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B O Colli

Publications and source records attributed to B O Colli.

31 records · Page 2Linked to original sources

[Multiple non-neoplastic lesions in computerized cranial tomography].

Multiple intracranial lesions observed in the computerized tomography ever cause worry due to the possibility of neoplastic etiology, although granulomatous diseases (parasitic or not) and vascular diseases can produce this type of lesions. Five patients with clinical picture that suggested expansive intracranial masses and that had multiple lesions in the computerized tomography that suggested neoplastic diseases are presented. In all patients the clinical evolution and/or other complementary diagnostic tests showed the non neoplastic etiology of the lesions. In three patients the lesions were due to parasitic diseases (intracranial tuberculomas in one case and neurocysticercosis in two cases) and in the other two cases the lesions were due to vascular disturbs (cerebral infarcts). The knowledge of the several diseases that can cause multiple intracranial lesions as seen in the computerized tomography allows to direct the etiologic diagnostic that is essential to introduce the correct treatment avoiding irradiation of non neoplastic lesions and unnecessary surgical procedures. In our country, granulomatous parasitic diseases, mainly neurocysticercosis, tuberculosis and fungal diseases must be considered in the differential diagnosis of multiple intracranial lesions observed in the computerized tomography, together with cerebral infarcts and neoplasms.

Adolescent↗

Results of surgical treatment of neurocysticercosis in 69 cases.

The clinical course of 69 patients with neurocysticercosis who underwent surgery to control increased intracranial pressure (ICP) or cyst removal is analyzed. Increased ICP was caused by hydrocephalus in 63 patients, by cerebral edema in four, and by giant cysts in two. Skull x-ray films showed calcifications in 14% and signs of elevated ICP in 46%. Examination of cerebrospinal fluid (CSF) revealed pleocytosis with eosinophils in 52% of cases and a positive complement fixation test for cysticercosis in 66%. Ventriculography allowed localization of the CSF obstruction and ventricular cysts, and generally differentiated between an obstruction due to cysts and an inflammatory process. Computerized tomography showed cysts in the cerebral parenchyma and ventricular dilatation. Ventricular cysts were best seen when intraventricular metrizamide was used. Intracranial shunting and posterior fossa exploration were less effective in the treatment of hydrocephalus than was ventriculoatrial (VA) or ventriculoperitoneal (VP) shunting, although VA or VP shunting was associated with a high percentage of complications. Quality of survival was good in 87% of the cases in the first 3 postoperative months and in 93% of patients who survived 2 years after surgery. Forty-seven patients (68%) were readmitted one or more times for CSF shunt revision; 14 of them for shunt infection (meningitis). The early operative mortality rate was 1.8% for patients with VA or VP shunt placement and 5.3% for those with posterior fossa exploration. The authors conclude that placement of CSF shunts is indicated in the treatment of hydrocephalus, and cyst removal is indicated only when the cyst exhibits tumor-like behavior. Surgical exploration is also indicated when the diagnosis is uncertain.

Adolescent↗

Ultrasonographic evaluation of infantile hydrocephalus before and after shunting. A study in 20 children.

The authors present the results of a prospective study of 20 children with congenital or acquired hydrocephalus of nontumoral etiology and submitted to ventriculo- (or cyst-) peritoneal shunting with valve. The diagnosis was established by B-mode or real-time brain sonography, in association with another neuroradiological procedure (computed tomography, ventriculography with air or Dimer-X, cerebral angiography). Among the proposed measurements (cortical thickness, lateral ventricle height, III ventricle width and ventricular ratio) for pre- and postoperative comparison, the cortical thickness and the lateral ventricle height were the ones that changed significantly when analyzed by sonography. The routine use of brain sonography allowed the visualization of the ventricular catheter position and the diagnosis of complications, such as subdural collection, progressive enlargement of cysts, isolated IV ventricle, etc, even before symptoms arise. The authors conclude that sonography is easily performed, inexpensive and innocuous, and should be used routinely during the follow-up of children with hydrocephalus.

Cerebral Cortex↗

[Computerized tomography in patients with neurocysticercosis with intracranial hypertension due to obstructive hydrocephalus: comparison with Dimer-X ventriculography].

