S urgical clipping of MCA aneurysms is usually preferred to EVT. This preference is largely the result of a relatively easy surgical access and unfavorable endovascular approach due to the complex branching pattern of the MCA. As of this writing, no direct comparison between results of endovascular and surgical treatment of MCA aneurysms has been published in the literature, leaving the optimal treatment strategy unclear and choices depending mainly on the practice at the different centers. We therefore considered it important to study procedure-related risks as well as the immediate and midterm angiographic and clinical results after EVT of MCA aneurysms. MethodsFrom October 1992 to October 2001, a total of 940 patients with 1120 cerebral aneurysms were seen in our institute. Of these 940 patients, 202 (21.5%) were found to have MCA aneurysms (a total of 238 [21.3% of all identified aneurysms]). The closing date was chosen to have more than 5 years of follow-up data.Since the first use of detachable coils in our department in October 1992, data pertaining to all patients referred for EVT has been prospectively recorded. These data include: patients' demographic characteristics, mode of presentation, aneurysmal angiographic features, angiographic outcome at immediate post-EVT and follow-up examinations, procedure-related complications, and clinical status, using Hunt and Hess grading (in case of hemorrhage) on admission and GOS scores upon discharge Object. The object of this study was to evaluate the initial and mid-term angiographic and clinical results after endovascular coil occlusion of middle cerebral artery (MCA) aneurysms at the authors' institution.Methods. The authors conducted a retrospective analysis of a consecutive series of 152 MCA aneurysms (73 ruptured) treated by endovascular coiling in 140 patients. Angiographic and clinical data at initial and midterm follow-up as well as procedure-related complications were prospectively registered.Results. At discharge, favorable clinical outcomes (Glasgow Outcome Scale score of 1 or 2) were obtained in 89.3% of patients (125/140). Seven patients (5%) were in a vegetative state or had died. Complications were encountered in association with 11.8% of the procedures (18/152), and most (13/18) involved thromboembolic events (which led to permanent ischemia in 4 cases and death in 1). The overall procedure-related mortality rate was 0.7%, and the rates of permanent and transient morbidity were 2.6 and 2%, respectively. At a mean follow-up duration of 4.3 years there had been 4 cases of rebleeding: early rebleeding occurred during the initial postoperative period in 3 cases and later in 1. Total or subtotal occlusion was obtained in 84.2% of aneurysms (128/152). At follow-up, this satisfactory occlusion persisted in 83.3% of aneurysms (110/132) at 1 year posttreatment, 79.5% (89/112) at 3 years, and 80.2% (73/91) at 5 years.Conclusions. Risks and initial and midterm angiographic and clinical results after endovascular treatment of MCA aneurysms are nearly identi...

The aim of this study was to describe the differences in the profile of elderly residents in non-profit and for-profit Long-Term Residential Institutions for the Elderly (ILPI). We visited 12 ILPIs in the city of Natal, Rio Grande do Norte. Six of them were non-profits housing 260 elderly, and six were for-profit institutions, housing 127 elderly. The unequal characteristics of the elderly in these facilities are based on socioeconomic data and the reason for institutionalization. The data was submitted to Chi-squared or Student's t, with a significance level of 5%. Illiterate, single, black or brown, individuals with no retirement/pension or healthcare plan, no children and no visitors who purchase something outside the institution with their own money are associated with non-profit ILPIs. When analyzing the reasons for institutionalization, family conflict, abandonment and being homeless were associated with the elderly institutionalized in non-profit ILPIs. The main reason for the elderly institutionalized in for-profit ILPIs was "being ill". The conditions of the elderly in non-profit ILPIs were poorer, reflecting the social inequality these subjects experienced throughout their lifetime.

