Actualización sobre los tumores de la región pineal / Update on pineal region tumors

Introducción: Los tumores de la región pineal constituyen un grupo heterogéneo de lesiones agrupadas más por su localización común que por su relación histológica. Pueden clasificarse en tumores de células germinales, del parénquima pineal, embrional y de estructuras adyacentes. Objetivo: Caracterizar la fisiopatología de los tumores de la región pineal y algunos aspectos de su tratamiento. Métodos: Se realizó una revisión bibliográfica, se seleccionaron estudios relacionados con la fisiopatología de los tumores de la región pineal y su manejo. Las fuentes de información consultada fueron Google Scholar, PubMed, SciElo y Dialnet; se utilizaron los descriptores: neoplasias pineales, pinealoma, neoplasias encefálicas. Se seleccionaron 23 artículos, más del 75 por ciento son de los últimos 5 años. Desarrollo: La tasa y la velocidad de crecimiento de estas neoplasias determinan la rapidez con la que se instauran los diversos síntomas, de ahí que la presentación más común es la hidrocefalia triventricular, acompañada de dolor de cabeza, náuseas, vómitos, disminución de la actividad, somnolencia o letargo y alteraciones visuales. También se pueden observar paresias y síndromes endocrinos. El diagnóstico se basa en la exploración de marcadores tumorales en suero, líquido cefalorraquídeo, tomografía y resonancia magnética. Finalmente, la quimioterapia y la intervención quirúrgica constituyen las principales alternativas terapéuticas tras el diagnóstico de la enfermedad. Conclusiones: Este tipo de neoplasia es poco frecuente, sus manifestaciones clínicas dependen de la localización, tamaño y tipo de tumor; además, el tratamiento suele ser quirúrgico y posterior a la quimioterapia, si las características de la neoplasia lo permiten(AU)

Introduction: Tumors of the pineal region constitute a heterogeneous group of lesions better grouped by their common location than by their histological relationship. They can be classified into tumors of germ cells, pineal parenchyma, embryonal and adjacent structures. Objective: To characterize the pathophysiology of pineal region tumors and some aspects of their treatment. Methods: A literature review was carried out, we selected studies related to the pathophysiology of pineal region tumors and their management. The information sources consulted were Google Scholar, PubMed, SciELO and Dialnet; the descriptors were used pineal neoplasms, pinealoma, brain neoplasms. Twenty three articles were selected, more than 75percent are from the last 5 years. Results: The rate and speed of growth of these neoplasms determine the speed with which the various symptoms are established, hence the most common presentation is triventricular hydrocephalus, accompanied by headache, nausea, vomiting, decreased activity, drowsiness or lethargy and visual disturbances. Paresis and endocrine syndromes may also be seen. The diagnosis is based on the examination of tumor markers in serum, cerebrospinal fluid, tomography and magnetic resonance imaging. Finally, chemotherapy and surgery are the main therapeutic alternatives after diagnosis of the disease. Conclusions: This type of neoplasm is rare, the clinical manifestations depend on the location, size and type of tumor; in addition, the treatment is usually surgical and then chemotherapy, if the characteristics of the neoplasm allow so(AU)

Correlation of Lumbar Intervertebral Disc Degeneration, Abdominal Aortic Calcification on Plain X-ray and Pineal Gland Calcification at CT in Patients with Low Back Pain

Background: The lumbar spine, or low back, is a remarkably well-engineered structure of interconnecting bones, joints, nerves, ligaments, and muscles all working together to provide support, strength, and flexibility. However, this complex structure also leades the low back susceptible to injury and pain. To find out the correlations among plain radiographic findings of lumbar intervertebral disc degeneration, abdominal aortic calcification & CT findings of pineal gland calcification in low back pain subjects. Material & Methods:This observational analytical study was carried out in the Department of Radiology and imaging of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from 1 January 2011 to 31 December 2012. A total of 100 subjects attending the department of Radiology and imaging, BIRDEM for X-ray of the Lumbosacral spine and CT scan of the brain with low back pain were enrolled first for the study. A complete history was taken either from the patient or accompanying attendants. Relevant investigations reports were collected. All the information was recorded in the data collection sheet. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using SPSS-23.Results:The mean age of study subjects was 61.26 years with a standard deviation of the mean (SD) of 13.34 years and their age ranged from 41 to 74 years. It was observed that nearly two-thirds (61.7%) of the subjects were male and 38.3% were female and the male-female ratio was 1.6:1. It was seen that majority of the subjects had a density of the Pineal gland ranging from +51 to +150 HU. Only 4 subjects had a density of Pineal gland ranging from +351 to +1000 HU. Meant SD density of the Pineal gland among a total of 30 subjects was 136.98164.11 HU. In Group X, the density of Pineal Gland was 83,57 14.45 HU. The density of the Pineal gland was 134.65±13.23HU and 151.66+21.32 HU in Group Y and Group Z respectively. Some parameters of the degenerative disc disease and aortic wall calcification. had a significant positive association with calcification. with the density of Pineal gland calcification.Conclusions:The study was undertaken to find out the Correlation between lumbar intervertebral disc degeneration, abdominal aortic calcification on plain X-ray and Pineal gland calcification at CT in low back pain subjects. The data obtained showed that the density of pineal gland calcification is statistically significant with increasing age. There was also a positive association between intradiscal calcification and density of pineal gland calcification, but no significant association among other parameters with the density of pineal gland calcification

Regulatory aspects and evidences of melatonin use for sleep disorders and insomnia: an integrative review / Aspectos regulatórios e evidências do uso de melatonina em distúrbio do sono e insônia: uma revisão integrativa

