Traumatic Dissection of Arterial Cervical Vessels: Report of Two Cases and Literature Review

Even though traumatic dissection of cervical arterial vessels is themajor cause of stroke among adults, it is still an underdiagnosed disease in neurosurgical emergencies, since most patients do not have or present subtle clinical signs in the acute phase. The authors report two interesting cases of cervical artery dissection with different traumatic mechanisms and present a broad literature review about this subject.

Evaluation of sclerotherapy with different dilutions of ethanolamine oleate in the treatment of oral varicose veins / Avaliação da escleroterapia com diferentes diluições de oleato de etanolamina no tratamento de varizes orais

ABSTRACT Objective: This study aim to evaluate the effectiveness of sclerotherapy protocols with different dilutions of ethanolamine oleate in the treatment of oral varicose veins. Methods: Clinical data and images of 14 cases treated with sclerotherapy were analyzed and descriptive analyses were performed. Results: Females (58%) and white skin color (83%) prevailed. Age varied between 14 and 79 years, with 47 years on mean (SD = 19 years). The most common anatomical locations were the buccal mucosa and lower lip. The final volume of the sclerosing agent (Ethamolin®) ranged from 0.4 to 4.3ml and the concentration ranged from 5% to 100%. The number of sessions ranged from 1 to 12 and the number of points per application was 1 to 7 points. Pain and edema were seen in 43% and 29% of patients, respectively. Conclusion: Sclerotherapy with monoethanolamine oleate diluted in anesthetic is a safe and effective option for the treatment of this lesion, regardless of concentration. However, edema and pain seem to be directly associated with increased drug concentration.

RESUMO Objetivos: Este estudo tem como objetivo avaliar a efetividade de protocolos de escleroterapia com diferentes diluições de oleato de etanolamina no tratamento de varizes orais. Métodos: Dados clínicos e imagens de 14 casos tratados com escleroterapia foram avaliados, sendo realizado análises descritivas. Resultados: As mulheres (58%) e a cor de pele branca (83%) prevaleceram na amostra. A idade variou entre 14 e 79 anos, com média de 47 anos (DP = 19 anos). As localizações anatômicas mais comuns foram a mucosa jugal e o lábio inferior. O volume final do agente esclerosante (Ethamolin®) variou de 0,4 a 4,3ml e a concentração variou de 5% a 100%. O número de sessões variou de 1 a 12 e o número de pontos por aplicação foi de 1 a 7 pontos. Dor e edema foram observados em 43% e 29% dos pacientes, respectivamente. Conclusão: A escleroterapia com oleato de monoetanolamina diluído em anestésico é uma opção segura e eficaz para o tratamento das varizes orais, independentemente da concentração. No entanto, edema e dor parecem estar diretamente associados ao aumento da concentração do medicamento.

Correalation between injury of draining veins around meningiomas in superficial middle cerebral vein areas and postoperative cognitive changes / 中国基层医药

Objective To explore the correalation between change of postoperative cognitive function and injury of the draining veins around meningiomas in superficial middle cerebral vein areas ,to discuss the importance and protection method of draining veins around meningiomas in order to guide the microneurosurgery .Methods From July 2013 to July 2017,the clinical data of 54 patients with superficial middle cerebral vein areas meningiomas (tumor group) in the Central Hospital of Guangdong Nongken were retrospectively analyzed .And 52 healthy volunteers were selected as the control group.The preoperative and postoperative cognitive function and meningiomas peritumoral edema(MPE) were assessed by the Montreal Cognitive Assessment ( MoCA) and CT／MRI.Results The scores of visuospatial and executive [(3.23 ±1.27)points],order[(2.52 ±1.27) points],memory[(2.20 ±1.14) points], attention[(4.71 ±0.97)points],language[(2.19 ±0.74)points],abstract [(1.43 ±0.63)points],location[(5.83 ± 0.42) points],total[(22.06 ±0.33) points] in the tumor group were significantly lower than those in the control group[(4.83 ±0.38)points,(3.0 ±0.02)points,(3.5 ±1.04)points,(5.98 ±0.14)points,(2.54 ±0.50) points, (1.88 ±0.38) points,(5.98 ±0.33) points,(27.83 ±0.16) points] ( t ＝4.504,6.116,9.338,2.782,4.509, 2.390,8.670,all P＜0.05).According to the injury of the draining veins around meningioma ,54 patients were divided into the two groups,43 cases in the no -injuried group,11 cases in the injuried group.There were no statistically significant differences between the no -injuried group and injuried group in all measurements before operation (all P＞0.05).Both no-injuried group and injuried group had decline in MoCA and increase in MPE at 5 days after surgery. Both no-injuried group and injuried group had rise in MoCA [(26.35 ±0.36)points vs.(22.00 ±0.67)points] and decrease in MPE[(23.95 ±4.34)cm3 vs (44.64 ±9.68) cm3 ] at 30 days after surgery ( t＝5.944,2.098,all P＜0.05).The MoCA[(22.59 ±0.31)points vs (26.35 ±0.36)points] was obviously increased and the MPE [(87.84 ± 12.78)cm3 vs.(23.95 ±4.34)cm3] was obviously increased in 30 days after operation in no-injuried group(t＝7.289, 5.014,all P＜0.05),but the injuried group had just the opposite.Conclusion Injury of the draining veins around meningiomas in superficial middle cerebral vein areas can lead to cognitive dysfunction and compromise the quality of postoperative life in patients,every effort should be undertaken to preserve the draining veins around meningioma .

