ABSTRACT BACKGROUND: Respiratory failure is the most common cause of death in patients with amyotrophic lateral sclerosis (ALS), and morbidity is related to poor quality of life (QOL). Non-invasive ventilation (NIV) may be associated with prolonged survival and QOL in patients with ALS. OBJECTIVES: To assess whether NIV is effective and safe for patients with ALS in terms of survival and QOL, alerting the health system. DESIGN AND SETTING: Systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards using population, intervention, comparison, and outcome strategies. METHODS: The Cochrane Library, CENTRAL, MEDLINE, LILACS, EMBASE, and CRD databases were searched based on the eligibility criteria for all types of studies on NIV use in patients with ALS published up to January 2022. Data were extracted from the included studies, and the findings were presented using a narrative synthesis. RESULTS: Of the 120 papers identified, only 14 were related to systematic reviews. After thorough reading, only one meta-analysis was considered eligible. In the second stage, 248 studies were included; however, only one systematic review was included. The results demonstrated that NIV provided relief from the symptoms of chronic hypoventilation, increased survival, and improved QOL compared to standard care. These results varied according to clinical phenotype. CONCLUSIONS: NIV in patients with ALS improves the outcome and can delay the indication for tracheostomy, reducing expenditure on hospitalization and occupancy of intensive care unit beds. SYSTEMATIC REVIEW REGISTRATION: PROSPERO database: CRD42021279910 — https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=279910. BACKGROUND ALS, , (ALS) QOL. . (QOL) Noninvasive Non invasive (NIV OBJECTIVES system SETTING MetaAnalyses Meta Analyses population intervention comparison strategies METHODS Library CENTRAL MEDLINE LILACS EMBASE 2022 synthesis RESULTS 12 identified 1 reviews reading metaanalysis meta analysis eligible stage 24 however hypoventilation phenotype CONCLUSIONS tracheostomy beds REGISTRATION database CRD4202127991 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=279910. httpswwwcrdyorkacukprosperodisplayrecordphpRecordID279910 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID https //www.crd.york.ac.uk/prospero/display_record.php RecordID=279910. www crd york ac uk prospero display record php RecordID 279910 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=279910 (ALS (QOL 202 2 CRD420212799 phpRecordID https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=279910 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID27991 wwwcrdyorkacukprosperodisplayrecordphp RecordID279910 RecordID=279910 27991 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=27991 20 CRD42021279 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=27991 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID2799 RecordID27991 RecordID=27991 2799 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=2799 CRD4202127 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=2799 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID279 RecordID2799 RecordID=2799 279 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=279 CRD420212 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=279 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID27 RecordID279 RecordID=279 27 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=27 CRD42021 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=27 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID2 RecordID27 RecordID=27 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=2 CRD4202 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=2 RecordID2 RecordID=2 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID= CRD420 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID= RecordID= https://www.crd.york.ac.uk/prospero/display_record.php?RecordID CRD42 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID CRD4

ABSTRACT The Atlantic Forest of southeastern Brazil has been considered to have the highest number of tree species per hectare in the world. Assessing the influence of climate on tropical tree species is a priority in the face of ongoing climate change, and for which dendrochronological studies have been important. We address the dendrochronological potential of Licaria bahiana Kurz (Lauraceae), an endemic species of the Atlantic forests. We studied growth ring anatomy of L. bahiana and applied dendrochronological methods to investigate how short-term variation in climate affect its radial growth. Distinct growth rings were observed in all individuals and demarcated by darker tangential fiber zones in latewood. Trees showed high climatic sensitivity (0.48) and growth synchrony (intercorrelation r = 0.69; rbar = 0.38). Radial growth was negatively influenced by high temperatures at the beginning of the current growing season (r = -0.46) and by excessive rainfall at the end of the current growing season (r = -0.29), which are periods that correspond to the phenological reproductive phases of the species. Climate anomalies during this period may alter the tradeoff between growth and reproduction, in favor of the latter.

