Unruptured Brain Arteriovenous Malformations: A Systematic Review and Meta-Analysis of Mortality and Morbidity in Aruba-Eligible Studies.

BACKGROUND: Treating unruptured brain arteriovenous malformations (bAVMs) represent significant challenges, with numerous uncertainties still in debate. The ARUBA trial induced further investigation into optimal management strategies for these lesions. Here, we present a systematic-review and meta-analysis focusing on ARUBA-eligible studies, aiming to correlate patient data with outcomes and discuss key aspects of these studies. METHODS: Following PRISMA guidelines, we conducted a systematic-review. Variables analyzed included bAVM Spetzler-Martin (SM) grade, treatment modalities, and outcomes such as mortality and neurological deficits. We compared studies with a minimum of 50% cases classified as SM 1-2 lesions and those with less than 50% in this category. Similarly, a comparison between studies with at least 50% microsurgery-cases and those with less than 50% was performed. We examined correlations between mortality incidence, SM distribution, and treatment modalities. RESULTS: Our analysis included 16 studies with 2.417 patients. The frequency of bAVMs SM-grade 1-2 ranged from 44% to 76%, SM-grade 3 from 19% to 48%, and SM 4-5 from 5 to 23%. Notably, studies with more than 50% cases presenting lesions SM-grade 1-2 presented significantly lower mortality rates than those with less than 50% cases of SM 1-2 lesions (P < 0.001). No significant difference in mortality rates or neurological deficits was identified between studies with more than 50% of microsurgery-cases and those with less than 50%. CONCLUSIONS: The analysis revealed that studies with a higher proportion of bAVMs presenting SM 1-2 lesions were associated with lower mortality rates. Mortality did not show a significant association with treatment modalities.

Cognitive abilities and medical students' practice of physical exams: A quasi-experimental study.

BACKGROUND: To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching. OBJECTIVE: To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory. DESIGN AND SETTING: A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil. METHODS: A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction). RESULTS: Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000). CONCLUSION: Concentrated laboratory practice resulted in positive improvements in students' physical examination skills.

Survival in patients undergoing surgical resection for brain metastasis from lung cancer and utility of different prognostic scales.

Brain metastases (BM) from lung cancer are among the most common intracranial tumors. Several studies have published scales to estimate the survival of patients with BM. Routine access to molecular diagnostics and modern oncologic treatments, including targeted therapy and immunotherapy, is limited in low- and middle-income countries (LMICs); therefore, incorporating them into recent prognostic scales may diminish the reliability of the scales in LMICs. This retrospective study aimed to determine the survival of 55 patients who were surgically treated for BM from lung cancer at a Brazilian public tertiary teaching hospital between 2012 and 2022. We determined clinical factors associated with survival, and compared observed survival rates with the estimated survival on prognostic scales. The mean overall survival (OS) was 9.3 months (range:0.2-76.5). At univariate analysis, female sex and improved postoperative Karnofsky performance status (KPS) score were associated with longer survival. The median survival did not differ between groups when classified using the Graded Prognostic Assessment (GPA)-2008, Lung-molecular GPA-2017, and Lung-GPA-2021 scales. According to the Diagnosis-Specific (DS)-GPA-2012 scale, there was a significant difference between the groups. In the multivariate Cox regression survival analysis, a higher DS-GPA-2012 and improved postoperative KPS score remained significantly associated with longer survival. In conclusion, this cohort showed a mean OS of < 1 year. Improved KPS score after surgery was associated with increased survival. This cohort DS-GPA scale demonstrated the highest concordance with observed survival, indicating its potential as a valuable tool for patient stratification in surgical treatment decision-making in LMICs.

Métodos de avaliação cognitiva de pacientes com Síndrome de Apert e de Crouzon / Cognitive assessment methods of patients with Apert and Crouzon syndrome

