Neurovascular reconstruction with flow diverter stents for the treatment of 87 intracranial aneurysms: Clinical results.

BACKGROUND: Flow diverter stents represent a new endovascular tool to treat complex aneurysms, such as giant, large, wide-necked and fusiform. The highly dense mash of these stents reduces inflow and outflow inside the aneurysm, resulting in intra aneurysmal thrombosis and stent endothelialization. OBJECTIVES: To present the results of treatment of intracranial aneurysms with flow diverter stents in a single center. METHODS: Retrospective review of 77 patients with 87 aneurysms treated using two different types of flow diverter stent, the Pipeline Embolization Device and SILK stent, between October 2010 and September 2013 in an interventional neuroradiology center. RESULTS: Flow diverter stent placement was successful in 98% of the lesions and resulted in an immediate major stasis within most of the treated aneurysms. The overall aneurysm occlusion rate at six months and 18 months was 80% and 84% respectively. Symptomatic complications occurred in 11 patients (14.3%) with morbidity in eight (10.4%) and mortality in three patients (3.9%). CONCLUSION: Flow diversion is a promising technique for treatment of challenging intracranial aneurysms with acceptable morbidity. A high rate of complete occlusion for small large necked aneurysms, a low morbidity and mortality rate and no recanalization encourage their use in these aneurysms. Further studies accessing long-term aneurysm occlusion and recanalization are required.

XI cranial nerve cervical schwannoma - case report / Schwannoma do nervo acessório cervical- relato de caso

Cisternal spinal accessory schwannoma are still a rare condition without neurofibromatosis with only 32 cases reported so far. We describe a cisternal accessory schwannoma presented in a 36-year-old woman with posterior cervical pain and cervical mieolopaty, defined by grade IV tetraparesia. A suboccipital craniectomy with C1 posterior arch resection was performed. During microsurgical dissection together with electrophysiological monitoring and nerve stimulation tumor was identified as having the spinal accessory root as its origins. Carefully intraneural dissection was then performed with complete lesion removal, histopatological examination confirmed the hypothesis of schwannoma. The patient was free from pain and improved her neurological status with no accessory nerve palsy. Complete surgical resection is indicated for such lesions and can be achieved with good outcome.

O schwannoma do ramo espinhal do nervo acessório em sua porção cisternal, quando não associado à neurofibromatose, é uma condição rara, com apenas 32 relatos de caso na literatura. O diagnóstico diferencial da lesão deve ser atentado, principalmente no que diz respeito à preservação da função motora do nervo acessório. Este é um relato de caso de uma paciente do sexo feminino de 36 anos com queixa de cervicalgia associada à mielopatia cervical compressiva secundária à lesão expansiva intradural, extramedular, estendendo-se do forame magno até a porção superior da lâmina de C2. A paciente foi submetida a uma craniectomia de fossa posterior e ressecção do arco posterior de C1. Durante exploração cirúrgica, auxiliada por monitoração eletrofisiológica e estimulação neural, foi identificado que a lesão tinha origem no ramo espinhal do nervo acessório direito. Foi então ressecada de forma completa com preservação dos fascículos íntegros do nervo de origem. O exame anatomopatológico confirmou a hipótese de schwannoma. A paciente evoluiu sem dor e com melhora do quadro neurológico, sendo preservada a função do nervo acessório. O schwannoma do ramo espinhal do nervo acessório é uma condição rara. A ressecção cirúrgica total é o tratamento de escolha para esses pacientes e pode ser alcançada sem lesões neurológicas significativas secundárias ao ato cirúrgico.

Resíduos de estações de tratamento de água e a ISO 24512: desafio do saneamento brasileiro / Residues of water treatment plants and ISO 24512: challenge of the Brazilian sanitation

O advento da ISO 24512:2007 suscita discussões muito interessantes em relação ao funcionamento dos sistemas de abastecimento de água em âmbito mundial. No Brasil, a maioria das estações de tratamento de água é convencional de ciclo completo, gerando resíduos complexos e de difícil manejo e disposição. Este trabalho teve como objetivo avaliar de forma crítica a problemática dos resíduos das estações de tratamento de água no Brasil, mediante o estudo da viabilidade de construção e uso de indicadores, tais como aqueles preconizados pela ISO 24512. A grande maioria das estações de tratamento de água analisadas, que refletem um quadro comum no Brasil, não dimensiona a quantidade de resíduos gerados, poucas avaliam suas características e destinam adequadamente esses resíduos, o que dificulta e, em muitos casos, pode impossibilitar o uso de indicadores como ferramentas de gestão. Esse cenário remete ao desafio enfrentado na área de saneamento em relação à gestão dos resíduos em consonância com as normas internacionais.

The advent of ISO 24512:2007 arouses some interesting discussions regarding the operation of water supply systems worldwide. In Brazil, the majority of water treatment plants is conventional, with a complete cycle, generating complex waste of difficult handling and disposal. This paper aimed at critically evaluating the problem of residues from water treatment plants in Brazil by studying the feasibility of construction and use of some indicators, such as those recommended by ISO 24512. The vast majority of water treatment plants analyzed, reflecting a common framework in Brazil, does not measure the amount of waste generated, few evaluate their features and dispose the residues properly, which makes it difficult and in many cases may preclude the use of indicators as management tools. This scenario brings to the challenge faced in the sanitation sector, regarding the management of residues in line with the international standards.

