The purpose of this study was to correlate the morphology of giant intracranial aneurysms (GIA) with their clinical presentation. Eighty patients with GIA, 14 males and 66 females, were studied. Univariate and multivariate analyses were made to test the associations between morphological and clinical features. The main locations of the unruptured GIA included the carotid cavernous segment, and for the ruptured GIA, the most frequent were the carotid supraclinoid and middle cerebral arteries. There was a significant association among communicating arteries (CA) of "bad" quality and presence of thrombus and calcification (TC). The risk of rupture is 8 times higher in patients with CA of "bad" quality and 11 times higher in patients without TC. GIA are more frequent in the cavernous segment. There is a high rupture risk in the middle cerebral artery. CA of "bad" quality are associated with TC. The rupture risk is significantly higher in patients without TC.
-In the past few years, the monoclonal antibody MIB-1 has been used by researchers in order to retrospectively study paraffin imbibed tumor fragments. The medulloblastoma is the most common malignant central nervous system tumor in childhood. The objectives were: determination of the mean Mib-1 LI value from these patients, as well as the prognostic value of the method.This retrospective study represents an analysis of the cellular proliferation index of posterior fossa medulloblastomas collected from 22 patients at A.C. Camargo Hospital, from January 1990 to December 1999. The histopathological diagnosis was confirmed by H&E and proliferative index (LI) was achived with Mib-1 which detects proliferating cells during G1, G2, S and M phases.The results demostrated that the mean Mib-1 was 30,1%, and ranged from 5,2% to 62,0%.In conclusion, this method has prognostic value, has to be used as routine for patients harboring medulloblastomas and the ones who have PI greater than the mean value found in this study, should be treated aggressively.KEY WORDS: medulloblastoma, labelling index (LI), MIB-1, prognostic factors. Meduloblastoma: avaliação do padrão proliferativo pelo anticorpo monoclonal Mib-1, correlação prognóstica e implicações terapêuticasRESUMO -Nos últimos anos, o anticorpo monoclonal Mib1 tem sido bastante utilizado pelos pesquisadores para estudo retro e prospectivo, pela possibilidade de se obter um índice de proliferação de fragmentos tumorais conservados em parafina. O meduloblastoma é o tumor maligno mais freqüente do sistema nervoso central na infância. Os objetivos do trabalho foram determinar a média IP através do Mib-1 destas neoplasias, e estabelecer seu valor prognóstico. Neste trabalho foi determinado retrospectivamente o índice de proliferação celular de tumores extraídos de 22 pacientes portadores de meduloblastoma da fossa craniana posterior, tratados no Departamento de Neurocirurgia do Hospital A.C. Camargo de S. Paulo, no período de janeiro de 90 a dezembro de 99. O diagnóstico histopatológico de meduloblastoma foi confirmado pela coloração pela hematoxilina e eosina (HE) e o IP foi determinado através do marcador tumoral anticorpo monoclonal Mib1, que detecta as células em proliferação tumoral nas fases G1, G2, S e M do ciclo celular. Os resultados mostraram que a média do IP Mib1 foi de 30,1%, e variou de 5,2% a 62,0%. A conclusão é que este método tem valor prognóstico, deve ser realizado como rotina no diagnóstico anatomopatológico dos pacientes portadores de meduloblastoma e que aqueles com IP Mib1 maior que a média deverão ser submetidos a tratamentos adjuvantes mais agressivos. The behaviour of a brain neoplasm is not predictable by routine pathological diagnosis. Many parameters are involved in order to analize the biological behaviour of a brain tumor, however the proliferative index evaluated by MIB-1 has been applied to different types of brain neoplasm with important prognostic correlation [1][2][3][4][5][6][7] . MIB -1 is a monoclonal antibody (ma) which binds to a ...
Although the maintenance of analgesia and hemodynamic stability was a challenge with the patient awake, the target-controlled infusion of propofol provided the desired level of consciousness, remifentanil titrated analgesia and sedation without drug accumulation, and the blockade with ropivacaine provided satisfactory analgesia. We conclude that the anesthetic technique was satisfactory for our patient.
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