Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

Avaliação da pressão liquórica em pacientes obstétricas submetidas à anestesia subaracnoidea que apresentaram cefaleia pós-punção dural

Pós-graduação em Anestesiologia - FMB

Rehabilitacion oral sobre implantes instalados por medio de la tecnica sin colgajo (flapless) y carga inmediata

The oral rehabilitation with osseointegrated implants is a well-documented treatment with high rate of success. Nevertheless, demands related to treatment time and surgical technique began to appear. In this context, the procedure of immediate loading in which the dental prosthesis is placed right after implant surgery has become a constant practice. Although immediate loading has been an important advance, minimally invasive procedures, such as implant placement without raising a mucoperiosteal flap (flapless) are increasingly being performed. Association of immediate loading with the flapless technique improves acceptance by patients and professionals, because no suturing is required. Moreover, it reduces swelling, bleeding during and after surgery, postoperative pain, surgery time, discomfort and hematoma, as well as the need for postoperative medication. These characteristics ease the stages of rehabilitation soon after implant placement, cooperating with prosthodontist's work. Thus, the proposal of this study is to present a clinical case of oral rehabilitation with osseointegrated implants and fixed prosthesis in both arches, in which the flapless technique was applied, followed by immediate loading. It will discuss the diagnosis, prosthetic planning, surgical/prosthodontic procedures and follow-up for 20 months.

Plasma rico em plaquetas, medula óssea ou quitosana nas osteossínteses minimamente invasivas na tíbia de cães

Pós-graduação em Cirurgia Veterinária - FCAV

Human death caused by a giant anteater (Myrmecophaga tridactyla) in Brazil

The fatal outcome of a defensive attack by a giant anteater (Myrmecophaga tridactyla) is reported. The attack occurred while the victim was hunting, and his dogs cornered the adult anteater, which assumed an erect, threatening position. The hunter did not fire his rifle because of concern about accidentally shooting his dogs. He approached the animal armed with a knife, but was grabbed by its forelimbs. When his sons freed him, he had puncture wounds and severe bleeding in the left inguinal region; he died at the scene. Necroscopic examination showed femoral artery lesions and a large hematoma in the left thigh, with death caused by hypovolemic shock. A similar case is cited, and recommendations are made that boundaries between wildlife and humans be respected, especially when they coinhabit a given area.

Clinical evaluation of the bicoronal flap in the treatament of facial fractures: retrospective study of 132 patients

The aim of the present study was to evaluate the postoperative complications of bicoronal flaps used to treat facial fractures. One hundred and thirty two patients that received bicoronal flaps for the treatment of upper and middle third facial fractures were called for clinical and radiographic examination. Minimum follow-up was 1 year and all patients had charts with adequate information about their perioperative care pertinent to the study. Results showed as complications hypoesthesia (17%), partial unilateral frontal motor deficit (11%), infection (3%), hypertrophic scars (3%), varying degrees of alopecia (18%), seroma or hematoma in the immediate postoperative period (5%). The flap provided wide surgical access to the upper and middle facial thirds with very few serious complications, most frequently allowing good aesthetic results.

Impacto do estresse no bem-estar dos animais e na qualidade da carcaça e da carne

Pós-graduação em Zootecnia - FCAV

Spontaneous intracerebral hemorrhage treated by neuroendoscopy: technical note

Spontaneous intracerebral hemorrhage (SICH) is responsible for 10%-15% of the acute stroke. Hematoma or the occlusion of cerebrospinal fluid (CSF) flow by ventricular clotting can result in obstructive hydrocephalus, increasing intracranial pressure, which needs urgent decompression. We report our results of management of spontaneous deep cerebral hematoma by endoscopic approach.

Hemofilia A em cão: relato de caso

Hemophilia A is an X-linked inherited disorder characterized by a Factor VIII (FVIII) deficiency, being therefore transmitted by female dogs to their offspring. Since it is a secondary hemostatic defect, the main clinical signs are hematomas and deep hemorrhage in body cavities, muscles and joints. A four-month-old male Boxer was presented to the Veterinary Hospital at the School of Veterinary Medicine and Animal Science in Botucatu with excessive bleeding due to an incision made three days prior by another veterinarian to drain a local hematoma. Laboratory results showed platelet count within the reference range, as well as prolonged whole blood clotting and activated partial thromboplastin times. FVIII activity was 0,96%, which characterizes the most severe degree of hemophilia A.

