RESUMO
INTRODUCTION AND AIMS: The adenoma detection rate (ADR) is the most important quality indicator for the prevention of colorectal cancer but serrated polyps are also precursor lesions of the disease. The aim of our study was to compare the detection rate of proximal serrated polyps (PSPs) and that of clinically significant serrated polyps (CSSPs) between endoscopists and analyze the relation of those parameters to the ADR. METHODS: An observational, prospective, cross-sectional study was conducted on all patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of July 2015 and August 2016. The ADR and PSP and CSSP detection rates between endoscopists were compared through multivariate logistic regression and the association between those parameters was calculated through the Pearson correlation coefficient. RESULTS: The study included 15 endoscopists and 1,378 colonoscopies. The PSP detection rate ranged from 1.8-17% between endoscopists and had an almost perfect correlation with the CSSP detection rate (p = 0.922), as well as strongly correlating with the ADR (p = 0.769). CONCLUSIONS: There was great variability in the PSP detection rate between endoscopists. It also had an almost perfect correlation with the CSSP detection rate and strongly correlated with the ADR. Those results suggest a high CSSP miss rate at endoscopy and a low PSP detection rate.
Assuntos
Pólipos do Colo , Neoplasias Colorretais , Pólipos do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Estudos Transversais , Humanos , Estudos ProspectivosRESUMO
Resumen La osteoartritis de la articulación temporomandibular (ATM) es un desorden degenerativo de etiología multifactorial, que requiere un manejo interdisciplinario. Se presenta entre el 8% al 16% de la población y está asociada al exceso de carga articular, trauma, factores genéticos, parafunciones y desarreglos internos de la articulación, también se reconoce una alta frecuencia de otalgia refleja y tinnitus en pacientes con desorden degenerativo de la ATM. El uso combinado de tomografía computarizada y resonancia magnética permite observar las variaciones morfológicas en los tejidos duros y blandos de la estructura articular. El tratamiento no invasivo incluye la indicación de férulas de reposicionamiento mandibular, además del uso de antiinflamatorios y preferencia por inhibidores selectivos de la ciclooxigenasa-2 (COX-2). La inyección intraarticular de corticoides disminuye a largo plazo la inflamación de los tejidos articulares y mejora la movilidad, mientras que el ácido hialurónico parece disminuir la fricción en los espacios articulares. Los procedimientos quirúrgicos como artroscopia, condilectomía, artroplastia, reemplazo autógeno de disco o reemplazo total de la articulación deben ser reservados para los casos en donde la intervención no invasiva no muestra mejoría clínica.
Abstract Osteoarthritis of the temporomandibular joint (TMJ) is a degenerative disorder of multifactorial etiology, which requires interdisciplinary management. It occurs between 8% to 16% of the population and is associated with excess joint load, trauma, genetic factors, parafunctions and internal disorders of the joint, a high frequency of reflex otalgia and tinnitus is also recognized in patients with degenerative TMJ disorder. The combined use of computed tomography and magnetic resonance allows to observe the morphological variations in the hard and soft tissues of the joint structure. Non-invasive treatment includes the indication of mandibular repositioning splints, in addition to the use of anti-inflammatory drugs and preference for selective cyclooxygenase-2 inhibitors (COX-2). Intra-articular injection of corticosteroids reduces inflammation of the articular tissues and improves mobility in the long term, while hyaluronic acid seems to decrease friction in the articular spaces. Surgical procedures such as arthroscopy, condylectomy, arthroplasty, autogenous disc replacement, or total joint replacement should be reserved for cases where non-invasive intervention shows no clinical improvement.