The authors reviewed the alterations observed on computerized tomography (CT) examinations of 16 patients with increased intracranial pressure and obstructive hydrocephalus due to cerebral cysticercosis. Plain radiograms of the skull were available in all cases and Dimer-X ventriculography in 12 cases. In 7 cases there were radiologic signs of increased intracranial pressure. CT scan showed normal cerebral parenchyma in 9 cases and low density areas, with various size, with or without surround contrast enhancement, and/or small calcifications in the parenchyma. Hydrocephalus was the only alteration observed in the ventricular system in the case that the examination was done before ventricular drainage. Ventriculography was analyzed in other paper and permitted to situate the obstruction, determine its morphological characteristics and identify occuping space lesions within the ventricles. Comparison between ventriculography and CT scan made in the same period evidence that the former gives best information about the ventricular system and that tomography gives additional information about the cerebral parenchyma. In conclusion, CT scan and ventriculography are investigations that complete each the other for evaluation and diagnosis of cerebral cysticercosis.

Brain Diseases↗

[Tumor form of neurocysticercosis: surgical removal of a cysticercus measuring 70X77 mm and treatment with praziquantel].

The authors report a case of a female patient, age 22, who presented episodes of focal seizures, right hemiparesis and dysphasia of five months duration. The neurologic exam revealed bilateral papilledema and computarized tomography of the head showed a cystic lesion (70X77 mm) in the left fronto-temporo-parietal area, midline shift and similar lesions scattered in the brain parenchyma. She was submitted to a left craniotomy with the diagnosis of cerebral cysticercosis and the major cyst (Cysticercus racemosus) and a small cortical cyst (10X10 mm) were removed to aliviate the increased intracraneal pressure and for histopathological examination. Thirteen days after surgery she was discharged without neurological deficits, except mild papilledema. One month later she was treated with praziquantel (50 mg/kg/day) during 21 days. The CSF examination was normal before the treatment started and showed a transient eosinophilic cellular reaction with positivation of the complement fixation test for cysticercosis while on treatment. The CT-Scan performed before the medical treatment revealed ventricular dilatation and several low density areas (10 to 40 mm) scattered in the cerebral parenchyma, including the operative site. CT-Scan performed three months later showed small low density areas only in the left cerebral hemisphere, including the operative site, calcification in the parenchyma, and slight dilatation of the left lateral ventricle. The clinical evolution was uneventful and the neurologic examination was normal three months later.

Adult↗

[Surgical treatment of hydrocephalus in children. I. Clinical development and mortality].

The authors analized the clinical evolution and the mortality of fifty seven children with hydrocephalus due to congenital malformation (41.1%), meningitis (36.8%) and tumors (21.1%), that were submitted to surgical treatment for hydrocephalus, from 1970 to 1980. Insertions of ventriculostomy reservoir and of external ventricular drainage were satisfactory used to control the expanding hydrocephalus in children with meningitis, that wait insertion of the valve. The use of hypothalamic ventriculostomy with catheter has showed satisfactory results in the treatment of children with hydrocephalus due to non inflammatory origin. Ventriculoatrial shunts were utilized in few cases but were useful in the treatment of hydrocephalus in children. The operative mortality rate was 25.7%. Ventriculoperitoneal shunts showed good results in the treatment of hydrocephalus in 89.4% of the cases in the immediate post-operative time and this number drop to 88.2% at the eighteen post-operative month. The overall mortality rate was 34%. At the end of the third post-operative month 27.3% of the survivors of the children with hydrocephalus due to congenital malformation and meningitis submitted to ventriculoperitoneal shunts showed normal neuromotor development and at the end of the second post-operative year this number increased to 50%. The operative mortality rate in this group was 25% and the majority of death occurred due to meningitis.

Cerebral Ventricle Neoplasms↗

[Surgical treatment of hydrocephalus in children. II. Complications].

