Paraganglioma of the cauda equina region

BACKGROUND CONTEXT: Cauda equina paragangliomas (CEPs) are rare neuroendocrine tumors. The difficulty in differential diagnosis with other tumors of this region may be misleading for surgical planning and prognostic expectations. PURPOSE: To report on a rare case of CEP and review the most current information regarding the diagnosis, treatment options, and outcomes. STUDY DESIGN: Case report and literature review. PATIENT SAMPLE: One patient affected by CEP. METHODS: We report on a 33-year-old woman with a 2-month history of worsening low back pain, aggravated by sitting, bending, and coughing. Neurological examination revealed normal power and muscular tone, no sensory or sphincter abnormality, and normal reflex. Magnetic resonance imaging of the lumbar spine demonstrated an intradural extramedullary lesion at L3, with homogeneous contrast enhancement and hypointense punctate foci. The patient underwent an L3 laminectomy and tumor removal. Relevant articles covering CEPs from 1970 to the present were reviewed. RESULTS: The histopathological examinations described paraganglioma features. The postoperative coursewas uneventful, and all the symptoms resolved, with no tumor recurrence after 3 years’ follow-up. CONCLUSIONS: Cauda equina paragangliomas are rare, benign, and slow-growing tumors. Except for its secreting tumor characteristics, preoperative CEP diagnosis is very difficult.Magnetic resonance imaging is important andmay suggest specific radiological features for these tumors; however, these are only relative, and it is rare that diagnosis ismade before surgery.Diagnosis is established by histological examination and electron microscopy, and immunohistochemical techniques must be used to achieve a correct diagnosis. Cauda equina paragangliomas arewell-encapsulated tumors that may be cured by surgery alone, whereas radiotherapy is reserved for incompletely resected tumors. Overall, prolonged postoperative observation is mandatory because of the slow tumor evolution and the possibility of tumor relapse even up to 30 years after surgery

Spin 1 fields in Riemann-Cartan space-times "via" Duffin-Kemmer-Petiau theory

We consider massive spin 1 fields, in Riemann-Cartan space-times, described by Duffin-Kemmer-Petiau theory. We show that this approach induces a coupling between the spin 1 field and the space-time torsion which breaks the usual equivalence with the Proca theory, but that such equivalence is preserved in the context of the Teleparallel Equivalent of General Relativity.Comment: 8 pages, no figures, revtex. Dedicated to Professor Gerhard Wilhelm Bund on the occasion of his 70th birthday. To appear in Gen. Rel. Grav. Equations numbering corrected. References update

Dynamic Transitions for Quasilinear Systems and Cahn-Hilliard equation with Onsager mobility

The main objectives of this article are two-fold. First, we study the effect of the nonlinear Onsager mobility on the phase transition and on the well-posedness of the Cahn-Hilliard equation modeling a binary system. It is shown in particular that the dynamic transition is essentially independent of the nonlinearity of the Onsager mobility. However, the nonlinearity of the mobility does cause substantial technical difficulty for the well-posedness and for carrying out the dynamic transition analysis. For this reason, as a second objective, we introduce a systematic approach to deal with phase transition problems modeled by quasilinear partial differential equation, following the ideas of the dynamic transition theory developed recently by Ma and Wang

An unexpected guest: Pulmonary echinococcosis diagnosed by intraoperative frozen section examination. A case report and literature review

Echinococcosis is caused by tapeworms belonging to the Echinococcus genus. The most common site of infection is the liver although it may involve almost any organ. Symptoms of pulmonary echinococcosis vary depending on the location and structure of the cyst. While uncomplicated cysts usually appear at imaging as well-defined homogeneous lesions with fluid content and smooth walls of variable thickness, complicated lesions may have a more heterogeneous content with higher density making more difficult the distinction from malignancies or other infections. Hereby we describe the case of a 61-year-old Northern African male admitted to our tertiary center for left upper chest pain who then underwent a chest computed tomography (CT) scan which demonstrated a large hypodense lesion, with smooth and thick walls, in the upper left lobe. The following magnetic resonance confirmed the homogeneous fluid content, and the 18 F- fluorodeoxyglucose-positron emission tomography/CT demonstrated a mild uptake of the walls. According to these findings, the main differential diagnoses at imaging included bronchogenic cyst, synovial sarcoma, and pulmonary hematoma although the patient denied any recent trauma. Given the large size and clinical symptoms he underwent surgery. Intra-operative frozen section, supported by imprint cytology, excluded the presence of malignancy while suggested an echinococcal laminar exocyst. The final pathological examination confirmed the diagnosis of echinococcosis (i.e., Echinococcus Granulosus protoscolex). After surgery he was treated with albendazole and at the six-month follow-up he was in good clinical conditions. Our case highlights the importance of considering rare infections, particularly in individuals from endemic areas. Frozen tissue analyses can be a diagnostic challenge and often require ancillary tools such as imprint cytology and serial sections for more sensitive and accurate diagnosis