Bilateral extradural haematoma after acute ventricular over-drainage.

BACKGROUND: Ventricular over-drainage is a common complication of dysfunctional ventriculoperitoneal devices. Subdural haematomas are usually the most common lesions associated with that complication. Such lesions may arise after ventricular collapse and bridging veins disruption that follows over-drainage, thus contributing to distortion of brain parenchyma, increased intracranial hypertension and neurological decline. More rarely, extradural haematomas may also be observed after ventricular shunt hyperfunction and may result in rapid neurological decline unless a surgical procedure can be promptly performed. CASE: This study reports the case of a 38-old-woman who presented supratentorial hydrocephalus and developed bilateral extradural haematomas after the placement of a ventricular shunt device. Both haematomas were surgically approached and the dysfunctional shunt device was replaced. CONCLUSION: Extradural haematomas may develop precociously after ventricular over-drainage. Surgical treatment is mandatory and must include not only the evacuation of haematoma, but also the replacement of dysfunctional shunt to prevent further recurrence. The pathophysiology of extradural haematomas consequent of ventricular over-drainage and the possible use of a programmable valve to prevent these lesions are briefly discussed.

Interhemispheric chronic subdural haematoma: case report and brief review of the literature.

BACKGROUND: Chronic subdural haematoma usually arises from a traumatic acute haemorrhage in the subdural space, frequently causing mass effect and consequent neurological decline. This lesion is mainly found over the cortical convexity and its evolution and surgical approach has been extensively studied. Nevertheless, inter-hemispheric chronic subdural haematoma is considered a rare lesion. AIM AND CASE REPORT: This study reported a case of traumatic acute interhemispheric subdural haematoma, initially asymptomatic, and its evolution to a chronic symptomatic lesion, as well as the surgical approach employed. A brief review of the literature is presented with a discussion of the therapeutic options.

Leito de drenagem: sistema natural para redução de volume de lodo de estação de tratamento de água / Draining beds: natural system for sludge volume reduction in the water treatment plant

As Estações de Tratamento de Água (ETAs) tem funcionamento semelhante a uma indústria e podem em diversas etapas gerar resíduos que, na maioria das ETAs, são lançados nos corpos d'água sem tratamento. Neste trabalho avaliou-se o desempenho de Leitos de Drenagem, para o desaguamento de lodo, provenientes de ETAs de ciclo completo que empregam sulfato de alumínio e cloreto de polialumínio (PACl), como coagulantes. Analisou-se as características, a drenagem e secagem dos amostras de lodo e característica do drenado. Os Leitos de Drenagem mostraram-se eficientes para desaguamento e redução de volume de lodo de ETA, de forma natural, sem consumo de energia ou adição de produtos químicos. Obteve-se, aos sete dias, reduções da ordem de 87 por cento em volume para os lodos de PACl e 83 por cento para o lodo de Sulfato de Alumínio e teor de sólidos totais 28 por cento e 31 por cento respectivamente.

In this work the performance of Draining Beds for sludge dewatering was assessed. The sludge was provided from full cycle Water Treatment Plants (WTPs) that employ aluminum sulfate and polyaluminium chloride (PACl) as coagulants. The characteristics, drainage and drying of samples of sludge and characteristic of drained were analysed. The Draining Beds were shown to be efficient for dewatering and sludge volume reduction in the WTP, in a natural way, without energy consumption or adding of chemical products. On the seventh day, it was possible to obtain reduction around 87 percent in volume for PACl sludge and 83 percent for the aluminum sulfate sludge and total solids content of 28 and 31 percent respectively.

Botulinum toxin type A for the treatment of the spastic equinus foot in cerebral palsy.

Muscle overactivity, one of the cardinal features of spasticity, is a common sequel of cerebral palsy. In this group of patients spasticity is responsible for several limitations that interfere with gait, causing variable functional disability. Drugs such as baclofen, tizanidine, or benzodiazepines, or even definitive treatments such as orthopedics or neurosurgeries are generally prescribed with uncertain results. The use of botulinum toxin type A has been frequently suggested for the treatment of spastic equinus foot in cerebral palsy, but few studies with adequate methodology support this idea. The present paper reviews and summarizes the data of published double-blind, randomized clinical trials to assess, with a meta-analysis, if botulinum toxin type A is an adequate treatment for spasticity caused by cerebral palsy. The results reveal a statistical superiority of botulinum toxin type A over placebo on gait improvement, tested using the Physician Rating Scale and Video Gait Analysis (Peto odds ratio = 3.99, 95% confidence interval = 2.20-7.22) in patients with spastic equinus foot. The botulinum toxin group also presented better results in the subjective assessment than the placebo group (Peto odds ratio = 3.49, 95% confidence interval = 1.50-8.12). Adverse events were more frequently observed after the use of botulinum toxin type A, but they were considered mild and self-limited.