Aggressive papillary tumor of endolymphatic sac: case report of a rare neoplasia / Tumor papilar agressivo do saco endolinfático: relato de caso de uma rara neoplasia

ABSTRACT Aggressive papillary endolymphatic sac tumor (ELST) is a rare neoplasm, occasionally related to von Hippel-Lindau disease, characterized by locally aggressive growth with temporal bone destruction. The authors report a case of ELST in a female patient exhibiting fifth through eighth cranial nerve paralysis. Computed tomography (CT) revealed a large lytic process involving the right temporal bone. The patient underwent surgical resection. At microscopy, a neoplastic process was identified exhibiting monomorphic columnar cells with mild atypias, arranged in a papillary pattern. The lesion exhibited positivity for A31/AE3, epithelial membrane antigen (EMA), and vimentin; and negativity for synaptophysin, glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), thyroglobulin, transthyretin, chromogranin, thyroid transcription factor 1 (TTF-1), trans-acting T-cell specific transcription factor GATA-3, and intestinal transcription factor CDX-2. The diagnosis of ELST was then established. Six years after surgical resection, lesion recurrence was observed.

RESUMO O tumor papilar agressivo do saco endolinfático (TPASE) é uma neoplasia rara, ocasionalmente relacionada com a doença de von Hippel-Lindau, que se caracteriza pelo crescimento agressivo local com destruição do osso temporal. Os autores relatam um caso de TPASE em paciente do sexo feminino, exibindo paralisia do quinto ao oitavo par craniano. A tomografia computadorizada (TC) revelou grande processo lítico comprometendo o osso temporal direito. A paciente foi submetida a ressecção cirúrgica. À microscopia, identificou-se processo neoplásico que exibiu células cilíndricas monomórficas com atipias leves, dispostas em padrão papilar. A lesão apresentou positividade para AE1/ AE3, antígeno da membrana epitelial (EMA) e vimentina; e negatividade para sinaptofisina, proteína ácida fibrilar glial (GFAP), enolase específica do neurônio (NSE), tireoglobulina, transtirretina, cromogranina, fator de transcrição da tireoide 1 (TTF-1), fator de transcrição de ação trans específico de células GATA-3 e fator de transcrição intestinal CDX-2. O diagnóstico de TPASE foi então estabelecido. Após seis anos da ressecção cirúrgica, foi identificada recorrência da lesão.

Investigación documental sobre escritura académica en tres universidades nacionales: Período 1990-2011 / Documentary research on academic writing in three national universities: Period 1990-2011

We present a documental research, period 1990-2011, which wanted to know the course of research published in scientific events of three national universities: National University of La Plata, National University of Mar del Plata and University of Buenos Aires. The issue was the written production of students in higher education. We identified and classified the documentary source (N=72) according to their place of publication, publication subject area, temporal distribution, place of establishment of research projects, unit of analysis, instructional intervention, skills trying to be promoted. Encouraging results are available showing a positive trend in researches that present contextual analysis units.

Se presenta un trabajo de investigación documental, periodo 1990-2011, en el que se quiso conocer el decurso de investigaciones publicadas en memorias de eventos científicos y anuarios de investigación de las facultades de psicología de tres universidades nacionales: Universidad Nacional de La Plata, Universidad Nacional de Mar del Plata y Universidad de Buenos Aires. El tema explorado fue la producción escrita de estudiantes del nivel superior. Se identificó y clasificó la fuente documental (N=72) según su lugar de publicación, área temática de publicación, distribución temporal, lugar de radicación de los proyectos de investigación, unidad de análisis, intervención instruccional, habilidades que se quieren promover. Se ofrecen resultados alentadores que muestran tendencia positiva de las investigaciones con unidades de análisis contextuales.