ABSTRACT Background: Insomnia is a sleep disorder characterized by difficulty of falling asleep or maintaining sleep, which affects different age groups. Currently, melatonin is used as a therapeutic treatment in cases of insomnia in children, adults, and elderly people. Objective: To evaluate the effectiveness of melatonin in sleep disorders, its dosage, potential adverse effects, as well as labeling laws and regulations in Brazil. Methods: This integrative review was carried out using the Cochrane Library, Medline (Pubmed), and Science Direct databases. Twenty-five articles and three documents available on the Brazilian Society of Endocrinology and Metabology (SBEM) and National Health Surveillance Agency (ANVISA) websites published between 2015 and 2020 were selected to be evaluated in full. Results: It was found that in most of the selected articles the use of melatonin reduces sleep latency. The effective melatonin doses varied according to each age group, from 0.5 to 3 mg in children, 3 to 5 mg in adolescents, 1 to 5 mg in adults, and 1 to 6 mg in elderly people. Side effects are mild when taking usual doses. In Brazil, no registered drug and current regulation on the use and marketing of melatonin has been identified. Conclusion: The use of melatonin is an alternative therapy that can be used for sleeping disorders. According to the evidences found, it did not demonstrate toxicity or severe side effects, nor dependence even when administered at high doses, suggesting that it is a safe medication to treat patients of different ages suffering from sleeping disorders.

RESUMO Antecedentes: Insônia é um distúrbio do sono caracterizado por dificuldade de iniciar e manter o sono, afetando diferentes faixas etárias. Atualmente, a melatonina é utilizada no tratamento de insônia em crianças, adultos e idosos. Objetivo: Avaliar a eficácia da melatonina nos distúrbios do sono, posologia e potenciais efeitos adversos, bem como a regulamentação vigente no Brasil. Métodos: Trata-se de uma revisão integrativa, os artigos foram identificados nas bases de dados Cochrane Library, Medline (Pubmed) e Science Direct, totalizando 25 artigos, e foram selecionados três materiais disponíveis no site da Sociedade Brasileira de Endocrinologia e Metabologia e Agência Nacional de Vigilância Sanitária, publicados entre 2015 e 2020. Resultados: Verificou-se na maioria dos artigos selecionados que a melatonina reduz a latência do sono. Quanto as dosagens de melatonina identificou-se variação em cada faixa etária, para crianças de 0,5 a 3mg; adolescentes de 3 a 5mg; adultos de 1 a 5mg e idosos 1 mg a 6 mg demostraram serem eficazes. Em doses habituais os efeitos colaterais são leves. No Brasil, não foi identificado medicamento registrado e regulamentação vigente sobre o uso e comercialização de melatonina. Conclusão: A utilização da melatonina é uma alternativa que pode ser utilizada em distúrbios do sono. De acordo com as evidências encontradas, não demonstrou toxicidade ou efeitos colaterais severos, nem dependência mesmo em doses elevadas, sendo, portanto, segura para tratamento de pacientes desde crianças a idosos que sofrem de distúrbios do sono.

DESCARTES and his project of a fantasized brain / DESCARTES e seu projeto de um cérebro fantasioso

ABSTRACT. Interest in anatomy dates from the earliest times. Such knowledge was acquired through dissections of animals and human corpses by many researchers. The macroscopic anatomy of the varied structures of the brain were identified over the centuries, and the predominating solid substance was seen as amorphous, and devoid of any specific function, until the Renaissance. René Descartes, a personage with a brilliant and creative mind, conceived the brain, its structure and function, in a distinct manner to what was known at his time. He valued the solid matter and gave it, for the first time, a theoretical minute structure, related to a presumptive function based on the presence of the pineal gland and the animal spirits, underlying cognitive, sensory and motor activities. Such structural view was endorsed, in a given sense, by the microscopic findings of Marcello Malpighi, which begun to change the understanding of the nervous system.

RESUMO. O interesse pela anatomia data desde a mais remota antiguidade. Esse conhecimento foi adquirido por meio de dissecções em animais e cadáveres humanos, por muitos pesquisadores. A anatomia macroscópica de variadas estruturas do cérebro foi identificada com o passar dos séculos, e a substância sólida predominante foi vista como amorfa e destituída de qualquer função específica até o período do Renascimento. René Descartes, um personagem com uma mente brilhante e criativa, concebeu o cérebro, sua estrutura e função, de um modo distinto ao que era conhecido no seu tempo. Ele valorizou e deu à substância sólida, pela primeira vez, uma estrutura teórica formada por elementos minúsculos, relacionada a uma função presuntiva, baseada na presença da glândula pineal e dos espíritos animais, subjacentes às atividades cognitiva, sensorial e motora. Essa vista estrutural foi, de certa maneira, endossada pelos achados microscópicos de Marcello Malpighi, o que começou a modificar a compreensão do sistema nervoso.

Prevalence of pineal gland and choroid plexus calcification among iraqi patients attending CT scan units / Prevalencia de calcificación de la glándula pineal y del plexo coroideo entre pacientes iraquíes que asisten a las unidades de tomografía computarizada

SUMMARY: Pineal gland calcification is the most common physiological intracranial calcification followed by the choroid plexus calcification. The objective of the study was to determine the prevalence of the pineal gland and choroid plexus calcification among the Iraqi population attending computed tomography scan units in Baghdad, estimate the mean diameters of the pineal gland calcification, and to detect any correlation between these calcifications with age and sex. This multi-centric cross-sectional study examined 485 CT scans of Iraqi patients between the ages of 1 and 100 years attending CT scan units in the period 1 December 2018 to 1 April 2019. Descriptive and inferential statistics were used. The prevalence of pineal gland calcification was found to be 68 % with the 30-39 age group and male sex predominance. It was found to increase after the first decade of life without real consistency. The mean for pineal gland calcification anterior-posterior diameter was 4.55±2.13 and the mean of the right-left diameter was 3.95±1.54. These diameters were found to differ according to sex and age. Choroid plexus calcification was found to have a prevalence of 53.6 %. In most cases, choroid plexus calcification was found bilaterally (77.3 %). There was no difference in sex, but choroid plexus. In conclusion, calcification was noticed to increase gradually according to age. Both pineal gland and choroid plexus calcification have a relatively high prevalence. While pineal gland calcification formation was demonstrated to have a close relation to age and sex, choroid plexus calcification formation was noticed to relate only to age.

