Geometry and Microstructure Control of Remanufactured Metallic Parts by Cold Spray Additive Manufacturing

Cold Spray Additive Manufacturing (CSAM) is a thermal spray technique that is typically used for the repair of metallic components. One of the challenges of CSAM is to improve the geometrical accuracy of the sprayed parts, along with overcoming the inferiority of the mechanical properties of the deposits by tailoring their microstructure with different deposition strategies. For this, Cu, Al, Ti, and Ti6Al4V substrates were reconstructed by two Cold Spray (CS) methods: Traditional (T) and a novel strategy, Metal Knitting (MK). The final geometry, microstructure, and mechanical properties of the reconstructed parts by these two methods were compared. Additionally, we investigated the effects of annealing on the microstructure of sprayed components and its influence on adhesion, resistance to erosion, and abrasive wear. The results indicate that annealing effectively reduces the microstructure defects of the remanufactured parts (up to 30% porosity reduction) and improves the adhesive strength (i.e., below 30 MPa for as-sprayed deposits, and up to 160 MPa for heat-treated Ti4Al4V deposits). Notably, the abrasive and erosive resistance of the Cu and Al annealed deposits sprayed by MK gave very similar results compared to their bulk counterparts, suggesting that it is an efficient method for the reconstruction of damaged parts.

Long-term outcome of redo discectomy for recurrent lumbar disc herniations

PURPOSE

Recurrent lumbar disc herniation (RLDH) is an important cause of morbidity and healthcare costs. The goal of this investigation is to assess surgical outcomes and their predictors in patients who underwent revision discectomy for RLDH, with a minimum follow-up of ten years, to shed light on the best treatment to offer to these patients.

METHODS

Patients who underwent revision discectomy to treat RLDH between 2004 and 2011 in our Department were enrolled. Demographic, clinical, and surgical data were collected. The need of third intervention for RLDH was the primary outcome. Patient's satisfaction, Core Outcome Measures Index, Oswestry Disability Index, and EuroQoL-5D scores were also evaluated.

RESULTS

This study includes 55 patients, with a mean follow-up time of 144 months [112-199]. In this period, a third intervention was needed in 30.9% (n = 17) of patients. Most recurrences took place in the first 2 years after the second surgery (58.8%, n = 10) and the risk of needing a third surgery decreased over time. After 5 years, the probability of not having surgery for recurrence was 71% [CI 95%: 60-84%], with a tendency to stabilize after that. An interval between the first discectomy and the surgery for recurrence shorter than 7.6 months was identified as a predictor for a second recurrence.

CONCLUSION

The risk of needing a third surgery seems to stabilize after five years. Patients with an early recurrence after the first discectomy seem to have a higher risk of a new recurrence, so an arthrodesis might be worth considering.

ONLY IN DREAMS: a case report of sleep deprivation psychosis

Introduction

Sleep is essential for an adequate neurobiological functioning, being implicated in several cognitive functions. Even in healthy individuals, sleep deprivation can lead to a number of psychopathological changes, including perceptual distortions, hallucinations and delusions. Thus, the resulting clinical picture may be similar to a psychotic disorder.

Objectives

To present a clinical case of psychotic symptomatology induced by sleep deprivation.

Methods

Patient’s clinical file consultation and literature review using the search engine Pubmed® and the keywords: “sleep deprivation”, “sleep loss” and “psychosis”.

Results

We present the case of a 41-year-old woman with a history of an episode of mood changes with psychotic symptoms that was preceded by a period of total insomnia. No psychotropic drugs since then and no relapses. In May 2020, she was admitted in psychiatry department due to clinical picture composed by significant psychomotor slowing, drowsiness, slowed speech, verbal visual, tactile and auditory hallucinations accompanied by grandiose delusions. These symptoms were preceded by total insomnia with one week of duration. In the hospital was administered quetiapine 100mg and lorazepam 2.5mg to aid in the recovery of sleep deprivation and concomitantly aripiprazole 15mg was prescribed. The patient presented a rapid and significant clinical improvement. Currently, it is without any type of medication and without psychopathological changes.

Conclusions

The clinical picture present in this case report was triggered after a significant period of sleep deprivation. Thus, it illustrates the role that sleep has in the development of psychiatric symptomatology, sometimes difficult to differentiate from psychiatric disorders.

Disclosure

No significant relationships.

Catatonia and dementia: a case report

Introduction

Catatonia is a neuropsychiatric disorder characterized by motor, behavioral and autonomic changes. It is associated with several psychiatric disorders, including dementia. Catatonia is an underdiagnosed syndrome, so it is important to draw attention to it. Here, we review a case of a patient admitted to our psychiatric department with a clinical presentation compatible with catatonia. After proper treatment, further assessment revealed dementia.

Objectives

This work aims to describe a case of catatonia in a patient with dementia.

Methods

Bibliographic research using Pubmed®. Clinical file consultation and patient interviews.

Results

Catatonia is a disorder that was already been described as part of several types of dementia. We present a 69-year-old female patient, admitted to our psychiatric department with clinical presentation compatible with catatonia. To admission, she presented some typical complications resulting from long immobility such as pressure ulcers and nutritional deficiencies. During the hospitalization, she developed a urinary infection and there was the need to tube feeding. She was treated with benzodiazepines and improved. Further assessment revealed dementia.

