Hipopituitarismo e síndrome amenorreia-galactorreia causados por trombose de aneurisma carotídeo e da artéria carótida no pescoço: relato de caso

Giant intra and parasellar aneurysm with a spontaneous thrombosis of internal carotid artery is rare. We report the case of a 34 years old woman presenting a unique giant sellar and parasellar aneurysm associated with hypopituitarism and amenorrhea-galactorrhea syndrome. Computed tomographic scans and magnetic resonance images were suggestive of a sellar tumor with a cystic component. Digital cerebral angiography showed spontaneous thrombosis of a intrasellar and parasellar carotid artery aneurysm and left internal carotid artery in the neck. A transseptal endoscopic biopsy was done and confirmed a thrombosed aneurysm. No other surgical treatment was required in this patient but permanent endocrinological treatment was necessary.Aneurismas selares e paraselares gigantes com trombose da artéria carótida cervical e intracraniana são raros. Apresentamos o caso de mulher de 34 anos apresentando hipopituitarismo e síndrome amenorréia-galactorréia. A tomografia computadorizada craniana e a ressonância magnética foram sugestivas de tumor selar com componente cístico. Angiografia digital cerebral mostrou aneurisma único gigante selar e parasselar e trombose completa da artéria carótida comum esquerda no pescoço. A biopsia transeptal endoscópica da lesão mostrou tratar-se de aneurisma carotídeo trombosado. Não foi realizado nenhum outro tratamento cirúrgico na paciente, mas apenas tratamento endocrinológico de reposição.Fortaleza General Hospital Department of NeuroendocrinologyUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Federal University of Ceará Department of AnesthesiologyFortaleza General Hospital Department of Neck and Head SurgeryUNIFESP, EPMSciEL

Transnasal endoscopic surgery of the sellar region: study of the first 100 cases

An endoscopic endonasal transsphenoidal approach to the sella was performed in 100 consecutive patients, with a follow up from 3 to 55 months: 57 females and 43 males, age ranging from 14 and 70 years. 76 cases pituitary adenomas: 22 were acromegaly (7 microadenomas and 15 macroadenomas); 21 null cell adenomas (3 microadenomas and 18 macroadenomas); 19 Cushing disease (11 microadenomas and 8 macroadenomas), 10 prolactinomas (6 microadenomas and 4 macroadenomas), and 4 LH adenomas (4 macroadenomas). In this serie, remission was achieved in 44.8% for macroadenomas, 60% for acromegaly, 27.7% for null cell adenoma, 50% for Cushing disease, 50% for prolactinomas and 50% for LH adenomas, and 81.4% for microadenomas 85% for acromegaly, 100% for null cell adenoma, 81.8% for Cushing disease, 66% for prolactinoma. We had also four craniopharyngiomas, four sphenoidal mucocele, three sphenoidal aspergillus, one Rathke cyst, one hypophysitis, one cavernous aneurysm, one encefalocele, one intrasellar meningioma, one intrasellar tuberculoma and a sphenoid fibrous dysplasia. In this series we also had six fistulas of the anterior base that were completely cured. We had a mortality of 2, one null cell giant adenoma in a 57 years old man and another patient, 38 years old, with a giant craniopharyngioma. The morbidity was: two cured meningitis, three cured fistulas, and two permanent diabetes insipidus. Endoscopic endonasal transsphenoidal surgery in this series resulted with comparable surgical outcomes to conventional microscopic transsphenoidal surgery. The advantages of this technique have been represented by an easier access to the lesion, better visualisation and increased illumination of the surgical sites, microdissection of the tumor with maximum preservation of the pituitary function, and reduction of hospitalization times and coasts. The main limits have been the reduction of field depth, constant need of manual control of the endoscope, and required experience of the endoscope technique.A abordagem neuroendoscópica transnasal para a sela túrcica foi realizada em 100 pacientes consecutivos com um seguimento variando entre 3 e 55 meses: 57 mulheres e 43 homens, com idade compreendida entre 14 e 70 anos; 76 eram adenomas hipofisários: 22 acromegálicos (7 microadenomas e 15 macroadenomas), 21 adenomas não secretores (3 microadenomas e 18 macroadenomas), 19 doença de Cushing (11 microadenomas e 8 macroadenomas), 10 prolactinomas (6 microadenomas e 4 macroadenomas), 4 adenomas secretor de LH (4 macroadenomas). A remissão da sintomatologia foi conseguida em 44,8% para os macroadenomas (60% para acromegalia, 27,7% para os adenomas não secretores, 50% para os pacientes com doença de Cushing, 50% para os prolactinomas, e 50% para os adenomas secretantes de LH), e 81,4% para os microadenomas (85% para acromegalia, 100% para os adenomas não secretores, 81,8% para os pacientes com doença de Cushing, e 66% para os prolactinomas). Na série tivemos ainda quatro craniofaringeomas, quatro mucoceles esfenoidal, três aspergilose esfenoidal, e um caso de cada uma das patologias seguintes: cisto de Rathke, hipofisíte, aneurisma da carótida cavernosa, encefalocele, meningeoma intraselar, tuberculoma intra-selar e displasia fibrosa esfenoidal. Na série encontramos ainda seis fístulas liquóricas que foram todas fechadas através dessa via. A mortalidade foi de 2%, um paciente de 57 anos com um adenoma gigante não produtor e um outro paciente de 38 anos com um volumoso craniofaringeoma predominantemente cístico. Como complicações tivemos duas meningites pós-operatórias curadas com antibioticoterapia e três fístulas pós-cirúrgica que foram reoperadas. Dois pacientes desenvolveram diabetes insípidus permanente. As vantagens desta técnica são representadas por um acesso mais fácil, melhor iluminação e visualização da lesão, mais fácil distinção entre tumor e hipófise normal, redução do tempo de hospitalização e dos custos hospitalares. As desvantagens são a diminuição da profundidade de campo, a necessidade de constante controle do endoscópio e a necessidade de maior experiência com as técnicas de endoscopia.Hospital Geral de FortalezaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicínaUniversidade Federal de São Paulo (UNIFESP) Hospital das Clinicas Faculdade de MedicinaUNIFESP, Escola Paulista de MedicínaUNIFESP, Hospital das Clinicas Faculdade de MedicinaSciEL

