As artérias lenticuloestriadas podem interferir na extensão da ressecção tumoral e sobrevida nos gliomas da ínsula? / Can lenticulostriated arteries interfere with the extent of tumor resection and survival in insula gliomas?

Introdução: Os gliomas são tumores encefálicos e da medula espinhal que se originam nas células gliais e cuja progressão invade o tecido cerebral adjacentee e dentre eles um dos mais desafiadores são localizados no lobo cerebral da ínsula. Estas artérias irrigam estruturas nobres e sua lesão pode produzir danos sensitivos, motores e de linguagem. Objetivo: Descrever o impacto da extensão da ressecção, sobrevida global e dos resultados funcionais após a cirurgia dos gliomas insulares, quando estes tumores estejam ou não envolvidos pelas artérias lenticuloestriadas. Métodos: Revisão integrativa nas plataformas virtuais em português e inglês, buscando AND ou OR dados através dos seguintes descritores "Gliomas da ínsula, Mapeamento cerebral, Artérias lenticuloestriadas". A busca inicial foi baseada no título e/ou resumo. Decididos os trabalhos incluíveis foi realizada a leitura na íntegra dos textos. Ao total foram estudados 55 artigos. Resultados: O lobo da ínsula fica "escondido" pela sobreposição dos lobos frontal, parietal e temporal. Para alcançá-lo pode-se realizar as abordagens transsilviana ou transcortical. Ocorre que ao chegar na ínsula visualiza-se significativa ramificação constituída pelas artérias lenticuloestriadas, cuja manipulação pode determinar déficit neurológico e, ao se aprofundar no córtex insular, depara-se com outras estruturas tão importantes quanto a própria ínsula. O conhecimento anatômico das artérias lenticuloestriadas e suas relações é de fundamental importância para a ressecção de glioma insular, pois o comprometimento delas e da artéria cerebral média podem determinar a isquemia dos núcleos da base e da cápsula interna. Conclusão: O tratamento dos gliomas insulares permanece como grande desafio. Devido à sua localização e possibilidade de desenvolvimento de déficits neurológicos na manipulação cirúrgica é necessário não somente conhecer sua localização topográfica, mas também a íntima relação vascular com as artérias lenticuloestriadas. O envolvimento delas pelo tumor possui implicações na sobrevida e na preservação da função neurológica. O conhecimento detalhado da anatomia da região é fundamental para diminuir complicações que afetem grandemente a qualidade de vida dos pacientes.

Introduction: Gliomas are brain and spinal cord tumors that originate in glial cells and whose progression invades the adjacent brain tissue and among them one of the most challenging are located in the cerebral lobe of the insula. These arteries supply noble structures and their damage can cause sensory, motor and language damage. Objective: To describe the impact of the extent of resection, overall survival and functional results after surgery for insular gliomas, when these tumors are or are not involved by lenticulostriate arteries. Methods: Integrative review on virtual platforms in Portuguese and English, searching for AND or OR data using the following descriptors "Insula gliomas, Brain mapping, Lenticulostriate arteries". The initial search was based on the title and/or abstract. Once the included works were decided, the texts were read in full. In total, 55 articles were studied. Results: The insula lobe is "hidden" by the overlap of the frontal, parietal and temporal lobes. To achieve this, transsylvian or transcortical approaches can be performed. It turns out that when arriving at the insula, a significant branch made up of lenticulostriate arteries is seen, the manipulation of which can cause neurological deficits and, when going deeper into the insular cortex, one comes across other structures as important as the insula itself. Anatomical knowledge of the lenticulostriate arteries and their relationships is of fundamental importance for the resection of insular glioma, as their involvement and that of the middle cerebral artery can determine ischemia of the basal ganglia and internal capsule. Conclusion: The treatment of insular gliomas remains a major challenge. Due to its location and the possibility of developing neurological deficits during surgical manipulation, it is necessary not only to know its topographic location, but also the intimate vascular relationship with the lenticulostriate arteries. Their involvement by the tumor has implications for survival and preservation of neurological function. Detailed knowledge of the region's anatomy is essential to reduce complications that greatly affect patients' quality of life.

É possível prever a mortalidade molecular em meduloblastomas pela análise dos receptores de membrana CD114? / Is it possible to predict molecular mortality in meduloblastomas by analysis of CD114 membrane receptors?

