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R D Lobato

Publications and source records attributed to R D Lobato.

At least 37 records · Page 2Linked to original sources
PubMed2004

[Lasegue's test as prognostic factor for patients undergoing lumbar disc surgery].

INTRODUCTION: In patients operated for herniated lumbar disc it could be very useful to develop physical examination criteria that would allow early prediction of medium or long term clinical outcomes. The result of the Lasegue test after surgery depends on the occurrence of recurrent herniated disc and/or scar formation around the nerve root. Previous studies have shown the association between the result of Lasegue test, assessed 4 months after surgery, and the short term functional outcome. OBJECTIVE: To determine the prognostic value of postoperative Lasegue test in relation with medium term functional and clinical outcomes which were estimated by analyzing the functional grade, employment status, quality of life, reoperation for recurrent disc herniation, and the number of clinical revisions and imaging studies needed during the follow-up. PATIENTS AND METHODS: 243 patients who underwent hemilaminectomy for lumbar herniated disc between 1996 and 2002 were studied. The Lasegue sign was tested 3 months after surgery. A modification of Spangfort's criteria (to measure the functional grade) and the 12-item Short-form health survey (SF-12) method (to measure the quality of life) were used to quantify outcomes at 12, 24 and 36 months after initial surgery. RESULTS: This investigation has proved the prognostic value of Lasegue test assessed 3 months after initial surgery. A statistically significant correlation was found between a positive straight leg raising test and a poor functional status at 24 and 36 months, and the risk do not return to work because of persistent pain at 12, 24 and 36 months. A statistically significant correlation was also found between the result of the test and the frequency of reoperation for recurrent disc herniation and the number of clinical revisions and imaging control studies needed through the follow-up. Likewise, the prognostic value of Lasegue test on different aspects of quality of life (health perception, functional performances, poor social interaction and severe pain) analyzed at 24 and 36 months after surgery were also confirmed. CONCLUSION: This study provides additional information about the predictive value of the straight leg raising tested 3 months after surgery on the clinical (diagnostic resources consumption, successive outpatient revisions, etc) and functional (quality of life, functional grade and return to work) outcomes assessed 24 and 36 months after initial surgery.

Adult↗
PubMed2004

[Silent corticotroph adenomas: presentation of two cases that presented with pituitary apoplexy].

Among the group of pituitary adenomas surgically treated, about 25-30% are not associated with clinical or analytical findings of hormonal hypersecretion. The development of immunohistochemical techniques has allowed the demonstration of a subgroup of adenomas that show immunoreactivity against several hormones among the group of, apparently, non-functioning adenomas. This subgroup has been called silent adenomas. Silent adenomas positive for ACTH show a singular clinical picture and different from those adenomas producing Cushing's disease, as they present more frequently as macroadenomas, with more frequent pituitary apoplexy, invasion of cavernous or sphenoidal sinus and recurrences. We present two new cases of silent corticotroph adenomas in two female patients that presented with pituitary apoplexy, one of them after giving birth after a normal full-term pregnancy. Both of them presented with macroadenomas that invaded the sphenoidal and cavernous sinus. Although both tumors were immunoreactive for ACTH, none of the patients presented clinical or analytical findings compatible with Cushing's disease.

Adenoma↗
PubMed2004

[Postraumatic subdural collections: case report and review of the literature].

Posttraumatic and postcraniectomy subdural fluid collections have been usually described with the general term of hygroma. Recently, different clinical entities have been described, such as simple or complex hygroma, subdural effusion or external hydrocephalus, based on the mechanisms of formation of the fluid collection, its biochemical composition or the characteristics exhibited in modern imaging studies. However, there is no agreement in the literature regarding the use of these terms. We report a new case of a mixed posttraumatic and postcraniectomy subdural fluid collection and review the literature concerning these entities.

Brain Injuries↗
PubMed2004

Solitary fibrous tumor of the tentorium cerebelli. Case report.