RESUMEN: La calcificación de la glándula pineal es la calcificación intracraneal fisiológica más común después de la calcificación del plexo coroideo. El objetivo del estudio fue determinar la prevalencia de calcificación de la glándula pineal y del plexo coroideo entre la población iraquí que asiste a las unidades de tomografía computarizada en Bagdad, estimar los diámetros medios de la calcificación de la glándula pineal y detectar la posible correlación entre estas calcificaciones con la edad y el sexo. Este estudio transversal multicéntrico examinó 485 tomografías computarizadas de pacientes iraquíes entre 1 y 100 años de edad que asistieron a unidades de tomografía computarizada en el período del 1 de diciembre de 2018 al 1 de abril de 2019. Se utilizaron estadísticas descriptivas e inferenciales. Se encontró una prevalencia de calcificación de la glándula pineal del 68 % con predominio del sexo masculino en el grupo de 30 a 39 años. Se observó que aumentaba después de la primera década de vida sin una coherencia real. La media del diámetro anteroposterior de la calcificación de la glándula pineal fue de 4,55 ± 2,13 y la media del DIÁ- METRO derecho-izquierdo fue de 3,95 ± 1,54; estos diámetros difieren según el sexo y la edad. La calcificación del plexo coroideo tiene una prevalencia del 53,6 %. En la mayoría de los casos, la calcificación del plexo coroideo se encontró de forma bilateral (77,3%). No hubo diferencia de sexo, no obstante en el plexo coroideo se observó que la calcificación aumentaba gradualmente según la edad. Tanto la calcificación de la glándula pineal como del plexo coroideo tienen una prevalencia relativamente alta. Si bien se demostró que la formación de calcificación de la glándula pineal está relacionada con la edad y el sexo, se observó que la formación de calcificación del plexo coroideo se relaciona solo con la edad.

Improvement Effects of Isopimpinelline on PCPA-induced Pineal Gland Injury Model Rats and Its Effects on Expression of Biological Clock Gene / 中国药房

OBJECTIVE：To study the improvement effects of isopimpinelline on p-chlorophenylalanine（PCPA）-induced pineal injury model rats and its effect on expression of biological clock gene. METHODS ：Totally 60 rats were divided into blank control group（2％ polysorbate solution），model control group （2％ polysorbate solution），positive control group （melatonin，10 mg/kg） and isopimpinelline high-dose ，medium-dose and low-dose groups （3，1.5，0.75 mg/kg）. Except for blank control group ，rats in other groups were given PCPA intraperitoneally （450 mg/kg）to establish pineal injury model. After modeling finished ，they were given relevant medicine intragastrically ，once a day ，for consecutive 7 d. On the 6th day of administration ，the sleep latency and sleep duration of rats in each group were investigated by pentobarbital sodium coordination sleep test ；after last administration ， ELISA assay was used to determine the serum level of melatonin in rats. Fluorescence microscope and electron microscope were used to observe the pathological tissue and cell ultrastructure changes of the pineal gland. RT-qPCR was used to detect the mRNA expressions of biological clock gene Clock，Bmal1，Per1，Per2，Per3，Cry1，Cry2 in pineal gland of rats. RESULTS ：Compared with blank control group ，model control group had significantly longer sleep latency （P＜0.05）；serum melatonin ，mRNA expressions of Bmal1 and Per1 in pineal gland were significantly decreased （P＜0.05 or P＜0.01）while mRNA expression of Per3 was increased significantly （P＜0.05）. The pineal gland cell arrangement disorder ，nuclear pyknosis ，vacuolar degeneration increased and cell number decreased significantly ；mitochondria swollen ，cristae broken and pyknosis were observed. Compared with model control group ，the sleep latency of isopimpinelline high-dose group was shortened significantly （P＜0.05），sleep duration time was prolonged significantly （P＜0.05）；the levels of melatonin in serum ，mRNA expressions of Clock，Bmal1， Per1，Cry1 and Cry2 in pineal gland of rats were increased significantly （P＜0.05 or P＜0.01）. In isopimpinelline medium-dose group，the sleep latency was shortened significantly （P＜0.05）；the levels of melatonin in serum and mRNA expressions of Clock， Bmal1，Per1，Cry1，Cry2 in pineal gland were increased significantly （P＜0.05 or P＜0.01），while mRNA expression of Per3 was decreased significantly （P＜0.05）. In isopimpinelline low-dose group ，the levels of mRNA expressions of Clock，Bmal1，Per2 and Cry2 were increased significantly （P＜0.05），while mRNA expression of Per3 was decreased significantly （P＜0.05）. Cell arrangement disorder was improved and nuclear pyknosis vacuole degeneration was decreased to some extent in isopimpinelline groups；mitochondria swelled ，cristae fractured ，and pyknosis decreased to some extent. CONCLUSIONS ：Isopimpinelline can improve PCPA-induced pineal gland injury in rats ；it can up-regulate the expressions of positive regulators Clock，Bmal1 and negative regulators Per1，Per2，Cry1，Cry2，while down-regulate the expression of negative regulator Per3.

Uso da melatonina como curativo endodõntico em reimplante dentário de ratos pinealectomizados: estudo histométrico / Late dental replantation after the use of melatonia as an endodontic dressing: histological and morphometric study in pinealectomized rats