Introdução: Os meduloblastomas são os tumores sólidos mais comuns da infância e classificados em 4 subgrupos moleculares: WNT, SHH, grupo 3 e grupo 4. Muitos estudos buscam desenvolvimento de novos quimioterápicos para os meduloblastomas através da identificação de genes cuja expressão sejam novos alvos moleculares para drogas, como receptores de membrana associados a replicação celular. Objetivo: Avaliar a associação da expressão de CD114 com a mortalidade de pacientes portadores de meduloblastoma. Métodos: Revisão feita colhendo informações publicadas em plataformas virtuais em português e inglês. Inicialmente foi realizada busca por descritores relacionados ao tema - neurocirurgia, oncologia cirúrgica, terapia de alvo molecular e meduloblastoma - e seus equivalentes em inglês - neurosurgery, surgical oncology, molecular targeted therapy e medulloblastoma - com busca AND ou OR, considerando o título e/ou resumo. Após, foram incluídos somente os que tinham maior relação ao tema, e realizada a leitura da íntegra dos textos. Finalmente foram referidos 2 artigos. Resultados: Há diferença na expressão do receptor de membrana CD114 entre o Grupo 3 e os demais grupos moleculares, além de diferença entre o subtipo molecular SHH γ e os subtipos moleculares Grupo 3 α e Grupo 3 ß. Não houve diferença estatisticamente significativa entre os demais grupos e subtipos. Em relação à mortalidade, esta revisão não demonstrou significância estatística na relação entre expressões baixas e elevadas desse gene e a mortalidade. Conclusão: Não há relação direta entre a expressão do receptor de membrana CD114 e a mortalidade em pacientes portadores de meduloblastoma. Entretanto, são necessários estudos adicionais sobre as vias de sinalização intracelulares associadas a esse receptor e ao seu gene, o CSF3R.

Introduction: Medulloblastomas are the most common solid tumors of childhood and classified into 4 molecular subgroups: WNT, SHH, Group 3 and Group 4. Many studies seek to develop new chemotherapy drugs for medulloblastomas by identifying genes whose expression is new molecular targets for drugs, such as membrane receptors associated with cell replication. Objective: To evaluate the association of CD114 expression with mortality in patients with medulloblastoma. Methods: Review carried out collecting information published on virtual platforms in Portuguese and English. Initially, a search was carried out for descriptors related to the topic - neurosurgery, surgical oncology, molecular targeted therapy and medulloblastoma, with AND or OR search, considering the title and/or summary. Afterwards, only those that were most related to the topic were included, and the texts read in full. Finally, 23 articles were referred. Results: There is a difference in the expression of the CD114 membrane receptor between Group 3 and the other molecular groups, in addition to a difference between the SHH γ molecular subtype and the Group 3 α and Group 3 ß molecular subtypes. There was no statistically significant difference between the other groups and subtypes. Regarding mortality, this review did not demonstrate statistical significance in the relationship between low and high expressions of this gene and mortality. Conclusion: There is no direct relationship between the expression of the CD114 membrane receptor and mortality in patients with medulloblastoma. However, additional studies are needed on the intracellular signaling pathways associated with this receptor and its gene, CSF3R.

Sectioning of the Filum Terminale in Patients with Chiari Malformation Type 1 Associated with Occult Tethered Cord Syndrome: Literature Review / Secção do filum terminale em pacientes com malformação de chiari tipo 1 associado a síndrome oculta da medula presa: revisão de literatura

Approximately 125 years ago, a group of pathologies now known as Chiari malformations was described for the first time. However, some mechanisms of its formation still remain unknown. A bibliographic survey was performed through a search in PubMed. In 1938, it was already theorized that an increase in spinal cord tension could be the cause of Chiari malformation type 1 (CM1) tonsillar herniation. In 1953, a condition known for the anchoring of the filum terminale to the vertebral canal was described for the first time and would later be known as tethered cord syndrome (TCS). Some studies have shown that it is associated with increased tension in the spinal cord, and this formed the basis for a possible pathophysiological explanation of tonsillar herniation. Case series emerged reporting that treatment for TCS with the sectioning of the filum terminale (SFT) could provide clinical improvement of patients with CM1. A new pathological entity emerged when it was realized that patients with the clinical picture of TCS could have the medullary cone in its normal position, differing from the caudal migration expected for the TCS. This condition became known as occult tethered cord syndrome (OTCS). Case series attempted to demonstrate its association with the origin of CM1, a non-intuitive association, since the cone in the normal position contradicts traction as a source of tonsillar herniation. To this day, the absence of randomized control trials limits any conclusions regarding the effectiveness of SFT for the treatment of patients with CM1.

Há cerca de 125 anos, era descrita pela primeira vez um grupo de patologias hoje conhecidas como malformações de Chiari. No entanto, alguns mecanismos de sua formação ainda permanecem desconhecidos. Um levantamento bibliográfico foi feito através do PubMed. Em 1938, já se teorizava que um aumento da tensão medular poderia ser a causa da herniação tonsilar da malformação de Chiari tipo 1 (MC1). Em 1953, foi descrita pela primeira vez uma condição conhecida pelo ancoramento do filum terminale ao canal vertebral e que mais tarde viria a ser conhecida como síndrome da medula presa (SMP). Alguns estudos demonstraram que ela estava associada à tensão aumentada na medula espinhal, e a partir disso estava formada a base para uma possível explicação fisiopatológica da herniação tonsilar. Séries de casos surgiram relatando que o tratamento para a SMP com a secção do filum terminale poderia proporcionar melhora clínica aos pacientes com MC1. Uma nova entidade patológica surgiu quando se percebeu que pacientes com o quadro clínico de SMP poderiam ter o cone medular em sua posição normal, diferente da migração caudal esperada para a SMP. Essa condição ficou conhecida como SMP oculta. Séries de casos tentaram demonstrar sua associação com a origem da MC1, uma associação nada intuitiva, visto que o cone na posição normal contradiz a tração como fonte da herniação tonsilar. A ausência de ensaios randomizados controlados até o dia de hoje não permite concluir a eficácia do método de secção do filum no tratamento de pacientes com MC1.

