RESUMO
There is evidence of association between sellar barrier thickness and intraoperative cerebrospinal fluid (CSF) leakage, impacting the postoperative prognosis of the patients. The aim of this study is to analyze the clinical applicability of the sellar barrier concept in a series of operated patients with pituitary apoplexy (PA). A retrospective study was conducted including 47 patients diagnosed with PA who underwent surgical treatment through a transsphenoidal approach. Brain magnetic resonance imaging (MRI) of the patients were evaluated and classified utilizing the following criteria: strong barrier (greater than 1 mm), weak barrier (less than 1 mm), and mixed barrier (less than 1 mm in one area and greater than 1 mm in another). The association between sellar barrier types and CSF leakage was analyzed, both pre- and intraoperatively. The preoperative MRI classification identified 10 (21.28%) patients presenting a weak sellar barrier, 20 patients (42.55%) with a mixed sellar barrier, and 17 patients (36.17%) exhibiting a strong sellar barrier. Preoperative weak and strong sellar barrier subtypes were associated with weak (p ≤ 0.001) and strong (p = 0.009) intraoperative sellar barriers, respectively. Strong intraoperative sellar barrier subtypes reduced the odds of CSF leakage by 86% (p = 0.01). A correlation between preoperative imaging and intraoperative findings in the setting of pituitary apoplexy has been observed.
RESUMO
Background Primary central nervous system lymphomas (PCNSL) are infrequent. The traditional treatment of choice is chemotherapy. Complete resections have generally not been recommended, because of the risk of permanent central nervous system deficits with no proven improvement in survival. The aim of the current study was to compare survival among patients with PCNSL who underwent biopsy versus surgical resection. Methods A retrospective study was conducted on 50 patients with a confirmed diagnosis of PCNSL treated at our center from January 1994 to July 2015. Results Patients in the resection group exhibited significantly longer median survival time, relative to the biopsy group, surviving a median 31 months versus 14.5 months; p = 0.016. Conclusions In our series, patients who had surgical resection of their tumor survived a median 16.5 months longer than patients who underwent biopsy alone.
Assuntos
Neoplasias do Sistema Nervoso Central/cirurgia , Linfoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Neoplasias do Sistema Nervoso Central/imunologia , Neoplasias do Sistema Nervoso Central/mortalidade , Neoplasias do Sistema Nervoso Central/patologia , Feminino , Humanos , Imunocompetência , Estimativa de Kaplan-Meier , Linfoma/imunologia , Linfoma/mortalidade , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
ABSTRACT Background Primary central nervous system lymphomas (PCNSL) are infrequent. The traditional treatment of choice is chemotherapy. Complete resections have generally not been recommended, because of the risk of permanent central nervous system deficits with no proven improvement in survival. The aim of the current study was to compare survival among patients with PCNSL who underwent biopsy versus surgical resection. Methods A retrospective study was conducted on 50 patients with a confirmed diagnosis of PCNSL treated at our center from January 1994 to July 2015. Results Patients in the resection group exhibited significantly longer median survival time, relative to the biopsy group, surviving a median 31 months versus 14.5 months; p = 0.016. Conclusions In our series, patients who had surgical resection of their tumor survived a median 16.5 months longer than patients who underwent biopsy alone.
RESUMO Introducción Los linfomas primarios del sistema nervioso central (LPSNC) son infrecuentes. Tradicionalmente el tratamiento de elección es la quimioterapia. Existe un paradigma de no indicar resección, por el riesgo de déficit neurológico sin aumento de la sobrevida. El objetivo del presente estudio es comparar la sobrevida de pacientes con LPSNC sometidos a biopsia versus resección. Métodos Estudio retrospectivo que incluye 50 pacientes con diagnóstico confirmado de LPSNC tratados en nuestra Institución desde enero de 1994 hasta julio de 2015. Resultados Los pacientes del "grupo resección" mostraron una sobrevida media significativamente mayor respecto a los del "grupo biopsia"; 31 meses versus 14,5 meses respectivamente, p = 0,016. Conclusiones En nuestra serie, los pacientes que con resección quirúrgica de su tumor tuvieron una sobrevida media de 16,5 meses superior que los pacientes biopsiados.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Sistema Nervoso Central/cirurgia , Linfoma/cirurgia , Fatores de Tempo , Biópsia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Neoplasias do Sistema Nervoso Central/imunologia , Neoplasias do Sistema Nervoso Central/mortalidade , Neoplasias do Sistema Nervoso Central/patologia , Estimativa de Kaplan-Meier , Imunocompetência , Linfoma/imunologia , Linfoma/mortalidade , Linfoma/patologiaRESUMO
Se refieren 95 casos de leishmaniasis infantil, estudiados en los Servicios de las Cátedras de Enfermedades Infecciosas y Dermatología de la Universidad Nacional de Tucumán. La edad de los enfermos oscilaba entre algunos meses y 15 años. El 52.63 por ciento pertenecen a la provincia de Tucumán, el 42.11 por ciento a la de Santiago del Estero y 5.26 por ciento a la de Salta. Merece ser destacado que en el 10.66 por ciento de nuestros enfermos se presentaban lesiones cutáneo-mucosas en labios, nariz y boca, muy destructivas, con caracteres similares a las que estamos acostumbrados a observar en la leishmaniasis del adulto
Assuntos
Lactente , Pré-Escolar , Criança , Adolescente , Humanos , Masculino , Feminino , Leishmaniose/epidemiologia , Leishmaniose Mucocutânea/epidemiologia , ArgentinaRESUMO
Se refieren 95 casos de leishmaniasis infantil, estudiados en los Servicios de las Cátedras de Enfermedades Infecciosas y Dermatología de la Universidad Nacional de Tucumán. La edad de los enfermos oscilaba entre algunos meses y 15 años. El 52.63 por ciento pertenecen a la provincia de Tucumán, el 42.11 por ciento a la de Santiago del Estero y 5.26 por ciento a la de Salta. Merece ser destacado que en el 10.66 por ciento de nuestros enfermos se presentaban lesiones cutáneo-mucosas en labios, nariz y boca, muy destructivas, con caracteres similares a las que estamos acostumbrados a observar en la leishmaniasis del adulto (AU)