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Sample records for venosa dural relato

  1. Anestesia venosa total para timectomia em paciente com Miastenia Gravis: relato de caso

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    Rezer Gabrielle

    2003-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Pacientes com doenças neuromusculares, como Miastenia Gravis, respondem de maneira anormal aos anestésicos, conforme a técnica e as drogas administradas. O objetivo deste relato é mostrar um caso de paciente portadora de Miastenia Gravis, submetida a timectomia sob anestesia venosa total com propofol e remifentanil. RELATO DO CASO: Paciente feminina, 52 anos, 72 kg, com história de Miastenia Gravis submetida a timectomia transesternal, sob anestesia venosa total, com o uso de propofol em infusão alvo controlada (3 g.ml-1 e remifentanil contínuo (0,3 µg.kg-1.min-1. Para a intubação traqueal foi utilizada succinilcolina (50 mg, sendo realizada sem dificuldade. Com a finalidade de realizar a analgesia pós-operatória, foram utilizados tramadol (50 mg, cetoprofeno (100 mg e dipirona (1 g, no per-operatório. Após a cirurgia, a infusão de propofol e remifentanil foi encerrada e, 15 minutos depois, a paciente foi extubada. A paciente apresentava-se eupnéica, acordada, sem dor, movimentando membros, com freqüência respiratória de 14 mpm e mantendo saturação de oxigênio de 97%. Permaneceu com cateter nasal de O2 a 2 L.min-1 na UTI intermediária, durante 36 horas, e recebeu alta hospitalar no 4º dia do pós-operatório. CONCLUSÕES: A anestesia venosa total, com agentes anestésicos de curta duração e sem metabólitos ativos, favoreceu a recuperação e a extubação precoce da paciente

  2. Anestesia venosa total (AVT) em lactente com doença de Werdnig-Hoffmann: relato de caso

    OpenAIRE

    Resende, Marco Antonio Cardoso de; Silva, Elizabeth Vaz da; Nascimento, Osvaldo José Moreira; Gemal, Alberto Esteves; Quintanilha, Giseli; Vasconcelos, Eliana Maria

    2010-01-01

    JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, co...

  3. Uso de ácidos graxos essenciais no tratamento de úlcera venosa: relato de caso

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    Nayana Nobre

    2012-05-01

    Full Text Available Nesse estudo relata-se o uso de ácidos graxos essenciais (AGE no tratamento de úlcera venosa em membro inferior esquerdo de um paciente do sexo masculino de 60 anos. O tratamento foi realizado nas Clínicas Integradas Izabela Hendrix.  A coleta dos dados foi realizada por meio de anamnese  e exame físico do paciente. Na avaliação da lesão foram realizadas medidas geométricas desde o momento em que o paciente procurou o serviço, bem como foram feitos registros fotográficos ao longo do atendimento. Ao final de três meses a lesão obteve sua completa cicatrização. Não houve relato de desconforto ou qualquer complicação durante o uso do AGE, o que permite afirmar que o produto apresentou eficácia terapêutica para esse caso em particular.   

  4. Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso

    OpenAIRE

    Costa, José; Mendes, Dalva Maria Carvalho; Lobo, José Eduardo de Oliveira; Furuguem, Adriana Barrozo Ribeiro; Santos, Gabriel Gilberto

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO:...

  5. Trombose venosa profunda e neoplasia mamária maligna: relato de caso em idosa

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    Eliton Edmilson Couto

    2017-08-01

    Full Text Available A Trombose Venosa Profunda (TVP é caracterizada pela formação de trombos no interior de veias profundas, mais comum nos mem¬bros inferiores (80 a 95% dos casos. A incidência da doença, no Brasil, mostra-se em torno de 0,6 por 1.000 habitantes/ano. A literatura descreve alguns fatores principais no processo de formação dos trombos: estase sanguínea, lesões do endotélio e estados de hipercoagulabilidade. As neoplasias também são reconhecidas como fatores de risco independentes para TVP. Como complicação grave da TVP, em sua fase aguda, cita-se a embolia pulmonar e, tardiamente, a síndrome pós-trombótica. O objetivo do presente estudo é relatar um caso clínico de uma paciente do sexo feminino, idosa, portadora de hipertensão arterial sistêmica, diabetes mellitus tipo 2 e dislipidemia, em uso irregular das medicações. Concomitantemente, há 3 meses, a paciente foi diagnosticada com neoplasia mamária maligna, ainda sem início do tratamento. Ao exame físico a paciente apresentou-se com dor em membro inferior direito, sem hiperemia, com edema e sinal de Homams positivo. Como tratamento para TVP foi proposto uso de anticoagulante oral, e a paciente segue internada, em repouso, há 6 dias. Diante do caso apresentado, cabe destacar que é de suma importância compreender os fatores de risco para TVP, bem como suas alterações fisiológicas no organismo, o que é de extrema importância para o diagnóstico correto e o sucesso terapêutico de cada caso.

  6. Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso Anestesia venosa total para laringectomía parcial en paciente en la 28ª semana de embarazo: relato de caso Total intravenous anesthesia for partial laryngectomy in 28 weeks pregnant patient: case report

    OpenAIRE

    José Costa; Dalva Maria Carvalho Mendes; José Eduardo de Oliveira Lobo; Adriana Barrozo Ribeiro Furuguem; Gabriel Gilberto Santos

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO:...

  7. Anestesia venosa total (AVT) em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia general intravenosa (AVT) en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA) in an infant with Werdnig-Hoffmann disease: case report

    OpenAIRE

    Marco Antonio Cardoso de Resende; Elizabeth Vaz da Silva; Osvaldo José Moreira Nascimento; Alberto Esteves Gemal; Giseli Quintanilha; Eliana Maria Vasconcelos

    2010-01-01

    JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, co...

  8. Anestesia venosa total (AVT em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia venosa total (AVT en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA in an infant with Werdnig-Hoffmann disease: case report

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    Luis Otavio Esteves

    2010-10-01

    Full Text Available Foi com grande interesse que li o artigo "Anestesia Venosa Total (AVT em Lactente com Doença de Werdnig-Hoffmann. Relato de Caso", de Resende e col. ¹, publicado nesta revista. Gostaria, em primeiro lugar, de parabenizar os autores pela iniciativa. Entretanto, dois pontos me chamaram a atenção. O primeiro refere-se à definição de lactente, a qual compreende o período de 1 a 12 meses de idade. A partir de 12 meses, define-se como pré-escolar ou apenas criança. No artigo, o autor coloca a idade do paciente como 1 ano, mas não especifica meses ou dias. Provavelmente, esse paciente tem mais de 12 meses, sendo, dessa forma, a definição de lactente inadequada. O segundo e mais importante ponto diz respeito à técnica usada e ao título do artigo. No título, utilizou-se a expressão "anestesia venosa total", mas no relato foi dito que, além de propofol e remifentanil, a anestesia foi mantida com oxigênio e N2O. Se foi usado um gás com propriedades anestésicas (N2O, não seria correto classificar essa técnica como venosa total. Além disso, ele cita o artigo de Crawford e col. ², que definiu doses de remifentanil para intubação em crianças. Esse estudo foi realizado utilizando-se oxigenação na concentração de 100%, pois os autores provavelmente entendem que a adição de gases com propriedades anestésicas interferiria nos resultados obtidosFue con un gran interés que leí el artículo "Anestesia Venosa Total (AVT en Lactante con Enfermedad de Werdnig-Hoffmann. Relato de Caso", de Resende y col. ¹, publicado en esta revista. Y de hecho quiero, en primer lugar, felicitar a los autores por la iniciativa. Sin embargo, dos puntos me llamaron la atención. El primero, se refiere a la definición de lactante, la cual abarca el período de 1 a 12 meses de edad. A partir de los 12 meses, se define como preescolar o apenas como niño. En el artículo, el autor coloca la edad del paciente como de 1 año, pero no especifica meses o d

  9. Papel da lidocaína por via venosa no tratamento da dor na esclerodermia: relato de caso Papel de la lidocaína por vía venosa en el tratamiento del dolor en la esclerodermia: relato de un caso Intravenous lidocaine to treat scleroderma pain: case report

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    Durval Campos Kraychete

    2003-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A esclerodermia ou esclerose sistêmica progressiva é uma doença sistêmica do tecido conjuntivo, de causa desconhecida, que costuma cursar com microangiopatia, isquemia de extremidades e dor intensa. O objetivo deste relato é descrever um caso do emprego de lidocaína por via venosa no tratamento da dor no curso de isquemia e enfatizar a possível ação antiinflamatória dos anestésicos locais nos pacientes com esclerodermia. RELATO DO CASO: Paciente do sexo feminino, 34 anos, auxiliar de enfermagem, portadora de esclerodermia há aproximadamente 8 anos, apresentava dor de elevada intensidade (escala numérica =10 nos membros superiores e inferiores, contínua, diária, acompanhada de alterações tróficas, da cor e da temperatura e pequenas úlceras nas extremidades. A paciente foi submetida a uma sessão semanal de lidocaína a 2% (400 mg sem vasoconstritor por via venosa durante 10 semanas com alívio da dor, do turgor, da elasticidade da pele e da perfusão periférica. CONCLUSÕES: O alívio da dor e de outros sintomas após a administração de lidocaína por via venosa sugere que os anestésicos locais podem modular a resposta inflamatória em vários estágios da esclerodermia.JUSTIFICATIVA Y OBJETIVOS: La esclerodermia o esclerosis sistémica progresiva es una enfermedad sistémica del tejido conjuntivo, de causa desconocida, que acostumbra acontecer con microangiopatía, isquemia de extremidades y dolor intenso. El objetivo de este relato es describir un caso del empleo de lidocaína por vía venosa en el tratamiento del dolor en el curso de isquemia y dar énfasis a una posible acción antiinflamatoria de los anestésicos locales en los pacientes con esclerodermia. RELATO DE CASO: Paciente del sexo femenino, 34 anos, auxiliar de enfermera, portadora de esclerodermia hace aproximadamente 8 años, presentaba dolor de elevada intensidad (escala numérica =10 en los miembros superiores e inferiores

  10. Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso Anestesia venosa total para laringectomía parcial en paciente en la 28ª semana de embarazo: relato de caso Total intravenous anesthesia for partial laryngectomy in 28 weeks pregnant patient: case report

    Directory of Open Access Journals (Sweden)

    José Costa

    2005-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO: Paciente com 29 anos, 59 kg, primigesta de 28 semanas com diagnóstico prévio de carcinoma epidermóide próximo à corda vocal direita, sendo indicada laringectomia. A monitorização inicial constituiu-se de pressão arterial não-invasiva e invasiva, cardioscopia, oxicapnografia e cardiotocografia contínua realizada pela obstetra. Punção venosa no membro superior direito e membro superior esquerdo com cateter 16G e 18G, respectivamente. Foram administrados por via venosa midazolam (1 mg, cefazolina (1 g, metoclopramida (10 mg e dipirona (1 g. A paciente recebeu oxigênio a 100% sob máscara por 3 minutos e indução venosa foi feita com o uso de propofol em infusão na dose alvo de 3 µg.mL-1 e remifentanil contínuo (1 µg.kg-1 em bolus e 0,2 µg.kg-1.min-1 de manutenção. Como bloqueador neuromuscular, foi administrado cisatracúrio (13 mg e procedeu-se a intubação traqueal com tubo 6,5 mm aramado com balonete. Foi mantida em plano anestésico com propofol e remifentanil em bomba, além de complementações de cisatracúrio. O feto permaneceu monitorizado continuamente com cardiotocografia realizada e analisada pela obstetra. Após o término da cirurgia foram desligadas as bombas infusoras de propofol e remifentanil, tendo a paciente despertado 10 minutos depois. Acordou sem dor e hemodinamicamente estável, sendo então encaminhada à sala de recuperação pós-anestésica. CONCLUSÕES: A anestesia venosa total com propofol e

  11. Hipoxemia por fístulas artério-venosas pulmonares em criança: relato de caso Hipoxemia por fístulas artério-venosas pulmonares en niño: relato de caso Hypoxemia by pulmonary arteriovenous fistulae in childhood: case report

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    Aleksandra Paula Lima

    2004-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A presença de fístulas artério-venosas pulmonares (FAVP deve ser investigada em pacientes com cianose sem causa esclarecida. O objetivo é relatar um caso de lobectomia pulmonar em criança portadora de FAVP. RELATO DO CASO: Paciente do sexo masculino, 3 anos, com história de cianose sem dispnéia desde 8 meses, com baqueteamento digital e ausculta cardíaca normal. ECG e ecocardiografia eram normais e a radiografia de tórax mostrou condensação na metade superior do pulmão esquerdo. A gasometria arterial mostrou PaO2 de 28 mmHg, em ar ambiente, e PaO2 de 31,5 mmHg com cateter nasal de O2. Foi feito diagnóstico de FAVP através de ressonância nuclear magnética, sem possibilidade de embolização. O paciente foi submetido a lobectomia superior esquerda sob anestesia geral associada à anestesia subaracnóidea com morfina e bupivacaína. Foi realizada ventilação monopulmonar com introdução do tubo traqueal seletivo para o pulmão direito. A SaO2 era: em ar ambiente de 59%; à admissão à sala de operações, 69% (FiO2 = 1,0; após indução da anestesia geral, 65% (FiO2 = 1,0; durante a ventilação monopulmonar, 58% (FiO2 = 1,0; após a lobectomia e 98% (FiO2 = 0,6 ao final da cirurgia, com extubação traqueal uma hora após o final do procedimento. A partir do 5º dia de pós-operatório, começou a apresentar progressiva diminuição da SpO2 (até 83% devido aumento de outra FAVP, tratada com embolização sob anestesia geral. A alta hospitalar ocorreu no 15º do pós-operatório. CONCLUSÕES: Neste caso, havia refratariedade à suplementação com O2 e houve melhora imediata com o tratamento cirúrgico. Entretanto, após ressecção da FAVP de maior tamanho ocorreu aumento de outra fístula, que contribuiu para a diminuição da SpO2 no pós-operatório, revertida com a embolização. Com o crescimento da criança, outras fístulas pulmonares ou em outros órgãos poderão surgir, caracterizando a s

  12. Dural ectasia

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    Neha Gupta

    2014-01-01

    Full Text Available Dural ectasia is one of the likely causes of incomplete or failed spinal anaesthesia. Its association with diseases like Marfans syndrome, neurofibromatosis, osteogenesis imperfecta, vertebral fracture, postopertative adhesions, trauma etc., is often overlooked as a reason for inadequate spinal anaesthesia. Greater than normal volume of cerebrospinal fluid in the lumber theca in dural ectasia is postulated to restrict the spread of intrathecally injected Local anaesthetic. Here, we report a case of failed spinal anaesthesia but successful epidural anaesthesia in later setting in a patient with dural ectasia.

  13. Anestesia venosa total (AVT em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia general intravenosa (AVT en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA in an infant with Werdnig-Hoffmann disease: case report

    Directory of Open Access Journals (Sweden)

    Marco Antonio Cardoso de Resende

    2010-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, com doença de Werdnig-Hoffmann diagnosticada desde os dois meses de idade. Candidata à gastrostomia e fundogastroplicatura na técnica aberta e traqueostomia. Monitorização com cardioscópio, pressão arterial não invasiva, oxímetro de pulso, estetoscópio precordial e temperatura retal após venóclise. Foi préoxigenada e após bolus de atropina (0,3 mg foi realizada indução anestésica com remifentanil bolus (20 µg e propofol (30 mg. Após intubação traqueal foi ventilada de forma controlada manual, em sistema sem absorvedor de CO2, Baraka (sistema Mapleson D, FGF de 4 L.min-1, FiO2 0,5 (0(2/N(20. Mantida sob anestesia com propofol 250 µg.kg-1.min-1 e remifentanil 0,3 µg.kg-1.min-1 em infusão contínua manual. O tempo cirúrgico foi de 150 minutos. O despertar ocorreu 8 minutos após o término da infusão, com ventilação espontânea. Duas horas depois foi transferida para unidade pediátrica e recebeu alta hospitalar no 4º dia de pós-operatório. CONCLUSÕES: A escolha da técnica anestésica prioriza a segurança que advém da familiaridade do manuseio dos fármacos existentes. Em crianças com doenças neuromusculares, a anestesia venosa total com remifentanil e propofol em sistemas de infusão, pela duração de ação extremamente curta, pode influenciar a evolução da doença favoravelmente.JUSTIFICATIVA Y OBJETIVOS: La enfermedad de Werdnig-Hoffmann es la causa más común de hipotonía en el lactante y cuando est

  14. Embolia gasosa venosa inadvertida durante cesariana: bolsas retráteis ​​para líquidos intravenosos sem saídas autovedantes oferecem riscos. Relato de caso

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    Mefkur Bakan

    2013-08-01

    Full Text Available O anestesiologista deve estar ciente das causas, do diagnóstico e do tratamento de embolia venosa e adotar padrões de prática para prevenir sua ocorrência. Embora a embolia gasosa seja uma complicação conhecida da cesariana, descrevemos um caso raro de desatenção que causou embolia gasosa iatrogênica quase fatal durante uma cesariana sob raquianestesia. uma das razões para o uso de bolsas autorretráteis para infusão em vez dos frascos convencionais de vidro ou plástico é a precaução contra embolia gasosa. Também demonstramos o risco de embolia venosa com o uso de dois tipos de bolsas plásticas retráteis (à base de cloreto de polivinil [PVC] e de polipropileno para líquidos intravenosos. As bolsas para líquidos sem saídas autovedantes apresentam risco de embolia gasosa se o sistema de fechamento estiver quebrado, enquanto a flexibilidade da bolsa limita a quantidade de entrada de ar. bolsas à base de pvc, que têm mais flexibilidade, apresentam risco significativamente menor de entrada de ar quando o equipo de administração intravenosa (IV é desconectado da saída. usar uma bolsa pressurizada para infusão rápida sem verificar e esvaziar todo o ar da bolsa IV pode ser perigoso.

  15. Extrasinusal dural arteriovenous malformations

    International Nuclear Information System (INIS)

    Piske, R.L.; Lasjaunias, P.

    1988-01-01

    Of 60 cases of dural arteriovenous malformations (DAVM) explored and treated in the Vascular Neuroradiology Unit of the Hospital of Bicetre between 1980 and 1986, 3 presented in an extrasinusal location: intraorbital, middle cerebral fossa and the region of the superior orbital fissure. We have not found any prior description of DAVMs in these regions in the literature. The classic concept that DAVMs rise in direct relationship with the dural sinuses is limited. We believe that these lesions may also developed in relationship with the venous drainage system of the sinuses and the venous drainage of the peripheral nervous system. We note that the superior ophthalmic vein which drains DAVMs of the orbit and the olfactory vein which drains DAVMs of the anterior cranial fossa and other veins that accompany the cranial nerves through the skull base have the characteristics of emissary veins. It may be that DAVMs can develop wherever veins follow a transosseous trajectory. (orig.)

  16. Fat in the dural sinus

    International Nuclear Information System (INIS)

    Tokiguchi, S.; Ando, K.; Tsuchiya, T.; Ito, J.

    1986-01-01

    Fat density in the dural sinus on computed tomography (CT) is described in eight cases. Of the eight cases, five had fat deposit in the torcular Herophili, and three in the superior sagittal sinus. This finding was incidentally found by CT and there was no common underlying disease in these cases. It is suggested that this finding represents normal adipose tissue in the dural sinus. (orig.)

  17. Prevención de la trombosis venosa profunda

    OpenAIRE

    Cebrià Iranzo, M. Àngels

    2010-01-01

    Entre las medidas profilácticas que se pautan en la trombosis venosa profunda, encontramos la asistencia venosa intermitente. Se trata de un dispositivo de compresión neumática que simula las presiones sobre la bóveda plantar durante la deambulación.

  18. DURAL CAROTID-CAVERNOUS FISTULAS

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    Barbara Cvenkel

    2002-12-01

    Full Text Available Background. Dural carotid-cavernous sinus fistulas (CCF are communications fed by meningeal branches of the intracavernous internal carotid artery (ACI or/and external carotid artery (ACE. In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause.Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical presentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present (»redeyed shunt syndrome«. Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion (»white-eyed shunt syndrome«. Also different therapeutic approaches as well as possible complications are described.Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.

  19. Trombosis venosa profunda bilateral en una puérpera

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    Leydis Bárbara Ferreiro Hernández

    2015-05-01

    Full Text Available Se describe el caso clínico de una paciente de 29 años de edad, con antecedente de prolapso de la válvula mitral, quien a los 16 días de parida se le diagnosticó trombosis venosa profunda ileofemoral del lado derecho y a los 15 días, aúncon tratamiento anticoagulante, comenzó con trombosis venosa profunda del lado izquierdo, así como también con cuadro clínico sugestivo de tromboembolismo pulmonar.Se concluyó como una enfermedad tromboembólica venosa, dada por la presencia de trombosis venosa profunda bilateral.No hubo oclusión de la vena cava inferior, los resultados de la ecografía Doppler fueron positivos en ambos miembros y la respuesta al tratamiento anticoagulante resultó adecuada

  20. Dural enhancement with primary calvarial lesions.

    Science.gov (United States)

    Arana, E; Martí-Bonmatí, L; Ricart, V; Pérez-Ebrí, M

    2004-11-01

    The purpose of this study was to relate the pathological and imaging features of dural enhancement and meningeal sign ("dural tail") on contrast-enhanced T1-weighted magnetic resonance (MR) images from patients with primary calvarial lesions as well to assess the accuracy of MR imaging in predicting dural invasion. Thirty-two calvarial tumors studied with contrast-enhanced MR imaging and histopathological examination of the dural specimens were reviewed. Sixteen patients presented dural enhancement, eight with tumor invasion. Tumoral invasion of the dura was observed in one case without enhancement. Malignant lesions showed enhanced dura more commonly than benign lesions (P=0.02). Nodular and discontinuous dural enhancement was statistically associated with dural invasion (P=0.05). Dural tail did not show a specific pathological association. Meningeal enhancement is a nonspecific reaction to calvarial lesions unless nodular and discontinuous. False-negative and -positive cases of dural invasion imply some limitation of contrast-enhanced MR imaging in predicting dural invasion by calvarial neoplasms.

  1. Dural enhancement with primary calvarial lesions

    Energy Technology Data Exchange (ETDEWEB)

    Arana, E. [Clinica Quiron, Department of Radiology, Valencia (Spain); Marti-Bonmati, L. [Clinica Quiron, Department of Radiology, Valencia (Spain); Hospital Universitario Dr. Peset, Department of Radiology, Valencia (Spain); Ricart, V. [Hospital de la Ribera, Department of Radiology, Valencia (Spain); Perez-Ebri, M. [Hospital Universitario Dr. Peset, Department of Pathology, Valencia (Spain)

    2004-11-01

    The purpose of this study was to relate the pathological and imaging features of dural enhancement and meningeal sign (''dural tail'') on contrast-enhanced T1-weighted magnetic resonance (MR) images from patients with primary calvarial lesions as well to assess the accuracy of MR imaging in predicting dural invasion. Thirty-two calvarial tumors studied with contrast-enhanced MR imaging and histopathological examination of the dural specimens were reviewed. Sixteen patients presented dural enhancement, eight with tumor invasion. Tumoral invasion of the dura was observed in one case without enhancement. Malignant lesions showed enhanced dura more commonly than benign lesions (P=0.02). Nodular and discontinuous dural enhancement was statistically associated with dural invasion (P=0.05). Dural tail did not show a specific pathological association. Meningeal enhancement is a nonspecific reaction to calvarial lesions unless nodular and discontinuous. False-negative and -positive cases of dural invasion imply some limitation of contrast-enhanced MR imaging in predicting dural invasion by calvarial neoplasms. (orig.)

  2. Dural sinus filling defect: intrasigmoid encephalocele

    Science.gov (United States)

    Karatag, Ozan; Cosar, Murat; Kizildag, Betul; Sen, Halil Murat

    2013-01-01

    Filling defects of dural venous sinuses are considered to be a challenging problem especially in case of symptomatic patients. Many lesions have to be ruled out such as sinus thrombosis, arachnoid granulations and tumours. Encephalocele into dural sinus is also a rare cause of these filling defects of dural sinuses. Here, we report an extremely rare case with spontaneous occult invagination of temporal brain tissue into the left sigmoid sinus and accompanying cerebellar ectopia. PMID:24311424

  3. Uso do ultra-som para punção venosa central em paciente obeso com adenomegalia cervical

    Directory of Open Access Journals (Sweden)

    Jaderson Wollmeister

    2008-08-01

    Full Text Available JUSTIFICATICA E OBJETIVOS: As técnicas clássicas para punção venosa central são realizadas com base em referências anatômicas de superfície e conhecimento da anatomia vascular da região em que se realizará a punção. O uso do ultra-som permite a realização da punção sob visão direta das estruturas vasculares, peri-vasculares e da agulha de punção. O objetivo deste relato foi descrever o uso do ultra-som no auxílio de acesso venoso central em paciente obeso e com adenomegalias. RELATO DO CASO: Paciente do sexo masculino, branco, 28 anos, 1,70 m, 120 kg, com diagnóstico de linfoma de Hodgkin esclerose nodular. Solicitado ao Serviço de Anestesiologia do Hospital Governador Celso Ramos, punção de veia jugular interna direita guiada por ultra-som devido à presença de gânglio supraclavicular que prejudicava a referência anatômica de punção e à obesidade do paciente. Após a obtenção da melhor imagem a veia jugular interna esquerda foi puncionada e colocado um cateter venoso de triplo lúmen. A punção foi única, com progressão fácil do cateter e realizada sem complicações. CONCLUSÕES: O uso da ultra-sonografia para punção venosa central pode evitar complicações tornando o procedimento mais seguro para o paciente.

  4. Symptomatic hemorrhagic complications associated with dural substitutes

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    Po-Yuan Chen

    2018-01-01

    Conclusion: The increased risk of hemorrhagic complications associated with craniotomy is modified by choice of dural replacement. Our results could assist clinicians in their decision-making with respect to the optimal timing for synthetic dural substitutes in patients with tumor infiltration of the patient's dura, severe brain swelling in traumatic brain injury, or a result of shrinkage from exposure and electrocautery.

  5. MALFORMACIÓN ARTERIO VENOSA CERVICAL COMPLEJA SINTOMÁTICA

    OpenAIRE

    Bombin F,Juan; Kotlik A,Alejandro; Seguel S,Gabriel; Pizarro S,Carla; Aliaga S,Erik

    2015-01-01

    Introducción: Las Malformaciones Arterio-Venosas (MAV) son alteraciones estructurales congénitas del desarrollo del sistema vascular en que se observan comunicaciones anómalas arterio-venosas conformando un "nido" arterio-venoso-capilar. Caso Clínico: Mujer que consulta a los 15 años de edad por una MAV en la región cervical posterior izquierda desde su nacimiento. Se efectúa una resección amplia de la lesión hasta el plano aponeurótico cubriendo el defecto con un colgajo de rotación cutáneo-...

  6. Dural metastasis of Ewing's sarcoma.

    Science.gov (United States)

    Ben Nsir, Atef; Boughamoura, Mohamed; Maatouk, Mezri; Kilani, Mohamed; Hattab, Nejib

    2013-01-01

    Metastatic Ewing's sarcoma to the central nervous system is an uncommon condition and debate concerning the true origin of its metastases is still up to date. To the best of our knowledge, only two cases of dural metastatic Ewing's sarcoma have been published in the English medical literature. We present an additional case in a 24-year-old female and discuss the pathogenesis of these unusual tumors with review of the relevant literature concerning their treatment and outcome. A 24-year-old female with previous history of pelvis Ewing's sarcoma and recently discovered lung metastases, presented with moderate headache for the past 2 weeks and weakness in her left leg for the past 2 days. Computed tomography scan and magnetic resonance imaging revealed an extra-axial right frontoparietal mass invading the superior sagittal sinus but with clear delineation with brain parenchyma. Imaging features were suggestive of a meningioma as no abnormalities in the skull abutting to the tumor were noted. The patient underwent surgical removal of her tumor. Near total resection was achieved and histological examination showed evidence of metastatic Ewing's sarcoma. Postoperative adjuvant radiation and chemotherapy were administered. The patient improved well postoperatively with full recovery of her motor weakness. She is symptom free with no signs of progression, at most recent follow-up, 8 months after surgery. Despite its rarity, metastatic Ewing's sarcoma must be considered in the differential diagnosis of extra-axial dural masses particularly meningiomas.

  7. Neck massage induced dural sinus thrombosis

    Directory of Open Access Journals (Sweden)

    Verma Ashish

    2007-01-01

    Full Text Available Thrombosis of the intracranial dural sinuses and internal jugular veins may occur as a complication of head and neck infections, surgery, central venous access, local malignancy, polycythemia, hyperhomocysteinemia, neck massage and intravenous drug abuse. A high degree of clinical suspicion followed by adequate imaging is prerequisite to early diagnosis and management. We report a young man who had dural sinus thrombosis with jugular venous thrombosis following neck massage.

  8. Úlcera venosa: seis años de existencia por 92 días de cicatrización

    Directory of Open Access Journals (Sweden)

    Maísa Mara Lopes Macêdo

    Full Text Available Objetivo: Describir la evolución del tratamiento de úlcera venosa con el uso de coberturas avanzadas y presentar las respuestas del paciente frente a los cuidados dispensados en la atención primaria de salud. Método: Estudio realizado con planteamiento metodológico de relato del caso, con consentimiento informado por parte del paciente. Resultados: Rápida respuesta con disminución del dolor, alcance de la cicatrización y mejoría de los impactos negativos con uso de coberturas apropiadas, cuidados sistemáticos y profesional capacitado. Conclusión: el tratamiento ha sido posible gracias a la disponibilidad de coberturas adecuadas y el conocimiento de los profesionales para la conducción del caso.

  9. Dural AVM supplied by the ophthalmic artery.

    LENUS (Irish Health Repository)

    Flynn, T H

    2012-02-03

    Dural arteriovenous malformations in the anterior cranial fossa are rare and are especially prone to haemorrhage. These lesions are usually treated by surgical excision. We report the embolization of an anterior cranial fossa DAVM using an endovascular approach via the ophthalmic artery.

  10. Práctica 7. Fisioterapia en la insuficiencia venosa de miembros inferiores

    OpenAIRE

    Cebrià Iranzo, M. Àngels

    2011-01-01

    La fisioterapia en la insuficiencia venosa y sus complicaciones (trombosis venosa), sustenta su aplicación en la estimulación de los mecanismos favorecedores del retorno venoso. Entre las medidas favorecedoras del retorno venoso encontramos: el postural en declive, la respiración abdomino-diafragmática y torácica, el masaje deplectivo, la presoterapia neumática, las medidas de contención-compresión y la cinesiterapia. La fisioteràpia en la insuficiència venosa i les seues complicacions (tr...

  11. Dural ectasia and conventional radiography in the Marfan lumbosacral spine

    International Nuclear Information System (INIS)

    Ahn, N.U.; Nallamshetty, L.; Ahn, U.M.; Buchowski, J.M.; Kebaish, K.M.; Sponseller, P.D.; Rose, P.S.; Garrett, E.S.

    2001-01-01

    Objective. To determine how well conventional radiographic findings can predict the presence of dural ectasia in Marfan patients.Design and patients. Twelve Marfan patients without dural ectasia and 21 Marfan patients with dural ectasia were included in the study. Five radiographic measurements were made of the lumbosacral spine: interpediculate distance, scalloping value, sagittal canal diameter, vertebral body width, and transverse process width.Results. The following measurements were significantly larger in patients with dural ectasia: interpediculate distances at L3-L4 levels (P 38.0 mm, sagittal diameter at S1 >18.0 mm, or scalloping value at L5 >5.5 mm.Conclusion. Dural ectasia in Marfan syndrome is commonly associated with several osseous changes that are observable on conventional radiographs of the lumbosacral spine. Conventional radiography can detect dural ectasia in patients with Marfan syndrome with a very high specificity (91.7%) but a low sensitivity (57.1%). (orig.)

  12. Dural arteriovenous fistula as a treatable dementia.

    Science.gov (United States)

    Enofe, Ikponmwosa; Thacker, Ike; Shamim, Sadat

    2017-04-01

    Dementia is a chronic loss of neurocognitive function that is progressive and irreversible. Although rare, dural arteriovenous fistulas (DAVFs) could present with a rapid decline in neurocognitive function with or without Parkinson-like symptoms. DAVFs represent a potentially treatable and reversible cause of dementia. Here, we report the case of an elderly woman diagnosed with a DAVF after presenting with new-onset seizures, deteriorating neurocognitive function, and Parkinson-like symptoms.

  13. Spinal endoscopy combined with selective CT myelography for dural closure of the spinal dural defect with superficial siderosis: technical note.

    Science.gov (United States)

    Arishima, Hidetaka; Higashino, Yoshifumi; Yamada, Shinsuke; Akazawa, Ayumi; Arai, Hiroshi; Tsunetoshi, Kenzo; Matsuda, Ken; Kodera, Toshiaki; Kitai, Ryuhei; Awara, Kousuke; Kikuta, Ken-Ichiro

    2018-01-01

    The authors describe a new procedure to detect the tiny dural hole in patients with superficial siderosis (SS) and CSF leakage using a coronary angioscope system for spinal endoscopy and selective CT myelography using a spinal drainage tube. Under fluoroscopy, surgeons inserted the coronary angioscope into the spinal subarachnoid space, similar to the procedure of spinal drainage, and slowly advanced it to the cervical spine. The angioscope clearly showed the small dural hole and injured arachnoid membrane. One week later, the spinal drainage tube was inserted, and the tip of the drainage tube was located just below the level of the dural defect found by the spinal endoscopic examination. This selective CT myelography clarifies the location of the dural defect. During surgery, the small dural hole could be easily located, and it was securely sutured. It is sometimes difficult to detect the actual location of the small dural hole even with thin-slice MRI or dynamic CT myelography in patients with SS. The use of a coronary angioscope for the spinal endoscopy combined with selective CT myelography may provide an effective examination to assess dural closure of the spinal dural defect with SS in cases without obvious dural defects on conventional imaging.

  14. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2006-10-15

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  15. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    International Nuclear Information System (INIS)

    Rooij, Willem Jan van; Sluzewski, Menno; Beute, Guus N.

    2006-01-01

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  16. DIAGNÓSTICO CLÍNICO Y MANEJO DE LA TROMBOSIS VENOSA CEREBRAL. PRESENTACIÓN DE UN CASO CLÍNICO.

    Directory of Open Access Journals (Sweden)

    Yorman Rafael Flores Molina

    2011-01-01

    Full Text Available La Trombosis de los Senos Durales y/o Trombosis Venosa Cerebral, se considera una entidad poco frecuente de accidente cerebro vascular que usualmente ocurre en individuos jóvenes. Cada año, afecta a 5 personas por millón a nivel mundial y representa el 0.5 al 1% de todos los episodios de enfermedad cerebrovascular. Se describe el caso de un paciente masculino de 31 años, sin antecedentes patológicos conocidos, que consultó en el servicio de urgencias por cefalea holocraneana y movimientos tónico-clónicos generalizados; se le practicó Tomografía Axial Computarizada Cerebral y Arteriografía de 4 vasos, descartándose malformaciones arteriovenosas y/o aneurismas cerebrales. Se solicita Angioresonancia, que revela Imágenes de defecto sugestivas a Trombosis del Seno Longitudinal Superior, por lo que se indica anticoagulación con Heparina de Bajo Peso Molecular y Warfarina Sódica, obteniéndose una evolución favorable. A propósito de este caso, se realiza una revisión de la literatura, haciendo especial énfasis en su diagnóstico, factores de riesgo y controversias terapéuticas.

  17. Radiographic anatomy of the distal dural SAC

    International Nuclear Information System (INIS)

    Larsen, J.L.; Olsen, K.O.

    1991-01-01

    A radio-anatomical study was performed of the distal dural sac (DS) in 121 patients subjected to myelography. In 83.4% the termination of the DS was located from the upper half of the S1-segment to the lower half of the S2-segment. In the remaining patients the dural terminations were more distally located. The average location of the DS-termination was higher than that found in a previous anatomic study. The inference is that in patients with low-back pain and sciatica, the DS tends to terminate at a higher spinal level than in a non-selected anatomic material. The caudal reduction in sagittal diameter of the DS was less than that of the frontal diameter of the sac. The linear diminution in cross-sectional area of the DS from the level of L3 towards the lumbosacral junction was not correlated with the degree of caudal extension of the DS into the sacrum. Thus the length of the DS and its transverse diameters are independent of each other. These results supported the view that the location of the termination of the DS (and hence that of the spinal cord) is not related to stenosis of the central spinal canal. (orig.)

  18. Dural ectasia and conventional radiography in the Marfan lumbosacral spine

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, N U [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); Johns Hopkins Outpatient Center, Dept. of Orthopaedic Surgery, Baltimore, MD (United States); Nallamshetty, L; Ahn, U M; Buchowski, J M; Kebaish, K M; Sponseller, P D [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); Rose, P S [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (United States); Garrett, E S [Dept. of Oncology, Division of Biostatistics, Johns Hopkins University School of Medicine, Baltimore (United States)

    2001-06-01

    Objective. To determine how well conventional radiographic findings can predict the presence of dural ectasia in Marfan patients.Design and patients. Twelve Marfan patients without dural ectasia and 21 Marfan patients with dural ectasia were included in the study. Five radiographic measurements were made of the lumbosacral spine: interpediculate distance, scalloping value, sagittal canal diameter, vertebral body width, and transverse process width.Results. The following measurements were significantly larger in patients with dural ectasia: interpediculate distances at L3-L4 levels (P<0.03); scalloping values at the L1 and L5 levels (P<0.05); sagittal diameters of the vertebral canal at L5-S1 (P<0.03); transverse process to width ratios at L2 (P<0.03). Criteria were developed for diagnosis of dural ectasia in Marfan patients. These included presence of one of the following: interpediculate distance at L4 >38.0 mm, sagittal diameter at S1 >18.0 mm, or scalloping value at L5 >5.5 mm.Conclusion. Dural ectasia in Marfan syndrome is commonly associated with several osseous changes that are observable on conventional radiographs of the lumbosacral spine. Conventional radiography can detect dural ectasia in patients with Marfan syndrome with a very high specificity (91.7%) but a low sensitivity (57.1%). (orig.)

  19. Traumatic dural venous sinus thrombosis: A Mini Review

    Directory of Open Access Journals (Sweden)

    Moscote-Salazar Luis Rafael

    2016-09-01

    Full Text Available The dural venous sinus thrombosis is a benign disease, representing about 1% of cerebral vascular events. In some cases the development of the disease increased intracranial pressure or symptomatic epilepsy. The development towards a dural venous sinus thrombosis is rare, but is a condition to be considered before the development of ischemic vascular events and a history of recent head trauma. Intracranial hematomas or skull fractures can lead to the establishment of obstructive pathology of the dural venous sinuses. The knowledge of this entity is necessary for the critical care staff and neurosurgery staff.

  20. MR diagnosis of dural sinus thrombosis

    International Nuclear Information System (INIS)

    Rovira Canellas, A.; Turon Estrada, A.; Alvarez Sabin, J.; Lozano Sanchez, M.; Castano Duque, Ch.; Grive Isern, E.; Sumalla Sune, J.

    1994-01-01

    Four adult patients were diagnosed as having dural sinus thrombosis (DST) by means of magnetic resonance (MR). In the three cases of acute thrombosis, MR disclosed diffuse or segmental hyperintensity in the sinuses involved, which persisted regardless of the sequence and orientation of the plane selected. MR angiography (MRA) provided diagnostic information that proved useful in the chronic case, as well as in the two cases in which follow-up was carried out to determine the degree to which permeability was restored to the sinuses involved. MR diagnosis of DST can produce false positives and negatives, the causes of which should be known, as well as the ways to avoid them, in order to prevent diagnostic errors. MR, when applied and interpreted correctly, can be considered the first, and in many cases the only, choice as a diagnostic method in DST. (Author)

  1. Histology of the distal dural ring.

    Science.gov (United States)

    Graffeo, Christopher S; Perry, Avital; Copeland, William R; Raghunathan, Aditya; Link, Michael J

    2017-09-01

    The distal dural ring (DDR) is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery (ICA) exits the cavernous sinus (CS) and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge no prior study has analyzed the histologic relationship between the ICA and DDR. Correspondingly, our objective was to assess the relationship of the DDR to the ICA and determine whether the DDR can be dissected from the ICA and thus divided, or can only be circumferentially trimmed around the artery. The authors examined ten fresh-frozen, adult cadaveric specimens. A standard frontotemporal craniotomy, orbito-optic osteotomy, and extradural anterior clinoidectomy was performed bilaterally. The cavernous ICA, DDR, and supraclinoid ICA were harvested as an en bloc specimen. Specimens formalin-fixed and paraffin-embedded prior to routine histochemical staining with hematoxylin and eosin and Masson trichrome. In all specimens, marked microscopic investment of the DDR throughout the ICA adventitia was noted. Dural collagen fibers extensively permeated the arterial layers superficial to the muscularis propria, with no evidence of a clear separation between the DDR and arterial adventitia. Histologic analysis suggests that the ICA and DDR are highly interrelated, continuous structures, and therefore attempted intraoperative dissection between these structures may carry an elevated risk of injury to the ICA. We correspondingly recommend careful circumferential trimming of the DDR in lieu of direct dissection in cases requiring mobilization of the clinoidal ICA. Clin. Anat. 30:742-746, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  2. A New Classification for Pathologies of Spinal Meninges, Part 1: Dural Cysts, Dissections, and Ectasias.

    Science.gov (United States)

    Klekamp, Jörg

    2017-07-01

    The clinical significance of pathologies of the spinal dura is often unclear and their management controversial. To classify spinal dural pathologies analogous to vascular aneurysms, present their symptoms and surgical results. Among 1519 patients with spinal space-occupying lesions, 66 patients demonstrated dural pathologies. Neuroradiological and surgical features were reviewed and clinical data analyzed. Saccular dural diverticula (type I, n = 28) caused by defects of both dural layers, dissections between dural layers (type II, n = 29) due to defects of the inner layer, and dural ectasias (type III, n = 9) related to structural changes of the dura were distinguished. For all types, symptoms consisted of local pain followed by signs of radiculopathy or myelopathy, while one patient with dural ectasia presented a low-pressure syndrome and 10 patients with dural dissections additional spinal cord herniation. Type I and type II pathologies required occlusion of their dural defects via extradural (type I) or intradural (type II) approaches. For type III pathologies of the dural sac no surgery was recommended. Favorable results were obtained in all 14 patients with type I and 13 of 15 patients with type II pathologies undergoing surgery. The majority of dural pathologies involving root sleeves remain asymptomatic, while those of the dural sac commonly lead to pain and neurological symptoms. Type I and type II pathologies were treated with good long-term results occluding their dural defects, while ectasias of the dural sac (type III) were managed conservatively. Copyright © 2017 by the Congress of Neurological Surgeons

  3. Força e arquitetura muscular do gémeo interno na bomba muscular venosa

    OpenAIRE

    Peixoto, Flávia; Pinto, Ângela; Kozlova, Veronika; Crisóstomo, Rute

    2015-01-01

    Objetivo: Avaliar e comparar a Força Muscular (FM), Amplitude de Movimento (ADM) e Arquitetura Muscular da bomba muscular venosa em sujeitos com e sem Insuficiência Venosa Crónica (IVC). Relevância: A IVC provoca alterações na função da bomba muscular venosa, no entanto, pouco se conhece acerca das suas repercussões físicas e funcionais. Amostra: Sujeitos com IVC (alterações da tróficas, e úlcera ativa/cicatrizada) e saudáveis. Foram avaliados 33 sujeitos dos quais foram analis...

  4. Dural opening/removal for combined petrosal approach: technical note.

    Science.gov (United States)

    Terasaka, Shunsuke; Asaoka, Katsuyuki; Kobayashi, Hiroyuki; Sugiyama, Taku; Yamaguchi, Shigeru

    2011-03-01

    Detailed descriptions of stepwise dural opening/removal for combined petrosal approach are presented. Following maximum bone work, the first dural incision was made along the undersurface of the temporal lobe parallel to the superior petrosal sinus. Posterior extension of the dural incision was made in a curved fashion, keeping away from the transverse-sigmoid junction and taking care to preserve the vein of Labbé. A second incision was made perpendicular to the first incision. After sectioning the superior petrosal sinus around the porus trigeminus, the incision was extended toward the posterior fossa dura in the middle fossa region. The tentorium was incised toward the incisura at a point just posterior to the entrance of the trochlear nerve. A third incision was made longitudinally between the superior petrosal sinus and the jugular bulb. A final incision was initiated perpendicular to the third incision in the presigmoid region and extended parallel to the superior petrosal sinus connecting the second incision. The dural complex consisting of the temporal lobe dura, the posterior fossa dura, and the freed tentorium could then be removed. In addition to extensive bone resection, our strategic cranial base dural opening/removal can yield true advantages for the combined petrosal approach.

  5. Comparison of the efficiency, side effects and complications of the synthetic dural grafts: Beriplast and Tissudura

    OpenAIRE

    HAMZAOĞLU, Vural; ÖZALP, Hakan; KARKUCAK, Ahmet; ÇOKLUK, Cengiz

    2015-01-01

    The purpose of this study was to compare human fibrinogen-thrombin-based liquid dural graft; Beriplast® (Behring, Malburg, Germany) and collagen-based dural graft; Tissudura® (Baxter, Heidelberg, Germany) in terms of efficiency, side effects and complications. Thirty Spraque Dawley rats were used in this experimental study. A burrhole was opened on the left parietal bone of each subject and experimental dural defect was created. While 10 subjects were in sham group without any dural defect re...

  6. Intracranial Dural Metastasis of Ewing's Sarcoma: a Case Report

    International Nuclear Information System (INIS)

    Kim, Eung Yeop; Lee, Seung Koo; Kim, Dong Joon; Kim, Jin Na; Lee, Kyu Sung; Jung, Woo Hee; Kim, Dong Ik

    2008-01-01

    Ewing's sarcoma is a malignant bone tumor that can occur anywhere in the body, but it is most commonly observed in the long bones of the arms and legs, the pelvis and in the chest. The predominant sites of metastasis include the lung (38%), bone (including the spine; 31%), and the bone marrow (11%). Metastasis of Ewing's sarcoma to the central nervous system (CNS) is relatively rare, and most of the previous reports have demonstrated involvement of the bony calvarium or brain parenchyma. We describe here the imaging findings of dural metastasis of Ewing's sarcoma, and these imaging findings have not been previously reported on in the medical literature. In conclusion, dural metastasis of Ewing's sarcoma is very rare and its imaging characteristics are similar to those of a primary tumor, which mimic the findings of a schwannoma or meningioma. Despite its rarity, secondary Ewing's sarcoma may be included in the differential diagnosis of extra-axial dural masses

  7. CRIPTOCOCOSE: RELATO DE CASO

    Directory of Open Access Journals (Sweden)

    Fernanda Alvarez GENTIL

    2016-12-01

    Full Text Available Criptococose, doença infecciosa fúngica, oportunista, potencialmente fatal, que acomete animais silvestres e domésticos, principalmente cachorro e gato e o homem. Causada pela levedura, Cryptococcus neoformans. Mais frequente em adultos, comumente diagnosticada em pacientes imunodeprimidos, como os soropositivos, fator predisponente mais frequente. Outros fatores são: uso prolongado de medicações imunossupressoras, doenças como diabetes, sarcoidose, doença de Hodgkin e outras neoplasias hematológicas, lúpus eritematoso, artrite reumatoide, doença de Behçet, e transplante de vísceras sólidas. Geralmente adquirida pela inalação do agente etiológico. Objetivo: este estudo objetiva relatar o caso de um paciente portador de criptococose, que esteve invernado no Hospital São José do Avaí (HSJA de Itaperuna, no mês de setembro de 2016, corroborando na literatura descrita sobre o tema, justifica-se o tema pela raridade do caso. Metodologia: inicialmente realizou-se pesquisa bibliográfica através da seleção de autores que asseguraram uma fundamentação teórico-metodológica que serviu de arcabouço para o desenvolvimento do estudo. A metodologia apresentada refere-se a um relato de caso, realizado a partir do prontuário do paciente e dos exames disponíveis. Resultados: a Radiografia de tórax evidenciou massa pulmonar em lobo inferior direito e a Tomografia de tórax também demonstrou esse acometimento; sendo realizada biópsia desse fragmento, que consolidou o diagnóstico de criptococose. A lâmina do paciente, corada com hematoxilina-eosina demonstrou aspectos característicos do acometimento por esse fungo. Conclusão: para o tratamento, pode-se utilizar antifúngicos como a anfotericina B associado com 5-flucitosina, em infecções disseminadas; ou fluconazol e itraconazol, para infecções cutâneas. 

  8. Cefalea secundaria a punción dural Headache as a result of dural puncture

    Directory of Open Access Journals (Sweden)

    Ariadna García Rodríguez

    2005-03-01

    Full Text Available Se realizó una revisión bibliográfica sobre cefalea pospunción en el Hospital "Abel Santamaría", de Pinar del Río, en el período comprendido de febrero a junio del 2004, con el objetivo de ampliar los conocimientos de los profesionales de la salud encargados de diagnosticar y tratar esta complicación. La cefalea secundaria a punción dural se debe al escape persistente de LCR (líquido cefalorraquídeo a través del desgarro hecho en la duramadre, causado por la penetración de la aguja; se presenta cuando el paciente adopta la posición erecta y se alivia con el decúbito, característica esta que de no aparecer debe hacer dudar el diagnóstico. La elección de un trocar fino para realizar la punción y la dirección del bisel paralelo a las fibras de la duramadre son los factores determinantes en la profilaxis de la cefalea. Aún existen controversias en cuanto a su tratamiento, pero si hay un consenso unido en que el parche de sangre epidural es el tratamiento definitivo de esta complicación.A review of the most updated literature on dural post-puncture headache was made at Abel Santamaría University Hospital in February - June 2004 aimed at spreading the awareness to health professionals at diagnosing and treating this condition. The headache secondary to dural puncture is caused by the persistent leakage of cerebrospinal fluid through the dura tear because of the needle insertion; it presents when the patient adopts the erect position and it alleviates with the supine position; if this characteristic is not present it may appear some doubts on diagnosis. The selection of a fine trocar for puncture and guiding the bevel parallel to the fibers of dura are the main factors for profilaxis of headache. Its treatment is controversial, but it does exist a consensus in that the epidural blood patch is the definitive treatment for this condition.

  9. Effectiveness of a new gelatin sealant system for dural closure.

    Science.gov (United States)

    Kawai, Hisashi; Nakagawa, Ichiro; Nishimura, Fumihiko; Motoyama, Yasushi; Park, Young-Su; Nakamura, Mitsutoshi; Nakase, Hiroyuki; Suzuki, Shuko; Ikada, Yoshito

    2014-10-01

    Watertight dural closure is imperative after neurosurgical procedures because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. In this study, the authors test the use of a new gelatin glue as a dural sealant in in vitro and in vivo canine models of transdural CSF leakage. The in vitro model was sutured semicircles of canine dura mater and artificial dural substitute. The sutures were sealed with gelatin glue (n  =  20), fibrin glue (n  =  20), or a polyethylene glycol (PEG)-based hydrogel sealant (n  =  20). Each sample was set in a device to measure water pressure, and pressure was increased until leakage occurred. Bonding strength was subjectively evaluated. The in vivo model was dogs who underwent dural excision and received either no sealant (control group; n  =  5) or gelatin glue sealant (n  =  5) before dural closure. Twenty-eight days post-surgery, the maximum intracranial pressure was measured at the cisterna magna using Valsalva maneuver and tissue adhesion was evaluated. The water pressure at which leakage occurred in the in vitro model was higher with gelatin glue (76·5 ± 39·8 mmHg) than with fibrin glue (38·3 ± 27·4 mmHg, P control group (13·8 ± 4·0 mmHg, P control group (P  =  0·005). The new gelatin glue provides an effective watertight closure when used as an adjunct to sutured dural repair.

  10. Embolia pulmonar na sala de cirurgia: relato de caso Embolia pulmonar en sala operatoria: relato de caso Pulmonary embolism in the operating room: case report

    Directory of Open Access Journals (Sweden)

    Karina Bernardi Pimenta

    2002-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embolia pulmonar é uma complicação freqüente no período pós-operatório. O objetivo deste relato é apresentar um caso de embolia pulmonar ocorrida na sala de operação e chamar a atenção para a importância da profilaxia de trombose venosa em pacientes cirúrgicos. RELATO DO CASO: Trata-se de um paciente do sexo masculino, 55 anos e 83 kg com diagnóstico de câncer de próstata, submetido a prostatectomia supra-púbica sob anestesia geral. Ao final da cirurgia, o paciente já extubado e logo após sua passagem para a maca de transporte apresentou instabilidade hemodinâmica e diminuição da SpO2 para 80%. Foi reintubado e encaminhado para a UTI. A tomografia computadorizada mostrou imagens com aspecto de embolia pulmonar. O paciente evoluiu para óbito no 5º dia de pós-operatório. CONCLUSÕES: O elevado índice de suspeita não é suficiente para firmar o diagnóstico pois a embolia pulmonar é uma doença silenciosa e a rotina de investigação não possui elevada sensibilidade. A profilaxia precoce e adequada é a melhor estratégia.JUSTIFICATIVA Y OBJETIVOS: Embolia pulmonar es una complicación frecuente en el período pós-operatorio. El objetivo de este relato es presentar un caso de embolia pulmonar ocurrida en la sala de operación y llamar la atención para la importancia de la profilaxis de trombosis venosa en pacientes cirúrgicos. RELATO DE CASO: Se trata de un paciente del sexo masculino, 55 años y 83 kg con diagnóstico de cáncer de próstata, sometido a prostatectomia supra-púbica bajo anestesia general. Al final de la cirugía, el paciente ya entubado y luego después de pasar para la camilla de transporte presentó inestabilidad hemodinámica y diminución de la SpO2 para 80%. Fue reintubado y encaminado para la UTI. La tomografía computadorizada mostró imágenes con aspecto de embolia pulmonar. El paciente evolucionó para óbito en el 5º día de pós-operatorio. CONCLUSIONES: El

  11. MR diagnosis of dural sinus thrombosis. Diagnostico por RM de las trombosis de senos durales

    Energy Technology Data Exchange (ETDEWEB)

    Rovira Caellas, A.; Turon Estrada, A.; Alvarez Sabin, J.; Lozano Sanchez, M.; Castao Duque, Ch.; Grive Isern, E.; Sumalla Sue, J. (Hospital General Vall d' Hebron Barcelona (Spain))

    1994-01-01

    Four adult patients were diagnosed as having dural sinus thrombosis (DST) by means of magnetic resonance (MR). In the three cases of acute thrombosis, MR disclosed diffuse or segmental hyperintensity in the sinuses involved, which persisted regardless of the sequence and orientation of the plane selected. MR angiography (MRA) provided diagnostic information that proved useful in the chronic case, as well as in the two cases in which follow-up was carried out to determine the degree to which permeability was restored to the sinuses involved. MR diagnosis of DST can produce false positives and negatives, the causes of which should be known, as well as the ways to avoid them, in order to prevent diagnostic errors. MR, when applied and interpreted correctly, can be considered the first, and in many cases the only, choice as a diagnostic method in DST. (Author)

  12. Comparación de cambios clínicos y hemodinámicos en pacientes con insuficiencia venosa mixta según tipo de manejo.

    OpenAIRE

    Escobar Diaz, Alejandro

    2015-01-01

    Existen varias causas de la insuficiencia venosa profunda, la insuficiencia venosa superficial es una de ellas; por tal motivo, una intervención activa de la insuficiencia superficial ya sea cirugía convencional, esclerosis o radiofrecuencia mejora el reflujo del sistema venoso profundo. En nuestro medio no se acostumbra a intervenir los pacientes con insuficiencia venosa mixta bajo la creencia de exacerbar la enfermedad o generar complicaciones. Se pretende documentar los cambios clínicos y ...

  13. Adherencia a la terapia compresiva en los pacientes con úlceras venosas

    Directory of Open Access Journals (Sweden)

    María del Carmen Folguera Álvarez

    Full Text Available Objetivo: Analizar la bibliografía publicada en relación con los factores que influyen en la adherencia al tratamiento de la terapia compresiva en las personas con úlceras venosas. Método: Se ha realizado una revisión bibliográfica, consultando PubMed, BioMed Central, Library Cochrane Plus, CUIDEN, LILACS, IBECS, IME, SciELO, CINAHL, desde enero del 2003 a mayo de 2013. Resultados: Se han encontrado dieciséis documentos que cumplen los criterios de inclusión. Existen factores que influyen en la adherencia al tratamiento relacionados con los pacientes, profesionales e instituciones. Conclusiones: Se debe considerar el carácter crónico de las úlceras venosas y realizar las intervenciones, teniendo en cuenta las preferencias, conocimientos y habilidades tanto propias como de los pacientes.

  14. Anestesia venosa total com infusão alvo-controlada de remifentanil e propofol para ablação de fibrilação atrial Anestesia venosa total con infusión objeto-controlada de remifentanil y propofol para ablación de la fibrilación atrial Total intravenous anesthesia with target-controlled infusion of remifetanil and propofol for ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Fernando Squeff Nora

    2009-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A ablação de fibrilação atrial (FA é um procedimento novo em nosso meio, embora seja comum em outros centros. A escolha da anestesia, monitores e cuidados anestesiológicos para esse procedimento, realizado fora do bloco cirúrgico, não tem sido descrita. O objetivo deste relato foi descrever uma técnica de anestesia para a realização de ablação de FA. RELATO DO CASO: Paciente feminina, 49 anos, 73 kg, 155 cm, ASA II por hipertensão arterial sistêmica. A monitorização constou de eletrocardiograma com 12 derivações, oximetria de pulso, frequência cardíaca, eletroencefalografia bispectral para medidas de BIS, taxa de supressão (SR e SEF95 e pressão arterial média (PAM. A indução anestésica foi realizada com propofol por via venosa, em infusão alvo-controlada (IAC, com alvo regulado em 4 µg.mL-1, remifentanil por via venosa, em IAC, com alvo de 3 ng.mL¹, e rocurônio por via venosa em bolus na dose de 0,2 mg.kg-1. O modelo farmacocinético de propofol utilizado foi o descrito por Marsh e incorporado à bomba de propofol PFS®. O modelo farmacocinético de remifentanil utilizado foi o descrito por Minto e incorporado à bomba de infusão Alaris PK®. As concentrações, no local efetor ou biofase, corresponderam às informações obtidas através das bombas de infusão e representaram medidas preditivas das concentrações de ambos os fármacos nos respectivos locais de ação. As concentrações de propofol e de remifentanil foram reguladas de acordo com o BIS e a PAM, respectivamente. CONCLUSÕES: A anestesia venosa total para ablação de FA pode ser uma opção segura, levando-se em conta que não há alteração da eletrofisiologia das vias acessórias. A literatura é escassa a este respeito e novas publicações poderão ou não justificar esta modalidade de anestesia durante ablação de FA.JUSTIFICATIVA Y OBJETIVOS: La ablación de fibrilación atrial (FA es un procedimiento nuevo en

  15. Dural diverticulum with a symptomatic cerebrospinal fluid leak

    Directory of Open Access Journals (Sweden)

    Nicholas Armstrong, MD

    2016-03-01

    Full Text Available A case report of a 63-year-old female patient with a cervical spinal dural diverticulum and intracranial hypotension secondary to a symptomatic CSF leak after minor trauma. The patient responded well after the cervical approach epidural blood patch procedure.

  16. Iatrogene duralæsioner ved dekompressionskirurgi i lumbalcolumna

    DEFF Research Database (Denmark)

    Thomsen, Frederik; Amtoft, Ole; Andersen, Mikkel

    2010-01-01

    at the Private Hospital Hamlet. The study covers cases from the 10-month period from September 1, 2007 to June 30, 2008. Data was collected after this period and consists of surgeon-documented dural tears. At the time of surgery, the surgeon was unaware that there would be a subsequent registration. A total...

  17. Efectividad de la electromagnetoterapia en el tratamiento de la insuficiencia venosa crónica

    Directory of Open Access Journals (Sweden)

    María Onelia Díaz Rivadeneira

    2015-03-01

    Full Text Available Se realizó un estudio experimental prospectivo, con el objetivo de evaluar la efectividad de la electromagnetoterapia en pacientes con insuficiencia venosa crónica, atendidos en el Hospital Universitario “Manuel Ascunce Doménech” de Camagüey, en la etapa comprendida desde febrero hasta agosto de 2012. El universo estuvo constituido por 135 pacientes que acudieron al servicio de Angiología con insuficiencia venosa crónica y la muestra se formó con 42 pacientes mayores de 18 años diagnosticados, seleccionados según muestreo aleatorio simple. Se aplicó magnetoterapia en los puntos E36 (+, E41 (-, Vb34 (+, Vb39 (-, el tiempo de duración fue de quince minutos cada sesión, una vez al día durante quince sesiones. La totalidad de los pacientes presentaron pesadez, prurito y edema. Predominó la desaparición del prurito a partir de la quinta sesión de magnetoterapia; la pesadez, el edema y el dolor fueron disminuyendo en el transcurso del tratamiento. La calidad de vida al finalizar el tratamiento fue buena. No se encontraron reacciones adversas. El tratamiento con electromagnetoterapia fue efectivo en los pacientes con insuficiencia venosa crónica

  18. Bilateral subdural hematoma secondary to accidental dural puncture

    Directory of Open Access Journals (Sweden)

    Sofía Ramírez

    2015-07-01

    Full Text Available We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma.The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time. Resumo: Apresentamos o caso clínico de uma paciente de 25 anos de idade, na qual uma técnica peridural foi realizada durante o trabalho de parto e posteriormente apresentou cefaleia com características de cefaleia pós-punção dural. Foi iniciado tratamento conservador e tampão de sangue peridural. Devido a ausência de melhora clínica e à mudança do componente postural da cefaleia, decidiu-se realizar um exame de imagem cerebral que demostrou a presença de hematoma subdural bilateral.A cefaleia pós-punção dural é relativamente frequente, mas a falta de resposta ao tratamento médico instaurado, assim como a mudança em suas características e a presença de foco neurológico, devem levantar a suspeita de presença de um hematoma subdural que, embora infrequente, pode chegar a ser devastador se não for diagnosticado e tratado oportunamente. Keywords: Accidental dural puncture, Epidural analgesia, Post-dural puncture headache, Subdural hematoma, Epidural blood patch, Palavras chave: Dura-Máter, Analgesia epidural, Cefaleia pós-punção dural, Hematoma subdural, Placa de sangue epidural

  19. Evaluation of three different measurement methods for dural ectasia in Marfan syndrome

    International Nuclear Information System (INIS)

    Weigang, E.; Ghanem, N.; Chang, X.-C.; Richter, H.; Frydrychowicz, A.; Szabo, G.; Dudeck, O.; Knirsch, W.; Samson, P. von; Langer, M.; Beyersdorf, F.

    2006-01-01

    Aim: Dural ectasia is a major diagnostic criterion for Marfan syndrome using the Ghent nosology. Our aim was to evaluate the efficacy of three different radiological methods previously proposed for the assessment of dural sac diameter in Marfan syndrome. Methods: Marfan syndrome was diagnosed in our study using the Ghent criteria, disregarding dural ectasia as a criterion. Three proposed radiological methods were applied to measure dural sac diameter, examined for 41 patients (18 patients with and 23 without Marfan syndrome) by computed tomography or magnetic resonance imaging. Results: Using Oosterhof's method, 94% of the patients with and 44% of the patients without Marfan syndrome fulfilled the criteria of dural ectasia. According to Villeirs, dural ectasia was diagnosed in 18% of the patients with and in none of the patients without Marfan syndrome. With Ahn's method, dural ectasia was found in 72% of the patients with and in 44% of the patients without Marfan syndrome. In only two patients with Marfan syndrome was dural ectasia diagnosed by all three methods. Conclusion: Our results reveal overt discrepancy between the three methods of assessing dural ectasia. Considering the key role played by dural ectasia in reinforcing the diagnosis of Marfan syndrome according to the Ghent nosology, a standardized and reliable method should be sought

  20. Evaluation of three different measurement methods for dural ectasia in Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Weigang, E.; Ghanem, N.; Chang, X.-C.; Richter, H.; Frydrychowicz, A.; Szabo, G.; Dudeck, O.; Knirsch, W.; Samson, P. von; Langer, M.; Beyersdorf, F

    2006-11-15

    Aim: Dural ectasia is a major diagnostic criterion for Marfan syndrome using the Ghent nosology. Our aim was to evaluate the efficacy of three different radiological methods previously proposed for the assessment of dural sac diameter in Marfan syndrome. Methods: Marfan syndrome was diagnosed in our study using the Ghent criteria, disregarding dural ectasia as a criterion. Three proposed radiological methods were applied to measure dural sac diameter, examined for 41 patients (18 patients with and 23 without Marfan syndrome) by computed tomography or magnetic resonance imaging. Results: Using Oosterhof's method, 94% of the patients with and 44% of the patients without Marfan syndrome fulfilled the criteria of dural ectasia. According to Villeirs, dural ectasia was diagnosed in 18% of the patients with and in none of the patients without Marfan syndrome. With Ahn's method, dural ectasia was found in 72% of the patients with and in 44% of the patients without Marfan syndrome. In only two patients with Marfan syndrome was dural ectasia diagnosed by all three methods. Conclusion: Our results reveal overt discrepancy between the three methods of assessing dural ectasia. Considering the key role played by dural ectasia in reinforcing the diagnosis of Marfan syndrome according to the Ghent nosology, a standardized and reliable method should be sought.

  1. Anestesia em paciente com Distrofia Muscular de Duchenne: relato de caso

    Directory of Open Access Journals (Sweden)

    Tonelli Deoclécio

    2003-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A distrofia muscular de Duchenne é uma afecção recessiva ligada ao cromossomo X, geralmente diagnosticada na infância, acentuando-se progressivamente até agravar a função respiratória. O objetivo deste relato é apresentar um caso de um paciente com distrofia muscular de Duchenne diagnosticada há 2 anos, submetido à postectomia, sob anestesia geral com cetamina S. RELATO DO CASO: Paciente com 9 anos de idade com Distrofia Muscular de Duchenne diagnosticada há 2 anos, submetido à anestesia geral com levo-cetamina (1,5 mg.kg-1, por via venosa, sob ventilação espontânea assistida manualmente por sistema de Baraka (Mapleson A e bloqueio peniano com bupivacaína a 0,5% (25 mg. Foram usados monitores de pressão arterial não invasiva, oximetria de pulso, cardioscopia e temperatura esofagiana. No decorrer da cirurgia, o caso evoluiu sem intercorrências, sendo que no período pós-operatório o paciente apresentou alguns episódios de vômitos sem outras alterações significativas. Permaneceu internado por 24 horas, tendo alta hospitalar assintomático. CONCLUSÕES: A avaliação pré-anestésica cuidadosa, o uso de monitorização adequada e medicações que não predisponham o aparecimento de complicações tornam seguro o procedimento em pacientes portadores de Distrofia Muscular de Duchenne e seu pós-operatório.

  2. Raquitismo carencial: relato de caso

    OpenAIRE

    Porto, Juliana Antola et al.

    2005-01-01

    Introdução: O raquitismo é uma doença do tecido ósseo em formação, onde há falha na calcificação e conseguinte acúmulo de tecido osteóide. O raquitismo carencial é decorrente da deficiência dos precursores da vitamina D, sendo a causa de raquitismo mais facilmente evitável e tratável. Objetivo: Relatar um caso, revisar a etiopatogenia e o tratamento do raquitismo carencial. Relato de caso: Paciente masculino com 2 anos de idade, previamente hígido, consulta com dificuldade de deambular progre...

  3. Trombosis Venosa Retiniana y Trombosis Venosa Profunda; ¿hablamos de dos manifestaciones de una misma enfermedad? Estudio comparativo de 2 cohortes.

    OpenAIRE

    Guirado Torrecillas, Leticia

    2018-01-01

    La oclusión venosa retiniana (OVR) es un trastorno vascular retiniano muy frecuente (la 2ª en frecuencia tras la retinopatía diabética), poco conocida y una importante causa de pérdida de visión. Su prevalencia varía de un 0,3-1,6% y aumenta con la edad, sobre todo a partir de los 65 años. Su etiopatogenia está poco aclarada, ya que no parece que hay una relación estrecha con la triada clásica de trombogénesis de Virchow, y si con la proximidad anatómica entre las venas y las arterias retini...

  4. Imaging diagnosis of dural and direct cavernous carotid fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Daniela dos; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante, E-mail: danisantos2404@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2014-07-15

    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. (author)

  5. MR inflow angiography for the evaluation of dural sinus patency

    International Nuclear Information System (INIS)

    Poncelet, B.; Baleriaux, D.; Grand, C.; Van Dijk, P.; De Graaf, R.; Segebarth, C.

    1990-01-01

    This paper assesses dural sinus patency with two-dimensional inflow MR angiography. Twelve patients with potential dural sinus (superior sagittal and transverse sinus) involvement related to tumors of the falx or the convexity (meningiomas, metastasis) were examined with digital subtraction angiography (DSA), Mr imaging (1.5-T Gyroscan system), including T1-weighted (pre- and post-agadolinium) and T2-weighted spin-echo imaging, and MR angiography. For the MR angiographic study, a gradient-echo fast field echo sequence with flow compensation was used. Thin (2-mm), contiguous coronal or transverse sections were acquired sequentially. Three-dimensional reconstruction with MIP processing was then performed. CT, DSA, and MR imaging were performed for presurgical evaluation. Surgical confirmation of sinus patency was obtained for all patients

  6. A rare case of spinal dural arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Mariya Apostolova

    2012-12-01

    Full Text Available Spinal dural arteriovenous fistula (SDAVF is a rare vascular malformation of the spine. Only a limited number of cases of SDAVF have been reported in the current literature. We describe the case of a 74 year old male who presented with gradually progressive bilateral lower extremity weakness and bladder dysfunction and was subsequently diagnosed with SDAVF affecting both the thoracic and lumbar spine. The patient later underwent embolization with some improvement in his neurologic symptoms.

  7. Phase-contrast MR angiography of intracranial dural arteriovenous fistulae

    International Nuclear Information System (INIS)

    Cellerini, M.; Mascalchi, M.; Mangiafico, S.; Ferrito, G.P.; Scardigli, V.; Pellicano, G.; Quilici, N.

    1999-01-01

    MRI and phase-contrast MR angiography (PC MRA) were obtained in 13 patients with angiographically confirmed intracranial dural arteriovenous fistulae (DAVF). Three- and two-dimensional PC MRA was obtained with low (6-20 cm/s) and high (>40 cm/s) velocity encoding along the three main body axes. MRI showed focal or diffuse signal abnormalities in the brain parenchyma in six patients, dilated cortical veins in seven, venous pouches in four with type IV DAVF and enlargement of the superior ophthalmic vein in three patients with DAVF of the cavernous sinus. However, it showed none of the fistula sites and did not allow reliable identification of feeding arteries. 3D PC MRA enabled identification of the fistula and enlarged feeding arteries in six cases each. Stenosis or occlusion of the dural sinuses was detected in six of eight cases on 3D PC MRA with low velocity encoding. In six patients with type II DAVF phase reconstruction of 2D PC MRA demonstrated flow reversal in the dural sinuses or superior ophthalmic vein. (orig.)

  8. Efficacy and safety of small intestinal submucosa in dural defect repair in a canine model

    Energy Technology Data Exchange (ETDEWEB)

    He, Shu-kun [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Guo, Jin-hai [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Department of Orthopedics, The Third People' s Hospital of Chengdu, Chengdu, Sichuan 610031 (China); Wang, Zhu-le [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Zhang, Yi [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Tu, Yun-hu [Department of Neurosurgery, Chengdu Military General Hospital, Chengdu, Sichuan 610083 (China); Wu, Shi-zhou [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Huang, Fu-guo [Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Xie, Hui-qi, E-mail: xiehuiqi@scu.edu.cn [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China)

    2017-04-01

    Dural defects are a common problem, and inadequate dural closure can lead to complications. Several types of dural substitute materials have recently been discarded or modified owing to poor biocompatibility or mechanical properties and adverse reactions. The small intestinal submucosa (SIS) is a promising material used in a variety of applications. Based on the limitations of previous studies, we conducted an animal study to evaluate the efficacy and safety of the SIS in preclinical trials. Twenty-four male beagle dogs were subjected to surgical resection to produce dural defects. SIS or autologous dural mater was patched on the dural defect. Gross and histological evaluations were carried out to evaluate the efficacy and safety of the therapy. Our findings demonstrated that the SIS, which stimulated connective and epithelial tissue responses for dural regeneration and functional recovery without immunological rejection, could provide prolonged defect repair and prevent complications. The mechanical properties of the SIS could be adjusted by application of multiple layers, and the biocompatibility of the material was appropriate. Thus, our data suggested that this material may represent an alternative option for clinical treatment of dural defects. - Highlights: • SIS stimulates dura regeneration without immunological rejection. • SIS has adjustable mechanical properties and appropriate biocompatibility. • SIS may be an effective alternative option for clinical treatment of dural defects.

  9. Efficacy and safety of small intestinal submucosa in dural defect repair in a canine model

    International Nuclear Information System (INIS)

    He, Shu-kun; Guo, Jin-hai; Wang, Zhu-le; Zhang, Yi; Tu, Yun-hu; Wu, Shi-zhou; Huang, Fu-guo; Xie, Hui-qi

    2017-01-01

    Dural defects are a common problem, and inadequate dural closure can lead to complications. Several types of dural substitute materials have recently been discarded or modified owing to poor biocompatibility or mechanical properties and adverse reactions. The small intestinal submucosa (SIS) is a promising material used in a variety of applications. Based on the limitations of previous studies, we conducted an animal study to evaluate the efficacy and safety of the SIS in preclinical trials. Twenty-four male beagle dogs were subjected to surgical resection to produce dural defects. SIS or autologous dural mater was patched on the dural defect. Gross and histological evaluations were carried out to evaluate the efficacy and safety of the therapy. Our findings demonstrated that the SIS, which stimulated connective and epithelial tissue responses for dural regeneration and functional recovery without immunological rejection, could provide prolonged defect repair and prevent complications. The mechanical properties of the SIS could be adjusted by application of multiple layers, and the biocompatibility of the material was appropriate. Thus, our data suggested that this material may represent an alternative option for clinical treatment of dural defects. - Highlights: • SIS stimulates dura regeneration without immunological rejection. • SIS has adjustable mechanical properties and appropriate biocompatibility. • SIS may be an effective alternative option for clinical treatment of dural defects.

  10. Complicações na rede venosa de mulheres com câncer de mama durante tratamento quimioterápico Complicaciones en la red venosa de mujeres con cáncer de mama durante tratamiento quimioterapéutico Complications in the venous network of women with breast cancer during chemotherapy treatment

    Directory of Open Access Journals (Sweden)

    Elga Zacharias Martins

    2010-01-01

    Full Text Available OBJETIVOS: Identificar as reações da rede venosa, investigar a frequência e as características dessas reações em mulheres com câncer de mama durante o tratamento quimioterápico. MÉTODOS: Foram avaliados 339 prontuários de mulheres submetidas à quimioterapia, de 2003 a 2007. RESULTADOS: Durante os tratamentos neoadjuvantes e adjuvantes 17,1% e 22,4% mulheres apresentaram intercorrências registradas no prontuário, sendo as frequentes: extravasamento, dor e alteração na coloração da pele. As condutas mais citadas na neoadjuvância foram: utilização de compressas frias (2,9% e aplicação de glicocorticoide subcutâneo no local (3,5% e na adjuvância foram: aplicação de hidrocortisona subcutâneo no local (3,2%, aplicação do protocolo de extravasamento (6,2% e utilização de compressas de gelo (7,1%. CONCLUSÃO: O registro das intercorrências e o relato da equipe de enfermagem são essenciais para o acompanhamento dos sítios de punções venosas utilizados durante o tratamento quimioterápico, além de mensuração e registro fotográfico do local.OBJETIVOS: Identificar las reacciones de la red venosa e investigar la frecuencia y las características de esas reacciones en mujeres con cáncer de mama durante el tratamiento quimioterapéutico. MÉTODOS: Fueron evaluadas 339 fichas de mujeres sometidas a quimioterapia, de 2003 a 2007. RESULTADOS: Durante los tratamientos neo-adyuvantes y adyuvantes (17,1% y 22,4% las mujeres presentaron ocurrencias registradas en fichas, siendo las más frecuentes: infiltración externa, dolor y, alteración en la coloración de la piel. Las conductas neo-adyuvantes más citadas fueron: utilización de compresas frías (2,9% y aplicación de glucocorticoide subcutáneo en el local (3,5%, y las adyuvantes fueron: aplicación de hidrocortisona subcutánea en el local (3,2%, aplicación del protocolo de infiltración externa (6,2% y utilización de compresas de hielo (7,1%. CONCLUSIÓN: El

  11. Trombose venosa dos membros superiores Venous thrombosis of the upper limbs

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    Waldemy Silva

    2005-01-01

    Full Text Available Foi realizada uma revisão da evolução clínica de 52 pacientes portadores de trombose venosa axilar e/ou subclávia. Na opinião do autor, até o presente não se tem evidência do esforço na patogenia dessa forma topográfica de trombose venosa. A terminologia síndrome de Paget-Schrötter pode ser usada quando existe um trombo, conforme sugeriram esses autores. No que diz respeito aos pacientes cujo quadro clínico têm como fator preponderante uma compressão extrínseca dos troncos venosos, deve-se levar em consideração uma outra síndrome, como a do desfiladeiro torácico. Para a confirmação de uma suspeita clínica de trombose venosa profunda, a flebografia é o padrão-ouro. O tratamento ideal da oclusão venosa axilo-subclávia não foi ainda estabelecido, mas o anticoagulante tem a preferência. A eficácia do efeito trombolítico in situ é contestada em publicações da literatura médica. O acesso cirúrgico direto para a trombectomia pode ser feito somente em condições especiais.Clinical course of 52 patients with axillary and/or subclavian vein thrombosis was reviewed. In the author's opinion, up to the present time we have no evidence of strain in the pathogenesis of this topographic vein thrombosis. The term Paget-Schrötter syndrome can be used when a thrombus is present, as these authors have suggested. With regard to the patients whose clinical picture is supported by an extrinsic compression on the venous trunks, another syndrome must be considered, such as the thoracic outlet syndrome. For the determination of a clinically suspected deep venous thrombosis, phlebography is the gold standard. The optimal treatment for the axillary-subclavian venous occlusion remains to be established, but the anticoagulant therapy has the preference. The efficacy of in situ thrombolytic effect is contested in medical publications. A direct surgical access for thrombectomy can be made only under special conditions.

