Tratamento do glioblastoma recorrente com BCNU [1, 3-bis (2-chloroethyl)-1-nitrosourea] intra arterial

Contemporary therapies for patients with glioblastomas remain marginally efficient, and recurrence following surgery, radiation therapy and adjuvant chemotherapy is practically universal. The major obstacles to the successful use of chemotherapy for CNS tumors are the drug delivery to the tumor site and the infusion of chemotherapeutic agents directly into the arterial supply of a tumor. The latter could provide a pharmacokinetic advantage by enhancing drug delivery to the tumor. Sixteen patients with recurrent unilateral glioblastomas treated with intra-arterial BCNU were evaluated retrospectively. During the infusion, eleven patients referred pain in the ipsilateral eye, five patients were nauseated, three reported headache, one patient presented mental confusion, while two presented focal signs. There were two deaths during the course of therapy. Four patients achieved temporary clinical improvement, seven showed disease stability, and three presented clinical deterioration. The median total survival time was 87.9 weeks. Unilateral vision loss and focal signs were observed as delayed complications of this treatment. This study has confirmed previous reports indicating that arterial chemotherapy is clearly not curative, and presents serious toxicity. Only through a randomized prospective study performed in a large series of patients can the questions concerning survival period increment be answered properlyOs tratamentos atuais para pacientes com glioblastoma permanecem pouco eficientes e a recorrência, acompanhando cirurgia, radioterapia e quimioterapia, é a regra geral. O maior obstáculo para o sucesso da quimioterapia para os tumores do SNC é a disponibilização da droga no sitio do tumor sendo que a infusão do agente quimioterápico diretamente na trama arterial da lesão pode proporcionar vantagens por maior liberação da substância diretamente no tumor. Estudamos retrospectivamente dezesseis pacientes com glioblastomas recorrentes, unilaterais, que foram tratados com BCNU intra-arterial; durante a infusão, onze pacientes sentiram dor no olho ipsilateral, cinco ficaram nauseados, três queixaram-se de cefaléia, um apresentou confusão mental e dois apresentaram sinais focais. Ocorreram duas mortes durante a terapia. Quatro pacientes apresentaram melhora clinica temporária, sete apresentaram estabilização e três apresentaram deterioração. A média de sobrevida total foi de 87,9 semanas. Perda da visão unilateral e sinais focais foram complicações tardias. Este estudo confirmou trabalhos anteriores indicando que a quimioterapia intra-arterial claramente não é curativa, séria toxicidade pode ocorrer e somente um estudo prospectivo e randomizado, realizado em uma serie maior de pacientes, poderá responder questões sobre o aumento do tempo de sobrevida de forma adequad

ALTAS DE NUVENS: UMA LEITURA POSSÍVEL POR MEIO DE WALTER BENJAMIN

Knowing that Cloud Atlas (2016) opens various analytical possibilities, this brief essay chooses to map possible relationships that the book, especially concerning stories 3, 5, and 6, can establish with Walter Benjamin's philosophy, more punctually, his Theses on the Philosophy of History. It will be briefly introduced, to this end, a summary of each of the six short stories that make up Cloud Atlas and its structural organization. After that, it will be indicated specific passages by Walter Benjamin that would present similarities and resonances synchronized with the concepts that cross the literary work of David Mitchell.Este breve ensaio, diante às várias possibilidades analíticas abertas por Atlas de Nuvens (2016), opta por mapear possíveis relações que o livro, em especial no que concerne as histórias 3, 5 e 6, pode estabelecer com a filosofia de Walter Benjamin, mais pontualmente suas Teses Sobre o Conceito de História. Para tal, introduzir-se-á brevemente um resumo de cada um dos seis contos que compõem Atlas de Nuvens e sua organização estrutural. Após isso, indicar-se-á pontuais passagens de Walter Benjamin que apresentariam semelhanças e ressonâncias sincronizadas com os conceitos que transpassam a obra literária de David Mitchell

De Roma a Sodoma: Uma análise estruturalista de Orphéus, Eurydíkē e Lot

Este breve ensaio busca, por meio da análise estruturalista e distanciada indicada por Lévi-Strauss, aproximar o conjunto de funções literárias das relações presentes entre os personagens principais do mito de Orphéus e Eurydíkē, fundadores dos mistérios órficos da Antiguidade Clássica, e de Lot e sua esposa, apresentados no Livro de Gênesis. Os pontos correlacionados são: o ponto de partida da jornada de ambos os casais, a figura mítico-mágica que anuncia a saída, o olhar para trás da figura feminina e a punição sobre elas exercida