Salinity induced anatomical and morphological changes in Chloris gayana Kunth roots

Chloris gayana Kunth is a grass species valuable as forage which was introduced into Argentina to be used as pasture in saline soils of subtropical and warm-temperate zones, given its good adaptability to drought, salinity and mild freezing. However, its tolerance varies according to the cultivar. In tetraploid cultivars, important reductions in yield have been observed. Here, a study of the variations produced on the root and stem system by salinity at different NaCl concentrations (0, 150 and 250 mM) was performed in the Boma cultivar, with the aim of determining the anatomical and morphological alterations produced by the salt excess. Plants cultivated with the highest level of salinity showed, in the whole, significant differences in the measured variables. A diminution in absolute values of the variables and a major reduction in vascular tissue dimensions were observed, which suggests that the lack of tolerance to salt stress could be related to a deficient adaptation to absorb and transport water and nutrients from the roots.

Incidência de aposição incompleta persistente e tardia após implante de stents com sirolimus e zotarolimus / Incidence of persistent and late-acquired incomplete stent apposition after sirolimus and zotarolimus-eluting stents

Introdução: Aposição incompleta (AI) é descrita após implante de stents farmacológicos (SF) e pode associar-se à trombose de stents. Em razão de diferentes plataformas, polímeros e fármacos utilizados, diferenças na eficácia e na segurança entre SF também são esperadas. Objetivo: Avaliar a incidência de AI persistente e tardia após implante de stents com sirolimus (SES) e com zotarolimus (ZES) e a evolução dos pacientes que apresentem essa alteração. Método: Análise de 242 pacientes tratados com SF (175 pacientes com SES – Cypher® – e 67 pacientes com ZES – Endeavor™) e submetidos a ultra-sonografia intracoronária após o implante e aos seis meses. Resultados: No grupo tratado com SES, 7 (4%) pacientes apresentaram AI tardia e 12 (6,8%), AI persistente. No grupo tratado com ZES, nenhum caso de AI tardia foi identificado e, em 4 pacientes, observou-se AI após o implante e que desapareceu aos seis meses. Nos pacientes com AI tardia, observou-se aumento evolutivo dos volumes do vaso (de 377,2 ± 148,9 mm3 para 431,9 ± 155,1 mm3; p = 0,51)e da placa (de 206,1 ± 51,5 mm3 para 236,9 ± 68,4 mm3; p = 0,36). O volume de hiperplasia intimal foi maior após ZES (16,6 ± 5,8 mm3 vs. 5,1 ± 5,5 mm3; p < 0,0001). Após nove meses, não ocorreram eventos cardíacos adversos nos pacientes com AI. Conclusão: A incidência de AI tardia foi de 2,9% e observada após SES. A presença de AI não esteve relacionada a eventos adversos a médio prazo.

Background: Incomplete stent apposition (ISA) has been documented after drug-eluting stents (DES) and could be related to stent thrombosis. Because DES differ in metal platform, polymer and pharmacological agent, differences in performance and safety are expected. Objective: We sought to investigate the frequency and clinical consequences of ISA after implantation of sirolimus- (SES) and zotarolimuseluting stents (ZES). Methods: 242 patients (pts) who underwent DES placement (175 pts with Cypher® and 67 pts with EndeavorTM stents) had serial intravascular ultrasound (IVUS) performed (at index procedure and after 6-months). Results: 7 pts (4%) had late-acquired ISA after SES. Another 12 (6.8%) pts treated with SES had persistent ISA. Among pts treated with ZES, none had late ISA and 4 had ISA observed after stent implantation that completely resolved at 6-months. There was an increase in vessel (377.2 ± 148.9 to 431.9 ± 155.1 mm3, p = 0.51) and in plaque volume (206.1 ± 51.53 to 236.91 ± 68.4 mm3, p=0.36) in pts with late ISA. Amount of neointimal hyperplasia was significantly higher in ZES than SES (16.6 ± 5.8 mm3 vs 5.1 ± 5.5 mm3, p < 0.0001). After 9 months, no adverse clinical event was observed in pts with ISA. Conclusion: Overall incidence of IVUS-detected late incomplete DES apposition was 2.9%, all after SES. The presence of ISA was not related to clinical adverse events during mid term follow-up.

