Bilateral hypogeusia and food aversion due to lacunar infarct in the right dorsomedial pontine tegmentum.

A 70-year-old right-handed housewife suffered an acute loss of taste, an unpleasant change in the taste of foods and liquids, and a strong aversion to all kinds of food due to a small lacune in the right dorsomedial pontine tegmentum. Eating became so unpleasant that she lost 7 kg in three weeks. Olfaction and the sensibility of the tongue were spared. The right medial longitudinal fascicle, the central tegmental tract, or both, were injured by the tegmental lesion. A discrete right-sided lesion in the upper pontine tegmentum may cause a reversible syndrome consisting of bilateral hypogeusia which is more severe ipsilaterally.

Micro-Surgical Treatment of Fetal Myelomeningocele / Tratamento microcirúrgico da mielomeningocele fetal

Introduction Myelomeningocele (MMC) is the most common malformation of the central nervous system compatible with life. We will report the results obtained with the prenatal closure of MMC at the Instituto Estadual do Cérebro Paulo Niemeyer (IECPN). Objectives Clinical outcome of fetuses undergoing intrauterine MMC repair by the Peralta mini-hysterotomy. Monitor the reduction of Arnold-Chiari II secondary to MMC, reduction of hydrocephalus and also motor development in these children. Methods Descriptive study of 26 cases with intrauterine MMC repair by mini-hysterotomy, or Peralta technique, performed at the IECPN from December 2017 to February 2020. Results Between December 2017 and February 2020, 26 pregnant women with children with MMC were operated on using Peralta technique. Fetuses were born at an average gestational age of 34.2 weeks and 8% were born before 30 weeks of gestation. The average birth weight was 2096g. It was possible to observe a significant reduction in the occurrence of Arnold-Chiari II in these patients, as well as an evident improvement in motor function in the neurological examination of these babies at the end of the first month of life, where 20 of 23 babies had active movement in the lower limbs. Discussion This study demonstrates the correction of fetal MMC through a mini-hysterotomy of 2.5 to 3.5 cm, developed in order to reduce maternal and fetal mortality. This mini-hysterotomy technique is not a minimally invasive procedure, as it is based on open surgery for the treatment of fetal MMC, as recommended by the Management of Myelomeningocele Study (MOMS).

Introdução Mielomeningocele (MMC) é a malformação mais comum do sistema nervoso central compatível com a vida. Nós relataremos os resultados obtidos com o fechamento pré-natal da MMC no Instituto Estadual do Cérebro Paulo Niemeyer (IECPN). Objetivos Desfecho clínico dos fetos submetidos a correção intrauterina de MMC por mini-histerotomia de Peralta. Monitorar a redução de Arnold-Chiari II secundária à MMC, redução da hidrocefalia e também o desenvolvimento motor nessas crianças. Métodos Estudo descritivo de 26 casos com correção intrauterina de MMC por mini-histerotomia ou técnica de Peralta realizadas no IECPN no período entre dezembro de 2017 a fevereiro de 2020. Resultados Entre dezembro de 2017 a fevereiro de 2020, 26 gestantes com filhos portadores de MMC, foram operadas utilizando-se a técnica de Peralta. Os fetos nasceram com uma idade gestacional média de 34,2 semanas e 8% nasceram antes das 30 semanas de gestação. O peso médio ao nascer foi de 2096 gramas. Foi possível observarmos uma significativa redução na ocorrência de Arnold-Chiari II nestes pacientes, bem como uma evidente melhora da função motora no exame neurológico destes bebês ao final do primeiro mês de vida, aonde 20 de 23 bebês apresentavam movimentação ativa nos membros inferiores. Discussão Este estudo demonstra a correção da MMC fetal através de uma mini-histerotomia de 2,5 à 3,5cm, desenvolvida com o intuito de reduzir a mortalidade materna e fetal. Esta técnica de mini-histerotomia não é um procedimento minimamente invasivo, pois é baseada na cirurgia aberta para o tratamento da MMC fetal, como preconiza o estudo Management of Myelomeningocele Study (MOMS).

Humanization of pediatric care in the world: focus and review of existing models and measurement tools.

