RESUMO
Brain death results in the breakdown of effective central regulatory mechanisms of cardiocirculatory stability, even in patients with artificial mechanical ventilation, correction of electrolytic and acid-basic disorders and maximal conventional pharmacological support of the circulation. Recent evidences have shown that the fall of vasopressin levels in the blood circulation significantly influences the cardiocirculatory stability of patients with brain death, and its exogenous administration is defended by many authors for the management of multiorgan donor patients. In this brief review we analyse and discuss some experimental and clinical relevant studies about the role of vasopressin in the control of cardiocirculatory stability in brain death, and its potential usefulness in the management of multiorgan donor. We conclude that the role of vasopressin in the pathophysiology of brain death and its usefulness as a pharmacological agent in the management of multiorgan donor are not well elucidated, deserving further investigations.
Assuntos
Morte Encefálica/fisiopatologia , Circulação Coronária/efeitos dos fármacos , Vasoconstritores/farmacologia , Vasopressinas/farmacologia , Hemodinâmica/efeitos dos fármacos , Humanos , Doadores de TecidosRESUMO
Pilonidal cysts and sinuses are described as dermoid cysts which contain follicles of hairs and sebaceous glands. They clinically present as a classic case of inflammation which comes with pain, local infection and redness. The origin of pilonidal disease remains controverse. There are many hypothesis as lack of hygiene on the affected area and a penetration and growth of a hair in the subcutaneous tissue caused by constant friction or direct trauma on the damaged area. The option for clinical treatment is very frequent. However, taking into consideration the incidence and the possibility of recidive, surgical treatment is presently recommended. Complications include cellulitis and abscess formation. Pilonidal cysts are mostly found on the sacral region. In the literature is found description of pilonidal cysts on the penis, interdigital region on the hands as well as on the cervical region. We present a case of pilonidal cyst located on the vault biparietal region, without malignant degeneration.
Assuntos
Neoplasias Encefálicas/diagnóstico , Cisto Dermoide/diagnóstico , Seio Pilonidal/diagnóstico , Crânio , Adulto , Neoplasias Encefálicas/complicações , Cisto Dermoide/complicações , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Seio Pilonidal/etiologiaRESUMO
We report a case of neurocryptococcosis which is unique in the literature because the patient had a pseudocystic form of the disease during pregnancy and without any evidence of AIDS. The clinical picture was that of intracranial hypertension and the epidemiological background was highly suggestive of cysticercosis. CT showed multiple round hypodense lesions in the basal ganglia and cerebellum, without contrast enhancement. Since a scolex was not visible, the diagnosis of neurocysticercosis was considered probable. CSF examination was not performed in view of its high risk. The patient had progressive downhill course. Autopsy disclosed multiple gelatinous pseudocysts in the cerebral and cerebellar gray matter, containing abundant Cryptococcus neoformans. Meningeal involvement was minimal. The child was delivered by caesarean section and was free of infection, but died later of hyaline membrane disease. The neuroimaging appearances of this rare instance of the pseudocystic form of neurocryptococcosis mimicked closely neurocysticercosis and only postmortem examination allowed correct diagnosis. The pseudocystic form has so far only been reported in AIDS.
Assuntos
Criptococose/complicações , Cryptococcus neoformans , Neurocisticercose/complicações , Complicações Infecciosas na Gravidez , Adulto , Gânglios da Base/microbiologia , Gânglios da Base/parasitologia , Gânglios da Base/patologia , Criptococose/microbiologia , Criptococose/patologia , Cryptococcus neoformans/isolamento & purificação , Evolução Fatal , Feminino , Humanos , Neurocisticercose/patologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/patologia , Complicações Parasitárias na Gravidez/parasitologia , Complicações Parasitárias na Gravidez/patologia , Tomografia Computadorizada por Raios XRESUMO
Olanzapine, an atypical antipsychotic drug, was administered to a patient with Huntington's disease (HD) with marked choreiform movements. Brain SPECT with 99mTc-HMPAO was performed before and after treatment. Brain SPECT imaging has been performed in patients with HD in order to determine the status of basal ganglia perfusion. The use of brain SPECT with 99mTc-HMPAO before and after treatment in patients with HD has not been yet reported. The marked hypoperfusion of the basal ganglia on brain SPECT performed before therapy with olanzapine improved significantly after treatment.
Assuntos
Antipsicóticos/uso terapêutico , Encéfalo/diagnóstico por imagem , Doença de Huntington/tratamento farmacológico , Pirenzepina/análogos & derivados , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Benzodiazepinas , Feminino , Humanos , Doença de Huntington/diagnóstico por imagem , Olanzapina , Pirenzepina/uso terapêutico , Compostos Radiofarmacêuticos , Tecnécio Tc 99m ExametazimaRESUMO
The authors report the case of a 50-day-old baby who was brought to the Pediatric Emergency Room of the "Hospital de Clinicas da UNICAMP" with seizures. At the examination she presented without external signs of trauma, hypoactive and with generalized seizures. Numerous hemorrhages were found in the ocular fundi. CT scan showed interhemisferic hemorrhage and brain swelling. The child was admitted to the Pediatric Intensive Care Unit, kept under controlled ventilation and hydantal. Although these measures, she died three days later. Since the beginning there was suspicion of child abuse. One day after the admission the father told that he had shaken the baby because she was crying too much. The present paper discuss social and epidemiological aspects, and about the difficulties in the diagnosis of this syndrome that sometimes may be fatal, as in this case.