ABSTRACT: Objective: Development of a minimum set of competencies in Cariology that every dentist graduated from a Dental School in Chile must have. Methodology: Starting from a meeting of scholars from the Universities of Talca and Chile (year 2011), an initial proposal for a curriculum was developed, based on the domains proposed by the European Cariology Curriculum (Schulte, et al, 2011). During 2016, this proposal was discussed through online dialogues and working groups, with the participation of 95.2% of the Chilean dental schools, which resulted in an intermediate document. This document was analyzed, discussed and refined during the Workshop for the Development of a Curriculum of Minimum Competencies in Cariology for Chilean Dental Schools (May 22, 2017, Talca, organized by the Universities of Talca and Chile) with the attendance of representatives from 95.2% of the Chilean dental schools, the Chilean Ministry of Health, Chilean College od Dentists and with the assistance of the professors of Cariology Margherita Fontana and Carlos González-Cabezas (University of Michigan, Ann Arbor, USA). Each working group revised the document and provided feedback, which was incorporated in the final document by an advisory committee, elected on the day of the workshop, including the authors of the present article. Results: The Cariology Curriculum was organized in 5 Domains: 1. Basic knowledge; 2. Risk assessment, caries diagnosis and caries lesion detection; 3. Decision-making and non-operative preventive treatment; 4. Decision making and operative treatment; and 5. Evidence-based, clinical and public health practice. Operational definitions, main competencies and sub-competencies for each domain were agreed. Sub-competencies were classified into three levels: A: Be competent in; B: Have knowledge about, and C: Be familiar with. The final document was sent to all the participants of the workshop for dissemination in each of the institutions involved. Conclusions: The development of the Competency-based Curriculum in Cariology for undergraduate dental students at Chilean universities was achieved through consensus.

RESUMEN: Objetivo: Creación de un currículo de competencias mínimas en Cariología, para la formación de los Cirujano-Dentistas egresados de las escuelas de Odontología de Chile. Metodologías: A partir de una reunión de académicos de las Universidades de Talca y de Chile (año 2011), se elaboró una propuesta de currículo inicial, basado en los dominios propuestos por la Unión Europea (Schulte AG y cols). Durante el año 2016, dicha propuesta fue analizada mediante diálogos digitales y grupos de trabajo, con la participación del 96% de las Escuelas de Odontología existentes en el país, que concluyeron en un documento intermedio. Este documento fue analizado, discutido y perfeccionado durante el Taller para el Desarrollo de un Currículo de Competencias Mínimas en Cariología para las Escuelas de Odontología Chilenas (22/Mayo/2017, Talca, organizado por la Universidad de Talca y la Universidad de Chile) con la asistencia de representantes del 96% de las escuelas dentales chilenas, Ministerio de Salud de Chile, Colegio de Cirujano-Dentistas de Chile y con la asesoría de los profesores de Cariología Dres. Margherita Fontana y Carlos González-Cabezas (Universidad de Michigan, Ann Arbor, EEUU). Cada grupo de trabajo revisó el documento y envió nuevos comentarios, los que fueron incorporados en el documento final por una comisión asesora. Resultados: El documento del Currículo en Cariología se organizó en 5 Dominios: 1. Conocimientos base; 2. Determinación de Riesgo, diagnóstico de caries y detección de lesiones de caries; 3. Toma de decisiones y manejo preventivo no operatorio; 4. Toma de decisiones y manejo operatorio y 5. Cariología basada en la evidencia, en la práctica clínica y de salud pública. Se consensuaron las definiciones operacionales, las competencias principales y las sub-competencias para cada uno de los dominios. Las sub-competencias fueron clasificadas en tres niveles: A: Ser competente en; B: Tener conocimientos sobre y C: Estar familiarizado con. El documento final fue enviado a todos los participantes del taller para su aprobación y difusión en cada una de las instituciones involucradas. Conclusiones: Se logró, por medio de consenso, la construcción del Currículo de Competencias mínimas en Cariología para estudiantes de pregrado de Odontología en las universidades chilenas.

BACKGROUND: Fibromyalgia is characterized by chronic widespread pain, tenderness at muscle and tendon insertions point when digital pressure is applied, sleep disorders, chronic fatigue, depressive episodes, anxiety, and other functional somatic syndromes. OBJECTIVE: The aim of this study was to determine whether balneotherapy with mineral waters and mineral-water containing mud is effective in the management of fibromyalgia. METHODS: We conducted a systematic review of the literature regarding spa therapy in the treatment of the fibromyalgia. We searched many databases for articles published between 2000 and 2012 and we selected 7 studies among 65 articles retrieved. A total of 142 patients received balneotherapy and 129 were controls. CONCLUSIONS: Study data confirms that spa therapy could improve the symptoms of fibromyalgia including pain, depression and minor symptoms.

Amongst other botanical sources, Annona muricata L., Annonaceae, seeds and Piper nigrum L., Piperaceae, fruits are particularly enriched with acetogenins and piperine-related amides, respectively. These crude ethanolic extracts are potent Aedes aegypti bioactives that can kill Aedes aegypti larvae (dengue fever mosquito). A. muricata displayed a 93.48 µg/mL LC50 and P. nigrum an 1.84 µg/mL LC50. An uncommon pharmacognostical/toxicological approach was used, namely different combinations of both extracts to achieve an improved lethal effect on the larvae. The independence test (χ²) was utilized to evaluate the combination of the two crude extracts. All of the tested combinations behaved synergistically and these novel results were attributed to the completely different biochemical mechanisms of the differentiated chemical substances that were present in the two botanical sources. Besides the two above selected plants, Melia azedarach L., Meliaceae, Origanum vulgare L., Lamiaceae, and Ilex paraguariensis A. St.-Hil., Aquifoliaceae, in order of decreasing toxicity, may also be sought as potential extracts for the sake of synergic combinations.