A Craniossinostose Coronal bilateral implica em diminuição do Perímetro Craniano (PC) no eixo ântero-posterior (Braquicefalia) e frequentemente se associa ao aumento do eixo céfalo-caudal (vertical-altura) do crânio (Turricefalia), sendo um dos achados mais comuns nas Síndromes de Crouzon e Apert. Objetivo: Identificar, analisar e sintetizar os métodos de avaliação cognitiva apropriados para o acompanhamento da evolução de pacientes com cranioestenoses sindrômicas, em particular as síndromes de Apert e de Crouzon. Método: Trata-se de uma revisão de escopo. Para a formulação da pergunta norteadora da pesquisa e da estratégia de busca, foi utilizada a estratégia Population [((Apert OR Crouzon) AND (Disease OR Syndrom*))], Concept [((cognit* OR neurobehavioral OR neurocognit* OR neuropsyc*) AND (evaluation OR evaluations OR assessment OR "test" OR tests OR status OR development OR disorder OR disorders OR impairment OR impairments OR impaired OR function OR functions))] e Context (em qualquer contexto). Foram inclusos os artigos escritos em inglês, português e espanhol em qualquer período. A busca foi realizada nas bases de dados: Embase, Scopus, PubMed/MEDLINE e rede BVS Salud. Resultados:Inúmeros testes de avaliação cognitiva validados internacionalmente foram aplicados aos pacientes com Apert e Crouzon, mas não se observou uma padronização (protocolo) seguida pelas várias unidades de assistência. Dos 75 tipos de Testes Cognitivos aplicados houve o predomínio da Escala de Inteligência de Wechsler (e seus subtestes), 50%. Na população avaliada predominou duas faixas etárias: escolares e adolescentes. As crianças com Apert e Crouzon obtiveram escores piores nos transtornos de socialização, atenção e internalização quando comparadas com o grupo normativo, sendo os piores resultados encontrados em Apert. Fatores que interferem no desenvolvimento neuropsicomotor: pressão intracraniana, malformações encefálicas, genética, idade na correção cirúrgica (postergação da primeira cirurgia após um ano de idade associou-se a um quociente de inteligência mais baixo), institucionalização, ambiente familiar, escolaridade dos cuidadores e nível socioeconômico. Considerações finais: os resultados obtidos contribuíram para maior conhecimento do perfil cognitivo dos pacientes com estas síndromes. Somente conhecendo as habilidades e dificuldades neuropsicomotoras, cognitivas e psicossociais dos pacientes com Apert e Crouzon é que as equipes de saúde, da escola e de cuidadores poderão entender melhor a capacidade perceptiva destes no processo de aprendizado e estarão mais aptas em atender as necessidades especiais destes pacientes e poderão ofertar os estímulos mais adequados no momento mais oportuno (AU).

Bilateral Coronal Craniosynostosis implies a decrease in the Cranial Perimeter (CP) in the anteroposterior axis (Brachycephaly) and is frequently associated with an increase in the cephalocaudal (vertical height) axis of the skull (Turrycephaly); being one of the most common findings in Crouzon and Apert Syndromes (Syndromic Craniosynostosis). In this Scope Review study, among the Syndromic Craniosynostosis, Apert and Crouzon Syndromes will be of special interest. Objective: This study aimed to identify, analyze, and synthesize the appropriate cognitive assessment methods for monitoring the evolution of patients with syndromic craniosynostosis, in particular Apert's and Crouzon's syndromes. Method: This is a scope review. In order to formulate the research guiding question and the searching strategy, the Population [((Apert OR Crouzon) AND (Disease OR Syndrom*))], Concept [((cognit* OR neurobehavioral OR neurocognit* OR neuropsyc*) AND (evaluation OR evaluations OR assessment OR "test" OR tests OR status OR development OR disorder OR disorders OR impairment OR impairments OR impaired OR function OR functions))] and Context (in any context) strategy was used. The articles written in English, Portuguese, and Spanish in any period were included. The search was performed in the following databases: Embase, Scopus, National Library of Medicine (PubMed/MEDLINE), and in the BVS Salud network (PAHO, WHO, BIREME, LILACS). Results: many internationally validated cognitive assessment tests were applied to patients with Apert and Crouzon, but no standardization (protocol) was followed. Of the 75 types of Cognitive Tests applied, the Wechsler Intelligence Scale predominated, 50%. In the evaluated population, two age groups predominated: school children and adolescents. Children with Apert and Crouzon had worse scores on disorders of socialization, attention, and internalization when compared to the normative group, with the worst results found in Apert. Factors that interfere with cognitive development: intracranial pressure, brain malformations, genetics, age at surgical correction, institutionalization, family environment, caregiver education, and socioeconomic status. Conclusion: the results contributed to a better understanding of the cognitive profile of patients with these syndromes and only by knowing about the neuropsychomotor, cognitive, and psychosocial skills and difficulties of these patients with Apert and Crouzon that health, school, and caregiver teams will be able to understand the perceptive capacity in the learning process of these patients deeply and will be able to offer the most appropriate stimuli at the most opportune time. Keywords: Apert, Crouzon, Neuropsyc, Tests, Development (AU).

