Joacil Carlos da Silva

Hypertonic saline more efficacious than mannitol in lethal intracranial hypertension model

Abstract Background: Medical management of brain edema and elevated intracranial pressure (ICP) is a crucial challenge in neurosurgical practice. Depending on the cause, the treatments for brain edema fall into three categories: stabilization of the blood-brain barrier, depletion of brain water and surgical decompression. Although mannitol is the mainstay of hyperosmolar therapy, hypertonic saline (HS) is emerging as an effective alternative to traditional osmotic agents. Methods: Experimental elevated ICP (50 mmHg) was induced in rabbits using an intracranial balloon. The effects of mannitol and HS (10% NaCl) were compared in this specific physiopathological model. Twelve animals were divided into three groups (control, HS and mannitol) according to intravenous administration of 0·9% NaCl, 10% NaCl or 20% mannitol 5 minutes after the elevation of ICP. The doses of 10% NaCl and 20% mannitol were iso-osmolar. During 90 minutes, continuous recording of ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) was realized. Results: The control group had a median survival of only 53 minutes, significantly lower than the treated groups (p = 0·0002). There was statistical difference between mannitol and HS; the 10% NaCl group had lower values of ICP (p = 0·0116) and higher values of MAP (p<0·0001) and CPP (p<0·0001). Conclusion: The findings demonstrate higher efficacy of the 10% NaCl treatment in this comparison with 20% mannitol. Further efforts should be directed toward development of clinical studies using iso-osmotic doses of mannitol and HS in specific etiologies of intracranial hypertension.

Aplasia cutis congenita of the scalp

Dr. João Paulo Cavalcante de Almeida – Rua Paulo Morais 130 60175-175 Fortaleza CE Brasil. E-mail: jpaulocavalcante@yahoo.com.br Aplasia cutis congenita (ACC) is an uncommon disorder that presents as a focal defect of the skin at birth, frequently involving the midline over the skull vertex (70%), but it may affect any region of the body. Since 1767, about 500 cases have been reported in medical literature. The skin lesions are quite variable, ranging from absence of skin to a complete lack of subcutaneous tissue, bone or even the dura. The ACC can be isolated or associated with other malformations in a genetic syndrome, like Adams-Oliver syndrome. There are no exact etiologies for ACC, but some conditions have been associated to it like intrauterine vascular ischemia, amniotic adherences and viral infections. Teratogenic medications like metimazole and misoprostol have been proposed as causes of ACC. There is no consensus about the ideal treatment for the ACC, which is probably related to the low prevalence and incidence of this condition. The treatment options are conservative management or surgical correction, based on the clinical picture presented by each patient.

Estudo comparativo macroscópico dos defeitos osteocondrais produzidos em fêmures de coelhos preenchidos com gel de biopolímero da cana-de-açúcar

OBJECTIVE: To study the surface, coloring, consistency, continuity and healing of osteochondral defects produced in the femoral condyles of rabbits and filled with sugar cane biopolymer gel (SCBG), after 90, 120 and 180 days, and in comparison with a control group. METHOD: Sixteen adult New Zealand white rabbits aged 6 to 7 months, weighing between 2 and 2.5 kg and without locomotor system abnormalities were studied. In all the animals, a defect was made in the femoral condyles of the right and left knees, measuring 3.2 mm in diameter and 4 mm in depth, using a trephine. The animals were divided into two groups: study group formed by the right knees, in which the medial and lateral condyles received implants of SCBG; and control group formed by the left knees, in which the medial and lateral condyles were allowed to heal naturally. The knees were assessed 90, 120 and 180 days after the operation. After the animals had been sacrificed, the anatomical specimens were resected and placed in Bouins solution. They were then photographed with a Nikon Coolpix 5400® coupled to a Nikon SM2800® stereoscopic loupe, to analyze the surface, coloring, consistency, continuity and healing. RESULTS: The results were evaluated using the chi-square test. There were no significant differences in the macroscopic assessments of healing between the study and control groups. CONCLUSION: With regard to the surface, coloring, consistency, continuity and healing of the defects, the macroscopic appearance of the tissue repaired with SCBG was similar to that of the control group.

Schistosomiasis mansoni presenting as a cerebellar tumor: case report

The Mansons schistosomiasis tumoral form rarely affects the brain. There are only 12 cases prior related with a mean age of 25 years and a male predominance. We describe a 16-year-old Brazilian Northeastern boy with a cerebellar mass lesion. The radiological aspect was considered compatible with glioma and a gross total resection was performed. Microscopic examination disclosed intraparenchymal granulomas surrounding Schistosoma mansoni eggs. The case is compared with the literature findings and some peculiar aspects of this trematode infection are reviewed.

