Ricardo Santos de Oliveira

Aplasia cutis congenita of the scalp: is there a better treatment strategy?

BackgroundAplasia cutis congenita (ACC) is a rare disease of unknown etiology, involving any site of the body. The scalp is the most frequent location, followed by the forearms, knees, both sides of the trunk, and neck, in decreasing order of frequency. Superficial lesions may heal spontaneously and seldom result in morbidity or mortality. However, in patients with large scalp and skull defects, there are risks of infection and bleeding. Conservative treatment has been described and advocated, but some authors have highlighted the disadvantages of this treatment modality. On the other hand, several authors claim that aggressive surgical treatment has an important role for large defects.Materials and methodsIn this paper, we report three newborns with ACC of the scalp, two large defects and a medium one, respectively, treated conservatively and surgically.ConclusionThe management of ACC of the scalp is still controversial. Our series suggests that conservative treatment should be performed for initial management in newborns.

Extradural arachnoid cysts in children

BackgroundExtradural arachnoid cysts in the spine are uncommon causes of spinal cord compression in the pediatric population that are thought to arise from congenital defects in the dura mater. Most reports describe such cysts as communicating with the intrathecal subarachnoid space through a small defect in the dura. Excision of the cyst with obliteration of the communicating dural defect is the mainstay of treatment in symptomatic patients. Solitary extradural arachnoid cysts have been reported in several studies, but multiple extradural arachnoid cysts are very rarely reported in children.Materials and methodsThe authors report a case of multiple extradural spinal arachnoid cysts in a 14-year-old boy who presented progressive lower extremity weakness, myelopathy, and severe gait ataxia. Magnetic resonance (MR) of the spine demonstrated four extradural arachnoid cysts extending from T-1 to T-9. The patient underwent a thoracic laminoplasty for en bloc resection of the spinal extradural arachnoid cysts. Postoperatively, the patient’s motor strength and ambulation improved immediately.ConclusionsMultiple spinal extradural arachnoid cysts are rarely reported in the literature. Excision of the cysts at the spinal cord level leads to a favorable outcome.

The Success of Endoscopic Third Ventriculostomy in Children: Analysis of Prognostic Factors

Objective: The treatment of hydrocephalus in children with endoscopic third ventriculostomy (ETV) has particular features and is associated with different success rates (SR). The aim of this study was to identify putative factors that could influence the outcome of ETV in children. Methods: Clinical data of 114 consecutive patients under 18 years of age who underwent 116 consecutive ETVs from January 2000 to January 2010 were reviewed. Data were analyzed with regards to clinical and radiological SR. The actual long-term SR was compared to that predicted by the ETV Success Score (ETVSS) model. Results: The study group included 49 males (43%) and 65 females (57%) with a mean age of 6.17 ± 1.02 years (ranging from 11 days to 18 years) at surgery. Concerning the etiology of hydrocephalus, tumors and aqueductal stenosis (AS) were the most frequently observed, with each occurring in 33 cases (29%), followed by malformations in 24 (21%), cystic lesions in 6 (5%) and other etiologies in 18 patients (16%). The overall SR at the first ETV attempt was 80% (91/114), compared to 74.8% (variance 14.35, 95% CI 69.37-78.22) predicted by the ETVSS. Regarding age, SR was 58% in patients under 6 months of age, 65% in children between 6 months and 1 year, and 86% in children older than 1 year. SR for AS and hydrocephalus associated with posterior fossa tumors were 88 and 90%, respectively. Unsatisfactory results were related to previous intraventricular hemorrhage and infection. The overall complication rate in this series was 13%. Conclusion: ETV is safe and effective in children. In this series, the age of the patient and etiology of hydrocephalus were related to SR. Also, the ETVSS was accurate to predict outcome. In a long-term follow-up, surgical experience was statistically significant in reducing complications.

Evaluation of toxic effects of a diet containing fish contaminated with methylmercury in rats mimicking the exposure in the Amazon riverside population.