Assuntos
Lesões Encefálicas , Maus-Tratos Infantis/diagnóstico , Lesões Encefálicas/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Lactente , Tomografia Computadorizada por Raios XRESUMO
Report of an early case of Shy-Drager syndrome in a 67 year-old woman patient. Autonomic failure was diagnosed by functional evaluation as well as laboratory tests. MR imaging disclosed a prominent putamina hypodensity in T2-weighted images at high field strength due to iron increased depositing in this basal ganglia. MR imaging evidences confirm Shy-Drager syndrome diagnosis, and contributes for differential diagnosis of idiopathic hypotension (pure autonomic failure) in special in SDS early cases.
Assuntos
Gânglios da Base/metabolismo , Ferro/metabolismo , Imageamento por Ressonância Magnética , Síndrome de Shy-Drager/diagnóstico , Idoso , Pressão Sanguínea , Feminino , Frequência Cardíaca , Humanos , Síndrome de Shy-Drager/fisiopatologiaRESUMO
Two patients, a 40-year-old woman and a 75-year-old man, were investigated due to a chronic polyneuritis. Amiodarone was used by them to treat refractory cardiac arrhythmia since 4 and 6 years before, respectively. The EMG study showed an axonal neuropathy. The light and electron-microscopical study of sural nerve displayed a loss of large myelinated fibers and a marked reduction of unmyelinated axons, associated with osmiophilic lamellated inclusions in Schwann cells and endothelial venulae. The interruption of amiodarone therapy improved neuropathy. Considered together with similar reports in perhexiline neuropathy and with chloroquine induced neuropathy this would stress the importance of these new drug-induced neurolipidosis.
Assuntos
Amiodarona/efeitos adversos , Polineuropatias/induzido quimicamente , Nervos Espinhais , Nervo Sural , Adulto , Idoso , Amiodarona/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Axônios/ultraestrutura , Biópsia , Feminino , Humanos , Metabolismo dos Lipídeos , Masculino , Polineuropatias/patologiaRESUMO
Dois pacientes, uma mulher de 40 anos e um homem de 75 anos, apresentavam polineurite sensitivo-motora, cujo único antecedentes era o uso de amiodarona há 4 e 6 anos respectivamente. O ENMG revelou quadro neuropático tipo axonal. A biópsia do nervo sural mostrou rarefaçäo axonal, mielínica e amielínica, bem como inclusöes lamelares osmiofílicas nas células de Schwann e no endotélio venular. Com a retirada da amiodarona houve regressäo da polineurite. A semelhança do que foi descrito na neuropatia pelo maleato de perhexiline e pela cloroquina, a amiodarona constitui constitui importante fator de induçäo de neurolipidose medicamentosa
Assuntos
Adulto , Idoso , Humanos , Masculino , Feminino , Amiodarona/efeitos adversos , Neurite (Inflamação)/induzido quimicamente , Amiodarona/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Axônios/ultraestrutura , Lipídeos/metabolismo , Nervo Sural/patologiaRESUMO
Three patients were investigated due to neurological symptoms induced by amiodarone used to treat refractory cardiac arrhythmia. Chronic polineuritis was found in two and dyskinesia in one. The light and electromicroscopical studies (cases 1 and 2) of a N. Suralis (neuropathic cases) display a loss of large myelinated fibers and marked reduced unmyelinated axons associated with osmiophilic inclusions in Schwann cells and endothelial venulae. The EEG was abnormal in the case of dyskinesia (n.3). The interruption of amiodarone improved the neurological symptoms.
Assuntos
Amiodarona/efeitos adversos , Discinesia Induzida por Medicamentos/etiologia , Polineuropatias/induzido quimicamente , Adulto , Idoso , Sistema Nervoso Central/efeitos dos fármacos , Eletroencefalografia , Feminino , Humanos , Masculino , Nervos Periféricos/efeitos dos fármacos , Nervo Sural/patologiaRESUMO
Os autores avaliaram o poder discriminativo do Teste de Bender no psicodiagnostico da epilepsia. Foram estudados 60 pacientes 30 epilepticos (11 com epilepsia focal com ou sem generalizacao secundaria, 11 com epilepsia primariamente generalizada e oito com epilepsia tardia) e 30 pacientes com patologias funcionais, 12 dos quais apresentam um quadro de psicose. Os dados neurologicos clinicos eram complementados pelo exame EEG. O indice de concordancia media do Teste de Bender com as provas neurologicas e de 80%, correpondendo a 90% no grupo de epilepticos e a 70% no grupo de nao-organicos.O estudo e exploratorio tendo em vista as limitacoes inerentes aos tipos de provas empregadas, em particular no que se refere a epilepsia.No entanto os resultados sao promissores no que se refere a avaliacao da epilepsia tanto para fins clinicos como para fins de pesquisa