OBJECTIVEDural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous connections within the dural leaflets. Their associated symptoms may be mild or severe and are related to the patient’s venous anatomy. With the hypothesis that the patient’s venous anatomy determines the development of symptoms, the authors aimed to identify which venous anatomy elements are important in the development of major symptoms in patients with a DAVF.METHODSA multicenter study was performed based on the retrospective analysis of cerebral angiographies with systematic assessment of brain drainage pathways (including fistula drainage) in patients over 18 years of age with a single DAVF. The patients were divided into two groups: those with minor (group 1, n = 112) and those with major (group 2, n = 89) symptoms. Group 2 was subdivided into two groups: patients with hemorrhage (group 2a, n = 47) and patients with severe nonhemorrhagic symptoms (group 2b, n = 42).RESULTSThe prevalence of stenosis in DAVF venous drainage and the identification of tiny anastomoses between venous territories were significantly higher in group 2 (32.6% and 19.1%, respectively) compared with group 1 (2.68% and 5.36%, respectively). Stenosis of DAVF venous drainage was significantly more frequent in group 2a than in group 2b (51.1% vs 11.9%, p < 0.001). Group 2b patients had increased prevalence of shared use of the cerebral main drainage pathway (85.0% vs 53.2%, p = 0.002), the absence of an alternative route (45.0% vs 17.0%, p = 0.004), and the presence of contrast stagnation (62.5% vs 29.8%, p = 0.002) compared with group 2a patients. In patients with high-grade fistulas, the group with major symptoms had increased prevalence of a single draining direction (31.3% vs 8.33%, p = 0.003), stenosis in the draining vein (35.0% vs 6.25%, p = 0.000), the absence of an alternative pathway for brain drainage (31.3% vs 12.5%, p = 0.017), and the presence of contrast stagnation (48.8% vs 22.9%, p = 0.004).CONCLUSIONSMajor symptoms were observed when normal brain tissue venous drainage was impaired by competition with DAVF (predominance in group 2b) or when DAVF venous drainage had anatomical characteristics that hindered drainage, with consequent venous hypertension on the venous side of the DAVF (predominance in group 2a). The same findings were observed when comparing two groups of patients with high-grade lesions: those with major versus those with minor symptoms.

Implantes dentários realizados imediatamente após a exodontia contam com uma alta taxa de sucesso e permitem a reabilitação do paciente com uma quantidade menor de intervenções para a finalização do caso. O estudo em questão tem o objetivo de relatar um caso de uma paciente que foi submetida a técnica do implante imediato em área estética. Neste artigo é relatado um caso clínico de uma paciente do sexo feminino, jovem, onde houve a indicação de exodontia do elemento 11, incisivo central direito, e após a exodontia atraumática foi feita a instalação do implante dentário de forma imediata, entretanto, sem carga imediata. Foi utilizado enxerto ósseo Geistlich Bio-Oss® para preencher os espaços entre o implante e o alvéolo e para melhorar a qualidade dos tecidos moles foi feito enxerto de tecido conjuntivo concomitante. A reabilitação provisória da paciente consistiu na instalação de uma prótese adesiva, que permite a reabilitação provisória, sem colocar carga no implante recém instalado e sem realizar desgaste nos dentes adjacentes. Sabe-se que a estética do sorriso tem impacto direto na autoestima do paciente, já que os seres humanos são seres sociais que baseiam toda sua existência na comunicação e imagem, ter uma parte de destaque da face afetada negativamente pode trazer enormes prejuízos ao auto apreço e relações psicossociais. Desta forma, o uso desta técnica possibilitou a reabilitação da paciente de forma funcional e estética, tendo ganho em sua qualidade de vida.

Objective: to evaluate the prevalence of halitosis and associated factors in institutionalized elderly persons. Methods: a sectional study was performed with 268 elderly persons from 11 long-term care institutions in Natal in the northeast of Brazil. Data collection included an oral epidemiologic examination and questions about self-perception of oral health, as well as a consultation of medical records and the application of a questionnaire to the directors of the institutions. Halitosis was measured using the organoleptic test. The independent variables were oral, sociodemographic, institutional, general health and functional conditions. Bivariate analysis was performed using the Pearson chi-square test and Fisher's exact test, and the magnitude of effect was verified by the prevalence ratio for the independent variables in relation to the outcome, with a 95% confidence level. Results: the prevalence of halitosis was 26.1%, which was exhaled by the mouth in 98.57% of cases and by the nose in 10% of cases. Prevalence was 43% higher among nonwhite individuals ( p=0.006); 65% higher among those living in non-profit institutions ( p=0.039); 52% higher in elderly persons with oriented cognitive status ( p=0.047); 41% higher in elderly persons with root caries ( p=0.029); 62% higher in those who did not use dentures ( p=0.046); 57% lower in edentulous persons ( p<0.001); and 73% higher in elderly individuals with tongue biofilm ( p=0.001). Conclusion: The occurrence of halitosis in institutionalized elderly persons was similar to other studies, but there was an expressive number of extrabuccal cases and an association with oral health problems, as well as sociodemographic, institutional and functional factors.