Dentre os vários tipos de traumas, a avulsão dentária representa uma condição crítica por deslocar o dente de seu ambiente natural, expondo-o a um meio externo seco e contaminado, resultando na reabsorção da raiz que pode ser parcial ou total. Pouco tem sido estudado sobre os fatores sistêmicos no processo de reparo em traumatismo dentário. Uma dessas condições é a deficiência da melatonina, que pode ocorrer em pessoas com hábitos noturnos. A sua deficiência tem sido relacionada a prejuízo no reparo de diversos tipos de tecidos, mas não existem estudos desta condição nos casos de traumas dentários. Assim o objetivo deste trabalho foi avaliar a influência da melatonina no processo de reparo em reimplante dentário. Para isso estudou-se o emprego de um curativo endodôntico à base de melatonina (M) ou corticosteroide e antibiótico (CA) no reimplante tardio de incisivos de ratos, pinealectomizados (PNX) ou não. Foram utilizados 40 ratos divididos em 4 grupos de 10 animais. Em 2 desses grupos (PNX-M e PNX-CA), a glândula pineal foi removida cirurgicamente. Trinta dias depois, o incisivo superior direito desses animais foi extraído, a polpa radicular foi removida, os canais foram limpos, irrigados e secos. Na sequência, nos Grupos PNX-M e M, os canais foram preenchidos com curativo a base de melatonina a 3%. Nos grupos PNX-CA e CA os canais foram preenchidos com curativo à base de Doxiciclina e Triancinolona. O ápice foi selado com um plug de MTA e os dentes foram reimplantados nos alvéolos de origem. O período extrabucal em meio seco foi de 20 minutos. Os animais receberam dose única de penicilina G Benzatina por via intramuscular. A eutanásia foi realizada 45 dias depois e as peças contendo os dentes foram processadas para obtenção de lâminas que foram coradas em hematoxilina e eosina para análise histológica e morfométrica. Os resultados demonstraram que o grupo PNX-M foi mais comprometido pela reabsorção radicular do que os grupos PNX-CA e CA. Quando analisado somente o tipo de reabsorção, a reabsorção inflamatória foi a que predominou (p< 0,05). Pode-se concluir que o curativo endodôntico com melatonina a 3% proporcionou reparo semelhante ao do curativo com corticosteroide antibiótico nos dentes reimplantados em animais não pinealectomizados. Nos animais pinealectomizados o curativo com a melatonina a 3% foi menos efetivo no controle da reabsorção radicular, principalmente a reabsorção inflamatória(AU)

Among the various types of trauma, tooth avulsion is a critical condition for displacing the tooth from its natural environment, exposing it to a dry and contaminated external environment, resulting in partial or total root resorption. Little has been studied about the systemic factors in the process of dental trauma repair. One such condition is melatonin deficiency, which can occur in people with nocturnal habits. Its deficiency has been related to impairment in the repair of various tissue types, but there are no studies of this condition in cases of dental trauma. Thus, the objective of this study was to evaluate the influence of melatonin on the repair process in dental replantation. For this purpose, we studied the use of a melatonin-based endodontic dressing in late reimplantation of rat incisors, pinealectomized or not. Forty rats divided into 4 groups of 10 animals were used. In 2 of these groups (PNX-M and PNX-CA), the pineal gland was surgically removed. Thirty days later, the right upper incisor of these animals was extracted, the root pulp was removed, the canals were cleaned, irrigated and dried. Then, in the PNX-M and M Groups, the channels were filled with a 3% melatonin-based dressing. In the PNX-CA and CA groups, the channels were filled with Doxycycline and Triamcinolone dressing. The apex was sealed with an MTA plug and the teeth were reimplanted into the original alveoli. The extraoral period in dry medium was 20 minutes. The animals received a single dose of intramuscular penicillin G benzathine. Euthanasia was performed 45 days later and the teeth containing parts were processed to obtain slides that were stained with hematoxylin and eosin for histological and morphometric analysis. The results showed that the PNX-M group was more affected by root resorption than the PNX-CA and CA groups. When analyzing only the type of resorption, inflammatory resorption predominated (p < 0.05). It can be concluded that the 3% melatonin endodontic dressing provided similar repair to the antibiotic corticosteroid dressing on the reimplanted teeth in non-pinealectomized animals. In pinealectomized animals the dressing with 3% melatonin was less effective in controlling root resorption, especially inflammatory resorption(AU)

Quiste benigno de la glándula pineal en paciente con retinoblastoma bilateral. Reporte de caso y revisión de la literatura / Benign pineal gland cyst in a patient with bilateral retinoblastoma. Case report and literature review

Introducción: Los pacientes con Retinoblastoma (RB) hereditario se encuentran en riesgo de desarrollar otros tipos de tumores malignos primarios extraoculares durante la vida. Dentro de estos tumores se encuentra el pinealoblastoma, un tipo de neoplasia maligna que aparece en la glándula pineal y que se puede desarrollar en cualquier momento del diagnóstico del retinoblastoma bilateral. Objetivo: Presentar un caso inusual de retinoblastoma (RB) hereditario tratado y en remisión quien desarrolló un quiste pineal benigno. Diseño del estudio: Reporte de caso y revisión de literatura. Resumen del caso: Presentamos un paciente con diagnóstico de RB hereditario tratado y en remisión quien desarrolló un quiste pineal benigno durante el seguimiento clínico. Las lesiones quísticas de la glándula pineal reportadas por resonancia magnética son infrecuentes en edad pediátrica, sin embargo, su incidencia se ve aumentada en pacientes con RB, lo que genera incertidumbre sobre la posibilidad de presentar una neoplasia maligna. Aún se desconoce el mecanismo fisiopatológico de la aparición de quistes de la glándula pineal en pacientes con RB hereditario, pero podría tener relación con la alteración genética o con el tratamiento quimioterápico que reciben los pacientes para el tumor primario intraocular. Conclusión: Las características imagenológicas son fundamentales para diferenciar entre lesiones benignas y malignas de la glándula pineal en pacientes con retinoblastoma hereditario y para hacer el estrecho seguimiento junto con el examen clínico.

Background: Patients with hereditary Retinoblastoma (RB) are at risk of developing other types of extraocular primary malignancies throughout life. Among these tumors, pinealoblastoma is a type of malignancy that appears in the pineal gland and can develop at any time from the diagnosis of bilateral retinoblastoma. Objective: To present an unusual case of a patient with a diagnosis of hereditary BR who developed a pineal cyst. Study design: Case report. Case summary: We present in this article the case of a patient with a diagnosis of hereditary BR with remission who developed a pineal cyst during clinical follow-up. The cystic lesions of the pineal gland reported by magnetic resonance are infrequent in pediatric age, however its incidence is increased in patients with RB, which generates uncertainty about the possibility of the development of a primary pineal gland malignancy. The pathophysiological mechanism of pineal gland cysts in patients with hereditary RB is still unknown, but it could be related to a genetic alteration or to chemotherapy treatment that these patients receive for the primary intraocular tumor. Conclusion: The imaging characteristics are fundamental to differentiate between benign and malignant lesions of the pineal gland in patients with Hereditary Retinoblastoma and to make a close follow up.

