ABSTRACT Objective: To evaluate the cumulative incidence, risk factors, and outcomes of COVID-19 in patients with Cushing's disease (CD). Subjects and methods: In all, 60 patients with CD following up in our outpatient clinic answered via phone interview a questionnaire about the occurrence of COVID-19 infection documented by RT-PCR (including the diagnosis date and clinical outcome) and vaccination status. Clinical and biochemical data on disease activity (hypercortisolism) and comorbidities (obesity, diabetes mellitus, and hypertension) were obtained from the patients' electronic medical records. Risk ratios (RRs) of risk factors were obtained using univariate and multivariate analyses. Results: The cumulative incidence of COVID-19 in patients with CD during the observation period was 31.7%, which was higher than that in the general reference population (9.5%). The cumulative incidence of COVID-19 was significantly higher in patients with hypercortisolism (57% versus 17% in those without hypercortisolism, p = 0.012) and obesity (54% versus 9% in those without obesity, p < 0.001) but not in patients with hypertension or diabetes mellitus. On multivariate analysis, hypercortisolism and obesity were each independent risk factors for COVID-19 (RR 2.18, 95% CI 1.06-4.46, p = 0.033 and RR 5.19, 95% CI 1.61-16.74, p = 0.006, respectively). Conclusion: The incidence of COVID-19 in patients with CD was associated with hypercortisolism, as expected, and obesity, a novel and unexpected finding. Thus, correction of hypercortisolism and obesity should be implemented in patients with CD during the current and future COVID-19 outbreaks. Objective COVID19 COVID 19 COVID-1 Cushings Cushing s CD. . (CD) methods all 6 RTPCR RT PCR including outcome status (hypercortisolism (obesity mellitus records RRs (RRs analyses Results 317 31 7 31.7% 9.5%. 95 9.5% 9 5 (9.5%) 57% 57 (57 17 0.012 0012 0 012 54% 54 (54 0.001 0001 001 analysis 218 2 18 2.18 1.064.46, 106446 1.06 4.46, 1 06 4 46 1.06-4.46 0033 033 0.03 519 5.19 1.6116.74, 1611674 1.61 16.74, 61 16 74 1.61-16.74 0006 006 0.006 respectively. respectively respectively) Conclusion expected finding Thus outbreaks COVID1 COVID- (CD 3 31.7 9.5 (9.5% (5 0.01 01 0.00 000 00 21 2.1 064 1.064.46 10644 106 1.0 446 4.46 1.06-4.4 003 03 0.0 51 5.1 6116 1.6116.74 161167 161 1.6 1674 16.74 1.61-16.7 31. 9. (9.5 ( 2. 1.064.4 1064 10 1. 44 4.4 1.06-4. 0. 5. 611 1.6116.7 16116 167 16.7 1.61-16. (9. 1.064. 4. 1.06-4 1.6116. 1611 16. 1.61-16 (9 1.064 1.06- 1.6116 1.61-1 1.611 1.61-

A técnica cirúrgica clássica para ressecção de schwannomas vestibulares enfatiza a anatomia microcirúrgica dos nervos cranianos. Acreditamos que o foco na preservação da membrana aracnóide pode servir como parâmetro seguro para a remoção do tumor. Método A abordagem extracisternal é descrita em detalhe. Analisamos o prontuário de 120 pacientes tratados com esta técnica entre 2006 e 2012. Os resultados cirúrgicos foram baseados em extensão de ressecção, recorrência tumoral e função do nervo facial. Resultados Ressecção total foi obtida em 81% dos pacientes. O resultado global da função do nervo facial (House-Brackmann graus I-II) após um ano da cirurgia foi de 93%. Não houve recidiva em um seguimento médio de 4,2 anos. Conclusão A técnica extracisternal difere de outras descrições cirúrgicas no tratamento de schwannoma vestibular pois não requer a identificação do nervo facial, contanto que o plano de aracnóide seja preservado em toda circunferência do tumor.

The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.

With over 130 species, bats are the most diverse group of mammals almost everywhere in sub-Saharan Africa. Since 2000, two books (Monadjem et al. 2010; Taylor 2000) have made it much easier to appreciate this reality. Species previously unrecognised are frequent discoveries (e.g. Taylor et al. 2012). Whilst most species are mainly insectivorous, some rely more directly on plants, taking fruit and visiting flowers to obtain nectar and pollen. The combination of mobility, long lifespan and diversity of trophic roles makes bats potentially valuable as indicators of ecosystem health (Cumming & Spiesman 2006). Lack of detailed information, however, makes it easy to overlook bats when focusing on issues of conservation.

