The craniocaudal extension of posterolateral approaches and their combination: a quantitative anatomic and clinical analysis.

OBJECTIVE: The aim of this study was to describe quantitatively the properties of the posterolateral approaches and their combination. METHODS: Six silicone-injected cadaveric heads were dissected bilaterally. Quantitative data were generated with the Optotrak 3020 system (Northern Digital, Waterloo, Canada) and Surgiscope (Elekta Instruments, Inc., Atlanta, GA), including key anatomic points on the skull base and brainstem. All parameters were measured after the basic retrosigmoid craniectomy and then after combination with a basic far-lateral extension. The clinical results of 20 patients who underwent a combined retrosigmoid and far-lateral approach were reviewed. RESULTS: The change in accessibility to the lower clivus was greatest after the far-lateral extension (mean change, 43.62 +/- 10.98 mm2; P = .001). Accessibility to the constant landmarks, Meckel\u27s cave, internal auditory meatus, and jugular foramen did not change significantly between the 2 approaches (P \u3e .05). The greatest change in accessibility to soft tissue between the 2 approaches was to the lower brainstem (mean change, 33.88 +/- 5.25 mm2; P = .0001). Total removal was achieved in 75% of the cases. The average postoperative Glasgow Outcome Scale score of patients who underwent the combined retrosigmoid and far-lateral approach improved significantly, compared with the preoperative scores. CONCLUSION: The combination of the far-lateral and simple retrosigmoid approaches significantly increases the petroclival working area and access to the cranial nerves. However, risk of injury to neurovascular structures and time needed to extend the craniotomy must be weighed against the increased working area and angles of attack

Tuberculose e leite: elementos para a história de uma polêmica Tuberculosis and milk: elements of a polemic

Pode o ser humano contrair tuberculose pela ingestão do leite de vacas tuberculosas? São efetivos o diagnóstico e o controle da tuberculose bovina para a proteção da população humana? Questões como estas estiveram em pauta no pensamento médico paulistano no início do século XX. O presente estudo procurou reconstituir elementos da polêmica travada em São Paulo, com o intuito de incentivar a divulgação de dados suplementares sobre a matéria. Aqui são apresentadas indicações sintéticas das posições em confronto: de um lado, as preocupações em intensificar as ações de controle do gado tuberculoso; de outro, o cuidado de não prejudicar os criadores nacionais com a demanda de precauções adicionais, as quais se temia serem lesivas à comercialização do produto. O acompanhamento das intervenções sobre o tema na imprensa médica permitiu identificar a preponderância da primeira posição, com conseqüências para o controle sanitário de alimentos.<br>Can human beings get tuberculosis from the milk taken from cows infected with tuberculosis? Are the diagnosis and control of cattle tuberculosis effective for the protection of human populations? Questions such as these were the main concern of doctors from São Paulo at the beginning of the twentieth century. The present study tried to recover elements from the polemic that took place in São Paulo, in order to encourage the coming up of complementary facts about such matter. The article presents some indicators of confronting positions: on one hand, the goal of intensifying the control of tuberculosis among the cattle; on the other hand, the attempt not to bring up any loss to national cattle raisers through the demand of additional precaution measures, which would affect the production and distribution of their products. Medical publications kept records of the interventions, which have allowed the author to identify the first position as the stronger one, which has brought up relevant consequences for the sanitary food control

The changing epidemiology of Acinetobacter spp. producing MA. carbapenemases causing bloodstream infections in Brazil: a BrasNet report

Made available in DSpace on 2019-09-12T16:53:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2015Merieux Research Grants - Institut MerieuxWe evaluated the epidemiology of Acinetobacter spp. recovered from patients diagnosed with bloodstream infections in 9 tertiary hospitals located in all Brazilian geographic regions between April and August 2014. Although OXA-23-producing Acinetobacter baumannii clones were disseminated in most hospitals, it was observed for the first time the spread of OXA-72 among clonally related A. baumannii isolated from distinct hospitals. Interestingly, Acinetobacter pittii was the most frequent species found in a Northern region hospital. Contrasting with the multisusceptible profile displayed by A. pittii isolates, the tetracyclines and polymyxins were the only antimicrobials active against all A. baumannii isolates. (C) 2015 Elsevier Inc. All rights reserved.[Vasconcelos, Ana Tereza R.] Lab Nacl Comp Cient LNCC MCTI, Petropolis, RJ, Brazil[Barth, Afonso L.; Zavascki, Alexandre P.] Univ Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Lab Pesquisa Resistencia Bacteriana LABRESIS, Porto Alegre, RS, Brazil[Gales, Ana C.; Furtado, Guilherme H. C.; da Silva, Juliana O.; Correa, Luci; Cayo, Rodrigo; Martins, Willames M. B. S.] Univ Fed Sao Paulo UNIFESP, Disciplina Infectol, Dept Med, Sao Paulo, SP, Brazil[Levin, Anna S.; Rossi, Flavia; Silva, Mariama T.; Oliveira, Maura S.; Dalben, Mirian F.; Santos, Sania A.] Univ Sao Paulo, Inst Med Trop USP LIM 54, Dept Patol LIM 03, Hosp Clin,Fac Med, Sao Paulo, SP, Brazil[Lucarevschi, Bianca R.; Moreira, Marina] Universidade de Taubaté (Unitau) , Dept Med[Cabral, Blenda G.; Brasiliense, Danielle M.; Carneiro, Irna Carla R. S.; Lima, Karla V. B.; da Conceicao, Marilia L.] Fundacao Santa Casa Misericordia Para UFPA, Belem, Para, Brazil[Cabral, Blenda G.; Brasiliense, Danielle M.; Carneiro, Irna Carla R. S.; Lima, Karla V. B.; da Conceicao, Marilia L.] Inst Evandro Chagas SVS MS, Belem, Para, Brazil[Ribeiro, Julival; Guzman, Ricardo D.] Hosp Base, Brasilia, DF, Brazil[Correa, Luci; Martino, Marines D. V.] Hosp Israelita Albert Einstein HIAE, Sao Paulo, SP, Brazil[Correa, Luci; Martino, Marines D. V.] Fac Ciencias Med Santa Casa Sao Paulo, Sao Paulo, SP, Brazil[Britto, Maria H.; de Freitas, Manse R.; Morais, Rosangela] Univ Fed Rio Grande Norte UFRN, Ctr Patol Clin, Natal, RN, Brazi