Evaluation of 68Ga-DOTATATE uptake at the pituitary region and the biochemical response to somatostatin analogs in acromegaly.

PURPOSE: Acromegaly is associated with many comorbidities and increased mortality. The first-line treatment is transsphenoidal surgery. However, many patients also need adjuvant drug treatment after surgery. Somatostatin analog (SSA), which suppresses GH secretion by somatotrophs by binding to the SSTR2 receptor, is the first choice. Nevertheless, 50% of patients are partially or totally resistant to SSA, so predictive factors of response are helpful to individualize drug treatment. 68GaDOTATATE PET/CT has emerged as the gold-standard method in the diagnosis and follow-up of gastroenteropancreatic neuroendocrine tumors, which also express SSTR. Our objective was to evaluate whether 68Ga-DOTATATE uptake (SUV max) at the pituitary region of patients on SSA therapy would be useful as a drug response predictor without the need of tumoral tissue. METHODS: Fifteen acromegalics patients on SSA treatment for at least 6 months were underwent to 68Ga-DOTATATE PET/CT at the nuclear medicine service. There was an SSA complete response group (n = 5), defined as GH < 1 µg/L and IFG-1 in the normal range for gender and age, and a group that did not meet these criteria (n = 10). RESULTS: As a result, we did not find out a significantly higher SUV max in the complete response group (p = 0.0576) to SSA. However, we found a significant inverse relationship between postoperative GH values and the SUVmax at the sella turcica (p = 0.0188), probably reflecting tumor SSTR2 expression. CONCLUSION: Thus, after this initial evaluation, 68GaDOTATATE PET/CT should be better studied to assess its usefulness in the follow-up of acromegalic patients.

Analysis of a Minimally Invasive Intracranial Pressure Signals During Infusion at the Subarachnoid Spinal Space of Pigs.

OBJECTIVE: We developed a new minimally invasive method for intracranial pressure monitoring (ICPMI). The objective of this project is to verify the similarities between the ICPMI and the invasive method (ICPInv), for different components of the intracranial pressure signal-namely, the mean value (trend) as well as its pulsatile component. MATERIALS AND METHODS: A 9 kg anesthetized pig was used for simultaneous ICP monitoring with both methods. ICP was increased by performing ten infusions of 6 ml 0.9% saline into the spinal subarachnoid space, using a catheter implanted in the lumbar region. For correlation analysis, the signals were decomposed into two components-trend and pulsatile signals. Pearson correlation coefficient was calculated between ICPInv and ICPMI. RESULTS: During the infusions, the correlation between the pulsatile components of the signals was above 0.5 for most of the time. The signal trends showed a good agreement (correlation above 0.5) for most of the time during infusions. CONCLUSIONS: The ICPMI signal trends showed a good linear agreement with the signal obtained invasively. Based on the waveform analysis of the pulsatile component of ICP, our results indicate the possibility of using the minimally invasive method for assessing the neuroclinical state of the patient.

Analysis of a Non-invasive Intracranial Pressure Monitoring Method in Patients with Traumatic Brain Injury.

OBJECTIVE: We aimed to compare the invasive (iICP) and a non-invasive intracranial pressure (nICP) monitoring methods in patients with traumatic brain injury, based on the similarities of the signals' power spectral densities. MATERIALS AND METHODS: We recorded the intracranial pressure of seven patients with traumatic brain injury admitted to Hospital São João, Portugal, using two different methods: a standard intraparenchymal (iICP) and a new nICP method based on mechanical extensometers. The similarity between the two monitoring signals was inferred from the Euclidean distance between the non-linear projection in a lower dimensional space (ISOMAP) of the windowed power spectral densities of the respective signals. About 337 h of acquisitions were used out of a total of 608 h. The only data exclusion criterion was the absence of any of the signals of interest. RESULTS: The averaged distance between iICP and nICP, and between arterial blood pressure (ABP) and nICP projections in the embedded space are statistically different for all seven patients analysed (Mann-Whitney U, p < 0.05). CONCLUSIONS: The similarity between the iICP and nICP monitoring methods was higher than the similarity between the nICP and the recordings of the radial ABP for all seven patients. Despite the possible differences between the shape of the ABP waveform at radial and parietal arteries, the results indicate-based on the similarities of iICP and nICP as functions of time-that the nICP method can be applied as an alternative method for ICP monitoring.

Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis.

Mortality and adverse neurologic sequelae from HIV-associated cryptococcal meningitis (HIV-CM) remains high due to raised intracranial pressure (ICP) complications. Cerebrospinal fluid (CSF) high opening pressure occurs in more than 50% of HIV-CM patients. Repeated lumbar puncture with CSF drainage and external lumbar drainage might be required in the management of these patients. Usually, there is a high grade of uncertainty and the basis for clinical decisions regarding ICP hypertension tends to be from clinical findings (headache, nausea and vomiting), a low Glasgow coma scale score, and/or fundoscopic papilledema. Significant neurological decline can occur if elevated CSF pressures are inadequately managed. Various treatment strategies to address intracranial hypertension in this setting have been described, including: medical management, serial lumbar punctures, external lumbar and ventricular drain placement, and either ventricular or lumbar shunting. This study aims to evaluate the role of a non-invasive intracranial pressure (ICP-NI) monitoring in a critically ill HIV-CM patient.