Most Frequent Compressive Limb Neuropathies: A Literature Review / Neuropatias compressivas mais frequentes que acometem os membros: Revisão da literatura

Peripheral nerve injuries vary in length and severity, and they can occur secondary to trauma, compression and ischemia, leading to both motor and sensory neurological deficits. Nerve compression can occur in both the upper and lower limbs. These injuries can affect the quality of life, including the total or partial loss of the individual's productive capacity. The diagnostic methods are based on clinical criteria, but they may also include imaging and electroneurophysiological studies. A clinical examination using the Tinel and Phalen tests, for example, may suggest carpal tunnel syndrome. Complementary exams are used to confirm the diagnosis and rule out other possibilities, and the most used are electroneuromyography (ENMG), computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). Depending on the type of injury, recovery may be spontaneous or may require conservative or surgical treatment.

As lesões nervosas periféricas variam em extensão e gravidade, as quais podem ocorrer secundárias a trauma, compressão e isquemia, e acarretam déficits neurológicos tanto motores quanto sensoriais. A compressão nervosa pode ocorrer nos membros superiores e inferiores. Estas lesões podem afetar a qualidade de vida, incluindo a perda total ou parcial da capacidade produtiva do indivíduo. Os métodos diagnósticos são baseados em critérios clínicos, mas também podem incluir métodos de imagem e estudos eletroneurofisiológicos. O exame clínico por meio dos testes de Tinel e de Phalen, por exemplo, pode sugerir síndrome do túnel do carpo. Os exames complementares servem para confirmar o diagnóstico e descartar outras possibilidades, sendo os mais utilizados a eletroneuromiografia (ENMG), a tomografia computadorizada (TC), a ressonância magnética (RM) e a ultrassonografia (US). De acordo com o tipo da lesão, a recuperação pode ser espontânea ou necessitar de tratamento conservador ou cirúrgico.

Evaluation of progesterone receptor expression in low- and high-grade astrocytomas.

OBJECTIVE: Gliomas are tumors originating from glial cells. Gliomas are the most common primary neoplasms of the central nervous system, with astrocytomas being the most prevalent glioma subtype. Progesterone regulates several reproductive processes, such as ovulation and sexual behavior, and influences neuronal excitability, learning, and the neoplastic proliferation of glial cells. Progesterone functions mainly by interacting with intracellular progesterone receptors to modify the expression of the genes involved in cell proliferation, angiogenesis, and epidermal growth factor production. As not many studies on the hormone receptors in glial tumors have been reported, the objective of this study was to evaluate the expression of these proteins in astrocytomas and to determine whether their expression levels vary according to the tumor grade. METHODS: This was a retrospective study using glial tumor paraffin blocks obtained from the São Marcos Hospital Pathology Department archives. Forty cases were divided equally into two groups, based on histological types and the World Health Organization criteria (low- and high-grade tumors). Progesterone receptor expression was analyzed by immunohistochemistry. The data were statistically analyzed using the Mann-Whitney U test and Spearman's correlation coefficient; results with p<0.05 were considered statistically significant. RESULTS: There were no statistically significant differences between the mean nuclear progesterone receptor expression of low-grade (0.1495) and high-grade (0.0937) astrocytomas (p=0.2). CONCLUSION: Progesterone receptors are present in both low- and high-grade gliomas; however, there is no significant difference in the levels of progesterone receptor expression between the tumor grades.

Evaluation of progesterone receptor expression in low- and high-grade astrocytomas

SUMMARY OBJECTIVE: Gliomas are tumors originating from glial cells. Gliomas are the most common primary neoplasms of the central nervous system, with astrocytomas being the most prevalent glioma subtype. Progesterone regulates several reproductive processes, such as ovulation and sexual behavior, and influences neuronal excitability, learning, and the neoplastic proliferation of glial cells. Progesterone functions mainly by interacting with intracellular progesterone receptors to modify the expression of the genes involved in cell proliferation, angiogenesis, and epidermal growth factor production. As not many studies on the hormone receptors in glial tumors have been reported, the objective of this study was to evaluate the expression of these proteins in astrocytomas and to determine whether their expression levels vary according to the tumor grade. METHODS: This was a retrospective study using glial tumor paraffin blocks obtained from the São Marcos Hospital Pathology Department archives. Forty cases were divided equally into two groups, based on histological types and the World Health Organization criteria (low- and high-grade tumors). Progesterone receptor expression was analyzed by immunohistochemistry. The data were statistically analyzed using the Mann-Whitney U test and Spearman's correlation coefficient; results with p<0.05 were considered statistically significant. RESULTS: There were no statistically significant differences between the mean nuclear progesterone receptor expression of low-grade (0.1495) and high-grade (0.0937) astrocytomas (p=0.2). CONCLUSION: Progesterone receptors are present in both low- and high-grade gliomas; however, there is no significant difference in the levels of progesterone receptor expression between the tumor grades.