Correalation between injury of draining veins around meningiomas in superficial middle cerebral vein areas and postoperative cognitive changes / 中国基层医药

Objective@#To explore the correalation between change of postoperative cognitive function and injury of the draining veins around meningiomas in superficial middle cerebral vein areas, to discuss the importance and protection method of draining veins around meningiomas in order to guide the microneurosurgery.@*Methods@#From July 2013 to July 2017, the clinical data of 54 patients with superficial middle cerebral vein areas meningiomas(tumor group) in the Central Hospital of Guangdong Nongken were retrospectively analyzed.And 52 healthy volunteers were selected as the control group.The preoperative and postoperative cognitive function and meningiomas peritumoral edema(MPE) were assessed by the Montreal Cognitive Assessment(MoCA) and CT/MRI.@*Results@#The scores of visuospatial and executive[(3.23±1.27)points], order[(2.52±1.27)points], memory[(2.20±1.14)points], attention[(4.71±0.97)points], language[(2.19±0.74)points], abstract[(1.43±0.63)points], location[(5.83±0.42)points], total[(22.06±0.33)points] in the tumor group were significantly lower than those in the control group[(4.83±0.38)points, (3.0±0.02)points, (3.5±1.04)points, (5.98±0.14)points, (2.54±0.50)points, (1.88±0.38)points, (5.98±0.33)points, (27.83±0.16)points](t=4.504, 6.116, 9.338, 2.782, 4.509, 2.390, 8.670, all P<0.05). According to the injury of the draining veins around meningioma, 54 patients were divided into the two groups, 43 cases in the no-injuried group, 11 cases in the injuried group.There were no statistically significant differences between the no-injuried group and injuried group in all measurements before operation(all P>0.05). Both no-injuried group and injuried group had decline in MoCA and increase in MPE at 5 days after surgery.Both no-injuried group and injuried group had rise in MoCA[(26.35±0.36)points vs.(22.00±0.67)points] and decrease in MPE[(23.95±4.34)cm3 vs (44.64±9.68)cm3] at 30 days after surgery(t=5.944, 2.098, all P<0.05). The MoCA[(22.59±0.31)points vs (26.35±0.36)points] was obviously increased and the MPE[(87.84±12.78)cm3 vs.(23.95±4.34)cm3] was obviously increased in 30 days after operation in no-injuried group(t=7.289, 5.014, all P<0.05), but the injuried group had just the opposite.@*Conclusion@#Injury of the draining veins around meningiomas in superficial middle cerebral vein areas can lead to cognitive dysfunction and compromise the quality of postoperative life in patients, every effort should be undertaken to preserve the draining veins around meningioma.

Donantes de órganos en muerte cerebral por herida por proyectil de arma de fuego en cráneo: una trágica realidad que beneficia receptores de órganos en Colombia / Fire arm wounded cerebral death organ donors: a tragic reality that benefits organ receptors in Colombia

Antecedentes y objetivo. Los pacientes con muerte encefálica por trauma craneoencefálico secundario a herida por proyectil de arma de fuego ayudan a mitigar la necesidad de donantes de órganos y tejidos. En Colombia, el 78 % de los homicidios son por arma de fuego. Se buscaba describir la experiencia con donantes de órganos y tejidos con muerte encefálica secundaria a trauma craneoencefálico por herida por proyectil de arma de fuego en un centro colombiano de trasplantes. Materiales y métodos. Se trató de un estudio de cohorte histórica retrospectiva. Se caracterizaron 169 donantes con diagnóstico de muerte encefálica secundaria a trauma craneoencefálico por herida con proyectil de arma de fuego en la institución, entre 2010 y 2016. Las variables cualitativas se evaluaron mediante proporciones, las variables cuantitativas continuas, con medidas de tendencia central, y la supervivencia, con el método de Kaplan-Meier. Resultados. La mayoría de los pacientes eran de sexo masculino (93 %), con una mediana de edad de 21 años (rango intercuartílico, RIQ=17-27) y el 32 % tenía antecedentes de consumo de sustancias psicoactivas. El 12 % de los pacientes necesitó manejo con hemoderivados y el 62 % requirió dosis altas de vasopresores. Se trasplantaron 338 órganos sólidos. La supervivencia del injerto renal y hepático a un año fue de 90 % y 85 %, respectivamente, y a 5 años, de 87 % y 76 %. Conclusiones. Según este estudio, la mayoría de estos pacientes eran hombres jóvenes con órganos potencialmente trasplantables que mostraron excelentes resultados en la supervivencia de los injertos. Consideramos que estos donantes son una buena alternativa para aumentar el número de donantes de órganos y tejidos

