The impacts of the coronavirus pandemic on the mental health of Brazilian diagnosed with COVID-19 and comparison of symptoms of depression, anxiety, insomnia, and post-traumatic stress with undiagnosed subjects.

Background: The impacts of the COVID-19 pandemic on the mental health of survivors are little known, especially regarding the occurrence of psychological disorders such as anxiety and depression. In this study, we evaluated the impacts on the mental health of Brazilian survivors who were not infected or asymptomatic with COVID-19. Methods: A cross-sectional study was conducted collecting information through an electronic form from January to May 2021. The sample consisted of 1,334 people and were divided into two groups: case, with individuals who reported a positive diagnosis of the disease, with or without symptoms, and control, who reported not being diagnosed with COVID-19 and did not present any symptoms during the collection period. Validated instruments were used to investigate symptoms of depression (Patient Health Questionnaire), anxiety (Generalized Anxiety Disorder-7), post-traumatic stress disorder (Post Traumatic Stress Disorder Checklist) and insomnia (Insomnia Severity Index). The data were presented as standard deviation or median and interquartile ranges. The chi-square test was applied for statistical significance between categorical variables, considering a p < 0.05. Results: Regarding post-traumatic stress levels, the case and control groups showed no differences (p = 0.82). The results of the research indicated that was no statistical correlation between the group that was affected by the virus infection and the group that was not affected in terms of depression (p = 0.9) and anxiety (p = 0.7). At the same time, the levels of insomnia (p = 0.02) demonstrated a statistical correlation between the groups. The prevalence of the analyzed mental health disorders was similar among both groups. Conclusion: In conclusion, the population of survivors of COVID-19 infection tends to show little difference in terms of developing post-traumatic stress disorder, anxiety, and depression when compared to uninfected individuals. On the other hand, disorders such as insomnia are more prevalent and show a significant difference between groups, appearing more in infected individuals.

Physical structure and supplies for hand hygiene in the CCU of a public hospital / Estrutura física e insumos destinados à higienização das mãos no CTI de um hospital público / Estructura física e insumos destinados a la higienización de manos en la UCI de un hospital público

Background and Objectives: healthcare-associated infections (HAIs) are a serious public health problem worldwide. They occur mainly in Critical Care Units (CCUs), where physical structure and supplies do not favor hand hygiene (HH) compliance among health professionals. Thus, the present study aimed to describe and assess the physical structure and supplies for HH practice in a CCU of a public cancer hospital in the North region, Pará, Brazil. Methods: this is a descriptive, observational and cross-sectional study with a quantitative approach. Data were collected through a questionnaire based on the Guide to the Implementation of the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. Results: the study identified that there were 17 functioning beds and 6 interdicted, in addition to 11 sinks on site, but only 5 had liquid soap and paper towels, all with water. Ten alcohol dispensers were identified, but only 7 were functioning and replenished. None of the professionals found had a pocket alcoholic bottle. Conclusion: the study concluded that the physical structure and supplies found in the investigated CCU are partially adequate for carrying out hand disinfection. However, improvements in these structures must be implemented as well as periodic audits and permanent health education activities, aiming to remind professionals about HH practice correctly.(AU)

Justificativas e objetivos: as infecções relacionadas à assistência a saúde (IRAS) são um grave problema de saúde pública mundial. Ocorrem principalmente nos Centros de Terapia Intensiva (CTI), onde a estrutura física e insumos não favorecem a adesão da higienização das mãos (HM) entre os profissionais de saúde. Dessa forma, o presente estudo teve como objetivo descrever e avaliar a estrutura física e de insumos destinados à prática de HM em um CTI de um hospital público oncológico da região Norte, Pará, Brasil. Métodos: trata-se de um estudo descritivo, observacional e transversal com abordagem quantitativa. Os dados foram coletados através de um questionário baseado no Guia para a Implementação da Estratégia Multimodal da Organização Mundial da Saúde (OMS) para a Melhoria da Higiene das Mãos. Resultados: o estudo identificou que existiam 17 leitos funcionantes e 6 interditados, além de 11 pias no local, porém apenas 5 possuíam sabão líquido e papel toalha, todas com água. Foram identificados 10 dispensadores de álcool, porém apenas 7 estavam funcionantes e reabastecidos. Nenhum dos profissionais encontrados possuíam frasco alcoólico de bolso. Conclusão: o estudo concluiu que a estrutura física e os insumos encontrados no CTI investigado estão parcialmente adequados para a realização da prática de desinfecção das mãos. Contudo, devem ser implementadas melhorias nessas estruturas, bem como auditorias periódicas e atividades de educação permanente em saúde, visando relembrar os profissionais sobre a prática de HM de forma correta.(AU)

