BackgroundPneumocephalus (PNC) is defined as a pathological collection of gas within the cranial cavity. The authors studied the effects of hyperbaric oxygenation (HBO2) therapy on a group of patients with PNC, comparing them with a control group to determine the relative impact on pneumocephalus volume, clinical symptoms, and duration of hospitalization.MethodsTwenty-four patients with PNC treated at our hospital were consecutively studied. These patients were divided into a treated group (n=13) and a control group (n=11). Thirteen patients (treated group) were treated with HBO2 therapy sessions in a monoplace hyperbaric chamber at 2.5 atmospheres with 100% oxygen concentration. The control group was treated with normobaric oxygenation.ResultsClinical improvement was seen in all patients. In the treated group, a decrease of the gas bubble was observed on the computerized tomography scan after each session of HBO2. The treated group also experienced a lower rate of meningitis compared with the control group. The length of hospital stay was significantly higher in the control group compared with the treated group.ConclusionsHBO2 therapy in selective cases may lead to clinical and radiological improvement in patients with PNC.
Abstract:The evaluation of patients in the emergency room department (ER) through more accurate imaging methods such as computed tomography (CT) has revolutionized their assistance in the early 80s. However, despite technical improvements seen during the last decade, surgical planning in the ER has not followed the development of image acquisition methods. The authors present their experience with DICOM image processing as a navigation method in the ER. The authors present 18 patients treated in the Emergency Department of the Hospital das Clínicas of the University of Sao Paulo. All patients were submitted to volumetric CT. We present patients with epidural hematomas, acute/subacute subdural hematomas and contusional hematomas. Using a specific program to analyze images in DICOM format (OsiriX ® ), the authors performed the appropriate surgical planning. The use of 3D surgical planning made it possible to perform procedures more accurately and less invasively, enabling better postoperative outcomes. All sorts of neurosurgical emergency pathologies can be treated appropriately with no waste of time. The three-dimensional processing of images in the preoperative evaluation is easy and possible even within the emergency care. It should be used as a tool to reduce the surgical trauma and it may dispense methods of navigation in many cases.
Penetrating injury of the skull and brain are relatively uncommon events, representing about 0.4% of all head injuries. Transorbital penetrating brain injury is an unusual occurrence in emergency practice and presents with controversial management. We report the case of a 10-year-old boy who fell forward on a bamboo stick while playing with other children, causing a penetrating transorbital injury, resulting in meningitis. We performed a combined surgical approach with neurosurgeons and ophthalmogic surgeons. Upon discharge, the patient had a Glasgow Coma Scale score of 15, no motor deficit and no visual loss. We discuss the management of this case and review current literature.
RESUMO -Analisamos 15 casos de meduloblastoma em adultos (8 homens e 7 mulheres), com idade média de 23,7 anos (variação de 13 a 46) submetidos a ressecção cirúrgica no período de fevereiro de 1988 a outubro de 1995. Os tumores se localizavam no hemisfério cerebelar em 7 casos (1 com extensão supratentorial e outro atingindo a cisterna do ângulo pontocerebelar), no vermis e hemisférico em 4 e apenas no vermis em outros 4. A ressecção foi considerada radical em 7 casos, subtotal em 7 e parcial em um. Não houve mortalidade operatória. Aspectos relativos ao comportamento biológico e prognóstico são discutidos.PALAVRAS-CHAVE: fossa craniana posterior, meduloblastoma, tumor neuroectodérmico primitivo, adulto. Medulloblastoma in adulthood: analysis of a casuistics and surgical resultsABSTRACT -We report on 15 cases of medulloblastoma of adult onset (8 male and 7 female) operated upon posterior fossa approach from February 1988 to October 1995. Tumors were localized in cerebellar hemisphere in 7 cases (one with extension to supratentorial notch and another case reaching the cerebello-pontine angle cistern), in vermis and hemisphere in four, only in vermis in another four. Resection was total in seven patients, subtotal in other seven, and partial in one.There was no operative mortality. Aspects regarding biological behavior, diagnosis, pathological findings, surgery and survival are discussed as well as prognostic factors.KEY WORDS: posterior cranial fossa, medulloblastoma, primitive neuroectodermic tumor, adult hood.Desde 1925, quando Bailey e Cushing 1 reconheceram e denominaram o meduloblastoma como um processo distinto dos gliomas e sarcomas, ele tem sido reconhecido como um tumor cerebelar maligno relacionado à faixa etária pediátrica 2,3 , com um pico de incidência aos 5 anos de idade 4 . Entretanto o seu aparecimento em adolescentes e adultos não é infreqüente. Em seu artigo original, Bailey e Cushing descreveram 9 pacientes com idades superiores a 18 anos, portadores de meduloblastoma, que possuíam semelhanças em relação ao comportamento clínico e aspecto histopatológico. O comportamento biológico do meduloblastoma do adulto bem como seus aspectos histopatológicos têm sido estudados, procurando-se estabelecer parâmetros para avaliação prognóstica 2,[4][5][6][7][8][9][10][11][12][13][14][15] . O padrão de resposta ao tratamento cirúrgico e radioterápico difere entre o grupo adulto e o pediátrico 2, 7-9,16 , com recorrência local mais frequente no primeiro 12 .O objetivo deste artigo é mostrar nossa experiência cirúrgica com meduloblastomas no adulto e enfatizar os fatores relativos ao comportamento clínico, diagnóstico, cirurgia, bem como a análise de complicações e sobrevida, ressaltando possíveis fatores prognósticos.
Homenagem de Marcelo dos Santos Prudente para Marcelo Denny.
O presente artigo se propõe a acompanhar parte das quebras de paradigmas e percepções sociais desde os primeiros museus, e seu conceito eurocêntrico e colecionista, distante da pluralidade atual, até as discussões sobre a relevância enquanto espaço público representativo da cultura afro-brasileira tendo o papel decolonial enquanto espaço não-formal de aprendizagem, aparelhos culturais esses, por vezes, perdidos no anacronismo conservador de um formato que não dialoga com os sujeitos que se propõe a refletir. A investigação utiliza da revisão narrativa de literatura como aporte metodológico, embasada em autores da área da história da museologia, da identidade cultural afro-brasileira e da educação patrimonial. Diante disso, o resultado obtido no estudo possibilitou desenhar reflexões para uma reconfiguração dos espaços museais que permitam, quando concebido criticamente, ter na sua potencialidade transformadora a oportunidade de reparar apagamentos históricos por meio de ações para visibilidade de uma diversidade cultural que realmente represente a sociedade do seu tempo.
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