  12. Successful Ablation for Atrial Tachycardia Originated from Sinus Venosa with Tachycardia-Induced Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Sou Takenaka

    2016-01-01

    Full Text Available A 74-year-old male suffering from congestive heart failure with atrial tachycardia (AT with 2 : 1 atrioventricular conduction was admitted to our hospital. After the therapy with diuretics and β-blocker, his rapid AT was still sustained. He took the catheter ablation for his AT. Postpacing interval mapping from entrainment and noncontact mapping system revealed the mechanism of his AT, originated from sinus venosa. His AT was successfully terminated and eliminated by radiofrequency catheter ablation. After the successful ablation, he has been free from any AT, and his cardiac function was also improved.

  13. ''Dural tail'' adjacent to acoustic neuroma on MRI: a case report

    International Nuclear Information System (INIS)

    Lunardi, P.; Mastronardi, L.; Nardacci, B.; Acqui, M.; Fortuna, A.

    1993-01-01

    A 'dural tail' on Gd-DTPA-enhanced MRI has been often observed adjacent to meningiomas and considered to be useful in distinguishing meningioma of the cerebellopontine angle from acoustic neuroma. However, demonstration of a dural tail adjacent to an acoustic neuroma indicates that this sign is not specific. (orig.)

  14. Prognosis of cerebral vein and dural sinus thrombosis - Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)

    NARCIS (Netherlands)

    Ferro, José M.; Canhão, Patrícia; Stam, Jan; Bousser, Marie-Germaine; Barinagarrementeria, Fernando

    2004-01-01

    Background and Purpose - The natural history and long-term prognosis of cerebral vein and dural sinus thrombosis (CVT) have not been examined previously by adequately powered prospective studies. Methods - We performed a multinational ( 21 countries), multicenter ( 89 centers), prospective

  15. Intracranial dural arterio-venous fistula presenting with progressive myelopathy.

    LENUS (Irish Health Repository)

    Ogbonnaya, Ebere Sunny

    2011-01-01

    Spinal dural arterio-venous fistula (DAVF) is rare and usually involves the thoracic segments. The classical presentation is a slowly progressive ataxia. Clinical presentation of intracranial DAVF depends on the site of the DAVF, as well as the vessels involved. Patients may present with pulsatile tinnitus, occipital bruit, headache, dementia, visual impairment as well as neurological deterioration distant from the DAVF as a result of venous hypertension and cortical haemorrhage. The authors present a rare case of progressive myelopathy secondary to an intracranial DAVF.

  16. Dural ectasia and FBN1 mutation screening of 40 patients with Marfan syndrome and related disorders: role of dural ectasia for the diagnosis.

    Science.gov (United States)

    Attanasio, Monica; Pratelli, Elisa; Porciani, Maria Cristina; Evangelisti, Lucia; Torricelli, Elena; Pellicanò, Giannantonio; Abbate, Rosanna; Gensini, Gian Franco; Pepe, Guglielmina

    2013-07-01

    Marfan syndrome is an autosomal dominant disorder of connective tissue caused by mutations in the gene encoding fibrillin-1 (FBN1), a matrix component of microfibrils. Dural ectasia, i.e. enlargement of the neural canal mainly located in the lower lumbar and sacral region, frequently occurs in Marfan patients. The aim of our study was to investigate the role of dural ectasia in raising the diagnosis of Marfan syndrome and its association with FBN1 mutations. We studied 40 unrelated patients suspected for MFS, who underwent magnetic resonance imaging searching for dural ectasia. In all of them FBN1 gene analysis was also performed. Thirty-seven patients resulted affected by Marfan syndrome according to the '96 Ghent criteria; in 30 of them the diagnosis was confirmed when revaluated by the recently revised criteria (2010). Thirty-six patients resulted positive for dural ectasia. The degree of dural ectasia was grade 1 in 19 patients, grade 2 in 11 patients, and grade 3 in 6 patients. In 7 (24%) patients, the presence of dural ectasia allowed to reach a positive score for systemic feature criterion. Twenty-four patients carried an FBN1 mutation, that were represented by 13 missense (54%), and 11 (46%) mutations generating a premature termination codon (PTC, frameshifts and stop codons). No mutation was detected in the remaining 16 (6 patients with MFS and 10 with related disorders according to revised Ghent criteria). The prevalence of severe (grade 2 and grade 3) involvement of dura mater was higher in patients harbouring premature termination codon (PTC) mutations than those carrying missense-mutations (8/11 vs 2/13, P = 0.0111). Our data emphasizes the importance of dural ectasia screening to reach the diagnosis of Marfan syndrome especially when it is uncertain and indicates an association between PTC mutations and severe dural ectasia in Marfan patients. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. A dural metastatic small cell carcinoma of the gallbladder as the first manifestation: a case report.

    Science.gov (United States)

    Tonomura, Shuichi; Kitaichi, Tomoko; Onishi, Rina; Kakehi, Yoshiaki; Shimizu, Hisao; Shimada, Keiji; Kanemasa, Kazuyuki; Fukusumi, Akio; Takahashi, Nobuyuki

    2018-03-16

    A dural metastasis is one of the essential differential diagnoses of meningioma. In general, carcinomas of the breast and lung in females and prostate in males have been the most commonly reported primary lesions of dural metastases. However, dural metastasis of gallbladder carcinoma is extremely rare. Here, we report a unique case of a dural matter metastasis of gallbladder carcinoma as the first manifestation, which was autopsy-defined as small cell carcinoma. A 78-year-old man came to our hospital complaining of left hemianopia. Brain computed tomography (CT) revealed a sizeable parasagittal dural-based extra-axial tumor. However, the findings for meningioma were atypical by magnetic resonance imaging, suggesting a meningioma mimic. A contrast-enhanced CT scan of the abdomen revealed a large gallbladder carcinoma. The patient opted for the best supportive care and died 2 months later. The post-mortem examination revealed small cell carcinoma in gallbladder carcinoma. Moreover, an immunologically similar carcinoma was detected in the dural metastasis. To the best of our knowledge, this is the first case of a dural metastasis of gallbladder small cell carcinoma. A systemic examination is essential for clinicians when atypical findings of meningioma are observed, suggesting a meningioma mimic. We present this rare case with a review of the literature.

  18. Relatos de pesquisas científicas

    Directory of Open Access Journals (Sweden)

    Congresso Internacional de Dislexia

    2011-05-01

    Full Text Available Relatos de pesquisas científicas apresentadas na terceira edição do Congresso Internacional de Dislexia (CID, realizado nas dependências do Centro Universitário Metodista Izabela Hendrix, em maio de 2011. Tratam-se de relatos de resultados de pesquisas científicas, descritivas ou experimentais das áreas da Psicologia, Fonoaudiologia, Piscopedagogia, Pedagogia e Neurociências realizadas no contexto nacional e internacional em torno da temática dislexia. 

  19. A Multicenter Study of the Presentation, Treatment, and Outcomes of Cervical Dural Tears.

    Science.gov (United States)

    O'Neill, Kevin R; Fehlings, Michael G; Mroz, Thomas E; Smith, Zachary A; Hsu, Wellington K; Kanter, Adam S; Steinmetz, Michael P; Arnold, Paul M; Mummaneni, Praveen V; Chou, Dean; Nassr, Ahmad; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Smith, Justin S; Shaffrey, Christopher; Tannoury, Chadi A; Tannoury, Tony; Gokaslan, Ziya L; Gum, Jeffrey L; Hart, Robert A; Isaacs, Robert E; Sasso, Rick C; Bumpass, David B; Bydon, Mohamad; Corriveau, Mark; De Giacomo, Anthony F; Derakhshan, Adeeb; Jobse, Bruce C; Lubelski, Daniel; Lee, Sungho; Massicotte, Eric M; Pace, Jonathan R; Smith, Gabriel A; Than, Khoi D; Riew, K Daniel

    2017-04-01

    Retrospective multicenter case series study. Because cervical dural tears are rare, most surgeons have limited experience with this complication. A multicenter study was performed to better understand the presentation, treatment, and outcomes following cervical dural tears. Multiple surgeons from 23 institutions retrospectively identified 21 rare complications that occurred between 2005 and 2011, including unintentional cervical dural tears. Demographic data and surgical history were obtained. Clinical outcomes following surgery were assessed, and any reoperations were recorded. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), Nurick classification (NuC), and Short-Form 36 (SF36) scores were recorded at baseline and final follow-up at certain centers. All data were collected, collated, and analyzed by a private research organization. There were 109 cases of cervical dural tears among 18 463 surgeries performed. In 101 cases (93%) there was no clinical sequelae following successful dural tear repair. There were statistical improvements ( P < .05) in mJOA and NuC scores, but not NDI or SF36 scores. No specific baseline or operative factors were found to be associated with the occurrence of dural tears. In most cases, no further postoperative treatments of the dural tear were required, while there were 13 patients (12%) that required subsequent treatment of cerebrospinal fluid drainage. Analysis of those requiring further treatments did not identify an optimum treatment strategy for cervical dural tears. In this multicenter study, we report our findings on the largest reported series (n = 109) of cervical dural tears. In a vast majority of cases, no subsequent interventions were required and no clinical sequelae were observed.

  20. Prevalence of dural ectasia in Loeys-Dietz syndrome: comparison with Marfan syndrome and normal controls.

    Directory of Open Access Journals (Sweden)

    Atsushi K Kono

    Full Text Available BACKGROUND AND PURPOSE: Dural ectasia is well recognized in Marfan syndrome (MFS as one of the major diagnostic criteria, but the exact prevalence of dural ectasia is still unknown in Loeys-Dietz syndrome (LDS, which is a recently discovered connective tissue disease. In this study, we evaluated the prevalence of dural ectasia in LDS according by using qualitative and quantitative methods and compared our findings with those for with MFS and normal controls. MATERIAL AND METHODS: We retrospectively studied 10 LDS (6 males, 4 females, mean age 36.3 years and 20 MFS cases (12 males, 8 females, mean age 37.1 years and 20 controls (12 males, 8 females, mean age 36.1 years both qualitatively and quantitatively using axial CT images and sagittal multi-planar reconstruction images of the lumbosacral region. For quantitative examination, we adopted two methods: method-1 (anteroposterior dural diameter of S1> L4 and method-2 (ratio of anteroposterior dural diameter/vertebral body diameter>cutoff values. The prevalence of dural ectasia among groups was compared by using Fisher's exact test and the Tukey-Kramer test. RESULTS: In LDS patients, the qualitative method showed 40% of dural ectasia, the quantitative method-1 50%, and the method-2 70%. In MFS patients, the corresponding prevalences were 50%, 75%, and 85%, and in controls, 0%, 0%, and 5%. Both LDS and MFS had a significantly wider dura than controls. CONCLUSIONS: While the prevalence of dural ectasia varied depending on differences in qualitative and quantitative methods, LDS as well as MFS, showed, regardless of method, a higher prevalence of dural ectasia than controls. This finding should help the differentiation of LDS from controls.

  1. How I do it: surgical ligation of craniocervical junction dural AV fistulas.

    Science.gov (United States)

    Sorenson, Thomas J; La Pira, Biagia; Hughes, Joshua; Lanzino, Giuseppe

    2017-08-01

    Dural arteriovenous fistulas (DAVFs) of the craniocervical junction are uncommon vascular lesions, which often require surgical treatment even in the endovascular era. Most commonly, the fistula is placed laterally, and surgical ligation is performed through a lateral suboccipital craniotomy. After dural opening, the area is inspected, and the arterialized vein is identified emerging from the dura, often adjacent to the entry point of the vertebral artery, and ligated. A far lateral craniotomy is the authors' preferred surgical approach for accessing and treating dural arteriovenous fistulas of the craniocervical junction that cannot be reached endovascularly.

  2. Anterior dural ectasia mimicking a lytic lesion in the posterior vertebral body in ankylosing spondylitis.

    Science.gov (United States)

    Bele, Keerthiraj; Pendharkar, Hima Shriniwas; Venkat, Easwer; Gupta, Arun Kumar

    2011-12-01

    Anterior dural ectasia is an extremely rare finding in ankylosing spondylitis (AS). The authors describe a unique case of AS in which the patient presented with cauda equina syndrome as well as an unusual imaging finding of erosion of the posterior aspect of the L-1 (predominantly) and L-2 vertebral bodies due to anterior dural ectasia. Symptomatic patients with long-standing AS should be monitored for the presence of dural ectasia, which can be anterior in location, as is demonstrated in the present case.

  3. Cranial dural arteriovenous fistula as a rare cause of tinnitus – case report

    International Nuclear Information System (INIS)

    Kuśmierska, Małgorzata; Gać, Paweł; Nahorecki, Artur; Szuba, Andrzej; JaŸwiec, Przemysław

    2013-01-01

    Tinnitus, occurring at least once in a lifetime in about 10–20% of the population, is an important clinical problem with complex etiology. Rare causes of tinnitus include cranial dural arteriovenous fistulas (DAVFs), which are usually small lesions consisting of abnormal connections between branches of dural arteries and venous sinuses or veins. Authors present a case of a 44-year-old woman with persistent, unilateral, treatment-resistant pulsatile tinnitus caused by a small dural arteriovenous fistula revealed in computed tomography angiography. Computed tomography angiography is a useful diagnostic method that in some cases allows for establishing the cause of unilateral, pulsatile tinnitus

  4. Cranial dural arteriovenous fistula as a rare cause of tinnitus – case report

    Energy Technology Data Exchange (ETDEWEB)

    Kuśmierska, Małgorzata; Gać, Paweł [Department of Medical Radiology and Imaging Diagnostics, 4th Military Clinical Hospital, Wrocław (Poland); Nahorecki, Artur [Department of Internal Diseases, 4th Military Clinical Hospital, Wrocław (Poland); Szuba, Andrzej [Department of Internal Diseases, 4th Military Clinical Hospital, Wrocław (Poland); Medical University, Wrocław (Poland); JaŸwiec, Przemysław [Department of Medical Radiology and Imaging Diagnostics, 4th Military Clinical Hospital, Wrocław (Poland)

    2013-07-01

    Tinnitus, occurring at least once in a lifetime in about 10–20% of the population, is an important clinical problem with complex etiology. Rare causes of tinnitus include cranial dural arteriovenous fistulas (DAVFs), which are usually small lesions consisting of abnormal connections between branches of dural arteries and venous sinuses or veins. Authors present a case of a 44-year-old woman with persistent, unilateral, treatment-resistant pulsatile tinnitus caused by a small dural arteriovenous fistula revealed in computed tomography angiography. Computed tomography angiography is a useful diagnostic method that in some cases allows for establishing the cause of unilateral, pulsatile tinnitus.

  5. Trauma inguinal penetrante com formação de fístula arteriovenosa e pseudoaneurisma: relato de caso

    Directory of Open Access Journals (Sweden)

    Frederico Michelino de Oliveira

    2015-12-01

    Full Text Available Resumo Os autores apresentam um relato de caso de vítima de acidente de trabalho com ferimento penetrante em região inguinal direita com peça metálica em espiral, que evoluiu com fístula arteriovenosa da artéria femoral profunda com a veia femoral profunda associado a pseudoaneurisma envolvendo essas estruturas e a veia femoral comum. As fístulas arteriovenosas ocorrem frequentemente após traumas e a associação com pseudoaneurisma é fato raro, devendo ser tratadas precocemente após seu diagnóstico. O ultrassom duplex é atualmente o exame mais utilizado para a avaliação inicial e a arteriografia, o padrão ouro para diagnóstico. No paciente em questão foi realizado tratamento convencional com abordagem cirúrgica direta, sutura arterial e ligaduras venosas. Entretanto, nos dias atuais a cirurgia endovascular e a compressão guiada por ultrassom são métodos terapêuticos que têm sido utilizados com sucesso. O paciente evoluiu sem intercorrência, recebendo alta para acompanhamento ambulatorial com preservação do membro.

  6. Massive granular cell ameloblastoma with dural extension and atypical morphology

    Directory of Open Access Journals (Sweden)

    Vandana Raghunath

    2014-01-01

    Full Text Available Ameloblastomas are rare histologically benign, locally aggressive tumors arising from the oral ectoderm that occasionally reach a gigantic size. Giant ameloblastomas are a rarity these days with the advent of panoramic radiography in routine dental practice. Furthermore, the granular cell variant is an uncommon histological subtype of ameloblastoma where the central stellate reticulum like cells in tumor follicles is replaced by granular cells. Although granular cell ameloblastoma (GCA is considered to be a destructive tumor with a high recurrence rate, the significance of granular cells in predicting its biologic behavior is debatable. However, we present a rare case of giant GCA of remarkable histomorphology showing extensive craniofacial involvement and dural extension that rendered a good prognosis following treatment.

  7. Management of intracranial dural arteriovenous shunts in adults

    International Nuclear Information System (INIS)

    Sarma, Dipanka; Brugge, Karel ter

    2003-01-01

    Dural arteriovenous shunts are abnormal arteriovenous communications within the dura. They are thought to be an acquired condition in adults and can present with a variety of clinical features, ranging from benign bruits to intracranial hemorrhage and neurological deficits. The presentation and natural history of these shunts is largely determined by the pattern of venous drainage. Knowledge of natural history and careful study of the angioarchitexture by angiography is therefore mandatory for correct management of these lesions. In this review, principles of management in adults and the various factors that influence treatment decisions are discussed, with a focus on endovascular therapy. Retrograde leptomeningeal or cortical venous drainage has a strong correlation with adverse clinical events and the requirement for aggressive management in this situation is highlighted. Indications for endovascular treatment, therapeutic goals, approaches and techniques are reviewed. The role of surgical treatment is also briefly discussed

  8. Dural arteriovenous fistula presenting with exophthalmos and seizures.

    Science.gov (United States)

    Feyissa, Anteneh M; Ponce, Lucido L; Patterson, Joel T; Von Ritschl, Rudiger H; Smith, Robert G

    2014-03-15

    Concomitant seizures and exophthalmos in the context of a temporal dural arteriovenous fistula (dAVF) has not been described before. Here, we report a 55-year-old-male who presented with an 8-month history of progressive painless exophthalmos of his left eye, conjunctival chemosis, reduced vision and new onset complex partial seizures. Cerebral angiography demonstrated Cognard Type IIa left cerebral dAVF fed by branches from the left occipital artery and an accessory meningeal artery, with drainage to the superior ophthalmic vein. Following surgical obliteration of dAVF feeding vessels, our patient had dramatic improvement in visual acuity, proptosis and chemosis along with cessation of clinical seizures. Published by Elsevier B.V.

  9. Spontaneous Resolution of a Fetal Dural Sinus Thrombosis: One Case Report and Review of the Literatures

    Directory of Open Access Journals (Sweden)

    Chen Wang

    2012-01-01

    Full Text Available Fetal dural sinus thrombosis is a rare finding. Most cases have been terminated without long-term follow-ups. Recently some reports have indicated the potentially favorable evolution of fetal dural sinus thrombosis. Most of the fetuses showing symptoms have been delivered with normal neurologic outcome. We report a case of fetal dural sinus thrombosis. Serial ultrasound and magnetic resonance images (MRI showed the shrinkage of the thrombosis which indicated good prognosis. No physical or neurological abnormality was observed at 8-months follow-up. Conservative treatment is appropriate to prenatally diagnosed dural sinus thrombosis with favorable prognostic factors. Serial MRI or ultrasound should be taken every 1-2 months to monitor the thrombosis development and fetal well-beings.

  10. Prevalência de deficiência de vitamina D em pacientes com úlceras de perna de etiologia venosa

    Directory of Open Access Journals (Sweden)

    Claudine Juliana C Burkievcz

    Full Text Available OBJETIVO: Estudar se a prevalência da deficiência de vitamina D em indivíduos com úlcera de perna de causa venosa é maior do que em população controle. MÉTODOS: Estudaram-se os níveis séricos de 25-OH-vitamina D por quimioluminescência em 27 portadores de úlcera venosa crônica e 58 controles do Hospital Universitário Evangélico de Curitiba. RESULTADOS: Os níveis de 25-OH-vitamina D3 eram inferiores a 8 ng/dl em 11,1% dos pacientes com úlcera e 3,4% dos controles; entre 8 e 20 ng/dl em 46,1% dos pacientes com úlcera e 25,8% dos controles; entre 21 e 30 ng/dl em 22.2% dos pacientes com úlcera e 27,5% dos controles e acima de 30 ng/dl em 43,1% dos controles e 18,5% dos pacientes com úlcera (p=0,04. CONCLUSÃO: Existe aumento de prevalência de deficiência de vitamina D em pacientes com úlceras venosas crônicas de pernas.

  11. Agenesia de veia cava inferior associada à trombose venosa profunda Agenesis of inferior vena cava associated with deep venous thrombosis

    Directory of Open Access Journals (Sweden)

    Clovis Luis Konopka

    2010-09-01

    Full Text Available A agenesia da veia cava inferior é uma anomalia congênita rara, que foi recentemente identificada como um importante fator de risco para o desenvolvimento e a recorrência de trombose venosa profunda de membros inferiores em jovens. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou trombose venosa profunda dois meses após a realização de cirurgia de varizes. A angiotomografia computadorizada demonstrou a presença de anomalia venosa complexa com ausência da veia cava inferior.The agenesis of the inferior vena cava is a rare congenital anomaly, which was recently identified as an important risk factor for the development and recurrence of deep venous thrombosis especially in young people. The goal of this work was to report the case of a patient who presented deep venous thrombosis approximately two months after varicose vein surgery. The computerized angiotomography demonstrated the presence of a complex venous anomaly with absence of the inferior vena cava.

  12. Caracterização dos pacientes com úlcera venosa acompanhados no Ambulatório de Reparo de Feridas

    Directory of Open Access Journals (Sweden)

    Beatriz Guitton Renaud Baptista de Oliveira

    2012-03-01

    Full Text Available Objetivos: caracterizar os pacientes que apresentam úlcera venosa atendidos no ambulatório de um hospital universitário, avaliar as características das úlceras venosas e citar os produtos utilizados para o seu tratamento. Trata-se de um estudo clínico observacional, aprovado pelo Comitê de Ética em Pesquisa, realizado no Ambulatório de Reparo de Feridas, no período de janeiro a dezembro de 2008. O instrumento de coleta de dados abordou: informações clínicas do paciente e dados específicos da lesão e do tratamento tópico. Participaram do estudo 49 pacientes com úlcera venosa crônica; 55% eram mulheres entre 51-70 anos. Os participantes apresentavam 67 úlceras, a maioria localizada na porção inferior da perna (68,6%, com tempo de evolução menor de cinco anos (53,8%, apresentando leito com tecido de granulação e áreas desvitalizadas (49% e bordas apresentavam com epitelizacão em 58% dos casos. Os produtos disponíveis na instituição eram os ácidos graxos essenciais e a colagenase.

  13. A case report of spinal dural arteriovenous fistula: origins, determinants, and consequences of abnormal vascular malformations

    OpenAIRE

    Zakhary, Sherry M.; Hoehmann, Christopher L.; Cuoco, Joshua A.; Hitscherich, Kyle; Alam, Hamid; Torres, German

    2017-01-01

    A spinal dural arteriovenous fistula is an abnormally layered connection between radicular arteries and venous plexus of the spinal cord. This vascular condition is relatively rare with an incidence of 5–10 cases per million in the general population. Diagnosis of spinal dural arteriovenous fistula is differentiated by contrast-enhanced magnetic resonance angiography or structural magnetic resonance imaging, but a definitive diagnosis requires spinal angiography methods. Here, we report a cas...

  14. Refractory seizures due to a dural-based cavernoma masquerading as a meningioma.

    Science.gov (United States)

    Zeng, Xianwei; Mahta, Ali; Kim, Ryan Y; Saad, Ali G; Kesari, Santosh

    2012-04-01

    A 37-year-old female presented with medically intractable complex partial seizures with secondary generalization. She was found to have a dural-based lesion with radiologic features of meningioma. A gross total resection was performed and pathology confirmed a diagnosis of cavernous angioma and she became seizure free after the surgical resection. Cavernous angioma should be considered in differential diagnosis of a dural-based lesion manifesting with refractory seizures.

  15. Hormonas sexuais femininas e trombose venosa profunda Female hormones and venous thrombosis

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    Rita Ataíde Lobo

    2011-12-01

    Full Text Available O tromboembolismo venoso é uma doença grave. Embora raramente fatal, leva frequentemente a elevada morbilidade, associada à síndrome pós-trombótica. Como factores etiopatogénicos da trombose venosa (TV continuam-se a considerar-se os clássicos da tríade de Virchow, descrita em 1895: estase venosa, alteração de factores de coagulação, no sentido de hipercoagulação e lesão do endotélio venoso. A incidência de trombose aumenta lentamente com a idade, sendo de cerca de 160 por 100,000 habitantes/ano. Quando analisamos a incidência em mulheres vemos que esta está aumentada, sobretudo na gravidez - 60 por 100,000/ano -, mas também em utilizadoras de contraceptivos orais combinados (COC - 15 a 25 por 100,000/ano - e de terapêutica hormonal (TH para tratamento da menopausa - 10 por 100,000/ano. Sendo o risco de morte súbita associado a complicações major de 20% por embolia pulmonar (EP e de 1-2% por trombose venosa. Os moduladores selectivos dos receptores de estrogéneos (SERMs são moléculas que actuam ligando-se aos receptores de estrogéneos, induzindo uma acção metabólica que pode ser agonista ou antagonista dos estrogéneos, consoante o tecido alvo. Os mais utilizados, raloxifeno e tamoxifeno, estão associados a um aumento do risco para tromboembolismo (TE venoso de cerca de, três e sete vezes, respectivamente.Venous thrombosis is a serious disorder. Although rarely fatal, often leads to a disabling post thrombotic syndrome. The risk factors for thrombosis can be divided into 3 groups of causes, according to Virchow (1985: reduced blood flow, changes in the vessel wall, and changes in the composition of the blood. The incidence of the disease slowly increases with age, and it is about 160 in 100,000 people/year. When we look at the incidence in women, it is easy to see that it is higher in pregnancy - 60 in 100,000/year; but it is also increased in women that use combined oral contraceptives - 15 to 25 in 100

  16. Relato de caso: esclerose tuberosa

    Directory of Open Access Journals (Sweden)

    Samuel Simis

    2016-10-01

    Full Text Available Introdução: O Complexo de Esclerose Tuberosa (CET é uma síndrome neurocutânea transmitida hereditariamente, de traço autossômico dominante e que se manifesta por uma tríade clássica: deficiência mental, convulsões e adenoma sebáceo. A mutação responsável pela síndrome está presente em até 85% dos portadores de CET e.ocorre nos genes supressores tumorais TSC1 e TSC2, que produzem hamartina e tuberina, respectivamente.A prevalência do CET é de 1:10.000 a 1:170.000, atinge mais indivíduos do sexo masculina e é rara em negros. Relato de Caso: R.C.S.B., paciente do sexo feminino, 16 anos, vem encaminhada ao ambulatório de neurologia devido a quadro de convulsões tônico-clônicas generalizadas e crises de ausência diárias há 1 ano, mas com história de convulsões aos 2 anos que cessaram espontaneamente. Está em tratamento com fenitoína 200mg/dia e carbamazepina 800mg/dia, mas ainda apresenta crises de ausência. A paciente apresenta as lesões cutâneas típicas do CET: adenomas sebáceos (angiofibroma em face distribuídos simetricamente entre nariz e bochechas, envolvendo ainda fronte e queixo. Não há sinais de retardo mental. A ressonância nuclear magnética revelou imagens com padrão compatível com áreas de desmielinização. O eletroencefalograma encontrava-se normal. Conclusão: O tratamento do CET ainda é um desafio para muitos neurologistas, uma vez que não há tratamento específico para doença. A paciente deve contar com equipe multidisciplinar, por vezes é necessário acompanhamento com neurologista, dermatologista, geneticista, psicólogos e outros, dependendo das manifestações do CET. A finalidade terapêutica é a qualidade de vida da paciente, que pode ser prejudicada pelas várias convulsões ou alterações estéticas da doença.

  17. Ascite meconial - relato de caso

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    Celeste Gomez Sardinha Oshiro

    2016-10-01

    Full Text Available INTRODUÇÃO: A ascite meconial resultante da perfuração intestinal fetal tem baixa incidência (1:30.000 nascimentos e elevada mortalidade (50%. Os achados ecográficos fetais incluem ascite e calcificações intra-abdominais. OBJETIVO: Relatar um caso de ascite meconial neonatal no Conjunto Hospitalar de Sorocaba. METODOLOGIA: Descrição do referido caso e revisão de literatura. RELATO DE CASO: Recém-nascido de J.A.P., masculino, de parto cesáreo por iteratividade em 12/05/2016, cuja mãe com 44 anos, sem intercorrências no pré-natal, negou consanguinidade, vícios e infecções; ultrassonografia obstétrica evidenciou ascite moderada, circunferência abdominal >p95, hepatomegalia e hidrocele. Ao nascimento, idade gestacional 3 8 2 /7 semanas, peso=3630g, comprimento=49 cm, Apgar 8/9. Apresentava abdome globoso, fígado a 4 cm do rebordo costal direito e hidrocele volumosa. Realizada paracentese com saída de 310 ml de líquido esverdeado (meconial. No 5o dia de vida, durante laparotomia, observou-se aderência de alças intestinais, perfuração de íleo terminal a 8 cm da vávula íleo-cecal, sendo realizada ileostomia. O anátomo-patológico de apêndice cecal evidenciou processo inflamatório crônico, neovascularização e fibrose. Paciente recebeu nutrição parenteral por 14 dias; houve progressão da dieta do 6o ao 36o dia de vida, recebendo alta em aleitamento materno e boa recuperação clínica. CONCLUSÃO: A ascite meconial por perfuração intestinal deve ser considerada no diagnóstico diferencial de ascite fetal. O diagnóstico ecográfico pré-natal é fundamental para o prognóstico pós-natal.

  18. Detector location selection based on VIP analysis in near-infrared detection of dural hematoma

    Directory of Open Access Journals (Sweden)

    Qiuming Sun

    2018-03-01

    Full Text Available Detection of dural hematoma based on multi-channel near-infrared differential absorbance has the advantages of rapid and non-invasive detection. The location and number of detectors around the light source are critical for reducing the pathological characteristics of the prediction model on dural hematoma degree. Therefore, rational selection of detector numbers and their distances from the light source is very important. In this paper, a detector position screening method based on Variable Importance in the Projection (VIP analysis is proposed. A preliminary modeling based on Partial Least Squares method (PLS for the prediction of dural position μa was established using light absorbance information from 30 detectors located 2.0–5.0 cm from the light source with a 0.1 cm interval. The mean relative error (MRE of the dural position μa prediction model was 4.08%. After VIP analysis, the number of detectors was reduced from 30 to 4 and the MRE of the dural position μa prediction was reduced from 4.08% to 2.06% after the reduction in detector numbers. The prediction model after VIP detector screening still showed good prediction of the epidural position μa. This study provided a new approach and important reference on the selection of detector location in near-infrared dural hematoma detection. Keywords: Detector location screening, Epidural hematoma detection, Variable importance in the projection

  19. Meningeal norepinephrine produces headache behaviors in rats via actions both on dural afferents and fibroblasts.

    Science.gov (United States)

    Wei, Xiaomei; Yan, Jin; Tillu, Dipti; Asiedu, Marina; Weinstein, Nicole; Melemedjian, Ohannes; Price, Theodore; Dussor, Gregory

    2015-10-01

    Stress is commonly reported to contribute to migraine although mechanisms by which this may occur are not fully known. The purpose of these studies was to examine whether norepinephrine (NE), the primary sympathetic efferent transmitter, acts on processes in the meninges that may contribute to the pain of migraine. NE was applied to rat dura using a behavioral model of headache. Primary cultures of rat trigeminal ganglia retrogradely labeled from the dura mater and of rat dural fibroblasts were prepared. Patch-clamp electrophysiology, Western blot, and ELISA were performed to examine the effects of NE. Conditioned media from NE-treated fibroblast cultures was applied to the dura using the behavioral headache model. Dural injection both of NE and media from NE-stimulated fibroblasts caused cutaneous facial and hindpaw allodynia in awake rats. NE application to cultured dural afferents increased action potential firing in response to current injections. Application of NE to dural fibroblasts increased phosphorylation of ERK and caused the release of interleukin-6 (IL-6). These data demonstrate that NE can contribute to pro-nociceptive signaling from the meninges via actions on dural afferents and dural fibroblasts. Together, these actions of NE may contribute to the headache phase of migraine. © International Headache Society 2015.

  20. Avaliação da memória sob anestesia venosa total

    Directory of Open Access Journals (Sweden)

    Gulistan Aktas

    2013-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Neste estudo, objetivamos avaliar a memória implícita e explícita em pacientes submetidos à cirurgia abdominal sob anestesia venosa total (AVT com propofol e remifentanil, na qual o nível de anestesia foi controlado pelo monitoramento do índice bispectral (BIS. MÉTODO: Anestesia venosa total foi administrada a 60 pacientes adultos para obter níveis de BIS de 40-60. Os pacientes foram randomicamente divididos em três grupos, de acordo com as gravações que ouviram. Os pacientes do grupo categoria (CT ouviram uma fita gravada contendo cinco nomes de animais. Os pacientes do grupo recordar palavras (RP ouviram uma fita gravada contendo cinco palavras de frequência média na língua turca, depois de adaptadas. Os pacientes do grupo controle (GC ouviram os sons do mar até o fim da cirurgia. Duas horas após a cirurgia, os testes foram administrados a cada paciente na sala de recuperação para avaliar a memória. RESULTADOS: Houve uma diferença entre os escores dos grupos CT e GC no Miniexame do Estado Mental (MMSE; todos os escores foram > 20. Os resultados dos testes de categoria e recordar palavras, aplicados para avaliar a memória implícita, não foram estatisticamente diferentes entre os grupos. Não houve evidência de memória implícita em nenhum dos pacientes. Um paciente lembrou-se de ouvir "o som de água" como uma prova de memória explícita. Onze pacientes declararam não ter sonhado. CONCLUSÕES: Apesar de não termos encontrado nenhuma evidência de memória implícita sob anestesia adequada com AVT, um paciente apresentou memória explícita. Embora a profundidade adequada da anestesia fornecida pelo monitoramento do BIS corrobore nossos resultados para a memória implícita, ela não explica os resultados para a memória explícita.

  1. ANSIEDAD, DEPRESIÓN Y RASGOS DE PERSONALIDAD EN PACIENTES CON INSUFICIENCIA VENOSA CRÓNICA PERIFÉRICA

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    L A Carmona-López

    2016-07-01

    Full Text Available Introducción: La Insuficiencia Venosa Crónica Periférica (IVCP es un cambio clínico que se produce como resultado de la dilatación patológica de las venas en los miembros inferiores, de la incompetencia de sus válvulas y de la hipertensión venosa resultante. Pudiera cursar dentro de la categoría de trastornos sistémicos que producen depresión y ansiedad, las cuales a su vez son alteraciones psiquiátricas relacionadas con toda la esfera cardiovascular. Objetivo: Determinar la frecuencia de ansiedad, depresión y su relación con los rasgos de personalidad, en pacientes con Insuficiencia Venosa Crónica Periférica. Metodología: Se realizó un trabajo de tipo descriptivo, de corte transversal. Se utilizó la escala de Hamilton para ansiedad y depresión; la personalidad fue evaluada con el cuestionario Factorial de Personalidad 16 FP de Catell además de otras variables sociodemográficas. Resultados: Se evaluaron 30 pacientes; 93% (N=28 de sexo femenino, 7% (N=2 de sexo masculino diagnosticados. Con edades entre 25 y 74 años; encontrándose 36,7% (N=11 ansiedad severa, seguida de ansiedad menor en 33,3% (N=10. 50% de los pacientes no presentó depresión, y 50% se distribuyó de forma homogénea en leve, moderada y severa. Predominando personalidad que se le dificulta manejar las frustraciones, suelen ser nerviosos o ansiosos ante ciertas circunstancias, suspicaces, inteligentes y leales a nivel grupal. El rasgo de personalidad que predominó en el grupo de estudio es el de tipo ansioso. Conclusión: Los pacientes con insuficiencia venosa crónica periférica tienen inclinación a la ansiedad con dificultades para manejar la frustración. Palabras claves: Insuficiencia venosa, Ansiedad, Depresión, Personalidad

  2. Hipertensão venosa episcleral idiopática unilateral em mulher jovem

    Directory of Open Access Journals (Sweden)

    Marcelo Mendes Lavezzo

    2013-02-01

    Full Text Available O objetivo é relatar o caso de uma paciente de 33 anos, que veio ao Pronto Socorro de Oftalmologia apresentando queixa de redução da acuidade visual à esquerda, de caráter insidioso e progressivo, há dois anos. Ao exame oftalmológico, apresentava ingurgitamento dos vasos da conjuntiva bulbar, pressão intraocular muito elevada e nervo óptico com escavação total à esquerda. Foi submetida à campimetria computadorizada 24:2 WW e SITA-SWAP do olho direito, ambas com resultados dentro da normalidade. As tomografias de crânio e órbitas, bem como ultrassonografia com doppler do globo ocular, artérias oftálmicas e veias supraorbitárias não apresentavam anormalidades. Diante disso, aventou-se a hipótese diagnóstica de hipertensão venosa episcleral idiopática, um diagnóstico de exclusão, visto que patologias intracranianas e intraorbitárias haviam sido excluídas. Paciente foi tratada clinicamente com colírios hipotensores, com redução importante da pressão intraocular à esquerda, porém não o suficiente, evoluindo para trabeculectomia.

  3. Controversias sobre la enfermedad tromboembólica venosa no provocada en ancianos

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    Mónica Ríos-Prego

    2016-12-01

    Full Text Available La forma no provocada de enfermedad tromboembólica venosa (ETV representa aproximadamente la mitad de los casos de esta patología en ancianos. Como lo demuestran de forma reiterada diferentes trabajos epidemiológicos, es en mayores de 80 años donde la incidencia de la ETV es mayor. Ante la falta de estudios sobre ETV no provocada en ancianos, las recomendaciones sobre tratamiento de esta patología se extrapolan a partir de pacientes más jóvenes. Lo mismo sucede con las reglas de predicción de sangrado y recurrencias. Se dispone en la actualidad de nuevos fármacos anticoagulantes con igual efectividad y mayor seguridad que el tratamiento convencional; aunque la experiencia en ancianos es escasa. Esperamos que los estudios que se publicarán en el futuro (TEVIS, ExACT, ETV-GA nos ayuden a resolver dudas que aún tenemos en este campo.

  4. Diphyllobothrium latum: relato de caso no Brasil

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    Emmel Vanessa Erichsen

    2006-01-01

    Full Text Available Difilobotriose é causada em humanos pela infecção com vermes adultos do gênero Diphyllobothrium adquiridos pelo consumo de peixe cru ou mal cozido. Diphyllobothrium latum foi confirmado pelo exame dos proglotes grávidos e típicos ovos operculados nas fezes. O paciente havia comido crustáceos e peixes. É o relato do primeiro brasileiro infectado.

  5. Reversibility of cognitive disorder after treatment of dural arteriovenous fistulae

    International Nuclear Information System (INIS)

    Kai, Yutaka; Ito, Koichi; Kinjo, Tatsuya; Hokama, Youhei; Nagamine, Hideki; Kushi, Sukemitsu; Kinjo, Shigemasa; Tsuchida, Yukihiro; Sugimoto, Kouichi; Yoshii, Yoshihiko; Morioka, Motohiro; Yano, Shigetoshi; Ohmori, Yuki; Kawano, Takayuki; Nakamura, Hideo; Makino, Keishi; Kuratsu, Jun-ichi; Hamada, Jun-ichiro

    2009-01-01

    Dural arteriovenous fistulae (DAVF) occasionally lead to cognitive disorders whose reversibility after DAVF treatment remains unclear. We studied changes on pre- and post-treatment magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) scans in ten patients with cognitive disorder due to DAVF. We studied the symptoms, pre- and post-treatment MRI scans, SPECT findings, and mini-mental state examination (MMSE) and treatment results in ten patients with cognitive disorder due to DAVF. They were divided into two groups; the post-treatment MMSE score exceeded 25 points in group 1 (n = 6) and was lower than 24 points in group 2 (n = 4). In the six group 1 patients, pretreatment diffusion-weighted images (DWI) showed hyperintense areas, and SPECT scans demonstrated the preservation of vasoreactivity after acetazolamide challenge. In the four group 2 patients, pretreatment SPECT demonstrated hypoperfusion areas that coincided with the hyperintense areas seen on DWI; there were areas with marked disturbance in vasoreactivity. The post-treatment MMSE score in groups 1 and 2 improved by 13.7 ± 2.4 and 3.8 ± 1.0 points, respectively; the difference was significant at p < 0.01. In patients with cognitive disorder due to DAVF, the preservation of vasoreactivity on SPECT after acetazolamide challenge indicates that their cognitive disorder may be reversible by DAVF treatment. (orig.)

  6. Screen for intracranial dural arteriovenous fistulae with carotid duplex sonography.

    Science.gov (United States)

    Tsai, L-K; Yeh, S-J; Chen, Y-C; Liu, H-M; Jeng, J-S

    2009-11-01

    Early diagnosis and management of intracranial dural arteriovenous fistulae (DAVF) may prevent the occurrence of stroke. This study aimed to identify the best carotid duplex sonography (CDS) parameters for screening DAVF. 63 DAVF patients and 170 non-DAVF patients received both CDS and conventional angiography. The use of seven CDS haemodynamic parameter sets related to the resistance index (RI) of the external carotid artery (ECA) for the diagnosis of DAVF was validated and the applicability of the best CDS parameter set in 20 400 patients was tested. The CDS parameter set (ECA RI (cut-off point = 0.7) and internal carotid artery (ICA) to ECA RI ratio (cut-off point = 0.9)) had the highest specificity (99%) for diagnosis of DAVF with moderate sensitivity (51%). Location of the DAVF was a significant determinant of sensitivity of detection, which was 70% for non-cavernous DAVF and 0% for cavernous sinus DAVF (pdetected abnormality in 92 of 20 400 patients. These abnormalities included DAVF (n = 25), carotid stenosis (n = 32), vertebral artery stenosis (n = 7), intracranial arterial stenosis (n = 6), head and neck tumour (n = 3) and unknown aetiology (n = 19). Combined CDS parameters of ECA RI and ICA to ECA RI ratio can be used as a screening tool for the diagnosis of DAVF.

  7. Surgical management of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb.

    Science.gov (United States)

    Tirakotai, W; Benes, L; Kappus, C; Sure, U; Farhoud, A; Bien, S; Bertalanffy, H

    2007-01-01

    Dural arteriovenous fistulas located in the vicinity of the jugular foramen are complex vascular malformations and belong to the most challenging skull base lesions to treat. The authors comprehensively analyze multiple features in a series of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb. Four patients who underwent surgery via the transcondylar approach to treat dural arteriovenous fistulas around the jugular foramen were retrospectively reviewed. Previously, endovascular treatment was attempted in all patients. The success of the surgical treatment was examined with postoperative angiography. Complete obliteration of the dural arteriovenous fistulas (DAVFs) was achieved in three patients, and significant flow reduction in one individual. All patients had a good postoperative outcome, and only one experienced mild hypoglossal nerve palsy. Despite extensive bone drilling, an occipitocervical fusion was necessary in only one patient with bilateral lesions. The use of an individually tailored transcondylar approach to treat dural arteriovenous fistulas at the region of the jugular foramen is most effective. This approach allows for complete obliteration of the connecting arterial feeders, and removal of bony structures containing pathological vessels.

  8. Bacterial Cellulose Membranes Used as Artificial Substitutes for Dural Defection in Rabbits

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    Chen Xu

    2014-06-01

    Full Text Available To improve the efficacy and safety of dural repair in neurosurgical procedures, a new dural material derived from bacterial cellulose (BC was evaluated in a rabbit model with dural defects. We prepared artificial dura mater using bacterial cellulose which was incubated and fermented from Acetobacter xylinum. The dural defects of the rabbit model were repaired with BC membranes. All surgeries were performed under sodium pentobarbital anesthesia, and all efforts were made to minimize suffering. All animals were humanely euthanized by intravenous injection of phenobarbitone, at each time point, after the operation. Then, the histocompatibility and inflammatory effects of BC were examined by histological examination, real-time fluorescent quantitative polymerase chain reaction (PCR and Western Blot. BC membranes evenly covered the surface of brain without adhesion. There were seldom inflammatory cells surrounding the membrane during the early postoperative period. The expression of inflammatory cytokines IL-1β, IL-6 and TNF-α as well as iNOS and COX-2 were lower in the BC group compared to the control group at 7, 14 and 21 days after implantation. BC can repair dural defects in rabbit and has a decreased inflammatory response compared to traditional materials. However, the long-term effects need to be validated in larger animals.

  9. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

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    Pritam Yadav

    2018-01-01

    Full Text Available >Background: Dural puncture epidural (DPE is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique.Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural. In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2% with 20 mcg of Fentanyl (2 mcg/ml in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS, sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome.Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05.Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

  10. Trombosis venosa profunda masiva de miembro superior secundaria a fractura de tercio medio de clavícula. Caso clínico

    OpenAIRE

    Úbeda-Pérez de Heredia, Í.; Sobrá-Hidalgo, G.Á.

    2016-01-01

    Resumen Objetivo: La trombosis venosa profunda del miembro superior es una entidad rara que se asocia con el uso de catéteres, estados de hipercoagulabilidad, anticonceptivos orales, neoplasias, síndrome de costilla cervical o de los escalenos, fracturas de clavícula y trombosis inducida por el esfuerzo. Método: Varón de 53 años que desarrolló una trombosis venosa de las venas axilar, cefálica y basílica tres días después de sufrir una fractura de tercio medio de clavícula que se inmovilizó...

  11. Trombosis venosa profunda masiva de miembro superior secundaria a fractura de tercio medio de clavícula. Caso clínico

    OpenAIRE

    Í. Úbeda-Pérez de Heredia; G.Á. Sobrá-Hidalgo

    2016-01-01

    Objetivo: La trombosis venosa profunda del miembro superior es una entidad rara que se asocia con el uso de catéteres, estados de hipercoagulabilidad, anticonceptivos orales, neoplasias, síndrome de costilla cervical o de los escalenos, fracturas de clavícula y trombosis inducida por el esfuerzo. Método: Varón de 53 años que desarrolló una trombosis venosa de las venas axilar, cefálica y basílica tres días después de sufrir una fractura de tercio medio de clavícula que se inmovilizó inicia...

  12. ACTOS DE HABLA EN RELATOS DE TRADICION ORAL*: Notas sobre un relato oral cusqueño

    OpenAIRE

    Espino Relucé, Gonzalo

    2014-01-01

    En este artículo se explora el comportamiento de los hablantes dela construcción de relatos orales a partir del texto Saqsaywaman, recogido por el autor en Cusco. Se propone una categoría operativa sobrelos actos del habla haciéndose lo propio con relatos orales. Se transcribe Saqsaywaman y se analiza el texto.

  13. Experimental inflammation following dural application of complete Freund's adjuvant or inflammatory soup does not alter brain and trigeminal microvascular passage

    DEFF Research Database (Denmark)

    Lundblad, Cornelia; Haanes, Kristian A; Grände, Gustaf

    2015-01-01

    , following dural application of complete Freund's adjuvant (CFA) or inflammatory soup (IS) on brain and trigeminal microvascular passage. METHODS: In order to address this issue, we induced local inflammation in male Sprague-Dawley-rats dura mater by the addition of CFA or IS directly on the dural surface...

  14. Spontaneous acute subdural hematoma: A rare presentation of a dural intracranial fistula.

    Science.gov (United States)

    de Aguiar, Guilherme Brasileiro; Veiga, José Carlos Esteves; Silva, João Miguel de Almeida; Conti, Mario Luiz Marques

    2016-03-01

    Dural arteriovenous fistulas are acquired lesions between the meningeal arteries and their associated draining veins. They may have highly variable clinical presentations and evolution, from severe neurological deficit to no or trivial symptoms. Intracranial hemorrhage occurs in less than 24% of all dural fistulas, and the bleeding is usually subarachnoid, more infrequently intracerebral, and rarely in the subdural space. Here, we present a rare case of a patient who presented with a subdural spontaneous hemorrhage. After investigation by cerebral angiography, the diagnosis of a dural arteriovenous fistula was made. The patient underwent uneventful endovascular treatment. As there are with only a few reports in the literature of such a presentation, we present this patient and perform a brief review of the literature. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Preclinical characterization and safety of a novel hydrogel for augmenting dural repair

    International Nuclear Information System (INIS)

    Strong, Michael J; Carnahan, Michael A; D’Alessio, Keith; Butlin, Jared D G; Butt, Mark T; Asher, Anthony L

    2015-01-01

    Cerebrospinal fluid (CSF) leakage is a potentially serious complication in surgical procedures involving opening of the dura mater. Although several materials have been developed to help achieve watertight dural closures, CSF leakages persist. The goal of this study was to evaluate the performance of a novel hydrogel designed to provide augmentation to standard methods of dural repair. Performance measures such as polymerization time, dimensional swelling, burst strength, and elasticity were examined in laboratory situations. Additionally, biocompatibility in an in vivo rat model was examined. The results demonstrate that this novel hydrogel has superior mechanical strength and tissue adherence with enhanced flexibility, reduced swelling, and quicker set time compared with existing hydrogel dural sealants approved for intra-cranial use. Furthermore, biocompatibility studies demonstrate that this compound is both non-toxic and non-immunogenic. (paper)

  16. A case report of spinal dural arteriovenous fistula: origins, determinants, and consequences of abnormal vascular malformations

    Directory of Open Access Journals (Sweden)

    Sherry M. Zakhary, DO

    2017-06-01

    Full Text Available A spinal dural arteriovenous fistula is an abnormally layered connection between radicular arteries and venous plexus of the spinal cord. This vascular condition is relatively rare with an incidence of 5–10 cases per million in the general population. Diagnosis of spinal dural arteriovenous fistula is differentiated by contrast-enhanced magnetic resonance angiography or structural magnetic resonance imaging, but a definitive diagnosis requires spinal angiography methods. Here, we report a case of a 67-year-old female with a spinal dural arteriovenous fistula, provide a pertinent clinical history to the case nosology, and discuss the biology of adhesive proteins, chemotactic molecules, and transcription factors that modify the behavior of the vasculature to possibly cause sensorimotor deficits.

  17. A case report of spinal dural arteriovenous fistula: origins, determinants, and consequences of abnormal vascular malformations.

    Science.gov (United States)

    Zakhary, Sherry M; Hoehmann, Christopher L; Cuoco, Joshua A; Hitscherich, Kyle; Alam, Hamid; Torres, German

    2017-06-01

    A spinal dural arteriovenous fistula is an abnormally layered connection between radicular arteries and venous plexus of the spinal cord. This vascular condition is relatively rare with an incidence of 5-10 cases per million in the general population. Diagnosis of spinal dural arteriovenous fistula is differentiated by contrast-enhanced magnetic resonance angiography or structural magnetic resonance imaging, but a definitive diagnosis requires spinal angiography methods. Here, we report a case of a 67-year-old female with a spinal dural arteriovenous fistula, provide a pertinent clinical history to the case nosology, and discuss the biology of adhesive proteins, chemotactic molecules, and transcription factors that modify the behavior of the vasculature to possibly cause sensorimotor deficits.

  18. Endovascular and surgical treatment of spinal dural arteriovenous fistulas

    International Nuclear Information System (INIS)

    Andres, Robert H.; University of Berne; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA; University of Berne; Barth, Alain; Medical University of Graz, Department of Neurosurgery, Graz; University of Berne; Guzman, Raphael; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA; University of Berne; Remonda, Luca; El-Koussy, Marwan; Schroth, Gerhard; University of Berne; Seiler, Rolf W.; Widmer, Hans R.; University of Berne

    2008-01-01

    The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization. The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff-Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years). Surgical as well as endovascular treatment resulted in a significant improvement in ALS (-62.5% and -31.4%, respectively, p<0.05) and a tendency toward improved MRS (-50% and -32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (-16.7%), whereas the MRS score was not affected. We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team. (orig.)

  19. A Rare Case of Composite Dural Extranodal Marginal Zone Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

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    Mark Bustoros

    2018-04-01

    Full Text Available BackgroundPrimary extranodal marginal zone lymphoma (MZL of the dura is a rare neoplastic entity in the central nervous system (CNS.MethodsWe used literature searches to identify previously reported cases of primary dural MZL. We also reviewed clinical, pathologic, and radiographic data of an adult patient with concurrent dural MZL and chronic lymphocytic leukemia (CLL/small lymphocytic lymphoma (SLL.ResultsWe identified 104 cases of dural MZL in the literature. None of them presented concurrently with another type of non-Hodgkin lymphoma. This is the first report of composite lymphoma consisting of dural MZL and CLL/SLL in the bone marrow and lymph nodes.ConclusionPrimary dural MZL is a rare, indolent low-grade CNS lymphoma, with a relatively good prognosis. Its treatment is multidisciplinary and often requires surgical intervention due to brain compression, along with low to moderate doses of radiotherapy and/or systemic chemotherapy.

  20. Evaluation of venous congestion in dural arteriovenous fistulae using the acetazolamide test

    International Nuclear Information System (INIS)

    Deguchi, Jun; Yamada, Makoto; Kobata, Hitoshi; Kuroiwa, Toshihiko

    2002-01-01

    The pattern of venous drainage determines the clinical presentation of dural arteriovenous fistulas (AVFs). We assessed the degree of venous congestion in dural AVFs using acetazolamide test and stable Xenon-CT. In 11 patients (8 sigmoid-transverse dural AVFs, 3 cavernous dural AVFs) before treatment and in 8 patients 6 months after treatment, cerebral hemodynamics were studied by stable Xenon-CT. Regions of interest (ROI) were placed in the temporo-occipital region in cases of sigmoid-transverse AVFs, and in the frontal operculum in cases of cavernous AVFs. Patients were classified into 5 groups according to Cognard's classification. In the groups without venous reflux (Cognard type I) and reflux only to the venous sinus (type IIa), regional cerebral blood flow (rCBF) at rest and after acetazolamide challenge were normal. In the group showing reflux to the cortical vein (type IIb), the increase in rCBF after acetazolamide challenge on the lesion side was less than that on the opposite side. In the group showing reflux to both cortical vein and sinus (type IIa+b), rCBF did not increase after acetazolamide challenge. The CBF and increase in rCBF after acetazolamide in the symptomatic group were significantly lower than those in the asymptomatic group. After embolization, the increase in rCBF by acetazolamide improved in all except for type III cases. Cerebral venous hypertension in dural AVFs causes weak response to acetazolamide challenge. The degree of venous hypertension can be evaluated quantitatively by acetazolamide challenge and stable Xenon-CT. Therefore acetazolamide challenge is useful for determination of the embolization of dural AVFs. (author)

  1. Anestesia em paciente portador de distrofia muscular de Duchenne: relato de casos Anestesia en un paciente portador de distrofia muscular de Duchenne: relato de casos Anesthesia for Duchenne muscular dystrophy patients: case reports

    Directory of Open Access Journals (Sweden)

    Rodrigo Machado Saldanha

    2005-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Este estudo objetiva relatar dois casos de anestesia em pacientes portadores de Distrofia Muscular de Duchenne (DMD, uma doença rara, progressiva e incapacitante, e discutir sobre a conduta anestésica. O comprometimento das funções pulmonar e cardíaca, a possibilidade de ocorrência de hipertermia maligna, a maior sensibilidade aos bloqueadores neuromusculares e o aumento da morbidade pós-operatória são alguns dos desafios enfrentados pelo anestesiologista. RELATO DOS CASOS: O primeiro caso foi o de um paciente pediátrico com diagnóstico de DMD e rabdomiossarcoma, agendado para exérese da lesão e esvaziamento cervical ampliado. Na avaliação pré-anestésica (anamnese, exame clínico e exames complementares não foram detectadas alterações, exceto pela tumoração cervical. Optou-se pela técnica venosa total, com remifentanil em infusão contínua e propofol em infusão alvo-controlada, sem a utilização de bloqueadores neuromusculares. O procedimento cirúrgico teve duração de 180 minutos, sem intercorrências. O segundo caso foi de um paciente do sexo masculino, 24 anos, com diagnóstico de DMD e colelitíase com indicação cirúrgica, cuja avaliação pré-operatória revelou pneumopatia restritiva grave, com diminuições da capacidade e da reserva respiratórias, sendo necessário o uso de BIPAP nasal noturno. Neste paciente, optou-se pela intubação traqueal com sedação mínima e anestesia tópica, seguida pela técnica venosa total com remifentanil em infusão contínua e propofol em infusão alvo-controlada, sem a utilização de bloqueadores neuromusculares. Ao término, o paciente foi extubado ainda na sala de operações e imediatamente colocado no BIPAP nasal. Encaminhado à UTI, com alta no 2º PO e alta hospitalar no 3º PO. CONCLUSÕES: A anestesia venosa total com infusão contínua de propofol e remifentanil sem bloqueadores neuromusculares constitui-se em opção segura e

  2. Hemangioma de úvula: relato de um caso

    Directory of Open Access Journals (Sweden)

    G. Sobrinho Fernando P.

    2003-01-01

    Full Text Available O hemangioma é o mais comum tumor de origem vascular, benigno, freqüentemente diagnosticado em crianças, e com predileção pela cabeça e pescoço, mas que raramente tem origem na úvula. Neste órgão, apresenta risco de traumatismo local e sangramento. Este artigo relato um caso de hemangioma de úvula num adulto jovem com disfagia orofaríngea progressiva e sensação de corpo estranho na garganta, tratado com sucesso por ressecção cirúrgica do tumor com bisturi de radiofreqüência.

  3. Relatos de vivências educacionais

    Directory of Open Access Journals (Sweden)

    Congresso Internacional de Dislexia

    2011-05-01

    Full Text Available Relatos de experiências em educação, abrangendo a descrição de projeto ou vivência específica em sala de aula ou outro ambiente educacional, que envolva o trabalho com escolares com dislexia e outros transtornos da aprendizagem da leitura e escrita.Os trabalhos foram apresentados na terceira edição do Congresso Internacional de Dislexia (CID, realizado nas dependências do Centro Universitário Metodista Izabela Hendrix, em maio de 2011. 

  4. Formações venosas superficiais da fossa cubital: aspectos de interesse para a prática da Enfermagem

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    Nilton Alves

    Full Text Available O objetivo deste estudo é contribuir para o conhecimento que auxilie o profissional de enfermagem na identificação dos tipos mais comuns de formações venosas da região da fossa cubital e, ainda, enfocar a importância de estar sempre atento aos casos pouco comuns como o aqui relatado. Através de uma revisão bibliográfica, constatamos que as formações venosas dessa região podem ser classificadas em 5 tipos mais comuns, sendo o tipo II o mais frequente. Constatamos ainda, que a VICo é o local de punção mais indicado, seguido pela VIB. Descrevemos também uma variação anatômica, onde observamos ausência de comunicação entre VC e VB no nível da fossa cubital e VIA drenando na VB, estando presente a VCA.

  5. PROTOCOLO DE ASSISTÊNCIA A PESSOAS COM ÚLCERAS VENOSAS: VALIDAÇÃO DE CONTEÚDO

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    Daniele Vieira Dantas

    2013-01-01

    Full Text Available Las úlceras venosas requieren tratamiento complejo y son responsables por morbilidad y mortalidad significativas. El objetivo fue identificar aspectos validados por jueces para preparación de protocolo para personas con úlceras venosas. Investigación descriptiva y cuantitativ a, con 39 profesionales (30 enfermeros, 7 médicos y 2 fisioterapeutas, en el Hospital Universitario Onofre Lopes, entre abril y julio/2010. La recolección de datos a través de lista de verificación cuestionario. Análisis se realizó en Statistical Package for Social Science 15.0 evaluando directrices de cumplimiento. Los resultados fueron aspectos compositivos del protocolo: evaluación del paciente y lesión de registro/documentación, cuidado de herida/piel perilesional, cobertura de sentencias, uso de antibióticos y tratamiento del dolor, tratamiento quirúrgico/medicación, mejorando retorno venoso y prevención repetición, derivación de pacientes, formación, referencia/contra-referencia. Para componer el protocolo, son aspectos necesarios diagnóstico, tratamiento y prevención de lesiones.

  6. Plexopatia lombar após histerectomia abdominal: relato de caso Plexopatía lumbar después de la histerectomía abdominal: relato de caso Lumbar plexopathy after abdominal hysterectomy: case report

    Directory of Open Access Journals (Sweden)

    Elizabeth Vaz da Silva

    2006-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As lesões neurológicas diagnosticadas no período pós-operatório muitas vezes são atribuídas ao ato anestésico, embora possam também decorrer do ato cirúrgico. O objetivo deste relato foi apresentar o caso de uma paciente submetida à intervenção cirúrgica pélvica que evoluiu com quadro de plexopatia lombar e discutir as possíveis causas. RELATO DO CASO: Paciente do sexo feminino, 38 anos, 58 kg, 1,63 m de altura, estado físico ASA I, internada para tratamento de leiomiomatose uterina, com indicação de histerectomia total abdominal. A monitorização inicial incluiu oxímetro de pulso, pressão arterial não-invasiva, eletrocardioscópio e diurese. Após punção venosa no membro superior esquerdo com cateter 18G, foram administrados, por via venosa, cefazolina (2 g, dipirona (2 g, dexametasona (10 mg e metoclopramida (10 mg. A anestesia peridural foi realizada com agulha Tuohy 16G, no espaço L3-L4, na linha mediana com a paciente em decúbito lateral esquerdo. Foram administrados 15 mL de ropivacaína a 0,75% e 2 mg de morfina, a seguir posicionado cateter para analgesia pós-operatória. A intervenção cirúrgica não teve intercorrência, mantendo-se a paciente estável sob o ponto de vista cardiovascular. Na visita pós-anestésica, oito horas após o procedimento, a paciente não deambulava e apresentava monoparesia no membro inferior esquerdo. Após investigações clínicas e radiológicas foi descartada a hipótese diagnóstica de síndrome radicular. Como não houve regressão do quadro, 30 dias após foi realizada eletroneuromiografia que foi compatível com plexopatia lombar de possível origem traumática. CONCLUSÕES: O anestesiologista deve estar atento às complicações neurológicas que podem surgir no pós-operatório, participando da elucidação das causas, do tratamento e da sua evolução.JUSTIFICATIVA Y OBJETIVOS: Las lesiones neurológicas diagnosticadas en el per

  7. Influência da anestesia venosa total, entropia e laparoscopia sobre o estresse oxidativo

    Directory of Open Access Journals (Sweden)

    Rogean Rodrigues Nunes

    2012-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Estudos recentes correlacionam mortalidade pós-operatória e anestésica, especialmente a profundidade anestésica e pressão arterial sistólica (PAS. O objetivo deste estudo foi avaliar os efeitos da profundidade da anestesia venosa total (AVT realizada com remifentanil e propofol com monitoração da entropia de resposta (RE sobre as concentrações sanguíneas dos marcadores do estresse oxidativo: TBARS e glutationa, durante operações pelo acesso vídeolaparoscópico. MÉTODO: Vinte pacientes adultas, ASA I, IMC 20-26 kg.m-2, idades entre 20 e 40 anos, foram aleatoriamente distribuidas em dois grupos iguais: Grupo I - submetidas a procedimento anestésico-cirúrgico com RE mantida entre 45 e 59 e Grupo II - submetidas a procedimento anestésico-cirúrgico com RE entre 30 e 44. Em ambos os grupos, a infusão de remifentanil e propofol foi controlada pelo sitio efetor (Se, ajustados para manter RE nos valores desejados (Grupos I e II e avaliando-se sempre a taxa de supressão (TS. As pacientes foram avaliadas em seis momentos: M1(imediatamente antes da indução anestésica, M2 (antes da intubação traqueal [IT], M3 (5 minutos após IT, M4 (imediatamente antes do pneumoperitônio-PPT, M5 (1 minuto após o PPT e M6 (uma hora após a operação. Em todos os momentos foram avaliados os seguintes parâmetros: PAS, PAD, FC, RE, TS, TBARS e glutationa. RESULTADOS: Observaram-se aumentos no TBARS e glutationa em M5, tanto no Grupo I como no Grupo II (p GI em M5 - p < 0,05% sugerem interferência de mais um fator (anestesia profunda, como responsável pelo aumento no MA, provavelmente como resultados de maior depressão do sistema nervoso autônomo e menor autorregulação esplâncnica.

  8. Oligomeric stability of Rapana venosa hemocyanin (RvH) and its structural subunits.

    Science.gov (United States)

    Dolashka-Angelova, Pavlina; Schwarz, Heinz; Dolashki, Aleksandar; Stevanovic, Stefan; Fecker, Miriam; Saeed, Muhammad; Voelter, Wolfgang

    2003-03-21

    The two structural subunits RvH1 and RvH2 were separated after overnight dialysis of Rapana venosa Hc against 130 mM Gly/NaOH buffer, pH 9.6, on an ion exchange column Hiload 26/10 Sepharose Q using a fast performance liquid chromatography (FPLC) system. The reassociation characteristics of these two RvH isoforms and the native molecule were studied in buffers with different pH values and concentrations of Ca(2+) and Mg(2+). Reassociation of mixed RvH subunits was performed over a period of several days using a stabilizing buffer (SB) of pH 7.0 containing different concentrations of Ca(2+) and Mg(2+) ions. After 2 days of dialysis, an RvH subunit mixture of didecamers and multidecamers was observed in the presence of 100 mM CaCl(2) and MgCl(2), though RvH1 and RvH2 are biochemically and immunologically different and have also different dissociation properties. The reassociation, performed at pH 9.6 with 2 mM CaCl(2) and MgCl(2) at 4 degrees C over a period of one to several weeks, led to the formation of decameric oligomers, while didecamers formed predominantly in the SB at pH 7.0. Higher concentrations of calcium and magnesium ions led to a more rapid reassociation of RvH1 resulting in long stable multidecamers and helical tubules, which were stable and slowly dissociated into shorter multidecamers and decamers at higher pH values. The reassociation of the RvH2 structural subunit in the same buffers processed slowly and yielded didecamers, shorter tubule polymers and long multidecamers which are less stable at higher pH values. The stability of RvH isoforms under varying ionic conditions is compared with the stability of keyhole limpet (KLH, Megathura crenulata) hemocyanin (KLH) and Haliotis tuberculata hemocyanin (HtH) isoforms. The process of dissociation and reassociation is connected with changes of the fluorescence intensity at 600 nm, which can be explained by differences in opalescence of the solutions of these two isoforms. The solutions of longer tubule

  9. Fisioterapia vascular no tratamento da doença venosa crônica

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    Flávia de Jesus Leal

    2015-09-01

    Full Text Available ResumoContextoA aplicação da fisioterapia vascular através dos exercícios terapêuticos e da drenagem linfática manual (DLM na Doença Venosa Crônica (DVC contribui para a minimização das alterações vasculares, com melhora do retorno venoso, diminuindo a estase sanguínea e contribuindo para a melhora do quadro clínico.ObjetivoVerificar a eficácia da fisioterapia vascular no tratamento da DVC.MétodosEstudo-piloto prospectivo longitudinal, que avaliou dez pacientes com DVC, com classificação CEAP (1-5, que responderam aos questionários de qualidade de vida (QV SF-36 e AVVQ, sendo submetidos a pletismografia a água e goniometria dos membros inferiores. Finalizada a avaliação inicial, receberam tratamento fisioterapêutico vascular, com exercícios terapêuticos e DLM, em dez sessões de 60 minutos. Após tratamento, foram novamente avaliadas pela aplicação dos questionários iniciais e realização dos métodos de mensuração volumétrica e de amplitude de movimento articular (ADM.ResultadosPacientes do gênero feminino, com idade média de 43,1 anos. Nas atividades de vida prática (AVPs, a posição predominante foi ortostatismo prolongado. Na classificação CEAP, a maioria das pacientes apresentou C3 e apenas 10% delas eram C2. Nos questionamentos sobre suas principais queixas, relataram sensação de peso e cansaço nos membros, dor nas pernas, prurido e edema. Após as sessões de fisioterapia vascular, todas as pacientes encontravam-se sem queixas. A ADM e a QV apresentaram melhora significativa após intervenção da fisioterapia vascular.ConclusãoA fisioterapia vascular contribui para o controle do quadro clínico da DVC, melhorando edema e ADM, e favorecendo a melhora da QV dos acometidos pela doença.

  10. [Feasibility and efficiency of embolization of spinal dural arteriovenous fistula].

    Science.gov (United States)

    Zhang, Hong-qi; Liu, Jiang; Wang, Jian-sheng; Zhi, Xing-long; Zhang, Peng; Bian, Li-song; He, Chuan; Ye, Ming; Wang, Zhi-chao; Li, Meng; Ling, Feng

    2013-03-01

    To evaluate the feasibility and efficiency of embolization of spinal dural arteriovenous fistula (SDAVF). From December 2010 to May 2012, there were 104 cases of SDAVF were treated, and 26 cases were selected to be treated with embolization. The inclusion criteria was as follows: (1) No anterior or posterior spinal artery originated from the fistula segment; (2) The segmental artery can be catheterized with guiding or micro catheter; (3) High flow in fistula; (4) Patient's situation was not suitable for surgery or general anesthesia. Among 26 cases, there were 22 male and 4 female patients, the average age was 55.9 years (ranged from 34 to 81 years). The locations of SDAVF were 10 cases in thoracic, 9 in lumbar and 7 in sacral segment. The main symptoms were progressive numbness and weakness in both lower extremities, most cases accompanied with difficulties in urination and defecation. The average history was 17.1 months (from 1 to 156 months). ONYX-18 liquid embolic agent or Glubran-2 surgical glue were used as embolic material. The patients not cured with embolization were treated with surgery in the following 1 - 2 weeks. Follow-up evaluation was done with MRI after 3 months and DSA after 6 months, besides physical examination. Fifteen from 26 cases achieved immediate angiographic cure results: 14 in 20 cases which embolized with ONYX-18; only 1 in 6 cases with Glubran-2. Three in 10 cases of thoracic SDAVF and 12 in 16 cases of lumbar/sacral SDAVF were cured with embolization. Partially embolized cases were treated with surgical obliteration of drainage veins within 2 weeks. Cured patients experienced immediate improvement after embolization and kept getting better in the follow-up. All the patients had MRI follow-up after 3 months and DSA follow-up after 6 months. In 6 month's follow-up, MRI showed the edema and flow void signal in the spinal cord disappeared. DSA showed no fistula recurrence or remnant. There was no deterioration case in all of the embolized

  11. Angioceratoma conjuntival canino: relato de caso

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    J.O.T. Souza

    Full Text Available RESUMO O angioceratoma é um tumor de origem vascular, semelhante ao hemangioma, que se diferencia deste por alterações histológicas epiteliais. A apresentação ocular do angioceratoma é pouco frequente em cães, sendo mais comum a ocorrência de hemangioma e hemangiossarcoma. Neste relato, é descrito o caso de um cão, macho, da raça Border Collie, que apresentava uma massa localizada, hiperêmica, bem vascularizada e protrusa, na região temporal da conjuntiva bulbar do olho direito (OD. Foi realizado exame oftalmológico completo e ultrassonografia ocular, tendo sido possível observar que a massa não envolvia outras estruturas oculares além da conjuntiva. Dessa forma, foi realizada a conjuntivectomia parcial, e o material foi encaminhado para análise histológica. O exame histopatológico foi conclusivo para um angioceratoma e mostrou que as margens da amostra estavam livres. O procedimento cirúrgico com margem de segurança foi eficiente no tratamento da neoplasia, sem recorrência até o momento do presente relato.

  12. Anestesia para cirurgia ortopédica em criança com susceptibilidade à hipertermia maligna: relato de caso Anestesia para cirugía ortopédica en niño con susceptibilidad a la hipertermia maligna: relato de caso Anesthesia for orthopedic surgery in a child susceptible to malignant hyperthermia: case report

    Directory of Open Access Journals (Sweden)

    Renato Santiago Gomez

    2003-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hipertermia maligna é uma miopatia autossômica dominante desencadeada por anestésicos inalatórios e bloqueadores neuromusculares, como halotano e succinilcolina, causando aumento da temperatura que pode ser fatal sem o tratamento imediato. O objetivo deste relato é descrever a conduta anestésica em uma criança susceptível à hipertermia maligna que foi submetida a procedimento cirúrgico ortopédico. RELATO DO CASO: Paciente do sexo feminino, com 3 anos, portadora de luxação congênita do quadril e susceptibilidade à hipertermia maligna, conforme história de anestesia anterior, foi submetida à correção cirúrgica ortopédica sob anestesia geral, com propofol e fentanil, associada à anestesia peridural lombar. A temperatura da paciente foi monitorizada continuamente durante a cirurgia e no período pós-operatório. A paciente apresentou recuperação pós-operatória sem intercorrências e recebeu alta hospitalar após cinco dias. CONCLUSÕES: A combinação de anestesia regional e venosa para o procedimento cirúrgico proposto em paciente com susceptibilidade à hipertermia maligna permitiu a condução anestésica com segurança.JUSTIFICATIVA Y OBJETIVOS: Hipertermia maligna es una miopatia autosómica dominante desencadenada por anestésicos inhalatorios y bloqueadores neuromusculares, como halotano y succinilcolina, causando aumento de la temperatura que puede ser fatal sin el tratamiento inmediato. El objetivo de este relato es describir la conducta anestésica en un niño susceptible a la hipertermia maligna que fue sometida a procedimiento quirúrgico ortopédico. RELATO DEL CASO: Niño, del sexo femenino, con 3 años, portadora de luxación congénita del cuadril (anca y susceptibilidad a la hipertermia maligna, conforme historia de anestesia anterior, fue sometida a la corrección quirúrgica ortopédica bajo anestesia general, con propofol y fentanil, asociada a anestesia peridural lumbar. La

  13. Performance of a new quantitative method for assessing dural ectasia in patients with FBN1 mutations and clinical features of Marfan syndrome

    International Nuclear Information System (INIS)

    Soeylen, Bahar; Schmidtke, Joerg; Arslan-Kirchner, Mine; Hinz, Kerstin; Prokein, Jana; Becker, Hartmut

    2009-01-01

    This study presents a comparison of established methods for measuring dural ectasia with a new quantitative method of assessing this clinical feature. Seventeen patients with an identified mutation in FBN1 were examined for dural ectasia. The results were compared with 17 age- and sex-matched controls. Our images were also evaluated using the two methods of quantifying dural ectasia, namely those of Ahn et al. and of Oosterhof et al. With our method, 80% MFS1 patients and 7% controls fulfilled the criterion for dural ectasia. Using the method of Oosterhof et al., dural ectasia was found in 88% patients with MFS1 and in 47% controls. Using the method of Ahn et al. 76% patients with Marfan syndrome and 29% controls showed dural ectasia. We present a novel quantitative method of evaluating MRT images for dural ectasia, which, in our own patient cohort, performed better than those previously described. (orig.)

  14. Performance of a new quantitative method for assessing dural ectasia in patients with FBN1 mutations and clinical features of Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Soeylen, Bahar; Schmidtke, Joerg; Arslan-Kirchner, Mine [Hannover Medical School, Institute of Human Genetics, Hannover (Germany); Hinz, Kerstin [Hannover Medical School, Institute of Diagnostic and Interventional Neuroradiology, Hannover (Germany); Vivantes Klinikum Neukoelln, Institut fuer Radiologie und Interventionelle Therapie, Berlin (Germany); Prokein, Jana [Hannover Medical School, Institute for Biometrics, Hannover (Germany); Becker, Hartmut [Hannover Medical School, Institute of Diagnostic and Interventional Neuroradiology, Hannover (Germany)

    2009-06-15

    This study presents a comparison of established methods for measuring dural ectasia with a new quantitative method of assessing this clinical feature. Seventeen patients with an identified mutation in FBN1 were examined for dural ectasia. The results were compared with 17 age- and sex-matched controls. Our images were also evaluated using the two methods of quantifying dural ectasia, namely those of Ahn et al. and of Oosterhof et al. With our method, 80% MFS1 patients and 7% controls fulfilled the criterion for dural ectasia. Using the method of Oosterhof et al., dural ectasia was found in 88% patients with MFS1 and in 47% controls. Using the method of Ahn et al. 76% patients with Marfan syndrome and 29% controls showed dural ectasia. We present a novel quantitative method of evaluating MRT images for dural ectasia, which, in our own patient cohort, performed better than those previously described. (orig.)

  15. Progressive subcortical calcifications secondary to venous hypertension in an intracranial dural arteriovenous fistula.