Justificación y objetivos: las infecciones asociadas a la atención de la salud (IAAS) son un grave problema de salud pública a nivel mundial. Ocurren principalmente en Unidades de Cuidados Intensivos (UCI), donde la estructura física y los suministros no favorecen la adherencia a la higiene de manos (HM) entre los profesionales de la salud. Así, el presente estudio tuvo como objetivo describir y evaluar la estructura física y los insumos para la práctica de la HM en una UCI de un hospital oncológico público de la región Norte de Pará, Brasil. Métodos: se trata de un estudio descriptivo, observacional, transversal con enfoque cuantitativo. Los datos fueron recolectados a través de un cuestionario basado en la Guía para la Implementación de la Estrategia Multimodal para la Mejora de la Higiene de Manos de la Organización Mundial de la Salud (OMS). Resultados: el estudio identificó que había 17 camas en funcionamiento y 6 intervenidas, además de 11 lavabos en el lugar, pero solo 5 tenían jabón líquido y toallas de papel, todas con agua. Se identificaron 10 dispensadores de alcohol, pero solo 7 funcionaban y se reponían. Ninguno de los profesionales encontrados tenía una botella de alcohol de bolsillo. Conclusión: el estudio concluyó que la estructura física y los insumos encontrados en la UCI investigada son parcialmente adecuados para la realización de la práctica de desinfección de manos. Sin embargo, se deben implementar mejoras en estas estructuras, así como auditorías periódicas y actividades de educación continua en salud, con el objetivo de recordar a los profesionales sobre la práctica correcta de HM.(AU)

Hazardous impact of vinasse from distilled winemaking by-products in terrestrial plants and aquatic organisms.

Vinasses obtained from the distillation of winemaking by-products (WDV) are complex effluents with variable physicochemical properties. Frequently, WDVs are used to irrigate agricultural soil, and/or discharged into aquatic bodies, which may result in serious environmental pollution, due to the presence of organic acids and recalcitrant compounds (polyphenols, tannins and metals). The present study aimed to evaluate the toxicity impact of an untreated WDV on terrestrial and aquatic organisms, at different levels of biological organization. The effluent was collected at the distillation column exit and characterized according to several physicochemical properties. The WDV potential phytotoxicity was assessed by germination inhibition assays on six agricultural crops, and its acute toxicity was assessed on Aliivibrio fisheri (microtox assay), Daphnia magna neonates (freshwater crustacean), and zebrafish Danio rerio (fish embryo toxicity test, FET). The WDV presented a low pH (3.88), high levels of electrical conductivity, ECond (6.36 dS m-1) and salinity (3.3 ppt), besides high level of potassium (2.1 g L-1) and organic compounds (TOC = 17.7 g L-1), namely polyphenols (1.7 g L-1). The diluted WDV displayed variable inhibitory effects on the plant endpoints (percentage of inhibition of germination and radicle elongation and germination index). Overall, plants' susceptibility to increasing concentrations of WDV were differential (onion ≈ garden cress ≥ tomato > lettuce > maize > green beans) and the germination index EC50 varied from 10.9 to 64.4% v/v. Also, the acute negative effects toward aquatic organisms were determined, decreasing from the more complex organism to the simpler one: zebrafish embryos (96 h-LC50 = 0.34% v/v)>D. magna (48 h-LC50 = 4.8% v/v)>A. fisheri (30min-EC50 = 7.0% v/v). In conclusion, the findings suggest that WDVs might have a high toxicological impact on both terrestrial plants and aquatic organisms, even at high dilution levels, reinforcing the need for appropriate treatments before considering its discharge or reuse.