RESUMO
INTRODUCTION AND AIMS: The adenoma detection rate (ADR) is the most important quality indicator for the prevention of colorectal cancer but serrated polyps are also precursor lesions of the disease. The aim of our study was to compare the detection rate of proximal serrated polyps (PSPs) and that of clinically significant serrated polyps (CSSPs) between endoscopists and analyze the relation of those parameters to the ADR. METHODS: An observational, prospective, cross-sectional study was conducted on all patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of July 2015 and August 2016. The ADR and PSP and CSSP detection rates between endoscopists were compared through multivariate logistic regression and the association between those parameters was calculated through the Pearson correlation coefficient. RESULTS: The study included 15 endoscopists and 1,378 colonoscopies. The PSP detection rate ranged from 1.8-17% between endoscopists and had an almost perfect correlation with the CSSP detection rate (p = 0.922), as well as strongly correlating with the ADR (p = 0.769). CONCLUSIONS: There was great variability in the PSP detection rate between endoscopists. It also had an almost perfect correlation with the CSSP detection rate and strongly correlated with the ADR. Those results suggest a high CSSP miss rate at endoscopy and a low PSP detection rate.
RESUMO
Resumen Introducción: El divertículo de Meckel (DM) es una anomalía congénita gastrointestinal producto de obliteración incompleta del conducto onfalomesentérico, habitualmente en menores de dos años. Como complicación destaca obstrucción intestinal, intususcepción e inflamación. Caso Clínico: Paciente de sexo masculino, 19 años, sin antecedentes mórbidos. Ingresa a Urgencias por dolor abdominal, 24 h de evolución, que inicia en mesogastrio y luego irradia a fosa ilíaca derecha (FID), intenso, asociado a vómitos, fiebre y taquicardia. Al examen abdominal destaca resistencia muscular, dolor en FID, Blumberg positivo y ruidos hidroaéreos disminuidos. Se realiza laparotomía de McBurney hallándose gran cantidad de líquido libre citrino viscoso y signos de obstrucción de intestino delgado; decidiendo cierre de laparotomía de McBurney y realizar laparotomía media infraumbilical. Se encuentra divertículo de Meckel torcido y estrangulado, con brida hacia raíz del mesenterio de intestino delgado distal. Se realiza resección DM y bridolisis, recuperando vitalidad de asa y apendicectomía profiláctica. Discusión: El diagnóstico preoperatorio del DM es infrecuente y requiere exploración quirúrgica. El DM volvulado es raro, en nuestro caso produjo obstrucción intestinal secundaria a brida entre DM y mesenterio.
Introduction: Meckel's diverticulum is the most frequent gastrointestinal anomaly. It's more frequently seen in children less than 2 years of age. It's caused by the incomplete obliteration of the omphalomesenteric conduct. Case report: 19 year old male patient with no previous medical history presents sudden onset of high intensity abdominal pain, initially located in the periumbilical region, radiating to right lower quadrant associated with emesis, fever and tachycardia. Physical examination showed abdominal guarding, rebound tenderness and decreased bowel sounds. During McBurney laparotomy a large volume of viscous free fluid was found and signs of small bowel obstruction, deciding close McBurney laparotomy and performing sub-umbilical midline laparotomy. Meckel diverticulum is founded, twisted and strangled, with a bridle adhesion to the mesenteric root, compromising the small bowel. The adherence and the MD are resected, obtaining appropriate peristaltic activity and color. Appendectomy and peritoneal lavage are performed without complications. Discussion: preoperatory diagnosis of MD is unfrequented and its need surgical exploration. MD's volvulus is infrequent and in our case, intestinal obstruction it's secondary to an adherence between the volvulated MD and the mesentery.