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that has been recognized to occur almost all along the organism. Since its description in 1996 at the meninges, a total of 59 cases of meningeal SFT have been reported. Different authors have emphasized the difficulties in the differential diagnosis with other more frequent meningeal neoplasms such as meningioma or hemangiopericytoma, as the clinico-radiological characteristics of this lesion seem to be non specific and the morphological features on pathological study may resemble other spindle cell neoplasms. The diffuse and strong reactivity for CD34 and the negativity for EMA and S-100 are data allowing the diagnosis of SFT. We report the case of a 50-year-old woman suffering from headache, in whom MRI study showed a tentorial lesion initially thought to be a meningioma. In spite of morphological similarities with a fibrous meningioma, inmunohistochemical study finally led to the diagnosis of SFT. As occurred in previous cases, the findings in our patient reflect the similarities in clinico-radiological and pathological characteristics between meningeal SFT and other spindle cell meningeal neoplasms, mainly fibrous meningioma. When a clear diagnosis cannot be done based on typical findings on conventional hematoxylin-eosin study, inmunohistochemical study should be performed in meningeal spindle cell lesions to exclude SFT.

Cranial Fossa, Posterior↗
PubMed2004

[Delayed brain abscess as a complication of a CSF shunt].

INTRODUCTION: Infection is a common complication of ventriculoperitoneal shunts, but the formation of a brain abscess related to shunt system is very rare. We present the case of a patient who developed a brain abscess around a ventricular catheter left in place after removing the valvular system. CASE REPORT: This 38 years old woman, underwent ventriculoperitoneal shunting for hydrocephalus secondary to an acoustic neurinoma. During a period of thirteen years she suffered two episodes of meningitis, and after the second one the CSF shunt was removed excepting for the ventricular catheter which appeared to be adherent to the choroid plexus. One year later, a brain abscess arised around that catheter, and both the abscess and the catheter were removed (Proteus mirabilis was the cultured germ). DISCUSSION: In spite of the risks related to removal of a proximal catheter adherent to the choroid plexus, the risk linked to the removal of a ventricular catheter must be counterbalanced with the risk of infection.

Adult↗
PubMed2003

Posterior fossa subdural hematoma mimicking intracerebellar hemorrhage.

Subdural hematomas of the posterior fossa are very rare and most cases are related to head injury. The influence of anticoagulation in cases of spontaneous development is well known. Although diagnosis is easily achieved by CT sean, atypical forms may lead to the wrong diagnosis of cerebellar hematoma. We present a case of a posterior fossa acute subdural hematoma occurring in an anticoagulated patient who was preoperatively misdiagnosed as an intracerebellar hemorrhage.

Aged↗
PubMed2003

[The new residency program in neurological surgery in Spain].

A new Residency Program in Neurological Surgery has been recently elaborated by the "Comisión Nacional de Neurocirugía" following the requirement of the National Council of Specialities. This new Program, which will replace the one proposed in 1992, has been designed in a similar way as those applied in countries providing the best neurosurgical training. Changes included deal with the definition of the speciality, and the introduction of new rotations,a resident Log Book, a Tutor with a well defined profil and commitments, a structured planning of academic and clinical objectives, a rotation or training in research, and a planning for continuous evaluation of the progress of the resident. It is likely that an appropriate application of the new Program in Spanish neurosurgical units with accreditation for training will result in formation of highly competent neurosurgeons. However, there are new challenges for improving neurosurgical training and the development of our speciality in Spain, as those related with new legislation regulating resident working hours, or some political decisions changing the mechanisms for controlling the number of resident positions per year.

Curriculum↗
PubMed2002

Giant cell reparative granuloma of the occipital bone.

Giant cell reparative granuloma (GCRG) is a non-neoplastic fibrous lesion with unevenly distributed multinucleated giant cells, areas of osseous metaplasia and hemorrhage. The small bones of the hands and feet are the most common sites, followed by the vertebral bodies and craniofacial bones. In the craniofacial bones GCRG has been reported in the temporal bone, in the frontal bone and paranasal sinus. However, to the best of our knowledge no case has been reported in the occipital bone. We report on the imaging findings and pathological features of a GCRG of the occipital bone and discuss the differential diagnosis of this entity in this particular location, especially with giant cell tumor because of the therapeutic and prognostic implications.

Bone Diseases↗
PubMed2002

Intratumoural bleomycin as a treatment for recurrent cystic craniopharyngioma. Case report and review of the literature.