    Science.gov (United States)

    Pascoe, Heather M; Lui, Elaine H; Mitchell, Peter; Gaillard, Frank

    2017-05-01

    Intracranial dural arteriovenous fistulas (dAVF) are acquired lesions, with the most commonly reported findings on CT haemorrhage or focal oedema. We describe a case of progressive subcortical calcification on CT secondary to venous hypertension from a high grade dAVF. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Utility of the magnetic resonance in the evaluation of the dural sinus occlusive disease

    International Nuclear Information System (INIS)

    Delgado, Jorge Andres; Toro, Nancy; Bolivar, Guillermo; Pulgarin, Luis German

    1998-01-01

    The dural sinus occlusive disease is potentially fatal (20-78% cases) and of unspecific clinical symptoms. CT sensibility is only 75% and angiography is invasive. The MRI offers several advantages in the diagnosis due to its high sensibility to flow, high intrinsic contrast and no invasively. The MRI findings in 7 cases are described

  17. Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion

    Directory of Open Access Journals (Sweden)

    Pooja Binnani

    2012-01-01

    Full Text Available The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly dete-riorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.

  18. A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules.

    Science.gov (United States)

    Aspelund, Aleksanteri; Antila, Salli; Proulx, Steven T; Karlsen, Tine Veronica; Karaman, Sinem; Detmar, Michael; Wiig, Helge; Alitalo, Kari

    2015-06-29

    The central nervous system (CNS) is considered an organ devoid of lymphatic vasculature. Yet, part of the cerebrospinal fluid (CSF) drains into the cervical lymph nodes (LNs). The mechanism of CSF entry into the LNs has been unclear. Here we report the surprising finding of a lymphatic vessel network in the dura mater of the mouse brain. We show that dural lymphatic vessels absorb CSF from the adjacent subarachnoid space and brain interstitial fluid (ISF) via the glymphatic system. Dural lymphatic vessels transport fluid into deep cervical LNs (dcLNs) via foramina at the base of the skull. In a transgenic mouse model expressing a VEGF-C/D trap and displaying complete aplasia of the dural lymphatic vessels, macromolecule clearance from the brain was attenuated and transport from the subarachnoid space into dcLNs was abrogated. Surprisingly, brain ISF pressure and water content were unaffected. Overall, these findings indicate that the mechanism of CSF flow into the dcLNs is directly via an adjacent dural lymphatic network, which may be important for the clearance of macromolecules from the brain. Importantly, these results call for a reexamination of the role of the lymphatic system in CNS physiology and disease. © 2015 Aspelund et al.

  19. Imaging findings in patients with ventral dural defects and herniation of neural tissue

    International Nuclear Information System (INIS)

    Baur, A.; Staebler, A.; Reiser, M.; Psenner, K.; Hamburger, C.

    1997-01-01

    The aim of this paper is to describe clinical and imaging findings in three patients with ventral dural defects and herniation of the spinal cord or cauda equina. The literature is reviewed and the clinical, radiological and operative findings are compared. Three patients with ventral dural defects of different etiologies are presented. One patient gave a longstanding history of ankylosing spondylitis, the second patient presents 37 years after spinal trauma, and the third patient presents with spontaneous spinal cord herniation. All patients had typically slowly progressive neurological symptoms with multiple hospitalizations until diagnosis was made. Characteristic findings in postmyelographic CT included a ventral or ventrolateral displacement with deformation of the spinal cord or the cauda equina. Sagittal MRI showed this abrupt and localized anterior deviation of the spinal cord or the cauda equina to the posterior portions of a vertebral body with or without a bony vertebral defect optimally. Additionally, due to the ventral displacement of the spinal cord, the dorsal subarachnoid space was relatively enlarged without evidence of an arachnoid cyst, in all patients. Magnetic resonance imaging and postmyelographic CT can diagnose ventral dural defects with spinal cord herniation or nerve root entrapment. Dural defects must be considered in the presence of neurological symptoms in cases of longstanding ankylosing spondylitis, late sequelae of fractures of vertebral bodies, and without history of spinal trauma or surgery. (orig.). With 3 figs

  20. Epistaxis caused by a dural AV-fistula at the cribriform plate

    NARCIS (Netherlands)

    van Dijk, J. Marc C.; Korsten-Meijer, Astrid G. W.; Mazuri, Aryan

    2014-01-01

    Objectives/HypothesisA dural arteriovenous fistula (DAVF) with cortical venous reflux (CVR) is a dangerous neurovascular entity. A DAVF at the cribriform plate is typically silent until its inevitable presentation with intracranial hemorrhage. Case SummaryA 67-year-old male presented with severe

  1. Contribution of dynamic contrast MR imaging to the differentiation between dural metastasis and meningioma

    International Nuclear Information System (INIS)

    Kremer, S.; Grand, S.; Le Bas, J.F.; Remy, C.; Pasquier, B.; Benabid, A.L.; Bracard, S.

    2004-01-01

    To determine the perfusion-sensitive characteristics of cerebral dural metastases and compare them with the data on meningiomas. Twenty-two patients presenting with dural tumor underwent conventional and dynamic susceptibility-contrast MR imaging: breast carcinoma metastases, two patients; colorectal carcinoma metastasis, one patient; lung carcinoma metastasis, one patient; Merkel carcinoma metastasis, one patient; lymphoma, one patient; meningiomas, 16 patients. The imaging characteristics were analyzed using conventional MR imaging. The cerebral blood volume (CBV) maps were obtained for each patient and the relative CBV (rCBV) in different areas was calculated using the ratio between the CBV in the pathological area (CBVp) and in the contralateral white matter (CBVn). The differentiation between a meningioma and a dural metastasis can be difficult using conventional MR imaging. The rCBVs of lung carcinoma metastasis (1 case: 1.26), lymphoma (1 case: 1.29), breast carcinoma metastasis (2 cases: 1.50,1.56) and rectal carcinoma metastasis (1 case: 3.34) were significantly lower than that of meningiomas (16 cases: mean rCBV = 8.97±4.34, range 4-18). Merkel carcinoma metastasis (1 case: 7.56) showed an elevated rCBV, not different from that of meningiomas. Dural metastases are sometimes indistinguishable from meningiomas using conventional MR imaging. rCBV mapping can provide additional information by demonstrating a low rCBV which may suggest the diagnosis of metastasis. (orig.)

  2. Relato literario, relato periodístico: el caso Elián González

    OpenAIRE

    Lic. María Inés Loyola; Lic. Miriam Eugenia Villa

    2000-01-01

    Nos proponemos estudiar las relaciones entre relato literario y relato periodístico a partir del caso del niño balsero cubano, Elián González, que estuvo retenido en Estados Unidos durante siete meses. En este análisis, el principal objetivo es describir las diferencias y similitudes respecto a la construcción discursiva de la historia narrada, sus personajes y escenarios. La finalidad de la comparación es demostrar cómo los relatos "no ficcionales" que los medios imponen como verdaderos y ac...

  3. Cranial dural arteriovenous shunts. Part 4. Clinical presentation of the shunts with leptomeningeal venous drainage.

    Science.gov (United States)

    Baltsavias, Gerasimos; Spiessberger, Alex; Hothorn, Torsten; Valavanis, Anton

    2015-04-01

    Cranial dural arteriovenous fistulae have been classified into high- and low-risk lesions mainly based on the pattern of venous drainage. Those with leptomeningeal venous drainage carry a higher risk of an aggressive clinical presentation. Recently, it has been proposed that the clinical presentation should be considered as an additional independent factor determining the clinical course of these lesions. However, dural shunts with leptomeningeal venous drainage include a very wide spectrum of inhomogeneous lesions. In the current study, we correlated the clinical presentation of 107 consecutive patients harboring cranial dural arteriovenous shunts with leptomeningeal venous drainage, with their distinct anatomic and angiographic features categorized into eight groups based on the "DES" (Directness and Exclusivity of leptomeningeal venous drainage and features of venous Strain) concept. We found that among these groups, there are significant angioarchitectural differences, which are reflected by considerable differences in clinical presentation. Leptomeningeal venous drainage of dural sinus shunts that is neither direct nor exclusive and without venous strain manifested only benign symptoms (aggressive presentation 0%). On the other end of the spectrum, the bridging vein shunts with direct and exclusive leptomeningeal venous drainage and venous strain are expected to present aggressive symptoms almost always and most likely with bleeding (aggressive presentation 91.5%). Important aspects of the above correlations are discussed. Therefore, the consideration of leptomeningeal venous drainage alone, for prediction of the clinical presentation of these shunts appears insufficient. Angiographic analysis based on the above concept, offers the possibility to distinguish the higher- from the lower-risk types of leptomeningeal venous drainage. In this context, consideration of the clinical presentation as an additional independent factor for the prediction of their clinical

  4. USO DE VENDAS ELÁSTICAS EN EL PRE Y TRANSOPERATORIO EN COLECISTECTOMIA PARA PREVENIR TROMBOSIS VENOSA PROFUNDA

    Directory of Open Access Journals (Sweden)

    Carlos Mario Marín Rodríguez

    2012-04-01

    Full Text Available Una de las intervenciones realizadas por el profesional de Enfermería para prevenir sucesos adversos en los pacientessometidos a intervención quirúrgica, como es el caso de la colescistectomía, es la aplicación de vendas elásticas en losmiembros inferiores en el pre y transoperatorio para prevenir la Trombosis Venosa Profunda (TVP. Sin embargo, estapráctica no ha sido fundamentada con la mejor evidencia disponible, por ello el objetivo de esta revisión es obtener unrespaldo científico que avale esta práctica. Inicialmente, para recabar la mejor evidencia posible, se estableció una preguntaclínica en formato PICO; luego, se indagó en distintas bases de datos como PUBMED de las cual se obtuvieron 136artículos siete de ellos de gran importancia clínica, ya que se halló, inclusive, una guía de práctica clínica. Luego se aplicó elanálisis crítico mediante la plantilla CASPe y AGREE. Por último, a partir de los resultados encontrados se analizó lapráctica que se desarrolla en el nosocomio con el fin de ser divulgados posteriorrmente y, así, mejorar la práctica clínica.Existe escasa o nula bibliografía específica que respalde el uso de vendas elásticas en el pre y transoperatorio de unacolecistectomía, lo que puede deberse a que no hay evidencia suficiente respecto de sufrir trombosis venosa profunda poresta intervención. Por otro lado, cabe recordar que existen diferentes factores que afectan la colocación de las vendaselásticas, dígase la pericia del profesional que las aplica, su nivel profesional y la ausencia de métodos para medir la presiónque se ejerce al colocar este tratamiento. Conclusión: no existe evidencia científica aparente que respalde el uso de vendaselásticas en los miembros inferiores aplicadas en el pre, trans y postoperatorio de una colecistectomía con la finalidad deprevenir la Trombosis Venosa Profunda, práctica que se lleva a cabo en el Hospital de La Anexión, Guanacaste.

  5. Rastreio de trombofilia hereditária no contexto de trombose venosa profunda Screening of familiar trombophylia in patients with deep venous thrombosis

    Directory of Open Access Journals (Sweden)

    Fernando Mota

    2011-09-01

    Full Text Available A trombose venosa profunda é uma doença frequente e importante que se manifesta em indivíduos com factores de risco conhecidos ou desconhecidos. A sua etiopatogenia é multifactorial incluindo factores adquiridos e factores genéticos. Dois tipos de defeitos genéticos podem causar trombose venosa: mutações que resultam em deficiência dos inibidores naturais da coagulação e mutações com aumento do nível/função dos factores da coagulação. O objectivo deste trabalho é referir e discutir as situações em que se deve rastrear a presença de trombofilia hereditária no contexto de um episódio de trombose venosa profunda. Foram relatadas como factor de risco para trombose venosa, por ordem cronológica, a deficiência de antitrombina, deficiência de proteína C e proteína S, factor V Leiden, mutação G20210A do gene da protrombina e os níveis elevados de factor VIII. Apesar da associação entre trombofilia hereditária e o risco de trombose venosa estar bem documentada, o mesmo não ocorre em relação ao risco de recorrência. A única situação em que o risco de recorrência foi documentado foi em doentes jovens com deficiência de inibidores naturais da coagulação no contexto de um primeiro episódio de trombose venosa e/ou uma história familiar positiva para trombose venosa. Actualmente não existe consenso sobre o rastreio de trombofilia hereditária no contexto de trombose venosa profunda. Seria importante que fossem seguidas as guidelines actuais, no sentido de uniformizar a abordagem aos doentes com trombose venosa profunda e facilitar a realização de estudos que permitam elaborar novas guidelines com recomendações baseadas em evidência de elevada qualidade.Deep vein thrombosis is a common and important disease that occurs in individuals with known or unknown risk factors. Its pathogenesis is multifactorial and includes genetic and acquired factors. Two types of genetic defects can cause venous thrombosis

  6. Profilaxia para tromboembolia venosa em um hospital geral Venous thromboembolism prophylaxis in a general hospital

    Directory of Open Access Journals (Sweden)

    Fernanda Fuzinatto

    2011-04-01

    Full Text Available OBJETIVO: Avaliar a prática de profilaxia para tromboembolia venosa (TEV em pacientes em um hospital geral. MÉTODOS: Estudo de coorte transversal conduzido no Hospital Nossa Senhora da Conceição, localizado na cidade de Porto Alegre (RS, com uma amostra constituída de pacientes internados selecionados randomicamente entre outubro de 2008 e fevereiro de 2009. Foram incluídos pacientes maiores de 18 anos e internados por mais de 48 h. Os critérios de exclusão foram pacientes em uso de anticoagulantes, história de doença tromboembólica, gestação e puerpério. A adequação da profilaxia foi avaliada seguindo as recomendações de um protocolo criado pela instituição e tendo como base principal a diretriz da American College of Chest Physician, oitava edição. RESULTADOS: Foram incluídos 262 pacientes com média de idade de 59,1 ± 16,6 anos. Os fatores de risco mais comuns foram imobilização (70,6%, infecção (44,3%, câncer (27,5%, obesidade (23,3% e cirurgia maior (14,1%. Na avaliação do nível de risco para TEV, 143 (54,6% e 117 pacientes (44,7%, respectivamente, foram classificados como de risco alto e moderado. No geral, 46,2% dos pacientes tiveram profilaxia adequada, assim como 25% dos pacientes com três ou mais fatores de risco e 18% dos pacientes com câncer, e houve diferenças estatisticamente significativas entre esses grupos quando comparados àqueles com menos de três fatores de risco e sem câncer (p OBJECTIVE: To evaluate the use of venous thromboembolism (VTE prophylaxis in a general hospital. METHODS: A cross-sectional cohort study at the Hospital Nossa Senhora da Conceição, located in the city of Porto Alegre, Brazil, involving a random sample of patients admitted between October of 2008 and February of 2009. We included patients over 18 years of age and hospitalized for more than 48 h. The exclusion criteria were anticoagulant use, pregnancy, puerperium, and a history of thromboembolic disease. The

  7. Tratamiento de las malformaciones venosas con alambres de cobre Treatment of venous malformations with cooper wires

    Directory of Open Access Journals (Sweden)

    F. Coiffman

    2011-06-01

    Full Text Available Las lesiones vasculares de la piel constituyen la anomalía congénita más frecuente. Van desde una simple mácula rosada, hasta tumores deformantes e incapacitantes. La gran mayoría desaparece en el primer año de vida. Otras involucionan espontáneamente en los primeros 6 años. Son más frecuentes en la mujer y en la raza blanca. Hay múltiples tratamientos, pero ninguno da garantías absolutas de curación. En base a las observaciones de los campesinos que notan que una lesión de este tipo, cuando es puncionada o se ulcera reduce de tamaño, Wang en China, recomendó puncionar las malformaciones venosas con agujas de cobre y aplicar sobre ellas ligeras descargas eléctricas. Nosotros modificamos el método: implantamos simples alambres de cobre usando una aguja recta larga y bajo anestesia local ambulatoriamente, creando un emparrillado de alambres en la lesión. A la semana los extraemos. La irritación que producimos estimula la coagulación intravascular y al reabsorberse los coágulos, la malformación desaparece o por lo menos reduce considerablemente de tamaño. Si es necesario, después resecamos la piel sobrante bajo anestesia local también de forma ambulatoria. Este método resulta muy efectivo, es sencillo, económico y puede ser practicado por cualquier cirujano. En 68 casos tratados en los últimos 15 años, no hemos tenido complicaciones serias, excepto dolor y edema en el postoperatorio inmediato.Vascular injuries of the skin constitute the most frequent congenital anomaly. They go from a simple pink stain, up to tumors that can cause great deformities. Most of them disappears in the first year of life. Other, suffers spontaneous involution in the first 6 years. They are more frequent in woman and in white race. There are multiple treatments, but none gives absolute guarantees. On the basis of the observations of rural people, who notice that an injury of this type, when it is punctioned or sore reduces its size, Wang in

  8. Osteocondromatose em gato: relato de caso

    Directory of Open Access Journals (Sweden)

    S. Winter

    Full Text Available RESUMO A osteocondromatose é caracterizada por nódulos únicos ou múltiplos decorrentes de um crescimento ósseo excessivo benigno. É encontrada em cães, gatos, equinos e humanos. Em felinos, tem maior incidência dos dois aos quatro anos de idade. A etiologia em gatos está relacionada ao vírus da leucemia felina, e também já foi encontrada relação com o fibrossarcoma. A manifestação clínica depende do local acometido e do tamanho da lesão. O diagnóstico definitivo é por meio de histopatologia e o prognóstico é desfavorável, pois ocorrem muitas recidivas. Este relato de caso objetiva descrever a apresentação dessa enfermidade em um felino jovem.

  9. Hipomelanose de Ito - relato de um caso

    Directory of Open Access Journals (Sweden)

    Adriana S. de Almeida

    2001-02-01

    Full Text Available Objetivo: Os autores têm como objetivo relatar um caso de hipomelanose de Ito (HI, uma síndrome neurocutânea rara, com alterações neurológicas e cromossômicas associadas ao comprometimento cutâneo e pneumonias de repetição. Relato do caso: Este relato é referente a um paciente masculino, 1 ano e 11 meses, internado no Hospital Universitário São Vicente de Paulo por broncopneumonia bilateral. Ao exame foram observadas máculas hipocrômicas na pele compatíveis com HI, além de atraso do desenvolvimento neuropsicomotor. O paciente foi submetido à biópsia incisional de pele das lesões do abdômen, eletroencefalograma, ressonância magnética e estudo citogenético. Resultados: Os exames histológico e imunoistoquímico evidenciaram ausência de melanina e diminuição de melanócitos em áreas focais da epiderme, respectivamente. O eletroencefalograma apresentou disfunção córtico-subcortical difusa. A ressonância magnética do encéfalo foi compatível com cisto aracnoídeo em região temporal. O cariótipo evidenciou mosaicismo cromossômico com uma linhagem normal (46,XY e uma linhagem celular que apresentava deleção intersticial nas bandas 22.2 - 24.2 do braço longo do cromossomo 10 (25%. Conclusões: Os autores, com o presente estudo, destacam a importância das lesões de pele na definição etiológica das desordens neuropediátricas.

  10. Cavernous sinus invasion by pituitary adenomas. Relationship between magnetic resonance imaging findings and histologically verified dural invasion

    Energy Technology Data Exchange (ETDEWEB)

    Daita, Go; Yonemasu, Yukichi; Nakai, Hirofumi; Takei, Hidetoshi; Ogawa, Katsuhiro [Asahikawa Medical Coll., Hokkaido (Japan)

    1995-01-01

    The relationship between magnetic resonance (MR) imaging findings and histologically verified invasion of the cavernous sinus by tumor cells was studied in 26 patients treated surgically for pituitary adenoma. Dural invasion of the sellar floor by tumor cells was found in 10 cases (38%). All patients were classified according to MR imaging findings into three types. Type I showed a gadolinium-enhanced stripe medial to the carotid artery (5 patients), none of which showed dural invasion. Type II showed no enhanced stripe (17 patients), six of which showed dural invasion. Within this type, tumor size and dural invasion showed no correlation. Type III showed displacement or encasement of the carotid artery by the tumor with or without extracranial extension (4 patients), all of which showed massive infiltration of the tumor cells into the dura mater. This study shows that preoperative MR imaging can provide information for assessment of invasion into the cavernous sinus in patients with pituitary adenoma. (author).

  11. Normal measurement of spinal cord and dural sac by CT myelography

    International Nuclear Information System (INIS)

    Yun, Ku Sub; Choi, Yo Won; Han, Moon Hee; Chang, Kee Hyun

    1988-01-01

    The data on the normal measurement of spinal cord are essential for an objective assessment of equivocal change of spinal cord size in the various clinical settings. The present study was therefore undertaken to evaluate normal range of spinal cord dimensions in Koreas. CT myelography of the cervical and thoracic region was performed in 60 patients who had symptoms referable to lumbosacral region and then computed tomographic measurement of spinal cord and dural sac was performed. The results are as follows: 1. The anteroposterior diameter of spinal cord was maximum at C1 level (8.6±1.4mm) and minimum at T6 level (6.4±1.7mm). 2. The transverse diameter of spinal cord was maximum at C4 and C5 levels (13.3±1.6mm) and minimum at T8 (8.1±1.9mm) and T10 (8.1±1.3mm) levels. 3. The area of spinal cord was maximum at C5 level (76±16mm 2 ) and minimum at T6 (40±24mm 2 ) and T8 (40±23mm 2 ) levels. 4. The ratio of anteroposterior diameter/transverse diameter of spinal cord was smallest at C4 (0.57±0.11) and C5 (0.57±0.09) levels and largest at T12 (0.9±0.17) level. 5. The ratio of anteroposterior diameter of spinal cord/dural sac was maximum at C4 level (0.73±0.14) and minimum at T12 level (0.52±0.15). The ratio of transverse diameter of spinal cord/dural sac was maximum at C3 (0.66±0.10) and C4 (0.66±0.14) levels and minimum at T12 level (0.46±0.18). The ratio of area of spinal cord/dural sac was maximum at C3 level (0.48±0.13) and minimum at T12 level (0.29±0.20). 6. The location of cervical cord in dural sac was mainly ventral (56%) at C1 level, middle (40-73%) from C2 to C6 level and dorsal (44%) at C7 level. The location of thoracic cord in dural sac was chiefly middle (61%) at T2 level and lower thoracic level (T10: 60% and T12: 51%) and mainly ventral (59-84%) at other levels.

  12. Transcutaneous Drainage of Gel-Like Substance after Application of Hydrogel Dural Sealant: Report of Two Cases

    OpenAIRE

    Siman, Homayoun; Techy, Fernando

    2015-01-01

    Study Design?Case report. Objective?Incidental durotomy (IDT) is a common complication of spinal surgery. The use of collagen matrix graft along with hydrogel dural sealant is a common method of IDT repair. With this method, there have been several reported cases of detrimental dural sealant expansion in the literature. One case study reported an expansion rate greater than 300%; many report neurologic damage. This article reports the clinical course of two patients who developed postoperativ...

  13. Comparison of Porcine and Bovine Collagen Dural Substitutes in Posterior Fossa Decompression for Chiari I Malformation in Adults.

    Science.gov (United States)

    Lee, Christine K; Mokhtari, Tara; Connolly, Ian D; Li, Gordon; Shuer, Lawrence M; Chang, Steven D; Steinberg, Gary K; Hayden Gephart, Melanie

    2017-12-01

    Posterior fossa decompression surgeries for Chiari malformations are susceptible to postoperative complications such as pseudomeningocele, external cerebrospinal fluid (CSF) leak, and meningitis. Various dural substitutes have been used to improve surgical outcomes. This study examined whether the collagen matrix dural substitute type correlated with the incidence of postoperative complications after posterior fossa decompression in adult patients with Chiari I malformations. A retrospective cohort study was conducted of 81 adult patients who underwent an elective decompressive surgery for treatment of symptomatic Chiari I malformations, with duraplasty involving a dural substitute derived from either bovine or porcine collagen matrix. Demographics and treatment characteristics were correlated with surgical outcomes. A total of 81 patients were included in the study. Compared with bovine dural substitute, porcine dural substitute was associated with a significantly higher risk of pseudomeningocele occurrence (odds ratio, 5.78; 95% confidence interval, 1.65-27.15; P = 0.01) and a higher overall complication rate (odds ratio, 3.70; 95% confidence interval, 1.23-12.71; P = 0.03) by univariate analysis. There was no significant difference in the rate of meningitis, repeat operations, or overall complication rate between the 2 dural substitutes. In addition, estimated blood loss was a significant risk factor for meningitis (P = 0.03). Multivariate analyses again showed that porcine dural substitute was associated with pseudomeningocele occurrence, although the association with higher overall complication rate did not reach significance. Dural substitutes generated from porcine collagen, compared with those from bovine collagen, were associated with a higher likelihood of pseudomeningocele development in adult patients undergoing Chiari I malformation decompression and duraplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. In utero magnetic resonance imaging for diagnosis of dural venous sinus ectasia with thrombosis in the fetus

    Energy Technology Data Exchange (ETDEWEB)

    Fanou, Evgenia Maria [University Hospital of North Staffordshire, Stoke-on-Trent (United Kingdom); Reeves, Mike J.; Griffiths, Paul D. [Royal Hallamshire Hospital, University of Sheffield, Academic Unit of Radiology, Sheffield (United Kingdom); Howe, David T. [Princess Anne Hospital, Wessex Fetal Medicine Unit, Southampton (United Kingdom); Joy, Harriet [University Hospital of Southampton, Department of Radiology, Southampton (United Kingdom); Morris, Susan [University Hospital of Wales, Radiology Department, Cardiff, Wales (United Kingdom); Russell, Sarah [St. Mary' s Hospital, Radiology Department, Manchester (United Kingdom)

    2013-12-15

    Dural venous sinus ectasia with thrombosis (DVSET) in the fetus is a rare condition that can be diagnosed prenatally with the use of fetal MR imaging, yet with limited indication of long-term clinical significance. To describe and evaluate the diagnostic value of fetal MR imaging in the prenatal diagnosis of dural venous sinus ectasia with thrombosis and its clinical significance. We report a series of nine fetuses with dural venous sinus ectasia with thrombosis. The mothers, located in four feto-maternal centres, were referred for fetal MR imaging due to space occupying lesions identified on second-trimester antenatal ultrasound. In all but one case the dural venous sinus ectasia with thrombosis was in the vicinity of the venous confluence (VC) with various extension in the posterior dural sinuses. Antenatal follow-up imaging was performed in seven cases and showed progression in one, stable appearances in one and regression in five cases. Three pregnancies were terminated. In the remaining six cases there was no reported neurological deficit at up to 44 months of clinical follow-up. This is among the largest series of postnatal clinical follow-up in cases of prenatal diagnosis of dural venous sinus ectasia with thrombosis in the literature. Clinical follow-up suggests a good prognosis when antenatal follow-up shows partial or complete thrombus resolution. (orig.)

  15. Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability.

    Science.gov (United States)

    Liao, Shiyao; Schneider, Niko R E; Weilbacher, Frank; Stehr, Anne; Matschke, Stefan; Grützner, Paul A; Popp, Erik; Kreinest, Michael

    2017-12-01

    To analyze the compression of the dural sac and the cervical spinal movement during performing different airway interventions in case of atlanto-occipital dislocation. In six fresh cadavers, atlanto-occipital dislocation was performed by distracting the opened atlanto-occipital joint capsule and sectioning the tectorial membrane. Airway management was done using three airway devices (direct laryngoscopy, video laryngoscopy, and insertion of a laryngeal tube). The change of dural sac's width and intervertebral angulation in stable and unstable atlanto-occipital conditions were recorded by video fluoroscopy with myelography. Three-dimensional overall movement of cervical spine was measured in a wireless human motion track system. Compared with a mean dural sac compression of - 0.5 mm (- 0.7 to - 0.3 mm) in stable condition, direct laryngoscopy caused an increased dural sac compression of - 1.6 mm (- 1.9 to - 0.6 mm, p = 0.028) in the unstable atlanto-occipital condition. No increased compression on dural sac was found using video laryngoscopy or the laryngeal tube. Moreover, direct laryngoscopy caused greater overall extension and rotation of cervical spine than laryngeal tube insertion in both stable and unstable conditions. Among three procedures, the insertion of a laryngeal tube took the shortest time. In case of atlanto-occipital dislocation, intubation using direct laryngoscopy exacerbates dural sac compression and may cause damage to the spinal cord.

  16. Evaluation of the effect of hemoglobin or hematocrit level on dural sinus density using unenhanced computed tomography.

    Science.gov (United States)

    Lee, Seung Young; Cha, Sang-Hoon; Lee, Sung-Hyun; Shin, Dong-Ick

    2013-01-01

    To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included (n=122). We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Quantitative measurement of dural sinus density using the circle regions of interest (ROI) method was calculated as average ROI values at 3 or 4 points. Simple regression analysis was used to evaluate the correlation between mean HU and Hgb or mean HU and Hct. The mean densities of the dural sinuses ranged from 24.67 to 53.67 HU (mean, 43.28 HU). There was a strong correlation between mean density and Hgb level (r=0.832) and between mean density and Hct level (r=0.840). Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore, the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis.

  17. Preservation of Frontal Sinus Anatomy and Outflow Tract Following Frontal Trauma with Dural Defect

    Directory of Open Access Journals (Sweden)

    James Wei Ming Kwek, MBBS, MRCS

    2015-02-01

    Full Text Available Summary: Our case report describes a young male mechanic who was hit in his face by a spring while repairing a car, resulting in traumatic injury to the frontal sinus, with fractures of both the anterior and the posterior tables with dural defect and cerebrospinal fluid leak. Current guidelines recommend that comminuted and/or displaced fractures of the posterior table of the frontal sinus with dural defects should be either cranialized or obliterated. In this patient, instead of cranializing or obliterating the frontal sinus, we managed to preserve the frontal sinus anatomy and its outflow tract using a combined open bicoronal and nasoendoscopic approach. This avoids the long-term complications associated with cranialization or obliteration including mucocele formation and frontocutaneous fistula.

  18. Embolization of intracranial dural arteriovenous fistulas using PHIL liquid embolic agent in 26 patients

    DEFF Research Database (Denmark)

    Lamin, S.; Chew, H. S.; Chavda, S.

    2017-01-01

    BACKGROUND AND PURPOSE: The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid......: This was a retrospective multicenter study. Twenty-six consecutive patients with dural arteriovenous fistulas (de novo or previously treated) treated by injection of PHIL only or with PHIL in combination with other embolization products (such as Onyx or detachable coils) were included in the study. Recruitment started......, 3 were retreated with PHIL and 1 achieved angiographic cure. An adverse event was seen in 1 patient who developed worsening of preexisting ataxia due to acute thrombosis of the draining vein. CONCLUSIONS: PHIL appears to be safe and effective for endovascular treatment of cranial dural arteriovenous...

  19. Dural metastases from prostate carcinoma: A systematic review of the literature apropos of six patients

    International Nuclear Information System (INIS)

    Vasconcelos Sobreira Guedes, Bruno de; Rocha, Antonio Jose da; Pereira Pinto Gama, Hugo; Silva, Carlos Jorge da

    2011-01-01

    Intracranial metastases are a rare manifestation of prostate carcinoma and the dura mater is the most affected site. We report a series of six patients with dural prostate metastases (DPM) and perform a systematic review of the current literature in order to depict imaging trademarks of this condition. This review points to a magnetic resonance imaging (MRI) pattern of meningeal involvement characterized by a diffuse smooth thickening, nodular appearance or dural-based masses. We also demonstrate an osteoblastic pattern of lesions, particularly in sphenoid wing, by computed tomography (CT) scans. We suggest that these imaging findings may support an elevated index of suspicion of DPM in elderly men, including those patients without urologic symptoms.

  20. Dural ectasia of the optic nerve sheath: is it always benign?

    Directory of Open Access Journals (Sweden)

    Berker Bakbak

    2009-11-01

    Full Text Available Berker Bakbak1, Hava Dönmez2, Tülay Kansu3, Hayyam Kiratli41Hacettepe University Institute of Neurological Sciences and Psychiatry, Neuro-ophthalmology Unit, Ankara, Turkey; 2Diskapi Yildirim Beyazid Education and Research Hospital Neurology Clinic, Ankara, Turkey; 3Hacettepe University Medical Faculty, Department of Neurology, Neuro-Ophthalmology Unit, Ankara, Turkey; 4Hacettepe University Medical Faculty, Department of Ophthalmology, Ocular Oncology Unit, Ankara, TurkeyAbstract: A 36-year-old woman with a 3-month history of progressive visual loss had papilledema, dilatation of the optic nerve sheaths and normal cerebrospinal fluid pressures. She was diagnosed as dural ectasia of the optic nerve sheaths and surgical decompression was performed. In this case report, severe visual loss is described as a serious complication of this rare disease and the importance of early surgical intervention is emphasized.Keywords: optic nerve, dural ectasia, meningocele

  1. Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis

    Directory of Open Access Journals (Sweden)

    Suraj Mammen

    2017-01-01

    Full Text Available Background: In dural venous sinus thrombosis (DVST, the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. Materials and Methods: Eight patients with magnetic resonance imaging (MRI-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System®. In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. Results: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS, with 5/8 (62% patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months, and there were no new neurological events during the follow-up period. Conclusion: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.

  2. The interperiosteo-dural concept applied to the perisellar compartment: a microanatomical and electron microscopic study.

    Science.gov (United States)

    François, Patrick; Travers, Nadine; Lescanne, Emmanuel; Arbeille, Brigitte; Jan, Michel; Velut, Stéphane

    2010-11-01

    The dura mater has 2 dural layers: the endosteal layer (outer layer), which is firmly attached to the bone, and the meningeal layer (inner layer), which directly covers the brain. These 2 dural layers join together in the middle temporal fossa or the convexity and separate into the orbital, lateral sellar compartment (LSC), or spinal epidural space to form the extradural neural axis compartment (EDNAC). The aim of this work was to anatomically verify the concept of the EDNAC by using electron microscopy. The authors studied the cadaveric heads obtained from 13 adults. Ten of the specimens (or 20 perisellar areas) were injected with colored latex and fixed in formalin. They carefully removed each brain to allow a superior approach to the perisellar area. The 3 other specimens were studied by microscopic and ultrastructural methods to describe the EDNAC in the perisellar area. Special attention was paid to the dural layers surrounding the perisellar area. The authors studied the anatomy of the meningeal architecture of the LSC, the petroclival venous confluence, the orbit, and the trigeminal cave. After dissection, the authors took photographs of the dural layers with the aid of optical magnification. The 3 remaining heads, obtained from fresh cadavers, were prepared for electron microscopic study. The EDNAC is limited by the endosteal layer and the meningeal layer and contains fat and/or venous blood. The endosteal layer and meningeal layer were not identical on electron microscopy; this finding can be readily related to the histology of the meninges. In this study, the authors demonstrated the existence of the EDNAC concept in the perisellar area by using dissected cadaveric heads and verified the reality of the concept of the meningeal layer with electron microscopy. These findings clearly demonstrated the existence of the EDNAC, a notion that has generally been accepted but never demonstrated microscopically.

  3. RAQUITISMO HIPOFOSFATÊMICO: RELATO DE CASO

    Directory of Open Access Journals (Sweden)

    Marta Liliane de Almeida Maia

    2018-03-01

    Full Text Available RESUMO Objetivo: O raquitismo hipofosfatêmico precisa ser precocemente diagnosticado porque seu tratamento previne sequelas incapacitantes. Este relato alerta para a doença. Relato de caso: Relato de perfil metabólico, depuração de creatinina, estado nutricional e desenvolvimento pôndero-estatural de paciente com características clínico-laboratoriais de raquitismo hipofosfatêmico, atendido em ambulatório de tubulopatias por período de 12 meses. Chegou ao serviço após tempo prolongado acamado, dependente de ventilação mecânica e com perfil metabólico ósseo alterado. Terapêutica consistiu na administração de fósforo (inicial: 65 mg/kg/dia, final: 24,2 mg/kg/dia, cálcio (inicial: 127 mg/kg/dia, final: 48,4 mg/kg/dia e calcitriol (inicial: 0,06 mcg/kg/dia, final: 0,03 mcg/kg/dia, e a análise constou da descrição das consultas, utilizando-se mediana de exames laboratoriais e dados antropométricos. Observou-se nítida melhora inicial do padrão respiratório do paciente, que evoluiu com ventilação espontânea e deambulação autônoma; com exames laboratoriais: cálcio (mg/dL inicial 7,1, final 10,1; fósforo (mg/dL inicial 1,7, final 3,2; magnésio (mg/dL inicial 1,5, final 2,1; paratormônio (pg/L inicial 85,8, final 52,7; fosfatase alcalina (UI/L inicial 12660, final 938; e melhora do desenvolvimento pôndero-estatural (escore Z: E/I inicial: -6,05, final -3,64; P/I: inicial -2,92, final -1,57 com presença de litíase transitória. A depuração de creatinina (mL/min/1,73 m2sc foi constante durante o seguimento. O tratamento propiciou benefícios clínicos, bioquímicos e nutricionais, mas, apesar da boa resposta inicial, a família abandonou o seguimento por dois anos, apresentando o paciente piora da deambulação e das deformidades esqueléticas. Comentários: Não apenas diagnóstico precoce é necessário, como também a adesão ao tratamento é fundamental para o sucesso na condução dessa patologia.

  4. Insuficiencia venosa crónica en trabajadores sin factores de riesgo que permanecen horas prolongadas en bipedestación

    Directory of Open Access Journals (Sweden)

    Paula Astudillo

    Full Text Available La insuficiencia venosa crónica (IVC es una patología prevalente en la sociedad actual. Los problemas derivados de ella, son una causa importante de gasto económico y absentismo laboral. Las condiciones laborales actuales, como jornadas de larga duración, con largas horas en bipedestación, inadecuada carga de pesos y malas condiciones de humedad y temperatura, contribuyen al desarrollo de esta patología. En este trabajo se ha realizado una revisión sistemática de la bibliografía existente en relación a la insuficiencia venosa crónica y el tiempo en bipedestación de las jornadas laborales. Para determinar el nivel de evidencia de los estudios evaluados, se han seguido los criterios del Scottish Intercollegiate Guidelines Network (SIGN. En particular, se ha concluido que existe una asociación significativamente positiva entre el tiempo prolongado en bipedestación y el riesgo de padecer insuficiencia venosa crónica. Sin embargo, la literatura actual no permite establecer un umbral que determine el número de horas considerado como bipedestación prolongada. Para poder valorar si la insuficiencia venosa crónica debería considerarse una enfermedad profesional, es necesario diseñar y llevar a cabo nuevos estudios de investigación en esta dirección. Estos estudios son necesarios para poder establecer evidencias de cara a concienciar a la sociedad y generar campañas de prevención y promoción de la salud que disminuyan los costes económicos y mejoren la calidad de vida de la población.

  5. Large capillary hemangioma of the temporal bone with a dural tail sign: A case report

    KAUST Repository

    YANG, GUANG

    2014-05-13

    The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date.

  6. Use of collagen film as a dural substitute: preliminary animal studies.

    Science.gov (United States)

    Collins, R L; Christiansen, D; Zazanis, G A; Silver, F H

    1991-02-01

    Cadaver grafts, laminated metallic materials, and synthetic fabrics have been evaluated as dural substitutes. Use of cadaver tissues is limited by fear of transmission of infectious disease while use of synthetic materials is associated with implant encapsulation and foreign body reactions. The purpose of this study is to evaluate the use of collagen film as a dural substitute. Collagen films prepared from bovine skin were used to replace the dura of rabbits and histological observations were made at 16, 28, 42, and 56 days postimplantation. Controls consisted of dura that was removed and then reattached. Control dura showed no signs of inflammation or adhesion to underlying tissue at 16 and 28 days postimplantation. By 56 days postimplantation, extensive connective tissue deposition was observed in close proximity to adjacent bone as well as pia arachnoid adhesions. Implanted collagen film behaved in a similar manner to control dura showing minimal inflammatory response at all time periods. At 56 days postimplantation collagen film appeared strongly infiltrated by connective tissue cells that deposited new collagen. The results of this study suggest that a reconstituted type I collagen film crosslinked with cyanamide acts as a temporary barrier preventing loss of fluid and adhesion formation. It is replaced after approximately 2 months with host collagen with limited inflammatory and fibrotic complications. Further studies are needed to completely characterize the new connective tissue formed as well as long-term biocompatibility and functioning of a reconstituted collagen dural substitute.

  7. Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization.

    Science.gov (United States)

    Tian, Bing; Xu, Bing; Lu, Jianping; Liu, Qi; Wang, Li; Wang, Minjie

    2015-06-01

    This study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA. Eleven patients with cranial dural arteriovenous fistulas detected on DSA underwent transarterial embolization with ONYX-18. Four-dimensional CTA was performed an average of 2 days before and 4 days after DSA. Four-dimensional CTA and DSA images were reviewed by two neuroradiologists for identification of feeding arteries and drainage veins and for determining treatment effects. Interobserver and intermodality agreement between four-dimensional CTA and DSA were assessed. Forty-two feeding arteries were identified for 14 fistulas in the 11 patients. Of these, 36 (85.71%) were detected on four-dimensional CTA. After transarterial embolization, one patient got partly embolized, and the fistulas in the remaining 10 patients were completely occluded. The interobserver agreement for four-dimensional CTA and intermodality agreement between four-dimensional CTA and DSA were excellent (κ=1) for shunt location, identification of drainage veins, and fistula occlusion after treatment. Four-dimensional CTA images are highly accurate when compared with DSA images both before and after transarterial embolization treatment. Four-dimensional CTA can be used for diagnosis as well as follow-up of cranial dural arteriovenous fistulas in clinical settings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Large capillary hemangioma of the temporal bone with a dural tail sign: A case report

    KAUST Repository

    YANG, GUANG; LI, CHENGUANG; CHEN, XIN; LIU, YAOHUA; HAN, DAYONG; Gao, Xin; KAWAMOTO, KEIJI; ZHAO, SHIGUANG

    2014-01-01

    The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date.

  9. Intracranial Dural Metastasis of Ewing's Sarcoma: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eung Yeop; Lee, Seung Koo; Kim, Dong Joon; Kim, Jin Na; Lee, Kyu Sung; Jung, Woo Hee; Kim, Dong Ik [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2008-02-15

    Ewing's sarcoma is a malignant bone tumor that can occur anywhere in the body, but it is most commonly observed in the long bones of the arms and legs, the pelvis and in the chest. The predominant sites of metastasis include the lung (38%), bone (including the spine; 31%), and the bone marrow (11%). Metastasis of Ewing's sarcoma to the central nervous system (CNS) is relatively rare, and most of the previous reports have demonstrated involvement of the bony calvarium or brain parenchyma. We describe here the imaging findings of dural metastasis of Ewing's sarcoma, and these imaging findings have not been previously reported on in the medical literature. In conclusion, dural metastasis of Ewing's sarcoma is very rare and its imaging characteristics are similar to those of a primary tumor, which mimic the findings of a schwannoma or meningioma. Despite its rarity, secondary Ewing's sarcoma may be included in the differential diagnosis of extra-axial dural masses.

  10. The anterior medullary-anterior pontomesencephalic venous system and its bridging veins communicating to the dural sinuses: normal anatomy and drainage routes from dural arteriovenous fistulas

    International Nuclear Information System (INIS)

    Kiyosue, Hiro; Tanoue, Shuichi; Sagara, Yoshiko; Okahara, Mika; Kashiwagi, Junji; Mori, Hiromu; Hori, Yuzo; Nagatomi, Hirofumi

    2008-01-01

    We evaluated the normal venous anatomy of the anterior medullary/anterior pontomesencephalic venous (AMV/APMV) system and bridging veins connected to the dural sinuses using magnetic resonance (MR) imaging and demonstrated cases of dural arteriovenous fistulas (DAVFs) with bridging venous drainage. MR images obtained using a 3D gradient echo sequence in 70 patients without lesions affecting the deep or posterior venous channels were reviewed to evaluate the normal anatomy of the AMV/APMV system and bridging veins. MR images and digital subtraction angiography in 80 cases with intracranial or craniocervical junction DAVFs were reviewed to evaluate the bridging venous drainage from DAVFs. MR images clearly revealed AMV/APMV in 35 cases. Fifteen cases showed a direct connection between AMV and APMV, while 15 cases showed an indirect communication via the transverse pontine vein or the bridging vein. In the five remaining cases, the AMV and APMV end separately to the bridging vein or the transverse pontine vein. Bridging veins were identified in 34 cases, connecting to the cavernous sinus in 33, to the suboccipital cavernous sinus in 11, and the inferior petrosal sinus in five cases. In 80 DAVF cases, seven of 40 cavernous sinus DAVFs, two craniocervical junction DAVFs, and one inferior petrosal sinus DAVF drained via bridging veins to the brain stem. The AMV/APMV and bridging veins showed various anatomies and frequently showed a connection to the cavernous sinus. Knowledge of the venous anatomy is helpful for the diagnosis and intravascular treatment of DAVFs. (orig.)

  11. Úlcera venosa e terapia compressiva para enfermeiros: desenvolvimento de curso online Úlcera venosa y terapia compresiva para enfermeros: desarrollo de un curso online Venous ulcer and compression therapy for nurses: development of online course

    Directory of Open Access Journals (Sweden)

    Fernanda Mateus Queiroz

    2012-01-01

    Full Text Available OBJETIVO: Descrever a elaboração de um curso on-line sobre úlcera venosa, com enfoque em terapia compressiva, para capacitação de enfermeiros. MÉTODOS: O desenvolvimento do curso on-line seguiu as fases de análise, design, desenvolvimento, implementação e avaliação, baseadas no design instrucional contextualizado. RESULTADOS: O curso dividiu-se em dez módulos estruturados no ambiente virtual de aprendizagem Moodle. Caracterizou-se por uma proposta construtivista, visando ampliar a participação do aluno, disponibilizar as principais referências, revisões e consensos, bem como utilizar objetos multimídia e recursos didáticos interativos. CONCLUSÃO: O curso possibilita a capacitação profissional do enfermeiro em terapia compressiva de maneira inovadora, flexível, interativa em diversos ambientes de cuidado.OBJETIVO: Describir la elaboración de un curso online sobre úlcera venosa, con enfoque en terapia compresiva, para la capacitación de enfermeros. MÉTODOS: El curso online se desarrolló siguiendo las fases de análisis, diseño, desarrollo, implementación y evaluación, basadas en el diseño instruccional contextualizado. RESULTADOS: El curso se dividió en diez módulos estructurados en el ambiente virtual de aprendizaje Moodle. Se caracterizó por una propuesta constructivista, pretendiendo ampliar la participación del alumno, poner a disposición las principales referencias, revisiones y consensos, así como utilizar objetos multimedia y recursos didácticos interactivos. CONCLUSIÓN: El curso permite la capacitación profesional del enfermero en terapia compresiva de manera innovadora, flexible, interactiva en diversos ambientes de cuidado.OBJECTIVE: To describe the development of an online course about venous ulcer, with a focus on compression therapy, for the educating of nurses. METHODS: The development of an online course followed the phases of analysis, design, development, implementation and evaluation, based

  12. Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study.

    Science.gov (United States)

    Guo, W-Y; Lee, C-C J; Lin, C-J; Yang, H-C; Wu, H-M; Wu, C-C; Chung, W-Y; Liu, K-D

    2017-01-01

    Sinus stenosis occasionally occurs in dural arteriovenous fistulas. Sinus stenosis impedes venous outflow and aggravates intracranial hypertension by reversing cortical venous drainage. This study aimed to analyze the likelihood of sinus stenosis and its impact on cerebral hemodynamics of various types of dural arteriovenous fistulas. Forty-three cases of dural arteriovenous fistula in the transverse-sigmoid sinus were reviewed and divided into 3 groups: Cognard type I, type IIa, and types with cortical venous drainage. Sinus stenosis and the double peak sign (occurrence of 2 peaks in the time-density curve of the ipsilateral drainage of the internal jugular vein) in dural arteriovenous fistula were evaluated. "TTP" was defined as the time at which a selected angiographic point reached maximum concentration. TTP of the vein of Labbé, TTP of the ipsilateral normal transverse sinus, trans-fistula time, and trans-stenotic time were compared across the 3 groups. Thirty-six percent of type I, 100% of type IIa, and 84% of types with cortical venous drainage had sinus stenosis. All sinus stenosis cases demonstrated loss of the double peak sign that occurs in dural arteriovenous fistula. Trans-fistula time (2.09 seconds) and trans-stenotic time (0.67 seconds) in types with cortical venous drainage were the most prolonged, followed by those in type IIa and type I. TTP of the vein of Labbé was significantly shorter in types with cortical venous drainage. Six patients with types with cortical venous drainage underwent venoplasty and stent placement, and 4 were downgraded to type IIa. Sinus stenosis indicated dysfunction of venous drainage and is more often encountered in dural arteriovenous fistula with more aggressive types. Venoplasty ameliorates cortical venous drainage in dural arteriovenous fistulas and serves as a bridge treatment to stereotactic radiosurgery in most cases. © 2017 by American Journal of Neuroradiology.

  13. Enfermedad tromboembólica venosa y cirrosis hepática Venous thromboembolism and liver cirrhosis

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    M. J. García-Fuster

    2008-05-01

    Full Text Available Objetivos: la enfermedad tromboembólica venosa (ETV es poco frecuente en la cirrosis hepática, no estando su tratamiento contemplado en las guías del American College of Chest Physicians. El objetivo del presente trabajo es aportar la experiencia de pacientes cirróticos con ETV hospitalizados en nuestro centro en los últimos 15 años. Material y método: de enero de 1992 a diciembre de 2007 fueron hospitalizados en nuestro centro 2.074 pacientes con cirrosis hepática. Presentaron una ETV no esplácnica 17, siendo ellos la población a estudio. Se recogen datos epidemiológicos y analíticos: hemograma, VSG, química hemática, coagulación, trombofilia congénita, anticuerpos antifosfolípidos (AAFL y homocisteinemia. Se valoran factores de riesgo adquiridos, características de la trombosis, el tratamiento y las complicaciones. Resultados y conclusiones: la ETV no esplácnica se observa en el 0,8% de pacientes cirróticos. En ellos es frecuente observar hipoalbuminemia, disminución de factores anticoagulantes (ATIII, PC, y PS, presencia de AAFL e hiperhomocisteinemia, así como la presencia de factores de riesgo adquiridos: intervenciones quirúrgicas, insuficiencia venosa, inmovilización e infecciones. Tras la anticoagulación, se observan complicaciones hemorrágicas mayores en el 35% de los pacientes.Objective: despite the endogenous coagulopathy of cirrhosis, some patients do experience thrombophilic states. The American College of Chest Physicians failed to address the prevention and treatment of venous thromboembolism (VTE occurring among these patients. This study aims to describe the characteristics of cirrhotics patients hospitalized in the last 15 years, and to use the experience gained. Material and method: we retrospectively reviewed all admissions for cirrhosis in our hospital from 1992 to 2007. A total of 17 patients had non-portal venous thromboembolic disease. We recorded risk factors, epidemiological and laboratory data

  14. Diagnóstico angiográfico dos hematomas subdurais: valor da fase venosa em incidência sagital

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    José Zaclis

    1955-12-01

    Full Text Available Êste trabalho tem por fim demonstrar o valor da fase venosa em incidência sagital no diagnóstico angiográfico dos hematomas subdurais. Êle é baseado em 8 casos verificados cirürgicamente, dois dos quais com hematoma bilateral, compreendendo um total de 10 hematomas subdurals demonstrados pela angiografia cerebral. Em 9 exemplares a elipse avascular que caracteriza essa entidade nosológica só apareceu na fase venosa; sòmente em um caso êsse sinal patognomônico foi claramente revelado na fase arterial em incidência ântero-posterior. O arteriograma mostra, apenas, às mais das vêzes, deslocamento da artéria cerebral anterior e seus ramos para o lado oposto àquele em que se encontra o hematoma, como acontece nos casos de lesões expansivas em geral. Menos freqüentemente os principais troncos arteriais do encéfalo não sofrem modificações no seu trajeto, apesar do espaço intracraniano ocupado pelos hematomas. A existência de hematoma subdural no interior de um hemicrânio sem desvio da artéria cerebral anterior, embora não implique necessàriamente na existência de outra coleção sangüínea do lado oposto, é altamente sugestiva dessa dupla lesão. A exploração bilateral nesses casos é, portanto, obrigatória. Dos três casos desta série em que a angiografia em um dos lados revelou a elipse avascular característica e artéria cerebral anterior com trajeto normal, a angiografia do lado oposto resultou positiva em dois dêles e negativa em um. Pôsto que alguns Serviços especializados não sejam dotados de equipamento para angiografia em séries, o autor recomenda o flebograma em incidência sagital como tempo obrigatório, mesmo que para tanto seja necessária nova injeção de contraste.

  15. Existe associação entre doenças venosas e nível de atividade física em jovens?

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    Júlio César Oliveira Pena

    Full Text Available INTRODUÇÃO: A associação dos benefícios da prática regular da atividade física a indicadores de saúde encontra-se amplamente discutida na literatura evidenciando a relação de um estilo de vida sedentário com as doenças crônicas degenerativas. OBJETIVO: Descrever a prevalência de doenças venosas entre jovens e sua associação com a atividade física. MATERIAIS E MÉTODOS: Corte transversal. Amostra: jovens voluntários. Os indivíduos responderam a uma ficha clínica e foram examinados por meio do sistema de classificação clínica, etiológica, anatômica e patofisiológica (CEAP, que classifica a gravidade e a incapacidade para o trabalho de pessoas com doenças venosas; eles responderam também ao questionário internacional de atividade física (IPAQ. RESULTADOS: Participaram 95 indivíduos, sendo 57,9% (55 mulheres, tendo como média de idade 26,12 ± 4,5 (18H35. De acordo com o IPAQ, os indivíduos foram classificados em categoria 1 (inativos: 41,1%; categoria 2 (moderadamente ativos: 49,5%; e categoria 3 (ativos: 9,5%. Houve diferença entre os níveis de atividade física entre homens e mulheres (p = 0,02. Na classificação da CEAP foram encontrados: classe 0 = 43,2%; classe 1 = 45,3%; classe 2 = 11,6%, já as demais classes não apareceram na amostra. Mulheres apresentaram maior frequência de doenças vasculares que homens (p < 0,001. O maior nível de atividade física esteve associado com a menor prevalência de doenças venosas periféricas (p = 0,02. CONCLUSÕES: Na amostra foi encontrada prevalência elevada de doenças venosas, maior entre mulheres. Foi elevado o número de indivíduos considerados sedentários pelo IPAQ, sendo os homens mais ativos quando comparados às mulheres. Os indivíduos com maior nível de atividade física apresentaram menor frequência de doenças venosas.

  16. Avaliação da memória sob anestesia venosa total Evaluación de la memoria bajo anestesia venosa total The assessment of memory under total intravenous anesthesia

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    Gulistan Aktas

    2013-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Neste estudo, objetivamos avaliar a memória implícita e explícita em pacientes submetidos à cirurgia abdominal sob anestesia venosa total (AVT com propofol e remifentanil, na qual o nível de anestesia foi controlado pelo monitoramento do índice bispectral (BIS. MÉTODO: Anestesia venosa total foi administrada a 60 pacientes adultos para obter níveis de BIS de 40-60. Os pacientes foram randomicamente divididos em três grupos, de acordo com as gravações que ouviram. Os pacientes do grupo categoria (CT ouviram uma fita gravada contendo cinco nomes de animais. Os pacientes do grupo recordar palavras (RP ouviram uma fita gravada contendo cinco palavras de frequência média na língua turca, depois de adaptadas. Os pacientes do grupo controle (GC ouviram os sons do mar até o fim da cirurgia. Duas horas após a cirurgia, os testes foram administrados a cada paciente na sala de recuperação para avaliar a memória. RESULTADOS: Houve uma diferença entre os escores dos grupos CT e GC no Miniexame do Estado Mental (MMSE; todos os escores foram > 20. Os resultados dos testes de categoria e recordar palavras, aplicados para avaliar a memória implícita, não foram estatisticamente diferentes entre os grupos. Não houve evidência de memória implícita em nenhum dos pacientes. Um paciente lembrou-se de ouvir "o som de água" como uma prova de memória explícita. Onze pacientes declararam não ter sonhado. CONCLUSÕES: Apesar de não termos encontrado nenhuma evidência de memória implícita sob anestesia adequada com AVT, um paciente apresentou memória explícita. Embora a profundidade adequada da anestesia fornecida pelo monitoramento do BIS corrobore nossos resultados para a memória implícita, ela não explica os resultados para a memória explícita.JUSTIFICATIVA Y OBJETIVOS: En este estudio evaluamos la memoria implícita y explícita en pacientes sometidos a la cirugía abdominal bajo anestesia venosa total

  17. Malformação de veia cava inferior e trombose venosa profunda: fator de risco de trombose venosa em jovens Inferior vena cava malformation and deep venous thrombosis: a risk factor of venous thrombosis in the young

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    Renan Roque Onzi

    2007-06-01

    Full Text Available A ausência da veia cava inferior, alteração no processo de formação embriológica que ocorre entre a sexta e a oitava semanas de gestação, é uma rara anomalia congênita. Porém, recentemente foi confirmada como sendo um fator de risco importante para o desenvolvimento de trombose venosa profunda, especialmente em jovens. Apresentamos um caso de trombose em veias cava inferior, ilíacas, femorais e poplíteas num jovem de 16 anos com agenesia de um segmento de veia cava infra-renal e veia renal esquerda retroaórtica.Absence of inferior vena cava, caused by aberrant development within the sixth to eighth weeks of gestation, is a rare congenital anomaly. However, it has been recently confirmed as a major risk factor for the development of deep venous thrombosis, especially in young patients. We report a case of inferior vena cava, iliac, femoral and popliteal vein thrombosis in a 16-year-old patient with inferior vena cava agenesis and retroaortic left renal vein.

  18. Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

    International Nuclear Information System (INIS)

    Knirsch, Walter; Kurtz, Claudia; Langer, Mathias; Haeffner, Nicole; Kececioglu, Deniz

    2005-01-01

    The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

  19. Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Knirsch, Walter [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany); University Children' s Hospital Zurich, Division of Paediatric Cardiology, Zurich (Switzerland); Kurtz, Claudia; Langer, Mathias [University Hospital Freiburg, Department of Radiology, Freiburg (Germany); Haeffner, Nicole; Kececioglu, Deniz [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany)

    2005-04-01

    The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

  20. Transcutaneous Drainage of Gel-Like Substance after Application of Hydrogel Dural Sealant: Report of Two Cases.

    Science.gov (United States)

    Siman, Homayoun; Techy, Fernando

    2016-02-01

    Study Design Case report. Objective Incidental durotomy (IDT) is a common complication of spinal surgery. The use of collagen matrix graft along with hydrogel dural sealant is a common method of IDT repair. With this method, there have been several reported cases of detrimental dural sealant expansion in the literature. One case study reported an expansion rate greater than 300%; many report neurologic damage. This article reports the clinical course of two patients who developed postoperative transcutaneous drainage of a gel-like substance after the use of a dural sealant, which is a previously unreported complication. Methods The clinical course and treatment outcome of two patients is presented. Results Both patients experienced postoperative transcutaneous drainage of a gel-like substance at the surgical site. Case one began draining this substance on postoperative day 14. This patient required no further intervention, and the drainage ended after 3 mL of a gel-like substance was expressed from his incision while in the clinic. Case two began draining the gel on postoperative day 16. This patient underwent two washout procedures and resolution of the drainage. No infection was ever detected. Conclusions To our knowledge, our patients are the first reported cases of transcutaneous drainage of expanded dural sealant. It is important to take into consideration the unexpected expansion of a dural sealant when using it for the repair of IDT.

  1. A method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus: the "mosquito" method.

    Science.gov (United States)

    Lee, Hee Chang; Lee, Ji Yeoun; Ryu, Seul Ki; Lim, Jang Mi; Chong, Sangjoon; Phi, Ji Hoon; Kim, Seung-Ki; Wang, Kyu-Chang

    2016-12-01

    The posterior fossa dural opening requires the ligation of the occipital sinus to gain successful exposure. However, there could be a prominent occipital sinus which is functioning as the main drainage route and is harboring the risk of unpredictable massive hemorrhage during the dural opening. We introduce a safe method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus using four curved hemostat clamps. For the dural incision at the midline part of the posterior cranial fossa, we used four curved hemostat clamps to occlude the prominent occipital sinus: one pair of clamps at the proximal part and the other pair at the distal part to occlude the occipital sinus. Dural incision was made between the two pairs of the curved hemostat clamps. By clamping of the sinus, it allows observation of possible brain swelling after occlusion of the occipital sinus as well as minimizes hemorrhage during incision of the midline dura of the posterior fossa. This method allows observation of brain swelling after occipital sinus occlusion and is an easy and safe incision of the midline dura minimizing hemorrhage in selected cases with a prominent occipital sinus.

  2. Haemocyanins from Rapana venosa and Helix vulgaris display an antitumour activity via specific activation of spleen lymphocytes

    International Nuclear Information System (INIS)

    Iliev, I.; Toshkova, R.; Yossifova, L.; Zacharieva, S.; Dolashka-Angelova, P.; Hristova, R.; Yaneva, J.

    2008-01-01

    We have determined and analysed some immuno-adjuvant properties of haemocyanins isolated from the haemolymph of the snails Rapana venosa (RvH) and Helix vulgaris (HvH) acting via activation of cell-mediated immunity. As a result of nonspecific activation of the immune system in tumour-bearing animals treated with RvH and HvH, an increased resistance against Guerin ascites tumour progression was observed in comparison with controls (non-immunized animals). The investigations were focused on elucidation of the different mechanisms of immune response of spleen lymphocytes from experimental animals preliminary immunized with vaccines supplemented with either RvH or HvH. Experimental data showed significant immune activation, much higher than that in the control group immunized with Keyhole limpet haemocyanin (KLH). Supporting these data are the results on the survival rate determination of tumour-bearing animals immunized with each of the haemocyanins or conjugates haemocyanin/tumour antigen showing highest survival in animals treated with HvH, RvH and KLH in comparison with non immunized animals. (authors)

  3. Deep electrical resistivity tomography and geothermal analysis of Bradano foredeep deposits in Venosa area (Southern Italy: preliminary results

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    V. Lapenna

    2008-06-01

    Full Text Available Geophysical surveys have been carried out to characterize the stratigraphical and structural setting and to better understand the deep water circulation system in the Venosa area (Southern Italy located in the frontal portion of the southern Appenninic Subduction. In this area there are some deep water wells from which a water conductivity of about 3 mS/cm and a temperature of about 35°C was measured. A deep geoelectrical tomography with dipole-dipole array has been carried out along a profile of 10000 m and an investigation depth of about 900 m. Furthermore a broad band magnetotelluric profile consisting of six stations was performed to infer the resistivity distribution up to some kilometres of depth. The MT profile was almost coincident with the geoelectrical outline. The applied methods allow us to obtain a mutual control and integrated interpretation of the data. The high resolution of the data was the key to reconstruct the structural asset of buried carbonatic horst whose top is located at about 600 m depth. The final results coming from data wells, geothermal analysis and geophysical data, highlighted a horst saturated with salted water and an anomalous local gradient of 60°C/km. The proposed mechanism is that of a mixing of fossil and fresh water circulation system.

  4. Manejo anestésico de paciente com síndrome de Cri Du Chat (miado do gato: relato de caso

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    Klaus Morales dos Santos

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A síndrome de Cri Du Chat é uma desordem cromossômica com características clínicas peculiares, incluindo anormalidades de vias aéreas, que exigem do anestesiologista cuidados especiais no manuseio desses pacientes. OBJETIVO: Apresentar um caso de anestesia ambulatorial em paciente com síndrome de Cri Du Chat e abordar os aspectos anestésicos relacionados com essa doença. RELATO DO CASO: Paciente do sexo masculino, 14 anos, 25 kg, portador de síndrome de Cri Du Chat, estado físico ASA P2, admitido para realização de endoscopia digestiva alta e dilatação esofagiana. Quadro neurológico com retardo mental, alguns episódios de convulsões e hipertonia acentuada de membros. Exame das vias aéreas demonstrando mobilidade cervical limitada e distância tireomentoniana inferior a 6 cm. Paciente não atendia ao comando verbal, sendo difícil a avaliação completa das vias aéreas. Outros achados ao exame físico incluíram microcefalia, micrognatia, discreto estrabismo, hipertonia de membros em flexão e protrusão de língua. Administrados, por via venosa, 50 µg de citrato de fentanila, 1 mg de midazolam e 60 mg de propofol. Mantido em ventilação espontânea. Procedimento com duração de 5 minutos, realizado sem intercorrências. CONCLUSÕES: Pacientes com síndrome de Cri Du Chat apresentam características clínicas de grande relevância no manejo anestésico, cabendo ao anestesiologista considerar com cautela as particularidades estruturais de cada paciente.

  5. ''Dural tail'' adjacent to a giant posterior cerebral artery aneurysm: case report and review of the literature

    International Nuclear Information System (INIS)

    Good, C.D.; Kingsley, D.P.E.; Taylor, W.J.; Harkness, W.F.

    1997-01-01

    The ''dural tail'' sign on gadolinium (Gd-DTPA)-enhanced MRI has been described in association with meningiomas. Various series with histopathological correlation have shown that in some cases there is tumour invasion into the dura mater, but in the majority of cases it represents a hypervascular, non-neoplastic reaction. While this sign was originally thought to be specific for meningioma, subsequent case reports have described the presence of a dural tail in other intra- and extra-axial lesions. We present a patient with a giant aneurysm arising from the P2 segment of the right posterior cerebral artery, adjacent to the tentorium, with a prominent dural tail on Gd-DTPA-enhanced MRI. In this location, differentiation of an aneurysm from a meningioma was critical. (orig.). With 2 figs

  6. Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization

    International Nuclear Information System (INIS)

    Tian, Bing; Xu, Bing; Lu, Jianping; Liu, Qi; Wang, Li; Wang, Minjie

    2015-01-01

    Highlights: • 4D CTA showed excellent agreement with DSA with regard to identification of feeding arteries and drainage veins. • The most important finding was 4D CTA in determining the impact of DAVF treatment with transarterial embolization. • 4D CTA provides images similar to those obtained with DSA both before and after treatment. - Abstract: Purpose: This study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA. Patients and Methods: Eleven patients with cranial dural arteriovenous fistulas detected on DSA underwent transarterial embolization with ONYX-18. Four-dimensional CTA was performed an average of 2 days before and 4 days after DSA. Four-dimensional CTA and DSA images were reviewed by two neuroradiologists for identification of feeding arteries and drainage veins and for determining treatment effects. Interobserver and intermodality agreement between four-dimensional CTA and DSA were assessed. Results: Forty-two feeding arteries were identified for 14 fistulas in the 11 patients. Of these, 36 (85.71%) were detected on four-dimensional CTA. After transarterial embolization, one patient got partly embolized, and the fistulas in the remaining 10 patients were completely occluded. The interobserver agreement for four-dimensional CTA and intermodality agreement between four-dimensional CTA and DSA were excellent (κ = 1) for shunt location, identification of drainage veins, and fistula occlusion after treatment. Conclusion: Four-dimensional CTA images are highly accurate when compared with DSA images both before and after transarterial embolization treatment. Four-dimensional CTA can be used for diagnosis as well as follow-up of cranial dural arteriovenous fistulas in clinical settings

  7. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, M. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Universitaetsklinikum Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Henkes, H.; Liebig, T.; Weber, W.; Golik, S.; Kuehne, D. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Esser, J. [Universitaetsklinikum Essen, Zentrum fuer Augenheilkunde, Essen (Germany)

    2006-07-15

    Introduction: The purpose of this study was to evaluate the single-centre experience with transvenous coil treatment of dural carotid-cavernous sinus fistulas. Methods: Between November 1991 and December 2005, a total of 141 patients (112 female) with dural carotid-cavernous sinus fistula underwent 161 transvenous treatment sessions. The patient files and angiograms were analysed retrospectively. Clinical signs and symptoms included chemosis (94%), exophthalmos (87%), cranial nerve palsy (54%), increased intraocular pressure (60%), diplopia (51%), and impaired vision (28%). Angiography revealed in addition cortical drainage in 34% of the patients. Partial arterial embolization was carried out in 23% of the patients. Transvenous treatment comprised in by far the majority of patients complete filling of the cavernous sinus and the adjacent segment of the superior and inferior ophthalmic vein with detachable coils. Complete interruption of the arteriovenous shunt was achieved in 81% of the patients. A minor residual shunt (without cortical or ocular drainage) remained in 13%, a significant residual shunt (with cortical or ocular drainage) remained in 4%, and the attempted treatment failed in 2%. There was a tendency for ocular pressure-related symptoms to resolve rapidly, while cranial nerve palsy and diplopia improved slowly (65%) or did not change (11%). The 39 patients with visual impairment recovered within the first 2 weeks after endovascular treatment. After complete interruption of the arteriovenous shunt, no recurrence was observed. The transvenous coil occlusion of the superior and inferior ophthalmic veins and the cavernous sinus of the symptomatic eye is a highly efficient and safe treatment in dural carotid-cavernous sinus fistulas. In the majority of patients a significant and permanent improvement in clinical signs and symptoms can be achieved. (orig.)

  8. The internal vertebral venous plexus prevents compression of the dural sac during atlanto-axial rotation

    Energy Technology Data Exchange (ETDEWEB)

    Reesink, E.M.; Lataster, L.M.A.; Mameren, H. van [Dept. of Anatomy/Embryology, Maastricht Univ. (Netherlands); Wilmink, J.T. [Dept. of Radiology, University Hospital Maastricht (Netherlands); Kingma, H. [Dept. of ENT, University Hospital Maastricht (Netherlands)

    2001-10-01

    Deformation of the extradural space and the possibility of impression upon the dural sac during atlanto-axial rotation are investigated. Atlanto-axial rotation leads to a reduction in the cross-sectional area of the bony spinal canal of approximately 40 %. Atlanto-axial rotation was recorded by endocanalar views from a video camera fixed inside the skull of six unembalmed cadavers. Axial thin-section T1-weighted MRI slice sets were acquired from three volunteers (mid-position and maximal left and right rotation of the head and cervical spine). The axial cross-sectional areas of the bony spinal canal, dural sac and spinal cord were measured. In two other persons post-gadolinium contrast-enhanced T1-weighted MRI volume scans with fat-suppression prepulse were acquired (mid-position and rotation) to determine venous contents of the extradural space. The 50:50 ratio between left and right extradural halves in mid-position changed to an ipsilateral:contralateral ratio of 20:80 in maximum rotation at the level just above the lateral C1-C2 joints. Directly below these joints the opposite occurred. The post-contrast studies showed an enhancing internal vertebral venous plexus (IVVP), which almost completely occupied the extradural space at the atlanto-axial level. This could not be shown in the cadaver experiments, because of absence of blood and cerebrospinal fluid (CSF) pressure. During atlanto-axial rotation blood displacement in the IVVP allows major deformations of the extradural space. This prevents dural sac impression. (orig.)

  9. Dural venous sinuses distortion and compression with supratentorial mass lesions: a mechanism for refractory intracranial hypertension?

    Science.gov (United States)

    Qureshi, Adnan I.; Qureshi, Mushtaq H.; Majidi, Shahram; Gilani, Waqas I.; Siddiq, Farhan

    2014-01-01

    Objective To determine the effect of supratentorial intraparenchymal mass lesions of various volumes on dural venous sinuses structure and transluminal pressures. Methods Three set of preparations were made using adult isolated head derived from fresh human cadaver. A supratentorial intraparenchymal balloon was introduced and inflated at various volumes and effect on dural venous sinuses was assessed by serial intravascular ultrasound, computed tomographic (CT), and magnetic resonance (MR) venograms. Contrast was injected through a catheter placed in sigmoid sinus for both CT and MR venograms. Serial trasluminal pressures were measured from middle part of superior sagittal sinus in another set of experiments. Results At intraparenchymal balloon inflation of 90 cm3, there was attenuation of contrast enhancement of superior sagittal sinus with compression visualized in posterior part of the sinus without any evidence of compression in the remaining sinus. At intraparenchymal balloon inflation of 180 and 210 cm3, there was compression and obliteration of superior sagittal sinus throughout the length of the sinus. In the coronal sections, at intraparenchymal balloon inflations of 90 and 120 cm3, compression and obliteration of the posterior part of superior sagittal sinus were visualized. In the axial images, basal veins were not visualized with intraparenchymal balloon inflation of 90 cm3 or greater although straight sinus was visualized at all levels of inflation. Trasluminal pressure in the middle part of superior sagittal sinus demonstrated a mild increase from 0 cm H2O to 0.4 cm H2O and 0.5 cm H2O with inflation of balloon to volume of 150 and 180 cm3, respectively. There was a rapid increase in transluminal pressure from 6.8 cm H2O to 25.6 cm H2O as the supratentorial mass lesion increased from 180 to 200 cm3. Conclusions Our experiments identified distortion and segmental and global obliteration of dural venous sinuses secondary to supratentorial mass lesion and

  10. Headache in the parturient: Pathophysiology and management of post-dural puncture headache

    Directory of Open Access Journals (Sweden)

    Gita Nath

    2011-01-01

    Full Text Available Headache in the postpartum period is common and multifactorial in origin. Apart from primary causes such as tension headaches and migraine, secondary headaches such as post-dural puncture headache (PDPH are increasingly common because of increasing use of regional anaesthesia and analgesia during childbirth. Preventive measures for PDPH include the use of smaller gauge pencil-point needles for spinal blocks; epidural needles of 18 G or less; using saline rather than air for epidural space identification and the use of ultrasound guidance, especially for difficult cases such as morbid obesity and spinal deformities. In case of accidental dural puncture (ADP, the choice is between inserting the catheter in an adjacent space or intrathecal catheterization. Current evidence seems to be in favour of inserting the epidural catheter into the subarachnoid space and using the intrathecal catheter for analgesia/anaesthesia after prominently labelling it as intrathecal, to prevent misuse. It should be removed after at least 24 hours and a 10 ml bolus of saline injected before removal of catheter may be helpful. Either way, having written protocols for the management of accidental dural puncture helps to reduce the incidence of PDPH. PDPH can be disabling in severity and can mar the whole experience of childbirth. In addition, severe untreated PDPH can cause complications such as nerve palsies, subdural hematoma and cerebral venous thrombosis. Conservative methods of treatment should be tried first such as adequate hydration, paracetamol, caffeine, sumatriptan or ACTH/hydrocortisone. Epidural blood patching is the most effective treatment for PDPH. It is more effective if done 24-48 hours after dural puncture. It is an invasive procedure with its own complications as well as a failure rate of up to 30%, so that a second or even third patch may be necessary. Both these facts should be intimated to the patient beforehand. Meticulous follow-up and evaluation

  11. Persistent dural cerebrospinal fluid leak shown by retrograde radionuclide myelography: case report

    International Nuclear Information System (INIS)

    Kadrie, H.; Driedger, A.A.; McInnis, W.

    1976-01-01

    Following inadvertent spinal anesthesia for delivery, a patient developed incapacitating post-lumbar puncture headache that persisted for 9 weeks. Scintigrams of the lumbar region, obtained after injection of /sup 99m/Tc-human serum albumin into the cisterna magna, showed the cerebrospinal fluid leak. Blood patch repair was carried out, with immediate relief of all symptoms. Because of subsequent atypical headaches, a second cisternogram was done by the same technique. This study confirmed that there was no further dural leak, and other evidence indicated that the recurrent headache was related to functional problems

  12. Conduta na lesão dural intraoperatória em artrodese da coluna lombar

    OpenAIRE

    Grandese, Fabiano de Mendonça; Yamazato, Clóvis; Oliveira, Fábio Mastromauro de; Ribeiro, Iberê; Bastos Júnior, José Olympio Catão; Kusabara, René

    2010-01-01

    OBJETIVO: estudo retrospectivo de pacientes com lesão dural intraoperatória de cirurgia da coluna vertebral lombar, conduzido por meio de um protocolo independente da extensão da lesão, complicações associadas e resultados após seguimento mínimo de um ano. MÉTODOS: um total de 10 pacientes com durotomia acidental em cirurgias de descompressão e artrodese da coluna vertebral lombar, no período de Janeiro de 2007 a Janeiro de 2009, para tratamento de doença degenerativa, tiveram seus prontuário...

  13. Dynamic subtraction magnetic resonance venography: a new real time imaging technique for the detection of dural sinus thrombosis

    International Nuclear Information System (INIS)

    Mandel, C.; Birchall, D.; Connolly, D.; English, P.