BACKGROUND: The term "humanization" indicates the process by which people try to make something more human and civilized, more in line with what is believed to be the human nature. The humanization of care is an important and not yet a well-defined issue which includes a wide range of aspects related to the approach to the patient and care modalities. In pediatrics, the humanization concept is even vaguer due to the dual involvement of both the child and his/her family and by the existence of multiple proposed models. OBJECTIVE: The present study aims to analyze the main existing humanization models regarding pediatric care, and the tools for assessing its grade. RESULTS: The main Humanization care programs have been elaborated and developed both in America (Brazil, USA) and Europe. The North American and European models specifically concern pediatric care, while the model developed in Brazil is part of a broader program aimed at all age groups. The first emphasis is on the importance of the family in child care, the second emphasis is on the child's right to be a leader, to be heard and to be able to express its opinion on the program's own care. Several tools have been created and used to evaluate humanization of care programs and related aspects. None, however, had been mutually compared. CONCLUSIONS: The major models of humanization care and the related assessment tools here reviewed highlight the urgent need for a more unifying approach, which may help in realizing health care programs closer to the young patient's and his/her family needs.

Morphometric and histopathological findings in the adrenal glands of dogs with chronic diseases

Prolonged stress suffered by the organism in the presence of chronic diseases can result in functional and morphological changes to the adrenal glands; although the effects of chronic stress on the adrenal gland function in live dogs is well documented, studies focusing on the morphologic changes in the adrenal glands have been lacking. Thus, this study aimed to identify and connect possible morphometric and histopathological changes in the adrenal glands of necropsied dogs in the presence or absence of chronic diseases. Morphological changes in the adrenal glands of 46 necropsied dogs were evaluated through morphometric and histopathological analyses. The morphometric characteristics of the adrenal glands of dogs were influenced more by the animal’s body weight (p < 0.0001) and adrenocortical hyperplasia (p < 0.05) than by the stress associated with chronic diseases or acute conditions. Previously healthy animals with sudden death or animals that died from acute diseases had significant severe congestion in the adrenal glands (p = 0.0272), while adrenocortical hyperplasia was more frequent in the chronic diseases group (p = 0.0041). Fibrosis at the corticomedullary junction (p < 0.0001) and inflammatory infiltrate (p = 0.0015) were observed only in animals with chronic diseases. The adrenal glands of dogs with chronic cardiac dysfunction frequently showed significant necrosis (p = 0.0256), fibrosis (p = 0.0002) and lipid depletion (p = 0.0288). Thus, while the weight or dimensions of the adrenal glands of dogs at necropsy should not be used alone as parameters to indicate a relation with the stress suffered prior to death, the histopathological findings could aid and support necropsy conclusions regarding the presence of chronic diseases.

Morphometric and histopathological findings in the adrenal glands of dogs with chronic diseases

Prolonged stress suffered by the organism in the presence of chronic diseases can result in functional and morphological changes to the adrenal glands; although the effects of chronic stress on the adrenal gland function in live dogs is well documented, studies focusing on the morphologic changes in the adrenal glands have been lacking. Thus, this study aimed to identify and connect possible morphometric and histopathological changes in the adrenal glands of necropsied dogs in the presence or absence of chronic diseases. Morphological changes in the adrenal glands of 46 necropsied dogs were evaluated through morphometric and histopathological analyses. The morphometric characteristics of the adrenal glands of dogs were influenced more by the animals body weight (p < 0.0001) and adrenocortical hyperplasia (p < 0.05) than by the stress associated with chronic diseases or acute conditions. Previously healthy animals with sudden death or animals that died from acute diseases had significant severe congestion in the adrenal glands (p = 0.0272), while adrenocortical hyperplasia was more frequent in the chronic diseases group (p = 0.0041). Fibrosis at the corticomedullary junction (p < 0.0001) and inflammatory infiltrate (p = 0.0015) were observed only in animals with chronic diseases. The adrenal glands of dogs with chronic cardiac dysfunction frequently showed significant necrosis (p = 0.0256), fibrosis (p = 0.0002) and lipid depletion (p = 0.0288). Thus, while the weight or dimensions of the adrenal glands of dogs at necropsy should not be used alone as parameters to indicate a relation with the stress suffered prior to death, the histopathological findings could aid and support necropsy conclusions regarding the presence of chronic diseases.(AU)

Carbon Dioxide Fluctuations Are Associated with Changes in Cerebral Oxygenation and Electrical Activity in Infants Born Preterm.

