Functional MRI evaluation of supplementary motor area language dominance in right- and left-handed subjects.

Functional magnetic resonance imaging (fMRI) is a non-invasive brain imaging technique widely used in the evaluation of the brain function that provides images with high temporal and spatial resolution. Investigation of the supplementary motor area (SMA) function is critical in the pre-surgical evaluation of neurological patients, since marked individual differences and complex overlapping with adjacent cortical areas exist, and it is important to spare the SMA from lesions when adjacent cortical tissue is surgically removed. We used fMRI to assess the activity of SMA in six right-handed and six left-handed healthy volunteers when a task requiring silent repetition of a series of words was given. Brain activation areas in each of the subjects were localized according to the standard Talairach coordinate space, and the individual voxels for each map were compared after 3D sagittal images were created and SMA was delimited. Quantitative analysis of hemispheric and bilateral SMA activation was described as mean ± standard deviation of hot points/total points. The results show that the language task induced bilateral SMA activation. Left SMA activation was significantly higher than right SMA activation in both right-handed and left-handed subjects.

Pain management in the elderly at the end of life.

BACKGROUND: The treatment of older adults with pain is complex and affected by age-related changes in pharmacokinetics and pharmacodynamics. Chronic pain encompasses a complex array of sensory-discriminatory, motivational-affective, and cognitive-evaluative components. Because of this complexity, both pharmacologic and nonpharmacologic approaches should be considered to treat pain. AIMS: Given the large number of older persons with pain at the end of life and the few data about this issue, the objective of this article is to review the treatment of pain in this population. PATIENTS AND METHODS: We searched The Cochrane Library, MEDLINE and LILACS from 1990 to 2011 and the references in retrieved manuscripts. The search terms were pain AND elderly AND end of life. RESULTS: There are evidences of undertreatment among elderly people. The association of nonpharmacologic resources with the pharmacological treatment can help reduce the use of analgesics minimizing the side effects of long term medication. Pharmacological treatment is escalated in an orderly manner from non-opioid to weak opioid to strong opioid. Adjuvant drugs like anticonvulsants and antidepressants may be necessary. CONCLUSIONS: The sequential use of analgesics drugs and opioids are considered effective and relatively inexpensive for relieving pain, but no well designed specific studies in the elderly patient are available. There are not specific recommendations about the long-term use of complementary and alternative therapies and although their effectiveness remains unproven they should not be discouraged. Palliative sedation may be a valid palliative care option to relieve suffering in the imminently dying patient.

Trauma facial por arma de fogo com lesão simpática associada: relato de caso / Facial trauma by a firegun with sympathic lesion associated: case report

Relatamos o caso de um paciente que sofreu ferimento por arma de fogo na região do terço médio da face. Além das implicações decorrentes de um ferimento desse tipo, observou-se o envolvimento de nervos simpáticos periféricos das glândulas sudoríparas causando sudorese cervicofacial homolateral

Giant pseudoaneurysm of the extracranial vertebral artery: case report

Pseudoaneurysms of the extracranial vertebral artery are extremely rare due to their deep location and the anatomical protection of this artery. They can be caused by cervical traumas (firearm inhuries, sports, hyperextension of the neck and iatrogeny). The authors report the case of a patient who developed a giant pseudoaneurysm of the extracranial vertebral artery after surgery for the removal of a tumor of the cerebellopontine angle in which surgical lesion of the artery occurred. Treatment was performed by endovascular approach. Literature is reviewed and comments are made on the physiopathogeny of the lesion and the different forms of treatment.

Localizaçäo incomum do papiloma de plexo coróide: relato de caso / An unusual presentation of choroid plexus papilloma: case report

Os autores relatam um caso de papiloma de plexo coróide de localizaçao incomum, no ângulo ponto-cerebelar, com quadro de hipertensao intracraniana, em adulto jovem. Sao analisados a incidência, fisiopatogenia e diagnóstico destes tumores. A revisao da literatura disponível mostrou tratar-se do segundo caso publicado na bibliografia nacional.