Neurological League, na experience of twenty years

The Neurosurgical League of University of São Paulo Medical School is an Academic Interest Group with twenty years of history. At present, it has twenty five members distributed between second and fifth year of undergraduation in medicine. Among its activities (divided into two types: mandatory and optionals) are: lectures, activities in the ward with case discussion, observation of neurosurgical procedures, on call in the neurosurgery emergency, anatomical dissection on the Serviço de Verificação de Óbitos da Capital (SVO), and scientific projects. Throughout this period, we have spread information about the speciality and consolidated competences in the medical students which is not fulfilled by the traditional curriculum. In all these years, the league have produced several published articles in many journals nationally and internationally (presented in more than fifty congresses), have helped to write a book about neurosurgery to undergraduation students and organized continuing education courses.A liga de neurocirurgia da Faculdade de Medicina da USP (LNC) é uma liga com 20 anos de história. Atualmente conta com 25 membros distribuídos entre o segundo e quinto ano da graduação. Dentre suas atividades (divididas em obrigatórias e opcionais) temos: aulas teóricas, atividades de enfermarias com discussão de casos clínicos, plantões no pronto-socorro, acompanhamento de procedimentos neurocirúrgicos, dissecções no Serviço de Verificação de Óbito da Capital (SVOC), e atividades de iniciação científica. Durante todo esse período conseguimos disseminar informações sobre a especialidade e consolidar competências nos estudantes de medicina não preenchidas pelo currículo atual. Já produzimos diversos artigos publicados em revistas indexadas nacional e internacionalmente (apresentados em mais de 50 congressos), ajudamos a escrever um livro voltado para alunos de graduação e produzimos diversos cursos de aprimoramento para os alunos

Quick-Time VRTM: when medical education meets virtual reality

Learning medicine is a difficult process to undertake, partially due to the complexity of the subject and limitations of traditional methods of teaching (lectures, textbooks, laboratory and anatomical dissections). These resources have been effective for decades, even though presenting intrinsic drawbacks. Textbooks are non-interactive education tools and do not provide any three dimensional experience. Cadaver dissection is an invaluable aid to learn anatomy. It provides an immersive, interactive experience allied with an inimitable tactile feedback. However, it has several limitations, including availability of specimens, costs and a substantial time commitment. Computer based virtual reality methods may overcome these drawbacks and provide interesting alternatives for medical training. Technological advances have generated great expectations for the use of computer-based virtual reality technologies in medical education, mainly anatomy and surgery. However, these Virtual Reality tools for general medical education are expensive due to the equipment necessary to create highly detailed, immersive three-dimensional image environments with real time friendly user interactivity. The concepts of Virtual Reality methods that generate immersive environments, as well as those that create simulated objects with interactive viewing features may be contemplated by the QuickTimeTM which is one of the technologies that can be successfully used for interactive, photorealistic displaying of medical images (radiological, anatomical and histological) and interaction on current generation of personal computers at a low and accessible cost. In this paper, the authors provide an overview of the Quick Time Virtual Reality methods aimingLearning medicine is a difficult process to undertake, partially due to the complexity of the subject and limitations of traditional methods of teaching (lectures, textbooks, laboratory and anatomical dissections). These resources have been effective for decades, even though presenting intrinsic drawbacks. Textbooks are non-interactive education tools and do not provide any three dimensional experience. Cadaver dissection is an invaluable aid to learn anatomy. It provides an immersive, interactive experience allied with an inimitable tactile feedback. However, it has several limitations, including availability of specimens, costs and a substantial time commitment. Computer based virtual reality methods may overcome these drawbacks and provide interesting alternatives for medical training. Technological advances have generated great expectations for the use of computer-based virtual reality technologies in medical education, mainly anatomy and surgery. However, these Virtual Reality tools for general medical education are expensive due to the equipment necessary to create highly detailed, immersive three-dimensional image environments with real time friendly user interactivity. The concepts of Virtual Reality methods that generate immersive environments, as well as those that create simulated objects with interactive viewing features may be contemplated by the QuickTimeTM which is one of the technologies that can be successfully used for interactive, photorealistic displaying of medical images (radiological, anatomical and histological) and interaction on current generation of personal computers at a low and accessible cost. In this paper, the authors provide an overview of the Quick Time Virtual Reality methods aiming to introduce them to medical educators and illustrate their application on medical training

History of virtual reality and its use in medicine

Virtual Reality can be defined as an advanced interface between man and machine, that simulates a realistic environment and allows participants to interact with such ambience. This Science has its origins in the military academies and in the entertainment industry, and experienced great impulse in the second half of twentieth century. Using techniques like stereoscopy, it is possible to use human senses and to emulate experiences with much fidelity. Models of Virtual Reality became more and more important for medicine. Today, we can find many applications in this field, such as preoperative planning, assistance, surgical training and teaching. For the study of neuroanatomy and neurosurgery in particular, the technology of Virtual Reality has shown great effectiveness and utility, despite of high costs and low quality of visual information. Virtual Reality is now definitively included in the context of medical education.Realidade Virtual pode ser definida como uma avançada interface homem-máquina que simula um ambiente realístico e permite que participantes interajam com ele. Essa ciência tem suas origens nas academias militares e na indústria do entretenimento, com grande impulso na segunda metade do século XX. Através de técnicas como a estereoscopia, é possível usar os sentidos humanos e emular experiências com grande fidelidade. Modelos de Realidade Virtual ganham importância cada vez maior para a medicina. Hoje é possível encontrar diversas aplicações nessa área, como planejamento pré-operatório, assistência, treinamento cirúrgico e ensino. Para o estudo da neuroanatomia e da neurocirurgia especificamente, embora os custos proibitivos e a experiência visual limitada ainda sejam realidade, a tecnologia da Realidade Virtual tem demonstrado grande eficiência e utilidade, assumindo definitivamente seu papel no contexto da educação médica

