helder picarelli - Academia.edu (original) (raw)
Papers by helder picarelli
The Journal of Pain, Nov 1, 2010
Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is ef... more Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is effective in the treatment of chronic pain patients, but the analgesic effect of repeated sessions is still unknown. We evaluated the effects of rTMS in patients with refractory pain due to complex regional pain syndrome (CRPS) type I. Twenty-three patients presenting CRPS type I of 1 upper limb were treated with the best medical treatment (analgesics and adjuvant medications, physical therapy) plus 10 daily sessions of either real (r-) or sham (s-) 10 Hz rTMS to the motor cortex (M1). Patients were assessed daily and after 1 week and 3 months after the last session using the Visual Analogical Scale (VAS), the McGill Pain Questionnaire (MPQ), the Health Survey-36 (SF-36), and the Hamilton Depression (HDRS). During treatment there was a significant reduction in the VAS scores favoring the r-rTMS group, mean reduction of 4.65 cm (50.9%) against 2.18 cm (24.7%) in the s-rTMS group. The highest reduction occurred at the tenth session and correlated to improvement in the affective and emotional subscores of the MPQ and SF-36. Real rTMS to the M1 produced analgesic effects and positive changes in affective aspects of pain in CRPS patients during the period of stimulation. This study shows an efficacy of repetitive sessions of high-frequency rTMS as an add-on therapy to refractory CRPS type I patients. It had a positive effect in different aspects of pain (sensory-discriminative and emotional-affective). It opens the perspective for the clinical use of this technique.
Arquivos De Neuro-psiquiatria, Sep 1, 2012
Objective: There are many evidences that repetitive transcranial magnetic stimulation (rTMS) of t... more Objective: There are many evidences that repetitive transcranial magnetic stimulation (rTMS) of the motor cortex is effective in relief of chronic pain. The aim of this study was to evaluate the analgesic effects of rTMS in patients with refractory complex regional pain syndrome (CRPS). Methods: Twenty-three patients presenting with CRPS of the hand were randomly selected and treated with conventional treatment (analgesics, adjuvant medications and physical therapy) plus sham-TMS or rTMS to the motor cortex opposite the affected limb: 100% MT, 10 hz, 10 s trains, 25 trains daily, 10 daily sessions. The Visual Analogical Scale of Pain (VAS), McGill Questionnaire, Pain Impact Questionnaire (PIQ-6), Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Hamilton Depression and Anxiety Rating Scales and SF-36 Questionnaire were the instruments used for the evaluation. The groups were comparable with regards to socio-demographics, mood and pain intensity. Evaluations were performed before, during TMS treatment and up to three months the end of the treatment. Results: There was a significant reduction in VAS scores favoring the rTMS group up to the seventh follow-up day (p<0.05). The mean reduction in the rTMS group was of 4.65 cm (fall of 50.9%) against 2.18 cm (fall of 24.7%) in sham group during treatment. Improvement in VAS scores was independent of other variables, except for improvement in emotional aspects in the SF-36. Conclusions: During rTMS sessions, there was significant and positive improvement in pain experience of CRPS patients regardless of mood, function or quality of life effects.
