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Defini??o do limite anterolateral do lobo occipital em pe?as anat?micas e exames de imagem
Gusm?o, Sebasti?o;Reis, Cassius;Tazinaffo, Uedson;Mendon?a, Celso;Silveira, Roberto Leal;
Arquivos de Neuro-Psiquiatria , 2002, DOI: 10.1590/S0004-282X2002000100009
Abstract: the anterolateral limit of the occipital lobe was studied in anatomical specimens and with neuroimaging. seven human cadaver heads, 103 normal ct-scan and 104 mrj of the brain were studied. there was a fold of the dura mater on the transverse sinus (preoccipital tentorial plica) and a bony protuberance related directly to the preoccipital notch. it was also determined the mean distance between the parieto-occipital sulcus and the lambdoid suture. in the imaging studies, especially magnetic resonance, it was possible to identify the preoccipital notch and/or a protuberance in the cranial vault related to this notch, besides the parieto-occipital sulcus and lambdoid suture, making possible, therefore, the definition of the anterolateral limit of the occipital lobe.
Via de acesso anterolateral minimamente invasiva para as artroplastias totais de quadril
Sawaia, Rogério Naim;Galv?o, Antonio Felipe Martensen;Oliveira, Fernando Machado;Secunho, Guilherme Rondinelli;Vilela Filho, Geraldo;
Revista Brasileira de Ortopedia , 2011, DOI: 10.1590/S0102-36162011000200012
Abstract: objective: the aim of this study was to present a minimally invasive anterolateral access route and to ascertain whether this enables total hip replacement without compromising the quality of the implant positioning, while maintaining the integrity of the gluteus muscles. method: a retrospective study was conducted on 260 patients (186 females and 74 males) of average age 62 years. there were 18 bilateral cases, thus totaling 278 hips. all the patients had osteoarthritis and had undergone non-cemented total hip arthroplasty (metal-metal or metal-polyethylene) between october 2004 and december 2007. a minimally invasive anterolateral access route was used, measuring 7 to 10 cm in length, according to body weight and the size of the femoral head. the patients were assessed clinically regarding age, sex and presence of the trendelenburg sign, and radiologically regarding acetabular and femoral positioning. results: the acetabular inclination was between 30° and 40° in 78 patients, between 41° and 50° in 189 patients, and 51° or over in 11 patients. on anteroposterior radiographs to study femoral positioning, the positioning was central in 209 cases, 41 presented valgus deviation and 28 presented varus deviation. on lateral views, 173 were central, 67 anterior and 38 posterior. the mean duration of the procedure was 63 minutes. regarding complications, there were five cases of infection, three of deep vein thrombosis, two of hip dislocation, 80 of lengthening of the lower limbs and five of shortening of the operated limb. the trendelenburg sign was present in four cases, of which one showed superior gluteal nerve injury. conclusion: the minimally invasive anterolateral access route made it possible to perform total hip arthroplasty without compromising the positioning of the implants, thereby maintaining the integrity of the gluteus muscles.
Defini o do limite anterolateral do lobo occipital em pe as anat micas e exames de imagem  [cached]
Gusm?o Sebasti?o,Reis Cassius,Tazinaffo Uedson,Mendon?a Celso
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: Com o objetivo de definir o limite anterolateral do lobo occipital foram estudados sete segmentos cefálicos de cadáveres humanos, 103 exames de tomografia computadorizada e 104 exames de ressonancia magnética do encéfalo considerados normais. Foram encontradas uma prega da dura-máter sobre o seio transverso (plica tentorial pré-occipital) e uma protuberancia óssea relacionadas diretamente com a incisura pré-occipital. Foi calculada, também, a distancia média entre o sulco parieto-occipital e a sutura lambdóide. Nos exames de imagem, especialmente na ressonancia magnética, foi possível identificar a incisura pré-occipital e/ou a protuberancia na parede craniana relacionada a ela, bem como o sulco parieto-occipital e a sutura lambdóide, referências que permitem a defini o do limite anterolateral do lobo occipital.