Changes of the Melatonergic System in Bipolar Disorder: A Literature Review / 우울ㆍ조울병

Recently, melatonergic agents have been gaining much interest in the treatment of mood disorders. The elucidation of the underlying biological mechanisms related to the melatonergic system in mood disorders is warranted to ensure the proper use of melatonergic agents. Changes of the melatonergic system have been investigated in several studies of patients with bipolar disorder (BP) and depression. Accumulating evidence has indicated that patients with BP might exhibit abnormal melatonin secretion patterns, increased light-induced melatonin suppression, altered pineal gland volume, genetically abnormal melatonin synthesis enzyme, and modified melatonin receptors. In this review, the findings of studies performed to explore the association between the melatonergic system and BP are discussed. Moreover, the interpretations and limitations of these findings are described.

Meningioma of the Pineal Region ­ Differential Radiologic Aspects of Pineal Region Tumors Based on a Clinical Case

Pineal region tumors are uncommon among neoplasm of the central nervous system, with this region being the most heterogeneous in terms of histological types. Meningiomas are rarer still, but can be found at this site, with origins in either the velum interpositum or falcotentorial junction. Neuroimaging exams can distinguish malignant from benign lesions besides helping to define the origin of the lesion as the pineal parenchymal or surrounding structures. We report the case of a woman with a pineal region tumor in which differential diagnoses included meningioma and germinoma, with confirmation of the former based on radiological characteristics and histopathology. In addition, a brief review of differential diagnoses and approaches for cases of lesions in this region is provided.

Os tumores da região da pineal apresentam uma baixa frequência entre as neoplasias do sistema nervoso central, sendo esta região a mais heterogênea em termos de tipos histológicos possíveis. Meningiomas são lesões ainda mais raras, porém possíveis de advirem desta localização, sejam originados do velum interpositum ou da junção falcotentorial. Os exames de neuroimagem permitem distinguir lesões malignas de benignas além de auxiliar na definição entre origem do parênquima pineal ou de estruturas adjacentes. Apresentamos o caso de uma mulher adulta com uma neoplasia da região da pineal cujos diagnósticos diferenciais incluíram meningioma e germinoma, evidenciando-se pelas características radiológicas e resultados histopatológicos tratar-se do primeiro. Além disso, fazemos uma breve revisão a respeito dos diagnósticos diferencias e condutas frente a uma lesão desta região.

Surgical Treatment of Cavernous Angiomas in the Pineal Gland ­ Case Report

Pineal cavernous angioma is a vascular malformation that has a prevalence lower than 1%. The etiology is debated. It is believed that it is originated from an autosomal dominant inheritance or from radiotherapeutic treatment. Complete resection enables the cure and prevents complications of the natural evolution of the lesion, mainly hemorrhagic events. A female patient, with 67 years of age, presented mental confusion and visual acuity deficit, which evolved to periods of psychomotor agitation. A magnetic resonance imaging (MRI) scan of the head showed a lobulated mass lesion in the pineal region with hypersignal on T1 and hyposignal on the susceptibility weighted imaging (SWI) sequence. Hydrocephalus was also noticed. The patient underwent a microsurgery for complete lesion resection though a supracerebellar/ supratentorial access. The anatomopathology revealed an arteriovenous malformation compatible with cavernous angioma. The pineal cavernous angioma is a rare malformation that should be considered in the differential diagnosis of expansive lesions of the pineal gland.

Papillary Tumor of the Pineal Region: Case Report and Literature Review

Papillary tumor of the pineal region (PTPR) is a neuroectodermal tumor thought to originate from cells of the subcommissural organ. Its oncologic properties are still under investigation, as well as the most suitable therapeutic measures for this type of neoplasm.We report the case of a 36-year-old woman with a 1-year history of headache and intermittent diplopia. The magnetic resonance imaging (MRI) scan showed a heterogeneously enhancing mass in the pineal region that caused an acute hydrocephalus, and an emergency shunt derivation was necessary. One week later, the patient was submitted to subtotal tumor resection, and remained asymptomatic in the post-operative period. In the follow-up, the patient remained asymptomatic; in the imaging control 3.5 years after the surgical resection, local recurrence was identified, and the patient was submitted to a local radiation protocol. Our literature review showed an early clinical onset due to intracranial hypertension signs. Definitive clinical onset might be reached only through a histopathological examination. Gross total resection followed by radiotherapy is the current standard of care. Local recurrence is often observed, with rare dissemination to the cerebral spinal fluid. The natural history of the PTPR remains unknown, as well as the best treatment strategy. Large case series with longer follow-ups are necessary for further conclusions.

Systemic melatonin application increases bone formation in mandibular distraction osteogenesis

Abstract This study aimed to investigate the effects of different doses of systemic melatonin application on new bone formation during mandibular distraction osteogenesis (DO) in rats. Mandibular DO was performed on 30 adult female Sprague-Dawley rats, which were randomly divided into three groups: control group (CNT), melatonin dose 1 (MLT-D1), and melatonin dose 2 (MLT-D2). A five-day latent waiting period and a ten-day distraction phase followed the surgery. After the surgery, rats from the MLT-D1 and MLT-D2 groups received 25 and 50 mg/kg melatonin, respectively, at 7, 14, 21, 28, and 35 days. The animals were euthanised 28 days after distraction, i.e. at 43 days after surgery. Histological and histomorphometric analyses revealed that the distracted bone area was completely filled with new bone formation in all three groups. The MLT-D2 group exhibited the most new bone formation, followed by MLT-D1 and CNT. The melatonin groups had more osteoclasts than the CNT (p < 0.05). The number of osteoblasts was higher in the melatonin groups than in the CNT group, and the MLT-D2 had more osteoclasts than the MLT-D1 group (p < 0.05). Finally, the osteopontin (OPN) and vascular endothelial growth factor (VEGF) levels were higher in the melatonin groups than in the CNT group, and the MLT-D2 had higher OPN and VEGF levels than the MLT-D1 (p < 0.05). This study suggests that systemic melatonin application could increase new bone formation in DO.

