Medical wastes management in the south of Brazil.

In developing countries, solid wastes have not received sufficient attention. In many countries, hazardous and medical wastes are still handled and disposed together with domestic wastes, thus creating a great health risk to municipal workers, the public and the environment. Medical waste management has been evaluated at the Vacacai river basin in the State of Rio Grande do Sul, Brazil. A total of 91 healthcare facilities, including hospitals (21), health centers (48) and clinical laboratories (22) were surveyed to provide information about the management, segregation, generation, storage and disposal of medical wastes. The results about management aspects indicate that practices in most healthcare facilities do not comply with the principles stated in Brazilian legislation. All facilities demonstrated a priority on segregation of infectious-biological wastes. Average generation rates of total and infectious-biological wastes in the hospitals were estimated to be 3.245 and 0.570 kg/bed-day, respectively.

[Paracoccidioidomycosis of the central nervous system: case report]. / Paracoccidioidomicose do sistema nervoso central: relato de caso.

The involvement of the central nervous system in paracoccidioidomycosis is more frequent than previously thought. The first reference to the possibility that Paracoccidioides brasiliensis could affect the central nervous system was by Pereira & Jacobs in 1919. Since then, a great number of other studies has showed this form of clinical behavior and, in some of them, the frequency has ranged 27.27%. We report a clinical case of a 34-year-old white Brazilian woman admitted because of bacterial pneumonia. In the sixth day of admission, the patient developed cerebellar symptomatology with nausea, vomiting, dysmetria and gait disturbance. Central nervous system computer tomographic scanning disclosed a hypodense lesion in the right cerebellar hemisphere. The patient was submitted to surgery with total excision of the lesion. Histopathological examination confirmed the diagnosis of neuroparacoccidioidomycosis. Coadjuvant treatment with sulfamethoxazole-trimetoprim was introduced. The patient had a good outcome and was discharge 30 days after surgery.

Commissioning and operation of the first brazilian synchrotron light source.

The synchrotron light source designed and constructed at the LNLS is composed of a 1.37 GeV electron storage ring and a 120 MeV linac for low-energy injection. The storage ring has been commissioned and has already reached the designed electron-beam energy, current and emittance. The electron lifetime is now 6 h at 60 mA, and is steadily increasing. Seven beamlines (TGM, SGM, SXS, XAFS, XRD, SAXS, PCr) have been constructed in parallel with the electron accelerators and are at present in operation. Beam time was allocated to 129 approved research projects for the second semester of 1997. A number of them are currently under way.

[Basilar impression and malformation of Arnold-Chiari. Postoperative complications in 126 cases (author's transl)]. / Postoperative Komplikationen bei 126 Fällen basilärer Impression und Arnold-Chiarischer Missbildung.

Within a period of ten years we operated on 126 cases of basilar impression and/or Arnold-Chiari malformation. Two surgical techniques were employed for decompression of the posterior fossa. In the group I (64 cases) the operation consisted of craniectomy and the dura mater was left open and was fixed to the lateral musculature. The technique of the group II (62 cases) consisted in endotracheal intubation without flexion of the head, position of the head without anterior flexion during the operation and plastic closure of the dura. The dural graft was employed to create more space at the craniocervical joint, to avoid cerebrospinal fluid fistula and to restore the integrity of the dura as a protection for the nervous structures of the posterior fossa. The frequency of postoperative complications and mortality observed in group II was definitely less than in the group I.

[Postoperative complications in 139 cases of basilar impression and/or Arnold-Chiari deformity]. / Complicações pos-operatórias em 139 casos de impressão basilar e/ou malformação de Arnold-Chiari.

The many kinds of complication that have been observed following operations of basilar impression and/or malformation of Arnold-Chiari are analysed. Two surgical techniques were adopted in the treatment of the patients. In the first 64 cases, the operation consisted in the craniectomy of the posterior fossa and high cervical laminectomy, while the dura-mater remained opened and saturated to the lateral musculature. Concerning the other 75 cases, it was made a plastic of the dura-mater of the posterior fossa and, in most of the cases, the patients were intubated with no retroflexion of the head and operated in sitting position without anterior flexion of the head. In the second group of patients, it was observed lesser occurrence of complications and death.

Complicacoes pos-operatorias em 139 casos de impressao basilar e/ou malformacao de Arnold-Chiari. / Postoperative complications in 139 cases of basilar impression and/or Arnold-Chiari deformity.

No presente trabalho, foram analisadas as complicacoes pos-operatorias observadas em 139 casos de impressao basilar e/ou malformacao de Arnold-Chiari. Os autores chamam a atencao para a menor ocorrencia de complicacoes e de mortalidade verificadas nos pacientes que foram submetidos a plastica da duramater da fossa posterior.

[A rare orbito-cerebral penetrating knife-wound (author's transl)]. / Eine seltene orbito-zerebrale Messerstichverletzung.

The authors describe a case of open brain injury caused by a 30 cm long knife, which penetrated the right orbit, the point of which reached as far as the right posterior fossa. The patient survived with minor neurologic deficit in relation to the extensive lesion.

[The basilar impression and the Arnold-Chiari malformation. Techno-surgical considerations apropos of 13 cases]. / Impressão basilar e malformação de Arnold-Chiari. Considerações técnico-cirúrgicas a propósito de 13 casos.

The surgical technic for decompression of the posterior fossa in cases of basilar impression and malformation of Arnold-Chiari mainly based in (1) endotracheal intubation without any flexion of the head, (2) position of the head without anterior flexion during the surgery, (3) plastic of the posterior fossa with dura-mater of cadaver conserved in glicerina, was emploied in 13 patients. The plastic was made to create space at the craniocervical joint in order to avoid cerebrospinal fluid fistula and to restore the integrity of the dura. Infection was not observed.

[Decompression craniotomy in acute brain edema. Apropos of 30 operated cases]. / Craniotomia descompressiva no edema cerebral grave. A propósito de 30 casos operados

Uni or bilateral decompressive craniotomy was carried out in 30 patients bearing severe cerebral edema of etiology predominantly traumatic. Coma, midriasis and decerebrate state were the mostly commonly clinical features presented. The average survival in the series was 46.6%.

[Frontobasal cranio-encephalic injuries]. / Traumatismos cranio-encefalicos frontobasais

The authors deal with the results accomplished by surgical procedure on 10 cases of fronto-basal trauma. X-Rays taken from the skull disclosed an involvement of bone structures of the fronto-basal region in all cases examined. The most outstanding clinical findings in these cases were: lesion of the olfactory nerve (7cases), bacterial meningitis (3 cases), cerebrospinal fluid cranio-nasal fistula (3 cases). The surgical technic was accomplished according to the procedure devised by Dietz and consisted of plastics of the anterior floor of the skull accompanied by galea-periosteal junction taken out from the scalp. The authors did not find any post-operative complications in the cases registered.