Conclusions

Catatonia in dementia is not uncommon, although it is an underdiagnosed syndrome, and when treated early and properly it has a good prognosis.

Disclosure

No significant relationships.

Role of migration in the development of a first episode of psychosis

Introduction

Currently, there is scientific evidence supporting the relationship between socio-environmental factors and the onset of a first episode of psychosis (FEP). In this context, the phenomenon of migration, seen as a negative life experience, may become an important risk factor in developing a psychotic disorder (PD). In Europe, the impact of this phenomenon is growing and, therefore, it’s necessary to provide a proper answer to these individual’s mental health problems.

Objectives

Identify which phases of this migration process are most important in the development of a FEP and what are the more significant socio-environmental factors in each phase.

Methods

Bibliographic research in Pubmed database using the terms “Migration” and “First Episode Psychosis”.

Results

Research confirms that migrants have a 2 to 3-fold increased risk of developing a PD. This risk will be even higher in the refugee population. Pre- and post-migration factors demonstrated to be more important than factors related with the migration process itself. In the pre-migration phase highlight factors like the lower parental social class and a previous trauma. In the post-migration phase highlight factors like discrimination, social disadvantage and a mismatch between expectations and reality.

Conclusions

Literature is unanimous in considering migrant status as an independent risk factor for the development of FEP, possibly due to the outsider’s role in society. Thus, despite the growing interest in Biological Psychiatry, this work demonstrates that socio-environmental factors are very preponderant in the development of these disorders and because of that further investigation is still necessary.

Disclosure

No significant relationships.

“Walking with myself by my side” - non-medical use of Ketamine

Introduction

Ketamine, synthesized in 1962 as phencyclidine derivate, is denominated a “dissociative anesthetic” because of its side-effects, such as dissociative episodes and psychotic-like symptoms, which have limited its applicability on clinical practice. Otherwise, in the last decades the non-medical use of ketamine has been growing and today is one of the most popular illicit substances consumed between adolescents and young adults.

Objectives

Increasing the knowledge and understanding of the factors related to crescent use of ketamine and the experiences and consequences associated to its consumption.

Methods

Clinical interview with patients diagnosed with ketamine use disorder and bibliographic research in Pubmed database using the terms “Ketamine use” and “Ketamine addiction”.

Results

Pat et al. (2002) describes a clinical case of a young male, diagnosed with substance use disorders, specifically alcohol and cocaine use disorders, that started a treatment with ketamine. After the treatment, pleasant depersonalization experiences contributed to the development of patient’s ketamine dependence. Other patient’s reports confirm the association of ketamine use with psychedelic effects and dissociative episodes and pointed these effects as main reason for its consumption.

Conclusions

The adverse effects that limited the medical use of ketamine are the same that promote its utilization with recreational purposes by adolescents and young adults in parties and nightclubs. About the ketamine dependence, the literature is scarce and doesn´t clearly identify a physical withdrawal syndrome, pointing only to a serious psychological dependence. Thus, with the crescent non-medical use of ketamine, it’s urgent to develop an intervention plan directed to this problem.

Disclosure

No significant relationships.

Dissociation and emotional dysregulation in pathological personalities related to the fear of SARS-COV-2: a case report

Introduction

The COVID-19 pandemic represented a serious strain on the mental health resilience worldwide. Implementation of restrictive rules implied the disruption of social networks, eliciting emotional exhaustion and intense response to fear. This was amplified by media spread of panic and fake news, representing risk factors for post traumatic stress disorder (PTSD). Fear can be dangerous, especially accounting premorbid psychopathological vulnerability, such as pathological personality traits. Emotional dysregulation increases fear levels, mediated by the relationship between emotional dysregulation and lack of tolerance.

Objectives

Clinical case presentation of patient who developed dissociative and behavioral symptoms following COVID-19 infection. Bibliographic research.

Methods

Bibliographic research using Pubmed®. Clinical file consultation and patient interviews.

Results

Heightened psychophysiological reactivity can result from the persistent fear experienced during a traumatic event and repeated memories related to it, leading to a sensitization of the response to fear. We present 57 year-old female patient, admitted to the COVID ward after trying to escape from home isolation due to positivity to COVID-19. In the hospital setting she developed dissociative symptoms, trying to escape from the ward and infect other people.

Conclusions

Intense fear responses to COVID-19 are likely explained by poor emotion regulation capacities as well as dissociative mechanisms. Studies have shown that this pandemic was experienced as a real traumatic event and some studies have found that it may lead to the development of PTSD. Pathological personality is positively related to PTSD symptoms, attributable to higher levels of mood instability, cognitive/perceptual disorders, interpersonal dysfunctions and negative affection.

Disclosure

No significant relationships.

Anorexia Nervosa and Gender Dysphoria: A Clinical Case

Introduction

Eating disorders (ED) and gender dysphoria (GD) are associated with a change in body perception. Therefore, body dissatisfaction plays a common and central role in these disorders. In GD, body image concerns are related to the features of the biological sex. In ED, body dissatisfaction comes from a distorted perception of weight and body shape and plays an important role in the development and maintenance of the psychopathology.

Objectives

To present and discuss the clinical case of a patient with a previous diagnosis of GD who presented with a clinical condition suggesting a restrictive anorexia nervosa (AN).