Arquivos De Neuro-psiquiatria, Oct 4, 2022
Background The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocy... more Background The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) have been previously studied as predictors of survival in different malignancies. Objective The aim of this study was to evaluate the predictive value of these hematologic inflammatory biomarkers for patients with brain metastases (BM). Methods We reviewed a consecutive cohort of patients at Instituto do Cancer do Estado de São Paulo (ICESP-FMUSP) from 2011 to 2016 with ! 1 BM treated primarily by surgical resection. The primary outcome was 1-year survival. We optimized the NLR, MLR, PLR, and RDW cutoff values, preserving robustness and avoiding overestimation of effect size. Results A total of 200 patients (mean age 56.1 years; 55.0% female) met inclusion criteria. Gross-total resection was achieved in 89.0%. The median (quartiles) preoperative and postoperative KPS scores were 60 (50-80) and 80 (60-90), respectively. Preoperative NLR was significantly associated with survival (HR 2.66, 95% CI: 1.17-6.01, p ¼ 0.019). A NLR cutoff value of 3.83 displayed the most significant survival curve split. Conclusions Preoperative NLR is an independent predictor of survival in newly diagnosed BM. We propose a cutoff value of 3.83 for preoperative NLR testing may be clinically useful as predictor of poor survival in this population. The wide accessibility
Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is ef... more Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is effective in the treatment of chronic pain patients, but the analgesic effect of repeated sessions is still unknown. We evaluated the effects of rTMS in patients with refractory pain due to complex regional pain syndrome (CRPS) type I. Twenty-three patients presenting CRPS type I of 1 upper limb were treated with the best medical treatment (analgesics and adjuvant medications, physical therapy) plus 10 daily sessions of either real (r-) or sham (s-) 10Hz rTMS to the motor cortex (M1). Patients were assessed daily and after 1 week and 3 months after the last session using the Visual Analogical Scale (VAS), the McGill Pain Questionnaire (MPQ), the Health Survey-36 (SF-36), and the Hamilton Depression (HDRS). During treatment there was a significant reduction in the VAS scores favoring the r-rTMS group, mean reduction of 4.65 cm (50.9%) against 2.18 cm (24.7%) in the s-rTMS group. The highest reduction occurred at the tenth session and correlated to improvement in the affective and emotional subscores of the MPQ and SF-36. Real rTMS to the M1 produced analgesic effects and positive changes in affective aspects of pain in CRPS patients during the period of stimulation. Perspective: This study shows an efficacy of repetitive sessions of high-frequency rTMS as an add-on therapy to refractory CRPS type I patients. It had a positive effect in different aspects of pain (sensory-discriminative and emotional-affective). It opens the perspective for the clinical use of this technique.
Neurology® Neuroimmunology & Neuroinflammation, 2021
Brain MRI revealed subcortical and periventricular white matter lesions in the right frontopariet... more Brain MRI revealed subcortical and periventricular white matter lesions in the right frontoparietal and insular lobes, with a perivascular punctate and curvilinear enhancement, with no restricted diffusion, associated with edema without significative mass effect (figure 1). MRI angiography, including vessel wall sequences, did not show vascular stenosis or signs of vasculitis. CSF analysis showed slightly elevated protein levels (49 mg/dL) and cytology with 5 white blood cells; there were no oligoclonal bands, and protein electrophoresis was normal. Infectious screening of CSF was negative for herpes simplex virus I/II, Cytomegalovirus, Adenovirus, Mycobacterium tuberculosis, Varicella zoster virus, human herpesvirus 6/7, and Enterovirus. In addition, neoplastic cells were not detected in CSF. The investigation was also negative for Treponema pallidum, HIV, and hepatitis B and C. The screening for systemic autoimmunity and neoplastic diseases, including FDG PET-CT, was unremarkable.
Revista De Medicina, Dec 20, 2001
RESUMO: Dor, especialmente nos membros superiores relacionada às atividades laborais, é condição ... more RESUMO: Dor, especialmente nos membros superiores relacionada às atividades laborais, é condição comum. Decorre geralmente de anormalidades músculo-esqueléticas e neurais. Além das condições mecânicas admite-se que a tensão emocional esteja relacionada à sua instalação e manutenção. Não basta apenas haver a identificação da condição clínica, mas é necessário haver nexo entre ela e a condição ambiental causal. A eliminação dos fatores desencadeantes, a reformulação do ambiente e da organização do trabalho, a readaptação profissional, medidas de medicina física e psicocomportamental quando aplicados com critério, melhora na maioria dos casos em que as lesões não estão estruturadas ou irreversíveis. DESCRITORES: Transtornos traumáticos cumulativos/história. Síndromes da dor miofascial/história. Dor/história. INTRODUÇÃO As lesões por esforços repetitivos (LER) ou os distúrbios ósteomusculares relacionados ao trabalho (DORT) correspondem a um conjunto de afecções relacionadas às atividades laborativas que acomete músculos, fáscias musculares, tendões, ligamentos, articulações, nervos, vasos sangüíneos e tegumento. As várias formas clínicas de manifestação das LER/DORT têm como aspecto comum a dor e as incapacidades funcionais temporárias ou permanentes 34,57. A polêmica sobre DORT inicia-se já em sua denominação e