FUNDAMENTO: A detecção do limiar anaeróbico (LA) pela análise da variabilidade da frequência cardíaca (LiVFC) pode significar uma nova maneira de avaliação da capacidade funcional cardiorrespiratória (CFCR) em pré-adolescentes. OBJETIVO: Testar o método de LiVFC para detecção do LA em pré-adolescentes não obesos (NO), obesos (O) e obesos mórbidas (OM), a fim de determinar diferenças em sua CFCR. MÉTODOS: Foram estudados 30 pré-adolescentes, com idades entre 9 e 11 anos, divididos em três grupos de 10: a) grupo NO - índice de massa corpórea (IMC) com percentil do National Center for Chronic Disease Prevention and Health Promotion entre 5 e 85; b) grupo O - IMC de percentil entre 95 e 97 e c) grupo OM - IMC com percentil acima de 97. Todos foram submetidos a um protocolo incremental realizado em esteira rolante e registraram-se os batimentos cardíacos para detecção do LiVFC, que foi determinado pelo valor de 3,0 ms do índice do desvio-padrão 1 (SD1), extraído dos intervalos RR. RESULTADOS: Os valores médios no momento do LiVFC mostraram maiores valores para o grupo NO, destacando-se: a) VO2 (ml/kg/min) NO = 27,4 ± 9,2; O = 13,1 ± 7,6 e OM = 11,0 ± 1,7; b) FC (bpm): NO = 156,3 ± 18,0; O =141,7 ± 11,4 e OM = 137,7 ± 10,4; e c) distância percorrida (metros): NO = 1.194,9 ± 427,7; O = 503,2 ± 437,5 e OM = 399,9 ± 185,1. CONCLUSÃO: O LiVFC se mostrou efetivo para avaliação da CFCR e poderá vir a ser aplicado como método alternativo à ergoespirometria em determinadas situações.

BACKGROUND: The detection of anaerobic threshold (AT) by heart rate variability analysis (HRVt) may mean a new way to assess the cardiorespiratory capacity (CRC) in pre-adolescents. OBJECTIVE: To test the method of HRVt to detect AT in non-obese (NO), obese (O) and morbidly obese (MO) pre-adolescents in order to determine differences in their CRC. METHODS: Were studied 30 pre-adolescents, aged between 9 and 11 years, divided into three groups of ten pre-adolescents each: a) NO group - body mass index (BMI) between 5 and 85 percentiles of the chart of National Center for Chronic Disease Prevention and Health Promotion.; b) O group - BMI between 95 and 97 of the same chart; c) MO group - BMI with percentile over 97. All were submitted to an incremental protocol conducted on a treadmill, and the heart rate was recorded for the detection of the HRVt when the beat-to-beat variability (SD1), extracted from the RR intervals, reached the value of 3 ms. RESULTS: The mean values obtained at HRVt were higher for the NO group, which included: a) VO2 (ml/kg/min) NO = 27.4 ± 9.2; O = 13.1 ± 7.6, and MO = 11.0 ± 1.7 b) HR (bpm): NO = 156.3 ± 18.0, O = 141.7 ± 11.4 and 137.7 ± 10.4 MO; c) distance (m): NO = 1,194.9 ± 427.7, O = 503.2 ± 437.5 and MO = 399.9 ± 185.1. CONCLUSION: HRVt was effective for evaluation of CRC and could be applied as an alternative method to ergoespirometry in certain situations.

