RESUMO
AIM: This study aimed to evaluate the prevalence of S. pneumoniae colonization in three different sites in healthy adults: nasopharynx, oropharynx and gingival sulcus. METHODS: Two-hundred and sixty five adults, aged 20-60 years, who attended dental clinics in one public university (n = 106) and one military institution (n = 159) were enrolled in this study. Pneumococcal detection was performed by direct culture (DC) and PCR for lytA gene after a broth enrichment step. Capsular types were determined by sequential multiplex PCR. RESULTS: We identified 18 (6.8%) pneumococcal carriers among 265 adults by PCR, but only one (0.4%) pneumococcal strain was isolated by DC method. Oropharynx (17; 6.4%) was the main source of S. pneumoniae. Colonization of gingival sulcus and nasopharynx was found in 4 (1.5%) and 2 (0.8%) adults, respectively. Nine distinct capsular types were detected from 9 adults and co-colonization with 2 serotypes was confirmed in 4 (1.5%) subjects. Factors associated with carriage were being females, low level of schooling, non-military and regular medication. We observed a low (6.8%) pneumococcal carriage prevalence, but oropharyngeal samples yielded more sensitive results, especially by the PCR-based detection methodology. CONCLUSION: Gingival sulcus was found to be a possible reservoir for S. pneumoniae independently of the oropharynx or nasopharynx colonization.
Assuntos
Infecções Pneumocócicas , Streptococcus pneumoniae , Adulto , Brasil/epidemiologia , Portador Sadio/epidemiologia , Feminino , Humanos , Lactente , Nasofaringe , Orofaringe , Vacinas Pneumocócicas , Prevalência , Streptococcus pneumoniae/genéticaRESUMO
BACKGROUND: The purpose was to analyze clinical manifestations, hormonal changes, diagnosis difficulties and treatment of pituitary apoplexy (PA). EXPERIMENTAL DESIGN: A retrospective study of clinical records from patients with pituitary adenomas admitted from January 1980 to June 1996; the purpose was to identify the patients with clinical evidence compatible with PA. SETTING: Neurosurgery unit of an institutional hospital. PATIENTS: Sixteen (12.8%) of 125 patients with pituitary adenomas were analyzed because they had pituitary apoplexy. INTERVENTIONS: Surgical treatment by the trans-sphenoidal or transcranial route or both routes; dexamethasone (DXM) treatment with 16 mg/day i.v. MEASURES: Hormone assays were performed either by radioimmunoassay or by chemical luminescence. RESULTS: Tumors were nonfunctioning in nine patients and functioning in seven. TSH and prolactin basal serum levels were impaired in 55.5% and 10%, respectively; after exogenous TRH 80% of the patients did not show stimulation of TSH and prolactin secretions. LH and FSH levels were low in 63.6% and 54.6% of the patients, respectively; gonadotrophin-releasing hormone (GnRH) testing was abnormal in 75% of the patients evaluated. Cortisol levels were low in 50% of the patients. After insulin-induced hypoglycemia, cortisol and GH failed to rise in 25% and 40% of cases, respectively. Ten patients were submitted to surgical treatment, but none during PA. The average time from the onset of apoplectic symptoms and surgery was 70+/-50 days. Only one patient died two months after surgery. Five patients were treated with dexamethasone (DXM) during the apoplectic symptoms: three patients died; one patient had good quality of life; the other patient was treated initially with DXM with improvement of vision, but after surgery he developed panhypopituirarism. Two other patients did not receive specific treatment for PA. CONCLUSIONS: PA is not a rare pituitary adenoma complication and its prognosis may be poor; baseline hormone levels showed a wide range of abnormalities of pituitary function; surgical treatment was required in the majority of patients and the prognosis was relatively good; on the contrary, the treatment with DXM only had high levels of mortality.