Daily melatonin administration improves osseointegration in pinealectomized rats

Abstract The hypothesis of this study was that the peri-implant bone healing of the group of pinealectomized rats would differ from the control group. The samples were subjected to immunohistochemical, microtomographic (total porosity and connectivity density), and fluorochrome (mineralized surface) analyses. Objectives The goal of this study was to investigate the cellular changes and bone remodeling dynamics along the bone/implant interface in pinealectomized rats. Material and Methods The total of 18 adult male rats (Rattus norvegicus albinus, Wistar) was divided into three groups (n=6): control (CO), pinealectomized without melatonin (PNX) and pinealectomized with melatonin (PNXm). All animals were submitted to the first surgery (pinealectomy), except the CO group. Thirty days after the pinealectomy without melatonin, the second surgery was conducted, in which all animals received an implant in each tibia (36 titanium implants with surface treatment were installed - Implalife® São Paulo, SP, Brazil). By gavage, the rats of the PNX group received the vehicle solution, and the procedure. Results Immunohistochemical analysis for runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteopontin (OP) and osteocalcin (OC) showed that the bone repair process in the PNXm group was similar to that of the CO group, whereas the PNX group showed a delay. The microtomographic parameters of total porosity [Po(tot)] and bone surface (BS) showed no statistically significant differences, whereas for the connective density (Conn.Dn) a statistical difference was found between the CO and PNXm groups. Fluorochrome analysis of the active mineralized surface showed statistically significant difference between the CO and PNX and between the CO and PNXm groups. Conclusion The absence of the pineal gland impaired the bone repair process during osseointegration, however the daily melatonin replacement was able to restore this response.

Sleep-wake rhythm after extracorporeal circulation in New Zealand rabbits / 中南大学学报(医学版)

Objective:To evaluate the change of sleep-wake rhythm after extracorporeal circulation (ECC) in New Zealand rabbits,and to explore the role of clock genes in sleep-wake rhythm disorder by ECC.Methods:A total of 54 New Zealand rabbits were randomly divided into 3 groups:a normal group (Group N),a sham group (Group S) and a model group (Group ECC).Electrocorticogram (ECOG),electroophthalmogram (EOG) and electromyogram (EMG) were respectively recorded by multipurpose EEG recorder,and the sleep-wake rhythm was also recorded.The mRNA and protein expressions of period1 (Per1) and cryptochrome1 (Cry1) were detected by semiquantitative reverse transcriptase PCR (RT-PCR) and Western blot in pineal gland of rabbits.The differences between the 3 groups were compared.Results:1) Compared with the Group N and Group S at 24,48 h respectively,the total amount of sleep (TAS),light time,slow wave sleep (SWS) in the Group ECC at 24,48 h were significantly reduced (all P＜0.05),and the proportion of light sleep increased (all P＜0.05),the proportion of SWS decreased (all P＜0.05);2) Compared with the Group N and Group S,the expression of Per1 mRNA in the Group ECC at 24,48 h and Cry1 mRNA at 24 h significantly increased (all P＜0.05);3) Compared with the Group N and Group S,the expression of Perl protein in the Group ECC at 48 h and Cry1 protein at 24 h significantly increased (all P＜0.05);4) In the Group ECC,the sleepwake rhythm disorder and clock genes expression were ameliorated at 72 h after surgery.Conclusion:ECC can cause sleep-wake rhythm disorder in New Zealand rabbits,which may be related to the abnormal expression of Per1 and Cry1,and their transcription proteins.

Mature teratoma of the pineal region in the paediatric age group: A case report and review of the literature

@#Introduction: Intracranial teratomas account for 0.5% of all intracranial tumours and 2-4% of intracranial tumours in children. However, in terms of tumours of the pineal area, the exact incidence is not ascertained. Although, it is noted that 50-60% of central nervous system (CNS) germ cell tumours are found in the pineal gland. The degree of difficulty in the sampling of lesions in the pineal gland during biopsy emphasizes the importance of correlating the imaging studies, histopathologic findings, and serum and cerebrospinal fluid (CSF) tumour markers. Case Report: This case report is that of a 9-year-old male who presented with frontal headache of eight days, with associated photophobia, nausea and vomiting, and diplopia. Biopsy with intraoperative navigation was done and the specimen was referred for histopathologic evaluation. The biopsy showed findings consistent with a mature teratoma with no histologic findings of an immature component or secondary somatic malignancy. Comparison of the pre-operative and post-operative multiaxial cranial CT scan showed findings that was consistent with a residual lesion. This was correlated with the pre-operative serum tumour markers which showed alpha-fetoprotein of 22.5 ng/mL and beta-HCG of 1.0 mIU/mL(IU/L), and the post-operative tumour markers of the cerebrospinal fluid that showed alpha-fetoprotein of 3.28 ng/mL and beta-HCG of 18.9 mIU/mL (IU/L). Conclusion: A review of the literature and comparison with current case in relation to the histopathologic, serum and CSF findings, and imaging studies was done to better understand the mechanism of this lesion.