Cognitive abilities and medical students' practice of physical exams: A quasi-experimental study

ABSTRACT BACKGROUND: To highlight the importance of clinical simulations and simulated laboratories for student training, especially in physical examination teaching. OBJECTIVE: To evaluate the gains obtained by medical students in their cognitive and practical performance of physical examinations (abdominal, cardiological, and pulmonary), as well as satisfaction and self-confidence in what they have learned, after concentrated practice developed in a skills and simulation laboratory. DESIGN AND SETTING: A quantitative and quasi-experimental study in which 48 students were evaluated at the Faculdade de Odontologia de Bauru, São Paulo, Brazil. METHODS: A quantitative and descriptive study was conducted with regularly enrolled 2nd year medical students over 18 years of age who had content prior to data collection regarding anamnesis and physical examination remotely taught in a Moodle virtual learning environment. For data collection, the participants were subjected to a concentrated period of skill training (abdominal, cardiological, and pulmonary). Every day after the skill training session, they were subjected to a practical evaluation and completed a theoretical test before and after the practical activities. At the end of all activities, they answered the instrument to assess the simulated practices (self-confidence and satisfaction). RESULTS: Among the 49 students evaluated, positive and significant theoretical and practical gains were identified in all three components (abdominal, cardiological, and pulmonary) (P = 0.000), as well as in the general evaluation (Theoretical 1 and Theoretical 2) (P = 0.000), satisfaction, and self-confidence (P = 0.000). CONCLUSION: Concentrated laboratory practice resulted in positive improvements in students' physical examination skills.

Syndromic craniosynostosis: neuropsycholinguistic abilities and imaging analysis of the central nervous system.

OBJECTIVE: To characterize patients with syndromic craniosynostosis with respect to their neuropsycholinguistic abilities and to present these findings together with the brain abnormalities. METHODS: Eighteen patients with a diagnosis of syndromic craniosynostosis were studied. Eight patients had Apert syndrome and 10 had Crouzon syndrome. They were submitted to phonological evaluation, neuropsychological evaluation and magnetic resonance imaging of the brain. The phonological evaluation was done by behavioral observation of the language, the Peabody test, Token test and a school achievement test. The neuropsychological evaluation included the WISC III and WAIS tests. RESULTS: Abnormalities in language abilities were observed and the school achievement test showed abnormalities in 66.67% of the patients. A normal intelligence quotient was observed in 39.3% of the patients, and congenital abnormalities of the central nervous system were observed in 46.4% of the patients. CONCLUSION: Abnormalities of language abilities were observed in the majority of patients with syndromic craniosynostosis, and low cognitive performance was also observed.

Syndromic craniosynostosis: neuropsycholinguistic abilities and imaging analysis of the central nervous system / Craniossinostoses sindrômicas: habilidades neuropsicolinguísticas e análise por imagem do sistema nervoso central

ABSTRACT Objective: To characterize patients with syndromic craniosynostosis with respect to their neuropsycholinguistic abilities and to present these findings together with the brain abnormalities. Methods: Eighteen patients with a diagnosis of syndromic craniosynostosis were studied. Eight patients had Apert syndrome and 10 had Crouzon syndrome. They were submitted to phonological evaluation, neuropsychological evaluation and magnetic resonance imaging of the brain. The phonological evaluation was done by behavioral observation of the language, the Peabody test, Token test and a school achievement test. The neuropsychological evaluation included the WISC III and WAIS tests. Results: Abnormalities in language abilities were observed and the school achievement test showed abnormalities in 66.67% of the patients. A normal intelligence quotient was observed in 39.3% of the patients, and congenital abnormalities of the central nervous system were observed in 46.4% of the patients. Conclusion: Abnormalities of language abilities were observed in the majority of patients with syndromic craniosynostosis, and low cognitive performance was also observed.

RESUMO Objetivo: Caracterizar as habilidades neuropsicolinguísticas de indivíduos com craniossinostoses sindrômicas e apresentar esses achados com as anomalias do sistema nervoso central. Métodos: Participaram do estudo 18 sujeitos com diagnóstico clínico de craniossinostose sindrômica, 44,4% com a síndrome de Apert e 55,6% síndrome de Crouzon. Todos os sujeitos foram submetidos a avaliação fonoaudiológica, psicológica e exames de ressonância magnética do encéfalo. A avaliação fonoaudiológica foi contemplada pela Observação Comportamental da Linguagem, Teste Peabody (TVIP), Teste Token e Teste de Desempenho Escolar (TDE); enquanto a psicológica utilizou a WISC-III e a WAIS. Resultados: Observou-se alteração nas habilidades de linguagem em todos os protocolos utilizados, sendo o TDE o que apresentou maior porcentagem de alteração (66,67%).A avaliação cognitiva evidenciou quociente de inteligência dentro da média em 39,3% dos sujeitos, enquanto que 46,4% apresentaram malformações congênitas do sistema nervoso central. Conclusão: Constatou-se alterações nas habilidades de linguagem na maioria dos sujeitos com craniossinostoses sindrômicas, bem como o baixo desempenho cognitivo.

