Expression of circulating microRNAs as predictors of diagnosis and surgical outcome in patients with mesial temporal lobe epilepsy with hippocampal sclerosis.

MicroRNAs have been progressively investigated as post-transcriptional regulators playing important roles in epilepsy pathophysiology. Here we investigate three promising microRNAs (miR-27a-3p, miR-328-3p and miR-654-3p) previously described in the literature as possible peripheral biomarkers for epilepsy diagnose and surgical prognosis. Serum samples from 28 patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) were analyzed, 14 with good surgical prognosis (Engel I) and 14 with unfavorable surgical prognosis (Engel III-IV). Serum samples from 11 healthy volunteers were the control group. The microRNAs expression analysis was performed using real-time PCR. The present results did not endorse the role of miR-27a-3p as a peripheral biomarker for epilepsy diagnosis or surgical prognosis. MiR-328-3p, however, presented significant area under the curve (AUC) values when comparing controls to Engel I (90.3%), controls to Engel III-IV (96.8%) and controls to Engel I + Engel III-IV (i.e., epilepsy patients, AUC = 93.5%). Additionally, miR-654-3p displayed AUC = 74.7% when comparing controls to Engel I patients (p = 0.004), and AUC = 73.6% (p = 0.04) in the attempt to discriminate unfavorable from favorable surgical prognosis. In conclusion, the ANOVA and ROC analyzes with the respective AUC, specificity and sensitivity values allows us to conclude that miR-328-3p is the most important peripheral biomarker for the diagnosis of MTLE-HS. In terms of predicting the surgical prognosis of MTLE-HS patients, miR-654-3p proved to be the only microRNA evaluated to present statistical power to differentiate, as a peripheral biomarker, Engel I from Engel III-IV patients.

Risk factors and results of hemispherotomy reoperations in children.

OBJECTIVE: The goal of this study was to perform an analysis of a single-center experience with hemispherotomy reoperations for refractory hemispheric pediatric epilepsy due to persistence of seizures after initial surgery. The authors also identify possible anatomical and neurophysiological reasons for hemispherotomy failure, as well as risk factors and surgical options for this subgroup of patients. METHODS: A review was performed of the medical records in 18 consecutive cases in which candidates for redo hemispherotomy were treated between 2003 and 2018 at the authors' epilepsy surgery center. Fourteen patients underwent reoperation due to seizure recurrence and were studied herein, whereas in 3 the initial surgical procedure was stopped because of uncontrollable bleeding, and the remaining patient refused to undergo a reoperation in spite of seizure recurrence and went on to have a vagus nerve stimulation device placed. RESULTS: Among the 14 patients whose seizures recurred and in whom reoperations were done, the etiology of epilepsy consisted of 7 cases with malformations of cortical development (50%), 5 cases of Rasmussen encephalitis (35.8%), 1 case of porencephaly (7.1%), and 1 case of Sturge-Weber syndrome (7.1%). Eleven patients had radiological evidence of incomplete disconnection. After reoperation, 6 patients were Engel class IA, 1 was Engel II, 5 were Engel III, and 2 were Engel IV, within a mean follow-up of 48.4 months. CONCLUSIONS: Patients with malformations of cortical development have a higher risk of seizure recurrence, and these malformations comprised the main etiology in the reoperation series. Failure of an initial hemispherotomy usually occurs due to incomplete disconnection and needs to be extensively assessed. Outcomes of reoperation are most often favorable, with acceptable complication rates.

O efeito da rizotomia dorsal seletiva no quadro clínico e nos cuidados diários de crianças com paralisia cerebral espástica / Effect of the selective dorsal rhizotomy on the clinical presentation and daily care of children with spastic cerebral palsy

A Paralisia Cerebral (PC) acomete 4 a cada 1000 crianças no mundo,representando uma grave problema para o sistema de saúde. Essa entidade nosológica, caracterizada por déficit motor instalado durante o desenvolvimento cerebral, pode acarretar a condição clínica denominada espasticidade, uma hipertonia muscular causada por exarcebação do arco reflexo medular na ausência da inibição advinda de vias superiores. A espasticidade acarreta diversos comprometimentos motores e funcionais para a criança, dificultando o posicionamento e os cuidados de higiene. É de fundamental importância, portanto, o estudo da associação de intervenções cirúrgicas e tratamentos fisioterapêuticos que proporcionem controle da espasticidade. Objetivo: avaliar o impacto da Rizotomia Dorsal Seletiva (RDS) no quadro clínico de crianças espásticas e na realização dos cuidados diários. Métodos: Participaram do estudo 7 crianças com espasticidade, GMFCS de 4 a 5, de 5 a 11 anos de idade. Antes e depois da cirurgia, os seguintes dados foram avaliados: grau de espasticidade dos grupos musculares adutores do quadril e isquiotibiais nos membros inferiores e para o grupo flexor do cotovelo nos membros superiores (escala de Ashworth Modificada); medida do ângulo poplíteo unilateral e bilateral, do ângulo de abdução do quadril e de dorsiflexão do tornozelo com goniometria. Além disso,foi aplicado questionário às famílias para avaliar o grau de dificuldade para os cuidados diários e o grau de satisfação após a RDS. Conclusões: Houve redução da espasticidade no pós-operatório em todos os grupos musculares testados, em todos os pacientes. Houve alteração significativada goniometria para o ângulo poplíteo bilateral (p<0,05). Das 7 famílias questionadas, 6 (85,7%) relataram melhora para o posicionamento,alimentação, higiene e facilidade para vestir e instalar órteses. Desse modo, a RDS mostra-se uma opção para o tratamento de casos de espasticidade refratária ao tratamento clínico em crianças com...

