Stentoplastia no tratamento precoce das fraturas de coluna em idoso: relato de caso / Stentoplasty for early treatment for spine fracture in elderly: Case report

O objetivo deste artigo é fazer o relato de caso de um paciente idoso, submetido a tratamento cirúrgico de fratura osteoporóticade coluna lombar com um método pouco difundido no Brasil. Normalmente o tratamento instituído é a vertebroplastia oucifoplastia, mas os autores vêm obtendo melhores resultados com a stentoplastia nesta população, método este que envolve acolocação de um stent no corpo vertebral associado a cimento ósseo. Este procedimento fornece mais segurança e estabilidadeà vértebra quando comparado aos métodos tradicionais...

The main purpose of this article is to describe a new method, that has not been used frequently in Brazil. Mostly the physicianshas used the vertebroplasty or kyphoplasty to treat spine fracture, but the authors have been achieving better results with thestentoplasty in this population. This method evolves a vertebral stent inside the fractured bone. This procedure gives the patientmore safety and stability when comparing it to other kind of treament...

Aneurysm and neurocysticercosis: casual or causal relationship? Case report and review of the literature.

Four cases of suggestive inflammatory aneurysms in patients with neurocysticercosis have been described. We report a case of a 49-year-old woman who presented with subarachnoid haemorrhage from a right middle cerebral artery bifurcation aneurysm and had a casual relationship with neurocysticercosis. At surgery, a viable cysticercus without signs of inflammation or thickened leptomeninges was found in the distal position of the aneurysm. Postoperatively, the patient received albendazole and dextrochlorpheniramine. In the subsequent three years, the patient was asymptomatic and took drugs to prevent convulsion and arterial hypertension. The relationship between NCC and the presence of cerebral aneurysm is discussed.

The effects of 6% hydroxyethyl starch-hypertonic saline in resuscitation of dogs with hemorrhagic shock.

BACKGROUND: Hemodynamic and global oxygen transport variables have failed to reflect splanchnic hypoperfusion, resulting in a failure to recognize inadequately treated hemorrhagic shock. Volemic expansion after fluid resuscitation is essential to improve global and regional oxygen in hemorrhagic shock. We hypothesized that, in contrast to conventional plasma expanders, the smaller volemic expansion from 7.5 NaCl/6% hydroxyethyl starch (HHES) solution administration in hemorrhagic shock may provide lesser systemic oxygen delivery and gastric perfusion. We used hemorrhaged dogs to compare intravascular volume expansion and the early systemic oxygenation and gastric perfusion effects of fixed fluid bolus administration, which are usually used in clinical situations with severe hemorrhage, of HHES, lactated Ringer (LR), and 6% hydroxyethyl starch (HES) solutions. METHODS: Thirty dogs were bled (30 mL · kg(-1)) to hold mean arterial blood pressure at 40 to 50 mm Hg over 45 minutes and were resuscitated in 3 groups: LR (n = 10) at 3:1 ratio to shed blood; HES (mean molecular weight 130 kDa, degree of substitution 0.4) (n = 10) at 1:1 to shed blood; and HHES (n = 10), 4 mL · kg(-1). Intravascular volume expansion (Evans blue and hemoglobin dilution), hemodynamic, systemic oxygenation, venous-to-arterial CO(2) gradient (Pv-aCO(2)), and gastric intramucosal-arterial PCO(2) gradient (PCO(2) gap) variables were measured at baseline, after 45 minutes of hemorrhage, and 5, 45, and 90 minutes after fluid resuscitation. RESULTS: HHES increased blood volume because of the high volume expansion efficiency, but intravascular volume expansion with this solution was the smallest of the solutions (P < 0.05). All 3 solutions induced a similar hemodynamic performance but HHES showed lower mixed venous PO(2) and higher systemic oxygenation extraction, Pv-aCO(2), and PCO(2) gap than LR and HES (P < 0.05). CONCLUSIONS: In dogs submitted to pressure-guided hemorrhagic shock and fixed-volume resuscitation, the smaller intravascular volume expansion from HHES solutions provides worse recovery of systemic oxygenation and gastric perfusion compared with LR and HES solutions despite its high volume expansion efficiency, which was limited by low infused volume.

Endoscopic third ventriculostomy / Terceiroventriculostomia endoscópica

Objectives: In the present paper we report and discuss our experience with endoscopic third ventriculostomies (ETVs). We will point out surgical, technical data and complicationsinvolved. Methods: Between September 1995 and August 2007, we selected 283 patients with hydrocephalus which were submitted exclusively to ETV. Results: In our series, 145 (51.24%) patients were male, and 138 (48.76%) female. Age varied from 2 days to 83 years-old (medium of 15 years and 8 months). Most of the patients had obstruction at the cerebral aqueduct level (aqueduct stenosis, benign tectal tumors). In our series there was not a single death directly due to the procedure. However 20 patients (7%) evolved with post-surgical complications and 3 of them were permanent, with memory deficit in one and epilepsy in two. There was failure in the procedure during the early post-surgical eriod in 37 (13%) patients, who then needed ventricular shunt systems to resolve hydrocephalus. Conclusions: Our results suggest that ETV should be considered as the initial treatment to hydrocephalus in all patients whose magnetic resonance exams shows a site of obstruction to the CSF flow. We consider that the most important factor to the treatment success is the adequate selection of patients.

