Intraoperative Neuropsychological assessment in brain tumors ressection located at eloquent areas - Is it ethical not considering "awake surgery"?

 Brain tumors consist of a heterogeneous group of lesions with potential surgical morbidity when located in eloquente brain areas (motor area, language areas, visual areas, etc.) (1,6) Although intraoperative neurophysiological monitoring has the potential to decrease the risk of sequelae (hemiparesis/hemiplegia) in surgeries with the patient under general anesthesia (primary motor cortex and subcortical motor tract), this modern armamentarium cannot be used to map the speech (the patient is anesthetized). This is particularly important in a large group of patients with low-grade gliomas located in or aroud language areas

The foramen spinosum: a landmark in middle fossa surgery

The foramen spinosum is an easily identifiable landmark in microsurgery of the middle cranial fossa, and knowledge of the variations in its relationship to the surrounding neurovascular structures is important when operating in this area. We studied the anatomical relationship of the foramen spinosum to the foramen ovale, the mandibular branch of the trigeminal nerve, the greater superficial petrosal nerve, and the petrous part of the internal carotid artery in 12 cadaver heads. We also tried to define an external landmark for early identification of the location of the foramen spinosum in ten dry skulls. We found considerable variations in the anatomy around the foramen spinosum. This knowledge may improve the identification and preservation of the neurovascular structures when using approaches to the middle cranial foss

Relaçăo entre imunomarcaçăo das proteínas Ki-67 e p53 com grau de malignidade e variante histológica em neoplasias astrocitárias /

Orientador: Jurandir Marcondes Ribas FilhoInclui apęndiceTese (doutorado) - Universidade Federal do Paraná, Setor de Cięncias da Saúde, Programa de Pós-Graduaçăo em Clínica Cirúrgica. Defesa: Curitiba, 2004Inclui bibliografi

Receptor tyrosine kinases as candidate prognostic biomarkers and therapeutic targets in meningioma

Meningioma (MGM) is the most common type of intracranial tumor in adults. The validation of novel prognostic biomarkers to better inform tumor stratification and clinical prognosis is urgently needed. Many molecular and cellular alterations have been described in MGM tumors over the past few years, providing a rational basis for the identification of biomarkers and therapeutic targets. The role of receptor tyrosine kinases (RTKs) as oncogenes, including those of the ErbB family of receptors, has been well established in several cancer types. Here, we review histological, molecular, and clinical evidence suggesting that RTKs, including the epidermal growth factor receptor (EGFR, ErbB1), as well as other members of the ErbB family, may be useful as biomarkers and therapeutic targets in MGM

Microanatomia do compartimento arterial do seio cavernoso e suas variações: análise de 24 seios cavernosos

The cavernous sinus is a complex compartment situated in both sides of the sella turcica, being its microsurgical anatomy knowledge of fundamental importance when consider to approach surgically. We studied the arterial microanatomy of 24 cavernous sinus at the microsurgical laboratory, considering that in all the internal carotid artery were filled with colored latex. The meningohypophyseal trunk was present in 18 cases (75%) with its origin in intracavernous portion of the internal carotid artery. In relation to the 18 presented cases with meningohypophyseal trunk, 14 (77.7%) had a trifurcate and 4 (23.3%) had a bifurcate pattern. The tentorial artery was present in all. Its origin was observed, arising from the meningohypophyseal trunk in 17 (70.8%) and as an isolated artery in some extension of the intracavernous portion in 7 (29.1%). An accessory tentorial artery was found in one specimen. The dorsal meningeal artery was present in 22 cases (91.6%). Its origin was in the meningohypophyseal trunk in 17 cases (77.2%), arising from internal carotid artery in 4 cases (18.1%) and from inferior hypophyseal artery in one case (4.1%).The inferior hypophyseal artery was present in all cases, having its origin at the meningohypophyseal trunk in 16 cases (66.6%). In the remaining 8 cases (33.3%) the artery was found arising alone from the intracavernous portion also. The artery of the inferior cavernous sinus or inferolateral trunk was present in all cases and had its origin from internal carotid artery in its intracavernous segment. The McConnell's artery was not found in any cavernous sinus.O seio cavernoso é estrutura complexa localizada de cada lado da sela túrcica, sendo seu conhecimento microanatômico indispensável quando se considera abordar cirurgicamente esta região. Estudaramos em laboratório de microcirurgia a microanatomia dos componentes arteriais deste espaço em 24 seios cavernosos, sendo que em todos a artéria carótida interna estava preenchida com látex colorido. O tronco meningo-hipofisário esteve presente em 18 casos (75%). Quando ausente, as artérias constituintes deste tronco se originaram diretamente das artérias carótidas internas (ACIs) intracavernosas. Quando presente, em 14 casos (77,7%), estavam trifurcados e em 4 casos (23,3%) bifurcados. A artéria tentorial foi identificada em todos os casos, porém sua origem foi variada, ocorrendo no tronco meningo-hipofisário em 17 casos (70,8%) e na artéria carótida interna intracavernosa em 7 casos (29,1%). Em 1 caso verificou-se a presença de uma artéria tentorial acessória. A artéria meningéia dorsal estava presente em 22 casos (91,6%) e ausente em 2 casos (8,4%). Nos seios cavernosos onde a mesma foi identificada, a sua origem ocorreu no tronco meningo-hipofisário em 17 casos (77,2%), da ACI intracavernosa em 4 casos (18,1%) e da artéria hipofisária inferior em 1 caso (4,1%). A artéria hipofisária inferior foi identificada em todos os casos, tendo sua origem no tronco meningo-hipofisário em 16 (66,6%) e na ACI intracavernosa em 8 (33,3%) casos. A artéria inferior do seio cavernoso ou tronco ínfero-lateral foi isolada em 100% dos casos e em todos se originou da ACI intracavernosa. A artéria de McConnell não foi identificada em nenhum seio cavernoso.25926

