Use of Sham Interventions in Randomized Controlled Trials in Neurosurgery.

BACKGROUND: The use of sham interventions in randomized controlled trials (RCTs) is essential to minimize bias. However, their use in surgical RCTs is rare and subject to ethical concerns. To date, no studies have looked at the use of sham interventions in RCTs in neurosurgery. METHODS: This study evaluated the frequency, type, and indication of sham interventions in RCTs in neurosurgery. RCTs using sham interventions were also characterized in terms of design and risk of bias. RESULTS: From a total of 1,102 identified RCTs in neurosurgery, 82 (7.4%) used sham interventions. The most common indication for the RCT was the treatment of pain (67.1%), followed by the treatment of movement disorders and other clinical problems (18.3%) and brain injuries (12.2%). The most used sham interventions were saline injections into spinal structures (31.7%) and peripheral nerves (10.9%), followed by sham interventions in cranial surgery (26.8%), and spine surgery (15.8%). Insertion of probes or catheters for a sham lesions was performed in 14.6%.In terms of methodology, most RCTs using sham interventions were double blinded (76.5%), 9.9% were single blinded, and 13.6% did not report the type of blinding. CONCLUSION: Sham-controlled RCTs in neurosurgery are feasible. Most aim to minimize bias and to evaluate the efficacy of pain management methods, especially in spinal disorders. The greatest proportion of sham-controlled RCTs involves different types of substance administration routes, with sham surgery the less commonly performed.

Electronic search strategies fail to identify randomized controlled trials (RCTs) in neurosurgery.

Randomized controlled trials (RCTs) are the gold standard studies to evaluate the efficacy of therapeutic interventions. Although they are frequently identified through open searches in electronic databases, no studies have evaluated how easy it is to identify RCTs in neurosurgery using electronic search strategies. The present study evaluated the sensitivity and specificity of different search strategies applied to commonly used databases to identify RCTs in neurosurgery. The total number of RCTs in neurosurgery published between 1960 and 2013 was determined through a detailed search involving open keyword searches in PubMed, Cochrane Library and Center for Reviews and Dissemination (CRD) databases, a PubMed search based on clinical entity-related keywords and hand-searches on the reference list of identified articles. The sensitivity and specificity were calculated for the open keyword searches on PubMed, the Cochrane Library and the CRD database and for the Cochrane's HSSS, based on the total number of the identified RCTs. Compared to the total of 1102 RCTs identified, PubMed open search yielded 4660 articles, among which 365 were RCTs (sensitivity: 33.1%; specificity: 7.8%). Cochrane open search yielded 621 among which 36 were RCTs (sensitivity: 3.2%; specificity: 5.8%) and CRD open search returned 78 articles, among which 4 were RCTs (sensitivity: 0.4% sensitivity; specificity: 5.1%). The Cochrane HSSS retrieved 10702 results, among which 340 were RCTs (sensitivity: 30.9%; specificity: 3.2%). Most RCTs in neurosurgery cannot be identified by commonly used search strategies, which emphasizes the need to improve their indexing.

Assessment of time perception: the effect of aging.

Studies concerning time perception lack a validated assessment tool and a consensual "gold-standard" measure. Moreover, the present evidence suggests modification of timing with aging. This study aimed to develop and validate a neuropsychological tool to measure time perception and to study temporal perception with aging. Eighty-six healthy participants, aged 15-90 years old, were asked to verbally estimate and produce empty intervals signaled by auditory beeps, of 7-, 32-, and 58-s duration. Two tests were used as "gold-standards": estimation of the duration of time necessary to draw a clock ("clock time") and estimation of the duration of neuropsychological evaluation ("global time"). Results showed a correlation between estimation and production (p < .01) and a correlation between estimation or production and "global time" (p < .01). The correlation between either estimation or production and age (p < .01), suggested a faster "internal-clock" in the older participants. However, this finding lost significance when controlled for literacy. The results suggest that these tests are potentially a useful tool to measure subjective perception of time. They also corroborate the hypothesis of a change in subjective time perception with aging. It was not possible to conclude if this effect was a specific result of aging or biased by the interference of literacy.

Leiomioma de reto tratado por ressecçäo transretal / Leiomyoma of rectum treated by transrectal resection

Relato de um caso de leiomioma de reto com diagnóstico histopatológico pré-operatório tratado por ressecçäo local transretal no Hospital Municipal Miguel Couto, Rio de Janeiro, com follow-up de um ano. Este raro tumor deve ser lembrado no diagnóstico diferencial das lesöes retais que levam a proctalgia, mudanças do hábito intestinal e outros sintomas locais. Exames simples como toque retal, anuscopia e biópsia, podem ser concludentes no diagnóstico. O diagnóstico histopatológico, no intuito de se diferenciar lesöes benígnas das malígnas, requer patologista com especial interesse nesse tipo tumoral

Tuberculose enterica / Intestinal tuberculosis

Os autores revisaram 11 casos de tuberculose enterica (TE) diagnosticados no Hospital Universitario da Faculdade de Medicina da Universidade Federal do Rio de Janeiro, num periodo de tres anos (abril de 1989 a março de 92). Nove obtiveram diagnostico histopatologico, um bacteriologico e outro clinico e radiologico. Sete eram secundarios a outras formas de tuberculose, sendo quatro de origem pulmonar. A localizaçao mais frequente foi a regiao ileocecal. Quatro pacientes apresentavam sorologia positiva para o HIV. A maioria (sete) foi submetida a intervençao cirurgica, seis dos quais por complicaçoes, sendo que em nenhum destes houve a suspeita previa de etiologia tuberculosa. A incidencia de complicaçoes diferiu daquela citada pela literatura, onde a mais comum e a obstruçao intestinal e a menos comum e a hemorragia. Nenhum paciente nesse estudo apresentou obstruçao e dois (18,18 por cento) desenvolveram hemorragia intestinal maciça. O tratamento quimioterapico foi instituido em 10 pacientes, dos quais tres abandonaram o acompanhamento, tres faleceram durante o periodo de tratamento e quatro o completaram, sendo que um destes apresentou recidiva dos sintomas. A despeito da quimioterapia antituberculosa eficaz e da pasteurizaçao do leite, a TE tem recrudescido em todo o mundo, relacionando-se nao so com o padrao socio-economico, mas tambem com condiçoes de imunossupressao, entre elas a AIDS. O diagnostico diferencial se faz principalmente com a doença de Crohn, e a intervençao cirurgica fica reservada para as complicaçoes

Hemangioma do retpo e sigmóide: apresentaçäo de um caso / Sigmoid and rectum haemangioma: apresentation of a case

Os autores apresentam um caso de hemangioma de reto e sigmóide. Chamam a atençäo pela raridade de patologia e discutem os métodos diagnósticos assim como as diversas etapas no tratamento durante a evoluçäo da doença por 16 anos, que apesar de ser benigna necessita às vezes tratamento bastante agressivo