Background and objectives: Patients with brain death (BD) due to traumatic brain injury (TBI) secondary to a gunshot (GS) wound in the skull contribute to mitigate the demand for organ and tissue donors. In Colombia, 78% of the homicides are by GS. We describe our experience with BD secondary to TBI by GS organ and tissue donors at a transplant center in Cali, Colombia. Materials and methods: This is a retrospective historical cohort study for characterization of donors diagnosed with BD secondary to TBI by GS at our institution in the period 2010-2016 (n=169). Qualitative variables were assessed by proportions, continuous quantitative variables with measures of central tendency, and survival with Kaplan Meier. Results: The majority of the patients were male (93%), with a median age of 21 years (RIQ 17-27), 32% had history of psychoactive substance use. 12% of the patient's required management with blood products and 62% with high doses of vasopressors. 338 solid organs were transplanted. Survival of the renal and hepatic graft at one year was 90% and 85% respectively and at five years of 87% and 76%. Conclusions: According to our study, the majority of these patients are young men with potentially transplantable organs, showing excellent results in the survival of the grafts. We consider these donors to be a good alternative to increase the number of organ and tissue donors

Development and effect evaluation of nurse-led emergency cerebral ischemia-reperfusion procedure / 中华护理杂志

Objective To optimize the cerebral ischemia-reperfusion process for acute ischemic stroke patients,so as to reduce the time of in-hospital delays.Methods A multi-disciplinary management team was established to design the flowchart of the cerebral ischemia-reperfusion process for acute ischemic stroke patients.By applying Healthcare Failure Mode and Effect(HFMEA) management mode,intervention was conducted and its effect was analyzed.Results After implementation of the HFMEA intervention,the door to needle time(DNT)was reduced from 88 (42,140) minutes to 45 (37,59) minutes(P＜0.001);the ratio of patients with the DNT＜60 minutes increased from 20％ to 87.7％(P＜0.001);the door to cerebral ischemia-reperfusion time was shortened from 207(169,227) minutes to 165(155,185) minutes (P＜O.05).There was no significant difference in the incidence and mortality of symptomatic cerebral hemorrhage between before and after intervention (P＞0.05).Conclusion Utilization of HFMEA to optimize the emergency cerebral ischemia-reperfusion process can effectively reduce the in-hospital delays of acute ischemic stroke patients.

The correlation study of cerebral vascular hemo -dynamic index with blood pressure,body mass index etc.in 28 616 outpatients / 中国基层医药

Objective To explore the correlation study of cerebral vascular hemo -dynamic index(CVHI) with blood pressure,body mass index (BMI)etc.in outpatients.Methods Participants were outpatients with non -invasive CVHI test,who were selected as study subjects.Height,weight,blood pressure and other general information were investigated and the distribution characteristics of blood pressure,BMI and CVHI were compared in different age and gender groups.Results A total of 28 616 subjects were included in the study.The age range was 11 -99 years. Means of CVHI integral score in males and females were (77.78 ±28.44)points and (79.18 ±27.8)points(t =4.275,P <0.01),and abnormality rates of the score(<75 points)were 30.1% and 28.1%(χ2 =13.444,P <0.01),the differences were statistically significant.CVHI score was decreased and the abnormal rate was increased with aging.Systolic blood pressure was elevated with aging and diastolic blood pressure was higher in middle age subjects (40 -65 years).The proportions of over weighted and obesity in male were 37.5% and 15.4%,which in female were 33.2% and 14.9%(χ2 =70.661,P <0.01).It was especially higher in middle age subjects.Conclusion Degree of injury of cerebrovascular function and level of systolic blood pressure are along with aging.Means of BMI and diastolic blood pressure is higher in middle age population.The rate of high risk individuals in outpatients is about 30%.

Disección espontánea de la arteria vertebral / Spontaneous vertebral artery dissection

La disección arterial como causa de ataque cerebrovascular es infrecuente, presentándose más comúnmente en población joven asociado a un trauma menor que involucra la hiperextensión del cuello. Presentamos el reporte de un paciente hombre, joven, con un accidente cerebrovascular de fosa posterior y cuya etiología fue una disección espontánea de la arteria vertebral derecha.

Arterial dissection as a cause of stroke is uncommon, most commonly presenting in young people sometimes associated with trauma involving hyperextension of the neck as the only history which would suggest the traumatic origin. We present the case report of a young man with posterior stroke whose etiology was a spontaneous dissection of the right vertebral artery.

Manejo hemodinámico mediante monitor no invasivo de gasto cardiaco para craneotomía urgente en el síndrome X frágil: reporte de caso / Haemodynamic management using non-invasive cardiac output monitoring for urgent craniotomy in fragile X syndrome: Case report

Fragile X syndrome is an inherited form of mental retardation with a connective tissue component involving mitral valve prolapse. The most frequent manifestations of fragile X syndrome are learning disability, orofacial morphological alterations and macroorchidism. The usefulness of advanced haemodynamic monitoring for goal-directed therapy is increasingly high during neurosurgical procedures. Non-invasive cardiac output monitoring may be considered as a new alternative for emergency neurosurgical procedures. Our aim was to detect haemodynamic changes in a syndromic fragile X patient, given the usual concomitant presentation of cardiovascular disease, such as mitral valve prolapse and dilated aortic root, in an attempt at obtaining the best intraoperative and postoperative neurological outcomes without worsening cardiovascular function, by means of individualized intra-operative goal directed therapy. This type of non-invasive monitoring allows surgery to proceed without delay and provides excellent information of the haemodynamic status. This syndrome is relevant due to its anaesthetic implications and the paucity of cases published to date.