BACKGROUND: La detección del umbral anaeróbico (UA) por el análisis de la variabilidad de la frecuencia cardíaca (LiVFC) puede significar una nueva manera de evaluación de la capacidad funcional cardiorrespiratoria (CFCR) en preadolescentes. OBJECTIVE: Testear el método de LiVFC para detección del UA en preadolescentes no obesos (NO), obesos (O) y obesos mórbidos (OM), a fin de determinar diferencias en su CFCR. METHODS: Fueron estudiados 30 preadolescentes, con edades entre 9 y 11 años, divididos en tres grupos de 10: a) grupo NO - índice de masa corporal (IMC) con percentil del National Center for Chronic Disease Prevention and Health Promotion entre 5 y 85; b) grupo O - IMC de percentil entre 95 y 97 y c) grupo OM - IMC con percentil encima de 97. Todos fueron sometidos a un protocolo incremental realizado en cinta rodante y se registraron los latidos cardíacos para detección del LiVFC, que fue determinado por el valor de 3,0 ms del índice de desviación-estándar 1 (SD1), extraído de los intervalos RR. RESULTS: Los valores medios en el momento del LiVFC mostraron mayores valores para el grupo NO, destacándose: a) VO2 (ml/kg/min) NO = 27,4 ± 9,2; O = 13,1 ± 7,6 y OM = 11,0 ± 1,7; b) FC (lpm): NO = 156,3 ± 18,0; O =141,7 ± 11,4 y OM = 137,7 ± 10,4; y c) distancia recorrida (metros): NO = 1.194,9 ± 427,7; O = 503,2 ± 437,5 y OM = 399,9 ± 185,1. CONCLUSION: El LiVFC se mostró efectivo para evaluación de la CFCR y podrá comenzar a ser aplicado como método alternativo a la ergoespirometría en determinadas situaciones.

The investigations about the dimensions of cerebral aneurysms are not precise because of the different methodologies that have been employed and the absence of their standardization, so as the inherent difficulties. There is plenty of classifications by size of the cerebral aneurysms with different cutpoints after the goals of the authors (determination of the size of rupture or of the surgical risk are the most searched). The consequent concepts of those criterions have then, relative value. The morphologic characterization of aneurisms iniciated by German and Black almost sixty years ago may be a valid alternative to employ in practice as a complement of the dimensions. The aspect ratio points in this sense but could be insufficient. The shape of the sack has been given little attention in practice, except for multilocularity, in surgical decision making. We think that incipient aneurysms should have a semiesferic shape and that the neck apparition possibly generates changes in the sack, that makes it to change to an irregular ellipsoid. Loculation definitely gives the terminal shape to the aneurism. If the shape would indicate the developement stadium of the aneurysm, it could became an issue that deserves to be analyzed in detail. Angio CT could be of great help to this aim. The iniciation, growth and rupture of a cerebral aneurysm could be related to some static factors such as: hypertension, increase of cerebrovascular resistance and the increase of arterial pulsatility.

Las investigaciones realizadas hasta ahora acerca de las dimensiones de los aneurismas cerebrales tienen un margen de error nada despreciable debido a las diversas metodologías empleadas y a la falta de estandarización de las mismas, como así también a las dificultades inherentes. Han proliferado muchas clasificaciones con puntos de corte diversos de acuerdo a la intención de los autores (tamaño de ruptura, riesgo quirúrgico, entre los objetivos más buscados). Los conceptos emitidos según estos criterios tienen. pues un valor relativo. La caracterización morfológica del aneurisma, iniciada por German y Black hace casi 60 años, puede ser una alternativa válida a emplear en conjunto con las dimensiones. La razón de aspecto, es un intento en este sentido, aunque posiblemente insuficiente. La forma del saco es un tema al que se le ha dado poca importancia en la práctica, salvo la multiloculación, en la toma de decisión quirúrgica. Opinamos que los aneurismas incipientes deberían tener forma semiesférica y que la aparición del cuello genera posiblemente cambios en el saco, que hacen que cambie de forma, más probablemente hacia un elipsoide irregular. La aparición de loculaciones termina dando la forma definitiva al saco. Si la forma indicara el estadio del desarrollo del aneurisma, debería analizarse este tema en mayor profundidad. La angiotomografía puede resultar de gran ayuda para este menester. La aparición, crecimiento y ruptura de un aneurisma podrían estar relacionados con algunos factores estáticos, como la hipertensión arterial, el aumento de la resistencia cerebrovascular y el aumento de la pulsatilidad arterial.

Circulation in elastic, branching, curved tubes is complex. Laminar and turbulent flow are extreme and infrequent forms of different circulation types named disturbed flow. Pulsatility also contributes to it. Those types of flow produce enrgy loss, transferred in part, to the arterial wall. Velocity, density and diameter of the vessel favor a tidy flow, viscosity instead, acts inversely. The intima reacts to the low shear stress generating pads thar reinforce the lateral faces of bifurcations and less in the vertex, where the strss is maximal. The hemodynamic forces that act upon the vertex are lateral pressure, hemodynamic pressure, that sums to the lateral, the kinetic energy of blood, and the shear stress. The bifurcations of cerebral vessels have weak points at the vertex and lateral faces, characterized by absence of the muscle coat of the media. At this point, the wall is compound of the connective tissue of adventicia, the elastica interna, and the intima. These weak points can be found from birth, but grow in number and width with age, and are larger in patients with aneurysms, or with risk factors such as hypertension or policystic kidneys. Aneurysms grow at the vertex of bifurcations or branchings by the effect of shear stress and hemodynamic pressure, in vessels with change of the geometry of the bifurcation because of aging. Degeneration of the internal elastic lamina seems necessary, and is the consequence of the effect of those forces. Increase of the transmural pressure from different causes, and increase of the hemodinamic requirement by assymetries of the polygon of Willis could be necessary conditions to its growth. Aneurysms would develope because of the impairement of the capacity to damp the pulsatility of the cerebral circulation because of the progressive enhancing of the rigidity of the cerebral vessels and the decline of the other mechanisms of "closed box" of the skull. As atherosclerosis, cerebral berry aneurysms could be considered a degenerative disease of the arterial wall, but in this case for excessive requirement of flow, the opposite to the first.

