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Schistosomal myeloradiculopathy due to Schistosoma mansoni: report on 23 cases
Nobre, Vandack;Silva, Luciana CS;Ribas, Jo?o G;Rayes, Abdunnabi;Serufo, JC;Lana-Peixoto, MA;Marinho, Rosana FZ;Lambertucci, JR;
Memórias do Instituto Oswaldo Cruz , 2001, DOI: 10.1590/S0074-02762001000900020
Abstract: schistosoma mansoni infection is likely to be responsible for a significant proportion of cases of myelopathy occurring in areas where schistosomiasis is endemic. the aim of this study is to describe the clinical, laboratory and therapeutic data of 23 patients with schistosomal myeloradiculopathy. the medical records of 23 patients with schistosomal myelopathy admitted to two general hospitals of belo horizonte (mg), in brazil, from 1995 to 1999, were reviewed retrospectively. seventeen patients were male (74%). the mean age for the whole group was 27 years. lower limb weakness and associated lumbar and/or lower limb pain were reported by 20 patients (87%), and 16 (70%) were unable to walk. all individuals presented urinary retention and 19 (83%) complained of intestinal dysfunction. the treatment was based on the association of antischistosomal drugs and corticosteroids. five patients (22%) presented a full response to treatment, 13 (57%) partial response without functional limitations and 4 (17%) partial improvement with limitations or no response. three out of the 4 patients who stopped steroids before 45 days of treatment developed recurrence of the symptoms and signs of myelopathy. our cases demonstrate the severe presentation of the disease and the data disclosed here suggest that treatment with steroids should be kept for months after clinical improvement.
Neuro-oftalmologia: Sistema sensorial - parte I revis?o 1997-1999
Lana-Peixoto, Marco Aurélio;
Arquivos Brasileiros de Oftalmologia , 2002, DOI: 10.1590/S0004-27492002000100024
Abstract: this is the first part of a review of papers on the visual afferent system published from 1997 to 1999. in this part the author presents the most important contributions made in areas such as neuro-ophthalmic tests, optic nerve anatomy, nonarteritic anterior ischemic optic neuropathy (epidemiology, etiopathogenesis, clinical features, treatment and prophylaxis), arteritic anterior ischemic optic neuropathy, posterior ischemic optic neuropathy, carotid artery disease, demyelinating optic neuritis, relationship between optic neuritis and multiple sclerosis, optic neuromyelitis, autoimmune optic neuritis and infectious optic neuritis. selected papers are considered in relation to their results and previously established concepts.
Neuro-Oftalmologia: sistema sensorial -- Parte II Revis?o 1997 -- 1999
Lana-Peixoto, Marco Aurélio;
Arquivos Brasileiros de Oftalmologia , 2002, DOI: 10.1590/S0004-27492002000200020
Abstract: this is the second part of a review of papers on the visual afferent system published from 1997 to 1999. in this part the author presents the most important contributions made to areas such as neuroretinitis, optic nerve tumors, idiopathic intracranial hypertension, hereditary optic neuropathies, optic disc drusen, optic nerve hypoplasia, traumatic and toxic optic neuropathy as well as geniculate and retrogeniculate visual disorders. selected papers are considered in relation to their results and previously established concepts.
Devic’s neuromyelitis optica: a critical review
Lana-Peixoto, Marco Aurélio;
Arquivos de Neuro-Psiquiatria , 2008, DOI: 10.1590/S0004-282X2008000100034
Abstract: devic's neuromyelitis optica (nmo) is an idiopathic inflammatory demyelinating and necrotizing disease characterized by predominant involvement of the optic nerves and spinal cord. in asian countries relapsing nmo has been known as opticospinal multiple sclerosis. it has long been debated if nmo is a variant of multiple sclerosis (ms) or a distinct disease. recent studies have shown that nmo has more frequently a relapsing course, and results from attack to aquaporin-4 which is the dominant water channel in the central nervous system, located in foot processes of the astrocytes. distinctive pathological features of nmo include perivascular deposition of igg and complement in the perivascular space, granulocyte and eosinophil infiltrates and hyalinization of the vascular walls. these features distinguish nmo from other demyelinating diseases such as ms and acute demyelinating encephalomyelopathy. an igg-antibody that binds to aquaporin-4, named nmo-igg has high sensitivity and specificity. magnetic resonance imaging (mri) studies have revealed that more frequently there is a long spinal cord lesion that extends through three or more vertebral segments in length. brain mri lesions atypical for ms are found in the majority of cases. treatment in the acute phase includes intravenous steroids and plasma exchange therapy. immunosupressive agents are recommended for prophylaxis of relapses.