El síndrome X frágil es una forma hereditaria de retraso mental con una afectación de tejido conectivo que produce prolapso de la válvula mitral. Las manifestaciones más frecuentes del síndrome X frágil son la dificultad en el aprendizaje, alteraciones morfológicas orofaciales y macroorquidismo. La utilidad de la monitorización hemodinámica avanzada para terapia dirigida por objetivos es cada vez mayor durante los procedimientos neuroquirúrgicos. La monitorización no invasiva de gasto cardiaco puede considerarse una nueva alternativa en los procedimientos neuroquirúrgicos emergentes. Nuestro objetivo fue detectar los cambios hemodinámicos en un paciente sindrómico X frágil que suelen presentar patología cardiovascular, como prolapso mitral y dilatación de la raíz aórtica, intentando obtener los mejores resultados neurológicos intraoperatorios y posoperatorios sin deteriorar la función cardiovascular individualizada por una terapia guiada por objetivos. Este tipo de monitorización no invasiva permite desarrollar la intervención quirúrgica sin demora, aportando gran información del estado hemodinámico. Este síndrome es relevante debido a sus implicaciones anestésicas y los pocos casos publicados hasta la fecha.

Effects of docosahexaenoic acid on expression of Ang-2 and VEGF in rat brain microvascular endo-thelial cells subjected to oxygen-glucose deprivation / 中华麻醉学杂志

Objective To evaluate the effects of docosahexaenoic acid ( DHA) on the expression of angiotensin?2 ( Ang?2) and vascular endothelial growth factor ( VEGF) in rat brain microvascular endo?thelial cells (BMVECs) subjected to oxygen?glucose deprivation (OGD). Methods Primarily cultured rat BMVECs were divided into 3 groups ( n=18 each) using a random number table: control group ( group C) , OGD group and DHA group. The cells were cultured with glucose?free and serum?free DMEM culture medium in OGD and DHA groups. In group DHA, DHA 40μmol was added, and then the cells were ex?posed to 1%O2?5%CO2?94%N2 in an air?tight incubator. The cells were cultured in the normal glucose and normal oxygen conditions in group C. All the cells were cultured for 24 h. Cell apoptosis was detected using Annexin V∕propidium iodide flow cytometry assay, and the apoptosis rate was calculated. The concentra?tions of Ang?2, VEGF, prostaglandin E2 ( PGE2 ) and prostacyclin ( PGI2 ) in the supernatant of the cul?ture medium were determined by enzyme?linked immunosorbent assay. The expression of Ang?2 mRNA and VEGF mRNA in cells was detected by real?time polymerase chain reaction. The expression of cyclooxygen?ase?2 ( COX?2) protein in cells was detected by Western blot. Results Compared with group C, the ap? optosis rate and concentrations of Ang?2, VEGF, PGE2 and PGI2 in the supernatant were significantly in?creased, and the expression of Ang?2 mRNA, VEGF mRNA and COX?2 protein was significantly up?regu?lated in OGD and DHA groups (P<0.05). Compared with group OGD, the apoptosis rate and concentra?tions of Ang?2, VEGF, PGE2 and PGI2 in the supernatant were significantly decreased, and the expression of Ang?2 mRNA, VEGF mRNA and COX?2 protein was significantly down?regulated in group DHA ( P<0.05) . Conclusion DHA can inhibit the expression of Ang?2 and VEGF in rat brain BMVECs subjected to OGD and reduce cell apoptosis, and down?regulated expression of COX?2 protein is involved in the mecha?nism.

Clinical efficacy of Yangxueqingnao granule improve cerebral small vessel disease cognitive impairment / 中国基层医药

Objective To explore the effect of Yangxueqingnao granule in treatment of cerebral small vessel disease (SVD)patients with mild cognitive dysfunction (MCI).Methods 52 patients with SVD related MCI were selected.They were treated with Yangxueqingnao granule,each 4.0 g,3 times a day,3 months for a course of treat-ment.Montreal cognitive scale (MoCA),simple mental state scale (MMSE)and event related potential (P300)were detected before and after treatment,and the clinical effect was observed.Results After a course of treatment by Yan-gxueqingnao granule,the cognitive function and memory of 52 patients were improved to some extent.In addition to the attention of an MoCA meter to a foreign project[Visual space:before taking the medicine (2.92 ±0.26)points,after taking the medicine (3.25 ±0.66)points;Named:before taking the medicine (2.26 ±0.70)points,after taking the medicine(2.92 ±0.49)points;Language:before taking the medicine (1.47 ±0.70)points,after taking the medicine (2.17 ±0.98)points;Abstraction:before taking the medicine (0.45 ±0.38)points,after taking the medicine (0.68 ±0.63)points;Delayed recall:before taking the medicine (1.67 ±0.74)points,after taking the medicine (2.52 ±1.50)points;Directional:before taking the medicine (4.73 ±0.35 )points,after taking the medicine (5.52 ±0.57)points ]and total score[Before taking the medicine (18.75 ±0.66)points,after taking the medicine (19.12 ±1.45)points],the differences were statistically significant (the total score:t =7.56,P =0.000;Visual space:t =5.86,P =0.002;Named:t =5.42,P =0.000;Be careful:t =1.23,P =0.121;Language:t =4.52,P =0.000;Abstraction:t =2.65,P =0.001;Delayed memory:t =7.96,P =0.000).While the total score of MMSE scale [before taking the medicine (25.36 ±1.89)points,after taking the medicine (28.53 ±2.91 )points],memory [before taking the medicine (2.64 ±0.42)points,after taking the medicine (2.75 ±0.53)points]and recall [before taking the medicine (1.52 ±0.48)points,after taking the medicine (1.98 ±0.78)points ],the differences were statistically significant(the total score:t =2.78,Memory:t =1.95,Recall:t =3.43,all P <0.05).P300 before and after treatment[before taking the medicine P300 latency of (389 ±21)ms,after taking the medicine P300 latency of (341 ±18)ms)],the difference was significant (t =12.514,P <0.001).Conclusion Yangxueqingnao granule had therapeutic effect in patients with SVD -MCI.

