Non-schwannomatosis lesions of the internal acoustic meatus-a diagnostic challenge and management: a series report of nine cases.

Vestibular schwannomas (VS) are the most common lesions of cerebellopontine angle (CPA) corresponding to 76-91 % of the cases. Usually, these lesions present typical CT and MRI findings. Non-schwannomatous tumors restricted to the internal auditory meatus (IAM) are rare and their preoperative radiological diagnosis may be difficult. This article describes nine surgically treated intrameatal non-schwannomatous lesions (NSL) and reviews the literature. In the last 16 years, a total of 471 patients with diagnosis of VS were operated on in our department. Preoperatively, 42 patients had diagnosis of intrameatal schwannomas, but surgery revealed in nine cases NSL (3 meningiomas, 3 arachnoiditis/neuritis, 1 cavernoma, 1 vascular loop, and 1 arachnoid cyst). Most frequent symptoms presented by patients with NSL were hearing loss 89 % (8/9) of patients, tinnitus 78 % (7/9), and vertigo 33 % (3/9). Almost all lesions (8/9) presented MRI findings of isointense signal in T1W with contrast enhancement. The only exception was the arachnoid cyst with intracystic bleeding, which was hyperintense in T1W that is not enhanced with contrast. This series shows an occurrence of 21.4 % of non-schwannomatous tumors in 42 cases of lesions restricted to the IAM. Whenever a solely intrameatal enhanced tumor is detected, it is necessary to think about other diagnostic possibilities rather than VS. Therapeutic management may be changed, specially if radiosurgical treatment is considered.

Prolong intermittent injection of human parathyroid hormone in rats modulates the expression of several proteins in the neuropil of the cerebellar cortex.

INTRODUCTION: The intermittent use of recombinant human parathyroid hormone (iPTH) alters calcium metabolism and induces osteogenesis in experimental models. However, the real effects of iPTH in excitable cells and neurons that require membrane receptors to undergo membrane depolarization/repolarization (Na+K+ATPase) to generate ATP, voltage-gated calcium channel (calcium-IP3R-calponin) as well as GABAergic (GABAA) signaling remains unclear. OBJECTIVES: In this study, the expression of IP3R, Na+K+-ATPase, GABAA and calmodulin proteins were evaluated in histological sections of the cerebellum of rats following prolonged injection of iPTH. METHODS: Twenty Wistar rats were used in this study and randomly assigned as either or control group. The test group were subcutaneously injected with 20 µg/kg of iPTH, 3×/week for 8 weeks, while the control group received 1 ml/kg of 0.9% saline solution. The rats were euthanized on the 60th day after the first administration, and their cerebellar vermis was removed and submitted to histological and immunohistochemical evaluation for detection of IP3R, Na+K+-ATPase, GABAA and calmodulin proteins. The expression of proteins was evaluated in the areas corresponding to the Purkinje cells as well as in neuropil of molecular layer of cerebellum. All results were transformed into a percentage for each area analyzed to verify significance between groups. RESULTS: Rats that received iPTH demonstrated significant reduction of IP3R, calmodulin and GABAA in Purkinje cells and neuropil of molecular layer while the expression of Na+K+-ATPase was similar. CONCLUSION: It was concluded that iPTH decreased the expression of IP3R and calmodulin while it did not alter the expression of Na+K+-ATPase. These changes insinuate the ionic activity of calcium and sodium/potassium. Yet, the iPTH alters GABAergic signaling in Purkinje cells, suggesting neurotransmission activity changes in the cerebellum.

Prevalência da síndrome de burnout em profissionais de saúde durante a pandemia de COVID-19 / Prevalence of burnout syndrome in health professionals during the COVID-19 pandemic