Impact of mesophilic co-composting conditions on the quality of substrates produced from winery waste activated sludge and grape stalks: Lab-scale and pilot-scale studies.

In this study, different amounts of a mixture of winery waste activated sludge and grape stalks were co-composted for 8 weeks, at lab-scale under different temperatures and aeration rates, and at pilot-scale. None of the experiments showed the occurrence of a thermophilic stage, even when the composting temperature was kept at 34 °C, which might suggest biological suppression by the acclimated mesophilic microorganisms ubiquitous to the winery waste activated sludge. The composted substrates were fully characterized by physicochemical analysis, plant growth tests and germination indexes using parsley (Petroselinum crispum) seedlings and seeds. Surprisingly, despite the higher volume reduction at lab-scale, it was the initial mixture and the mixture composted outdoors which presented the best horticultural qualities, with seedling survival rates of 88.9% and 87.0% and modified germination indexes of 54% and 161%, respectively. These findings shed some light on previous contradictory results and allow the development of new recycling strategies.

Effect of an intervention in Physical Education classes on health related levels of physical fitness in youth / Efeito de um programa de Educação Física Escolar nos níveis de aptidão física relacionada à saúde de jovens

The aim of this study was to verify the effect of an interven-tion program during Physical Education (PE) classes on levels of physical fitness related to health in youth. This is a pre-ex-perimental study. The students (40 boys and 48 girls) were conveniently selected from a private school in Southern Brazil. Cardiorespiratory fitness was assessed through the six-minute test, recorded in meters (m), flexibility through the sit-and-reach test, recorded in centimeters (cm), abdominal strength/resistance through repetitions in one minute (rep) and body mass index (BMI) through the [mass/height²] equation. The intervention program was conducted in PE classes, often twice a week, during an entire school year. Data analysis was performed using descriptive analysis, Student's t-test and repeated meas-ures ANOVA, taking into consideration p<0.05. The PE pro-gram promoted improvement in cardiorespiratory fitness for boys (pre-test: 1123.0m±197.0m; post-test: 1247.2m±139.6m; p=0.002) and girls (pre-test: 940.7m±75.0m; post-test: 1028.7m±67.3m; p=0.001); abdominal strength/resistance for boys (pre-test: 46.1 rep±10.1 rep; post-test: 53.9 rep±10.4 rep; p=0.001) and girls (pre-test: 36.4 rep ± 8.3 rep; post-test: 44.0 rep±6.1 rep; p=0.001); and flexibility for boys (pre-test:22.7cm ± 8.1cm; post-test: 27.6cm ±7.2cm; p=0.006) and girls (pre-test: 32.0cm±6.2cm; post-test: 34.8cm ± 6.4cm; p=0.032). There wer-en't changes in mean BMI values. Therefore, it's considered that the PE program aimed at health promotion through physical fitness can improve the indicators of cardiometabolic and muscle-skeletal health in students.

