Measuring pituitary tumor volume: a comparison of the simplified and non-simplified ellipsoid equation with the 3D planimetric volume assessment.

PURPOSE: The ellipsoid equation came in an attempt to facilitate the estimation of tumor volume, by measuring the height, width, and anteroposterior length of the lesion. The estimated tumor volume can sometimes be different between methods, thus, it is of extreme interest to evaluate if the methods are significantly different, as well as to discuss the main limitations of each one. METHODS: This is an observational, analytical, cross-sectional study. A systematic review of the literature was also performed in order to discuss the results observed in the present study. RESULTS: A total of 82 patients (43 males and 39 females) ranging in age from 15 to 78 years (mean 47.95 ± 14.76) were included in the study. Seven patients were classified as Knosp grade 0 (8.5%), 36 Knosp grade 1 (44%), 14 Knosp grade 2 (17%), 20 Knosp grade 3 (24.4%), 5 Knosp grade 4 (6.1%). The tumor volume estimated by 3D planimetric assessment, non-simplified ellipsoid equation, and simplified ellipsoid formula averaged 10.68 cm³, 10.36 cm³, and 9.9 cm³ respectively. CONCLUSION: A simplified form of the ellipsoid equation increases the divergence between the measurement obtained in planimetry, and should be discouraged, in view of the new automated methods of performing quick calculations using periodic digits. The non-simplified form underestimated the tumor volume by 2.9% on average but did so regularly. In clinical practice, measurement should be accompanied by an evaluation of tumor morphology.

Sudden Death in Adults Caused by Intracranial Pathology: A Systematic Review.

AIM: To review the literature, and to identify the main intracranial pathologies that cause sudden deaths in adults. MATERIAL AND METHODS: The systematic review was carried out in concordance with the PRISMA checklist. RESULTS: Epilepsy and intracranial hemorrhage have been found to be the two main causes of sudden and unexplained deaths in adults due to intracranial pathologies. Intracranial neoplasms are not among the two main causes of SD, as they are usually discovered before fatality, so their rate of SD is not so extensive. It is noticed that the highest incidence of this type of death is also related to the abusive use of alcohol and other drugs, such as cocaine, heroin and nicotine. There is a possibility that the actual incidence of SD in adults due to intracranial pathologies is even greater, since there is a lack of reliability in autopsies and the fact that most SD in adults are not witnessed. CONCLUSION: The most recurrent etiologies of SD in adults are epilepsy, intracranial hemorrhage, meningitis or purulent abscess and tumors. Thus, it represents real challenge for neurosurgeons, since their understanding, accurate diagnosis and adequate treatment of these pathologies, in addition to healthy lifestyle habits by people can reduce the possibility of SD.

The use of an endoscopic endonasal approach for a secondary intraorbital meningioma: illustrative case.

BACKGROUND: Meningiomas are the most frequent primary tumors in the central nervous system (CNS), but intraorbital location is uncommon and accounts for only 0.2% to 4% of all CNS meningiomas. Lesions in this compartment could be classified as primary, secondary, or ectopic. The close relationship with the optic nerve sheath is a landmark to identify the tumor as primary, whereas secondary tumors commonly come from an extension of an intracranial meningioma, and ectopic meningioma is a concept not yet completely established. OBSERVATIONS: The authors present a rare case of a secondary intraorbital meningioma operated through an endoscopic endonasal approach. Secondary meningiomas at the medial orbit are very uncommon, given their more common superior and lateral location as an extension of sphenoid meningiomas. The endoscopic endonasal route provides direct access to the medial orbit. The authors present an illustrative case of a meningioma located at the medial orbit and resected through an endoscopic endonasal approach that provided excellent visualization and anatomical exposure. Additionally, the authors review the concept and possible similarities between secondary and ectopic intraorbital meningiomas. LESSONS: An endoscopic endonasal approach should be considered as a feasible treatment option for intraorbital meningiomas, especially if they are in the medial orbital wall.

Conhecimento sobre ética médica e resolução de conflitos na graduação / Knowledge about medical ethics and conflict resolution during undergraduate courses / Conocimiento sobre ética médica y resolución de conflictos en la carrera de grado

Resumo Estudo quantitativo transversal descritivo que tem o objetivo de avaliar a percepção do graduando em medicina sobre a importância do ensino da ética médica e mensurar seu conhecimento sobre a temática em universidade pública do Nordeste brasileiro. Por meio de questionário aplicado a 230 estudantes foi possível avaliar deficiências provocadas pela ausência do ensino formal da ética médica e discutir a necessidade de abordagens diversificadas do tema durante a graduação. Resultados mostram maior taxa de acertos entre graduandos que cursaram ao menos uma disciplina sobre ética médica, mas índice insatisfatório em ambos os grupos. Um terço dos discentes que não tiveram contato com a temática revelaram não se sentir prejudicados por essa lacuna e 25,6% da amostra sequer valorizou a importância do tema em relação a outras disciplinas da graduação. Assim, torna-se necessário rever as estratégias do ensino médico para garantir melhores profissionais no futuro.