Prevalence of pineal gland calcification as an incidental finding in patients referred for implant dental therapy

PURPOSE: Pineal gland calcification has been proposed to play a role in the pathogenesis of Alzheimer disease. This study evaluated the prevalence and extent of pineal gland calcification in cone-beam computed tomography (CBCT) scans of patients referred for dental implant therapy who could possibly be a vulnerable group for this condition. MATERIALS AND METHODS: A retrospective evaluation of 500 CBCT scans was conducted. Scans that showed the area where the pineal gland was located were included. The scans were initially screened by a single observer to record the prevalence and extent of calcification. Six weeks following the completion of the study, another investigator randomly reviewed and selected 50 scans to investigate inter-observer variation, which was evaluated using reliability analysis statistics. The prevalence and measurements of the calcifications were reported using descriptive statistics. The chi-square test was used to compare the prevalence between males and females. RESULTS: The prevalence of pineal gland calcification was 58.8%. There was no statistically significant correlation between age and the extent of the calcification. The prevalence of calcification was 58.6% in females and 59.0% in males. The average anteroposterior measurement was 3.73±1.63 mm, while the average mediolateral measurement was 3.47±1.31 mm. The average total calcified area was 9.79±7.59 mm². CONCLUSION: The prevalence of pineal gland calcification was high in patients undergoing implant therapy. While not all pineal gland calcifications lead to neurodegenerative disorders, they should be strongly considered in the presence of any symptoms as a reason to initiate further investigations.

Effects of diurnal and nocturnal strenuous exercise on serum melatonin levels / Efeitos do exercício extenuante diurno e noturno sobre os níveis séricos de melatonina / Efectos del ejercicio extenuante diurno y nocturno en los niveles séricos de la melatonina

ABSTRACT Introduction: There are reports of a possible relationship between melatonin, a hormone secreted by the pineal gland, and exercise. Objective: The present study aims to investigate how diurnal and nocturnal strenuous exercise affects melatonin levels. Methods: The study enrolled 10 healthy sedentary males who did not actively exercise. The subjects had a mean age of 22.20±0.24 years, a mean height of 174.60±2.33 cm, and a mean weight of 69.70±2.42 kg. Two blood samples were collected from the subjects, one at rest, at 10:00 am, and the other immediately after strenuous exercise. Likewise, blood samples were taken from the same group of subjects after 48 hours: at 24:00 hours at rest and immediately after strenuous exercise. Samples were analyzed using the ELISA method to determine the serum melatonin levels (pg/ml). Results: By comparing the values at rest and after exercise, it was found that serum melatonin values remained unchanged with exercise. Serum melatonin values at rest or post-exercise measured at night were higher when compared with those measured during the day (p<0.05). Conclusions: Higher levels of melatonin found in the study appear to result from the increased release of melatonin at night, and not from exercise. The results of this study indicate that strenuous exercise carried out day or night, did not significantly influence serum melatonin levels.

RESUMO Introdução: Há relatos de uma possível relação entre a melatonina, hormônio secretado pela glândula pineal, e exercício. Objetivo: O presente estudo tem como objetivo investigar como o exercício extenuante diurno e noturno afeta os níveis de melatonina. Métodos: O estudo inscreveu 10 homens sedentários saudáveis que não se exercitavam ativamente. Os sujeitos tinham média de idade de 22,20 ± 0,24 anos, estatura média de 174,60 ± 2,33 cm e peso médio de 69,70 ± 2,42 kg. Duas amostras de sangue foram coletadas dos sujeitos, uma em repouso, às 10h00 da manhã e a outra imediatamente após exercício extenuante. Da mesma forma, foram coletadas amostras de sangue do mesmo grupo de sujeitos depois de 48 horas: às 24h00 em repouso e imediatamente após exercício extenuante. As amostras foram analisadas pelo método ELISA para determinar os níveis séricos de melatonina (pg/ml). Resultados: Ao serem comparados os valores de repouso e depois do exercício, verificou-se que os valores séricos de melatonina permaneceram inalterados após exercício. Os valores séricos de melatonina em repouso e pós-exercício, medidos à noite foram mais elevados em comparação com os valores medidos durante o dia (p < 0,05). Conclusões: Os níveis elevados de melatonina encontrados no estudo parecem resultar do aumento da liberação de melatonina à noite, e não do exercício. Os resultados deste estudo indicam que o exercício extenuante realizado durante o dia ou à noite, não influenciou significativamente os níveis séricos de melatonina.

RESUMEN Introducción: Hay reportes de una posible relación entre la melatonina, una hormona secretada por la glándula pineal, y el ejercicio. Objetivo: Este estudio tiene como objetivo investigar cómo el ejercicio extenuante diurno y nocturno afecta a los niveles de melatonina. Métodos: En el estudio participaron 10 hombres sanos sedentarios que no hacían ejercicio de forma activa. Los sujetos tenían una edad promedio de 22,20 ± 0,24 años, altura promedio de 174,60 ± 2,33 cm, y peso promedio de 69,70 ± 2,42 kg. Dos muestras de sangre se obtuvieron de los sujetos, una en reposo, a las 10:00 horas de la mañana y la otra inmediatamente después del ejercicio vigoroso. Igualmente, las muestras de sangre se recogieron del mismo grupo de sujetos después de 48 horas: a las 24:00 horas en reposo e inmediatamente después del ejercicio extenuante. Las muestras se analizaron usando el método ELISA para determinar los niveles de melatonina en suero (pg/ml). Resultados: Mediante la comparación de los valores en reposo y después del ejercicio, se encontró que los valores séricos de melatonina se mantuvieron sin cambios después del ejercicio. Ambos valores de melatonina en reposo y después del ejercicio, medidos por la noche fueron más altos en comparación con los medidos durante el día (p < 0,05). Conclusiones: Los altos niveles de melatonina encontrados en el estudio parecen ser el resultado del aumento de la liberación de melatonina en la noche, y no del ejercicio. Los resultados de este estudio indican que el ejercicio extenuante realizado durante el día o por la noche, no afectó significativamente los niveles de melatonina en suero.