Methods

Patient´s clinical files consultation and literature review using Pubmed and the keywords: eating disorders and gender dysphoria.

Results

We present the case of a 25-year-old patient who was living in a shelter for victims of domestic violence and was admitted for severe restrictive AN. The patient was discharged after 40 days and medicated with sertraline, diazepam and olanzapine, as well as her previous medication (hormonal therapy): cyproterone, finasteride, estradiol, oxybutynin.

Conclusions

Although studies on this subject are still scarce, there has been some progress and the literature recognizes the coexistence of these conditions. However ED symptoms in patients with GD could have a different meaning: they may represent a dysfunctional coping strategy adopted to block features of the biological sex. Therefore health professionals may take a more holistic approach to body image. Additional studies will be necessary, allowing the establishment of cause-consequence interactions between weight loss and psychopathology related to GD.

Disclosure

No significant relationships.

Transcatheter aortic valve implantation (balloon-expandable versus self-expandable valves) - what echocardiographic parameters should we evaluted?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter aortic valve implantation (TAVI) is currently the recommended treatment for aortic stenosis (AS) in high or intermediate-risk or inoperable patients. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the two major types of transcatheter heart valves (TTHV). Despite major diferences, both designs are recomended, however, there are only limited data available for the comparison of newer generation BEV and SEV.

Purpose

Compare echocardiographic and clinical parameters, during 1 year of follow-up of a balloon-expandable (BS) versus self-expanding (SE) transcatheter aortic valve implantantation, with emphasis on the composite endpoits proposed by uptade Valve Academic Researc Consortium (VARC-2).

Methods

Retrospective, comparative study in patients with symptomatic severe AS with a high operative risk, who implanted BEV or SEV between January 2016 and December 2019. All patients underwent echocardiographic study before an after the procedure (on the day , 6 months and 1 year of follow up), clinical data were collected. The following ecocardiographic parameters were evaluated: transvalvular and prosthetic aortic gradientes and paravalvular leak (PVL).

Results

We studied 106 patients (81 ± 8 years, 60% female) with severe AS (mean gradient of 49 ± 12 mmHg), who were threated with BE or SE transcatheter aortic valve. Comparative analysis between BEV vs SEV, showed: there were no statistically significant in mean transprosthetic gradients (9.5 ± 4.8 vs 10 ±6.2; p = 0.49). There were no statistically significant differences between BE and SE valves in the cumulative incidence of death from any cause (21% vs. 28%; p = 0.49), death from cardiovascular causes (3.3% vs. 0%; p= 0.26), all strokes (1.6% vs. 1.6%; p = 0.85), pacemaker implatation (18% vs. 15% p = 0.79); major bleeding (3.3% vs 6.5%; p = 0.18) and renal injury (1.6% vs. 2.1%: p = 0.67). There were statistically significant differences between BE and SE valves in the cumulative incidence of moderate or severe PVL (5% vs. 23.9%; p = 0.009) and repeat hospitalization (11.6% vs. 28%;p = 0.04). Device sucess was achieved in 97 % for BEV vs 91% for SEV (p = 0,39). The early safety at 30 days was observed in 5% for BVE vs. 4.3% for SVE (p = 0.87). The clinical efficacy after 30 days was achieved in 1,6% for BVE vs. 4.3% for SVE (p = 0.03), with higher incidence of moderate or severe PVL. The composite endpoint valve safety occured in 3,3 % for BVE vs 26% for SVE (p < 0,001), with moderate or severe PVL in 23%.

Conclusion(s): In patients with symptomatic severe aortic stenosis who implanted BEV or SEV transcatheter aortic valve there was a significant improvement in the hemodynamic status. The present study suggests that use of SEV was associated with a higher risk of PVL and repeat hospitalization, with a endpoint clinical efficacy after 30 days (4,3%) and time-related valve safety (26%).

Regression of left ventricular mass after transcatheter aortic valve implantation

Funding Acknowledgements

Type of funding sources: None.

Introduction

Regression of left ventricular mass (LVM) after transcatheter aortic valve implantation (TAVI) is an important parameter of left ventricular reverse remodeling and is associated with less hospitalizations 1year after TAVI. The association between LVM índex (LVMi) at 6 months and outcome 1 year after TAVI is unclear.

Purpose

Evaluate and compare LVMi, before TAVI and 6 months after, and determine the association between LVMi regression and clinical outcomes at 1-year follow-up.

Methods

Retrospective, comparative study in patients with symptomatic severe aortic stenosis with a high operative risk, after TAVI. All patients underwent echocardiographic study before TAVI and 6 months of follow-up, the LVMi (by the Devereux formula) was evaluated. Associations between LVMi regression (percent change between baseline and 6 months after TAVI), rehospitalization rate and death at 1 year of follow-up were examined.

Results

We studied 50 patients, 82% with moderade or severe LVMi before TAVI. Comparative analysis between ecocardiography study before and 6 months after TAVI, showed there was statistically significant decrease in LVMi (150,7 ± 38 g/m2 vs 132 ± 36 g/m2; p = 0.03). LVMi moderate or severe (between 130 and 154 g/m2) at 6 months was associated with biggest hospitalization rate (p = 0,03).Comparative analysis between regression of LVMi (before and 6 months after TAVI) and death, showed: decrease of 5% and 10% in LVMi was independently associated with death at 1 year (p = 0,77 vs p = 0,4).