Neuro-Oncology, Nov 1, 2017
BACKGROUNDPost-treatment assessment of primary brain tumors presents a diagnostic challenge to di... more BACKGROUNDPost-treatment assessment of primary brain tumors presents a diagnostic challenge to distinguish real tumor progression (PD) from pseudoprogression or radiation necrosis (PsP/RN). Brain MRI, the gold standard imaging modality is often misleading, even when adding functional sequences (perfusion and/or spectroscopy). SPECT-CT (99mTc-MIBI SPECT with CT) might add complimentary data to MRI in this regard, merging the molecular imaging capabilities of SPECT with more accurate morphologic data from CT images in one single exam.METHODSThis retrospective study included consecutive patients (pts) treated for glioblastomas (GB) in our institution that had at least one MIBI for suspected PD. Main objective was to assess MIBI early uptake performance in differentiating PD from PsP/RN. PD is defined as unequivocal active tumor on surgical resection/biopsy specimens when available, and/or clinical/radiological PD in the ensuing three months following the MIBI. Uptake in the suspected area was calculated relatively to uptake in the contralateral normal brain. The primary outcomes are sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (A), based on the ROC curve generated from early uptake data against outcome.RESULTSWe included 27 pts, comprising of 30 independent observations (3 pts underwent repeated MIBIs for suspected PD in two distinct occasions). 19 males and 8 females, median age of 50 years (range 25 to 70). The ROC curve identified 4.2 as the most appropriate cut-off value for early uptake (Youden´s Index 0,62). With this, MIBI reached 91,3% Sn, 71,4% Sp, 91,3% PPV, 71,4% NPV and 86,7% A. CONCLUSIONMIBI seems to be an accurate and inexpensive imaging modality to assess in glioblastomas. We plan to do a prospective study evaluating MIBI in this setting in GB.
XXXII Congresso Brasileiro de Neurocirurgia
Temporomandibular disorders are pathological orofacial conditions characterized by a dysfunction ... more Temporomandibular disorders are pathological orofacial conditions characterized by a dysfunction at the temporomandibular joint, pre-auricular area and masticatory or skull muscles. They are associated with acute and chronic pain in the temporomandibular joint and other bodily areas, such as the ears, neck and head. Limitations of jaw and joint functions and the production of sounds during mastication.1,2 Approximately 75% of the population has one of the signs of temporomandibular disorders and 33% of the population has at least one temporomandibular disorders symptom.3–5
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
The present report describes the case of a male 17-year-old patient who progressively developed a... more The present report describes the case of a male 17-year-old patient who progressively developed a hydrocephalus and polyradiculopathy due to involvement of central nervous system (CNS) by a diffuse leptomeningeal glioneuronal tumor (DLGNT). The tumor had partial remission in response to the treatment with radiotherapy plus procarbazine, lomustine, and vincristine (PCV) chemotherapy, and the patient had improvement in function and pain levels. The current knowledge about DLGNT, including its clinical manifestations, imaging findings, histological characteristics, and treatment are revised and discussed in the present paper.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
The Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuro... more The Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuroimaging examinations, are small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Typically, they have similar physicochemical characteristics to cerebral spinal fluid (CSF) and there is no contrast enhancement on brain CT and MRI images. Its real meaning is unknown, although some contemporary studies have suggested that it might be related to certain traumatic brain injury or several other central nervous system (CNS) disorders, as degenerative diseases. Occasionally, some wide and atypical VRS may be mistaken for primary cystic brain tumors, especially in the context of large and symptomatic lesions, multiple clustered cysts, cortical lesions and if there is adjacent reactive gliosis. The present paper reports four patients who were affected by atypical VRS mi...