Abstract This descriptive cross-sectional study aimed to evaluate the medical student's perception of the importance of medical ethics being taught and to measure their knowledge about the subject in a public university in the Northeast of Brazil. Through a questionnaire, applied to 230 undergraduates, it was possible to evaluate deficits caused by the absence of formal medical ethics education and to discuss the need for diversified approaches to the subject during graduation. Results show a higher rate of correct answers among undergraduates who attended at least one discipline on medical ethics; whereas they indicated an unsatisfactory rate of success in both groups. One third of the undergraduates who did not have contact with the subject revealed that they did not feel put at a disadvantaged by this gap, and 25.6% of the sample did not value the importance of the subject in comparison to other undergraduate subjects. Therefore, it is necessary to review medical education strategies to ensure better professionals in the future.

Resumen Estudio cuantitativo transversal descriptivo que tiene el objetivo de evaluar la percepción del estudiante de medicina sobre la importancia de la enseñanza de la ética médica y mensurar su conocimiento sobre la temática en una universidad pública del Nordeste brasileño. A través de un cuestionario aplicado a 230 estudiantes fue posible evaluar las deficiencias provocadas por la ausencia de la enseñanza formal de la ética médica y discutir la necesidad de abordajes diversificados del tema durante el grado. Los resultados muestran una mayor tasa de aciertos entre los estudiantes que cursaron al menos una disciplina sobre ética médica, pero un índice insatisfactorio en ambos grupos. Un tercio de los estudiantes que no tuvieron contacto con la temática revelaron no sentirse perjudicados por esa laguna, y el 25.6% de la muestra ni siquiera valora la importancia del tema en relación con otras disciplinas de la carrera. Así, se hace necesario revisar las estrategias de la formación médica para garantizar mejores profesionales en el futuro.

Masculinidade hegemônica, vulnerabilidade e prevenção ao HIV/AIDS / Hegemonic masculinity, vulnerability and the prevention of HIV/AIDS

O estudo tem como objetivo analisar as relações entre masculinidade, vulnerabilidade e prevenção do HIV/AIDS, com a ancoragem em narrativas de homens jovens pertencentes às chamadas classes trabalhadoras urbanas, levando em conta não só os sentidos atribuídos à prevenção por parte desses sujeitos, mas também considerando a relação dialética entre individuo e sociedade. O referencial conceitual engloba três eixos masculinidade hegemônica, prevenção e vulnerabilidade. Trata-se de uma pesquisa qualitativa baseada na perspectiva da hermenêutica dialética que utiliza o método de interpretação de sentidos. A análise produziu dois eixos como resultados: A masculinidade hegemônica como fator de vulnerabilidade; Mitos e preconceitos como fatores de vulnerabilidade ao HIV/AIDS; Em termos de conclusão, reforça-se a necessidade da discussão acerca da prevenção encampar a necessidade de colocar na ordem do dia a construção do sistema sexo/gênero em volta do qual se articulam os significados sociais da masculinidade e da feminilidade que influenciam estruturalmente o plano das relações afetivo sexuais, em geral, e a prevenção do HIV/AIDS, em específico.

The study aims to examine the relationship between masculinity, vulnerability and the prevention of HIV/AIDS, based on reports from young men from the so-called urban working classes, taking into account not only the meanings attributed to prevention by these subjects, but also considering the dialectical relationship between the individual and society. The conceptual framework encompasses the three main aspects of hegemonic masculinity, prevention and vulnerability. This involves qualitative research based on the perspective of dialectical hermeneutics that uses the method of interpretation of meanings. The analysis yielded two main results, namely hegemonic masculinity as a vulnerability factor, and myths and prejudices as factors of vulnerability to HIV/AIDS. By way of conclusion, it reinforces the need for discussion of prevention encompassing the need to put on the agenda the construction of the sex/gender system around which to articulate the social meanings of masculinity and femininity that influence the structural plan of affective sexual relations in general and HIV/AIDS in particular.