Anaplastic Ganglioglioma of the Pineal Region ­ A Case Report

Introduction Gangliogliomas are tumors commonly found in the temporal lobe and related to seizures; their appearance in the pineal region is rarely described. This report characterizes the first case of anaplastic ganglioglioma of the pineal region. Case Report The authors describe the case of a 32-year-old woman that developed progressive headache. An MRI investigation revealed a pineal tumor. The patient tested negative for biomarkers and underwent surgery through supracerebellar infratentorial approach and achieved gross total resection of the tumor in a challenging location. Pathological analysis revealed a biphasic neoplasm with the following two distinct phenotypes in separate fields: an immature neuronal component with several atypical mitoses and a mature astrocytic component with bipolar cells, microcysts, and eosinophilic bodies. The Ki67/MIB1 proliferation index was 20­30% in localized hotspots. Based on the pathological findings, the tumor was defined as an anaplastic ganglioglioma World Health Organization (WHO) grade III. Discussion/Conclusion Gangliogliomas are classified as glioneural neoplasms based on the histologic findings described as a mixture of neoplastic astrocytes and neurons. Moreover, these tumors represent 0.4­1.3% of tumors of the central nervous system. Authors describe de novo anaplastic ganglioglioma as 1% of the largest series. Gross total resection and adjuvant treatment may play important role in patients' prognostic. In this case, due to the malignant anaplastic component of her tumor, the patient received treatment with temozolamide and radiotherapy after gross total resection of the lesion.

Introdução Gangliogliomas são tumores comumente encontrados no lobo temporal e se relacionam com crises epilépticas; o aparecimento desses tumores na região da pineal é raramente descrito. Este relato caracteriza o primeiro caso de ganglioglioma anaplásico da região da pineal. Relato de Caso Paciente do sexo feminino, 32 anos, apresentou-se com cefaleia de piora progressiva. Investigação com ressonância magnética revelou tumor na região da pineal. Os biomarcadores para tumores da pineal foram negativos e a paciente foi submetida a microcirurgia com o acesso supracerebelar e infratentorial atingindo ressecção total da lesão. A análise patológica revelou neoplasia bifásica com dois fenótipos distintos em campos separados: um componente era composto por células neuronais imaturas com inúmeras mitoses atípicas e o segundo componente era composto por astrócitos maduros, microcistos e corpos eosinofílicos. Foi encontrado um índice proliferativo Ki67/M1B1 de 20­30%. Baseado nos achados anatomopatológicos, o tumor foi definido como ganglioglioma anaplásico grau III da OMS. Discussão/Conclusão Gangliogliomas são classificados como neoplasias glioneurais baseado nos achados histológicos descritos como misto de neoplasia neuronal e glial; esses tumores representam 0,4­1,3% de todos os tumores do sistema nervoso central. Ganglioglioma anaplásico de novo tem sido descrido em 1% nas maiores series de gangliogliomas. Ressecção total da lesão e tratamento adjuvante desempenham um papel importante no prognóstico dos pacientes. Devido ao componente anaplásico do tumor em questão, a paciente foi tratada com temozolamida e radioterapia após ressecção total da lesão.

Pinealectomia em ratas Wistar (Rattus norvegicus albinus): descrição de um novo método cirúrgico / Pinealectomy in Wistar rats (Rattus norvegicus albinus): Description of a new surgical method

A necessidade de manejo adequado antes, durante e após a implementação de procedimentos em animais de laboratório é essencial para proporcionar bem-estar. Portanto, no presente trabalho, objetivou-se padronizar uma nova técnica de pinealectomia em ratas Wistar. Trinta fêmeas nulíparas aos 90 dias de idade foram submetidas à anestesia dissociativa. Após a tricotomia e a assepsia, realizou-se uma incisão na linha média dorsal da cabeça. Com um micromotor e uma broca de aço PM 03, realizou-se a craniotomia; a glândula pineal foi removida por intermédio de um fórceps cápsula arruga. Em seguida, o fragmento ósseo foi recolocado em seu lugar de origem, e a pele aproximada por pontos simples. Finalizado o procedimento cirúrgico, foi realizada antibioticoterapia e soroterapia parenteral. O acompanhamento diário dos animais não evidenciou nenhum comprometimento da ferida operatória com padrão de cicatrização por primeira intenção. Os animais apresentaram normalidade de atos fisiológicos, como alimentação, defecação e micção, assim como socialização com o grupo. Técnicas cirúrgicas vêm sendo realizadas com o desenvolvimento das pesquisas envolvendo a glândula pineal. A técnica ideal para pinealectomia consiste no pouco sangramento, na curta duração da cirurgia e na nitidez da glândula pineal, diminuindo a probabilidade de acidentes neurológicos. Considerando-se os resultados obtidos ao longo do desenvolvimento experimental e clínico, o aprimoramento da técnica cirúrgica utilizando a broca PM03 associada ao fórceps cápsula arruga foi exímio na pesquisa científica da pinealectomia de ratas Wistar em virtude da rapidez e praticidade alcançadas. Tem-se a perspectiva de que este artigo sirva de subsídio para o aprimoramento e a otimização do modelo experimental para posteriores estudos acerca de pesquisas com a glândula pineal e, assim, maior compreensão de sua complexidade sobre todos os sistemas do organismo.

The need for adequate management before, during and after procedures involving laboratory animals is essential to their wellbeing. Thus, the aim of the present study was to standardize a novel method of pinealectomy in Wistar rats. Thirty nullipara females aged 90 days were submitted to dissociative anesthesia. Following fur removal and asepsis, an incision was performed along the dorsal line of the head. Craniotomy was performed with a mini-drill and PM 03 stainless steel drill bit. The pineal gland was removed using a serrated capsule forceps. The bone fragment was replaced and the skin was sutured with simple stitches. The surgical procedure was finalized with antibiotic therapy parenteral serotherapy. Daily follow up was performed and no animal demonstrated any compromised surgical wound with first intention wound healing. The animals exhibited normal physiological acts (feeding, defecation, urination and group socialization). Surgical techniques were performed with the development of research involving the pineal gland. The ideal pinealectomy method consists of little bleeding, a short surgery and a clear view of the pineal gland, thereby diminishing the probability of neurological accidents. Considering the results obtained through the experimental and clinical development, the perfection of the surgical technique involving the PM03 drill bit and serrated capsule forceps was successful in scientific research involving pinealectomy of Wistar rats in terms of quickness and practicality. This article can assist in the optimization of experimental models for subsequent studies involving the pineal gland and the understanding of its complexity over all organism systems.