Biomedical subjects
Publications and source records attributed to J Fandiño.
We report the case of a multiple intracranial lipoma in a 47 year-old patient presenting with headache dizziness and quadrantanopsia. MR imaging revealed the presence of 2 lipomas, one located within the quadrigeminal cistern and the other in the calcarine fissure. To our knowledge, this combination of this rare lesion has not been yet described. We review the current literature.
A case of meningitis caused by Streptococcus Equisimilis and cerebrospinal fluid rhinorrhea, in which the head trauma occurred 16 years before, is presented. To the best of the author's knowledge this is the first case reported with such characteristics. Several precipitating factors could be responsible for the unusually late reopening of the fistula Streptococci equisimilis is an uncommon cause of the bacteremia. An appropriate antimicrobrial therapy against S. Equisimilis followed by surgical dural repair were performed.
The authors present the results of a series of corpus callosotomies (CCS) in 97 patients performed from 1989 to 1997 at the Hospital Neurologico of the Liga Colombiana Contra La Epilepsia, Cartagena, Colombia. This study demonstrates the feasibility of performing these procedures in the developing world and analyzes the outcome and cost of treatment. Patients with medically intractable secondarily generalized epilepsy, bilateral nonfocal epileptic electroencephalogram (EEG), and absence of progressive encephalopathy were accepted as candidates (patients aged 0-30 years; 62 children, 19 girls and 43 boys, with mean age at surgery of 7.9 years; 35 adults, 19 women and 16 men, with mean age at surgery of 25.8 years). Preoperatively, the mean seizure frequency was 12.1 per day, or 364 per month (range, 0.06-200 per day, 1.8-6000 per month). Before surgery, 40% of patients were classified with generalized tonic-clonic seizures of different etiologies, or cryptogenic seizures; 36% had mixed seizures; 19% had Lennox-Gastaut Syndrome; and 5% had West Syndrome. Usually, routine EEG, computed tomography, and clinical findings sufficed for the surgical decision. The standard microsurgical technique performed was an anterior two-thirds CCS by the same surgeon under general anesthesia. In five cases, an additional frontal lobe excision after electrocorticography and subdural electrode monitoring was carried out in the same session. The results were evaluated after a mean follow-up of 35 months (range, 12-28). Two thirds of patients became seizure-free or were left with none or some disabling seizures. AED medication was eased slightly after surgery. The complication rate was low. The patients underwent postoperative psychosocial studies and neuropsychological rehabilitation and showed tendencies toward improvement. The direct cost of CCS in U.S. dollars (US$) ranged between 3,137 and 3,995 depending on the preoperative studies. Thus, CCS is well suited for selected patients in developing countries. Thus far, implantation of a vagus nerve stimulator has exceeded our economic possibilities in treating similar patients. Some reflections on care and research among epilepsy patients in developing countries are discussed.
INTRODUCTION: It is very unusual to find cysts situated intraventricularly. Only 24 cases have been described to date in the literature. CLINICAL CASES: In this paper we present two new cases considering that because of their exceptional size they deserve to be called 'giant'. The two patients had been diagnosed as having epilepsy during childhood or youth. No neuroradiological studies had ever been done. The cause of hospital admission in the first case was headache and vomiting and in the second case a convulsive crisis. We did cerebral CT scans in both cases and a MR control scan in the second case. This formed the basis for our diagnosis. Unlike previous cases they were not operated on. Their clinical course may be considered satisfactory to date, since there have been no further convulsive crisis nor other neurological alterations. We have therefore been conservative with regard to the indication for surgery in these patients. CONCLUSIONS: Review of the literature does not completely clarify the origin of these lesions but we are inclined to believe that there is an intimate relationship between the formation of an intraventricular arachnoid cyst and the choroid plexus. Many new cases will have to be diagnosed before we can fully understand the true physiopathology of these cysts.
Out of a series of 1850 cases operated upon for lumbar disc herniation 130 underwent re-operation because of persistent or recurrent symptoms. Re-operation was successful in 62%. The prognosis of re-operation was not related to special clinical symptoms and signs but only to the operative findings. Herniations at other levels and recurrences of lumbar disc herniations had the best results (excellent in 98% respectively 54%), but scar formations alone came out much less satisfactory (only 38% excellent results). Computed tomography (CT) findings were less reliable in distinguishing between disc prolapse and fibrosis than magnet resonance imaging (MR). Therefore MR is the diagnostic method of choice in these conditions, and scar formations alone should be considered a contra-indication for re-operation.