Journal of Neurological Surgery Part A: Central European Neurosurgery
Objective Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection (NS... more Objective Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection (NSR) remains a mainstay of the treatment of brain metastases (BMs). Although it is unequivocal in instances of diagnostic doubt, radioresistance, and risk of death due to neurologic causes, NSR may be controversial in other situations. Many aspects related to NSR have not yet been well established, and the primary prognostic indices were proposed only in the last decade. This study evaluates the survival and the morbidity, causes of death, prognostic factors, and the impact of RT in patients with BMs treated by NSR in the current era. Methods A total of 200 patients with BMs who were treated by NSR were evaluated sequentially and followed prospectively. We used logistic regression and Cox regression models to identify independent factors associated with mortality at 4 weeks and at 1 year, respectively. Clinical features, morbidity, recurrence, and causes of death were also studied. Results...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoRelatamos o caso de um homem de 49 anos, com episódio convulsivo único, portador de um tumo... more ResumoRelatamos o caso de um homem de 49 anos, com episódio convulsivo único, portador de um tumor na convexidade parietal direita, implantado na dura-máter, que foi submetido a tratamento cirúrgico com remoção radical da lesão. O exame anatomopatológico foi compatível com meningioma papilar e o tratamento foi complementado com radioterapia externa. Após cinco anos, o paciente apresenta-se assintomático, sem sinais de recidiva local ou a distância.Na tomografia computadorizada do crânio, a lesão levemente hiperdensa, sem calcificações e com pequeno edema vasogênico, apresentava realce heterogêneo após injeção do contraste iodado. Como na maioria dos meningiomas, na ressonância magnética do encéfalo, o tumor isointenso em T1 aumentava a intensidade do sinal em T2 e após a injeção do contraste paramagnético. No caso descrito, esses achados permitiram diagnóstico da extensão e localização da lesão, entretanto não foram úteis para prever o possível comportamento biológico e subtipo do t...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoOs gliomas representam 30%-40% de todas as neoplasias intracranianas e aproximadamente 50% ... more ResumoOs gliomas representam 30%-40% de todas as neoplasias intracranianas e aproximadamente 50% são glioblastomas. São classificados em graus pela OMS, de acordo com sua patologia. Apresentam altas taxas de mortalidade. Existem marcadores tumorais que podem auxiliar na detecção precoce e avaliar prognóstico. Realizada revisão sobre o tema marcadores tumorais por meio do site PubMed. MGMT é uma proteína que restaura o DNA, impedindo a sua alquilação. A metilação do MGMT por meio de fenômeno epigenético impede sua transcrição inibindo sua ação, tornando o tumor suscetível a fármacos. IDH e codeleção cromossômica 1p19q são marcadores tumorais e estão associados a melhor prognóstico. As neoplasias intracranianas apresentam altas taxas de mortalidade e sua detecção precoce por meio de marcadores e o conhecimento de alterações que conferem bom prognóstico podem auxiliar no tratamento dessa doença. A análise molecular auxilia na detecção e no tratamento de tumores.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Journal of Neurology and Neuroscience, 2017
Background and objectives: The management of complex regional pain syndrome (CRPS) remains a chal... more Background and objectives: The management of complex regional pain syndrome (CRPS) remains a challenging task therefore a large number of interventions have been investigated. Lately, invasive and non-invasive neuromodulation have been coming up as an alternative for some patients even as an add-on treatment to medicines or physical therapy. The objective of this review is to evaluate the evidence of its effectiveness in CRPS chronic pain management. Methods: We have used key words referring to neuromodulation techniques and CRPS to select studies from Medline, Lilacs and Cochrane Library databases. All relevant articles which have described any kind of neuromodulation as CRPS primary treatment have been reviewed by two independent researchers to assign the level of evidence according to Oxford Level of Evidence. A third researcher was consulted in dubious cases to get to the final conclusion. Results: Although a variety of methods and devices have been used, the evidences are still poor. There is no level 1 study which confers grade A of recommendation for any method of neuromodulation in the CRPS treatment. Repetitive transcranial magnetic stimulation (rTMS) over the motor cortex and spinal cord stimulation (SCS) were the techniques with the best grade of recommendation (B or C). Conclusion: The literature still lacks high-quality evidence supporting neuromodulation effectiveness in CRPS pain treatment. We found only a few studies that had approached this issue properly. Those facts themselves were the main limitation of this study and of those that must be coming soon. High-quality multicentre trials ought to be performed for definitive conclusions.
