Investigação da capacidade intelectiva de pacientes pediátricos diagnosticados com tumores de fossa posterior

Central Nervous System are the most common pediatric solid tumors. 60% of these tumors arise in posterior fossa, mainly in cerebellum. The first therapeutic approach is surgical resection. Malignant tumors require additional strategies - chemotherapy and radiotherapy. The increasing survival evidences that childhood brain tumors result in academic and social difficulties that compromise the quality of life of the patients. This study investigated the intellectual functioning of children between 7 to 15 years diagnosed with posterior fossa tumors and treated at CEHOPE - Recife / PE. 21 children were eligible - including 13 children with pilocytic astrocytoma (G1) who underwent only surgery resection, and eight children with medulloblastoma (G2) - submitted to surgical resection, chemotherapy and craniospinal radiotherapy. Participants were evaluated by the Wechsler Intelligence Scale for Children - WISC-III. Children of G1 scored better than children of G2. Inferential tools (Mann-Whitney Ü Test) identified significant diferences (p ≤ 0.05) between the Performance IQ (PIQ) and Processing Speed Index (PSI) as a function of treatment modality; Full Scale IQ (FSIQ), PIQ and PSI as a function of parental educational level; PIQ, FSIQ, IVP and Freedom from Distractibility (FDI) as a function of time between diagnosis and evaluation. These results showed the late and progressive impact of radiotherapy on white matter and information processing speed. Furthermore, children whose parents have higher educational level showed better intellectual performance, indicating the influence of xxii socio-cultural variables on cognitive development. The impact of cancer and its treatment on cognitive development and learning should not be underestimated. These results support the need to increase the understanding of such effects in order to propose therapeutic strategies which ensure that, in addition to the cure, the full development of children with this pathology

Relação entre achados em neuroimagem, habilidades auditivas e metafonológicas em escolares com dislexia do desenvolvimento

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Aspectos clínicos e laboratoriais em ovinos submetidos a dietas com níveis elevados de enxofre com objetivo de indução de polioencefalomalácia

A polioencefalomalacia (PEM) é uma doença neurológica que acomete ruminantes e pode ser desencadeada por diversos fatores, dentre eles o consumo excessivo de enxofre. Este trabalho teve como objetivo verificar a relação entre dietas ricas em enxofre, altos níveis de gás sulfídrico ruminal e a ocorrência de polioencefalomalácia em ovinos. Foram utilizados 18 ovinos, divididos em três grupos (G1, G2 e G3) que receberam diferentes níveis de enxofre na dieta; 0,2%, 0,9% e 1,2%, respectivamente. Exames físicos (frequência cardíaca, frequência respiratória, temperatura retal e motricidade ruminal) e complementares (concentração de sulfeto de hidrogênio ruminal, hemogasometria venosa, pH do fluído ruminal, concentração de cobre sérico e hepático, tomografia computadorizada, necropsia e histopatologia) foram realizados. A temperatura retal, a hemogasometria venosa e o pH do fluido ruminal permaneceram dentro dos valores de referência para a espécie. A motricidade ruminal estava diminuída nos grupos G2 e G3 em comparação com o G1 (controle). Quanto maior a ingestão de enxofre, menores foram os níveis de cobre sérico e hepático. Valores elevados de sulfeto de hidrogênio ruminal foram detectados nos grupos G2 e G3. Nenhum animal apresentou sinais clínicos de PEM. Nos exames de tomografia computadorizada, necropsia e exame histopatológico do sistema nervoso central (SNC), não foram observadas alterações compatíveis com PEM. É provável que algum outro fator esteja associado ao excesso de enxofre na dieta para o desenvolvimento de PEM em ovinos.