Assuntos
Humanos , Masculino , Adulto Jovem , Obstrução Intestinal/etiologia , Divertículo Ileal/complicações , Abdome Agudo/etiologia , Obstrução Intestinal/cirurgia , Laparotomia , Divertículo Ileal/cirurgiaRESUMO
OBJECTIVE: This study was conducted to compare the correlation between the Pap smear and colposcopy findings in postmenopausal Mexican women. MATERIAL AND METHODS: Observational, Retroelective, longitudinal, descriptive study, all menopausal women who consulted for pap smears and colposcopy performed was studied. RESULTS: 119 patients were evaluated. 72 % of pap smears were negative to human papilloma virus, 29 (24%) had a low-grade lesion and 4 (4%) had a high-grade lesions. In the colposcopic study: 31 studies (26%) report low-grade intraepithelial lesion and 2 cases (2%) high-grade lesion. The histopathological biopsy reported one invasive cervical cancer (2.43%) and 20 cases of low-grade lesions (48.7%). cytology had a sensitivity of 85.3% and specificity of 56.09% with a false negative rate of 14.3%, a positive predictive value of 66.03 % and a negative predictive value of 79.31%. Colposcopy: sensitivity= 82.92%, specificity = 56.09% with a false negative rate of 17.07% positive predictive value of 65.38% and a negative predictive value of 76.66%. CONCLUSIONS: The correlation between Pap smear and colposcopy shows that the diagnosis of low and high grade lesions differs only by 2%, therefore indicates adequate sensitivity for diagnosis. In this population of women routine gynecological tests most be performed.
Assuntos
Colposcopia/métodos , Teste de Papanicolaou/métodos , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/métodos , Idoso , Idoso de 80 Anos ou mais , Reações Falso-Negativas , Feminino , Humanos , Estudos Longitudinais , México , Pessoa de Meia-Idade , Infecções por Papillomavirus/diagnóstico , Perimenopausa , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Displasia do Colo do Útero/diagnósticoRESUMO
BACKGROUND: Identifying persons at high risk for advanced colorectal neoplasia can aid in the prevention of colon cancer. Previous studies have shown that some patients can present with proximal advanced neoplasia with no distal findings. AIMS: To determine the factors related to advanced neoplasia and advanced proximal colorectal neoplasia in a Latin American population. MATERIAL AND METHODS: A prospective, cross-sectional, observational, analytic study was conducted. It included patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of January and July 2012. Advanced neoplasia was defined as the presence of lesions ≥ 10mm with a villous component, high-grade dysplasia, or carcinoma. The splenic flexure was the limit between the proximal and distal colon. RESULTS: A total of 846 patients were included in the study. Advanced neoplasia was detected in 108 patients (12.8%) and advanced proximal neoplasia in 55 patients (6.7%), 42 (76.4%) of whom had no neoplasia in the distal colon. Factors related to advanced neoplasia found in the multivariate analysis were age, at the intervals of 50-59 (p=0.019), 60-69 (p=0.016), and ≥ 70 years (0.002) and male sex (p=0.003). In the evaluation of advanced proximal neoplasia, the multivariate analysis identified the 60-69 year age interval (p=0.039) and advanced distal neoplasia (p=0.028) as factors related to advanced proximal disease. The ROC curve established the age cut-off point at 60 years for initially performing colonoscopy, rather than sigmoidoscopy. CONCLUSIONS: Age and sex are related to advanced neoplasia, whereas age and advanced distal neoplasia are related to advanced proximal neoplasia.
Assuntos
Adenoma/patologia , Colo/patologia , Neoplasias Colorretais/patologia , Adenoma/diagnóstico por imagem , Adenoma/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colonoscopia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Peru , Estudos Prospectivos , Fatores de Risco , Fatores SexuaisRESUMO
Early degeneration of pedunculopontine nucleus (PPN) is considered part of changes that characterize premotor stages of Parkinson's disease (PD). In this paper, the effects of unilateral neurotoxic lesion of the PPN in motor execution and in the development of oxidative stress events in striatal and nigral tissues in rats were evaluated. The motor performance was assessed using the beam test (BT) and the cylinder test (CT). Nigral and striatal redox balance, was studied by means of biochemical indicators such as malondialdehyde (MDA), nitric oxide (NO) and the catalase enzymatic activity (CAT EA). Lesioned rats showed fine motor dysfunction expressed both as an increase in the length (p<0.001) and deviation (p<0.001) of the traveled path and also in the time spent (p<0.01) in the circular small beam (CBS) (p<0.01) in comparison with control groups. In addition, the lesioned rats group presented a right asymmetry index greater than 0.5 which is consistent with a significant increase in the percentage of use of the right forelimb (ipsilateral to the lesion), compared with the control group (p<0.05). Biochemical studies revealed that after 48-h PPN neurotoxic injury, the CAT EA showed a significant increase in the subtantia nigra pars compacta (SNpc) (p<0.05). This significant increase of CAT EA persisted in the nigral tissue (p<0.001) and reached the striatal tissue (p<0.001) seven days after PPN injury. Also at seven days post-injury PPN, increased concentrations of MDA (p<0.01) and a tendency to decrease in the concentrations of NO in both structures (SNpc and striatum) were found. The events associated with the generation of free radicals at nigral and striatal levels, can be part of the physiological mechanisms underlying motor dysfunction in rats with unilateral PPN neurotoxic lesion.