Conclusions

Patients with severe symptomatic aortic stenosis treated with TAVI who had a significant decrease of LVMi after 6 months of follow-up had lower hospitalization rates, but decrease of LVMi is independently associated with death at 1 year of follow-up.

A study of commercially available complementary foods for infants and young children under 36 months

Background

Commercially available complementary foods (CACFs) have been assuming an important proportion of infants and toddlers' diets in high-income countries, despite the concerns regarding their nutritional content and potential problematic marketing strategies used to promote these products. In 2016, the WHO guidance on ending the inappropriate promotion of foods for infants and young children (IYC) was approved (1) to support countries to take action on this issue. To implement this Guidance, a draft Nutrient Profile Model (NPM) (2) was developed to drive decisions regarding the identification of foods which are inappropriate for promotion.

Aim

To support the implementation of the NPM at National Level, studying the availability, composition, and marketing of CACFs for IYC in Portugal.

Methods

Three phases were considered: 1) collect data on CACFs products targeted at IYC (0-36 months); 2) compare composition of these products with WHO guidance; 3) compare methods used to promote these products with WHO Guidance.

Results

A total of 209 products were sampled. The most common products were soft-wet spoonable, ready-to-eat foods (n = 129), dry, powdered and instant cereal/starchy foods (n = 61) and dry finger foods and snacks (n = 16). Twenty-five products (11%) were marketed as being suitable for infants under the age of 6 months. For infants between 6-8 months 78% of the products were marketed as being suitable. For the age group 12 months and over, 11% of the products were marketed as being suitable.

Conclusions

This study provides valuable insights into the CACFs at the national level and reinforces that action is needed to improve the implementation and operationalization of WHO guidance on ending the inappropriate promotion of foods for IYC.

Key messages

NPM can support countries identifying products that can/cannot be promoted for IYC. It is a key opportunity to build policy measures, ensuring children healthy growth and development.

Anxiety and depression risk in patients with allergic rhinitis: a systematic review and meta-analysis

BACKGROUND

Allergic diseases appear to be associated with mood disorders. However, particularly regarding allergic rhinitis (AR), such association has not been adequately systematically reviewed. Therefore, we conducted a systematic review and meta-analysis to quantify the association between AR and depression and anxiety.

METHODOLOGY

We performed an electronic search of PubMed, Web of Science and Scopus for observational studies assessing the association between AR and depression and anxiety. Such association was quantified by means of random-effects meta-analysis, with estimation of pooled odds ratio (OR). Sources of heterogeneity were explored by subgroup analysis.

RESULTS

We included a total of 24 primary studies, of which 23 assessed depression and 11 assessed anxiety. Of these, 12 studies presented OR from multivariable regression models and were included in our meta-analysis. AR was associated with higher odds of depression and anxiety.

CONCLUSIONS

AR appears to be associated with high risk of depression and anxiety. While our results point to the importance of mental comorbidities among patients with AR, longitudinal studies are needed adopting uniform definitions and presenting results stratified by AR severity.

Thalamic deep brain stimulation for post-traumatic neuropathic limb pain: Efficacy at five years' follow-up and effective volume of activated brain tissue

Chronic neuropathic pain affects 7%-10% of the population. Deep brain stimulation (DBS) has shown variable but promising results in its treatment. This study prospectively assessed the long-term effectiveness of DBS in a series of patients with chronic neuropathic pain, correlating clinical results with neuroimaging. Sixteen patients received 5 years' post-surgical follow-up in a single center. Six had phantom limb pain after amputation and 10 had deafferentation pain after traumatic brachial plexus injury. Patient-reported outcome measures were completed before and after surgery, using VAS, UWNPS, BPI and SF-36 scores. Neuroimaging evaluated electrode location and effective volumes of activated tissue (VAT). Two subgroups were created based on the percentage of VAT superimposed upon the ventroposterolateral thalamic nucleus (eVAT), and clinical outcomes were compared. Analgesic effect was assessed at 5 years and compared to preoperative pain, with an improvement on VAS of 76.4% (p=0.0001), on UW-NPS of 35.2% (p=0.3582), on BPI of 65.1% (p=0.0505) and on SF-36 of 5% (p=0.7406). Eight patients with higher eVAT showed improvement on VAS of 67.5% (p=0.0017) while the remaining patients, with lower eVAT, improved by 50.6% (p=0.03607). DBS remained effective in improving chronic neuropathic pain after 5 years. While VPL-targeting contributes to success, analgesia is also obtained by stimulating surrounding posterior ventrobasal thalamic structures and related spinothalamocortical tracts.

Monitoring of brain tissue oxygenation in surgery of middle cerebral artery incidental aneurysms

Introduction:

The management of incidental unruptured aneurysms remains a matter of controversy; middle-sized or large anterior circulation incidental aneurysms, in young or middle age patients, should be considered for treatment. Surgical clipping is an accepted treatment for middle cerebral artery unruptured aneurysms. Ischemic events can occur even in cases of incidental aneurysm surgery. Since regional cerebral blood flow can be compromised due to temporary arterial clipping or to incorrect placement of defi nitive clip, we performed intra-operative monitoring of brain tissue oxygen concentration (PtiO₂), to detect changes in brain oxygenation due to reduced blood fl ow, eventually leading to ischemia, during surgery of middle cerebral artery incidental aneurysms.