Cultivares de trigo Embrapa - i) resultados das unidades de observação, safra 2004, no RS, SC e PR.

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A Complex Case of Pulmonary Silico-Tuberculosis and Review of Literature

Silicosis caused by the inhalation/deposition of free silica particles is characterized by pulmonary inflammation/fibrosis. Among the clinical disorders associated with silicosis, tuberculosis is by far the most prominent. A 66-year-old male non-smoker, originally from North Africa, reported a dry cough and significant weight loss. He was a foundry worker. He had a medical history of bladder carcinoma associated with schistosomiasis. Computed tomography (CT) and positron emission tomography (PET)/CT showed bilateral multiple hypermetabolic lung nodules, some with cavitation. The patient underwent surgical resection of the largest nodule, which was highly suspicious of lung metastasis. The histological examination revealed multiple nodular formations. Several lesions showed the characteristic features of silicotic nodules. There were also adjacent well-formed granulomas, some with central caseous necrosis. A real-time polymerase chain reaction, performed for the identification and quantification of the DNA of the Mycobacterium tuberculosis complex, was positive. Pulmonary silico-tuberculosis is often encountered in patients with a history of silica exposure in tuberculosis-endemic areas. This case serves as a reminder to never underestimate patient occupational exposure and geographic origin. A careful histological diagnosis and molecular investigation are mandatory when approaching difficult cases, especially patients with a prior cancer history and clinical/radiological features suggestive of tumour recurrence/metastasis

Incentivador respiratório em cirurgias de grande porte: uma revisão sistemática

OBJECTIVE: To conduct a systematic review to evaluate the evidence of the use of incentive spirometry (IS) for the prevention of postoperative pulmonary complications and for the recovery of pulmonary function in patients undergoing abdominal, cardiac and thoracic surgeries. METHODS: Searches were performed in the following databases: Medline, Embase, Web of Science, PEDro and Scopus to select randomized controlled trials which the IS was used in pre- and/or post-operative in order to prevent postoperative pulmonary complications and/or recover lung function after abdominal, cardiac and thoracic surgery. Two reviewers independently assessed all studies. In addition, the studies quality was assessed using the PEDro scale. RESULTS: Thirty studies were included (14 abdominal, 13 cardiac and 3 thoracic surgery; n=3,370 patients). In the analysis of the methodological quality, studies achieved a PEDro average score of 5.6, 4.7 and 4.8 points in abdominal, cardiac and thoracic surgeries, respectively. Five studies (3 abdominal, 1 cardiac and 1 thoracic surgery) compared the effect of the IS with control group (no intervention) and no difference was detected in the evaluated outcomes. CONCLUSION: There was no evidence to support the use of incentive spirometry in the management of surgical patients. Despite this, the use of incentive spirometry remains widely used without standardization in clinical practice.OBJETIVO: Realizar um levantamento da literatura para avaliar as evidências do uso do incentivador respiratório (IR) na prevenção de complicações pulmonares pós-operatórias (CPPs) e recuperação da função pulmonar em pacientes submetidos a cirurgias abdominal, cardíaca e torácica. MÉTODOS: Esta revisão sistemática utilizou as bases de dados Medline, Embase, Web of Science, PEDro e Scopus para selecionar ensaios clínicos randomizados, nos quais o IR foi utilizado nos período pré e/ou pós-operatório, visando prevenir CPP e/ou recuperar função pulmonar após cirurgias abdominal, cardíaca ou torácica. Dois revisores analisaram independentemente os estudos. Além disso, a qualidade dos estudos foi avaliada segundo a escala PEDro. RESULTADOS: Trinta estudos foram incluídos (14 de cirurgia abdominal, 13 de cardíaca e três de torácica; n=3370 pacientes). Na análise de qualidade, os estudos obtiveram média de 5,6, 4,7 e 4,8 pontos nas cirurgias abdominais, cardíacas e torácicas, respectivamente. Cinco estudos (três de cirurgia abdominal, um de cardíaca e um de torácica) compararam o efeito do IR com grupo controle (sem intervenção) e não se verificou diferença nos desfechos estudados. CONCLUSÃO: Não se encontraram evidências que subsidiem o uso do IR no manejo de pacientes cirúrgicos. Apesar disso, o uso do IR continua não-padronizado e amplamente difundido na prática clínica.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Biodegradable nanoparticles containing benzopsoralens : an attractive strategy for modifying vascular function in pathological skin disorders

