Biomedical subjects
J Lobo Antunes
Publications and source records attributed to J Lobo Antunes.
The management of brain abscesses.
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Professionalism endangered.
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Normal pressure hydrocephalus and Parkinson's disease.
Three patients with normal pressure hydrocephalus and Parkinson's disease are reported. The recognition of this association is important because these two entities require specific therapeutic approaches. The presence of Parkinson's disease does not preclude an excellent response of the hydrocephalus to a shunting procedure. Although several reports of cases with the characteristic clinical manifestations of normal pressure hydrocephalus--progressive dementia, gait difficulty and urinary incontinence--have been published earlier, it was Adams and Hakim who emphasized the clinical triad and the effect of shunting the cerebrospinal fluid as a means of treatment. Messert and Baker stressed that the gait disturbance had a close resemblance to the freezing gait of parkinsonism. We are reporting three patients who had both conditions. Recognition of the existence of both disorders in the same patients is important since appropriate treatment of each of them led to marked improvement of their symptoms.
Benign isolated fibrohistiocytic tumor arising from the central nervous system. Considerations about two cases.
Benign fibrous histiocytomas (BFHs) are tumors with fibroblastic and histiocytic components without histological anaplasia. Intracerebral lesions are exceptional and to our knowledge a spinal location was not yet described. We describe 2 cases of BFHs of the neural axis: the first, a 22-month-old boy with Down's syndrome, presented with a paraparesis and the magnetic resonance (MR) of the spine disclosed an intradural extramedullary, thoracic mass, totally resected; the second, a 13-year-old boy with left partial motor seizures, in whom the MR of the brain showed an intracerebral, right frontal tumor, also surgically removed. Both patients are free of recurrence, 6 years and 15 months after surgery, respectively. Histological examination and immunoreactivity for vimentin and histiocytic markers favored the diagnosis of BFH. It is likely that these tumors may originate from spinal dura mater mesenchymal stem cells and from the intracerebral perivascular pial sheath or the brain vessel walls themselves, respectively. Other benign, isolated, intracranial fibrohistiocytic neoplasms, namely the juvenile xanthogranuloma, can harbor a clinical, morphological and immunohistochemical profile overlapping the one of the BFH. Intracranial germ cell tumors may be associated with Down's syndrome, although harboring an unusual, non-pineal and non-chiasmatic location. One can speculate that a similar, still unknown genetic mechanism responsible for this association, could also induce the growth of other type of tumors in patients with this syndrome. BFHs should be added to the differential diagnosis of intracerebral or spinal dural attached tumors. Furthermore, we propose to name these intracranial tumors "benign isolated fibrohistiocytic tumors of the CNS".
[Giant pituitary adenoma (report of a case)].
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Clear cell meningioma variant and clinical aggressiveness.
The few reports about clear cell meningiomas (CCM) point to an inordinate clinical aggressiveness despite their histological benignity. We studied 5 CCM aiming to assess their clinicopathological, cytometric, and ultrastructural features. Two patients were females and 3 males, with a mean age of 36 years. Two tumors were spinal, one of the cerebral convexity, one of the tentorium-clinoid region, and one of the base of the skull. The first 3 were totally removed and have not recurred for a mean follow-up time of 40 months. The tentorium-clinoid and the skull base tumors had radical subtotal and partial resections, and recurred after 16 and 1.5 months, respectively. All tumors but one, a non-recurrent one, presented no signs of histological anaplasia. The proliferative capacity, as assessed by MIB-1 staining index (SI), of recurrent tumors was slightly higher than that of those tumors that did not recur. All cases showed DNA diploid pattern. Amianthoid-type fibers were disclosed on ultrastructural study. CCM arose in patients younger than those with other variants of meningioma, the spinal canal and the posterior fossa were the common sites. Finally, intracranial tumors were linked to an aggressive behavior.