    2002-01-01

    Full text: Requests for imaging suspected dural sinus thrombosis are increasing. Conventional magnetic imaging (MRI) and magnetic resonance venography (MRV) are often used to detect venous sinus thrombosis, but these techniques are prone to technical problems. Catheter angiography is sometimes required as the final arbiter in the evaluation of the dural venous sinuses. Recent technical developments in MR scanning have allowed the development of dynamic subtraction MRA. This technique is beginning to be applied to the assessment of intracranial vascular malformations. We have recently applied the technique to the imaging of the dural venous sinuses, and describe our early experience with the technique. Imaging was performed on a Philips Intera 1.5T scanner with gradient strength 33 mT and slew rate 130 T/m/sec. T1-weighed fast field echo imaging was performed (flip angle 400, TR 1.5 msec) during bolus injection of gadolinium (5ml gadolinium followed by a 10 ml saline chaser) at 5-6 ml/sec using a MRI-compatible pump injector. Slice thickness depended on the plane of acquisition, but was between 100- 150 mm. Images were acquired in three orthogonal projections in each case, using 3 separate contrast injections. Mask images were obtained before the arrival of contrast, and subtracted reconstructed images were obtained in real time, providing a dynamic display of the intracranial circulation including the dural venous sinuses. Frame rate was 1 frame per 0.8 seconds. We will present dynamic MR angiographic images in a number of patients. Normal appearances and those seen in venous sinus thrombosis will be presented in the video display. Dynamic MR venography is a new technique for the imaging of dural venous sinuses. In our practice, it has proved a valuable adjunct for the imaging of patients with dural venous sinus thrombosis. Copyright (2002) Blackwell Science Pty Ltd

  14. Relato de caso: transtorno afetivo bipolar

    Directory of Open Access Journals (Sweden)

    Carlos Von Krakauer Hübner

    2016-10-01

    Full Text Available Introdução: O transtorno afetivo bipolar (TAB é uma doença crônica e grave, marcada pela variância de episódios depressivos com episódios de mania ou hipomania, podendo haver sintomas psicóticos. É classificado em dois tipos, I e II. Sua etiologia é desconhecida, mas supõe-se que envolva influências genéticas e ambientais, variando a cada indivíduo afetado. As apresentações clínicas do TAB podem variar de episódios leves de depressão ou hipomania até episódios depressivos graves ou mania acompanhados ou não de sintomas psicóticos. Objetivos: Relatar o caso de um paciente internado na enfermaria da psiquiatria do Conjunto Hospitalar de Sorocaba que foi diagnosticado com TAB. Metodologia: As informações foram obtidas por meio de revisão do prontuário, entrevista com o paciente e revisão da literatura. Relato de Caso: Homem de 20 anos encaminhado do serviço hospitalar de Itapetininga após alteração de comportamento, heteroagressividade e alucinações auditivas. Conclusões: Transtorno depressivo maior, de ansiedade generalizada, de estresse pós-traumático e esquizofrenia são diagnósticos diferenciais. O episódio maníaco provoca prejuízo no funcionamento social, profissional e até necessidade de hospitalização. O risco de suicídio em pessoas com TAB é estimado em pelo menos 15 vezes o da população em geral. A taxa de não adesão ao tratamento no TAB é de 47%. A conduta terapêutica medicamentosa mais eficaz para a mania é a associação do carbonato de lítio com risperidona, já para a depressão bipolar o carbonato de lítio é a primeira escolha.

  15. Eritema polimorfo farmacoinduzido: relato de caso

    Directory of Open Access Journals (Sweden)

    Lais Orosco Bialon Santana

    2014-10-01

    Full Text Available Introdução: Farmacodermias são queixas comuns devendo ser diferenciadas para o tratamento e a investigação precoce de complicações. O eritema polimorfo é uma doença inflamatória caracterizada por lesões em alvo que permanecem fixas por mais de 6 dias. As etiologias são medicamentosa (anticonvulsivantes, antibióticos e anti- inflamatórios e infecções, sendo o vírus herpes o mais relacionado. Classificado na forma minor, associado a infecções, sem sintomas sistêmicos ou lesões mucosas, e major, com padrão inflamatório e mucoso, considerado forma leve da síndrome de Stevens-Johnson. O diagnóstico é clínico e histopatológico. Relato de Caso: Paciente epilética, com diagnóstico de infecção de via aérea há 12 dias tratada com amoxicilina, ibuprofeno, ácido acetil salicílico e loratadina. Após 10 dias, apresentou edema, prurido, eritema, e bolhas por todo corpo, acompanhadas de febre, dispnéia e odinofagia, além de uma convulsão tônico clônica com perda da consciência. Devido à epilepsia, fazia uso de fenobarbital, o qual foi ajustado há 3 dias (50mg para 100mg/dia. Feito diagnóstico, feito hidrocortisona IV, dipirona e cuidados de suporte. Evoluiu com leucocitose e aumento de PCR, introduziu-se ceftriaxona e aciclovir. Houve em uma semana, melhora das lesões cutâneas e estado geral da paciente. Conclusão: As principais causas de farmacodermias são anticonvulsivantes e anti- inflamatórios, usados pela paciente. Alguns medicamentos estão mais associados à certos padrões de lesão, colaborando para o diagnóstico, confirmado através da biopsia cutânea. Frente aos quadros de eritema, as farmacodermias devem ser aventadas como importante diagnóstico diferencial. O fator causal deve ser identificado a fim do tratamento adequado e diminuição da morbidade.

  16. Malformação venosa associada a hiperelasticidade cutânea e atrofia do tecido subcutâneo

    Directory of Open Access Journals (Sweden)

    Ana Julia de Deus Silva

    2016-01-01

    Full Text Available Resumo A rigidez da parede venosa pode aumentar em síndromes em que há uma redução da quantidade de elastina, ocasionando malformações venosas mesmo em indivíduos que possuem mosaicismo para tais síndromes. Casos com apresentação de afecções colagenosas em áreas delimitadas não foram descritos na literatura. O paciente apresentava lesão bem delimitada em região anteromedial da coxa com aumento de elasticidade e presença de vasos tortuosos apenas no local da lesão, não apresentando nenhuma síndrome colagenosa. Foi realizada uma biópsia que evidenciou alterações em relação ao padrão das fibras elásticas e proliferação de vasos sanguíneos. A malformação venosa foi tratada satisfatoriamente com embolização. As doenças do colágeno causam hiperextensibilidade cutânea, o que provoca flacidez e propicia traumas. As colagenoses bem delimitadas são raras, pois geralmente esse grupo de doenças envolve acometimento sistêmico. As malformações vasculares podem ocorrer em diversas doenças do colágeno, mas de forma generalizada e não localizada, e uma explicação para isso seria o mosaicismo genético.

  17. Trombosis venosa subclavia asociada a electrodo de marcapasos y síndrome de la plaqueta pegajosa

    Directory of Open Access Journals (Sweden)

    Carolina Ocampo-Salgado

    2018-03-01

    Full Text Available Resumen: El síndrome de la plaqueta pegajosa en un trastorno cualitativo plaquetario en el que bajas concentraciones de epinefrina y adenosina difosfato producen hiperagregabilidad plaquetaria considerable. Se ha especulado mucho sobre la etiología de este trastorno sin que sean claros sus mecanismos fisiopatológicos. Desde el punto de vista clínico, se asocia a trombosis arteriales y venosas recurrentes en pacientes jóvenes, pérdidas gestacionales, otras complicaciones obstétricas y cefalea recurrente.En la literatura se ha descrito su presentación familiar, lo que hace sospechar su comportamiento hereditario autosómico dominante; también se ha reportado un fenotipo adquirido de la enfermedad en algunas poblaciones especiales como pacientes con enfermedad renal crónica en terapia de reemplazo renal o posterior al trasplante renal y en pacientes con cuadros inflamatorios o inmunosupresión. Se expone el caso de una paciente con antecedente de cefalea de difícil manejo, síndrome hipertensivo asociado al embarazo y mortinato, con síndrome del nodo enfermo y disautonomía manejadas con implantación de marcapasos definitivo bicameral con sensor CLS, que desarrolló trombosis de la vena subclavia, asociada al electrodo de marcapasos, recurrente a pesar de anticoagulación con warfarina y rivaroxabán e incluso a pesar de antiagregación con ácido acetilsalicílico, con posterior diagnóstico de síndrome de la plaqueta pegajosa. Abstract: Sticky platelet syndrome is a qualitative platelet disorder in which low concentrations of adrenaline and adenosine diphosphate produce considerable platelet hyperaggregability. There has been much speculation on the origin of this disorder as its pathophysiological mechanisms of action are not yet clear. From a clinical point of view, it is associated with recurrent arterial and venous thrombosis in young patients, miscarriages, other obstetric complications and recurrent headaches.Its familial

  18. Angio-OCT de la zona avascular foveal en ojos con oclusión venosa de la retina.

    Science.gov (United States)

    Wons, Juliana; Pfau, Maximilian; Wirth, Magdalena A; Freiberg, Florentina J; Becker, Matthias D; Michels, Stephan

    2017-07-11

    Objetivo: El objetivo del estudio comprendía visualizar y cuantificar las alteraciones patológicas de la zona avascular foveal (ZAF) mediante angio-OCT en ojos con oclusión venosa de la retina (OVR) en comparación con el ojo contralateral sano. Procedimientos: La angio-OCT se llevó a cabo mediante el sistema Avanti® RTVue 100 XR (Optovue Inc., Fremont, Calif., EE. UU.). Los bordes de la capa vascular superficial (CVS) se definieron como 3 μm por debajo de la membrana limitante interna y 15 μm por debajo de la capa plexiforme interna y, para la capa vascular profunda (CVP), como 15 y 70 μm por debajo de la membrana limitante interna y de la capa plexiforme interna, respectivamente. La longitud de la ZAF horizontal, vertical y máxima de la CVS y la CVP en cada ojo se midió de forma manual. Además, se midió el ángulo entre el diámetro máximo de la ZAF y el plano papilomacular. Resultados: La angio-OCT representó los defectos dentro de la vasculatura en el área perifoveal en ojos con oclusión de rama venosa de la retina (ORVR; n = 11) y con oclusión de la vena central de la retina (OVCR; n = 8). Esto resultó en un crecimiento del diámetro máximo de la ZAF en ojos con OVR (n = 19) en comparación con el ojo contralateral (n = 19; 921 ± 213 frente a 724 ± 145 µm; p = 0,008). Además, se observó una correlación significativa entre la mejor agudeza visual corregida (MAVC) y el diámetro máximo de la ZAF en la CVP (ρ de Spearman = -0,423, p < 0,01). Por último, en los ojos con OVR, el ángulo entre el plano papilomacular y el diámetro máximo de la ZAF se dio tan solo en el 21,05% (CVS) y en el 15,79% (CVP) de los casos a 0 ± 15 ó 90 ± 15°, respectivamente. En ojos sanos, estos ángulos (que supuestamente representan una configuración de la ZAF regular) fueron más prevalentes (CVS 68,42 frente a 21,05%, p = 0,003; CVP 73,68 frente a 15,79%, p < 0,001). Conclusiones: La angio-OCT muestra alteraciones morfológicas de la ZAF en ojos con

  19. Aneurisma y fístula arterio-venosa renal: manejo quirúrgico laparoscópico asistido por robot

    OpenAIRE

    CASTILLO C,OCTAVIO A; CUENTAS J,MARIANO; VIDANGOS V,RUBÉN; GUTIÉRREZ,RODRIGO; PALAVECINO R,PATRICIO

    2013-01-01

    Introducción: Los aneurismas de la arteria renal constituyen una patología infrecuente, y plantean dificultades en la decisión terapéutica. Objetivo: Presentar un caso de un aneurisma complejo intrarenal, asociado a una fístula arterio-venosa de alto flujo, el cual fue resuelto con asistencia robótica. Caso clínico: Paciente de 51 años, con historia prolongada de hipertensión arterial, al cual, en estudio radiológico de rutina, se le diagnostica 3 aneurismas intrarenales derechos, asociado a ...

  20. La Cateterización Venosa Central en la Fundación Santafé de Bogotá.

    Directory of Open Access Journals (Sweden)

    Sonia Echeverry de Pimiento

    2003-03-01

    Full Text Available

    De Seguimiento Asistencial a Indicador de Gestión.

    La introducción del catéter venoso central (CVC ha significado un gran avance en la medicina moderna y su uso generalizado ha permitido el desarrollo de nuevas técnicas diagnósticas y tratamientos especializados. La cateterización intravascular es uno de los procedimientos más comunes en la actualidad; se utiliza para la monitoria hemodinámica, hemodiálisis, el soporte metabólico y nutricional,
    la administración de líquidos, quimioterapia y antibioticoterapia prolongada, sangre y derivados, entre otros.
    A pesar de que se lleva casi 50 años de experiencia con estos accesos vasculares, se continúa buscando y aplicando nuevos métodos que permitan prevenir, diagnosticar y tratar las complicaciones relacionadas. Es de conocimiento general que la inserción de accesos venosos centrales y de lineas
    arteriales implica un riesgo reconocido de complicaciones mecánicas o técnicas (neumotórax, trombosis venosa, fístulas arteriovenosas, etc. e infecciosas locales o sistémicas, tales como tromboflebitis séptica, endocarditis, bacteriemia e infecciones metastásicas.

    Según el consenso del Hospitallnfection Control Practices Advisory Committee (HICPAC, las infecciones del torrente sanguíneo relacionadas con catéteres se asocian con incremento en las tasas de morbilidad y mortalidad del 10 al 20%, con estancias prolongadas y aumento en los costos de hospitalización, principalmente por la terapia antibiótica...


  1. Radiographic anatomy of the distal dural SAC; A myelographic investigation of dimensions and termination

    Energy Technology Data Exchange (ETDEWEB)

    Larsen, J.L.; Olsen, K.O. (Haukeland Sykehus, Bergen (Norway). Dept. of Diagnostic Radiology)

    1991-05-01

    A radio-anatomical study was performed of the distal dural sac (DS) in 121 patients subjected to myelography. In 83.4% the termination of the DS was located from the upper half of the S1-segment to the lower half of the S2-segment. In the remaining patients the dural terminations were more distally located. The average location of the DS-termination was higher than that found in a previous anatomic study. The inference is that in patients with low-back pain and sciatica, the DS tends to terminate at a higher spinal level than in a non-selected anatomic material. The caudal reduction in sagittal diameter of the DS was less than that of the frontal diameter of the sac. The linear diminution in cross-sectional area of the DS from the level of L3 towards the lumbosacral junction was not correlated with the degree of caudal extension of the DS into the sacrum. Thus the length of the DS and its transverse diameters are independent of each other. These results supported the view that the location of the termination of the DS (and hence that of the spinal cord) is not related to stenosis of the central spinal canal. (orig.).

  2. Spinal Dural Arteriovenous Fistula (SDAVF in a Patient with Progressive Paraparesia: A Case Report

    Directory of Open Access Journals (Sweden)

    Mehrdokht Mazdeh

    2016-07-01

    Full Text Available Background: Spinal dural arteriovenous fistula (SDAVF is a known cause of nontraumatic slow progressive araparesia and is frequently overlooked because its clinical features overlap with more common causes of myelopathy and also neuroimaging may be normal. Case Report: A 53 year-old man with developed weakness of both lower limbs had symptoms begun spontaneously 3.5 month before admission and progressed from 1 month ago with bowel and bladder incontinence. The patient's physical examination was normal and neurologic testing revealed lower extremity motor strength of 3/5. Deep tendon reflexes were decreased and superficial abdominal reflexes were absent. Sensation of pinprick and temperature was absent distal to the T4-T5 level. Vibration and proprioception were decreased to the ankle and saddle anesthesia and the patient was non ambulatory. Laboratory routine and specific tests for vitamin B12 level, hepatitis, HIV, HTLV1, 2 were negative. MRI of spine with and without contrast raised the possibility of dural arteriovenous malformation extended from T3 level to conus medullaris which was confirmed by angiography. The patient referred to neurosurgeon for deciding route of treatment. Conclusion: SDAVF can be a significant non traumatic slowly progressive cause of myelopathy. The majority of the affected patients are males older than 50 years of age. Rapid diagnosis in these patients leads to significant improvement.

  3. Indocyanine green videoangiography "in negative": definition and usefulness in intracranial dural arteriovenous fistulae.

    Science.gov (United States)

    Simal Julián, Juan Antonio; Miranda Lloret, Pablo; Aparici Robles, Fernando; Beltrán Giner, Andrés; Botella Asunción, Carlos

    2013-09-01

    Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae. Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure. In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae. In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization. IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

  4. Widening of the spinal canal and dural ectasia in Marfan's syndrome: assessment by CT

    International Nuclear Information System (INIS)

    Villeirs, G.M.; Verstraete, K.L.; Kunnen, M.F.; Tongerloo, A.J. van; Paepe, A.M. de

    1999-01-01

    We describe a method for diagnosing dural ectasia (DE) and spinal canal widening (SCW) using CT. We examined 23 patients with Marfan's syndrome (MFS), 17 with Ehlers-Danlos syndrome (EDS) and 29 normal subjects, using six axial slices at the level of the L1-S1 pedicles. Transverse diameters of the vertebral bodies, spinal canal and dural sac were measured and indices were defined to differentiate patients with DE and SCW from normal. Statistical significance was assessed using Student's t -test, χ 2 -test and Pearson's correlation coefficient. DE and SCW occurred in 69.6 % and 60.9 % of cases of MFS and in 23.5 % and 35.3 % of EDS respectively. In MFS, prevalence was significantly higher than in the control group. DE was significantly more frequent in MFS than in EDS. A strong correlation existed between DE and SCW in MFS and the control group, but not in EDS. Our system enables quantitative assessment of SCW and DE. The latter is particularly important in subjects suspected of having MFS, in whom it is a common and characteristic sign. (orig.)

  5. Dural sinus malformation (DSM) in fetuses. Diagnostic value of prenatal MRI and follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Merzoug, Valerie; Drissi, Cyrine; Adamsbaum, Catherine [Hopital Saint Vincent de Paul, Service de Radiopediatrie, Paris (France); Flunker, Sabrina; Couture, Alain [Hopital Arnaud de Villeneuve, Service de Radiopediatrie, Montpellier cedex 5 (France); Eurin, Danielle [Hopital Charles Nicolle, Service de Radiopediatrie, Rouen (France); Grange, Gilles [Hopital Cochin, Service de Gyneco-Obstetrique, Maternite Port-Royal, Paris (France); Garel, Catherine [Hopital Armand Trousseau, Service de Radiopediatrie, Paris (France); Richter, Brigitte [Hopital Clemenceau, Service de Radiopediatrie, Caen (France); Geissler, Frederic [Centre Hospitalier Universitaire, Service de Radiopediatrie, Clermont Ferrand (France)

    2008-04-15

    Dural sinus malformations (DSM) are rare malformations mainly reported after birth. The objectives of this study are to describe their prenatal patterns and to focus on their possible favorable outcome. This multicenter retrospective study reported 13 cases of DSM prenatally diagnosed. The admission criterion was a dural mass posterior to the vermis. In 12 patients, MRI was performed after US. Follow-up in 10 born babies (mean: 8 months) and three neuropathological examinations were available. In all fetuses, DSM presented as a well-delimited round mass involving the torcular. The follow-up examinations (n = 10) revealed progressive thrombosis of the DSM marked by a heterogeneous pattern (US and MRI) with concentric rings. The volume of the mass decreased, with complete regression in seven patients (five before and two after birth). One child died at the age of 5 months in the context of major hydrocephalus and another developed atrophy of the frontal lobes. The eight other babies were doing well (5 days to 3 years) without any treatment (n = 6) or following treatment for hydrocephalus (n = 2). Prenatal DSM may have a typical MR pattern, and the prognosis might not be as bad as has previously been reported. In the absence of criterion to predict the hydrovenous cerebral imbalance, it is mandatory to check the parenchyma and the ventricles during the pregnancy. (orig.)

  6. Dural sinus malformation (DSM) in fetuses. Diagnostic value of prenatal MRI and follow-up

    International Nuclear Information System (INIS)

    Merzoug, Valerie; Drissi, Cyrine; Adamsbaum, Catherine; Flunker, Sabrina; Couture, Alain; Eurin, Danielle; Grange, Gilles; Garel, Catherine; Richter, Brigitte; Geissler, Frederic

    2008-01-01

    Dural sinus malformations (DSM) are rare malformations mainly reported after birth. The objectives of this study are to describe their prenatal patterns and to focus on their possible favorable outcome. This multicenter retrospective study reported 13 cases of DSM prenatally diagnosed. The admission criterion was a dural mass posterior to the vermis. In 12 patients, MRI was performed after US. Follow-up in 10 born babies (mean: 8 months) and three neuropathological examinations were available. In all fetuses, DSM presented as a well-delimited round mass involving the torcular. The follow-up examinations (n = 10) revealed progressive thrombosis of the DSM marked by a heterogeneous pattern (US and MRI) with concentric rings. The volume of the mass decreased, with complete regression in seven patients (five before and two after birth). One child died at the age of 5 months in the context of major hydrocephalus and another developed atrophy of the frontal lobes. The eight other babies were doing well (5 days to 3 years) without any treatment (n = 6) or following treatment for hydrocephalus (n 2). Prenatal DSM may have a typical MR pattern, and the prognosis might not be as bad as has previously been reported. In the absence of criterion to predict the hydrovenous cerebral imbalance, it is mandatory to check the parenchyma and the ventricles during the pregnancy. (orig.)

  7. Effect of Hemoconcentration on Dural Sinus Computed Tomography Density in a Pediatric Population.

    Science.gov (United States)

    Yurttutan, Nursel; Kizildag, Betul; Sarica, Mehmet Akif; Baykara, Murat

    2016-10-01

    Unenhanced brain computed tomography (CT) is inexpensive, easily available, and the first-choice imaging modality for patients presenting with various neurologic symptoms. Venous thrombosis is not rare in childhood, but diagnosis can be difficult. In some cases, only denser vessels can be used to highlight an issue. The aim of this study was to retrospectively evaluate the relationship between X-ray attenuation and hemoconcentration in a pediatric population. This study enrolled 99 pediatric patients who had been referred radiology department for unenhanced brain CT. Images were retrospectively evaluated for measurement of dural sinus densities from four distinct dural sinus locations. Correlation between mean Hounsfield unit (HU) values and hemoglobin/hematocrit (Hb/Htc) levels, as well as age and gender were further analyzed. There was a strong correlation between mean HU and Hb levels (r = 0.411; standard deviation: 0.001) and also between mean HU and Htc levels (r = 0.393; p pediatric group. In conclusion, before deciding between a diagnosis of thrombosis and a determination of normal findings during an evaluation of unenhanced CT in a pediatric population, radiologists should consider complete blood count results as well as H:H ratios. Georg Thieme Verlag KG Stuttgart · New York.

  8. Standardization and validation of a novel and simple method to assess lumbar dural sac size

    International Nuclear Information System (INIS)

    Daniels, M.L.A.; Lowe, J.R.; Roy, P.; Patrone, M.V.; Conyers, J.M.; Fine, J.P.; Knowles, M.R.; Birchard, K.R.

    2015-01-01

    Aim: To develop and validate a simple, reproducible method to assess dural sac size using standard imaging technology. Materials and methods: This study was institutional review board-approved. Two readers, blinded to the diagnoses, measured anterior–posterior (AP) and transverse (TR) dural sac diameter (DSD), and AP vertebral body diameter (VBD) of the lumbar vertebrae using MRI images from 53 control patients with pre-existing MRI examinations, 19 prospectively MRI-imaged healthy controls, and 24 patients with Marfan syndrome with prior MRI or CT lumbar spine imaging. Statistical analysis utilized linear and logistic regression, Pearson correlation, and receiver operating characteristic (ROC) curves. Results: AP-DSD and TR-DSD measurements were reproducible between two readers (r = 0.91 and 0.87, respectively). DSD (L1–L5) was not different between male and female controls in the AP or TR plane (p = 0.43; p = 0.40, respectively), and did not vary by age (p = 0.62; p = 0.25) or height (p = 0.64; p = 0.32). AP-VBD was greater in males versus females (p = 1.5 × 10 −8 ), resulting in a smaller dural sac ratio (DSR) (DSD/VBD) in males (p = 5.8 × 10 −6 ). Marfan patients had larger AP-DSDs and TR-DSDs than controls (p = 5.9 × 10 −9 ; p = 6.5 × 10 −9 , respectively). Compared to DSR, AP-DSD and TR-DSD better discriminate Marfan from control subjects based on area under the curve (AUC) values from unadjusted ROCs (AP-DSD p < 0.01; TR-DSD p = 0.04). Conclusion: Individual vertebrae and L1–L5 (average) AP-DSD and TR-DSD measurements are simple, reliable, and reproducible for quantitating dural sac size without needing to control for gender, age, or height. - Highlights: • DSD (L1-L5) does not differ in the AP or TR plane by gender, height, or age. • AP- and TR-DSD measures correlate well between readers with different experience. • Height is positively correlated to AP-VBD in both males and females. • Varying

  9. The entire dural sinus tree is compressed in patients with idiopathic intracranial hypertension: a longitudinal, volumetric magnetic resonance imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Rohr, Axel; Bindeballe, Jan; Riedel, Christian; Jansen, Olav [University Clinic of Schleswig-Holstein Campus Kiel, Department of Neuroradiology, Kiel (Germany); Baalen, Andreas van [University Clinic of Schleswig-Holstein Campus Kiel, Department of Neuropediatrics, Kiel (Germany); Bartsch, Thorsten [University Clinic of Schleswig-Holstein Campus Kiel, Department of Neurology, Kiel (Germany); Doerner, Lutz [University Clinic of Schleswig-Holstein Campus Kiel, Department of Neurosurgery, Kiel (Germany)

    2012-01-15

    The objective of this study was to explore the volumetric alterations of dural sinuses in patients with idiopathic intracranial hypertension (IIH). Standardized cranial magnetic resonance imaging (MRI) was used in 17 patients prior to and following treatment of IIH and in seven controls. Magnetic resonance venographies (MRV) were employed for (a) judgement of circumscript dural sinus stenoses and (b) computation of sinus volumes. Cross-sectional areas (CSA) of the superior sagittal sinuses (SSS) were measured on T2-weighted images. Results of the initial MRIs were compared to those on follow-up MRIs and to results of controls. Stenoses of the transverse sinuses (TS) resulting in cranial venous outflow obstruction (CVOO) were present in 15/17 (88%) patients, normalizing in 7/15 cases (47%) after treatment of IIH. CVOO was not detected in the control group. Segmentation of MRV revealed decreased dural sinus volumes in patients with IIH as compared to controls (P = 0.018). Sinus volumes increased significantly with normalization of intracranial pressure independent from disappearing of TS stenoses (P = 0.007). The CSA of the SSS were normal on the initial MRIs of patients with IIH and increased on follow-up after treatment (P < 0.001). However, volumetries displayed overlap in patients and controls. Patients with IIH not only exhibit bilateral stenoses of the TS as has been reported, but volume changes of their entire dural sinus system also occur. The potential etiopathological and diagnostic roles of these changes are discussed. (orig.)

  10. Cerebral venous thrombosis: treatment with local fibrinolysis plus alteplase; Trombosis venosa cerebral. Tratamiento mediante fibrinolisis local con alteplasa

    Energy Technology Data Exchange (ETDEWEB)

    Asis Bravo, F. de; Delgado, F.; Cano, A.; Bautista, D.

    2002-07-01

    Cerebral venous thrombosis is a rare entity with widely variable clinical signs: thus, a high degree of suspicion is required for diagnosis. It affects the dural sinuses and may or may not invade cerebral veins. The diagnosis has usually been based on an angiographic study although, at the present time, new noninvasive imaging techniques, such as computed tomography, magnetic resonance and magnetic resonance angiography are being employed in a growing number of cases. Treatment should involve symptomatic and etiologic therapy. Although anti coagulation would appear to be a reasonable option in these patients, it remains controversial. As in other processes such as pulmonary embolism and coronary thrombosis, the introduction of novel and increasingly safe fibrinolytic drugs, together with technical innovations in the field of interventional neuroradiology, is changing the perspectives for the management of these patients. We present the case of a 43-year-old woman with right sinus thrombosis who was treated with local thrombolysis plus alteplase (tissue plasminogen activator). The authors describe the technique employed and review the literature. (Author) 16 refs.

  11. Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis.

    Science.gov (United States)

    Iyer, Rajiv R; Wu, Adela; Macmillan, Alexandra; Musavi, Leila; Cho, Regina; Lopez, Joseph; Jallo, George I; Dorafshar, Amir H; Ahn, Edward S

    2018-01-01

    Cranial vault remodeling surgery for craniosynostosis carries the potential risk of dural venous sinus injury given the extensive bony exposure. Identification of the dural venous sinuses can be challenging in patients with craniosynostosis given the lack of accurate surface-localizing landmarks. Computer-aided design and manufacturing (CAD/CAM) has allowed surgeons to pre-operatively plan these complex procedures in an effort to increase reconstructive efficiency. An added benefit of this technology is the ability to intraoperatively map the dural venous sinuses based on pre-operative imaging. We utilized CAD/CAM technology to intraoperatively map the dural venous sinuses for patients undergoing reconstructive surgery for craniosynostosis in an effort to prevent sinus injury, increase operative efficiency, and enhance patient safety. Here, we describe our experience utilizing this intraoperative technology in pediatric patients with craniosynostosis. We retrospectively reviewed the charts of children undergoing reconstructive surgery for craniosynostosis using CAD/CAM surgical planning guides at our institution between 2012 and 2016. Data collected included the following: age, gender, type of craniosynostosis, estimated blood loss, sagittal sinus deviation from the sagittal suture, peri-operative outcomes, and hospital length of stay. Thirty-two patients underwent reconstructive cranial surgery for craniosynostosis, with a median age of 11 months (range, 7-160). Types of synostosis included metopic (6), unicoronal (6), sagittal (15), lambdoid (1), and multiple suture (4). Sagittal sinus deviation from the sagittal suture was maximal in unicoronal synostosis patients (10.2 ± 0.9 mm). All patients tolerated surgery well, and there were no occurrences of sagittal sinus, transverse sinus, or torcular injury. The use of CAD/CAM technology allows for accurate intraoperative dural venous sinus localization during reconstructive surgery for craniosynostosis and

  12. Retrograde flow in the dural sinuses detected by three-dimensional time-of-flight MR angiography

    International Nuclear Information System (INIS)

    Uchino, Akira; Nomiyama, Keita; Takase, Yukinori; Nakazono, Takahiko; Tominaga, Yukiko; Imaizumi, Takeshi; Kudo, Sho

    2007-01-01

    Retrograde flow in the left dural sinuses is sometimes detected by three-dimensional time-of-flight (3D-TOF) magnetic resonance (MR) angiography. The purpose of this study was to evaluate the incidence of this phenomenon and its characteristic features on 3D-TOF MR angiograms. We retrospectively reviewed cranial MR angiography images of 1,078 patients examined at our institution. All images were obtained by the 3D-TOF technique with one of two 1.5-T scanners. Maximum intensity projection (MIP) images in the horizontal rotation view were displayed stereoscopically. We reviewed the source images, inferosuperior MIP images, and horizontal MIP images and identified retrograde flow in the dural sinuses. We found retrograde flow in the dural sinuses of 67 patients on the source images from 3D-TOF MR angiography; the incidence was 6.2%. In 47 of the 67 patients, retrograde flow was identified in the left inferior petrosal sinus, in 13, it was seen in the left sigmoid sinus, and in 6, it was seen in the left inferior petrosal and left sigmoid sinuses. The remaining patient had retrograde flow in the left inferior petrosal and left and right sigmoid sinuses. The mean age of the patients with retrograde flow was slightly greater than that of the patients without this phenomenon (70 years vs 63 years). Retrograde flow in the dural sinuses frequently occurs on the left side in middle-aged and elderly patients during 3D-TOF MR angiography performed with the patient in the supine position. This phenomenon should not be misdiagnosed as a dural arteriovenous fistula. (orig.)

  13. Padrões de refluxo nas veias safenas em homens com insuficiência venosa crônica

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Engelhorn

    Full Text Available Resumo Contexto A insuficiência venosa crônica (IVCr é frequente e predomina nas mulheres, mas ainda há poucas informações sobre o refluxo nas veias safenas na população masculina. Objetivos Identificar os diferentes padrões de refluxo nas veias safenas magnas (VSMs e parvas (VSPs em homens, correlacionando esses dados com a apresentação clínica conforme a classificação Clínica, Etiológica, Anatômica e Fisiopatológica (CEAP. Métodos Foram avaliados 369 membros inferiores de 207 homens pela ultrassonografia vascular (UV com diagnóstico clínico de IVCr primária. As variáveis analisadas foram a classificação CEAP, o padrão de refluxo nas VSMs e VSPs e a correlação entre os dois. Resultados Nos 369 membros avaliados, 72,9% das VSMs apresentaram refluxo com predominância do padrão segmentar (33,8%. Nas VSPs, 16% dos membros inferiores analisados apresentaram refluxo, sendo o mais frequente o padrão distal (33,9%. Dos membros classificados como C4, C5 e C6, 100% apresentaram refluxo na VSM com predominância do refluxo proximal (25,64%, e 38,46% apresentaram refluxo na VSP com equivalência entre os padrões distal e proximal (33,3%. Refluxo na junção safeno-femoral (JSF foi detectado em 7,1% dos membros nas classes C0 e C1, 35,6% nas classes C2 e C3, e 64,1% nas classes C4 a C6. Conclusões O padrão de refluxo segmentar é predominante na VSM, e o padrão de refluxo distal é predominante na VSP. A ocorrência de refluxo na JSF é maior em pacientes com IVCr mais avançada.

  14. Endovascular management of sigmoid sinus dural arteriovenous fistula associated with sinus stenosis in an infant.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Benifla, Moni; Itshayek, Eyal; Moscovici, Samuel

    2013-01-01

    A 4-month-old female presented with a dural arteriovenous fistula (DAVF), which was successfully managed using endovascular techniques. There are very few case series reporting DAVF in infants younger than 12 months and, to our knowledge, only 60 pediatric patients with DAVF have been reported to date. Although most DAVF have a benign course, they can result in life-threatening hemorrhage. Endovascular therapies are usually indicated in the management of these neurosurgical vascular malformations. Endovascular therapy of DAVF in neonatal patients presents some major issues. Gaining arterial access may be problematic in femoral arteries too small for the introduction of a sizeable guiding catheter. The volumes of contrast and infused fluids must be carefully monitored to prevent fluid overload. Radiation exposure should be restricted as far as possible. This report contributes to the limited body of evidence on neonatal DAVF and its endovascular management. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. The MR imaging and DSA features and embolization therapy of spinal dural arteriovenous fistulae

    International Nuclear Information System (INIS)

    Zhang Hua; Hu Jinqing; Lin Dong; Wu Daming; Wang Dengbin; Yang Yanmin; Cheng Kemin

    2005-01-01

    Objective: To investigate the MR imaging and DSA features together with endovascular embolization of spinal dural arteriovenous fistulae (SDAVF). Methods: Twelve patients with SDAVF underwent both MR imaging and angiography of spinal cord, 4 of them received endovascular embolization. The imaging findings of MRI and angiography in all patients were analyzed. Results: Among 12 cases with SDAVF, 11 cases showed diffuse long T 2 signal, 2 cases demonstrated inhomogeneous maculate enhancement in the spinal cord and 6 cases revealed abnormal vessels in the dorsal spaces of spinal cord on MRI. Angiography of spinal cord showed orifices of all fistulae, draining veins, the extent of lesions, amount of feeding vessels and the angiographic features in all the 12 cases. 4 cases with embolization treatment showed improvement clinically. Conclusions: Angiography of spinal cord is the main method and MRI provides important assistance for diagnosing SDAVF while endovascular embolization is an effective method for the treatment. (authors)

  16. Dural carotid cavernous sinus fistula presenting as isolated oculomotor nerve palsy: Case report

    Directory of Open Access Journals (Sweden)

    Şehnaz Arıcı

    2015-04-01

    Full Text Available Indirect (dural carotid cavernous fistula is formed by the connection between meningeal branches of the internal carotid artery and the cavernous sinüs, and low flow circulation with low pressure is occured. Proptosis, ophtalmoplegia, headache, scleral and conjuctival hyperemia expanding around the eyeball can be observed. A forty-eight year old female patient with a background of diabetes mellitus and hypertension was admitted with complaints of double vision. Isolated oculomotor nerve palsy was found in neurological examination and an indirect carotid cavernous fistula was revealed by digital subtraction angiography. Our case with carotid cavernous fistula as a rare cause of isolated oculomotor nerve palsy is worth to be reported.

  17. Hematoma subdural intracraniano pós-anestesia subaracnóidea: relato de dois casos e revisão de 33 casos da literatura

    Directory of Open Access Journals (Sweden)

    Jane Auxiliadora Amorim

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hematoma subdural intracraniano é uma complicação rara pós-anestesia subaracnóidea. Relatamos dois casos de mulheres que desenvolveram hematoma subdural crônico pós-anestesia subaracnóidea, diagnosticados após a evolução clínica prolongada de cefaleia pós-punção dural (CPPD e analisamos outros 33 casos encontrados em revisão da literatura. RELATO DOS CASOS: Nos 35 pacientes (idade entre 20-88 anos, 19 homens, 14 tinham mais de 60 anos (40% sendo 12 (86% homens. A relação se inverte no grupo de pacientes mais jovens (< 60 anos, no qual há duas vezes mais mulheres (14:7. Dois picos de maior incidência foram observados: 30-39 anos (31% e 60-69 anos (29%. O período de tempo decorrido entre o início dos sintomas até o diagnóstico variou entre 4 horas e 29 semanas. Cefaleia foi referida por 26/35 (74,3% casos; alteração do nível de consciência em 14/35 (40,0%; vômitos em 11/35 (31,4%; hemiplegia ou hemiparesia em 8/35 (22,9%; diplopia ou paresia do VI nervo craniano em 5/35 (14,3%; e distúrbio da linguagem em 4/35 (11,4%. Os fatores contribuintes foram: gravidez, múltiplas punções, uso de anticoagulantes, anormalidades vasculares intracranianas e atrofia cerebral. Em 15 casos, não foi citado qualquer fator contribuinte. Quatro em 35 pacientes (11,4% ficaram com sequelas neurológicas e 4/35 (11,4% morreram. CONCLUSÕES: A presença de qualquer um desses sinais ou sintomas mencionados serve de alerta para a possibilidade de ocorrer hematoma subdural intracraniano como complicação da punção dural, principalmente naqueles pacientes que apresentaram CPPD por mais de uma semana, quando uma investigação por neuroimagem se faz necessária.

  18. O papel do mapeamento dúplex no diagnóstico da trombose venosa profunda assintomática dos membros inferiores Role of duplex scanning in the diagnosis of asymptomatic lower-extremity deep vein thrombosis

    Directory of Open Access Journals (Sweden)

    Mariangela Giannini

    2005-09-01

    Full Text Available O diagnóstico da trombose venosa profunda sintomática está bem estabelecido com o uso do mapeamento dúplex, que apresenta sensibilidade de 100% e especificidade de 98%, para trombose venosa profunda proximal, e sensibilidade de 94% e especificidade de 75%, para distal. Na trombose venosa profunda recente e assintomática, o diagnóstico com o mapeamento dúplex ainda não está bem estabelecido, mostrando uma queda na acurácia desse método diagnóstico. Essa queda é devida ao fato de o trombo recente não ser oclusivo, apresentar a mesma ecogenicidade do sangue e uma consistência diminuída, prejudicando o teste da compressibilidade, que é o mais sensível para diagnóstico da trombose venosa profunda. Nesta revisão, serão revistos artigos publicados que avaliaram a acurácia do mapeamento dúplex no diagnóstico da trombose venosa profunda assintomática.The diagnosis of symptomatic deep vein thrombosis is well established using duplex scanning, with a sensitivity of 100% and specificity of 98% for proximal deep vein thrombosis, and 94% sensitivity and 75% specificity for distal deep vein thrombosis. In the early and asymptomatic deep vein thrombosis, diagnosis by duplex scanning is not well established yet, which shows a decrease in the accuracy of this diagnostic method. This is because the fresh thrombus is not occlusive, has the same echogenicity as blood and a reduced consistency, jeopardizing the compressibility test, which is the most sensitive test for deep vein thrombosis. This article will review published articles, which evaluated the accuracy of the duplex scanning in the diagnosis of asymptomatic deep vein thrombosis.

  19. Investigação da trombose venosa na gravidez Deep vein thrombosis during pregnancy work up

    Directory of Open Access Journals (Sweden)

    Jorge Agle Kalil

    2008-03-01

    Full Text Available CONTEXTO: A trombose venosa profunda (TVP na gravidez é fator determinante no aumento da morbidade e da mortalidade maternofetal. Pode ocorrer na presença de trombofilias, por compressão da veia cava inferior, estase venosa ou alterações hormonais. OBJETIVOS: Analisar pacientes grávidas e no pós-parto imediato portadoras de TVP em membros inferiores, pesquisar as possíveis causas de trombofilia e realizar revisão de literatura. MÉTODOS: Foram analisadas gestantes e puérperas encaminhadas por ginecologistas e obstetras com quadro clínico suspeito de TVP, de janeiro de 2004 a novembro de 2006, período em que foram realizados 24.437 partos no Hospital e Maternidade São Luiz (HMSL, sendo 89% cesarianas, 7,5% partos normais e 3,5% fórceps. Do total de pacientes encaminhadas com quadro clínico sugestivo, foram realizados 42 diagnósticos clínicos de TVP em gestantes com idade entre 21 e 39 anos, confirmados por duplex scan venoso. Imediatamente antes da introdução da terapia anticoagulante, foram colhidos exames para pesquisa de trombofilia, os quais foram repetidos após o período de tratamento. RESULTADOS: Das 42 pacientes portadoras de TVP, 32 eram primigestas (três gemelares sem alterações trombofílicas, duas por fecundação in vitro, oito secundigestas e duas tercigestas. Em quatro pacientes, a TVP ocorreu no primeiro trimestre da gestação (9,5%; em 11, no segundo trimestre (26,2%; em 27, no terceiro trimestre (64,3%. Dos 42 casos de diagnóstico de TVP, 18 (42,8% ocorreram nas veias infrapatelares. Houve um caso de tromboembolismo pulmonar (TEP em paciente de 37 anos que havia realizado fecundação in vitro, com gestação gemelar, e TVP (ausência de trombofilia diagnosticada após a cesariana. Das 42 pacientes, 16 (38,1% tiveram a causa da TVP estabelecida, com prevalência de mutação heterozigótica do fator V de Leiden (FVL em seis pacientes (14,2%, seguida pela síndrome antifosfolípide e outras. A maioria das

  20. Documented development of a dural arteriovenous fistula in an infant subsequent to sinus thrombosis: case report and review of the literature

    International Nuclear Information System (INIS)

    Morales, Humberto; Jones, Blaise V.; Leach, James L.; Abruzzo, Todd A.

    2010-01-01

    Controversy exists as to whether sinus thrombosis is the cause or the result of dural arteriovenous fistula (DAVF) and to whether DAVF are congenital or acquired lesions, especially in children. An infant presented with rupture of an anterior communicating artery aneurysm diagnosed with computed tomography angiography and catheter angiography. Pretreatment hospital course was complicated by extensive dural sinus thrombosis. Subsequent arteriography showed a new adult-type dural arteriovenous fistula to the previously thrombosed right sigmoid sinus. This is the first report of definitive angiographic documentation of the development of an adult-type DAVF after recanalization of a thrombosed dural sinus in a child. This case confirms the acquired etiology of at least one type of DAVF in children, even at this young age. We review the previously documented cases of formation of DAVF subsequent to sinus thrombosis with serial angiography in adults. (orig.)

  1. Treinamento de sobrecarga muscular não afeta o diâmetro das principais veias dos membros inferiores em mulheres adultas com insuficiência venosa

    Directory of Open Access Journals (Sweden)

    Gigliola Cibele Cunha da Silva

    2010-12-01

    Full Text Available O exercício físico pode promover benefícios na funcionalidade do sistema venoso. Contudo, tratando-se de exercício com sobrecargas musculares, observa-se contraindicações quanto à sua prática diante da possibilidade da mesma estar relacionada ao agravamento das disfunções venosas. OBJETIVO: Analisar os efeitos da prática do exercício com sobrecargas musculares sobre o diâmetro venoso de mulheres fisicamente inativas portadoras de insuficiência venosa crônica de membros inferiores. MÉTODOS: Vinte e duas mulheres com idades entre 21 e 58 anos (34,27 ± 12 anos foram divididas aleatoriamente em dois grupos: experimental (n = 12 e controle (n = 10. O treinamento com cargas foi realizado por 16 semanas, e o diâmetro venoso foi medido nas veias safenas magna (em nível da coxa e perna e parva no membro inferior esquerdo por meio de ecodoppler colorido. Utilizou-se a ANOVA por dois fatores para avaliar as possíveis modificações dos diâmetros entre os grupos e ao longo do tempo (p < 0,05. RESULTADOS: Não foram encontradas alterações significativas nos diâmetros das veias safenas parva (porções superior, média e inferior: p = 0,80, 0,32 e 0,20, respectivamente, magna em nível da perna (p = 0,17, 0,74 e 0,96 e magna em nível da coxa (p = 0,57, 0,67 e 0,52. CONCLUSÃO: A prática do exercício com sobrecargas musculares pode ser considerada um meio de intervenção ou tratamento, uma vez que não promoveu alterações no diâmetro venoso de mulheres que apresentaram insuficiência venosa crônica nos membros inferiores.

  2. Condiciones de trabajo en la producción de comidas como factores de riesgo para la enfermedad venosa de miembros inferiores

    Directory of Open Access Journals (Sweden)

    Clarissa Medeiros da Luz Bertoldi

    2007-03-01

    Full Text Available El presente estudio tiene por objetivo identificar los factores que pueden desencadenar o, según el caso, empeorar el desarrollo de enfermedades venosas en los miembros inferiores en operarios de una cocina colectiva, denominada Unidad de Alimentación y Nutrición. Se ha realizado un estudio cualitativo descriptivo de las condiciones de trabajo de los operarios de la cocina del Hospital Universitario de Florianópolis, al sur de Brasil. Se ha utilizado la metodología del Análisis Ergonómico del Trabajo. Como técnicas para la recopilación de datos se han realizado entrevistas con cuestionario aplicado por el observador, evaluación del Índice de Masa Corporal, examen clínico específico, volumetría por desplazamiento de agua de miembros inferiores, observación directa de las actividades desarrolladas en el ambiente de trabajo, con registro de imágenes y utilización de material como podómetro, cronómetro y termo-higrómetro digital. Tras la realización del estudio se ha podido observar la presencia de distintos grados de enfermedad venosa en un 78,57% de los casos, con una variación media para volumetría del 5,13%. Se han encontrado factores de riesgo para enfermedad venosa en el ambiente investigado, tales como, la postura de bipedestación por largos periodos de tiempo, temperatura y humedad elevados, la carga inadecuada de peso y el sobrepeso de los operarios.The present study evaluates which factors may influence the appearance or severity of lower limb venous disease on workers of a Unit of Food Service. A qualitative research, in the form of a case study, was carried out at a hospital Unit of Food Service located in Florianópolis, Santa Catarina, Brazil. The followed methodology was the Ergonomic Analysis of Work. As for data collection, the following were used: interviews and Body Mass Index (BMI assessment; specific clinical examination, water displacement volumetry of the lower extremities, in addition, on site direct

  3. Neural-Dural Transition at the Thoracic and Lumbar Spinal Nerve Roots: A Histological Study of Human Late-Stage Fetuses

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    Kwang Ho Cho

    2016-01-01

    Full Text Available Epidural blocks have been used extensively in infants. However, little histological information is available on the immature neural-dural transition. The neural-dural transition was histologically investigated in 12 late-stage (28–30 weeks fetuses. The dural sheath of the spinal cord was observed to always continue along the nerve roots with varying thicknesses between specimens and segments, while the dorsal root ganglion sheath was usually very thin or unclear. Immature neural-dural transitions were associated with effective anesthesia. The posterior radicular artery was near the dorsal root ganglion and/or embedded in the nerve root, whereas the anterior radicular artery was separated from the nearest nerve root. The anterior radicular artery was not associated with the dural sheath but with thin mesenchymal tissue. The numbers of radicular arteries tended to become smaller in larger specimens. Likewise, larger specimens of the upper thoracic and lower lumbar segments did not show the artery. Therefore, elimination of the radicular arteries to form a single artery of Adamkiewicz was occurring in late-stage fetuses. The epidural space was filled with veins, and the loose tissue space extended ventrolaterally to the subpleural tissue between the ribs. Consequently, epidural blocks in infants require special attention although immature neural-dural transitions seemed to increase the effect.

  4. Suitability of cerebrospinal fluid as a signal-intensity reference on MRI: evaluation of signal-intensity variations in the lumbosacral dural sac

    International Nuclear Information System (INIS)

    Luoma, E.K.; Luukkonen, R.; Riihimaeki, H.A.; Raininko, R.; Manninen, H.I.; Nummi, P.J.

    1997-01-01

    The suitability of the cerebrospinal fluid (CSF) in the lumbosacral dural sac as an internal signal-intensity reference was studied on magnetic resonance imaging (MRI) of the lumbar spine using a surface coil and motion artefact suppression technique. A signal-intensity reference is needed when signal is compared between images, studies or subjects. Homogeneity of the CSF was estimated visually on T2-weighted images of 60 subjects at 1.5 T and of another 60 subjects at 0.1 T. Spines with a severely narrowed dural sac or marked scoliosis were excluded from the study to avoid partial volume effect. CSF was homogeneous in 82% and 73% of the examinations at 1.5 T and 0.1 T, respectively. The type and location of the local inhomogeneities did not relate to local narrowings of the dural sac. The signal intensity of CSF was measured in 108 examinations at 0.1 T after correcting the spatially-dependent signal-intensity nonuniformities with a phantom-based method. The signal-intensity difference between the CSF in the upper and lower lumbar dural sac was less than 10% in 73% of the examinations. The CSF in the lumbosacral dural sac can be a useful signal-intensity reference for estimation of the signal of the adjacent structures in patients without severe narrowing of the dural sac or marked scoliosis. It may contribute to assessing spinal disease processes. (orig.). With 1 fig., 3 tabs

  5. Apnéia na sala de recuperação pós-anestésica: relato de caso Apnea en la sala de recuperación pós-anestésica: relato de caso Apnea in the postanesthetic recovery room: case report

    Directory of Open Access Journals (Sweden)

    Joel Massari Rezende

    2003-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A depressão respiratória é uma complicação que pode ocorrer no pós-operatório quando se utilizam opióides na anestesia. O objetivo deste relato é discutir um caso de apnéia em paciente que chegou consciente à sala de recuperação pós-anestésica (SRPA, após ter sido submetido à tireoidectomia sob anestesia geral com propofol, fentanil e isoflurano. RELATO DO CASO: Paciente do sexo feminino, 50 anos, 60 kg, estado físico ASA I, submetida à tireoidectomia sob anestesia geral induzida com propofol (140 mg, fentanil (350 µg, atracúrio (30 mg e mantida com isoflurano, duas doses subseqüentes em bolus de atracúrio (10 mg cada e ventilação controlada mecânica. No final da cirurgia, após antagonização do bloqueio neuromuscular, a paciente foi extubada, obedeceu aos comandos para respirar e colaborou na passagem à maca, sendo transportada para a SRPA, aonde chegou consciente. Minutos após, apresentou apnéia, cianose e inconsciência. Foi realizada ventilação manual com oxigênio a 100% seguida de injeção de naloxona (0,2 mg por via venosa, havendo retorno da ventilação espontânea e da consciência. CONCLUSÕES: Os cuidados ventilatórios no pós-operatório, durante o transporte, admissão à SRPA e permanência nessa unidade, devem ser contínuos em pacientes que receberam opióides, mesmo demonstrando estar conscientes ao deixarem a sala cirúrgica.JUSTIFICATIVA Y OBJETIVOS: La depresión respiratoria es una complicación que puede ocurrir en el pós-operatorio cuando se utilizan opioides en la anestesia. El objetivo de este relato es discutir un caso de apnea en paciente que llegó consciente a la sala de recuperación pós-anestésica (SRPA, después de haber sido sometido a tireoidectomia sobre anestesia general con propofol, fentanil e isoflurano. RELATO DE CASO: Paciente del sexo femenino, 50 años, 60 kg, estado físico ASA I, sometida a la tireoidectomia sobre anestesia general

  6. Dural Ectasia of the Optic Nerve and Unilateral Proptosis-Two Rare Comorbidities Associated with Idiopathic Intracranial Hypertension

    Directory of Open Access Journals (Sweden)

    Serkan Dağdelen

    2013-08-01

    Full Text Available A 24-year-old woman with a recent history of visual abnormality (obscurations had bilateral optic disc swellings, dilatation of the optic nerve sheaths, monocular proptosis, and increased cerebrospinal fluid pressures. She was diagnosed as idiopathic intracranial hypertension (IIH. IIH can present with both papilledema and dural ectasia although the latter is usually seen as an isolated entity. Various conditions also have been implicated in IIH. However, apart from female sex, recent weight gain and obesity, there are no proven associations. In this case report, we present a case of IHH associated with two different pathologies: dural ectasia of the optic nerve sheaths and monocular proptosis. (Turk J Ophthalmol 2013; 43: 297-300

  7. Is there a dural wall between the cavernous sinus and the pituitary fossa? Anatomical and MRI findings

    International Nuclear Information System (INIS)

    Dietemann, J.L.; Diniz, R.; Reis, M. Jr.; Neugroschl, C.; Vinclair, L.; Maillot, C.

    1998-01-01

    We compared MRI studies of the sellar area and embryological and adult histological studies of the cavernous sinuses and pituitary fossa. MRI studies were performed in 50 normal subjects with coronal sections using a fast inversion-recovery sequence to demonstrate the dural walls of the cavernous sinus and pituitary fossa. With this sequence, dura mater appears as a high-signal linear structure. The lateral and superior walls of the cavernous sinus was easily identified on all studies, but demonstration of a dural wall separating the cavernous sinus from the pituitary fossa was not possible. These results correlated well with embryological and adult histological studies obtained from 14 specimens. The absence of a strong separation between the pituitary fossa and the cavernous sinus explains the high incidence of extension of pituitary tumours to the cavernous sinuses and vice versa. (orig.) (orig.)

  8. Acute Tetraparesis with Respiratory Failure after Steroid Administration in a Patient with a Dural Arteriovenous Fistula at the Craniocervical Junction

    Science.gov (United States)

    Takahashi, Hisashi; Ueshima, Taiki; Goto, Daiki; Kimura, Tadashi; Yuki, Natsuko; Inoue, Yasuo; Yoshioka, Akira

    2017-01-01

    A 63-year-old man developed vomiting, paraparesis, dysuria, bulbar palsy, and orthostatic hypotension over a period of 5 months. Neuroradiological examinations showed a swollen lower brainstem with a dural arteriovenous fistula at the craniocervical junction (DAVF-CCJ). A steroid was administered intravenously in the hospital to relieve brainstem edema. A few hours later, however, the patient developed acute tetraparesis with respiratory failure. Recently, there have been several reports describing the acute worsening of paraparesis in patients with a spinal dural arteriovenous fistula after steroid treatment. In addition to these reports, the present case suggests the risk of administering steroids to patients with DAVF-CCJ, especially those with brainstem dysfunction. PMID:29225249

  9. Avaliação das limitações de úlcera venosa em membros inferiores Evaluation of limitations of venous ulcers in legs

    Directory of Open Access Journals (Sweden)

    Célia Regina Lopes

    2013-03-01

    Full Text Available CONTEXTO: A insuficiência venosa crônica tem um impacto socioeconômico considerável nos países ocidentais devido à alta prevalência, custo das investigações e tratamento e à perda de dias trabalhados. O questionário de qualidade de vida Short Form Health Survey (SF-36, bem como a análise da ativação muscular e mobilidade da articulação tibiotársica, é um instrumento utilizado para a sua mensuração. OBJETIVO: Avaliar as limitações osteomusculares e as alterações na qualidade de vida em portadores de úlcera venosa em membros inferiores. MÉTODOS: Foram estudados dez pacientes com úlceras classificadas com Classificação de Doença Venosa Crônica (CEAP: Clinica, Eliologia, Anatomia e Fisiopatologia 6, que responderam ao questionário SF36 e à escala analógica de dor e realizaram a goniometria, força muscular e eletromiografia. RESULTADOS: A idade média do grupo estudado foi 67,4 (±11,7, sendo 70% dos casos do sexo feminino. Não houve correlação significativa entre dor amplitude do movimento (ADM, força muscular, eletromiografia (EMG e o tamanho da lesão. Entretanto, houve correlação entre o perfil psicológico do SF-36 e o domínio de atividades motoras, bem como do perfil psicológico com as atividades sociais e percepção de si mesmo. Também houve diferença significativa na avaliação eletromiográfica dos músculos estudados. CONCLUSÃO: A presença de úlcera venosa em membros inferiores pode gerar limitações e alterações na qualidade de vida destes indivíduos. O aspecto psicossocial demonstrou-se preponderante sobre o aspecto motor, aumentando as restrições nas atividades de vida diária.BACKGROUND: : The chronic venous insufficiency has a considerable socioeconomic impact in western countries because of high prevalence, treatment and research cost, and loss of days worked. The health survey questionnaire Short Form Health Survey (SF36, as well as the analysis of muscle activation and mobility

  10. Uso de terapias alternativas en la cicatrización de úlceras de etiología venosa: La cromoterapia Colour therapy in venous ulcers healing: chromoteraphy

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    Sandra Alexandre Lozano

    2012-12-01

    Full Text Available La úlcera de etiología venosa es la más prevalente de las úlceras de extremidad inferior. Entre el 75 y el 80% de las úlceras de la extremidad inferior son de esta etiología. De acuerdo con las evidencias disponibles, el tratamiento de las úlceras de etiología venosa tiene como base dos grandes pilares: el manejo de la úlcera como una herida crónica y el control de la hipertensión venosa crónica (HTV, su causa primordial, mediante sistemas de alta compresión decreciente y mantenida. De todos los métodos de control de la HTV, el sistema multicapa ha demostrado clínicamente que permite alcanzar un 80% de tasa de cicatrización de lesiones a las doce semanas de tratamiento, erigiéndose como el tratamiento más efectivo de los existentes hasta el momento. Por otro lado, a menudo, una compresión de 40 mm Hg en el tobillo no es bien tolerada por todas las personas afectadas de HTV crónica. Para esos casos rebeldes en los que debemos utilizar recursos alternativos, nosotros hemos utilizado la cromoterapia ya que ha demostrado, mediante varios estudios, ser útil en la curación de heridas consiguiendo, entre otros beneficios, estimular el aporte sanguíneo al lecho de la herida, favoreciendo así la oxigenación. En base a estos hechos, nos planteamos la aplicabilidad de la cromoterapia en la cura de las úlceras venosas, como tratamiento complementario a las curas habituales, cuando estos no son lo suficientemente efectivos o cuando el paciente no tolera el vendaje elástico multicapa.Venous ulcers are the most prevalent ulcers of the lower extremity. They account for 75%-80% of ulcers of the lower extremity. According to the evidence available, there are two main strands to therapy: treatment of the ulcer as a chronic wound, and management of venous hypertension (VHT, the prime cause of venous ulcers. VHT is managed using decreasing and sustained high-compression systems. According to the literature, the multilayer system has been

  11. Relatos reconfiguradores de la violencia familiar en Antioquia (Colombia)*

    OpenAIRE

    Builes Correa, María Victoria; López Serna, Lina María

    2009-01-01

    Introducción: La autoridad impuesta con sangre y lágrimas ha empezado a cuestionarse, debido a que se percibe como inefciente y plantea la necesidad de introducir el diálogo y la negociación en las prácticas de crianza. Objetivo: Reconocer los relatos de buen trato en la experiencia de las familias donde hay violencia. Método: En este estudio comprensivo, de tipo fenomenológico-hermenéutico, se privilegia la salida ética frente a la experiencia de violencia intrafamiliar y se preocupa por dev...

  12. Dural arteriovenøs fistel er en sjælden, men behandlelig årsag til transversal myelopati

    DEFF Research Database (Denmark)

    Hansen, Julie Richter; Poulsgaard, Lars; Holtmannspötter, Markus

    2017-01-01

    This is a case report of a 60-year-old male admitted on suspicion of relapse of idiopathic transverse myelitis (TM), who after further diagnostic workup underwent successful closure of a dural arteriovenous fistula (DAVF). Magnetic resonance imaging in DAVF usually shows longitudinal TM, which, u......, unlike DAVF, is also seen with the more common inflammatory or infectious causes usually showing inflammation in the cerebrospinal fluid. The natural history of DAVF is progressive. Since curable options exist, timely diagnosis is most important....

  13. Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus.

    Science.gov (United States)

    Mizutani, Katsuhiro; Miwa, Tomoru; Akiyama, Takenori; Sakamoto, Yoshiaki; Fujiwara, Hirokazu; Yoshida, Kazunari

    2018-03-01

    The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls. Three embryonic dural sinuses, i.e., the primitive tentorial, occipital, and falcine sinuses, were retrospectively analyzed in CT-DSV images of infants and adults. We also analyzed the drainage patterns of the superficial middle cerebral vein (SMCV), determined by the connection between the primitive tentorial sinus and the cavernous sinus. The primitive tentorial, occipital, and falcine sinuses were present in 15.4%, 46.2%, and none of the infants, respectively, and in 10.0, 8.6, and 2.9% of the adults, respectively. The difference in SMCV draining pattern between infants and adults was insignificant. The incidence of the occipital sinus was significantly higher in infants than in adults. The connection between the primitive tentorial sinus and the cavernous sinus appears to be established before birth. The occipital sinus is formed at the embryonic stage and mostly regresses after infancy. The falcine sinus is usually obliterated prenatally. Our findings form the basis for interventions by pediatric interventional neuroradiologists and neurosurgeons.

  14. Optic pathway glioma associated with orbital rhabdomyosarcoma and bilateral optic nerve sheath dural ectasia in a child with neurofibromatosis-1

    International Nuclear Information System (INIS)

    Nikas, Ioannis; Theofanopoulou, Maria; Lampropoulou, Penelope; Hadjigeorgi, Christiana; Pourtsidis, Apostolos; Kosmidis, Helen

    2006-01-01

    Neurofibromatosis-1 (NF-1) is a multisystem disorder presenting with a variety of clinical and imaging manifestations. Neural and non-neural tumours, and unusual benign miscellaneous conditions, separately or combined, are encountered in variable locations. We present a 21/2-year-old boy with NF-1 who demonstrated coexisting optic pathway glioma with involvement of the chiasm and optic nerve, orbital alveolar rhabdomyosarcoma and bilateral optic nerve sheath dural ectasia. (orig.)

  15. Fratura de agulha durante punção subaracnóidea: relato de caso Fractura de aguja durante punción subaracnóidea: relato de caso Needle fracture during spinal puncture: case report

    Directory of Open Access Journals (Sweden)

    Marcos G C Cruvinel

    2004-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Depois da introdução das agulhas de fino calibre (26G, 27G e 29G e a conseqüente diminuição da incidência de cefaléia pós-punção da dura-máter, a raquianestesia vem sendo cada dia mais empregada. Suas complicações são pouco freqüentes. Recentemente, entretanto, foi observada uma complicação aparentemente rara, de fratura da agulha durante punção subaracnóidea. O objetivo deste relato é registrar o fato e aventar as possíveis causas e sua prevenção. RELATO DO CASO: Paciente do sexo masculino, 53 anos, 90 kg, 175 cm, portador de hipertensão arterial sistêmica crônica e insuficiência renal crônica apresentou-se, em caráter de urgência, para transplante renal. Foi proposta a administração de morfina subaracnóidea visando analgesia pós-operatória. Inicialmente tentou-se, sem sucesso, punção em L3-L4 com agulha 27G, seguiu-se tentativa de punção em L2-L3 quando se percebeu deformação da agulha. Ao ser retirada a agulha partiu-se, permanecendo um fragmento de 43 mm no ligamento interespinhoso de L2-L3, confirmado por fluoroscopia. Foi induzida anestesia geral e procedeu-se exploração cirúrgica guiada por fluoroscopia com retirada do fragmento da agulha. A seguir, o transplante renal foi realizado sem intercorrências. CONCLUSÕES: A diminuição do calibre das agulhas, que trouxe a vantagem da redução da incidência de cefaléia pós-punção da dura-máter, fez também com que elas se tornassem mais frágeis. Em casos onde os ligamentos são mais resistentes e a punção tentada mais de uma vez, pode haver deformação do material que fica susceptível a quebra. Conclui-se que em situações em que há resistência aumentada à passagem da agulha ou dificuldade de punção, o risco de sua deformação e a possibilidade de fratura devem ser confrontados com as vantagens do uso de agulhas de fino calibre.JUSTIFICATIVA Y OBJETIVOS: Después de la introducción de las agujas de

  16. Relato autobiográfico e identidad personal: Un modelo de análisis narrativo

    Directory of Open Access Journals (Sweden)

    Dante Duero

    2007-05-01

    Full Text Available En el siguiente trabajo analizamos cómo las estrategias narrativas que las personas emplean para construir relatos autobiográficos condiciona sus formas de pensar acerca de sí mismas, el mundo y sus propias acciones. Hemos partido del supuesto de que la organización y la coherencia de esta clase de relatos constituyen un aspecto clave para entender el problema de la identidad personal. Analizamos los relatos autobiográficos de dos muestras de estudiantes universitarios, pertenecientes a la Universidad Nacional de Córdoba (Argentina a la Universidad Autónoma de México (México. Nos hemos propuesto, en primer lugar, describir y analizar los diferentes relatos autobiográficos que obtuvimos en ambas muestras a través de entrevistas en profundidad. A través de dicho análisis, hemos procurado caracterizar el proceso de construcción narrativa, estableciendo la estructura y las funciones que los elementos del relato cumplen en su organización, contribuyendo a su coherencia y composición. Teniendo en cuenta esto, y teniendo en cuenta los datos de ambos grupos, intentamos, por una parte, identificar diferentes tipos de relatos. Simultáneamente, analizamos cómo las características de las historias condicionaba el modo en que las personas construyen su propia identidad, en tanto personajes de tales relatos.

  17. Induced dural lymphangiogenesis facilities soluble amyloid-beta clearance from brain in a transgenic mouse model of Alzheimer's disease

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    Ya-Ru Wen

    2018-01-01

    Full Text Available Impaired amyloid-β clearance from the brain is a core pathological event in Alzheimer's disease. The therapeutic effect of current pharmacotherapies is unsatisfactory, and some treatments cause severe side effects. The meningeal lymphatic vessels might be a new route for amyloid-β clearance. This study investigated whether promoting dural lymphangiogenesis facilitated the clearance of amyloid-β from the brain. First, human lymphatic endothelial cells were treated with 100 ng/mL recombinant human vascular endothelial growth factor-C (rhVEGF-C protein. Light microscopy verified that rhVEGF-C, a specific ligand for vascular endothelial growth factor receptor-3 (VEGFR-3, significantly promoted tube formation of human lymphatic endothelial cells in vitro. In an in vivo study, 200 μg/mL rhVEGF-C was injected into the cisterna magna of APP/PS1 transgenic mice, once every 2 days, four times in total. Immunofluorescence staining demonstrated high levels of dural lymphangiogenesis in Alzheimer's disease mice. One week after rhVEGF-C administration, enzyme-linked immunosorbent assay results showed that levels of soluble amyloid-β were decreased in cerebrospinal fluid and brain. The Morris water maze test demonstrated that spatial cognition was restored. These results indicate that the upregulation of dural lymphangiogenesis facilities amyloid-β clearance from the brain of APP/PS1 mice, suggesting the potential of the VEGF-C/VEGFR-3 signaling pathway as a therapeutic target for Alzheimer's disease.

  18. [Ropivacaine use in transnasal sphenopalatine ganglion block for post dural puncture headache in obstetric patients - case series].

    Science.gov (United States)

    Furtado, Inês; Lima, Isabel Flor de; Pedro, Sérgio

    2018-02-02

    Sphenopalatine ganglion block is widely accepted in chronic pain; however it has been underestimated in post dural puncture headache treatment. The ganglion block does not restore normal cerebrospinal fluid dynamics but effectively reduces symptoms associated with resultant hypotension. When correctly applied it may avoid performance of epidural blood patch. The transnasal approach is a simple and minimally invasive technique. In the cases presented, we attempted to perform and report the ganglion block effectiveness and duration, using ropivacaine. We present four obstetrics patients with post dural puncture headache, after epidural or combined techniques, with Tuohy needle 18G that underwent a safe and successful Sphenopalatine ganglion block. We performed the block 24-48h after dural puncture, with 4mL of ropivacaine 0.75% in each nostril. In three cases pain recurred within 12-48h, although less intense. In one patient a second block was performed with complete relief and without further recurrence. In the other two patients a blood patch was performed without success. All patients were asymptomatic within 7 days. The average duration of analgesic effect of the block remains poorly defined. In the cases reported, blocking with ropivacaine was a simple, safe and effective technique, with immediate and sustained pain relief for at least 12-24h. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  19. Late-presenting dural tear: incidence, risk factors, and associated complications.

    Science.gov (United States)

    Durand, Wesley M; DePasse, J Mason; Kuris, Eren O; Yang, JaeWon; Daniels, Alan H

    2018-04-18

    Unrecognized and inadequately repaired intraoperative durotomies may lead to cerebrospinal fluid leak, pseudomeningocele, and other complications. Few studies have investigated durotomy that is unrecognized intraoperatively and requires additional postoperative management (hereafter, late-presenting dural tear [LPDT]), although estimates of LPDT range from 0.6 to 8.3 per 1,000 spinal surgeries. These single-center studies are based on relatively small sample sizes for an event of this rarity, all with <10 patients experiencing LPDT. This investigation is the largest yet conducted on LPDT, and sought to identify incidence, risk factors for, and complications associated with LPDT. This observational cohort study employed the American College of Surgeons National Surgical Quality Improvement Program dataset (years 2012-2015). Patients who underwent spine surgery were identified based on presence of primary listed Current Procedural Terminology (CPT) codes corresponding to spinal fusion or isolated posterior decompression without fusion. The primary variable in this study was occurrence of LPDT, identified as reoperation or readmission with durotomy-specific CPT or International Classification of Diseases, Ninth Revision, Clinical Modification codes but without durotomy codes present for the index procedure. Descriptive statistics were generated. Bivariate and multivariate analyses were conducted using chi-square tests and multiple logistic regression, respectively, generating both risk factors for LPDT and independent association of LPDT with postoperative complications. Statistical significance was defined as p<.05. In total, 86,212 patients were analyzed. The overall rate of reoperation or readmission without reoperation for LPDT was 2.0 per 1,000 patients (n=174). Of LPDT patients, 97.7% required one or more unplanned reoperations (n=170), and 5.7% of patients (n=10) required two reoperations. On multivariate analysis, lumbar procedures (odds ratio [OR] 2.79, p

  20. Timing, severity of deficits, and clinical improvement after surgery for spinal dural arteriovenous fistulas.

    Science.gov (United States)

    Safaee, Michael M; Clark, Aaron J; Burkhardt, Jan-Karl; Winkler, Ethan A; Lawton, Michael T

    2018-04-20

    OBJECTIVE Spinal dural arteriovenous fistulas (dAVFs) are rare vascular abnormalities caused by arteriovenous shunting. They often form at the dural root sleeve between a radicular feeding artery and draining medullary vein causing venous congestion and edema, decreased perfusion, and ischemia of the spinal cord. Treatment consists of either surgical ligation of the draining vein or selective embolization via an endovascular approach. There is a paucity of data on which modality provides more durable and effective outcomes. METHODS The authors performed a retrospective review of a prospectively maintained database by the senior author to assess clinical outcomes in patients undergoing surgical treatment of spinal dAVFs. Preoperative and postoperative motor and Aminoff-Logue Scale (ALS) scores were collected. RESULTS A total of 41 patients with 44 spinal dAVFs were identified, with a mean patient age of 64 years. The mean symptom duration was 14 months, with weakness (82%), urinary symptoms (47%), and sensory symptoms (29%) at presentation. The fistula locations were as follows: 30 thoracic, 9 lumbar, 3 sacral, and 2 cervical. Five patients had normal motor and ALS scores at presentation. Among the remaining 36 patients with motor deficits or abnormal gait and micturition at presentation, 78% experienced an improvement while the remaining 22% continued to be stable. There was a trend toward improved outcomes in patients with shorter symptom duration; mean symptom duration among patients with clinical improvement was 13 months compared with 22 months among those without improvement. Additionally, rates of improvement were higher for lower thoracic and lumbosacral dAVFs (85% and 83%) compared with those in the upper thoracic spine (57%). No patient developed recurrent fistulas or worsening neurological deficits. CONCLUSIONS Surgery is associated with excellent outcomes in the treatment of spinal dAVFs. Early diagnosis and treatment are critical, with a trend toward

  1. Rabdomiólise em paciente obeso mórbido submetido a gastroplastia redutora e durante revascularização de membro superior em paciente pediátrico: relato de casos

    Directory of Open Access Journals (Sweden)

    Abrão Maria Angélica

    2006-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A rabdomiólise é uma síndrome que decorre da lesão ao músculo esquelético. Sua etiologia é ampla, trazendo um interesse particular, quando se manifesta como complicação intra ou pós-anestésica. O objetivo desse relato foi mostrar dois casos de rabdomiólise ocorridos no pós-operatório de intervenções cirúrgicas de longa duração, em pacientes com obesidade mórbida e lesão traumática, enfatizando a sua relação com a anestesia. RELATO DOS CASOS: O primeiro caso é de um paciente com 39 anos, obeso mórbido, IMC 62, submetido a gastroplastia redutora por laparotomia, sob anestesia geral. Apresentou, no pós-operatório, fraqueza muscular nos membros superiores e inferiores e alterações da sensibilidade. Evoluiu com dor muscular e urina avermelhada. O aumento dos níveis plasmáticos da enzima creatinocinase (CK confirmou o diagnóstico de rabdomiólise. Tratado com hidratação forçada e diurético, não evoluiu com insuficiência renal, porém teve alta com seqüela muscular e neurológica. O segundo caso apresenta uma criança de sete anos, vítima de acidente com porta de vidro, operada de urgência para revascularização do membro superior esquerdo. Apresentou mudança da coloração da urina, que se tornou avermelhada, durante a anestesia. Foram administrados bicarbonato de sódio e manitol por via venosa, com os objetivos de alcalinizar a urina e aumentar o débito urinário. Enviado ao CTI, onde foi confirmada a hipótese de rabdomiólise, pelo aumento da enzima CK e pela mioglobinúria. Obteve alta no 10º dia de internação, sem seqüelas. CONCLUSÕES: Os casos apresentados mostraram os fatores de risco da rabdomiólise e sua relação com a anestesia e a cirurgia. O diagnóstico precoce é importante, no sentido de um tratamento rápido e agressivo, a fim de se evitarem complicações mais graves.

  2. Relato policial y el crimen que lo habita

    Directory of Open Access Journals (Sweden)

    Francisco de Undurraga

    2011-05-01

    Full Text Available La aparición de publicidad y de novelas en serie en las portadas de periódicos franceses, apartir de 1836, marca la relación entre el género policial y los nuevos modos de visibilidad de la información en las sociedades industrializadas. Algunos ejemplos, tomados de un periódico de la época, la "Gazette des Tribunaux", permiten demostrar que la prensa estuvo desde sus comienzos vinculada a la literatura, si acaso no es una derivación de ella. E.A. Poe, creador del relato policial, conduce la retórica del morbo trabajada por Dante, Swift, Lautréamont y Baudelaire, de una apelación al lector, al orden del argumento y del procedimiento que lo estructura. En el relato policial conviven el discurso de lo que se cuenta, característico de la literatura, y el de la ciencia, pero solo en apariencia éste viene a suplantar a aquél, configurando de este modo su retórica.

  3. Instabilidade hemodinâmica grave durante o uso de isoflurano em paciente portador de escoliose idiopática: relato de caso Severe hemodynamic instability during the use of isoflurane in a patient with idiopathic scoliosis: case report

    Directory of Open Access Journals (Sweden)

    Adriano Bechara de Souza Hobaika

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O isoflurano é considerado um anestésico inalatório seguro. Apresenta reduzido grau de biotransformação, baixa toxicidade hepática e renal. Em concentrações clínicas apresenta efeito inotrópico negativo mínimo, diminuição da resistência vascular sistêmica e, raramente, pode provocar disritmias cardíacas. O objetivo deste relato foi apresentar um caso de instabilidade hemodinâmica grave em paciente portador de escoliose idiopática. RELATO DO CASO: Paciente do sexo masculino, 13 anos, estado físico ASA I, sem antecedente de alergia a medicamentos, agendado para correção cirúrgica de escoliose idiopática. Após indução da anestesia com fentanil, midazolam, propofol e atracúrio, isoflurano a 1%, em 100% de oxigênio foi então iniciado para manutenção. Cinco minutos depois, o paciente apresentou hipotensão arterial grave (PAM = 26 mmHg associada à taquicardia sinusal (FC = 166 bpm que não respondeu ao uso de vasopressores e infusão de volume. A ausculta pulmonar e precordial, oximetria, capnografia, temperatura nasofaríngea e gasometria arterial revelaram-se sem alterações. O paciente recebeu tratamento para anafilaxia e a intervenção cirúrgica foi interrompida. A clara relação temporal entre a administração de isoflurano e a ocorrência dos sintomas sugeriu um diagnóstico de intolerância cardiovascular à administração inalatória de isoflurano. Duas semanas depois a anestesia venosa total foi administrada sem intercorrências. CONCLUSÕES: Não há relatos de instabilidade hemodinâmica grave causada por isoflurano em pacientes previamente sadios. Anafilaxia, taquicardia supraventricular com repercussão hemodinâmica e sensibilidade cardíaca aumentada ao isoflurano são discutidas como possíveis causas da instabilidade hemodinâmica. Atualmente, há evidências que o isoflurano pode interferir no sistema de acoplamento-desacoplamento da contratilidade miocárdica por meio

  4. Embolization of cranial dural arteriovenous fistulae with ONYX: Indications, techniques, and outcomes

    Directory of Open Access Journals (Sweden)

    Saraf Rashmi

    2010-01-01

    Full Text Available Objectives: The purpose of this study was to establish the role of the liquid embolic agent, ONYX, in the treatment of cranial dural arteriovenous fistulae (DAVFs and to redefine the indications, techniques and outcomes of treatment with ONYX. Materials and Methods: This is a retrospective study of 25 DAVF patients who underwent endovascular treatment with ONYX between February 2006 and July 2008. All patients of DAVF presenting in this period were treated with ONYX. Results: Anatomic cure (i.e., complete angiographic closure of the fistula was achieved in a single session and through a single arterial pedicle injection in 21 out of 25 patients (cure rate of 84%. Out of four patients with residual fistulae, one achieved cure that was evident on a control angiogram obtained at 3 months while three had no vascular access for further embolization and so were referred for radiosurgery. There was only one recurrence seen in angiograms obtained at the end of one year and this patient was re-embolized successfully with ONYX. Complications were seen in two patients. Conclusion: ONYX embolization of DAVFs has revolutionized the endovascular treatment of DAVFs, achieving high cure rates in a single session with minimal complications. Transarterial ONYX embolization should be the first option for all locations, except cavernous DAVFs.