The authors analized the complications of fifty seven children with hydrocephalus due to congenital malformation (42.1%), meningitis (36.8%) and tumor (21.1%), that were submitted to surgical treatment for hydrocephalus, from 1970 to 1980. External ventricular drainage and insertion of ventriculostomy reservoir were used to control the expanding hydrocephalus in children with meningitis. Complications weren't observed in the first procedure. Cutaneous abscess, brain abscess, cerebrospinal fluid leakage, wound dehiscence, malposition of the reservoir and local tumor were observed in the use of the ventriculostomy reservoir and these complications caused a revision rate of 0.47 revisions per patient. Hypothalamic ventriculostomy with catheter showed complications (catheter obstruction and meningitis) that caused a revision rate of 0.57 revisions per patient. Ventriculoatrial shunting procedure showed several complications (malposition of the distal catheter, malfunction of the valvular system without obstruction and infection and thrombosis of the superior vena cava), that caused a revision rate of 0.57 revisions per patient. Ventriculo-peritoneal shunting procedure showed infections in 30.8%, malfunction of the valvular system in 32.2% cerebrospinal fluid leakage in 17.3%, malposition of catheter in 13.5%, catheter disconnection in 9.6%, transient abdominal distension in two cases and overdrainage phenomena, ascites and abdominal pseudocyst in one case.

Brain Abscess↗

[Intraspinal syphilitic gumma causing spinal cord compression. Report of a case].

A case of an syphilitic intraspinal gumma is reported. A 48 years-old woman developed severe spastic crural paraparesis of two months duration, associated with sensory and sphincteric disturbances. Myelography revealed an intraspinal tumor at T3 level. Surgical exploration by dorsal laminectomy showed a syphilitic gumma attached to the spinal cord. Clinical observations and laboratory studies are discussed. Revision and comments on previous reports are presented.

Female↗

[Morphology of the lymph vessels and axillary and mediastinal lymph nodes of the white rat (Rattus norvegicus)].

In this work, the authors studied the morphology of the axillary and mediastinal lymph nodes and their efferent branches in the white rat (Rattus norvegicus). The main characteristics observed were: The presence of two groups of axillary lymph nodes, one in the lateral and the other in the medial portion, and the presence of two groups of mediastinal lymph nodes, one being ventrolateral and the other dorsoventral relating to cranial precava veins. Usually, in both sides, there is a lymphatic plexus dorsally to the jugulsubclavian angle, formed by reunion of internal jugular and subclavian trunks and the thoracic duct (to the left) or the right lymphatic trunk (to the right). From this plexus, one or two branches run off and flow into the venous jugulosubclavian angle. The subclavian trunk begins in the medial axillar lymph nodes and joins to the lymphatic plexus at the internal jugular trunk or at the thoracic duct or yet at the right lymphatic trunk according to the site, and finally it may link itself directly to the venous system. The mediastinal lymph nodes at the side send branches forming the right lymphatic trunk and branches adhering to the lymphatic plexus; the left lymph nodes join to the plexus or the thoracic duct.

Animals↗

MIB-1 labeling index in astrocytic tumors--a clinicopathologic study.

BACKGROUND: Although neuroimage and surgical techniques have improved substantially, the prognosis of patients with astrocytic tumors remains unchanged. The purpose of this study was to evaluate the proliferative activity in astrocytic tumors in different grades of malignancy and correlate it to other clinical features. PATIENTS AND METHODS: From archival paraffin-embedded surgical specimens of 40 patients of the Ribeirão Preto Medical School with World Health Organization grade II (n = 10), grade III (n = 5) and grade IV astrocytomas (n = 25), the MIB-1 labeling index (LI) was determined using at least a half of the blocks per case. The results were correlated to the biological behavior of the tumors. The aims of this study were to determine the level of MIB-1 LI values (cut-off) that reflect differences in biological behavior of these tumors, the impact on survival of clinical features such as age, tumor location or extension of surgical removal as well as the adjuvant therapy. RESULTS AND CONCLUSIONS: As expected, a wide range of MIB-1 LI values was disclosed (mean of 2.35% in grade II astrocytomas to 12.28% in glioblastomas). A close relationship was found between MIB-1 LI and survival of patients with astrocytomas according to the histological grade. All but 1 recurrent tumor presented higher MIB-1 LI in the second biopsy, and the mean MIB-1 LI of the patients who died in the immediate postoperative period (n = 7) was higher in comparison to the MIB-1 LI of the respective grade. Postoperative radiation therapy was an important factor that affected the survival of patients with high-grade astrocytomas (p = 0.006). MIB-1 LI cut-off of 3% divided the astrocytomas in 2 groups with significantly different survival (p < 0.001): median survival time of 12 months (low-grade) versus 45 months (high-grade). On the other hand, univariate analysis did not show any correlation between survival and extension of surgical resection (radical versus partial), tumor's location or patient's age at surgery.

Adolescent↗