Asunto(s)
Péptidos beta-Amiloides/metabolismo , Amiloidosis/metabolismo , Apoptosis , Traumatismos Craneocerebrales/metabolismo , Amiloidosis/etiología , Amiloidosis/genética , Amiloidosis/patología , Apolipoproteínas E/genética , Encéfalo/metabolismo , Encéfalo/patología , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/patología , Humanos , Neuronas/metabolismo , Neuronas/patología , Polimorfismo GenéticoRESUMEN
The authors analyze the clinical and morphological manifestations of brain hemorrhages occurring in craniocerebral injuries in various periods after the trauma. Specific features in the diagnosis of various types of hemispheric and stem hemorrhages, quantitative parameters (involvement indexes), and the fundamentals of expert evaluation are presented, based on the comprehensive topographic and anatomical, pathomorphological, morphometric, statistical, and other studies.
Asunto(s)
Lesiones Encefálicas/patología , Hemorragia Cerebral/patología , Fracturas Craneales/patología , Heridas no Penetrantes/patología , Heridas Penetrantes/patología , Adolescente , Adulto , Anciano , Autopsia , Encéfalo/patología , Hemorragia Cerebral/clasificación , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
Fifty three consecutive patients with Cushing's disease were operated on in the Neurosurgical Institute from 1987 to 1995. In all cases the diagnosis was based on clinical and laboratory data, as well as radiographic images. Ten patients with false-negative CT scans had MRI confirming the presence of microadenomas less than 5 mm in size. The majority of patients (n = 51) were operated via transsphenoidal approach, transcranial route was utilized in 2 cases. Among the pathological findings, corticotropinomas were revealed in 49 cases, 4 patients were considered to have hyperplasia of the anterior pituitary without well demarcated adenoma. All patients were divided into 2 groups based on the history of previous treatment. Group 1 included 37 primary patients who had not been treated before admission. Group 2 included 16 patients treated surgically (e.g. neurosurgical operations, bilateral/unilateral adrenalectomy), or with irradiation therapy, including proton beam irradiation prior to admission. We came to conclusion that the following principles were essential in the management of Cushing's disease. 1. Properly interpreted clinical signs and symptoms along with biochemical data and radiographic imaging (including MRI) are extremely helpful in the preoperative evaluation of such patients. Our approach helped us reveal corticotropinomas with 98% accuracy. 2. Microsurgical removal was proved to be effective in up to 83% of patients, which was demonstrated by clinical and biochemical remission. 3. It should be emphasized that the results of treatment were significantly better in the first group versus the second one. In group 1, remission was reached in 91.1% of patients as compared to 62.5% in Group 2. 4. In primary patients, the trauma associated with surgical procedure is less and tumors demonstrate a less aggressive biological behavior.
Asunto(s)
Síndrome de Cushing/cirugía , Procedimientos Neuroquirúrgicos , Adenoma/diagnóstico , Adenoma/cirugía , Adolescente , Adulto , Enfermedad Crónica , Síndrome de Cushing/diagnóstico , Femenino , Humanos , Masculino , Microcirugia , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugía , Inducción de RemisiónAsunto(s)
Neoplasias Hipofisarias/metabolismo , Neoplasias Hipofisarias/patología , Prolactinoma/metabolismo , Prolactinoma/patología , Hormona del Crecimiento/metabolismo , Humanos , Prolactina/metabolismo , Somatostatina/fisiología , Hormona Liberadora de Tirotropina/fisiología , Células Tumorales CultivadasRESUMEN
The authors' material was based on the analysis of 49 patients with primary gliomas of the lateral ventricles and transparent septum who were treated from 1988 to 1992. The main method of patients' selection was to analyze clinical and topographic data obtained from computed and magnetic resonance tomographic studies. In 39 (79.6%) cases, the tumors were found in the cavity of the lateral ventricles, in 10 (20.4%) cases there was a partial paraventricular growth when the bulk of the tumors was located in the lumen of the lateral ventricles. Out of the 49 patients examined, 46 (93.3%) were operated on, while 3 (6.1%) patients were found inoperable. In 37 (80.4%) cases, an external ventricular drain was set at the end of an operation. The operative material was histologically studied in 46 cases. Following the operation, 24 (52.2%) patients underwent split fractional radiation therapy with a total focal dose of 60 Gy. The postoperative mortality was 15.2%. The follow-up of patients was from 1 to 4 years. The combined treatment of patients substantially prolonged the relapseless period of the disease. At the same time, the postoperative longevity of patients with malignant gliomas of the lateral ventricles and transparent septum becomes similar to that of the relapseless period in patients with low-grade gliomas untreated with radiation rays.
