Carmen Lúcia Penteado Lancellotti

Expression of cell adhesion proteins and proteins related to angiogenesis and fatty acid metabolism in benign, atypical, and anaplastic meningiomas

Most meningiomas are benign tumours of arachnoidal origin, although a small number have high proliferative rates and invasive properties which complicate complete surgical resection and are associated with increased recurrence rates. Few prognostic indicators exist for meningiomas and further research is necessary to identify factors that influence tumour invasion, oedema and recurrence. Paraffin sections from 25 intracranial meningiomas were analysed for expression of the proteins vascular endothelial growth factor (VEGF), VEGF receptors Flt1 and Flk1, E-cadherin, metalloproteinases 2 and 9 (MMP2, MMP9), CD44, receptor for hyaluronic acid-mediated motility (RHAMM), hyaluronic acid (HA), CD45, cyclooxygenase 2 (COX2), brain fatty acid binding protein (BFABP), Ki67, and proliferating cell nuclear antigen (PCNA). Correlations among protein expression were found for several markers of proliferation (Ki67, PCNA, MI) and microvessel density (MVD). COX2 expression increased with increasing with tumour grade and correlated with Ki67, PCNA, MI, MVD, and BFABP. BFABP expression also correlated with Ki67 and PCNA expression. Relationships were also identified among angiogenic factors (VEGF, Flt1, Flk1) and proliferation markers. Oedema was found to correlate with MMP9 expression and MMP9 also correlated with proliferation markers. No correlations were found for MMP2, E-cadherin, or CD44 in meningiomas. In conclusion Ki67, PCNA, MI, MVD, BFABP, and COX2 were significantly correlated with meningioma tumour grade and with each other. These findings, by correlating both intracellular fatty acid transport and eicosanoid metabolism with tumour proliferation, as determined by Ki67 labelling and mitotic index, suggest fatty acids are involved in the progression of meningiomas.

Endoscopic endonasal transsphenoidal approach for pituitary adenomas: technical aspects and report of casuistic

OBJECTIVE Analyse technical aspects, effectiveness and morbidity of the endoscopic endonasal transphenoidal approach for pituitary adenomas. METHOD From January 2005 to September 2008, 30 consecutive patients underwent endoscopic endonasal resection of pituitary adenomas with a follow up from 3 to 36 months. Their medical charts were retrospectively analysed. RESULTS There were 18 women and 12 men, mean age 44 years (range 17-65 yr). Among the 30 patients, 23 had macroadenomas and 7 microadenomas. Twelve patients had non-functioning tumors, 9 had ACTH-secreting tumors, 8 had GH-secreting tumors and 1 prolactinoma. Complete resection and hormonal control was achieved in all microadenomas. Macroadenomas were completely removed in 6 patients, subtotal resection in 6 and partial resection in 11. Three patients had diabetes insipidus and 5 had CSF leaks treated with lumbar drainage. CONCLUSION The endonasal endoscopic approach for pituitary tumors is effective and has low morbidity.

Supratentorial intraventricular schwannoma of the choroid plexus

Dr. Lucas Perez de Vasconcellos – Rua Desembargador Joaquim Barbosa de Almeida 368 05463-010 São Paulo SP Brasil. E-mail: lucas.vasconcellos@ terra.com.br Intraventricular tumours represent around 10% of central nervous system tumours. A variety of intraventricular tumours can be found, with the differential diagnosis depending upon the location in the ventricular system. In the lateral ventricles, the more common intraventricular tumours are meningiomas, astrocytomas and ependymomas, whereas choroid plexus papillomas and carcinomas, subependymomas and dermoid cysts are rare. We report a case of intraventricular schwannoma of the choroid plexus in the lateral ventricle, presenting with headache.

Spontaneous thrombosis of internal carotid artery: a natural history of giant carotid cavernous aneurysms

OBJECTIVE To describe five cases of giant carotid cavernous aneurysms which evolved with spontaneous thrombosis of internal carotid artery (STICA), with emphasis at epidemiology, clinical presentation, natural history, related factors and neurological outcome. METHOD There were 711 consecutives patients with 802 aneurysms with and without surgical treatment during a period of 19 years. We selected 35 patients with 40 carotid cavernous aneurysms (5%) of which 20 (50%) were giant aneurysms. Among those cases, 5 patients evolved with STICA (25%). Symptoms and findings at presentation were recorded and compared with those at outcome. RESULTS Clinical presentation was commonly related to atherosclerotic factors such as elevated blood pressure (80%), diabetes mellitus (40%) and dislipidemy (40%). All patients presented with hemicranial headache, ophthalmparesy and retro bulbar pain, and after STICA all presented improvement of symptoms. After STICA, 4 patients had regression of deficit, 2 partial and 2 complete. Four patients had sensorial trigeminal neuropathy in V1 and V2 territories, also showing improvement of symptoms after STICA. CONCLUSION STICA is a common outcome in giant carotid cavernous aneurysms, and is related with significant improvement of symptoms; however, it may be catastrophic for those patients without efficient collateral circulation.