Facial nerve hemangioma of the lateral portion of the internal acoustic canal : a case report and a review of literature

Introduction facial nerve hemangiomas (FNH) are rare tumors. Although it can occur in any portion of the nerve, it predominantly appears near the geniculate ganglion. We present a case of facial nerve hemangioma of an unusual location. Case Report A 30-year-old woman presented with right-sided severe hearing loss and progressive facial palsy. Magnetic resonance showed a 5 mm lesion in the lateral portion of the right internal auditory canal. Due to facial palsy, the patient was submitted to a translabyrinthine approach and a total tumor resection, followed by hypoglossal-facial nerve anastomosis. Discussion The facial nerve is susceptible in its path to expansive lesions, which have high morbidity. FNH is a rare and difficult-to-diagnose lesion. Computerized tomography and nuclear magnetic resonance can be used in its diagnosis. The differential diagnosis of FNH includes, in addition to schwannomas, meningiomas, cholesteatomas, paragangliomas, and other temporal bone tumors. There is no well-established consensus on the best approach. Because of its slow growth and benign behavior, some studies suggest conservative treatment and serial imaging. However, surgery is the cornerstone of treatment, as it is the only curative option. Conclusion FNHs are often small but very symptomatic. Its high morbidity demands early diagnosis and, sometimes, surgical treatment

Intenção de adoção de Guia de Trânsito Animal Eletrônica (e-GTA) no Rio Grande do Sul, Brasil