A forma arterítica da neuropatia óptica isquêmica anterior: estudo de 25 casos
Lana-Peixoto, Marco Aurélio;
Arquivos de Neuro-Psiquiatria , 1994, DOI: 10.1590/S0004-282X1994000300010
Abstract: the clinical, laboratorial,perimetric and fluorescein angiographic features of the arteritic type of the anterior ischemic optic neuropathy (a-aion) was studied in 25 patients (40 eyes) in order to characterize the profile of the disease and to allow the differential diagnosis with the non-arteritic anterior ischemic optic neuropathy (na-aion) and other disorders of the optic nerve. the a-aion occurred in patients 60 to 88 years old (mean 74 years) and was highly predominant in females (64 per cent). fifteen patients had both eyes involved , either simultaneously or usually within few days or weeks after the initial involvement. headache and eye pain were the most commonly observed prodromic complaints whereas systemic symptoms of giant cell arteritis (gca) were seen in all patients. the laboratorial abnormalities most commonly found were high values of reactive c protein, plasmatic fibrinogen and erythrocyte sedimentation rate. in the great majority of the patients visual acuity was severely affected. the optic disc was always abnormal, usually showing a pale edema. in addition to that retinal changes were commonly found. goldmann perimetry disclosed a wide variety of visual fields abnormalities, the most common of them being inferior altitudinal defects. fluorescein fundus angiography revealed delayed or absent disc fluorescence, or sectorial or diffuse hypofluorescence or hyperfluorescence of the optic disc. choroidal filling delay was the most characteristic and frequent angiographic finding in the arterite type of the disease.
A residência médica e o título de especialista em neurologia
Lana-Peixoto, Marco Aurélio;
Arquivos de Neuro-Psiquiatria , 1989, DOI: 10.1590/S0004-282X1989000400022
Abstract: medical residency is the most appropriate form of post-graduate training in the various areas of medicine. during residency young doctors have close contact with teachers at the bebside approach and management of a wide variety of situations in the actual practice of the profession. it is in this period that basic technical skills and methods of learning through medical observation and scientific discussions develop and the comprehension and sympathy toward suffering disease imposes upon man deepen. the medical societies have the ultimate responsibility to qualify residency programs in the various specialties, as well as to establish the standards of qualification doctors must fulfill to be eligible for certification. continued government intervention on these issues in the last years in brazil have brought catastrophic consequences for the medical education in this country. the brazilian academy of neurology must expand its educational programs and define the standards of competence for a neurologist. at the time brazil returns to democratic life it is challenging for the medical profession to resume their right in relation to qualification of their own members.
O neurologista e a literatura médica: o processo de educa??o interminável
Lana-Peixoto, Marco Aurélio;
Arquivos de Neuro-Psiquiatria , 1992, DOI: 10.1590/S0004-282X1992000200023
Abstract: to keep up to date with new advances in medical care and in the understanding of the disease process which affects their specific patients neurologists need to develop strategies for continuing education. they must be learners throughout their careers and the learning must be self-directed, active and independent. the best way to reach this goal is to devote regular time to the medical literature. however as the great volume of journal literature precludes clinicians from reading all of it, special tactics of scanning, selecting and reading medical articles are necessary. priority should be given to original reports, meaning firsthand accounts of planned investigations, as they go through expert critical review before publication. this safeguard improves their clarity and usually keeps flawed research away. furthermore one should read only original articles that have direct bearing on his ows clinical practice and with scientific rigor making the results likely to be true. employment of these rules may reduce the relevant literature to an affordable size. extraction of these articles depend on the regular surveillance of high-yield, high-circulation general medical journals and the specialty and subspecialty journals which are relevant to one's practice. review articles may be helpful either as an initial approach to a subject whose current knowledge is beyond one's usual domain or as a source of references of original articles. meta-analysis or the integration and statistical combination of the results of previous research may be a further and a most important advantage of reviews.