Objective: The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve. Methods: Retrospective study including 2,406 appropriate for gestational age newborns following the Alexander et al curve (1996) from 29 to 42 weeks of gestational age. Weight and lenght were measured following standard procedures. For the construction aof a normal smoothed percentile curve, the 3rd, 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were determined and a statistical procedure based on the mathematical model "sinosuoidal fit" was applied to establish a curve that estimates biological growth parameters. Results: The Body Mass Index values for gestational age in all percentiles shows a steady increase up to 38 weeks, levels off up to the 40th week, followed by a slight decrease to the 42nd week in both genders. Conclusion: The results show a direct correlation between gestational age and Body Mass Index for both genders in the nine percentiles, and can provide a useful reference to assess intra-uterine proportional growth.

Objetivo: La combinación de dos parámetros antropométricos ha sido descrita como una manera más apropiada para determinar la composición y proporciones del cuerpo en niños, con especial atención para el índice de masa corporal (IMC), pues relaciona el peso y la estatura. Sin embargo, los valores del IMC para el periodo neonatal no han sido determinados todavía. Este estudio muestra el IMC para recién nacidos de diversas edades gestacionales presentados en una curva de percentiles suavizados. Métodos: En un estudio retrospectivo incluyendo 2.406 recién nacidos apropiados para la edad gestacional según la curva de Alexander y cols. (1996), entre 29 y 42 semanas de edad gestacional. El peso y la estatura fueron medidos según los procedimientos estándares. Para la construcción de la referida curva fueron determinados los siguientes percentiles: 3, 5, 10, 25, 50, 75, 90 y 95. El modelo matemático de ajuste sinusoidal fue aplicado para establecer una curva que estimase los parámetros biológicos del crecimiento. Resultados: Los valores del IMC para las edades gestacionales en todos los percentiles demostraron aumento constante hasta 38 semanas, estabilización hasta 40 semanas, seguida por una leve disminución hasta 42 semanas en ambos los sexos. Conclusión: Los resultados demuestran una correlación directa entre la edad gestacional y el IMC para ambos sexos en todos los percentiles estudiados, y pueden proporcionar una herramienta útil para determinar un crecimiento intrauterino proporcional.

Assessing the composition of an area's bat fauna is typically accomplished by using captures or by monitoring echolocation calls with bat detectors. The two methods may not provide the same data regarding species composition. Mist nets and harp traps may be biased towards sampling low flying species, and bat detectors biased towards detecting high intensity echolocators. A comparison of the bat fauna of Fazenda Intervales, southeastern Brazil, as revealed by mist nets and harp trap captures, checking roosts and by monitoring echolocation calls of flying bats illustrates this point. A total of 17 species of bats was sampled. Fourteen bat species were captured and the echolocation calls of 12 species were recorded, three of them not revealed by mist nets or harp traps. The different sampling methods provided different pictures of the bat fauna. Phyllostomid bats dominated the catches in mist nets, but in the field their echolocation calls were never detected. No single sampling approach provided a complete assessment of the bat fauna in the study area. In general, bats producing low intensity echolocation calls, such as phyllostomids, are more easily assessed by netting, and bats producing high intensity echolocation calls are better surveyed by bat detectors. The results demonstrate that a combined and varied approach to sampling is required for a complete assessment of the bat fauna of an area.

In this study the incidence of moths and beetles was examined from feces samples of bats that use different foraging behaviors. Twenty sites around the Fazenda Intervales, a Field Research Station located in São Paulo State, in southeastern Brazil were sampled. Feces were collected from bats caught in mist nets, Turtle Traps or hand nets and, in one case, from beneath a roost. Feces samples were taken from six species of bats: Micronycteris megalotis (Gray, 1842), Mimon bennettii (Gray, 1838), Furipterus horrens (F. Cuvier, 1828), Myotis riparius Handley, 1960, Myotis ruber (E. Geoffroy, 1806) and Histiotus velalus (I. Geoffroy, 1824). To record and describe the frequencies dominating bat echolocation calls, an Anabat II bat detector coupled with an Anabat ZCA interfaces and DOS laptop computers were used. The data show that Furipterus horrens feeds extensively on moths, as predicted from the features of its echolocation calls. Gleaning bats, whose echolocation calls are much less conspicuous to moths take a wide range of insect (and other) prey.

The common carotid arteries were anastomosed through a venous graft in a group of ten rats. The right common carotid artery was ligated below and the left above the anastomosis. In a control group both common carotid arteries (CCA) were ligated. While the animals of the experimental group survived without neurological deficit, those in the control group died 2 hours to 11 days after operation. The anastomoses and brains were studied by light microscopy. The model described is convenient for practising microsurgery, and should constitute part of the routine training program of young neurosurgeons.