Revista De Medicina, Dec 20, 2001
Journal of Clinical Case Reports, 2016
The Journal of Pain, Nov 1, 2010
Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is ef... more Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is effective in the treatment of chronic pain patients, but the analgesic effect of repeated sessions is still unknown. We evaluated the effects of rTMS in patients with refractory pain due to complex regional pain syndrome (CRPS) type I. Twenty-three patients presenting CRPS type I of 1 upper limb were treated with the best medical treatment (analgesics and adjuvant medications, physical therapy) plus 10 daily sessions of either real (r-) or sham (s-) 10 Hz rTMS to the motor cortex (M1). Patients were assessed daily and after 1 week and 3 months after the last session using the Visual Analogical Scale (VAS), the McGill Pain Questionnaire (MPQ), the Health Survey-36 (SF-36), and the Hamilton Depression (HDRS). During treatment there was a significant reduction in the VAS scores favoring the r-rTMS group, mean reduction of 4.65 cm (50.9%) against 2.18 cm (24.7%) in the s-rTMS group. The highest reduction occurred at the tenth session and correlated to improvement in the affective and emotional subscores of the MPQ and SF-36. Real rTMS to the M1 produced analgesic effects and positive changes in affective aspects of pain in CRPS patients during the period of stimulation. This study shows an efficacy of repetitive sessions of high-frequency rTMS as an add-on therapy to refractory CRPS type I patients. It had a positive effect in different aspects of pain (sensory-discriminative and emotional-affective). It opens the perspective for the clinical use of this technique.
Arquivos De Neuro-psiquiatria, Sep 1, 2012
Objective: There are many evidences that repetitive transcranial magnetic stimulation (rTMS) of t... more Objective: There are many evidences that repetitive transcranial magnetic stimulation (rTMS) of the motor cortex is effective in relief of chronic pain. The aim of this study was to evaluate the analgesic effects of rTMS in patients with refractory complex regional pain syndrome (CRPS). Methods: Twenty-three patients presenting with CRPS of the hand were randomly selected and treated with conventional treatment (analgesics, adjuvant medications and physical therapy) plus sham-TMS or rTMS to the motor cortex opposite the affected limb: 100% MT, 10 hz, 10 s trains, 25 trains daily, 10 daily sessions. The Visual Analogical Scale of Pain (VAS), McGill Questionnaire, Pain Impact Questionnaire (PIQ-6), Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Hamilton Depression and Anxiety Rating Scales and SF-36 Questionnaire were the instruments used for the evaluation. The groups were comparable with regards to socio-demographics, mood and pain intensity. Evaluations were performed before, during TMS treatment and up to three months the end of the treatment. Results: There was a significant reduction in VAS scores favoring the rTMS group up to the seventh follow-up day (p<0.05). The mean reduction in the rTMS group was of 4.65 cm (fall of 50.9%) against 2.18 cm (fall of 24.7%) in sham group during treatment. Improvement in VAS scores was independent of other variables, except for improvement in emotional aspects in the SF-36. Conclusions: During rTMS sessions, there was significant and positive improvement in pain experience of CRPS patients regardless of mood, function or quality of life effects.