Introdução: A síndrome de Burnout no âmbito profissional é uma condição causada por estresse de longo prazo no local de trabalho e que diante da pandemia causada pela COVID-19, foram evidenciados agravos à saúde psíquica de trabalhadores da saúde. Objetivo: Analisar as diferentes categorias e setores de atuação profissional, elencando os principais fatores de risco e as principais formas de enfrentamento adotadas pelos profissionais de saúde associados à síndrome de Burnout. Métodos: Foi realizada busca bibliográfica e aplicação de formulário eletrônico, aos profissionais de saúde que prestaram assistência médica direta a pacientes diagnosticados e hospitalizados com COVID-19 no município de Curitiba-PR entre o período de março de 2020 a novembro de 2021; contendo questionário com informações pessoais, profissionais e relacionadas com as condições específicas vivenciadas durante a pandemia/ medidas de enfrentamento e aplicação do questionário Maslach Burnout Inventory ­ Human Services Survey para análise da prevalência da Síndrome de Burnout. Resultados: A amostra foi composta por 89 profissionais de saúde. Evidenciou-se uma prevalência de 48,31% de Síndrome de Burnout. Não foram encontrados resultados estatisticamente significantes ao analisar diferentes categorias profissionais e setores de atuação. A mudança de setor durante a pandemia foi fato estatisticamente significante (p=0,0245), assim como a busca por apoio emocional/psiquiátrico/psicológico (p=0,0004) e a relevância acerca do uso de mediação durante a pandemia (p=0,0027). Conclusões: A mudança de setor durante a pandemia foi considerada o único fator de risco encontrada no estudo. As principais formas de enfrentamento à Síndrome de Burnout adotadas pelos profissionais de saúde durante a pandemia de COVID-19 foram a procura por apoio emocional, psicológico, psiquiátrico e o aumento do uso de medicação psicotrópica

Introduction: Burnout syndrome in the professional context is a condition caused by long-term stress in the workplace. In the face of the COVID-19 pandemic it has been observed that healthcare workers have experienced psychological health issues. Objective: This study aims to analyze different professional categories and sectors, identifying the main risk factors and coping mechanisms adopted by healthcare professionals associated with Burnout syndrome. Methods: A literature search was conducted, and an electronic form was administered to healthcare professionals who provided direct medical care to COVID-19 diagnosed and hospitalized patients in the city of Curitiba, Brazil, from March 2020 to November 2021. The questionnaire included personal and professional information, as well as specific conditions experienced during the pandemic, coping strategies, and the application of the Maslach Burnout Inventory - Human Services Survey to assess the prevalence of Burnout syndrome. Results: The sample consisted of 89 healthcare professionals, and a prevalence of 48.31% for Burnout syndrome was identified. No statistically significant results were found when analyzing different professional categories and sectors. However, changing sectors during the pandemic was statistically significant (p=0.0245), as well as seeking emotional/ psychiatric/psychological support (p=0.0004), and the importance of using mediation during the pandemic (p=0.0027). Conclusions: Changing sectors during the pandemic was identified as the only risk factor in this study. The main coping mechanisms adopted by healthcare professionals during the COVID-19 pandemic to address Burnout syndrome included seeking emotional, psychological, and psychiatric support, as well as an increased use of psychotropic medication.

Perfil epidemiológico de tumores intracranianos metastáticos submetidos à neurocirurgia / Epidemiological profile of metastatic intracranial tumors submitted to neurosurgery

Introdução: As metástases cerebrais são, geralmente, decorrentes de carcinoma pulmonar, mama e melanoma. A procura ao hospital por sintomas neurológicos sem o conhecimento prévio do câncer primário é frequente. Objetivos: Analisar o perfil epidemiológico dos pacientes com metástase cerebral. Método: Estudo transversal, com coleta de dados dos pacientes com metástases cerebrais de serviço de neurocirurgia, entre 2010 a 2020. Resultados: A amostra foi de 114 pacientes e os principais sítios primários foram pulmão (39%), sítio não determinado (25%) e melanoma (15%). A maior parte (61%) desconhecia o câncer primário. O local mais acometido foi lobo frontal (32%), do lado direito (41%), e a maioria das lesões eram únicas (68%). Conclusão: A análise epidemiológica mostrou sítio primário pulmonar e a descoberta da metástase antes do câncer primário na maioria dos casos.

Introduction: Brain metastases are usually due to lung carcinoma, breast cancer and melanoma. The search to hospitals for neurological symptoms without prior knowledge of primary cancer is frequent. Objective: Analyze the epidemiological profile of patients with brain metastases. Method: This is a cross-sectional study, with data collection from patients with brain metastases from a neurosurgery service, between 2010 and 2020. Results: The sample consisted of 114 patients and the main primary sites were lung (39 %), non-determined site (25%) and melanoma (15%). Most (61%) were unaware of the primary cancer. The most affected site was the frontal lobe (32%), on the right side (41%), and most lesions were single (68%). Conclusion: The epidemiological analysis showed the primary site being pulmonary and the discovery of metastasis before the primary cancer being the majority of cases.