Methods:

PtiO₂ monitoring was performed during surgery of eight patients harboring incidental MCA aneurysms, using a polarographic microcatheter (Licox, GMS – Kiel, Germany), placed in the temporal lobe on the side of the lesion, from dural opening to dural closure.

Results:

Basal values varied between 2.3 and 27.3 mmHg; these values are lower than those previously described in the literature as “normal” for uninjured brain or in cases of subarachnoid hemorrhage. In all patients, a significant decrease in PtiO2 was found in every period of temporary clipping of MCA. Post-operative infarction in the territory of middle cerebral artery occurred in one patient and, in that case, there was a persistent minimum value of 0.6 mmHg, without recovery after the placement of the definitive clip. In another patient, an incorrect placement of the definitive clip could be predicted by a decrease in PtiO₂ value.

Conclusions:

PtiO₂ monitoring during aneurysm surgery shows brain tissue perfusion in real time and there is a correlation between any episode of reduced blood flow to the affected vascular territory during surgery and a decrease of PtiO2 values. Unexpected low basal values were obtained in “uninjured” brain, with no influence from subarachnoid hemorrhage. The values of risk for brain infarction during temporary arterial occlusion still need further studies, but an incomplete recovery or a persistent fall in PtiO₂ values after definitive clipping should be considered as an indication for verification of the position of the clip.

[Lumbar tuberculous spondylodiscitis: a minimally invasive surgical approach]

INTRODUCTION

Tuberculous spondylodiscitis is the most frequent and severe manifestation of extra-pulmonary tuberculosis, accounting for 40 to 50 percent of the cases with osteoarticular involvement. Although antituberculous drugs remain the cornerstone of therapy, surgical treatment still has an important role in the management of some situations. Classical approaches of radical debridement have been gradually replaced by minimally invasive surgical procedures.

CASE REPORT

The authors describe a case of an 86-year-old male, diagnosed with a L2-L3 tuberculous spondylodiscitis complicated by an anterior epidural abscess, bilateral psoas muscle abscesses and meningoencephalitis. The patient underwent surgery by minimally invasive posterior paramedian approaches with tubular retractors. A L2-L3 discectomy, drainage of the abscesses and L2-L3 percutaneous transpedicular fixation were performed. The procedure and postoperative period were uneventful and the patient had a favourable outcome.

DISCUSSION

A minimally invasive posterior approach allows adequate access to the spinal canal for neural decompression in cases of spinal infection. Combined with percutaneous internal fixation the procedure prevents the loss of vertebral alignment and facilitates an early mobilization of the patient.

[Cavernous malformation of the pineal region. Case report and review of the literature]

Cavernous malformations rarely occur in the pineal region with only 21 reported to date. Although its diagnosis is not easy because of the extreme rareness of this condition, the presence of this lesion can be suspected based on its typical radiological findings. We report the case of a 57-year-old woman presented with desorientation, somnolence and diplopy. The CT-scan showed an acute hemorrhage in the pineal region and triventricular hydrocephalus. An MRI suggested a cavernous malformation. The patient was operated with total en-bloc removal of the lesion. We conclude that surgical exploration and total resection is the treatment of choice when the diagnosis of cavernous angioma is suspected of the basis of neuroimaging.

[Trigeminal neuralgia caused by contra lateral cerebellopontine angle tumor. A case report]

In most cases, trigeminal neuralgia is due to compression of the trigeminal nerve in the zone of entrance at the pons by vascular structures. About 1% of cases, have trigeminal neuralgia associated with the presence of ipsilateral lesion of cerebellar-pontine angle. Rarely, trigeminal neuralgia may be due to contralateral posterior fossa tumors. We present a case of a 37-year- old patient who presented with right trigeminal neuralgia and harboured a left acoustic neuroma of significant dimension. Facial pain completely disappeared after tumor removal.

Sexual Health in Parkinson’s Disease

Introduction:

The changes in sexual health of patients with Parkinson's disease must be a concern to the clinicians. The effects in sexual health of patients submitted to functional cirurgy is still a matter of debate.

Objectives:

To describe and evaluate the sexual health of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).

Methods:

Patients with Parkinson's disease bilaterally implanted for DBS of STN and those only pharmacologically treated, will be evaluated. Sexual functioning will be assessed using the international erectile function indices (IEFI) and the female sexual function indices (FSFI). Depression and anxiety will be evaluated using the Beck depression inventory and the brief symptom indices. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease will be analyzed.

Results and conlusions:

We expect to find positive changes in the sexual health of these patients, given the fact of the procedure improve the overall burden of the disease by reduction of medication and motor symptoms.

