Percutaneous Foramen Ovale Puncture: Usefulness of Intraoperative CT Control, in the Eventuality of a Narrow Foramen.

BACKGROUND: Balloon compression of the gasserian ganglion has been a well-established percutaneous treatment of trigeminal neuralgia since the 1980s. However, puncture of the foramen ovale by conventional single-plane fluoroscopy can be difficult in cases of local anatomic abnormalities. CASE PRESENTATION: We present the case of a 49-year-old woman diagnosed with idiopathic trigeminal neuralgia refractory to pharmacological treatment. After failure of puncture by conventional fluoroscopy for percutaneous gasserian ganglion balloon compression due to a narrow foramen ovale, the patient was submitted to puncture guided by computed tomography. CONCLUSION: Alternative imaging methods, such as computed tomography, should be considered when puncture of the foramen ovale by conventional single-plane fluoroscopy fails, to minimize the risk of potential complications triggered by frustrated puncture attempts.

The Dilemma of Anticoagulating Patients with Cerebral Venous Thrombosis Who Underwent Decompressive Craniectomy.

BACKGROUND: Cerebral venous thrombosis is an uncommon subtype of cerebrovascular accident. The appropriate time interval between decompressive craniectomy and the onset of anticoagulation in patients with cerebral venous thrombosis is a controversial topic among neurosurgeons, neurologists, and intensivists. CASE DESCRIPTION: We present a brief clinical case report of a female patient who underwent decompressive craniectomy. Cerebral venous thrombosis was subsequently diagnosed, and anticoagulation was initiated 24 hours postoperatively. CONCLUSIONS: Early onset of anticoagulation is important for a favorable outcome. Clinical decision making should rely on the following: 1) postoperative imaging studies with no evidence of increase in hematoma, 2) intracranial pressure monitoring for patients on mechanical ventilation, and 3) protocols for immediate suspension of anticoagulants and use of antagonistic drugs in case of an increase in a pre-existing intracranial hemorrhage.

Acute schistosomiasis mansoni: the pathophysiological cycle of the schistosoma mansoni and the granulomas as egg of columbus / Esquistossomose mansônica aguda: o ciclo fisiopatológico do Schistosoma mansoni e o granuloma como ovo de colombo*

Background and objectives: Schistosomiasis has a wide geographical distribution, and is found in many countries including Brazil, where it is endemic in some states. This study aimed to describe the main pathogenic aspects of the Homo sapiens sapiens / Shistosoma mansoni interaction, focusing on the acute phase of illness. Accordingly, we reviewed the literature using a with a defined search strategy, using PubMed. The selected papers were read and the information organized into two sections, focusing on (1) the pathophysiological human-helminth interaction "cycle" and (2) the role of granuloma in the disease. Content: The pathologic process begins with the penetration of the cercariae into the skin, from which point the response mechanisms to infection are triggered - linked to the biological cycle of the helminth in the human body - and justifying the development of acute and chronic forms of the disease. The acute phase is characterized by the formation of necrotic-exudative granulomas around the eggs. Continuous oviposition allows for modulation of the immune response, the histopathological significance of which is the disappearance of the necrotic areas and size reduction of the granulomas surrounding the eggs. Conclusion: An understanding of the Homo sapiens sapiens/Schistosoma mansoni interaction is essential in order to think of ways to intervene with the natural history of the disease, avoiding the emergence of severe forms - especially in the context of evolution to chronic disease -, and, perhaps, corroborating for a better coexistence between man and helminth, in the best spirit of cohabitology...

Art and pain in Frida Kahlo / Arte e dor em Frida Kahlo

BACKGROUND AND OBJECTIVES: The Mexican painter Frida Kahlo is one of the most important artists of the twentieth century. After being involved in a car accident, remained at home to recover from several injuries, significant event for the dawning of her painting. The aim of this study was to present aspects of the biography and life of Frida, seeking intersections between her artwork and her painful experiences. CONTENTS: From the appreciation of film and screens selected author - analyzed with the support of the articles obtained in the literature review - held four sections to the presentation of evidence obtained: (1) the 'origins' of Frida (2) first accident, (3) the second accident: Diego Rivera and (4) the Martyrdom of frustrated motherhood. CONCLUSION: Frida found in art her comfort, transforming her painful and intense trajectory in a work that reflected the meaning of her existence. .

JUSTIFICATIVA E OBJETIVOS: A pintora mexicana Frida Kahlo é uma das mais importantes artistas do século XX. Após envolvimento em um acidente automobilístico, permaneceu em repouso para se recuperar das diversas lesões, evento significativo para o alvorecer de sua pintura. O objetivo deste estudo foi apresentar aspectos da biografia e da arte de Frida, buscando interseções entre sua arte e suas experiências de dor. CONTEÚDO: A partir da apreciação do filme e de telas selecionadas da autora - analisadas com o apoio dos artigos obtidos na revisão da literatura - foram organizadas quatro seções para a apresentação dos elementos obtidos: (1) As 'origens' de Frida, (2) O primeiro acidente, (3) O segundo acidente: Diego Rivera e (4) O martírio da maternidade frustrada. CONCLUSÃO: Frida obteve na arte seu maior conforto, transformando sua trajetória dolorosa e intensa em um fecundo processo de criação, o qual refletiu os sentidos de sua existência. .