Assuntos
Corpo Estriado/fisiologia , Atividade Motora/fisiologia , Núcleo Tegmental Pedunculopontino/fisiopatologia , Equilíbrio Postural/fisiologia , Substância Negra/fisiologia , Animais , Catalase/metabolismo , Agonistas de Aminoácidos Excitatórios/toxicidade , Membro Anterior/fisiopatologia , Lateralidade Funcional , Masculino , Malondialdeído/metabolismo , Transtornos dos Movimentos/fisiopatologia , N-Metilaspartato/toxicidade , Óxido Nítrico/metabolismo , Oxirredução , Estresse Oxidativo/fisiologia , Núcleo Tegmental Pedunculopontino/efeitos dos fármacos , Núcleo Tegmental Pedunculopontino/patologia , Ratos WistarRESUMO
Background: Endoscopic argon plasma ablation of Barrett esophagus decreases the risk of future esophageal cancer development. Aim: To assess the endoscopic regression of columnar epithelium and the presence of intestinal metaplasia among patients operated for Barrett esophagus and subjected to argon plasma ablation. Patients and Methods: In 19 patients with extensive Barrett esophagus subjected to a Nissen fundoplication, Barrett esophagus was endoscopically ablated with argon plasma. Patients were assessed 6 and 12 months after surgery to evaluate the regression of columnar epithelium and the presence of intestinal metaplasia. Results: One, two and three ablation sessions were carried out in 10, three and six patients, respectively. Three patients had complications. The initial length of columnar epithelium segment was 52 +/- 15.6 mm and decreased to 22.6 +/- 10.6 mm (p < 0.05). In 12 patients, there was absence of intestinal metaplasia on follow up, in six it persisted (one of them with "buried cells") and in one patient, dysplasia appeared. Conclusions: Endoscopic argon plasma ablation may have a complementary therapeutic role for the regression of columnar epithelium in Barrett esophagus.
Introducción: Pacientes con esófago de Barrett extenso presentan un riesgo de cáncer. De allí surge la posibilidad de someter a estos pacientes a ablación con argón plasma por vía endoscópica para disminuir este riesgo de desarrollar un adenocarcinoma. Objetivo: Evaluar la regresión endoscópica del epitelio columnar y la presencia de metaplasia intestinal en pacientes operados por esófago de Barrett y sometidos a ablación con argón plasma. Material y Método: Se incluyen 19 pacientes en este estudio, todos ellos con esófago de Barrett extenso confirmado por endoscopia e histología, los cuales se someten a ablación con argón plasma por vía endoscópica. Estos pacientes se controlaron con endoscopia e histológicamente a los 6 meses y al año de operados para evaluar la regresión del área con epitelio columnar y precisar la presencia histológica de metaplasia intestinal. Resultados: En 10 pacientes se efectuó 1 sesión de ablación, en 3 pacientes 2 sesiones y en 6 pacientes se efectuó 3 sesiones de ablación. Tres pacientes presentaron complicaciones. El largo de las lengüetas de epitelio columnar inicial fue de 52 +/- 15,6 mm el cual disminuyó a 22,6 +/- 10,6 mm (p < 0,05). El seguimiento histológico reveló ausencia de metaplasia intestinal en 12 pacientes (63,1 por ciento) persistencia de metaplasia en 6 pacientes (1 de ellos con células en submucosa, "buried cells") y un paciente con aparición de displasia. Conclusión: La ablación con argón plasma puede tener un rol en el tratamiento complementario a la cirugía para mejorar la regresión del epitelio columnar y disminuir los riesgos de presentar un adenocarcinoma de Barrett.