A Promo o do Acesso à Educa o Superior: custos e benefícios de um projeto de extens o
Helder Bueno Leal,Candido Alberto da Costa Gomes
Meta : Avalia??o , 2011,
Abstract: Esta pesquisa avalia os custos e benefícios de um projeto de extens o universitária destinado a elevar o acesso da popula o de baixa renda à educa o superior, por meio de um "cursinho" preparatório gratuito. A literatura patenteia as rela es entre origens sociais e acesso e êxito dos alunos no sistema educacional. Utilizando um desenho quase experimental, realizaram-se entrevistas semi-estruturadas com os atores envolvidos e procedeu-se à análise de conteúdo. Os resultados mostram que, por custos modestos, o projeto proporcionou significativos benefícios: 1) aos licenciandos, que aperfei oaram as suas competências; 2) aos alunos beneficiados, em compara o com os seus homólogos, que ter o expressivo aumento da sua renda e empregabilidade após a conclus o do curso superior, empreendendo mobilidade social vertical intergeracional.
Bony reconstruction by reposition of bony chips in suboccipital craniectomy  [cached]
Chowdhury Forhad,Haque Raziul,Islam Shafiqul,Sarkar Mainul
Neurology India , 2010,
Abstract: In suboccipital craniectomy where the bone is not repositioned, there may be a significant cosmetic defect due to lack of skull bone in the suboccipital region. It may accompanied by sensory symptoms, including pain. To prevent any cosmetic defect and sensory symptoms we repositioned the bone chips at the craniectomy site in 42 suboccipital craniectomies before the closure of the scalp. At a mean follow-up of 22 months (range: 5-44 months), two patients complained of mild discomfort in the healed wound or of occasional local pain. One patient complained of mild itching at the site. In two patients, bone chips were accumulated at the lower part of the suboccipital craniectomy and failed to form a uniform bone cover at the operated site. In one patient, all bone chips were reabsorbed and there was no bone at the operated site. There was pseudomeningocele formation in one patient. In the rest of the cases there was satisfactory bone coverage at the operated site, both clinically and radiologically. The wound sites were aesthetically acceptable in 40 cases. Our study suggests that in the majority of cases where suboccipital craniotomy is not possible or not done, repositioning of the bone chips at the craniectomy site is associated with satisfactory aesthetic and functional outcome and formation of bone coverage at the operated site.
Suboccipital segment of the vertebral artery: A cadaveric study  [cached]
Muralimohan S,Pande Anil,Vasudevan M,Ramamurthi Ravi
Neurology India , 2009,
Abstract: Objective: To study the course, relationships, branches and possible anomalies of the vertebral artery in the suboccipital region in adult Indian cadavers. Materials and Methods: Twenty-one suboccipital segment vertebral artery specimens from embalmed, Indian adult cadavers were dissected and studied. Dissection was performed using microsurgical instruments and was carried out from the skin up to the vertebral artery in layers. The course, relationships and the branches of the vertebral artery were studied and measurements were taken using Vernier calipers. The readings obtained were corroborated with the measurements derived from the digital images using a computer. Observations: All the vertebral arteries had a tortuous course and were covered with rich venous plexuses. None of the specimens had an anomalous course. The artery was divided into a vertical segment (Vv) between C2 and C1 vertebra and a horizontal segment (Vh) from the C1 transverse foramina to its dural entry. The mean diameter of the artery was 4.8mm. The shortest distance of Vv segment from the dural tube was 16.1mm, and the distance from the C2 ganglion was 7.2mm. The average length of the Vv segment was 15mm and the average length of the Vh segment was 35.6mm. The average of the shortest distance between the vertebral artery and the midline was 13.4mm. Conclusion: The vertebral artery has a tortuous course and is prone to accidental iatrogenic injury, which can result in devastating neurological sequelae depending on contralateral vertebral artery flow. A thorough anatomical knowledge of this segment is essential for the surgeon who intends to operate in this area.
