We examined the oxygen uptake (VO2) and carbon dioxide output (VCO2) during completion of a circuit developed for testing fire fighters and related performance time to laboratory measures of fitness. Twenty-two healthy university students (ten women) were trained in the tasks then performed the circuit as quickly as possible. Breath-by-breath gas exchange and heart rate were continuously measured with a portable system. Median circuit time was 6:13 (min:s, 25-75% = 5:46-6:42) for men and 7:25 (25-75% = 6:49-10:21) for 8 women finishers (P = 0.023), and VO2 averaged 68 and 64% VO2max for the men and women during the circuit. Both men and women had high respiratory exchange ratios (>1.0) suggesting marked anaerobic energy contribution. Physiological variables associated with circuit time were assessed by backward stepwise regression yielding a significant model that included only peak work rate during arm cranking exercise as a function of circuit completion time across men and women combined (P < 0.001). For men, but especially for women, the time required for the simulated victim drag (68.2 kg mannequin) was positively correlated with total time to complete the other circuit elements (r = 0.51, r = 0.96 respectively). The simple correlation between circuit time and VO2max (mL/kg/min) revealed poor relationships for men (r = -0.37, P > 0.05) and women (r = 0.20, P > 0.05). These data demonstrated that upper body fitness as reflected by peak work rate during arm cranking correlated with total circuit time for the men and women in our population sample.

Vertebrobasilar dolichoectasia (VBD) is an anatomic variant that consists of enlargement and dilatation, often associated with a tortuous and elongated vessel 1 . The anomaly is probably due to a marked thinning of the internal elastica lamina and media, most likely as a consequence of prolonged systemic arterial hypertension 2 . It accounts for approximately 3 to 5% of all cerebellopontine mass lesions. A variety of clinical syndromes have been related due to pulsatile compression by the aberrant vessel: cerebellar dysfunction, hydrocephalus, ischemic stroke, transient or permanent motor deficits, central sleep apnea, trigeminal neuralgia, as well as brain stem compression syndrome 1,3,4 . Microvascular decompression surgery was introduced in the 1960s and was initially used to treat trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia 5 . Lately, it was used to treat brainstem dysfunction caused by an ectatic vessel 1 . Nowadays, microvascular decompression with repositioning of the ectatic vessel is a new technique that has been used successfully.The purpose of this study is to report and discuss a rare case of brain stem compression syndrome caused by vertebrobasilar dolichoectasia successfully treated with microvascular decompression repositioning technique and documented by computed tomography angiography (CTA) and magnetic resonance imaging (MRI). CASEA 60-years old man with a past medical history of diabete mellitus type 2 sought neurological treatment after experiencing mild progressive disartria for eight months. He did not have other complaints. The patient's neurologial examination revealed, besides the speech abnormality, left side pyramidal syndrome with hiperreflexia and Babinski´s sign. All the other aspects of the neurological examination were intact. Imaging investigationMRI and CTA showed an elongated and tortuous vertebrobasilar artery that crossed the ventral aspect of the medulla oblongata causing mechanial compression at the left side (Figs 1 and 2). Surgical techniqueThe patient was placed in the prone oblique (park bench) position, and a left far lateral suboccipitoretromastoidea approach was performed with left vertebral artery exposure. The dura was opened, and cerebrospinal fluid was released at the cisterna magna to provide a capacious working environment.Arachnoid dissection revealed a large vascular structure, identified as the basilar dolichoectatic artery, dislocating and compressing the brain stem (medulla oblongata) in its left ventral region. As soon as the neurovascular conflicting area was