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Humanos , Esôfago de Barrett/cirurgia , Esôfago de Barrett/patologia , Fundoplicatura , Fotocoagulação a Laser , Terapia Combinada , Esofagoscopia , Seguimentos , Metaplasia , Complicações Pós-OperatóriasAssuntos
Hérnia Hiatal/complicações , Ruptura Gástrica/etiologia , Volvo Gástrico/etiologia , Idoso , Feminino , HumanosRESUMO
Efforts are currently underway to improve carotenoids content in cassava roots through conventional breeding as a strategy to reduce vitamin A deficiency. However, only few samples can be quantified each day for total carotenoids (TCC) and ß-carotene (TBC) contents, limiting the gains from breeding. A database with >3000 samples was used to evaluate the potential of NIRS and chromameter devices to predict root quality traits. Maximum TTC and TBC were up to 25.5 and 16.6 µg/g (fresh weight basis), respectively. NIRS predictions were highly satisfactory for dry matter content (DMC, R(2): 0.96), TCC (R(2): 0.92) and TBC (R(2): 0.93). NIRS could also distinguish roots with high or low cyanogenic potential (R(2): 0.86). Hunter color parameters could also be used for predictions, but with lower accuracy than NIRS. NIRS or chromameter improve selection protocols, allowing faster gains from breeding. Results also demonstrate that TBC and DMC can be improved simultaneously (required for the adoption of biofortified cassava).
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Carotenoides/química , Cianetos/química , Manihot/química , Raízes de Plantas/química , Espectroscopia de Luz Próxima ao Infravermelho/métodos , beta CarotenoRESUMO
Brain-derived neurotrophic factor (BDNF) concentration was measured in the striatum and cortex after quinolinic acid intrastriatal lesion and transplantation of bone marrow cells (BMSC). The results showed a significant increase of the BDNF levels in the striatum and cortex of the lesioned animals and the ability of the transplanted cells to increase the levels of BDNF in both sites. This recovery of BDNF production and distribution might have beneficial effects and ameliorate the negative consequences of the striatal lesion, a mechanism of potential interest for the treatment of Huntington's disease (HD).
Assuntos
Transplante de Medula Óssea/métodos , Fator Neurotrófico Derivado do Encéfalo/biossíntese , Ácido Quinolínico/toxicidade , Animais , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/metabolismo , Córtex Cerebral/cirurgia , Corpo Estriado/efeitos dos fármacos , Corpo Estriado/metabolismo , Corpo Estriado/cirurgia , Masculino , Ratos , Ratos Sprague-DawleyRESUMO
Cavernous hemangiomas are the most common benign mesenchymal hepatic tumor. Most have a typical appearance, but atypical forms have been reported that can make diagnosis difficult. Objective: To show a case of cystic hemangioma mimicking a hydatid cyst. Case: 60 year old woman with abdominal pain. Abdominal ultrasound: polycystic lesion with parietal calcifications, 6 cm in size, in the left hepatic lobe. Computed tomography of the abdomen shows the lesion as a simple cyst. During conversation the patient revealed she lives with 13 dogs. Hydatid disease was suspected and treatment with albendazole and segmental hepatectomy was indicated. A hemorrhagic tumor biopsy compatible with infarcted hemangioma was obtained. Discussion: The typical hepatic hemangioma is presented in ultrasound as an echogenic mass with posterior acoustic enhancement. The contrasted CT also presents with a classic pattern. Among the atypical presentations the cystic form is extremely rare and has only been mentioned in a few reports.
