Clinical presentation, treatment and outcome of patients with cerebral metastases: the University of São Paulo series.

INTRODUCTION: Secondary neoplasias are the most common tumors affecting the central nervous system and several clinical aspects of this disease are still controversial. METHOD: Forty-seven consecutive patients with the diagnosis of cerebral metastases (CM) were retrospectively studied at the Clinical Hospital of Sao Paulo University Medical School. Mean age was 53.9 years and 25 patients were female. RESULTS: The most frequent primary sites were breast, lung and skin. Symptoms were related to increased intracranial pressure (ICP) in 48.9%, focal neurological events in 27.7% and both in 17.0%. Single brain metastases were found in 57.4% of those cases, the frontal lobe being most frequently affected. Surgical treatment was performed in 68.1%, radiotherapy in 40.4% and chemotherapy in 17.0%. CONCLUSION: After statistical analysis, there was a trend towards prolonged survival of female patients, patients with ICP symptoms and the surgical group. Data from different centers are essential to establish the best management of CM.

Clinical presentation, treatment and outcome of patients with cerebral metastases: the University of São Paulo series

INTRODUÇÃO: As neoplasias secundárias são o principal grupo de tumores que afetam o sistema nervoso central. Diversos aspectos da evolução e tratamento desta doença são controversos. MÉTODO: Quarenta e sete pacientes com metástase cerebral foram estudados retrospectivamente no Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo. A idade média foi 53,9 anos e 25 pacientes eram do sexo feminino. RESULTADOS: Os sítios primários mais freqüentes foram mama, pulmão e pele. Os sintomas apresentados foram relacionados à hipertensão intracraniana (HIC) em 48,9%, sintomas focais em 27,7% e ambos em 17,0%. Metástases únicas foram encontradas em 57,8% dos casos. O tratamento foi cirurgia em 68,1% dos casos, radioterapia em 40,4% e quimioterapia em 17,0%. CONCLUSÃO: Após análise estatística, foram encontradas tendências a maior sobrevida nos pacientes do sexo feminino, no grupo de pacientes que apresentava sintomas de HIC e no grupo cirúrgico. Dados de diferentes centros são essenciais para o estabelecer a melhor forma de tratamento para as mestástases cerebrais.

Surgical management of Guyon's canal syndrome, an ulnar nerve entrapment at the wrist: report of two cases

Guyon's canal syndrome, an ulnar nerve entrapment at the wrist, is a well-recognized entity. The most common causes that involve the ulnar nerve at the wrist are compression from a ganglion, occupational traumatic neuritis, a musculotendinous arch and disease of the ulnar artery. We describe two cases of Guyon's canal syndrome and discuss the anatomy, aetiology, clinical features, anatomical classification, diagnostic criteria and treatment. It is emphasized that the knowledge of both the surgical technique and anatomy is very important for a satisfactory surgical result

Cisto sinoval intraneural do nervo fibular / Intraneural synovial cyst of the peroneal nerve. Case report

Os autores apresentam um caso de um cisto sinovial intraneural ocorrendo no nervo fibular comum. O paciente apresentou-se com quadro de dor e dificuldade para a flexäo dorsal e eversao do pé sendo submetido a exploraçäo cirúrgica com exérese do cisto. Neste estudo säo discutidos a patogênese, manifestaçoes clínicas e tratamento desta rara lesäo.

Hemisferectomia: modificaçäo técnica / Hemisferectomy: a techinical modification

Os autores relatam uma modificaçäo técnica nas hemisferectomias totais, com intuito de prevenir os sangramentos tardios e distorçöes cerebrais