A craniectomia descompressiva (CD) tem papel fundamental no tratamento da hipertensão intracraniana refratária, mas não é isenta de complicações. Uma complicação rara é a “síndrome do trefinado” (ST). Ela ocorre quando as forças gravitacionais se sobrepõem à pressão intracraniana. Objetivo Determinar a utilidade do diâmetro da bainha do nervo óptico (DBNO) como fator prognóstico após cranioplastia. Método Foram acompanhados 5 pacientes trefinados portadores da ST. Estes pacientes foram submetidos à ressonância magnética com medida do diâmetro da bainha do nervo óptico (DBNO). Resultados Dois pacientes apresentaram uma assimetria do DBNO, sendo o diâmetro maior do lado craniectomizado. Para nossa surpresa estes evoluíram melhor do que os que apresentavam o DBNO simétrico. Estes pacientes se tornaram independentes uma semana após, e estatisticamente mais cedo do que os outros. Conclusão Há evidências de que a assimetria do DBNO sirva como fator de bom prognóstico após cranioplastia no pacientes portadores da ST.

Decompressive craniectomy (DC) is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension, but not without complications. A rare complication is the “syndrome of the trephined” (ST). It occurs when the forces of gravity overwhelm intracranial pressures, leading the brain to become sunken. Objective To determine the usefulness of asymmetric optic nerve sheath diameter (ONSD) as an outcome factor after cranioplasty. Method We followed-up 5 patients submitted to DC and diagnosed with ST. All were submitted to brain MRI to calculate the ONSD. Results Only two patients presented an asymmetric ONSD, being ONSD larger at the site of craniectomy. Surprisingly these patients had a marked neurological improvement after cranioplasty. They became independent a week after and statistically earlier than others. Conclusion It is presumed that the presence of an asymmetric ONSD in trephined patients is an independent factor of good outcome after cranioplasty.

Introduction Despite the great advances in serological testing for transfusion-transmitted infections, the selection of blood donors by blood bank operators remains the only way to avoid transmission within the testing window period. Part of this selection is the self-exclusion form, on which the donors can exclude their blood from donation without any explanation. This study assessed the clinical and epidemiological characteristics related to positivity for viral hepatitis and to the use of the confidential self-exclusion (CSE) form. Methods This transversal study analyzed the data collected from blood donors' files in a hospital in Southern Brazil. Univariate and multivariate analyses identified the clinical and epidemiological variables related to positive serologies of viral hepatitis and to whether the donor was self-excluded. Results Of the 3,180 donors included in this study, 0.1% tested positive for HBsAg, 2.1% for anti-HBc, and 0.9% for anti-HCV. When the 93 donors with positive serologies for viral hepatitis were compared with those who were negative, a greater proportion of the positive serology group was found to have had a history of blood transfusions (OR=4.908; 95%CI=1.628 - 14.799; p<0.01), had repeatedly donated (OR=2.147; 95%CI=1.236 - 3.729; p<0.01), and used the CSE form for self-exclusion (OR=7.139; 95%CI=2.045 - 24.923; p<0.01). No variables were independently associated with self-exclusion. Conclusions A history of blood transfusion, repeated donations, and self-exclusion are factors that should be considered during viral hepatitis screenings in blood banks.

Purpose To evaluate preoperative rectal electrical stimulation in the recovery of urinary continence in patients who undergo radical retropubic prostatectomy. Materials and Methods Patients were divided into 3 randomized groups: control, pelvic exercises, and electrical stimulation. A 1 hour pad-test, the ICIQ-SF, and the SF-36 were performed 1, 3, and 6 months after the surgical procedure. Results Of the 58 patients who were initially included in the study, 9 were excluded due to radiotherapy after surgical intervention, an indwelling urethral catheter for more than 30 days, high surgical risk, loss of follow-up, or incomplete participation in the study routines and spontaneous interruption. Forty-nine patients concluded the study (15 in the control group, 17 in the exercise group, and 17 in the electrical stimulation group). We did not observe any significant difference in the pad test (p > 0.05), the 8 domains of the SF-36, or ICIQ-SF score compared with control groups (control, exercise, and electrical stimulation). Conclusion Preoperative rectal electrical stimulation has no impact on continence status in patients who undergo radical retropubic prostatectomy. There is no difference in the three above mentioned groups with regard to urinary leakage and quality of life.

O conhecimento da frequência e das características clinicoepidemiológicas do melanoma cutâneo nas diversas regiões do Brasil é importante para avaliar a magnitude do problema e direcionar adequadamente as ações de saúde. Neste estudo, revisaram-se os dados de 55 pacientes com melanoma cutâneo atendidos em duas instituições de saúde da cidade de Manaus. Verificou-se maior frequência entre homens pardos, na oitava década de vida, com lesões do tipo melanoma acrolentiginoso nos membros inferiores, com Breslow maior que 1mm e Clark nível V.

Knowledge on the frequency and clinical and pathological characteristics of cutaneous melanoma in the different geographical regions of Brazil is important in evaluating the magnitude of the problem and in directing healthcare actions appropriately. The present study reviewed data from 55 cases of cutaneous melanoma in patients treated at two healthcare institutions in the city of Manaus, Amazonas, Brazil. Rates were higher in brown-skinned males and in individuals of 70-80 years of age. Lesions were most commonly located on the lower limbs, were of the acral lentiginous melanoma type and at advanced stages of the disease, with Breslow thickness > 1 mm and Clark level V.