliação neurológica e da voz durante as fases off e on do uso da levodopa, nos momentos pré-operatório, no primeiro e no terceiro mês pós-operatório. Os pacientes foram avaliados com base na escala UPDRS - item motor - e por meio dos parâmetros acústicos da voz - f0, NHR, jitter, PPQ, Shimmer, APQ (usando o software MDVP - Kay Elemetrics - 3700). RESULTADOS: Na fase off o escore UPDRS revelou tendência de melhora no 1º pós-operatório e na fase on piora. Os parâmetros acústicos shimmer e APQ apresentaram melhora. CONCLUSÃO: Este estudo mostrou que a palidotomia resulta em discreta melhora no uso funcional da comunicação dos pacientes com DP.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Disartria/etiologia , Globo Pálido/cirurgia , Doença de Parkinson/cirurgia , Qualidade da Voz , Distúrbios da Voz/etiologia , Antiparkinsonianos/efeitos adversos , Antiparkinsonianos/uso terapêutico , Disartria/cirurgia , Levodopa/efeitos adversos , Levodopa/uso terapêutico , Doença de Parkinson/complicações , Índice de Gravidade de Doença , Acústica da Fala , Resultado do Tratamento , Distúrbios da Voz/cirurgia
15.
Arq Neuropsiquiatr ; 62(4): 1095-9, 2004 Dec.
Artigo em Português | MEDLINE | ID: mdl-15608977

RESUMO

We describe the incidence, causes, management and prognosis of traumatic fractures of the thoracic spine from T1 to T10 in surgical cases of traumatic fractures of spine during the period from June 1994 to June 2003 studied retrospectively. The type of fracture was determined according to the Gertzbein classification, and the degree of stability using the Denis classification. The neurological picture at admission and 30 days after surgery was evaluated using the ASIA/IMSOP classification. Surgery was performed in patients with complete spinal cord injury (n=7) for the purpose of stabilization using the posterior approach. In cases without spinal cord injury or incomplete injury (n=12), the surgical procedure was performed aiming to decompress the nerve tissue, to correct the alignment of the spine and to stabilize the spine.


Assuntos
Fraturas da Coluna Vertebral , Vértebras Torácicas/lesões , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Índices de Gravidade do Trauma
16.
J Neurosurg ; 101(6): 970-6, 2004 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15597757

RESUMO

OBJECT: The. diagnosis of low-grade glioma (LGG) cannot be based exclusively on conventional magnetic resonance (MR) imaging studies, and target selection for stereotactic biopsy is a crucial issue given the high risk of sampling errors. The authors hypothesized that perfusion-weighted imaging could provide information on the microcirculation in presumed supratentorial LGGs. METHODS: All adult patients with suspected (nonenhancing) supratentorial LGGs on conventional MR imaging between February 2001 and February 2004 were included in this study. Preoperative MR imaging was performed using a dynamic first-pass gadopentate dimeglumine-enhanced spin echo-echo planar perfusion-weighted sequence, and the tumors' relative cerebral blood volume (rCBV) measurements were expressed in relation to the values observed in contralateral white matter. In patients with heterogeneous tumors a stereotactic biopsy was performed in the higher perfusion areas before resection. Among 21 patients (16 men and five women with a mean age of 36 years, range 23-60 years), 10 had diffuse astrocytomas (World Health Organization Grade II) and 11 had other LGGs and anaplastic gliomas. On perfusion-weighted images demonstrating heterogeneous tumors, areas of higher rCBV focus were found to be oligodendrogliomas or anaplastic astrocytomas on stereotactic biopsy; during tumor resection, however, specimens were characterized predominantly as astrocytomas. Diffuse astrocytomas were associated with significantly lower mean rCBV values compared with those in the other two lesion groups (p < 0.01). The rCBV ratio cutoff value that permitted better discrimination between diffuse astrocytomas and the other lesion groups was 1.2 (80% sensitivity and 100% specificity). CONCLUSIONS: Perfusion-weighted imaging is a feasible method of reducing the sampling error in the histopathological diagnosis of a presumed LGG, particularly by improving the selection of targets for stereotactic biopsy.