Association between Single Nucleotide Polymorphisms and Glioma Risk: A Systematic Literature Review.

This study aimed to determine the main single nucleotide polymorphisms (SNPs) that are associated with an increased or decreased risk of glioma development in healthy individuals. We conducted a systematic review of the articles published in English on the PUBMED database between January 2008 and December 2017. Our search resulted in a total of 743 articles; however, only 56 were included in this review. A total of 148 polymorphisms were found, which involved 64 different genes. The polymorphisms that were most associated with an increased risk of glioma development were polymorphic variants rs179782, rs13181, and rs3791679 of the genes XRCC1, ERCC2, and EFEMP1, respectively.

Basilar invagination associated with chiari malformation type I: A literature review.

Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.

Importance of the First Coil in the Embolization of Intracranial Aneurysms : A Case Control Study.

PURPOSE: Endovascular therapy for the treatment of cerebral aneurysms has a higher incidence of rebleeding and a lower occlusion rate than microsurgical clipping. This study investigated whether first coil volume packing density (1st VPD) and first loop diameter of the first coil (1st LD) are associated with recanalization after endovascular coiling. METHODS: The study included 174 initial saccular aneurysm cases from 2010 to 2015. Between the recanalization and non-recanalization groups, we compared age, sex, aneurysm location, rupture occurrence, shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume, coil volume, VPD, 1st VPD, 1st LD, relation of the first loop diameter of the first coil and the maximum aneurysm size (RLAS), types of assistance techniques, and the Raymond scale score at initial and follow-up angiography. RESULTS: Recanalization occurred in 41 cases (23.6%). The factors associated with recanalization were irregular shape, maximum aneurysm size, neck width, dome-to-neck ratio, aneurysm volume, VPD, 1st VPD and 1st LD smaller than the maximum aneurysm size. The cut-off values for aneurysmal recanalization were 92%, 11% and 37% for RLAS, 1st VPD and VPD, respectively. CONCLUSION: The 1st VPD and 1st LD were associated with aneurysmal recanalization after embolization. These factors provide a helpful index for coil programming.

Basilar invagination associated with chiari malformation type I: A literature review

Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.

Embryonic Tumor with Abundant Neuroepithelium and True Rosettes (ETANTR): Case Report and Literature Review

The embryonal tumor with abundant neuropil and true rosettes (ETANTR) is an extremely rare variant of the primitive neuroectodermal tumor (PNET). About 80 cases have been reported since its first description in the literature, in 2000. The ETANTR occurs in very young patients, especially children under 6 years of age. It is found mainly in the cerebral cortex. Headache, focal neurological signs, seizures, increased head circumference and psychomotor developmental delay are the most frequent symptoms of ETANTR. Histologically, it displays the features of an ependymoblastoma and a neuroblastoma, showing areas of neuroepithelium fibrillar rosettes with ependymoblastic zones and interposed undifferentiated neuroepithelial cells. The ETANTR is distinguishable from other embryonal tumors due to the abundance of neuroepithelium. Genetic studies have demonstrated the presence of polysomy of chromosome 2 and chromosome 19q13.42 amplification. This is an extremely aggressive tumor with a mean survival ranging from 9 to 48 months. We present the first report in Brazil, published in indexed literature, of an ETANTR case involving a young child.

O tumor embrionário com neurópilo abundante e rosetas verdadeiras (TENARV) é uma variante muito rara do tumor neuroectodérmico primitivo (TNEP), com cerca de 80 casos publicados desde a sua primeira descrição na literatura, em 2000. O TENARV ocorre em pacientes muito jovens, especialmente crianças abaixo de 6 anos de idade, atingindo principalmente o córtex cerebral. Cefaleia, sinais focais, crise convulsiva, aumento do perímetro cefálico e atraso do desenvolvimento psicomotor são os sintomas mais frequentes da TENARV. Histologicamente, este tipo de tumor apresenta as características combinadas de um ependimoblastoma e um neuroblastoma, demonstrando áreas de neuroepitélio fibrilar com rosetas ependimoblásticas de permeio e zonas de células neuroepiteliais indiferenciadas. O TENARV é distinguível de outros tumores embrionários pela abundância de neuroepitélio. Estudos genéticos demonstram a presença de polissomia do cromossomo 2 e amplificação do cromossomo 19q13.42. Trata-se de um tumor extremamente agressivo, com sobrevida média entre 9 e 48 meses. Apresentamos o primeiro relato brasileiro, publicado em literatura indexada, de um caso de TENARV acometendo uma criança jovem.

Concepção de Profissionais da Estratégia Saúde da Família sobre a Saúde Mental na Atenção Básica¹ / Conception of Family Health Strategy Professionals on Mental Health in Primary Care / Estrategia de Salud de los Profesionales de Diseño de la Familia de la Salud Mental en Atención Primaria

Este artigo teve como objetivo analisar a concepção de profissionais da Estratégia Saúde da Família sobre saúde mental com base na Política Nacional de Saúde Mental. Realizou-se uma pesquisa de campo, com abordagem qualitativa e a participação de 20 profissionais. Os dados foram coletados por meio de uma entrevista semiestruturada e investigados a partir da análise de conteúdo e agrupados em categorias. Foi possível identificar que a demanda relativa à saúde mental mais frequente é a de renovação de receitas médicas e as intervenções são fragmentadas por especialidades e encaminhamentos. Considerou-se a importância do apoio matricial envolvido com a responsabilização dos profissionais de saúde na intersetorialidade e integração das ações multidisciplinares de saúde mental com os usuários, família e comunidade.