O objetivo deste estudo foi verificar o efeito de um programa de in-tervenção nas aulas de Educação Física Escolar sobre os níveis de aptidão física relacionada à saúde de jovens. Trata-se de um estudo pré-experimental. Os estudantes (40 meninos e 48 meninas) fo-ram selecionados por conveniência em uma escola privada do sul do Brasil. Foram avaliados a aptidão cardiorrespiratória através do teste de seis minutos, anotado em metros (m), flexibilidade através do teste de sentar e alcançar, anotado em centímetros (cm), força/resistência abdominal através de repetições em um minuto (rep) e índice de massa corporal (IMC) através da equação massa/estatu-ra². O programa de intervenção foi realizado nas aulas de Educa-ção Física, com frequência de duas vezes semanais, durante um ano letivo. Para análise dos dados recorreu-se a análise descritiva, teste t de Student e ANOVA de medidas repetidas, levando em conside-ração um p < 0,05. O programa de Educação Física Escolar pro-moveu melhoria da aptidão cardiorrespiratória dos meninos (pré: 1123,0m±197,0m; pós: 1247,2m±139,6m; p: 0,002) e meninas (pré: 940,7m±75,0m - pós: 1028,7m±67,3m; p: 0,001), força/re-sistência abdominal dos meninos (pré: 46,1 rep±10,1 rep - pós: 53,9 rep±10,5 rep; p: 0,001) e meninas (pré: 364 rep±8,3 rep - pós: 44,0 rep±6,1 rep; p: 0,001) e flexibilidade dos meninos: (pré: 22,7cm±8,-1cm - pós: 27,6cm±7,2cm; p: 0,006) e meninas (pré: 32,0cm±6,-2cm - pós: 34,8cm±6,4cm; p: 0,032). Não houveram variações nos valores médios do IMC. Portanto, considera-se que o programa de educação física escolar direcionado à promoção da saúde, através da aptidão física pode melhorar os indicadores de saúde cardiometabó-lica e musculoesquelética em estudantes.

[Low back pain and associated factors in children and adolescents in a private school in Southern Brazil]. / Ocorrência de dor lombar e fatores associados em crianças e adolescentes de uma escola privada do sul do Brasil.

Studies have shown that children and adolescents with low back pain are also similarly affected when they reach adulthood, thus highlighting the importance of investigating causes of low back pain in school-age children. The study examined low back pain and associated factors in 770 schoolchildren 7 to 17 years of age in a private school in Porto Alegre, Rio Grande do Sul State, Brazil. Low back pain was defined as pain or discomfort in the lumbar region in the previous month, assessed by a questionnaire. Low back pain was found in 31.6% of the subjects and was more prevalent in girls (41.9%) than boys (21.4%). Factors associated with lumbar pain were female gender, age 9 to 17 years, hyperactivity (borderline and abnormal categories), and emotional symptoms (abnormal category). Mapping the occurrence of low back pain and associated factors is important for identifying children and adolescents at risk and for developing effective programs for primary prevention.

Ocorrência de dor lombar e fatores associados em crianças e adolescentes de uma escola privada do sul do Brasil / Low back pain and associated factors in children and adolescents in a private school in Southern Brazil / La aparición de dolor de espalda y los factores asociados en niños y adolescentes en una escuela privada en el sur de Brasil

Estudos têm demonstrado que indivíduos que apresentam dor lombar na infância e adolescência são acometidos também na vida adulta, reforçando a importância de que as causas sejam investigadas desde a idade escolar. Avaliou-se a ocorrência de dor lombar e fatores associados em 770 escolares de 7 a 17 anos de idade de uma escola privada de Porto Alegre, Rio Grande do Sul, Brasil. A dor lombar foi definida como dor ou desconforto na região lombar no último mês e avaliada por meio de questionário. A ocorrência de dor lombar foi de 31,6%, sendo mais prevalente no sexo feminino (41,9%) do que no masculino (21,4%). Os fatores associados à dor lombar foram sexo feminino, idade de 9 a 17 anos e os aspectos psicossociais hiperatividade (categorias limítrofe e anormal) e sintomas emocionais (categoria anormal). O mapeamento da ocorrência de dor lombar, bem como a investigação de seus fatores associados é de fundamental importância para a identificação de crianças e adolescentes em risco e para o desenvolvimento de programas eficazes de prevenção primária.

Studies have shown that children and adolescents with low back pain are also similarly affected when they reach adulthood, thus highlighting the importance of investigating causes of low back pain in school-age children. The study examined low back pain and associated factors in 770 schoolchildren 7 to 17 years of age in a private school in Porto Alegre, Rio Grande do Sul State, Brazil. Low back pain was defined as pain or discomfort in the lumbar region in the previous month, assessed by a questionnaire. Low back pain was found in 31.6% of the subjects and was more prevalent in girls (41.9%) than boys (21.4%). Factors associated with lumbar pain were female gender, age 9 to 17 years, hyperactivity (borderline and abnormal categories), and emotional symptoms (abnormal category). Mapping the occurrence of low back pain and associated factors is important for identifying children and adolescents at risk and for developing effective programs for primary prevention.