A Spline-Based Partial Element Equivalent Circuit Method for Electrostatics

This contribution investigates the connection between Isogeometric Analysis (IgA) and the Partial Element Equivalent Circuit (PEEC) method for electrostatic problems. We demonstrate that using the spline-based geometry concepts from IgA allows for extracting circuit elements without an explicit meshing step. Moreover, the proposed IgA-PEEC method converges for complex geometries up to three times faster than the conventional PEEC approach and, in turn, it requires a significantly lower number of degrees of freedom to solve a problem with comparable accuracy. The resulting method is closely related to the isogeometric boundary element method. However, it uses lowest-order basis functions to allow for straightforward physical and circuit interpretations. The findings are validated by an analytical example with complex geometry, i.e., significant curvature, and by a realistic model of a surge arrester

Putting Security on the Table: The Digitalisation of Security Tabletop Games and its Challenging Aftertaste

IT-Security Tabletop Games for developers have been available in analog format; with the COVID-19 pandemic, interest in collaborative remote security games has increased. In this paper, we propose a methodology to evaluate the impact of a (remote) security game-based intervention on developers. The study design consists of the respective intervention, three questionnaires, and a small open interview guide for a focus group. A validated self-efficacy scale is used as a proxy for measuring effects on participants' ability to develop secure software. We tested this design with 9 participants (expert and novice developers and security experts) as part of a small feasibility study to understand the challenges and limitations of remote tabletop games. We describe how we selected and digitalised three security tabletop games, and report the qualitative findings from our evaluation. Setting up and running the virtual tabletop games turned out to be more challenging and complex for both moderator and participants than we expected. Completing the games required patience and persistence, and social interaction was limited. Our findings can be helpful in building and evaluating a better, more comprehensive, technically sound and issue-specific game-based training measure for developers. The methodology can be used by researchers to evaluate existing and new game designs