A revision is made of the methods employed up to date in determining cerebral blood-flow by means of radioactive isotopes. The quantitative methods are compared to the qualitative ones regarding their clinical and diagnostic value. While quantitative methods allow an exact determination of the cerebral blood-volume, and thus of the blood-flow through the entire brain or through certain of its areas, qualitative methods offer special advantages because of their clinical and diagnostic value. By determining cerebral circulatory time and tracing the activity curves enregistered over both hemisphere it is possible to obtain differential diagnostic conclusions on the presence of a tumor, an arteriovenous malformation, as well as on an arteriosclerotic cerebral process. The test, besides taking only a few minutes, does not overload the patient neither does it expose him to a significant amount of radiation. It can also be performed on older patients, to whom angiography is not entirely free of risks.

Es wird über die bisher entwickelten Methoden zur bestimmung der Hirndurchblutung mit radioaktiven Isotopen berichtet, wobei die quantitativen Untersuchungsmethoden hinsichtlich ihrer klinischen Bedeutung den qualitativen gegenübergestellt werden. Während die quantitativen Methoden eine genaue Bestimmung des cerebralen Blutvolumens und damit der Gesamtdurchblutung des Hirns bzw. bestimmter Hirnareale ermöglichen, bieten die qualitativen Untersuchungsmethoden hinsichtlich der klinisch-diagnostischen Aussagekraft besondere Vorteile. Aus der Bestimmung der Zirkulationszeit des Hirns und dem Verlauf der über beiden Hemisphären registrierten Aktivitätskurven lassen sich differenzial-diagnostische Schlüsse auf das Vorliegen eines Tumors, einer arteriovenösen Missbildung und auch eines cerebralen Gefässprozesses, im Sinne einer Arteriosclerosis cerebri Ziehen. Die Untersuchung, die nur wenige Minuten beansprucht, ist weder mit einer Belastung für den Patients verbunden, noch mit einer nennenswerten Strahlenbelastung. Sie kann auch bei älteren Patienten vorgenommen werden, bei denen eine Angiographie gefahrvoll erscheint.

Dentre 1.400 doentes examinados, o positrocefalograma (PCG) permitiu a localização correta em 77% dos casos com tumor cerebral. A segurança para a exclusão do diagnóstico de tumor situou-se entre 76% e 87%. Pela associação dos dados obtidos angiogràficamente com os proporcionados pelo PCG foi possível estabelecer o diagnóstico topográfico preciso em 97% dos casos de tumor. Além disso foi conseguida substancial melhoria das previsões quanto à espécie do tumor. Associado ao EEG, o PCG proporciona aprimoramento tão nítido do diagnóstico em casos de ambulatório que, de regra, quando são negativos para tumor os resultados do exame neurológico, do EEG, do PCG e da radiologia simples, é lícito desistir da execução de métodos contrastados de diagnóstico. Isto elimina, em especial, a sobrecarga constituída pelos doentes com crises convulsivas, nos quais o esclarecimento do diagnóstico e a exclusão da existência de tumor cerebral só eram possíveis mediante internação dos pacientes.

Among a total of 1,400 examined cases, the positrocephalogram (PCG) allowed correct localization in 77% of the patients with a brain tumor. The diagnostic safety for the exclusion of an expansive process varied from 76% to 87%. By associating the data obtained through angiography with those furnished by the PCG it has been possible to establish a precise site diagnosis in 97% of the cases of brain tumor. Additional substantial improvement was attained as far as the diagnosis of the tumor type is concerned. When associated with the EEG, the PCG represents such a marked improvement in policlinical diagnosis that, as a rule, if the results of the neurological examination, the EEG, the PCG and plain radiology are negative for tumor, it is valid to give up further contrast methods. This mainly eliminates the overchange represented by patients with convulsive disorders as, up to now, diagnostic research in order to exclude a brain tumor in such cases was only possible with safety by means of stationary observation.

Bei insgesamt 1400 untersuchten Fällen konnte mit dem Positrocephalo-gramm (PCG) in 77% der Tumorfälle eine richtige Tumorlokalisation erzielt werden. Die diagnostische Sicherheit beim Tumorausschluss lag zwischen 76% und 87%. Durch die Kombination der im Angiogramm und PCG gewon-nenen Befunde konnten 97% der Grosshirntumoren genau lokalisiert werden und darüber hinaus ist damit eine wesentliche Verbesserung der artdiagno-stischen Voraussagen möglich. In Verbindung mit dem EEG bietet das PCG sowohl zum Tumorausschluss, als auch zum Tumornachweis eine so wesentliche Verbesserung der bisherigen poliklinischen Diagnostik, dass in der Regel bei negativem neurologischen-, EEG-, Isotopen- und Röntgen-befund auf die Kontrastmitteldiagnostik verzichtet werden kann, wodurch besonders bei der Abklärung von Anfallsleiden die nur stationär durchzu-führenden klinische Diagnostik entlastet wird.

