No abstract

There still is no cure for the acquired immunodeficiency syndrome (AIDS). Its etiologic agent is the human immunodeficiency virus (HIV), and transmission occurs through sexual relationships, contacts with blood, and vertically (mother to child). In this study, we sought to determine the prevalence of HIV among blood donors at a blood bank in Curitiba. We studied 213,666 blood donations made from March 1, 1992, to April 25, 1999. Each potential blood donor first answered a questionnaire, submitted to a clinical examination, and filled out a self-exclusion card. Blood was collected and analyzed only from the candidates approved by the first two criteria. Two tests were used to detect HIV: ELISA for screening, and Western-Blot for confirmation. The results were analyzed statistically by determining the 95% confidence interval. Of the total number of donors, 156,942 were men, and 56,724 were women. There were 319 cases of HIV infection (244 men, 75 women). There were no significant differences between genders, or among the different age groups, or between first-donation and repeated-donation donors. There was a significant predominance of HIV infection among single individuals compared to married, widowed, and other individuals. The same occurred among married and divorced individuals compared to widowed subjects. The prevalence of HIV among blood donors was 0.149% (0.155% among men and 0.132% among women). The frequency of HIV was statistically identical among new blood donors and repeat donors. A large number of HIV-infected married women was also observed.

RESUMO -Criança de cinco anos, feminina, branca, com história de oito internamentos nos últimos dois meses por crises convulsivas caracterizadas por vômitos, perda de consciência e clonias em hemicorpo direito. No exame físico, verificou-se hipertensão arterial grave (270/140 mmHg). Os estudos de neuroimagem (tomografia computadorizada e ressonância magnética) revelaram extensas áreas hipodensas, sugerindo edema cerebral. A arteriografia renal mostrou estenose da artéria renal direita, determinando a etiologia da hipertensão arterial. Com o controle da hipertensão, após a nefrectomia, houve reversão completa dos sintomas, assim como das anomalias de imagem.PALAVRAS-CHAVE: encefalopatia hipertensiva, edema cerebral, estenose da artéria renal. Hypertensive encephalopathy associated to repetitive seizures : case reportABSTRACT-Five years old, female, who started with tonic-clonic seizures on the right side of the body, with vomits and unconsciousness. The patient had been hospitalized for eight times in the last sixty days because of seizures. At physical exam, she had a severe arterial hypertension (270/140mmHg). The computerized tomographic scan and magnetic ressonance imaging revealed hypodense areas, mainly on the right parietal-temporal region, suggesting presence of edema. The angiography showed stenosis of the right renal artery, that was the cause of arterial hypertension. After the control of arterial hypertension by nefrectomy, the patient had a complete remission of the symptoms, as well as the images anomalies.KEY WORDS: hypertensive encephalopathy, brain edema, stenosis of the renal artery.O estado de mal epiléptico de repetição pode estar associado a múltiplas causas. Apresentamos o relato de um caso pediátrico que exemplifica uma situação clínica incomum, na qual se demonstrou que um quadro de repetidas crises convulsivas tinha por causa primária uma encefalopatia hipertensiva subjacente; uma síndrome neurológica que se instala em decorrência da elevação súbita e grave da pressão arterial, levando a alterações de neuroimagem, compatíveis com edema cerebral 1,2 . Essa síndrome caracteriza-se clinicamente por náuseas, vômitos, cefaléia, alteração no nível de consciência, distúrbios visuais, papiledema e convulsões 3 . Dentre as diversas etiologias de hipertensão arterial secundária em crianças, destacam-se as doenças renais (74%), coarctação da aorta (15%), alterações renovasculares (7%), doenças adrenais (1%), enfermidades sistêmicas (1%) e tumores não adrenais (1%) 4 .

No abstract

Multiple myeloma in the central nervous system (CNS) is an extremely rare condition, described in over 100 cases in the literature. In this article, the authors report the case of a 55-year-old female patient, subjected to an autologous bonemarrow transplant, and, furthermore, to a brain tissue biopsy with immunohistochemistry confirmation, revealing infiltration by a great amount of plasma cells, compatible with the clinical history of multiple myeloma. The patient was then subjected to CNS adjuvant radiotherapy, with constant observation by clinical oncology and monthly pamidronate disodium prescription. Despite being an incurable pathology, radiation therapy showed important local control.