Intervenção fonoaudiológica precoce em afasia infantil decorrente de um acidente vascular cerebral: relato de caso / Early speech-language intervention in childhood aphasia after a stroke: case report / Intervención fonoaudiológica precoz en afasia infantil debido a un accidente vascular cerebral: reporte de un caso

O Acidente Vascular Cerebral é menos frequente em crianças do que em adultos, porém possui um poder devastador para o futuro destes indivíduos, mesmo com indícios de melhor recuperação das alterações. O objetivo deste estudo é descrever os achados fonoaudiológicos de um caso de Acidente Vascular Cerebral infantil, evidenciando a evolução após 12 meses de terapia fonoaudiológica, iniciada precocemente, após lesão neurológica adquirida. Trata-se de um indivíduo de 11 anos, gênero masculino, com normalidade de desenvolvimento neuropsicomotor e independência para as atividades funcionais durante a primeira infância. Em março de 2015 sentiu um mal súbito, foi encaminhado para o hospital de urgência e diagnosticado com Acidente Vascular Cerebral, do tipo hemorrágico, em região frontoparietotemporal esquerda. Foram realizados procedimentos cirúrgicos, e a internação durou 25 dias. No momento da alta hospitalar houve a orientação sobre a necessidade de atendimento fonoaudiológico. A primeira avaliação de linguagem evidenciou afasia adquirida do tipo emissiva, conforme as classificações propostas para crianças. Foram realizadas 91 sessões de terapia fonoaudiológica, com duração de 50 minutos, pelo período de 12 meses. Ao analisar as habilidades formais de linguagem que permaneceram alteradas, observa-se que as relacionadas à leitura e escrita são as de maior significância, interferindo no desempenho escolar e desenvolvimento comunicativo. Assim, além do atendimento fonoaudiológico até que seja possível uma comunicação funcional, é importante que haja o apoio escolar.

Stroke is less common in children than in adults, but it has a devastating power for the future of these individuals, even with signs of better recovery from the changes. The aim of this study is to describe the speech therapy findings of a case of stroke child, showing the progress after 12 months of speech therapy initiated early after acquired neurological injury. This is an individual of 11 years old, male, with neurodevelopment normality and independence to the functional activities during early childhood. In March of 2015, he suffered a sudden illness, was referred to the emergency hospital and diagnosed with hemorrhagic stroke, in the left frontoparetotemporal region. Surgical procedures were performed, and hospitalization lasted 25 days. At the time of hospital discharge, there was guidance about the need for speech therapy care. In the first evaluation of language, there was evidence of acquired aphasia of the emissive type, according to the classifications proposed for children. A total of 91 speech therapy sessions lasting 50 minutes were performed for 12 months. When analyzing formal language skills that have remained altered, it is observed that those related to reading and writing are those of greater significance, interfering in school performance and communicative development. Thus, in addition to speech and language therapy until functional communication is possible, it is important that there be school support.

El accidente cerebrovascular es menos común en niños que en adultos, pero tiene un poder devastador para el futuro de estes individuos aun que se tenga indicios de mejor recuperación de las alteraciones. El objetivo de este estudio es describir los hallazgos fonoauiológicos de un caso de Accidente Vascular Cerebral Infantil, que muestra el progreso después de 12 meses de terapia fonoaudiológica iniciada precozmente, en un caso de lesión neurológica adquirida. Se trata de un individuo de 11 años, de sexo masculino, con normalidad el desarrollo neuropsicomotor y independencia de las actividades funcionales durante la primera infancia. En marzo el año 2015 sintió un mal súbito, fue remitido al hospital de emergencia y diagnosticado como Accidente Vascular Cerebral, de tipo hemorrágico en la región frontoparietotemporal izquierda. Se realizaron procedimientos quirúrgicos y la hospitalización duró 25 días. En el momento del alta hospitalaria hubo orientación sobre la necesidad de tratamiento fonoaudiológico. La primera evaluación del lenguaje mostró afasia adquirida de tipo emisivo, de acuerdo con las clasificaciones propuestas para los niños. Se realizaron 91 sesiones de terapia fonoaudiológica, con una duración de 50 minutos, el período de 12 meses. Mediante el análisis de las habilidades lingüísticas formales que permanecieron cambiada, se observa que las relacionadas con la lectura y la escritura son las más significativas, porque interfieren con el desempeño escolar y desarrollo comunicativo. Por lo tanto, además de la terapia fonoaudiologoca hasta que una comunicación funcional sea posible, es importante el apoyo escolar.