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Objective: It is a consensus that most unruptured intracranial aneurysms (UIA) can be treated with acceptably low morbidity. However, some studies recently reported postoperative cognitive impairment, suggesting that it could be attributable to surgical damage. Our goal is to evaluate cognitive function before and after microsurgical clipping in patients with UIA. Method: A consecutive series of 40 patients who underwent microsurgical clipping for UIA were studied. The cognitive assessment (Mini Mental State Examination, MMSE) was performed immediately before and at least one month after surgery. Paired Student's "t" test and analysis of variance (ANOVA) were used for statistical purposes. Results: The mean MMSE score in the preoperative analysis was 28.12 (SD, 1.34). In the postoperative period the mean MMSE score was 28.40 (SD, 1.46). Paired Student's "t" test was applied to the scores and no significant difference was found (p=0.315). ANOVA did not find independent associations between MMSE scores and age, hypertension, smoking, dyslipidemia, education, aneurysm location, number, laterality or size. Conclusion: The present study suggests that microsurgical clipping for UIA does not result in major cognitive dysfunction as determined by the MMSE. Key words: cerebral aneurysm, surgical clipping, cognitive impairment, mini mental state examination.Clipagem microcirúrgica em 40 pacientes com aneurisma de circulação cerebral anterior não-roto: uma investigação cognitiva RESUMO Objetivo: É consenso que a maioria dos aneurismas intracranianos não-rotos (AINR) podem ser tratados com aceitável taxa de morbidade. Entretanto, alguns estudos reportaram déficits cognitivos no pós-operatório, sugerindo que poderiam ser atribuídos ao dano cirúrgico. O objetivo desse estudo é avaliar a função cognitiva antes e após clipagem microcirúrgica em pacientes com AINR. Método: Uma série de 40 pacientes com AINR submetidos à clipagem microcirúrgica foi estudada. A avaliação cognitiva (Mini Exame do Estado Mental, MEEM) foi realizada antes e após a intervenção cirúrgica. A análise estatística foi realizada com teste "t" de Student e análise de variância (ANOVA). Resultados: A média dos escores do MEEM na análise pré-operatória foi 28,12 (DP, 1,34). No período pós-operatório, a média dos escores foi 28,40 (DP, 1,46). Não houve diferença estatística (teste "t" de Student; p=0,315). A ANOVA não encontrou associações independentes entre os escores de MEEM e idade, hipertensão, tabagismo, dislipidemia, educação e características dos aneurismas (topografia, número, lado e tamanho). Conclusão: O presente estudo sugere que a clipagem microcirúrgica não está associada a danos cognitivos maiores em pacientes com AINR. Palavras-chave: aneurisma cerebral, clipagem cirúrgica, déficit cognitivo, mini exame do estado mental.

Background:As a consequence of the progressive evolution of neurosurgical techniques, there has been increasing concern with the esthetic aspects of burr holes. Therefore, the objective of this study was to compare the use of cortical bone graft and bone dust for correcting cranial deformities caused by neurosurgical trephines.Methods:Twenty-three patients were enrolled for cranial burr hole reconstruction with a 1-year follow-up. A total of 108 burr holes were treated; 36 burr holes were reconstructed with autogenous cortical bone discs (33.3%), and the remaining 72 with autogenous wet bone powder (66.6%). A trephine was specifically designed to produce this coin-shaped bone plug of 14 mm in diameter, which fit perfectly over the burr holes. The reconstructions were studied 12 months after the surgical procedure, using three-dimensional quantitative computed tomography. Additionally, general and plastic surgeons blinded for the study evaluated the cosmetic results of those areas, attributing scores from 0 to 10.Results:The mean bone densities were 987.95 ± 186.83 Hounsfield units (HU) for bone fragment and 473.55 ± 220.34 HU for bone dust (P < 0.001); the mean cosmetic scores were 9.5 for bone fragment and 5.7 for bone dust (P < 0.001).Conclusions:The use of autologous bone discs showed better results than bone dust for the reconstruction of cranial burr holes because of their lower degree of bone resorption and, consequently, better cosmetic results. The lack of donor site morbidity associated with procedural low cost qualifies the cortical autograft as the first choice for correcting cranial defects created by neurosurgical trephines.