A case of malignant mesenchymoma of the brain, containing rhabdomyosarcomatous, osteoid and cartilaginous components is presented. The patient received surgery and irradiation for his tumor, but died 10 months after the operation. Previous reports of malignant mesenchymoma of the brain are exceptional. The neurobiological behavior of this tumor is yet to be determined.
A case of fourth ventricle cysticercosis treated with praziquantel is presented. The disappearance of the lesion six months after the treatment was demonstrated by CT scan. A review of the literature indicates that this is a very exceptional result, because with recently intraventricular cysticercosis was considered to be non-responsive to praziquantel treatment, making surgery necessary.
Ninety patients operated for single cerebral metastasis in the Hospital General de Vigo between 1978 and 1986 were retrospectively studied. All of them also received radiotherapy after surgery. Several prognosis factors were studied with the aim of using them in future patients. The most significant factors were: histologic diagnosis Karnofsky's presurgery index, gap between diagnosis of the primary tumor and the time when the metastasis showed up, age and the TAC's morphology of the metastasis. These results are an important help when considering either surgery or a more conservative attitude.
Sphenoidal aspergillosis is an unusual cause of sella turcica enlargement. Pituitary abscess secondary to Aspergillus had been reported. In the present case, a woman with sphenoid sinus aspergillosis mimicked a pituitary tumor. This patient survived her infection with intact pituitary function following a transsphenoidal approach. No postoperative amphotericine-B and 5-fluorocytosine were necessary. CT scan revealed a mass occupying the sphenoid sinus extending to the sella turcica. Factors that should alert the clinican to the presence of a sphenoidal and pituitary abscess in a patient with sella turcica enlargement are prior episodes of sinusitis, meningitis and immunosuppression and, as in the present case, hyperglycemia.
Ten patients with cerebral cysticercosis seen between 1983 and 1986 were treated with praziquantel and in some cases by a ventriculoperitoneal shunt and/or surgical excision of cysts. Clinical and biological data were of no prognostic value. CT only was useful in orientating therapy and establishing the prognosis. A favorable course was obtained in 7 parenchymatous and meningeal forms, the fatal cases being of the mixed type. Praziquantel was inactive against intraventricular cysts.
A study of 131 eyes with massive vitreous hemorrhage of diabetic origin showed that 3 months after the hemorrhage visual acuity had improved in 34 eyes (25.9%), was unchanged in 82 (62.6%), and had worsened in 15 (11.4%). The number of eyes improving between 3 and 6 months post-hemorrhage was the same as the number whose visual acuity worsened, 19 (14.5%). After 6 months, the proportion of worsening eyes was much greater than that of improving eyes, so that 2 years post-hemorrhage, 48.8% of the 86 eyes remaining in the study had visual acuity of below hand-movements standard, and 29.1% visual acuity better than hand-movements standard, as against respectively 22.1% and 38.2% of the original 131 eyes 6 months post-hemorrhage.
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We have performed an ultrasound study of 46 eyes with Leucocoria. The results obtained demonstrate that 20 eyes (43.5%) were affected by retinoblastoma. Of these, 17 eyes (85%) showed calcifications and 3 eyes (15%) did not show calcifications. In the remaining 26 eyes, in 6 cases there were intraocular calcifications, and in two of these the calcifications were found within the pathological intraocular mass showing retinoblastoma. The eyes with intraocular calcifications were diagnosed as: uveitis, retrolental fibroplasia, Coats disease, retinal dysplasia. Because of these, we conclude that, although the existence of calcifications is a meaningful datum, there are uncalcified retinoblastomas and calcifications in entities other than retinoblastoma.
INTRODUCTION: This paper reviews current literature about intracranial lipomas with emphasis on histogenesis, diagnosis and therapy. DEVELOPMENT: Intracranial lipoma is a congenital malformation. Epilepsy, mental dysfunctions and headache are the most common clinical manifestations, being a third of the asymptomatic cases; certain localizations cause specific symptomatology of the involved area. Associate anomalies are given in half of the lipomas, being the most frequent the agenesia of the corpus callosus. The diagnosis is not possible based on the clinical data, so it is necessary the practice of complementary exams in every suspected cases. The neuroimaging studies (TC or MRI) usually permit the diagnosis of this entity in an objective way and practically of certainty. It has been adduced a numberless histogenic theory on the lipomas, being accepted the lipoma like congenital malformation at the present time. The surgery is contraindicated, however still play a role in the management of some cases of hydrocephalus and bony affectation. The medical control of the epilepsy is forced. CONCLUSIONS: The development of the neuroimaging techniques and the biggest compression in the histogenesis have increased the knowledge that one had of the intracranial lipomas, modifying their presage and giving up the aggressive surgery of last times.
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