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    Análise da reoperação na recidiva do glioblastoma em um serviço público no Brasil
    (Universidade Federal de São Paulo (UNIFESP), 2015-09-30) Zanovello, Willey Goncalves [UNIFESP]; Paiva Neto, Manoel Antonio de Paiva Neto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Glioblastoma (GBM) recurrence in patients treated with surgery, radiotherapy and chemotherapy is practically universal. Recently, several studies showed an increase in overall survival in patients undergoing reoperation for recurrent GBM. Objectives: The primary objective of the study was to analyze patients with recurrent GBM who underwent reoperation in a public Institution in Brazil and describe the epidemiological, clinical and survival characteristics of the patients. As a secondary objective, we tried to assess which patients would benefit from reoperations after recurrence. Materials/Methods: We retrospectively analyzed 39 patients who underwent reoperation for recurrent GBM (GIV WHO) in the Neurosurgery Department of the Hospital São Paulo, Federal University of São Paulo from January 2000 to December 2014. Data were collected from medical records and from the Neuro-oncology database. Results: The median age was 49 years (range of 20-69 years), with 21 males (54%). The initial symptom was headache in 59% of patients. The median functional performance index measured by the Karnofsky scale (KPS) at presentation was 80. Sixteen patients (41%) underwent re-operation before starting adjuvant treatment. In 29 patients (74%), there was a delay of radiotherapy (> 6 weeks). The median overall survival was 20 months (95% CI 14.9 ? 25.2) and survival after reoperation was 9.1 months (95% CI 2.8 ? 15.4). The only factor associated with overall survival in a multivariate analysis was adjuvant therapy after first surgery (HR 0.3 95% CI 0.2 ? 0.7; p: 0.005). Conclusion: Survival of patients with recurrent GBM undergoing reoperation in a public Institution in Brazil was similar to the literature. Reoperation should be considered as a treatment option in selected patients.
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    Retrocollis, anterocollis or head tremor may predict the spreading of dystonic movements in primary cervical dystonia
    (Academia Brasileira de Neurologia - ABNEURO, 2009-06-01) Godeiro-Junior, Clecio [UNIFESP]; Felício, André Carvalho [UNIFESP]; Aguiar, Patrícia Maria de Carvalho [UNIFESP]; Borges, Vanderci [UNIFESP]; Silva, Sonia Maria Azevedo [UNIFESP]; Ferraz, Henrique Ballalai [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND AND PURPOSE: Few studies have attempted to develop clinical predictors for cervical dystonia (CD) aiming at progression of the dystonic movement. METHOD: We retrospectively evaluated 73 patients with primary CD who underwent treatment with Botulinum toxin type-A (BTX-A). The patients were assembled in two groups according to the spread of dystonia during follow-up: spreading and non-spreading CD. We performed a binary logistic regression model using spreading of cervical dystonia as dependent variable aiming to find covariates which increase the risk of spreading. RESULTS: Our logistic regression model found the following covariates and their respective risk ratios: time of disease >18.5 months=2.4, retrocollis=1.9, anterocollis=1.8, head tremor=1.6. CONCLUSION: Time of disease >18.5 months, retrocollis, anterocollis and head tremor may predict spreading of dystonic movement to other regions of the body in CD patients.