RESUMO
We report a case of a carotid artery bifurcation aneurysm which ruptured into a silvian fissure arachnoid cyst. In the review of the literature, only three cases were before reported. We discuss about uncommon clinical findings, the surgical aspects and the associations among the lesions.
Assuntos
Aneurisma Roto/complicações , Cistos Aracnóideos/complicações , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/etiologia , Adulto , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Masculino , Tomografia Computadorizada por Raios XRESUMO
Natural killer (NK) cells play an important role in immune surveillance against tumors. The present work aimed to study the cytotoxic activity of NK cells and T cell subsets in peripheral blood of 13 patients with primary tumors in central nervous system (CNS). As controls 29 healthy subjects with the age range equivalent to the patients were studied. The methods employed were: a) determination of cytotoxic activity of NK cells towards K562 target cells, evaluated by single cell-assay; b) enumeration of CD3+ lymphocytes and their CD4+ and CD8+ subsets defined by monoclonal antibodies; c) the identification of tumors were done by histologic and immunochemistry studies. The results indicated that adults and children with tumor in CNS display reduced percentage of total T cells, helper/inducer subset and low helper/suppressor ratio. The cytotoxic activity of NK cells was decreased in patients with CNS tumors due mainly to a decrease in the proportion of target-binding lymphocytes. These results suggest that cytotoxic activity of NK cells may be affected by the immunoregulatory disturbances observed in patients with primary tumors in CNS.
Assuntos
Neoplasias do Sistema Nervoso Central/imunologia , Células Matadoras Naturais/imunologia , Subpopulações de Linfócitos T/imunologia , Adolescente , Adulto , Neoplasias do Sistema Nervoso Central/sangue , Criança , Pré-Escolar , Citotoxicidade Imunológica , Feminino , Humanos , Imunidade Celular , Masculino , Pessoa de Meia-Idade , Subpopulações de Linfócitos T/químicaRESUMO
There are many reports supporting a self-limitation mechanism involved with hypermetabolic response after severe cranial injury. It was proposed a study with severe head injury patients, in three stages of the evolution. The first 7 days after admission (moment 1-M1), the second three days latter (M2) and the last 7 days after the first (M3). Among male patients with severe head injury, attended between January 1992 and December 1993 in University Hospital of Botucatu, UNESP, were selected 28 male patients, with Glasgow severity scale between 4 and 6, with pO2 < 70 mm Hg, weighting 60 kg or more. Among these patients, 6 finished the study, including analysis of the excretion of N, acute phase proteins, glycemia, triglycerides and amine nitrogen. During the study there were no changes in nitrogen balance and there was a decrease in protein C-reative. Glycemia tends to fall within two weeks after injury. The authors make some considerations about possible mechanisms involved in brain modulation associated with the period of dependence of hypermetabolism and hypercatabolism after closed brain injury. There are some evidences that the brain responds to head trauma with a gobal non specific way, which tends to be reorganized beyond the first two weeks after lesion. The study does not show any influence of the type and severity of head trauma.
Assuntos
Proteínas de Fase Aguda/metabolismo , Glicemia/metabolismo , Lesões Encefálicas/metabolismo , Metabolismo Energético/fisiologia , Proteínas de Fase Aguda/análise , Adulto , Glicemia/análise , Seguimentos , Escala de Coma de Glasgow , Humanos , Masculino , Fatores de Tempo , Triglicerídeos/sangue , Triglicerídeos/metabolismoRESUMO
The authors report two female patients with chronic sensitive and motor findings in lower limbs caused by compression of distal branches of sciatic nerve by lipoma. Similar cases were not described on literature. Nerve conduction studies allowed to localize the exact site of compression. At surgery, lipomas compressing the deep peroneal nerve (case 1) and the posterior tibial nerve (case 2) were observed. Histologic studies of tumors confirmed the diagnoses.
Assuntos
Lipoma/diagnóstico , Síndromes de Compressão Nervosa/diagnóstico , Nervo Isquiático , Neoplasias de Tecidos Moles/diagnóstico , Adulto , Eletrodiagnóstico , Feminino , Humanos , Lipoma/patologia , Lipoma/cirurgia , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/patologia , Síndromes de Compressão Nervosa/cirurgia , Nervo Fibular/patologia , Nervo Fibular/fisiopatologia , Nervo Fibular/cirurgia , Nervo Isquiático/patologia , Nervo Isquiático/fisiopatologia , Nervo Isquiático/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Nervo Tibial/patologia , Nervo Tibial/fisiopatologia , Nervo Tibial/cirurgiaRESUMO
The clinical evolution of two patients with continuous intracranial pressure (ICP) monitoring, admitted to the Intensive Care Unit of Neurology, University Hospital of Botucatu, and followed until irreversible cardiac failure (ICF) was studied retrospectively. The evolution of ICP showed that it reached a maximum 5 to 12 hours before a decrease in wave amplitude occurred (this was observed approximately 47 to 60 hours before ICF). The tracing became linear approximately 30 hours before ICF in both cases. The clinical diagnosis of brain death (BD) was obtained 3 to 28 hours after the tracing had become linear. The authors suggest that, in absence of sedation, the diagnosis of BD may be made early with the use of ICP monitoring even before the clinical diagnosis, and emphasize the need for more observations in a larger number of patients.
Assuntos
Morte Encefálica/diagnóstico , Pressão Intracraniana , Adulto , Feminino , Humanos , MasculinoRESUMO
A case of a 32-year old male patient with complaints of frontal headache progressive decrease in visual acuity, altered behaviour, and positive results of immunological tests for cysticercosis performed on the cystic and cerebrospinal fluids is presented. After several clinical and surgical proceedings, the frontal craniotomy was indicated and a multi-lobulated cystic tumor was excised. Biopsy material revealed an oligodendroglioma invading the degenerated membrane of cystic wall. Some aspects related to the possible mechanisms involved in the association of oligodendroglioma with neurocysticercosis in the presented case are discussed. Three different types of conclusions may be reached: (1) neurocysticercosis may have acted as an oncogenetic factor for the oligodendroglioma; (2) the glycoprotein nature of the antigens of gliomas and cysticercosis and the similarity in the molecular weight range of their polypeptides may be responsible for the positivity of the reactions for cysticercosis in the cystic fluid; or (3) the association of oligodendroglioma with cysticercosis may be a simple coincidence. The present study strengthens the opinion that other pathologies should be looked for when clinical treatment of cysticercosis does not follow the expected course.