Study on the relationship between blood pressure variability and senile asymptomatic cerebrovascular damage / 中国医师进修杂志

Objective To explore the relationship between asymptomatic lacunar cerebral infarction and blood pressure variability (BPV) in senile patients with essential hypertension.Methods According to the results of the cranial magnetic resonance imaging (MRI),160 patients were divided into two groups:96 cases of hypertension combined with lacunar cerebral infarction group and 64 cases of simple hypertension group.Their levels and variability blood pressure were investigated by 24 hours ambulatory blood pressure monitoring.All markers included 24 h average systolic blood pressure variation (24 h SBPV),24 h average diastolic blood pressure variation (24 h DBPV),the day average systolic blood pressure variation (dSBPV),the night average systolic blood pressure variation (nSBPV),the day average diastolic blood pressure variation (dDBPV),the night average diastolic blood pressure variation (nDBPV),the standard deviation (SD)and variable coefficient (CV) of morning peak systolic blood pressure and diastolic blood pressure.Results 24 h SBPV,dSBPV,nSBPV,24 h DBPV,dDBPV,nDBPV was increased significantly in hypertension combined with lacunar cerebral infarction group compared with those in simple hypertension group (0.15±0.03 vs.0.11 ± 0.02,0.14 ± 0.02 vs.0.10 ± 0.03,0.14 ± 0.03 vs.0.10 ± 0.08,0.13 ± 0.08 vs.0.11 ±0.04,0.14 ±0.02 vs.0.11 ±0.07,0.14 ±0.05 vs.0.09 ±0.02),and there was significant difference (P ＜ 0.05).SD and CV of morning peak systolic blood pressure and diastolic blood pressure in hypertension combined with lacunar cerebral infarction group was higher than that in simple hypertension group [(15.37 ±4.55) mmHg (1 mmHg =0.133 kPa) vs.(13.53 ±2.26) mmHg,(13.64 ±4.95) mmHg vs.(9.80 ± 3.46) mmHg,0.141 ± 0.048 vs.0.113 ± 0.037,0.145 ± 0.056 vs.0.105 ± 0.036],and there was significant difference(P ＜ 0.05).Conclusion The BPV,especially morning blood pressure surge BPV are increased significantly in the hypertension combined with lacunar cerebral infarction group compared with that simple hypertension group,BPV increase is one of the important risk factors of cerebral infarction.

Characteristics and clinical application of different types of cerebral vascular scaffolds / 中国组织工程研究

BACKGROUND:With the development of the basic research and clinical application, as wel as stent materials, endovascular stent therapy has been widely used in cerebrovascular disease treatment. OBJECTIVE:To review the characteristics and clinical application of several kinds of stent materials. METHODS: A computer-based search of CNKI, Wanfang, and PubMed databases was performed for relevant articles published before Match 2014 using the keywords of “cerebrovascular disease, stents, biocompatibility” in Chinese and English. RESULTS AND CONCLUSION:According to release methods, cerebrovascular stents can be divided into baloon expanding stents and self-expanding stents. The original materials are mainly bare metal materials, made of memory aloy, medical stainless steel, tantalum, cobalt, nickel and titanium aloy. Because the metalic stent after implantation wil release metal ions that are easy to cause thrombosis and the restenosis rate is high, the coating stents and covered stents appear. Perioperative complications of stent implantation mainly include excessive perfusion syndrome, acute thrombosis, and vascular rupture and distal vascular embolization, vasospasm and puncture-related complications; the long-term complications are mainly restenosis after stent implantation. With the continuous improvement of stent materials and production techniques, vascular stent implantation wil be more safe and effective.