  5. The accessory super-selective techniques in performing the transarterial embolization of intracranial dural arteriovenous fistulas

    International Nuclear Information System (INIS)

    Zhao Wenyuan; Liu Jianmin; Li Qiang; Fang Yibin; Xu Yi; Hong Bo; Huang Qinghai

    2010-01-01

    Objective: To evaluate the assistant techniques in performing transarterial embolization of intracranial dural arteriovenous fistulas (DAVF) when routine super-selective catheterization with microcatheter fails. Methods: Temporary balloon occlusion of the parent artery was adopted in 4 cases of anterior fossa DAVF and in one case of tentorial DAVF, and permanent occlusion of the distal main trunk with coils was carried out in one tentorial DAVF in order to help the super-selective catheterization. Results: The microcatheter was successfully advanced to, or near, the nidus with the help of these assistant techniques and all 6 cases were cured with single session. After the surgery no operation-related complications occurred. Conclusion: Our preliminary results indicate that the assistant techniques, including temporary balloon occlusion of the parent artery and permanent occlusion of the distal main trunk with coils, are a safe and effective method which can reliably help the successful performance of microcatheter catheterization, it can be safely used in complex cases when routine super-selective catheterization fails. (authors)

  6. Indocyanine green videoangiography "in negative": definition and usefulness in spinal dural arteriovenous fistulae.

    Science.gov (United States)

    Simal Julián, Juan Antonio; Miranda Lloret, Pablo; López González, Antonio; Evangelista Zamora, Rocío; Botella Asunción, Carlos

    2013-05-01

    Indocyanine green videoangiography (IGV) has proven its effectiveness in the field of exovascular neurosurgery, both in the intracranial and spinal compartment, but is necessary to define a systematic process for the performance of the IGV to facilitate its interpretation during the procedure. We have defined and applied the concept of videoangiography "in negative" (INIGV) to spinal dural arteriovenous fistulae (dAVF) for the detection and treatment of arteriovenous shunts, so called because the first phase is performed with the vessel suggestive of being pathological occluded. A Pentero-operating microscope with near-infrared IGV-integrated system (Carl Zeiss Co., Germany) was used. At our institution, 24 patients were treated for a spinal dAVF between 1995 and 2011, only in the last 4 cases, INIGV was performed. We describe the IGV in negative procedure and show the most illustrative cases. In all cases, the fistula occlusion was confirmed by postoperative selective digital subtraction angiography (DSA). INIGV demonstrate its capacity in detecting vessels not actually arterialized that should be respected and avoid some of the main limitations of the conventional IGV. This is a technical description about an Indocyanine green (ICG) videoangiographic procedure modification that is superior to merely performing ICG before and after clipping of a dAVF. The INIGV results are rapid and easy to interpret procedure and provide great advantages to the dAVF treatment. Nevertheless, further studies are needed with a larger sample size to determine if INIGV may reduce the need to perform immediate postoperative DSA.

  7. Superior cerebellar artery infarction in endovascular treatment for tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Jingbo; Lv Xianli; Jiang Chuhan; Li Youxiang [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China)

    2010-06-15

    Background: Superior cerebellar artery (SCA) syndrome shows ipsilateral cerebellar ataxia and Horner's syndrome, contralateral superficial sensory disturbance, as well as nystagmus toward the impaired side, vertigo, and nausea. Occasionally, unilateral lesions may produce bilateral hypogeusia and contralateral hypoacusia. Objective: To report 2 patients with unilateral lower midbrain ischemic lesions of the inferior colliculus level caused by transarterial embolization for tentorial dural arteriovenous fistulas (TDAVFs). Methods: Hospital records for 21 patients with TDAVFs mainly treated by endovascular techniques between 2005 and 2008 were reviewed. Two patients with MRI evidence of unilateral SCA territory infarction were investigated. Results: Of 21 patients, 2 treated transarterially with Onyx-18 (a nonahesive liquid embolic agent) developed infarctions in the territory of SCA. One patient had lateral SCA infarction characterized by ipsilateral gait ataxia, contralateral hemihypoesthesia, with additional ipsilateral ocular motor palsy and bilateral gustatory loss. And the other patient had medial SCA infarction characterized by ipsilateral ataxia contralateral hemihypoesthesia with additional contralateral hypoacusia. Conclusion: SCA infarction can be caused by transarterial injection of Onyx-18 via SCA or the posterior cerebral artery (PCA) for TDAVFs and additionally presented with gustatory loss and deafness, which is generally not a feature of the SCA syndrome.

  8. Management of a case with misdiagnosed spinal dural arterio-venous fistula.

    Science.gov (United States)

    Lien, Chia-Yi; Lui, Chun-Chung; Lu, Cheng-Hsien; Chang, Wen-Neng

    2014-03-01

    Spinal dural arterio-venous fistula (SDAVF) is an uncommon and easily misdiagnosed vascular malformation. We aimed to report the diagnosis and management of a case with SDAVF. A 62-year-old man suffered from acute paraparesis about 15 months before this study. He underwent a neurosurgical procedure for herniated discs of the cervical spine at that time but there was no relief and the symptoms worsened despite the surgery. Neurologically, he had spastic paraparesis and decreased vibration sensation of the lower limbs. Spinal magnetic resonance imaging (MRI) revealed intra-medullary hyper-intensity lesion at T8 to T10 levels and tubular-like signal void structures in the corresponding posterior sub-arachnoid space. Further trans-arterial angiography through right T6 intercostal artery catheterization revealed engorged veins, thereby confirming the diagnosis of SDAVF. The patient was treated via endovascular embolization (18% Onyx, EV3TM MIT, Bonn, Germany) through spinal angiography and the results showed a marked decrease in engorged veins. After a 4-month follow-up, the patient was symptomatic but stable. Follow-up MRI showed a complete disappearance of the hyper-intensity change of the spinal cord. Spinal MR angiography did not reveal any recurrence of SDAVF. This case study demonstrated the easily misdiagnosed state of SDAVF. Serial neuroimage studies including spinal MRI, endovascular embolization through spinal angiography and MR angiography can be useful tools for its diagnostic confirmation, management and follow-up study.

  9. Determining the Level of the Dural Sac Tip: Magnetic Resonance Imaging in an Adult Population

    International Nuclear Information System (INIS)

    Binokay, F.; Akgul, E.; Bicakci, K.; Soyupak, S.; Aksungur, E.; Sertdemir, Y.

    2006-01-01

    Purpose: To determine the variation in the location of the dural sac (DS) in a living adult population and to correlate this position with age and sex. Material and Methods: T2-weighted, midline, sagittal, spin-echo magnetic resonance imaging (MRI) studies of 743 patients were assessed to identify the tip of the DS. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disk. Results: Frequency distribution for levels of termination of the DS on MRI demonstrated that the end of the DS was usually located at the upper one-third of S2 (25.2%). The mean level in females was also the upper one-third of S2 (26.5%) and in males the lower one-third of S2 (24.1%). The overall mean DS position was mostly at the upper one-third of S2. No significant differences in DS position were seen between male and female patients or with increasing age. Conclusion: It is important to know the possible range for the termination level of the DS when performing caudal anesthesia and craniospinal irradiation in some clinical situations. The distribution of DS location in a large adult population was shown to range from the L5-S1 intervertebral disk to the upper third of S3 vertebrae

  10. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance

    Energy Technology Data Exchange (ETDEWEB)

    Battal, Bilal; Hamcan, Salih; Akgun, Veysel; Sari, Sebahattin; Tasar, Mustafa [Gulhane Military Medical School, Department of Radiology, Ankara (Turkey); Oz, Oguzhan [Gulhane Military Medical School, Department of Neurology, Ankara (Turkey); Castillo, Mauricio [University of North Carolina School of Medicine, Division of Neuroradiology, Department of Radiology, Chapel Hill, NC (United States)

    2016-06-15

    To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients' symptoms and clinical findings were recorded. Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. (orig.)

  11. Medullary Venous Hypertension Secondary to a Petrous Apex Dural Arteriovenous Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Meghan Murphy

    2012-11-01

    Full Text Available Background: Dural arteriovenous fistulae (dAVF are common intracranial vascular lesions typically becoming symptomatic with cortical venous hypertension and possible hemorrhage. Here, we present a case illustration of a petrous apex dAVF with marked medullary venous hypertension and a unique clinical presentation. Methods: Case report. Results: A 72-year-old female, whose clinical progression was significant for altered mental status and progressive weakness, presented with diplopia, right leg paresis, and ataxia. Magnetic resonance imaging revealed edema involving the medulla. On digital subtraction cerebral angiogram, the patient was found to have a petrous apex dAVF, Cognard type IV. Following treatment with Onyx embolization, her symptoms rapidly improved, with complete resolution of diplopia and drastic improvement of her ataxia. Conclusion: The importance of this case is in the presentation and deterioration of the clinical exam, resembling an acute ischemic event. Further, this case illustrates that dAVF may cause venous hypertension with rapid onset of focal neurologic symptoms not exclusive to cortical locations.

  12. Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, M [Ernst-Moritz-Arndt-Universitaet Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Liebig, T [TU Muenchen, Institut fuer Neuroradiologie, Klinikum Rechts der Isar, Munich (Germany); Kuehne, D [Klinik fuer Radiologie und Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen (Germany); Henkes, H [Katharinenhospital-Klinikum Stuttgart, Klinik fuer Neuroradiologie, Stuttgart (Germany)

    2009-07-15

    This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse-sigmoid sinus dural arteriovenous fistulas (TS{sub d}AVF). A total of 150 consecutive patients and 348 procedures were evaluated. Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS{sub d}AVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%). Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful. (orig.)

  13. Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing

    Energy Technology Data Exchange (ETDEWEB)

    Xianli, Lv; Chuhan, Jiang; Youxiang, Li; Xinjian, Yang [Beijing Neurosurgical institute, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Chongwen, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical institute, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Chongwen, Beijing (China)

    2010-08-15

    Background: We report the recovery of ophthalmoplegia in 11 patients with cavernous sinus dural arteriovenous fistula (CSDAVF) after sinus packing at follow-up. Methods: Of 18 patients with CSDAVF treated with transvenous cavernous sinus packing between August 2002 and December 2007 at Beijing Tiantan Hospital, there were 9 patients with initial CNIII or CNVI dysfunction and 2 patients with CNVI dysfunction immediately after cavernous sinus packing selected and reevaluated. Results: Of 11 patients with CNIII or CNVI palsy, recovery was complete in 10. In 1 patient, complete CNVI palsy was unchanged because the CSDAVF was not cured. There were 6 men and 5 women with a mean age of 52.9 years. In 5 patients, CNVI palsy was associated with chemosis, proptosis and pulsatile tinnitus. Timing of treatment after onset of symptoms was from 4 to 35 days in 9 patients. All CSDAVFs were Barrow type D. Mean follow-up after treatment was 17.7 months (range, 2-54 months). Conclusion: CSDAVF-induced CNIII or CNVI palsies can be cured after cavernous sinus packing transvenously in most patients.

  14. Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing

    International Nuclear Information System (INIS)

    Lv Xianli; Jiang Chuhan; Li Youxiang; Yang Xinjian; Wu Zhongxue

    2010-01-01

    Background: We report the recovery of ophthalmoplegia in 11 patients with cavernous sinus dural arteriovenous fistula (CSDAVF) after sinus packing at follow-up. Methods: Of 18 patients with CSDAVF treated with transvenous cavernous sinus packing between August 2002 and December 2007 at Beijing Tiantan Hospital, there were 9 patients with initial CNIII or CNVI dysfunction and 2 patients with CNVI dysfunction immediately after cavernous sinus packing selected and reevaluated. Results: Of 11 patients with CNIII or CNVI palsy, recovery was complete in 10. In 1 patient, complete CNVI palsy was unchanged because the CSDAVF was not cured. There were 6 men and 5 women with a mean age of 52.9 years. In 5 patients, CNVI palsy was associated with chemosis, proptosis and pulsatile tinnitus. Timing of treatment after onset of symptoms was from 4 to 35 days in 9 patients. All CSDAVFs were Barrow type D. Mean follow-up after treatment was 17.7 months (range, 2-54 months). Conclusion: CSDAVF-induced CNIII or CNVI palsies can be cured after cavernous sinus packing transvenously in most patients.

  15. Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

    International Nuclear Information System (INIS)

    Kirsch, M.; Liebig, T.; Kuehne, D.; Henkes, H.

    2009-01-01

    This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse-sigmoid sinus dural arteriovenous fistulas (TS d AVF). A total of 150 consecutive patients and 348 procedures were evaluated. Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS d AVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%). Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful. (orig.)

  16. Effectiveness of autologous epidural blood patch to relieve post dural puncture headache

    International Nuclear Information System (INIS)

    Iqbal, L.A.A.; Naqvi, E.H.

    2013-01-01

    Background: Post-dural puncture headache (PDPH) is a common problem in anaesthesia practice especially in obstetric anaesthesia. Autologous epidural blood patch (AEBP) is the main stay of treatment of PDPH when it is not relieved with conservative management. Objective: To describe the efficacy of AEBP in treatment of PDPH. Study Design: Prospective descriptive study. Setting and Duration: The study was conducted at departments of Anaesthesia and Intensive Care, Military Hospital, Rawalpindi and Combined Military Hospital, Malir, from July 2008 to July 2011. Methodology: All patients who received AEBP during study period secondary to PDPH were included. Up to 20 ml of autologous blood was injected in epidural space. Effectiveness of AEBP was judged by relief of symptom; any complications associated with AEBP i.e. backache and paresthesia were also noted. Data was interpreted as mean and percentages. Results: A total of 30 AEBP were performed during the study period in predominantly female patients (n=27) with mean age of 27.8 years. AEBP was performed after a mean 3.83 days of lumbar puncture. Complete relief was observed in 29 (96%) patients; one patient required a second patch. During the follow-up, 7 (23%) patients complained of backache and 2(6%) of paresthesias. conclusion: AEBP is an effective way of providing relief from PDPH. (author)

  17. Identificação pelo eco-Doppler colorido de fístula arteriovenosa na trombose venosa profunda Arteriovenous fistula in deep venous thrombosis identified by color-flow Doppler ultrasonography

    Directory of Open Access Journals (Sweden)

    Fanilda Souto Barros

    2006-09-01

    Full Text Available Os três casos são referentes a pacientes em tratamento para trombose venosa profunda encaminhados ao laboratório vascular para avaliação da recanalização e/ou progressão do processo trombótico. Durante o estudo pelo eco-Doppler colorido, foram identificados sinais ecográficos compatíveis com fístula arteriovenosa no interior do trombo e adjacente à parede venosa.We report on a case series of three patients undergoing treatment for deep venous thrombosis, referred to our vascular laboratory for evaluation of recanalization and/or progression of the thrombotic process. During the color-flow Doppler ultrasonography, we identified ultrasound signs typical of arteriovenous fistula flow pattern within the thrombus and adjacent to the venous wall.

  18. Guía de práctica clínica para la prevención, diagnóstico y tratamiento de la enfermedad tromboembólica venosa en el deporte

    OpenAIRE

    Drobnic, Franchek; Pineda, Antoni; Román Escudero, José; Soria, José Manuel; Souto, Joan Carles

    2015-01-01

      El término enfermedad tromboembólica venosa se refiere a varios procesos patológicos, entre los que destacan la trombosis venosa profunda, el tromboembolismo pulmonar, la hipertensión pulmonar tromboembólica crónica y el síndrome postrombótico. La importancia en nuestro medio reside en que es una patología que precisa un periodo de recuperación largo, de 3 a 6 meses, y que un diagnóstico tardío o no bien realizado puede ocasionar una enfermedad más grave e incluso un desenlace fatal. Es dif...

  19. Comparação entre nifedipina por via sublingual e clonidina por via venosa no controle de hipertensão arterial peri-operatória em cirurgias de catarata

    Directory of Open Access Journals (Sweden)

    Stocche Renato Mestriner

    2002-01-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Estudo recente mostra que a clonidina por via venosa apresenta-se eficaz e segura no tratamento de crises hipertensivas durante cirurgia de catarata. Este estudo visa comparar o uso de nifedipina, droga amplamente utilizada por via sublingual, e clonidina por via venosa no controle da hipertensão arterial em cirurgias de catarata. MÉTODO: Setenta e cinco pacientes submetidos à facectomia foram distribuídos de forma aleatória e encoberta em: Grupo A, que recebeu nifedipina e Grupos C2 e C3, que receberam, respectivamente, 2 e 3 µg.kg-1 de clonidina por via venosa. Todos os pacientes apresentavam hipertensão arterial (PAS > 170 mmHg ou PAD > 110 mmHg. As PAS, PAD e freqüência cardíaca (FC foram medidas e comparadas nos momentos: 0 (antes do tratamento e de 2 em 2 minutos até o final do procedimento. Os eventos adversos foram anotados. RESULTADOS: Após o tratamento ocorreram diminuições da PAS e PAD nos 3 grupos (p <0,001. Houve controle da pressão arterial (<160 mmHg em 32%, 64% e 72% dos pacientes nos grupos A, C2 e C3, respectivamente (p < 0,05. No grupo C3 ocorreu maior incidência de efeitos colaterais que nos grupos C2 e A (p < 0,05. CONCLUSÕES:A clonidina por via venosa é mais eficaz que a nifedipina, por via sublingual, no controle de crises hipertensivas no peri-operatório de cirurgias de catarata. Contudo, a dose de 3 µg.kg-1 pode estar relacionada a efeitos colaterais, devendo-se iniciar o tratamento com 2 µg.kg-1.

  20. The dural entrance of cerebral bridging veins into the superior sagittal sinus: an anatomical comparison between cadavers and digital subtraction angiography

    International Nuclear Information System (INIS)

    Han, Hui; Tao, Wei; Zhang, Ming

    2007-01-01

    Intracranial venous structures have received increasing attention due to improved neuroimaging techniques and increased awareness of cerebral venous disease. To date, few studies have attempted to investigate the dural entrance of the cerebral bridging vein (BV). The aim of this study was to use the superior sagittal sinus (SSS) as an example to identify anatomical features of the dural entrance of the BVs into the SSS in both human cadavers and digital subtraction angiography (DSA) images. A total of 30 adult and 7 fetal human cadavers and 36 patients were examined with anatomical dissections, vascular casting and DSA. The number, diameter and angle of the BVs entering the SSS were measured and compared between the cadavers and DSA images. The results demonstrated that (1) the way a BV entered the SSS varied in three dimensions, and thus the BV dural entrance was difficult to precisely localize by DSA, (2) the distribution pattern of the dural entrance of the BVs into the SSS was relatively constant and a nontributary segment of the SSS was centered at the coronal suture and was identifiable by DSA, and (3) nearly all the BVs (97%, 561/581) entered the SSS at an angle opposite to the direction of blood flow. Unique anatomical features of the dural entrance of a BV into the SSS should be considered in neuroimaging interpretation of the sinus and its associated veins. (orig.)

  1. Uso do azul de metileno no tratamento de choque anafilático durante anestesia: relato de caso Uso del azul de metileno en el tratamiento de choque anafiláctico durante anestesia: relato de caso Methylene blue to treat anaphylaxis during anesthesia: case report

    Directory of Open Access Journals (Sweden)

    Renato Mestriner Stocche

    2004-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: No período peri-operatório, o risco de anafilaxia deve sempre ser considerado. A incidência de reações alérgicas em anestesia é controversa, variando entre 1/3000 a 1/20.000, com mortalidade entre 3% e 9 %. Neste caso, relata-se o uso do azul de metileno como coadjuvante ao tratamento do choque anafilático refratário à terapêutica tradicional. RELATO DO CASO: Paciente do sexo masculino, 53 anos, submetido a herniorrafia inguinal sob raquianestesia. No final do procedimento, ao receber dipirona (1,5 g, por via venosa, o paciente imediatamente apresentou broncoespasmo, cianose, diminuição da SpO2 e da PAS, culminando com parada cardiorrespiratória. Foi iniciada reanimação cardiorrespiratória com massagem cardíaca externa, seguida de IOT e injeção de adrenalina (1 mg, atropina (1 mg, restabelecendo-se FC de 150 bpm, porém sem pulso palpável. Administrou-se mais 1 mg de adrenalina além de 1 g de hidrocortisona, com restabelecimento de pulso central (8 minutos. Apesar de receber dopamina (20 µg.kg-1.min-1, o paciente manteve-se hipotenso (60 mmHg até 80 minutos. Administraram-se 100 mg de azul de metileno por via venosa, quando houve aumento da PAS para 85 e 105 mmHg, após a segunda dose. Seguiu-se da diminuição da dose de dopamina de 20 para 10, 7, 5 e, finalmente, 2 µg.kg-1.min-1. CONCLUSÕES: A anafilaxia tem como principal mediador a liberação de histamina, que induz a produção de óxido nítrico (NO, com conseqüente aumento da guanilato ciclase que promove vasodilatação arteriolar por aumento do GMP cíclico. O azul de metileno pode ser útil nestas situações, pois inibe a guanilato ciclase e conseqüentemente a vasodilatação, o que resulta em melhora hemodinâmica.JUSTIFICATIVA Y OBJETIVOS: En el período peri-operatorio, el riesgo de anafilaxis siempre debe ser considerado. La incidencia de reacciones alérgicas en anestesia es polémica, variando entre 1/3000 a 1/20.000, con

  2. Conduta na lesão dural intraoperatória em artrodese da coluna lombar Conducta en lesión de duramadre intraoperatoria en artrodesis de la columna lumbar Management of intraoperatory dural tear in lumbar spine arthrodesis

    OpenAIRE

    Fabiano de Mendonça Grandese; Clóvis Yamazato; Fábio Mastromauro de Oliveira; Iberê Ribeiro; José Olympio Catão Bastos Júnior; René Kusabara

    2010-01-01

    OBJETIVO: estudo retrospectivo de pacientes com lesão dural intraoperatória de cirurgia da coluna vertebral lombar, conduzido por meio de um protocolo independente da extensão da lesão, complicações associadas e resultados após seguimento mínimo de um ano. MÉTODOS: um total de 10 pacientes com durotomia acidental em cirurgias de descompressão e artrodese da coluna vertebral lombar, no período de Janeiro de 2007 a Janeiro de 2009, para tratamento de doença degenerativa, tiveram seus prontuário...

  3. Edén: relato, imagen y proyecto. El concepto de paraíso terrenal como generador de arquitecturas

    OpenAIRE

    Casha Vida, Stephanie

    2016-01-01

    Esta tesis, Edén: relato, imagen y proyecto. El concepto de Paraíso terrenal como generador de arquitecturas se realiza con el objetivo de estudiar los vínculos entre la idea de Edén, o Paraíso y la arquitectura. Siempre trabajando desde los tres niveles de representación, relato, imagen y proyecto. En la aproximación al objeto de estudio, se procede a estudiar el relato en sí, y se hallan, en la forma misma del relato, unas implicaciones relacionadas con el mundo mitológico y arquetípico. E...

  4. Hipercapnia acentuada durante circulação extracorpórea em cirurgia para revascularização do miocárdio: relato de caso Hipercapnia acentuada durante circulación extracorpórea en cirugía para revascularización del miocárdio: relato de caso Marked hypercapnia during cardiopulmonary bypass for myocardial revascularization: case report

    Directory of Open Access Journals (Sweden)

    Maurício Serrano Nascimento

    2002-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A função primordial de desviar o sangue do coração e retorná-lo oxigenado à circulação sistêmica é conseguida às custas de importantes alterações na fisiologia cardiopulmonar. O objetivo deste relato é apresentar uma complicação anestésica que ocorreu durante a CEC e alertar para a necessidade da interação de toda a equipe anestésico-cirúrgica na prevenção de eventos adversos per-operatórios. RELATO DO CASO: Paciente feminina, parda, 56 anos, 95 kg, altura 1,65 m, estado físico ASA IV, portadora de insuficiência renal crônica em hemodiálise, foi admitida para realização de revascularização do miocárdio. A monitorização constou de eletrocardiograma (ECG, medida invasiva da pressão arterial, oximetria de pulso, capnografia, temperatura esofágica, pressão venosa central e análise dos gases anestésicos. A paciente recebeu como medicação pré-anestésica, midazolam (0,05 mg.kg-1, por via venosa. Iniciou-se indução venosa com fentanil (16 µg.kg-1, etomidato (0,3 mg.kg-1 e pancurônio (0,1 mg.kg-1. A manutenção foi feita com oxigênio, isoflurano (0,5 - 1 CAM e infusão contínua de fentanil. A gasometria arterial colhida após a indução demonstrou: pH: 7,41; PaO2: 288 mmHg; PaCO2: 38 mmHg; HCO3: 24 mmol.L-1; BE: 0 mmol.L-1; SatO2: 100%. A segunda gasometria arterial, colhida logo após o início da CEC, chegou em 30 minutos e apresentou: pH 7,15; PaO2: 86 mmHg; PaCO2 224 mmHg; HCO3: 29 mmol.L-1; BE: -3 mmol.L-1; SatO2: 99%. Foi feita verificação completa e urgente dos equipamentos anestésicos e de perfusão. Foi constatada conexão do misturador de gases de perfusão (blender à rede de O2 e a um cilindro de dióxido de carbono (CO2, quando deveria estar conectado ao cilindro de ar comprimido. CONCLUSÕES: Falhas mecânicas dos componentes do circuito de extracorpórea podem ocorrer no per-operatório e exigem correções rápidas. Os avanços tecnológicos nos equipamentos

  5. Anestesia para tratamento intraparto extra-útero em feto com diagnóstico pré-natal de higroma na região cervical: relato de caso Anestesia para tratamiento intraparto extraútero en feto con diagnóstico prenatal de higroma en la región cervical: relato de caso Anesthesia for ex utero intrapartum treatment of fetus with prenatal diagnosis of cervical hygroma: case report

    Directory of Open Access Journals (Sweden)

    Angélica de Fátima de Assunção Braga

    2006-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O tratamento intraparto extra-útero (EXIT constitui procedimento realizado durante a cesariana, com preservação da circulação feto-placentária, que permite manuseio seguro da via aérea do feto, com risco de obstrução das vias aéreas. O objetivo deste relato foi apresentar um caso de anestesia para EXIT, em feto com higroma cístico na região cervical. RELATO DO CASO: Paciente com 22 anos, 37 semanas de idade gestacional, sem antecedentes anestésicos, estado físico ASA I, submetida ao EXIT para manuseio de via aérea e intubação traqueal em feto com risco para obstrução de vias aéreas. O procedimento foi realizado sob anestesia geral associada a peridural contínua; no pré-operatório foram utilizados metoclopramida (10 mg e ranitidina (50 mg, por via venosa. No espaço peridural administrou-se bupivacaína a 0,25% com adrenalina (30 mg associada a fentanil (100 µg, seguida de passagem de cateter cefálico, para analgesia pós-operatória. O útero foi deslocado para a esquerda. A indução anestésica foi feita em seqüência rápida, com fentanil, propofol e rocurônio e a manutenção com isoflurano 2,5% a 3%, em O2 e N2O (50%. Após histerotomia, procedeu-se à liberação parcial do feto, assegurando-se a circulação útero-placentária, seguindo-se as manobras de laringoscopia e intubação traqueal fetal. A seguir, foi realizada liberação total do feto, com pinçamento de cordão umbilical, administração de ocitocina (20 UI em infusão venosa contínua seguida de metil-ergonovina (0,2 mg por via venosa. Durante o procedimento, a pressão arterial sistólica materna foi mantida acima de 100 mmHg, com efedrina em bolus (5 mg e cristalóide (3.000 mL. A concentração do isoflurano foi diminuída gradativamente durante o fechamento uterino. Ao final da intervenção cirúrgica o bloqueio neuromuscular foi revertido e injetou-se morfina (2 mg pelo cateter peridural para analgesia p

  6. Aprendizagem significativa: relato de experiência no ensino superior

    Directory of Open Access Journals (Sweden)

    Caren E. Studer

    1999-12-01

    Full Text Available O presente artigo tem como finalidade, o relato e a análise da prática de elaboração de relatórios semanais, a partir de textos pertinentes ao conteúdo de uma disciplina em cursos de nível superior em uma faculdade particular no interior do Estado de S. Paulo.Tendo como referencial teórico a Teoria Crítica da Educação, procura analisar a abrangência dessa experiência situada em um ambiente preponderantemente tradicional de ensino, utilizando-se como ferramentas de análise as categorias de aprendizagem significativa de Masetto (1998 e alienação desenvolvida por Castanho (1989.

  7. Audiologia em comunidade: relato de experiência

    OpenAIRE

    Barros,Paulo Marcelo Freitas de; Cavalcante,Tícia Cassiany Ferro; Andrade,Aline Fernanda de

    2010-01-01

    OBJETIVO: caracterizar queixas, sintomas e fatores de risco relacionados à perda auditiva em crianças com suspeita de perda auditiva no Distrito Sanitário I do Recife/Brasil. MÉTODOS: relato de experiência de atuação fonoaudiológica em parceria com Agentes Comunitários de Saúde - ACS que foram capacitados sobre saúde auditiva para identificar crianças com queixas de audição. Foram realizadas visitas aos domicílios indicados e ao posto de saúde e entrevistadas 80 mães obtendo-se informações a ...

  8. Síndrome de Asperger: relato de um caso

    Directory of Open Access Journals (Sweden)

    Letícia Viana Pereira

    2012-04-01

    Full Text Available Objetivo: O presente estudo tem como real objetivo o relato de um caso de Síndrome de Asperger comprado às características descritas na literatura. Metodologia: A partir de um relato de um caso atendido na Clínica Escola de Fonoaudiologia do Centro Universitário Metodista Izabela Hendrix, determinadas características foram comparadas com o descrito na literatura pertinente. Os trabalhos foram lidos, fichados e agrupados, segundos algumas características de abordagem, para posterior análise e comparação com o caso clínico relatado. Discussão e resultados: As crianças com Síndrome de Asperger são, em geral, diferentes entre si. Freqüentemente procedimentos realizados que podem ser indicados para uma criança seriam inadequados para outra. Assim, sugestões apresentadas pela literatura devem ser consideradas para melhorar a assistência à criança, como a compreensão mais abrangente e a reflexão aprofundada em relação a cada caso em específico. Conclusão: O acompanhamento e tratamento fonoaudiológico nesses casos, é de suma importância para o desenvolvimento o mais próximo possível do considerado formal na linguagem e na comunicação destes indivíduos. Vivências clínicas mostram as estratégias que podem ser sugeridas para estas crianças, lembrando que casa criança possui suas particularidades, que devem sempre ser levadas em consideração.

  9. Automated Cross-Sectional Measurement Method of Intracranial Dural Venous Sinuses.

    Science.gov (United States)

    Lublinsky, S; Friedman, A; Kesler, A; Zur, D; Anconina, R; Shelef, I

    2016-03-01

    MRV is an important blood vessel imaging and diagnostic tool for the evaluation of stenosis, occlusions, or aneurysms. However, an accurate image-processing tool for vessel comparison is unavailable. The purpose of this study was to develop and test an automated technique for vessel cross-sectional analysis. An algorithm for vessel cross-sectional analysis was developed that included 7 main steps: 1) image registration, 2) masking, 3) segmentation, 4) skeletonization, 5) cross-sectional planes, 6) clustering, and 7) cross-sectional analysis. Phantom models were used to validate the technique. The method was also tested on a control subject and a patient with idiopathic intracranial hypertension (4 large sinuses tested: right and left transverse sinuses, superior sagittal sinus, and straight sinus). The cross-sectional area and shape measurements were evaluated before and after lumbar puncture in patients with idiopathic intracranial hypertension. The vessel-analysis algorithm had a high degree of stability with <3% of cross-sections manually corrected. All investigated principal cranial blood sinuses had a significant cross-sectional area increase after lumbar puncture (P ≤ .05). The average triangularity of the transverse sinuses was increased, and the mean circularity of the sinuses was decreased by 6% ± 12% after lumbar puncture. Comparison of phantom and real data showed that all computed errors were <1 voxel unit, which confirmed that the method provided a very accurate solution. In this article, we present a novel automated imaging method for cross-sectional vessels analysis. The method can provide an efficient quantitative detection of abnormalities in the dural sinuses. © 2016 by American Journal of Neuroradiology.

  10. Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

    Energy Technology Data Exchange (ETDEWEB)

    Manabe, Shinji; Satoh, Koichi; Matsubara, Shunji; Satomi, Junichiro; Hanaoka, Mami; Nagahiro, Shinji [University of Tokushima, Department of Neurosurgery, Tokushima (Japan)

    2008-08-15

    We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a 'magic wand' appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction. (orig.)

  11. Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment

    International Nuclear Information System (INIS)

    Sherif, Camillo; Gruber, Andreas; Bavinzski, Gerhard; Standhardt, Harald; Widhalm, Georg; Knosp, Engelbert; Gibson, Daniel; Richling, Bernd

    2008-01-01

    The optimal treatment of spinal dural arteriovenous fistulae (SDAVF) remains controversial and long-term follow-up data, especially data from multidisciplinary treatment, are rarely available. Thus, long-term outcomes following a multidisciplinary approach to the treatment of SDAVF were investigated. The investigation included 26 patients with SDAVF treated at the authors' department over a 15-year period including a follow-up of more than 2 years. The treatment strategy when occlusion of the draining vein could be achieved was to embolize the fistula with Histoacryl, with surgery reserved for those patients unsuitable for embolization. Posttreatment angiography followed by MRI was performed in all patients. Clinical follow-up was performed using the gait and micturition Aminoff-Logue scale scores and the modified Rankin scale score. Embolization was performed in 19 patients (73.1%), and direct surgery in 7 patients (26.9%). Follow-up angiography (at a mean of 21.7 months) showed occlusion of the SDAVF in 24 patients (92.3%). Of the 19 embolized patients, 2 (10.5%) developed recurrence secondary to insufficient occlusion of the SDAVF draining vein, and one of these two patients underwent re-embolization and one re-operation. No negative effects of SDAVF recurrence on the final clinical outcome were identified in either patient. MRI after angiography (at a mean of 91.5 months) demonstrated occlusion of all SDAVFs. After a mean clinical follow-up of 103.4 months there was a statistically significant improvement in both the modified Rankin scale score and the Aminoff-Logue gait scale score (P < 0.05). The present multidisciplinary study showed for the first time that embolization leads to stable neuroradiological results and favourable clinical outcomes even for very long follow-up times of more than 100 months. Microsurgery remains the treatment of choice when safe embolization of the draining vein cannot be achieved. (orig.)

  12. Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas

    Science.gov (United States)

    Dmytriw, Adam A; Schwartz, Michael L; Cusimano, Michael D; Mendes Pereira, Vitor; Krings, Timo; Tymianski, Michael; Radovanovic, Ivan

    2016-01-01

    Background Intracranial dural arteriovenous fistulae (DAVF) may present a treatment challenge. Endovascular embolization is in most cases the first line of treatment but does not always achieve cure. Gamma Knife (GK) radiosurgery represents an alternative treatment option, and the purpose of this study was to further evaluate its utility. Methods We reviewed all cases of DAVF treated between 2009 and 2016 at our institution with GK radiosurgery independently, or following failed/refused endovascular or surgical management. Patients’ clinical files, radiological images, catheter angiograms, and surgical DAVF disconnection reports were retrospectively reviewed. Results Sixteen DAVF (14 patients) treated by GK radiosurgery were identified. Eleven fistulae were aggressive and five were benign. Marginal doses ranged from 15 to 25 Gy. Target volumes ranged from 0.04 to 4.47 cm3. In all symptomatic patients, GK treatment resulted in symptom palliation. In 13/15 lesions, cure of symptoms (86.0%) was reported. One lesion was asymptomatic. Angiographic cure was achieved in eight cases (50%), small residual DAVF occurred in four, and four were unchanged. One patient developed headache that resolved at one year. No hemorrhage occurred during the follow-up period. There was no significant association between Borden type and cure rate. Prior failed endovascular treatment and small target volume were associated with lower rates of cure. Conclusions Stereotactic radiosurgery is viable treatment for DAVF. It is very effective in palliating symptoms as a de novo approach or adjunctive to endovascular therapy. In our experience it is only somewhat effective in achieving complete angiographic cure. PMID:28156167

  13. Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas.

    Science.gov (United States)

    Lee, Cheng-Chia; Chen, Ching-Jen; Chen, Shao-Ching; Yang, Huai-Che; Lin, Chung Jung; Wu, Chih-Chun; Chung, Wen-Yuh; Guo, Wan-Yuo; Hung-Chi Pan, David; Shiau, Cheng-Ying; Wu, Hsiu-Mei

    2018-05-01

    OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm 3 (range 6.2-40.3 cm 3 ). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.

  14. Cranial Nerve Dysfunction Associated with Cavernous Dural Arteriovenous Fistulas After Transvenous Embolization with Onyx

    Energy Technology Data Exchange (ETDEWEB)

    Li, Chuanhui; Wang, Yang; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue; Yang, Xinjian, E-mail: yang-xj@163.net [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital (China)

    2015-10-15

    PurposeCranial nerve dysfunction (CND) is not uncommon in patients with cavernous dural arteriovenous fistulas (cDAVFs), and may represent an initial manifestation or a complication after endovascular treatment. This study evaluated the outcome of CND associated with cDAVFs after transvenous embolization (TVE) using Onyx.Materials and MethodsForty-one patients with cDAVFs were treated with TVE in our department between April 2009 and October 2013. For each patient, clinical and radiologic records were retrospectively reviewed and evaluated, with an emphasis placed on evaluating the outcomes of the pre-existing cDAVF-induced CND and the TVE-induced CND.ResultsOf the 41 cases, 25 had a history of preoperative CND. Postoperatively, gradual remission to complete recovery (CR) within 8 months was observed in 17 of these cases, transient aggravation in 7, and significant improvement to be better than preoperative function but no CR in 1. All aggravation of CND occurred immediately or within 1 day after TVE and resolved completely within 5 months. Nine patients developed new CND after TVE. New CND occurred during the perioperative period in 8 cases, but all cases resolved completely within 15 days–6 months. Delayed CND was observed in 3 cases with a time lag of 3–25 months after TVE. Two of these completely resolved within 20 days–1 month and the remaining case significantly improved.ConclusionBoth the pre-existing cDAVF-induced CND and the TVE-induced new or aggravated CND completely resolved in almost all cases after embolization with Onyx.

  15. Clinical presentation, imaging findings, and prognosis of spinal dural arteriovenous fistula.

    Science.gov (United States)

    Lee, Jookyung; Lim, Young-Min; Suh, Dae Chul; Rhim, Seung Chul; Kim, Sang Joon; Kim, Kwang-Kuk

    2016-04-01

    Spinal dural arteriovenous fistula (SDAVF) is a relatively common acquired vascular malformation of the spinal cord. Assessment of a SDAVF is often difficult because of non-specific findings on non-invasive imaging modalities. Diagnosis of a SDAVF is often delayed, and some patients receive unnecessary treatment and treatment delays, often resulting in a poor outcome. The aim of this study was to characterize the clinical presentation, typical imaging findings, and long-term outcome of SDAVF. Forty patients (13 women, 27 men; mean age 58.18 ± standard deviation 14.75 years) who were treated at our hospital from June 1992 to March 2014 were retrospectively reviewed. We investigated the baseline characteristics, clinical presentation, imaging findings, treatment modalities, and outcome of the patients. The most common clinical presentation was a sensory symptom (80%), followed by motor weakness (70%), and sphincter dysfunction (62.5%). Roughly one-third (32.5%) of patients had a stepwise progression of fluctuating weakness and sensory symptoms, but the most common presentation was chronic progressive myelopathic symptoms (47.5%). Thirty-four patients (85%) had T2 signal change on the spinal cord MRI, indicative of cord edema. Thirty-eight patients had typical perimedullary vessel flow voids on T2-weighted MRI. Twenty-eight patients were treated with endovascular embolization, five patients underwent surgery, and four patients underwent both. Clinical outcome was determined by severity of initial deficit (p=0.008), extent of cord edema (p=0.010), treatment failure (p=0.004), and a residual fistula (p=0.017). SDAVF causes a treatable myelopathy, so early diagnosis and intervention is essential. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Diagnosis of spinal dural arteriovenous fistula using 3D T2-weighted imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kralik, Stephen F.; Murph, Daniel; Mehta, Peter; O' Neill, Darren P. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States)

    2017-10-15

    To evaluate spinal MRIs without and with 3D T2W imaging among patients without and with spinal dural arteriovenous fistula (SDAVF) confirmed by spinal digital subtraction angiography (DSA). A retrospective case-control study was performed among patients without and with SDAVF who had both spinal MRIs and gold standard spinal DSA. Two neuroradiologists independently reviewed spinal MRIs that were performed with either sagittal T2W turbo spin echo (2D group) or sagittal 3D T2W sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) (3D group) and documented the presence or absence of SDAVF. Using spinal DSA diagnosis as a gold standard, the sensitivity, specificity, and interobserver agreement for the 2D-group and 3D-group MRI diagnosis were calculated. The 2D group consisted of 21 patients and the 3D group consisted of 16 patients. For both radiologists, the 2D group demonstrated a sensitivity of 100% and specificity of 100%. Interobserver agreement in the 2D group was perfect (k = 1.0). For both radiologists, the 3D group demonstrated sensitivity of 100.0% and specificity of 92.3%. Interobserver agreement in the 3D group was perfect (k = 1.0). While flow voids were considered more conspicuous, spinal cord signal abnormality was considered less conspicuous with 3D T2W SPACE compared with conventional 2D STIR sequence. 3D T2W SPACE should be used in conjunction with 2D T2W sequences to more accurately detect abnormal cord signal and determine when perimedullary flow voids are pathologically abnormal for the radiologic diagnosis of SDAVF. (orig.)

  17. Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

    Energy Technology Data Exchange (ETDEWEB)

    Manabe, Shinji; Satoh, Koichi; Matsubara, Shunji; Satomi, Junichiro; Hanaoka, Mami; Nagahiro, Shinji [University of Tokushima, Department of Neurosurgery, Tokushima (Japan)

    2008-08-15

    We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a 'magic wand' appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction. (orig.)

  18. Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

    International Nuclear Information System (INIS)

    Manabe, Shinji; Satoh, Koichi; Matsubara, Shunji; Satomi, Junichiro; Hanaoka, Mami; Nagahiro, Shinji

    2008-01-01

    We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a ''magic wand'' appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction. (orig.)

  19. Onyx embolization as a first line treatment for intracranial dural arteriovenous fistulas with cortical venous reflux

    International Nuclear Information System (INIS)

    Panagiotopoulos, V.; Forsting, M.; Wanke, I.; Moeller-Hartmann, W.; Asgari, S.; Sandalcioglu, I.E.

    2009-01-01

    Our purpose was to present our experience regarding embolization of intracranial dural arteriovenous fistulas (DAVFs) with cortical venous reflux using Onyx, a non-adhesive liquid embolic agent. From January 2006 to December 2007, 16 patients (12 men and 4 women) with a mean age of 61 years (range 42 - 78) with an intracranial DAVF with cortical venous reflux underwent at least one transarterial embolization using Onyx. According to the Cognard classification, 2 lesions were grade V, 5 were grade IV, 6 were grade III, 2 were grade IIa+b, and 1 was grade IIb. The clinical presentation included 5 hemorrhagic deficits, 10 non-hemorrhagic manifestations, and 1 patient was asymptomatic. Twenty-four embolization sessions were performed in 16 patients with an average of 3 arterial feeders (range 1 - 9) embolized per DAVF. Immediately after embolization, complete occlusion was achieved in 9 / 16 (56 %) patients after the first session. Further postembolization surgical treatment was performed in 3 patients. Partial reperfusion occurred in 1 patient at the time of mean follow-up of 3.7 months (range 0 - 12). Treatment has been completed for 11 / 16 patients with angiographic cure in 10 / 11 (91 %). An infratentorial bleeding complication related to embolization occurred in one patient with temporary worsening of the patient's gait disturbance. At the time of mean clinical follow-up of 4.5 months (range 0 - 12), no procedure-related permanent morbidity was added to our cohort. According to our experience, embolization of intracranial DAVFs with cortical venous drainage using Onyx is feasible with promising results, indicating stability at the time of mid-term follow-up. In very complex DAVFs additional embolization material might be necessary, and in some cases surgery is warranted. (orig.)

  20. Experimental inflammation following dural application of complete Freund's adjuvant or inflammatory soup does not alter brain and trigeminal microvascular passage.

    Science.gov (United States)

    Lundblad, Cornelia; Haanes, Kristian A; Grände, Gustaf; Edvinsson, Lars

    2015-01-01

    Migraine is a paroxysmal, disabling primary headache that affects 16 % of the adult population. In spite of decades of intense research, the origin and the pathophysiology mechanisms involved are still not fully known. Although triptans and gepants provide effective relief from acute migraine for many patients, their site of action remains unidentified. It has been suggested that during migraine attacks the leakiness of the blood-brain barrier (BBB) is altered, increasing the passage of anti-migraine drugs. This study aimed to investigate the effect of experimental inflammation, following dural application of complete Freund's adjuvant (CFA) or inflammatory soup (IS) on brain and trigeminal microvascular passage. In order to address this issue, we induced local inflammation in male Sprague-Dawley-rats dura mater by the addition of CFA or IS directly on the dural surface. Following 2, 24 or 48 h of inflammation we calculated permeability-surface area product (PS) for [(51)Cr]-EDTA in the trigeminal ganglion (TG), spinal trigeminal nucleus, cortex, periaqueductal grey and cerebellum. We observed that [(51)Cr]-EDTA did not pass into the central nervous system (CNS) in a major way. However, [(51)Cr]-EDTA readily passed the TG by >30 times compared to the CNS. Application of CFA or IS did not show altered transfer constants. With these experiments we show that dural IS/CFA triggered TG inflammation, did not increase the BBB passage, and that the TG is readily exposed to circulating molecules. The TG could provide a site of anti-migraine drug interaction with effect on the trigeminal system.

  1. Dural afferents express acid-sensing ion channels: a role for decreased meningeal pH in migraine headache.

    Science.gov (United States)

    Yan, Jin; Edelmayer, Rebecca M; Wei, Xiaomei; De Felice, Milena; Porreca, Frank; Dussor, Gregory

    2011-01-01

    Migraine headache is one of the most common neurological disorders. The pathological conditions that directly initiate afferent pain signaling are poorly understood. In trigeminal neurons retrogradely labeled from the cranial meninges, we have recorded pH-evoked currents using whole-cell patch-clamp electrophysiology. Approximately 80% of dural-afferent neurons responded to a pH 6.0 application with a rapidly activating and rapidly desensitizing ASIC-like current that often exceeded 20nA in amplitude. Inward currents were observed in response to a wide range of pH values and 30% of the neurons exhibited inward currents at pH 7.1. These currents led to action potentials in 53%, 30% and 7% of the dural afferents at pH 6.8, 6.9 and 7.0, respectively. Small decreases in extracellular pH were also able to generate sustained window currents and sustained membrane depolarizations. Amiloride, a non-specific blocker of ASIC channels, inhibited the peak currents evoked upon application of decreased pH while no inhibition was observed upon application of TRPV1 antagonists. The desensitization time constant of pH 6.0-evoked currents in the majority of dural afferents was less than 500ms which is consistent with that reported for ASIC3 homomeric or heteromeric channels. Finally, application of pH 5.0 synthetic-interstitial fluid to the dura produced significant decreases in facial and hind-paw withdrawal threshold, an effect blocked by amiloride but not TRPV1 antagonists, suggesting that ASIC activation produces migraine-related behavior in vivo. These data provide a cellular mechanism by which decreased pH in the meninges following ischemic or inflammatory events directly excites afferent pain-sensing neurons potentially contributing to migraine headache. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  2. The influence of age on positions of the conus medullaris, Tuffier's line, dural sac, and sacrococcygeal membrane in infants, children, adolescents, and young adults.

    Science.gov (United States)

    Jung, Ji-Yun; Kim, Eun-Hee; Song, In-Kyung; Lee, Ji-Hyun; Kim, Hee-Soo; Kim, Jin-Tae

    2016-12-01

    The purpose of this study was to analyze the distances between the conus medullaris and the Tuffier's line, and between the dural sac and the sacrococcygeal membrane (SCM) in the same pediatric population. Spinal magnetic resonance images and simple X-ray images of 350 patients aged from 1 month to 20 years were reviewed. Positions of the conus medullaris, Tuffier's line, the dural sac, and the SCM were identified. Each position was recorded in relation to the corresponding vertebral body segments. The distances between the conus medullaris and Tuffier's line, and between the dural sac and the SCM, were measured and then assessed according to age using an analysis of variance and a linear regression analysis. The median levels of the conus medullaris and Tuffier's line were in the lower third of L1 [the first lumbar vertebral body] and the middle third of L5, respectively. The levels of the conus medullaris and Tuffier's line were lower in younger populations. The distance between the conus medullaris and Tuffier's line ranged from 1.5 to 4.75 vertebral body height. However, a narrow range of 1.5-2.5 vertebral height was observed only in children younger than 2 years. The level of the dural sac did not differ greatly by age, but the upper limit of the SCM was lower in older populations. The distance between the dural sac and the upper limit of the SCM increased with age. In children, there is a distance of 1.5-4.75 vertebral body height between the conus medullaris and the Tuffier's line. However, these distances were narrower among younger populations. The distance between the dural sac and the upper limit of the SCM increased with age. © 2016 John Wiley & Sons Ltd.

  3. Formações venosas superficiais da fossa cubital: aspectos de interesse para a prática da Enfermagem Formaciones venosas superficiales de la fosa cubital: aspectos de interés para la práctica de Enfermería Superficial venous formation of the cubital fossa: aspects of interest for nursing practice

    Directory of Open Access Journals (Sweden)

    Nilton Alves

    2012-12-01

    Full Text Available O objetivo deste estudo é contribuir para o conhecimento que auxilie o profissional de enfermagem na identificação dos tipos mais comuns de formações venosas da região da fossa cubital e, ainda, enfocar a importância de estar sempre atento aos casos pouco comuns como o aqui relatado. Através de uma revisão bibliográfica, constatamos que as formações venosas dessa região podem ser classificadas em 5 tipos mais comuns, sendo o tipo II o mais frequente. Constatamos ainda, que a VICo é o local de punção mais indicado, seguido pela VIB. Descrevemos também uma variação anatômica, onde observamos ausência de comunicação entre VC e VB no nível da fossa cubital e VIA drenando na VB, estando presente a VCA.El objetivo de esta investigación es contribuir al conocimiento que auxilie al profesional de enfermería en la identificación de los tipos más comunes de formaciones venosas de la fosa cubital, además de advertir sobre la importancia de fijar la atención a los casos poco comunes, como lo aquí reportado. A través de la revisión bibliográfica, clasificamos las formaciones venosas de esta región en cinco tipos más comunes, siendo lo más frecuente el Tipo II. La utilización de la VICo se recomienda como el mejor sitio de punción, seguido por la VIB. Además, describimos una variación anatómica, donde se observó la ausencia de comunicación entre VC y VB a nivel de fosa cubital y VIA drenando en VB, con presencia de la VCA.The aim of this study is to contribute to the knowledge to assists the nursing staff to identify the most common types of venous formations of the cubital fossa region, and also focus on the importance of always being alert to unusual cases as that reported here. Through a literature review, we found that the venous formations of this region can be classified into five common types, bring the Type II the was most frequent. We also found that MCV is considered the best puncture site, followed by MBV

  4. Atitudes atuais de anestesiologistas e médicos em especialização com relação à anestesia venosa total Actitudes actuales de anestesiólogos y médicos en especialización con relación a la anestesia venosa total Current attitude of anesthesiologists and anesthesiology residents regarding total intravenous anesthesia

    Directory of Open Access Journals (Sweden)

    Fernando Squeff Nora

    2006-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: No passado, tempo, custos, informações, treinamento e avaliação da profundidade da anestesia limitavam a aceitação da anestesia venosa total (TIVA. O objetivo deste estudo foi determinar atitudes de anestesiologistas e médicos em especialização com relação à anestesia venosa total. MÉTODO: Um questionário foi enviado a 150 anestesiologistas e 102 residentes. A concordância (C e discordância (D em cada item foram comparadas por testes z (consenso, se p JUSTIFICATIVA Y OBJETIVOS: Antiguamente, tiempo, costes, informaciones, capacitación y evaluación de la profundidad de la anestesia limitaban la aceptación de la anestesia venosa total (TIVA. El objetivo de este estudio fue el de determinar las actitudes de anestesiólogos y médicos en especialización con relación a la anestesia venosa total. MÉTODO: Un cuestionario fue enviado a 150 anestesiólogos y 102 residentes. La concordancia (C y discordancia (D en cada ítem se compararon por pruebas z (consenso, si p BACKGROUND AND OBJECTIVES: In the past, time, cost, information, training, and the evaluation of the plane of anesthesia limited the acceptance of total intravenous anesthesia (TIVA. The objective of this study was to determine the attitude of anesthesiologists and other anesthesiology residents regarding total intravenous anesthesia. METHODS: A questionnaire was sent to 150 anesthesiologists and 102 residents. The concordance (C and disaccord (D of each item were compared by z tests (consensus if p < 0.05. RESULTS: There were 98 responses. The data represent the number of answers for each category. The majority of the participants agreed that the quality of the awakening stimulates the use of the TIVA (C/D = 86/8; p < 0.05; that the future depends on the development of drugs with a fast onset of action and immediate recovery (C/D = 88/5; p < 0.05; that they would like to use TIVA more often (C/D = 72/21; p < 0.05; and to have more information

  5. Systematic review of topic treatment for venous ulcers Revisión sistemática del tratamiento tópico de la úlcera venosa Revisão sistemática do tratamento tópico da úlcera venosa

    Directory of Open Access Journals (Sweden)

    Eline Lima Borges

    2007-12-01

    Full Text Available Venous ulcer patients can experience this situation for several years without achieving healing if treatment is inadequate. Evidence-based professional practice generates effective results for patients and services. This research aimed to carry out a systematic review to assess the most effective method to improve venous return and the best topic treatment for these ulcers. Studies were collected in eight databases, using the following descriptors: leg ulcer, venous ulcer and similar terms. The sample consisted of 33 primary studies and two Meta-analyses. A wide range of treatments was identified, grouped in compression therapy (54.3% and topical treatment (45.7%. It was evidenced that compression therapy increases ulcer healing rates and should be used in patients with intact arteries. There is no consensus about the best topical treatment, although different options should be associated with compression therapy.Pacientes con úlcera venosa pueden convivir con esta situación durante varios años, sin obtener la cicatrización de la herida caso el tratamiento no sea adecuado. La práctica profesional basada en evidencias produce resultados efectivos para el paciente y para los servicios. La finalidad del estudio fue realizar una revisión sistemática para evaluar el método más eficaz para mejorar el retorno venoso y el mejor tratamiento tópico de la úlcera. Se buscaron estudios indexados en ocho bases de datos, mediante los descriptores úlcera de pierna, úlcera venosa y similares. La muestra incluyó 33 estudios primarios y 2 estudios de metanálisis. Se identificó una diversidad de tratamientos que fueron agrupados en terapia compresiva (54,3% y tratamiento tópico (45,7%. Fue evidenciado que la terapia compresiva aumenta la tasa de cicatrización de la úlcera y que debe ser usado en pacientes sin comprometimiento arterial. No queda claro cual es la mejor terapia tópica. Sin embargo, las diferentes opciones deben ser asociadas a la

  6. Dural invasion of meningiomas adjacent to the tumor margin on Gd-DTPA-enhanced MR images: histopathologic correlation

    International Nuclear Information System (INIS)

    Hutzelmann, A.; Palmie, S.; Freund, M.; Heller, M.; Buhl, R.

    1998-01-01

    In intracranial meningiomas a flat, contrast-enhancing, dural structure adjacent to the tumor can occasionally be observed on gadolinium-DTPA-enhanced MR images. We wished to evaluate whether there is a correlation between MR images and meningeal invasion of intracranial meningiomas. The study included 54 patients with intracranial meningioma and the meningeal sign. MR studies included T2-weighted and gadolinium-DTPA-enhanced T1-weighted images in axial, coronal, and sagittal planes. Histopathologic examinations were done on the meningiomas adjacent to the dura mater. The meningeal sign on MRI was observed from 2 up to 35 mm from the main tumor mass in 31 (57 %) of the 54 patients. In 20 of these 31 the histopathologic examination showed tumor invasion, while 11 patients had no tumor invasion but tissue proliferation, hypervascularity, and vascular dilatation. Seven of the 23 meningiomas without the meningeal sign had histologically proven infiltration of the adjacent dura. MR imaging is not able to determine definitive whether or not there is dural infiltration of the meningiomas. In conclusion, resection of the tumor with a wide margin is necessary to achieve complete excision of meningioma and to avoid recurrence. (orig.)

  7. Widening of the spinal canal and dural ectasia in Marfan's syndrome: assessment by CT

    Energy Technology Data Exchange (ETDEWEB)

    Villeirs, G.M.; Verstraete, K.L.; Kunnen, M.F. [Dept. of Radiology, Univ. Hospital, Gent (Belgium); Tongerloo, A.J. van; Paepe, A.M. de [Dept. of Medical Genetics, Univ. Hospital, Gent (Belgium)

    1999-11-01

    We describe a method for diagnosing dural ectasia (DE) and spinal canal widening (SCW) using CT. We examined 23 patients with Marfan's syndrome (MFS), 17 with Ehlers-Danlos syndrome (EDS) and 29 normal subjects, using six axial slices at the level of the L1-S1 pedicles. Transverse diameters of the vertebral bodies, spinal canal and dural sac were measured and indices were defined to differentiate patients with DE and SCW from normal. Statistical significance was assessed using Student's t -test, {chi} {sup 2}-test and Pearson's correlation coefficient. DE and SCW occurred in 69.6 % and 60.9 % of cases of MFS and in 23.5 % and 35.3 % of EDS respectively. In MFS, prevalence was significantly higher than in the control group. DE was significantly more frequent in MFS than in EDS. A strong correlation existed between DE and SCW in MFS and the control group, but not in EDS. Our system enables quantitative assessment of SCW and DE. The latter is particularly important in subjects suspected of having MFS, in whom it is a common and characteristic sign. (orig.)

  8. Single-Session Hematoma Removal and Transcranial Coil Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: A Technical Case Report.

    Science.gov (United States)

    Akamatsu, Yosuke; Sato, Kenichi; Endo, Hidenori; Matsumoto, Yasushi; Tominaga, Teiji

    2017-08-01

    Patients with cavernous sinus dural arteriovenous fistulas (CS dAVFs) with cortical venous varix are indicated for aggressive treatment because of the associated risk for intracranial hemorrhage. We present a case of surgical transvenous embolization in an 84-year-old woman with CS dAVF who presented with massive intracerebral hematoma. Cerebral angiograms revealed the dural AVF drained only into the superficial middle cerebral vein. Because an emergent mass reduction and prevention of rebleeding were necessary, single-session hematoma removal and transcranial embolization of a CS dAVF were performed in the neurosurgical operating room, using a mobile C-arm fluoroscopy. After the right frontotemporal craniotomy, intracerebral hematoma was removed and coil packing of the affected cavernous sinus was successfully performed via the dilated superficial middle cerebral vein. The transcortical vein approach enables occlusion of CS dAVF with isolated cortical venous drainage and may be a valuable alternative approach for some cases needed emergency craniotomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. The effect of intravenous propofol on the incidence of post-dural puncture headache following spinal anesthesia in cesarean section

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    Parisa Golfam

    2016-09-01

    Full Text Available Introduction: Post Dural puncture headache is still a common complication among young women undergone cesarean section, although use of small size spinal needles reduced its prevalence. Several methods have been suggested for prevention and treatment of this side effect; such as complete bed rest, hydration, non-opioid analgesics, caffeine, codeine, which none of them proved to be totally effective. The last option would be epidural blood patch, if headache persist. The aim of this study was evaluation the efficacy of intravenous propofol on post dural puncture headache incidence after cesarean section. Methods: In a randomized clinical trial 120 patients aged 18-45 years old in American Society of Anesthesiologist (ASA class I or II, who had no history of headache, analgesic consumption, substance abuse and drug addiction, candidate for elective cesarean section, were randomly assigned into intervention (propofol and control groups. The anesthesia method for both groups was precisely the same. After spinal anesthesia in the first group 30µg/kg/min of intravenous propofol have been infused slowly. Then at 1, 6, 18, 24 hours and 2nd to 7th days after surgery, anesthesiologist asked groups for presence or absence of headache. The data analyzed with SPSS 16.0 software. Results: Headache incidence rate in the group who receiving propofol was significantly reduced (P.V=0.001. Conclusion: This study showed that 30µg/kg/min of intravenous propofol caused reduced the incidence of post spinal headache in young women undergone elective cesarean section.

  10. CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas: Findings associated with cortical venous reflux

    Energy Technology Data Exchange (ETDEWEB)

    Letourneau-Guillon, Laurent; Cruz, Juan Pablo; Krings, Timo, E-mail: Timo.Krings@uhn.ca

    2015-08-15

    Highlights: • The conventional neuroimaging manifestations of dural arteriovenous fistulas are highly variable. • Identification of cortical venous reflux is important to prevent complications. • Tortuous and dilated vessels without a nidus are associated with cortical venous reflux. • Digital subtraction angiography remains the gold standard for DAVF diagnosis. - Abstract: Purpose: To compare the conventional CT and MR findings of DAVFs in relation to the venous drainage pattern on digital subtraction angiography (DSA). Materials and Methods: Cross-sectional imaging findings (CT and/or MR) in 92 patients were compared to the presence of cortical venous reflux (CVR) on DSA. Results: Imaging features significantly more prevalent in patients with CVR included: abnormally dilated and tortuous leptomeningeal vessels (92% vs. 4%, p < 0.001) or medullary vessels (69% vs. 0%, p < 0.001), venous ectasias (45% vs. 0%, p < 0.001) and focal vasogenic edema (38% vs. 0%, p < 0.001). The following findings trended towards association but did not reach the p value established following Bonferroni correction: dilated external carotid artery branches (71% vs. 38%, p = 0.005), cluster of vessels surrounding dural venous sinus (50% vs. 19%, p = 0.009), presence of hemorrhage (33 vs. 12%, p = 0.040), and parenchymal enhancement (21% vs. 0%, p = 0.030). Conclusion: In the appropriate clinical setting, recognition of ancillary signs presumably related to venous arterialization and congestion as well as arterial feeder hypertrophy should prompt DSA confirmation to identify DAVFs associated with CVR.

  11. Morphological analysis of the cervical spinal canal, dural tube and spinal cord in normal individuals using CT myelography

    International Nuclear Information System (INIS)

    Inoue, H.; Ohmori, K.; Takatsu, T.; Teramoto, T.; Ishida, Y.; Suzuki, K.

    1996-01-01

    To verify the conventional concept of ''developmental stenosis of the cervical spinal canal'', we performed a morphological analysis of the relations of the cervical spinal canal, dural tube and spinal cord in normal individuals. The sagittal diameter, area and circularity of the three structures, and the dispersion of each parameter, were examined on axial sections of CT myelograms of 36 normal subjects. The spinal canal was narrowest at C4, followed by C5, while the spinal cord was largest at C4/5. The area and circularity of the cervical spinal cord were not significantly correlated with any parameter of the spinal canal nor with the sagittal diameter and area of the dural tube at any level examined, and the spinal cord showed less individual variation than the bony canal. Compression of the spinal cord might be expected whenever the sagittal diameter of the spinal canal is below the lower limit of normal, that is about 12 mm on plain radiographs. Thus, we concluded that the concept of ''developmental stenosis of the cervical spinal canal'' was reasonable and acceptable. (orig.). With 2 figs., 3 tabs

  12. Total dural irradiation: RapidArc versus static-field IMRT: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, Paul J., E-mail: paulj.kelly@hse.ie [Department of Radiation Oncology, Dana Farber/Brigham and Women' s Cancer Center, Harvard Medical School, Boston, MA (United States); Mannarino, Edward; Lewis, John Henry; Baldini, Elizabeth H.; Hacker, Fred L. [Department of Radiation Oncology, Dana Farber/Brigham and Women' s Cancer Center, Harvard Medical School, Boston, MA (United States)

    2012-07-01

    The purpose of this study was to compare conventional fixed-gantry angle intensity-modulated radiation therapy (IMRT) with RapidArc for total dural irradiation. We also hypothesize that target volume-individualized collimator angles may produce substantial normal tissue sparing when planning with RapidArc. Five-, 7-, and 9-field fixed-gantry angle sliding-window IMRT plans were generated for comparison with RapidArc plans. Optimization and normal tissue constraints were constant for all plans. All plans were normalized so that 95% of the planning target volume (PTV) received at least 100% of the dose. RapidArc was delivered using 350 Degree-Sign clockwise and counterclockwise arcs. Conventional collimator angles of 45 Degree-Sign and 315 Degree-Sign were compared with 90 Degree-Sign on both arcs. Dose prescription was 59.4 Gy in 33 fractions. PTV metrics used for comparison were coverage, V{sub 107}%, D1%, conformality index (CI{sub 95}%), and heterogeneity index (D{sub 5}%-D{sub 95}%). Brain dose, the main challenge of this case, was compared using D{sub 1}%, Dmean, and V{sub 5} Gy. Dose to optic chiasm, optic nerves, globes, and lenses was also compared. The use of unconventional collimator angles (90 Degree-Sign on both arcs) substantially reduced dose to normal brain. All plans achieved acceptable target coverage. Homogeneity was similar for RapidArc and 9-field IMRT plans. However, heterogeneity increased with decreasing number of IMRT fields, resulting in unacceptable hotspots within the brain. Conformality was marginally better with RapidArc relative to IMRT. Low dose to brain, as indicated by V5Gy, was comparable in all plans. Doses to organs at risk (OARs) showed no clinically meaningful differences. The number of monitor units was lower and delivery time was reduced with RapidArc. The case-individualized RapidArc plan compared favorably with the 9-field conventional IMRT plan. In view of lower monitor unit requirements and shorter delivery time, Rapid

  13. A microcontroller-based simulation of dural venous sinus injury for neurosurgical training.

    Science.gov (United States)

    Cleary, Daniel R; Siler, Dominic A; Whitney, Nathaniel; Selden, Nathan R

    2018-05-01

    OBJECTIVE Surgical simulation has the potential to supplement and enhance traditional resident training. However, the high cost of equipment and limited number of available scenarios have inhibited wider integration of simulation in neurosurgical education. In this study the authors provide initial validation of a novel, low-cost simulation platform that recreates the stress of surgery using a combination of hands-on, model-based, and computer elements. Trainee skill was quantified using multiple time and performance measures. The simulation was initially validated using trainees at the start of their intern year. METHODS The simulation recreates intraoperative superior sagittal sinus injury complicated by air embolism. The simulator model consists of 2 components: a reusable base and a disposable craniotomy pack. The simulator software is flexible and modular to allow adjustments in difficulty or the creation of entirely new clinical scenarios. The reusable simulator base incorporates a powerful microcomputer and multiple sensors and actuators to provide continuous feedback to the software controller, which in turn adjusts both the screen output and physical elements of the model. The disposable craniotomy pack incorporates 3D-printed sections of model skull and brain, as well as artificial dura that incorporates a model sagittal sinus. RESULTS Twelve participants at the 2015 Western Region Society of Neurological Surgeons postgraduate year 1 resident course ("boot camp") provided informed consent and enrolled in a study testing the prototype device. Each trainee was required to successfully create a bilateral parasagittal craniotomy, repair a dural sinus tear, and recognize and correct an air embolus. Participant stress was measured using a heart rate wrist monitor. After participation, each resident completed a 13-question categorical survey. CONCLUSIONS All trainee participants experienced tachycardia during the simulation, although the point in the simulation

  14. The road less traveled: transarterial embolization of dural arteriovenous fistulas via the ascending pharyngeal artery.

    Science.gov (United States)

    Gross, Bradley A; Albuquerque, Felipe C; Moon, Karam; McDougall, Cameron G

    2017-01-01

    With the introduction of Onyx, transarterial embolization has become the most common endovascular approach to treating dural arteriovenous fistulas (dAVFs), often via the middle meningeal or occipital arteries. The ascending pharyngeal artery (APA) is a less frequently explored transarterial route because of its small caliber, potential anastomoses to the internal carotid and vertebral arteries, and vital supply to lower cranial nerves. To review our institutional experience and highlight the prevalence of APA supply to dAVFs and cases where it is a safe and effective pedicle for embolization. We reviewed our endovascular database (January 1, 1996 to March 1, 2016) for cranial dAVFs, evaluating dAVF characteristics and embolization results for those treated transarterially via the APA. Of 267 endovascularly treated dAVFs, 68 had APA supply (25%). Of these 68 dAVFs, embolization was carried out via this pedicle in 8 (12%) and 7 were ultimately occluded. No complications, including post-treatment cranial neuropathies or radiographic evidence of non-target embolization, were found. For 5 dAVFs, the APA was selected as the initial pedicle for embolization (two marginal sinus, one distal sigmoid, one cavernous, one tentorial). In four of these five cases, dAVF occlusion was achieved via the initial APA feeding artery pedicle. In one case, near-complete, stagnant occlusion was achieved after APA embolization; complete occlusion was achieved after adjunctive embolization of a single additional middle meningeal artery pedicle. In three other cases of complex transverse/sigmoid dAVFs, the APA was used after multiple attempts via middle meningeal and occipital artery pedicles. Occlusion was not achieved transarterially; two of these three dAVFs were ultimately occluded transvenously. In rare, select cases, the APA is an excellent route for transarterial embolization of cranial dAVFs. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  15. RELATO EVANGÉLICO E SENTIDO DA FAMÍLIA

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    Ignacio Antonio Madera Vargas, SDS

    2015-01-01

    Full Text Available Alguns dos relatos sobre a relação de Jesus com a sua família nos possibilitam considerar o sentido que podemos encontrar nos mesmos para uma compreensão teológica que aponte para o sentido da experiência das relações no interior da mesma. Tanto o casal como a família constituem uma realidade que, interpretada à luz da experiência de fé que os evangelistas nos oferecem como a Boa Nova do Reino, orientam-se em direção a uma relação a se viver à imagem da comunhão trinitária. A liberdade e a capacidade de crescer em adultícia como sabedoria e graça caracterizam os relatos os quais nos apresentam Jesus e sua família ou familiares. Uma visão de Jesus de Nazaré que o apresenta não afetado pelos traumas e as limitações, que provoca a relação no interior das famílias, em qualquer um de nós, eco da visão que os relatos nos oferecem dEle à luz da ressurreição. Este artigo é resultado das investigações do Projeto Significado da linguagem teológica do Grupo de Investigação Teologia e Mundo Contemporâneo da Faculdade de Teologia da Pontifícia Universidade Javeriana.    ABSTRACT: Some of the tales about the relationship of Jesus to his family allow us enter to consider the sense that we can Knd in them for a theological under standing that in dicate the meaning of the experience of relations to the interior of the family. Both the couple and the family constitute a reality which, interpreted in the light of the experience of faith that the evangelists oVer us as the good news of the Kingdom, directed towards a relationship to living in the image of the Trinitarian communion. Freedom and the ability to grow in adulthood as wisdom and grace characterize the stories in which presents itself to Jesus and his family or relatives. A view of Jesus from Nazareth which presents it not aVected by trauma and limitations that causes the relationship to the interior of the families at any one of us, echo of the vision that the

  16. Abdome agudo obstrutivo pela veia porta - relato de caso

    Directory of Open Access Journals (Sweden)

    Celeste Gomes Sardinha Oshiro

    2016-10-01

    Full Text Available Introdução: A veia porta pré-duodenal é uma anomalia congênita rara, sintomática em apenas 50% dos casos, sendo que seu diagnóstico é feito por laparotomia exploradora. O tratamento de escolha é cirúrgico, com bom prognóstico. Objetivo: Relatar um caso de Abdome Agudo Obstrutivo por Veia Porta Pré Doudenal (VPPD no período neonatal no Conjunto Hospitalar de Sorocaba. Metodologia: Descrição do referido caso e revisão de literatura. Relato de Caso: Recém-nascido de F.S.S., feminino, de parto normal em 30/05/2016, cuja mãe com 21 anos, apresentou durante pré-natal Diabetes Mellitus Gestacional e polihidrâmnio; negou consanguinidade, vícios e infecções. Ao nascimento, idade gestacional 38 1/7 semanas, peso 2865g, comprimento 47 cm, Apgar 9/9. Durante rotinas de sala de parto, à aspiração gástrica, saída de 55 ml de líquido claro com grumos (LCCG. No 4o dia de vida, episódios de vômito com sangue e distensão abdominal. No 11° dia de vida, realizada Laparotomia Exploradora que identificou dilatação gástrica e duodenal, principalmente na 3° porção, onde passa anteriormente a Veia Porta, comprimindo parcialmente a borda antimesentérica duodenal, o que comprometia seu esvaziamento. Realizada anastomose duodeno-jejunal. Recebeu alimentação parenteral por 15 dias. RN apresentou infecções fúngica e bacteriana, tratadas durante internação. Recebe alta com 46 dias de vida em aleitamento materno e boa recuperação clínica. Conclusão: Existem poucos relatos sobre a formação anômala da veia porta e suas consequências. O diagnóstico pré-natal ou pré-operatório de VPPD raramente é feito. Boa evolução pós correção cirúrgica.

  17. Anestesia para ventriculostomia por via endoscópica para tratamento de hidrocefalia: relato de casos Anestesia para ventriculostomía por vía endoscópica para tratamiento de hidrocefalia: relato de casos Anesthesia for endoscopic ventriculostomy for the treatment of hydrocephalus: case report

    Directory of Open Access Journals (Sweden)

    Friederike Wolff Valadares

    2007-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A terceiro-ventriculostomia endoscópica está se tornando um procedimento de rotina entre as intervenções neurocirúrgicas infantis. Entretanto, relatos sobre anestesia para crianças submetidas a tais procedimentos ainda são escassos. O objetivo desta série de casos foi demonstrar os cuidados e a eficácia do método empregado. RELATO DOS CASOS: Foram avaliadas retrospectivamente 38 crianças abaixo de 2 anos que se submeteram à terceiro-ventriculostomia neuroendoscópica para tratamento de hidrocefalia obstrutiva no período de 1999 a 2004 no Biocor Instituto. Foram estudados o diagnóstico, comorbidades, idade, peso, técnica anestésica, monitorização e as complicações intra e pós-operatórias. Todos os pacientes, entre 1 semana e 20 meses, apresentavam hidrocefalia obstrutiva por compressão do aqueduto de etiologia variada. A indução anestésica em 35 crianças foi por via inalatória e por via venosa em três delas. A monitorização de 34 pacientes foi com eletrocardiograma, oxímetro de pulso, capnógrafo e termômetro esofágico, sendo quatro crianças monitorizadas com pressão arterial invasiva contínua. A manutenção da anestesia em 15 pacientes foi balanceada com fentanil e isoflurano e em outros 23 pacientes inalatória com isoflurano. Trinta e cinco crianças foram extubadas após o procedimento na sala cirúrgica e outras três no CTI. Seis pacientes foram encaminhados ao CTI após a extubação. Complicações observadas: disritmias cardíacas sem repercussão hemodinâmica no intra-operatório (seis casos. Dois pacientes tiveram sangramento intra-operatório, mas somente um deles demandou implante de derivação ventricular externa. As complicações no pós-operatório foram: vômitos (6, picos febris (4 convulsões (2, laringoespasmo (1 e estridor laríngeo (1. CONCLUSÕES: A terceiro-ventriculostomia apresenta baixa incidência de complicações mesmo em pacientes com menos de 24

  18. Dural attachment of intracranial meningiomas: evaluation with contrast-enhanced three-dimensional fast imaging with steady-state acquisition (FIESTA) at 3 T

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Junkoh; Takahashi, Mayu; Aoyama, Yuichi; Soejima, Yoshiteru; Saito, Takeshi; Akiba, Daisuke; Nishizawa, Shigeru [University of Occupational and Environmental Health, Department of Neurosurgery, Kitakyusyu (Japan); Kakeda, Shingo; Korogi, Yukunori [University of Occupational and Environmental Health, Department of Radiology, Kitakyusyu (Japan)

    2011-06-15

    The purpose of this study was to evaluate the role of contrast-enhanced fast imaging with steady-state acquisition (CE-FIESTA) for assessing whether dural attachment in intracranial meningiomas is adhesive or not by correlation with intraoperative findings. Fourteen consecutive patients who were candidates for surgical treatment of meningiomas were prospectively analyzed with preoperative magnetic resonance imaging, including CE-FIESTA at 3 T. First, two neuroradiologists assessed several characteristics of the attachment of the meningioma to the dura mater or skull base on CE-FIESTA images. Second, the surgical findings of adhesion at the dural attachment of meningiomas were evaluated by two neurosurgeons. Finally, the CE-FIESTA findings were correlated with the surgical findings by one neurosurgeon and one neuroradiologist by consensus. CE-FIESTA clearly depicted a hypointense marginal line at the attachment site of the meningioma. When CE-FIESTA revealed smooth marginal lines or hyperintense zones along the marginal lines, tumors were detached easily from the dura mater. On the contrary, when CE-FIESTA showed an irregularity, such as partial disruption of the marginal lines, vessels, or bony hyperostosis, the tumors tended to adhere firmly to the dura mater, which was found to contain small vessels and fine fibrous tissues. There seems to be an excellent correlation between the characteristics of dural attachment of meningiomas on CE-FIESTA images and intraoperative findings. Therefore, for operative planning, CE-FIESTA may provide useful information regarding the adhesiveness of dural attachment. (orig.)