Arquivos De Neuro-psiquiatria, Oct 4, 2022
Background The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocy... more Background The neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) have been previously studied as predictors of survival in different malignancies. Objective The aim of this study was to evaluate the predictive value of these hematologic inflammatory biomarkers for patients with brain metastases (BM). Methods We reviewed a consecutive cohort of patients at Instituto do Cancer do Estado de São Paulo (ICESP-FMUSP) from 2011 to 2016 with ! 1 BM treated primarily by surgical resection. The primary outcome was 1-year survival. We optimized the NLR, MLR, PLR, and RDW cutoff values, preserving robustness and avoiding overestimation of effect size. Results A total of 200 patients (mean age 56.1 years; 55.0% female) met inclusion criteria. Gross-total resection was achieved in 89.0%. The median (quartiles) preoperative and postoperative KPS scores were 60 (50-80) and 80 (60-90), respectively. Preoperative NLR was significantly associated with survival (HR 2.66, 95% CI: 1.17-6.01, p ¼ 0.019). A NLR cutoff value of 3.83 displayed the most significant survival curve split. Conclusions Preoperative NLR is an independent predictor of survival in newly diagnosed BM. We propose a cutoff value of 3.83 for preoperative NLR testing may be clinically useful as predictor of poor survival in this population. The wide accessibility
Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is ef... more Single-session repetitive transcranial magnetic stimulation (rTMS) of the motor cortex (M1) is effective in the treatment of chronic pain patients, but the analgesic effect of repeated sessions is still unknown. We evaluated the effects of rTMS in patients with refractory pain due to complex regional pain syndrome (CRPS) type I. Twenty-three patients presenting CRPS type I of 1 upper limb were treated with the best medical treatment (analgesics and adjuvant medications, physical therapy) plus 10 daily sessions of either real (r-) or sham (s-) 10Hz rTMS to the motor cortex (M1). Patients were assessed daily and after 1 week and 3 months after the last session using the Visual Analogical Scale (VAS), the McGill Pain Questionnaire (MPQ), the Health Survey-36 (SF-36), and the Hamilton Depression (HDRS). During treatment there was a significant reduction in the VAS scores favoring the r-rTMS group, mean reduction of 4.65 cm (50.9%) against 2.18 cm (24.7%) in the s-rTMS group. The highest reduction occurred at the tenth session and correlated to improvement in the affective and emotional subscores of the MPQ and SF-36. Real rTMS to the M1 produced analgesic effects and positive changes in affective aspects of pain in CRPS patients during the period of stimulation. Perspective: This study shows an efficacy of repetitive sessions of high-frequency rTMS as an add-on therapy to refractory CRPS type I patients. It had a positive effect in different aspects of pain (sensory-discriminative and emotional-affective). It opens the perspective for the clinical use of this technique.
Neurology® Neuroimmunology & Neuroinflammation, 2021
Brain MRI revealed subcortical and periventricular white matter lesions in the right frontopariet... more Brain MRI revealed subcortical and periventricular white matter lesions in the right frontoparietal and insular lobes, with a perivascular punctate and curvilinear enhancement, with no restricted diffusion, associated with edema without significative mass effect (figure 1). MRI angiography, including vessel wall sequences, did not show vascular stenosis or signs of vasculitis. CSF analysis showed slightly elevated protein levels (49 mg/dL) and cytology with 5 white blood cells; there were no oligoclonal bands, and protein electrophoresis was normal. Infectious screening of CSF was negative for herpes simplex virus I/II, Cytomegalovirus, Adenovirus, Mycobacterium tuberculosis, Varicella zoster virus, human herpesvirus 6/7, and Enterovirus. In addition, neoplastic cells were not detected in CSF. The investigation was also negative for Treponema pallidum, HIV, and hepatitis B and C. The screening for systemic autoimmunity and neoplastic diseases, including FDG PET-CT, was unremarkable.
Revista De Medicina, Dec 20, 2001
RESUMO: Dor, especialmente nos membros superiores relacionada às atividades laborais, é condição ... more RESUMO: Dor, especialmente nos membros superiores relacionada às atividades laborais, é condição comum. Decorre geralmente de anormalidades músculo-esqueléticas e neurais. Além das condições mecânicas admite-se que a tensão emocional esteja relacionada à sua instalação e manutenção. Não basta apenas haver a identificação da condição clínica, mas é necessário haver nexo entre ela e a condição ambiental causal. A eliminação dos fatores desencadeantes, a reformulação do ambiente e da organização do trabalho, a readaptação profissional, medidas de medicina física e psicocomportamental quando aplicados com critério, melhora na maioria dos casos em que as lesões não estão estruturadas ou irreversíveis. DESCRITORES: Transtornos traumáticos cumulativos/história. Síndromes da dor miofascial/história. Dor/história. INTRODUÇÃO As lesões por esforços repetitivos (LER) ou os distúrbios ósteomusculares relacionados ao trabalho (DORT) correspondem a um conjunto de afecções relacionadas às atividades laborativas que acomete músculos, fáscias musculares, tendões, ligamentos, articulações, nervos, vasos sangüíneos e tegumento. As várias formas clínicas de manifestação das LER/DORT têm como aspecto comum a dor e as incapacidades funcionais temporárias ou permanentes 34,57. A polêmica sobre DORT inicia-se já em sua denominação e