Assuntos
Hormônios/sangue , Apoplexia Hipofisária/diagnóstico , Adenoma/complicações , Adolescente , Adulto , Idoso , Terapia Combinada , Dexametasona/uso terapêutico , Feminino , Hormônio Foliculoestimulante/sangue , Glucocorticoides/uso terapêutico , Humanos , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Apoplexia Hipofisária/fisiopatologia , Apoplexia Hipofisária/terapia , Neoplasias Hipofisárias/complicações , Prolactinoma/complicações , Estudos Retrospectivos , Tireotropina/sangue , Hormônio Liberador de Tireotropina/sangueRESUMO
The arterious venous oxygen difference (AVDO2) due to the close relationship with cerebral metabolic rate of oxygen and cerebral blood flow shows metabolic alterations that occur in some pathological situations in the brain including subarachnoid haemorrhage. The AVDO2 was calculated by the Fick equation and the results evaluated by the Glasgow outcome scale. Measurements of arteriojugular oxygen difference were carried out in 30 patients with subarachnoid haemorrhage due to rupture of intracranial aneurysms, as an attempt to monitor the relationship between changes in AVDO2, clinical picture, and evolution of the patients. The subarachnoid haemorrhage was diagnosed by CT scan in 17 patients and by lumbar punction in 13 and the diagnosis of arterial vasospasm was carried out by clinical evaluation and confirmed by four vessels angiogram in only eight patients. Eighteen patients were admitted with Hunt & Hess (H&H) I/II, seven with H&H III and five with H&H IV/V. Nineteen patients had AVDO2 normal and this group had three deaths; five patients had AVDO2 continuously low with three deaths; and six patients had AVDO2 continuously high with two deaths. The patients with normal AVDO2 had better prognosis and clinical evolution than the patients with abnormal values of AVDO2. In conclusion, AVDO2 measurements could not be correlated with the diagnosis of vasospasm, but was useful in the early identification of metabolic changes that occur after subarachnoid haemorrhage and could be used as an supplementary monitoring in the clinical evaluation of patients with this pathology.
Assuntos
Aneurisma Intracraniano/complicações , Oxigênio/metabolismo , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/metabolismo , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Ataque Isquêmico Transitório , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Prognóstico , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/mortalidadeRESUMO
The studies on the factors that regulate the biology of the neuroblastoma cell lines may offer important information on the development of tissues and organs that derive from the neural crest. In the present paper we study the action of epidermal growth factor (EGF) on two human neuroblastoma cell lines: SK-N-SH which is composed at least of two cellular phenotypes (neuroblastic and melanocytic/glial cells), and its pure neuroblastic subclone SH-SY5Y. The results show that EGF (10 ng/ml) significantly stimulates the incorporation of [3H]-thymidine in the SK-N-SH cells only in the presence of fetal bovine serum (FBS) (control = 58,285 +/- 9327 cpm; EGF = 75,523 +/- 4457, p < 0.05). Such effect is not observed in the presence of a chemical defined medium, that is, in the absence of FBS (control = 100,997 +/- 4375; EGF = 95,268 +/- 4683; NS) In the SH-SY5Y cells the EGF does not modify the incorporation of [3H]-thymidine either in the presence of 10% of BFS (control = 113,838 +/- 6978; EGF = 119,434 +/- 9441; NS) or in its absence (control = 46,197 +/- 3335; EGF = 44,472 +/- 3493; NS). The results here reported suggest that: a) EGF may affect the proliferation of cells derived from a primary human neuroblastoma; b) this is evident by the EGF-induced increase of [3H]-thymidine incorporation in SK-N-SH cells; c) it is required the presence of other growth factors, present in the FBS, for the mitogenic action to be accomplished; d) since the pure neuroblastic SH-SY5Y cell line are refractory to the EGF, the effects observed in SK-N-SH cells probably occur on the melanocytic/glial cell subpopulation.