La circulación en tubos muy ramificados y con curvas es compleja. El flujo laminar y el turbulento son extremos infrecuentes de distintos tipos de circulación que se denominan flujo alterado. La pulsatilidad también contribuye a la alteración del flujo. Estos tipos de flujo requieren de un mayor gasto de energía, que en parte es absorbida por la pared arterial. La velocidad, la densidad de la sangre y el diámetro del vaso favorecen un flujo ordenado, mientras que la viscosidad actúa inversamente. La íntima reacciona al stress de deslizamiento o cizallamiento formando almohadillas que refuerzan la pared en las caras laterales de las bifurcaciones y menos a menudo en el vértice. Las fuerzas hemodinámicas que se ponen en juego en el vértice son la presión lateral que se transforma en tensión, la presión hemodinámica, que suma a la lateral, la energía cinética de la sangre, y la tensión de cizallamiento. Las bifurcaciones de los vasos cerebrales tienen puntos débiles en el vértice y las caras laterales que se caracterizan por ausencia de la capa muscular de la media, quedando la pared constituida por tejido conectivo de la adventicia, la capa elástica interna y la íntima. Estas debilidades de la media pueden aparecer desde el nacimiento, pero su número y tamaño aumentan a lo largo de la vida y son más amplias en pacientes portadores de aneurismas, o con factores de riesgo, como hipertensión y poliquistosis renal. Los aneurismas se forman en los vértices de las ramificaciones o bifurcaciones por efecto del stress de deslizamiento y la presión hemodinámica, en vasos con alteración de la geometría de la bifurcación por envejecimiento. La degeneración de la elástica parece necesaria, y se debe al efecto de estas fuerzas. Aumentos de la presión transmural de diferentes causas, y de los requerimientos hemodinámicos por asimetría del polígono, serían condiciones necesarias para su desarrollo. Como la aterosclerosis, los aneurismas saculares cerebrales podrían ser considerados una enfermedad degenerativa de la pared arterial, pero por exceso de demanda de flujo, contrariamente a la primera.

The geometry of the wall (radio- thickness ratio) determins the distensibility of the vessel. The tension developed at the wall by transmural pressure is bigger at the internal layers, coicident with a greater development of the internal elastic lamina, that is the only existent in the cerebral arteries. The consistency of the wall of cerebral arteries is greater than in other vessels with the same diameter. It is compensated by its thinness that makes it more distensible. This compensation is at the expense of a weakening of the wall with propension to excessive dilatation or aneurysm formation. The disposition of smooth muscle fibers of the media could be responsible for some properties of the vessels as the capacity of retraction. The cause of the different structure of the wall of cerebral vessels are not well explained, but ambient buffering (skull and its contents) and embryological factors are in consideration.

La geometría de la pared (relación radio- espesor) determina la distensibilidad de un vaso a presiones semejantes. La tensión desarrollada en la pared de un vaso por la presión transmural es mayor en las capas internas que en las externas, coincidiendo con un mayor desarrollo de la capa elástica interna, que es la única que existe en los vasos cerebrales. La consistencia de la pared arterial cerebral es mayor que la de otros vasos del mismo calibre, compensada por su notable delgadez, que la hace más distensible. Esta compensación se hace a expensas de un debilitamiento de la pared con propensión a dilatación excesiva o a formación de aneurismas. La disposición de las fibras musculares de la capa media sería responsable de algunas propiedades de los vasos como su capacidad de retracción. Las razones de la diferente estructura de la pared de los vasos cerebrales no han sido bien dilucidadas, pero se consideran factores ambientales amortiguadores (cráneo rígido y su contenido) y embriológicos.