Experimental comparative study in rabbits of three different ways of cartilage graft fixation: suture, gelatin-resorcin-formaldehyde and butyl-2-cyanoacrylate

CONCLUSION The compound gelatin-resorcin-formaldehyde (GRF) was a better stabilizing material for cartilage grafts in rabbits than butyl-2-cyanoacrylate. GRF was also better than the suture when comparing fixation of cartilage to the periosteum and inflammatory reaction. OBJECTIVE Cartilage grafting is an interesting option for refinements on rhinoplasties. The objective of this study was to compare butyl-2-cyanoacrylate to GRF and suture to determine the efficacy of these methods in restraining grafted cartilage in rabbits. MATERIALS AND METHODS Fifteen male adult New Zealand rabbits underwent surgery with the aim of collecting six auricular cartilage grafts from each animal. Two of these grafts in each animal were glued together with butyl-2-cyanoacrylate, two were glued together with compound GRF, and two were sewn together with nylon suture. These sandwich grafts were then glued or sutured to the periosteum of the glabella. After 2, 6, and 12 weeks, groups of five animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion, and deformities of the grafts were also evaluated. RESULTS There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. GRF showed statistically less inflammatory reaction and angiogenesis than the other two methods. The three methods showed a tendency to decrease of fibrosis, inflammation, and angiogenesis as weeks passed. There was no detachment or deformity in the cartilage sandwiches sutured to the glabellas periostium. The majority of detached and deformed cartilages were those glued with cyanoacrylate. The number of detached cartilages was directly related to the number of deformed cartilages. The data were statistically significant (p<0.05).Conclusion: The compound gelatin-resorcin-formaldehyde (GRF) was a better stabilizing material for cartilage grafts in rabbits than butyl-2-cyanoacrylate. GRF was also better than the suture when comparing fixation of cartilage to the periosteum and inflammatory reaction. Objective: Cartilage grafting is an interesting option for refinements on rhinoplasties. The objective of this study was to compare butyl-2-cyanoacrylate to GRF and suture to determine the efficacy of these methods in restraining grafted cartilage in rabbits. Materials and methods: Fifteen male adult New Zealand rabbits underwent surgery with the aim of collecting six auricular cartilage grafts from each animal. Two of these grafts in each animal were glued together with butyl-2-cyanoacrylate, two were glued together with compound GRF, and two were sewn together with nylon suture. These sandwich grafts were then glued or sutured to the periosteum of the glabella. After 2, 6, and 12 weeks, groups of five animals were sacrificed and histological analysis for inflammation was performed. Cartilage graft migration, adhesion, and deformities of the grafts were also evaluated. Results: There was less migration of the cartilages glued with GRF than with cyanoacrylate and suture. GRF showed statistically less inflammatory reaction and angiogenesis than the other two methods. The three methods showed a tendency to decrease of fibrosis, inflammation, and angiogenesis as weeks passed. There was no detachment or deformity in the cartilage sandwiches sutured to the glabellas periostium. The majority of detached and deformed cartilages were those glued with cyanoacrylate. The number of detached cartilages was directly related to the number of deformed cartilages. The data were statistically significant (p<0.05).

Motor neuron disease associated with non‐fluent rapidly progressive aphasia: case report and review of the literature

The superimposed clinical features of motor neuron disease (MND) and frontotemporal lobar degeneration (FTLD) comprise a rare neurological overlap syndrome that represents a diagnostic challenge to neurologists. Currently, FTLD‐MND is considered a distinct entity and its clinicopathological basis has recently been reviewed. Our aim is to present a patient with MND and non‐fluent rapidly progressive aphasia with clinical, imaging and histopathological correlation, as well as a brief review of the literature. We demonstrated the selective corticospinal tract (CST) and temporal lobe involvement using T1 spin‐echo with an additional magnetization transfer contrast pulse on resonance (T1 SE/MTC) and FLAIR MR sequences in our patient, with further clinical and histopathological correlation. To the best of our knowledge, there is no description about the use of these particular MR sequences in the evaluation of FTLD‐MND patients.