  19. Dural attachment of intracranial meningiomas: evaluation with contrast-enhanced three-dimensional fast imaging with steady-state acquisition (FIESTA) at 3 T

    International Nuclear Information System (INIS)

    Yamamoto, Junkoh; Takahashi, Mayu; Aoyama, Yuichi; Soejima, Yoshiteru; Saito, Takeshi; Akiba, Daisuke; Nishizawa, Shigeru; Kakeda, Shingo; Korogi, Yukunori

    2011-01-01

    The purpose of this study was to evaluate the role of contrast-enhanced fast imaging with steady-state acquisition (CE-FIESTA) for assessing whether dural attachment in intracranial meningiomas is adhesive or not by correlation with intraoperative findings. Fourteen consecutive patients who were candidates for surgical treatment of meningiomas were prospectively analyzed with preoperative magnetic resonance imaging, including CE-FIESTA at 3 T. First, two neuroradiologists assessed several characteristics of the attachment of the meningioma to the dura mater or skull base on CE-FIESTA images. Second, the surgical findings of adhesion at the dural attachment of meningiomas were evaluated by two neurosurgeons. Finally, the CE-FIESTA findings were correlated with the surgical findings by one neurosurgeon and one neuroradiologist by consensus. CE-FIESTA clearly depicted a hypointense marginal line at the attachment site of the meningioma. When CE-FIESTA revealed smooth marginal lines or hyperintense zones along the marginal lines, tumors were detached easily from the dura mater. On the contrary, when CE-FIESTA showed an irregularity, such as partial disruption of the marginal lines, vessels, or bony hyperostosis, the tumors tended to adhere firmly to the dura mater, which was found to contain small vessels and fine fibrous tissues. There seems to be an excellent correlation between the characteristics of dural attachment of meningiomas on CE-FIESTA images and intraoperative findings. Therefore, for operative planning, CE-FIESTA may provide useful information regarding the adhesiveness of dural attachment. (orig.)

  20. Gamma Knife radiosurgery for intracranial meningiomas : Do we need to treat the dural tail? A single-center retrospective analysis and an overview of the literature

    NARCIS (Netherlands)

    Bulthuis, Vincent J; Hanssens, Patrick E J; Lie, Suan Te; van Overbeeke, Jacobus J

    2014-01-01

    BACKGROUND: The dural tail (DT) has been described as a common feature in meningiomas. There is a great variation of tumor invasion and extent of tumor cells in the DT. Therefore, the necessity to include the whole DT in Gamma Knife radiosurgery is not clear, since inclusion increases the target

  1. Measurement of the cross-sectional area of the dural tube in the lumbar spine on magnetic resonance imaging. Comparison between normal, pre- and post-discectomy conditions

    International Nuclear Information System (INIS)

    Matsubayashi, Yasutomo

    1997-01-01

    This study evaluated the usefulness of pre- and postoperative magnetic resonance imaging (MRI) of lumbar disc hernia with special attention to measurement of the cross-sectional area of the dural tube. Twenty-five patients (20 men and 5 women; 25 discs) who underwent posterior lumbar discectomy and 73 normal individuals (44 men and 29 women; 219 discs) of a similar age distribution were studied. Axial MRI was mainly used for the measurement of the dural tube. In the patient group, MRI examination was performed 1, 3, 6, and 12 months postoperatively. Assessment of the clinical symptoms was also included and used for comparison with the MRI evaluation. The cross-sectional area was significantly reduced to about 50% of the normal preoperatively. One month postoperatively, there was no significant increase in the size of the area, but after three months, the area increased significantly and progressed to the normal size within a year. One-month postoperatively, MRI examination was not considered useful because of postoperative hematoma and/or edema at the surgical site. The increase in the size of the cross-sectional area of the dural tube correlated well with the improvement in clinical symptoms. Three-months postoperatively, MRI evaluation of the lumbar disc seemed useful and measurement of the cross-sectional area of the dural tube appeared to serve as an indicator of the effectiveness of the surgery. (author)

  2. Measurement of the cross-sectional area of the dural tube in the lumbar spine on magnetic resonance imaging. Comparison between normal, pre- and post-discectomy conditions

    Energy Technology Data Exchange (ETDEWEB)

    Matsubayashi, Yasutomo [Juntendo Univ., Tokyo (Japan). School of Medicine

    1997-07-01

    This study evaluated the usefulness of pre- and postoperative magnetic resonance imaging (MRI) of lumbar disc hernia with special attention to measurement of the cross-sectional area of the dural tube. Twenty-five patients (20 men and 5 women; 25 discs) who underwent posterior lumbar discectomy and 73 normal individuals (44 men and 29 women; 219 discs) of a similar age distribution were studied. Axial MRI was mainly used for the measurement of the dural tube. In the patient group, MRI examination was performed 1, 3, 6, and 12 months postoperatively. Assessment of the clinical symptoms was also included and used for comparison with the MRI evaluation. The cross-sectional area was significantly reduced to about 50% of the normal preoperatively. One month postoperatively, there was no significant increase in the size of the area, but after three months, the area increased significantly and progressed to the normal size within a year. One-month postoperatively, MRI examination was not considered useful because of postoperative hematoma and/or edema at the surgical site. The increase in the size of the cross-sectional area of the dural tube correlated well with the improvement in clinical symptoms. Three-months postoperatively, MRI evaluation of the lumbar disc seemed useful and measurement of the cross-sectional area of the dural tube appeared to serve as an indicator of the effectiveness of the surgery. (author)

  3. Maison de verre / Zonestraal. Relato de dos edificios

    Directory of Open Access Journals (Sweden)

    Jan Molema

    2014-01-01

    Full Text Available Desde los años sesenta del siglo XX el sanatorio Zonnestraal de Hilversum y la Maison de Verre en París han sido descritos extensamente en la literatura de la arquitectura moderna. Sin embargo, no se ha hecho ningún esfuerzo por colocarlos juntos en un mismo relato. Este ensayo es un esfuerzo para enmendar ese vacío. Ambos están relacionados íntimamente por sus autores: Bernard Bijvoet, como codiseñador de los planos de la Maison, y Johannes Duiker, quien trabajó con el anterior en los preliminares de Zonnestraal, aunque lo finalizó en solitario, al mismo tiempo que se terminó el diseño de la casa. En el trabajo se cuestiona además, ofreciendo fundadas conjeturas, la creencia establecida de que se precisó una nueva estructura metálica para sustentar la inalterada vivienda situada encima de la Maison de Verre.

  4. Síndrome de Isaacs: relato de um caso

    Directory of Open Access Journals (Sweden)

    Hélio Ghizoni Teive

    1988-06-01

    Full Text Available Relato do caso de paciente do sexo feminino com 40 anos de idade, com quadro progressivo de diminuição de força, disfonia, disfagia, dispnéia e hiperidrose. O exame físico revelava contratura em flexão das mãos, déficit de força muscular, fasciculações, mioquimia facial e pseudomiotonia nas mãos, A eletromiografia mostrou atividade elétrica contínua em repouso. O estudo histoquímico muscular revelou atrofia de fibras do tipo II, enquanto a microscopia eletrônica mostrou dilatação importante das cisternas do retículo sarcoplasmático. O diagnóstico de síndrome de Isaacs foi firmado. Excelente resposta clínica ao emprego de carbamazepina foi observada. São discutidos e revistos vários aspectos relacionados a essa rara síndrome.

  5. ENCIERRO, TRABAJO Y LIBERTAD. RELATO DE OPORTUNIDADES GANADAS Y PERDIDAS

    Directory of Open Access Journals (Sweden)

    Mariana Cecilia Fernández

    2016-08-01

    Full Text Available Este trabajo se propone rastrear los elementos que estructuran la vida de Julián, un hombre de 47 años que se “gana la vida” vendiendo copos de azúcar en Morón, como parte de una tesis doctoral en curso que analiza las políticas públicas de “inclusión social” dirigidas a personas liberadas de prisión durante el proceso post-penitenciario en la ciudad de Buenos Aires en la actualidad. Las siguientes líneas se proponen abrir el campo de exploración referido al delito y la sociedad a partir de los repertorios experienciales y asuntos significativos de su biografía.El trabajo se segmenta en dos partes: 1 el tiempo (eterno del encierro; 2 el trabajo como tranquilidad y la libertad como no rutina. Dos momentos en que podrían dividirse las “oportunidades” de su vida. He aquí el punto recurrente en torno al cual fue y vino el relato de Julián durante el transcurso de dos entrevistas en profundidad realizadas recientemente. La oportunidad, como una suerte de intersticio cuasi voluntario que no se halla distribuido en partes iguales ni todos llegan a alcanzar. Y que confirma, una y otra vez, la inexistencia de la justicia.

  6. no cotidiano da enfermagem: um relato de experiência

    Directory of Open Access Journals (Sweden)

    Maria Cristina Soares Figueiredo Trezza

    2007-01-01

    Full Text Available Este trabajo trata sobre el relato de la experiencia de la realización del I Festival: Enfermería en el arte de educar en Salud, realizado por la Escuela de Enfermería y Farmacia de la Universidad Federal de Alagoas. En este evento se presentaron creaciones artísticas realizadas en el cotidiano de la Enfermería, las cuales surgieron como un instrumento para desarrollar procesos de Educación en salud. El evento fue realizado en tres fases: el Festival con la presentación de las creaciones para los jueces de las comisiones; la exposición de las creaciones ganadoras; y la publicación de un libro con las producciones presentadas. De las 77 creaciones presentadas, 15 fueron vencedoras, las cuales fueron hechas por enfermeros, auxiliares y estudiantes de enfermería, revelando así la creatividad de los profesionales de la enfermería en la difícil tarea de educar en salud. El Festival así como el libro que de él resultó, mostraron cómo los autores desarrollaron estrategias pedagógicas a través de las cuales los sujetos del aprendizaje alcanzaron el lugar que por derecho les pertenecía. La experiencia demostró que cuando se actúa innovadoramente, los resultados pueden sorprender.

  7. Fetal MR imaging of posterior intracranial dural sinus thrombosis: a report of three cases with variable outcomes

    International Nuclear Information System (INIS)

    Byrd, Sharon E.; Elias, Dean; Abramowicz, Jacques S.; Kent, Paul; Kimura, Robert E.; Heydeman, Peter T.

    2012-01-01

    Thrombosis of fetal intracranial dural sinuses is a rare entity. A specific type of midline dural sinus thrombosis (DST) at the torcular Herophili with extension into the superior sagittal sinus (SSS) was initially seen on fetal US and was referred to fetal MRI for definite diagnosis and better delineation. Retrospective comparison to medical literature of three cases, diagnosed at our institution, of midline fetal DST with MR imaging findings and clinical outcomes. We reviewed MRI findings on T2-weighted images of our three cases of fetal midline DST and clinical outcomes of these fetuses and compared our findings to medical literature. The MR imaging and clinical findings of our cases extend over 6 years. They consist of three pregnant women, 31-39 years of age each with a single fetus, with fetal MR imaging performed at different gestational ages (GA). Case 1 the MR imaging was performed at 21 5/7 weeks' GA, case 2 at 24 and 33 4/7 weeks' GA, and case 3 at 22 and 25 weeks' GA. Postnatal MRI was performed in case 2 at 6 months of life and case 3 at 1 day of life. Clinical follow-up occurred during the last 6 years. In all of our cases, T2-W MR imaging demonstrated ballooned midline torcular Herophili with iso- to hypointense mass with or without focal eccentric area of greater hypointensity occupying the torcular Herophili with extension into the SSS. Case 3 had associated leptomeningeal dural vascular malformation overlying the left cerebral hemisphere with development of migrational disorder in the left cerebral hemisphere. Clinical outcome consisted of fetal demise in case 1, normal postnatal outcome in case 2 and severe brain damage with poor postnatal outcome in case 3. Our findings of large iso-hypointense thrombus with or without a focal eccentric area more hypointense to thrombus in a dilated torcular Herophili with extension into the SSS on T2-W images corresponds to the majority of cases of this rare type of DST in the medical literature. (orig.)

  8. Fetal MR imaging of posterior intracranial dural sinus thrombosis: a report of three cases with variable outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Byrd, Sharon E.; Elias, Dean [Rush Medical College and Rush University Medical Center, Department of Diagnostic Radiology and Nuclear Medicine Section of Neuroradiology, Chicago, IL (United States); Abramowicz, Jacques S. [Rush Medical College and Rush University Medical Center, Department of Obstetrics and Gynecology, Rush Fetal and Neonatal Medicine Center, Chicago, IL (United States); Kent, Paul [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Hematology and Oncology, Chicago, IL (United States); Kimura, Robert E. [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Neonatology, Chicago, IL (United States); Heydeman, Peter T. [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Pediatric Neurology, Chicago, IL (United States)

    2012-05-15

    Thrombosis of fetal intracranial dural sinuses is a rare entity. A specific type of midline dural sinus thrombosis (DST) at the torcular Herophili with extension into the superior sagittal sinus (SSS) was initially seen on fetal US and was referred to fetal MRI for definite diagnosis and better delineation. Retrospective comparison to medical literature of three cases, diagnosed at our institution, of midline fetal DST with MR imaging findings and clinical outcomes. We reviewed MRI findings on T2-weighted images of our three cases of fetal midline DST and clinical outcomes of these fetuses and compared our findings to medical literature. The MR imaging and clinical findings of our cases extend over 6 years. They consist of three pregnant women, 31-39 years of age each with a single fetus, with fetal MR imaging performed at different gestational ages (GA). Case 1 the MR imaging was performed at 21 5/7 weeks' GA, case 2 at 24 and 33 4/7 weeks' GA, and case 3 at 22 and 25 weeks' GA. Postnatal MRI was performed in case 2 at 6 months of life and case 3 at 1 day of life. Clinical follow-up occurred during the last 6 years. In all of our cases, T2-W MR imaging demonstrated ballooned midline torcular Herophili with iso- to hypointense mass with or without focal eccentric area of greater hypointensity occupying the torcular Herophili with extension into the SSS. Case 3 had associated leptomeningeal dural vascular malformation overlying the left cerebral hemisphere with development of migrational disorder in the left cerebral hemisphere. Clinical outcome consisted of fetal demise in case 1, normal postnatal outcome in case 2 and severe brain damage with poor postnatal outcome in case 3. Our findings of large iso-hypointense thrombus with or without a focal eccentric area more hypointense to thrombus in a dilated torcular Herophili with extension into the SSS on T2-W images corresponds to the majority of cases of this rare type of DST in the medical literature

  9. Sensitization of dural afferents underlies migraine-related behavior following meningeal application of interleukin-6 (IL-6

    Directory of Open Access Journals (Sweden)

    Yan Jin

    2012-01-01

    Full Text Available Abstract Background Migraine headache is one of the most common neurological disorders, but the pathophysiology contributing to migraine is poorly understood. Intracranial interleukin-6 (IL-6 levels have been shown to be elevated during migraine attacks, suggesting that this cytokine may facilitate pain signaling from the meninges and contribute to the development of headache. Methods Cutaneous allodynia was measured in rats following stimulation of the dura with IL-6 alone or in combination with the MEK inhibitor, U0126. The number of action potentials and latency to the first action potential peak in response to a ramp current stimulus as well as current threshold were measured in retrogradely-labeled dural afferents using patch-clamp electrophysiology. These recordings were performed in the presence of IL-6 alone or in combination with U0126. Association between ERK1 and Nav1.7 following IL-6 treatment was also measured by co-immunoprecipitation. Results Here we report that in awake animals, direct application of IL-6 to the dura produced dose-dependent facial and hindpaw allodynia. The MEK inhibitor U0126 blocked IL-6-induced allodynia indicating that IL-6 produced this behavioral effect through the MAP kinase pathway. In trigeminal neurons retrogradely labeled from the dura, IL-6 application decreased the current threshold for action potential firing. In response to a ramp current stimulus, cells treated with IL-6 showed an increase in the numbers of action potentials and a decrease in latency to the first spike, an effect consistent with phosphorylation of the sodium channel Nav1.7. Pretreatment with U0126 reversed hyperexcitability following IL-6 treatment. Moreover, co-immunoprecipitation experiments demonstrated an increased association between ERK1 and Nav1.7 following IL-6 treatment. Conclusions Our results indicate that IL-6 enhances the excitability of dural afferents likely via ERK-mediated modulation of Nav1.7 and these responses

  10. Tratamento do laringoespasmo em anestesia pediátrica por digitopressão retroauricular: relato de casos Tratamiento del laringoespasmo en anestesia pediátrica por digitopresión retroauricular: relato de casos Treatment of laryngeal spasm in pediatric anesthesia by retroauricular digital pressure: case report

    Directory of Open Access Journals (Sweden)

    Raquel Reis Soares

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Os problemas com a via aérea pediátrica estão entre os maiores desafios que o anestesiologista pode encontrar em sua prática clínica. Dentre eles, destaca-se o laringoespasmo, que ocorre com freqüência duas a três vezes maior na população pediátrica. O objetivo deste trabalho foi relatar o tratamento de laringoespasmo realizado com digitopressão de ponto localizado atrás do lóbulo da orelha. A técnica é fácil, antiga, porém pouco divulgada. Pode ser utilizada de forma segura e rápida, dispensando o acesso venoso periférico que, em algumas situações, pode estar ausente. RELATO DOS CASOS: Dois casos de anestesia pediátrica em pacientes de 3 anos e de 6 meses de idade, nos quais ocorreu laringoespasmo. Ambos foram tratados apenas com a digitopressão da depressão retroauricular e evoluíram com pronta melhora do padrão respiratório e da saturação arterial de oxigênio. Como o laringoespasmo é complicação comum e potencialmente grave pela sua morbimortalidade, é necessário tratamento seguro, eficaz e rápido. CONCLUSÃO: O tratamento clássico do laringoespasmo é a administração de oxigênio a 100% com pressão positiva por unidade ventilatória (balão e máscara e, se não houver resposta, administração venosa de 0,25 a 1 mg.kg-1 de succinilcolina. A técnica apresentada para tratamento do laringoespasmo é fácil, segura e eficaz, e realizada com digitopressão bilateral da região localizada atrás do lóbulo das orelhas. O laringoespasmo cedeu em poucos segundos e os pacientes tiveram evolução favorável.JUSTIFICATIVA Y OBJETIVOS: Los problemas con la vía aérea pediátrica están entre los más grandes retos que el anestesiólogo puede encontrar en su práctica clínica. Entre ellos se destaca el laringoespasmo, que ocurre con frecuencia de dos a tres veces más en la población pediátrica. El objetivo de este trabajo fue relatar el tratamiento de laringoespasmo realizado con

  11. Anestesia em gestante com hipertensão intracraniana por meningite tuberculosa: relato de caso Anestesia en gestante con hipertensión intracraneal por meningitis tísica: relato de caso Anesthesia in pregnant patient with intracranial hypertension due to tuberculous meningitis: case report

    Directory of Open Access Journals (Sweden)

    Vanessa Breitenbach

    2005-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Está bem estabelecido que a técnica anestésica de escolha para cesariana eletiva é a anestesia regional. Porém, em gestantes com hipertensão intracraniana e infecção do sistema nervoso central esta técnica deve ser evitada. O objetivo deste artigo é relatar o manejo anestésico de uma gestante, com hipertensão intracraniana secundária à meningite tuberculosa, que foi submetida à cesariana eletiva. RELATO DO CASO: Paciente branca, 32 anos, 60 kg, 1,62 m de estatura, na 36ªsemana de idade gestacional, agendada para interrupção cirúrgica da gestação por apresentar-se tetraparética, com hidrocefalia decorrente de meningite tuberculosa. Escolheu-se a anestesia geral para a cesariana com indução em seqüência rápida e manobra de Sellick para a intubação traqueal. As drogas utilizadas foram tiopental (250 mg, rocurônio (50 mg, fentanil (100 µg e lidocaína (60 mg por via venosa. A indução anestésica foi suave e mantida com isoflurano até o início do fechamento da pele da paciente, com mínimas alterações de seus sinais vitais e do recém-nascido, que recebeu índice de Apgar 8 e 9, no 1º e 5º minutos, respectivamente. A paciente despertou precocemente, sem deficits neurológicos adicionais. CONCLUSÕES: A anestesia geral ainda é a técnica anestésica preferida para cesariana em gestantes com hipertensão intracraniana, utilizando-se drogas de meia-vida curta e que tenham mínima interferência na pressão intracraniana e no recém-nascido.JUSTIFICATIVA Y OBJETIVOS: Está bien establecido que la técnica anestésica de elección para cesárea electiva es la anestesia regional. Sin embargo, en gestantes con hipertensión intracraneal e infección del sistema nervioso central esta técnica debe ser evitada. El objetivo de este artículo es relatar el manejo anestésico de una gestante, con hipertensión intracraneal secundaria a la meningitis tísica, que fue sometida a la ces

  12. ¿Fútbol de verdad? : Observaciones narratológicas sobre los relatos en vivo

    OpenAIRE

    Martínez, Matías

    2011-01-01

    En el relato periodístico retrospectivo de un partido de futbol –el de Chile contra México por la Copa América, el 30 de junio de 1999- se puede observar el uso de diversos elementos narratológicos que lo vuelven interesante. Los reportajes de distintos diarios chilenos contienen crónicas, historias y esquemas narrativos construidos a partir del antagonismo entre adversarios, el protagonismo de ciertos personajes y los puntos culminantes que ellos viven. Además, hay en los relatos una identif...

  13. Raquianestesia total após bloqueio do plexo lombar por via posterior: relato de caso

    OpenAIRE

    Duarte, Leonardo Teixeira Domingues; Saraiva, Renato Ângelo

    2006-01-01

    JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo lombar pode ser bastante útil em procedimentos cirúrgicos do quadril, da coxa e do joelho, mas exige prática do anestesiologista tendo em vista suas potenciais complicações. O presente relato tem por objetivo apresentar um caso de raquianestesia total após bloqueio do plexo lombar pela via posterior e discutir o provável mecanismo fisiopatológico. RELATO DO CASO: Paciente do sexo masculino, 34 anos, 97 kg, estado físico ASA I, programado para art...

  14. Bloqueio bilateral do nervo pudendo para hemorroidectomia em paciente acondroplásico: relato de caso

    OpenAIRE

    Morais, Bruno Salomé de; Cruvinel, Marcos Guilherme Cunha; Silva, Yerkes Pereira; Diniz, Dener Augusto; Castro, Carlos Henrique Viana de

    2006-01-01

    JUSTIFICATIVA E OBJETIVOS: O nanismo acondroplásico ou acondroplasia é a forma mais comum de nanismo e ocorre na maioria dos casos por alteração genética espontânea. A anestesia desses pacientes apresenta várias particularidades. O objetivo do presente relato foi descrever um caso de paciente acondroplásico, com história prévia de intervenção cirúrgica da coluna para descompressão medular, submetido a hemorroidectomia através de bloqueio bilateral dos nervos pudendos. RELATO DO CASO: Paciente...

  15. Dificuldade de intubação traqueal em paciente com craniossinostose: relato de caso

    OpenAIRE

    Gifoni, Cláudia Luisa; Nascimento, Henrique S; Mizumoto, Nelson

    2001-01-01

    JUSTIFICATIVA E OBJETIVOS: Existem formas complexas de craniossinostose acompanhadas de malformações da face e das vias aéreas, que podem levar a dificuldade de intubação traqueal (IOT). O objetivo deste relato é apresentar um caso de intubação traqueal difícil, em criança submetida à cirurgia para correção da craniossinostose. RELATO DO CASO: Criança com 57 dias, 3700 gramas, perímetro cefálico 39 cm, ASA II, com craniossinostose, retrognatia, macroglosia e exoftalmo bilateral, dificuldade i...

  16. Anestesia em paciente com síndrome de Rubinstein-Taybi: relato de caso

    OpenAIRE

    Oliveira, Carlos Rogério Degrandi; Elias, Luciana

    2005-01-01

    JUSTIFICATIVA E OBJETIVOS: A síndrome de Rubinstein-Taybi (SRT) é uma doença genética causada por uma mutação ou apagamento do cromossomo 16, caracterizada por retardo físico e mental, anormalidades craniofaciais e hálux e polegares largos. Há pouca informação sobre esta síndrome na literatura anestésica. O objetivo deste relato foi apresentar a conduta anestésica em paciente submetido à cirurgia odontológica e discutir as características de interesse para a anestesia nesses pacientes. RELATO...

  17. Malformación arterio-venosa cerebral causante de insuficiencia cardiaca congestiva en un neonato Cerebral arteriovenous malformation as a cause of congestive heart failure in a newborn

    OpenAIRE

    R. Fernández Montes; S. Bueno Pardo; M. Montes Granda; S. Lareu Vidal; M. González Sánchez; G. Solís Sánchez

    2013-01-01

    La malformación arterio-venosa de la vena de Galeno representa una anomalía congénita vascular muy infrecuente. Esta patología se presenta de forma preferente en el periodo neonatal pudiendo causar una importante morbi-mortalidad. La forma de presentación clínica es muy variable, siendo la asociación de soplo craneal e insuficiencia cardiaca la forma de presentación más frecuente en el periodo neonatal. El grado de insuficiencia cardiaca asociada constituye el principal factor pronóstico y co...

  18. Biological parameters and feeding behaviour of invasive whelk Rapana venosa Valenciennes, 1846 in the south-eastern Black Sea of Turkey

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    Hacer Saglam

    2014-06-01

    Full Text Available Objective: To determine length-weight relationships, growth type and feeding behavior of the benthic predator Rapa whelk at the coast of Camburnu, south-eastern Black Sea. Methods: Rapa whelk was monthly collected by dredge sampling on the south-eastern Black Sea at 20 m depth. The relationships between morphometric parameters of Rapa whelk were described by linear and exponential models. The allometric growth of each variable relative to shell length (SL was calculated from the function Y=aSLb or logY=loga+blogSL. The functional regression b values were tested by t-test at the 0.05 significance level if it was significantly different from isometric growth. The total time spent on feeding either on mussel tissue or live mussels was recorded for each individual under controlled conditions in laboratory. Results: The length-weight relationships showed positive allometric growth and no inter-sex variability. Body size in the male population was significantly higher than in the individuals of the female. All characters in males and females showed a trend towards allometry rather than isometry. While the total time spent feeding increased with increasing prey size the total time that Rapana venosa spent feeding decreased with increasing Rapa whelk size. The total average feeding time needed by Rapa whelks was 160 min. But they took 310 min on live mussels in 27-28 °C in the laboratory conditions. Conclusions: Length and weight relationships, growth type, total time spent feeding of this species were explained in details for this region. It would be useful to sustainable management in the south-eastern Black Sea of Turkey. The results about the feeding behaviour of this species will contribute to the understanding of the role of this species within the ecosystem.

  19. AVALIAÇÃO E COMPARAÇÃO ENTRE KITS LABORATORIAIS “D-DÍMERO” COMO DIAGNÓSTICO DE TROMBOSE VENOSA PROFUNDA

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    Rafaela Natiéli LIMA

    2015-12-01

    Full Text Available O presente estudo teve como objetivos realizar análise comparativa entre kits laboratoriais D-Dímero para Trombose Venosa Profunda (TVP pelos métodos de Imunoturbidimetria (metodologia 1 e Quimiluminescência (metodologia 2, ambos da marca Siemens, e comparar o resultado das análises realizadas, com o diagnóstico clínico confirmatório do paciente, analisando seus prontuários. A amostra foi constituída por uma população de 95 voluntários que realizaram o teste laboratorial D-Dímero, em um laboratório de análises clínicas da cidade de Cascavel-PR. Os resultados foram comparados através dos parâmetros para validação sorológica, através dos cálculos de especificidade, o qual foi de 33% em ambos os métodos, sensibilidade, o qual foi de 89% e 90%, e a eficiência de 68% e 69%, respectivamente para as metodologias 1 e 2. O valor preditivo positivo (VPP foi de 69% em ambos os testes, o valor preditivo negativo (VPN foi de 33%, a prevalência foi de 62%, e a prevalência sorológica foi de 81%. Conclui-se assim que, os testes analisados são pouco específicos para TVP, não podendo ser utilizados como método diagnóstico, mas sim para excluir prováveis suspeitas de tromboembolismo venoso.

  20. Microcurrent application as analgesic treatment in venous ulcers: a pilot study La aplicación de microcorriente como tratamiento en las úlceras venosas: un estudio piloto Aplicação da microcorrente como recurso para tratamento de úlceras venosas: um estudo piloto

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    Raciele Ivandra Guarda Korelo

    2012-08-01

    Full Text Available This study aimed to evaluate the effect of microcurrent electrical stimulation on pain and area of venous ulcers. In a pilot study for a single-blind controlled clinical trial, carried out at an outpatient clinic during four weeks, 14 subjects with venous ulcers (mean age 62±9 years were divided in two groups: microcurrent (n=8 and control group (n=6. Pain (by Visual Analogue Scale and the ulcer area were measured by planimetry. There was a significant difference between the two groups with respect to pain (microcurrent group from 8.5 (6.5-9.75 to 3.5 (1-4.75 and control group from 7.5 (5.75-10 to 8.5 (5.5-10, pEste estudio objetivó evaluar el efecto de la estimulación eléctrica por microcorriente sobre el dolor y el área de superficie de úlceras venosas. En un estudio piloto para un ensayo clínico controlado simple ciego, realizado en una clínica durante 4 semanas, se dividieron 14 individuos (62±9 años de edad en dos grupos: grupo microcorriente (n=8 y grupo control (n=6. Se evaluaron el dolor (por medio de la Escala Visual Analógica y el área de superficie de la úlcera por medio de la Planimetría. Hubo diferencia significativa entre los dos grupos con relación al dolor (grupo de microcorriente de 8,5 (6,5-9,75 para 3,5 (1-4,75 y grupo control de 7,5 (5,75-10 para 8,5 (5,5-10, pO objetivo neste estudo foi avaliar o efeito da estimulação elétrica, por microcorrente, sobre a dor e a área de superfície de úlceras venosas. Em estudo-piloto para um ensaio clínico controlado simples-cego, realizado em uma clínica durante 4 semanas, dividiram-se 14 indivíduos (62±9 anos de idade em dois grupos: grupo microcorrente (n=8 e grupo-controle (n=6. Avaliaram-se a dor (por meio da Escala Visual Analógica e a área de superfície da úlcera por meio da Planimetria. Houve diferença significativa entre os dois grupos em relação à dor (grupo de microcorrente de 8,5 (6,5-9,75 para 3,5 (1-4,75 e grupo-controle de 7,5 (5,75-10 para 8

  1. Microneurografia e pletismografia de oclusão venosa na insuficiência cardíaca: correlação com prognóstico Microneurografía y pletismografía de oclusión venosa en la insuficiencia cardiaca: correlación con pronóstico Microneurography and venous occlusion plethysmography in heart failure: correlation with prognosis

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    Robinson Tadeu Munhoz

    2009-01-01

    Full Text Available FUNDAMENTO: Microneurografia e pletismografia de oclusão venosa podem ser considerados métodos de avaliação da atividade simpática. OBJETIVO: Avaliar a intensidade da atividade simpática através da microneurografia e da pletismografia de oclusão venosa em pacientes com insuficiência cardíaca, e correlacionar essa intensidade com prognóstico. MÉTODOS: 52 pacientes com insuficiência cardíaca (FE 53,5 impulsos/min para ANSM (S=90,55. E=73,68% e 1,81 ml/min/100gr (PFUNDAMENTO: Microneurografía y pletismografía de oclusión venosa se pueden considerar como métodos de evaluación de la actividad simpática. OBJETIVO: Evaluar la intensidad de la actividad simpática a través de la microneurografía y de la pletismografía de oclusión venosa en pacientes con insuficiencia cardiaca, y correlacionar esa intensidad con pronóstico. MÉTODOS: Un total de 52 pacientes con insuficiencia cardiaca (FE 53,5 impulsos/min para ANSM (S=90,55. E=73,68% y 1,81 ml/min/100gr (PBACKGROUND: Microneurography and venous occlusion plethysmography can be considered methods of assessment of the sympathetic activity. OBJECTIVE: To evaluate the intensity of the sympathetic activity through microneurography and venous occlusion plethysmography in patients with heart failure (HF and correlate this intensity with prognosis. METHODS: 52 patients with HF (ejection fraction 53.5 impulses/min for MSNA (S=90.55. E=73.68% and 1.81 ml/min/100gr (P<0.001. Logistic regression analysis: the higher the MSNA and the lower the MBF, the higher is the probability of death. CONCLUSION: The intensity of the MSNA and the MBF can be considered prognostic markers in advanced HF.

  2. Protocolo de preparo da criança pré-escolar para punção venosa, com utilização do brinquedo terapêutico Protocolo de preparación de niños en edad preescolar para la punción venosa con utilización del juguete terapeutico Protocol for the preparation of preschool children to venous puncture using therapeutic play

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    Maria do Rosário Martins

    2001-04-01

    Full Text Available Este trabalho, do tipo exploratório descritivo, consiste na elaboração de um protocolo utilizando brinquedo terapêutico para preparar crianças pré-escolares que seriam submetidas à punção venosa, assim como testá-lo em algumas crianças para verificar sua aplicabilidade e eficiência. As crianças submetidas à sessão do brinquedo, tornaram-se mais cooperativas durante a punção venosa; compreenderam a necessidade e a técnica dos procedimentos; exteriorizaram sentimentos; elaboraram situações familiares e hospitalares, passando a relacionar-se melhor com as outras crianças e com a equipe de enfermagem. Consideramos que este protocolo é factível e útil; sugerimos que integre o plano de assistência de enfermagem a crianças hospitalizadas.Este trabajo de tipo exploratorio descriptivo consiste en la elaboración de un protocolo utilizando el juguete terapéutico para preparar niños preescolares para la punción venosa y su aplicación en algunos niños, con el sentido de verificar su aplicabilidad. Los niños que fueron sometidos a la sesión del juguete, se tornaron más cooperativos durante la punción venosa; comprendieron la necesidad y la técnica de los procedimientos; exteriorizaron sentimientos; elaboraron situaciones familiares y hospitalarias y empezaron a relacionarse mejor con los otros niños y con el equipo de enfermería. Consideramos que éste protocolo es factible y util; sugerimos que el mismo pase a integrar el plan de atención de enfermería a los niños hospitalizados.This exploratory - descriptive study aims at elaborating a protocol, using therapeutic play, for the preparation of preschool children to venous puncture and also at testing its efficiency and applicability. The children that attended the play session were more cooperative when they were punctured. They understood the need and technical aspects of this clinical procedure; manifested their feelings, elaborated familiar and hospital situations

  3. Angio-Architectural Features of High-Grade Intracranial Dural Arteriovenous Fistulas: Correlation With Aggressive Clinical Presentation and Hemorrhagic Risk.

    Science.gov (United States)

    Della Pepa, Giuseppe Maria; Parente, Paolo; D'Argento, Francesco; Pedicelli, Alessandro; Sturiale, Carmelo Lucio; Sabatino, Giovanni; Albanese, Alessio; Puca, Alfredo; Fernandez, Eduardo; Olivi, Alessando; Marchese, Enrico

    2017-08-01

    High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses. To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms). The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage). Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%. Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk. Copyright © 2017 by the Congress of Neurological Surgeons

  4. [Dural arteriovenous fistula involving the superior sagittal and transverse-sigmoid sinuses, treated by thrombolysis: case report].

    Science.gov (United States)

    Arai, T; Ohno, K; Yoshino, Y; Tanaka, Y; Nariai, T; Hirakawa, K; Nemoto, S

    1997-07-01

    A rare case of dural arteriovenous fistula (DAVF) in the superior sagittal sinus (SSS), the transverse sinus and the sigmoid sinus is reported. A 64-year-old man, who had had an episode of temporary visual disturbance after moderate fever for a week about 20 years before, was aware of loss of visual acuity and reduced field of view in the right eye. When he was introduced to our outpatient service, increased intracranial pressure (ICP) was detected by lumbar puncture. Cerebral angiograms showed bilateral DAVFs both in the posterior fossa and the SSS concomitant with thrombosis in the transverse sinus, sigmoid sinus and SSS. Afterwards, endovascular transarterial embolization through bilateral occipital, posterior auricular and left middle meningeal, superior temporal arteries was carried out. In addition, transvenous thrombolytic therapy using a catheter inserted into SSS resulted in the improvement of his visual problems. Although he was discharged at once, he was readmitted to our department with Foster Kennedy syndrome and increased ICP. Cerebral angiograms showed recurrence of both DAVF and sinus thrombosis. Transarterial embolization was performed again resulting in a significant reduction of DAVF, and his visual acuity was recovered to a moderate degree. The origin of DAVF is still controversial. Although two theories, "congenital" and "acquired", are put forward, it has been thought that both factors play important roles. In our case, the patient had stenosis in the jugular canal portions of the sigmoid sinus. In addition, sinus thrombosis seemed to have occurred. It is thought that increased intrasinus pressure may have lead to communication with surrounding arteries through existing dural vessels. We applied transvenous thrombolytic therapy in this case. Our result suggests that we should consider this therapy for some cases of DAVF.

  5. Auto-relato e relato de informante secundário na avaliação da saúde em idosos

    OpenAIRE

    Jardim, Renata; Barreto, Sandhi Maria; Giatti, Luana

    2010-01-01

    OBJETIVO: Analisar se o modelo explicativo para a avaliação da saúde do idoso com base no auto-relato é comparável com o modelo de relato do informante secundário e se a auto-avaliação de saúde do informante secundário influencia a avaliação da saúde do idoso. MÉTODOS: Estudo transversal com 230 pares idoso-informante secundário realizado em Belo Horizonte, MG, em 2007. Foram investigadas variáveis sociodemográficas e de saúde dos idosos por meio de entrevista estruturada. Utilizou-se regress...

  6. Projeto Sérgio Arouca: Relato de Experiência

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    Marcos Aurélio Maeyama

    Full Text Available RESUMO Historicamente, a formação médica encontra-se voltada para o tradicional modelo biomédico. As Diretrizes Curriculares Nacionais dos Cursos de Medicina, aprovadas em 2001, indicam a necessidade de ajustar a formação de recursos humanos ao serviço, seguindo os princípios do Sistema Único de Saúde (SUS. Em conformidade com tais Diretrizes, o governo federal elabora, em 2005, o Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde, com o objetivo de favorecer a formação de profissionais adequados às perspectivas da Atenção Básica. Em 2009, no contexto do Pró-Saúde e inspirados pelo Projeto Rondon, professores do curso de Medicina da Universidade do Vale do Itajaí (Univali criam o Projeto Sérgio Arouca, uma iniciativa que visa à atuação na Atenção Básica de municípios carentes do Estado de Santa Catarina. O presente relato baseia-se em participações de acadêmicos de Medicina e objetiva demonstrar o quanto estas experiências foram enriquecedoras para a formação profissional e a construção de uma nova visão da prática médica, enfrentando situações e cenários distintos dos vivenciados no cotidiano na universidade.

  7. Dissecção da artéria basilar: relato de caso

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    TOGNOLA WALDIR ANTONIO

    2000-01-01

    Full Text Available Relato de um caso de dissecção da artéria basilar, documentado com neuroimagem (tomografia computadorizada do crânio, ressonância magnética e angiografia digital com subtração de imagem.

  8. Exposição ao vivo no tratamento de agorafobia: relato de caso

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    Gustavo J. Fonseca D'El Rey

    Full Text Available Relato de caso, em que a Exposição ao Vivo foi utilizada no tratamento de paciente com diagnóstico de agorafobia. O tratamento foi realizado em doze sessões, apresentando êxito no uso dessa técnica comportamental.

  9. Hemoglobin measured by Hemocue and a reference method in venous and capillary blood: a validation study Hemoglobina medida por Hemocue y por un método de referencia en sangre venosa y capilar: estudio de validación

    Directory of Open Access Journals (Sweden)

    Lynnette Neufeld

    2002-06-01

    Full Text Available Objective. To assess the comparability of hemoglobin concentration (Hb in venous and capillary blood measured by Hemocue and an automated spectrophotometer (Celldyn and to document the influence of type of blood (capillary or venous and analysis method on anemia prevalence estimates. Material and Methods. Between February and May 2000, capillary and venous samples were collected from 72 adults and children at Hospital del Niño Morelense (Morelos State Children's Hospital in Cuernavaca, Morelos, Mexico, and assessed for Hb using the Hemocue and Celldyn methods. Estimated Hb levels were compared using the concordance correlation coefficient and Student's t test for paired data. The sensitivity and specificity for anemia diagnosis were estimated and compared between type of blood and method of assessment. Results. Capillary blood had higher Hb (+0.5g/dl than venous blood in adults and children, as did samples assessed by Celldyn compared to Hemocue (+0.3g/dl. Specificity to detect anemia was adequate (>0.90 but sensitivity was low for capillary blood assessed by Hemocue (Objetivo. Evaluar la comparabilidad de la concentración de hemoglobina (Hb en sangre venosa y capilar medida por Hemocue y por espectrofotómetro automatizado (Celldyn, así como documentar la influencia del tipo de sangre (capilar o venosa y del método de análisis sobre la prevalencia de anemia. Material y métodos. De febrero a mayo de 2000, se recolectaron muestras de sangre capilar y venosa en 72 adultos y niños en el Hospital del Niño Morelense, Cuernavaca, Morelos, México. Se determinaron los niveles de Hb con los métodos Hemocue y Celldyn. Las cifras de Hb estimadas se compararon con el coeficiente de concordancia y la prueba pareada de t de Student. También se comparó la sensibilidad y especificidad para el diagnóstico de anemia, utilizando sangre de los dos tipos y métodos de análisis. Resultados. La Hb fue mayor en sangre capilar comparada con sangre venosa

  10. Relatos audiovisuales de ficción sobre la identidad adolescente en contextos escolares

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    Laia Falcón Díaz-Aguado

    2014-01-01

    Full Text Available Los relatos audiovisuales que tienen a los adolescentes como audiencia y protagonistas son utilizados por éstos para buscar referencias con las que construir su identidad. Esta investigación busca comprender cómo es la identidad de los estudiantes adolescentes en distintos tipos de relatos audiovisuales de ficción, como punto de partida para la elaboración de materiales de alfabetización mediática que les ayude en dicho proceso. Para ello se seleccionaron tres narraciones europeas recientes sobre la vida escolar de adolescentes, con las que poder contrastar entre géneros, códigos y valores: la serie televisiva «Física o Química» y las películas «Harry Potter y la Orden del Fénix» y «La clase». El método ha sido el análisis textual de tipo cualitativo, utilizando como categorías las de la morfología del relato clásico. Los resultados reflejan que dicho esquema, familiar para el profesorado de Literatura, permite detectar importantes coincidencias entre relatos (como la importancia de las relaciones de pareja y amistad…, que hacen más significativas las diferencias del contraste (como la orientación hacia el futuro o el valor del pensamiento y del profesorado en dicho proceso. Se concluye que la comparación entre los tres tipos de relatos representa un óptimo recurso para la alfabetización mediática así como para ayudarles a tomar conciencia de cuáles son los valores con los que quieren identificarse y los problemas que pueden obstaculizarlos.

  11. Hipertensão venosa episcleral idiopática unilateral em mulher jovem Unilateral idiopathic elevated episcleral venous pressure in a young woman

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    Marcelo Mendes Lavezzo

    2013-02-01

    Full Text Available O objetivo é relatar o caso de uma paciente de 33 anos, que veio ao Pronto Socorro de Oftalmologia apresentando queixa de redução da acuidade visual à esquerda, de caráter insidioso e progressivo, há dois anos. Ao exame oftalmológico, apresentava ingurgitamento dos vasos da conjuntiva bulbar, pressão intraocular muito elevada e nervo óptico com escavação total à esquerda. Foi submetida à campimetria computadorizada 24:2 WW e SITA-SWAP do olho direito, ambas com resultados dentro da normalidade. As tomografias de crânio e órbitas, bem como ultrassonografia com doppler do globo ocular, artérias oftálmicas e veias supraorbitárias não apresentavam anormalidades. Diante disso, aventou-se a hipótese diagnóstica de hipertensão venosa episcleral idiopática, um diagnóstico de exclusão, visto que patologias intracranianas e intraorbitárias haviam sido excluídas. Paciente foi tratada clinicamente com colírios hipotensores, com redução importante da pressão intraocular à esquerda, porém não o suficiente, evoluindo para trabeculectomia.The objective is to report a 33 year old female who came to the emergency room of Ophthalmology complaining of reduced visual acuity on the left eye, in a progressive and insidious way, about two years ago. In the ophthalmological examination, she presented dilated tortuous vessels in her left bulbar conjunctiva, very high intraocular pressure and increased cupping of the optic disc. SITA-SWAP and 24:2 computed perimetry were performed on the right eye, both within normal limits. CT scans of the skull and orbits, and ultrasonography of the eyeball and doppler of the ophthalmic artery and the supra-orbital veins had no abnormalities. Thus, it was suggested the possibility of idiopathic elevated episcleral venous pressure, an exclusion diagnosis, since intra-cranial and intraorbital pathologies were excluded. The patient was treated medically with hypotensive eyedrops, with significant reduction

  12. Avaliação da pressão venosa periférica na esclerose sistêmica Peripheral venous pressure in systemic sclerosis

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    João Potério-Filho

    2004-02-01

    Full Text Available OBJETIVO: Estabelecer a utilidade da medida indireta da pressão venosa periférica (PVP na avaliação de pacientes com esclerose sistêmica (ES, comparando com uma população controle normal. MÉTODOS: Estudo prospectivo avaliando 18 pacientes esclerodérmicas do sexo feminino (sendo oito delas com úlcera cutânea isquêmica submetidas à medida indireta da PVP (por pletismografia. Os dados foram comparados a um grupo controle normal de 18 mulheres hígidas, pareadas para idade. RESULTADOS: Os níveis de pressão arterial foram semelhantes nos dois grupos. Os valores de PVP estavam significativamente diminuídos nos pacientes com ES (58.9 ± 11.6 mmHg no grupo ES e 96.9 ± 7.1 mmHg no grupo controle; p OBJECTIVE: The aim of this prospective study was to establish the usefulness of indirect measurement of peripheral venous pressure (PVP in the evaluation of patients with systemic sclerosis (SSc, comparing them with a normal control population. METHODS: Eighteen female SSc patients (eight patients presenting cutaneous ischemic ulcers were submitted to indirect measurement of the PVP (by plethysmography, and data were compared with a control group of 18 healthy women, paired by age. RESULTS: Arterial pressure levels were similar in both groups. PVP levels were significantly decreased in the SSc patients (58.9 ± 11.6 mmHg in the SSc group and 96.9 ± 7.1 mmHg in the control group; p < 0.0001; in the SSc group, patients with ischemic ulcers presented PVP levels significantly decreased compared with those patients without ulcers (50.6 ± 10.8 mmHg in the ulcer group and 65.5 ± 7.2 mmHg in the group without ulcers; p = 0.006. CONCLUSIONS: It can be concluded that decreased PVP in SSc is associated with a decrease in the blood flow of these patients, predisposing them to cutaneous ischemic ulcers.

  13. Guía de recomendaciones para la profilaxis de la enfermedad tromboembólica venosa en adultos en la Argentina

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    Fernando Javier Vázquez

    2013-10-01

    Full Text Available La enfermedad tromboembólica venosa (ETV en adultos posee elevada morbimortalidad y puede asociarse a complicaciones crónicas invalidantes. Sin embargo, la adherencia a estándares de cuidado no es óptima. Se analizó la evidencia disponible en tromboprofilaxis y se generaron recomendaciones (1 o sugerencias (2 con diferentes grados de evidencia (A, B o C para diferentes escenarios y métodos de tromboprofilaxis. En cirugías ortopédicas mayores se recomienda la profilaxis farmacológica con heparinas de bajo peso molecular, HBPM (1B, fondaparinux, dabigatrán y rivaroxaban (1B que deben iniciarse durante la internación y mantenerse hasta 35 días después de la cirugía de cadera y hasta 10 días posteriores a la artroplastia de rodilla. La artroscopia de rodilla y la cirugía de columna programada no requieren profilaxis farmacológica (2B salvo que posean factores de riesgo adicionales, en cuyo caso se recomiendan las HBPM. En pacientes con internación clínica y movilidad reducida esperable mayor a tres días, que posean factores de riesgo adicionales, se recomienda tromboprofilaxis con HBPM, HNF o fondaparinux (1B hasta el alta. Aquellos pacientes neuroquirúrgicos o con HIC deberán recibir inicialmente tromboprofilaxis mecánica (2C y dependiendo del caso, iniciar HBPM o HNF entre las 24-72 horas posteriores (2C. Estas últimas dos drogas son recomendadas para pacientes críticos. Los pacientes sometidos a cirugías no ortopédicas con bajo riesgo de ETV deberán realizar deambulación precoz (2C y tromboprofilaxis mecánica (2C, mientras que aquellos en los que el riesgo de ETV sea elevado deberán recibir HBPM y HNF (1B o 2C según su riesgo de sangrado.

  14. Dexmedetomidina como droga adjuvante no despertar transitório no intra-operatório de correção cirúrgica de escoliose: relato de caso Dexmedetomidina como droga adyuvante en el despertar transitorio en el intra-operatorio de corrección quirúrgica de escoliosis: relato de caso Dexmedetomidine as adjuvant drug for wake-up test during scoliosis correction surgery: case report

    Directory of Open Access Journals (Sweden)

    Airton Bagatini

    2004-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A escoliose é um defeito da coluna vertebral que necessita muitas vezes de correção cirúrgica. Uma peculiaridade desta correção é a necessidade do paciente despertar no intra-operatório e movimentar os membros inferiores com intuito de afastar lesões do sistema nervoso central (SNC, após a correção do defeito ortopédico. Neste relato, foi associada dexmedetomidina à anestesia venosa total com propofol e remifentanil com o objetivo de obter as ações sedativa, analgésica e de estabilidade ventilatória desta droga, durante o despertar transitório em paciente submetida à correção cirúrgica de escoliose. RELATO DO CASO: Paciente do sexo feminino, 16 anos, branca, estado físico ASA I, com escoliose torácica e lombar em 12 níveis, foi submetida à cirurgia sob anestesia geral. Como medicação pré-anestésica foi utilizado lorazepam na dose de 2 mg, por via oral, na véspera e 90 minutos antes do procedimento. Após monitorização, foi realizada venóclise e punção da artéria radial no membro superior esquerdo; a veia subclávia direita foi puncionada com cateter de duplo lúmen, para infusão de drogas e medidas hemodinâmicas. A indução anestésica foi feita com 1 µg.kg-1 de remifentanil e propofol, em infusão alvo-controlada, para concentração plasmática de 3 µg.ml-1. Como bloqueador neuromuscular, foi utilizado atracúrio na dose de 0,5 mg.kg-1. A manutenção da anestesia foi realizada com infusão contínua de dexmedetomidina (0,4 µg.kg-1.h-1, remifentanil (0,3 µg.kg-1.min-1 e propofol (3 µg.ml-1 em infusão alvo-controlada. No momento do teste para movimentação dos membros inferiores, foram interrompidas as infusões de propofol e remifentanil, mantendo a dexmedetomidina. Com a superficialização do plano anestésico, o paciente assumiu ventilação espontânea e após 14 minutos da interrupção das drogas, sob comando verbal, movimentou os membros inferiores. Durante este

  15. Rosácea fulminante: relato de caso

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    José Otávio Alquezar Gozzano

    2016-10-01

    Full Text Available Introdução: Rosácea fulminante (RF ou pioderma facial é uma doença rara, descrita em 1940 por Kierland e O’Leary. É considerada uma variante extrema de rosácea conglobata, esta, consiste em formação de placas e abscessos hemorrágicos na pele. A RF tem sua etiologia desconhecida, porém há teorias que relacionam seu acometimento com a variação de hormônios femininos e a ingestão de vitamina B12. A RF é frequente em mulheres, principalmente pós- adolescentes. Apresenta-se abruptamente na face, amiúde na região mento- mandibular, através de pápulas inflamatórias, pústulas, cistos e nódulos com comedões escassos ou inexistentes, além de abcessos, sem manifestações sistêmicas e com a recidiva rara. Seu diagnóstico é fundamentalmente clínico, apenas com a história do paciente, sem necessidade de exames complementares. Para o tratamento, são utilizados corticoides orais, isotretinoína oral e antibióticos a fim de minimizar as sequelas físicas e psicológicas. Objetivo: Relatar caso de paciente com diagnóstico de rosácea fulminante. Metodologia: Paciente diagnosticada com rosácea fulminante atendida em serviço ambulatorial e revisão de literatura. Relato de caso: Paciente do sexo feminino, 19 anos, refere lesões súbitas em face há uma semana. Nega quadro acneico anterior, histórias de alergias e outras comorbidades. Relata ausência de uso de anticoncepcionais orais há 5 meses e data de última menstruação há 3 semanas, sem atraso menstrual. Ao exame: pápulas eritematosas e pústulas, além de pequenos nódulos inflamatórios na face. Hipótese diagnóstica: RF. Como conduta, foi prescrito tetraciclina. Conclusões: A RF é uma forma infrequente de rosácea, sendo importante o diagnóstico precoce e tratamento eficaz, a fim de melhorar a qualidade de vida do paciente.

  16. Anestesia para craniotomia em paciente acordado: relato de caso

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    Nelson Davi Bolzani

    2013-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Alguns procedimentos intracranianos são possíveis com pacientes acordados e os desafios vão da cooperação do paciente até a homeostasia. O objetivo é apresentar um caso de cirurgia intracraniana para exérese de tumor em lobo parietal esquerdo com o paciente em estado vígil. RELATO DE CASO: Após seleção do paciente e preparo psicológico, foi esclarecida e aceita a proposta de exérese de lesão parietal esquerda em estado vígil. Administraram-se propofol e remifentanil em perfusão contínua para manter o escore de Ramsay entre 2-3. Foi feito um bloqueio bilateral do escalpo com ropivacaína. Foi instalado o fixador de Mayfield e os campos cirúrgicos foram ajustados para manter vias aéreas e olhos acessíveis para o mapeamento com eletroestimulação e exérese da lesão. Para incisão da dura-máter foi aplicada uma compressa com lidocaína 2% por três minutos. A cirurgia transcorreu sem intercorrências. O paciente recebeu alta hospitalar no sétimo dia de internação sem apresentar complicação. CONCLUSÃO: Apesar de ser um desafio manter analgesia e estabilidade hemodinâmica com o paciente acordado, a infusão alvo-controlada do propofol estabeleceu o nível de consciência desejado; a do remifentanil titulou a analgesia e a sedação sem o acúmulo da droga e o bloqueio com a ropivacaína, uma analgesia satisfatória. Concluímos que a técnica anestésica foi satisfatória para nosso paciente.

  17. Notalgia parestésica: relato de caso

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    José Otávio Alquezar Gozzano

    2016-10-01

    Full Text Available Introdução: Notalgia parestésica (NP é uma condição neurocutânea, caracterizada por crises pruriginosas, hiperpigmentação e neuropatia sensorial. Apesar de pouco descrita em literatura, a doença é mais frequente do que se imagina, sendo subdiagnosticada em muitos casos. NP pode afetar qualquer idade e sexo, mas acomete principalmente pessoas de média idade e mulheres. Sua etiologia inclui alterações degenerativas vertebrais, trauma vertebral e predisposição genética. NP envolve o trajeto anatômico dos nervos espinhais e está relacionada com o comprometimento de neuropeptídios, dando origem a marcapassos neurais ectópicos, responsáveis pela clínica da NP. O diagnóstico é clínico, a partir da identificação de máculas hiperpigmentadas unilaterais em zona escapular, sem eritema ou descamação, com piora ao estresse. Deve-se diferenciar de líquen simples, amiloidose macular e hanseníase. Na anatomopatologia observa-se acantose focal e queratinócitos necróticos; a derme papilar mostra depósito de substância amiloide. Com sintomas leves o tratamento medicamentoso nem sempre é necessário, se mais severa utiliza-se capsaicina tópica, gabapentina, oxicarba-mazepina, corticoides e toxina botulínica. Objetivo: Relatar caso de NP. Material e métodos: Paciente atendida ambulatorialmente com revisão de literatura. Relato de Caso: Feminina, 50 anos, com queixa de mancha em dorso há 2 anos; refere dor na coluna torácica. Ao exame: presença de mácula hipercrômica. Hipótese diagnóstica: NP. Foi prescrito corticoide tópico para alívio de sintomas. Conclusão: Por tratar-se de uma doença subdiagnosticada, o conhecimento médico da clínica de NP é fundamental para o diagnóstico precoce, permitindo a escolha do tratamento específico, o que melhora a evolução dos pacientes e evita o uso de fármacos ineficazes.

  18. Psoríase com eosinofilia: relato de caso

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    Thays Brunelli Pugliesi

    2015-10-01

    Full Text Available A psoríase, doença inflamatória crônica é caracterizada por lesões dérmicas sobrepostas a áreas de lesões eritematosas ou pustulares. Ocorre pela alteração no ciclo de crescimento das células epidérmicas, levando ao espessamento epidérmico decorrente da hiperproliferação celular e vascular com presença de infiltrado linfocitário. Pode desencadear manifestações como febre, mal-estar, fraqueza e outros. Seu diagnóstico é predominantemente clínico, podendo ser complementado pela biópsia das lesões. Entretanto, alguns casos encontrados na literatura e no caso que será relatado existe a presença de eosinofilia, mesmo na ausência de fatores que justificariam o surgimento desse sinal em pacientes portadores da psoríase. Objetivo: Relatar o caso de paciente encaminhado à hematologia com quadro de psoríase concomitante à eosinofilia. Relato de Caso: Paciente de 67 anos, masculino, vem encaminhado com hipótese diagnóstica de Síndrome Hipereosinofílica. Queixa de eosinofilia persistente (>1500 por mais de seis meses tendo realizado tratamento com Albendazol e Metronidazol, sem êxito. Concomitantemente, apresenta psoríase em acompanhamento da dermatologia sem sintomas sistêmicos. Exames laboratoriais: NR para Hepatite B ou C, HIV ou Toxocara canis. Ausência de população celular com imunofenótipo anômalo. Aumento do percentual de granulócitos eosinófilos. Coleta de JAK2 e BLC/ABR negativos. Tratamento da psoríase é realizado com shampoo indicado. Após dois meses, ainda apresenta eosinófilos = 1820. Conclusão: Recentemente, estabeleceu-se uma relação entre a eosinofilia e o aparecimento da psoríase. Não encontramos mais nenhuma causa possível que explique a eosinofilia deste paciente. Pretendemos acompanhá-lo e avaliar se o tratamento da psoríase relaciona-se com a diminuição da eosinofilia

  19. Abordagem multidisciplinar no trauma facial: um relato de caso

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    Carolina Ando Matsuno

    2014-10-01

    Full Text Available Introdução: Em todo o mundo, diversas medidas de segurança têm sido aplicadas para minimizar os danos relacionados aos acidentes de trabalho. Ainda assim, muitos casos são rotineiramente encaminhados aos Prontos Socorros do Sistema Único de Saúde (SUS, particularmente nas zonas rurais. Objetivo: Relatar a abordagem multidisciplinar de um caso de traumatismo facial grave secundário a acidente de trabalho atendido no Conjunto Hospitalar de Sorocaba (CHS. Relato do Caso: Paciente masculino, 19 anos, branco, trabalhador rural, vítima de trauma após ter saltado de um trator em movimento durante o exercício de sua atividade laboral, trazido por seus familiares com hemiface direita, desfigurada pela avulsão da pele e da musculatura com exposição óssea, caracterizada à TC como fratura complexa zigomático-maxilar Le Fort tipo 2 à direita além da destruição do seio maxilar, do assoalho da órbita e dos rebordos orbitários lateral, superior e inferior. A abordagem cirúrgica foi realizada pelas equipes de Cirurgia Plástica, Cirurgia Bucomaxilofacial e Cirurgia Oftalmológica que procederam à reconstrução óssea por placas de titânio, estabilização da arcada dentária superior por amarramento e reposicionamento das partes moles. O globo ocular foi preservado por apresentar-se íntegro. Conclusões: A abordagem multidisciplinar das fraturas faciais complexas busca primariamente restaurar a complexa anatomia de toda essa região por primeira intenção. Considerando tratar-se de fratura secundária a um “acidente de trabalho”, ilustramos aqui uma trágica consequência do não uso dos equipamentos de proteção individual e da inobservância das normas de segurança.

  20. Crise tireotóxica - um relato de caso

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    Mariana Fidelis Solla

    2015-10-01

    Full Text Available A crise tireotóxica (CT é a complicação mais grave dohipertireoidismo, caracterizada por um conjunto de sinais e sintomassecundários à hipersecreção aguda de hormônios tireoidianos. Contudo, adescompensação da tireoide até o estado de CT ainda não está bemestabelecida. Os fatores desencadeantes incluem: infecções, cirurgias,traumas, extrações dentárias, alterações glicêmicas, suspensão da medicaçãoanti-tireoidiana, parto e palpação vigorosa da tireóide . A CT é uma emergênciamédica que exige cuidados em unidade de tratamento intensivo (UTI. Odiagnóstico precoce é imprescindível para o êxito terapêutico e influidiretamente no prognóstico e sobrevida do paciente. Objetivos: Relatar o casoda paciente do Conjunto Hospitalar de Sorocaba (CHS que ficou sobrecuidados na UTI devido à CT que evolui para fibrilação atrial (FA etromboembolismo pulmonar (TEP, contribuindo para o meio acadêmico ecientífico. Metodologia: As informações contidas nesse trabalho foram obtidaspor meio de análise de prontuário e revisão de literatura. Relato de caso:Paciente de 25 anos, sexo feminino, deu entrada ao pronto atendimento doCHS com quadro de dispneia, palpitações intensas, ansiosa e com tremores deextremidades. A ectoscopia revelou paciente corada, hidratada, anictérica,acianótica, febril e anasarca evidente. O exame específico da tireóidedemonstrou glândula aumentada de tamanho, bócio difuso, sem nodulações àpalpação. Observou-se veias jugulares ingurgitadas e hepatomegalia. Àausculta verificou-se bulhas arrítimicas com hiperfonese de P2 e FC:214bpm.O ECG padrão de FA e sobrecarga de VE. Conclusão: O hipertiroidismo semtratamento clínico pode evoluir ,culminando com sinais e sintomas compatíveiscom crise tireotóxica. sendo necessários diagnóstico e tratamento precoces.

  1. A traumatic dural arteriovenous fistula between the inferolateral trunk of the internal carotid artery and the ophthalmic vein: A case of transvenous coil embolization via the facial vein

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    Kim, Jun Young; Hong, Chang Ki; Suh, Sang Hyun [Dept. of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Dong Ik [Dept. of of Radiology, CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)

    2017-05-15

    A 31-year-old man was admitted with exophthalmos. He suffered from progressive exophthalmos, bruit and conjunctival chemosis 7 days after head trauma caused by falling down. Cerebral angiography showed a dural arteriovenous fistula (DAVF) draining into the ophthalmic vein caused by tear in the inferolateral trunk, which is a rare presentation of traumatic DAVF. Selective transvenous coil embolization was performed via the facial vein without neurologic complications.

  2. Endovascular treatment of a cavernous sinus dural arteriovenous fistula by transvenous embolisation through the superior ophthalmic vein via cannulation of a frontal vein

    International Nuclear Information System (INIS)

    Venturi, C.; Bracco, S.; Cerase, A.; Gennari, P.; Lore, F.; Polito, E.; Casasco, A.E.

    2003-01-01

    We describe a new approach for transvenous embolisation of cavernous sinus dural arteriovenous fistulae through the superior ophthalmic vein (SOV), i.e., via percutaneous cannulation of a frontal vein. Modern neurointerventional angiographic materials make it possible to reach the SOV in this way without puncturing it in the orbit or a surgical exposure. Orbital phlebography should still be in the repertoire of interventional neuroradiology units in large centres. (orig.)

  3. Warmed intravenous infusion for controlling intraoperative hypothermia Infusión venosa calentada en el control de la hipotermia durante el período intraoperatorio Infusão venosa aquecida no controle da hipotermia no período intraoperatório

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    Ana Lúcia De Mattia

    2013-06-01

    Full Text Available OBJECTIVE: to verify the effectiveness of warmed intravenous infusion for hypothermia prevention in patients during the intraoperative period. METHOD: experimental, comparative, field, prospective and quantitative study undertaken at a federal public hospital. The sample was composed of 60 adults, included based on the criteria of axillary temperature between 36ºC and 37.1ºC and surgical abdominal access, divided into control and experimental groups, using the systematic probability sampling technique. RESULTS: 22 patients (73.4% from both groups left the operating room with hypothermia, that is, with temperatures below 36ºC (p=1.0000. The operating room temperature when patients arrived and patients' temperature when they arrived at the operating room were statistically significant to affect the occurrence of hypothermia. CONCLUSION: the planning and implementation of nursing interventions carried out by baccalaureate nurses are essential for preventing hypothermia and maintaining perioperative normothermia. OBJETIVO: verificar la eficacia de la intervención de infusión venosa calentada en la prevención de la hipotermia en pacientes en el período intraoperatorio. MÉTODO: estudio experimental, comparativo, de campo, prospectivo y cuantitativo, en un hospital público federal. La muestra abarcó a 60 adultos, que tuvieron como uno de los criterios de inclusión la temperatura axilar entre 36ºC y 37,1ºC y acceso quirúrgico abdominal, divididos en grupos control y experimental, compuestos utilizándose la técnica de muestreo probabilístico sistemático. RESULTADOS: en los 2 grupos, 22 pacientes (73,4% salieron del quirófano con hipotermia, o sea, temperatura inferior a 36ºC (p=1,0000. La temperatura del quirófano cuando de la entrada del paciente y la temperatura del paciente cuando de la entrada en el quirófano fueron estadísticamente significativas para influir en la ocurrencia de hipotermia. CONCLUSÍON: la planificación e

  4. Pessoas com úlceras venosas: estudo do modo psicossocial do modelo adaptativo de Roy Personas con úlceras venosas: estudio de los aspectos psicosociales del modelo de adaptación de Roy People with venous ulcers: a study of the psychosocial aspects of the adaptive model of Roy

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    Isabelle Katherinne Fernandes Costa

    2011-09-01

    Full Text Available Estudo transversal, descritivo, quantitativo, realizado com 50 pessoas com úlcera venosa (UV em um Hospital Universitário, que objetivou verificar o nível de adaptação psicossocial do Modelo de Roy das pessoas com UV. A pesquisa foi aprovada pelo Comitê de Ética da instituição. Os dados foram coletados com formulário estruturado e após a organização dos dados das alterações ocorridas na vida das pessoas com UV classificamos segundo o modo psicossocial de Roy. Verificamos que no modo autoconceito, 36% sentiam-se insatisfeitos com aparência física, 18% apresentavam sentimentos negativos; no modo desempenho de papéis: alteração no papel laboral (52,0%, atividades domésticas (34,0%, conjugal (6,0%, restrições de lazer, dor, social, escolar e locomoção (82,0%; no modo de interdependência: apoio no tratamento (82,0%, discriminação (58,0%. A identificação do modo psicossocial direciona as ações de enfermagem abrangendo a pessoa que recebe o cuidado considerando-a no todo em suas relações com ambiente promovendo melhor nível de adaptação.Estudio transversal, descriptivo, cuantitativo realizado con 50 personas con úlcera venosa (UV en el Hospital Universitario que objetivó conocer nivel de adaptación psicosocial del modelo de Roy de las personas con UV. Estudio aprobado por el Comité de Ética (nº 279/09. Los datos fueron recogidos mediante formulario y después de organizar los datos de los cambios en la vida de las personas con UV, fueron clasificados de acuerdo con los aspectos psicosociales de Roy. Verificamos en el modo de auto-concepto: 36% insatisfacción con apariencia física, 18% sentimientos negativos, desempeño de papel: cambio en el papel de trabajo (52,0%, tareas domésticas (34,0%, estado civil (6,0%, restricción de ocio, dolor, sociales, educativos y transporte (82,0%; modo de interdependencia: apoyo en el tratamiento (82,0%, discriminación (58,0%. La identificación de aspectos psicosociales

  5. Cost survey of procedure with Unna boot in patients with venous ulcer Levantamento del costo del procedimiento com bota de Unna en pacientes com úlcera venosa (UV Levantamento do custo do procedimento com bota de Unna em pacientes com úlcera venosa

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    Cleide Maria Caetano Baptista

    2006-12-01

    Full Text Available Aims was to identify the social-demographic characteristics and the lesions of patients with venous ulcer (VU, as well as to estimate the total direct cost of materials and nursing personnel necessary for the procedure with unna boot, by the average total direct cost (ATDC and the observed cost (OTDC. The theoretical referential adopted for cost calculation was the costing system by absorption of procedure or product. This study was conducted at the University Hospital of Sao Paulo University (HU Ambulatory. The sample was constituted by 65 procedures in nine patients with VU. The results show that the predominant age groups were 49 to 56 years (33,33% and 65 to 72 years (33,33%, in female patients (77,78%. Regarding associated diseases, there was a predominance of Systemic Arterial Hypertension (33,33% and Diabetes Mellitus (22,22%. The ATDC was R$ 107,99 and the OTDC was R$ 96,47.El objetivo fue identificar características sócio-demográficas y de las lesiones de los pacientes con úlcera venosa (UV, y calcular el costo total directo de los materiales y de personal de enfermería utilizados en del procedimiento con bota de unna, por el costo total directo medio (CTDM y por lo observado (CTDO. El referencial teórico adoptado para la medición de los costos fue el sistema de costeo por absorción por procedimiento o producto. El estudio fue realizado en el Consultorio Externo el Hospital Universitario de la Universidad de Sao Paulo (HUUSP. La muestra fue constituida por 65 procedimientos en nueve pacientes con UV. Los resultados muestran que la faja etária predominante fue 49 a 56 años (33,33% y de 65 a 72 años (33,33% y del sexo femenino (77,78%. Cuanto a la enfermedad asociada, hubo predominio de Hipertensión Arterial Sistemática (33,33% y Diabetes Mellitus (22,22%. El CTDM fue de R$ 107,99 y el CTDO fue de R$ 96,47.O objetivo foi identificar características sociodemográficas e das lesões dos pacientes com úlcera venosa (UV e

  6. Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso A bloqueo del nervio frénico después de la realización de bloqueo del plexo braquial por la vía interescalénica: relato de caso Phrenic nerve block after interscalene brachial plexus block: case report

    Directory of Open Access Journals (Sweden)

    Luis Henrique Cangiani

    2008-04-01

    embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilatorio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2% con epinefrina a 1:200.000 y ropivacaína a 0,75% en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95%, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos.BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective

  7. Manuseio anestésico de paciente portador de telangiectasia hemorrágica hereditária (síndrome de Rendu-Osler-Weber: relato de caso Manoseo anestésico de paciente portador de telangiectasia hemorrágica hereditaria (síndrome de Rendu - Osler - Weber: relato de caso Anesthetic management of a patient with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome: case report

    Directory of Open Access Journals (Sweden)

    Alexandre Palmeira Goulart

    2009-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A telangiectasia hemorrágica hereditária (THH, também conhecida como síndrome de Rendu-Osler-Weber, é uma doença autossômica dominante, caracterizada por displasia vascular mucocutânea e visceral associada a episódios freqüentes de epistaxe e sangramentos gastrintestinais. O objetivo do presente relato foi descrever a anestesia em paciente portador dessa síndrome. RELATO DO CASO: Paciente do sexo masculino, 25 anos, submetido à correção cirúrgica de fratura de órbita esquerda. Portador da tríade epistaxe recorrente, histórico familiar e telangectasia, apresentava diagnóstico de THH. Durante a investigação pré-operatória não foram encontradas malformações vasculares pulmonares, encefálicas ou do trato gastrintestinal. O paciente foi submetido à anestesia venosa total, uma hora após a administração profilática de antifibrinolítico. O sangramento foi considerado normal para a operação proposta e não houve instabilidade hemodinâmica ou necessidade de transfusão sanguínea perioperatória. A extubação ocorreu na sala cirúrgica e o paciente foi liberado para o quarto após 60 minutos e a alta hospitalar foi após 24 horas. CONCLUSÕES: A THH é uma doença autossômica dominante que provoca displasia vascular musculocutânea e visceral. Pode haver perda sanguínea perioperatória acima da esperada para pacientes portadores dessa síndrome. Como o sangramento não é resultado de defeito na cascata de coagulação mas da exposição cirúrgica da estrutura vascular malformada, a conduta perioperatória inclui o emprego de antifibrinolíticos, a realização de hemostasia adequada e da hipotensão arterial induzida, quando não houver contra-indicação. A avaliação pré-anestésica deve incluir a pesquisa de malformações vasculares encefálicas, pulmonares ou do trato gastrintestinal.JUSTIFICATIVA Y OBJETIVOS: La telangiectasia hemorrágica hereditaria (THH, también conocida como

  8. Reconstructive treatment of dural arteriovenous fistulas of the transverse and sigmoid sinus: transvenous angioplasty and stent deployment

    International Nuclear Information System (INIS)

    Liebig, T.; Henkes, H.; Brew, S.; Miloslavski, E.; Kuehne, D.; Kirsch, M.

    2005-01-01

    Various techniques for the endovascular treatment of dural arteriovenous fistulas (dAVFs) of the transverse and sigmoid sinus have recently evolved. Transvenous coil occlusion of the involved segment and transarterial embolization of the feeding arteries with liquid agents are the commonest treatments utilized. However, with respect to venous hypertension as the probable pathogenic cause of this disorder, a nonocclusive or remodeling technique might be preferable. We will present a series involving four patients, treated with transvenous angioplasty and stent deployment as a definitive treatment of dAVFs of the transverse and sigmoid sinus. This method was used as a primary treatment or as an adjunct to previous noncurative transarterial n-butyl cyanoacrylate and particle embolization. In three of the four cases, complete occlusion of the fistula was achieved with confirmation of occlusion seen on follow-up angiographical studies. In one case a negligible and nonsymptomatic remnant of the fistula fed by the tentorial artery was left untreated. From our experience, we conclude that transvenous stent deployment is an alternative to traditional concepts. Additionally, the pathological theory of dAVFs in this region located in venous pouches of the sinus wall is supported by the fact that they can be occluded by mechanical compression during angioplasty and subsequently maintained by a stent. (orig.)

  9. The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience

    Energy Technology Data Exchange (ETDEWEB)

    Lindenholz, Arjen [University Medical Center Groningen, Department of Neurosurgery AB71, PO Box 30001, Groningen (Netherlands); Toronto Western Hospital, Department of Medical Imaging, Division of Neuroradiology, Toronto, ON (Canada); TerBrugge, Karel G.; Farb, Richard I. [Toronto Western Hospital, Department of Medical Imaging, Division of Neuroradiology, Toronto, ON (Canada); Dijk, J.M.C. van [University Medical Center Groningen, Department of Neurosurgery AB71, PO Box 30001, Groningen (Netherlands)

    2014-11-15

    The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF). A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutive conventional MR-imaging, CE-MRA, and digital subtraction angiography (DSA). The presence or absence of serpentine flow voids, T2-weighted hyperintensity, and cord enhancement were evaluated, as well as location of the fistula as predicted by CE-MRA. DSA was used as the reference standard. Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of vascular malformation, and 7 were DSA-negative. On MRI, all reported cases of SDAVF showed serpentine flow voids (100 %). T2-weighted hyperintensity was seen in 48 of 50 cases (96 %), extending to the conus in 41 of 48 cases (85 %). Cord enhancement was seen in 38 of 41 cases (93 %). CE-MRA correctly localized the SDAVF in 43 of the 53 cases (81 %). CE-MRA is a useful non-invasive examination for the detection and localization of SDAVF. CE-MRA facilitates but does not replace DSA as confirmation of location, fistula type, and arterial detail, which are required before treatment. (orig.)

  10. Predictability of the future development of aggressive behavior of cranial dural arteriovenous fistulas based on decision tree analysis.

    Science.gov (United States)

    Satomi, Junichiro; Ghaibeh, A Ammar; Moriguchi, Hiroki; Nagahiro, Shinji

    2015-07-01

    The severity of clinical signs and symptoms of cranial dural arteriovenous fistulas (DAVFs) are well correlated with their pattern of venous drainage. Although the presence of cortical venous drainage can be considered a potential predictor of aggressive DAVF behaviors, such as intracranial hemorrhage or progressive neurological deficits due to venous congestion, accurate statistical analyses are currently not available. Using a decision tree data mining method, the authors aimed at clarifying the predictability of the future development of aggressive behaviors of DAVF and at identifying the main causative factors. Of 266 DAVF patients, 89 were eligible for analysis. Under observational management, 51 patients presented with intracranial hemorrhage/infarction during the follow-up period. The authors created a decision tree able to assess the risk for the development of aggressive DAVF behavior. Evaluated by 10-fold cross-validation, the decision tree's accuracy, sensitivity, and specificity were 85.28%, 88.33%, and 80.83%, respectively. The tree shows that the main factor in symptomatic patients was the presence of cortical venous drainage. In its absence, the lesion location determined the risk of a DAVF developing aggressive behavior. Decision tree analysis accurately predicts the future development of aggressive DAVF behavior.

  11. Reflexão Jornalística sobre o Relato Desportivo

    OpenAIRE

    Nunes, João Miguel Santos

    2013-01-01

    Relatório de Estágio apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Ciências da Comunicação – Estudos dos Media e de Jornalismo O presente trabalho tem como objetivo refletir academicamente sobre o relato desportivo. O tema foi até hoje pouco estudado, embora a narração de acontecimentos desportivos seja presença assídua nas grelhas de programação das estações de rádio. Se na prática parece existir um consenso em relação à forma como o relato des...