Vigilância do desenvolvimento da linguagem da criança: conhecimentos e práticas de profissionais da atenção básica à saúde / Child’s language development surveillance: knowledge and practices among primary health care professionals

RESUMO Objetivo: analisar os conhecimentos e as práticas dos enfermeiros, médicos e cirurgiões-dentistas que atuam na Atenção Básica em relação ao desenvolvimento da linguagem da criança nos primeiros anos de vida. Métodos: tratou-se de uma pesquisa qualitativa com 30 profissionais de uma rede de Atenção Básica dentre eles, médicos, enfermeiros e cirurgiões-dentistas. Uma consulta individual foi realizada mediante um questionário semiestruturado. Empregou-se a técnica de análise temática de discurso, utilizando-se três figuras metodológicas: a Ideia Central, as Expressões-Chaves e o Discurso do Sujeito Coletivo. Resultados: os conhecimentos que os profissionais têm sobre o desenvolvimento da linguagem da criança estavam ancorados às ideias centrais de conhecer alguns marcos do desenvolvimento, a linguagem da criança depende do estímulo do meio, da família e da audição normal, saber muito pouco ou não saber nada sobre o assunto. Os profissionais relataram que gostariam de obter mais informações sobre o assunto em relação aos marcos do desenvolvimento da linguagem da criança, desvios da normalidade e orientações para pais de forma a aprimorar o atendimento da saúde infantil. Conclusão: o conhecimento dos profissionais sobre o assunto apresentou-se limitado, havendo necessidade de ampliar práticas de educação em saúde pela Fonoaudiologia, em parceria com as Instituições de Ensino e os profissionais dos Núcleos de Apoio Saúde da Família, junto aos profissionais da Equipe de Estratégia Saúde da Família, destacando-se o trabalho sobre os marcos do desenvolvimento da linguagem da criança.

ABSTRACT Purpose: to analyze the knowledge and practices of nurses, doctors and dentists working in Primary Care for the development of the child's language early in life Methods: it is a qualitative research with 30 professionals from a network of Primary Care, among them doctors, nurses and dentists. An individual consultation was carried out through a semi-structured questionnaire. The technique of thematic speech analysis was used using three methodological approaches: The Central Idea, Expressions-Keys and the Collective Subject Discourse. Results: the knowledge that professionals have about the development of children's language were anchored to the core ideas to meet some milestones of development, the child's language depends on the middle stimulus, the family and normal hearing to know little or know nothing about the subject. The professionals reported that they would like to get more information on the subject in relation to the milestones of the child's language development, normal deviations and guidelines for parents in order to improve the care of children's health. Conclusion: the knowledge of professionals on the subject has been limited, and there is a need to expand educational practices in health through speech therapy, in partnership with the institutions of education and professionals of the Family Health Support Centers, with professionals of the Family Health Strategy Team, highlighting the work of the milestones of the child's language development.

Neuroradiology and voice findings in stroke.

Neurological dysphonias are vocal disorders followed by injuries or changes in the nervous system. Stroke is the second leading cause of death worldwide and the brain damage caused by it can affect communication in several aspects. The changes in the vocal features caused by these lesions are poorly described regarding the location and extent of cerebral involvement. The aim of this study was to describe vocal parameters of ten elderly patients affected by stroke according to the topography of the lesion at neuroimaging. We recorded from them: perceptual and auditory evaluation of voice and laryngeal diadochokinesis. Neuroimaging studies were classified according to location, extent, laterality territory of brain injury. The results show a population of extensive middle cerebral artery strokes and strokes with varied location in the brain. The subjects' voices showed predominantly the presence of roughness, breathiness, richeness and instability, and change in laryngeal motor control, demonstrated by reduced speed and instability in laryngeal diadochokinesis. These features presented in patients with extensive middle cerebral artery stroke and in patients with short strokes with varied location in the brain. The results suggest that the vocal features in the assessed cases do not depend only on the topography of the brain damage. Thus, it is important to consider the patient as unique in clinical evaluation.