RR3D: Uma solução para renderização remota de imagens médicas tridimensionais

The visualization of three-dimensional(3D)images is increasigly being sed in the area of medicine, helping physicians diagnose desease. the advances achived in scaners esed for acquisition of these 3d exames, such as computerized tumography(CT) and Magnetic Resonance imaging (MRI), enable the generation of images with higher resolutions, thus, generating files with much larger sizes. Currently, the images of computationally expensive one, and demanding the use of a righ and computer for such task. The direct remote acess of these images thruogh the internet is not efficient also, since all images have to be trasferred to the user´s equipment before the 3D visualization process ca start. with these problems in mind, this work proposes and analyses a solution for the remote redering of 3D medical images, called Remote Rendering (RR3D). In RR3D, the whole hedering process is pefomed a server or a cluster of servers, with high computational power, and only the resulting image is tranferred to the client, still allowing the client to peform operations such as rotations, zoom, etc. the solution was developed using web services written in java and an architecture that uses the scientific visualization packcage paraview, the framework paraviewWeb and the PACS server DCM4CHEE.The solution was tested with two scenarios where the rendering process was performed by a sever with graphics hadwere (GPU) and by a server without GPUs. In the scenarios without GPUs, the soluction was executed in parallel with several number of cores (processing units)dedicated to it. In order to compare our solution to order medical visualization application, a third scenario was esed in the rendering process, was done locally. In all tree scenarios, the solution was tested for different network speeds. The solution solved satisfactorily the problem with the delay in the transfer of the DICOM files, while alowing the use of low and computers as client for visualizing the exams even, tablets and smart phones

Carcinoma de pequenas células do esôfago: estudo clínico patológico de dois casos

RACIONAL: O carcinoma de pequenas células primário do esôfago é tumor raro, agressivo, morfologicamente indistinguível de seu correspondente no pulmão. OBJETIVO: Apresentar os aspectos clínico-patológicos de dois pacientes com carcinoma de pequenas células do esôfago. RELATO DE CASOS: Paciente 1: masculino, 56 anos com disfagia progressiva há seis meses e emagrecimento, com antecedentes de tabagismo e etilismo. A endoscopia mostrou lesão vegetante dos 30 aos 40 cm da arcada dentária superior e o exame anatomopatológico, diagnosticou neoplasia maligna indiferenciada de pequenas células com marcadores imunoistoquímicos positivos para cromogranina e sinaptofisina, caracterizando a linhagem neuroendócrina da neoplasia. Após dois ciclos de quimioterapia (cisplatina e etoposide) associada à radioterapia ele apresentou remissão da disfagia. Paciente 2: masculino, 55 anos, com queixas de pirose, disfagia, rouquidão há seis meses, com emagrecimento de 10 kg no período. A endoscopia mostrou lesão vegetante à 30 cm da arcada dentária superior, obstrutiva. O exame anatomopatológico revelou carcinoma de pequenas células, com os mesmos marcadores imunoistoquímicos positivos para linhagem neuroendócrina. Tomografia computadorizada mostrou metástases hepáticas. Frente ao estadio avançado da doença optou-se pela indicação de gastrostomia. O paciente desenvolveu pneumonia e faleceu dois meses após o diagnóstico. CONCLUSÃO: A evolução dos portadores de carcinoma de pequenas células do esôfago depende do estadiamento da doença e apesar da alta agressividade biológica, este tumor apresenta boa resposta à quimioterapia associada à radioterapia.

Linfoma não-Hodgkin de órbita: relato de caso

O objetivo é relatar manifestação incomum de linfoma não-Hodgkin de órbita. Paciente masculino, de 75 anos, se apresentou com queixa de lacrimejamento crônico bilateral. Havia feito dacriocistorrinostomia endonasal à direita e à esquerda por duas vezes, sem sucesso. Ao exame, massas de consistência fibroelástica, em topografia das bolsas de gordura das pálpebras inferiores e proptose axial. O paciente negava outros sintomas ou sinais sistêmicos. Hemograma sem alteração, hormônios tireoidianos normais. A tomografia computadorizada mostrava infiltrado difuso na órbita e proptose axial. Biópsia de gordura orbitária e de medula óssea diagnosticaram linfoma não-Hodgkin. O paciente foi tratado com quimioterapia, sendo em seguida submetido à cirurgia da via lacrimal bilateral, com resolução do quadro. A doença sistêmica que exigia diagnóstico e tratamento adequados para que se tivesse bom prognóstico estava mascarada pelo quadro de epífora bilateral.