Psoralens are often used to treat skin disorders such as psoriasis, vitiligo and others. The toxicity and fast degradation of these drugs can be diminished by encapsulation in drug delivery systems (DDS). Nanoparticles (NPs) containing the benzopsoralen (BP) (3-ethoxy carbonyl-2H-benzofuro[3,2-e]-1-benzopiran-2-one) were prepared by the solvent evaporation technique, and parameters such as particle size, zeta potential, drug encapsulation efficiency, and external morphology were evaluated. The analysis revealed that the NPs are spherical and possessed a smooth external surface with diameter of 815 ± 80 nm, they present low tendency toward aggregation, as confirmed by their zeta potential (+17.3±2.9 mV) and the encapsulation efficiency obtained was 74%. The intracellular distribution of NPs as well as their uptake by tissues was monitored by using laser confocal microscopy and transmission electron microscopy. The use of benzopsoralen in association with ultraviolet light (360 nm) revealed morphological characteristics of cell damage such as cytosolic vesiculation, mitochondria condensation, and swelling of both the granular endoplasmic reticulum and the nuclear membrane. The primary target of DDS and drugs in vascular system are endothelial cells and an attractive strategy for modifying vascular function in various pathological states of skin disorders, cancer and inflammation. The result presented in this work indicates that PLGA NP could be a promising delivery system for benzopsoralen in connection with ultraviolet irradiation therapy (PUVA) for further application in different therapies.CNPq , CAPES, FAPESP (Braisl

Reduced levels of circulating progenitor cells in juvenile idiopathic arthritis are counteracted by anti TNF-α therapy

Abstract Background: Endothelial progenitor cells (EPC) promote angiogenesis and vascular repair. Though reduced EPC levels have been shown in rheumatoid arthritis, no study has so far evaluated EPCs in children with juvenile idiopathic arthritis (JIA). We aimed to study circulating EPCs in children with JIA, their relation to disease activity, and effects of anti TNF-α treatment. Methods: Circulating EPCs were quantified by flow cytometry based on CD34, CD133 and KDR expression in peripheral blood of 22 patients with oligoarticular JIA and 29 age-matched controls. EPCs were re-assessed in children with methotrexate-resistant oligo-extended JIA before and up to 12 month after initiation of anti-TNF-alpha therapy. Plasma concentrations of inflammatory and EPC-regulating factors were measured using a multiplex array. Confocal immunofluorescence was used to demonstrate EPCs in synovial tissues. Results: Children with active JIA showed a significant reduction of relative and absolute counts of circulating progenitor cells and EPCs compared to age-matched healthy controls. CD34+ cell levels were modestly and inversely correlated to disease activity. A strong inverse correlation was found between serum TNF-α and EPC levels. In 8 patients treated with anti TNF-α agents, the number of EPCs rose to values similar to healthy controls. CD34+KDR+ EPCs were found in the synovial tissue of JIA children, but not in control. Conclusions: Children with JIA have reduced levels of the vasculoprotective and proangiogenic EPCs. While EPCs may contribute to synovial tissue remodelling, EPC pauperization may indicate an excess cardiovascular risk if projected later in life