Epithelioid hemangioendothelioma and multiple thoraco-lumbar lateral meningoceles: two rare pathological entities in a patient with NF-1

Epithelioid hemangioendothelioma (EHE) is a rare vascular soft-tissue tumour of intermediate malignancy. Neurofibromatosis type I (NF-1) is a genetic syndrome associated with soft tissue sarcoma and higher risk of developing neoplasia. Lateral meningoceles are uncommon entities, being mostly associated with NF-1. We report a case of a 31-year-old woman, with NF-1 and past history of right thalamic/peduncular astrocytoma WHO grade II, admitted to the Neurosurgery Department in December 2003 due to severe low back pain, irradiating to the left leg without a radicular pattern. Thoraco-lumbar magnetic resonance imaging (MRI) showed a large left posterior paravertebral expansive lesion, bilateral and multiple thoraco-lumbar lateral meningoceles and dural ectasias with scalloping of the vertebral bodies. Biopsy of the paravertebral mass lesion disclosed EHE. We present this case because of the novel association between NF-1 and EHE, and the unusual aggressiveness of the neoplasia. Additionally, we highlight the co-existence of bilateral and multiple lateral meningoceles.

Voluminoso hamartoma hipotalámico en un niño de 5 meses: Epilepsia y cirugía

The authors report the case of 5-month-old boy with a hypothalamic hamartoma and persistent gelastic seizures in spite of a wide combination of different antiepileptic drugs. It was decided to carry out only partial removal of the tumor for decompression and to decreasing the activity of the epileptogenic focus. Surgical therapy revealed as a valid option in the treatment of the uncontrollable gelastic seizures.

[Cranial Procedures without shaving. A 1-year experience at the Hospital São João. ]

Scalp shaving has been a ritual usually said to make easier orientation and surgical access and also to prevent local infection. However, this last aspect has been challenged in several publications and progressive evidence on favourable psychological effects of non-shaved patients has accumulated. The authors review 328 intracranial surgeries performed without scalp shaving from 1 October 1999 to 30 September 2000 in the Department of Neurosurgery of Hospital de S.João. All patients were included except those undergoing approaches, such as transphenoidal external ventricular drainages, removal of collocated non-organic materials and surgery for infections. The technique was implemented in patient having CSF shunting only during the second half of the study period. Antibiotic prophylaxis was the same previously used in the Department. The infection rate was 1.82%. The authors comment the disadvantages and benefits of the technique, remarking positive psychological effects for the patient.

[Stereotactic brain biopsy: review of 80 cases. The need of ct-scan in the first hours]

OBJECTIVE

Evaluate the efficacy of the stereotactic brain biopsies performed in the Neurosurgery Department of the São João Hospital in order to diagnose intracerebral damage and to determine the existence of post-biopsy haemorrhage.

METHODS

The authors evaluated 80 consecutive cases of patients submitted to a stereotactic brain biopsy. 63 of them had a control CT-scan from 4 to 6 hours after the proceeding.

RESULTS

Stereotactic biopsy yield a conclusive diagnosis in 75 of the 80 patients which corresponds to 93.7% of the cases. Inconclusive results occurred in 5 patients (6.25%). Significant morbidity occurred in 4 cases (5%) and there was no mortality. Control CT-scan revealed no alterations in 25 patients and vestigial haemorrhage in 27. In the remaining 11 the haemorrhage was of little significance.

CONCLUSIONS

Stereotactic biopsy is a safe and effective method to diagnose brain lesions. The realization of a control CT-scan within few hours after biopsy allows the identification of a sub-group of patients without intracerebral haemorrhage that may be discharged from hospital on the same day.

[Craniopharyngiomas. Clinicopathological aspects in different age groups]

Craniopharyngiomas are rare brain tumors of the hypothalamo-pituitary region, developing from embryonic remnants of Rathke's pouch and sac. Their overall incidence is 0.13 per 100,000 person years. Most frequently, they are suprasellar, start growing in childhood and originate neurological and hormonal symptoms. We retrospectively studied patients treated in our institution for craniopharyngioma in the last 10 years, in order to evaluate their clinical, imaging and pathological characteristics. Of the 32 patients analysed, 18 were females and 14 males with ages ranging between 6 and 81 years (early onset group--EOG aged 5-14 years: 7 patients; middle age onset group--MAOG aged 15-49 years: 15 patients; late age onset group--LOG aged > or = 50 years: 10 patients). Visual impairment was the most frequent presenting clinical feature in EOG (71.4%) and MAOG (86.6%), while in the LOG personality and cognitive changes including memory loss predominated (60%). Headaches were very frequent in all groups (EOG 42.8%, MAOG 60%, LOG 40%). Meningitis and seizures were presenting features, each in one patient. Regarding endocrine symptoms and signs, growth failure was present in 57.2% of the EOG. Amenorrhea was present in 5 of 10 female patients of the MAOG. Preoperatively, TSH was deficient in 25%, ACTH in 15.6% and gonadotropin in 25% of the patients. There were no cases of diabetes insipidus. Preoperative CT and MR revealed a calcified mass in 12 (37.5%), a partially cystic mass in 20 (62.5%) and a lesion involving or extending into the third ventricle in 7 (21.9%) patients. Twenty seven (84.4%) patients were treated primarily by surgery. In 4 (12.5%) cases the tumour was considered inoperable and 1 (3.1%) patient refused surgery; all were in the LOG. Surgical approach was transsphenoidal in 2/27 (7.4%) (all of them in the LAOG) and by craniotomy in the others. The tumour removable was considered complete in 10 (37%--EOG 2/7, MAOG 6/15, LOG 2/5) and subtotal in 17 (62.9%) patients. Eight (29.6%) patients were reoperated for recurrent tumour. Postoperative radiotherapy was administered in 12 cases with residual tumor, and 3 inoperable tumors were treated primarily by conventional external radiotherapy. Pathological study revealed the adamantinomatous type in 25 (92.6%) and the papillary type in 2 (7.4%--all men in the MAOG) tumors. The average follow-up was longer in the EOG (82.6 +/- 40.7 months) than in MAOG (57.2 +/- 48.5 months) and in LOG (48 +/- 92 months). Four (12.5%) patients died, 1 during the follow-up period due to a radiation-induced astrocytoma and 3 in the postoperative period because of cerebral hemorrhage and hydrocephalus (1 in the EOG and 2 in the LOG). In summary, we found the clinical presentation to be different in the 3 age groups, with a large number of patients in the MAOG. In this group were the only examples of the papillary form. Better prognosis was associated with a total resection at initial surgery.

