Biomedical subjects

J E Pittella

Publications and source records attributed to J E Pittella.

At least 19 recordsLinked to original sources

PubMed2001

October 2000: a 47 year old man with long-standing progressive tetraparesis.

A 47-year-old man with a six-month history of progressive tetraparesis and sphincter disturbances developed tetraplegy after two years and died. A cervical MRI revealed an ill-defined, enhancing lesion from C1 to C6, internally attached to the dura mater and compressing the spinal cord. At necropsy, eight whitish nodes and diffuse thickening of the dura mater from C1 to C6 were found. Histological studies revealed multiple en plaque lymphoplasmacyte-rich meningiomas. The radiologic and pathologic aspects of lymphoplasmacyte-rich meningioma are reviewed and the atypical features of this case, such as macroscopic appearance and the histological variant, are described.

Disease Progression↗

PubMed1999

[Intracranial hypertension in victims of fatal traffic accidents].

A morphological study, macro and microscopical, was made of brain lesions in 120 victims of fatal road traffic accidents. Parahipoccampal hernia, Duret haemorrhage and infarction in the medio-basal occipital lobe, clear evidence of raised intracranial pressure, occurred in 43 (35.8%) patients. The increased intracranial pressure from the head injury is caused by brain swelling and by intracranial haematomas. In this series 3 cases of extradural haematomas (7.0%), 9 of subdural haematomas (20.9%), 6 of intracerebral haematomas (14%), 6 of burst lobe (14%) and 9 of brain swelling (20.9%) were observed.

Accidents, Traffic↗

PubMed1999

[Cerebral contusion in victims of fatal traffic accidents. Frequency and association with other craniocerebral lesions].

A morphological study, macro and microscopical, was made of brain lesions in 120 victims of fatal road traffic accidents. Contusions of the brain were identified in 67 (55.8%) of the patients. The contusions especially affected the orbital surfaces of the frontal lobes (27.8%) and the temporal poles (19.8%). The recent brain contusion was associated with a skull fracture in 70.1% of the cases and with a diffuse axonal injury in 89.5%. These can be explained by the association of contact and inertia from the road traffic accidents. Old contusions were identified in six patients (5.0%).

Accidents, Traffic↗

PubMed1999

[Congestive brain swelling in victims of fatal road accident. Frequency and association with other head injury lesions].

A morphological study, macro and microscopical, was made of brain lesions in 120 victims of fatal road traffic accidents. Congestive brain swelling occurred in 21 (17.5%) patients. Owing to the brain swelling that increases the brain volume, an increase of brain weight was also observed. Brain contusion was the most frequent lesion associated with congestive brain swelling (76.2%), while the intracranial haematomas were observed in almost half of the cases.

Accidents, Traffic↗

PubMed1999

[Burst lobe in victims of fatal road traffic accident. Frequency and association with other head injury].

A morphological study, macro and microscopical, was made of brain lesions in 120 victims of fatal road traffic accidents. Burst lobes were identified in 12 (10.0%) of the patients. It occurred in the frontal lobe in 6 (50.0%) patients, in the temporal lobe in 2 (16.7%) and in both lobes in 4 (33.3%) patients. A skull fracture occurred in 8 (66.7%) patients and intracranial hypertension occurred in half of cases. Nine patients were admitted in coma and three patients died immediately after the road traffic accident. All cases of burst lobes were associated with diffuse axonal injury, which explains the severe alteration of consciousness observed at the patients' admission.

Accidents, Traffic↗

PubMed1999

[Actinomycosis of the brain: case report].

Actinomycosis located in the central nervous system is an extremely uncommon event, but if correctly diagnosed and properly treated may have a good prognosis. This case report of a cerebral abscess caused by actinomyces suggests that such a rare event should be included in the differential diagnosis of infectious diseases that affect the central nervous system.

Actinomyces↗

PubMed1998

Extradural haematoma and diffuse axonal injury in victims of fatal road traffic accidents.

Seven cases of victims of road traffic accidents with extradural haematoma (EH) and diffuse axonal injury (DAI) are reported. Such cases are part of a total of 120 victims of fatal road traffic accidents that were subjected to pathological study. The association of the two lesions occurred in 5.8% of the patients and all cases of EH were associated with DAI. The latter explains the immediate coma (absence of lucid interval) and the grave prognosis for all seven patients. It was noted that EH is relatively infrequent in road traffic accidents, but in such cases it is more severe since it is frequently associated with DAI and immediate coma.

Accidents, Traffic↗

PubMed1997

Neuroschistosomiasis.

