Pure Neuroendoscopic Resection of Cystic Cerebellar Tumors.

BACKGROUND: We describe the resection of cerebellar cystic tumors using pure neuroendoscopy. This technique consists of performing all of the procedures under an endoscopic view, with the instruments introduced into the operative field coaxially to the endoscope through a trocar. CASE DESCRIPTION: Three cases of cerebellar cystic lesions (two pilocytic astrocytomas and one hemangioblastoma) were approached using the pure neuroendoscopic technique. Under general anesthesia and prone positioning, a suboccipital burr hole was created. The endoscope was introduced into the tumor cavity, and a reddish nodule was identified. The monopolar electrode was used to coagulate and dissect the surrounding nodular tissue. Grasping forceps were used to remove the nodule. There were no complications related to tumor removal, and the patients recovered from their symptoms. The follow-up images showed reduction of the cavity with no contrast enhancement. CONCLUSION: The pure neuroendoscopic technique was shown to be minimally invasive and a successful and secure method to treat cystic cerebellar tumors.

Neuroendoscopic biopsy of brain lesions: accuracy and complications.

OBJECT: The authors conducted a study to analyze the accuracy of neuroendoscopic biopsies of ventricular and periventricular lesions and record any difficulties or complications of the neuroendoscopic biopsy procedure. METHODS: A total of 50 patients with different diseases consecutively underwent endoscopic biopsy procedures. The biopsy result was considered diagnostic if the pathologist reported any specific finding on which clinicians could base decisions about treatment or observation. The biopsy result was referred to as accurate if the results matched results of a sample obtained later or if the treatment response and disease evolution were compatible with the diagnosis. The biopsy result was considered inaccurate if results showed any relevant differences from those of the later sample or if the patient's disease did not evolve as expected. Complications were recorded and compared with those found in a literature review. RESULTS: For 2 patients, the procedure had to be terminated. The biopsy diagnostic rate was 89.6%, and the accuracy rate was 86%. Complications associated with the procedure were 3 hemorrhages (6%), 2 infections (4%), and 1 death (2%); no reoperations were needed. CONCLUSIONS: Endoscopic biopsy seems to be an accurate procedure with acceptable morbidity and mortality rates.

Infecção por Rhodococcus equi em imunossuprimidos: uma revisão / Rhodococcus equi infection in human immunodeficiency: a review

O nocardioforme actinomiceto Rhodococcus equi é um importante patógeno de equinos e um patógeno emergente oportunista de humanos. Infecta, frequentemente, potroscom menos de 6 meses de idade. Amaioria dos humanos infectados apresenta algum deficit na imunidade celular e contato prévio com animais, solo contaminado ou ambos. A inalação dos organismos infectantes do solo pode levar a uma crônica e severa pneumonia piogranulomatosa em potros e pacientes imunocomprometidos. Alem disso, colite ulcerativa é uma sequela comum em potros e a disseminação do pulmão para outros sítios não é rara, tanto em animais quanto em humanos. Embora o R. equi, um cocobacilo gram-positivo e bactéria intracelular facultativa, seja susceptível à  morte por neutrófilos, ele é capaz de resistir as defesas macrofágicas inatas e estabelecer residência no ambiente intracelular desse fagócito. Usualmente, o pulmão é o órgão primário da infecção. As manifestações de disseminação extrapulmonares, fruto de bacteremia,têm sido descritas como abscessos cutâneo, cerebral, ósseo, etc. As manifestações clínicas da doença são febre, dispnéia, tosse, expectoração, dor torácica, hemoptise, emagrecimento, entre outras assim como na tuberculose. A propedêutica da rodococose inclui radiografia de tórax, exame direto e cultura do escarro, hemocultura, broncoscopia com BAL, biopsia transbrônquica, aspiração transparietal, exame anatomopatológico e, mais recentemente, análise genética. No diagnóstico diferencial da rodococose consideram-se tuberculose, nocardiose, actinomicose, abscesso pulmonar, pneumonia bacteriana por Pneumocystis carinii e outros...

The nocardioform actinomycete Rhodococcus equi is an important pathogen of horses and an emerging opportunistic pathogen of humans. The infection occurs most in foals with six months age. Most of the infected humans has some deficit in cellularimmunity and a previous contact with animals, contaminated soil or both. Inhalation of the soil-borne organism can lead to chronic and severe pyogranulomatous pneumonia in young horses and immunocompromised people. In addition, ulcerative colitis is a common sequel to infection in foals, and dissemination from the lung to other body sites is not uncommon in either horse or human. Although R. equi, a facultative intracellular bacterium, is susceptible to neutrophil-mediated killer, it is able to resist innate macrophage defenses and establish residencewithin the intracellular environment of thatphagocyte. Usually, the lung is the first organ to be compromised. The extra pulmonarymanifestations, resultant of the bloodspread bacteria, are cutaneous, bone and cerebral abscess. The clinical manifestations of the disease are fever, dyspnea, cough, increased sputum production, chest pain, hemoptysis,weight loss and others, like in tuberculosis. The investigation to diagnosis includes routine chest radiographs, sputum smears and cultures, hemoccult, bronchoscopy with BAL, over bronchioles biopsy, over parietal aspiration, pathologic analysis and more recently through genetic analysis...