Cerebellar Tonsillar Cysts Associated with Chiari Malformation in Adults: A Short Series.

BACKGROUND: Authors analyzed surgical patients with Chiari malformation (CM) associated with cerebellar tonsillar cyst. This association is quite rarely encountered in the literature. CASE DESCRIPTION: We retrospectively reviewed 60 surgical adult patients with MRI evaluation who underwent posterior fossa decompression for treatment of CM type I. All surgeries were performed between January 1995 and July 2015. From 60 patients with CM, four cases presented cerebellar tonsillar cysts (male=2). Basilar invagination (BI) (n=4) and syringomyelia (n=1) were associated. There were pyramidal signs (n=4) and low cranial nerves dysfunction (n=1). Radiological evaluation showed T1-hypointense and T2-hyperintense image on the cystic tissue (n=4). The surgical technique was suboccipital craniectomy, C1-C2 laminectomy (if needed), y-shaped durotomy, total resection and coagulation/aspiration of tonsils. CONCLUSIONS: In the present series, we were able to identify 7% of tonsillar cysts among 60 patients with CM. MRI with Flair and Diffusion sequences should be pre-operatively used for evaluation of tissue characteristics as differential diagnosis of cystic lesion and gliosis. The clinical presentation endorses surgical indication, with a good chance of clinical improvement. This was the first time that the frequency of tonsillar cysts has been evaluated in a series of adult patients.

Nursing Staff Members Mental's Health and Factors Associated with the Work Process: An Integrative Review.

BACKGROUND: The mental health of nursing staff members influences the work process outcomes. OBJECTIVE: Identify the work related factors that harms the nursing team's mental health. METHODS: Databases PubMed, Scopus, CINAHL and MEDLINE, by mating between the indexed descriptors in MeSH terms "mental health" and "occupational health nursing". 783 articles were rescued to give a final sample of 18 articles. Integrative review in order to identify factors associated with the work process of the nursing staff that negatively affects mental health. RESULTS: The main associated factors were work demands, psychological demands, violence, aggression, poor relationships with administrators, accidents involving the risk of exposure to HIV, stress and errors in the execution of labor activities. The main findings regarding the nursing staff's mental health were post-traumatic stress disorder, depression, stress, major depressive episode and generalized anxiety disorder. CONCLUSION: Occupational nurses need to understand the complexities of mental health problems and substance use among nursing staff members to recognize, identify and care for workers at risk and offer adequate mental health care. Although the researches interests in this theme have increased, proving that all these factors contribute to the risk to mental health of nursing professionals, the protective measures and care are being neglected by managers in both private and public network . The health of nursing workers in question here is one more challenge for a profession that takes care of others in need, therefore, requires some caring with their own health.