Schistosomiasis is an infection caused by digenetic trematode platyhelminths of the genus Schistosoma. These blood flukes use man and other mammals as definitive hosts and aquatic and amphibious snails as intermediate hosts. Of the schistosomal species, S. mansoni, S haematobium and S. japonicum are the most important to man and the most widely distributed. The infection affects about 200 million individuals in 74 countries of Latin America, Africa and Asia. Far less commonly, schistosomes reach the central nervous system (CNS). This may occur at any time from the moment the worms have matured and the eggs have been laid. For this reason, CNS involvement may be observed with any of the clinical forms of schistosomal infection. The presence of eggs in the CNS induces a cell-mediated periovular granulomatous reaction. When eggs reach the CNS during the early stages of the infection or during evolution of the disease to its chronic forms, large necrotic-exudative granulomas are found. In-situ egg deposition following the anomalous migration of adult worms appears to be the main, if not the only, mechanism by which Schistosoma may reach the CNS in these stages. The mass effect produced by the heavy concentration of eggs and the presence of large granulomas in circumscribed areas of the brain and spinal cord explains, respectively, 1) the signs and symptoms of increased intracranial pressure and focal neurological signs; and 2) the signs and symptoms of rapidly progressing transverse myelitis, usually affecting the lumbosacral segments of the spinal cord. Most of the cases of CNS involvement associated with the hepatosplenic and cardiopulmonary chronic forms, or with severe urinary schistosomiasis, though more frequent, are asymptomatic. In the patients with these clinical forms, the random and sparse distribution of eggs in the CNS indicates that the embolization of eggs from the portal mesenteric system to the brain and spinal cord constitutes the main route of CNS invasion by Schistosoma. The discrete inflammatory reaction elicited by the sparsely distributed eggs in the CNS explains the lack of neurological symptoms that could be produced by egg deposition.

Animals↗

PubMed1997

Neurocysticercosis.

Cysticercosis is an infection caused by Taenia solium larvae (cysticerci). When the cysticercus is lodged in the central nervous system (CNS), the disease is known as neurocysticercosis (NCC). NCC is the most frequent and most widely disseminated human neuroparasitosis. It is endemic in many parts of the world, particularly Latin America, Africa, and Asia, and still relatively frequent in Portugal, Spain and Eastern European countries It is also endemic in developed countries with high rates of immigration from endemic areas. Man may act as an intermediate host after ingestion of mature, viable T. solium eggs via the fecal-oral route. The development of lesions in the brain and leptomeninges, and the consequent of onset of symptoms associated with NCC are mainly due to the host immune-inflammatory response. As long as the cysticercus remains viable, there is relative host immune tolerance. It is only when the parasite dies that massive antigen exposure occurs, with intensification of the immune response/inflammatory reaction and the appearance or worsening of symptoms. NCC can be asymptomatic or cause widely varied clinical manifestations, such as seizures, increased intracranial pressure, ischemic cerebrovascular disease, dementia, and signs of compression of the spinal roots/cord. The combination of two or more symptoms is common. Such clinical polymorphism is determined by 1) the number of lesions (single or multiple cysticerci); 2) the location of CNS lesions (subarachnoid, intracerebral, intraventricular, intramedullary); 3) the type of cysticercus (Cysticercus cellulosae, Cysticercus racemosus); 4) the stage of development and involution of the parasite (vesicular or viable, necrotic, fibrocalcified nodule); and 5) the intensity of the host immune-inflammatory response (no inflammatory reaction, leptomeningitis, encephalitis, granular ependymitis, arteritis).

Animals↗

PubMed1996

Tumoral form of cerebral schistosomiasis mansoni. A report of four cases and a review of the literature.

We describe four cases of the tumoral form of cerebral schistosomiasis mansoni. The patients had symptoms of increased intracranial pressure and focal neurological signs that varied according to the site of the lesion. Computerized tomography showed a hyperdense, enhancing lesion located in the cerebellum (2 patients), frontal lobe and thalamus (1 patient), and temporal subdural region (1 patient), with associated mass effects. The lesion was resected in three patients and a stereotactic biopsy was performed in one. Histopathologic specimens of all four patients revealed multiple schistosomal granulomas in various evolutive phases. Two of these patients differ from previously described cases; one because of the subdural location of the lesion, mimicking a meningioma, and the other one because two lesions were present.

Adult↗

PubMed1995

Frequency of schistosomiasis mansoni, of its clinicopathological forms and of the ectopic locations of the parasite in autopsies in Belo Horizonte, Brazil.