Análise dos acidentes motociclísticos no Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER) / Analysis of motorcycle accidents at the Dr. Henrique Santillo Rehabilitation and Readaptation Center (CRER)

Introdução: na última década, dentre os acidentes automobilísticos, observa-se um número crescente envolvendo motocicletas, veículo que ganha cada vez mais aceitação e aprovação da população. Nestes acidentes, as lesões neurológicas mais freqüentes são o traumatismo cranioencefálico (TCE), seguido de lesão medular (LM), ambas de grande importância devido à gravidade das seqüelas que provocam. Objetivos: identificar o perfil dos pacientes vítimas de acidentes de tráfego com motocicletas no Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), tipo de lesão neurológica, incapacidades adquiridas, reinserção laboral e capacidade para conduzir veículos após o trauma. Pacientes e métodos: realizou-se uma análise descritiva dos prontuários dos pacientes internados no CRER, no período de 2007 a 2010, selecionando apenas as vítimas de acidente motociclístico, assim como da atual situação produtiva dos mesmos através de contato telefônico no período de 01-07-2011 a 20-07-2011, utilizando formulário previamente elaborado. Resultados: houve predomínio de homens jovens economicamente ativos, sendo que a maioria não retornou sua vida laboral (86%) e está usufruindo de benefício previdenciário (79,6%). Conclusão: faz-se primordial a elaboração de estratégias para prevenção e controle dos traumas por motos, assim como medidas que estimulem a reinserção desses indivíduos incapacitados.

Introduction: in the last decade, among automobile accidents, it was observed that a growing number involved motorcycles, a vehicle that is beingmore and more accepted and approved by the population. In these accidentsthe most frequent neurological lesions are cranioencephalic trauma (CET), followed by medullary lesion (ML), both of great importance due to the gravity of their after-effects. Objectives: to identify the profile of the patients who are victims of motorcycle accidents at the Dr. Henrique Santillo Rehabilitation and Readaptation Center (CRER), their type of neurologicallesion, any acquired disabilities, their reinsertion into the job market, andtheir capacity to drive vehicles after the trauma. Patients and methods: a descriptive analysis of the medical history forms of patients admitted at CRER, from 2007 to 2010, selecting only the victims of motorcycle accidents, as well as the current productive situation of these victims through telephone contact between July 1st, 2011 and July 20th, 2011, utilizing apreviously-prepared form. Results: there was a predominance of youngmales economically active, the majority of whom did not return to work (86%) and are enjoying social welfare benefits (79.6%). Conclusion: The need to prepare strategies to prevent and control motorcycle traumas is evident, as well as measures that stimulate the reinsertion of these disabled individuals into the work market.

Condutas no paciente com trauma cranioencefálico: [revisão] / Managements in patients with traumatic brain injury: [review]

JUSTIFICATIVA E OBJETIVOS: Definir e atualizar protocolos de atendimento a vítimas de trauma cranioencefálico (TCE) na emergência médica, visando o diagnóstico e tratamento precoce.Há aumento do interesse em se definir protocolos e condutas de atendimento para vítimas de TCE, visando não somente ocontrole e estabilização da pressão intracraniana (PIC) e da pressão de perfusão cerebral (PPC), mas também de todos os outros parâmetros de suporte hemodinâmico adequado ao paciente com TCE, visando a redução de complicações pós-trauma e na taxa demortalidade. CONTEÚDO: O TCE tem grande impacto na saúde da população em geral, tendo notória importância tanto na morbidade quanto na mortalidade no trauma, representando aproximadamente 15% a 20% das mortes em pessoas com idade entre 5 e 35 anos e é responsável por 1% de todas as mortes em adultos. Nos Estados Unidos são admitidos por ano, mais de 250 mil pacientes com traumatismo craniano, e a cada ano ocorre óbito de aproximadamente 60 mil pacientes decorrente deste tipo de trauma. Aproximadamente 60% dos pacientes que sobrevivem a traumas cranianos têm sequelas significativas como déficit motor e cognitivo, trazendo grande impacto socioeconômico e emocional aos pacientes e seus familiares. As opções terapêuticas disponíveis na maioria das vezes como a hipotermia, manutenção da glicemia, hiperventilação, quando empregadas de forma correta melhoram o prognóstico dos pacientes com TCE. Considerando os altos gastos em saúde e para a sociedade com sua alta mortalidade, é preciso cada vez mais investigar novas formas de tratamento e elaborar protocolos e revisões sobre TCE, visando condutas diretas e concisas no trauma cranioencefálico. CONCLUSÃO: O TCE é uma situação comum no cotidiano médico, sendo responsável por altas taxas de mortalidade e morbidade em todo o mundo...

BACKGROUND AND OBJECTIVES: Define and update treatment protocols for victims of traumatic brain injury (TBI) in medical emergencies, for the diagnosis and early treatment. There is an increased interest in defining protocols and practicesof care for victims of head trauma, aiming not only the controland stabilization of the intracranial pressure (ICP) and cerebral perfusion pressure (CPP), but also all other parameters appropriate hemodynamic support for patients with TBI, aimed at reducing complications after trauma and the mortality rate. CONTENTS: Traumatic brain injury (TBI) has great impact on population health in general, with notable importance in morbidity and in mortality in trauma, representing approximately 15% to 20% of deaths in people aged between 5 and 35 years and is responsible for 1% of all deaths in adults. In the United States are admitted per year, more than 250.000 patients withhead injury, and death occurs every year approximately 60.000 patients induced by this trauma. Approximately 60% of patients who survive head injuries have significant sequelae such as motorand cognitive deficits, bringing great socioeconomic and emotional impact on patients and their families. The therapeutic options available in most cases as hypothermia, maintaining glucose levels, hyperventilation, when used correctly improve the prognosis of patients with TBI. Considering the numerous health expenditures and to society with its high mortality, we must increasingly explore new ways of treatment and develop protocolsand reviews about TBI, direct and concise in order to conductthe head injury, minimizing the time spent on patient care. CONCLUSION: TBI is a common situation in daily practice, isresponsible for high rates of morbidity and mortality worldwide...

