An 89-year-old woman admitted to the Emergency Care Department with reported back pain nine days earlier that started suddenly when sitting. This subsequently evolved into progressive paraparesis (Frankel D). An MRI of the lumbosacral spine revealed an extensive lumbar epidural hematoma ( Figure). The patient underwent decompressive laminectomy of T12-L1.Spontaneous epidural hematoma is a rare disease, most often involving the thoracolumbar region, followed by the cervical region 1 . Non-traumatic causes include hypertension, coagulopathies, use of anticoagulants, arteriovenous abnormalities, tumors of the backbone and lumbar puncture. In approximately 40% of cases, the etiology cannot be determined. Typically, pain is the root of the acute onset, accompanied by neurological deficit 1,2 . References 1.Liao CC, Hsieh PC, Lin TK, Lin CL, Lo YL, Lee SC. Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience.
Our results have shown that the effectiveness of ETV is not actually age-related, but etiology-related.
Este trabalho apresenta uma revisão da literatura das três últimas décadas sobre o papel da melatonina (MEL) na etiopatogenia e no tratamento do câncer. Os principais mecanismos de ação da MEL envolvem a regulação imunológica, efeitos bioquímicos e metabólicos. São relatados estudos in vitro e in vivo, inclusive em humanos com neoplasias malignas avançadas e/ou metastáticas, como tumores de mama, próstata, pulmonar, gástrico, hepático, ovariano e de intestino. Duas ações benéficas da MEL no tratamento do câncer são aparentemente importantes: a oncostática e a protetora contra os efeitos adversos da quimioterapia (mielossupressores, neurotóxicos e hematológicos). A MEL também passou a ser utilizada em uma nova modalidade de terapia oncológica, a imunoterapia, na década de 1990 para tratar pacientes com câncer de pulmão de células não-pequenas.
3cm foram seccionados radialmente, sendo processado um mínimo de seis fragmentos, com registro no mapa de clivagem. RESULTADOS: A maioria das cirurgias (40 casos; 76,6%) foi realizada para diagnóstico e 12 (23,4%) com finalidade terapêutica. Foram obtidos em média 7,4 blocos por espécime. Carcinoma ductal in situ (CDIS), isolado ou em associação com carcinoma ductal invasor, foi o tipo histológico mais freqüente (35/52 casos; 67,3%). Os tumores variaram de 0,1 a 4cm (média de 1,14cm). As margens foram positivas em 22 casos (42,2%). O tipo histológico mais comum nas margens foi o CDIS (12/22 casos). Foram reexcisados 33 casos, dos quais 17 tinham tumor residual (48,5%), a maioria de espécimes com fins diagnósticos. CONCLUSÃO: Nosso protocolo foi considerado de fácil uso pelos residentes. Embora não seja de baixo custo, devido ao tempo de exame, ao grande número de secções realizadas e por poder resultar em procedimento cirúrgico em dois tempos, ele é seguro para o diagnóstico e eficiente para a detecção de margens comprometidas.]]>
Objective To present a case-series study of extracranial-intracranial (EC-IC) bypass procedures performed in our service and evaluate indications and results. Method The medical records of 30 patients undergoing 32 EC-IC anastomosis procedures were evaluated. Seventeen patients were male (56.6%). The age ranged from 26 to 85 years (mean: 58.2). The follow-up ranged from 1 to 211 months (mean: 54). We evaluated the indications and complications of the surgical procedures. Results The bypass procedures comprised 28 STA-MCA anastomosis (87,5%) and four posterior circulation anastomosis. The main indications included cervical internal carotid artery occlusion (19 cases), Moyamoya disease (3 cases), giant aneurysms (3 cases), intracranial arterial stenosis (2 cases), and vertebral-basilar insufficiency (3 cases). On follow-up, graft patency was 93.7%, confirmed in half of the cases by arterial digital subtraction angiography, magnetic resonance angiography, and CT angiography. There was no surgical mortality. Three patients had PO complications (9.3%), including one case of ischemia (3.1%). Conclusion The EC-IC bypass is a procedure with low morbidity and mortality. The indication of EC-IC bypass surgery for cerebral atherosclerotic disease should not be generalized. The EC-IC bypass can be indicated for cerebral revascularization in Moyamoya disease, intracranial stenosis, and in the management of complex aneurysms. This procedure can be an alternative in the treatment of vertebral-basilar insufficiency. ResumoObjetivo Apresentar uma série de casos de anastomose extra-intracraniana (EC-IC) avaliando suas indicações e resultados. Método Foram avaliados retrospectivamente os prontuários de 30 pacientes submetidos a 32 procedimentos de anastomose EC-IC. Dezessete pacientes eram do sexo
Marfan syndrome is characterized by manifestations in three systems: skeletal, ocular and cardiovascular. There are no publications of typical Marfan syndrome patients associated with craniosynostosis or hydrocephalus. There are a series of publications of the association between craniosynostosis and marfanoid habitus, which led to the description of new syndromes: Loeys-Dietz types IA, IIA, IB e IIB and Shprintzen-Goldberg. Among those syndromes, there are cases of hydrocephalus, but they are typically associated with craniosynostosis. We describe two cases of patients with marfanoid habitus associated with hydrocephalus without craniosynostosis. The first patient presented with skeletal malformations with arachnodactyly, camptodactyly, malar hypoplasia in association with interatrial shunt, gastroparesis, mild mental retardation and symptomatic hydrocephalus. The other patient presented with marfanoid habitus associated with mild cognitive deficit and symptomatic hydrocephalus. None of those patients had craniosynostosis. Many phenotypic characteristics our patients presented resemble the craniosynostosis-marfanoid habitus syndromes. The absence of craniosynostosis raises suspicion on the possibility of occurrence of those syndromes with atypical characteristics or a new syndrome not yet described. We believe that the description of these cases may enlighten this discussion.
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