Neuroradiology and voice findings in stroke / Achados de neurorradiologia e voz no acidente vascular encefálico

Neurological dysphonias are vocal disorders followed by injuries or changes in the nervous system. Stroke is the second leading cause of death worldwide and the brain damage caused by it can affect communication in several aspects. The changes in the vocal features caused by these lesions are poorly described regarding the location and extent of cerebral involvement. The aim of this study was to describe vocal parameters of ten elderly patients affected by stroke according to the topography of the lesion at neuroimaging. We recorded from them: perceptual and auditory evaluation of voice and laryngeal diadochokinesis. Neuroimaging studies were classified according to location, extent, laterality territory of brain injury. The results show a population of extensive middle cerebral artery strokes and strokes with varied location in the brain. The subjects' voices showed predominantly the presence of roughness, breathiness, richeness and instability, and change in laryngeal motor control, demonstrated by reduced speed and instability in laryngeal diadochokinesis. These features presented in patients with extensive middle cerebral artery stroke and in patients with short strokes with varied location in the brain. The results suggest that the vocal features in the assessed cases do not depend only on the topography of the brain damage. Thus, it is important to consider the patient as unique in clinical evaluation.

As disfonias neurológicas são distúrbios vocais que acompanham lesões ou alterações no sistema nervoso. O acidente vascular encefálico (AVE) é a segunda causa de morte no mundo e os danos cerebrais causados podem afetar a comunicação do indivíduo em diversos aspectos. As alterações de voz características dessas lesões são pouco descritas quanto à localização e extensão do acometimento cerebral. O objetivo deste estudo foi descrever as características fonatórias de dez idosos acometidos por AVE, de acordo com a topografia da lesão observada ao exame de neuroimagem. Todos os participantes tiveram amostras de voz gravadas e foi realizada avaliação perceptivo-auditiva da voz e da diadococinesia laríngea. Os exames de neuroimagem foram classificados quanto à localização, extensão, lateralidade e território de vascularização da lesão cerebral. Os resultados mostram uma população de AVEs extensos de artéria cerebral média e AVEs de localização variada no cérebro. As vozes dos sujeitos mostraram predominantemente presença de rugosidade, soprosidade, instabilidade e pastosidade, além de alteração no controle motor laríngeo, demonstrado pela velocidade reduzida e instabilidade na repetição de vogais. Essas características ocorreram tanto no grupo de pacientes com AVE extenso de lesão da artéria cerebral média como em pacientes com AVEs menores de localização variada no cérebro. Os achados sugerem que as manifestações vocais dos casos estudados não dependem apenas da topografia da lesão. Daí a importância de considerar as individualidades de cada paciente no momento da avaliação clínica.

Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: a computed tomography evaluation.

INTRODUCTION: The force delivered during rapid maxillary expansion (RME) produces areas of compression on the periodontal ligament of the supporting teeth. The resulting alveolar bone resorption can lead to unwanted tooth movement in the same direction. The purpose of this study was to evaluate periodontal changes by means of computed tomography after RME with tooth-tissue-borne and tooth-borne expanders. METHODS: The sample comprised 8 girls, 11 to 14 years old, with Class I or II malocclusions with unilateral or bilateral posterior crossbites Four girls were treated with tooth-tissue-borne Haas-type expanders, and 4 were treated with tooth-borne Hyrax expanders. The appliances were activated up to the full 7-mm capacity of the expansion screw. Spiral CT scans were taken before expansion and after the 3-month retention period when the expander was removed. One-millimeter thick axial sections were exposed parallel to the palatal plane, comprising the dentoalveolar area and the base of the maxilla up to the inferior third of the nasal cavity. Multiplanar reconstruction was used to measure buccal and lingual bone plate thickness and buccal alveolar bone crest level by means of the computerized method. RESULTS AND CONCLUSIONS: RME reduced the buccal bone plate thickness of supporting teeth 0.6 to 0.9 mm and increased the lingual bone plate thickness 0.8 to 1.3 mm. The increase in lingual bone plate thickness of the maxillary posterior teeth was greater in the tooth-borne expansion group than in the tooth-tissue-borne group. RME induced bone dehiscences on the anchorage teeth's buccal aspect (7.1 +/- 4.6 mm at the first premolars and 3.8 +/- 4.4 mm at the mesiobuccal area of the first molars), especially in subjects with thinner buccal bone plates. The tooth-borne expander produced greater reduction of first premolar buccal alveolar bone crest level than did the tooth-tissue-borne expander.