Dor faríngea durante pun??o suboccipital lateral: lateral suboccipital puncture
Rossitti, Sandro L.;Araújo, Jo?o Flávio M.;Zuiani, A. Roberto;Balbo, Roque J.;
Arquivos de Neuro-Psiquiatria , 1989, DOI: 10.1590/S0004-282X1989000200009
Abstract: oropharyngeal pain was referred by five fully conscious and collaborative patients during lateral suboccipital puncture (lsp) of the cisterna magna, performed for myelography and/or cerebrospinal fluid collection. the anastomotic connections between the lower cranial nerves, the sympathetic nerves and the upper cervical spinal nerves are reviewed, with emphasis on the relationship between the first cervical nerve (ci), the superior cervical ganglion of the sympathetic trunk, and the spinal accessory nerve (nerve xi), and their central connections. the authors conclude that pharyngeal pain during lsp is provoked by the stimulation of afferent visceral fibers of ci, or of the gray communicating branches of the superior cervical ganglion to ci.
Editorial da Revista Ciência em Extens o  [cached]
Maria Candida Soares Del-Masso
Revista Ciência em Extens?o , 2010,
Abstract: A Revista Ciência em Extens o (RCE) da Pró-Reitoria de Extens o Universitária da UNESP, a partir de 2007, assume nova fase e nova proposta de organiza o seguindo os parametros de qualifica o acadêmica no sentido de valorizar as atividades de Extens o Universitária - um dos pilares da Universidade juntamente com o ensino e a pesquisa. Nessa proposta de qualifica o acadêmica, a estrutura da RCE é alterada e segue os preceitos do acesso livre à informa o divulgando à comunidade a sua produ o qualificada mediante os critérios estabelecidos por órg os nacionais e internacionais de valida o cientifica. A partir do volume 2 - 2009, a RCE conta com o Selo Cultura Acadêmica da Funda o Editora da UNESP, selo esse validado pelos órg os competentes com o Qualis em diferentes áreas do conhecimento. Assim, a RCE se apropria desse selo validando os artigos publicados neste periódico, a partir deste fascículo. Neste volume, além dos cinco artigos apresentados versando sobre diferentes temáticas, também s o apresentados os resumos dos 42 trabalhos premiados no 5o Congresso de Extens o Universitária da UNESP “Extens o Universitária e Tecnologias Sociais: Diálogo entre os diferentes saberes”, evento ocorrido no período de 10 a 12 de novembro de 2009, espa o privilegiado que congregou pesquisadores na área extensionista para a divulga o da produ o cientifica resultante dos Programas e Projetos de Extens o Universitária da UNESP e de outras universidades brasileiras.