  12. Reconstrução do sulco interglúteo: relato de caso

    OpenAIRE

    Almeida Junior, Genes Lopes de

    2011-01-01

    INTRODUÇÃO: O conceito de beleza feminina tem mudado ao longo dos anos, porém a forma e a projeção das nádegas permanecem como símbolos de máxima feminilidade. A exposição corporal, especialmente da região glútea, tem proporcionado aumento da procura pela cirurgia de gluteoplastia. OBJETIVO: O propósito deste relato é demonstrar a correção cirúrgica de uma deformidade do sulco interglúteo, utilizando a preservação do ligamento sacrocutâneo. RELATO DO CASO: Paciente do sexo feminino, com queix...

  13. Prevalência de insuficiência venosa superficial dos membros inferiores em pacientes obesos e não obesos Prevalence of lower limbs superficial venous insufficiency in obese and non-obese patients

    Directory of Open Access Journals (Sweden)

    Amélia Cristina Seidel

    2011-06-01

    Full Text Available CONTEXTO: A insuficiência venosa crônica dos membros inferiores é a mais prevalente das doenças venosas. Muito se discute sobre sua etiologia e fisiopatologia. Vários fatores de risco têm sido associados ao seu desenvolvimento, como idade, sexo, dieta, entre outros. A obesidade é um problema de saúde pública e sua incidência tem aumentado. O ecocolor Doppler é um método útil para avaliar a presença de refluxo e/ou obstrução no sistema venoso. OBJETIVO: Comparar a prevalência de insuficiência venosa superficial e sintomas associados em pacientes obesos e não obesos. MÉTODOS: Após pesagem, medição da estatura e exame físico, os pacientes com índice de massa corpórea (IMC 35 kg/m² e queixas compatíveis com insuficiência venosa foram distribuídos nos grupos I e II, respectivamente. Foram submetidos à realização do ecocolor Doppler dos membros inferiores para avaliação da presença ou não de refluxo. RESULTADOS: Foram examinados 311 membros de 168 pacientes com 25-72 anos. Para análise estatística, foram consideradas queixas de varizes, dor, edema, dermatite, eczema e úlcera, associados ou não. Foi obtido um total de 109 e 104 membros com varizes nos grupos I e II, respectivamente. Queixas de varizes visíveis (pBACKGROUND: Chronic venous insufficiency of the lower limbs is the most prevalent venous disease. There is an ongoing debate about its etiology and pathophysiology. Several risk factors have been associated with its development, such as age, sex and diet. Obesity is a public health problem and its prevalence has been increasing. Color Doppler ultrasonography is a useful method to evaluate the presence of reflux and/or obstruction of the venous system. OBJECTIVE: To compare the prevalence of superficial venous insufficiency and associated symptoms in obese and non-obese patients. METHODS: After weighing, height measurement and physical examination, patients with body mass index (BMI 35 kg/m² and

  14. Trombosis venosa en el embarazo

    Directory of Open Access Journals (Sweden)

    DR. M. Fernando Ferrer

    2014-11-01

    El uso de anticoagulantes en pacientes obstétricas requiere de un plan de interrupción del embarazo lo más controlado posible. En la práctica clínica cotidiana esto no siempre es posible, debido a la incapacidad de predecir el momento de inicio del trabajo de parto. Por este motivo las recomendaciones relativas al manejo analgésico y anestésico del parto están basadas en el conocimiento de los cambios fisiológicos, farmacocinético y farmacodinámico de los anticoagulantes utilizados, lo que se analiza en extenso en esta revisión.

  15. Staphylococcus cohnii spp urealyticus: relato de caso de um patógeno incomum

    OpenAIRE

    d'Azevedo,Pedro Alves; Antunes,Ana Lúcia Sousa; Martino,Marinês Dalla Valle; Pignatari,Antonio Carlos Campos

    2008-01-01

    Staphylococcus coagulase negativos tem surgido como importantes agentes em infecções de pacientes hospitalizados. Neste estudo, relatamos o caso de bacteremia associada a cateter venoso central devido a Staphylococcus cohnii spp urealyticus isolado em hemocultura de um paciente do sexo masculino, 53 anos, internado em hospital geral da cidade de São Paulo. Discutimos nesse relato a dificuldade em identificar rotineiramente esse microrganismo no Laboratório de Microbiologia Clínica. Staphyloco...

  16. Algunos relatos sobre santería, magia y etnomedicina en Cuba

    OpenAIRE

    Carrascosa Palomera, Cruz

    2008-01-01

    Este artículo presenta una colección de relatos sobre santería, magia y etnomedicina en Cuba. Incluye información sobre ritos y prácticas de iniciación, de purificación, de curación. This paper offers a selection of stories about santería, magic and folk medicine in Cuba. Includes reports on iniciation, purification and curation rites and practices

  17. Enfermedad tromboembólica venosa en el embarazo y puerperio. Enfoque de riesgo y diagnóstico Venous thromboembolic disease in pregnancy and puerperium. Risk and diagnosis approach

    Directory of Open Access Journals (Sweden)

    Danilo Nápoles Méndez

    2011-10-01

    Full Text Available La enfermedad tromboembólica venosa es la primera causa no obstétrica de morbilidad materna, con un aporte importante a la mortalidad. En este artículo no solo se describen los factores de riesgo relacionados con esta entidad clínica en la gravidez vinculados a trombofilia, sino también con las afecciones previas de la gestación y los concernientes a embarazo y puerperio, así como los medios para su diagnóstico precoz, incluidas las principales manifestaciones clínicas y los mecanismos más fiables para confirmar la presencia de trombosis venosa profunda y tromboembolismo pulmonar. Sobre la base de lo anterior y de los valores del test de probabilidad se decidió agrupar los elementos favorecedores de su ocurrencia en 3 categorías: alto, mediano y bajo riesgo, con vistas a poder diagnosticar clínicamente con certeza su cuadro sintomático, adoptar la conducta médica expedita y emplear la profilaxis adecuada en cada caso.Venous thromboembolic disease is the first non-obstetric cause of maternal morbidity with an important contribution to mortality. In this article, not only risk factors related to this clinical disorder of gravidity involving thrombophilias are described, but also previous pregnancy conditions and those concerning pregnancy and puerperium as well as resources for its early diagnosis, including main clinical manifestations and the most reliable mechanisms to assure the presence of deep venous thrombosis and pulmonary thromboembolism. Taking into account all the aforementioned data and the probability test values, elements favoring its occurrence were grouped into three categories: high risk, mild risk, and low risk; thus, diagnosis can be clinically made having the certainty of the symptomatic chart, assuming a clear medical behavior, and applying the appropriate prophylaxis in each case.

  18. El envejecimiento como relato: Una invitación a la gerontología narrativa

    Directory of Open Access Journals (Sweden)

    Feliciano Villar

    2015-07-01

    Full Text Available El presente artículo tiene como objetivo presentar una panorámica actual de la aplicación de un enfoque narrativo al estudio del envejecimiento. En primer lugar se delinea cuál es el objeto de conocimiento de la gerontología narrativa, que se extiende en un doble nivel interrelacionado: la identidad narrativa en la vejez por una parte, y los relatos culturales sobre el envejecimiento por otra. En segundo lugar, se describen las principales metodologías utilizadas en la gerontología narrativa, diferenciando entre aquellas interesadas en el contenido de los relatos (qué se narra de las interesadas en el proceso de elaboración dialogada de los relatos (cómo se narra. El artículo finaliza con algunas reflexiones sobre el futuro y desafíos a los que se enfrenta la gerontología narrativa.  

  19. Anestesia para colecistectomia videolaparoscópica em paciente portador de Doença de Steinert: relato de caso e revisão de literatura Anestesia para colecistectomía videolaparoscópica en oaciente oortador de Enfermedad de Steinert: relato de caso y revisión de la literatura Anesthesia for videolaparoscopic cholecystectomy in a patient with Steinert Disease: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Flora Margarida Barra Bisinotto

    2010-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: As distrofias miotônicas são doenças neuromusculares de transmissão autossômica dominante. Dentre elas, a distrofia miotônica tipo 1 (DM1, ou doença de Steinert, é a mais comum no adulto e, além do envolvimento muscular, apresenta manifestações sistêmicas importantes. A DM1 representa um desafio para o anestesiologista. Os pacientes apresentam maior sensibilidade às drogas anestésicas e complicações, principalmente cardíacas e pulmonares. Além disso, há a possibilidade de apresentarem hipertermia maligna e crise miotônica. Descreveu-se o caso de um paciente que teve complicação pulmonar importante após ser submetido à anestesia geral. RELATO DO CASO: Paciente de 39 anos, portador de DM1, foi submetido à anestesia geral para colecistectomia videolaparoscópica. A anestesia foi venosa total com propofol e remifentanil e rocurônio. O procedimento cirúrgico de 90 minutos não apresentou intercorrências, mas após a extubação o paciente apresentou insuficiência respiratória e crise miotônica, que tornou a intubação traqueal impossível. Utilizou-se a máscara laríngea, que possibilitou a oxigenação adequada, e a ventilação mecânica foi mantida até a recuperação total da atividade respiratória. Evolução ocorreu sem outras complicações. CONCLUSÕES: A DM1 é uma doença que apresenta várias peculiaridades para o anestesiologista. O conhecimento minucioso do seu envolvimento sistêmico, associado à ação diferenciada das drogas anestésicas nesses pacientes, proporcionará um ato anestésicocirúrgico mais seguro.JUSTIFICATIVA Y OBJETIVOS: Las distrofias miotónicas son enfermedades neuromusculares de transmisión autosómica dominante. Entre ellas está la distrofia miotónica tipo 1 (DM1, o enfermedad de Steinert, que es la más común en el adulto y además de la involucración muscular, presenta manifestaciones sistémicas importantes. La DM1 representa un reto para el

  20. Growth increments of the recent brachiopod Magellania venosa mechanically marked in Paso Comau and Comau Fjord, Chile, 2011/2012, supplement to: Baumgarten, Sebastian; Laudien, Jürgen; Jantzen, Carin; Häussermann, Verena; Försterra, Günter (2013): Population structure, growth and production of a recent brachiopod from the Chilean fjord region. Marine Ecology, 35(4), 401-413

    KAUST Repository

    Baumgarten, Sebastian

    2015-01-01

    Magellania venosa, the largest recent brachiopod, occurs in clusters and banks in population densities of up to 416 ind/m**2 in Comau Fjord, Northern Chilean fjord region. Below 15 m, it co-occurs with the mytilid Aulacomya atra and it dominates the benthic community below 20 m. To determine the question of why M. venosa is a successful competitor, the in situ growth rate of the brachiopod was studied and its overall growth performance compared with that of other brachiopods and mussels. The growth in length was measured between February 2011 and March 2012 after mechanical tagging and calcein staining. Settlement and juvenile growth were determined from recruitment tiles installed in 2009 and from subsequent photocensus. Growth of M. venosa is best described by the general von Bertalanffy growth function, with a maximum shell length (Linf) of 71.53 mm and a Brody growth constant (K) of 0.336/year. The overall growth performance (OGP index = 5.1) is the highest recorded for a rynchonelliform brachiopod and in the range of that for Mytilus chilensis (4.8-5.27), but lower than that of A. atra (5.74). The maximal individual production (PInd) is 0.29 g AFDM/ind/year at 42 mm shell length and annual production ranges from 1.28 to 89.25 g AFDM/year/m**2 (1-57% of that of A. atra in the respective fjords). The high shell growth rate of M. venosa, together with its high overall growth performance may explain the locally high population density of this brachiopod in Comau Fjord. However, the production per biomass of the population (P/B-ratio) is low (0.535) and M. venosa may play only a minor role in the food chain. Settling dynamics indicates that M. venosa is a pioneer species with low juvenile mortality. The coexistence of the brachiopod and bivalve suggests that brachiopod survival is affected by neither the presence of potential brachiopod predators nor that of space competitors (i.e. mytilids).

  1. Preparo e administração venosa de medicamentos e soros sob a ótica da Resolução COFEN n° 311/07 Preparación y administración venosa de medicamentos y sueros bajo la óptica de la Resolución COFEN n° 311/07 Preparation and administration of intravenous drugs and serums from the perspective of Resolution No. 311/07 COFEN

    Directory of Open Access Journals (Sweden)

    Elaine Antunes Cortez

    2010-01-01

    Full Text Available OBJETIVOS: Levantar na literatura os procedimentos cabíveis ao enfermeiro quanto ao preparo e administração venosa de medicamentos e soros e relacioná-los com os aspectos éticos estabelecidos pela Resolução COFEN n° 311/07. MÉTODOS: Pesquisa do tipo revisão bibliográfica realizada nas bases de dados Medline, Lilacs, SciELO e Bdenf. Uma análise temática foi realizada em 13 artigos e emergiram as categorias: Procedimentos realizados pelo enfermeiro no preparo e na administração venosa; Responsabilidades éticas do enfermeiro: atuação do Poder Judiciário frente às decisões administrativas de natureza disciplinar proferidas pelo Conselho Federal de Enfermagem e Conselhos Regionais da Enfermagem. RESULTADOS: O enfermeiro deve realizar o preparo e administração venosa observando os requisitos básicos que garantam a ausência de danos ao cliente, e em conformidade com o Código de Ética dos profissionais de Enfermagem. CONCLUSÃO: O conhecimento da ética é essencial para a profissão da enfermagem, porque subsidia o embasamento teórico e propicia um fazer com resultados efetivos de forma a proteger o ser humano.OBJETIVOS: Levantar en la literatura los procedimientos que le caben al enfermero en lo que se refiere a la preparación y administración venosa de medicamentos y sueros; y, relacionarlos con los aspectos éticos establecidos por la Resolución COFEN n° 311/07. MÉTODOS: Se trata de una investigación del tipo revisión bibliográfica, realizada en las bases de datos Medline, Lilacs, SciELO y Bdenf. Se realizó un análisis temático en 13 artículos de los que surgieron las categorías: 1 procedimientos realizados por el enfermero en la preparación y en la administración venosa; 2 responsabilidades éticas del enfermero (actuación del Poder Judicial frente a las decisiones administrativas de naturaleza disciplinar proferidas por el Consejo Federal de Enfermería y Consejos Regionales de la Enfermería. RESULTADOS

  2. Clinical and radiological profile of Hirayama disease: A flexion myelopathy due to tight cervical dural canal amenable to collar therapy

    Directory of Open Access Journals (Sweden)

    K M Hassan

    2012-01-01

    Full Text Available Background: Hirayama disease (HD is benign focal amyotrophy of the distal upper limbs, often misdiagnosed as motor neuron disease. Routine magnetic resonance imaging (MRI is often reported normal. Objective: To study the clinicoradiological profile of hand wasting in young males. Materials and Methods: Patients presenting with insidious-onset hand wasting from March 2008 to May 2011 were evaluated electrophysiologically. Cervical MRI in neutral position was done in 11 patients and flexion contrast imaging was done in 10 patients. Results: All patients were males less than 25 years of age, with median age 23 years, except one patient who was 50 years old. Duration of illness was 3 months to 3 years. All (100% had oblique amyotrophy, four (36% cold paresis, 10 (91% minipolymyoclonus and three (27% had fasciculations. Regional reflexes were variably absent. Two patients (18% had brisk reflexes of lower limbs with flexor plantars. Electromyography (EMG showed chronic denervation in the C7-T1 myotomes. Neutral position MRI showed loss of cervical lordosis in 10/11 (91%, localized lower cervical cord atrophy in 9/11 (82%, asymmetric cord flattening in 11/11 (100% and intramedullary hyperintensity in 2/11 (18%; flexion study showed loss of dural attachment, anterior displacement of dorsal dura, epidural flow voids in 9/10 (90% and enhancing epidural crescent in 10/10 (100%. Clinical profile, imaging and electrophysiological findings of the patient aged 50 years will be described in detail as presentation at this age is exceptional. Collar therapy slowed progression in most cases. Conclusion: Clinical features of HD corroborated well with electrophysiological diagnosis of anterior horn cell disease of lower cervical cord. While dynamic contrast MRI is characteristic, routine studies have a high predictive value for diagnosis. Prompt diagnosis is important to institute early collar therapy.

  3. MR imaging of the lumbar disk herniation : relationship between the direction of herniated disc and pressure effect on nerve root and dural sac

    International Nuclear Information System (INIS)

    Cha, B. H.; Shon, M. Y.; Kim, K. W.; Lim, M. A.; Kwon, K. R; Kim, S. S.

    1996-01-01

    To evaluate the relationship between the direction of herniated disc and pressure effect on nerve root and dural sac, as seen on MRI. We retrospectively reviewed lumbar spine MR images of 122 cases of lumbar disk herniation 75 patients MRI findings were analyzed with regard to the relationship between the direction of the herniated disc and pressure effect on nerve root and dural sac. Pressure effect on nerve root and dural sac was arbitrarily divided into three types. Type I was defined as zero or minimal compression of nerve roots or thecal sac by the herniated disc ; type II was defined as mild to moderate compression, while III was defined as severe compression or displacement of nerve roots and/or thecal sac. Of the 122 cases seen in these 75 patients, 97(80%) were observed at L4-5 and L5-S1. The central type(71cases ; 58%) was more frequently observed than the posterolateral type(48cases ; 40%) or lateral type(3cases ; 2%). The totals of types I, II, and III were 44(36%), 43(35%) and 35 cases(29%), respectively. Seventy-seven %(34/44) of type I and 65%(28/43) of type II were of the central type but for type III, the corresponding figure was only 26%(9/35). On MR imaging, most of lumbar disk herniations were observed at L4-5 and L5-S1, with a predominance of the central type rather than the posterolateral one. Most of the central types were either type I or type II

  4. The Termination Level of the Dural Sac Relevant to Caudal Epidural Block in Lumbosacral Transitional Vertebrae: A Comparison between Sacralization and Lumbarization Groups.

    Science.gov (United States)

    Jeon, Ji Young; Jeong, Yu Mi; Lee, Sheen-Woo; Kim, Jeong Ho; Choi, Hye-Young; Ahn, Yong

    2018-01-01

    Lumbosacral transitional vertebrae (LSTV) are a relatively common variant and have been considered as one of the reasons for back pain. It is not unusual for clinicians to encounter patients with LSTV who require caudal epidural block (CEB) for pain management. We investigated the termination level of the dural sac (DS) and anatomical features of the lumbosacral region relevant to CEB in patients with LSTV and compared these findings between sacralization and lumbarization groups. A retrospective evaluation. A university hospital with inpatient and outpatient LSTV cases presenting low back pain. Four hundred ninety-four LSTV patients were included and categorized into sacralization (n = 201) or lumbarization groups (n = 293). Magnetic resonance imaging (MRI) of all of the LSTV patients were reviewed to determine the level of DS termination, the shortest distance between the apex of the sacral hiatus and DS, and the presence and the caudal level of sacral perineural cysts. Each lumbosacral vertebra column was divided into 3 equal portions (upper, middle, and lower thirds). The MRI findings in both of the groups were compared and analyzed. The distribution frequency of the levels of DS termination demonstrated a significant difference between the 2 groups. The mean caudal DS level in the lumbarization group was significantly lower than the sacralization group (lower third of the S2 [131 {44.7%} of 293 patients] vs. lower third of the S1 [78 {38.8%} of 201 patients]). The DS terminated at the S3 in more than 19% of the lumbarization group, whereas in only one case of the sacralization group. Although the incidence of perineural cysts was not significantly different between the 2 groups, the mean level of caudal margin of perineural cysts in the lumbarization group was significantly lower than the sacralization group (middle third of the S3 [10 {35.7%} of 28 cases] vs. middle third of the S2 [11 {44%} of 25 cases]). This study reveals several limitations including the

  5. The importance of venous hypertension in the formation of dural arteriovenous fistulas: a case report of multiple fistulas remote from sinus thrombosis

    International Nuclear Information System (INIS)

    Kusaka, N.; Sugiu, K.; Katsumata, A.; Nakashima, H.; Tamiya, T.; Ohmoto, T.

    2001-01-01

    Various hypotheses have been reported concerning the pathogenesis of dural arteriovenous fistulas (DAVFs). However, it is still controversial whether sinus thrombosis or venous hypertension has a greater influence on the formation of DAVFs. We present a rare case of multiple DAVFs that developed after sinus thrombosis. Chronic venous hypertension secondary to sinus thrombosis in the left transverse-sigmoid sinus induced the multiple DAVFs, including one in the right cavernous sinus, which was remote from the occluded sinus. This case indicates the importance of venous hypertension in the formation of DAVFs. (orig.)

  6. Chronic changes in pituitary adenylate cyclase-activating polypeptide and related receptors in response to repeated chemical dural stimulation in rats.

    Science.gov (United States)

    Han, Xun; Ran, Ye; Su, Min; Liu, Yinglu; Tang, Wenjing; Dong, Zhao; Yu, Shengyuan

    2017-01-01

    Background Preclinical experimental studies revealed an acute alteration of pituitary adenylate cyclase-activating polypeptide in response to a single activation of the trigeminovascular system, which suggests a potential role of pituitary adenylate cyclase-activating polypeptide in the pathogenesis of migraine. However, changes in pituitary adenylate cyclase-activating polypeptide after repeated migraine-like attacks in chronic migraine are not clear. Therefore, the present study investigated chronic changes in pituitary adenylate cyclase-activating polypeptide and related receptors in response to repeated chemical dural stimulations in the rat. Methods A rat model of chronic migraine was established by repeated chemical dural stimulations using an inflammatory soup for a different numbers of days. The pituitary adenylate cyclase-activating polypeptide levels were quantified in plasma, the trigeminal ganglia, and the trigeminal nucleus caudalis using radioimmunoassay and Western blotting in trigeminal ganglia and trigeminal nucleus caudalis tissues. Western blot analysis and real-time polymerase chain reaction were used to measure the protein and mRNA expression of pituitary adenylate cyclase-activating polypeptide-related receptors (PAC1, VPAC1, and VPAC2) in the trigeminal ganglia and trigeminal nucleus caudalis to identify changes associated with repetitive applications of chemical dural stimulations. Results All rats exhibited significantly decreased periorbital nociceptive thresholds to repeated inflammatory soup stimulations. Radioimmunoassay and Western blot analysis demonstrated significantly decreased pituitary adenylate cyclase-activating polypeptide levels in plasma and trigeminal ganglia after repetitive chronic inflammatory soup stimulation. Protein and mRNA analyses of pituitary adenylate cyclase-activating polypeptide-related receptors demonstrated significantly increased PAC1 receptor protein and mRNA expression in the trigeminal ganglia, but not

  7. Expenditure survey on continued veno-venous hemodialysis procedure in the intensive care unit Levantamiento del costo del procedimiento de hemodiálisis vena-venosa continua en unidades de terapia intensiva Levantamento do custo do procedimento de hemodiálise veno-venosa contínua em unidades de terapia intensiva

    Directory of Open Access Journals (Sweden)

    Lígia Maria dal Secco

    2007-12-01

    Full Text Available This study aimed to characterize patients submitted to dialytic treatment with CVVHD in ICUs; monitor procedure time duration; estimate nurses' labor wages and; estimate the direct procedures mean costs. The study was developed in a public teaching hospital located in São Paulo, Brazil. A total of 93 procedures performed in 50 patients composed the sample. The results showed the predominance of male patients (62%; mean age was 60.8 years old; ICU hospitalization time was 19.2 days; 86% of the patients died; 76% of the patients presented acute renal insufficiency and, mean procedure time per patient was 1.9. The mean procedure duration was 26.6 hours. The mean cost of nurses' wages were R$ 592.04 which represented 28.7% of the total cost. The mean total expenditure was R$ 2,065.36 ranging from R$ 733.65 to R$ 6,994.18.El objetivo de este estudio fue identificar características sócio-demográficas de los pacientes sometidos al tratamiento de Hemodiálisis Vena-Venosa Continua (CVVHD en Unidades de Terapia Intensiva (UTIs; identificar el tiempo de duración de los procedimientos; calcular el costo del tiempo de los enfermeros y evaluar el costo promedio directo de los procedimentos. El estudio fue realizado en un hospital escuela público en la ciudad de São Paulo. La muestra fue constituida por 93 procedimientos realizados en 50 pacientes. Los resultados mostraron la predominancia del sexo masculino (62%; la edad promedia fue de 60,8 años; el tiempo promedio de permanencia en la UTI fue de 19,2 días; el 86% evolucionó a óbito y el promedio del número de los procedimientos por paciente fue de 1,9 días. La insuficiencia renal aguda (IRA está presente en el 76% de los pacientes. La duración promedia fue de 26,6 horas. El costo del tiempo del enfermero fue en promedio R$ 592,04 y representó el 28,7% del costo total. El costo total promedio del procedimiento fue de R$ 2.065,36, con variación de R$ 733,65 a R$ 6.994,18.Os objetivos deste

  8. Doença de Moyamoya e anestesia com sevoflurano fora do centro cirúrgico: relato de caso

    OpenAIRE

    Machado, Sheila Braga; Mendes, Florentino Fernandes; Angelini, Adriana de Campos

    2002-01-01

    JUSTIFICATIVA E OBJETIVOS: A doença de Moyamoya é uma desordem cerebrovascular progressiva que representa um desafio anestésico em virtude da precária circulação cerebral destes pacientes, constituindo-se numa importante causa de acidente vascular cerebral em indivíduos jovens. O objetivo deste relato é apresentar o caso de um paciente com doença de Moyamoya que foi submetido à anestesia geral com sevoflurano para procedimento diagnóstico fora do centro cirúrgico. RELATO DO CASO: Criança com ...

  9. Auto-relato de erros em tarefas de leitura: efeitos de um treino de correspondência.

    OpenAIRE

    Camila Domeniconi

    2006-01-01

    Quando crianças com história de fracasso escolar relatam seus resultados em leitura de palavras, a maioria delas tende a relatar a maior parte as respostas como corretas, mesmo que tenham cometido erros. Este estudo investigou as variáveis que influenciam a fidedignidade desses relatos e tentou treinar a correspondência para assegurar relatos correspondentes de erros, bem como de acertos. As sessões experimentais apresentaram diversas palavras em uma tela do computador. O compu...

  10. Dynamic changes in the dural space and spinal cord cross-sectional area during flexion and extension in patients with cervical spondylotic myelopathy

    International Nuclear Information System (INIS)

    Machino, Masaaki; Yukawa, Yasutsugu; Ito, Keigo; Nakashima, Hiroaki; Kato, Fumihiko

    2009-01-01

    The number of patients with cervical spondylotic myelopathy (CSM) is increasing with the aging of the population. The patients' during spinal cord tends to be compressed neck extension, because the yellow ligaments and intervertebral discs protrude into the spinal canal during neck extension (pincer mechanism). A total of 100 patients with CSM were prospectively enrolled in this study. After preoperative myelography, multi-detector-row CT (MDCT) scans were acquired in flexion and extension, and the dural space and spinal cord cross-sectional area at each disc level from C2/3 to C7/Th1 were measured by using Scion imaging software. The average dural space and average spinal cord cross-sectional area were smaller in extension than in flexion from the C3/4 to C7/Th1 disc level, and the greatest dynamic changes were seen at the C5/6 level. MDCT demonstrated dynamic factors in patients with CSM. The spinal cord cross-sectional area became narrower during extension in patients with CSM. (author)

  11. Resolution of clinical symptoms after reopening of an occluded inferior petrosal sinus in a patient with a cavernous sinus dural arteriovenous fistula. A case report.

    Science.gov (United States)

    Kojima, A; Onozuka, S; Kinoshita, Y

    2013-03-01

    We describe a rare case with a cavernous sinus (CS) dural arteriovenous fistula (DAVF) in which the clinical symptoms disappeared after the patient underwent reopening of an occluded inferior petrosal sinus (IPS). A 66-year-old woman presented with increased intraocular pressure, chemosis, and proptosis on the left side. Angiography demonstrated a left CS DAVF supplied by the dural branches of bilateral internal carotid arteries. The shunt flow was directed to the superior and inferior ophthalmic veins, while the bilateral IPSs were not opacified. Accordingly, a transvenous embolization of the fistula was attempted. Although the microcatheter was navigated to the cavernous sinus through the occluded left IPS, obliteration of the fistula was unsuccessful because of the failure of superselective catheterization at the fistulous point. However, the final image demonstrated the development of an antegrade shunt flow through the left IPS to the internal jugular vein and disappearance of the retrograde reflux to the superior and inferior ophthalmic veins. The patient's clinical symptoms immediately resolved after the operation, and the symptoms have not recurred during a one-year follow-up period. Inappropriate transvenous embolization of CS DAVFs can result in vascular complications arising from the unintentional redistribution of shunt flow. The present case illustrates that the disappearance of retrograde shunt flow to the ophthalmic veins after reopening of the occluded IPS may be sufficient if a superselective approach fails or is anticipated to result only in an incomplete embolization of the fistulous point.

  12. Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Yen-Heng [National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei (China); National Taiwan University Hospital in Taipei and Yuan-Lin Branch, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); Lin, Hsien-Ho [National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei (China); Liu, Hon-Man; Lee, Chung-Wei; Chen, Ya-Fang [National Taiwan University Hospital in Taipei and Yuan-Lin Branch, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China)

    2016-08-15

    This study aims to review the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) in symptomatic dural arteriovenous fistula (DAVF). EMBASE, PubMed, and Cochrane Library were searched until April 2015 for studies which compared CT, MRI, or both with angiography for the detection of DAVF. The diagnostic performances of MRI and CT were indirectly compared using modality as a covariate in the analysis. Thirteen studies met our inclusion criteria. MRI had a sensitivity of 0.90 (95 % confidence interval (CI) = 0.83-0.94) and specificity of 0.94 (95 % CI = 0.90-0.96). CT had a sensitivity of 0.80 (95 % CI = 0.62-0.90) and specificity of 0.87 (95 % CI = 0.74-0.94). MRI showed better diagnostic performance than CT (p = 0.02). Contrast medium use and time-resolved MR angiography did not improve MRI diagnostic performance (p = 0.31 and 0.44, respectively). Both CT and MRI had good diagnostic performance. MRI was better than CT on the detection of symptomatic intracranial dural arteriovenous fistula in the indirect comparison. (orig.)

  13. Mobilidade internacional na graduação em medicina: relato de experiência

    Directory of Open Access Journals (Sweden)

    Iago Gonçalves Ferreira

    2017-08-01

    Full Text Available Introdução: A mobilidade acadêmica nas universidades apresenta-se como uma ferramenta para a internacionalização do ensino superior brasileiro, promovendo a inserção dos estudantes universitários em diferentes contextos culturais e educacionais, agregando tanto novos conhecimentos teóricos como habilidades sociais e linguísticas. Relato de experiência: Este artigo trata‑se de um relato de experiência de um estudante de medicina viabilizado pelo programa de mobilidade internacional Ciência Sem Fronteiras, realizado no curso de Promoção da Saúde do Waterford Institute of Technology, na cidade de Waterford, Irlanda, no período de setembro de 2014 a julho de 2015. O relato apresenta as atividades acadêmicas desenvolvidas na instituição, bem como analisa a contribuição dos programas de intercâmbio para a graduação médica. Conclusão: A mobilidade internacional pode representar um importante instrumento para a formação médica, pois estimula o amadurecimento profissional e pessoal dos estudantes, ao expô‑los a um cenário diferenciado, no qual são incitados a refletir sobre suas práticas e seu conhecimento, ao se deparar com o novo e o diferente. Tais contribuições podem representar o aprimoramento das habilidades médicas e humanísticas dos graduandos, configurando-se como um avanço para o ensino médico no Brasi.

  14. DISCRIMINACION ETNICA EN RELATOS DE LA EXPERIENCIA ESCOLAR MAPUCHE EN PANGUIPULLI (CHILE)

    OpenAIRE

    Poblete S,María Pía

    2003-01-01

    El propósito de este artículo es indagar en las percepciones y valoraciones de la experiencia escolar en un contexto interétnico. Presentamos información proveniente de 30 relatos sobre la educación y la experiencia escolar de personas mapuches de la precordillera de la Comuna de Panguipulli. Los resultados nos muestran que las experiencias en la escuela estuvieron marcadas por la discriminación étnica en la mayoría de los entrevistados. La discriminación se vivió en la interacción con profes...

  15. Miastenia grave familiar: relato de caso em gêmeas idênticas

    Directory of Open Access Journals (Sweden)

    Elza Dias-Tosta

    1989-06-01

    Full Text Available Trata-se do sétimo relato da literatura mundial de casos de miastenia gravis em gêmeos homozigóticos em que ambos são acometidos. O homozigotismo foi provado com certeza por estudo de HLA e a forma adquirida da doença foi provada por determinação de níveis elevados de anticorpos anti-receptor de acetilcolina, havendo também níveis elevados de anticorpos antimúsculo estriado, sem outras evidências de timoma.

  16. Paracoccidioidomicose e síndrome de imunodeficiência adquirida: relato de necropsia

    Directory of Open Access Journals (Sweden)

    Godoy Pérsio

    2006-01-01

    Full Text Available Descrição de um caso de paracoccidioidomicose generalizada em homem de 59 anos com síndrome de imunodeficiência adquirida, sem diagnóstico clínico prévio, observado à necropsia. Houve disseminação do fungo para vários órgãos, caracterizando-se, especialmente nos linfonodos, reativação aguda de processo antigo. O relato acrescenta-se ao número relativamente reduzido dos anotados na literatura médica.

  17. Cistopexia videoassistida em cadela com cistocele após prolapso uterino: relato de caso

    OpenAIRE

    Krebs, T.; Brun, M.V.; Linhares, M.T.; Dalmolin, F.; Pohl, V.H.; Feranti, J.P.S.

    2015-01-01

    O prolapso de vesícula urinária associado ao prolapso uterino é condição rara em cães e gatos. O tratamento preconizado para essa afecção é o reposicionamento anatômico das estruturas afetadas. No presente relato é descrito o manejo por meio de ovariossalpingo-histerectomia por celiotomia e, após dois dias, cistopexia videoassistida. Essa condição, conforme o conhecimento dos autores, não havia sido previamente descrita. A operação apresentou-se como possibilidade viável de tratamento, sem co...

  18. O que se faz e o que se diz: auto-relatos emitidos por terapeutas comportamentais

    OpenAIRE

    Oliveira, Wilton de

    2008-01-01

    O presente trabalho tem o objetivo de verificar as relações entre os auto-relatos emitidos por terapeutas comportamentais sobre seus próprios comportamentos na interação com seus clientes e os respectivos comportamentos que de fato ocorreram. Como sujeitos da pesquisa foram selecionados três terapeutas analítico-comportamentais com tempo de experiência distintos (seis meses Ta, cinco anos Tb, e oito anos Tc). Cada terapeuta atendeu três clientes (uma sessão cada), de modo a perfazer um total ...

  19. Familias homoparentales: relatos desde la perspectiva de los “conocimientos situados”.

    OpenAIRE

    Buzaglo, Analía; Culla, Mónica; Morandi, Mariela

    2015-01-01

    En el presente trabajo nos proponemos indagar los aportes de la epistemología feminista en las investigaciones críticas en Ciencias Sociales. Partimos de una experiencia de investigación singular y situada: “Familias homoparentales: narrativas contrahegemónicas del parentesco” basada en la metodología de las producciones narrativas que retoma la propuesta de “conocimientos situados” de Donna Haraway (1995). Estos relatos, cuestionan teorías y prácticas hegemónicas con efectos concretos...

  20. Familias homoparentales: relatos desde la perspectiva de los “conocimientos situados”

    OpenAIRE

    Buzaglo, Analía; Culla, Mónica; Morandi, Mariela

    2015-01-01

    En el presente trabajo nos proponemos indagar los aportes de la epistemología feminista en las investigaciones críticas en Ciencias Sociales. Partimos de una experiencia de investigación singular y situada: “Familias homoparentales: narrativas contrahegemónicas del parentesco” basada en la metodología de las producciones narrativas que retoma la propuesta de “conocimientos situados” de Donna Haraway (1995). Estos relatos, cuestionan teorías y prácticas hegemónicas con efectos concretos en la ...

  1. Anestesia em paciente com síndrome de Marshall-Smith: relato de caso

    OpenAIRE

    Mandim, Beatriz Lemos da Silva; Fonseca, Neuber Martins; Ruzi, Roberto Araújo; Temer, Paulo Cezar Silva

    2007-01-01

    JUSTIFICATIVA E OBJETIVOS: A síndrome Marshall-Smith é uma doença rara, caracterizada por dismorfismo facial, acelerada maturação óssea, atraso no desenvolvimento neuropsicomotor e anormalidade das vias aéreas. Os pacientes com essa síndrome apresentam grande probabilidade de complicações anestésicas, sobretudo com relação ao manejo das vias aéreas. Há poucos dados na literatura anestésica a respeito desta síndrome. O objetivo deste relato foi apresentar as dificuldades e a conduta anestésica...

  2. Alcoolismo após cirurgia bariátrica: relato de caso

    Directory of Open Access Journals (Sweden)

    Juliana Garbayo dos Santos

    Full Text Available RESUMO Objetivo Discutir, a partir do relato de um caso de alcoolismo iniciado após tratamento cirúrgico de obesidade mórbida, a hipótese da “transferência de compulsão”. Segundo essa teoria, obesos submetidos à cirurgia bariátrica tendem a transferir sua “compulsão” dos alimentos para o álcool ou outras drogas, aumentando o risco de desenvolvimento de transtornos relacionados a substâncias. Evidências de que a alimentação hedônica (caracterizada pelo consumo exagerado de alimentos palatáveis na ausência de fome é regulada pelos mesmos sistemas cerebrais envolvidos no alcoolismo, aliadas a relatos anedóticos de alcoolismo após cirurgia bariátrica, alimentam essa hipótese. Métodos Relato de caso individual. O paciente concordou com a publicação do relato de caso e assinou um Termo de Consentimento Livre e Esclarecido. Resultados Homem de 25 anos, sem histórico prévio de abuso de álcool, evoluiu com alcoolismo grave quatro anos após a cirurgia bariátrica. Havia antecedentes familiares de transtornos relacionados a substâncias. Conclusão A cirurgia bariátrica (particularmente com derivação em Y de Roux pode alterar o metabolismo do etanol e implicar mudanças no estilo de vida e no nível de estresse. Somados, esses fatores podem contribuir para o surgimento de padrões nocivos de consumo de álcool; entretanto, é incontestável que a correção da obesidade traz enormes benefícios para as diversas áreas da vida do paciente. A detecção de fatores de risco para abuso e dependência alcoólica, como história familiar positiva, é essencial para identificar pacientes que necessitarão maior aconselhamento pré-operatório e seguimento pós-operatório cuidadoso.

  3. Presentación del Libro: Cuasi una Fantasía. Cuentos y Relatos.

    OpenAIRE

    Efraím Otero Ruiz

    2006-01-01

    Meses y varios huesos rotos después puedo, al fin, presentar ante ustedes mi libro de cuentos y relatos, salido de las prensas de Kimpres -con el generoso apoyo de esta Academia desde septiembre del año pasado. Afortunadamente, por tratarse de “Cuasi una fantasía” son narraciones que solo están parcialmente ancladas en el tiempo y comprenden una vivencia de medio siglo, no sólo por los personajes-hoy casi todos desaparecidos- sino por los sucesos, que a veces -aunque tomados ...

  4. Anestesia em paciente portadora de síndrome de Mckusick-Kaufman: relato de caso

    OpenAIRE

    Hobaika,Adriano Bechara de Souza; Borges,Ziltomar Donizetti; Teixeira,Vera Coelho

    2004-01-01

    JUSTIFICATIVA E OBJETIVOS: A síndrome de Mckusick-Kaufman é uma doença rara, caracterizada tipicamente por hidrometrocolpos, polidactilia e defeitos cardíacos congênitos. Pacientes portadores desta doença podem ser submetidos a diversos procedimentos cirúrgicos durante a sua vida e o anestesiologista deve estar preparado para possíveis alterações. O objetivo deste artigo é relatar a conduta anestésica adotada em uma paciente portadora desta síndrome. RELATO DO CASO: Paciente do sexo feminino ...

  5. FALANDO SOBRE SEXUALIDADE NA ADOLESCÊNCIA: RELATO DE EXPERIÊNCIA

    OpenAIRE

    Rabin, Eliane Goldberg; UFCSPA; Waterkemper, Roberta; UFCSPA; Caregnato, Rita C. A.; UFCSPA; Souza, Emiliane Nogueira de; UFCSPA

    2014-01-01

    Trata-se de um relato de experiência sobre atividade de extensão realizada por docentes e acadêmicos do Curso de Graduação em Enfermagem sobre sexualidade na adolescência. Atividade realizada com jovens de 10 a 19 anos, estudantes do ensino fundamental e médio de escolas públicas de Porto Alegre. Foram utilizadas diferentes estratégias e dinâmicas para o desenvolvimento das atividades, com vistas à maior participação dos jovens escolares. Os temas abordados foram as mudanças corporais, por me...

  6. Raquitismo carencial: relato de caso = Vitamin D-dependent Rickets: Case report

    OpenAIRE

    Porto, Juliana Antola

    2005-01-01

    Introdução: O raquitismo é uma doença do tecido ósseo em formação, onde há falha na calcificação e conseguinte acúmulo de tecido osteóide. O raquitismo carencial é decorrente da deficiência dos precursores da vitamina D, sendo a causa de raquitismo mais facilmente evitável e tratável. Objetivo: Relatar um caso, revisar a etiopatogenia e o tratamento do raquitismo carencial. Relato de caso: Paciente masculino com 2 anos de idade, previamente hígido, consulta com dificuldade de deambular ...

  7. Raquitismo carencial: relato de caso = Vitamin D-dependent rickets: case report

    OpenAIRE

    Porto, Juliana Antola; Piccoli, Cláudia; Salerno, Margareth Rodrigues; Henrique, Iara

    2005-01-01

    Introdução: O raquitismo é uma doença do tecido ósseo em formação, onde há falha na calcificação e conseguinte acúmulo de tecido osteóide. O raquitismo carencial é decorrente da deficiência dos precursores da vitamina D, sendo a causa de raquitismo mais facilmente evitável e tratável. Objetivo: Relatar um caso, revisar a etiopatogenia e o tratamento do raquitismo carencial. Relato de caso: Paciente masculino com 2 anos de idade, previamente hígido, consulta com dificuldade de deambular progre...

  8. Conduta na lesão dural intraoperatória em artrodese da coluna lombar Conducta en lesión de duramadre intraoperatoria en artrodesis de la columna lumbar Management of intraoperatory dural tear in lumbar spine arthrodesis

    Directory of Open Access Journals (Sweden)

    Fabiano de Mendonça Grandese

    2010-12-01

    Full Text Available OBJETIVO: estudo retrospectivo de pacientes com lesão dural intraoperatória de cirurgia da coluna vertebral lombar, conduzido por meio de um protocolo independente da extensão da lesão, complicações associadas e resultados após seguimento mínimo de um ano. MÉTODOS: um total de 10 pacientes com durotomia acidental em cirurgias de descompressão e artrodese da coluna vertebral lombar, no período de Janeiro de 2007 a Janeiro de 2009, para tratamento de doença degenerativa, tiveram seus prontuários revisados, após terem sido tratados por meio de um protocolo embasado em reparo primário da lesão, drenagem subaracnoidea fechada, subfascial e subcutânea aspirativa realizados por cirurgião experiente, associado a repouso relativo com mobilidade precoce e terapia medicamentosa. Suas anotações e exames radiológicos foram verificados com seguimento pós-operatório e direcionados para identificação de sintomas sugestivos de complicações. RESULTADOS: todos os pacientes apresentaram boa evolução, sem ocorrência de fístula liquórica ou infecção pós-operatória; três deles apresentaram cefaleia pós-operatória de leve intensidade. Não houve necessidade de reoperação em nenhum desses pacientes. CONCLUSÃO: concluiu-se que a conduta adotada é segura e de bom resultado para os pacientes quando ocorre esse tipo de lesão, independentemente da extensão da mesma.OBJETIVO: un estudio retrospectivo de pacientes con lesión de la duramadre intraoperatoria de cirugía en la columna lumbar, llevada a cabo por medio de un protocolo independiente de la extensión de la lesión, complicaciones asociadas y los resultados de seguimiento después de un mínimo de un año. MÉTODOS: 10 pacientes con durotomía accidental en la descompresión quirúrgica y artrodesis de la columna vertebral lumbar, en el período de enero de 2007 a enero de 2009, para el tratamiento de enfermedades degenerativas, tuvieron sus registros revisados después de

  9. Avaliação das pressões venosa e arterial em cães submetidos a diferentes tipos de hipotensão Evaluation of venous and arterial blood pressures in dogs submitted to hypotension

    Directory of Open Access Journals (Sweden)

    R.C. Rabelo

    2005-12-01

    Full Text Available Estabeleceram-se a pressão venosa periférica (PVP, a pressão venosa central (PVC, a pressão arterial invasiva (PAI e a pressão arterial não invasiva (PANI em cães após diferentes eventos de hipotensão. Foram utilizados 15 cães adultos, distribuídos aleatoriamente em três grupos (G com cinco animais cada, submetidos aos seguintes eventos hipotensores: GI - cloridrato de xilazina a 2%, GII - choque hipovolêmico agudo e GIII - veneno da serpente Bothrops moojeni. Os animais, avaliados durante 30 minutos após o início do evento hipotensor, foram tratados com cloridrato de ioimbina (GI, amido hidroxietílico a 6% (GII e cetoprofeno (GIII e reavaliados por mais 30 minutos. Somente os animais do GII apresentaram redução da PVP após o evento hipotensor e aumento, 25 minutos após tratamento. Os cães dos grupos II e III mostraram redução da PVC após o evento hipotensor, e somente os animais do GII exibiram discreto aumento cinco minutos imediatamente após o tratamento. Houve diminuição da PAI e PANI nos dos grupos II e III após o evento hipotensor, com recuperação gradativa imediata, após o tratamento, somente da PAI.The peripheral venous pressure (PVP, the central venous pressure (CVP, the invasive (IAP and non-invasive blood pressure (NIAP in dogs submitted to different hypotensive events were studied. Fifteen adult mongrel dogs were randomly divided in three groups with five animals each, and submitted to hypotensive event as follow: GI - xylazine chloride 2%, GII - acute hypovolemic shock and GIII - snake venom (Bothrops moojeni. All animals were evaluated for 30 minutes after starting hypotensive event, treated with yoimbine chloride (GI, colloid hetastarch 6% (GII and ketoprofen (GIII and reevaluated for more 30 minutes. Only the group II dogs showed PVP decrease after hypotensive event, and increase 25 minutes after treatment. In animals of groups II and III, the CVP decreased after hypotensive event and only in GII

  10. Análise dos efeitos dos exercícios aquáticos na qualidade de vida de indivíduos com doença venosa crônica

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    Michael Augusto dos Santos Aquino

    2016-03-01

    Full Text Available Resumo Contexto O uso dos exercícios aquáticos se tornou uma modalidade terapêutica muito importante na doença venosa crônica (DVC. Tais exercícios têm sido apontados pela literatura como um mecanismo favorável ao retorno venoso, sendo importantes na reeducação vascular. Também contribuem para a diminuição da hipertensão venosa ocasionada pela doença, melhorando a qualidade de vida dos indivíduos acometidos. Objetivos Analisar os efeitos dos exercícios aquáticos na qualidade de vida de pacientes com DVC. Métodos Trata-se de um estudo-piloto, interventivo prospectivo longitudinal, composto por 16 indivíduos com DVC classificados de C1 a C5. Os participantes foram avaliados através de um formulário de coleta de dados e instruídos a responder dois questionários sobre qualidade de vida: SF-36 (Geral e AVVQ-Brasil (específico para DVC, além da Escala Visual Analógica da dor (EVA. Em seguida, foram submetidos a 10 sessões de exercícios aquáticos, três vezes por semana, tendo respondido novamente aos questionários de qualidade de vida e EVA após o termino de todas as sessões. Resultados Os dados coletados foram tratados estatisticamente, com nível de significância de p < 0,05. Os pacientes apresentaram melhora na qualidade de vida medida pelo SF-36 nos domínios capacidade funcional, limitação e dor (p < 0,05. O nível de dor nos pacientes tratados reduziu segundo a EVA (p = 0,007. Em relação ao questionário AVVQ-Brasil, apenas o domínio Dor e Disfunção apresentou melhora significativa (p = 0,013. Conclusão Os exercícios aquáticos foram capazes de melhorar aspectos da qualidade de vida e de reduzir a dor, demonstrando trazer benefícios para pacientes com DVC.

  11. Brinquedo terapêutico no preparo da criança para punção venosa ambulatorial: percepção dos pais e acompanhantes El juego terapéutico en la preparación del niño para una punción venosa en ambulatorio: percepción de los padres y acompañantes Therapeutic play when preparing the child for venipuncture outpatient: perception from the parents and attendants

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    Caroline Monteiro Conceição

    2011-06-01

    Full Text Available Estudo descritivo qualitativo com o objetivo de compreender a percepção de pais e acompanhantes sobre o emprego do Brinquedo Terapêutico no preparo da criança para a punção venosa ambulatorial, realizado em um ambulatório da cidade de São Paulo. Os dados foram coletados por meio de entrevistas semiestruturadas realizadas com oito pais ou acompanhantes de crianças preparadas para a punção venosa com o Brinquedo Terapêutico e, após, submetidos à análise qualitativa de conteúdo. Os resultados evidenciaram que eles aprovam essa estratégia de preparo e acreditam que esta favorece o conhecimento sobre o procedimento, diminui o medo, acalma e promove a segurança deles e da criança, além de constituir-se em um atendimento de enfermagem humanizado e de qualidade à criança e família. Reitera-se a importância da implementação do Brinquedo Terapêutico na assistência à criança em ambulatórios e unidades básicas de saúde.Estudio descriptivo cualitativo realizado con el objetivo de comprender la percepción de los padres y acompañante a respecto de la utilización del Juego Terapéutico en la preparación de sus hijos para la punción venosa previa a la recolección de sangre. Fue realizado en un ambulatorio de la ciudad de São Paulo. Los datos fueron recolectados por medio de entrevistas seme-estructuradas realizadas con ocho padres o acompañantes de niños preparados con el juego para la recolección de sangre, y que, después, fueron sometidos al análisis cualitativo del contenido. Los resultados evidenciaron que los padres aprueban esa estrategia de preparación y consideran que la misma favorece al conocimiento sobre el procedimiento, disminuye el miedo, tranquiliza y promueve la seguridad de los adultos y de los niños, además de ser una atención de enfermería humanizada y de calidad al niño y a la familia. Se reitera la importancia de la implementación del Juego Terapéutico en la asistencia al niño en

  12. Tampão peridural com dextran 40 na profilaxia da cefaléia pós-punção acidental da duramáter em paciente HIV positivo: relato de caso Tampón peridural con dextran 40 en la profilaxia de la cefalea pós-punción accidental de la duramáter en paciente SIDA positivo: relato de caso Epidural patch with dextran 40 to prevent postdural puncture headache in an HIV patient: case report

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    Marcos Guilherme Cunha Cruvinel

    2002-11-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A cefaléia pós-punção de duramáter é uma complicação bem conhecida das anestesias subaracnóideas e peridurais, sendo o tampão sangüíneo considerado o tratamento mais eficaz, até o momento. Este é um procedimento invasivo e sujeito a complicações graves. Seu uso em certos pacientes, como portadores de HIV ou leucemias, é motivo de debate. Várias alternativas têm sido relatadas. O objetivo deste artigo é apresentar um caso do uso do tampão peridural com dextran 40 na profilaxia da cefaléia pós-punção de duramáter em paciente portador do vírus da imunodeficiência humana (HIV, com história de cefaléia em anestesia subaracnóidea anterior. RELATO DE CASO: Paciente masculino, 31 anos, 70 kg, estado físico ASA II, portador de HIV, para tratamento de condilomatose anal recidivada, com relato de cefaléia intensa e limitante durante duas semanas após anestesia subaracnóidea (agulha Quincke 25G. Durante tentativa de anestesia peridural com agulha de Tuohy 18G em L3-L4, houve perfuração acidental da duramáter. Foram injetados, por duas vezes, 20 ml de dextran 40 a 10% por cateter peridural; a primeira, 150 minutos após a administração dos anestésicos e a segunda na manhã seguinte à cirurgia. O paciente evoluiu assintomático e recebeu alta no dia seguinte à sua internação. CONCLUSÕES: O uso do tampão com soluções colóides como o dextran 40 não está bem estabelecido, porém existem alguns relatos do seu uso com sucesso e entendemos que seu potencial deva ser melhor explorado.JUSTIFICATIVA Y OBJETIVOS: La cefalea pós-punción de duramáter es una complicación bien conocida de las anestesias subaracnóideas y peridurales, siendo el tampón sanguíneo considerado el tratamiento más eficaz hasta el momento. Este es un procedimiento invasivo y sujeto a complicaciones graves. Su uso en ciertos pacientes, como portadores de SIDA o leucemias, es motivo de debate. Varias alternativas

  13. Identidad y colonialidad en los relatos de Alberto Alabí

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    Irene López

    2011-06-01

    Full Text Available En este artículo proponemos un análisis de algunos relatos del escritor argentino Alberto Alabí desde la noción de colonialidad en sus tres dimensiones —del poder, del saber y del ser— y sus implicaciones en las formaciones identitarias. Consideramos que los conflictos que estos relatos textualizan nos permiten comprender algunas de las problemáticas sociales candentes en el espacio norteño, como la racialización de la diferencia y, consecuentemente, el color de piel, tanto en la subalternización de sujetos y prácticas como en la construcción de representaciones identitarias.In this paper we propose an analysis of short stories of an argentinean writter, Alberto Alabí, from the notion of coloniality of power, of knowledge and being and its implications for identity formations. We believe that the conflicts textualized in these short stories permit us to understand many of social problems in the north of Argentina, such as the role played by the racialization of difference and, consequently, the color of skin in the subalternization of subjects and practices as well as in construction of identity representations.

  14. Definiendo a los otros: relatos académicos sobre la diversidad en la escuela

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    María Luisa Jiménez-Rodrigo

    2016-01-01

    Full Text Available Este artículo indaga en los usos académicos del concepto diversidad en el ámbito escolar a partir del análisis de la literatura científica española. El método se basa en el análisis documental partiendo de una exhaustiva búsqueda y revisión de 218 artículos publicados entre 2006 y 2012 en revistas indexadas en CSIC-ISOC y DIALNET. Se aplicó un esquema estructural de análisis que permitió identificar diferentes configuraciones narrativas en torno a la definición del “otro” en la escuela. Los resultados señalan dos relatos hegemónicos: institucional, basado en las clasificaciones legislativas del alumnado en función de sus capacidades y rendimientos escolares; e intercultural, sustentado en categorizaciones en torno a las diferencias culturales derivadas de la condición inmigrante-extranjera. Concluimos que en ambos relatos se proyecta predominantemente una visión esencializadade la diversidad construida desde parámetros dicotómicos y excluyentes, sin apenas considerar otras categorías sociales y económicas en la conformación de las diferencias y desigualdades educativas.

  15. La función del relato en la producción social de sentido

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    Cristina Palomar Verea

    2001-01-01

    Full Text Available Este artículo es una reflexión sobre la producción de sentido en las prácticas sociales a partir de la discusión en torno a la relación entre la historia, la investigación antropológica y la narrativa, intentando acercar esta discusión al análisis de las prácticas discursivas, entendidas como la puesta en acto del discurso en tanto vehículo primario a través del cual las relaciones sociales son producidas y reproducidas. La discursividad, entonces, hace referencia al conjunto de fenómenos en y a través de los cuales tiene lugar la producción de sentido que constituye a una sociedad como tal, mediante distintos relatos de las prácticas sociales que pueden ser vistas como textos narrativos más allá de la escritura. En este punto se retoman los planteamientos hermenéuticos de Paul Ricoeur sobre la noción de “texto”. Ricoeur se refiere al uso que hace Freud de esta noción: El relato del sueño es un texto ininteligible que el análisis sustituye por otro texto más inteligible.

  16. Los Relatos Zapatistas y su Vínculo con la Oralidad Tradicional

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    Ezequiel Maldonado

    2001-01-01

    Full Text Available Se examina, en la primera parte, la presencia inherente de una tradición oral en las literaturas indias. Una oralidad que permite en el 2001 no sólo la continuidad cul tural en el seno comunitario sino que, en su forma escrita, trasmite relatos e historias que atrapan a escuchas y lectores sin demeritar planos estéticos. En la segunda parte se ejemplifica esta persistente oralidad en los relatos de El Viejo An tonio a través de variados recursos estilísticos: uso de frases recurrentes, trastocamiento de tiempo y espacio, improvisación, sentido de hu mor, ausencia de un orden cronológico etcétera. En sentido estricto, se habla de literatura in dia aquella relatada y escrita por los propios indios; sin em bargo, en el presente caso, Marcos será la voz, el comunicador o “traductor” de An tonio. El ¡Ya basta! indio de 1994 abrió sendas inéditas e impulsó la voz de los sin rostro en el pan orama de la literatura nacional.

  17. Mapuche y ranqueles en la Argentina: relatos sobre su pasado y presente

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    Graciana Pérez Zavala

    2008-07-01

    Full Text Available En este artículo se planteo la reconstrucción de los relatos del pasado por parte de indígenas que viven en el territorio argentino, particularmente los mapuche y ronqueles. Para explicar estos variaciones en la interpretación del pasado por parte de las diferentes organizaciones indigenas, se examina la "Conquista del Desierto" (1878-1885, en tanto acontecimiento nodal en la estructuración de las relaciones interétnicas actuales en Argentina. En primer lugar, se sintetizan varios elementos de la historia de los indígenas de Pampa y Patagonia en los años previos a su sometimiento. Posteriormente, se describen los acontecimientos ligados a la "Conquista del Desierto", teniendo en cuenta al Estado argentino y a las diferentes "tribus". Luego, se caracteriza la situación de los indigenas después de 1885, y para finalizar, se analizan los relatos de los mapuche y ranqueles contemporaneos en el marco de su resurgimiento como pueblos preexistentes al Estado Nacional argentino.

  18. Dor e Gozo: relatos de mulheres jovens sobre automutilações

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    José Juliano Cedaro

    2013-08-01

    Full Text Available Este artigo discute a prática da automutilação, destacando os relatos de mulheres jovens (entre 15 e 21 anos, atendidas em um Centro de Atenção Psicossocial (CAPS. Tais atitudes consistem em provocar, de forma consciente, feridas no próprio corpo, como cortes, arranhões, queimaduras ou perfurações, não havendo nessas ações o desejo manifesto de suicídio, embora seja comum aparecerem ideações nesse sentido nas falas das pacientes. Os relatos acerca de tal comportamento são apresentados por meio de fragmentos de falas, registrados após atendimentos psicológicos, que esboçam a descrição dos sentimentos expostos dentro do setting terapêutico. As questões suscitadas são discutidas a partir das concepções psicanalíticas a respeito do gozo e do masoquismo, com ênfase nas proposições de Freud e Lacan, focalizando a seguinte indagação: qual é a função da dor autoprovocada - e das marcas corporais autoinflingidas - na dinâmica psíquica das pacientes com histórico de automutilações?

  19. A enfermagem no manejo da dor em pessoas com úlcera venosa: revisão integrativa Nursing in the management of pain in people with venous ulcer: integrative review

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    Samilly Márjore Dantas Liberato

    2016-04-01

    Full Text Available Objetivo: sintetizar o conhecimento produzido sobre as intervenções utilizadas para o manejo da dor em pessoas com úlcera venosa. Métodos: revisão integrativa da literatura realizada em junho de 2013 nas bases de dados PubMed, CINAHL, ISI Web of Knowledge, SCOPUS, The Cochrane Library e LILACS. Para o levantamento das publicações foram utilizados descritores do vocabulário MeSH – Medical Subject Headings: “Venous ulcers”; “Pain Management” e “Nursing”.  Resultados: foram selecionados sete artigos e estes apresentaram intervenções do tipo farmacológicas - curativos contendo ibuprofeno, técnicas como musicoterapia, aromoterapia e laserterapia e participação em grupos de apoio. Conclusão: concluiu-se que existe um déficit de estudos sobre o manejo da dor, contudo sugere-se a implementação das atividades de intervenção encontradas para realização de uma assistência eficaz e holística.

  20. Relato de experiência em educação musical: questões básicas

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    José Nunes Fernandes

    2015-12-01

    Full Text Available Pretende-se discutir a divulgação, cada vez maior, de relatos de experiência pelos educadores em todas as áreas do conhecimento relacionadas ao ensino, considerando-os, muitas vezes, como pesquisa, e, no nosso caso, como pesquisa em educação musical. Com isso, questiona-se: os relatos de experiência não são trabalhos considerados científicos? Qual a sua contribuição para a área? Quais são as diferenças e semelhanças entre relato de experiência, pesquisa-ação e estudo de caso? Como podemos estruturar um relato de experiência? Para responder tais questões foi necessário iniciarmos com a verificação da situação do campo através da análise do quadro de teses e dissertações (de 1970 a 2010, dos Anais dos Congressos Nacionais da ABEM e da Revista da ABEM (de 2001 a 2011. Discutimos em seguida alguns aspectos do estudo de caso e da pesquisa ação, e finalizamos com uma reflexão sobre relato de experiência, incluindo sua definição, usos, indicações de estruturação, cuidados a serem tomados e redação.

  1. Auto-relato e relato de informante secundário na avaliação da saúde em idosos

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    Renata Jardim

    2010-12-01

    Full Text Available OBJETIVO: Analisar se o modelo explicativo para a avaliação da saúde do idoso com base no auto-relato é comparável com o modelo de relato do informante secundário e se a auto-avaliação de saúde do informante secundário influencia a avaliação da saúde do idoso. MÉTODOS: Estudo transversal com 230 pares idoso-informante secundário realizado em Belo Horizonte, MG, em 2007. Foram investigadas variáveis sociodemográficas e de saúde dos idosos por meio de entrevista estruturada. Utilizou-se regressão logística múltipla para analisar associação com auto-avaliação da saúde do idoso como ruim e com as informações prestadas pelo informante secundário. RESULTADOS: No modelo com base no auto-relato, a variável mais fortemente associada à avaliação da saúde do idoso como ruim foi a presença de restrições ou incapacidade para realizar atividades relacionadas à vida diária e/ou à mobilidade. No modelo baseado no informante secundário, a variável explicativa mais relevante foi o número de doenças crônicas apresentadas pelo idoso. Além disso, a chance de o informante secundário avaliar a saúde do idoso como ruim foi três vezes maior quando ele auto-avaliou sua saúde da mesma forma. CONCLUSÕES: Os resultados mostram diferenças importantes entre o modelo da avaliação da saúde do idoso com base nas respostas do próprio indivíduo e nas do informante secundário. O idoso tende a valorizar suas restrições ou incapacidade de realizar atividades da vida diária/mobilidade, enquanto o informante secundário tende a valorizar o diagnóstico de doenças crônicas. O informante secundário com pior auto-avaliação da saúde apresenta chance quase três vezes maior de relatar a saúde do idoso da mesma forma. Assim, informações auto-relatadas refletem melhor a condição de saúde do indivíduo do que se relatadas por informantes secundários.

  2. Sympathetic ophthalmia - histopathological correlation with fluorescein and indocyanine green angiography: case report Oftalmia simpática - correlação da histopatologia com a angiografia por fluoresceína e indocianina verde: relato de caso

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    Antônio Marcelo Barbante Casella

    2008-12-01

    Full Text Available This study correlates fluorescein angiography (FA and indocyanine green angiography (ICGA to histopathologic findings in a patient with sympathetic ophtalmia. A male with a perforated trauma in right eye presented after two months a decrease in visual acuity of the left eye. FA and ICGA were performed and the images were correlated with the histopathologic findings of the enucleated eye; FA showed background areas of homogeneous hypofluorescence in the arterial and venous phases, as well as areas of granular progressive hyperfluorescence and leakage from the optic disc. ICGA showed areas of hypofluorescence in the early and intermediate phases of the examination, which persisted until the late phase. During the early phase, there was also diffuse hypofluorescence caused by blockage that allowed observation of areas of partial choroidal circulation. The histopathology of the enucleated right eye showed diffuse choriocapillaris edema and inflammation of the choroids, focal areas of hyperplasia of the retinal pigment epithelium (RPE as well as foci of epithelioid cells located between the choroid and the RPE. Furthermore, lymphocytic infiltration of the episcleral veins and retinal detachment were present. The hyperfluorescence observed on FA was correlated to retinal detachment and optic nerve inflammation. The hypofluorescence noted on FA and ICGA corresponded to the presence of blocking inflammatory cells (Dalen-Fuchs-like nodules and to diffuse choriocapillaris edema.O objetivo deste relato de caso foi correlacionar achados da histopatologia com a angiografia por fluoresceína (AF e por indocianina verde (AIV em um paciente com oftalmia simpática. Após dois meses de trauma perfurante no olho direito, o paciente apresentou baixa acuidade visual no olho esquerdo (OE. A AF do OE mostrou áreas de hipofluorescência homogênea na fase arterial e venosa, áreas de progressiva hiperfluorescência granular e vazamento do disco. A AIV mostrou

  3. Pulmonary thromboembolism in AIDS patient with chronic venous insufficiency, pulmonary tuberculosis and breast cancer: a case report and pathophysiology review Tromboembolismo pulmonar em uma paciente com AIDS com insuficiência venosa profunda, tuberculose pulmonar e câncer de mama: relato de um caso e revisão da fisiopatologia

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    Juan José Cortez-Escalante

    2006-04-01

    Full Text Available Recent literature reports thrombotic episodes occurring in patients with HIV infection associated with other abnormalities including neoplasms and infections predisposing to a hypercoagulable state. We report a 47-year-old woman who developed pulmonary thromboembolism in association with HIV infection, pulmonary tuberculosis and breast cancer. She was treated with rifampin, isoniazid, pyrazinamide; heparin, phenprocoumon, zidovudine, lamivudine and efavirenz. Acid fast bacilli were visualized in a sputum smear and three months after, Mycobacterium tuberculosis was isolated from lymph node biopsy during a episode of immune reconstitution. The isolated mycobacteria showed sensitivity to all first-line drugs. HIV infection, breast cancer and pulmonary tuberculosis have several mechanisms that induce hypercoagulable state and can lead to thromboembolic complications. Pulmonary thromboembolism in this patient was a diagnostic challenge because of all the other severe diseases that she experienced at the same time.Publicações recentes relatam episódios trombóticos em pacientes infectados pelo HIV associados a outras condições que incluem neoplasias e infecções que predispõem para um estado de hipercoagulabilidade. Relata-se o caso de uma paciente de 47 anos portadora do HIV que desenvolveu tromboembolismo pulmonar, tuberculose pulmonar e câncer de mama. Foi tratada com rifampicina, isoniazida, pirazinamida, heparina, femprocumona, zidovudina, lamivudina e efavirenz. Bacilos ácido-álcool-resistentes foram observados no exame de escarro e três meses depois foi isolado o Mycobacterium tuberculosis da biópsia de linfonodo durante um episódio de reconstituição imune. A micobactéria isolada demonstrou sensibilidade a todas as drogas anti-tuberculosas de primeira linha. A infecção pelo HIV, o câncer de mama e a tuberculose pulmonar possuem vários mecanismos que induzem um estado de hipercoagulabilidade e que podem produzir complicações tromboembólicas incluindo o TEP nos pacientes com AIDS. O TEP nesta paciente foi um desafio diagnóstico, considerando todas as outras doenças graves que apresentou simultaneamente.

  4. KYNA analogue SZR72 modifies CFA-induced dural inflammation- regarding expression of pERK1/2 and IL-1β in the rat trigeminal ganglion

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    Lukács, M; Warfvinge, K; Kruse, L S

    2016-01-01

    modify the neurogenic inflammatory response in the trigeminal ganglion. METHODS: Inflammation in the trigeminal ganglion was induced by local dural application of Complete Freunds Adjuvant (CFA). Levels of phosphorylated MAP kinase pERK1/2 and IL-1β expression in V1 region of the trigeminal ganglion were...... investigated using immunohistochemistry and Western blot. FINDINGS: Pretreatment with one dose of SZR72 abolished the CFA-induced pERK1/2 and IL-1β activation in the trigeminal ganglion. No significant change was noted in case of repeated treatment with SZR72 as compared to a single dose. CONCLUSIONS......: This is the first study that demonstrates that one dose of KYNA analog before application of CFA can give anti-inflammatory response in a model of trigeminal activation, opening a new line for further investigations regarding possible effects of KYNA derivates....

  5. Reabilitação funcional e analgesia com uso de toxina botulínica A na síndrome dolorosa regional complexa tipo I do membro superior: relato de casos Rehabilitación funcional y analgesia con uso de toxina botulínica A en el síndrome doloroso regional compleja tipo I del miembro superior: relato de casos Functional rehabilitation and analgesia with botulinum toxin A in upper limb complex regional pain syndrome type I: case reports

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    Gabriela Rocha Lauretti

    2005-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Freqüentemente, soma-se ao quadro de alodínia e hiperalgesia em pacientes portadores de Síndrome Dolorosa Regional Complexa (SDRC tipo I a incapacidade funcional do segmento acometido. Relatam-se dois casos de SDRC em que a aplicação de toxina botulínica-A como fármaco coadjuvante contribuiu na recuperação funcional motora do membro acometido. RELATO DOS CASOS: Duas pacientes portadoras de SDRC tipo I foram inicialmente avaliadas para controle da dor no membro superior direito. Ambas apresentavam incapacidade para abrir a mão e dor pela escala analógica numérica (EAN de 10 em repouso ou quando a mão ou os dedos eram passivamente manipulados. Iniciou-se seqüência de 5 bloqueios, do gânglio estrelado ipsilateral a intervalos semanais, com clonidina e lidocaína. Simultaneamente, durante a realização do terceiro bloqueio do gânglio estrelado, foram administrados 75 UI de toxina botulínica-A nos músculos flexores das falanges e da articulação do punho. Uma semana após a aplicação da toxina botulínica-A, as pacientes apresentavam relaxamento das falanges e punho, relatavam facilidade para execução da fisioterapia passiva e a dor classificada foi como 2 (EAN à manipulação passiva. Ao término da realização da seqüência de bloqueios do gânglio estrelado, as pacientes foram submetidas a 3 sessões semanais de administração por via venosa regional de clonidina, lidocaína e parecoxib. Após 8 meses de avaliação, as pacientes apresentaram 70% e 80% de recuperação motora e funcional do membro acometido. CONCLUSÕES: A aplicação por via muscular de toxina botulínica A resultou em melhora da movimentação do membro acometido, analgesia auxiliando na sua recuperação funcional.JUSTIFICATIVA Y OBJETIVOS: Frecuentemente, se suman al cuadro de alodínia e hiperalgesia en pacientes portadores de Síndrome Doloroso Regional Complejo (SDRC tipo I la incapacidad funcional del segmento

  6. Edema pulmonar após absorção sistêmica de fenilefrina tópica durante cirurgia oftalmológica em criança: relato de caso Edema pulmonar después de absorción de fenilefrina tópica durante cirugía oftalmológica en niño: relato de caso Pulmonary edema after topic phenylephrine absorption during pediatric eye surgery: case report

    Directory of Open Access Journals (Sweden)

    Maria de Fátima Savioli Fischer

    2004-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Soluções tópicas de fenilefrina são empregadas freqüentemente em cirurgia oftalmológica com o objetivo de promover descongestionamento capilar ou dilatação pupilar. Este artigo descreve um caso de hipertensão arterial grave seguida de edema pulmonar durante cirurgia para correção de estrabismo. A provável causa desta complicação foi a absorção sistêmica de fenilefrina administrada por via tópica ocular. O objetivo do relato é a discussão de meios de prevenção desta complicação, assim como do tratamento mais adequado. RELATO DO CASO: Paciente do sexo masculino, 12 anos, 50 kg, estado físico ASA I, admitido no centro cirúrgico para realização de correção de estrabismo convergente bilateral em regime ambulatorial. Foi submetido à anestesia geral venosa e a manutenção, realizada com infusão contínua de remifentanil e propofol. Após colocação do bléfaro, 6 gotas de fenilefrina a 10% foram aplicadas por via tópica. Decorridos 5 minutos do início da cirurgia, o paciente desenvolveu hipertensão arterial e taquicardia, refratárias à elevação da dose administrada de remifentanil e propofol, bem como à administração de droperidol. O controle da pressão arterial e da freqüência cardíaca foi possível após o emprego do sevoflurano, mas houve diminuição da saturação de oxigênio e o aparecimento de crepitações pulmonares difusas por provável desenvolvimento de edema pulmonar agudo. A furosemida foi administrada e os anestésicos foram suspensos. O paciente apresentou melhora progressiva do quadro pulmonar, enquanto os valores de pressão arterial permaneciam dentro da normalidade. Recebeu alta da sala de recuperação pós-anestésica 6 horas após a cirurgia, quando se apresentava em ventilação espontânea em ar ambiente, com saturação de O2, ausculta pulmonar e pressão arterial normais. CONCLUSÕES: A administração de fenilefrina tópica deve ser realizada com

  7. APLICAÇÃO DE ELETROLIFTING EM RUGAS FACIAIS: RELATO DE CASO

    OpenAIRE

    Paola Emanuele Bragato; Lorena Pohl Fornazari; Keila Cristiane Deon

    2013-01-01

    As rugas são sulcos ou pregas cutâneas que se apresentam de forma progressiva pelo declínio da junção dermoepidérmica, em que ocorre um distúrbio nos componentes do tecido conjuntivo. O colágeno torna-se mais rígido e a elastina perde a sua elasticidade natural com a redução do número de fibras elásticas e de outros componentes do tecido. O objetivo do estudo foi verificar osefeitos da aplicação de eletrolifting em rugas. É um relato de caso, com uma participante do sexo feminino, de 54 anos,...

  8. Endocardite por lactococcus garvieae: primeiro relato de caso da América Latina

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    Tatiana Franco Hirakawa

    2011-11-01

    Full Text Available Lactococcus garvieae, patógeno zoonótico emergente, é responsável por mastite em ruminantes e septicemia em peixes. Embora seja considerado oportunista e raramente causar infecções em humanos, sua incidência deve estar subestimada devido à dificuldade do diagnóstico. Há pouquíssimos relatos de osteomielite, abscesso hepático e peritonite, e apenas nove casos descritos na literatura mundial de endocardite. Relatamos o primeiro caso de endocardite por Lactococcus garvieae da América Latina em paciente portadora de prótese valvar metálica, com quadro de febre diária, calafrios, nodos de Osler e seis hemoculturas positivas para Lactococcus garvieae, que preenchiam os critérios de Duke para o diagnóstico de "endocardite infecciosa definitiva"

  9. Los huicholes, de Fernando Benítez: un relato de viaje

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    Lucero Margarita Aguirre-Valdés

    2015-01-01

    Full Text Available El género relato de viaje cuenta con una nueva apertura para su campo de estudio gracias a las investigaciones del español Luis Alburquerque García. Haciendo uso de sus aportaciones teóricas, este trabajo busca aplicarlas al texto Los huicholes , del escritor y periodista Fernando Benítez. Se demostró que en la construcción de dicha obra participan de igual manera lo referencial y la literatura gracias al constante uso del lenguaje poético; al mismo tiempo que se mantiene en el límite entre dos disciplinas, una objetiva e informativa, y otra, subjetiva y estética.

  10. ANESTESIA REGIONAL PARA HERNIORRAFIA INGUINAL EM PACIENTE PORTADOR DE CARDIOMIOPATIA HIPERTROFICA ASSIMETRICA: RELATO DE CASO.

    OpenAIRE

    Immich, Liége Caroline; Specht, Fabiana; Magro, Priscila Sartoretto Dal; Miranda Jr, Vasco

    2017-01-01

    Resumen Introdução: A cardiomiopatia hipertrófica assimétrica é uma doençade hipertrofia de ventrículo esquerdo e do septo interventricular. Há aumento da obstrução de saída do ventrículo esquerdo, da força contrátil; diminuição do volume diastólico final do ventrículo esquerdo e da resistência vascular periférica aumentando o consumo de oxigênio com risco de isquemia subendocárdica e arritmias. Relato de paciente portador de cardiomiopatia assimétrica submetido à herniorrafia inguinal aber...

  11. Intussuscepção jejunojejunal em potro: relato de caso

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    Paulo Ari Tiethböl Leiria

    2017-03-01

    Full Text Available As intussuscepções são acidentes intestinais incomuns e que podem resultar em desconforto abdominal agudo e progressivo ou recorrente em potros. Esta condição afeta potros neonatos de forma assintomática e de 3 a 12 meses são emergências cirúrgicas quando envolvem o intestino delgado, principalmente o jejuno. A avaliação ultrassonográfica transabdominal é um importante para o exame desses animais devido às limitações de seu tamanho para avaliações do abdômen agudo. O presente relato de caso mostra a importância da utilização do ultrassom transabdominal em potros com abdômen agudo

  12. Necrose de canto medial associado a hanseníase virchowiana: relato de caso

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    Leiser Franco

    2010-12-01

    Full Text Available O caso em relato aborda uma etiologia rara para necrose de canto medial da pálpebra com comprometimento do sistema canalicular em uma paciente em tratamento para hanseníase virchowiana. O exame histopatológico da lesão necrótica evidenciou reação inflamatória granulomatosa com acúmulo de histiócitos e presença de bacilos álcool-ácido resistentes. Após tratamento medicamentoso a paciente apresentou uma evolução favorável com recuperação espontânea da arquitetura do canto medial, porém com destruição total do sistema canalicular.