Hemangioma cavernoso es el tumor hepático mesenquimático benigno más frecuente. La mayoría tiene un aspecto típico, pero se han reportado formas atípicas que pueden dificultar el diagnóstico. Objetivo: Mostrar un caso de hemangioma quístico simulando a un quiste hidatídico. Caso: Mujer de 60 años consulta por dolor abdominal. Ecografía abdominal: lesión poliquística con calcificaciones parietales de 6 cm en el lóbulo hepático izquierdo. Tomografía computada de abdomen muestra la lesión como un quiste simple. Dirigidamente la paciente revela convivir con 13 perros. Se sospechó hidatidosis y se indicó albendazol y hepatectomía segmentaria. Se obtuvo un tumor hemorrágico con biopsia compatible con hemangioma infartado. Discusión: El hemangioma hepático típico se presenta ecográficamente como una masa ecogénica con refuerzo acústico posterior. La TC contrastada también presenta un patrón clásico. Dentro de las presentaciones atípicas la forma quística es extremadamente rara y sólo ha sido mencionada en escasos reportes.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Equinococose Hepática/diagnóstico , Hemangioma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Ultrassonografia , Diagnóstico Diferencial , Tomografia Computadorizada por Raios XRESUMO
El signo de la galaxia representa una lesión tipo masa, compuesta por innumerables nódulos granulomatosos coalescentes, más concentrados en el centro que en la periferia. Inicialmente se describió en paciente con sarcoidosis, y se denominó el signo de la galaxia sarcoidea. Actualmente se sabe que puede estar presente en otras entidades como la tuberculosis, el cáncer pulmonar y la fibrosis pulmonar masiva de las neumoconiosis. Es importante su identificación y adecuada interpretación, dado que en asociación con otros signos tomográficos permite una orientación al diagnóstico de sarcoidosis.
The galaxy sign represents a mass-like lesion, composed of innumerable coalescing granulo-matous nodules, more concentrated in the center than at the periphery. It was initially described in patients with sarcoidosis, and was referred to as the "sarcoid galaxy" sign. It is now known to be present in other entities such as tuberculosis, lung cancer and the pulmonary fibrosis mass of pneumoconiosis. Its identification and adequate interpretation is important, given that in association with other tomographic signs it allows an orientation toward the diagnosis of sarcoidosis.
Assuntos
Humanos , Granuloma , Sarcoidose Pulmonar , Sinais e Sintomas , Tuberculose Pulmonar , Diagnóstico Diferencial , Sarcoidose Pulmonar/patologia , Tuberculose Pulmonar/patologiaRESUMO
Intraocular invasion by Toxocara canis is one of the most commonly recognized etiologies of uveitis and blindness in children. In order to estimate the prevalence of ocular lesions caused by toxocariasis in a pediatric referral hospital, we conducted a retrospective analysis of clinical charts of all children seropositive to Toxocara canis, who also had an eye exam between the years 2005 and 2009 at the Calvo Mackenna Children's Hospital in Santiago, Chile. We identified 175 children [mean age 6 years (range 0.66-15)] seropositive to Toxocara canis, who had dilated eye exam. Only one child [(0.57%); 95% CI, -0.55 - 1.69] had ophthalmoscopic findings compatible with Toxocara canis infection. The patient also suffered from decreased vision of the affected eye. The information gained from this study may be of useful for the implementation of algorithms for the ophthalmological examination of children seropositive to Toxocara canis in public hospitals in Chile.
Assuntos
Infecções Oculares Parasitárias/epidemiologia , Toxocara canis , Toxocaríase/epidemiologia , Adolescente , Animais , Criança , Pré-Escolar , Chile/epidemiologia , Ensaio de Imunoadsorção Enzimática , Infecções Oculares Parasitárias/parasitologia , Feminino , Humanos , Lactente , Masculino , Prevalência , Estudos RetrospectivosRESUMO
Intraocular invasion by Toxocara canis is one of the most commonly recognized etiologies of uveitis and blindness in children. In order to estimate the prevalence of ocular lesions caused by toxocariasis in a pediatric referral hospital, we conducted a retrospective analysis of clinical charts of all children seropositive to Toxocara canis, who also had an eye exam between the years 2005 and 2009 at the Calvo Mackenna Children's Hospital in Santiago, Chile. We identified 175 children [mean age 6 years (range 0.66-15)] seropositive to Toxocara canis, who had dilated eye exam. Only one child [(0.57 percent); 95 percent CI, -0.55 - 1.69] had ophthalmoscopic findings compatible with Toxocara canis infection. The patient also suffered from decreased vision of the affected eye. The information gained from this study may be of useful for the implementation of algorithms for the ophthalmological examination of children seropositive to Toxocara canis in public hospitals in Chile.
