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J Pimentel

Publications and source records attributed to J Pimentel.

51 records · Page 3Linked to original sources
PubMedDate not supplied

Brain metastases of a malignant fibrous histiocytoma presenting as an acute cerebral hemorrhage.

Intracranial metastases from malignant fibrous histiocytoma (MFH) are rare, particularly with associated hemorrhage. This article reports one case and presents a review of the literature on this topic. A 55-year-old man presented with acute drowsiness, aphasia and right homonymous hemianopsia and hemiparesis. The first CT scan showed a left occipitoparietal hematoma and the second one, nodular, contrast-enhanced lesions. He had been previously operated on soft tissues MFH. Lung metastases developed subsequently. A craniotomy was performed with evacuation of the hematoma and total gross resection of the mass lesions. Microscopic examination disclosed a metastasis from a MFH. Neoangiogenesis, stimulated by angiogenic growth factors, seems to take part in this vascular, stroke-like event. Due to longer survivals of patients harboring systemic sarcomas, these tumors should be considered in the differential diagnosis of intracranial neoplasms, whether hemorrhagic or not. In particular, history of a previous soft tissue or heart tumor associated with lung metastasis should evoke the possibility of MFH metastasis.

Biomarkers, Tumor↗
PubMedDate not supplied

Benign isolated fibrohistiocytic tumor arising from the central nervous system. Considerations about two cases.

Benign fibrous histiocytomas (BFHs) are tumors with fibroblastic and histiocytic components without histological anaplasia. Intracerebral lesions are exceptional and to our knowledge a spinal location was not yet described. We describe 2 cases of BFHs of the neural axis: the first, a 22-month-old boy with Down's syndrome, presented with a paraparesis and the magnetic resonance (MR) of the spine disclosed an intradural extramedullary, thoracic mass, totally resected; the second, a 13-year-old boy with left partial motor seizures, in whom the MR of the brain showed an intracerebral, right frontal tumor, also surgically removed. Both patients are free of recurrence, 6 years and 15 months after surgery, respectively. Histological examination and immunoreactivity for vimentin and histiocytic markers favored the diagnosis of BFH. It is likely that these tumors may originate from spinal dura mater mesenchymal stem cells and from the intracerebral perivascular pial sheath or the brain vessel walls themselves, respectively. Other benign, isolated, intracranial fibrohistiocytic neoplasms, namely the juvenile xanthogranuloma, can harbor a clinical, morphological and immunohistochemical profile overlapping the one of the BFH. Intracranial germ cell tumors may be associated with Down's syndrome, although harboring an unusual, non-pineal and non-chiasmatic location. One can speculate that a similar, still unknown genetic mechanism responsible for this association, could also induce the growth of other type of tumors in patients with this syndrome. BFHs should be added to the differential diagnosis of intracerebral or spinal dural attached tumors. Furthermore, we propose to name these intracranial tumors "benign isolated fibrohistiocytic tumors of the CNS".

Adolescent↗
PubMedDate not supplied

[Traumatic diaphragmatic hernias: retrospective analysis].

AIMS: This study classifies cases of traumatic diaphragmatic hernias (TDH) in patients admitted to the Intensive Care Unit (ICU) of the Coimbra University Hospitals (HUC) from 1990 to 2004. METHODS: Retrospective analysis of 34 cases of TDH, studying anatomical location, place and time of diagnosis, complementary tests aiding diagnosis, herniated organs, associated traumatism, morbidity and mortality. RESULTS: Twenty-eight male and six female patients with an average age of 40.5 years +/- 20.5, average SAPS score 38.8. Average length of stay was 19.1 +/- 13.6 days, all suffered from closed traumatism and were put on artificial ventilation. The left-side diaphragm was more frequently affected (94.1%) then the right. Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism, in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism. In 13 patients the diagnosis was established intra-operatively. The stomach was typically one of the herniated organs. The most frequently associated lesions at the thoracic level were pulmonary contusion, haemothorax and pneumothorax, and at the abdominal level, haemoperitoneum and splenic lesion. The rates for complications and mortality were 55.8% and 11.7% respectively. CONCLUSIONS: TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents. This group of patients, on average younger than others admitted to ICU, presents a longer average hospitalisation period, but has lower rates of mortality and lower SAPS severity scores. The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic, splenic and pleural traumatisms. Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoraco-abdominal trauma. This diagnosis should always be considered a possibility in cases of closed thoraco-abdominal traumas.

Adolescent↗
PubMedDate not supplied

[Acute polyradiculoneuritis associated with boutonneuse fever].