INTRODUCTION: The majority of craniopharyngioma (CF) have a cystic component and only 10% are completely solid. In tumors with a large cystic component, stereotactic drainage or instillation of radioctive and/or chemotherapeutic agents have been used. Only several authors have reported the use of bleomycin for the treatment of cystic CF. CASE REPORT: The authors present the case of a nineteen years old patient with a recurrent cystic CF who was treated with intratumoral injections of bleomycin. The patient had been operated on three times before because of regrowth of the tumor. This last time he had a severe disturbance of his visual acuity and a huge regrowth of the cystic CF. An intracystic catheter stereotactically placed was connected to an Ommaya reservoir and, after assuring the impermeability of the cyst, bleomycin was administered through the reservoir up to a total dose of 45mg distributed in six doses. No complications were detected during and after the procedure. A MR performed 4 months after treatment showed a clear reduction in the size of the cyst but 10 months later a new regrowth of the cyst was detected by MR with no new signs or symptoms. A total dose of 30 mg divided in six doses was administered. No complications occurred. The MR 18 months after the first treatment showed the reduction in size of the tumor. The ophtalmological study showed almost normal visual acuity in both eyes. DISCUSSION: Although there is not an stablished protocol for the indication and the form of application of intracystic bleomycin, results with this treatment for cystic CF seem good in the literature. However, the risk of local complications after the administration of intratumoural bleomycin in these patients is around 10%, and some fatal toxic reactions have been recently reported. CONCLUSION: Intracystic administration of bleomycin is a valid option as adjuvant therapy for CF in patients with recurrences that are not surgical candidates because of the high risk of complications. The role of bleomycin as a primary treatment for CF and treatment protocols remain to be stablished with additional studies.

Adult↗
PubMed2002

[Arteriovenous malformation of the middle and posterior third section of the corpus callosum treated with embolization and surgery].

We are presenting the case of a 58 year-old woman with an arteriovenous malformation (AVM) of the middle and posterior thirds of the corpus callosum which had produced two episodes of bleeding before admission to our Department, when the patient was neurologically intact. The nidus was fed by the anterior and posterior pericallosal arteries draining through the left medial atrial vein to the vein of Galen, by parasagittal cortical veins to the superior sagittal sinus and by right temporal veins to the sphenoparietal sinus. The patient underwent embolization of the anterior and posterior feeders in two sessions separated by a week interval, and then the AVM was removed through a left paramedial parietooccipital craniotomy in a single stage. The patient showed transient mild short term memory deficit, but the final outcome was excellent.

Agenesis of Corpus Callosum↗
PubMed2002

[First tier measures in the treatment of intracranial hypertension in the patient with severe craniocerebral trauma. Proposal and justification of a protocol].

The management of severe head injuries in general and that of high intracranial pressure (ICP) in particular are among the most challenging tasks in neurocritical care. One of the difficulties still faced by clinicians is that of reducing variability among centers when implementing management protocols. The purpose of this paper is to propose a standardized protocol for the management of high ICP after severe head injury, consistent with recently published clinical practice guidelines and other clinical evidence such as that provided by the systematic reviews of the Cochrane Collaboration. Despite significant advances in neuromonitoring, deeper insight into the physiopathology of severe brain trauma and the many therapeutic options available, standardized protocols are still lacking. Recently published guidelines provide sketchy recommendations without details on how and when to apply different therapies. Consequently, great variability exists in daily clinical practice even though different centers apply the same evidence-based recommendations. In this paper we suggest a structured protocol in which each step is justified and integrated into an overall strategy for the management of severe head injuries. The most recent data from both the preliminary and definitive results of randomized clinical trials as well as from other sources are discussed. The main goal of this article is to provide neurotraumatology intensive care units with a unified protocol that can be easily modified as new evidence becomes available. This will reduce variation among centers when applying the same therapeutic measures. This goal will facilitate comparisons in outcomes among different centers and will also enable the implementation of more consistent clinical practice in centers involved in multicenter clinical trials.

Adrenal Cortex Hormones↗
PubMed2002

[Idiopathic subarachnoid hemorrhage; comparison of different bleeding patterns and long-term outcome].