La invasión intraocular por el nematodo Toxocara canis constituye una de las causas más frecuentes de uveitis en los niños, pudiendo conducir a la ceguera. Para conocer la prevalencia de lesiones oculares en niños con serología positiva para este parásito en un hospital pediátrico de referencia, realizamos un estudio retrospectivo de las fichas clínicas de los pacientes referidos para examen oftalmológico en el Hospital Luis Calvo Mackenna entre los años 2005 y 2009. Encontramos 175 niños con serología positiva y examen oftalmológico, cuya edad promedio al momento del examen fue de 6 años (rango 0,66-15). En sólo un niño [(0,57 por ciento); 95 por ciento IC, -0,55-1,69] se encontraron lesiones oculares atribuibles a T. canis. El paciente presentaba además disminución de visión. La información obtenida en este estudio podría ser de utilidad en el diseño de un algoritmo para el examen oftalmológico de niños seropositivos a T. canis en el ambiente hospitalario en Chile.
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Adolescente , Animais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Infecções Oculares Parasitárias/epidemiologia , Toxocara canis , Toxocaríase/epidemiologia , Chile/epidemiologia , Ensaio de Imunoadsorção Enzimática , Infecções Oculares Parasitárias/parasitologia , Prevalência , Estudos RetrospectivosRESUMO
In the present study we investigated whether individuals would take advantage of an extrinsic and incidental reappraisal strategy by giving them precedent descriptions to attenuate the emotional impact of unpleasant pictures. In fact, precedent descriptions have successfully promoted down-regulation of electrocortical activity and physiological responses to unpleasant pictures. However, the neuronal substrate underlying this effect remains unclear. Particularly, we investigated whether amygdala and insula responses, brain regions consistently implicated in emotional processing, would be modulated by this strategy. To achieve this, highly unpleasant pictures were shown in two contexts in which a prior description presented them as taken from movie scenes (fictitious) or real scenes. Results showed that the fictitious condition was characterized by down-regulation of amygdala and insula responses. Thus, the present study provides new evidence on reappraisal strategies to down-regulate emotional reactions and suggest that amygdala and insula responses to emotional stimuli are adaptive and highly flexible.
Assuntos
Mapeamento Encefálico , Encéfalo/irrigação sanguínea , Encéfalo/fisiologia , Emoções/fisiologia , Adolescente , Adulto , Feminino , Lateralidade Funcional , Humanos , Processamento de Imagem Assistida por Computador , Julgamento/fisiologia , Imageamento por Ressonância Magnética , Masculino , Testes Neuropsicológicos , Oxigênio/sangue , Estimulação Luminosa/métodos , Tempo de Reação/fisiologia , Adulto JovemRESUMO
In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information) is the disinhibition of auditory memory circuits due to sensory deprivation. Concerning the cortical area involved in musical hallucination, there is evidence that the excitatory mechanism of the superior temporal gyrus, as in epilepsies, is responsible for musical hallucination. In musical release hallucination there is also activation of the auditory association cortex. Finally, considering the laterality, functional studies with musical perception and imagery in normal individuals showed that songs with words cause bilateral temporal activation and melodies activate only the right lobe. The effect of hearing aids on the improvement of musical hallucination as a result of the hearing loss improvement is well documented. It happens because auditory hallucination may be influenced by the external acoustical environment. Neuroleptics, antidepressants and anticonvulsants have been used in the treatment of musical hallucination. Cases of improvement with the administration of carbamazepine, meclobemide and donepezil were reported, but the results obtained were not consistent.