OBJECTIVES: To evaluate the effects of acute arterial carbon dioxide partial pressure changes on cerebral oxygenation and electrical activity in infants born preterm. STUDY DESIGN: This retrospective observational study included ventilated infants born preterm with acute fluctuations of continuous end-tidal CO2 (etCO2) as a surrogate marker for arterial carbon dioxide partial pressure, during the first 72 hours of life. Regional cerebral oxygen saturation and fractional tissue oxygen extraction were monitored with near-infrared spectroscopy. Brain activity was monitored with 2-channel electroencephalography. Spontaneous activity transients (SATs) rate (SATs/minute) and interval between SATs (in seconds) were calculated. Ten-minute periods were selected for analysis: before, during, and after etCO2 fluctuations of ≥5 mm Hg. RESULTS: Thirty-eight patients (mean ± SD gestational age of 29 ± 1.8 weeks) were included, with 60 episodes of etCO2 increase and 70 episodes of etCO2 decrease. During etCO2 increases, brain oxygenation increased (regional cerebral oxygen saturation increased, fractional tissue oxygen extraction decreased; P < .01) and electrical activity decreased (SATs/minute decreased, interval between SATs increased; P < .01). All measures recovered when etCO2 returned to baseline. During etCO2 decreases, brain oxygenation decreased (regional cerebral oxygen saturation decreased, fractional tissue oxygen extraction decreased; P < .01) and brain activity increased (SATs/minute increased, P < .05), also with recovery after return of etCO2 to baseline. CONCLUSION: An acute increase in etCO2 is associated with increased cerebral oxygenation and decreased brain activity, whereas an acute decrease is associated with decreased cerebral oxygenation and slightly increased brain activity. Combining continuous CO2 monitoring with near-infrared spectroscopy may enable the detection of otherwise undetected fluctuations in arterial carbon dioxide partial pressure that may be harmful to the neonatal brain.

Working memory and phonological awareness in children with Rolandic Epilepsy / Memoria de trabajo y consciencia fonológica en niños con Epilepsia Rolándica

This study investigated how the difficulties in language in children with Rolandic Epilepsy (RE) could be related to alterations in their development of phonological awareness and/or working memory. We evaluated fourty-two children aged 6 to 13 years old. From these, twenty-one children were diagnosed with RE and formed the experimental group; and twenty-one children without RE, paired with the experimental group by sex, age, education and socioeconomic status, formed the control group. The results showed significant differences in the performances of children with RE and healthy children in the tests that evaluated working memory and phonological awareness. Also, positive and high significant correlations were found between working memory and phonological awareness in the RE clinical subgroup. Generally, the results suggest that compromises in both cognitive functions might be associated to loss of language capabilities in children with RE, and also point that the development of working memory and phonological awareness are interconnected.

En este estudio se investigó cómo las dificultades en el lenguaje en niños con epilepsia Rolandica (ER) podrían estar relacionadas con alteraciones en su desarrollo de la conciencia fonológica y/o memoria de trabajo. Se evaluaron 42 niños de 6 a 13 años de edad. De éstos, 21 niños fueron diagnosticados con ER y formaron el grupo experimental; y 21 niños sin RE, emparejados con el grupo experimental por sexo, edad, nivel educativo y socioeconómico, que formaron el grupo de control. Los resultados mostraron diferencias significativas en los resultados de los niños con ER y niños sanos en las pruebas que evaluaron la memoria de trabajo y la conciencia fonológica. Además, se encontraron correlaciones positivas y altas entre la memoria de trabajo y la conciencia fonológica en el subgrupo clínico RE. En general, los resultados sugieren que los compromisos en ambas funciones cognitivas pueden estar asociados a la pérdida de capacidades del lenguaje en los niños con RE, y también señalan que el desarrollo de la memoria de trabajo y la conciencia fonológica están interconectados.

