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Biomedical subjects

M L Monteiro

Publications and source records attributed to M L Monteiro.

At least 19 recordsLinked to original sources

Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe.

AIM: To prospectively assess the antibacterial resistance rate in Helicobacter pylori strains obtained from symptomatic children in Europe. METHODS: During a 4-year period, 17 paediatric centres from 14 European countries reported prospectively on patients infected with H pylori, for whom antibiotic susceptibility was tested. RESULTS: A total of 1233 patients were reported from Northern (3%), Western (70%), Eastern (9%) and Southern Europe (18%); 41% originated from outside Europe as indicated by mother's birth-country; 13% were <6 years of age, 43% 6-11 years of age and 44% >11 years of age. Testing was carried out before the first treatment (group A, n = 1037), and after treatment failure (group B, n = 196). Overall resistance to clarithromycin was detected in 24% (mean, A: 20%, B: 42%). The primary clarithromycin resistance rate was higher in boys (odds ratio (OR) 1.58; 1.12 to 2.24, p = 0.01), in children <6 years compared with >12 years (OR 1.82, 1.10 to 3.03, p = 0.020) and in patients living in Southern Europe compared with those living in Northern Europe (OR 2.25; 1.52 to 3.30, p<0.001). Overall resistance rate to metronidazole was 25% (A: 23%, B: 35%) and higher in children born outside Europe (A: adjusted. OR 2.42, 95% CI: 1.61 to 3.66, p<0.001). Resistance to both antibiotics occurred in 6.9% (A: 5.3%, B: 15.3%). Resistance to amoxicillin was exceptional (0.6%). Children with peptic ulcer disease (80/1180, 6.8%) were older than patients without ulcer (p = 0.001). CONCLUSION: The primary resistance rate of H pylori strains obtained from unselected children in Europe is high. The use of antibiotics for other indications seems to be the major risk factor for development of primary resistance.

Adolescent↗

Superior orbital 'petrositis' and late ischaemic monocular blindness induced by intense UV radiation exposure.

Many physical agents cause neuropathies. The most common are chronic pressure, vibration and temperature. In general, these lesions occur at work, as a result of accidents or through chronic exposure to the physical agent. Radiation leading to peripheral neuropathy is also related to radiotherapy in cancer treatment, as an undesirable side-effect. We present here a case report of short, intense UV radiation exposure at work, leading to delayed-onset ocular neuropathy. A clear cause-effect relationship is shown, demonstrated using magnetic resonance imaging scans. We suggest that the mechanism was thermal and ischaemic.

Accidents, Occupational↗

Spontaneous regression of optic gliomas: thirteen cases documented by serial neuroimaging.

OBJECTIVE: To demonstrate spontaneous regression of large, clinically symptomatic optic pathway gliomas in patients with and without neurofibromatosis type 1 (NF-1). METHODS: Patient cases were collected through surveys at 2 consecutive annual meetings of the North American Neuro-Ophthalmology Society (NANOS) and through requests on the NANOSNET Internet listserv. Serial documentation of tumor signal and size, using magnetic resonance imaging in 11 patients and computed tomography in 2 patients, was used to evaluate clinically symptomatic optic pathway gliomas. All tumors met radiologic criteria for the diagnosis of glioma and 4 patients had biopsy confirmation of their tumors. In 3 patients, some attempt at therapy had been made many years before regression occurred. In one of these, radiation treatment had been given 19 years before tumor regression, while in another, chemotherapy had been administered 5 years before signal changes in the tumor. In the third patient, minimal surgical debulking was performed 1 year before the tumor began to shrink. RESULTS: Spontaneous tumor shrinkage was noted in 12 patients. Eight patients did not have NF-1. In an additional patient without NF-1, a signal change within the tumor without associated shrinkage was detected. Tumor regression was associated with improvement in visual function in 10 of 13 patients, stability of function in 1, and deterioration in 2. CONCLUSIONS: Large, clinically symptomatic optic gliomas may undergo spontaneous regression. Regression was seen in patients with and without NF-1. Regression may manifest either as an overall shrinkage in tumor size, or as a signal change on magnetic resonance imaging. A variable degree of improvement in visual function may accompany regression. The possibility of spontaneous regression of an optic glioma should be considered in the planning of treatment of patients with these tumors.

Adolescent↗

Meningiomas involving the parasellar region.

The authors report on 180 cases of meningiomas involving the parasellar region, which have been surgically treated between 1978 and 1993. Most of the tumors originated in the middle cranial fossa (66%). Half of the patients had visual deficits, and palsy of the eye movements was observed in 25% of the cases. Depending on the tumor origin and extension, the surgical approach was chosen. Total tumor resection varied very much, depending mostly on the tumor extension, and the pattern of growth. The overall total resection (Simpson I-II) was 57%. The postoperative results were good in 77% of the cases, and surgical mortality was 3%.

Adolescent↗

Selenium and lipid parameters in plasma of Portuguese subjects.