A Forma??o do neurologista para o século XXI
Lana-Peixoto, Marco Aurélio;
Arquivos de Neuro-Psiquiatria , 1993, DOI: 10.1590/S0004-282X1993000300023
Abstract: the training of neurologists for the practice in the coming years requires deep changes in the system of medical education. it is critical for the medical student and the resident the acquisition of a broad knowledge of scientific information. but physicians must also know how to use knowledge they have accumulated from a variety of sources. they express their knowledge through abilities in the wards or in ambulatory settings in order to get an accurate diagnosis and the proper management of a particular condition. in addition to that they are expected to develop ethical attitudes toward their patients, peers and the greater society. they must be committed to work, to independent learning and to rationality. to accomplish its scholarly goals medical education has to emphasize the development of adequate personal attributes, skills and habits of mind rather than the transmission of factual information. with todiay's technology all the scientific information necessary for the practice of medicine is at the fingertips through computers. memorization is therefore an absolute nonsense in teaching. a better education involves reducing the working load and the number of lecture hours providing students and residents with sufficient unscheduled time to seek out information independently and to assess their own learning. problem-solving methods of teaching providing the formulation of multiple concurrent hypotheses, the critical analysis and evaluation of data and the application of new acquired knowledge as well as previously learned concepts to the solution of problems should be widely employed. faculty members are guides who assist students and residents to develop analytical and critical skills. they play an important role as models through their own attitudes and actions. the humanistic dimensions of the medical profession cannot be overemphasized.
Multiple sclerosis and positive lyme serology
Lana-Peixoto, Marco Aurélio;
Arquivos de Neuro-Psiquiatria , 1994, DOI: 10.1590/S0004-282X1994000400019
Abstract: as lyme neuroborreliosis (lnb) may clinically mimick multiple sclerosis (ms) the presence of antibodies to borrelia burgdorferi in serum of patients with a ms-like disease in non-edemic areas for lyme disease may be troublesome. we report the case of a 45-year-old white female with the diagnosis of relapsing/ remitting form of ms due to a 15-year history of optic neuritis and recurrent episodes of motor and sensation disturbance in the upper right limb and in both lower extremites associated with bladder dysfunction. a magnetic resonance imaging of the brain revealed multiple high intensity periventricular white matter lesions. the patient had been exposed to ticks but did not recall the presence of erythema migrans. elisa for lyme disease was positive in two different laboratories and the positive serology was confirmed by western blotting. no convincing reponse followed treatment with ceftriaxone. although it is clear that the patient had been infect by borrelia burgdorferi the relationship of this spirochetal infection with the neurological disease could not be ascertained.
O papel da academia brasileira de neurologia no ensino da neurologia uma vis?o pessoal
Lana-Peixoto, Marco Aurélio;
Arquivos de Neuro-Psiquiatria , 1991, DOI: 10.1590/S0004-282X1991000400020
Abstract: the brazilian academy of neurology (abn) may play an important role for a better education of medical students and residents in neurology in brazil. its field of action ranges from suggesting a core curriculum in neurology to medical schools and residency programs to assess the quality of teaching they offer in order to guide students and graduates who apply for positions. in addition to that abn may be itself a teaching institution offering educational activities in a program of continuing medical education with a well-designed system of credits. courses on basic sciences, methods of diagnosis and therapeutic advances, symposia and workshops as well as a programmed teaching in neurology suitable to residents and practioners are to be included. a video collection and a bank of data on the current literature may widen the available! set of services. the abn commitee on teaching is to play a central role defining policy, deciding on priorities, planning and establishing timing and placing of all educational activities. of utmost importance is to define humanistic qualities desirable in the neurologist identifying qualities students and residents bring to the educational process and those acquired in the practice of neurology. the cognitive dimensions of moral and ethics can be taught and should be regularly included in the educational activities sponsored by the academy.
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