Idiopathic spinal cord herniation: case report and literature review

We report one case of spontaneous thoracic spinal cord herniation presenting with a progressive spastic paraparesis for 4 years in a 55 years old man. From preoperative MRI, showing a ventrally displaced atrophic spinal cord at T2-T3 level, a dorsal intradural arachnoid cyst was suspected. At operation, after a 3 level laminectomy, no arachnoid cyst was found and spinal cord herniation into a meningeal diverticulum was confirmed. The herniated myelon was replaced intradurally and the lumen of the diverticulum was filled with Teflon settled with fibrin glue to prevent recurrence. Postoperatively some neurological recovery was achieved. The literature was reviewed, regarding clinical and epidemiological features, proposed pathophysiological mechanisms, treatment options and outcome. Only 32 surgically proved cases of thoracic spinal cord herniation with no past history of spine trauma, injury or surgery were found.

[Occipital condyle fracture without neurological deficit: apropos of a case]

Fracture of the occipital condyles is a rare pathology that can be easily undiagnosed. The bibliographic references on this theme are scarce and the majority are related to patients with palsy of the low cranial nerves and/or a high cervical subluxation with abnormal posture of the neck. The authors describe one case of the occipital condyle fracture without clinical manifestations other than persistent pain, and without alterations of the high cervical region. The patient was submitted to conservative treatment by means of a cervical collar due to the existence of minor symptoms. The clinical criteria that should lead to the study of this pathology are discussed, just as the use of a computerized tomography bone window as the fundamental instrument in its diagnosis and classification.

Antibodies against human putamen in adolescents with anorexia nervosa

OBJECTIVE

To examine whether antiputamen antibodies are present in adolescents with anorexia nervosa (AN).

METHOD

Using enzyme-linked immunosorbent assay (ELISA) with an extract of human putamen as an antigen, sera samples obtained from 22 adolescents with active AN and from 22 healthy adolescents (control group) were assayed for antibodies to neuronal components

RESULTS

Mean optical density (OD) readings for serum antibodies against human putamen in adolescents with AN was significantly greater than the mean OD readings in the control group (0.492 +/- 0.086 vs. 0.275 +/- 0.028, p =.02). When serum positivity was defined as an OD level greater than 2 SD above the mean control group value (0.541), antiputamen antibodies were detected in the blood of 6 AN patients (27%) whereas they were detected in the blood of 1 patient (5%) in the control group (p <.05; Fisher's exact test).

DISCUSSION

The detection of antiputamen antibodies in adolescents with AN suggests an underlying immune process at the putamen level in some patients with this eating disorder.

Omega-3 polyunsaturated fatty acids in adolescents: knowledge and consumption

OBJECTIVE

To assess adolescents' knowledge about n-3 polyunsaturated fatty acids (PUFA) and their dietary intake of these important nutrients.

METHODS

A questionnaire consisting of 12 questions assessing the knowledge and intake of n-3 PUFA and of a 24-h dietary recall was administered to 1117 ninth-grade adolescents (52% girls and 48% boys) attending five public schools. The adolescents were subsequently provided with verbal and written information on the health benefits, requirements, and dietary sources of n-3 PUFA. Dietary recalls were analyzed for energy and n-3 PUFA intake. Descriptive statistics, Student's t-tests, Chi-square analysis, and multiple regression analysis were used to assess adolescents' knowledge about n-3 PUFA as well as to examine relationships of independent variables with n-3 PUFA intake.

RESULTS

Most adolescents (89%) believed that eating fish, a main source of very long chain (VLC) n-3 PUFA, is healthy and may prevent heart disease (59%), but only a few knew about n-3 PUFA's role in alleviating inflammation (29%) and its potential for cancer prevention (25%). Many were aware of marine sources of n-3 PUFA, such as salmon (67%), tuna (46%), mackerel (30%), and herring (26%), but only 36% knew about adequate intake of VLC n-3 PUFA. The main source of n-3 PUFA information was parents (58%), whereas only 21% of adolescents reported that their care providers had discussed health benefits of n-3 PUFA with them. About one-third of adolescents consumed fish at least once a week, and 29% consumed fish once a month. Dislike (22% of participants) and allergy (3%) were the main reasons for rarely (< or = 3 times/year; 18%) or never (17%) consuming fish. Only one adolescent reported daily consumption of a fish concentrate supplement. Daily consumption of linolenic acid was higher in boys (0.38 +/- 0.02 g) than in girls (0.31 +/- 0.01 g; p =.002). Total intake of n-3 PUFA represented only 30% of the presently available (Canadian) recommended daily allowance (CRDA) for 14- to 15-year-old boys (1.4 g/day) and 29% of the CRDA for 14- to 15-year-old girls (1.2 g/day).