Biliary sludge: a well defined sonographic entity

Objetives: Identify the present of biliary sludge (BS) in our patients, since different authors have concluded that this entity may be an etiologic agent of biliary colic, gallbladder stones and some complications such as acute pancreatitis and acalculous cholecystitis. Methods: We reviewed retrospectively the abdominal sonographic reports of 2802 patients of our gastroenterologic unit, with an average age of 40.5 years. The variables of the protocol were: gallbladder stones, BS and acute and chronic gallbladder inflammation. Results: Considering the mentioned criteria, we entered to the study 2682 patients. 17.8 per cent (n=479) had lithiasis, 13.2 per cent (n=356) had BS, 2 per cent (n=54) had acute gallbladder inflammation and 2.3 per cent (n=64) had chronic gallbladder inflammation. Of the group of patients with BS 42.7 per cent (n=152) were female and 57.3 per cent (n=204) were males. 52 per cent of the patients with BS were between the ages of 26 to 45 years. Conclusions: In our study we found an important prevalence of BS that was over 13 per cent which is higher than the results reported by additional series. Its early sonographic detection, follow-up, removal of precipitating factors and treatment are all adequate measures in order to achieve its elimination. (AU)

Biliary sludge: a well defined sonographic entity

Objetives: Identify the present of biliary sludge (BS) in our patients, since different authors have concluded that this entity may be an etiologic agent of biliary colic, gallbladder stones and some complications such as acute pancreatitis and acalculous cholecystitis. Methods: We reviewed retrospectively the abdominal sonographic reports of 2802 patients of our gastroenterologic unit, with an average age of 40.5 years. The variables of the protocol were: gallbladder stones, BS and acute and chronic gallbladder inflammation. Results: Considering the mentioned criteria, we entered to the study 2682 patients. 17.8 per cent (n=479) had lithiasis, 13.2 per cent (n=356) had BS, 2 per cent (n=54) had acute gallbladder inflammation and 2.3 per cent (n=64) had chronic gallbladder inflammation. Of the group of patients with BS 42.7 per cent (n=152) were female and 57.3 per cent (n=204) were males. 52 per cent of the patients with BS were between the ages of 26 to 45 years. Conclusions: In our study we found an important prevalence of BS that was over 13 per cent which is higher than the results reported by additional series. Its early sonographic detection, follow-up, removal of precipitating factors and treatment are all adequate measures in order to achieve its elimination.

Biliary sludge: a well defined sonographic entity.

OBJECTIVES: Identify the present of biliary sludge (BS) in our patients, since different authors have concluded that this entity may be an etiologic agent of biliary colic, gallbladder stones and some complications such as acute pancreatitis and acalculous cholecystitis. METHODS: We reviewed retrospectively the abdominal sonographic reports of 2802 patients of our gastroenterologic unit, with an average age of 40.5 years. The variables of the protocol were: gallbladder stones, BS and acute and chronic gallbladder inflammation. RESULTS: Considering the mentioned criteria, we entered to the study 2682 patients, 17.8% (n = 479) had lithiasis, 13.2% (n = 356) had BS, 2% (n = 54) had acute gallbladder inflammation and 2.3% (n = 64) had chronic gallbladder inflammation. Of the group of patients with BS 42.7% (n = 152) were female and 57.3% (n = 204) were males. 52% of the patients with BS were between the ages of 26 to 45 years. CONCLUSIONS: In our study we found an important prevalence of BS that was over 13% which is higher than the results reported by additional series. Its early sonographic detection, follow-up, removal of precipitating factors and treatment are all adequate measures in order to achieve its elimination.

[Lipomyelomeningocele: experience with 16 operated cases]. / Lipomielomeningoceles. Experiência com 16 casos operados.

Sixteen patients with lipomyelomeningoceles were operated by microsurgery technics from 1980 to 1991. Patients with lipomyelomeningoceles inappropriately treated or not submitted to treatment will develop significant neurological sequelae. In the authors' opinion, proper management of the patient with spinal lipoma requires early prophylactic resection of the lipoma and untethering of the spinal cord.

[Multiple intracranial aneurysms]. / Aneurismas intracranianos múltiplos.

Thirty eight patients with multiple intracranial aneurysms were studied. They correspond to 19.4% of all aneurysms treated over a twelve year period in the Servidores do Estado Hospital. 89 aneurysms and 4 infundibuli were detected. In 71.0% of the patients, two aneurysms were found; in 18.4%, three aneurysms; and in 10.4%, 4 or 5 aneurysms were observed. Twenty-seven patients were women and 11 men, ranging in age from 16 to 72 (average 47 years old). Subarachnoid hemorrhage was found in 36 patients (86.8%). The operative mortality in this series was 3.5%. We concluded that patients with multiple intracranial aneurysms should have all aneurysms, that can bleed, clipped through standard micro-neurosurgery technics.

[Intracerebral abscess: clinical treatment. Experience with a case]. / Abscesso intracerebral: tratamento clínico. Experiência com um caso.

A case of brain abscess treated non surgically is reported. Complete clinical and radiological resolution is demonstrated. The authors conclude that in selected patients conservative management of focal intracerebral infection may obviate the need for surgical intervention.