This article aims to analyze the design professionals of the Family Health Strategy on mental health based on the National Mental Health Policy. We conducted a field research with qualitative approach and the participation of 20 professionals. Data were collected through a semi-structured interview and investigated from the content analysis and grouped into categories. It was possible to identify the relative demand for more frequent mental health is the renewal of prescriptions medicals and interventions are fragmented by specialties and referrals. It considered the importance of matric support involved with the accountability of health professionals in intersectoriality and integration of actions multidisciplinarys to mental health with users, family and community.

Este artículo tiene como objetivo analizar los profesionales del diseño de la Estrategia Salud de la Familia en la salud mental basado en la Política Nacional de Salud Mental. Se realizó una investigación de campo con enfoque cualitativo y la participación de 20 profesionales. Los datos fueron recolectados a través de una entrevista semiestructurada e investigados a partir del análisis de contenido y se agrupan en categorías. Fue posible identificar la demanda relativa de salud mental más frecuente es la renovación de las recetas médicas y las intervenciones fragmentado por especialidades y referencias. Se considera la importancia del apoyo matricial con la responsabilidad de los profesionales de la salud en enfoque intersectorial y la integración de acciones de salud mental multidisciplinar con los usuarios, familia y comunidad.

Fatores associados à queda de idosos que podem resultar em fratura de fêmur / Factors associated with the fall of elderly which may result in femoral fracture / Factores asociados con la caída de ancianos que pueden resultar en fractura de fémur

Objetivo: analisar os fatores associados a queda de idosos que podem resultar em fratura de fêmur. Método: estudo exploratório e descritivo com abordagem qualitativa, desenvolvido no Centro Integrado de Saúde do Uninovafapi, com 50 idosos. Os dados foram coletados por meio de entrevista, processados no Iramuteq e analisados pela classificação hierárquica descendente. Resultados: foram apresentados em cinco categorias, a saber: 1. Condição das residências dos idosos que facilitam as quedas; 2. Falta de adaptação das residências às necessidades dos idosos; 3. Condições irregulares do calçamento das ruas; 4. Condições irregulares das calçadas das casas e comércios; e 5. Hipertensão arterial e diabetes, como doenças crônicas associadas às quedas entre idosos. Conclusão: os fatores associados à queda de idosos tem relação com as condições das residências e as ruas da cidade, mas o que determina a gravidade desses acidentes são as doenças crônicas que o idoso possui. Há necessidade de melhorar a política pública de atenção ao idoso relacionada às quedas.(AU)

Objective: analyzing the factors associated with the fall of the elderly that may result in femur fractures. Method: an exploratory and a descriptive study of a qualitative approach developed at the Integrated Health Center Uninovafapi, with 50 seniors. Data were collected through interviews, processed in Iramuteq and analyzed through the descending hierarchical classification. Results: they were presented in five categories, namely: 1. Condition of the homes of the elderly that facilitate the falls; 2. Lack of adapting homes to the needs of the elderly; 3. Irregular conditions of paving of streets; 4. Irregular conditions of the sidewalks of homes and businesses; and 5. High blood pressure and diabetes, as chronic diseases associated with falls among the elderly. Conclusion: the factors associated with the fall of the elderly is related to the conditions of the homes and streets of the city, but what determines the severity of these accidents are the chronic diseases that old people have. There is a need to improve public policy of elderly care related to falls. (AU)

Objetivo: analizar los factores asociados con la caída de las personas mayores que pueden dar lugar a fracturas de fémur. Método: estudio exploratorio y descriptivo con enfoque cualitativo desarrollado en el Centro Integrado de Salud Uninovafapi, con 50 personas mayores. Los datos fueron recolectados a través de entrevistas, procesados en Iramuteq y analizados por la clasificación jerárquica descendente. Resultados: se presentaron en cinco categorías, a saber: 1. Condición de las viviendas de las personas mayores que facilitan las caídas; 2. La falta de adaptación de viviendas a las necesidades de los ancianos; 3. Condiciones de pavimento irregular de calles; 4. Condiciones irregulares de las aceras de las casas y negocios; y 5. La presión arterial alta y la diabetes como las enfermedades crónicas asociadas con caídas entre los ancianos. Conclusión: los factores asociados con la caída de personas mayores está relacionada con las condiciones de las viviendas y calles de la ciudad, pero lo que determina la gravedad de estos accidentes son las enfermedades crónicas que las personas mayores tienen. Hay una necesidad de mejorar las políticas públicas relacionadas con el cuidado de ancianos a las caídas.(AU)