We have recorded three cases of Mediterranean fever harboring peripheral nerve involvement. According to the time of occurrence of the neurological symptoms, the cerebrospinal fluid analysis and electromyographic features, we admit that the peripheral nervous system can be involved in two ways in this disease. One due to the direct action of the pathogenic agent, giving place to a vasculitis. The other by an immunological mechanism originating a Guillain-Barré syndrome.

Acute Disease↗
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[The factors triggering epileptic crises according to patients].

The authors were interested in knowing what epileptic patients think about seizure-inducing factors; whether they are convinced that their seizures are induced by any trigger factor and, if so, which factor it is. While mainly interested in the psychological reality of patients, data about objective factors could emerge from this study. An inquiry was made among the 1005 patients who attended the outpatient clinic for epilepsy of Santa Maria Hospital, Lisbon, during five months of 1994. Of the 308 that answered the inquiry, 147 could not recognise any inducing factor for their last seizure, while 144 mentioned such a factor (of the latter, some mentioned two or more factors acting together). Emotional factors were most often mentioned. Seventeen answers were discarded. In many instances, seizure-inducing factors are identified by the patients but difficult to objectivize by investigators, namely those of emotional type. Answers given by the patients might help doctors to provide patients with better care.

Adolescent↗
PubMedDate not supplied

[Therapeutic strategies in epilepsy].

With the advances in the so-called classic antiepileptic drugs (AED)--carbamazepine, phenobarbital, phenytoin and valproate--monotherapy has become the most popular strategy for the treatment of epilepsies, based on their unquestionable clinical efficacy and on frequent drug interactions and teratogenesis caused by polypharmacy. The choice of an AED should be ruled by its efficacy against a given seizure type; by its toxicity, either acute, dose-related or idiosyncratic, or chronic, due to the length of therapy or AED dosage; by its capacity to interact with other drugs, either AEDs or not, mainly through pharmacokinetic interactions, leading to fluctuation in the plasma concentration of the target drug and hence decreased in their efficacy; by its potential cognitive and behavioural side effects; by its teratogenesis which is common to all AEDs; by its cost. Despite their efficacy, about 35% of the patients are inadequately treated with monotherapy, partial, symptomatic or associated to encephalopathy being the most frequent of their seizures. For this particular group, the association of two AEDs could play an important role. The increasing knowledge of the mechanisms of the new generation of AEDs, such as vigabatrin and lamotrigine, and their favourable pharmacokinetic and pharmacodynamic profiles, rise to the new concept of rational polytherapy which allows an additive or supra-additive therapeutic efficacy, a limited toxicity, a decrease in drug interactions and an increased compliance. Although monotherapy should continue to be the choice therapy for epilepsies, this concept could be a reasonable and early option in the treatment of some refractory epilepsies.

Adult↗
PubMedDate not supplied

Meningioma with perivascular pseudorosettes: a morphological entity distinct from papillary meningioma?

Although papillary meningioma is a well known variant of meningiomas, many of the previously reported cases do not seem to contain structures that fulfill the classical microscopic descriptions of a papilla. The case of a 79-year-old man with a meningioma of the convexity is described. This meningioma was totally removed but recurred 36 months after surgery. The main cellular components of the tumor, some of them mimicking astrocytic cells, were arranged preferentially around vessels featuring perivascular pseudorosettes. The survey of the literature stresses a possible morphological misinterpretation of some of the mentioned papillary variants. Although both papillary variants and those with perivascular pseudorosettes seem to display a similar, not always malignant, behavior, strictly from the morphological point of view they should be separated.

Brain Neoplasms↗
PubMedDate not supplied

Clear cell meningioma variant and clinical aggressiveness.

The few reports about clear cell meningiomas (CCM) point to an inordinate clinical aggressiveness despite their histological benignity. We studied 5 CCM aiming to assess their clinicopathological, cytometric, and ultrastructural features. Two patients were females and 3 males, with a mean age of 36 years. Two tumors were spinal, one of the cerebral convexity, one of the tentorium-clinoid region, and one of the base of the skull. The first 3 were totally removed and have not recurred for a mean follow-up time of 40 months. The tentorium-clinoid and the skull base tumors had radical subtotal and partial resections, and recurred after 16 and 1.5 months, respectively. All tumors but one, a non-recurrent one, presented no signs of histological anaplasia. The proliferative capacity, as assessed by MIB-1 staining index (SI), of recurrent tumors was slightly higher than that of those tumors that did not recur. All cases showed DNA diploid pattern. Amianthoid-type fibers were disclosed on ultrastructural study. CCM arose in patients younger than those with other variants of meningioma, the spinal canal and the posterior fossa were the common sites. Finally, intracranial tumors were linked to an aggressive behavior.

Adult↗