The essential can be invisible to the eyes: the "fogging effect" phenomenon in the subacute stage of ischemic stroke.

Cerebral infarcts can be overlooked or grossly underestimated in the second and third week after an ischemic stroke. We report a patient who presented with a vanishing stroke on a follow-up brain computed tomography scan, a condition known as the "fogging effect" phenomenon.

Advances in stroke evaluation and treatment.

One of neurology's most challenging and evolving fields, vascular neurology has been constantly calling for attention. From small breakthroughs to large randomized trials, the quest for new answers in stroke treatment has brought us many advances and keeps bringing problems and solutions as new trials are coming.

Get with the guidelines stroke performance indicators in a brazilian tertiary hospital.

BACKGROUND: Stroke is the fourth leading killer in the US, the first in Brazil and a leading cause of adult long-term disability in both countries. In spite of widespread recommendation, clinical practice guidelines have had limited effect on changing physician behavior. Recognizing that both knowledge and acceptance of guidelines do not necessarily imply guideline adherence, the American Heart Association/American Stroke Association (AHA/ASA) developed a national stroke quality improvement program, the 'Get With The Guidelines (GWTG) stroke'. Even though GWTG has produced remarkable results in the US, other countries have not adopted the program. METHODS: We compared the stroke treatment quality indicators from a private Brazilian tertiary hospital to those published by the GWTG stroke program. Seven predefined performance measures selected by the GWTG stroke program as targets for stroke quality improvement were evaluated: (1) tissue plasminogen activator use in patients who arrived <2 h from symptom onset; (2) antithrombotic medication use within 48 h of admission; (3) deep vein thrombosis prophylaxis within 48 h of admission for nonambulatory patients; (4) discharge use of antithrombotics; (5) discharge use of anticoagulation for atrial fibrillation; (6) dosing of LDL and treatment for LDL >100 mg/dl in patients meeting the National Cholesterol Education Program Adult Treatment Panel (NCEP) III guidelines, and (7) counseling for smoking cessation. RESULTS: A total of 343 consecutive patients with acute ischemic stroke (70.8%) or transient ischemic attack (29.2%) were evaluated from August 2008 to December 2010. Antithrombotic medication within 48 h was used in 98.5% of the eligible patients and deep vein thrombosis prophylaxis in 100%. A total of 123 patients arrived within 2 h from symptoms onset, 23 were eligible for intravenous thrombolysis and 16 were treated (69.5%). All eligible patients were discharged using antithrombotic medication, and 86.9% of the eligible patients who had atrial fibrillation received anticoagulation. Only 56.1% of the eligible patients were treated according to the NCEP III guidelines. Counseling for smoking cessation was done in 63.6% of the eligible patients. CONCLUSIONS: Our study is the first in Brazil and the second outside the US to analyze compliance with the GWTG recommendations. Close attention to a better implementation of these measures may produce an improvement in such results similar to what happened after the full implementation of the program in the US. Whether or not a US disease-based registry such as GWTG can be adopted with success beyond the US is still a matter of debate.

Advances in stroke evaluation and treatment / Avanços na avaliação e tratamento do acidente vascular cerebral

One of neurology's most challenging and evolving s, vascularneurology has been constantly calling for attention. From smallbreakthroughs to large randomized trials, the quest for new answersin stroke treatment has brought us many advances and keeps bringingproblems and solutions as new trials are coming.

A neurologia vascular é uma das áreas mais envolventes e um dosmaiores desafios para o neurologista, e tem chamado constantemente aatenção. Desde pequenos estudos revolucionários até grandes ensaiosrandomizados, a necessidade de novas respostas no tratamento doacidente vascular cerebral tem trazido inúmeros avanços, problemas esoluções conforme novos estudos clínicos são publicados.

Acute stroke: postprocedural care and management of complications.

Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.

Influência do ambiente no desempenho de arremessos de lances-livres no basquetebol profissional / Environment influence in the performance of free-throws in professional basketball

Os objetivos do presente estudo foram: (a) comparar o percentual de aproveitamento de atletas profissionais de basquetebol, em uma mesma tarefa (lances-livre), executada em ambientes diferentes (treinamento vs. competição/jogos); (b) verificar se o aproveitamento dos atletas difere entre si nas situações de treino e competição. Participaram cinco atletas homens, com média de idade de 28,2 anos (mais ou menos 6,06), de um clube da Série A do Campeonato Nacional. O teste de McNemar mostrou que dois atletas obtiveram rendimento estatisticamente inferior (p menor ou igual 0,05) durante os treinamentos e o de KrusKal-Wallis, que os atletas não diferiram entre si no percentual de acertos. Habilidade de controlar a ansiedade e o nível técnico dos atletas pode estar relacionada com estes resultados.

