Scleral fixation is a versatile surgical approach in the setting of lens bag instability. Recently, a double-flanged polypropylene technique to fixate the intraocular lens in the sclera has been described. A common concern in using any flanged scleral fixation technique is the risk of infection and endophthalmitis secondary to exposed fixation material, which can erode through the conjunctiva. In this report, a case of an exposed polypropylene flange presenting 1 month postoperatively in a 70-year-old female patient who underwent a 4-flanged fixation procedure is described. The successful surgical management of this case is described as well as other operative considerations to reduce the risk of exposed fixation material and subsequent postoperative infection. The correct placement of scleral fixation material as well as regular clinical review is vital in reducing the risk of postoperative endophthalmitis.

We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treatment and physiotherapy, in an interval of one year, later examinations showed that there was spontaneous healing of AB.

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Introduction The observation of multiple lesions in a skull computed tomography (CT) scan is always cause for concern because of the frequent possibility of neoplastic etiology, although granulomatous, infectious, vascular, iatrogenic, demielinating, trauma, parasitic diseases, and strokes can produce a similar aspect on radiology. A wide range of non-neoplastic conditions can mimic a brain tumor, both clinically and radiologically, representing a potential pitfall for physicians involved in patient care. The study's goal is to alert specialists to the possibility of other neoplastic and nonneoplastic etiologies in the differential diagnosis of hypodense lesions in non-contrast. Methods We performed a literature review using PubMed, Medline, Science Direct, Embase, Clinical Trials, Ebsco, and Scielo. Articles were selected in the period of 1986 to 2015. Discussion Knowledge of various etiologies when with multiple lesions appear on computed tomography allows specialists to guide the diagnosis to appropriate treatment, avoiding the irradiation of non-neoplastic lesions and unnecessary surgeries. The most common lesions were the neoplasm (74% to 86%), especially gliomas, followed by infections (8% to 15%), and infarcts (0.6% to 6%), which represent nonneoplastic lesions.

Introduction Chronic subdural hematoma (CSH) is a hemorrhagic brain injury that persists for more than 21 days after its initial formation. The incidence is predominantly among the elderly population (> 65 years), and varies from 58 to 74/100,000 inhabitants. Spontaneous resolution is considered variable; in the literature series, it is < 1-20% of cases. Objectives To expose the CSH pathophysiological mechanisms of spontaneous resolution and some treatments that lead to hematoma volume reduction. Methods Literature review between 1971 to 2016, using the PubMed, Medline, Embase, Scielo, LILACS and Cochrane databases using key-words, with inclusion and exclusion criteria. Discussion Spontaneous resolution of the CSH pathophysiology is controversial; however, it can be attributed to four basic mechanisms: 1) outer capsule membrane maturation; 2) decreased fibrinolysis; 3) bidirectional flow of blood vessels; and 4) platelet plug. Some drugs, such as mannitol, corticosteroids, tranexamic acid and atorvastatin, contribute to CSH resolution, since they change the capsule membrane permeability, and inhibit the fibrinolytic and inflammatory systems. Conclusion Spontaneous resolution is unpredictable; in some cases, it has a large temporal evolution (of up to 6 years). It occurs in small or laminar collections, asymptomatic or with transient neurological symptoms, and the pathophysiology is still controversial to this day. Therefore, surgical treatment should remain the first option, even though the conservative management is adopted for some patients. Rigorous outpatient and radiological follow-up are recommended.

Specialists rarely perform neurosurgical procedures on patients in the semi-sitting position. This is due to several factors, most importantly, the perception of risks associated with this position and lack of practice in some services. Nevertheless, the benefit of this position is still the subject of controversy both in neurosurgery and neuroanesthesia. Our objective is to report on the benefits associated to its use for posterior fossa diseases and dorsal cervical spine procedures, through cases in the literature. We survey and analyze state-of -the art works that mention the semi-sitting position, based on searches in Pubmed, Scielo, Science Direct, and Lilacs. We found 46 original articles on the subject that we included in the review. This review demonstrates that the advantages for access in this position include gravitational drainage of venous blood and cerebrospinal fluid, easier surgical access to midline structures, as well as reduced cerebellar edema, surgery time and blood loss. This technique also allows ventilation with low pressure, less impairment of diaphragmatic motion, and better access to the tracheal tube. There are, however, some disadvantages, among which the most serious is paradoxical arterial embolism. We describe early detection methods of complications and discuss situations that can factor in to the choice of position. In summary, a semi-sitting position is safe and effective in neurosurgical posterior fossa and the upper cervical spine, provided there is a joint effort between neurosurgeons and anesthesiologists in selecting patients and complying with the technical standards favorable to this technique.

Vítimas de lesões medulares têm sido frequentes emconsequência de acidentes automobilísticos, quedas de altura e outras lesões traumáticas geradas pelo crescimento da violência urbana. A lesão medular leva a um importante impacto tanto ao nível físico quanto psicológico e se associa a vários graus de incapacidade que contribui para o  comprometimento da qualidade de vida dos pacientes e familiares. O TRM cervical pode ocasionar uma série de problemas neurológicos, envolvendo a perda da função sensitiva e motora, disfunção esfincteriana e intestinal, espasticidade,dor neuropática e DISREFLEXIA AUTONÔMICA. Asdisfunções autonômicas após o TRM cervical são responsáveis pelo aumento da morbidade e mortalidade, tanto na sua fase aguda como na crônica. Do ponto de vista terapêutico é necessário intervir precocemente, se possível, para evitar maiores danos tissular, medular e complicações, estabelecendo uma terapêutica medicamentosa que promova neuroproteção. O objetivo desta monografia é levar o conhecimento sobre essaafecção a todos os envolvidos no tratamento e na reabilitação dos pacientes vítimas de TRM, principalmente cervical; contribuir para ampliar os conhecimentos dos cuidadores de indivíduos vítimas de TRM cervical e seus familiares, bem como na compreensão e participação da sociedade.

Hans van Chiari (1851-1916) was an illustrious physician who gave many contributions to the scientific knowledge of Medicine and medical history. This paper describes a brief historical note and his contribution along the history of Medicine.