The frequency of schistosomiasis mansoni, of its clinicopathological forms, and of the distribution of Schistosoma mansoni eggs in ectopic locations in each clinicopathological form were studied in 1863 complete consecutive autopsies performed in Belo Horizonte, Brazil, in the period from 1971 to 1990. Three hundred and thirteen cases of S. mansoni infection (16.8%) were found. The intestinal form was the most frequent (67.4%), followed by the hepatosplenic form without pulmonary hypertension (24.9%). The intestinal form showed a smaller number of ectopic sites and a lower percentage of involvement of these sites compared to the more severe forms, particularly the hepatosplenic form with pulmonary hypertension. The distribution of the frequency of schistosomiasis mansoni cases, of the clinicopathological forms of the disease, and of the ectopic sites of S. mansoni eggs over the decades considered showed a marked reduction in all of these parameters, particularly in the more severe forms. These findings can be explained only by earlier diagnosis of the disease and the greater efficacy of the specific chemotherapy used today, preventing progression to the more severe forms of the parasitosis.

Adolescent↗

PubMed1993

Histopathological and immunohistochemical study of the brain and heart in the chronic cardiac form of Chagas' disease.

A histopathological and immunohistochemical study of the brain and heart was made in 50 patients with the chronic cardiac form of Chagas' disease. The immunohistochemical technique used was the peroxidase-antiperoxidase method adapted for the demonstration of the T. cruzi amastigotes. Histological and immunohistochemical examination of the brain showed encephalitis in multiple foci, although sparse, in four patients (8%). In one of the patients the process was recent, active, and containing parasites. In the other three patients, the lesions were of minor intensity, with light exudative inflammatory changes, suggesting a process becoming inactive, or already inactive. The search for parasites in these three patients was negative, even with use of immunoperoxidase. The heart histological and immunohistochemical study showed, besides the chronic myocarditis in multiple foci associated with interstitial fibrosis, amastigotes in seven patients (14%). The absence of parasites and of inflammatory changes in the brain in the great majority of patients with chronic Chagas' disease, contrasting with the constant finding of inflammatory changes and the occasional finding of amastigotes in the myocardium of the same patients, allows us to state, in the same way other authors did, that there is no histopathological basis to support the existence of the chronic nervous form of Chagas' disease.

Adult↗

PubMed1992

Coma and death in unrecognized Wernicke's encephalopathy. An autopsy study.

Eleven out of 36 autopsied cases of Wernicke's encephalopathy had developed coma. None of these patients had the diagnosis during life. There were six men and five women with ages ranging from 26 to 50 years (mean 36.6). Seven of these patients were heavy drinkers, three exhibited signs of severe malnutrition, whereas one was being evaluated for a disseminated gastric cancer and one was in treatment of hyperemesis gravidarum. Two patients were brought to the hospital after found unconscious at home. Neuropathological examination disclosed gross changes in the mammillary bodies in eight cases and microscopic changes in all cases. In one case there was atrophy of the anterior superior part of the vermis. Petechial hemorrhages were observed particularly in the walls of the third ventricle. Microscopically there were in addition to hemorrhages, glial proliferation, endothelial hypertrophy and necrosis of nerve cells and myelin. Central pontine myelinolysis was observed in one case. Wernicke's encephalopathy is a clinically underdiagnosed condition. Coma may mask its classical clinical picture or even be the sole manifestation. Although coma points to a poor outlook it may be reversed by thiamine administration. Any patient with coma of unknown etiology should be given parenteral thiamine.

Adult↗

PubMed1991

The relation between involvement of the central nervous system in schistosomiasis mansoni and the clinical forms of the parasitosis. A review.

A review of the available literature on the involvement of the central nervous system (CNS) in schistosomiasis mansoni was undertaken to assess the schistosomal lesions in the spinal cord and brain and the clinical forms of the disease that are associated with these lesions. In almost all clinically symptomatic cases of neuroschistosomiasis mansoni (NSM), involvement of the CNS starts in the early stages of infection (non-toxaemic form), during evolution of the disease to its chronic forms, or concomitantly with the (oligo or asymptomatic) chronic intestinal and hepatointestinal forms. In-situ ova deposition following the anomalous migration of adult worms appears to be the main, if not the only, mechanism by which Schistosoma mansoni may reach the CNS in patients with the intestinal and hepatointestinal forms of the parasitosis. The mass effect produced by the heavy concentration of ova and granulomas in circumscribed areas of the spinal cord and brain explains the severe neurological symptoms observed in most of these patients. Though more frequent, CNS involvement associated with the hepatosplenic and cardiopulmonary forms is almost always asymptomatic. The random distribution of ova in the CNS of patients with these forms suggests that ova are carried there mainly as emboli via the arterial system or through retrograde venous flow. Because of the discrete inflammatory reaction elicited by the sparsely distributed ova, neurological symptoms attributable to ova deposition are not present in most NSM patients with the hepatosplenic and cardiopulmonary forms.

