OBJECTIVE The authors sought to construct, implement, and evaluate an interactive and stereoscopic resource for teaching neuroanatomy, accessible from personal computers. METHODS Forty fresh brains (80 hemispheres) were dissected. Images of areas of interest were captured using a manual turntable and processed and stored in a 5337-image database. Pedagogic evaluation was performed in 84 graduate medical students, divided into 3 groups: 1 (conventional method), 2 (interactive nonstereoscopic), and 3 (interactive and stereoscopic). The method was evaluated through a written theory test and a lab practicum. RESULTS Groups 2 and 3 showed the highest mean scores in pedagogic evaluations and differed significantly from Group 1 (p < 0.05). Group 2 did not differ statistically from Group 3 (p > 0.05). Size effects, measured as differences in scores before and after lectures, indicate the effectiveness of the method. ANOVA results showed significant difference (p < 0.05) between groups, and the Tukey test showed statistical differences between Group 1 and the other 2 groups (p < 0.05). No statistical differences between Groups 2 and 3 were found in the practicum. However, there were significant differences when Groups 2 and 3 were compared with Group 1 (p < 0.05). CONCLUSIONS The authors conclude that this method promoted further improvement in knowledge for students and fostered significantly higher learning when compared with traditional teaching resources.

Persistent pain is a frequent health problem in the elderly. Its prevalence ranges from 45% to 80%. Chronic diseases, such as depression, cardiovascular disease, cancer and osteoporosis have a higher prevalence in aged individuals and increase the risk of developing chronic pain. The presence of pain is known to be associated with sleep disorders in these patients, as well as functional impairment, decreased sociability and greater use of the health system, with consequent increase in costs. Alzheimer's disease patients seem to have a normal pain discriminative capacity and they may probably have weaker emotional and affective experience of pain when compared to other types of dementia. Many patients have language deficits and thus cannot properly describe its characteristics. In more advanced cases, it becomes even difficult to determine whether pain is present or not. Therefore, the evaluation of these patients should be performed in a systematic way. There are three ways to measure the presence of pain: by direct questioning (self-report), by direct behavioral observation and by interviews with caregivers or informants. In recent years, many pain scales and questionnaires have been published and validated specifically for the elderly population. Some are specific to patients with cognitive decline, allowing pain evaluation to be conducted in a structured and reproducible way. The next step is to determine the type of painful syndrome and discuss the bases of the pharmacological management, the use of multiple medications and the presence of comorbidities demand the use of smaller doses and impose contraindications against some drug classes. A multiprofessional approach is the rule in the management of these patients. Key words: Alzheimer's disease, pain, chronic pain, elderly, cognitive impairment.Avaliação e manejo da dor em pacientes idosos com e sem demência RESUMO Dor persistente é um problema de saúde frequente no idoso e sua prevalência varia de 45 a 80%. Doenças crônicas, como depressão, distúrbios cardiovasculares, câncer e osteoporose tem alta prevalência em indivíduos idosos e aumentam o risco de desenvolver dor crônica. Nestes indivíduos, a presença de dor está associada a distúrbios do sono, prejuízo funcional, diminuição da sociabilidade e maior procura dos serviços de saúde, com o consequente aumento dos custos de saúde. Pacientes com Alzheimer têm uma capacidade discriminativa dolorosa normal e uma experiência afetiva e emocional da dor mais atenuada quando comparados com outros tipos de demência. Muitos pacientes

This study aimed at observing aspects of epidemiology in order to investigate the use of alcohol in patients older than 18 with severe and moderate traumatic brain injury, which were attended in the Clinics Hospital of the University of Uberlândia. Positive alcoholemy was found in 39.3% of the patients. Of the 33 positive exams alcoholemy was found higher than 60 mg/dL in 28 (84.6%). There was not significant relation between alcoholemy levels and trauma severity. The major prevalence occurred on Saturdays nights. The most frequent types of external causes were transportation accidents (64.74) followed by accidental falls (17.27%) and physical aggression (16.55%). 93.9% of the patients with positive alcoholemy were men aged 20-29. 24.2% of the ones with positive alcoholemy died yet no significant difference was found in the study of the ones with negative alcoholemy (n=51) (p=0.93); RR= 0.9; IC95%=0.40-2.08.

