Marco Antonio de Melo Tavares de Lima

Brainstem gliomas--retrospective analysis of 86 patients.

Brainstem gliomas constitute 10% of brain tumors in children and less than 2% in adults. Since therapeutic options are limited and brainstem gliomas are associated with a high morbidity and mortality, we sought to analyze the prognostic factors associated with a better outcome. We reviewed the records of 86 patients with brainstem gliomas treated between 1996 and 2006. We recorded demographic and clinical variables as well as radiological findings and survival. Patients were divided in two groups regarding overall survival: late progressors (survival >or=12 months) or early progressors (survival<12 months). Of 86 patients with brainstem gliomas, 55.8% were females. The mean age at diagnosis was 14.2 years (range 1 to 52 years). Twenty-four (27.9%) patients were adults. Lesions were located at pons in 75.6% of patients, midbrain in 15.1% and medulla in 9.3%. There was no difference between early and late progressors concerning gender, age at onset, location at pons, presence of necrosis or contrast enhancement observed at MRI or surgical resection. In both univariate and multivariate analysis, only a short duration of symptoms before diagnosis (<3 months) was associated with a worst prognosis (odds ratio 5.59, 95% CI 1.94 to 16, p=0.0014). A short duration of symptoms, which may imply a more aggressive tumor, was associated with a worst prognosis in patients with brainstem gliomas. This information may be useful in the selection of patients for future therapeutic trials.

Monocytes from HTLV-1–infected patients are unable to fully mature into dendritic cells

Human T-cell lymphotropic virus type 1 (HTLV-1) is a causative agent of adult T-cell leukemia and HTLV-1-associated myelopathy/tropical spastic paraparesis. HTLV-1-associated myelopathy/tropical spastic paraparesis is a chronic inflammatory disease characterized by loss of motor movement in response to spinal marrow cell destruction by T lymphocytes. To perform their cellular function, T cells need to be activated by antigen-presenting cells, such as dendritic cells (DCs). The aim of this work was to analyze DC differentiation and activation from monocytes of HTLV-1-infected individuals. We demonstrated that monocytes from HTLV-1-infected patients who had been stimulated to differentiate had an impaired loss of CD14 expression, expressed low levels of CD1a, and maintained secretion of tumor necrosis factor-α compared with monocytes from noninfected donors. We further evaluated DC activation by tumor necrosis factor-α. We observed that in response to activation, DCs that were derived from noninfected donors had an increase in the percentage of CD83(+), CD86(+), and human leukocyte antigen-DR(+) cells, whereas in DCs derived from HTLV-1-infected patients, the percentage of CD83(+), CD86(+), and human leukocyte antigen-DR(+) cells remained similar to that of nonactivated cells. Moreover, these cells had an impaired capacity to stimulate allogeneic T lymphocytes. We demonstrated that DC maturation was altered in HTLV-1-infected patients, which could contribute to the development of HTLV-1-associated diseases.

Avaliação da influência da idade no potencial evocado auditivo de tronco encefálico

Auditory brainstem response (ABR) is a simple, objective, and not invasive method of hearing pathway evaluation, which can be done at any age and which detects the electric activity from inner ear to inferior colliculus. ABR is formed by 7 waves (I - VII), but in general, waves I, III and V are its most important components. The level of sensation is a stimulus unit which is based on the personal phsycoacustic threshold and adding to it a constant intensity of stimulus in decibel (dB) giving the same amount of acoustic energy in case of asymmetric hearing loss. AIM: Evaluate how age influences ABR in men, using level of sensation as a stimulus unit. STUDY DESIGN: Observacional cohort with transversal cut. MATERIAL AND METHOD: Fifteen men with ages between 20 and 30 years old and 15 men above 60 years were examined and submitted to a clinical selection criteria in order to avoid any other factor that could influence in the results. The absolute latency of waves I, III and V and the interpeak latencies I-III, III-V and I-V were established in the 2 groups and values evaluated statistically. RESULTS: Absolute and interpeak latencies of ABR were similar in the 2 groups. CONCLUSION: In the analysed age group and in the prearranged conditions used in this study, the age was not an influence factor in ABR findings.

Low and high frequency tonal threshold audiometry: comparing hearing thresholds between smokers and non-smokers

UNLABELLED Cigarette smoking can cause many potentially fatal diseases and worsen others. Numerous studies have shown the relationship between smoking and hearing loss. However, the increase in auditory threshold in high frequency arising from smoking has been very little described. AIM to compare low and high frequency auditory thresholds among a group of smoking and non-smoking male individuals between 18 and 40 years. STUDY DESIGN Cross-sectional. MATERIALS AND METHODS by means of low and high frequency tonal threshold audiometry we studied 30 male individuals between 18 and 40 years and 30 non-smokers of matching age and gender. RESULTS auditory thresholds were different between smokers and non-smokers, being worse in the former. Although within normal ranges, auditory thresholds in low frequencies were higher among smokers. In high frequencies we noticed a marked increase in auditory thresholds among smokers. CONCLUSION we found statistically significant difference in auditory thresholds in low and high frequencies, among young male individuals, smokers and non-smokers, being worse in the former.