Assuntos
Fator de Crescimento Epidérmico/farmacologia , Neuroblastoma , Timidina/metabolismo , Células Tumorais Cultivadas/efeitos dos fármacos , Humanos , Neuroblastoma/patologiaRESUMO
We report a series of 110 patients with acute traumatic subdural hematoma (ASDH) admitted at HBDF emergency within 1994 (January 1st to December 1st). All patients were treated according to the same protocol. There was a predominance of males (79%), with ages ranging from 14 to 70, being car accidents (20%) and car-pedestrian accidents (34%) the most frequent causes. The majority of patients (85.7%) was admitted in very serious condition, with a score of 8 points on the Glasgow Coma Scale (GCS) or lesser, which directly influenced the mortality rates. CT scan was the diagnostic procedure of choice, and it showed contusion and brain swelling to be the most frequent associated intracranial lesions. Surgery was carried out in 45.1% of cases and, in most instances, through an ample fronto-temporo-parietal craniotomy, with hematoma drainage and dural reconstitution. In 54.9% of cases, clinical conditions did not allow surgery and in this group, 69.6%.
Assuntos
Hematoma Subdural/mortalidade , Acidentes , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Escala de Coma de Glasgow , Traumatismos Cranianos Fechados/complicações , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Tomografia Computadorizada por Raios XRESUMO
Meningiomas are benign tumors of central nervous system. They have high rates of relapse and sometimes are not amenable to total removal mainly when involve vital structures. Clinical, epidemiological, biochemical and "in vitro" experiment show evidence that meningioma growth is influenced by steroid hormonal medium. Several clinical trials have explored these meningioma characteristics with the use of substances interfering with steroid actions: RU486 (antiprogestinic and antiglucocorticoid), medroxiprogesterone acetate (antiprogestinic), gestrinone (antiestrogenic e antiprogestinic), tamoxifen (antiestrogenic) and buserelin (LHRH superagonist), beyond of octreotide (somatostatin analog) and bromocriptine (dopaminergic agonist). Other substances have potential for the meningiomas treatment: aminogluthetimide, suramin and trapidil. In this review, we analyzed the literature about these aspects.
Assuntos
Antagonistas de Hormônios/uso terapêutico , Meningioma/tratamento farmacológico , Mifepristona/uso terapêutico , Animais , Feminino , Humanos , Masculino , Meningioma/patologia , Camundongos , Receptores de Esteroides , Fatores SexuaisRESUMO
Long term follow-up of patients submitted to treatment of parasellar tumours region is important for the detection of late therapeutic complications. In this study the authors conducted an evaluation of six patients with craniopharyngioma, one with germinoma, one with meningioma, and one epidermoid cyst. All above tumours were localized at parasellar region. Six out of nine patients had been treated both by surgery and by radiotherapy and the other three surgically only, on an average 3.8 +/- 3.2 years before this observation was carried out. Five patients were female with their ages average 24.3 +/- 18.8 years old. Evaluation consisted: in the first place, an intravenous infusion of thyrotropin-releasing hormone (TRH, 200 micrograms), gonadotropin-releasing hormone (GnRH, 100 micrograms), and insulin tolerance test (0.1 IU/Kg, regular insulin); and secondly, in measurements of pituitary hormones secretion at different time points--0, 20, 40, 60 and 80 minutes. We found both diminished response of growth hormone and cortisol in all the patients. Seven out of nine patients did not have adequate response to follicle-stimulating hormone. Three out of nine responded unsatisfactory to luteinizing hormone. Four out of nine showed inadequate responses to prolactin as well as, two out of eight to thyrotropin. We concluded that: (a) growth hormone and cortisol deficiency are the most frequent finding in these patients; (b) post-radiotherapy lesions can be located in the hypothalamus or pituitary, or even in both; (c) hypophysial and hypothalamic cells sensitivity to irradiation is different, according to their respective hormones; and (d) it is necessary a frequent endocrinologic follow-up of patients to detect late hormonal deficiencies.