Dual-source virtual non-contrast CT of the head: a preliminary study / 中华放射学杂志

Objective To investigate image quality and clinical value of dual-source dual energy virtual non-contrast (VNC) CT of the head. MethodsSixty-two patients suspected of cerebrovascular diseases underwent conventional non-contrast (CNC) CT and dual energy CTA examination of the head with dual-source CT. Virtual non-contrast images were reconstructed using dual energy software. The CT values of gray matter, white matter, cerebrospinal fluid, hyperdense hemorrhagic lesion and hypodense ischemic lesion were compared between CNC and VNC images. A four-score scale was used to assess image quality subjectively. Image noise, radiation dosage and detection rate were compared between CNC and VNC images. Paired t test, Wilcoxon signed ranks test and Chi-square test (McNemar test and Kappa test) were used. Results The CT value on CNC and VNC images, were (43. 3 ± 1.5) and (33. 2 ± 1.3) HU for gray matter (t = 46.98, P ＜ 0. 01), (32. 9 ± 1.3) and (28.8 ± 1.6) HU for white matter(t = 16. 28, P ＜0.01), (9.0 ± 1.4) and (5.3 ± 1.9) HU for cerebrospinal fluid (t=12.41, P＜0.01),(62.8 ±10.0) and (51.3 ± 11.5) HU for hyperdense lesion (Z = -4.37, P ＜ 0.01), (20.7 ±4.7) and (18.0 ±6. 9) HU for hypodense lesion (t = 3. 84, P ＜ 0. 01), respectively. VNC images[(1.63 ±0.34) HU]had more noise than CNC images[(0.99±0.18) HU](Z= -6.41, P＜0.01). VNC [(0. 53 ± 0. 08) mSv]had less effective dose than CNC[(1.37 ± 0. 23) mSy](Z= - 6. 45, P ＜ 0. 01).In subjective assessment, VNC images had more noise (2. 7 ± 0. 5 for VNC and 3.9 ± 0. 3 for CNC,Z = -6. 84, P ＜ 0. 01) and skull base-related artifacts (2. 4 ± 0. 9 for VNC and 3.7 ± 0. 5 for CNC,Z = -6. 15, P ＜0. 01) than CNC images. The gray/white matter contrast (1.3 ± 0. 5 for VNC and 3.3 ±0. 6 for CNC, Z = - 7. 01, P ＜ 0. 01), hyperdense lesion display (3.0 ± 0. 4 for VNC and 4. 0 ± 0. 0 for CNC,Z = -4. 52, P ＜ 0. 01) and hypodense lesion display (3.2 ± 0. 8 for VNC and 3.9 ± 0. 3 for CNC,Z= -3. 12, P ＜0. 01) on VNC images were lower than those on CNC images. In per-patient analysis,29 cases of hyperdense lesion (hemorrhage) were found on VNC images without misdiagnosis. The sensitivity, specificity, positive predictive value and negative predictive value were all 100. 0% (29/29,33/33, 29/29, 33/33). VNC images had the same detection rate of hyperdense lesions as CNC images (P ＞0. 05, Kappa = 1. 000) at per-patient level. Twenty-two patients with hypodense ischemic lesions were found on VNC images with one false positive case and two false negative cases. The sensitivity,specificity, positive predictive value and negative predictive value were 91.3% (21/23), 97.4%(38/39), 95.5% (21/22) and 95.0% (38/40) respectively. No statistical difference was found in detecting hypodense lesions between VNC and CNC images (χ2 = 0. 00, P ＞ 0. 05, Kappa = 0. 895). In per-lesion analysis, 53 hemorrhage lesions were found on VNC images with false negative results of four lesions and no false positive result. The sensitivity, specificity, positive predictive value and negative predictive value were 93.0% (53/57), 100. 0% (38/38), 100. 0% (53/53) and 90. 5% (38/42)respectively. There was no significant difference in detection rate of hyperdense lesion between VNC and CNC images (χ2 =2. 25, P ＞0. 05, Kappa =0. 914). Thirty-eight hypodense lesions were found on VNC images with 2 false positive lesions and 13 false negative lesions. The sensitivity, specificity, positive predictive value and negative predictive value were 73.5% (36/49), 96.4% (53/55), 94. 7% (36/38)and 80. 3% (53/66) respectively. The detection rate of hypodense lesion on VNC images was lower than that on CNC images (χ2 = 6. 67 ,P ＜ 0.01, Kappa = 0. 707). Conclusion Compared with CNC images,head VNC images have reduced image quality and radiation dosage. VNC images can replace CNC images potentially in detecting intracranial hemorrhage and provide information for ischemic cerebrovascular diseases to some extent.

