Balo's concentric sclerosis – case report

Objetivos: O caso descrito a seguir busca incentivar a suspeição do médico frente a um provável diagnóstico de Esclerose Concêntrica de Baló (ECB). Métodos:Relato de caso associado à revisão da literatura científica a partir artigos publicados sobre o tema. Resultados: Há grande dificuldade na determinação da etiopatologia da ECB, já que há amplas áreas de desmielinização do sistema nervoso central (SNC) que  podem ser observadas em várias doenças neurológicas. A RNM faz grande suspeição diagnóstica, mas a confirmação só é realmente obtida através de biópsia cerebral. O tratamento consiste no uso de esteróides em doses altas com neuroimagem seriada de controle. Discussão: Uma vez determinada a natureza inflamatória da lesão, a dificuldade de determinar sua etiopatologia reside no fato de que amplas áreas de desmielinizaçãodo sistema nervoso central (SNC) podem ser observadas em várias doenças neurológicas.Clinicamente os pacientes com esclerose concêntrica de Balo se apresentam com sintomas agudos ou subagudos, sugerindo lesão expansiva encefálica. A doença tem um curso imprevisível, que varia de uma rápida evolução em semanas ou meses sem remissão até uma condição autolimitada que incluem vários sintomas cognitivos como cefaléia, afasia, distúrbios de comportamento, disfunção visual e ataxia.Goals: The case described forward search to motivate the medical suspicionin front of a probable diagnose of Balo’s Concentric Sclerosis (BCS) establishing a routine diagnostic. Methods: Case report with cientific review of articles published about the subject. Results: It is really difficult to determine the BCS’s etiology-fisiopathology because of the difuse demyelinating’s areas of the central nervous system (CNS) that are seen in a variety of CNS’s diseases. Magnetic resonance (MR) is very important to the diagnosis of BCS, but the diagnosis’s key is the brain biopsy. The therapy consists of high dose of steroidals being controled by magnetic resonance imaging. Discussion: Once the inflammatory demyelinating nature of the lesion has been established, the difficulty of determination ethiopathology as wide areas of demielynation of the central nervous system can be observed in several neurological diseases. On practice, the BCS’s patients show acute or sub-acute symptoms that suggest expansive brain injury. The disease has an unlikely course, that goes to a quickly evolution in weeks or months without remission until a self-limiting that includes several cognitive symptoms like headaches, aphasia, behavioral disturbance, visual dysfunction and ataxia

Open vs. endovascular repair of abdominal aortic aneurysm: a comparative analysis

Context:Abdominal aortic aneurysm (AAA) is a condition that is usually asymptomatic, but potentially fatal, and has a prevalence in men over 60 years old ranging from 4.3% to 8%. There are two treatment options available: open surgery (OS) and endovascular treatment (ET).Objective:To compare the results of repairs conducted using these two treatment methods from 2008 to 2013 in a tertiary hospital.Methods:A retrospective analysis comparing 119 patients treated with OS and 219 patients who underwent ET for AAA repair.Results:The ET group was older (71.3 vs. 68.2 years; p<0.001) and had a higher rate of coronary disease (44.7% vs. 27.7%; p=0.002) and a lower ejection fraction (57.6% vs. 64.3%; p<0.001); in turn, the OS group had more chronic obstructive pulmonary disease (16.0% vs. 5.9%; p=0.004) and a smaller proximal infrarenal neck (15.5 mm vs. 23.0 mm; p<0.001). However, there was no difference in ASA classification (American Society of Anesthesiology) (p=0.36). The ET group had less intraoperative bleeding (171 mL vs. 729 mL; p<0.001) and required fewer blood transfusions (11.9% vs. 73.1% p<0.001), and spent shorter stays in both ICU (2.4 vs. 3.5 days; p=0.002) and hospital (5.8 vs. 10.3 days; p<0.001). Thirty-day mortality was similar (OS 5.0% vs. ET 4.1%; p=0.78) and there was also no difference in postoperative complications. The average cost of ET was higher (R$34,277.76 vs. R$4,778.60; p<0.001).Conclusions:Rates of morbidity and mortality were similar, although ET was associated with less bleeding, fewer transfusions and shorter hospital stays, but was more expensive

Relationships between severity of signs and symptoms and quality of life in patients with chronic venous disease

BACKGROUND: Chronic venous disease (CVD) is progressive and has a high prevalence in the economically active population. Its impact on the quality of life of affected individuals is poorly understood. OBJECTIVE: To test for correlations between the CEAP classification of CVD severity and CVD symptoms and quality of life of affected individuals. METHODS: We investigated 91 lower limbs in 59 patients with CVD (CEAP C1- C6). Patients were assessed with a Visual Analogue Pain Scale (VAPS), the Venous Clinical Severity Score (VCSS) and the SF-36 quality-of-life questionnaire. Spearman correlation coefficients were calculated. RESULTS: There were positive correlations between the CEAP classification and scores for VAPS (0.815, p <0.000), VCSS (0.937, p <0.000), and SF-36 in the dimensions Physical Functioning: -0.791, p <0.000; Role Physical: -0.839; p <0.000; Bodily Pain: -0.684; General Health: -0.617, p <0.000; Role Emotional: -0.691, p <0.000). There was no correlation with Vitality: -0.003, p=0.979; Role Social: -0.188, p=0.740 or Mental Health: -0.085, p=0.421. CONCLUSIONS: There were positive correlations between CEAP and both VAPS and VCSS. Chronic Venous Insufficiency progressively affects quality of life (SF-36). Physical and emotional aspects are more severe at later stages of CVD. Vitality, Mental Health and Role Social can be negatively impacted from the early stages of the disease