Control of livestock and their movement has long been recognized as a crucial for the prevention and control of diseases. In Brazil, the control of livestock movement established in 1934. Since 1995 is regulated based on the Animal Movement Permit (GTA). Since then, the process has been improved and updated on its legal framework and strategies, including the use of emerging technological alternatives, which made possible the launching of the electronic Animal Movement Permit (e-GTA) in 2011. From a broader perspective, the e-GTA is inserted in a global context of the development of Information and Communication Technology (ICT) which since the early 1980s enabled governments worldwide to drive policies for the development of electronic government systems (e-government). After that, at a global level, there was an expansion and improvement of e-government services; however, discrepancies among countries persisted. Nonetheless, the levels of adoption of e-government by citizens have been lower than those expected by government authorities, which has attracted the attention of researchers in the area. In this context, studies of this nature that used theoretical antecedents related to the adoption of ICT have exposed peculiarities of the process of adoption of e-government, demanding research efforts directed to the structuring of specific models for this area. In Brazil, studies of this nature are still at an early stage, although government actions aimed at e-government date back to the 1990s. The objective of this article was to investigate, in an exploratory way, influence factors on the adoption intention of e-government related to animal health, having the e-GTA as the object of research. The conceptual framework was defined based upon the e-Government Adoption Model (GAM) For this objective, an online questionnaire oriented to intention to adopt e-GTA was applied to equine owners of Rio Grande do Sul not users of this system. Results indicated that respondents positively evaluated the quality of their computers and cellphones, as well as their efficacy to operate them, while quality of the internet connection was considered regular. In this context, the availability of computer and cellphone resources and computer self-efficacy did not influence the intention to adopt e-GTA. Moreover, aspects related to compatibility of e-GTA with users lifestyle have a positive association with the intention to adopt e-GTA. Also the study indicated that public information campaigns could contribute to the improvement of adoption of the e-GTA. Additionally, the authors suggested that further investigations considering other livestock sectors and variables, as well as the continuity of use after the adoption, could contribute to the expansion of the knowledge on this field.O controle dos estoques e de movimentações de animais pecuários há muito tempo é reconhecido como um fator crucial para a prevenção e resposta para a introdução e disseminação de doenças animais ou zoonóticas. No Brasil, o controle de movimentação animal foi inicialmente estabelecido em 1934 e, desde 1995, é regulamentado com base na Guia de Trânsito Animal (GTA). Desde então, o processo foi aprimorado e atualizado em seu arcabouço legal e estratégias, inclusive no uso de alternativas tecnológicas emergentes, que possibilitaram o lançamento em 2011 da Guia de Trânsito Animal Eletrônica (e-GTA). Considerado desde uma perspectiva mais abrangente, o e-GTA está inserido em um contexto global de desenvolvimento da Tecnologia da Informação e Comunicação (TIC), que desde o início dos anos 80 permite que governos em todo o mundo conduzam políticas para o desenvolvimento de sistemas de governo eletrônico (governo eletrônico). Posteriormente, a disponibilidade do governo eletrônico tem estado em expansão de qualidade e de amplitude dos serviços oferecidos, embora este processo seja permeado por desigualdades entre os países. No entanto, os níveis de adoção do governo eletrônico pelos cidadãos têm sido inferiores aos esperados pelas autoridades governamentais, o que tem atraído a atenção dos pesquisadores da área. Nesse contexto, estudos dessa natureza, que utilizaram antecedentes teóricos relacionados à adoção das TIC expuseram idiossincrasias do processo de adoção do governo eletrônico, exigindo que esforços de pesquisa sejam direcionados à estruturação de modelos específicos para essa área. No Brasil, estudos dessa natureza ainda estão em estágio inicial, embora as ações governamentais direcionadas ao governo eletrônico datem dos anos 90. Dessa forma, o objetivo deste artigo foi investigar, de forma exploratória, fatores de influência na intenção de adoção do governo eletrônico relacionado à saúde animal, tendo o e-GTA como objeto de pesquisa. A estrutura conceitual foi definida com base no Modelo de Adoção de Governo Eletrônico (GAM). Para esse objetivo, um questionário online dirigido à intenção de adoção do e-GTA foi aplicado a proprietários de equinos do Rio Grande do Sul que não eram usuários deste sistema. Os resultados indicaram que os entrevistados avaliaram positivamente a qualidade de seus computadores e telefones celulares, bem como sua eficácia em operá-los, enquanto a qualidade da conexão de internet foi considerada regular. Nesse contexto, a disponibilidade de recursos informáticos e de celulares, bem como a capacidade de operação dos mesmos não influenciaram a intenção de adoção do e-GTA. Além disso, aspectos relacionados à compatibilidade do e-GTA com o estilo de vida do usuário têm uma associação positiva com a intenção de adoção do e-GTA. Além disso, o estudo indicou que as campanhas de informação pública poderiam contribuir para o incremento na adoção efetiva do e-GTA. Finalmente, o estudo identificou oportunidades para o desenvolvimento de investigações adicionais, considerando distintas variáveis, setores produtivos e sistemas de governo eletrônico dirigidos à saúde animal, o que poderia contribuir para a expansão do conhecimento nesta área

Image-guided temporal bone dissection course

Introduction: Temporal bone anatomy is complex and demands a profound anatomical knowledge. Association between surgery and imaging helps in the process of learning three-dimensional (3D) anatomy and surgical techniques. High definition temporal bone imaging can play an important role in dissection training. Objective: To describe a computed tomography (CT) image-guided temporal bone dissection course for surgical training in otolaryngology and to verify the satisfaction level of the students with the course. Methods: Descriptive research. The course took place at a research laboratory, with three experienced temporal bone surgeons. The participants were 12 otolaryngology residents. The laboratory has 7 modern workstations with microscope and monitors linked with a computerized video system. Cadaveric temporal bones were donated to the university. Imaging acquisition of the cadaveric temporal bones used in the course was performed in a multislice CT scanner. The CT images of cadaveric temporal bones were available with real-time access on the laboratory monitor's screens during dissections. Results: A total of 13 temporal bones were included for dissection. Students had the opportunity to view on the same screen, simultaneously, both the dissection video and the respective CT images of their temporal bone anatomical specimens. This allowed correlating surgical and imaging aspects of temporal bone anatomy. At the end of the course, participants answered a satisfaction survey. Conclusion: Considering imaging methods are routinely used during most otologic surgeries, detailed knowledge of CT imaging should be explored in conjunction with the temporal bone anatomical dissection