Meningioma growth during interferon beta-1a treatment for multiple sclerosis

Fleury Diagnostic Center, Section of Radiology, São Paulo SP, Brazil; Santa Casa de Misericórdia de São Paulo, Section of Radiology, São Paulo SP Brazil; Santa Casa de Misericórdia de São Paulo, Section of Neurology, São Paulo SP, Brazil; Santa Casa de Misericórdia de São Paulo, Section of Neurosurgery, São Paulo SP, Brazil; Santa Casa de Misericórdia de São Paulo, Section of Pathology, São Paulo SP, Brazil; Fleury Diagnostic Center, Section of Pathology, São Paulo SP, Brazil

Estudo experimental comparativo entre o butil-2-cianoacrilato, a mistura gelatina-resorcina-formaldeído e sutura na estabilização de enxertos de cartilagem em coelhos

Os enxertos de cartilagem constituem-se em boa opcao tecnica para aprimoramento das rinoplastias. Procura-se um material para sua fixacao que seja de simples manuseio, e que provoque minima reacao tecidual. OBJETIVO: Comparar o uso do butil-2-cianoacrilato, mistura gelatina-resorcina-formaldeido (GRF) e sutura na estabilizacao de enxertos de cartilagem em coelhos. FORMA DE ESTUDO: Experimental. MATERIAL E METODO: Utilizaram-se 15 coelhos adultos da raca Nova Zelândia machos, de cujas orelhas foram ressecados 6 enxertos de cartilagem, fixados no periosteo da calvaria e unidos dois a dois com sutura, GRF e cianoacrilato. Apos 2, 6 e 12 semanas, grupos de 5 coelhos foram sacrificados e realizou-se avaliacao da distância de deslocamento do enxerto e analise histologica do processo inflamatorio tecidual e da adesao/deformidade das cartilagens. RESULTADOS: Houve deslocamento menor nas fixadas com GRF do que com cianoacrilato e sutura. O processo inflamatorio foi maior nos animais de 2 semanas, decaindo ate restar pequeno grau de fibrose em 12 semanas, de modo semelhante nas 3 fixacoes. Nao houve descolamento nem deformidade em nenhuma dupla de cartilagens fixada com sutura e o maior numero de cartilagens descoladas e deformadas se deu com o cianoacrilato. O numero de cartilagens deformadas foi diretamente proporcional ao numero de descoladas. Os dados foram significativos estatisticamente (p<0,05). CONCLUSAO: A mistura gelatina-resorcina-formaldeido mostrou ser um metodo de estabilizacao de enxertos de cartilagem em coelhos superior ao butil-2-cianoacrilato em todas as fixacoes, e a sutura na fixacao cartilagem-osso.

Meningeoma pós-radioterapia

Meningiomas are neoplasms derived from arachnoid cells with their origin linked to idiopathic genetic abnormalities (deletion of the long arm of chromosome 22), predisposing diseases and radiotherapy induction. We report the case of a 50 years-old man radiation-induced meningioma 20 years after the diagnosis, surgical and radiation treatment of an oligodendroglioma. The supporting diagnostic criteria of radiation-induced meningiomas are discussed and the pertinent literature of the theme is revised.

Influence of selant fibrin on the wound healing of the pigs vocal folds

UNLABELLED Fibrin sealants or fibrin glue are products made from human plasma proteins, which mimic the final pathway of the coagulation cascade. Its application to stimulate the healing process has been a topic of debate in the literature. The use of fibrin sealants in phonosurgery has been empirical; there have been no studies that investigate the action of fibrin sealant in Reinkes space. AIM To evaluate the effect of fibrin glue in healing of the vocal folds of pigs after surgical manipulation. MATERIALS AND METHODS This was a prospective and experimental study. Six animals had both vocal folds incised. Sealant was applied in one of them; the other served as a control. After three months, the animals were sacrificed and a collagen count was carried out. RESULTS The side on which glue was applied had an average of 27.8% against 20.4% of the side without glue. CONCLUSION The collagen concentration in the samples where the fibrin sealant was applied was significantly higher compared to samples without glue. Thus, the presence of a fibrin sealant stimulates fibrogenesis in this tissue.