Cerebral Palsy (CP) affects 4 in every 1000 children in the world, representing a serious problem for the health care systems. This disease, characterized by motor deficit engendered during brain development, may lead to the clinical condition known as spasticity, a muscle hypertonia caused by aggravation on the spinal cord reflex when the inhibition of the upper airway is absent. Spasticity causes various functional and motor impairments for the child, making positioning and hygiene difficult. The study of the association of surgery and physical therapeutic treatments that provide control of spasticity is of fundamental importance. Objective: To evaluate the impact of selective dorsalrhizotomy (SDR) in the clinical framework of spastic children and the routine of daily care. Methods: The study included seven children withspasticity, 4-5 GMFCS, 5 to 11 years old. Before and after surgery, the following data were evaluated: the degree of spasticity of the adductor muscle groups of the hip and hamstrings in the legs and the elbow flexor group of upper limbs by using a Modified Ashworth Scale, and the measurement of the unilateral and bilateral popliteal angle, the angle of hip abduction and ankle dorsiflexion by using goniometry. In addition, a questionnaire was applied to families to assess the degree of difficulty for the daily care and satisfaction after the SDR. Conclusions: Reduction of post-operative spasticity in all muscle groups tested in all patients. There was a significant change in the angle goniometry for bilateral popliteal movement (p <0.05). Of the seven families questioned, six (85.7%) reported improvement of the positioning, feeding, hygiene and easy-to-install orthoses. Thus, SDR appears as an option to medical treatment in the treatment of spasticity in refractory cases in CP children with severe spastic quadriplegia, being able to improve their quality of life and that of their care-givers.

Efeitos da injeção de solução bicarbonatada de ácido acetilsalicílico em mucosa colorretal de coelhos, com vistas a aplicação no preparo pré-operatório do cólon / Local effects of rectal washout with acetylsalicylic acid solution on the colonic mucosa of rabbits

INTRODUÇÃO: A recidiva local no câncer colorretal tem como principal causa o implante de células tumorais nas anastomoses. 11-15 Dessa maneira, lavagem química do lúmen intestinal é preconizada para evitar tanto o implante quanto à recidiva local. 11-28 Em estudos prévios constatamos que a solução bicarbonatada de ácido acetilsalicílico tem efeitos citolíticos e anti-tumorais in-vitro.31 OBJETIVOS: Avaliar a toxicidade da solução de aspirina na mucosa colônica de coelhos com o objetivo de usá-la no preparo intestinal de portadores de câncer colorretal. MATERIAIS E MÉTODOS: Foram utilizados 20 coelhos. Um clampe vascular foi colocado acima do cólon sigmóide. Os animais foram submetidos a um enema com 50 ml da solução de aspirina ou soro fisiológico de acordo com o grupo. Os animais foram sacrificados ao término do procedimento ou tardiamente de acordo com o grupo. RESULTADOS: A solução de aspirina não altera a mucosa colônica de coelhos. CONCLUSÃO: O uso da solução bicarbonatada de ácido acetilsalicílico no preparo intestinal de portadores de câncer colorretal é clinicamente possível.

BACKGROUND: The implantation of viable exfoliated intraluminal tumour cells is the major cause of local recurrence in colorectal cancer. 11-28 Therefore, the bowel lumen wash with a tumoricidal agent has been recommended. 11-28 In previous study we observe that acetylsalicylic acid solution cause neoplastic cell death in vitro.31 PURPOSE: Assess the local effect of acetylsalicylic acid solution on the colonic mucosa of rabbits, in order to use this agent in the bowel lumen wash. METHODS: 20 rabbits were used. A vascular clamp was placed on the distal colon, followed by the instillation per rectum of 50 ml of acetylsalicylic acid solution or saline solution, according to the group. The euthanasia was performed immediately or later according to the group. RESULTS: The acetylsalicylic acid solution doesn't cause any injury on the colonic mucosa of rabbits. Conclusion: The use of acetylsalicylic acid solution in the bowel lumen wash seems clinically feasible.

Estudo retrospectivo de pacientes portadores de câncer colorretal atendidos na Faculdade de Medicina de Botucatu no período de 2000-2003 / Retrospective study of carrying patients of colorectal cancer taken care of in the College of Medicine of Botucatu in the period of 2000-2003

O câncer colorretal é uma das neoplasias mais freqüentes na população adulta mundial. Dentre as neoplasias do trato gastrointestinal é a segunda em prevalência e mortalidade. Em nosso meio a grande maioria dos pacientes procura atendimento nas fases mais avançadas da doença. MÉTODO - Foram avaliados retrospectivamente 80 prontuários de pacientes com câncer colorretal atendidos no Hospital das Clinicas da Faculdade de Medicina de Botucatu, no período de 2000 A 2003. RESULTADOS - Observamos que o câncer colorretal incide prevalentemente em indivíduos na 5a e 6a décadas de vida, com maior incidência em homens do que em mulheres. Quanto à distribuição, a maioria dos tumores localiza-se nos segmentos distais do colón, isto é, sigmóide e reto (71por cento). Os principais sintomas observados foram: perda de peso, sangramento, alteração do habito intestinal e anemia. A taxa de complicação observada foi de 10por cento, sendo as deiscências e a trombose venosa profunda as principais. A maioria dos pacientes apresentava estadiamento avançado pelo sistema TNM e pela classificação de Dukes. CONCLUSÃO - Em nosso meio o câncer colorretal tem uma alta prevalência, com localização preferencial pelos segmentos distais do colón, sendo a maioria diagnosticada nas fases avançadas, reforçando a necessidade do diagnostico precoce e campanhas de prevenção.