Resumo -Com o advento da tecnologia vídeo-assistida a endoscopia tem assumido importante papel terapêutico na cavidade torácica. Este artigo é uma avaliação crítica da literatura e tem como objetivo demonstrar o estado atual da cirurgia endoscópica direcionada para a coluna torácica. Hérnias discais, deformidades, infecções, tumores, doenças congênitas e traumatismos estão sendo tratados por técnica endoscópica. Na literatura, as vantagens sobre a toracotomia aberta são visibilidade aumentada e reduções em: tempo de recuperação, perda sanguínea, custos, índice de infecção e morbidade pós-operatória. Algumas desvantagens são: intubação seletiva, significativa curva de aprendizado, dificuldades técnicas na operação de crianças muito pequenas, reparação da dura máter e instrumentação. Embora os benefícios sejam aparentemente claros e haja pronunciado grau de entusiasmo, os autores são cautelosos em afirmar que a toracoscopia já é uma alternativa definitiva à toracotomia convencional. A comparação dos resultados entre as técnicas endoscópica e aberta é dificultada pela escassez de estudos comparativos. Os autores, embora otimistas, recomendam análises de mais estudos prospectivos, multicêntricos e randomizados para uma conclusão definitiva. PALAVRAS-CHAVE: endoscopia, toracoscopia, coluna torácica. Endoscopic surgery for thoracic spine: critical reviewABSTRACT-After the development of video-assisted technology, endoscopic techniques have assumed an important therapeutic role into thoracic cavity. This is a literature review article to show the current state of the endoscopy for thoracic spine. Disc herniations, deformities, infections, tumors, congenital disorders and traumatic events have been treated by endoscopic techniques. On reviewing the literature, the advantages over open approaches are: enhanced visualization, shorter recovery time and decreased blood loss, costs, infection rate and post operative morbidity. Some disadvantages are: one lung anesthesia, significant learning curve, and technical problems in operating on small children, repairing the dura and performing instrumentation. Overall benefits are apparently clear. However, despite the high degree of enthusiasm, authors are cautious to state that endoscopic techniques to the spine already represent a definitive alternative to standard techniques. Comparison between endoscopic and open approaches are still difficult because of the lack of appropriate comparative studies. Authors, although optimistic recommend more prospective, multicentric and randomized studies in order to stand a definitive conclusion.KEY WORDS: endoscopy, thoracoscopy, thoracic spine.Tradicionalmente, a abordagem anterior para a coluna torácica vem sendo feita através de uma toracotomia 1 . As cirurgias abertas da parte anterior da coluna espinhal trouxeram importante avanço na recuperação e prognóstico dos pacientes. Entretanto, essa modalidade cirúrgica não é isenta de complicações e morbidade pós-operatória 1-10 ; o trauma cirúrgico na execução da abordagem é considerável 5,11 ...

RESUMO -Os autores apresentam o caso de uma paciente de 45 anos de idade com história de 15 meses de evolução, de hemiatrofia progressiva da face e língua à esquerda. A investigação laboratorial e de imagens foi normal, incluindo exames de sangue de rotina, líquido cerebro-espinhal, provas de função hepática, renal e reumáticas; além de raio X, tomografia computadorizada e ressonância magnética de crânio. A eletroneuromiografia mostrou alterações neurogênicas periféricas dos nervos trigêmio motor e hipoglosso, predominantemente à esquerda. Esses achados são compatíveis com o diagnóstico de hemiatrofia facial de Romberg, motivando a discussão de diversos aspectos desta rara doença de acordo com o relato e com a literatura.PALAVRAS-CHAVE: hemiatrofia facial, síndrome de Parry-Romberg, doença de Romberg. Romberg's facial hemiatrophy: case reportSUMMARY -The authors report the case of a 45-years-old female patient, with progressive hemiatrophy of the left face and tongue. The laboratorial and image studies were normal, including routine blood exams, cerebral-¬ spinal fluid, hepatic function tests, renal and rheumatic; besides X ray, computerized tomography and magnetic resonance of skull. The electroneuromyography showed peripheral neurogenic alterations of motor trigeminal and hypoglossal nerves, markedly on the left side. Those findings are compatible with Romberg's facial hemiatrophy diagnosis, motivating discussion of several aspects of this rare disease according to the account and literature.KEY WORDS: facial hemiatrophy, Parry-Romberg syndrome, Romberg's syndrome. O objetivo deste trabalho é relatar um caso de HFR e discutir alguns aspectos relevantesda doença. A hemiatrofia facial de Romberg (HFR),