Acute Disease↗

PubMed1991

Immune complexes in the choroid plexus in liver cirrhosis.

A histopathologic and immunofluorescence study of the choroid plexus was performed in 12 cases of liver cirrhosis (cirrhosis group) and in 20 patients who died of diseases with no evidence of liver or brain involvement, and in which renal disease and alcoholism were also excluded (control group). IgA, IgG, IgM, C3, and C1q were investigated by direct immunofluorescence technique. Positive immunofluorescence in the choroid plexus was found in 83.33% of the cirrhosis group. IgA and IgG were the immunoglobulins more frequently found. C3 was also commonly found. Histologic examination of the choroid plexus showed changes in 66.67% of the cirrhosis group characterized, mainly, by subepithelial deposition of a homogeneous, acidophilic, and periodic acid-Schiff-positive substance, with thickening of the epithelial basement membrane. In the control group, the immunofluorescence in the choroid plexus was negative in all cases and only two cases (10%) presented histopathologic changes of the choroid plexus with a pattern similar to that of the cirrhosis group.

Antigen-Antibody Complex↗

PubMed1990

Histopathological and immunohistochemical study of the brain in the acute and chronic phases of experimental trypanosomiasis cruzi in dogs.

A histopathological and immunohistochemical study was undertaken of the brains of 12 young purebred Pinscher dogs, eight of which were inoculated intraperitoneally with the Colombiana strain of Trypanosoma cruzi. The four non-infected dogs formed the control group. An immunoperoxidase method was employed for demonstrating amastigotes of T. cruzi in tissue sections. Three infected dogs died in the acute phase; the other five were sacrificed at different stages of the chronic phase, one of them having survived for almost three years after the inoculation. Histopathological and immunohistochemical examination of the brains showed changes only in the infected group. Three of the eight inoculated dogs showed encephalitis in multiple foci. In one of the dogs the lesion was recent, in activity, containing parasites. In the other two dogs the lesions were milder, without parasites, suggesting a process of regression. These three were the dogs which died in the acute phase. The other five infected dogs did not show brain changes, and these were the dogs which were sacrificed at different stages of the chronic phase. Based on these findings, the authors conclude that, in the experimental model used, central nervous system involvement in the acute phase of the infection is not very frequent. In the chronic phase the inflammatory changes and parasites would not have been still observable, firstly because most of these dogs would not have had central nervous system involvement in the acute phase, and secondly because in some dogs there would have been total regression of any mild inflammatory changes which had been present in the acute phase as the infection progressed to the chronic phase.

Acute Disease↗

PubMed1990

Wernicke's encephalopathy manifested as Korsakoff's syndrome in a patient with promyelocytic leukemia.

A case of Wernicke's encephalopathy associated with promyelocytic leukemia found at autopsy is reported. The patient was 30 years old and was undergoing chemotherapeutic treatment when she had a memory deficit for recent events (Korsakoff's syndrome) which persisted for 6 months, until death. The neuropathologic examination showed typical, old lesions that characterize Wernicke's encephalopathy, but only in the mamillary bodies. This case is compared with three other cases of Wernicke's encephalopathy associated with leukemia previously described in the literature. Comment is made on the cliniconeuropathologic picture and risk factors in leukemic patients that may favor the appearance of Wernicke's encephalopathy.

Adult↗

PubMed1989

Quantitation and karyometry of cerebral neuroglia and endothelial cells in liver cirrhosis and in the hepatosplenic schistosomiasis mansoni.

A morphological, karyometric, and quantitative study of cerebral neuroglia and endothelial cells of blood capillaries was done in cirrhotic and in hepatosplenic schistosomotic human autopsied cases. Cluster analysis applied to them revealed three subgroups (cirrhosis and schistosomiasis polar groups and one intermediate). The comparison of these three groups with a control revealed increased numbers of astrocytes, oligodendrocytes and endothelial cells, but no nuclear enlargement in the schistosomiasis group; the cirrhosis group exhibited a pronounced nuclear enlargement of both astrocyte and oligodendrocytes but no increase in cell numbers. The intermediate group, which encompasses the majority of pathological cases, is heterogeneous but on average behave as the cirrhosis group in that nuclear enlargement, but no increase in cell numbers, was noted. Such changes could represent a response of the nervous system to the metabolic disturbances present in hepatic and/or portal-systemic encephalopathy. There was a positive correlation between glial and endothelial cell numbers in cerebral cortex, suggesting a functional relationship between the glial cells and the capillary bed. This study points out the importance of clustering the cases, because the physiopathological status of individuals belonging to the same nosological condition can be different. Comparisons considering this aspect should be useful in understanding the progression of the pathological process.

Adolescent↗