Prevalência de complicações em tecidos moles e duros devido ao uso de piercing oral / Prevalence of complications in hard and soft tissues from oral piercing / La prevalência de complicaciones en tejidos duros y blandos debido a la utilizacion de la perforacion oral

O estudo objetivou analisar a prevalência de complicações na cavidade oral em indivíduos usuários depiercing oral. Trata-se de uma pesquisa exploratória, realizada no ano de 2009, com 57 usuários de piercing oral, de Teresina – Piauí, por meio de exame clínico da cavidade oral e entrevista. Os resultados indicaram que a idade dossujeitos variou de 18 a 35 anos e que 49,1% dos sujeitos usavam o piercing no lábio, 36,8% na língua, 8,8% no freiolabial, 1,8% no freio lingual e 3,5% em outras regiões da cavidade oral. A complicação de maior prevalência foi ainflamação com 36,84%, seguida por recessão gengival – 29,82%, aspiração – 21,05%, formação de queloide – 17,54%, fratura dental – 17,74%, perda de gustação – 12,28%, infecção – 10,53% e alergia – 1,75%. Conclui-se que a maioria das alterações provocadas pelo uso de piercing oral são prejudiciais à saúde dos usuários e levam a danos permanentes ou provisórios.

The study assessed the prevalence of complications in the oral cavity in individuals using oral piercing. This exploratory study was performed in 2009 with 57 users of oral piercing in Teresina (Piauí), through clinical examination of the oral cavity and interview. The results showed that the subjects were from 18 to 35 years old, and that 49.1% used piercing of the lip; 36.8%, of the tongue; 8.8%, of the labial frenulum; 1.8%, of the lingual frenulum; and 3.5% in other regions of the oral cavity. The most prevalent complication was inflammation (36.84%), followed by gingival recession (29.82%), aspiration (21.05%), keloid formation (17.54%), dental fractures (17.74%), loss of taste(12.28%), infection (10.53%) an allergy (1.75%). It can be concluded that most of the changes caused by the use of oral piercing are harmful to users’ health and cause temporary or permanent damage.

El objetivo del studio fue analizar la prevalencia de complicaciones en la cavidad oral en las personas que utilizan piercing oral. Este es un estudio exploratorio, realizado en 2009, con 57 usuarios de piercing oral, en Teresina-PI-Brasil, a través de examen clínico de la cavidad oral y entrevista. Los resultados indicaron que la edad de los sujetos varió de 18 a 35 años y que 49.1% de los sujetos utilizan la perforación del labio, 36.8% de la lengua, 8,8% en el frenillo labial, 1.8% en el freno de la lengua y 3,5% en otras regiones de la cavidad oral. La complicación más prevalerte fue la inflamación con 36,84%, seguida por recesión gengival con 29,82%, aspiración con 21,05%, queloide con 17,54%, fracturas dentales con 17,74%, pérdida del gusto con 12,28%, infección con 10,53% y alergia con 1,75%. Se concluye que la mayoria de los cambios causados por el uso de piercings orales son perjudiciales parala salud de los usuarios y los conduce a daños permanentes o provisorios.

Closed head injury in rats: histopathological aspects in an experimental weight drop model.

PURPOSE: To study histopathological findings due to a model of closed head injury by weight loss in rats. METHODS: A platform was used to induce closed cranial lesion controlled by weight loss with a known and predefined energy. 25 male Wistar rats (Rattus novergicus albinus) were divided in five equal groups which received different cranial impact energy levels: G1, G2, G3 and G4 with 0.234J, 0.5J, 0.762J and 1J respectively and G5 (Sham). Under the effect of analgesia, the brain of each group was collected and prepared for histopathological analysis by conventional optic microscopy. RESULTS: It was observed greater number of injured neurons in animals of group 4, however neuronal death also could be noticed in animals of group 5. Intraparenchymal hemorrhages were more frequent in animals of group 4 and the cytotoxic brain swelling and vascular congestion were more intense in this group CONCLUSION: The histopathological analysis of these findings allowed to observe typical cranial trauma alterations and these keep close relation with impact energy.

Closed head injury in rats: histopathological aspects in an experimental weight drop model / Trauma craniano fechado em ratos: aspectos histopatológicos em um modelo experimental de queda de peso

PURPOSE: To study histopathological findings due to a model of closed head injury by weight loss in rats. METHODS: A platform was used to induce closed cranial lesion controlled by weight loss with a known and predefined energy. 25 male Wistar rats (Rattus novergicus albinus) were divided in five equal groups which received different cranial impact energy levels: G1, G2, G3 and G4 with 0.234J, 0.5J, 0.762J and 1J respectively and G5 (Sham). Under the effect of analgesia, the brain of each group was collected and prepared for histopathological analysis by conventional optic microscopy. RESULTS: It was observed greater number of injured neurons in animals of group 4, however neuronal death also could be noticed in animals of group 5. Intraparenchymal hemorrhages were more frequent in animals of group 4 and the cytotoxic brain swelling and vascular congestion were more intense in this group CONCLUSION: The histopathological analysis of these findings allowed to observe typical cranial trauma alterations and these keep close relation with impact energy.