Assuntos
Astrocitoma/patologia , Imagem de Difusão por Ressonância Magnética , Neoplasias Supratentoriais/patologia , Adulto , Astrocitoma/cirurgia , Biópsia , Circulação Cerebrovascular , Feminino , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Prospectivos , Sensibilidade e Especificidade , Técnicas Estereotáxicas , Neoplasias Supratentoriais/cirurgia
17.
Arq. neuropsiquiatr ; 62(4): 1095-1099, dez. 2004. ilus, tab
Artigo em Português | LILACS | ID: lil-390685

RESUMO

Descrevemos a incidência, causas, manejo e prognóstico das fraturas traumáticas de coluna torácica de T1 a T10. Estudamos retrospectivamente os casos cirúrgicos de fraturas traumáticas da coluna torácica (T1 a T10), durante o período de junho de 1994 a junho de 2003. O tipo de fratura foi determinado segundo a classificação de Gertzbein e o grau de estabilidade através da classificação de Denis. O quadro neurológico à internação e 30 dias após a cirurgia foi avaliado através da classificação de ASIA/IMSOP. O objetivo da cirurgia nos pacientes com lesão medular completa (n=7) foi de estabilização, enquanto nos casos de instabilidade vertebral em que não houve lesão medular ou esta foi incompleta (n=12), optou-se pela descompressão do tecido nervoso, correção do alinhamento da coluna e estabilização da coluna.


Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Acidentes de Trânsito/estatística & dados numéricos , Brasil/epidemiologia , Incidência , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Fraturas da Coluna Vertebral/etiologia , Índices de Gravidade do Trauma
18.
Arq Neuropsiquiatr ; 62(2B): 499-502, 2004 Jun.
Artigo em Português | MEDLINE | ID: mdl-15273851

RESUMO

Dysphagia is one of the complications of anterior cervical surgery. Although common, few articles were published on this subject. Its incidence and duration varies depending on the author. We show a prospective study, analyzing the incidence, duration and quality of the dysphagia after anterior cervical surgery.


Assuntos
Transtornos de Deglutição/etiologia , Complicações Pós-Operatórias/etiologia , Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/cirurgia , Estudos Prospectivos , Radiculopatia/cirurgia , Doenças da Medula Espinal/cirurgia
19.
Arq Neuropsiquiatr ; 62(2B): 531-4, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15273858

RESUMO

We present a rare case of cavernous angioma of the cauda equina and review the eleven cases available in the literature. A 44-year-old woman presented with low back pain and sciatica associated with bowel and bladder dysfunction and motor weakness of the lower extremity. The MRI revealed an enhancing, heterogeneous and hyperintense intradural lesion compressing the cauda equina roots at the L4 level. Laminectomy at L3-L4 and total removal of the tumor were performed without additional neurological deficit. Pathology revealed a cavernous angioma. The literature, clinical presentation, technical examinations, and treatment are reviewed.


Assuntos
Cauda Equina , Hemangioma Cavernoso/diagnóstico , Neoplasias do Sistema Nervoso Periférico/diagnóstico , Adulto , Feminino , Hemangioma Cavernoso/cirurgia , Humanos , Neoplasias do Sistema Nervoso Periférico/cirurgia
20.
Arq Neuropsiquiatr ; 62(2A): 330-3, 2004 Jun.
Artigo em Português | MEDLINE | ID: mdl-15235740

RESUMO

The extra-intracranial bypass may be used in selected cases of brain vascular insufficiency refractory to clinical treatment. We report a case of encephalic ischemia in the territory of the right middle cerebral artery due to occlusion of the ipsilateral internal carotid artery, with consequent reduction of the perfusion and vascular reserve in the parietal and frontal regions. Despite the clinical treatment, motor deficit improvement was directly related to the maintenance of high systemic arterial tension levels due to the use of vasopressor agent. After lateral-terminal extra-intracranial bypass between the superficial temporal and right middle cerebral artery, there was significant improvement of cerebral perfusion with remission of the motor deficit.


Assuntos
Arteriopatias Oclusivas/cirurgia , Isquemia Encefálica/cirurgia , Revascularização Cerebral , Artéria Cerebral Média/cirurgia , Anastomose Cirúrgica , Arteriopatias Oclusivas/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Artéria Carótida Interna , Angiografia Cerebral/métodos , Circulação Cerebrovascular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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