Marlise de Castro Ribeiro

Immunohistochemical expression of markers Ki-67, neun, synaptophysin, p53 and HER2 in medulloblastoma and its correlation with clinicopathological parameters

Medulloblastoma (MB) is the most common malignant brain tumor in childhood. The alterations found include: presence of oncoproteins p53 and HER2, elevated mitotic index, and presence of neuronal differentiation. The aim of this study was to determine the immunohistochemical expression of markers Ki-67, NeuN, synaptophysin, HER2 and p53 in 40 MB samples and their correlation with clinicopathologic parameters and survival. In 29 patients (72.5%), >20% of cells were positive for Ki-67. Males showed greater ki-67 expression (p=0.02) and smaller survival rates (p=0.002). NeuN and synaptophysin were negative in 16 (40%) and 8 (20%) cases, respectively. P53 was positive in 18 (45%) cases, with 11 (61%) weakly positive and 7 (39%) strongly positive. HER2 was positive in 23 (57.5%) of the samples and did not show statistical association with survival (p=0.07).

The Critical Illness Polyneuropathy in Septic Patients With Prolonged Weaning From Mechanical Ventilation: Is the Diaphragm Also Affected? A Pilot Study

BACKGROUND: Critical illness myopathy and/or neuropathy (CRIMYNE) is a common alteration seen in the ICU. The currently available bedside methods of measuring respiratory and peripheral muscle function in critically ill patients are somewhat inadequate. The objective of this study was to evaluate the presence of diaphragmatic and peripheral CRIMYNE in septic patients with prolonged weaning from mechanical ventilation (MV). METHODS: Cohort prospective study with an entry period of 6 months. In 2 Brazilian medical-surgical ICUs, septic patients ≥ 18 years of age, dependent on MV ≥ 14 days, requiring prolonged weaning from MV, awake (Richmond Agitation Sedation Scale ≥ –2), and with no previous history of polyneuropathy or myopathy were included. Electrophysiological studies of the limbs and also of the respiratory system by phrenic nerve conduction and needle electromyography of the diaphragm were performed in all subjects. RESULTS: Twelve subjects were enrolled during 6 months of study. The electrophysiological signs of peripheral CRIMYNE occurred in 9 subjects, 7 of whom died in the ICU. Three subjects developed critical illness polyneuropathy, 4 critical illness myopathy, and 2 both. Only one subject who developed peripheral CRIMYNE did not present diaphragmatic involvement, whereas no subject developed diaphragm involvement alone. Thus, electrophysiological signs of diaphragmatic CRIMYNE occurred in 8 of the 9 subjects with peripheral CRIMYNE. Upon clinical examination, 8 subjects were not able to moves their limbs against gravity, and these findings were related to the presence of peripheral and diaphragmatic dysfunction. CONCLUSIONS: Our pilot findings suggested that CRIMYNE is common in septic patients with prolonged weaning from MV (MV ≥ 14 d). The inability to move limbs against gravity is frequently associated with peripheral and diaphragmatic CRIMYNE, and the findings of CRIMYNE in peripheral electrophysiological tests are associated with diaphragmatic involvement.

Corpora amylacea in temporal lobe epilepsy associated with hippocampal sclerosis

UNLABELLED Hippocampal sclerosis (HS) is the commonest pathology in epileptic patients undergoing temporal lobe epilepsy surgery. Beside, there are an increased density of corpora amylacea (CA) founded in 6 to 63% of those cases. OBJECTIVE verify the presence of CA and the clinical correlates of their occurrence in a consecutive series of patients undergoing temporal surgery with diagnosis of HS. METHOD We reviewed 72 hippocampus specimens from January 1997 to July 2000. Students t test for independent, samples, ANOVA and Tukey test were performed for statistical analysis. RESULTS CA were found in 35 patients (49%), whose mean epilepsy duration (28.7 years) was significantly longer than that group of patients without CA (19.5 years, p=0.001). Besides, when CA were found, duration was also significantly correlated with distribution within hippocampus: 28.7 years with diffuse distribution of CA, 15.4 with exclusively subpial and 17.4 years with distribution subpial plus perivascular (p=0.001). CONCLUSION Our findings corroborate the presence of CA in patients with HS and suggest that a longer duration of epilepsy correlate with a more distribution of CA in hippocampus.

Erratum to “Evaluation of the Expression of C-Kit (CD117) in Ependymomas and Oligodendrogliomas”

We came through this erratum and declare that we are aware that the author Ligia Maria Barbosa Coutinho, Professor at the Graduate Program in Pathology of Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Brazil, was a part of the implementation of this paper, and, by our mistake, was absent from the list of authors. We would like to add Ligia Maria Barbosa Coutinho as a coauthor.

Functional and psychological features immediately after discharge from an Intensive Care Unit: prospective cohort study

Objective To assess the functional and psychological features of patients immediately after discharge from the intensive care unit. Methods Prospective cohort study. Questionnaires and scales assessing the degree of dependence and functional capacity (modified Barthel and Karnofsky scales) and psychological problems (Hospital Anxiety and Depression Scale), in addition to the Epworth Sleepiness Scale, were administered during interviews conducted over the first week after intensive care unit discharge, to all survivors who had been admitted to this service from August to November 2012 and had remained longer than 72 hours. Results The degree of dependence as measured by the modified Barthel scale increased after intensive care unit discharge compared with the data before admission (57±30 versus 47±36; p<0.001) in all 79 participants. This impairment was homogeneous among all the categories in the modified Barthel scale (p<0.001) in the 64 participants who were independent or partially dependent (Karnofsky score ≥40) before admission. The impairment affected the categories of personal hygiene (p=0.01) and stair climbing (p=0.04) only in the 15 participants who were highly dependent (Karnofsky score <40) before admission. Assessment of the psychological changes identified mood disorders (anxiety and/or depression) in 31% of the sample, whereas sleep disorders occurred in 43.3%. Conclusions Patients who remained in an intensive care unit for 72 hours or longer exhibited a reduced functional capacity and an increased degree of dependence during the first week after intensive care unit discharge. In addition, the incidence of depressive symptoms, anxiety, and sleep disorders was high among that population.

