Comparative Study of the Effectiveness of Lumboperitoneal and Ventriculoperitoneal Shunting with Neuronavigation in the Treatment of Idiopathic Intracranial Hypertension.

BACKGROUND: Idiopathic intracranial hypertension is an uncommon intracranial disorder in which intracranial pressure is increased without radiological evidence of lesions. Surgery is indicated when severe optic neuropathy is present or medical treatment fails. OBJECTIVE: To assess the comparative effectiveness of lumboperitoneal (LPS) and ventriculoperitoneal shunt (VPS) with neuronavigation. SUBJECTS AND METHODS: A retrospective study was performed based on our database. We analyzed demographics, pre and postoperative parameters, and follow-up data on patients who had undergone either LPS or VPS between January 2007 and December 2017. RESULTS: Group I consisted of 17 VPS patients, of which 16 were female, and group II consisted of 29 LPS patients, of which 26 were female. The number of surgeries performed in the LPS group was higher (due to recurrence) than that in the VPS group. Moreover, the rate of complications was higher in the LPS group. CONCLUSIONS: VPS is safer and has a lower rate of complications and reinterventions compared to LPS.

Conventional physical therapy and physical therapy based on reflex stimulation showed similar results in children with myelomeningocele.

We aimed to investigate whether infants with myelomeningocele would improve their motor ability and functional independence after ten sessions of physical therapy and compare the outcomes of conventional physical therapy (CPT) to a physical therapy program based on reflex stimulation (RPT). Twelve children were allocated to CPT (n = 6, age 18.3 months) or RPT (n = 6, age 18.2 months). The RPT involved proprioceptive neuromuscular facilitation. Children were assessed with the Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory before and after treatment. Mann-Whitney tests compared the improvement on the two scales of CPT versus RPT and the Wilcoxon test compared CPT to RPT (before vs. after treatment). Possible correlations between the two scales were tested with Spearman correlation coefficients. Both groups showed improvement on self-care and mobility domains of both scales. There were no differences between the groups, before, or after intervention. The CPT and RPT showed similar results after ten weeks of treatment.

Conventional physical therapy and physical therapy based on reflex stimulation showed similar results in children with myelomeningocele / Fisioterapia convencional e fisioterapia com estimulação reflexa apresentaram resultados semelhantes em crianças com mielomeningocele

ABSTRACT We aimed to investigate whether infants with myelomeningocele would improve their motor ability and functional independence after ten sessions of physical therapy and compare the outcomes of conventional physical therapy (CPT) to a physical therapy program based on reflex stimulation (RPT). Twelve children were allocated to CPT (n = 6, age 18.3 months) or RPT (n = 6, age 18.2 months). The RPT involved proprioceptive neuromuscular facilitation. Children were assessed with the Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory before and after treatment. Mann-Whitney tests compared the improvement on the two scales of CPT versus RPT and the Wilcoxon test compared CPT to RPT (before vs. after treatment). Possible correlations between the two scales were tested with Spearman correlation coefficients. Both groups showed improvement on self-care and mobility domains of both scales. There were no differences between the groups, before, or after intervention. The CPT and RPT showed similar results after ten weeks of treatment.

RESUMO O estudo investigou se crianças com mielomeningocele melhorariam sua habilidade motora/funcional após dez sessões de fisioterapia e comparou o quadro motor de um grupo submetido à fisioterapia convencional (FC) com outro tratado com fisioterapia com estimulação reflexa (RF). Doze crianças foram alocadas em FC (n=6, 18,3 meses de idade) ou FR (n=6, 18,2 meses de idade). FR envolveu facilitação neuromuscular proprioceptiva. As crianças foram avaliadas com a Medida de Função Motora Grossa (GMFM) e o Inventário de Avaliação Pediátrica de Incapacidade (PEDI) antes e depois do tratamento. Testes de Mann-Whitney compararam a melhora na GMFM e PEDI (FC versus FR) e testes de Wilcoxon compararam FC e FR (antes versus depois). Possíveis correlações entre GMFM e PEDI foram testadas por coeficientes de Spearman. Ambos os grupos melhoraram na GMFM e PEDI (domínios autocuidado e mobilidade). Não houve diferença entre os grupos antes e após a intervenção. FC e FR apresentaram efeitos semelhantes depois de dez semanas de tratamento.

Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus.

Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.

Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus / Sintomas psiquiátricos são encontrados na maioria dos pacientes com hidrocefalia de pressão normal idiopática

Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.