The purposes of the current study were: a) to compare the percentage of success of professional basketball athlete’s in a same task (free-throw), executed in different environments (training vs. competition/matches); b) toverify if the percentage of the athletes success differ between themselves in the situations of training and competition. Participated five men, average age of 28,2 years (more or less 6,06), of a first division club of the National Championship. TheMcNemar’s test showed that two athletes had gotten inferior performance (p or less 0,05) during the training and the KrusKal-Wallis that the athletes had not differed between themselves in the percentage of success. Ability to controlthe anxiety and the technical level of the athlete’s can be related with these results.

Estudo retrospectivo do resultado anatomopatológico de 100 polipectomias colonoscópicas realizadas na FMB-UNESP / Retrospective study of the anatomopathological results of 100 colonoscopic polypectomies performed at FMB-UNESP

OBJETIVO: Analisar retrospectivamente o resultado do estudo anatomopatológico de polipectomias colonoscópicas realizadas no Setor de Endoscopia da Faculdade de Medicina de Botucatu - UNESP durante os anos de 2002 e 2003. Material e Métodos: Estudamos retrospectivamente, a partir de procedimentos colonoscópicos realizados em nosso serviço, as características dos pólipos retirados: tamanho, localização e distribuição, bem como o motivo da indicação do mesmo e o resultado do estudo anatomopatológico. RESULTADOS: Num total de 100 polipectomias colonoscópicas realizadas em 75 pacientes, observamos que 63 por cento dos pólipos localizava-se em reto e sigmóide e 15,8 por cento no cólon descendente; o estudo anátomopatologico evidenciou que a grande maioria tinha características adenomatosas (54 por cento). A idade dos pacientes variou entre 6 e 92 anos, não havendo predominância quanto ao sexo; a principal indicação para a realização de colonoscopia foi sangramento. CONCLUSÃO: Constatamos o importante papel diagnóstico e terapêutico das colonoscopias no que diz respeito ao câncer colorretal; os achados demonstram que, em nossa casuística, a maioria os pólipos colônicos são adenomatosos, pequenos e de localização distal.

OBJECTIVE: To analyze the retrospective results of the anatomopathological study of colonoscopic polypectomies performed at the Sector of Endoscopy of the School of Medicine of Botucatu - UNESP during the years of 2002 and 2003. Material and METHODS: We studied in retrospect the characteristics of the polyps found and removed during colonoscopies performed at our service, including: size, site of appearance and distribution, as well as the reasons for removal and the anatomopathological results. RESULTS: In 100 polypectomies performed in 75 patients we observed that 63 percent of the polyps were found in the area comprised by the sigmoid and the rectum and 15,8 percent were found in the left colon; the anatomopathological results showed that most of them had adenomatous features (54 percent). The patients' age varied between 6 and 92 years, with no predominance of any sex; the main indication for the colonoscopies was history of bleeding. CONCLUSION: We verified the important role of colonoscopies in diagnosing and treating the colorectal cancer; the results found showed that most of colonic polyps are adenomatous, small and distal in their localization.

Effect of lycopene on doxorubicin-induced cardiotoxicity: an echocardiographic, histological and morphometrical assessment.

Doxorubicin is an excellent chemotherapeutic agent utilized for several types of cancer but the irreversible doxorubicin-induced cardiac damage is the major limitation for its use. Oxidative stress seems to be associated with some phase of the toxicity mechanism process. To determine if lycopene protects against doxorubicin-induced cardiotoxicity, male Wistar rats were randomly assigned either to control, lycopene, doxorubicin or doxorubicin + lycopene groups. They received corn oil (control, doxorubicin) or lycopene (5 mg/kg body weight a day) (lycopene, doxorubicin + lycopene) by gavage for a 7-week period. They also received saline (control, lycopene) or doxorubicin (4 mg/kg) (doxorubicin, doxorubin + lycopene) intraperitoneally by week 3, 4, 5 and 6. Animals underwent echocardiogram and were killed for tissue analyses by week 7. Mean lycopene levels (nmol/kg) in liver were higher in the doxorubicin + lycopene group (5822.59) than in the lycopene group (2496.73), but no differences in lycopene were found in heart or plasma of these two groups. Lycopene did not prevent left ventricular systolic dysfunction induced by doxorubicin. However, morphologic examination revealed that doxorubicin-induced myocyte damage was significantly suppressed in rats treated with lycopene. Doxorubicin treatment was followed by increase of myocardium interstitial collagen volume fraction. Our results show that: (i) doxorubicin-induced cardiotoxicity was confirmed by echocardiogram and morphological evaluations; (ii) lycopene absorption was confirmed by its levels in heart, liver and plasma; (iii) lycopene supplementation provided myocyte protection without preventing interstitial collagen accumulation increase; (iv) doxorubicin-induced cardiac dysfunction was not prevented by lycopene supplementation; and (v) lycopene depletion was not observed in plasma and tissues from animals treated with doxorubicin.

Abscesso dento alveolar agudo / Acute dental alveolar abscess

No presente trabalho, apresentamos o tema: "Abscesso Dento Alveolar Agudo". Säo discutidos os aspectos relativos a sua evoluçäo, características clínicas radiográficas, histologia, diagnóstico e prognóstico, além dos tipos de tratamento usados em suas diversas fases