Comparative study of the areas of osteochondral defects produced in the femoral condyles of rabbits treated with gel of sugarcane biopolymer

PURPOSE To measure the healed areas of osteochondral defects produced in femoral condyles of rabbits filled with biopolymer sugar cane gel and to compare these with those of the control group at 90, 120 and 180 days. METHODS A study was made of 16 New Zealand rabbits, 6 and 7 months old, weighing between 2 and 2.5 kg. Defects of 3.2 x 4 mm were made, with trephine, in the femoral condyles of the right and left knees. As to the study group defects of the medial and lateral condyles of the right knee were used which were filled with Biopolymer Sugar Cane Gel; as to the Control Group defects of the medial and lateral condyles of the left t knees were used which were left open for natural healing. The defects were analyzed at 90, 120 and 180 days after surgery. After euthanasia, the knees were removed and fixed in Bouins solution for later digital photographic documentation with a digital camera. The areas healed were measured in both the study and control groups using the images obtained from an Image-J(®) program. Statistical analysis was conducted using the non-parametric Mann-Whitney test. RESULTS There were no significant differences between the means of the healed areas in the study and control groups at 90, 120 and 180 days after surgery. CONCLUSION The dimension of the healed areas of the defects treated with the biopolymer sugar-cane gel in the study group was similar to those of the control group, which healed naturally.

Craniovertebral junction malformation in Northeastern Brazil: the myth of the Dutch colonization

The high prevalence of craniovertebral junction malformation in Northeastern Brazil is historically associated with brachycephalic biotype (flat head), also common in this region. It has been postulated that this trait was introduced to this region by the Dutch during the colonial period in Brazils history. Based on the confrontation of this paradigm against some historical facts, the authors concluded that the brachycephalic phenotype was inherited from prehistoric ancestors (Amerindians) who were already living in this region when white European men arrived.

Comparative macroscopic study of osteochondral defects produced in femurs of rabbits repaired with biopolymer gel cane sugar

Objective: To study the surface, coloring, consistency, continuity and healing of osteochondral defects produced in the femoral condyles of rabbits and filled with sugar cane biopolymer gel (SCBG), after 90, 120 and 180 days, and in comparison with a control group. Method: Sixteen adult New Zealand white rabbits aged 6 to 7 months, weighing between 2 and 2.5 kg and without locomotor system abnormalities were studied. In all the animals, a defect was made in the femoral condyles of the right and left knees, measuring 3.2 mm in diameter and 4 mm in depth, using a trephine. The animals were divided into two groups: study group formed by the right knees, in which the medial and lateral condyles received implants of SCBG; and control group formed by the left knees, in which the medial and lateral condyles were allowed to heal naturally. The knees were assessed 90, 120 and 180 days after the operation. After the animals had been sacrificed, the anatomical specimens were resected and placed in Bouins solution. They were then photographed with a Nikon Coolpix 5400® coupled to a Nikon SM2800® stereoscopic loupe, to analyze the surface, coloring, consistency, continuity and healing. Results: The results were evaluated using the chi-square test. There were no significant differences in the macroscopic assessments of healing between the study and control groups. Conclusion: With regard to the surface, coloring, consistency, continuity and healing of the defects, the macroscopic appearance of the tissue repaired with SCBG was similar to that of the control group.

An Innovative Technique of Decompressive Craniectomy for Acute Ischemic Stroke

Currently, malignant hemispheric infarction is one of the main indications for DH (Chen et al., 2006; Delashaw et al., 1990; Rengachary et al., 1981; Schwab et al., 1998; Merenda & DeGeorgia, 2010) either when the intracranial hypertension does not respond to conservative therapies (i.e., osmotic therapy, hyperventilation, etc.); or when there is an important brain shift of the midline structures, or both (Gerriets et al., 2001).

Radicular dysfunction preponderance at early phase clinical evaluation in myelitis by Schistosoma mansoni

UNLABELLED In neuroschistosomiasis, the spinal cord is the most common place of the disease. In high prevalent areas for schistosomiasis mansoni, the clinical alertness is important for an early diagnostic, in order to decrease the final neurological damage. This study provides some useful neurologic information about a series of patients with schistosomal myelitis. METHOD The sample consisted of 13 schistosomiasis mansoni carriers examined at the moment of the diagnosis of myelitis. RESULTS The classical triad (lumbago, weakness at the lower limbs and urinary dysfunctions) was documented in 11 (86.61%) patients. The distribution of the clinical forms was: myeloradicular in six patients (46.15%), radicular in four (30.76%) and myelitic in three (23.07%). CONCLUSION The radicular dysfunction and their clinical associated forms were the most prominent pattern during the early phase of this disease.

Tuberculose óssea craniana: relato de caso

Tuberculosis is endemic in developing countries. However, calvarial tuberculosis is rare and only few cases have been reported with computed tomographic findings. We report on a 49-year-old woman with a occipital painless nodule. The microscopic examination indicated typical tuberculosis granulomas. Clinical presentation and management are discussed.