Perfil epidemiológico das fraturas traumáticas das colunas torácica e lombar submetidas ao tratamento cirúrgico / Epidemiological profile of traumatic fractures of the thoracic and lumbar spine submitted to surgical treatment

O traumatismo raquimedular é toda e qualquer lesão do complexo osteoligamentar da coluna vertebral além da medula espinhal e dos nervos espinhais, impactando diretamente na vida do paciente e no sistema de saúde pública. Este estudo transversal retrospectivo buscou, através de análise de prontuários, analisar os dados epidemiológicos de pacientes com fraturas traumáticas das colunas torácica e/ou lombar submetidos à cirurgia e formular uma propedêutica educacional de prevenção. Em conclusão, observou-se que as fraturas traumáticas da coluna toracolombar foram mais frequentes nos homens, com média de idade de 41,26 anos. As quedas de altura foram as principais causas. As fraturas de vértebras isoladas foram as mais incidentes, e a L1, a mais acometida, sem déficit neurológico na maioria dos casos. A cirurgia preconizada foi a artrodese curta, principalmente do segmento lombar.

Spinal cord injury is any injury to the osteoligamentary complex of the spine in addition to the spinal cord and spinal nerves, directly impacting the patient's life and the public health system. This retrospective cross-sectional study sought, through analysis of medical records, to analyze the epidemiological data of patients with traumatic fractures of the thoracic and/or lumbar spine who underwent surgery and to formulate a propaedeutic prevention education. In conclusion, was observed that traumatic fractures of the thoracolumbar spine were more frequent in males, with a mean age of 41.26 years. Falls from heights were the main causes. Fractures of isolated vertebrae were the most frequent, and L1 was the most affected, with no neurological deficit in most cases. The recommended surgery was short arthrodesis, mainly of the lumbar segment.

Distal posterior inferior cerebellar artery aneurysm: case report.

The majority of posterior inferior cerebellar artery (PICA) aneurysms are usually found on the bifurcation of the vertebral artery (VA) - PICA junction. Aneurysms arising from more peripheral PICA segments named distal PICA aneurysm are uncommon. The major clinical manifestation is that of an intracranial bleeding and the site of hemorrhage is related to the PICA segment originating the aneurysm. Lesions originating from distal PICA segments, particularly those arising from the telovelotonsillar segment, are associated with hemorrhage extending into the ventricular system, mainly the i.v. ventricle. A case of a 50-year-old woman with sudden headaches and vomiting, and intraventricular hemorrhage (four ventricles) caused by an aneurysm of the telovelotonsillar segment of the PICA, is presented. No signs of subarachnoidal hemorrhage were found in the computerized tomography. The aneurysm was clipped and the patient presented a favorable outcome. Anatomical aspects and clinical series are reviewed.

Distal posterior inferior cerebellar artery aneurysm: case report

A maioria dos aneurismas da artéria cerebelar posterior inferior (PICA) é geralmente encontrada na junção artéria vertebral (VA) - PICA. Aneurismas originando-se nos segmentos mais distais da PICA são considerados raros. A manifestação clínica em geral por hemorragia intracraniana, e o local desta está relacionado ao segmento que origina o aneurisma. Lesões localizadas em segmentos mais distais da PICA, em especial os originados do segmento telovelotonsilar, estão associados a hemorragias no sistema ventricular, particularmente no quarto ventrículo. Relatamos o caso de mulher de 50 anos de idade que desenvolveu quadro de cefaléia súbita e vômitos, com hemorragia nos quatro ventrículos, causada por ruptura de aneurisma localizado no segmento telovelotonsilar da PICA. Não havia sinais de hemorragia subaracnóidea na tomografia computadorizada de crânio. O aneurisma foi clipado e a paciente apresentou evolução favorável. Aspectos anatômicos e outras séries são revisados.

Cuidados pré-operatórios em pacientes com doenças reumáticas crônicas: parte 1 / Preoperative care in patients with chronic rheumatic diseases: part 1

Os pacientes portadores de doenças reumáticas crônicas freqüentemente requerem algum tipo de intervenção cirúrgica durante o curso de suas vidas, e a presença destas doenças (ex.: artrite reumatóide) pode aumentar o risco cirúrgico dos mesmos. Este artigo tem como objetivo revisar os principais aspectos clínicos da avaliação pré-operatória, assim como a estratificação de risco cirúrgico dos pacientes portadores de doenças reumáticas crônicas

Angiodisplasia do cólon: relato de caso e atualizaçäo da literatura / Angiodysplasia of the colon: a case report and review of the literature

Nas últimas décadas as lesöes vasculares do seco e do cólon têm sido reconhecidas como causa frequente de hemorragias do trato digestivo baixo, principalmente em pacientes idosos, causa esta atribuída, anteriormente, principalmente à doença diverticular do cólon. Contudo, quando diante de paciente com sangramento digestivo baixo, nem sempre este diagnóstico é aventado, motivo que levou os autores a descrever este caso para ilustrar esta realidade e revisar a literatura