Óbitos de cães e gatos durante procedimentos de banho e tosa: uma realidade pouco conhecida no Brasil / Death of dogs and cats during grooming procedures: a little known reality in Brazil

Com o crescimento do mercado pet e suas inovações, proprietáriosde cães e gatos encontram cada vez mais alternativas paraa saúde e bem-estar de seus animais. Os estabelecimentos debanho e tosa vem ganhando espaço, uma vez que muitos proprietáriosnão dispõem de tempo e habilidade para a realizaçãoda higiene de seus animais. Porém, o que muitos proprietáriose até mesmo médicos veterinários desconhecem, é que cães egatos podem vir a óbito durante tais procedimentos aparentementeinofensivos, principalmente devido ao estresse. A mortedecorrente de estresse pode ocorrer tanto em animais debilitadosquanto saudáveis, independente da raça, idade ou sexo. Em umambiente de banho e tosa, a presença de agentes estressores éinevitável, mas algumas regras devem ser seguidas a fim de minimizaro estresse nestes animais. Este trabalho tem como objetivofornecer informações acerca da causa de morte nessas circunstânciase suas implicações legais.

With the growth of the pet market and its innovations, ownersof dogs and cats have increasingly alternatives for the health andwelfare of their animals. Establishments of bathing and groomingare becoming more popular, as many owners do not have thetime and ability to provide the adequate hygiene of their pets.However, many pet owners and even veterinarians are unawarethat dogs and cats can die during bathing or grooming, due tostress. Death related to stress may happen to sick or healthyanimals, regardless of breed, age or sex. In the bathing andgrooming environment, the presence of stressors is inevitable,but some rules must be followed to minimize the stress in theseanimals. This paper aims to provide information about the causeof death of these animals and the legal implications involved.

Óbitos de cães e gatos durante procedimentos de banho e tosa: uma realidade pouco conhecida no Brasil / Death of dogs and cats during grooming procedures: a little known reality in Brazil

Com o crescimento do mercado pet e suas inovações, proprietáriosde cães e gatos encontram cada vez mais alternativas paraa saúde e bem-estar de seus animais. Os estabelecimentos debanho e tosa vem ganhando espaço, uma vez que muitos proprietáriosnão dispõem de tempo e habilidade para a realizaçãoda higiene de seus animais. Porém, o que muitos proprietáriose até mesmo médicos veterinários desconhecem, é que cães egatos podem vir a óbito durante tais procedimentos aparentementeinofensivos, principalmente devido ao estresse. A mortedecorrente de estresse pode ocorrer tanto em animais debilitadosquanto saudáveis, independente da raça, idade ou sexo. Em umambiente de banho e tosa, a presença de agentes estressores éinevitável, mas algumas regras devem ser seguidas a fim de minimizaro estresse nestes animais. Este trabalho tem como objetivofornecer informações acerca da causa de morte nessas circunstânciase suas implicações legais.(AU)

With the growth of the pet market and its innovations, ownersof dogs and cats have increasingly alternatives for the health andwelfare of their animals. Establishments of bathing and groomingare becoming more popular, as many owners do not have thetime and ability to provide the adequate hygiene of their pets.However, many pet owners and even veterinarians are unawarethat dogs and cats can die during bathing or grooming, due tostress. Death related to stress may happen to sick or healthyanimals, regardless of breed, age or sex. In the bathing andgrooming environment, the presence of stressors is inevitable,but some rules must be followed to minimize the stress in theseanimals. This paper aims to provide information about the causeof death of these animals and the legal implications involved.(AU)

Patologia veterinária forense: aplicação, aspectos técnicos e relevância em casos com potencial jurídico de óbito de animais / Forensic veterinary pathology: application, technical aspects and relevance in cases of animal death with legal potential / Patología forense veterinaria: aplicación, aspectos técnicos y su importancia en los casos con potencial jurídico de muerte de animales

O aumento da conscientização de médicos veterinários e proprietários de animais quanto às consequências legais referentes à prática da medicina veterinária se reflete na crescente demanda pela medicina veterinária legal. A patologia forense é um instrumento valioso nessa área, sendo seu conhecimento essencial em casos de óbito de animais com suspeita de maus-tratos, negligência, intoxicações exógenas e erros médicos, dentre outros. As necrópsias com fins periciais apresentam diferenças quanto ao exame necroscópico tradicional, especialmente no registro e na documentação de lesões, tornando necessário o conhecimento das bases da patologia forense. O presente trabalho visa reunir e divulgar informações técnicas quanto à patologia forense veterinária e à realização de uma necrópsia documentada com fins periciais, a fim de auxiliar o médico veterinário frente a um caso com potencial jurídico de óbito animal.