Intracranial Meningiomas in Children : Ten-Year Experience

Meningiomas are central nervous system neoplasms derived from arachnoid cap cells. They are the second most common brain tumors after gliomas, but are rare in children. Furthermore, meningiomas exhibit different behavior in this age group. From 1997-2007, 7 children with brain meningiomas were treated at the Department of Neurosurgery, Brazilian National Cancer Institute, Rio de Janeiro, Brazil. They represented 2.7% of all brain meningiomas, and 2.1% of all brain tumors, in children followed during this period at our institution. There were 4 boys, and the mean age at diagnosis was 7.3 years. Headaches, seizures, and motor deficits were the most frequent signs at presentation. All patients underwent surgery, and total resection was achieved in 6 of 7 patients. Most lesions were World Health Organization class I meningiomas. There were no deaths, and patients were asymptomatic or demonstrated mild motor or sensory signs at follow-up. In conclusion, meningiomas are rare in the pediatric population. Most of the lesions are low-grade, and the prognosis in this setting is good.

Da audiometria tonal limiar em baixa e alta frequência: comparação dos limiares auditivos entre tabagistas e não-tabagistas

Cigarette smoking can cause many potentially fatal diseases and worsen others. Numerous studies have shown the relationship between smoking and hearing loss....

Cyclosporine-induced parkinsonism

Marco A. Lima. Fundacao Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado a Fiocruz, mas nao consta a informacao no documento.

Avaliação de pacientes com queixa de tontura e eletronistagmografia normal por meio da estabilometria

As causas de tontura sao de dificil diagnostico. Atualmente dispomos de uma variedade de exames complementares, contudo, nenhum avalia bem a funcao vestibular. Os testes mais utilizados para este fim sao as provas eletronistagmograficas e posturograficas. OBJETIVO: O objetivo do trabalho foi o de analisar os resultados da estabilometria de pacientes com queixa de tontura que apresentaram eletronistagmografia normal e compara-los aos de um grupo controle. FORMA DE ESTUDO: Prospectivo, do tipo seccional transversal. MATERIAL E METODO: Realizou-se no SME do Servico de Otorrinolaringologia do HUCFF/UFRJ. No total foram avaliados 22 pacientes (15 mulheres e sete homens) com idade media de 47,6±9 anos. O grupo controle foi de 25 sujeitos saudaveis (18 mulheres e sete homens) com idade media de 46,8±7 anos. Todos os individuos foram submetidos a estabilometria com os olhos abertos, em seguida por olhos fechados, durante 30 segundos cada. RESULTADOS: O grupo de pacientes apresentou resultados estatisticamente significativos em todos os parâmetros estabilimetricos avaliados quando comparados ao grupo controle. Na comparacao dos resultados com os olhos fechados e abertos, apenas a velocidade media ântero-posterior no grupo controle foi significativa. CONCLUSAO: Conclui-se que o grupo de pacientes apresentou resultados estatisticamente significativos em relacao ao grupo controle em todos os parâmetros estabilometricos analisados, demonstrando, assim, que o grupo de pacientes com queixa de tontura apresentou maior instabilidade na posicao ortostatica do que o grupo de sujeitos saudaveis.

Avaliação dos limiares de audibilidade das altas freqüências em indivíduos entre 18 e 29 anos sem queixas otológicas

Estudos recentes que avaliaram os limiares auditivos em altas frequencias trouxeram novas perspectivas a investigacao de danos auditivos. Contudo, as pesquisas desenvolvidas ainda nao estabeleceram um consenso para os padroes de normalidade dos limiares de audicao nessas frequencias. OBJETIVO: Analisar os resultados dos limiares de audibilidade das altas frequencias, em nivel de audicao, de individuos entre 18 e 29 anos sem queixas otologicas. FORMA DE ESTUDO: Tipo seccional transversal. MATERIAL E METODOS: Foram realizadas 60 audiometrias convencionais, sendo 51 exames com resultados normais, em individuos entre 18 e 29 anos. Esses individuos foram submetidos a audiometria de altas frequencias utilizando o aparelho AMPLAID 460 e fones de orelha Sennheiser HD 520 II, sendo os limiares obtidos em dBNA. RESULTADOS: Observou-se nao existir diferenca significativa nos limiares de audibilidade entre o sexo masculino e feminino. Foram obtidos os limiares de audicao em dBNA nas altas frequencias para individuos sem queixas otologicas, entre 18 e 29 anos. CONCLUSAO: Sugeriu-se que esses dados poderiam ser utilizados como referencia de normalidade para estudos posteriores com equipamento de mesmo padrao, que tivessem como objetivo avaliar alteracoes auditivas apresentadas em individuos jovens.

Avaliação do processamento auditivo temporal em trabalhadores rurais expostos a agrotóxicos organofosforados

PURPOSE To evaluate the auditory temporal processing in workers occupationally exposed to organophosphate pesticides. METHODS Cross-sectional study in which 43 rural workers of both genders with bilaterally normal auditory thresholds that were occupationally exposed to organophosphates were assessed. The procedures included the following items: questionnaire regarding personal and professional background, period of exposition to organophosphates, otoscopy, pure-tone audiometry. Auditory temporal processing was tested through: the Frequency Pattern Test, the Duration Pattern Test and the Gaps-In-Noise Test. Performance on the tests were analyzed, as well as differences between left and right ears on the Gaps-In-Noise Test, and education level in all tests. RESULTS In great part of the subjects, auditory temporal processing performance was below normal standards. There was no difference between ears on the Gaps-In-Noise Test (p=0.33). Additionally, no differences were found on any of the tests according to education level (Gaps-In-Noise: p=0.21 on the right ear, and p=0.053 on the left ear; Frequency Pattern Test: p=0.37; Duration Pattern Test: p=0.84). CONCLUSION Temporal resolution and temporal order abilities were altered in individuals occupationally exposed to organophosphate pesticides, even when they showed normal peripheral auditory thresholds.