Arcabouço geofísico, isostasia e causas do magmatismo cenozóico da província Borborema e de sua margem continental (Nordeste do Brasil)

The Borborema Province (BP) is a geologic domain located in Northeastern Brazil. The BP is limited at the south by the São Francisco craton, at the west by the Parnaíba basin, and both at the north and east by coastal sedimentary basins. Nonetheless the BP surface geology is well known, several key aspects of its evolution are still open, notably: i)its tectonic compartmentalization established after the Brasiliano orogenesis, ii) the architecture of its cretaceous continental margin, iii) the elastic properties of its lithosphere, and iv) the causes of magmatism and uplifting which occurred in the Cenozoic. In this thesis, a regional coverage of geophysical data (elevation, gravity, magnetic, geoid height, and surface wave global tomography) were integrated with surface geologic information aiming to attain a better understanding of the above questions. In the Riacho do Pontal belt and in the western sector of the Sergipano belt, the neoproterozoic suture of the collision of the Sul domain of the BP with the Sanfranciscana plate (SFP) is correlated with an expressive dipolar gravity anomaly. The positive lobule of this anomaly is due to the BP lower continental crust uplifting whilst the negative lobule is due to the supracrustal nappes overthrusting the SFP. In the eastern sector of the Sergipano belt, this dipolar gravity anomaly does not exist. However the suture still can be identified at the southern sector of the Marancó complex arc, alongside of the Porto da Folha shear zone, where the SFP N-S geophysical alignments are truncated. The boundary associated to the collision of the Ceará domain of the BP with the West African craton is also correlated with a dipolar gravity anomaly. The positive lobule of this anomaly coincides with the Sobral-Pedro II shear zone whilst the negative lobule is associated with the Santa Quitéria magmatic arc. Judging by their geophysical signatures, the major BP internal boundaries are: i)the western sector of the Pernambuco shear zone and the eastern continuation of this shear zone as the Congo shear zone, ii) the Patos shear zone, and iii) the Jaguaribe shear zone and its southwestern continuation as the Tatajuba shear zone. These boundaries divide the BP in five tectonic domains in the geophysical criteria: Sul, Transversal, Rio Grande do Norte, Ceará, and Médio Coreaú. The Sul domain is characterized by geophysical signatures associated with the BP and SFP collision. The fact that Congo shear zone is now proposed as part of the Transversal domain boundary implies an important change in the original definition of this domain. The Rio Grande do Norte domain presents a highly magnetized crust resulted from the superposition of precambrian and phanerozoic events. The Ceará domain is divided by the Senador Pompeu shear zone in two subdomains: the eastern one corresponds to the Orós-Jaguaribe belt and the western one to the Ceará-Central subdomain. The latter subdomain exhibits a positive ENE-W SW gravity anomaly which was associated to a crustal discontinuity. This discontinuity would have acted as a rampart against to the N-S Brasiliano orogenic nappes. The Médio Coreaú domain also presents a dipolar gravity anomaly. Its positive lobule is due to granulitic rocks whereas the negative one is caused by supracrustal rocks. The boundary between Médio Coreaú and Ceará domains can be traced below the Parnaíba basin sediments by its geophysical signature. The joint analysis of free air anomalies, free air admittances, and effective elastic thickness estimates (Te) revealed that the Brazilian East and Equatorial continental margins have quite different elastic properties. In the first one 10 km < Te < 20 km whereas in the second one Te ≤ 10 km. The weakness of the Equatorial margin lithosphere was caused by the cenozoic magmatism. The BP continental margin presents segmentations; some of them have inheritance from precambrian structures and domains. The segmentations conform markedly with some sedimentary basin features which are below described from south to north. The limit between Sergipe and Alagoas subbasins coincides with the suture between BP and SFP. Te estimates indicates concordantly that in Sergipe subbasin Te is around 20 km while Alagoas subbasin has Te around 10 km, thus revealing that the lithosphere in the Sergipe subbasin has a greater rigidity than the lithosphere in the Alagoas subbasin. Additionally inside the crust beneath Sergipe subbasin occurs a very dense body (underplating or crustal heritage?) which is not present in the crust