To obtain further insight into the role of selenium in the development of atherosclerosis, plasma selenium and lipid parameters were determined in 126 Portuguese subjects living in the region of Lisbon, 60 women and 66 men, 20-60 years old, divided up in to three groups according to their plasma lipid profile: Group I consisted of normolipidemic subjects having plasma triglycerides and total cholesterol < 200mg/dL; Group II was composed of hypercholesteremic subjects with total cholesterol > 200mg/dL and plasma triglycerides < 200mg/dL; Group III was composed of hypercholesteremic and hypertriglyceremic subjects having total cholesterol and plasma triglycerides > 200mg/dL. Respective values for mean plasma selenium (+/- SD) in the groups were: 93 +/- 18 micrograms/L, 90 +/- 17 micrograms/L and 96 +/- 18 micrograms/L. A weak significant difference in plasma selenium between women and men was, however, observed in Group I (87 +/- 20 micrograms/L vs. 100 +/- 11 micrograms/L, p < 0.05). Regression analysis showed no significant relationship between plasma selenium and lipid parameters, except in the most hyperlipidemic women of Group III, where a weak correlation between plasma selenium and the HDL-cholesterol/total cholesterol ratio (r = 0.80, p < 0.05) was observed. The present study suggests that the relationship between selenium and HDL-cholesterol has to be further examined, taking into account nutritional, metabolic and genetic factors.

Adult↗

Iron mydriasis. Pupillary paresis from occult intraocular foreign body.

Two patients presented with unilateral dilated and poorly reactive pupils and were found to have a previously unsuspected intraocular iron foreign body. Both of them had normal vision and one had normal color of the iris so that the condition was missed by several physicians. The pupils reacted normally to pilocarpine 1% and also showed response to dilute (0.1%) pilocarpine. There was no response to phospholine iodide. These findings indicate that the mydriasis was due to a local siderotic parasympathetic neuropathy of the pupil.

Adult↗

Optic neuropathy associated with chronic lymphomatous meningitis.

A patient with paranasal sinus lymphoma (recognized retrospectively) developed unilateral, acute, self-limited optic neuritis during the course of chronic lymphocytic meningitis with elevated intracranial pressure and headache. Meningeal symptoms were adequately controlled with analgesics alone for 14 months and corticosteroids alone for a subsequent 11 months without evidence of development of other involvement of organs outside the central nervous system (CNS). Eventually, the visual alteration from optic neuritis prompted a repeat evaluation, which disclosed lymphoma in bone marrow. The subject of paraneoplastic optic neuritis is reviewed.

Biopsy↗

A microangiopathic syndrome of encephalopathy, hearing loss, and retinal arteriolar occlusions.

A syndrome consisting of a subacute encephalopathy, sensorineural hearing loss, and retinal arteriolar occlusions is described in two women. Laboratory investigations did not reveal any systemic vasculitis. CT and cerebral angiography showed no abnormalities, but magnetic resonance imaging revealed small, discrete lesions in the white matter. Biopsy of cortical brain from one patient showed disseminated microinfarcts in the gray matter as well as sclerosis of small vessels. This syndrome is characterized as an occlusive vasculopathy rather than vasculitis, and should be considered in evaluations of young women presenting with encephalopathy and hearing loss.

Adult↗

[Unilateral papilledema in pseudotumor cerebri].

The appearance of unilateral papilledema in the fundus photos of 6 women with pseudotumor cerebri is presented. Associated findings included obesity in 5 and a partially empty sella in 2. The possible explanations for the development of unilateral papilledema in pseudotumor cerebri are reviewed and favor a mechanism that is present at the distal end of the optic nerves.

Adult↗

[Retinal periphlebitis in multiple sclerosis. Report of a case].

Sheathing of peripheral retinal veins occurs in 10 to 20% of patients with multiple sclerosis and can be seen at any point in the progression of the disease. This finding may represent the retinal correlate of the vascular lesions that are present in the central nervous system of patients with multiple sclerosis. Its pathogenesis is still uncertain. In this paper it is registered the occurrence of retinal periphlebitis as one of the initial manifestations of a patient with multiple sclerosis and it is discussed the diagnostic implications of this finding.

Adolescent↗

Cryptic disseminated tuberculosis presenting as gaze palsy.

We present a case of gaze palsy caused by a pontine tuberculoma associated with cryptic disseminated tuberculosis. The only symptoms in this patient were those caused by her gaze abnormality despite the presence of disseminated tuberculosis that was later confirmed at autopsy.

Brain Diseases↗

Chronic ophthalmic Wegener's granulomatosis.

A case of Wegener's granulomatosis is reported which manifested episcleritis followed by scleritis, and followed in turn by separate episodes of right and left orbital pseudotumor spanning 15 years prior to respiratory tract disease. The unusually protracted progression of symptoms in this case may be explained on the basis of the histopathological findings. Areas of fibrinoid necrosis of connective tissue occurred alone or alternated with areas of nongranulomatous fibrinoid necrosis of blood vessel walls. Granulomatours vasculitis was not observed. This histopathological picture is pathognomic of early cases of Wegener's granulomatosis which run especially protracted courses.

Biopsy↗

Juxtapapillary subretinal hemorrhages in pseudotumor cerebri.

We report two cases of pseudotumor cerebri with subretinal hemorrhages. Bilateral juxtapapillary subretinal neovascular membranes were present in one. A unilateral hemorrhage occurred adjacent to a small anomalous optic disc in the other. Subretinal hemorrhages in papilledema may occur from juxtapapillary subretinal neovascular membranes that evolve rapidly and then involute. The relationship of the appearance and subsequent evolution of such juxtapapillary subretinal neovascular membranes to the course of the intracranial pressure is discussed. Occurrence in one eye may presage occurrence in the other eye, making control of intracranial pressure important once one eye is afflicted. Fortunately, severe permanent visual loss remains unreported. Some anomalous small optic discs may be particularly at risk for subretinal hemorrhage from papilledema because preexisting axonal crowding is aggravated by the swelling of the optic nerve from elevated intracranial pressure. Conditions related to the Valsalva maneuver that chronically or intermittently elevate intracranial pressure further and produce elevated cephalic venous pressure should be avoided.

Adult↗