Asunto(s)
Neoplasias del Ventrículo Cerebral/cirugía , Glioma/cirugía , Tabique Pelúcido , Adolescente , Adulto , Anciano , Neoplasias del Ventrículo Cerebral/diagnóstico , Enfermedad Crónica , Terapia Combinada , Femenino , Glioma/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , RadioterapiaRESUMEN
The authors characterize the principal pathomorphologic signs of diffuse axonal injuries. They present expert evaluation and discuss the criteria of forensic medical diagnosis of this type of cerebral injuries.
Asunto(s)
Axones/patología , Lesiones Encefálicas/patología , Encéfalo/patología , Traumatismos Craneocerebrales/patología , Animales , Fenómenos Biomecánicos , Humanos , Factores de TiempoRESUMEN
The article analyses 160 cases of fatal craniocerebral trauma encountered in the practice of the Burdenko Research Institute, AMS USSR, in 1980-1989. The results of the author's personal research and the literature data bear evidence of the different means of restoration of the functions of the central nervous system in localized and diffuse axonal brain damage. Reparative processes in the neurons of the pericontusion zone may provide compensatory changes. Compensation of disturbed functions of the central nervous system in diffuse axonal trauma is determined to a certain extent by the regenerative possibilities of partly damaged axons.
Asunto(s)
Adaptación Fisiológica , Lesiones Encefálicas/fisiopatología , Sistema Nervioso Central/fisiopatología , Heridas no Penetrantes/fisiopatología , Axones/patología , Encéfalo/fisiopatología , Humanos , Necrosis , Regeneración Nerviosa , Neuronas/patologíaRESUMEN
CT-stereotaxic biopsy is a modern method for the diagnosis of intracranial tumors. The histological diagnosis established by means of it makes it possible to choose the most rational tactics of treatment and determine more exactly the indications and contraindications for the operation. The examination was conducted on 219 patients with various brain tumors. Authentic histological information was obtained in 84% of cases, 4 patients died, a stable neurological defect developed in another 2 patients. Some methodical procedures for increasing the informativeness and reducing the risk of complications are discussed. An important component is rapid examination of part of the bioptic material by means of smears for intraoperative appraisal of its representativeness and correction of biopsy targets. Among 73 cases in which smears were examined only in 9 the findings were in disagreement with the data of the traditional histologic study, only in the degree of tumor differentiation in all of them. Stereotaxic biopsy is most expedient in situations in which the tactics and main method of treatment are determined to a greater degree by the histological structure rather than by the localization and the patient's general condition. Such cases account for one fourth of all cases of intracerebral tumors.
Asunto(s)
Neoplasias Encefálicas/patología , Técnicas Estereotáxicas , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Biopsia con Aguja/métodos , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Neoplasias Encefálicas/diagnóstico por imagen , Niño , Preescolar , Humanos , Persona de Mediana EdadRESUMEN
On the basis of complex clinical, computed tomographic, catamnestic, and pathomorphological examination of 336 patients with severe cerebrocranial injury the authors substantiate the need to distinguish, along with localized contusions and intracranial hematomas, diffuse axonal injuries of the brain whose biomechanics and pathogenesis are linked with trauma of angular or rotational acceleration-deceleration. The clinical manifestations and the course of diffuse axonal injuries are characterized by protracted coma occurring immediately after the injury with marked disorders of stem functions, postural motor reactions, slow recovery from coma, with the formation of a stable or transitory vegetative state, the development of syndromes of disconnection of the cerebral hemispheres and the brain stem, and severe invalidization of the patients due to mental and neurological deficits.
Asunto(s)
Axones/patología , Lesiones Encefálicas/diagnóstico por imagen , Enfermedad Aguda , Adolescente , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Lesiones Encefálicas/mortalidad , Lesiones Encefálicas/patología , Niño , Preescolar , Coma/diagnóstico por imagen , Coma/mortalidad , Coma/patología , Femenino , Fracturas Cerradas/diagnóstico por imagen , Fracturas Cerradas/mortalidad , Fracturas Cerradas/patología , Fracturas Abiertas/diagnóstico por imagen , Fracturas Abiertas/mortalidad , Fracturas Abiertas/patología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Fracturas Craneales/diagnóstico por imagen , Fracturas Craneales/mortalidad , Fracturas Craneales/patología , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Based on an analysis of 56 cases with diffuse axonal lesions the authors describe symptoms of dissociation of the brain hemispheres and brain stem. Such symptoms occur on transformation of long coma to a steady or transitory vegetative state and are characterized by chaotic activation of the subcortical and stem formations remaining intact and dynamic manifestation of a complex of postural and generalized motor reactions, complex pathological reflexes, oral, oculomotor, pupillary and cerebrospinal automatisms, paroxysmal vegeto-visceral abnormalities along with functional silence of the cortex.