Learning medicine is a difficult process to undertake, partially due to the complexity of the subject and limitations of traditional methods of teaching (lectures, textbooks, laboratory and anatomical dissections). These resources have been effective for decades, even though presenting intrinsic drawbacks. Textbooks are non-interactive education tools and do not provide any three dimensional experience. Cadaver dissection is an invaluable aid to learn anatomy. It provides an immersive, interactive experience allied with an inimitable tactile feedback. However, it has several limitations, including availability of specimens, costs and a substantial time commitment. Computer based virtual reality methods may overcome these drawbacks and provide interesting alternatives for medical training. Technological advances have generated great expectations for the use of computer-based virtual reality technologies in medical education, mainly anatomy and surgery. However, these Virtual Reality tools for general medical education are expensive due to the equipment necessary to create highly detailed, immersive three-dimensional image environments with real time friendly user interactivity. The concepts of Virtual Reality methods that generate immersive environments, as well as those that create simulated objects with interactive viewing features may be contemplated by the QuickTimeTM which is one of the technologies that can be successfully used for interactive, photorealistic displaying of medical images (radiological, anatomical and histological) and interaction on current generation of personal computers at a low and accessible cost. In this paper, the authors provide an overview of the Quick Time Virtual Reality methods aiming to introduce them to medical educators and illustrate their application on medical training.

Contemporary therapies for patients with glioblastomas remain marginally efficient, and recurrence following surgery, radiation therapy and adjuvant chemotherapy is practically universal. The major obstacles to the successful use of chemotherapy for CNS tumors are the drug delivery to the tumor site and the infusion of chemotherapeutic agents directly into the arterial supply of a tumor. The latter could provide a pharmacokinetic advantage by enhancing drug delivery to the tumor. Sixteen patients with recurrent unilateral glioblastomas treated with intra-arterial BCNU were evaluated retrospectively. During the infusion, eleven patients referred pain in the ipsilateral eye, five patients were nauseated, three reported headache, one patient presented mental confusion, while two presented focal signs. There were two deaths during the course of therapy. Four patients achieved temporary clinical improvement, seven showed disease stability, and three presented clinical deterioration. The median total survival time was 87.9 weeks. Unilateral vision loss and focal signs were observed as delayed complications of this treatment. This study has confirmed previous reports indicating that arterial chemotherapy is clearly not curative, and presents serious toxicity. Only through a randomized prospective study performed in a large series of patients can the questions concerning survival period increment be answered properly. Key words: malignant gliomas, chemotherapy, carmustine, carotid artery, ophthalmic artery.tratamento do glioblastoma recorrente com bcNU [1, 3-bis (2-chloroethyl)-1-nitrosourea] intra arterial resUmo Os tratamentos atuais para pacientes com glioblastoma permanecem pouco eficientes e a recorrência, acompanhando cirurgia, radioterapia e quimioterapia, é a regra geral. O maior obstáculo para o sucesso da quimioterapia para os tumores do SNC é a disponibilização da droga no sitio do tumor sendo que a infusão do agente quimioterápico diretamente na trama arterial da lesão pode proporcionar vantagens por maior liberação da substância diretamente no tumor. Estudamos retrospectivamente dezesseis pacientes com glioblastomas recorrentes, unilaterais, que foram tratados com BCNU intra-arterial; durante a infusão, onze pacientes sentiram dor no olho ipsilateral, cinco ficaram nauseados, três queixaram-se de cefaléia, um apresentou confusão mental e dois apresentaram sinais focais. Ocorreram duas mortes durante a terapia. Quatro pacientes apresentaram melhora clinica temporária, sete apresentaram estabilização e três apresentaram deterioração. A média de sobrevida total foi de 87,9 semanas. Perda da visão unilateral e sinais focais foram complicações tardias. Este estudo confirmou trabalhos anteriores indicando que