The ischemic lesions in dead patients from severe head injury are distributed predominantly in central territories, and could be secondary to distortion and occlussion of perforant vessels during encephalic desplacement and herniation. Some central lesions could also be primary. The ischemic lesions secondary to diminution of CPP during intracranial hipertension are less frequent than those due to vascular distortion. Thus, it seems physiopathologically more important desplacement and herniation than CPP. A cerebral infarct occurs when CBF is inadequate to support the basic metabolic needs or is lower than 20 ml/ 100 gm/ min., corresponding with a CPP between 35 - 40 mm Hg. The while during which the cell rests viable is not well known. Within traumatic foci, CPP could be lower than mesured by general methods, but ischemia sould not obligatorily follow it. The metabolic needs of those areas could be lowered because of primary cellular necrosis. The oxidative metabolism of glucose could be impaired during ischemia, producing accumulation of deleterious acid metabolites to the neuron. It is possible that "plateau waves" be pathogenic not by itself, but by concomitant structural causes. Nonrhytmic oscilations of volume are normal probably in all organs. Oscillations in volume of the same lesion could be another cause of plateau waves. Decompressive craniectomy could be forced by an exaggerated CPP therapy. CPP over 50 mmHg could produce edema and hemorhage in contused brain in vaso paralysis. Early decompressive craniectomy is indicated in cases with reperfusion edema. The cerebral veins does'nt collapse during intracranial hypertension. The composition of blood in one sigmoid sinus can be different from that of the other side in pathological cases, and is similar in normal subjects. Study of the flow or chemical composition of blood in the sinus rectus could be helpful for the prognosis and therapeutics in patients with acute cerebral disease. Changes in flow velocity at the jugular bulbs coud give an approximation about global CBF changes.

Las isquemias en pacientes que han fallecido por TEC grave se distribuyen predominantemente en territorios centrales y serían secundarias a distorsión y oclusión de los vasos perforantes por desplazamiento y hernia. Algunas lesiones centrales, podrían ser primarias. La isquemia por disminución de la PP por hipertensión endocraneana es menos frecuente que la debida a distorsión vascular. Por lo tanto, pareciera ser más importante para la fisiopatología de la isquemia, el desplazamiento y hernia, que la presión de perfusión. El infarto se produce cuando el flujo no puede abastecer las necesidades metabólicas mínimas (penumbra) es decir, es menor de 20 ml/ 100gr/min, correspondiente a una PP entre 25 y 40mm Hg. No conocemos bien los factores que pueden prolongar la penumbra. Es posible que en focos traumáticos la PP sea menor que la medida con las técnicas habituales, pero debería investigarse en qué casos produce isquemia. Por la lesión primaria, estas zonas pueden tener necesidades metabólicas despreciables. La oxidación de la glucosa puede estar impedida en zonas isquémicas y acumularse metabolitos ácidos que son dañinos para la neurona. Es posible que las ondas en "plateau" no sean patógenas por sí mismas sino por causas estructurales concomitantes. Las oscilaciones no rítmicas de volumen son normales probablemente en todos los órganos. Oscilaciones de volumen de la lesión podrían ser otro factor desencadenante de ondas A. La pulsación cerebral es transmitida a las venas intracraneanas y, a través de la columna sanguínea, a los senos durales, por las características de caja cerrada del cráneo. La craniectomía descompresiva podría ser forzada por una terapia de la presión de perfusión exagerada. Presiones de perfusión por encima de 50 mm Hg podrían provocar edema y hemorragia en zonas contusas en vasoparálisis. La craniectomía descompresiva está indicada en casos de edema de reperfusión, y debería realizarse precozmente. Las venas cerebrales no se colapsan durante el proceso de hipertensión endocraneana. La sangre de los senos sigmoideos puede tener contenidos diferentes de uno u otro lado en casos patológicos, mientras que éstos son similares en pacientes normales. Estudios del flujo o composición química de la sangre en el seno recto podrían ser de ayuda para la terapéutica y el pronóstico de pacientes con lesiones cerebrales agudas. Los cambios de velocidad circulatoria en los golfos yugulares podrían dar una idea aproximada de las variaciones de flujo cerebral global.

Objective: To study the anatomy of the IV ventricle recesses and their relationship to the surgical approaches. Methods: Three specimens of brain stem and cerebellum were prepared sistematically and the fibers were dissected with the Klingler's method. Two acrylic casts were obtained in order to analize the cavity shape details of the IV ventricle. Results. The recesses of the IV ventricle are better understood by the inspection of the casts. In the midline lies the posterior recess. There are two pairs of symmetrical recesses: the posterolateral and the lateral. The laters, are two ducts that drain into the cerebello ponto medullary angle through the foramina of Luschka. The excision of the amigdala helps to study the anatomical relations "in situ". The roof of the lateral recess is made up by cochlear fibers medially and the flocculus peduncle laterally. The dentate nucleus is separated from the posterolateral recess by fibers from of the flocculus pedicle. Conclusion: The IV ventricle has five recesses. Casts of the ventricle gave a better idea of their tridimensional disposition and relationships. With a proper anatomical knowledge, a rational non traumatic access to the different structures can be achieved.