The increasing awareness of veterinarians and animal owners regarding the legal consequences of the veterinary medicine practice is reflected on the growing demand for veterinary forensic medicine. Forensic pathology is a very valuable tool in this area, being essential in cases of animal death that may suggest abuse, neglect, poisoning and medical errors, among others. Necropsies for forensic ends present some differences regarding the traditional exam, especially regarding the recording and documentation of lesions, thus rendering the knowledge of the bases of forensic pathology necessary. The present study aims to gather and disclose technical information about the performance of forensic necropsies in animals, in order to assist the veterinarian in cases of animal death with legal potential.

El aumento de la concientización de los médicos veterinarios y de los propietarios de animales en relación a las consecuencias legales relacionadas con la práctica de la medicina veterinaria puede verse reflejada en la creciente demanda por una medicina veterinaria forense. La patología forense representa un valioso instrumento en esa área, siendo esencial su conocimiento en los casos de muerte de animales donde se sospecha de malos tratos, negligencia, intoxicaciones exógenas y errores médicos, entre otras situaciones. Las necropsias con fines periciales presentan diferencias con el examen necroscópico convencional, especialmente en el registro y en la documentación de las lesiones, siendo necesario que se conozcan las bases de la patología forense. El presente trabajo tiene como objetivo reunir y divulgar las informaciones técnicas relacionadas con la patología forense veterinaria, con la realización de una necropsia documentada con fines periciales, a fin de ayudar al médico veterinario en los casos donde exista un potencial jurídico relacionado con la muerte un animal.

Patologia veterinária forense: aplicação, aspectos técnicos e relevância em casos com potencial jurídico de óbito de animais / Forensic veterinary pathology: application, technical aspects and relevance in cases of animal death with legal potential / Patología forense veterinaria: aplicación, aspectos técnicos y su importancia en los casos con potencial jurídico de muerte de animales

O aumento da conscientização de médicos veterinários e proprietários de animais quanto às consequências legais referentes à prática da medicina veterinária se reflete na crescente demanda pela medicina veterinária legal. A patologia forense é um instrumento valioso nessa área, sendo seu conhecimento essencial em casos de óbito de animais com suspeita de maus-tratos, negligência, intoxicações exógenas e erros médicos, dentre outros. As necrópsias com fins periciais apresentam diferenças quanto ao exame necroscópico tradicional, especialmente no registro e na documentação de lesões, tornando necessário o conhecimento das bases da patologia forense. O presente trabalho visa reunir e divulgar informações técnicas quanto à patologia forense veterinária e à realização de uma necrópsia documentada com fins periciais, a fim de auxiliar o médico veterinário frente a um caso com potencial jurídico de óbito animal.(AU)

The increasing awareness of veterinarians and animal owners regarding the legal consequences of the veterinary medicine practice is reflected on the growing demand for veterinary forensic medicine. Forensic pathology is a very valuable tool in this area, being essential in cases of animal death that may suggest abuse, neglect, poisoning and medical errors, among others. Necropsies for forensic ends present some differences regarding the traditional exam, especially regarding the recording and documentation of lesions, thus rendering the knowledge of the bases of forensic pathology necessary. The present study aims to gather and disclose technical information about the performance of forensic necropsies in animals, in order to assist the veterinarian in cases of animal death with legal potential.(AU)

El aumento de la concientización de los médicos veterinarios y de los propietarios de animales en relación a las consecuencias legales relacionadas con la práctica de la medicina veterinaria puede verse reflejada en la creciente demanda por una medicina veterinaria forense. La patología forense representa un valioso instrumento en esa área, siendo esencial su conocimiento en los casos de muerte de animales donde se sospecha de malos tratos, negligencia, intoxicaciones exógenas y errores médicos, entre otras situaciones. Las necropsias con fines periciales presentan diferencias con el examen necroscópico convencional, especialmente en el registro y en la documentación de las lesiones, siendo necesario que se conozcan las bases de la patología forense. El presente trabajo tiene como objetivo reunir y divulgar las informaciones técnicas relacionadas con la patología forense veterinaria, con la realización de una necropsia documentada con fines periciales, a fin de ayudar al médico veterinario en los casos donde exista un potencial jurídico relacionado con la muerte un animal.(AU)

Necropsy findings in dogs that died during grooming or other pet service procedures.