Endovascular treatment of peripheral arterial injury with covered stents: an experimental study in pigs

OBJECTIVE: To evaluate the feasibility of using endovascular repair to treat penetrating arterial injuries with covered stents. Feasibility was examined according to the circumferential extent of the injury. INTRODUCTION: Surgical trauma often increases the risk of major morbidity and mortality associated with vascular injury, and endovascular repair has many advantages in such situations. METHODS: Twenty white male domestic pigs weighing 28-38 kg with controlled vascular injuries were divided into four equal groups according to the circumferential extent of their vascular lesion (i.e., no lesion, lesion <50 percent, lesion >50 percent, and complete lesion). The left common carotid artery was dissected with proximal and distal control, and this procedure was followed by controlled sectioning of the arterial wall. Local manual compression was applied for 10 min and was followed by endovascular repair with the placement of a 5x50 mm VIABHAN TM covered stent using the femoral approach. We also monitored additional variables, such as the duration of the procedures (the mean was 56.3 ± 19.1 min), ultrasound parameters (e.g., maximum arterial diameter, peak systolic and diastolic velocity, and resistance index), arteriography findings, and fluctuations in vital signs (e.g., cardiac output, arterial pressure, and central venous pressure). RESULTS: The experimental procedure was found to be feasible and reproducible. Repairs were successful in all animals in the control (no lesion) and <50 percent lesion groups. Success was also achieved in four out of five pigs in the >50 percent group and in one pig in the complete lesion group. DISCUSSION: The endovascular repair of an arterial injury is possible, but success depends on the circumferential extent of the arterial lesion. The present experimental model, which involved endovascular techniques, highlighted important factors that must be considered in future studies involving similar animals and materials.

Functional and Histologic Changes After Repeated Transcranial Direct Current Stimulation in Rat Stroke Model

Transcranial direct current stimulation (tDCS) is associated with enhancement or weakening of the NMDA receptor activity and change of the cortical blood flow. Therefore, repeated tDCS of the brain with cerebrovascular injury will induce the functional and histologic changes. Sixty-one Sprague-Dawley rats with cerebrovascular injury were used. Twenty rats died during the experimental course. The 41 rats that survived were allocated to the exercise group, the anodal stimulation group, the cathodal stimulation group, or the control group according to the initial motor function. Two-week treatment schedules started from 2 days postoperatively. Garcia, modified foot fault, and rota-rod performance scores were checked at 2, 9, and 16 days postoperatively. After the experiments, rats were sacrificed for the evaluation of histologic changes (changes of the white matter axon and infarct volume). The anodal stimulation and exercise groups showed improvement of Garcia's and modified foot fault scores at 16 days postoperatively. No significant change of the infarct volume happened after exercise and tDCS. Neuronal axons at the internal capsule of infarct hemispheres showed better preserved axons in the anodal stimulation group. From these results, repeated tDCS might have a neuroprotective effect on neuronal axons in rat stroke model.

Aspectos neuropsiquiátricos de las enfermedades cerebro-vasculares / Neuropsychiatric Aspects of Cerebrovascular Disorders

Introducción: la enfermedad cerebro-vascular (ECV) es un importante problema de salud pública, causa común de manifestaciones neuropsiquiátricas en personas médicamente afectadas. Las lesiones vasculares del sistema nervioso central generalmente se acompañan de secuelas neurocognitivas que producen importantes manifestaciones psicopatológicas, que infl uyen en el curso de la enfermedad. Objetivo: describir las manifestaciones neuropsiquiátricas de los pacientes con ECV diferentes a la depresión post-ECV. Método: revisión de la literatura médica existente sobre el tema. Conclusión: a pesar del extenso estudio de la neurobiología de los trastornos mentales a partir de modelos vasculares, no existe hasta el momento en los ensayos clínicos disponibles ninguna correlación sólida entre las lesiones estructurales, sus repercusiones funcionales y los trastornos neuropsiquiátricos específi cos. Los mecanismos implícitos en esta convergencia de manifestaciones clínicas tanto médicas como psiquiátricas siguen siendo pobremente comprendidos por gran parte de la comunidad médica. La gran mayoría de estudios consistentes en reportes y series de casos se limitan a describir poblaciones con ECV grave e incapacitante, y dejan por fuera otros enfermos con ECV menores, en quienes es bien reconocido un mayor riesgo para el desarrollo de trastornos neuropsiquiátricos como el Parkinson, los procesos demenciales y el delírium.

Introduction: Cerebrovascular disease is a major public health problem and common cause of neuropsychiatric disorders in the medically ill. Vascular lesions in the Central Nervous System cause signifi cant morbidity, usually followed by severe cognitive dysfunctions which become an important risk factor for developing psychopathology during the course of cerebrovascular disorders. Objective: To describe neuropsychiatric disorders affecting people with stroke other than post-stroke depression, as this will be reviewed extensively elsewhere. Method: Review of medical literature. Conclusions: Research on the neurobiology of mental disorders based on vascular theories to explain the etiology and physiopathology of some mental disorders has not come up with consistent results linking structural and functional studies with clinical correlates of neuropsychiatric syndromes. Implicit mechanisms responsible for the blend between systemic disease, neurological disorders and psychiatry are still poorly understood by the scientifi c community responsible for the treatment of cerebrovascular patients. Most studies are limited to case reports and series in severely ill patients leaving out those patients with mild to moderate stroke. These subjects are known to be at risk for neuropsychiatric disorders involving movement and cognitive symptoms such as Parkinson's, dementia and delirium.