Evaluation of the expression of C-kit (CD117) in ependymomas and oligodendrogliomas

C-kit is a proto-oncogene located on the long arm of chromosome 4. Its product, CD117, is a specific immunohistochemical (IHQ) marker that is associated with response to a potent tyrosine kinase inhibitor therapy with STI-571 (Gleevec®) in chronic myelogenous leukemia and GISTs. In our study, we aimed to evaluate the expression of CD117 in glial tumors as this finding may guide therapeutic approaches for these brain tumors. Ependymomas and oligodendrogliomas, in formalin fixed and paraffin embedded blocks were assayed for CD117 immunoreactivity using anti-c-kit (CD117, DAKO). GISTs were used as positive control. We observed immunoreactivity of CD117 protein in 25.5% of tumors in both histological types. In oligodendrogliomas, there was an association between older age at diagnosis and positivity for CD117 (P = 0.039). In addition, we observed an association between higher tumor grade (grade III) and positivity for CD117 (P = 0.007). No clinical association was observed in ependymomas (P > 0.05). This study encourages further investigations, considering that CD117 may be a possible oncogenic factor in some glial tumors. In this case, tumors that express this marker may eventually benefit from a therapy with selective inhibitors of receptor kinases.

Migraine‐Like Headache as Presentation Symptom in Susac Syndrome

Susac syndrome (SuS) is an autoimmune disorder in which occlusion of brain, inner ear, and retina microvessels causes the triad of encephalopathy, sensory neural hearing loss, and branch retinal artery occlusion. This syndrome, first described in 1979, can occur as a monophasic, recurrent, or chronically progressive disorder, and the three defining features may present concomitantly or consecutively. According to Dorr et al., there were 304 cases reported by 2013. Although rare, SuS should be considered in the differential diagnosis of many neurological, psychiatric, and ophthalmological conditions, mainly because it is a treatable condition that requires aggressive immunosuppression. Here we report a case of SuS, in which headache was the presentation symptom. A 22-year-old girl presented with severe headache that was of holocranial location, pulsatile character, and was accompanied by photophobia, nausea, and vomiting. There was no history of phonophobia, aura symptoms, or cranial autonomic signs. Although pain intensity was variable, it could be crippling at some moments. Soon after, she presented constant bilateral tinnitus and gait disturbance, in the form of right lateropulsion. After being diagnosed with labyrinthitis, the patient had some clinical improvement with symptomatic treatment and returned to her everyday activities. Seven months after the first bout, the same symptoms resumed, associated with bilateral hearing loss severe enough to make a hearing device necessary. Audiometry showed mixed hearing loss, mild in the right ear and moderate in the left. At this moment, a brain and inner ear MRI scan revealed multiple T2WI focal hyperintensities, scattered through periventricular white matter, corona radiata, and semioval centers, probably of demyelinating From the Depto. de Cl ınica M edica/Neurologia, Universidade Federal de Ciências da Sa ude de Porto Alegre, Porto Alegre, RS, Brazil (F. Kowacs and M. Castro Ribeiro); Universidade Federal de Ciências da Sa ude de Porto Alegre, Curso de Medicina, Porto Alegre, RS, Brazil (M. Ferreira Gomes); Irmandade da Santa Casa de Miseric ordia de Porto Alegre, Programa de Residência M edica em Neurologia, Porto Alegre, RS, Brazil (T. Pigozzo, A.L. Luiz Rodrigues Palmeira, and C. Muratt Carpenedo)

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

Purpose To associate the degree of biomechanical impairment in the swallowing process with the severity (National Institute of Health Stroke Scale - NIHSS) and type of neurological injury in patients post stroke. Methods A cross-sectional, descriptive study conducted with 42 patients (22 females), aged 65.7 years on average diagnosed with stroke. All patients underwent clinical neurological evaluation and application of the NIHSS in the first 48 hours after stroke. The swallowing function was evaluated using the Functional Oral Intake Scale (FOIS) and the Protocol for the Investigation of Oropharyngeal Dysphagia in Adults. The Fishers Exact Probability Test was used to assess the correlation between the degree of swallowing impairment and the severity (NIHSS score) and type of stroke. The study results were statistically analyzed at 5% significance level (p≤0.05). Results 92.9% of the patients presented ischemic stroke; 59.5% presented impairment of the anterior cerebral circulation. Statistically significant correlation was found between the neurological scale (NIHSS) scores and the swallowing impairment scale (p=0.016). Conclusion An association between stroke severity and oropharyngeal dysphagia severity was observed. A high proportion of patients with ischemic stroke with circulation affected in the anterior cerebral region presented severe oropharyngeal dysphagia. No statistically significant correlation was observed between the FOIS scale and stroke severity.

Paraplegia como manifestação inicial de medula presa: relato de caso

Tethered spinal cord (TSC) is a rare disorder; it occurs when the conus medularis is anchored to the base of the vertebral canal by thickened filum terminale cysts, lipoma and spinal dysraphia. This disorder may cause paraplegia, sensory and sphincter disturbance. We report a twenty-two months-old girl presenting with paraplegia. TSC diagnostic was confirmed by myelotomography. The patient was submitted to surgical relief of tethered filum terminale.