INTRODUCTION: Idiopathic subarachnoid haemorrhage (ISAH) represents approximately 15-30% of all subarachnoid haemorrhages. On the basis of the diagnostic CT and depending on the location of the subarachnoid bleeding, patients with ISAH may be classified into three groups: a) Patients with normal CT and diagnosis made by lumbar puncture (ISAHNCT); b) patients with a pure perimesencephalic pattern (ISAHPM) and c) patients with a bleeding pattern resembling that of aneurismatic rupture (ISAHA). This classification could permit the establishment of differences in the management and prognosis. OBJECTIVES: To describe the clinical and radiological characteristics of these three classes of patients and analyse their medium and long term outcome and moreover, compare these with those observed in patients suffering aneurysmal subarachnoid haemorrhage (ASAH). MATERIAL AND METHODS: A series of 122 patients consecutively admitted to Hospital 12 de Octubre Madrid between 1990 and 2000 with the diagnosis of ISAH were retrospectively reviewed. Patients were considered to have suffered ISAH when the first complete four vessel angiography did not show the presence of any aneurysm or vascular lesion responsible for the bleeding. Patients were classified depending on the pattern of bleeding into ISAHNCT, ISAHPM as described by Van Gijn et al., and ISAHA. The angiography study was repeated when: a) the first study was incomplete or had poor quality, b) vasospasm was present, c) in those patients who had an aneurysmal pattern of bleeding in the initial CT. Different clinical and radiological characteristics were recorded as well as complications that occurred during the hospital stay. Final outcome was evaluated by means of the Glasgow Outcome Score (GOS). With the purpose of comparing these clinical and radiological characteristics and the outcome of patients with ISAH with those suffering aneurysmal subarachnoid haemorrhage (ASAH), 294 patients diagnosed with ASAH during the same study period were also reviewed. RESULTS: 27% of patients admitted to our hospital with the diagnosis of non-traumatic subarachnoid hemorrhaged were diagnosed as ISAH. Of these, 41% presented with a ISAHA pattern, 39% ISAHPM and 20% ISAHNCT. The average age was similar in the different subgroups of SAH, being around 55 years. There was a greater frequency of male patients in the ISAHNCT and ISAHPM groups. In comparison with ASAH, ISAH characterises by patients presenting with less frequency a bad clinical grade and also loss of consciousness at stroke. There are fewer complications in patients with ISAH than ASAH, with a frequency of rebleeding and ischemia much less (5 and 6% respectively). Within the ISAH group, patients with ISAHA pattern of bleeding present more complications. Outcome is excellent for patients with ISAHNCT and ISAHPM, and rather worse for patients with ISAHA (median followup 5.8 years). CONCLUSIONS: This study confirms that the frequency of ISAH in our environment reaches the higher limit of that shown previously in the literature, replicating the results previously published by our group. Patients with ISAH have a better prognosis and a smaller risk of complications than patients with ASAH, the prognosis of patients with ISAHCTN and ISAHPM being particularly good. Patients with ISAHA present initially with a severe clinical situation, probably related to the bigger amount of bleeding, as well as a higher frequency of systemic complications, cerebral ischemia and hydrocephalus. However, if the absence of vascular lesions is confirmed, the long term prognosis is similar to that of the other subgroups of ISAH.

Aneurysm, Ruptured↗
PubMed2002

[Parasplenial arteriovenous malformations. Report of 15 surgically treated cases].

INTRODUCTION: Yasargil called paraesplenial those AVMs located at the confluence of the hippocampus, the isthmus of the cingulate girus and the girus occipitotemporalis medialis. Large AVMs at this location are among the most difficult to delineate and to treat. OBJECTIVE: Analyze the clinical presentation, the findings in the imaging studies, the surgical management and the final outcome in 15 patients with paraesplenial AVMs treated with embolization (the last 4 cases), and microsurgical removal. RESULTS: Nine patients (60%) were female and 6 males of ages between 15 and 39 years (mean = 24 yrs). Eleven (75%) presented with hemorrhage, (intraventricular in most cases) and the remaining with epilepsy. The Spetzler-Martin grade was II in one Case, III in 5 cases, IV in 8 cases and V in one case. Preoperative embolization clearly improved surgical management. All the patients had complete resection of the lesion, 13 in a single stage and 2 in two stages. The final outcome was good but four patients developed defects of the visual field not seen preoperatively. CONCLUSIONS: The authors comment the peculiarities of paraesplenial AVMs which can be safely and completely removed with microsurgery and the aid of preoperative embolization.