Neuro-Oncology, Nov 1, 2017
BACKGROUNDPost-treatment assessment of primary brain tumors presents a diagnostic challenge to di... more BACKGROUNDPost-treatment assessment of primary brain tumors presents a diagnostic challenge to distinguish real tumor progression (PD) from pseudoprogression or radiation necrosis (PsP/RN). Brain MRI, the gold standard imaging modality is often misleading, even when adding functional sequences (perfusion and/or spectroscopy). SPECT-CT (99mTc-MIBI SPECT with CT) might add complimentary data to MRI in this regard, merging the molecular imaging capabilities of SPECT with more accurate morphologic data from CT images in one single exam.METHODSThis retrospective study included consecutive patients (pts) treated for glioblastomas (GB) in our institution that had at least one MIBI for suspected PD. Main objective was to assess MIBI early uptake performance in differentiating PD from PsP/RN. PD is defined as unequivocal active tumor on surgical resection/biopsy specimens when available, and/or clinical/radiological PD in the ensuing three months following the MIBI. Uptake in the suspected area was calculated relatively to uptake in the contralateral normal brain. The primary outcomes are sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (A), based on the ROC curve generated from early uptake data against outcome.RESULTSWe included 27 pts, comprising of 30 independent observations (3 pts underwent repeated MIBIs for suspected PD in two distinct occasions). 19 males and 8 females, median age of 50 years (range 25 to 70). The ROC curve identified 4.2 as the most appropriate cut-off value for early uptake (Youden´s Index 0,62). With this, MIBI reached 91,3% Sn, 71,4% Sp, 91,3% PPV, 71,4% NPV and 86,7% A. CONCLUSIONMIBI seems to be an accurate and inexpensive imaging modality to assess in glioblastomas. We plan to do a prospective study evaluating MIBI in this setting in GB.
XXXII Congresso Brasileiro de Neurocirurgia
Temporomandibular disorders are pathological orofacial conditions characterized by a dysfunction ... more Temporomandibular disorders are pathological orofacial conditions characterized by a dysfunction at the temporomandibular joint, pre-auricular area and masticatory or skull muscles. They are associated with acute and chronic pain in the temporomandibular joint and other bodily areas, such as the ears, neck and head. Limitations of jaw and joint functions and the production of sounds during mastication.1,2 Approximately 75% of the population has one of the signs of temporomandibular disorders and 33% of the population has at least one temporomandibular disorders symptom.3–5
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
The present report describes the case of a male 17-year-old patient who progressively developed a... more The present report describes the case of a male 17-year-old patient who progressively developed a hydrocephalus and polyradiculopathy due to involvement of central nervous system (CNS) by a diffuse leptomeningeal glioneuronal tumor (DLGNT). The tumor had partial remission in response to the treatment with radiotherapy plus procarbazine, lomustine, and vincristine (PCV) chemotherapy, and the patient had improvement in function and pain levels. The current knowledge about DLGNT, including its clinical manifestations, imaging findings, histological characteristics, and treatment are revised and discussed in the present paper.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
The Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuro... more The Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuroimaging examinations, are small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Typically, they have similar physicochemical characteristics to cerebral spinal fluid (CSF) and there is no contrast enhancement on brain CT and MRI images. Its real meaning is unknown, although some contemporary studies have suggested that it might be related to certain traumatic brain injury or several other central nervous system (CNS) disorders, as degenerative diseases. Occasionally, some wide and atypical VRS may be mistaken for primary cystic brain tumors, especially in the context of large and symptomatic lesions, multiple clustered cysts, cortical lesions and if there is adjacent reactive gliosis. The present paper reports four patients who were affected by atypical VRS mi...