Los estudios han demostrado que las personas con dolor de espalda en la infancia y la adolescencia también se ven afectadas en la edad adulta, lo que subraya la importancia de que las causas se investiguen desde la edad escolar. Se evaluó la incidencia de dolor de espalda y factores asociados, en 770 escolares de 7 a 17 años en una escuela privada en Porto Alegre, Rio Grande do Sul, Brasil. La lumbalgia se define como un dolor o molestia en la espalda en el último mes y fue evaluada mediante un cuestionario. La aparición de dolor lumbar se produjo en un 31,6%, siendo más frecuente en el sexo femenino (41,9%) que en hombres (21,4%). Los factores asociados con el dolor de espalda eran: mujeres, edad de 9 a17 años, y aspectos psicosociales como hiperactividad (categorías borderline y anormal) y síntomas emocionales (categoría anormal). El mapeo de la aparición de dolor en la zona baja de la espalda, así como investigar factores asociados, es fundamental para identificar a los niños, niñas y adolescentes en situación de riesgo, con el fin de desarrollar programas eficaces para la prevención primaria.

Da rotatividade migratória à baixa migração: uma análise dos padrões da mobilidade populacional no Brasil de 1995-2000 / From rotative to low migration patterns: an analysis of 1995-2000 patterns of population mobility in Brazil / /De la rotación migratoria a la baja migración: un análisis de los patrones de la movilidad poblacional en Brasil de 1995-2000

Este trabalho propõe uma metodologia de classificação dos municípios brasileiros conforme a característica migratória, tendo como base as informações disponíveis no Censo Demográfico de 2000. Foram aplicadas análises multivariadas de redução e classificação de dados sobre um conjunto de variáveis selecionadas que descrevem a forma como os 5.507 municípios se articulam na rede migratória brasileira. Primeiramente, aplicou-se uma análise de componentes principais com a finalidade de reduzir o conjunto de variáveis originais em componentes não correlacionados entre si. Posteriormente, estes componentes foram empregados numa análise classificatória de cluster com o objetivo de estabelecer uma tipologia migratória das localidades em estudo. Os resultados mostraram que há importantes diferenciais na inserção dos municípios na rede migratória, na qual existe um grande número de lugares pouco conectados em contraste com um número pequeno de pontos que experimentam fortes conexões, e nos quais a população circula rapidamente. A classificação aponta para a existência de novas categorias de lugares, além das definições clássicas de atração e repulsão, como a rotatividade migratória.

The authors propose a method for classifying the 5507 municipalities in Brazil according to their characteristics of migration phenomena, as shown in the data now available from the 2000 National Brazilian Census. Multivariate classifications for data reduction and classification analysis were carried out on a set of selected variables that describe how the municipalities in the country are articulated with the overall Brazilian migration network. First a central component analysis was applied in order to reduce the set of original variables into a new set of uncorrelated components. Next these components were used in a classificatory cluster analysis with the purpose of establishing a migration typology for the locations being studied. The results showed that there are great differences among municipalities in their participation in the migration network. There are many municipalities with weak ties with the migration network and a few areas with strong ties, where the populations are very mobile. We have called these municipalities "rotative locations." This classification indicates the existence of new categories of territory beyond the classical definitions of attraction and repulsion, one example being these rotative areas.

Este trabajo propone una metodología de clasificación de los municipios brasileños según la característica migratoria, utilizando como base las informaciones disponibles en el Censo Demográfico de 2000. Se aplicaron análisis multivariantes de reducción y clasificación de datos sobre un conjunto de variables seleccionadas que describen la forma en la que los 5.507 municipios se articulan en la red migratoria brasileña. En primer lugar se aplicó un análisis de componentes principales con la finalidad de reducir el conjunto de variables originales en componentes no correlacionados entre sí. Posteriormente, estos componentes fueron utilizados en un análisis clasificatorio de cluster, con el objetivo de establecer una tipología migratoria de las localidades en estudio. Los resultados mostraron que hay importantes diferenciales en la inserción de los municipios en la red migratoria, en la que existe un gran número de lugares poco conectados en contraste con un número pequeño de puntos que experimentan fuertes conexiones, y en los cuales la población circula rápidamente. La clasificación señala la existencia de nuevas categorías de lugares, además de las definiciones clásicas de atracción y repulsión, como la rotación migratoria.