Biopsia renal percutânea monitorizada por ultrassonografia em cães

Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP)

Endovascular Treatment for Acute Aortic Syndrome

Background: The term "acute aortic syndrome" (AAS) includes conditions of high mortality, such as ruptured aneurysm, pseudoaneurysm and, aortic dissection. Open surgery for these cases has demonstrated unsatisfactory results, and endovascular treatment has become an excellent alternative. Methods: We performed a retrospective review of patients with AAS who underwent endovascular treatment in our emergency department from July 2009 to February 2011. They represent 64% (16 of 25) of all patients with AAS seen during this period. Results: Sixteen patients underwent endovascular treatment: eight ruptured aneurysms, six aortic dissections, one nonruptured painful aneurysm, and one pseudoaneurysm. No intramural hematoma or penetrating atherosclerotic ulcer was found. The mean age was 64.3 years, and arterial hypertension (100%) and smoking (64.7%) were the major comorbidities. Technical success rate was 93%, and overall 30-day mortality was 6.25%. Conclusion: Endovascular treatment for AAS was feasible. Technical success, 30-day mortality, hospital stay, and procedure time were similar to those of the other series reported in the literature, and the endovascular approach has became the main technique for AAS in our hospital.

Incidence of adverse events associated with percutaneous muscular biopsy among healthy and diseased subjects

The development of the percutaneous muscle biopsy technique is recognized as one of the most important scientific contributions in advancing our understanding of skeletal muscle physiology. However, a concern that this procedure may be associated with adverse events still exists. We reported the incidence of adverse outcomes associated with percutaneous muscle biopsy in healthy and diseased subjects. Medical records of 274 volunteers (496 muscle biopsies) were reviewed. This included 168 healthy subjects (330 muscle biopsies) as well as 106 chronically ill patients (166 muscle biopsies). This latter group encompassed patients with type II diabetes (n=28), osteoarthritis (n=39), inclusion body myositis (n=4), polymyositis (n=4), and chronic heart failure (n=31). The most common occurrences were pain (1.27%), erythema (1.27%), and ecchymosis (1.27%). Panic episode, bleeding, and edema were also reported (0.21%, 0.42%, and 0.84%, respectively), while infection, hematoma, inflammation, denervation, numbness, atrophy, and abnormal scarring were not verified. The percent of incidents did not differ between healthy and ill individuals. In conclusion, the incidence of complications associated with percutaneous muscle biopsy is scarce and of minor clinical relevance. Additionally, the rate of adverse events is comparable between healthy and chronically ill subjects.

Endovascular Treatment of Tentorial Dural Arteriovenous Fistulae

Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which accounts for less than 4% of all cases of intracranial DAVF Because of the high risk of intracranial hemorrhage, patients with tentorial DAVF need aggressive treatment. Management approaches are still controversial, and endovascular treatment has emerged as an effective alternative. In the current work, we describe our experience with the endovascular approach in the treatment of these deep and complex DAVF of the tentorium. Eight patients were treated between January 2006 and July 2009. Six patients (75%) presented with intracranial hemorrhage related to the DAVF rupture. Four patients (50%) had subarachnoid bleeding and two had intraparenchymal hematoma. Endovascular treatment was performed via the transarterial route alone in five cases (62.5%), by the transvenous approach in two cases (25.0%) and in a combined procedure using both arterial and venous routes in one patient (12.5%). Complete obliteration of the fistula was achieved in all cases. The outcome at 15 months was favorable (modified Rankin scale 0-3) in seven (87.5%) patients. Complete cure of the lesion was confirmed in these cases. This paper reports on the effectiveness of endovascular treatment in tentorial DAVF management The choice of the venous versus the arterial approach is determined by regarding different anatomical dispositions.

Whole-body computerized tomography and concomitant spine and head injuries A study of 355 cases

The authors present a prospective study on the coexistence of spinal injury (SI) and severe traumatic brain injury (TBI) in patients who were involved in traffic accidents and arrived at the Emergency Department of Hospital das Clinicas of the University of Sao Paulo between September 1, 2003 and December 31, 2009. A whole-body computed tomography was the diagnostic method employed in all cases. Both lesions were observed simultaneously in 69 cases (19.4%), predominantly in males (57 individuals, 82.6%). Cranial injuries included epidural hematoma, acute subdural hematoma, brain contusion, ventricular hemorrhage and traumatic subarachnoid hemorrhage. The transverse processes were the most fragile portion of the vertebrae and were more susceptible to fractures. The seventh cervical vertebra was the most commonly affected segment, with 24 cases (34.78%). The distribution of fractures was similar among the other cervical vertebrae, the first four thoracic vertebrae and the lumbar spine. Neurological deficit secondary to SI was detected in eight individuals (11.59%) and two individuals (2.89%) died. Traumatic subarachnoid hemorrhage was the most common intracranial finding (82.6%). Spinal surgery was necessary in 24 patients (34.78%) and brain surgery in 18 (26%). Four patients (5.79%) underwent cranial and spinal surgeries. The authors conclude that it is necessary a judicious assessment of the entire spine of individuals who presented in coma after suffering a brain injury associated to multisystemic trauma and whole-body CT scan may play a major role in this scenario.

Performance of fixed-pressure valve with antisiphon device SPHERA (R) in hydrocephalus treatment and overdrainage prevention

Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA (R) in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.