Variação sazonal de episódios de taquicardia ventricular avaliados por Holter / Seasonal variation of ventricular tachycardia registered in 24-hour Holter monitoring / Seasonal variation of ventricular tachycardia registered in 24-hour Holter monitoring

OBJETIVO: Avaliar a variação sazonal de arritmias ventriculares e sua correlação com a temperatura ambiente em pacientes submetidos à realização de Holter em Porto Alegre, Sul do Brasil. MÉTODOS: Foram avaliados os resultados de Holter de 3.034 pacientes realizados no período de 1996 a 2002. Taquicardia ventricular (TV) foi definida pela presença de três ou mais batimentos ventriculares consecutivos, em freqüência igual ou superior a 100 batimentos por minuto. Foram avaliadas a distribuição do percentual de pacientes com TV entre as estações do ano e sua correlação com a temperatura ambiente. RESULTADOS: A idade média foi 59,2 ± 17,4 anos, com predomínio do sexo feminino (61,9 por cento). A distribuição dos pacientes por estações do ano foi: verão 561 (18,5 por cento), outono 756 (24,9 por cento), inverno 843 (27,8 por cento) e primavera 874 (28,8 por cento). No verão, 52 pacientes apresentaram TV (9,3 por cento), no outono, 39 (5,2 por cento), no inverno, 56 (6,6 por cento) e, na primavera, 60 (6,9 por cento) (p = 0,035). Houve aumento relativo de 40 por cento na proporção de pacientes com TV no verão em relação ao inverno. Houve tendência de aumento da proporção de pacientes com TV com o aumento da temperatura (r = 0,57; p = 0,052). CONCLUSÃO: A ocorrência de TV apresenta variação sazonal no Sul do Brasil, com maior proporção de episódios ocorrendo durante o verão. Existe tendência de associação entre aumento da temperatura e TV.

OBJECTIVE: To evaluate the seasonal variation of ventricular arrhythmias and its correlation with ambient temperature in patients submitted to 24-hour Holter monitoring in the city of Porto Alegre, southern Brazil. METHODS: Holter monitoring reports of 3,034 patients from 1996 to 2002 were analyzed. Ventricular tachycardia (VT) was defined as the presence of 3 or more consecutive ventricular beats, at a rate equal to or higher than 100 beats per minute. Percentage distribution of patients presenting VT by seasons and its correlation with ambient temperature were analyzed. RESULTS: Mean age was 59.2 ± 17.4 years, with a predominance of the female sex (61.9 percent). Patient distribution by season of the year was: 561 (18.5 percent) in summer, 756 (24.9 percent) in fall, 843 (27.8 percent) in winter and 874 (28.8 percent) in spring. Fifty-two patients (9.3 percent) presented VT episodes in summer, 39 (5.2 percent) in autumn, 56 (6.6 percent) in winter and 60 (6.9 percent) in spring (p = 0.035). There was a 40 percent relative increase in the proportion of patients presenting VT during summer in comparison to winter. There was a trend of increase in the proportion of patients presenting VT with rising temperatures (r = 0.57; p = 0.052). CONCLUSION: The occurrence of VT presents seasonal variations in southern Brazil, with a higher proportion of episodes occurring in summer. There is an association trend between VT and temperature increase.

Primary Ewing's sarcoma of the spine: case report / Sarcoma de Ewing primário da coluna vertebral: relato de caso

Primary malignant sarcomas of the spine are extremely rare. Because of biological heterogeneity, these tumors have variable sensitivity to radiation and chemotherapy. Adequate local control through complete tumor removal is an important therapeutic goal. However, aggressive resection of tumors in the spinal column must be coupled with restoration of spinal column stability and minimization of neural deficits. The balance of these factors makes treatment of primary sarcomas of the spine challenging, and dictates an individual approach to treatment. We report on a 18 years old man with primary Ewing's sarcoma of the nonsacral spine. The clinical picture and imaging characteristics were analyzed as well as the management modalities and outcome.

Sarcomas malignos primários da coluna são extremamente raros. Devido sua heterogeneidade biológica, estes tumores apresentam sensibilidade variada à radioterapia e à quimioterapia.O controle local adequado através da ressecção tumoral completa é um objetivo terapêutico importante. Contudo, a ressecção completa dos tumores da coluna vertebral deve ser realizada com a restauração da estabilidade espinhal e minimização do déficit neurológico. O equilíbrio entre estes fatores torna o tratamento dos sarcomas da coluna desafiador, exigindo-se uma abordagem individualizada para o tratamento de cada paciente. Relatamos um caso de sarcoma de Ewing da coluna não-sacral em um homem de 18 anos. O quadro clínico e características de imagem foram analisados, bem como a modalidades de manejo e o prognóstico.