Avaliação de 76 casos de traumatismo crânio-encefálico por queda da própria altura atendidos na emergência de um hospital geral / Evaluation of 76 cases of traumatic brain injury from falling from standing height in an Emergency

Objetivo: O objetivo deste estudo foi elaborar um perfil epidemiológico de pacientes que sofreram traumatismo crânio-encefálico (TCE) por queda da própria altura (QPA). Métodos: Foram selecionados os pacientes com TCE atendidos na emergência de um hospital geral em Florianópolis (SC) durante um período de dois meses. Os pacientes que apresentaram TCE por QPA foram avaliados. As variáveis deste estudo incluíram: idade, sexo, presença de comorbidades e pontuação na Escala de Coma de Glasgow (ECG) no momento da admissão à emergência. Resultados: Setenta e seis pacientes (44 homens e 32 mulheres) preencheram os nossos critérios de inclusão. As idades dos pacientes à admissão variaram de 15 a 98 anos (média: 45,8 anos). Aproximadamente 63% dos pacientes utilizaram o carro privado como meio de transporte préhospitalar; 15% tinham história de ingestão alcoólica recente; 37% perderam a consciência imediatamente antes ou logo após o trauma e 37% tinham uma ou mais comorbidades conhecidas no momento do trauma. De acordo com a ECG, cerca de 90% dos pacientes sofreram TCE leve(ECG>12). Conclusões: A maioria dos pacientes atendidos na emergência devido a TCE por QPA são homens eindivíduos com idade superior a 40 anos. O sexo masculino está mais freqüentemente associado com uma história de ingestão alcoólica. O consumo de álcool está associado com a perda de consciência e maior gravidade do TCE. As análises demonstraram não haver relação da gravidade do TCE com osexo, a idade, a perda da consciência ou a presença de comorbidades associadas.

Objective: The aim of this study was to elaborate an epidemiological profile of patients who suffered traumatic brain injury (TBI) from falling from standing height. Methods: We selected the patients with TBI presented to the emergency room (ER) of a generalhospital in Florianopolis (Brazil) during a time period of two months. Patients who suffered TBI caused by falling from standing height were evaluated. The variables analyzed included: age, sex,presence of comorbidities and the Glasgow Coma Scale score (GCS) at the time of admission to the ER.Results: Seventy six patients (44 men and 32 women) fulfilled our inclusion criteria. Ages at admission ranged from 15 to 98 years (mean: 45.8 years). Approximately 63% of patients arrived at the hospital by private car, 15% had a history of recent alcohol consumption, 37% lost consciousness immediately before or right after the trauma, and 37% had one or more known comorbidities. According to the CGS, about 90% of patients had a mild TBI (GCS>12). Conclusions: Most patients admitted into ER with TBI from falling from standing height are men andpeople older than 40 years old. Male sex is more often associated with a history of alcohol intake. Alcohol consumption is associated with loss of consciousness and severity of TBI. The analysisdemonstrated no correlation between sex, age, loss of conscioussness or comorbidities and the severity of TBI.

Factors affecting reproductive performance of Holstein heifers.