Procedures involved in grooming, bathing, and other pet services can often lead animals to death. Of the necropsies of 1391 animals carried out at a private diagnostic laboratory in Sao Paulo, Brazil from 2004 to 2009, 94 were dogs that died during the above-mentioned procedures. Young male dogs and small breeds like Poodle Miniature, Yorkshire Terrier, and Lhasa Apso were most frequently observed. Blunt-force trauma was responsible for the deaths of 31% of the animals, with a higher incidence of trauma to the head, characterized chiefly by fractures and nervous tissue lesions. In the other 69% of cases, the animals showed signs of stress, and died due to pulmonary edema and hemorrhage. As we cannot rule out the intentional character in some situations, this article provides veterinary forensic support for veterinarians and pet owners, especially in lawsuits, helping in finding the cause of animal's death in such pet services.

Forensic veterinary pathology: Old dog learns a trick

Veterinary pathology specialists deal with a wide range of challenges in order to practice and provide useful results from analyzing deceased animals. The large number of species is certainly a first step that makes education in Veterinary Pathology so exciting. Knowing animal diseases is the basis of what we understand from comparative pathology and its contribution to public and environmental health. Recently a new search for veterinary pathology work is asked in situations that death of animals is linked to crime, or a crime scene investigation is taking place. Law Enforcement asks for Expert Witness Testimony to analyze cause of death of one, or even several animals that can be involved in a crime scene investigation. Different from a routine necropsy, forensic necropsies usually have medico-legal interest and this changes completely the scenario. For this purpose, postmortem examination requires additional and rigorous documentation of all steps taken from the crime scene, gross and microscopically detected lesions in the bodies and collected samples that will be analyzed in special laboratories. Criminal actions in which animals might be involved, either as a victim, a testimony or a perpetrator need a correct interpretation.

Forensic veterinary pathology: Old dog learns a trick

Veterinary pathology specialists deal with a wide range of challenges in order to practice and provide useful results from analyzing deceased animals. The large number of species is certainly a first step that makes education in Veterinary Pathology so exciting. Knowing animal diseases is the basis of what we understand from comparative pathology and its contribution to public and environmental health. Recently a new search for veterinary pathology work is asked in situations that death of animals is linked to crime, or a crime scene investigation is taking place. Law Enforcement asks for Expert Witness Testimony to analyze cause of death of one, or even several animals that can be involved in a crime scene investigation. Different from a routine necropsy, forensic necropsies usually have medico-legal interest and this changes completely the scenario. For this purpose, postmortem examination requires additional and rigorous documentation of all steps taken from the crime scene, gross and microscopically detected lesions in the bodies and collected samples that will be analyzed in special laboratories. Criminal actions in which animals might be involved, either as a victim, a testimony or a perpetrator need a correct interpretation.

Malformaçäo de Chiari do tipo II sintomática / Symptomatic Chiari type II malformation

Os autores analisam uma série de 17 crianças portadoras de mielodisplasias que desenvolveram sinais e sintomas da malformaçoes de Chiari do tipo II. De acordo com a idade, dois grupos ficaram bem definidos: Grupo I, crianças no primeiro ano de vida, em que predominaram sinais e sintomas de comprometimento do tronco encefálico e nervos cranianos bulbares (n=13); Grupo II, composto por crianças com idade superior a um ano, em que as principais manifestaçoes foram dor cervical e sinais cerebelares (n=4). O resultado do tratamento cirúrgico nos dois grupos foi distinto: enquanto a mortalidade no Grupo I atingiu 46,1 por cento, nenhum paciente do Grupo II veio a falecer. O tratamento inicial consistiu na manifestaçao ou revisao de derivaçao ventricular, sendo a descompressao crânio-vertebral reservada àqueles que nao se beneficiaram com esses procedimentos. Os autores enfatizam a necessidade do imediato reconhecimento e tratamento do quadro, de modo a se obter resultados satisfatórios.

Epitelioma basalióide: um caso de localizaçäo incomum / Basal cell carcinoma: an unusual localization

Os autores descrevem um caso de epitelioma basalióide localizado na falange distal do dedo polegar da mäo esquerda, entre a prega ungueal lateral e a posterior numa paciente de 68 anos de idade. Tecem alguns comentários a respeito dessa localizaçäo incomum, bem como a escassez de relatos na literatura