beneath Alagoas subbasin. The continental margin of the Pernambuco basin (15 < Te < 25 km) presents a very distinct free air edge effect displaying two anomalies. This fact indicates the existence in the Pernambuco plateau of a relatively thick crust. In the Paraíba basin the free air edge effect is quite uniform, Te ≈ 15 km, and the lower crust is abnormally dense probably due to its alteration by a magmatic underplating in the Cenozoic. The Potiguar basin segmentation in three parts was corroborated by the Te estimates: in the Potiguar rift Te ≅ 5 km, in the Aracati platform Te ≅ 25 km, and in the Touros platform Te ≅ 10 km. The observed weakness of the lithosphere in the Potiguar rift segment is due to the high heat flux while the relatively high strength of the lithosphere in the Touros platform may be due to the existence of an archaean crust. The Ceará basin, in the region of Mundaú and Icaraí subbasins, presents a quite uniform free air edge effect and Te ranges from 10 to 15 km. The analysis of the Bouguer admittance revealed that isostasy in BP can be explained with an isostatic model where combined surface and buried loadings are present. The estimated ratio of the buried loading relative to the surface loading is equal to 15. In addition, the lower crust in BP is abnormally dense. These affirmations are particularly adequate to the northern portion of BP where adherence of the observed data to the isostatic model is quite good. Using the same above described isostatic model to calculate the coherence function, it was obtained that a single Te estimate for the entire BP must be lower than 60 km; in addition, the BP north portion has Te around 20 km. Using the conventional elastic flexural model to isostasy, an inversion of crust thickness was performed. It was identified two regions in BP where the crust is thickened: one below the Borborema plateau (associated to an uplifting in the Cenozoic) and the other one in the Ceará domain beneath the Santa Quitéria magmatic arc (a residue associated to the Brasiliano orogenesis). On the other hand, along the Cariri-Potiguar trend, the crust is thinned due to an aborted rifting in the Cretaceous. Based on the interpretation of free air anomalies, it was inferred the existence of a large magmatism in the oceanic crust surrounding the BP, in contrast with the incipient magmatism in the continent as shown by surface geology. In BP a quite important positive geoid anomaly exists. This anomaly is spatially correlated with the Borborema plateau and the Macaú-Queimadas volcanic lineament. The integrated interpretation of geoid height anomaly data, global shear velocity model, and geologic data allow to propose that and Edge Driven Convection (EDC) may have caused the Cenozoic magmatism. The EDC is an instability that presumably occurs at the boundary between thick stable lithosphere and oceanic thin lithosphere. In the BP lithosphere, the EDC mechanism would have dragged the cold lithospheric mantle into the hot asthenospheric mantle thus causing a positive density contrast that would have generated the main component of the geoid height anomaly. In addition, the compatibility of the gravity data with the isostatic model, where combined surface and buried loadings are present, together with the temporal correlation between the Cenozoic magmatism and the Borborema plateau uplifting allow to propose that this uplifting would have been caused by the buoyancy effect of a crustal root generated by a magmatic underplating in the Cenozoic

Cerebral ischemia as initial neurological manifestation of atrial myxoma: case report

Infartos cerebrais de etiologia cardíaca são observados em cerca de 20% dos pacientes com acidente vascular cerebral isquêmico. Infarto cerebral ocorre como manifestação clínica inicial em um terço dos casos de mixoma atrial. Embora quase metade dos pacientes com mixoma atrial apresente alteração ao exame neurológico, infarto cerebral não hemorrágico é visto na tomografia computadorizada em praticamente todos os casos. Os autores apresentam o caso de uma paciente, cuja primeira manifestação clínica do mixoma atrial foi um acidente vascular cerebral isquêmico e chamam a atenção para a possibilidade de infarto cerebral silencioso em pacientes portadores de mixoma atrial.

Xantelasma: relato de um caso

Os autores relatam um caso raro em paciente do sexo masculino, de 71 anos de idade, com história de surgimento de carocinho na pálpebra superior direita há nove anos, que teve aumento importante há um ano. A tomografia computadorizada evidenciou espessamento da musculatura do reto lateral e de partes moles adjacentes. O diagnóstico pela biópsia foi de xantelasma.