We report a series of 110 patients with acute traumatic subdural hematoma (ASDH) admitted at HBDF emergency within 1994 (January 1st to December 1st). All patients were treated according to the same protocol. There was a predominance of males (79%), with ages ranging from 14 to 70, being car accidents (20%) and car-pedestrian accidents (34%) the most frequent causes. The majority of patients (85.7%) was admitted in very serious condition, with a score of 8 points on the Glasgow Coma Scale (GCS) or lesser, which directly influenced the mortality rates. CT scan was the diagnostic procedure of choice, and it showed contusion and brain swelling to be the most frequent associated intracranial lesions. Surgery was carried out in 45.1% of cases and, in most instances, through an ample fronto-temporo-parietal craniotomy, with hematoma drainage and dural reconstitution. In 54.9% of cases, clinical conditions did not allow surgery and in this group, 69.6%.

Arq Neuropsiquiatr 2011;69(5):854 854 ThesesPercutaneous vertebroplasty: a comparison between the procedure using the traditional and the new side-opening cannula for osteoporotic vertebral fracture (Abstract)*. Thesis. Brasília, 2009. Nicandro de Figueiredo Neto**Percutaneous vertebroplasty (PV) is a minimally invasive procedure used to treat focal pain of osteoporotic vertebral fractures, osteolytic metastatic disease, myeloma and aggressive hemangioma. PV has some potential complications: the most common are caused by cement extrusion, usually asymptomatic, but may lead to clinical complications, such as radicular or spinal cord compression and lung embolism. A new cannula for cement injection was developed by Heini and Allred, by closing the frontal aperture and opening a lateral one, close to the tip of the traditonal cannula. This allows the flow of cement to be redirected medially, thus reducing the risk of cement extravasation and increasing the safety of the procedure.Study Design: A clinical, single-blinded, randomized study, about a new cannula for percutaneous vertebroplasty.Objective: To analyze the safety and efficacy of a new cannula with lateral opening, especially the reduction of cement extravasation during the injection and the pain control.Method: This study included procedures of PV performed for osteoporotic vertebral fractures, using the frontal-opening and the new side-opening cannula, and the results were compared, aiming to detect mainly the difference between the two cannulas regarding the incidence of cement extravasation and the clinical outcome.Results: A total of 47 PVs, performed from March 2003 to February 2008, were performed for osteoporotic vertebral fractures in 31 patients, 25 PVs were performed using the frontal-opening and 22 using the new side-opening cannula, randomly distributed. The incidence of cement extrusion was 27% with the side-opening cannula, and 68% with the frontal-opening, all asymptomatic (p<0.01). The pain control was very hight and similar for both groups, and there were no clinical complications.Conclusion: Percutaneous vertebroplasty seems to be a very safe and efficacious pain relieving procedure for patients with osteoporotic vertebral fracture. Cement leakage is very common, usually asymptomatic, but there is a potential for clinical complications. This leakage can be significantly reduced with this new side opening cannula, which allows for a better cement injection toward the center of the vertebral body and increases the safety of the procedure with no elevation in cost. The aim of this work was to evaluate depressive symptoms and cognitive functions of attention and executive functions in children with dyslexia and children without learning disabilities.Method: A sample of 61 children, aged between 7 and 14 years old, was divided into two groups: (A) 31 children diagnosed with dyslexia at Learning Disabilities Ambulatory -Hospital de Clínicas; (B) 30 children without learning disabilities evaluated at a public school. Individual evaluations were ...