Introduction Primitive neuroectodermal tumors are rare neoplasms of the central nervous system that occur in children, with few reports in adults. These tumors are found most often in the cerebral hemispheres, with spinal cord disorders being rare. Case Report A 71-year-old man with motor and sensory deficits in the upper limbs, cervical pain, and urinary incontinence presented to the Neurosurgery Service. The physical examination revealed grade-III motor strength on the right side, grade IV- on the left upper limb, and grade IV+ on the left lower limb. A magnetic resonance imaging scan showed an expansive intramedullary lesion with a C3-C4 epicenter. Spinal decompression, lesional biopsy, and adjuvant radiotherapy were performed. The anatomopathological report showed a primitive neuroectodermal tumor. After a new treatment with adjuvant radiotherapy (20 × 1.8 Gy in the skull and neuroaxis and 5 × 1.8 Gy in tumor boost), the patient progressed without recurrence. Conclusion Since the characteristics of the tumor are similar to those of medulloblastoma, it is necessary to expand the studies on these lesions, to better understand their pathophysiology and list better diagnostic and therapeutic methods, in addition to those already available.

SinopseA abordagem extradural pela fossa média foi primeiramente empregada para tratamento da nevralgia do trigêmeo e posteriormente para remover neurinoma do acústico localizado dentro do meato acústico interno. Com o aprofundamento no estudo anatômico dessa região, vários corredores cirúrgicos foram criados e o contínuo aperfeiçoamento da técnica possibilitou menor morbidade pósoperatória. Os autores descrevem a técnica cirúrgica da abordagem zigomática-fossa média ampliada, a qual tem sido amplamente utilizada para o tratamento de alguns tipos de tumores, como os cordomas, neurinomas do trigêmeo ou do acústico. Uma detalhada descrição da anatomia da região, e também as indicações e limitações da abordagem extradural pela fossa média, serão amplamente discutidas. Palavras-chaveAbordagem zigomática, fossa média, cirurgia da base do crânio. Abstract The extended zygomatic-middle fossa approach: anatomical considerationsThe extended zygomatic-middle fossa approach was initially used to treat trigeminal neuralgia and afterwords, for the removal of intracanalicular acoustic neurinoma. With the improvement of skull base anatomy knowledgment, this surgical technique turned to be used to treat several lesions located in the cavernous sinus, middle fossa, infratemporal fossa and upper clivus. The utilization of an extradural route is the main factor responsible for the very low surgical morbidity of this approach. In this report, the authors shows a clinical and anatomical study of this approach, its indications, limitations, and lesions which can be removed by this surgical technique. KeywordsZygomatic approach, middle fossa, skull base surgery.BORBA LAB, MORAIS RL, LONDON C, KUMMER Jr. A -Abordagem zigomática-fossa média ampliada

Introduction The occurrence of malignant ocular melanomas is uncommon, and the association of these tumors with intradural extramedullary metastases in the cervical spine is exceptionally rare. Case Report A 62-year-old woman undergoing adjuvant chemotherapy after surgical treatment for malignant ocular melanoma begins to experience vertigo and headache. The condition evolved with walking difficulty and neck pain that was exacerbated by swallowing and mobilizing the neck. During her ocular melanoma follow-up, lesions suggestive of metastasis in the central nervous system were not evidenced until this moment. The physical examination did not show significant findings, and a cranial computed tomography scan was performed. The image showed a hyperdense lesion with postcontrast enhancement inside the vertebral canal, at the level of C1-C2. Spinal decompression and subtotal resection were performed. The anatomopathological report revealed intradural metastasis of a malignant ocular melanoma. The postoperative period was uneventful, with significant pain improvement and no recurrences. Conclusion Intradural extramedullary metastases are rare presentations of malignant ocular melanoma. In addition, less than ten similar cases have been reported in the literature. When caring for a patient with melanoma and neurological deficits, always consider evaluating central nervous system metastases. To evaluate this patient, a sensible and detailed neurological exam is extremely important to recognize the location of the deficits and guide the best approach, such as an indication for surgery.