Adolescent↗
PubMed2001

Traumatic cervical central cord syndrome due to intramedullary hemorrhage studied with MRI: case presentation.

Cervical central cord syndrome is characterized by disproportionately greater motor impairment of the upper than the lower extremities, predominantly distal motor dysfunction, varying degrees of sensory abnormalities, and bladder dysfunction. Although the original description stated that intramedullary hemorrhage is a possible cause of traumatic cervical central cord syndrome, recent studies have not demonstrated its presence on the basis of magnetic resonance imaging (MRI) or pathological evidence. The authors describe and discuss a case of traumatic central cervical cord syndrome studied with MRI, which presented intramedullary hemorrhage. This supports hemorrhage as a possible cause of traumatic cervical central cord syndrome.

Aged↗
PubMed2001

Prognostic factors on hospital admission after spontaneous subarachnoid haemorrhage.

BACKGROUND AND OBJECTIVE: Factors related to prognosis after subarachnoid haemorrhage (SAH) have been mainly extracted from surgical series, and only few authors have considered these factors in total management or population series. Though the level of consciousness is a major determinant of outcome after subarachnoid haemorrhage, there is not a consensus about which classification should be used to define it. The objective of this study was twofold. Firstly to find which factors recorded on hospital admission relate to outcome determining their relative importance in a non-selected series of patients suffering from aneurysmal SAH admitted to our centre, and secondly to assess the validity of the WFNS clinical scale for predicting the final result. METHODS: A series of 294 patients consecutively admitted to Hospital 12 de Octubre Madrid between January 1990 and June 2000 with the diagnosis of aneurysmal SAH were retrospectively reviewed. All factors possibly related to prognosis were recorded on hospital admission. Outcome was measured by means of the Glasgow Outcome Scale measured one month after hospital discharge. Relationship between factors and outcome was evaluated by univariate and logistic regression multivariate analysis. RESULTS: Although several factors, appeared related to prognosis in the univariate analysis, only the age. the level of consciousness defined by the WFNS scale and the presence of global brain hypodensity on the initial CT scan had a significant prognostic influence in the logistic regression model. Global brain hypodensity was strongly related to mortality. Since a number of factors associated with poor outcome in the univariate analysis are related to age, their influence could be explained by the difficulty of recovery of the ageing brain. The WFNS grading scale failed to predict significant differences in outcome between some of its grades. CONCLUSIONS: Age and clinical grade on admission are the most important factors influencing the final outcome of patients suffering aneurysmal SAH. A reappraisal of the WFNS grading scale should be considered as no significant differences in outcome were found between some of its grades.

Adolescent↗
PubMed2001

Intracranial hemangiopericytoma: study of 12 cases.

Most hemangiopericytomas (HPCs) are located in the musculoskeletal system and the skin, while the intracranial location is rare. They represent 2 to 4% in large series of meningeal tumours, thus accounting for less than 1% of all intracranial tumours. Many authors have argued about the true origin of this tumour. The current World Health Organization classification of Central Nervous System tumours distinguishes HPC as an entity of its own, and classified it into the group of "mesenchymal, non-meningothelial tumours". Radical surgery is the treatment of choice, but must be completed with postoperative radiotherapy, which has proved to be the therapy most strongly related to the final prognosis. HPCs have a relentless tendency for local recurrence and metastases outside the central nervous system which can appear even many years after diagnosis and adequate treatment of the primary tumour. Twelve patients with intracranial HPC were treated at our Unit between 1978 and 1999. There were 10 women and 2 men. Ten tumours were supratentorial and most located at frontoparietal parasagittal level. The most common manner of presentation was a focal motor deficit. All tumours were hyperdense in the basal Computed Tomography scans and most enhanced homogeneously following intravenous contrast injection. In 50% of cases, tumour margins were irregular or lobulated. Seven tumours were studied with Magnetic Resonance Imaging, being six of them iso-intense with the cortical gray matter on T1-weighted and T2-weighted images. Twenty operations were performed in the 12 patients. In 10 cases radical excision could be achieved with no operative mortality. Total recurrence rate was 33.3%. Eight patients were treated with external radiotherapy at some time through the course of their disease. Eight out of the 12 patients in this series are disease-free (Glasgow Outcome Scale categories 1 and 2) after a mean follow up of 52 months.

Adolescent↗