Diagnostico prenatal de las cardiopatias congenitas / Prenatal diagnosis of congenital cardiopathy

Fetal echocardiography can be performed as early as the 16th week gestation and with improved equipment all forms of congenital heart diseases can be detected in utero. In this article we discuss the indications for a fetal heart echocardiography and the techniques used in a fetal heart examination and review the structural and functional information that can be obtained.

Anillos vasculares. Experiencia en el Hospital del Niño / Vascular rings. Experience at the Children's Hospital

The authors present the clinical findings, diagnosis and treatment of vascular rings and their review of 12 cases treated between 1973 and 1998 at the Hospital del Niño, Panama city, Panama

Evaluacion clinica, electrocardiografica y angiografica de los reservorios naturales de la enfermedad de chagas en la Republica de Panama / Clinical, electrocardiographic and angiographic evaluation of natural reservoirs of Chagas' disease in the Republic of Panama

The authors studied two groups of natural animal reservoirs for Trypanosoma cruzi: a wild one, the common rat Rattus rattus and the house dog, Canis canis. Thirty one naturally infected rats were evaluated with a technique developed by the authors which allows the recording of the ECG and the performance of a ventricular angiogram without altering the functional capacity of the animal. Forty four dogs were followed clinically for a period of twenty years to study the development of the cardiac lesion seen in the chronic phase of the disease. The authors demonstrate the epidemiologic importance of the dog as a reservoir and the ease with which the infection can be acquired from rats, which live in the same habitat with human patients. The most common lesions in both groups were ventricular and atrial arrhythmias and second degree AV block; and, in the dogs, also death due to refractory cardiac failure, such as is seen in the human patient. Right bundle branch block and dilatation of the right cardiac chambers was the rule in both groups. The authors discuss the pathogenesis of the ECG in the rat and its anatomical basis. They propose the possibility of establishing and standardizing this techniques in the laboratories that study rats or other species

Hipertensión arterial en niños / Arterial hypertension in children

Arterial hypertension is the main cause of cardiovascular problems in adults. To better know the scope of arterial hypertension in children in our midst, the authors measured the arterial blood pressure in 8642 Panamanian children between 1 month and 18 years of age and studied the principal causes of arterial hypertension. The authors propose norms for the identification and clinical and pharmacological management of arterial hypertension in Panamanian children

Experiencia clínica en Panamá con metronidazole en el tratamiento de la enfermedad de Chagas, en la fase aguda y en la fase crónica / The clinical experience in Panama with metronidazole in treating Chagas' disease in the acute and chronic phases

The authors evaluated the serological response of metronidazole, or 8823 RP-(Hydroxy-2' ethy1)-1-methyl-2 nitro-5 imidazole) in 1307 patients, with Chagas' disease in the acute or chronic stage with age ranging between 6 months to 73 years. 273 patients were in the acute phase: 153 children and 120 adults. Patients in the chronic stage were classified with serological, clinical and cardiological criteria: 1.-POSITIVE SEROLOGY without cardiological signs or symptomatology (EKG, VECTO, ECHO M mode and 2-D, Chest Rx, physiological and pharmacological tests, radiocardiological-HMIBI, MUGA); 2.- POSITIVE SEROLOGY with cardiological signs and symptoms (all cardiological tests were abnormals); 3.- POSITIVE SEROLOGY with cardiomyopathy and cardiac failure. Metronidazole, P.O. or I.V. was utilizing dosages ranging from 15 to 25 mg/Kilo body weight per five days in acute phase and 250 to 500 mg. P.O. in the chronic stage of the disease for 180 days. The drug was well tolerated by all patients in both phases of the disease. Adequate anabolic effect was identified in both stages of the illness. Serological reactions were negative in all patients (100%) without cardiomyopathy. In patients with cardiomyopathy and cardiac failure, the complement fixation test title were similar before and after treatment