Traumatic Pseudoaneurysm of the Middle Meningeal Artery Causing an Intracerebral Hemorrhage

Traumatic aneurysms comprise less than 1% of all intracranial aneurysms. Most of these aneurysms are actually false aneurysms, or pseudoaneurysms, which are caused by the rupture of entire vessel wall layers, with the wall of the aneurysm being formed by the surrounding cerebral structures. Traumatic pseudoaneurysms of the middle meningeal artery are also rare. Only four cases have been reported in the literature with intracerebral hematoma. In this paper, the authors report a case of a patient with a ruptured traumatic pseudoaneurysm of the MMA who presented with an intracerebral hematoma in the left temporal region immediately after trauma; the patient underwent endovascular treatment

A evolução histórica do ensino da neuroanatomia

O estudo da neuroanatomia é mandatório e de fundamental importância para um bom exercício da medicina e, principalmente, da neurocirurgia. Esse artigo se propõe a revisar historicamente como ocorreu a evolução do ensino da neuro-anatomia em particular e da anatomia, em geral. Para essa finalidade foi realizada uma pesquisa com banco de dados em arquivos eletrônicos (PubMed, Lilacs) e em livros textos sobre o assunto.The study of neuroanatomy is mandatory and crucial for a good medical practice and especially of neurosurgery. This article proposes to review historically occurred as the evolution of learning and teaching of nervous system structures. For this purpose a survey was conducted with a database in electronic files (PubMed, Lilacs) and textbooks on the subject

The role of diffusion tensor imaging and tractography for deep brain stimulation planning in treatment of obsessive-compulsive disorder

Introduction: Obsessive-compulsive disorder (OCD) is a common, chronic and long-lasting mental disorder. The current first-line therapy for OCD is high doses of selective serotonin reuptake inhibitor (SSRI) and cognitive-behavioral psychotherapy. For patients with refractory symptoms, studies demonstrated that they may respond well to Deep Brain Stimulation (DBS), a technique that can modulate altered neuronal activity. Some stimulation sites are currently being used as targets to DBS and showed good response, but further analyses are necessary to improve the location of the electrodes since some patients demonstrated a poor outcome. Neuroimaging that assess white matter such as diffusion tensor image and tractography can evaluate the quality of the targets and assess the tracts that are affected by the electric field of the electrodes used in the surgery. Our hypothesis is that the patient outcome depends on the trajectory of the tracts that are affected by the electric field.Objectives: Our aim is to investigate which tracts connected with the stimulation sites contribute to clinical improvement effects and weather is possible to predict the outcomes based on connectivity.Methodology: We analyzed 4 patients (2 female) with treatment-refractory obsessive-compulsive disorder undergoing deep brain stimulation targeting the anterior limb of the internal capsule/ nucleus accumbens (ALIC). We will perform tractography analysis of the fibers using the volume of active tissue (VTA) as the region of interest. We will relate the alteration in OCD symptom severity on Yale-Brown obsessive-compulsive scale (Y-BOCS) between the condition before surgery and one-year follow-up with the tracts involved with the stimulation sites using DTI data such as fractal anisotropy and mean diffusivity.Partial Results: Half of the patients did show great improvement and the other two maintained a bad outcome. We found that active stimulation of the ALIC more lateral and posterior of the nucleus was associated with a better outcome. Currently, the description of the tracts involved in patients with better outcomes is performed. The tracts involved with this result will be determined by analysis of DTI and tractography.Discussion and Conclusion: For a future perspective, the results will be important to improve the stimulation sites in DBS surgery resulting in better outcomes

Serum sodium disorders in patients with traumatic brain injury

Sodium disorders are the most common and most poorly understood electrolyte disorders in neurological patients. The aim of this study was to determine the incidence of sodium disorders and its association with different traumatic brain injuries. This prospective study was conducted in 80 patients diagnosed with moderate and severe traumatic brain injuries. All patients underwent cerebral computed tomography. Incidence of sodium disorders, presence of injuries in the first computed tomography after traumatic brain injury, and level of consciousness were analyzed. Patients that presented other potential causes of sodium disorders and systemic trauma were excluded from the study. The incidence of sodium disturbances was 45%: 20 patients presented hypernatremia and 16 hyponatremia. Refers to all patients with sodium disturbances 53% were detected in the first sample. We recorded at least one measurement <125 mEq/L in 50% of the patients with hyponatremia. A greater incidence of sodium disorders was found in patients with subdural, intracerebral hematoma and with diffuse axonal injury. The incidence of sodium disorders among the patients with diffuse lesions was greater than in the group of patients with brain contusion (P = 0.022). The incidence of sodium disorders is higher in patients with diffuse traumatic brain injuries. No association was found between focal lesions and proportion of sodium disorders