De uma casuística maior - 215 angiomas artériovenosos intracranianos, dos quais 118 submetidos à extirpação total - foram selecionados 54 pacientes com angiomas situados na região rolândica, nas regiões temporais e nos territórios limítrofes entre estas zonas e áreas cerebrais vizinhas. Dêsse grupo fôram estudados 22 casos nos quais o angioma artériovenoso estava localizado na região motora. A análise da motricidade e da capacidade de trabalho pós-operatória, após exerese total da lesão, mostrou que a localização da malformação nesta área de elevada importância funcional não aumenta o risco cirúrgico nem agrava o prognóstico. A cifra pré-operatória de perturbações da motricidade aumenta de modo passageiro no período pós-operatório imediato, mas volta a decair aos índices iniciais no período tardio. Qualitativamente, as deficiências motoras após a cirurgia são, em geral, menos intensas do que antes do tratamento. A capacidade integral de trabalho é conservada na maioria dos casos. Apenas uma porcentagem relativamente restrita de pacientes não apresenta integridade funcional completa depois da operação. Na nossa casuística, êste grupo era constituido precisamente por enfêrmos com angiomas de volume superior a 25 cm³. O único registro de invalidez se referiu a paciente que já estava hemiparética ao ser internada. Concluímos que a extirpação total é o método de escolha também no tratamento dos angiomas artériovenosos cerebrais situados em áreas ditas de elevada importância funcional e que eram consideradas inabordáveis sem grandes danos para a capacidade funcional do paciente.

Among 215 intracranial arteriovenous angiomas (118 submitted to total extirpation) 54 were located in the central region, in the temporal regions an in the transition territories between these and neighbouring cerebral areas. From this group 22 cases have been selected, in which the angioma was seated in the motor area. The study of the motor functions and of the postoperative working capacity in these patients has shown that the localisation of the malformation in this functionally important area does not increase the surgical risk, nor aggravates the prognosis for the patient. The postoperative incidence of motor disfunctions increases reversibly during the immediate postoperative period but later decreases again to the initial values. From the qualitative point of view the motor deficits observed after operation are usually less severe than before treatment. Full working capacity is retained in most cases. Only a relatively low percentage of patients does not display full working capacity after operation. In our casuistic this group was composed precisely of patients with angiomas larger than 25 cc. The only case of invalidity observed was that of a preoperatively already hemiparetic patient. Our conclusion is that total extirpation is the method of choice also for the treatment of those arteriovenous angiomas seated in cerebral areas considered of high functional importance.

In einer Kasuistik von 215 arteriovenösen Angiomen (118 Totalexstir-pationen) befanden sich die Angiome bei 54 Patienten in der Zentralregion, in den Temporalregionen und in den Übergangsgebieten zwischen diesen und den benachbarten Hirngebieten. Aus dieser Gruppe wurden 22 Fälle aus-gesucht, bei denen das arteriovenõse Angiom in der motorischen Gegend lag. Die Analyse der Motorik und der postoperativen Arbeitsfähigkeit bei diesen Fällen zeigte, dass die Lokalisation der Missbildung in diesem funk-tionell hochwertigen Gebiet das operative Risko nicht erhöht und die Prog nose für den Kranken nicht verschlechtert. Die präoperative Inzidenz von motorischen Ausfällen steigt sofort nach dem Eingriff voriibergehend an, aber sinkt in der katamnestischen Periode wieder auf die Anfangswerte ab. Qualitativ, jedoch, sind die motorischen Ausfälle nach der Operation im Allgemeinen weniger ausgeprägt als vor der Behandlung. Die Arbeitsfähigkeit bleibt in der Mehrzahl der Falle völlig erhalten. Nur ein relativ geringer Prozentsatz der Patienten ist postoperativ nicht võllig arbeitsfähig. In unserem Krankengut stellte sich diese Gruppe gera-de aus Patienten zusammen, deren Angiome ein grösseres Volumen als 25,0 cm³ hatten. Der einzige Fall von Invalidität war eine schon präopera-tiv hemiparetische Patientin. Es wird gefolgert, dass die Totalextirpation die Behandlungsmethode der Wahl darstellt, auch bei arteriovenösen Angiomen, die sich in funktionell hochwertigen Hirnbezirken befinden.