Arquivos de neuro-psiquiatria
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Decompressive craniotomy (DC) is applied to treat post-traumatic intracranial hypertension (ICH). The purpose of this study is to identify prognostic factors and complications of unilateral DC. Eighty-nine patients submitted to unilateral DC were retrospectively analyzed over a period of 30 months. ⋯ Brain swelling plus acute subdural hematoma were the most common tomographic findings (64%). Complications occurred in 34.8% of the patients: subdural effusions in 10 (11.2%), hydrocephalus in 7 (7.9%) and infection in 14 (15.7%). The admittance Glasgow coma scale was a statistically significant predictor of outcome (p=0.0309).
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Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. ⋯ There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.
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Multicenter Study
Pain centers professionals' beliefs on non-cancer chronic pain.
The beliefs and attitudes of health professionals affect the care ultimately provided to patients. The objective of this study was to analyze health professionals' beliefs toward chronic no cancer pain in nine (82%) pain centers in the city of S. Paulo. ⋯ The professionals professed a belief in a medical cure for chronic pain, that solicitous displays were desirable behaviors in treating pain, that chronic pain is related to injury and that it is the cause of disability, all of which are erroneous beliefs. Contrary to the expected result, the health professionals with more experience and education did not express more appropriate beliefs. These beliefs may compromise the treatment of patients with chronic pain and should therefore be reviewed.
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Lesions of the cervicothoracic junction have a high propensity for causing instability and present unique challenges in the surgical treatment. Several surgical approaches to this region have been described in the literature. We report our experience in the surgical treatment of six patients with unstable lesions involving the cervicothoracic junction at T1 and T2 vertebral bodies. ⋯ Mesh and cervical plate system were used for stabilization and reconstruction of the region. No complication related to the surgical procedure was observed. In our experience, in injuries involving the T1 and T2 vertebral bodies, the transmanubrial approach offers good working room to remove the lesions and anterior reconstruction.
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Elevated intracranial pressure (ICP) is a common cause of death in acute liver failure (ALF) and is determinant for decision-making regarding the timing of liver transplantation. The recommended type ICP monitoring device is controversial in ALF patients. Epidural devices had less risk of hemorrhagic complications, but they are less reliable than intraparenchymal ones. ⋯ In our experience, intraparenchymal ICP monitoring in patients with ALF seems to be an accurate method with a low risk of complications.