The Clinical Application of Anterolateral Thigh Flap  [PDF]
Yao-Chou Lee,Haw-Yen Chiu,Shyh-Jou Shieh
Plastic Surgery International , 2011, DOI: 10.1155/2011/127353
Abstract: The anterolateral thigh flap can provide a large skin paddle nourished by a long and large-caliber pedicle and can be harvested by two-team work. Most importantly, the donor-site morbidity is minimal. However, the anatomic variations decreased its popularity. By adapting free-style flap concepts, such as preoperative mapping of the perforators and being familiar with retrograde perforator dissection, this disadvantage had been overcome gradually. Furthermore, several modifications widen its clinical applications: the fascia lata can be included for sling or tendon reconstruction, the bulkiness could be created by including vastus lateralis muscle or deepithelization of skin flap, the pliability could be increased by suprafascial dissection or primary thinning, the pedicle length could be lengthening by proximally eccentric placement of the perforator, and so forth. Combined with these technical and conceptual advancements, the anterolateral thigh flap has become the workhorse flap for soft-tissue reconstructions from head to toe. 1. Introduction Since Song et al. [1] introduced the anterolateral thigh flap in 1984, it gains popularity because of several advantages [2, 3]. First, the flap can be harvested simultaneously as two-team work. The operation time could be shortened. Second, the pedicle length is long enough to anastomosis with recipient vessels. The vein graft could be avoided. Third, the large caliber of pedicle vessels makes microanastomosis easier. Fourth, the flap could serve as fasciocutaneous, adipofascial, or myocutaneous flap as needed. Fifth, the flap can have great volume variability. Pliability could be achieved by primary thinning. Bulkiness could be added by incorporation of the deepithelialized skin or a portion of muscle cuff. Sixth, the lateral femoral cutaneous nerve can be included to provide as a sensate flap. Seventh, the flap pedicle could bridge the vascular gap as flow-through flap, especially in mangled extremities. Eighth, the donor site morbidity is minimal. 2. Flap Anatomy 2.1. Perforator Both septocutaneous and musculocutaneous perforators were identified in the anterolateral thigh flaps. Initially, it was thought that septocutaneous route composes the dominance [1, 4]. Recently, the anatomic studies suggested that musculocutaneous route takes the majority [2, 5–7]. In Shieh et al.’s and Wei et al.’s reports, 83.2% and 87.1% of perforators were found to be musculocutaneous, respectively [2, 3]. The differences between each studies might relate to the bias of the selection of the perforators by different authors.
Anesthesia for Suboccipital Craniotomy in a Patient with Lymphangioleiomyomatosis: A Case Report  [PDF]
Robert A. Peterfreund,Emily Luman,Robert L. Martuza
Case Reports in Pulmonology , 2012, DOI: 10.1155/2012/804789
Abstract: Lymphangioleiomyomatosis (LAM) is a rare pulmonary condition often presenting with spontaneous pneumothorax. Imaging or biopsy confirm the diagnosis. Published case reports describe the anesthetic management of patients with LAM undergoing brief procedures. No reports describe the anesthetic management for lengthy neurosurgical procedures. We describe anesthetic management for craniotomy in a patient with LAM. Clinical Features. A woman presented with 2 spontaneous left pneumothoraces. She received a diagnosis of LAM by imaging. She did well after pleurodesis. Hearing loss and tinnitus led to brain imaging demonstrating a large left cerebello-pontine angle mass. She presented for elective craniotomy to remove the mass while preserving cranial nerve function. Our technique for general endotracheal anesthesia aimed to reduce the likelihood of another pneumothorax while providing good surgical conditions and permitting neuromonitoring. Conclusion. We demonstrate the successful anesthetic management of a patient with LAM undergoing a lengthy suboccipital craniotomy for a posterior fossa mass. 1. Introduction Lymphangioleiomyomatosis (LAM) is a rare pulmonary condition manifested by cyst formation in the lungs. Previous reports describe anesthesia management for patients with LAM needing brief surgical procedures, typically in the abdomen or chest. We present the anesthesia management of a patient with LAM undergoing a lengthy suboccipital craniotomy. LAM primarily affects the lung. Proliferation of smooth muscle-like cells produces obstruction of the vasculature, the lymphatics, and the airway resulting in pulmonary cyst formation [1, 2]. Other organs, particularly the kidney, may also be affected. The prevalence of LAM is about 1?:?1,000,000 in the general population, predominantly in women. The initial presentation is typically with respiratory symptoms, often with pneumothorax as a physical finding. The precise etiology of LAM remains undetermined, but an association with tuberous sclerosis suggests a common genetic cause [3–5]. A patient with a large suboccipital mass presented for craniotomy. We were confronted with the question of how to anesthetize this patient. Only a few case reports found in a PubMed search discuss management of patients with LAM requiring general anesthesia. The majority of these reported patients had relatively brief obstetric, abdominal, or thoracic procedures [6–13]. The literature search returned no publications describing a patient undergoing a lengthy and complex neurosurgical procedure. With the patient’s written informed
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