Objetivos: Neste trabalho, relataremos nossa experiência na realização de terceiroventriculostomias endoscópicas (TVE’s). Discutiremos dados técnicos, cirúrgicos e as complicações ocorridas. Métodos: No período de Setembro de 1995 a Agosto de 2007, selecionamos 283 pacientes com hidrocefalia submetidos exclusivamente a TVE. Resultados: Na nossa série, 145 (51,24%) pacientes eram do gênero masculino e 138 (48,76%) do gênero feminino. A idade variou entre 2 dias a 83 anos de vida (media de 15 anos e 8 meses). A maioria dos pacientes apresentava obstrução ao nível do aqueduto cerebral (estenose aquedutal, tumores tectais). Na nossa série, não houve nenhum óbito relacionado ao procedimento. Entretanto, 20 (7%) pacientes evoluíram com complicações pós-operatórias sendo três permanentes, um com déficit de memória e dois com epilepsia. Ocorreu falha do procedimento no período pós-operatório precoce em 37 (13%) pacientes que necessitaram de sistemas de derivação ventricular para resolução da hidrocefalia. Nossos resultados sugerem que a TVE deve ser considerada o tratamento inicial da hidrocefalia em pacientes cujos exames de ressonância magnética evidenciem um sítio de obstrução ao fluxo liquórico. Consideramos que o fator mais importante para o sucesso do tratamento é a adequada seleção dos pacientes.

[Crouzon syndrome: factors related to the neuropsychological development and to the quality of life]. / Síndrome de crouzon: fatores envolvidos no desenvolvimento neuropsicologico e na qualidade de vida.

Crouzon syndrome is characterized by cranial and facial abnormalities and exophtalmos. Mental retardation is sometimes observed. The objective of this study was to correlate brain malformations, timing for surgery and also social classification of families and parents education to the neuropsychological evaluation and to the quality of life of these families. Eleven patients with Crouzon syndrome were studied, whose ages were between 16 and 132 months. The multidisciplinary evaluation included : social evaluation, cognitive evaluation, brain studies by magnetic resonance imaging and quality of life evaluation. The intelligence quotient values observed were between 46 and 102 (m=84.2) and was correlated (inverted correlation) to the factor IV of the short-form of the Questionnaire on Resources and Stress. Mental development was not correlated to brain malformation, neither to the age at time of operation or to the level of family environment and parents education.

Síndrome de crouzon: fatores envolvidos no desenvolvimento neuropsicologico e na qualidade de vida / Crouzon syndrome: factors related to the neuropsychological development and to the quality of life

A síndrome de Crouzon é caracterizada por deformidade craniana, alterações faciais e exoftalmia. O retardo no desenvolvimento neuropsicomotor é observado em alguns casos. Este estudo tem como objetivo analisar a influência do momento da cirurgia, da classe sócio-econômica associada ao nível educacional dos pais e da ocorrência de malformações do sistema nervoso central no desenvolvimento cognitivo destes pacientes correlacionando estes achados à qualidade de vida deles e de suas famílias. Foram estudados 11 pacientes com diagnóstico de síndrome de Crouzon com idade entre um ano e quatro meses e treze anos. A avaliação multidisciplinar dos pacientes incluiu, avaliação social, avaliação cognitiva, estudo do encéfalo por ressonância magnética e avaliação da qualidade de vida. O quociente de inteligência variou de 46 a 102 (m=84,2) e foi correlacionado de forma inversa com o Fator 4 do Questionário de Recursos e Estresse Simplificado (incapacidade da criança); não se correlacionou com as alterações encefálicas, com a condição sócio-econômica dos pais e nem com o momento do tratamento neurocirúrgico.

Crouzon syndrome is characterized by cranial and facial abnormalities and exophtalmos. Mental retardation is sometimes observed. The objective of this study was to correlate brain malformations, timing for surgery and also social classification of families and parents education to the neuropsychological evaluation and to the quality of life of these families. Eleven patients with Crouzon syndrome were studied, whose ages were between 16 and 132 months. The multidisciplinary evaluation included : social evaluation, cognitive evaluation, brain studies by magnetic ressonance imaging and quality of life evaluation. The intelligence quotient values observed were between 46 and 102 (m=84.2) and was correlated (inverted correlation) to the factor IV of the short-form of the Questionnaire on Resources and Stress. Mental development was not correlated to brain malformation, neither to the age at time of operation or to the level of family environment and parents education.