Apesar das alucinações musicais causarem grandes repercussões na vida dos pacientes, sempre foram pouco valorizadas e estudadas pelos profissionais. Alguns investigadores sugerem uma combinação de disfunções periféricas e centrais como o mecanismo causador das alucinações. A fisiopatologia mais aceita entre os pesquisadores de alucinação musical associada à hipoacusia ou anacusia (causada por lesão coclear, de nervo coclear ou interrupção de informação na ponte ou mesencéfalo) é a desibinição de circuitos de memória auditiva devido à deprivação sensorial. Em relação às áreas corticais envolvidas na alucinação musical, há evidência de que um mecanismo excitatório no córtex temporal superior, como nas epilepsias, seja responsável pela alucinação musical. Finalmente, considerando a lateralidade, estudos funcionais de percepção e imagética em indivíduos normais mostraram que canções com letras levam a ativação temporal bilateral e melodias ativam apenas o lobo temporal direito. É bem documentado o efeito de aparelhos auditivos na alucinação musical através de uma melhora da perda auditiva. Neurolépticos, antidepressivos e anticonvulsivantes têm sido usados no tratamento de alucinação musical na experiência clínica, mas não há eficácia comprovada na maioria dos casos. Há casos descritos na literatura com melhora das alucinações musicais com uso de carbamazepina, meclobemide e donepezil, entretanto sem resultados consistentes.
Assuntos
Humanos , Alucinações/fisiopatologia , Perda Auditiva/fisiopatologia , Música/psicologia , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Alucinações/tratamento farmacológico , Alucinações/psicologiaRESUMO
BACKGROUND AND PURPOSE: Tinnitus is a frequent disorder which is very difficult to treat and there is compelling evidence that tinnitus is associated with functional alterations in the central nervous system. Targeted modulation of tinnitus-related cortical activity has been proposed as a promising new treatment approach. We aimed to investigate both immediate and long-term effects of low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) in patients with tinnitus and normal hearing. METHODS: Using a parallel design, 20 patients were randomized to receive either active or placebo stimulation over the left temporoparietal cortex for five consecutive days. Treatment results were assessed by using the Tinnitus Handicap Inventory. Ethyl cysteinate dimmer-single photon emission computed tomography (SPECT) imaging was performed before and 14 days after rTMS. RESULTS: After active rTMS there was significant improvement of the tinnitus score as compared to sham rTMS for up to 6 months after stimulation. SPECT measurements demonstrated a reduction of metabolic activity in the inferior left temporal lobe after active rTMS. CONCLUSION: These results support the potential of rTMS as a new therapeutic tool for the treatment of chronic tinnitus, by demonstrating a significant reduction of tinnitus complaints over a period of at least 6 months and significant reduction of neural activity in the inferior temporal cortex, despite the stimulation applied on the superior temporal cortex.
Assuntos
Córtex Auditivo/diagnóstico por imagem , Córtex Auditivo/efeitos da radiação , Campos Eletromagnéticos , Zumbido/diagnóstico por imagem , Zumbido/terapia , Estimulação Magnética Transcraniana/métodos , Adulto , Córtex Auditivo/fisiopatologia , Vias Auditivas/diagnóstico por imagem , Vias Auditivas/fisiopatologia , Vias Auditivas/efeitos da radiação , Percepção Auditiva/fisiologia , Percepção Auditiva/efeitos da radiação , Mapeamento Encefálico , Doença Crônica/terapia , Método Duplo-Cego , Metabolismo Energético/fisiologia , Metabolismo Energético/efeitos da radiação , Potenciais Evocados Auditivos/fisiologia , Potenciais Evocados Auditivos/efeitos da radiação , Feminino , Lateralidade Funcional/fisiologia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde/métodos , Zumbido/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do TratamentoRESUMO
Liposarcoma of the oral cavity is very rare. The difficulty in clinical and histopatologic differentiation of these oral lipomatous lesions have been recognized by several authors. The aim of this article is to present a case report of a well-differentiated lipoma-like liposarcoma of the tongue, in a 36-year-old woman, and to review the existing literature.