OBJETIVO: Investigar as alterações histopatológicas produzidas por um modelo de trauma craniano fechado por queda de peso em ratos. MÉTODOS: Utilizando uma plataforma para produção de lesão craniana fechada controlada por queda de peso com energia pré-definida e conhecida, 25 ratos Wistar machos (Rattus norvegicus albinus) foram divididos em cinco grupos iguais que receberam níveis diferentes de energia de impacto craniano: G1, G2, G3 e G4 com 0,234J, 0,5J, 0,762J e 1J respectivamente e G5 (Sham). Sob analgesia, cada grupo teve seus encéfalos coletados e processados para análise histopatológica por microscopia óptica convencional. RESULTADOS: Houve maior número de neurônios lesados em animais do grupo 4, mas morte neuronal também pôde ser constatada nos animais do grupo 5. Hemorragias parenquimatosas foram mais frequentes nos animais do grupo 4 e o inchaço cerebral citotóxico e congestão vascular foram mais intensos neste grupo. CONCLUSÃO: Os achados à análise histopatológica permitem observar alterações típicas do trauma craniano e estas guardaram proporção direta com a energia do impacto.

Resultados tardios da descompressão microvascular do nervo facial pela artéria vertebral / Long-term outcomes of facial nerve microvascular decompression by vertebral artery

Espasmos faciais constituem afecção rara, caracterizada por contrações assimétricas, involuntárias e paroxísticas da musculatura facial. Frequentemente são de acometimento unilateral e levam a situação desconfortável e prejudicial à qualidade de vida dos pacientes. Na maioria das vezes, o quadro inicia-se gradualmente no músculo orbicular dos olhos, seguindo-se por acometimento do andar inferior da face ipsilateralmente. Os espasmos são causados por compressão vascular, mais comumente provocada pela presença da artéria cerebelosa póstero-inferior (PICA) ou da artéria cerebelosa antero-inferior (AICA) (sendo mais raro o envolvimento da artéria vertebral) sobre a raiz do nervo facial, na REZ (Root Entry Zone). Injeção de toxina botulínica no músculo facial envolvido é uma opção terapêutica medicamentosa, no entanto possui benefícios transitórios ao longo da terapia. A descompressão microvascular é um tratamento efetivo, com baixas taxas de complicação. Descreve-se o caso de um paciente de 65 anos portador de contrações involuntárias e esporádicas da musculatura orbicular do olho esquerdo de caráter insidioso e progressivo. Optou-se por microcirurgia descompressiva com interposição de teflon entre artéria vertebral esquerda e o nervo facial na fossa posterior, com significativa melhora clínica, e regressão progressiva dos espasmos até sua completa remissão.

Facial spasm is a rare disease characterized by asymmetriccontractions and involuntary paroxysmal activity offacial muscles. It is often unilateral disease and leadsto an uncomfortable and injurious situation that affectspatients’ quality of life. Most often, it begins gradually inthe orbicularis oculi muscle, followed by involvement of theipsilateral inferior face . The spasms are usually causedby PICA and AICA vascular compression (vertebral arterycompression is more rare) of the facial nerve root, in itsentry zone. Botulinum toxin injection in the involved facialmuscle is a treatment option, however has transient benefitsduring the therapy. Microvascular decompression is aneffective treatment, with low complication rates. We reporta case of a 65-year-old patient with sporadic involuntarycontractions of left orbicular muscle , with an insidious andprogressive character. Microsurgical decompression withTeflon interposition between the left vertebral artery and thefacial nerve in the posterior fossa was performed. There wasa significant clinical improvement, with progressive decreaseof the spasms until complete remission.

Lesão cerebral traumática: parâmetros clínicos e patológicos em um modelo experimental de queda de peso / Traumatic brain injury: clinical and pathological parameters in an experimental weightdrop model

PURPOSE: To investigate the function of an experimental cranium trauma model in rats. METHODS: The equipment, already described in the literature and under discreet adaptations, is composed by a platform that produces closed head impact controlled by weight drop with pre-defined and known energy. 25 Wistar male rats (Rattus norvegicus albinus) were divided into five equal groups that received different quantities of cranial impact energy: G1, G2, G3 and G4 with 0,234J, 0,5J, 0,762J and 1J respectively and G5 (Sham). Under intense analgesia, each group was evaluated clinically in a sequence of intervals and had their encephalon removed for pathologic analysis. RESULTS: Important clinical alterations (convulsions, bradycardia, bradypnea and abnormal postures) and focal pathologic (hematomas and hemorrhages) kept proportion with the intensity of the impact. No fracture was observed and the group 4 had 80 percent mortality rate. CONCLUSION: The experimental cranium trauma animal model by weight drop is an alternative of low cost and easy reproduction that allows evaluating clinical and pathological alterations in accordance with studies in experimental surgery aims for new traumatic brain injury approach in rats.