Assuntos
Neoplasias Encefálicas/radioterapia , Hipotálamo/efeitos da radiação , Hipófise/efeitos da radiação , Hormônios Adeno-Hipofisários/sangue , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Hormônio Liberador de Gonadotropina , Hormônio do Crescimento/metabolismo , Humanos , Insulina , Masculino , Pessoa de Meia-Idade , Prolactina/metabolismo , Hormônio Liberador de TireotropinaRESUMO
A case of patient with Cushing's syndrome due to an adrenal adenoma who conceived twice in the course of the disease is described. Pregnancy is known to be rare in these patients. When first seen she had some manifestations of Cushing's syndrome, but follow-up was lost prior to complete investigation. She conceived a few months later and gave birth to a 900 g premature liveborn infant. At the beginning of a second pregnancy, an adrenal adenoma was resected. The remainder of her pregnancy was uneventful and she delivered a normal fullterm 4 kg infant. Both children show normal physical and neurological development up to date. The patient presented herein illustrates the early diagnosis of Cushing's syndrome during pregnancy is extremely important, and early surgical treatment is indicated in order to avoid maternal and fetal complications.
Assuntos
Adenoma/fisiopatologia , Neoplasias do Córtex Suprarrenal/fisiopatologia , Síndrome de Cushing/fisiopatologia , Complicações Neoplásicas na Gravidez/fisiopatologia , Adenoma/cirurgia , Neoplasias do Córtex Suprarrenal/cirurgia , Adulto , Feminino , Humanos , Gravidez , Complicações Neoplásicas na Gravidez/cirurgiaRESUMO
The case of a male child with Russel's syndrome due to a pilocytic astrocytoma located in the diencephalic region is presented. The diagnosis was made in the 16th month of age, but symptoms began in the 4th months of life, when he started losing weight. By the time he was admitted weight was 6150g and he was 74cm tall, with an emaciated aspect, no panniculus adiposus, irritated, and with symptoms of intracranial hypertension. There was convergent strabismus, vertical nystagmus of the left eye and bilateral papilledema. Tendinous reflexes were exacerbated and he had spastic tetraparesis. The endocrine evaluation showed a basal raise of GH (23ng/ml), TSH (6.2mUI/1) and prolactin (26ng/ml). The first two hormones did not respond to the acute test with TRH, while prolactin had a poor response. He was submitted to radiotherapy with linear acceleration (total dose of 4000 rads) and surgery, during which the tumor could not be completely removed due to its large size. After 9 months, the child is doing well, with a considerable weight gain (2500g).
Assuntos
Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Diencéfalo , Emaciação/etiologia , Astrocitoma/sangue , Astrocitoma/cirurgia , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/cirurgia , Humanos , Lactente , Masculino , Prolactina/sangue , Síndrome , Tireotropina/sangue , Hormônio Liberador de TireotropinaRESUMO
To study the effects of clonidine on growth and plasma somatomedin C (SmC) levels, 42 male Wistar rats aged 28 days and weighing 75 to 105 g were given clonidine (1.5 micrograms/ml in drinking water), or filtered water alone and were weighed weekly. After 0, 4 and 8 weeks, the animals were sacrificed under ether anesthesia, their length was measured and blood was collected by cardiac puncture for measurement of SmC concentration. Growth and the weight/length ratio were lower, and plasma SmC levels (mean +/- SEM) were greater in the treated groups after 4 (616 +/- 44.7 vs 433.2 +/- 39.38 ng/ml, P less than 0.01) and 8 (595.2 +/- 28.3 vs 412.66 +/- 39.01 ng/ml, P less than 0.01) weeks of treatment, suggesting that clonidine treatment increased growth hormone secretion. In other experiments, treated animals showed increased food intake only during the first week of treatment and decreased epididymal fat weight after 3 weeks (1.412 +/- 0.0536 vs 1.6 +/- 0.1336 mg/100 g body weight, P less than 0.01). The results suggest that clonidine acts at the level of the central nervous system involving transitory modulation of food intake, as well as on the regulation of energy metabolism.