The correct identification of Candida species is of great importance, as it presents prognostic and therapeutical significance, allowing an early and appropriate antifungical therapy. The purpose of this study was to identify isolates of Candida spp. from oral mucosa of 38 patients with oral candidosis evaluated in 2004 by phenotypic methods and PCR, discriminating C. albicans from the other Candida species. The tests used for phenotypic analysis were germ-tube and chlamydoconidia production, culture in CHROMAgar™ Candida, carbohydrate assimilation test, growth at 45ºC and culture in Tween 80 agar. Genotypic confirmation was performed by PCR. Phenotypic tests showed that 63.2% strains formed germ-tubes, 73.7% produced chlamydoconidia, and 63.2% showed green colonies in chromogenic medium, presumptively indicating C. albicans or C. dubliniensis. The carbohydrate assimilation test confirmed these results. A total of 21% strains were identified as C. krusei and 13.2% were indicative of C. tropicalis. Of these later strains, three produced chlamydoconidia. The association of other phenotypic tests with culture in Tween 80 agar identified 95.8% of strains as C. albicans and 4.2% as C. dubliniensis. All 24 strains indicative of C. albicans and C. dubliniensis were confirmed by PCR as C. albicans.

Endometriosis is a common disease, which affects 5-10% of women in fertile age 1 . It can affect multiple organs, such as ovaries, lungs, colon, nasal mucosa and brain 2 . Endometriosis of the sciatic nerve is a rare presentation 3 , manifesting as cyclic sciatica, parestesis and paresis with loss of deep tendon reflex. We cite a case of sciatica endometriosis and make a review of the literature. CASEA 26-year-old Caucasian woman exhibits intense pain and weakness in the lower left limb, which had progressed over the past nine years. She had no previous pregnancy and symptoms were worse during the menstrual period.During examination, a dorsiflexion paresis of the left foot was notable. Magnetic resonance imagining (MRI) revealed an expansive process in the left sciatic nerve topography at gluteal topography.The patient was referred for microsurgery, proceeding exeresis of a cystic lesion in the left sciatic nerve. Neuropathology analysis showed an endometrioma ( Figure). The patient had no complications during the post-operative period.During initial follow-up, dorsiflexion paresis in the left foot persisted. Post-operative MRI showed a cicatricial process, with no residual tumor. The eletroneuromiography (ENMG) displayed signs of a subacute denervatory process.

Subdural hematoma (SH) is a neurosurgical emergency, usually caused by head trauma. Non-traumatic causes include aneurysm or arterial-venous malformation rupture, coagulopathy and others. We report the case of a 66 year-old man who developed apparently unprovoked signs of increased intracranial pressure. Brain computed tomography scan showed an acute spontaneous SH, surgically treated. Throughout surgery, a ruptured cortical artery with intensive bleeding appeared and was cauterized. After surgery, patient remained comatose and a new CT demonstrated Duret hemorrhage at the brainstem. Acute spontaneous SH of arterial origin is rare and highly lethal, in which a good prognosis relies on early diagnosis and treatment.

RESUMOEnxertos substituindo dura-máter são comumente aplicados em Neurocirurgia. O pericárdio bovino é considerado seguro e associado a raras complicações. Objetivamos mostrar caso de uma paciente com meningeoma do tubérculo selar, que apresentou uma complicação atípica após duroplastia utilizando pericárdio bovino para reconstrução da região fronto-temporal. Após dois dias de boa evolução pósoperatória, a paciente apresentou piora neurológica e a TC de crânio evidenciou hematoma intraparenquimatoso à direita, com edema peri-lesional, sendo necessária cirurgia para drenagem, e substituição do pericárdio bovino por enxerto de fáscia lata, com boa evolução pós-operatória. Pericrânio pediculado, fáscia temporal e fáscia lata constituem as mais efetivas e seguras escolhas para substituir dura-máter. Dentre os enxertos heterólogos e sintéticos utilizados, o pericárdio bovino é associado a poucas complicações. Todavia, intercorrências como reação inflamatória e infecção tem sido descritas relacionadas à substância glutaraldeído, presente neste enxerto. Palavras-chave: glutaraldeído, substituto dural, reação adversa, pericárdio bovino.ABSTRACT Dura mater grafts are commonly applied in neurosurgery. The bovine pericardium is safe and associated with rare complications. We report a case of a patient presenting with tuberculum sellae meningioma and unusual complication after frontotemporal duroplasty using bovine pericardium. After two days of good postoperative evolution, the patient presents with neurological worsening and CT scan shows intraparenchymal hematoma on the right, with perilesional edema, requiring surgery to drain and replace the pericardium of a fascia lata graft. with good postoperative evolution. Pediculated pericranium, temporal fascia and fascia lata are the most effective and safe choice to replace the dura mater. Among heterologous grafts, bovine pericardium is associated with few complications. However, complications such as inflammation and infection are related to the substance glutaraldehyde, present in such graft.

Introduction: Anesthesia preoperative evaluation clinics (APECs) are useful for high-risk surgical patient care, as they improve perioperative outcomes and optimize patient care flow. At Hospital de Clínicas de Porto Alegre, APEC assesses 20% of all patients undergoing surgery, showing the importance of implementing strategies to improve outpatient clinic efficiency by prioritizing high-risk patients. Methods: Using a specific quality management tool for process improvement (PDCA, which stands for Plan/Do/Check/Act), new protocols were developed for patient referral and preoperative evaluation. Clinical staff was trained in the new routines, and an electronic screening system for patient referral was adopted. Data on patient profiles, referring surgical specialties, type of surgery, and waiting times for appointment and surgical procedure were compared before and after the intervention. Results: APEC performed 1,286 appointments between 2013 and 2016, including 733 pre-intervention and 553 post-intervention. There was a significant decrease in the appointments for patients undergoing minor surgery and an increase in the appointments for those undergoing major surgery. The waiting time between referral to APEC and first APEC appointment reduced from 46 to 16 days. In addition, there was an increase in vascular, orthopedic, and urology referrals, as well as a reduction in ophthalmology and general surgery referrals. Conclusions: The PDCA method assisted with conceiving, executing, and monitoring the implemented strategies for changing the profile of patients evaluated at APEC. The major challenge is to measure the long-term impact of this intervention and expand care through specific strategies for surgical specialties and procedures.