Relação entre pressão intra-selar e volume de tumor de hipófise

OBJECTIVE: To determine if there was a relationship between intrassellar pressure (ISP) and pituitary tumor volume. METHOD: Between August 2002 and May 2004, 60 patients aged between 13 and 75 years old (39 males), having a pituitary adenoma were submitted to an endoscope transseptal approach. During the surgery and before tumor resection, 2 mm of the sella s floor were removed and a 1.5 mm dural opening made to place a transducer into the pituitary adenoma. The transducer was connected to a pressure monitor. RESULTS: The intrasellar pressure, ranged from 2-51 mmHg and was measured based on the classification of Hardy-Vezina. The most elevated was in the type II macro adenomas with 32.6 mmHg, sharply superior to the value of a normal intracranial pressure. CONCLUSION: These values showed that the macroadenomas confined to the sella, without destruction of the floor and integrity of the diaphragm, type II of Hardy-Vezina, presented a value of ISP much higher than intra-extrasellar macroadenoma s.OBJETIVO: Determinar se existia uma relação entre a pressão intraselar (ISP) e o volume de tumor de hipófise. MÉTODO: Entre agosto de 2002 e maio de 2004, 60 pacientes com idades variando entre 13 e 75 anos (39 homens), portadores de adenoma hipofisários foram operados por via transesfenoidal. Durante o ato cirúrgico e antes da resseção do tumor, uma osteotomia de 2 mm foi realizada no assoalho selar e uma abertura de 1,5 mm na duramater para a introdução de um transdutor dentro do tumor. O transdutor foi conectado a um monitor de pressão e esta foi medida por 2 minutos. RESULTADOS: A pressão intra-selar variou entre 2-51 mmHg e a correlação entre tamanho do tumor e ISP foi baseada na classificação de Hardy-Vezina. A média da ISP mais elevada foi encontrada nos macroadenomas tipo II com 32,6 mmHg, nitidamente superior a pressão intra selar normal. CONCLUSÃO: Estes valores mostram que os macroadenomas confinados a sela sem destruição do assoalho selar e com integridade do diafragma, classificados como tipo II de Hardy-Vezina, apresentam uma ISP muito superior aos outros adenomas.Hospital of Fortaleza Neurosurgery Department GeneralFederal University of São Paulo Neurosurgery ServiceFederal University of CearáUNIFESP, Neurosurgery ServiceSciEL

Experimental confirmation that inbreeding depression increases extinction risk in butterfly populations.

Laboratory and field studies on Melitaea cinxia in southwestern Finland showed a significant difference in the performance of experimental inbred and crossbred populations, which supports previous observational results on inbreeding-related extinctions in this species

Pendent polymers of 1-methyl-2-oxo-4,5-dicyanoimidazole and their electrochemical properties

The electron accepting 1-methyl-4,5-dicyanoimidazole group was attached to vinyl polymers, via an alkoxy link, by nucleophilic aromatic substitution (NAS) of 1-methyl-2-fluoro-4,5-dicyanoimidazole ( 1 ) with poly(vinyl alcohol), or conventional polymerizations of vinyl monomers containing 1-methyl-2-oxo-4,5-dicyanoimidazole. The cyclic voltammetry (CV) studies show that monomeric and oligomeric model compounds are electrochemically quasi-reversible and the degree of reversibility decreases as dicyanoimidazoles become more proximate within a molecule. On the other hand, the polymers show much less reversible reduction waves at −2.6∼−2.7 V vs Ag/Ag + , suggesting that there are chemical reactions among the pendent groups reduced at relatively high potential. © 2000 John Wiley & Sons, Inc. J Polym Sci A: Polym Chem 38: 3828–3838, 2000Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34999/1/140_ftp.pd

Abscessos cerebrais múltiplos após apendicectomia: relato de caso

Paciente masculino de 39 anos, com quadro de abdomen agudo de evolução de 72 horas, foi submetido a apendicectomia. Desenvolveu 14 dias após, quadro de cefaléia, vômitos, afasia, torpor, hemiplegia à direita e rigidez de nuca. A tomografia computadorizada craniana mostrou múltiplos abscessos cerebrais supra tentoriais bilateralmente. Após punção aspirativa do maior deles foi instituída antibióticoterapia resultando em cura do paciente.A 39 years old male patient with a 72 hours evolution of acute abdominal syndrome was submitted to appendicectomy. Fourteen days later he developed headache, vomiting, aphasia, torpor, nuchal stiffness and right hemiplegia. A CT-scan showed multiple brain abscesses on both hemispheres. After aspirative puncture of the largest one, antibiotic treatment was established with total recovery of the patient