Cholangiocarcinoma associated with limbic encephalitis and early cerebral abnormalities detected by 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography-positron emission tomography: a case report.

BACKGROUND: Limbic encephalitis was originally described as a rare clinical neuropathological entity involving seizures and neuropsychological disturbances. In this report, we describe cerebral patterns visualized by positron emission tomography in a patient with limbic encephalitis and cholangiocarcinoma. To our knowledge, there is no other description in the literature of cerebral positron emission tomography findings in the setting of limbic encephalitis and subsequent diagnosis of cholangiocarcinoma. CASE PRESENTATION: We describe a case of a 77-year-old Caucasian man who exhibited persistent cognitive changes 2 years before his death. A cerebral scan obtained at that time by 2-deoxy-2-[fluorine-18]fluoro- D -glucose integrated with computed tomography-positron emission tomography showed low radiotracer uptake in the frontal and temporal lobes. Cerebrospinal fluid analysis indicated the presence of voltage-gated potassium channel antibodies. Three months before the patient's death, a lymph node biopsy indicated a cholangiocarcinoma, and a new cerebral scan obtained by 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography-positron emission tomography showed an increment in the severity of metabolic deficit in the frontal and parietal lobes, as well as hypometabolism involving the temporal lobes. Two months before the patient's death, cerebral metastases were detected on a contrast-enhanced computed tomographic scan. Postmortem examination revealed a cholangiocarcinoma with multiple metastases including the lungs and lymph nodes. The patient's brain weighed 1300 g, and mild cortical atrophy, ex vacuo dilation of the ventricles, and mild focal thickening of the cerebellar leptomeninges, which were infiltrated by neoplastic epithelial cells, were observed. CONCLUSIONS: These findings support the need for continued vigilance in malignancy surveillance in patients with limbic encephalitis and early cerebral positron emission tomographic scan abnormalities. The difficulty in early diagnosis of small tumors, such as a cholangiocarcinoma, is discussed in the context of the clinical utility of early cerebral hypometabolism detected by 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography-positron emission tomography in patients with rapidly progressive dementia.

Sexologia e adolescencia

Objetivos: Este trabalho e uma tentativa de realizar um levantamento analitico sobre as principais duvidas de adolescentes do segundo grau, em relacao a sexo, excluida a relacao deste com a AIDS especificamente. Materiais e Metodos: Foram distribuidas, coletadas e analisadas 183 fichas de alunos de primeiro e segundo colegial de uma escola da rede publica estadual, nas quais estes se identificavam apenas pela serie, idade e sexo. Alem disso, foi relatado nas fichas, para um estudo empirico analitico, as duas principais duvidas dos alunos em relacao a sexo. Resultados: Dos alunos que participaram do estudo, 61,2 por cento eram do sexo feminino e 33,6 por cento do sexo masculino. A idade frequente foi de 15 anos, tanto no sexo feminino quanto no masculino (35,7 por cento; 47,8 por cento respectivamente). 16,4 por cento das fichas nao continham perguntas, e das perguntas das fichas restantes 63,77 por cento enquadravam-se nos quatro topicos mais frequentes.(Metodos anticoncepcionais, tipos de relacao sexual, gravidez e D.S.T.) Discussao: Apesar do comportamento sexual dos adolescentes ser um assunto de consideravel especulacao, ainda e muito pouco estudado. Deve-se entao pensar em novas alternativas para a educacao sexual.

A methodology for the determination of risk assessment related to handling of petrochemical products in developing countries

Se refiere al transporte de productos petroquímicos, destacando la alta incidencia de accidentes que se producen y que además ocasionan danos ecológicos. Igualmente se analiza el sistema del oleoducto Santos-Sao Paulo, instalado en 1951 y progresivamente reemplazado en sus partes débiles o vulnerables y las medidas de seguridad para disminuir los posibles riesgos de peligro individual y social