The objectives were to evaluate factors affecting reproductive performance of dairy heifers. Holstein heifers (6389) were housed in a feed lot located in Parma, ID. Each week heifers weighing > or =290 kg were initiated in the reproductive program, which consisted of one injection of PGF(2alpha) and AI on detection of estrus. Heifers not inseminated by 11 days after the initiation of the breeding program received a second injection of PGF(2alpha). Pregnancy was diagnosed at 40+/-3 and 90+/-3 days after AI. Average daily minimum temperature (ADMnT), average daily maximum temperature (ADMxT), and average daily rainfall (ARF) were recorded between 15 days prior to and 15 days after the day of AI or the day of initiation of the breeding program. Exposure to air temperature was classified as: cold stress (CS=ADMnT< or =4 degrees C), no stress (NS=ADMnT>4 degrees C and ADMxT<29 degrees C), and heat stress (HS=ADMxT> or =29 degrees C). Exposure to rainfall was classified as above (HRF) or below (LRF) the mean for the period in question. Heifers were classified according to body weight at initiation of the breeding program as thin (TH<340 kg); moderate (MD=340-365 kg); and heavy (HY>365 kg). Service sire was associated with conception rate at 40 and 90 days after first AI. Although exposure to air temperature was not correlated with conception rate at 40 days after first AI, heifers exposed to cold stress had smaller conception rates at 90 days after first AI because they were more likely to lose pregnancy between 40 and 90 days of gestation. The proportion of heifers inseminated after initiation of the breeding program was correlated with body weight and exposure to cold stress. Exposure to cold stress was also correlated with the proportion of heifers conceiving within 11 and 22 days after initiation of the breeding program. From this study a correlation was established between body weight and rate of insemination and between the exposure to cold stress and reproductive efficiency of Holstein heifers.

Neurosurgical management of cerebellar cavernous malformations.

OBJECT: The aim of this study was to analyze cerebellar cavernous malformations (CMs) with respect to epidemiological, clinical, radiological, and therapeutic aspects. METHODS: Between 1984 and 2004, 100 patients were surgically treated for intracranial CMs at the Division of Neurosurgery of Federal University of Sao Paulo. The authors reviewed the records of 10 patients whose lesions were located in the cerebellum. There were four male and six female patients (ratio 1:1.5) whose ages ranged from 14 to 45 years (mean age 33 years). Clinical presentation was sudden or acute in all cases, and neuroimaging examinations performed in all patients demonstrated signs of bleeding. The mean size of the malformations was 4.6 cm, and in all but one patient the lesions were totally removed without complications. After a mean follow-up period of 70 months, all patients were considered to be in good or excellent clinical condition. CONCLUSIONS: Cerebellar CMs should be analyzed separately from other posterior fossa CMs. These lesions can reach large sizes and cause massive hemorrhages, resulting in acute or sudden presentation. Surgery is a safe and effective option that provides a curative treatment when a complete removal is achieved.

[Dissecting aneurysm of the intracranial fenestrated vertebral artery submited to endovascular treatment: case report]. / Aneurisma dissecante de artéria vertebral intracraniana fenestrada submetido ao tratamento endovascular: relato de caso.

Dissecting aneurysms of the vertebral artery at its intracranial segment are uncommon lesions, mainly when associated to subarachnoid hemorrhage, being also rare fenestrations of the vertebral artery. They present high morbidity and mortality, with high rebleeding rate and difficulty of surgical approach. We present a 19 years old man who was victim of physical aggression in the occipto-cervical region, presenting subarachnoid hemorrhage and a dissecting aneurysm of the right vertebral artery, which had a fenestration, being submitted to endovascular treatment. We accomplished a literature review about this subject, proposing endovascular treatment as a therapeutic option for these cases.

Aneurisma dissecante de artéria vertebral intracraniana fenestrada submetido ao tratamento endovascular: relato de caso / Dissecting: aneurysm of the intracranial fenestrated vertebral artery submited to endovascular treatment case report

Aneurismas dissecantes da artéria vertebral em seu segmento intracraniano são lesões pouco comuns, principalmente quando associadas a hemorragia subaracnóidea, sendo também raras as fenestrações da artéria vertebral. Apresentam elevada morbidade e mortalidade, com elevado índice de ressangramento e dificuldade de abordagem cirúrgica. Apresentamos o caso de um homem de 19 anos, o qual foi vitima de agressão física em região occipto-cervical, apresentando hemorragia subaracnóidea e aneurisma dissecante na artéria vertebral direita, a qual era fenestrada, sendo submetido ao tratamento endovascular. Realizamos revisão da literatura sobre o assunto, sendo colocado o tratamento endovascular como uma opção terapêutica para estes casos.