Objetivo. Analizar la anatomía de los recesos del IV ventrículo y su relación con las vías de abordaje. Método. Se disecaron 3 especímenes de cerebelo en forma sistemática. Se utilizó la técnica de Klingler para las fibras y la cavidad se estudió en 2 moldes de acrílico. Se realizó un análisis bibliográfico. Resultados. Los moldes dieron una idea cabal de los recesos, su ubicación espacial y forma. Hay uno impar, el posterior, ubicado en la línea media y dos pares de recesos simétricos: los posterolaterales, ubicados a los lados del primero y algo por debajo del mismo, y los laterales, conductos que abrazan la unión bulbo protuberancial y se abren al ángulo bulbo pontocerebeloso por el agujero de Luschka. Para estudiar las relaciones de estas estructuras "in situ" fue útil extirpar primero las amígdalas. El techo de los recesos laterales está constituido por fibras cocleares en su parte medial y el pedúnculo del flóculo en su parte lateral. El núcleo dentado está separado del receso posterolateral por fibras del pedúnculo del flóculo. Conclusión. El IV ventrículo tiene 5 recesos. Los moldes del ventrículo permitieron tener una idea más clara de la disposición tridimensional de ellos. El conocimiento anatómico permitió un abordaje racional y menos traumático para lesiones del IV ventrículo o las estructuras vecinas.

Weperformed a selective bilbiographic review about dural fistulas that involvedthe superior sagital sinus to know its phisiopathology, clinical symptoms,diagnosis and treatment. The dural fistula of the region of the superiorsagittal sinus is a vascular anomaly characterized by an abnormalarteriolarvenous communication in the dura mater near the sinus wall. Becauseof the arterialized cerebral veins, intracranial hemorrhage is the most commonform of presentation of this infrequent disease. Feeding arteriolar rami fromthe superficial temporal and meningeal arteries commonly come from both sides.In these cases the anomaly lies in the sinus wall without involvement of thesinus lumen. Less frequently leptomeningeal rami of the internal carotid and orvertebral artery feed the fistula. In these patients, the sinus is totally orpartially occluded and the veins are filled with arterial blood by reflux. Acomplete and selective angiography is mandatory when this illness is suspected.The goal of the treatment is to eliminate the arterial flow in the cerebralveins. It can be accomplished by means of surgical or endovascular methods,through the arterial or venous side.

Se realizó unarevisión bilbiográfica selectiva sobre las fístulas durales de la proximidaddel seno sagital superior para conocer su fisiopatología, clínica, diagnósticoy tratamiento. La fístula dural del seno longitudinal superior es una anomalíavascular caracterizada por una comunicación anómala arteriolovenosa en elespesor de la duramadre en la pared del seno sagital. Es una patología pocofrecuente que se manifiesta habitualmente por sangrado intracraneano debido ala arterialización de las venas cerebrales. Por lo general los ramilletesarteriolares provienen de la arteria temporal superficial y meníngea media deambos lados, en estos casos la anomalía asienta en la pared del seno sinafectar su luz. Menos comúnmente las ramas leptomeníngeas de la carótida internay/o de la vertebral alimentan la fístula, en estos pacientes el seno estáparcial o totalmente ocluído y las venas se arterializan por reflujo. Ante lasosopecha de esta enfermedad es importante realizar una angiografía completa yselectiva. El tratamiento tiene como finalidad eliminar el flujo arterial enlas venas cerebrales, ello se logra en forma endovascular y/o quirúrgica desdeel lado arterial o venoso de la fístula.