OBJETIVO: Investigar o uso de um modelo de trauma craniano experimental em ratos. MÉTODOS: O equipamento, já descrito na literatura e sob discretas adaptações, contitui-se de uma plataforma para produção de lesão craniana fechada controlada por queda de peso com energia pré-definida e conhecida. 25 ratos Wistar machos (Rattus norvegicus albinus) foram divididos em cinco grupos iguais que receberam níveis diferentes de energia de impacto craniano: G1, G2, G3 e G4 com 0,234J, 0,5J, 0, 762J e 1J respectivamente e G5 (Sham). Sob intensa analgesia, cada grupo foi avaliado clinicamente em uma seqüência de intervalos e tiveram seus encéfalos removidos para análise patológica. RESULTADOS: Alterações clínicas importantes (convulsões, bradicardia, bradipnéia e posturas anormais) e patológicas focais (hematomas e hemorragias) guardaram proporção com a intensidade do impacto. Nenhuma fratura foi observada e o grupo 4 teve 80 por cento de mortalidade. CONCLUSÃO: O modelo animal para trauma craniano experimental por queda de peso é uma alternativa de baixo custo e fácil reprodução, gerando alterações clínicas e patológicas compatíveis com os objetivos de estudos em cirurgia experimental para abordagem do trauma craniano em ratos.

Traumatic brain injury: clinical and pathological parameters in an experimental weightdrop model.

PURPOSE: To investigate the function of an experimental cranium trauma model in rats. METHODS: The equipment, already described in the literature and under discreet adaptations, is composed by a platform that produces closed head impact controlled by weight drop with pre-defined and known energy. 25 Wistar male rats (Rattus norvegicus albinus) were divided into five equal groups that received different quantities of cranial impact energy: G1, G2, G3 and G4 with 0,234J, 0,5J, 0,762J and 1J respectively and G5 (Sham). Under intense analgesia, each group was evaluated clinically in a sequence of intervals and had their encephalon removed for pathologic analysis. RESULTS: Important clinical alterations (convulsions, bradycardia, bradypnea and abnormal postures) and focal pathologic (hematomas and hemorrhages) kept proportion with the intensity of the impact. No fracture was observed and the group 4 had 80% mortality rate. CONCLUSION: The experimental cranium trauma animal model by weight drop is an alternative of low cost and easy reproduction that allows evaluating clinical and pathological alterations in accordance with studies in experimental surgery aims for new traumatic brain injury approach in rats.

Relação do cuidador e da sociedade com a pessoa com esquizofrenia / Relación del cuidador con la sociedad y la persona com esquizofrenia / Caregiver’s relationship with society and the person with schizophrenia

Analisar a relação do cuidador e da sociedade com a pessoa com esquizofrenia. Métodos: Estudo descritivo-exploratório realizado no Centro de Apoio Psicossocial II de Teresina-PI, com nove cuidadores de pessoas com esquizofrenia que aceitaram participar do estudo. Os dados foram coletados por meio da entrevista com roteiro semi-estruturado, as quais foram organizadas em categorias semânticas. Resultados: Aborda a esquizofrenia enquanto geradora de conflito no meio familiar e a cisão social. Constatou-se conflitos sentimentais no núcleo familiar causando sua desestruturação antes do inicio do tratamento. A sociedade, por sua vez, vê a pessoa com esquizofrenia como parte de sua realidade, acolhendo-a no âmbito social, contudo, atribui ao cuidador a responsabilidade de sua vigília, sobrecarregando-o. Conclusão: O cuidador e a sociedade necessitam de apoio profissional para melhor compreenderem a problemática vivenciada, somando esforços com as instituições responsáveis pela recuperação destas pessoas.

El studio tuvo como objetivo analizar la relación entre los cuidadores de la familia y la sociedad con la persona con esquizofrenia. Métodos: Un estúdio exploratório descriptivo realizado Centro de Atención Psicosocial II en Teresina-PI, con nueve cuidadores de personas con esquizofrenia y que aceptaron participar. Los datos fueron recolectados a través de entrevistas semi-estructuradas, fueron organizados en categorias semánticas. Resultados: Aborda la esquizofrenia como un generador de conflictos en la familia y la división social. Se encontró que existe en los conflictos emocionales que causan la esencia misma de su familia desglos antes del inicio del tratamiento. La compañía, a su vez, vê la persona con esquizofrenia, como parte de su realidad, aceptando en el âmbito social, sin embargo, da la cuidador a cargo de la vigília, sobrecargarlo. Conclusión: Los cuidadores y la sociedad necessitam ser trabajados para comprender mejor y aceptar los problemas que, uniendo sus fuerzas con las instituciones responsables de la recuperación de estas personas.

The study aimed to analyze the relationship between family caregivers and society the person with schizophrenia. Method: An exploratory descriptive study performed Psychosocial Care Center II in Teresina-PI, with nine caregivers of people with schizophrenia and that participate in the study. Data were collected through semi-structured interviews were organized into semantic categories. Results: Addresses schizophrenia as a generator of conflict in the family and social division. It was found that there is at the very core emotional conflicts causing your family breakdown before the start of treatment. The company, in turn, sees the person with schizophrenia as part of their reality, accepting it in the social sphere, however gives the caregiver the responsibility of the vigil, over loading it. Conclusion: The caregivers and society need to be worked better understand and accept the problems experienced, joining forces with the institutions responsible for the recovery of these people.