Journal of Neurological Surgery Part A: Central European Neurosurgery
Objective Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection (NS... more Objective Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection (NSR) remains a mainstay of the treatment of brain metastases (BMs). Although it is unequivocal in instances of diagnostic doubt, radioresistance, and risk of death due to neurologic causes, NSR may be controversial in other situations. Many aspects related to NSR have not yet been well established, and the primary prognostic indices were proposed only in the last decade. This study evaluates the survival and the morbidity, causes of death, prognostic factors, and the impact of RT in patients with BMs treated by NSR in the current era. Methods A total of 200 patients with BMs who were treated by NSR were evaluated sequentially and followed prospectively. We used logistic regression and Cox regression models to identify independent factors associated with mortality at 4 weeks and at 1 year, respectively. Clinical features, morbidity, recurrence, and causes of death were also studied. Results...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoRelatamos o caso de um homem de 49 anos, com episódio convulsivo único, portador de um tumo... more ResumoRelatamos o caso de um homem de 49 anos, com episódio convulsivo único, portador de um tumor na convexidade parietal direita, implantado na dura-máter, que foi submetido a tratamento cirúrgico com remoção radical da lesão. O exame anatomopatológico foi compatível com meningioma papilar e o tratamento foi complementado com radioterapia externa. Após cinco anos, o paciente apresenta-se assintomático, sem sinais de recidiva local ou a distância.Na tomografia computadorizada do crânio, a lesão levemente hiperdensa, sem calcificações e com pequeno edema vasogênico, apresentava realce heterogêneo após injeção do contraste iodado. Como na maioria dos meningiomas, na ressonância magnética do encéfalo, o tumor isointenso em T1 aumentava a intensidade do sinal em T2 e após a injeção do contraste paramagnético. No caso descrito, esses achados permitiram diagnóstico da extensão e localização da lesão, entretanto não foram úteis para prever o possível comportamento biológico e subtipo do t...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
ResumoOs gliomas representam 30%-40% de todas as neoplasias intracranianas e aproximadamente 50% ... more ResumoOs gliomas representam 30%-40% de todas as neoplasias intracranianas e aproximadamente 50% são glioblastomas. São classificados em graus pela OMS, de acordo com sua patologia. Apresentam altas taxas de mortalidade. Existem marcadores tumorais que podem auxiliar na detecção precoce e avaliar prognóstico. Realizada revisão sobre o tema marcadores tumorais por meio do site PubMed. MGMT é uma proteína que restaura o DNA, impedindo a sua alquilação. A metilação do MGMT por meio de fenômeno epigenético impede sua transcrição inibindo sua ação, tornando o tumor suscetível a fármacos. IDH e codeleção cromossômica 1p19q são marcadores tumorais e estão associados a melhor prognóstico. As neoplasias intracranianas apresentam altas taxas de mortalidade e sua detecção precoce por meio de marcadores e o conhecimento de alterações que conferem bom prognóstico podem auxiliar no tratamento dessa doença. A análise molecular auxilia na detecção e no tratamento de tumores.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Journal of Neurology and Neuroscience, 2017
Background and objectives: The management of complex regional pain syndrome (CRPS) remains a chal... more Background and objectives: The management of complex regional pain syndrome (CRPS) remains a challenging task therefore a large number of interventions have been investigated. Lately, invasive and non-invasive neuromodulation have been coming up as an alternative for some patients even as an add-on treatment to medicines or physical therapy. The objective of this review is to evaluate the evidence of its effectiveness in CRPS chronic pain management. Methods: We have used key words referring to neuromodulation techniques and CRPS to select studies from Medline, Lilacs and Cochrane Library databases. All relevant articles which have described any kind of neuromodulation as CRPS primary treatment have been reviewed by two independent researchers to assign the level of evidence according to Oxford Level of Evidence. A third researcher was consulted in dubious cases to get to the final conclusion. Results: Although a variety of methods and devices have been used, the evidences are still poor. There is no level 1 study which confers grade A of recommendation for any method of neuromodulation in the CRPS treatment. Repetitive transcranial magnetic stimulation (rTMS) over the motor cortex and spinal cord stimulation (SCS) were the techniques with the best grade of recommendation (B or C). Conclusion: The literature still lacks high-quality evidence supporting neuromodulation effectiveness in CRPS pain treatment. We found only a few studies that had approached this issue properly. Those facts themselves were the main limitation of this study and of those that must be coming soon. High-quality multicentre trials ought to be performed for definitive conclusions.
Revista De Medicina, Dec 20, 2001
Journal of Clinical Case Reports, 2016