A hidrocefalia de pressão normal (HPN) é caracterizada por distúrbios da marcha, demência e/ou incontinência urinária associada com dilatação do sistema ventricular e pressão de abertura do líquido cefalorraquidiano normal. Evidências científicas confirmam associação entre HPN e sintomas psiquiátricos. Foram selecionados 35 pacientes com hidrocefalia de pressão normal idiopática, de janeiro de 2010 a janeiro de 2012 em um hospital terciário brasileiro e realizada uma avaliação psiquiátrica formal para identificar transtornos psiquiátricos. Transtornos psiquiátricos foram detectados em 71% dos pacientes, principalmente depressão, ansiedade e síndromes psicóticas. Pacientes com HPN podem desenvolver sintomas com predomínio frontal, tais como mudanças de personalidade, ansiedade, depressão, síndromes psicóticas, transtorno obsessivo compulsivo, síndrome de Otelo, furtos e mania. Sintomas incomuns de HPN podem dificultar o diagnóstico precoce e o tratamento adequado.

Espondilodiscite causada por Candida parapsilosis: relato de caso e revisão de literatura / Spondilodiscit caused bay Candida parapsilosis: case report and literature review

São raras as espondilodiscites fúngicas decorrentes de espéciesdo gênero Candida, sendo que até 2004 foram descritos menos de 75 casos. RELATO DE CASO: Homem, 42 anos, com história de etilismo por 35 anos, foi admitido com quadro de dorem abdome inferior com irradiação para membros inferiores e fraqueza dos mesmos nos últimos 3 meses. Os achados do exame físico foram: atrofia muscular em região glútea, dor àmobilização da articulação coxo-femoral, lombalgia em níveis L4 e L5 e força muscular grau II de parte distal de membros inferiores. O paciente foi internado e introduziu-se empiracamenteclindamicina e ciprofloxacina por suspeita de espondilodiscite, confirmada por meio do exame de Ressonância Magnética (RM)...

Fungic Spondilodiscit decorrent of Candida generus species arerare, being less than 75 cases described until 2004. Case Report: Man, 42 years old, with 35 years history of alcohol abuse, was admitted with a lower abdomen pain with irradiation toinferior members and weakness of them in the past 3 months. The physical exam were: gluteus muscular atrophy, mobilization pain of the coxo-femoral articulation, L4 and L5 back pain andmuscle strength grade II in the inferior member distal part. The patient was admitted and initiated clindamicin and ciprofloxacin with the suspect of spondilodiscit, confirmed by MagneticRessonance (RM)..

Ultrastructural study of the filum terminale and its elastic fibers.

OBJECTIVE: The filum terminale (FT) is a fibrovascular band involved in the pathophysiology of tethered cord syndrome (TCS). Its morphological and ultrastructural properties remain largely unknown even though they are thought to play a role in the generation of TCS in adult patients with normal level conus medullaris. MATERIALS AND METHODS: Twenty fresh adult human cadavers had their fila measured and removed. Transversal and longitudinal sections of the proximal, middle, and distal thirds of FT were submitted to light microscopy analysis with four different techniques. Five fila were selected for longitudinal and transversal scanning electron microscopy analysis. RESULTS: The bulk of the FT is composed of 5- to 20-microm thick longitudinal bundles of Type 1 collagen separated by 3- to 10-microm intervals, although capillaries and other elements may be present. A delicate (0.05-1.5 microm) meshwork of predominantly Type 3 collagen transversal fibers connects these bundles. Abundant longitudinally oriented elastic and elaunin fibers are found inside collagen bundles. A complex tridimensional structure is evidenced on electron microscopy. CONCLUSION: The longitudinal arrangement of collagen bundles and the impressive amount of elastic and elaunin fibers should elicit considerable elastic properties to the FT. An altered elasticity mechanism has been proposed for TCS; further studies are needed with TCS patients to define whether the collagen structure, Type 1/Type 3 proportion, or elastic fiber content are altered, which could lead to new histopathological definitions of TCS, helping neurosurgeons in the difficult management of TCS patients with normal level conus medullaris.

Estudo anatomico do Filus terminalis: disseccao de 31 cadaveres / Anatomical and topographical study of the Filum terminale in 31 human cadavers

Descrever a anatomia intradural do Filum terminalis (FT) e relacionar sua origem, comprimento e insercao com a coluna lombar e sacral em 31 cadaveres de adultos sem...

Principais variacoes do sistema biliar extra-hepatico e sua aplicacao na tecnica de transplante de figado chamada "split-liver" / Study of the hepatic duct system for application of the split-liver transplantation techruque

Estudou-se 60 figados de cadaveres frescos de adultos com o tronco celiaco, cabeca do pancreas e arteria mesenterica. Os ductos biliares extra-hepaticos direito, esquerdo e medio foram dissecados bem como suas ramificacoes. O ducto hepatico direito era unico em 13 (21,6 por cento) dos casos e multiplo em 47 (78,3 por cento). O ducto hepatico esquerdo era unico em 3 (5 por cento) dos casos e multiplos em 57 (95 por cento). O ducto hepatico medio apareceu em 18 (30 por cento) casos sendo 2(3,3 por cento) casos multiplo. Em conclusao, com relacao a drenagem biliar hepatica a tecnica de transplante de figado "split-liver" e factivel desde que se tenha consciencia da presenca do ducto hepatico medio o que em aproximadamente 3 por cento dos casos ele e multiplo.