Giant intrathoracic meningoceles associated with cutaneous neurofibromatosis type I: case report.

BACKGROUND: Intrathoracic meningocele is a rare pathology, almost always associated with neurofibromatosis type I and with a few cases related in the literature. In the majority of cases cysts are small or asymptomatic, and the surgery is indicated when big or symptomatic cysts are present. We report a case of giant intrathoracic cysts surgically extirpated through out thoracotomy. CASE: A 59-year-old male with familiar Von Recklinghausen's disease which developed thoracic radicular pain after a fall. On examination he presented some difficulty in walking fast and dyspneia on small efforts. The chest plain x-ray showed the presence of 3 huge left side intrathoracic cysts (10 to 15cm). The patient was submitted to a surgical treatment and complete extirpation of the cysts was performed through a left side thoracotomy. During the surgery a fourth smaller cyst was detected and also extirpated. Evolution was uneventful and the patient remains well in these last 12 years. This finding of intrathoracic cysts related to neurofibromatosis type I is rare and is probably unique in the literature the presence of 4 huge cysts in one side of the thorax.

Giant intrthoracic meningoceles associated with cutaneous neurofibromatosis type I: case report

BACKGROUND: Intrathoracic meningocele is a rare pathology, almost always associated with neurofibromatosis type I and with a few cases related in the literature. In the majority of cases cysts are small or asymptomatic, and the surgery is indicated when big or symptomatic cysts are present. We report a case of giant intrathoracic cysts surgically extirpated through out thoracotomy. CASE: A 59-year-old male with familiar Von Recklinghausen's disease which developed thoracic radicular pain after a fall. On examination he presented some difficulty in walking fast and dyspneia on small efforts. The chest plain x-ray showed the presence of 3 huge left side intrathoracic cysts (10 to 15cm). The patient was submitted to a surgical treatment and complete extirpation of the cysts was performed through a left side thoracotomy. During the surgery a fourth smaller cyst was detected and also extirpated. Evolution was uneventful and the patient remains well in these last 12 years. This finding of intrathoracic cysts related to neurofibromatosis type I is rare and is probably unique in the literature the presence of 4 huge cysts in one side of the thorax

Cervical epidural haematoma with clivus fracture: case report.

Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.

Cervical epidural haematoma with clivus fracture: case report

Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review

[Slipped clip: report of two cases]. / Slipped clip: relato de dois casos.

Aneurysm rest occurs in 1 to 10% of operated patients and of these, 21.8% are due to slipped clips. D'Angelo and coworker (1998) found 1 to 10% of residual aneurysms. They suggest that if the residual aneurysm has less than 2 mm, angiographic control must be performed after 3-5 years of the surgical procedure; if between 2 and 4 mm, the angiographic control must be done in the first 6 months after surgery and then, anually. If it has more than 4mm a direct surgical approach is advised. We present the cases of two female patients submitted to microsurgical treatment of intracranial aneurysm, without any intra-operative abnormal event. The angiographic study further made showed displacement of the clip from its original position and aneurysm again. A review of the literature is also presented.

Slipped clip. Relato de dois casos / Slipped clip: report of two cases

A incidência de clipagem de aneurismas em que permanecem restos da dilataçäo varia, nas séries estudadas, de 1-10 por cento. Deste percentual, 21,8 por cento é devido à migraçäo do clipe.D Angelo e seus colaboradores (1998), encontraram 1 a 10 por cento de aneurismas residuais. Sugerem que quando o resíduo for menor que 2 mm seja realizado estudo angiográfico entre 3-5 anos após o procedimento cirúrgico; se entre 2 e 4 mm, este estudo deve ser mais precoce, dentro dos primeiros 6 meses e depois anualmente; e, quando maior que 4 mm, a reabordagem. Apresentamos os casos de duas pacientes submetidas a tratamento cirúrgico de aneurismas intracranianos, com intra-operatório sem intercorrências e que, em exames ulteriores, evidenciaram migraçäo do clipe de sua posiçäo original. É apresentada, ainda, revisäo da literatura