Tratamento da hemorragia cerebral espontânea

O tratamento da hemorragia cerebral espontânea ainda é motivo de controvérsia. Alguns elementos do manejo pnítico, no entanto, têm sido apontados com relevância na literatura. O papel do controle da hipertensão arterial sistêmica, da pressão intracmniana c da pressão de perfusão cerebral é sistematizado na presente revisão. As indicações do tratamento conservador e das diversas modalidades de tmtamen to cirúrgico são discutidas.The treatment of spontaneous intracerebral hemorrhage is still controversial. However, some practical features h ave been poinled out in literature. The role of systemic arterial hypertension, intracranial pressure and cerebral perfusion pressure contrai is systematized in the present revision. Indications for conservative treatment and for the different modalities of surgical treatment are discussed

Manitol : fundamentos para sua utilização

O diurético osmótico manitol é uma droga amplamente utilizada em neurocirurgia e neurologia a fim de diminuir a pressão intracraniana e melhorar a microcirculação cerebral. As teorias sobre seu mecanismo de ação são revisadas: gradiente osmótico pela barreira hematoencefálica, auto-regulação vascular e neutralização dos radicais livres do oxigênio. Sua posologia é empírica, segundo a experiência própria de cada autor. O conhecimento dos critérios básicos para o uso do manitol e de sua reposição hidreletrolitica é fundamental para a manutenção da osmolaridade sérica em valores terapêuticos

Angioedema hereditário : revisão, apresentação de uma família com 15 indivíduos afetados e correlação com sistema HLA

Os autores apresentam sua experiência com o angioedema hereditário, descrevendo diversos casos no Rio Grande do Sul. As famílias acometidas foram investigadas com dosagem de C4, tipagem HLA, grupo sangüíneo e R h. Concluiu-se que não existe relação entre o surgimento da doença e antígenos de histocompatibilidade, grupos sangüíneos ABO e R h. A dosagem de C4 é importante na confirmação do diagnóstico clínico.The authors present their experience with Hereditary Angioedema describing many cases in one family from Rio Grande do Sul. The afflicted family was investigated by C4 measurements, HLA typing, as well as typing for blood groups and the Rh system. The conclusion was that there is no association between the appearance of the disease and histocompatibility antigens, blood groups ABO or Rh. The measurement of C4 is important in establishing the diagnosis of Hereditary Angioedema

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Hematomas intraparenquimatosos espontâneos supratentoriais: a proposito de 28 casos

Os autores analisam 28 pacientes com hematomas intraparenquimatosos espontâneos supratentoriais. Comentam as diversas topografias baseadas no estudo angiográfico, a mortalidade e a morbilidade da patologia. Os resultados são analisados em relação a presença de hipertensão arterial sistêmica, ao comprometimento da consciência e à topografia do processo expansivo. Chamam a atenção para a indefinição da escolha e da oportunidade do tratamento cirúrgico identificada na literatura

Comparative study between cortical bone graft versus bone dust for reconstruction of cranial burr holes

Background: As a consequence of the progressive evolution of neurosurgical techniques, there has been increasing concern with the esthetic aspects of burr holes. Therefore, the objective of this study was to compare the use of cortical bone graft and bone dust for correcting cranial deformities caused by neurosurgical trephines. Methods: Twenty-three patients were enrolled for cranial burr hole reconstruction with a 1-year follow-up. A total of 108 burr holes were treated; 36 burr holes were reconstructed with autogenous cortical bone discs (33.3%), and the remaining 72 with autogenous wet bone powder (66.6%). A trephine was specifically designed to produce this coin-shaped bone plug of 14 mm in diameter, which fit perfectly over the burr holes. The reconstructions were studied 12 months after the surgical procedure, using three-dimensional quantitative computed tomography. Additionally, general and plastic surgeons blinded for the study evaluated the cosmetic results of those areas, attributing scores from 0 to 10. Results: The mean bone densities were 987.95 ± 186.83 Hounsfield units (HU) for bone fragment and 473.55 ± 220.34 HU for bone dust (P < 0.001); the mean cosmetic scores were 9.5 for bone fragment and 5.7 for bone dust (P < 0.001). Conclusions: The use of autologous bone discs showed better results than bone dust for the reconstruction of cranial burr holes because of their lower degree of bone resorption and, consequently, better cosmetic results. The lack of donor site morbidity associated with procedural low cost qualifies the cortical autograft as the first choice for correcting cranial defects created by neurosurgical trephines