CONCLUSIONS

Adolescents are aware of some of the health benefits of n-3 PUFA but lack concrete information about dietary requirements of n-3 PUFA and about n-3 PUFA content of various dietary sources.

Serotesting versus presumptive varicella vaccination of adolescents with a negative or uncertain history of chickenpox

OBJECTIVE

To review the current practice of adolescent health care providers when an adolescent reports a negative or uncertain history of chickenpox in order to provide information for future practice.

METHODS

Retrospective chart review of a sample of patients seen in a hospital-based adolescent primary care clinic between 1996 and 1999.

RESULTS

Among adolescents who reported a positive history of chickenpox (190 patients, aged 15 +/- 1 years), varicella occurred before age 5 years in 30%, between 5 and 10 years in 56%, and at older than age 10 years in 14% of the patients. When adolescents reported a negative or uncertain history of varicella (55 patients, aged 15 +/- 1 years), serotesting was ordered for the majority (73%) of cases, while only 16% were presumptively vaccinated with varicella vaccine. In six patients no intervention was noted in the charts, and these patients were contacted. In 80% of the patients who were serotested, varicella IgG titers of > or = 1:32 indicated a previous unnoticed infection and lifelong immunity to varicella. In only 20% of the patients sera were negative for varicella IgG titer, requiring varicella vaccination. There was no statistical difference between the number of siblings of patients with a positive serologic test (3 +/- 1) and the number of siblings of seronegative patients (2 +/- 1, p = 0.41). Seven of the eight seronegative patients consented to varicella vaccination and were vaccinated within 10 months of serotesting.

CONCLUSIONS

These data support the practice of serotesting for a previously unnoticed varicella infection rather than presumptive vaccination in the adolescent age group. A follow-up vaccination of seronegative adolescents should be scheduled as close to serotesting as possible.

Urinary leukotriene (LT) E(4) in adolescents with dysmenorrhea: a pilot study

In the present study we measured levels of urinary leukotriene (LT) E(4) as an index of LT production during the menstrual cycle in adolescents. Mean urinary LTE(4) levels in girls with dysmenorrhea was approximately threefold higher than normal laboratory values on Day 1 of the menstrual period and approximately twofold higher than normal laboratory values on Day 5 of the menstrual period. Compared with urinary LTE(4) levels in girls with eumenorrhea, urinary LTE(4) levels in girls with dysmenorrhea were higher on Day 1 [361 +/- 123 pg/mg creatinine vs. 122 +/- 37 pg/mg creatinine, p =.1; not significant (NS)] and on Day 5 (202 +/- 26 pg/mg creatinine vs. 117 +/- 26 pg/mg creatinine, p <.05) of the menstrual period, as well as on Day 10 (159 +/- 33 pg/mg creatinine vs. 88 +/- 21 pg/mg creatinine, p =.1; NS) of the menstrual cycle. Increased urinary excretion of leukotrienes, inflammatory mediators known to cause potent vasoconstriction and uterine contractions, in girls with dysmenorrhea in this pilot study, suggests that these mediators may be involved in generating dysmenorrhea symptoms in adolescents.

The effects of chloroquine on bleeding time and disappearance of platelet 5-hydroxytryptamine in rabbits

BACKGROUND

Chloroquine inhibits platelet aggregation in vitro and in vivo. Because inhibition of platelet aggregation may prolong bleeding time, the effect of chloroquine administration on bleeding time and disappearance of platelet serotonin, which may affect bleeding time, were studied.

METHODS AND RESULTS

Platelets were harvested from 12 rabbits. They were labelled with (111)In to tag individual platelets and (14)C-labelled 5-hydroxytryptamine (5HT) or serotonin. Doubly labelled platelets from the rabbits were returned to their donors. At timed intervals, from 2 to 66 hours, blood samples were drawn and platelets collected. (111)In and (14)C were separately counted. In 6 experiments, the animals served as control and received normal saline intraperitoneally (IP) daily for 4 days; the other 6 rabbits served as test and were given a therapeutic dose of chloroquine phosphate (10 mg/kg, IP) daily for 4 days. Indium disappeared in an exponential fashion in both control and test groups. The fraction of indium disappearing per hour was significantly less in chloroquine-treated rabbits than in control rabbits (P <.001). Ninety-nine percent of the indium-labelled platelets disappeared in 7.0 days in chloroquine-treated rabbits and 5.8 days in control rabbits (P <.001). Bleeding times in chloroquine-treated and control rabbits were not significantly different (64.8 +/- 2.2 vs. 62.3 +/- 4.0 sec, respectively). However, the labelled platelet serotonin disappeared more slowly in chloroquine-treated rabbits than in control rabbits. (K for chloroquine-treated and control rabbits was 0.0096 +/- 0.0064 and 0. 0254 +/- 0.0016; respectively, P <.001).

CONCLUSION

Chloroquine prolongs platelet survival but does not affect bleeding time in rabbits. Chloroquine also slows down the disappearance of labelled platelet serotonin. We propose that chloroquine increases the recycling of platelet 5HT, passing it on from platelet to platelet in rabbits and this may have a role in the maintenance of hemostasis.