This study was designed to evaluate the effects of a diet rich in fish contaminated with MeHg, mimicking the typical diet of the Amazon riverside population, in rats. Animals were randomly assigned to one of three groups with eight rats in each group: Group I-control, received commercial ration; Group II-received a diet rich in uncontaminated fish; Group III-received a diet rich in fish contaminated with MeHg. Treatment time was 12 weeks. Oxidative stress markers were evaluated, as well as the effects of this diet on DNA stability, systolic blood pressure (SBP), nitric oxide (NO) levels and histological damage in different tissues. There was a significant increase in SBP values in rats fed with MeHg-contaminated fish diet after the 10th week of the treatment. As far as oxidative stress biomarkers are concerned, no differences were observed in reduced glutathione and protein carbonyl levels, glutathione peroxidase, catalase, superoxide dismutase or δ-aminolevulinate dehydratase activities between the groups of animals receiving contaminated and uncontaminated fish diets. On the other hand, malondialdehyde levels increased significantly in rats fed with contaminated fish. NO levels were similar in all groups. DNA migration showed augmented in rats exposed to contaminated fish and histopathological analyses showed weak but significant leukocyte infiltration. Thus, we conclude that the MeHg-contaminated fish diet induced a slight lipid peroxidation and genotoxicity. However, these effects seem to be much less pronounced than when rats are exposed to aqueous solution containing CH3HgCl. Our findings support the contention that the chemical form of MeHg in fish or fish nutrients such as polyunsaturated fatty acids, Se or vitamin E could minimize the toxic effects of MeHg exposure in fish-eating communities.

Tratamento de hidrocefalia com derivação ventrículo-peritoneal: análise de 150 casos consecutivos no Hospital das Clínicas de Ribeirão Preto

INTRODUCTION/OBJECTIVES: This study has analyzed 150 consecutive cases of treatment of hydrocephalus by ventriculoperitoneal shunt in the Faculty of Medicine of Ribeirao Pretos Hospital between May 1997 and July 2000, in order to stablish the main characteristics of the patients and proceedings , in particular the etiologies, diagnosis, complications, final outcome and associated factors. METHODS: Medica records as a source for assesment of the selected variables. RESULTS: The congenital and the acquired etiologies had the same incidence, with the complexes malformations and the complications of prematurity and meningitis with distinction in each group respectively. The main complications were malfunction of the valve (33%) and infection (15%). Including the operations caused by complications, there were 2,5 surgical proceedings to each patient, on average. In the final examination, 40% of the patients had some level of neurological deficit. The main etiologies related to this deficits were prematurity , meningitis and the complexes malformations. DISCUSSION: This report has contributed to characterize the evolution and treatment of hydrocephalus in our environment, producing basis to make comparisons with the literature and with other services. The rate of neurological deficit agrees with the literature. The rate of infection is higher, maybe because it is a Universitary Hospital. A longer period of observation would be necessary to compare the incidences of mechanical complications.

Brain abscess in a neonate: an unusual presentation

BackgroundNeonatal brain abscesses are very rare and their clinical presentation is specific for this age group. They usually occur as a complication of bacterial meningitis or septicemia. They are most often caused by gram-negative organisms, and mortality and morbidity are still significant in this particular group of patients in spite of antibiotics and modern radiological tools.MethodsWe report an unusual case of a multiloculated brain abscess in a term neonate caused by Staphylococcus aureus. The abscess developed in the absence of trauma, prior surgery, cyanotic heart disease, mother’s disease, or immune defect. The onset of infection in this case was not clear and image features mimicked a brain tumor in the initial evaluation. The infant was successfully treated by primary surgical excision of the lesion and a 6-week total course of intravenous antibiotics.ConclusionThe interest of this case lies in the rarity of the causative organism and the atypical features of clinical and neurological images in a term neonate.

Surgical management of pediatric Cushing's disease: an analysis of 15 consecutive cases at a specialized neurosurgical center

OBJECTIVE The aim of this study was to review the results of surgery for pediatric patients with Cushings disease who were less than 18 years old and underwent transsphenoidal surgery in a specialized center during a 25-year period. SUBJECTS AND METHODS Retrospective study, in which the medical records, histology and pituitary imaging of 15 consecutive pediatric patients with Cushings disease (mean age: 13 years) were evaluated by the same team of endocrinologists and a neurosurgeon from 1982 to 2006. Patients were considered cured when there was clinical adrenal insufficiency and serum cortisol levels were below 1. 8 microg/dL or 50 nmol/L after one, two, three, or seven days following surgery; they therefore required cortisone replacement therapy. Follow-up was for a median time of 11.5 years (range: 2 to 25 years). RESULTS Clinical and biochemical cure was achieved in 9/15 patients (60%) exclusively after transsphenoidal surgery. Hypopituitarism was observed in four patients; growth hormone deficiency, in two; permanent diabetes insipidus, in one case. CONCLUSIONS Cushings disease is rare in children and adolescents. Transsphenoidal surgery is an effective and safe treatment in most of these patients. Plasma cortisol level < 1. 8 microg/dL following surgery is the treatment goal and is a good predictive factor for long-term cure of Cushings disease.