RESUMO -Analisam-se 51 pacientes portadores de 55 aneurismas paraclinóideos (APC) submetidos a tratamento cirúrgico. Em decorrência de tratar-se de procedimento de alta complexidade, descrevemos em pormenor os seus aspectos técnicos. O processo clinóideo anterior foi removido por via extradural após secção da duplicação dural da tenda da fissura orbitária superior e/ou por via intradural. Conseguiu-se exclusão do APC nos 51 pacientes. Em dois casos a clipagem foi parcial e, em três, ocorreu oclusão da ACI. Em 42 (82%) pacientes ocorreu bom resultado; em 5 (10%), incapacidade moderada; em 1 (2%), incapacidade grave e três (6%) faleceram por infarto cerebral. Sete (13,7%) pacientes tiveram lesão adicional do nervo óptico, sendo parcial em 4 (7,7%) e total em 3 (6%). PALAVRAS-CHAVE: aneurismas paraclinóideos, aneurismas carótido-oftálmicos, artéria carótida interna, técnica cirúrgica. Paraclinoid aneurysms: surgical technique and results in 51 patientsABSTRACT -An analysis of the surgical results of 51 patients harboring 55 paraclinoid aneurysms is performed, along with a throughoutful description of it's complex microsurgical technique.The anterior clinoid process was removed by the extradural route after sectioning the dural duplication between the superior orbital fissure and the dura of the temporal lobe, and/or by the intradural approach. All 55 aneurysms was excluded. In two cases the clipping was partial and the internal carotid artery were ocluded in three cases. The surgical outcome was good in 42 (82%) patients, moderate incapacity occurred in five (10%) and severe incapacity in one patient (2%). Three patients (6%) died due to brain infarction. Seven patients (13,7%) had adicional lesion of the optic nerve, being partial in 4 (7,7%) and total in 3 (6%).KEY WORDS: paraclinoid aneurysms, carotid-ophthalmic aneurysms, internal carotid artery, operative technique.Os aneurismas paraclinóideos (APC), ou carótido-oftálmicos ou dos segmentos clinóideo e oftálmico da artéria carótida interna (ACI), são definidos como os aneurismas da ACI intratecal que se originam do segmento que é delimitado proximalmente pelo anel dural proximal e distalmente por um círculo imaginário em torno da ACI, na emergência da artéria comunicante posterior 1 .A incidência dos APC varia de 1,5 a 8% entre todos os aneurismas intracranianos. Eles formam um subgrupo especial em decorrência das dificuldades na abordagem determinadas pelas íntimas relações desses aneurismas com o nervo óptico, nervo oculomotor, seio cavernoso e processo clinóideo anterior. Como nos aneurismas em geral, os APC manifestam-se geralmente por ruptura e hemorragia subaracnóidea. . Ele propôs a remoção extradural do processo clinóideo anterior, do teto da órbita e das paredes superior e lateral do canal óptico para propiciar melhor exposição desses aneurismas.O objetivo deste estudo é revisar a técnica microcirúrgica usada na exposição completa dos segmentos clinóideo e oftálmico (segmento paraclinóideo) da ACI, no sentido de expor e clipar os APC, e relatar o resul...

Descrevemos o raro caso de um paciente de 45 anos portador de lesão expansiva intracraniana por angiopatia amilóide cerebral com características clínicas e de imagem compatíveis com um glioma de baixo grau. A biópsia revelou angiopatia amilóide cerebral. Os achados clínicos, radiológicos e histopatológicos são discutidos e analisados juntamente à literatura disponível.

Objective: to suggest a composite indicator that identifies the oral health condition of institutionalized elderly persons. Method: an observational and cross-sectional study was performed. A total of 315 elderly persons were investigated in long-stay care facilities for the elderly in the city of Natal, Rio Grande do Norte, Brazil. Such individuals underwent an epidemiological evaluation of their oral health conditions, based on the DMFT index, CPI and the PAL (periodontal attachment loss) index. Factor analysis was used to identify a relatively small number of common factors by principal component analysis. Results: five oral health variables were included in factor analysis, and using the Kaiser criterion, which considers the percentage of variance explained by the factors, a single factor which together explained 79.7% of the total variance of the variables included in the analysis model was selected. This factor was analyzed and interpreted according to the dimension to which it related, and was entitled the factor of Dental Functionality. Conclusion: this factor generated an objective indicator to characterize the oral health of the elderly in long-term care facilities for the elderly of Natal, Rio Grande do Norte, and represents a parameter for studies of the oral health outcomes of this elderly population. It also revealed a change in the dental profile of this population with more teeth present in the mouth and a reduction in edentulism.