Asunto(s)
Lesiones Encefálicas/complicaciones , Coma/complicaciones , Epilepsia/etiología , Adolescente , Adulto , Tronco Encefálico/lesiones , Niño , Preescolar , Epilepsia/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
The paper presents the results of morphological study of 668 cases of adenomas of the hypophysis on the basis of light optical and electron microscopy techniques, immunohistochemical analysis and a number of other methods. Correlation between cellular, tissue and hormonal characterization of adenomas and their capacity for invasive, infiltrative growth and relapses have been studied.
Asunto(s)
Adenoma/patología , Neoplasias Hipofisarias/patología , Adenoma/metabolismo , Autorradiografía , Citofotometría , Humanos , Inmunohistoquímica , Microscopía Electrónica , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Hormonas Hipofisarias/metabolismo , Neoplasias Hipofisarias/metabolismo , PloidiasRESUMEN
An antigen immunologically related to chordin was identified in white and gray matter of large hemispheres of human brain as well as in one of glial tumours. It was shown that human and rabbit brain extract components cross-react with eight monoclonal antibodies directed against chordin-specific epitopes of P-group. Exhaustive proteolysis of giant sturgeon notochord and human brain extracts resulted in fragments interacting with anti-chordin antibodies and eluted in an equal volume during chromatography on TSK HW-40 gel. At the same time, gel electrophoresis performed under denaturing conditions revealed that the mobility of chordin subunits strikingly differs from that of brain antigen immunologically related to chordin. Thus, the cross-reactivity of antichordin antibodies with the human brain extract component is due to the presence in this antigen of a P-type determinant which, after exhaustive proteolysis of both antigens, is detected in structures (presumably, glycopeptides) having an identical molecular mass.
Asunto(s)
Encéfalo/inmunología , Epítopos/análisis , Glicoproteínas/inmunología , Péptidos y Proteínas de Señalización Intercelular , Animales , Anticuerpos Monoclonales , Neoplasias Encefálicas/inmunología , Cromatografía en Gel , Humanos , Hidrólisis , Neuroglía/inmunología , Pronasa/metabolismo , Conejos , RadioinmunoensayoAsunto(s)
Cisticercosis/diagnóstico , Meningoencefalitis/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
The most informative neurological symptoms allowing the differentiation of 7 phases of consciousness disorders have been identified on the basis of clinico-physiological correlations and mathematical processing. In the first phase of coma the patient cannot be waken up. Addition of muscle atonia characterizes the transfer to the second phase of coma and of bilateral mydriasis indicates the transfer to the third phase. Eye opening in response to sound or pain points to awakening and transfer to the phase of apallitic syndrome. The performance of simple instructions is characteristic of the phase of deep stupor. Responses to questions characterize stupor, and recovery of orientation in the environment indicates clear consciousness.
Asunto(s)
Coma/diagnóstico , Encéfalo/patología , Lesiones Encefálicas/complicaciones , Coma/etiología , Coma/patología , Hematoma Epidural Craneal/complicaciones , Hematoma Subdural/complicaciones , Humanos , Examen Neurológico , Pronóstico , Reflejo Anormal , Fracturas Craneales/complicacionesRESUMEN
The authors analyse the results of computed tomography (CT) and the operative findings in 107 patients with metastatic tumors of the brain. The computer-tomographic image was studied in comparison with the size, macro- and microscopic structure of the removed metastases and in 15 cases of metastases discovered on autopsy. The results showed that CT makes it possible to determine the number, size, and location of the metastases, the attendant edema of the cerebral tissue, and the developmental stage of the tumorous node. With consideration for the duration of metastasis growth, these data, in a relatively favourable somatic condition of the patient, enable one to determine the indications for removing a solitary as well as one or two neurologically "resounding" tumorous nodes in multiple metastases if the others are in the subclinical stage of development.
Asunto(s)
Neoplasias Encefálicas/secundario , Adolescente , Adulto , Anciano , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Neoplasias de la Mama/cirugía , Femenino , Humanos , Neoplasias Renales/cirugía , Neoplasias Pulmonares/cirugía , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Neoplasias Cutáneas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Comprehensive examination of 24 patients suffering from adenoma of the hypophysis revealed no correlation between the characteristics of computer tomography (the size and density of the tumor, etc) and the level of blood prolactin. Hyperprolactinemia may be encountered both in hormonal active (prolactin secreting) and in hormonal inactive adenoma of the hypophysis.
Asunto(s)
Neoplasias Hipofisarias/metabolismo , Prolactina/metabolismo , Adolescente , Adulto , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Neoplasias Hipofisarias/diagnóstico por imagen , Prolactina/sangre , Tomografía Computarizada por Rayos XRESUMEN
Direct correlation was found between the results of a radioimmunoassay, electron microscopy and immunohistochemistry in cases of STH-secreting and hormonally inactive hypophyseal adenomas. In hyperprolactinemia and a simultaneous increase in the levels of 2 or more hormones the results of the radioimmunoassay coincided with those of electron microscopy and immunohistochemistry in 50-70% of the cases.