Approach to cortical dysplasia associated with glial and glioneuronal tumors (FCD type IIIb)

IntroductionBrain tumors are a frequent cause of epilepsy in the pediatric population. The last International League Against Epilepsy (ILAE) classification of focal cortical dysplasias (FCDs) includes a subgroup consisting of tumors with surrounding dysplastic abnormalities (FCD type IIIb). Although its pathogenesis is still unclear, it has several clinical and therapeutic (surgical) implications.BackgroundA number of benign tumors (such as dysembryoplastic neuroepithelial tumors and gangliogliomas) frequently present with medically refractory epilepsy associated with cortical dysplasia. In such cases, planning of surgical resection needs to take into consideration not only the tumor but also the whole area of epileptogenicity. The use of intraoperative electrocorticography recordings is reported to result in better postoperative outcomes, since they help delineate the abnormal cerebral cortex that needs to be resected to provide seizure freedom to patients. Clinical, radiological, and pathological features are also discussed herein.

The use of neoadjuvant chemotherapy to achieve complete surgical resection in recurring supratentorial anaplastic ependymoma

IntroductionEpendymoma is a central nervous system neoplasm that is often managed with surgery and radiotherapy. The benefits of chemotherapy in treating this tumor remain poorly defined. Case reportThe use of a platinum-based chemotherapy as a neoadjuvant treatment to permit complete surgical resection of a supratentorial anaplastic ependymoma recurring for the third time is described.Discussion This paper also discusses the possible use of chemotherapy as a strategy that may allow tumor shrinkage and ease tumor resection in giant recurring ependymomas.

Características dos pacientes com traumatismo craniencefálico atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto

The chart of 3468 patients with head injury assisted in the Hospital das Clinicas - Ribeirao Preto Medical School, from 1990 through 1992 were analyzed aiming to determine their main characteristics. Regarding sex, there was predominance of male. Accidental fall among children and traffic accidents among adults were the main causes of trauma. Daily distribution of assistance revelead an increase between 8 and 12 PM and during the week there was a constant flow from Tuesday to Friday and progressively increased on Saturday to Sunday. Approximately 75% of the patients presented mild head injury (score equal or superior to 13 in the Glasgow Coma Scale). Headache among children and vomiting, headache and alcoholic abuse among adults were the most frequent signs and symptoms at admission. At discharge 87.2% of patients had no symptoms and mortality was 5.7%. Peculiarities of head injury in Ribeirao Preto are discussed.The chart of 3468 patients with head injury assisted in the Hospital das Clínicas-Ribeirão Preto Medical School, from 1990 through 1992 were analyzed aiming to determine their main characteristics. Regarding sex, there was predominance of male. Accidental fall among children and traffic accidents among adults were the main causes of trauma. Daily distribution of assistance revealed an increase between 8 and 12 PM and during the week there was a constant flow from Tuesday to Friday and progressively increased on Saturday to Sunday. Approximately 75% of the patients presented mild head injury (score equal or superior to 13 in the Glasgow Coma Scale). Headache among children and vomiting, headache and alcoholic abuse among adults were the most frequent signs and symptoms at admission. At discharge 87.2% of patients had no symptoms and mortality was 5.7%. Peculiarities of head injury in Ribeirão Preto are discussed.Foram analisados os prontuarios de 3468 pacientes com traumatismo craniencefalico (TCE) atendidos no Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto (HC-FMRP) no periodo de 1990 a 1992, objetivando estabelecer seu perfil. Os pacientes do sexo masculino predominaram. As causas mais frequentes de TCE foram quedas acidentais em criancas e acidentes de trânsito em adultos. A distribuicao circadiana do atendimento mostrou um pico entre 20 e 24 horas e a distribuicao semanal mostrou um afluxo constante de segunda a quinta-feira e um aumento progressivo no sabado e no domingo. A maioria dos pacientes (74,5%) apresentou TCE leve (escore igual ou superior a 13 na Escala de Coma de Glasgow). Os sinais e sintomas mais comuns foram cefaleia nas criancas e vomitos, cefaleia e alcoolismo agudo nos adultos. Na alta hospitalar 87,2% dos pacientes apresentavam-se assintomaticos. A mortalidade foi de 5,7%. As peculiaridades do TCE na regiao sao discutidas em relacao a literatura.