  13. Síndrome de Cogan: relato de caso Cogan's Syndrome: case report

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    Fabricio Witzel de Medeiros

    2005-12-01

    Full Text Available Ceratite intersticial não luética, surdez e vertigem caracterizam a síndrome de Cogan. Os achados oculares mais comuns no início da síndrome são opacidades corneanas numulares periféricas bilaterais. O tratamento desta rara doença utiliza imunossupressão sistêmica com agentes citotóxicos e corticosteróides. O relato de caso apresenta uma paciente com a evolução da forma clássica da síndrome de Cogan.Non-luetic interstitial keratitis, deafness and vertigo characterize Cogan's syndrome. The most common ocular findings in early Cogan's syndrome are bilateral, peripheral, subepithelial numular corneal opacities. The report presents a patient with the evolution of the classic form of Cogan's syndrome.

  14. Miopatia nemalinica: relato de um caso com estudo histoquimico e microscopia eletrônica

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    Lineu Cesar Werneck

    1983-06-01

    Full Text Available Relato do caso de criança do sexo masculino, com hipotonia e dificuldades de deglutição desde os primeiros dias de vida, necessitando gastrostomia permanente. Apresentava retardo no desenvolvimento motor. A eletromiografia sugeria envolvimento muscular primário e a biópsia muscular, processada a fresco, histoquímica e pela microscopia eletrônica, revelou corpos nemalínicos clássicos e deficiência de fibras do tipo II. São feitos comentários a respeito dos sintomas e formas clínicas, origem e patogenia dos corpos nemalínicos, sendo o caso relatado caracterizado como miopatia nemalínica do tipo congênito.

  15. Particularidades discursivas de los relatos de la memoria: los años 70

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    María Paulinelli

    2007-12-01

    Full Text Available This article proposes to point out the discourse distinctiveness from memory stories, but centered in one enunciation: the episodes related to the 70’s in Argentina; particularly the Last Military Dictatorship event. It is inscribed within the investigations about argentine memory discourses, particularized in Córdoba as a cultural space. On this sense, it is form the consideration about the possibility/ impossibility to narrate and the incommensurable aspect of some of the experiences, that a series of considerations are structured to characterize the enunciations and-fundamentally- the enunciation processes. The marking of some determined resources related to the narrative structure, the enunciating voice/s, the plurality and the overlay of times, the metaphors, etc., which show the reminiscence work and ratify-simultaneously- a correspondence between aesthetics and politics, between memory and resistance.//El artículo se propone señalar las particularidades discursivas de los relatos de memoria pero centrados en un enunciado: los acontecimientos vinculados a los años setenta en Argentina, más puntualmente, al acontecimiento de la Última Dictadura Militar. Se inscribe dentro de las investigaciones realizadas sobre los trabajos de la memoria en los discursos argentinos particularizados en Córdoba como espacio cultural. Es así como, a partir de reflexiones sobre la posibilidad/ imposibilidad de relatar y lo inconmensurable de algunas experiencias, se estructuran una serie de consideraciones que buscan caracterizar los enunciados y- fundamentalmente- los procesos de enunciación. De allí el señalamiento de determinados recursos vinculados a la estructura narrativa la/s voz/voces enunciadoras, la pluralidad y superposición de tiempos, las metaforizaciones, etc., que muestran el trabajo de la memoria y ratifican- a su vez- una correspondencia entre estética y política entre relato de memoria y resistencia.

  16. Tipología del relato de viajes en la literatura hispanoamericana: definiciones y desarrollo

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    Guzmán Rubio, Federico

    2011-06-01

    Full Text Available Although travel accounts are one of literary genres with more tradition in literature, their poetic was far beyond of being well defined. Thanks to Alburquerque and Carrizo Rueda researches, among others, this situation has radically changed in the Hispanic world. From their definitions of travel accounts, that allow selecting texts by narratological, rhetoric and cultural criteria, not only focusing on the subject, as traditionally was done, this work explores the genre development in Latin American literature since Independence with the purpose of explaining its chronological development. It also tries to describe the different formal patterns in which the genre has been practiced, all of which has also suffered its own evolution. The suggested typology is formed by models that can be extrapolated to other literatures.Pese a ser uno de los géneros con mayor tradición en la historia de la literatura, el relato de viajes distaba mucho de contar con una poética definida. En el orbe hispánico, esta situación ha cambiado radicalmente gracias a las investigaciones recientes de Carrizo Rueda y de Alburquerque, entre otros especialistas. Partiendo de sus definiciones del relato de viajes, que permiten emprender una selección de textos basada en criterios retóricos, narratológicos y culturales, y no sólo temáticos, como tradicionalmente se acostumbraba, este trabajo explora el desarrollo del género en la literatura hispanoamericana desde la Independencia e intenta describir los diversos patrones formales en que se ha plasmado, los cuales también han experimentado su propia evolución. La tipología esbozada da cuenta de submodelos que pueden extrapolarse a otras literaturas.

  17. Efetividade do treinamento auditivo na plasticidade do sistema auditivo central: relato de caso

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    Tatiana Rocha Silva

    2014-08-01

    Full Text Available O objetivo do estudo foi descrever, por meio de relato de caso, a efetividade do treinamento auditivo na modificação do sistema auditivo central de uma criança com queixas de alteração de fala e linguagem. Trata-se de um estudo retrospectivo, por meio de relato de caso, de uma criança do gênero masculino de 02 anos e 06 meses com queixas de alteração de fala e/ou linguagem. Na avaliação de potencial evocado auditivo de tronco encefálico observou-se presença de ondas eletrofisiológicas I, III e V com latência absoluta e intervalos interpicos dentro da normalidade na orelha direita e presença de ondas I, III e V com latência absoluta da onda V elevada e intervalos interpicos III-V e I-V elevados na orelha esquerda. O limiar eletrofisiológico foi de 70dBNA à direita e 40dBNA à esquerda. Após a avaliação a criança foi encaminhada para terapia fonoaudiológica baseada no treinamento auditivo informal. Para monitorar a função auditiva, após 06 meses de terapia fonoaudiológica, a criança foi encaminhada para reavaliação auditiva. Na reavaliação auditiva os resultados foram presença de ondas eletrofisiológicas I, III e V com latência absoluta e intervalos interpicos dentro da normalidade em ambas as orelhas com limiares eletrofisiológicos de 20dBNA bilateral. O programa de treinamento auditivo foi eficaz na reabilitação das habilidades auditivas.

  18. Plasmocitoma extramedular em bulbo peniano de cão: relato de caso

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    T.G. Gorenstein

    2016-04-01

    Full Text Available O objetivo deste relato de caso é descrever a ocorrência de plasmocitoma em bulbo peniano de um cão, classificado como uma doença extramedular não cutânea de localização rara e casuística inédita. Um cão, sem raça definida, com sete anos de idade e pesando 15kg, não castrado, apresentou histórico clínico de anorexia, vômitos, anúria e constipação. Ao exame específico da genitália externa, foi encontrada uma massa em bulbo peniano durante a inspeção do prepúcio, aderida à pele e encapsulada, extremamente firme e arredondada, medindo cerca de 6cm de diâmetro. Por meio da ultrassonografia dessa estrutura, foi observado aumento do volume regional com ecotextura heterogênea e ecogenicidade mista, além de neovascularização tecidual ao Doppler colorido. Foi realizada biópsia da massa, sendo verificada a presença de neoplasia de células redondas. A caracterização do tumor foi realizada pela imuno-histoquímica, e as células neoplásicas foram imunoexpressas para CD79a e MUM1, indicando o diagnóstico de plasmocitoma extramedular. Embora os tumores penianos em cães sejam os predominantemente venéreos transmissíveis (TVT, e os plasmocitomas sejam neoplasias raras nessa localização, este relato de caso fornece com ineditismo a ocorrência de plasmocitoma extramedular em bulbo peniano de cão, condição ainda não descrita em veterinária.

  19. Efecto de un suplemento nutricional específico (Balnimax® en la cicatrización de úlceras de la extremidad inferior de etiología venosa y úlceras por presión

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    José Verdú Soriano

    Full Text Available Objetivo: evaluar un suplemento nutricional específico, Balnimax® (ácido alfa-lipoico, L-arginina, L-metionina, complejo de vitamina B, vitamina E y selenio junto con la práctica clínica diaria en la cicatrización de las úlceras por presión y úlceras de etiología venosa. Material y método: se llevó a cabo un estudio multicéntrico, prospectivo, de medidas repetidas en un solo grupo y postautorización en pacientes con úlceras por presión y úlceras de etiología venosa sin signos clínicos de infección local, que fueron tratados durante 8 semanas. Las medidas se registraron al inicio y en las semanas 2, 4, 6 y 8. Los pacientes recibieron una cápsula oral dos veces al día, con las comidas. La medida de resultado principal fue el porcentaje de reducción en el tamaño de la herida. Además, se estudió la cicatrización completa. El tamaño de la muestra se determinó para comparar los resultados frente a un valor de referencia. Se requería un total de 127 pacientes para detectar una diferencia igual o superior al 15% en la reducción del área. Se asumió como porcentaje de reducción de referencia un 57%. Además, se estimó un 10% de pérdidas en el seguimiento. Resultados: Se incluyeron y finalizaron el estudio 112 pacientes con 133 heridas (un 16,0% tuvieron dos o más lesiones, con una media de edad de 74,2 ± 12,0 (mediana: 77, extremos: 35-94. Un 69,8% eran mujeres, la mayoría pacientes ambulatorios (98,4%. En un 9% se utilizaron moduladores de las proteasas y solo en un 27,2% se aplicó un vendaje compresivo multicapa. Un total de 58 (43,6% úlceras cicatrizaron durante el periodo del estudio. La evolución del tamaño de la herida y su porcentaje de reducción fueron estadísticamente significativos (p ≤ 0,001, disminuyendo a lo largo del tiempo. Hubo diferencias estadísticamente significativas entre los resultados del estudio y el valor de referencia (p ≤ 0,001. Conclusiones: a pesar de las posibles limitaciones

  20. Doença venosa e sua relação com as condições de trabalho no setor de produção de refeições Venous insufficiency and its relation with work conditions in the foodservice sector

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    Clarissa Medeiros da Luz Bertoldi

    2008-08-01

    Full Text Available A doença venosa crônica é um problema de saúde pública importante, podendo promover inaptidão para o trabalho, tendo também uma repercussão indireta sobre a qualidade da produção e conseqüente perda de eficiência operacional. Embora ainda não haja evidência da relação direta causa-efeito de doença venosa com o trabalho, existe consenso científico de que o trabalho pode agravar o desenvolvimento da mesma. O presente estudo relata os fatores que podem influenciar o aparecimento ou agravamento de doenças venosas de membros inferiores em operadores de Unidades Produtoras de Refeições, ressaltando a importância e a possibilidade de aprofundamento do tema, o que poderia evoluir para o estabelecimento de um protocolo de prevenção e tratamento de doenças venosas em função do posto de trabalho executado. Reflete-se sobre o início de um processo de identificação deste distúrbio como uma doença de caráter ocupacional, o que contribuiria, portanto, para a reformulação conceitual dos encargos decorrentes dessa atividade profissional.Chronic venous disease is an important public health problem which may greatly impair the quality of one's work, generate absenteeism and hospital admittances. Although, so far, no evidence exists of the direct cause-effect relation between venous disease and work output, there is a scientific consensus that certain working conditions may increase the risk of developing the condition. The present study evaluates which factors may influence the onset or severity of lower limb venous disease in workers of a Unit of Food Service, pointing out the importance and the possibility of deepening the discussions around this subject and suggest that a protocol be established to prevent and treat venous diseases stemming from working conditions. It could be the start of a process to identify this condition as an occupational disease, therefore contributing for a conceptual reformulation of the obligations

  1. Uma análise comportamentalista de relatos verbais e práticas educativas parentais: alcance e limites

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    Vanessa Barbosa Romera Leme

    2009-08-01

    Full Text Available O presente artigo discute a relevância de algumas estratégias metodológicas da Análise Aplicada do Comportamento para examinar práticas educativas parentais. Um instrumento e um conceito relacionados à coleta e análise de dados são discutidos sob a ótica teórica e aplicada: relatos verbais e análise funcional comportamental descritiva. Conclui-se que, consideradas as limitações dos relatos, as informações obtidas com essa estratégia e com a análise funcional comportamental descritiva permitem inferir algumas hipóteses sobre os comportamentos de pais e de filhos que podem ser utilizadas em ações que procuram investigar e intervir sobre os comportamentos problema e as habilidades sociais.

  2. La ira de Dios: sobre ‘Relatos salvajes’ de Damián Szifrón

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    Gonzalo Aguilar

    2017-12-01

    Full Text Available “La ira de Dios (sobre ‘Relatos salvajes’ de Damián Szifrón” propone un debate sobre una de las películas argentinas más exitosas de todos los tiempos. En polémica con las lecturas que señalaban y cuestionaban el carácter prepolítico del film y su uso de las pasiones más bajas del público, este ensayo busca otro camino: por un lado, analizar la ira como uno de los capitales políticos más importantes y decisivos de la sociedad contemporánea. Por otro, investigar los vínculos entre la película Relatos salvajes y la pospolítica en la sociedad del espectáculo.

  3. Indicadores de desempenho de bibliotecas no campo da saúde: relato de estudo piloto na Fiocruz

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    Maria Cristina S. Guimarães

    Full Text Available Relato de projeto de pesquisa, em curso, sobre a implantação de um programa de avaliação de desempenho de bibliotecas no campo da saúde. Uma equipe de pesquisadores e bibliotecários tomou como ponto de partida a Norma ISO 11620 para derivar um conjunto mínimo de indicadores adequados à avaliação de três diferentes bibliotecas especializadas da Fundação Oswaldo Cruz. O relato enfatiza a importância do processo de cooperação entre os profissionais, ingrediente essencial para sustentabilidade da iniciativa e os desafios futuros que se avizinham.

  4. RELATO DE CASO: RESPOSTA COMPLETA COM QUIMIOTERAPIA DE SEGUNDA LINHA EM CÂNCER DE BEXIGA ESTADIO IV

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    Carla Simone Moreira de FREITAS

    2018-04-01

    Full Text Available O câncer de bexiga é a neoplasia mais comum do sistema urinário, sendo raro ocorrer casos de resposta completa a quimioterapia em tumores avançados, quando não realizado cirurgia com intuito curativo. Objetivo: relatar o caso de um paciente que apresentou resposta completa da neoplasia vesical em estadio IV após quimioterapia de 2ª linha. Metodologia: relato de caso. 

  5. Sindrome peri-silviana bilateral não relacionada a malformações: relato de dois casos

    OpenAIRE

    Grasel, Ralf Paulo; Carvalho Neto, Arnolfo; Bruck, Isac; Antoniuk, Sérgio A.

    1996-01-01

    In this case report we present the neuroimaging findings and clinical features of two patients with a bilateral perisylvian syndrome not related to malformations, but probably to ischemic etiology. Evaluations including history, general and neurologic examinations, electroencephalograms, and imaging data were reviewed as recent literature about the subject.Neste relato de caso, apresentamos os achados de neuroimagem e os aspectos clínicos de dois pacientes com síndrome peri-silviana bilateral...

  6. Infecção cutânea rara por Acinetobacter baumannii em imunocompetente: relato de um caso

    OpenAIRE

    Cirino,Pablo Vitoriano; Guimarães,Newton Sales; Follador,Ivonise

    2008-01-01

    O Acinetobacter baumanni é patógeno oportunista antigamente considerado de baixa virulência. Atualmente está envolvido em processos infecciosos que acometem pacientes imunocomprometidos,grandes queimados e pacientes em unidades de terapia intensiva que fazem uso de ventilação mecânica. Esse relato de caso chama atenção para infecção cutânea rara por essa bactéria em paciente imunocompetente.

  7. Del metafísico al parapsicólogo: el estereotipo del chino en dos relatos modernistas

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    Siwen Ning

    2017-02-01

    Full Text Available El presente trabajo examina los recursos narrativos y el tratamiento de dos personajes chinos que aparecen en dos relatos de la revista La Ilustración Española y Americana, publicados a finales del siglo xix el primero, a principios del xx el segundo. Este estudio tiene como finalidad comprobar la evolución del estereotipo chino en la literatura española en el contexto del fin de siglo.

  8. Relatos digitales: activando las competencias comunicativa, narrativa y digital en la formación inicial del profesorado

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    María Esther del Moral

    2016-01-01

    Full Text Available Los relatos digitales constituyen una técnica narrativa con gran potencial educativo al adoptar fórmulas creativas que integran información multiformato e instrumentos tecnológicos para comunicar ideas. Esta investigación evalúa el nivel de competencia comunicativa, narrativa y digital ligado al diseño de relatos en entornos digitales, alcanzado por estudiantes del Grado de Maestro de Primaria (N=143 -tras participar en una experiencia de creación colaborativa-, utilizando una rúbrica integrada por 28 indicadores: 12 relacionados con la competencia comunicativa (comunicación escrita y oral, 6 con la narrativa, y otros 10 específicos con la digital. Los resultados evidencian que si bien presentan gran destreza con las tecnologías, casi un tercio registra niveles medio-bajos en la competencia comunicativa. Se detectan dificultades en la elaboración y adaptación del guión escrito de los relatos al registro elegido -pobre vocabulario y precaria puntuación-, junto a limitaciones en la dicción al locutar los diálogos, no logrando imprimir expresividad al relato. Respecto a la competencia narrativa, solo un 40% muestra originalidad al resolver las tramas y construir personajes. Sin duda, este tipo de experiencias innovadoras ofrece un escenario idóneo para desarrollar habilidades narrativas y creativas en contextos digitales, y brinda numerosas oportunidades para la formación de los futuros docentes.

  9. Anestesia em paciente com Xeroderma Pigmentoso: relato de caso Anestesia en paciente con Xeroderma Pigmentoso: relato de caso Anesthesia in patient with Xeroderma Pigmentosum: case report

    Directory of Open Access Journals (Sweden)

    Carlos Rogério Degrandi Oliveira

    2003-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O Xeroderma Pigmentoso é uma doença autossômica recessiva rara, caracterizada pelo desenvolvimento prematuro de neoplasias devido à extrema sensibilidade à radiação ultravioleta. Estas manifestações ocorrem por falha no mecanismo de excisão e reparo do DNA. Se comparados a indivíduos normais, estes pacientes apresentam risco 1000 vezes maior de desenvolver neoplasias em áreas expostas ao sol. O objetivo deste relato é apresentar a conduta anestésica em uma paciente portadora de Xeroderma Pigmentoso submetida à cirurgia oftalmológica. RELATO DO CASO: Paciente do sexo feminino, 7 anos, portadora de Xeroderma Pigmentoso com comprometimento facial extenso, admitida para exérese de lesão papilar no olho direito. Foi prescrito midazolam (10 mg por via oral, como medicação pré-anestésica. A monitorização inicial consistiu de cardioscópio, oxímetro de pulso, estetoscópio precordial e pressão arterial não invasiva. Foi realizada pré-oxigenação com oxigênio a 100% por 3 minutos e indução inalatória sob máscara com oxigênio a 100% e sevoflurano em concentrações crescentes até 7%. Após acesso venoso periférico com cateter 22G, foram injetados propofol (50 mg e succinilcolina (20 mg e realizada intubação traqueal com tubo 5,5 mm sem balonete. Um guia de metal foi utilizado para facilitar a introdução do tubo traqueal. A manutenção da anestesia foi feita com sevoflurano a 3,5% e oxigênio a 100%, com sistema de Bain. A criança foi extubada na sala cirúrgica e encaminhada à sala de recuperação pós-anestésica em boas condições. CONCLUSÕES: As alterações faciais e orofaríngeas decorrentes desta doença determinaram dificuldades na adaptação da máscara facial e intubação traqueal. A educação constante do paciente e de seus familiares constitui o objetivo mais importante no manuseio desta doença.JUSTIFICATIVA Y OBJETIVOS: El Xeroderma Pigmentoso es una enfermedad autos

  10. FALANDO SOBRE SEXUALIDADE NA ADOLESCÊNCIA: RELATO DE EXPERIÊNCIA

    Directory of Open Access Journals (Sweden)

    Eliane Goldberg Rabin

    2014-09-01

    Full Text Available Trata-se de um relato de experiência sobre atividade de extensão realizada por docentes e acadêmicos do Curso de Graduação em Enfermagem sobre sexualidade na adolescência. Atividade realizada com jovens de 10 a 19 anos, estudantes do ensino fundamental e médio de escolas públicas de Porto Alegre. Foram utilizadas diferentes estratégias e dinâmicas para o desenvolvimento das atividades, com vistas à maior participação dos jovens escolares. Os temas abordados foram as mudanças corporais, por meio da demonstração de moldes anatômicos, métodos contraceptivos, gravidez na adolescência e doenças sexualmente transmissíveis. A atividade constitui-se num espaço de esclarecimento de dúvidas e discussão, possibilitando a ampliação de conhecimentos para todos os participantes. Palavras-chave: adolescente, anatomia humana, ensino básico. Talking on sexuality in adolescence: experience report Abstract: This is an experience report on extension activities undertaken by teachers and students of the Undergraduate Nursing Course on adolescent sexuality. The activity was carried out with young people from 10 to 19 years of age, students from elementary and secondary public schools in Porto Alegre. Different strategies and dynamics for the development of activities were applied, seeking for greater participation of young scholars. The topics covered were the body changes through the demonstration of anatomical models, contraceptive methods, teenage pregnancy and sexually transmitted diseases. The activity constitutes a space for discussion and clarifying doubts, enabling the acquisition of information for all participants. Keywords: adolescent, human anatomy, primary education. Hablar de la sexualidad en la adolescencia: un relato de experiencia Resumen: se trata de un relato de experiencia en actividades de extensión realizadas por profesores y estudiantes de Enfermería sobre la sexualidad del adolescente. Actividad realizada con j

  11. Hipoglicemia hiperinsulinêmica persistente em recém-nascido: relato de caso

    Directory of Open Access Journals (Sweden)

    Alcinda Aranha Nigri

    2016-10-01

    Full Text Available Introdução: A manutenção de adequados níveis glicêmicos é de vital importância no período neonatal e na lactância, pois o tecido cerebral, ainda imaturo, é marcado por intensa atividade metabólica sendo ávido por glicose, tornando-se sensível às reduções dos níveis glicêmicos. A hiperinsulinemia é a principal causa de hipoglicemia persistente e recorrente nessa fase da vida. Como consequência, a ocorrência de episódios repetidos de hipoglicemia nesta faixa etária, pode causar danos cerebrais, na maioria das vezes graves e irreversíveis. Objetivos: O objetivo deste relato é elucidar um caso clínico de Hipoglicemia Hiperinsulinêmica na infância, com ênfase no diagnóstico e instituição de terapêutica precoces. Metodologia: O caso foi acompanhado no ambulatório de Endocrinologia Pediátrica do Conjunto Hospitalar de Sorocaba, sendo sua descrição embasada na literatura. Relato de Caso: Lactente, 9 meses, masculino, sem queixas no momento, encaminhado para este ambulatório para seguimento do tratamento de Hipoglicemia Hiperinsulinêmica. Apresentou aos 4 dias de vida quadro de hipoglicemia refratária ao uso de soro de manutenção, sendo encaminhado para o Hospital Regional de Sorocaba para investigação diagnóstica, chegando-se a hipótese citada acima. Iniciou-se terapia com Octreotide para controle glicêmico e atualmente mantem níveis glicêmicos na faixa da normalidade com o uso contínuo desse medicamento. Foi avaliado pelo neurologista aos 5 meses de vida, sem alterações em desenvolvimento neurológico até o momento. Conclusão: A identificação precoce e a correta abordagem desta patologia são preditores de um bom prognóstico, afinal reduz-se substancialmente o risco de desenvolvimento de sequelas neurológicas com a terapêutica adequada.

  12. Maternal-infant bonding and the mother's participation during venipuncture: a psychoanalytic perspective Vínculo materno infantil y la participación de la madre durante la realización de la punción venosa: la ótica del psicoanálisis Vínculo materno-infantil e participação da mãe durante a realização da punção venosa: a ótica da psicanálise

    Directory of Open Access Journals (Sweden)

    Júlia Peres Pinto

    2007-02-01

    Full Text Available Professionals discuss accompanying mothers' participation during painful procedures as a possibility of care to mother and child, but there is no consensus on this subject. To contribute to this topic, this study addresses the child's needs during venipuncture in a hospital environment and the mother's participation in this procedure, based on authors from psychoanalysis and mother-child bonding.La participación de la madre acompañante junto al niño durante la realización de procedimientos dolorosos es discutida por profesionales como una posibilidad de cuidado al binomio, pero no hay un consenso sobre este tema. Para contribuir con esta discusión, el texto trata de las necesidades del niño durante la realización de la punción venosa en un ambiente de hospital y la participación de la madre en el procedimiento, tomando como base autores del psicoanálisis y el vínculo madre y hijo.A participação da mãe acompanhante junto à criança durante a realização de procedimentos dolorosos é discutida pelos profissionais como uma possibilidade de cuidado ao binômio, porém, não há consenso quanto a esse tema. Para contribuir com essa discussão, o texto aborda as necessidades da criança durante a realização da punção venosa no ambiente hospitalar e a participação da mãe no procedimento, tendo como base autores da psicanálise e o vínculo na relação mãe e filho.

  13. 3D MR cisternography to identify distal dural rings. Comparison of 3D-CISS and 3D-SPACE sequences

    International Nuclear Information System (INIS)

    Watanabe, Yoshiyuki; Makidono, Akari; Nakamura, Miho; Saida, Yukihisa

    2011-01-01

    The distal dural ring (DDR) is an anatomical landmark used to distinguish intra- and extradural aneurysms. We investigated identification of the DDR using 2 three-dimensional (3D) magnetic resonance (MR) cisternography sequences-3D constructive interference in steady state (CISS) and 3D sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE)-at 3.0 tesla. Ten healthy adult volunteers underwent imaging with 3D-CISS, 3D-SPACE, and time-of-flight (TOF) MR angiography (TOF-MRA) sequences at 3.0T. We analyzed DDR identification and internal carotid artery (ICA) signal intensity and classified the shape of the carotid cave. We identified the DDR using both 3D-SPACE and 3D-CISS, with no significant difference between the sequences. Visualization of the outline of the ICA in the cavernous sinus (CS) was significantly clearer with 3D-SPACE than 3D-CISS. In the CS and petrous portions, signal intensity was lower with 3D-SPACE, and the flow void was poor with 3D-CISS in some subjects. We identified the DDR with both 3D-SPACE and 3D-CISS, but the superior contrast of the ICA in the CS using 3D-SPACE suggests the superiority of this sequence for evaluating the DDR. (author)

  14. Safety of Pregnancy After Cerebral Venous Thrombosis: Results of the ISCVT (International Study on Cerebral Vein and Dural Sinus Thrombosis)-2 PREGNANCY Study.

    Science.gov (United States)

    Aguiar de Sousa, Diana; Canhão, Patrícia; Crassard, Isabelle; Coutinho, Jonathan; Arauz, Antonio; Conforto, Adriana; Béjot, Yannick; Giroud, Maurice; Ferro, José M

    2017-11-01

    Pregnancy is associated with increased risk of venous thrombotic events, including cerebral venous thrombosis. We aimed to study the complications and outcome of subsequent pregnancies in women with previous cerebral venous thrombosis. Follow-up study of women with acute cerebral venous thrombosis at childbearing age included in a previously described cohort (International Study of Cerebral Vein and Dural Sinus Thrombosis). Patients were interviewed by local neurologists to assess rate of venous thrombotic events, pregnancy outcomes, and antithrombotic prophylaxis during subsequent pregnancies. A total of 119 women were included, with a median follow-up of 14 years. Eighty-two new pregnancies occurred in 47 women. In 83% (68 of 82), some form of antithrombotic prophylaxis was given during at least 1 trimester of pregnancy or puerperium. Venous thrombotic events occurred in 3 pregnancies, including 1 recurrent cerebral venous thrombosis. Two of the 3 women were on prophylactic low-molecular-weight heparin at the time of the event. Outcomes of pregnancies were 51 full-term newborns, 9 preterm births, 2 stillbirths, and 20 abortions (14 spontaneous). In women with prior cerebral venous thrombosis, recurrent venous thrombotic events during subsequent pregnancies are infrequent. © 2017 American Heart Association, Inc.

  15. KYNA analogue SZR72 modifies CFA-induced dural inflammation- regarding expression of pERK1/2 and IL-1β in the rat trigeminal ganglion.

    Science.gov (United States)

    Lukács, M; Warfvinge, K; Kruse, L S; Tajti, J; Fülöp, F; Toldi, J; Vécsei, L; Edvinsson, L

    2016-12-01

    Neurogenic inflammation has for decades been considered an important part of migraine pathophysiology. In the present study, we asked the question if administration of a novel kynurenic acid analogue (SZR72), precursor of an excitotoxin antagonist and anti-inflammatory substance, can modify the neurogenic inflammatory response in the trigeminal ganglion. Inflammation in the trigeminal ganglion was induced by local dural application of Complete Freunds Adjuvant (CFA). Levels of phosphorylated MAP kinase pERK1/2 and IL-1β expression in V1 region of the trigeminal ganglion were investigated using immunohistochemistry and Western blot. Pretreatment with one dose of SZR72 abolished the CFA-induced pERK1/2 and IL-1β activation in the trigeminal ganglion. No significant change was noted in case of repeated treatment with SZR72 as compared to a single dose. This is the first study that demonstrates that one dose of KYNA analog before application of CFA can give anti-inflammatory response in a model of trigeminal activation, opening a new line for further investigations regarding possible effects of KYNA derivates.

  16. Fluorescence Behavior and Dural Infiltration of Meningioma Analyzed by 5-Aminolevulinic Acid-Based Fluorescence: Operating Microscope Versus Mini-Spectrometer.

    Science.gov (United States)

    Knipps, Johannes; Beseoglu, Kerim; Kamp, Marcel; Fischer, Igor; Felsberg, Joerg; Neumann, Lisa M; Steiger, Hans-Jakob; Cornelius, Jan F

    2017-12-01

    To compare fluorescence intensity of tumor specimens, as measured by a fluorescence-guided surgery microscope and a spectrometer, to evaluate tumor infiltration of dura mater around meningiomas with help of these 2 different 5-aminolevulinic acid (5-ALA)-based fluorescence tools, and to correlate fluorescence intensity with histopathologic data. In a clinical series, meningiomas were resected by 5-ALA fluorescence-guided surgery. Fluorescence intensity was semiquantitatively rated by the surgeon at predefined points. Biopsies were harvested and fluorescence intensity measured by a spectrometer and histopathologically analyzed. Sampling was realized at the level of the dura in a centrifugal direction. A total of 104 biopsies (n = 13 tumors) were analyzed. Specificity and sensitivity of the microscope were 0.96 and 0.53 and of the spectrometer 0.95 and 0.93, respectively. Fluorescence intensity as measured by the spectrometer was correlated to histologically confirmed tumor burden. In a centrifugal direction, tumor burden and fluorescence intensity continuously decreased (along the dural tail). Below a threshold value of 639 arbitrary units no tumor was histologically detectable. At the level of the dura the spectrometer was highly sensitive for detection of meningioma cells. The surgical microscope showed false negative results and missed residual tumor cells in more than one half of the cases. The complementary use of both fluorescence tools may improve resection quality. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Utility of time-resolved three-dimensional magnetic resonance digital subtraction angiography without contrast material for assessment of intracranial dural arterio-venous fistula

    International Nuclear Information System (INIS)

    Hori, Masaaki; Aoki, Shigeki; Nakanishi, Atsushi; Shimoji, Keigo; Kamagata, Koji; Houshito, Haruyoshi; Kuwatsuru, Ryohei; Oishi, Hidenori; Arai, Hajime

    2011-01-01

    Background: Intracranial dural arteriovenous fistula (DAVF) is an arteriovenous shunting disease of the dura. Magnetic resonance angiography (MRA) is expected to be a safer alternative method in evaluation of DAVF, compared with invasive intra-arterial digital subtraction angiography (IADSA). Purpose: To evaluate the diagnostic use of time-spatial labeling inversion pulse (Time-SLIP) three-dimensional (3D) magnetic resonance digital subtraction angiography (MRDSA) without contrast material in six patients with DAVF. Material and Methods: Images for 3D time-of-flight MRA, which has been a valuable tool for the diagnosis of DAVF but provide little or less hemodynamic information, and Time-SLIP 3D MRDSA, were acquired for each patient. The presence, side, and grade of the disease were evaluated according to IADSA. Results: In all patients, the presence and side of the DAVF were correctly identified by both 3D time-of-flight MRA and Time-SLIP 3D MRDSA. Cortical reflux present in a patient with a grade 2b DAVF was not detected by Time-SLIP 3D MRDSA, when compared with IADSA findings. Conclusion: Time-SLIP 3D MRDSA provides hemodynamic information without contrast material and is a useful complementary tool for diagnosis of DAVF

  18. Automated double-cone-beam CT fusion technique. Enhanced evaluation of glue distribution in cases of spinal dural arteriovenous fistula (SDAVF) embolisation

    International Nuclear Information System (INIS)

    Farago, Giuseppe; Caldiera, V.; Antozzi, C.; Bellino, A.; Innocenti, A.; Ciceri, E.

    2017-01-01

    Spinal dural arteriovenous fistulas (SDAVFs) are acquired diseases that represent the majority of all arteriovenous spinal shunts, leading to progressive and disabling myelopathy. Treatment is focused on accurately disconnecting the fistula point. We present our experience with the double-cone-beam CT fusion technique successfully applied to evaluate treatment results in a series of SDAVFs. Between November 2011 and December 2015 we performed double-DynaCT acquisition (pre- and post-embolisation) in 12 cases of SDAVF. A successful DynaCT fusion technique was only achieved in the group of patients with pre- and post-treatment images acquired at the same time as the treatment session, under general anaesthesia (4/12). DynaCT performed on different days proved to be inadequate for the automated fusion technique because of changes in the body position (8/12). A pre-treatment flat-panel cone-beam CT with contrast, at the time of diagnostic angiography, can be very helpful to detect the correct level of the fistula and the relationship between the fistula and the surrounding structures. In case of the endovascular approach, additional post-treatment native acquisition merged with the pre-treatment acquisition (double-cone-beam CT fusion technique) permits to immediately evaluate the distribution of the glue cast and to confirm the success of the procedure. (orig.)

  19. Comparison of the efficacy of epidural autologous blood patch in the treatment of spontaneous intracranial hypotension and post-dural puncture headache

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sung Hyun; Lee, Jon Woo; Lee, Geun Young; Lee, Eu Gene; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2014-04-15

    To evaluate and compare the effectiveness of fluoroscopy-guided epidural blood patch (EBP) in patients with post-dural puncture headache (PDPH) and spontaneous intracranial hypotension (SIH). Between August 2012 and September 2013, 16 patients (12 with PDPH, 4 with SIH; 5 males, 11 females; age range 19-58 years, mean age 32.8 years) who underwent EBP in the Department of Radiology were included in this study. Pain relief within three days after EBP was evaluated based on medical record and classified on a 3-level scale: complete relief; incomplete relief; and failure. Recurrence is defined as aggravated postural headache after three days. We evaluated and compared treatment outcome between PDPH and SIH, using Fisher's exact test (considered as significant when p < 0.05). In 12 PDPH patients, the EBP provided complete relief in 5 patients (41.7%), and incomplete relief in 7 patients (58.3%). In 4 SIH patients, the EBP provided complete relief in 1 patient (25%), and incomplete relief in 3 patients (75%). There was no significant difference (p = 0.511) of pain relief rate between PDPH and SIH. There was recurrence in 5 patients with PDPH and 1 patient with SIH. Five PDPH patients were retreated by EBP with incomplete relief. Fluoroscopy-guided EBP provides effective treatment of postural headache for both SIH and PDPH patients.

  20. Comparison of the efficacy of epidural autologous blood patch in the treatment of spontaneous intracranial hypotension and post-dural puncture headache

    International Nuclear Information System (INIS)

    Yoon, Sung Hyun; Lee, Jon Woo; Lee, Geun Young; Lee, Eu Gene; Kang, Heung Sik

    2014-01-01

    To evaluate and compare the effectiveness of fluoroscopy-guided epidural blood patch (EBP) in patients with post-dural puncture headache (PDPH) and spontaneous intracranial hypotension (SIH). Between August 2012 and September 2013, 16 patients (12 with PDPH, 4 with SIH; 5 males, 11 females; age range 19-58 years, mean age 32.8 years) who underwent EBP in the Department of Radiology were included in this study. Pain relief within three days after EBP was evaluated based on medical record and classified on a 3-level scale: complete relief; incomplete relief; and failure. Recurrence is defined as aggravated postural headache after three days. We evaluated and compared treatment outcome between PDPH and SIH, using Fisher's exact test (considered as significant when p < 0.05). In 12 PDPH patients, the EBP provided complete relief in 5 patients (41.7%), and incomplete relief in 7 patients (58.3%). In 4 SIH patients, the EBP provided complete relief in 1 patient (25%), and incomplete relief in 3 patients (75%). There was no significant difference (p = 0.511) of pain relief rate between PDPH and SIH. There was recurrence in 5 patients with PDPH and 1 patient with SIH. Five PDPH patients were retreated by EBP with incomplete relief. Fluoroscopy-guided EBP provides effective treatment of postural headache for both SIH and PDPH patients.

  1. Posterior reversible encephalopathy syndrome following an inadvertent dural puncture during an emergency laparotomy for ischemic colitis – a case report

    Directory of Open Access Journals (Sweden)

    Shah R

    2014-01-01

    Full Text Available Reena Shah, Agnieszka Kubisz-Pudelko, Jeremy Reid Yeovil District Hospital, Yeovil, UK Abstract: Posterior reversible encephalopathy syndrome (PRES is a clinico-neuroradiological syndrome characterized by various symptoms of neurological disease. It has commonly been reported in association with acute hypertension, pre-eclampsia, eclampsia, sepsis, and exposure to immunosuppressants. Here, we report on a normotensive woman who developed a severe frontal headache, visual disturbances, and hypertension 3 days after undergoing an emergency laparotomy for ischemic colitis during which she suffered an inadvertent dural puncture. Neuro-imaging revealed features consistent with PRES. The patient went on to make a good recovery, being discharged 21 days postoperatively, with only minor visual disturbances and memory problems. This case highlights the importance of awareness of PRES to all specialties. On reviewing the literature, we feel that PRES may be a potential differential diagnosis to post-procedural neurological symptoms in those patients undergoing routine procedures such as spinal anesthetics or lumbar punctures. Keywords: PRES, neurological disease, lumbar puncture, spinal anesthetic

  2. Automated double-cone-beam CT fusion technique. Enhanced evaluation of glue distribution in cases of spinal dural arteriovenous fistula (SDAVF) embolisation

    Energy Technology Data Exchange (ETDEWEB)

    Farago, Giuseppe [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Interventional Neuroradiology, Milan (Italy); Caldiera, V. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Antozzi, C.; Bellino, A. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Neuroimmunology and Neuromuscular Diseases, Milan (Italy); Innocenti, A. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Neuro-Oncology, Milan (Italy); Ciceri, E. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Azienda Ospedaliera Universitaria Integrata Borgo Trento, Department of Neuroradiology, Verona (Italy)

    2017-05-15

    Spinal dural arteriovenous fistulas (SDAVFs) are acquired diseases that represent the majority of all arteriovenous spinal shunts, leading to progressive and disabling myelopathy. Treatment is focused on accurately disconnecting the fistula point. We present our experience with the double-cone-beam CT fusion technique successfully applied to evaluate treatment results in a series of SDAVFs. Between November 2011 and December 2015 we performed double-DynaCT acquisition (pre- and post-embolisation) in 12 cases of SDAVF. A successful DynaCT fusion technique was only achieved in the group of patients with pre- and post-treatment images acquired at the same time as the treatment session, under general anaesthesia (4/12). DynaCT performed on different days proved to be inadequate for the automated fusion technique because of changes in the body position (8/12). A pre-treatment flat-panel cone-beam CT with contrast, at the time of diagnostic angiography, can be very helpful to detect the correct level of the fistula and the relationship between the fistula and the surrounding structures. In case of the endovascular approach, additional post-treatment native acquisition merged with the pre-treatment acquisition (double-cone-beam CT fusion technique) permits to immediately evaluate the distribution of the glue cast and to confirm the success of the procedure. (orig.)

  3. Programa de atenção ao idoso: relato de um modelo assistencial

    Directory of Open Access Journals (Sweden)

    Evelise Moraes Berlezi

    2011-01-01

    Full Text Available El artículo trata sobre el relato de un proyecto de extensión universitaria en el que se propone un modelo de atención a ancianos. El objetivo del programa es brindar asistencia a los ancianos de escasos recursos residentes en el municipio de Ijuí-RS, Brasil, en situaciones de fragilidad y con alto o medio riesgo de hospitalización o rehospitalización. Se incluyen en el proyecto las demandas de los ancianos de las unidades básicas de salud, del Hospital de Caridad de Ijuí, y los que buscan el proyecto vía telefónica. El equipo interdisciplinario, compuesto por profesores y estudiante de los cursos de enfermería, farmacia, fisioterapia y nutrición, realiza la evaluación del estado de salud de los ancianos a través de instrumentos cuantitativos, que clasifican a los individuos en clases de riesgo y luego eligen la atención prioritaria. Los ancianos que participan del programa reciben atendimiento de forma ambulatoria o en casa, dependiendo de las condiciones de acceso y capacidad funcional.

  4. APLICAÇÃO DE ELETROLIFTING EM RUGAS FACIAIS: RELATO DE CASO

    Directory of Open Access Journals (Sweden)

    Paola Emanuele Bragato

    2013-08-01

    Full Text Available As rugas são sulcos ou pregas cutâneas que se apresentam de forma progressiva pelo declínio da junção dermoepidérmica, em que ocorre um distúrbio nos componentes do tecido conjuntivo. O colágeno torna-se mais rígido e a elastina perde a sua elasticidade natural com a redução do número de fibras elásticas e de outros componentes do tecido. O objetivo do estudo foi verificar osefeitos da aplicação de eletrolifting em rugas. É um relato de caso, com uma participante do sexo feminino, de 54 anos, com rugas estáticas em regiões frontal, orbital, bucal e nasolabial, que foi submetida a seis sessões de aplicação de eletrolifting, com intervalo de sete dias entre cada intervenção, os resultados foram avaliados pela análise fotográfica e questionário de satisfação pessoal. Observou-se melhora no aspecto da face, atenuação das linhas de expressão, e como consequência melhora da auto-estima e aparência estética. A aplicação de eletrolifting mostrou resultados satisfatórios.

  5. ITINERARIOS DE LA BUENA ENSEÑANZA A PARTIR DE LOS RELATOS BIOGRÁFICOS DOCENTES

    Directory of Open Access Journals (Sweden)

    Zelmira Álvarez

    2010-01-01

    Full Text Available En la investigación cualitativa en educación, el enfoque biográfico y narrativo ha logrado su identidad propia. Siguiendo esta línea, se indaga aquí, por medio de entrevistas semi-flexibles, en las biografías de una selección de buenos docentes de la Facultad de Humanidades de la Universidad Nacional de Mar del Plata, Argentina. Éstos fueron identificados a través de cuestionarios semi-abiertos administrados a estudiantes avanzados de los Profesorados de esta Facultad. Del análisis de las conversaciones, se han seleccionado seis casos que confieren a sus recorridos de vida públicos y privados la acepción de itinerarios físicos o intelectuales. La interpretación de los datos transforma a estos relatos en historias de vida y sugiere el entretejido de las buenas prácticas con las trayectorias. Se construye así en la educación superior -donde la enseñanza en el aula es privada- un conocimiento local pero colegiado.

  6. Tarjetas de presentación e identidad. Las colecciones de relatos integrados desde los umbrales

    Directory of Open Access Journals (Sweden)

    José Sánchez Carbó

    2012-07-01

    Full Text Available Este artículo atiende la solicitud que Gerard Genette plantea en Umbrales sobre la necesidad de analizar género por género las funciones del paratexto. Así, se revisará la función de los paratextos en las colecciones de relatos integrados porque en estos márgenes se ubican claves que anticipan una intención estructural o temática del autor y una forma de lectura propias de la modalidad. En este sentido, de la amplia gama de paratextos, se intentará definir cuáles y cómo contribuyen de forma consistente a prolongar las ideas del autor, reconocer sus efectos en el lector y definir la peculiaridad de la colección integrada. This article was motivated by the urgent need of analyzing the function of paratexts in every genre, expressed by Gerard Genette in Paratexts, Thresholds of interpretation. Therefore, it is devoted to the review of the paratext’s functions in collections of short stories. This genre provides us with some key ideas related to the author’s intentions regarding structure or topic and reading. This article selects some paratexts to define which of them contribute to extend the author’s ideas and how this is accomplished; to recognize the effects on the reader and to define the uniqueness of the collections of short stories.

  7. Insuficiência renal aguda em paciente tratada com ATRA e anfotericina B: relato de caso

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    Gelcimar Moresco

    2011-06-01

    Full Text Available O presente relato apresenta o caso clínico de uma paciente com leucemia promie-locítica aguda tratada com ácido todo-transretinoico (ATRA, que apresentou suspeita de síndrome do ácido transreti-noico (síndrome de ATRA. Com a ocor-rência de leucopenia febril inespecífica, foram associados ao tratamento antimi-crobianos e antifúngicos. A diminuição da função renal, observada inicialmente, contribuiu para a suspeita de síndrome de ATRA, que foi agravada pelos antifúngi-cos. Assim, o uso de ATRA foi suspenso, mas somente 8 dias depois foi caracteriza-da pneumonia e descartada a hipótese de síndrome de ATRA. Nesse contexto, foi discutida a nefrotoxicidade do ATRA e a potencialização desse efeito adverso pelo uso de antifúngicos nefrotóxicos, em par-ticular da anfotericina B, assim como a im-portância do diagnóstico diferencial entre síndrome de ATRA e doença infecciosa.

  8. Síndrome de reiter: relato de caso Reiter's syndrome: a case report

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    Ana Elisabete Simões de Sousa

    2003-06-01

    Full Text Available Relato de um caso de síndrome de Reiter em paciente jovem, do sexo masculino, com lesões dermatológicas típicas e achado positivo para o antígeno do complexo de histocompatibilidade HLA-B27. O quadro surgiu após infecção intestinal por Salmonella enteritidis, evoluindo com melhora após utilização de tetraciclina, prednisona e indometacina. Episódio recidivante foi tratado com metotrexato. É feita uma revisão da literatura, abordando os aspectos clínicos, laboratoriais, etiológicos e fisiopatogênicos dessa síndrome.A case of Reiter's disease is reported in a young male showing typical dermatological lesions and positive finding for the HLA-B27 antigen histocompatibility complex. The condition arose following enteric infection with Salmonella enteritidis. Remission followed treatment with tetracycline, prednisone and indomethacin. The relapse of disease was treated with methotrexate. A review of clinical, physiopathologic and laboratory findings of Reiter's syndrome are presented.

  9. Pseudocisto esplênico não parasítico: um relato de caso

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    Alice de Moraes Baier

    2017-07-01

    Full Text Available Os cistos esplênicos são raros, podem ser congênitos ou adquiridos e são encontrados, muitas vezes, em exames incidentais. Aparecem como tumorações na topografia do hipocôndrio esquerdo, associados a sintomas obstrutivos e dor abdominal. Os pseudocistos são formados por uma camada de tecido fibroso, sem revestimento epitelial, e têm como fator etiológico mais provável o trauma esplênico prévio. Atualmente, o ultrassom abdominal é o método mais importante para o diagnóstico de cisto esplênico, pois evita a realização de exames mais agressivos. Para o tratamento de cisto esplênico sintomático de grande tamanho, não parasítico, com risco aumentado de ruptura e etiologia desconhecida, a indicação de escolha é a esplenectomia. Este relato objetiva apresentar essa doença incomum, ressaltando seu quadro clínico, métodos diagnósticos e tratamento. Palavras-chave: Pseudocisto; baço; esplenectomia

  10. O RELATO DA INFÂNCIA DE JESUS SEGUNDO O EVANGELHO DE MATEUS

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    Felipe Costa Silva

    2017-08-01

    Full Text Available Os relatos da infância de Jesus contidos no evangelho de Mateus, nos capítulos 1 e 2, refletem o plano teológico do autor sagrado, que situa Jesus de Nazaré, o Messias esperado, na história do povo de Israel, e, por conseguinte, na história da humanidade. O objetivo desta breve investigação bíblica e revisão bibliográfica é evidenciar os elementos centrais da infância do Nazareno como coordenadas necessárias para uma compreensão da historicidade dos acontecimentos frente à reflexão teológica, bem como da articulação entre os dados da fé e da história. A metodologia utilizada é a de uma leitura crítica da Bíblia com análise da bibliografia exegética sobre o tema. Esperamos com este método lançar uma luz sobre a leitura do texto com ênfase nos elementos históricos como forma de complementação à investigação cristológica. Acreditamos que a investigação da pessoa histórica de Jesus não contradiz sua qualidade de Cristo da fé, quando feita em respeito dos textos sagrados.

  11. Bursite iliopectínea: relato de caso Iliopectineal bursitis: case report

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    Eduardo Amaral Gomes

    2010-10-01

    Full Text Available A bursite iliopectínea, embora não tenha muitos relatos na literatura, apresenta-se clinicamente com sinais e sintomas frequentemente encontrados nos ambulatórios e consultórios. Sua clínica é de dor na parte anterior do quadril que piora à extensão, abdução e rotação interna do mesmo. O diagnóstico é confirmado pelo ultrassom ou ressonância nuclear magnética do quadril. A bursite iliopectínea responde bem ao tratamento conservador com anti-inflamatório não hormonal e repouso. Devido a esta boa evolução, não raro, pode-se tratar uma bursite iliopectínea com sucesso sem se saber o que está tratando.Although there are not many reports in literature, iliopectineal bursitis presents clinically with signs and symptoms frequently found in outpatient services and practice. Its clinical presentation is anterior hip pain that worsens with the extension, abduction and internal rotation of the hip. The diagnosis is confirmed by ultrasound or magnetic nuclear resonance imaging of the hip. The iliopectineal bursitis responds well to conservative treatment with non-hormonal anti-inflammatory drugs and rest. Due to its good evolution, it is not rare to treat iliopectineal bursitis successfully without even knowing what is being treated.

  12. Analgesia regional prolongada com catéteres periféricos: relato de casos

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    Karl Otto Geier

    2002-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Síndromes de Dor de Manutenção Simpática, Tromboangeíte Obliterante, Esclerodermia Sistêmica Progressiva (doença autoimune e analgesia pós-operatória respondem muito bem aos anestésicos locais quando em uso prolongado. O objetivo dos casos relatados visa divulgar o uso de catéteres curtos (catéteres venosos ou segmento de cateter peridural nas situações acima, na falta de material apropriado (Contiplexâ e similares associados ao estimulador de nervo periférico. RELATO DOS CASOS: São relatados casos de Síndrome de Dor Regional Complexa 1 e 2, úlcera de perna por tromboangeíte obliterante para preparação a enxertia de pele, esclerodermia sistêmica progressiva com comprometimento microcirculatório distal do pé, em que foram colocados catéteres venosos contíguos aos nervos periféricos dos respectivos territórios, visando o controle contínuo da dor através de injeções de anestésicos locais. CONCLUSÕES: Baseados nos princípios que norteiam a boa prática de anestesia regional e nos resultados obtidos, os casos apresentados mostraram que os catéteres usados podem substituir aqueles especialmente designados para as mesmas finalidades.

  13. Relatos de alunos surdos acerca da Escola Especial = Reports of deaf students on the Special School

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    André Luis Balan

    2012-01-01

    Full Text Available O presente recorte (adaptado apresenta uma análise das entrevistas feitas com três sujeitos surdos acerca das suas percepções sobre suas experiências educativas escolares no contexto das instituições especiais de ensino. Confirma-se, por meio do presente estudo, que os alunos estão cientes de algumas dificuldades das escolas especiais e sentem-se prejudicados por essas falhas. As análises das entrevistas realizadas, acerca das percepções dos alunos surdos sobre suas experiências educativas escolares nas escolas especiais, possibilitaram-nos reconhecer, por meio dos relatos dos próprios surdos, fatos recorrentes no espaço da escola especial, que influenciam ou mesmo delimitam a qualidade da educação destes estudantes.This excerpt (adapted presents an analysis of interviews performed with three (3 deaf students about their perceptions and educational experiences in the context of educational institutions and special education. Through this study it is confirmed that students are aware of some difficulties of special schools, besides feeling prejudiced because of these flaws. The analysis of the interviews about some perceptions of deaf students on their educational experiences in special schools allowed identifying, through their reports, recurring events within the special school, which nfluence or even limit the quality of education for these students.

  14. Mioclonia essencial hereditária: relato de uma família

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    Rosana S.C. Alves

    1994-09-01

    Full Text Available Tem sido descrita na literatura a ocorrência de movimentos mioclônicos e distônicos como expressão isolada de uma condição neurológica de caráter hereditário. Para essa entidade alguns autores propõem a denominação "distonia mioclônica hereditária", enquanto outros preconizam o uso da expressão "mioclonia essencial hereditária". O presente relato refere-se a uma família em que essa peculiar associação de movimentos anormais acometia diversos membros em três gerações. O propósito é uma paciente de 14 anos com movimentos distônicos instalados aos 7 anos e mioclonias aos 13 anos, com evolução lenta e tendendo à estabilização. Não havia referência a melhora sob ação do álcool (paciente abstêmia. A história familiar mostrava outros casos semelhantes. A investigação complementar (dosagens sericas de cobre, ceruloplasmina, T3, T4, TSH; pesquisa de acantócitos; exame do LCR; tomografia e ressonância do segmento cefálico não revelou anormalidades. O quadro foi satisfatoriamente controlado com clonazepam na dose de 3 mg/dia.

  15. La cartografía como relato: intervenir los mapas, narrar las ciudades

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    Esperanza López Parada

    2013-11-01

    Full Text Available El misterio que rodea el mapa de la primera ciudad imperial azteca, publicado en la traducción latina de la Segunda Carta de Relación de Hernán Cortés –su origen, su orientación, su autoría, su sentido–, se ve acompañado por los cambios que, con un claro sesgo ideológico, introducen las reproducciones posteriores en las imprentas de toda Europa. Si no resultan menos enigmáticos los rasgos que, en cambio, permanecen inalterados, tampoco arrojan luz sus nuevos empleos, independizándose ya de la relación cortesiana para ilustrar más crónicas o completar la descripción de otras ciudades americanas. El estudio de la suerte de aquel plano de la ciudad conquistada, que algunos atribuyeron al propio Durero, tendrá que habérselas con el proceso complejísimo por el que una representación como la cartográfica –que se busca sea descriptiva, objetiva, exacta– alcanza en este caso los modos y maneras de una ficción o un espejismo, hasta dejar de funcionar como mapa únicamente para convertirse en un ramillete de relatos entrecruzados.

  16. Relato de um caso de melanoma de conjuntiva Conjuntival melanoma: a case report

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    Carlos Gustavo Leite Vieira

    2000-10-01

    Full Text Available Objetivo: Relatar um caso raro de melanoma de conjuntiva de longa evolução em paciente melanodérmica. Método: Análise de caso. Resultado: Até a presente data a paciente encontra-se bem sem evidências de recorrência da patologia em questão após excisão local. Conclusão: Observamos que mesmo sem a realização de crioterapia adjuvante ou medidas mais agressivas, existem alguns casos como esse que acabamos de relatar para o qual a excisão simples pode garantir a cura. Um aspecto importante deste relato é a importância do exame histopatológico de peças e fragmentos cirúrgicos removidos.Purpose: The authors describe a rare case of malignant conjunctival melanoma with a long evolution. Methods: A case report. Results: Until this time the patient does not show any sign of relapse of this melanoma, after local excision. Conclusion: Without cryotherapy or more agressive methods we observe that there are some cases of conjunctival melanoma that might be cured with only a local excision. An important aspect of this case is the relevance of the histopathologic analysis of the removed surgical fragments.

  17. A trajetória de vida das mulheres judias, sobreviventes do Holocausto: relatos orais

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    Lilian Ferreira Souza

    2013-03-01

    Full Text Available A partir do registro dos relatos orais sobre o Holocausto, pretendemos analisar testemunhos que expressem as trajetórias das mulheres sobreviventes do nazismo. Como critério, optamos pelas narrativas daquelas que passaram por guetos, campos de concentração e/ ou trabalho forçados. O foco está nas histórias de vida daquelas que escolheram o Brasil como comunidade de destino pressionadas pela política antissemita endossada pelo Terceiro Reich e países colaboracionistas que previam a “Solução Final” para o povo judeu. Assim, os registros dos testemunhos têm como objetivo documentar essas narrativas redimensionadas à luz de documentos pessoais. Para nós – intermediários e interlocutores – esse exercício de reflexão ajudará a (repensar a sociedade que, ainda hoje, convive com novos genocídios.

  18. El relato de la memoria en el teatro de Buenos Aires

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    Silvina Díaz

    2016-07-01

    Full Text Available La recuperación de la memoria y el testimonio se han convertido en un requerimiento vital luego de la más cruenta dictadura militar argentina, que tuvo lugar entre 1976 y 1983. Los traumas históricos acarreados y las profundas heridas, individuales y colectivas, dieron lugar a innumerables hechos culturales. Nos proponemos analizar dos modos diversos, dentro de la dramaturgia de la posdictadura, de narrar la problemática de la represión y los desaparecidos, como paradigmas de toda una tendencia de textos que consideran al teatro como un instrumento de indagación social y política. La obra de Lola Arias recurre a un lenguaje referencial y explícito –propio del teatro político–, aun cuando contenga una importante carga simbólica, mientras que los textos de Omar Pacheco manifiestan la crisis del relato dramático tradicional y de la noción restrictiva que considera a la palabra únicamente en su dimensión psicologista y semántica, para destacar en cambio su materialidad y su opacidad sígnica.

  19. Vasculite cerebral e doença de Basedow-Graves: relato de dois casos

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    Rocha Maria Sheila Guimarães

    2001-01-01

    Full Text Available OBJETIVO: Relatar dois casos de pacientes com vasculite cerebral associada à doença de Basedow-Graves. RELATO DOS CASOS: O primeiro é uma paciente de 22 anos de idade com quadro súbito de disartria e déficit motor em dimídio esquerdo. Ao exame clínico, apresentava taquicardia, exoftalmia bilateral e bócio difuso. Referia tratamento para hipertiroidismo há um mês. O segundo é uma paciente de 15 anos de idade, que apresentou quadro súbito de perda da consciência seguindo-se distúrbio de linguagem e déficit motor em hemicorpo direito. RESULTADOS: Os exames de imagem revelaram áreas de lesão cerebral sugestivas de isquemia. Os estudos angiográficos cerebrais evidenciaram estenoses vasculares múltiplas compatíveis com arterite. Foram descartadas outras causas possíveis de vasculite cerebral. Os exames laboratoriais revelaram hipertiroidismo e presença dos anticorpos antimicrossomais e antitireoglobulina. As duas pacientes receberam tratamento para o hipertiroidismo. CONCLUSÃO: A associação entre arterite cerebral e doença de Basedow-Graves sugere que possa existir um elo na patogenia das duas doenças através de mecanismo auto-imune comum a ambas.

  20. Linfoma de Burkitt oral: relato de caso Oral Burkitt's lymphoma: case report

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    Roseana de Almeida Freitas

    2008-06-01

    Full Text Available O linfoma de Burkitt é um raro e agressivo tipo de linfoma não-Hodgkin pobremente diferenciado. O presente relato trata de uma criança do sexo masculino, com sete anos de idade, que foi examinada na Clínica de Odontopediatria do Departamento de Odontologia da UFRN, exibindo uma massa tumoral na região de pré-molares mandibulares com mobilidade dentária. O exame radiográfico revelou uma área radiolúcida difusa e o diagnóstico histopatológico foi de linfoma de Burkitt. O paciente foi tratado por poliquimioterapia e obteve completa remissão da patologia.Burkitt's lymphoma is a poorly differentiated rare and aggressive type of non-Hodgkin's lymphoma. This article reports the case of a male child aged seven years, who was examined at the Odontopediatric Clinic of the UFRN Dentistry Department. The patient presented a tumor in the premolar region of the mandible; teeth were mobile in this region. Radiology revealed a diffuse radioluscent area which was diagnosed histopathologically as Burkitt's lymphoma. The patient was treated with polychemotherapy; complete remission of the disease was attained.

  1. Raquianestesia total após bloqueio do plexo lombar: relato de caso

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    Zafer Dogan

    2014-04-01

    Full Text Available O bloqueio do plexo lombar (BPL é um método adequado para uso em pacientes idosos e cirurgias na extremidade inferior. Muitas complicações podem ser observadas durante o BPL, mas não tanto quanto no bloqueio central. Neste relato de caso, nosso objetivo foi relatar uma raquianestesia total, uma complicação incomum. BPL com bloqueio ciático foi planejado para um paciente do sexo masculino, 76 anos, programado para artroplastia total do joelho por causa de gonartrose. O paciente ficou inconsciente após o bloqueio do compartimento do psoas com a técnica de Chayen para BPL. A operação terminou em 145 minutos. O paciente foi internado em unidade de terapia intensiva até o segundo dia pós-operatório e recebeu alta hospitalar no quinto dia pós-cirúrgico. A principal preocupação da monitoração do paciente deve ser a presença do anestesiologista. Dessa forma, conclui-se que o contato com o paciente deve ser garantido durante esses procedimentos.

  2. Tricoepitelioma palpebral: relato de 2 casos Eyelid trichoepithelioma: report of 2 cases

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    Débora Mayumi Sugano

    2005-02-01

    Full Text Available O tricoepitelioma é tumor cutâneo benigno derivado dos folículos pilosos. É comum na face, porém há poucos relatos sobre a ocorrência na pálpebra. não é freqüentemente reconhecido devido à sua raridade, controvérsias na sua classificação, origem e potencial biológico. O objetivo deste artigo é apresentar 2 casos de tricoepitelioma solitário na pálpebra, o exame histopatológico e seu tratamento. Esta lesão deve ser considerada quando for encontrado um nódulo solitário na região facial e diferenciada do carcinoma basocelular. A confirmação por meio do exame histopatológico é essencial.Trichoepithelioma is a benign skin tumor and is most commonly found on the face, however, there are few reports about its occurrence on the eyelids. It is not usually recognized because of its rarity, origin, biological potential, and controversial classification. The purpose of this paper is to report two cases of solitary trichoepithelioma on the eyelid, their histopathology and treatment. This lesion should be considered when a single solid nodule on the face appears, and can be differentiated from basal-cell carcinoma. Histopathologic confirmation is essential.

  3. Intoxicação exógena por carbamato: relato de caso

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    Luciana Rodrigues Façanha Barreto Medeiros

    2017-08-01

    Full Text Available Os carbamatos usados com inseticidas são compostos anticolinesterásicos com variado grau de toxicidade para o ser humano. A maioria das intoxicações por esses agentes ocorre por exposição acidental da derme. Entretanto, ocorrem também ingestões acidentais e suicidas. Este relato de caso objetiva abordar o manejo intensivo da síndrome colinérgica em unidade de terapia intensiva e propor um fluxograma prático de manejo da intoxicação por carbamato. Abordamos o caso de um paciente jovem do sexo masculino, internado na UTI clínica do Hospital Universitário Walter Cantídio, admitido após ingestão intencional da substância aldicarbe (“chumbinho”, que é utilizado de forma irregular como raticida e sabidamente possui efeitos colinérgicos. O paciente apresentava rebaixamento do nível de consciência, bradicardia, sialorréia e insuficiência respiratória.

  4. Agonia de um mito pós-moderno: narrativas míticas arcaicas e o relato jornalístico do 11 de setembro

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    Mario Geraldo Rocha da Fonseca

    2006-01-01

    Este é um trabalho de comparação entre o relato jornalístico e algumas narrativas antigas. O objetivo é encontrar afinidades estruturais entre as narrativas contemporâneas e as narrativas arcaicas. Para isso, tomou-se como objeto de estudo o relato dos atentados terroristas aos Estados Unidos da América (EUA) que ficaram conhecidos pelo dia e pelo mês - 11 de Setembro - em que ocorreram, em 2001. Para a análise, escolheu-se 15 primeiras - páginas de jornais de várias partes do mundo, a maiori...

  5. Derechos colectivos en el empleo público. Construcción de relatos en la justicia constitucional costarricense. 1990-2015

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    Castro Méndez, Mauricio

    2016-01-01

    Resumen Este artículo propone una lectura crítica de la jurisprudencia de la Sala Constitucional sobre derechos colectivos del empleo público costarricense a partir de un análisis argumentativo y desde la perspectiva crítica del derecho. Más concretamente, el estudio se enfoca en el relato histórico mediante el cual la Sala Constitucional justifica su jurisprudencia y lo problematiza a partir de los estudios académicos disponibles. El análisis muestra que su relato se basa en opciones ideológ...

  6. Regeneração do fígado de ratos após oclusão parcial da drenagem venosa hepática Hepatic regeneration after parcial oclusion of hepatic vein drainage in rats

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    Luiz Roberto Farion de Aguiar

    2009-06-01

    Full Text Available INTRODUÇÃO: A regeneração hepática é um mecanismo para superar a perda de tecido funcional do fígado. Este processo é estudado através de diferentes métodos. OBJETIVO: Avaliar o efeito da oclusão parcial da drenagem venosa hepática sobre a regeneração do fígado remanescente de ratos submetidos à hepatectomia parcial. MÉTODO: Foram colhidas biópsias de fígado em 30 ratos Wistar machos, e a seguir realizada hepatectomia a dois terços. Os animais foram divididos em três grupos: um grupo controle e dois grupos de estudo, submetidos a diferentes graus de estenose da veia hepática direita. Após 96 horas do estímulo para regeneração hepática, todos submeteram-se à outra biópsia hepática. Analisaram-se os fragmentos por imunoistoquímica para os marcadores Ki-67 e fator de von Willebrand. Para a leitura das amostras utilizou-se o sistema SAMBA 4000. A deposição de colágeno foi avaliada pela coloração tricrômico de Masson. RESULTADOS: A proliferação celular dos animais submetidos à hepatectomia parcial e estenose moderada ou severa da veia hepática direita persistiu mais elevada quando comparada ao grupo controle. O Índice de Marcação para o Ki-67 foi significativamente mais elevado após a hepatectomia nos grupos submetidos à oclusão parcial da veia hepática, tanto moderada quanto severa. A expressão de fator de von Willebrand estava diminuída após a hepatectomia parcial nos três grupos. Houve pouco depósito de colágeno no tecido hepático nos animais dos dois grupos com estenose da veia hepática direita. CONCLUSÃO: A oclusão parcial da drenagem venosa hepática em ratos submetidos à hepatectomia parcial prolonga o tempo de proliferação de células hepáticas quando comparado aos animais com veias de calibre normal. Como consequência, também houve atraso na restauração da matriz extracelular e na formação de novos vasos sinusoidais.BACKGROUND: Hepatic regeneration is a mechanism to overcome

  7. Exotismo e autenticidade: relatos de viajantes à procura de sexo Exoticism and authenticity: tales of travelers in search of sex

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    Adriana Piscitelli

    2002-01-01

    Full Text Available A produção sócio-antropológica que trata do turismo discute a oposição entre o caráter de massa atribuído ao olhar dos turistas contemporâneos e o caráter individual vinculado à "viagem". Este texto dialoga com argumentos presentes nessa oposição, a partir da análise etnográfica de relatos de viajantes à procura de sexo que freqüentam pontos do circuito internacional de turismo sexual. Centrando-se em narrativas ficcionais/experienciais, Plateforme, romance de Michel Houellebecq, recentemente publicado, os relatos de viagem de Mattioli Ross e histórias contadas por viajantes à procura de sexo, no marco de uma pesquisa sobre turismo sexual internacional no Nordeste do Brasil, o texto estabelece esse diálogo considerando as noções centrais presentes nesse conjunto de relatos atravessados por gênero: exotismo, sexualidade e autenticidade.The socio-anthropological production on tourism opposes the mass character imputed to the views of contemporary tourists to the individual character attributed to the "trip". This text establishes a dialogue with arguments present in that opposition, based on ethnographic analyses of tales by travelers in search of sex used to places in the international circuit of sexual tourism. Centering on fictional/experiential accounts, Plateforme, recently published novel by Michel Houellebecq, Mattioli Ross' travel accounts and tales told by travelers in search of sex, framed by a research on international sexual tourism in Brazil's Northeast, the text establishes such a dialogue considering the notions central to those accounts crisscrossed by gender: exoticism, sexuality, authenticity.

  8. La comprensión del relato periodístico: ¿qué son los hechos?

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    Saharrea, Juan Manuel

    2013-01-01

    El objetivo de este trabajo echar luz acerca de la comprensión del relato periodístico planteando el debate filosófico acerca del estatus de los hechos. Tomando algunas distinciones de la filosofía del lenguaje y la epistemología contemporáneas definimos nuestra propia posición en relación con los hechos. De acuerdo con nuestra perspectiva los hechos, no son, bajo ningún aspecto, independientes de descripción. Planteamos las tesis del realismo y el relativismo en torno a los hechos y de cada ...

  9. Avaliação funcional de relatos de disfunção erétil.

    OpenAIRE

    Domingos, Vania Gomes Machado

    2014-01-01

    O presente estudo teve como objetivo analisar funcionalmente o comportamento verbal de uma pessoa diagnosticado com disfunção erétil. O participante, do sexo masculino de 37anos é casado. Para o controle dos procedimentos foram empregados dois delineamentos experimentais: o de múltiplos elementos e o de tratamentos alternados. Para avaliar os antecedentes e consequentes dos relatos de disfunção erétil, foi usado processo de avaliação funcional que incluiu (1) observação indiret...

  10. Síndrome de Moebius associada a artrogripose: relato de caso e revisão da literatura

    OpenAIRE

    Moreira,Ana Tereza Ramos; Teixeira,Sueli; Ruthes,Hilton Iran; Miranda,André Basso; Guerra,Daniel Roncaglio

    2001-01-01

    Os autores descrevem um caso de síndrome de Moebius associada a artogripose múltipla congênita, uma situação rara, sem relatos prévios na literatura latino-americana. A síndrome de Moebius é caracterizada por paralisia dos VII e VI pares cranianos, geralmente associada a outras anomalias ósseas e musculares, mais freqüentemente localizadas na parte distal das extremidades. A artrogripose múltipla congênita consiste de um grupo heterogêneo de alterações, sendo caracterizada por extrema rigidez...

  11. Relato autobiográfico e interpretación : una concepción narrativa de la identidad personal

    OpenAIRE

    Duero, Dante G.

    2006-01-01

    En este trabajo analizo el lugar de la explicación y la interpretación dentro de las ciencias en general y de las ciencias sociales e históricas en particular. Expongo los argumentos de algunos autores en favor de la especificidad y la legitimidad del modelo narrativo dentro de las ciencias sociales e históricas. A continuación analizo la tesis que propone pensar a la identidad personal como parte de un relato que presenta grados diferentes de coherencia e integración. A partir de propuestas ...

  12. Veracidad y verosimilitud en el relato autobiográfico: el valor de la ficción

    OpenAIRE

    Iriondo Aranguren, Mikel

    2015-01-01

    Este artículo trata de analizar la tensión entre autobiografía y ficción, partiendo del hecho de que la autobiografía es un género literario que se presenta como un discurso verdadero sobre el pasado. Así, suponemos que los datos que el autor proporciona están directamente vinculados con sus vivencias pasadas y, confiando en la palabra del protagonista del relato autobiográfico, nos dejamos seducir por sus experiencias vividas. Sin embargo, tenemos la sensación de situarnos en un territorio l...

  13. Reconstrucción de la memoria Colectiva: Madres y Abuelas de Plaza de Mayo : Relatos del Futuro

    OpenAIRE

    Coria, Carla

    2013-01-01

    El Proyecto de Extensión Universitaria "Madres y Abuelas de Plaza de Mayo" fue realizado por el Taller de Producción Audiovisual I de la Facultad de Periodismo y Comunicación Social de la Universidad Nacional de La Plata. Su objetivo fue relevar y compilar relatos audiovisuales de las madres y abuelas víctimas del terrorismo de Estado en la Argentina para socializar sus experiencias de vida, fomentar la participación política y el compromiso de la comunidad universitaria. El present...

  14. Associação entre artrite idiopática juvenil e osteogenesis imperfecta: relato de caso

    Directory of Open Access Journals (Sweden)

    Blanca Elena Rios Gomes Bica

    2013-12-01

    Full Text Available Os autores relatam o caso de uma paciente de 53 anos que apresenta uma rara associação entre artrite idiopática juvenil (AIJ e osteogenesis imperfecta (OI, com acometimento poliarticular, incluindo a articulação temporomandibular. Apresentam uma revisão da literatura e uma discussão dos aspectos radiológicos do acometimento da referida articulação. Não foram encontrados relatos de casos com semelhante associação de doenças na literatura especializada.

  15. Glomeruloesclerose segmentar e focal (GESF) colapsante associada ao parvovírus B19: relato de caso

    OpenAIRE

    Freitas, Geraldo Rubens Ramos de; Praxedes, Marcel Rodrigues Gurgel; Malheiros, Denise; Testagrossa, Leonardo; Dias, Cristiane Bitencourt; Woronik, Viktoria

    2015-01-01

    Objetivo: Descrever quadro clínico-laboratorial de glomeruloesclerose segmentar e focal (GESF) subtipo colapsante em associação com infecção por parvovírus B19 (PVB19). Relato do caso: Paciente feminino, 37 anos, parda, iniciou quadro de faringoalgia e febre aferida com melhora parcial após penicilina. Com uma semana, observou redução de débito urinário e edema de membros inferiores. Tabagista, com histórico familiar e pessoal negativos para hipertensão, diabetes ou nefropatias. À admissão, a...

  16. Neuralgia do trigêmeo bilateral: relato de caso Neuralgia del trigémino bilateral: relato de caso Bilateral trigeminal neuralgia: case report

    Directory of Open Access Journals (Sweden)

    Caio Marcio Barros de Oliveira

    2009-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A neuralgia do nervo trigêmeo é uma condição intensamente dolorosa, caracterizada por surtos de dor lancinante e súbita, tipo choque, com duração de poucos segundos a dois minutos e geralmente unilateral. Sua incidência anual é de cerca de 4,3 em 100.000 na população geral, tendo manifestação bilateral em apenas 3% desses casos. O objetivo deste artigo foi descrever um caso raro de neuralgia do trigêmeo primário bilateral. RELATO DO CASO: Paciente de 61 anos, maranhense, casada, do lar, com antecedente de hipertensão arterial e há seis anos com queixa de dor intensa em V2-V3 à esquerda, com duração de 5 a 10 segundos, em região lateral do nariz e mandibular, com piora ao falar, mastigar e com diminuição da temperatura. Já havia utilizado clorpromazina (3 mg a cada oito horas e carbamazepina (200 mg a cada oito horas durante seis meses sem alívio da dor. Ao exame físico apresentava alodinia térmica e mecânica em regiões de V2-V3. Estava em uso de gabapentina (1.200 mg ao dia com alívio parcial da dor. Foi então aumentada a gabapentina para 1500 mg ao dia e introduzida amitriptilina 12,5 mg à noite. Evoluiu com dor leve e esporádica com diminuição da intensidade da dor ao longo de 10 meses de tratamento, sendo reduzida progressivamente a gabapentina para 600 mg ao dia e mantida a amitriptilina 12,5 mg ao dia. Após um ano, começou a apresentar dor de característica semelhante em região mandibular à direita, tendo melhorado com aumento de gabapentina para 900 mg ao dia. Não apresentava exames alterados de tomografia ou ressonância magnética de encéfalo. CONCLUSÕES: A carbamazepina é o fármaco de primeira escolha para tratamento de neuralgia trigeminal, porém a gabapentina tem sido cada vez mais utilizada como primeira medida farmacológica ou em casos refratários à terapia convencional.JUSTIFICATIVA Y OBJETIVOS: La neuralgia del nervio trigémino es una condici

  17. Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25 g Quincke, 27 g Quincke and 27 g Whitacre spinal needles.

    Science.gov (United States)

    Shaikh, Jan Muhammad; Memon, Amna; Memon, Muhammad Ali; Khan, Majida

    2008-01-01

    To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. Liaquat University Hospital Hyderabad from October 2005 to December 2006. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I (25G Quincke spinal needle: n=168), Group II (27G Quincke spinal needle: n=160) and Group III (27G Whitacre spinal needle: n=152). Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I), 27G Quincke spinal needle (Group II) and 27G Whitacre spinal needle (Group III) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache (PDPH) were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke (Group I), 27G Quincke (Group II) and 27G Whitacre (Group III) spinal needles was 8.3% (14/168), 3.8% (6/160) and 2.0% (3/152) respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on 1st and 2nd postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used.

  18. Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25G quince, 27G quince and 27G whitacre spinal needles

    International Nuclear Information System (INIS)

    Shaikh, J.M.; Memon, M.; Khan, M.

    2008-01-01

    To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I (25G Quincke spinal needle: n=168), Group II (27G Quincke spinal needle: n=160) and Group III (27G Whitacre spinal needle: n=152). Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I), 27G Quincke spinal needle (Group II) and 27G Whitacre spinal needle (Group III) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache (PDPH) were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke (Group I), 27G Quincke (Group II) and 27G Whitacre (Group III) spinal needles was 8.3% (14/168), 3.8% (6/160) and 2.0% (3/152) respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on 1st and 2nd postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used. (author)

  19. Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Yen-Heng [National Taiwan University, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); National Taiwan University Hospital, Department of Medical Imaging, Douliu City (China); Wang, Yu-Fen; Lee, Chung-Wei; Chen, Ya-Fang [National Taiwan University, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); Liu, Hon-Man [National Taiwan University, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); Fu Jen Catholic University, Department of Medical Imag