A história da tuberculose no Brasil: os muitos tons (de cinza) da miséria / The history of tuberculosis in Brazil: The many shades (gray) of the misery

JUSTIFICATIVA E OBJETIVOS: A história da tuberculose (TB) no Brasil possui características próprias de acordo com o contexto político, social e científico vigente. O presente artigo teve por objetivo apresentar os aspectos de maior destaque atinentes à história da TB no Brasil, tecendo-se comentários relativos às principais conformações adquiridas pela moléstia em distintos intervalos temporais, do período colonial aos dias atuais. CONTEÚDO: A TB instalou-se no Brasil desde a colonização do país, disseminando-se entre as classes menos favorecidas. Durante o século XIX, a concepção da doença como "mal romântico" foi extremamente difundida, sobretudo entre os poetas da época. A partir do século XX a doença passa a ser claramente percebida como um preocupante problema de saúde, em termos individuais e coletivos. A partir de então, um conjunto de ações adotadas contribuíram para a importante redução da mortalidade da TB no país. CONCLUSÃO: O estudo da história da TB torna-se importante por oferecer subsídios para a elaboração de novas estratégias de controle, além de apontar para a não repetição de equívocos, os quais ecoam, historicamente, até os dias atuais.

BACKGROUND AND OBJECTIVES: The history of tuberculosis (TB) in Brazil has its own characteristics according to certain political, social and scientific current. This study aimed to present the most outstanding aspects related to the history of TB in Brazil, with comments relating to the major conformations acquired by the disease at different time intervals, from the colonial period to today. CONTENTS: The TB has settled in Brazil since its colonization, spreading in underprivileged classes. During the 19th century, the disease conception as "romantic sickness" was extremely widespread, especially among the poets of the time. At 20th century the illness was finally understood as a worrying health problem, both in individual and collective aspects. Since then, a set of actions were taken and all have contributed to the important TB mortality reduction in the country. CONCLUSION: The study of history of TB is important, since it may provide a substrate for the development of new strategies for the control of the disease, while pointing to the non-repetition of mistakes, which echoes, historically, until today.

Changes in management strategies after spontaneous migration of a retained intraorbital metallic foreign body.

PURPOSE: Because of the controversial biologic tolerance and management, retained intraorbital metallic foreign body (RIMFb) poses a formidable challenge to surgeons. Besides location of the foreign body, indications for surgical management include neurologic injury, mechanical restriction of the eye movement, and development of local infection or draining fistula. The authors describe an unusual case of spontaneous migration of a RIMFb. METHODS: A 26-year-old man had a gunshot injury on the left orbit. The patient was initially managed conservatively because of the posterior position of the bullet fragment. Thereafter, because of the clinical impairments and anterior migration of projectile, surgical treatment was considered. RESULTS: Spontaneous anterior migration has led to mechanical disturbances and inflammatory complications that comprise explicit surgical indications for removal. The patient underwent surgery with complete relief of symptoms. We suppose that extrinsic ocular muscles might play a role in shifting large RIMFb over time, leading to change in the management strategies. CONCLUSIONS: Spontaneous migration of RIMFb is a rare clinical situation that can lead to pain, local deformity, as well as changes in the management strategies of the affected patients even in the late phase of follow-up.

A obesidade infanto-juvenil e seu impacto da infância à vida adulta: uma revisão da literatura científica no período de 1997-2007 / The child-adolescent obesity and the impact from childhood to adult life: a systematic review of scientific literature in the period 1997-2007

Objetivos: O artigo objetiva identificar as consequências da obesidade infanto-juvenil, tanto na infância quanto na vida adulta, a partir de uma revisão sistemática com base na literatura médica atual. Fontes pesquisadas: Realizouse uma pesquisa bibliográfica às bases de dados MEDLINE, LILACS e Portal de Periódicos Capes , selecionando-se artigos publicados no período de 1997 a 2007. O principal critério de inclusão foi a presença de estudos que abordassemo impacto da obesidade infanto-juvenil da infância à vida adulta. Síntese dos dados: Nos resultados, a obesidade foi relacionada aos aspectos familiares, socioeconômicos, relativos a faixa etária, gênero e características constitucionais. Por fim, avaliou se o impacto dessa morbidade na saúde pública, evidenciando o aumento dos custos relacionados ao excesso de peso...

Objectives: This review purpose to identify the consequences of the child-adolescent obesity as in the childhood as in the adulthood from a systematic review based in the recent medical literature. Data source: A bibliography search was performed on MEDLINE, LILACS, and Capes Periodical Portal databases published between 1997 and 2007. The main inclusion criterion was the presence of studies which involves child-adolescent obesity impact from infancy to adulthood. Data synthesis: The results associate the obesity with genetics, socioeconomics, age and gender aspects. At last, we evaluate the impact of this disease in public health showing that the costs increase when related to overweight...