Normal-pressure hydrocephalus: evaluation of five-year experience and literature review

Hidrocefalia com pressão normal (HPN) é uma síndrome caracterizada por apraxia de marcha, demência e incontinência urinária, sendo uma das causas tratáveis de demência. O presente estudo avaliou os dados clínicos, laboratoriais e o tratamento dos pacientes com HPN,atendidos no período de 1992 a 1997, no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. A hipótese diagnóstica de HPN foi feita em 56 casos, tendo sido confirmada em 30. Distúrbios motores foram verificados em 100% dos casos, alterações cognitivas em 83,3% e distúrbios esfincterianos em 63,3%. A tríade ocorreu em 53,3% dos casos. A tomografia computadorizada mostrou hidrocefalia em 96,7% dos pacientes, sendo que, em 40%, havia evidência ainda de isquemia cerebral. Os pacientes foram submetidos a dois tipos de tratamento: punções liquóricas de repetição e instalação de derivação liquórica. No primeiro caso, observou-se melhora em 53,3%. Já, no caso da instalação de derivação liquórica, observou-se melhora em 63,1%. Conclui-se que HPN é uma síndrome que não pode ser considerada incomum, devendo, sempre, ser lembrada como diagnóstico diferencial de demências e distúrbios de marcha do idoso, por tratar-se de patologia potencialmente tratável.Normal-pressure hydrocephalus (NPH) is characterized by the clinical triad of gait apraxia, dementia and urinary incontinence, being one of the reversible causes of dementia. The present study evaluated clinical and laboratory data and the patients’ treatment with this disease assisted from 1992 to 1997 in the University Hospital of Ribeirão Preto. The hypothesis of NPH was made in 56 cases, having been confirmed in 30. Disturbances of the motor’s function were verified in 100% of the cases, cognitive alterations in 83,3% and sphincter disorders in 63,3%. The triad was seen in 53,3% of the cases. CT scan showed hydrocephalus in 96,7% of the patients, and in 40% there was still evidence of ischaemic disorders. Patients were submitted to two kinds of treatment: sucessive spinal fluid drainage or ventricular shunts. In the first case improvement was observed in 53,3%, against 63,1% in shunting cases. In conclusion, NPH is a syndrome that is not uncommon, and should always be reminded as a differential diagnosis of dementia and gait disturbances, being a potentially treatable disease

Differential protein folding and chemical changes in lung tissues exposed to asbestos or particulates

Environmental and occupational inhalants may induce a large number of pulmonary diseases, with asbestos exposure being the most risky. The mechanisms are clearly related to chemical composition and physical and surface properties of materials. A combination of X-ray fluorescence (\u3bcXRF) and Fourier Transform InfraRed (\u3bcFTIR) microscopy was used to chemically characterize and compare asbestos bodies versus environmental particulates (anthracosis) in lung tissues from asbestos exposed and control patients. \u3bcXRF analyses revealed heterogeneously aggregated particles in the anthracotic structures, containing mainly Si, K, Al and Fe. Both asbestos and particulates alter lung iron homeostasis, with a more marked effect in asbestos exposure. \u3bcFTIR analyses revealed abundant proteins on asbestos bodies but not on anthracotic particles. Most importantly, the analyses demonstrated that the asbestos coating proteins contain high levels of \u3b2-sheet structures. The occurrence of conformational changes in the proteic component of the asbestos coating provides new insights into long-term asbestos effects

An unusual initial presentation of mantle cell lymphoma arising from the lymphoid stroma of warthin tumor

BACKGROUND: Warthin tumors presenting concomitantly with a lymphoma is vanishingly rare with only 15 reported cases in English literature. Herein, we report an unusual initial presentation of a mantle cell lymphoma involving the lymphoid stroma of a Warthin tumor. CASE PRESENTATION: A seventy-seven year old otherwise healthy gentleman with a 50-pack year smoking history presents with a slowly enlarging left cheek mass. CT scan of the neck demonstrated a left parotid gland tumor measuring 3.4 cm in greatest dimension. He underwent a left superficial parotidectomy, with subsequent histopathologic examination revealing a Warthin tumor with extensive expansion of the lymphoid stroma. Flow cytometric, immunohistochemical, and cytogenetic studies of the stromal component of the tumor confirmed the presence of a mantle cell lymphoma. Clinical staging demonstrated stage IVa disease, and was considered to be at low to intermediate risk due to the slow growth of the parotid lesion. The patient is undergoing close follow up with repeat PET-CT scans at six months. CONCLUSION: To the best of our knowledge, this is the first well documented collision tumor between mantle cell lymphoma and a Warthin tumor. This case also brings to light the significance of thorough evaluation of the lymphoid component of Warthin tumor

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

Reperti istopatologici oculari in corso di morbo di Addison.

ANNALI DI OTTALMOLOGIA E DI CLINICA OCULISTICA (PARMA