O principal objetivo deste estudo foi verificar as alterações odontológicas mais freqüentes encontradas em jogadores de futebol. Num levantamento realizado pela Seção de Odontologia da Associação Portuguesa de Desportos-SP, 400 prontuários de futebolistas, correspondentes a um período de seis anos, foram avaliados. Todos eram do sexo masculino, sendo 353 amadores e 47 profissionais, com média de idade de 16,5 ± 2,1 anos (variação de 9 a 20) e 24,7 ± 3,6 anos (variação de 21 a 34), respectivamente, pertencentes ao quadro de atletas do Departamento de Futebol. Os equipamentos utilizados durante os procedimentos foram: espelho clínico e explorador nº 5 da marca Duflex em um consultório modelo MLX Plus da marca Funk. As radiografias oclusais foram realizadas com filmes da marca Kodak no equipamento de raios-X modelo Spectro II da marca Dabi Atlante. As seguintes alterações e os resultados encontrados nos futebolistas amadores foram: 199 casos (56%) de tartarectomia, 283 de cáries (71%), 61 de gengivites (17%), 51 de endodontias (14%), 51 de pulpites (14%), 33 de abscessos (9%), 21 de fístulas (6%) e 10 de aftas (3%). Nos casos de ortodontia foram verificados: diastema em 12 atletas (3,5%), apinhados em 35 (10%), heterotópicos em 36 (10,2%) e empactados em 4 (1%). Foram realizadas 78 exodontias (22%), 41 obturações (11,5%) e 72 próteses (20%). A profilaxia realizada atingiu 148 casos (42%). Os jogadores profissionais apresentaram os seguintes resultados: 17 casos de tartarectomia (36%), 32 cáries (68%), 14 gengivites (30%), 11 endodontias (23%), 6 pulpites 13%), nenhum abscesso, 2 fístulas e aftas (4%), respectivamente. Foram verificados 6 casos de ortodontia, subdivididos em 3 apinhados e heterotópicos (6%), respectivamente. Foram realizadas 24 exodontias (51%), 6 obturações (13%) e 23 próteses (49%). Conclusão: os resultados verificados neste estudo demonstraram a importância da odontologia, como medida preventiva e/ou corretiva, em jogadores de futebol. É importante salientar que uma dentição inadequada pode gerar desde alterações gastrintestinais até lesões músculo-esqueléticas, dificultando a participação do atleta em treinamentos e jogos competitivos.

The main purpose of this study was to verify the most frequent dental alterations found in soccer players. In a survey carried out by the dentistry department of this Association, the case histories of 400 soccer players were evaluated over a period of 6 years. The players _ 353 amateurs and 47 professionals _ aged 16.5 ± 2.1 (ranging from 9 to 20) and 24.7 ± 3.6 (ranging from 21 to 34), respectively, were all male members of the team of athletes in the soccer department. The tools used during the procedures were clinical mirror and explorer no. 5 (Duflex) in a model office (MLX Plus-Funk Trademark). The occlusion radiographs were obtained with Kodak films in the X-ray equipment (Spectro 11 model-Dabi Atlante Trademark). These were the alterations and results found in the amateur soccer players: 199 cases of tartarectomy (56%), 283 of caries (71%), 61 of gingivitis (17%), 51 of endodontics (14%), 33 of abscesses (9%), 21 of fistulas (6%) and 10 of aphthae (3%). In the orthodontic cases, the following alterations were found: diastema in 12 athletes (3.5%), crowded teeth in 35 (10%), heterotopic in 36 (10.2%), and impacted in 14 (1%). Seventy-eight extractions (22%), 41 fillings (11.5%) and 72 tooth replacements (20%) were carried out, while prophylactic measures covered 148 cases (42%). The professional soccer players presented the following results: 17 cases of tartarectomy (36%), 32 of caries (68%), 14 of gingivitis (30%), 11 of endodontics (23%), 6 of pulpitis (13%), absence of abscesses, 2 of fistulas and aphthae (4%), respectively. Six cases of orthodontics were verified, subdivided into 3 crowded and heterotopic teeth (6%), respectively. There were 78 extractions (51%), 6 fillings (13%), and 23 replacements of teeth (49%). Conclusion: results verified in this investigation have shown the importance of dentistry for both preventive and/or corrective measures. It is also important to stress that an inadequate teething process may cause gastrointestinal alterations and even musculoskeletal changes, thus making it difficult for athletes to participate in training and contests.

Os autores relatam três casos de neurocriptococose em crianças na primeira década de vida, no Estado do Rio Grande do Sul. O diagnóstico foi estabelecido pelo encontro do fungo Cryptococcus neoformans no líquido céfalo-raquidlano por exame direto com tinta da China e cultura em meio de Sabouraud. As formas de instalação da síndrome neurológica foram aguda, subaguda e crônica. Síndrome de hipertensão intracraniana e hidrocefalia foram complicações observadas durante a evolução da doença, sendo necessária a instalação de derivação ventrículo-peritonial em um caso. Desnutrição foi o processo mórbido associado nos três casos e infecção pelo bacilo da tuberculose em um caso. Terapia específica foi administrada aos três pacientes. Um paciente evoluiu para cura e dois evoluíram para óbito.

The authors report three cases of central nervous system cryptococcosis in children in the first decade of life, from Rio Grande do Sul State, Brazil. Diagnosis was supported by demonstration of Cryptoccoccus neformans with India-ink preparations of the spinal fluid and Sabouraud's media culture. Clinical presentation included acute, subacute and chronic forms. Increased intracranial pressure and hydrocephalus were the complications during the course of the disease, and a ventriculoperitoneal shunt was used in one case. Undernutrition was associated with all cases and tubercle bacillus infection with one. Specific therapy was administered to the three patients. One patient was cured and the other two died.