Saturday, May 31, 2014

iBook: Thoughts from the Hospital

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THOUGHTS FROM THE HOSPITAL

Júlio Pereira

Medicina, Livros, Profissional e técnico

16/12/2013

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I remember several times when coming home tired after being on call , but I was always wanting to write something. Sometimes I had had an unusual scene, listened an interesting phrase or experienced a sad case. We are not able to express ourselves in a hospital, even when seriously ill, we don't have time. But that's how the book "Thoughts from the hospital" emerged. My book contains texts that I wrote during college, medical school and during my residency of neurosurgery. I could set the book "Thoughts from the hospital" as clippings thoughts
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Copyright © 2014 Apple Inc. Todos os direitos reservados.
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Wednesday, May 28, 2014

Dor de Cabeça App



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One third of all brain aneurysms rupture: the size of an aneurysm is not a significant risk factor

One third of all brain aneurysms rupture: the size of an aneurysm is not a significant risk factor
Neurology News & Neuroscience News from Medical News Today

Approximately one third of all brain aneurysms rupture during a patient's lifetime, resulting in a brain haemorrhage.

Original Article: http://www.medicalnewstoday.com/releases/277226.php
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Consciousness Might Emerge from a Data Broadcast

Consciousness Might Emerge from a Data Broadcast
Scientific American: Mind and Brain

What is consciousness? A neuroscientist's new book argues that it arises when information is broadcast throughout the brain

-- Read more on ScientificAmerican.com


Original Article: http://www.scientificamerican.com/article/consciousness-might-emerge-from-a-data-broadcast/
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Are We Losing Our Curiosity?

Are We Losing Our Curiosity?
Medscape Today- Medscape

Physical exams engage clinicians in a way that may be lost with the growing reliance on technology and electronic records.
Medscape Diabetes & Endocrinology

Original Article: http://www.medscape.com/viewarticle/825414?src=rss
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Building Africa's Scientific Infrastructure

Building Africa's Scientific Infrastructure
Scientific American: Mind and Brain

Africa has the lowest scientific output of any continent, despite being the second most populous. Combined, its 54 nations generate approximately the same amount of scientific research as the...

-- Read more on ScientificAmerican.com


Original Article: http://www.scientificamerican.com/blog/post/african-nations-aim-to-address-scarcity-of-scientists/
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Experts Debate Use of Cannabis to Control Seizures

Experts Debate Use of Cannabis to Control Seizures
Medscape Today- Medscape

A new series of articles in Epilepsia examine the potential use of cannabidiol and medical marijuana in young patients with epilepsy.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/825642?src=rss
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Twitter to Release All Tweets to Scientists

Twitter to Release All Tweets to Scientists
Scientific American: Mind and Brain

A trove of billions of tweets will be a research boon and an ethical dilemma

-- Read more on ScientificAmerican.com


Original Article: http://www.scientificamerican.com/article/twitter-to-release-all-tweets-to-scientists-a-trove-of-billions-of-tweets-will-be-a-research-boon-and-an-ethical-dilemma/
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John M. Freeman, MD (1933-2014)

John M. Freeman, MD (1933-2014)
Neurology current issue

Pediatric neurologist John Freeman, who died on January 3 at age 80, spent 40 years at Johns Hopkins challenging established dogma in epilepsy, spina bifida, and cerebral palsy. In the process, he changed the outlook for many children with these conditions.



Original Article: http://www.neurology.org/cgi/content/short/82/21/1854?rss=1
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Neurosurgery App Provides Easy Access to Information for Medical Students ... - Becker's Orthopedic & Spine

Neurosurgery App Provides Easy Access to Information for Medical Students ... - Becker's Orthopedic & Spine
neurosurgery - Google News


Neurosurgery App Provides Easy Access to Information for Medical Students ...
Becker's Orthopedic & Spine
neuReference, a new application developed to help medical students on their neurosurgery rotation and neurosurgery residents, is available on the app store on iTunes, according to an iMedicalApps report. The app includes information on relevant anatomy ...



Original Article: http://news.google.com/news/url?sa=t&fd=R&ct2=us&usg=AFQjCNEToqOFWxbLCHfk5p10wpTGLkYA5w&clid=c3a7d30bb8a4878e06b80cf16b898331&ei=YQSEU4DcC8e1mQLA0oHADA&url=http://www.beckersspine.com/spine/20925-neurosurgery-app-provides-easy-access-to-information-for-medical-students-residents
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Clues about chronic fatigue syndrome revealed by brain imaging

Clues about chronic fatigue syndrome revealed by brain imaging
Neurology News & Neuroscience News from Medical News Today

A brain imaging study shows that patients with chronic fatigue syndrome may have reduced responses, compared with healthy controls, in a region of the brain connected with fatigue.

Original Article: http://www.medicalnewstoday.com/releases/277323.php
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Nerve Stimulator Eases Chronic Headache

Nerve Stimulator Eases Chronic Headache
MedPage Today Neurology

BOSTON (MedPage Today) -- Patients with intractable headache pain who underwent occipital nerve stimulation reported a marked reduction in severity and frequency within the first month after implantation, researchers said here.

Original Article: http://www.medpagetoday.com/MeetingCoverage/AAPA/45992
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New AHA/ASA Statement on Physical Activity After Stroke

New AHA/ASA Statement on Physical Activity After Stroke
Medscape NeurologyHeadlines

Physical activity and exercise advice should be incorporated into the management of stroke survivors, the American Heart Association/American Stroke Association says in an updated statement.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/825735?src=rss
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O médico bem sucedido ( Contos de Gerson Salvador)

O médico bem sucedido ( Contos de Gerson Salvador)
Neurosurgery Blog

O médico bem sucedido

Autor: Gerson Salvador

 

Após estar formado em medicina comecei a trabalhar em pronto-atendimentos (PA), locais que as pessoas costumam procurar por algum desconforto agudo, porém sem maior gravidade. Preferia o PA infantil, gostava das crianças, de examiná-las, de brincar com elas – quando era possível, muitas vezes só era necessário orientar as mães para cuidarem dos resfriados de seus filhos.
Eu chegava às dezenove em ponto, ou antes. Haveria um colega mais experiente para fazer dupla comigo.  Seria bom um médico com maior vivência. Em casos mais graves é bom ter com quem dividir as dúvidas e as condutas.
Quinze pras oito chegou meu parceiro. O mesmo de outros plantões. Era José qualquer outra coisa, não lembro. Chamava-lhe Zezão. Tinha poucos cabelo, todos brancos, cinquenta anos, olheiras e expressão cansada, parecia ter vinte a mais, um tanto bonachão. Gostava de falar de futebol e amenidades, era agradável acordado. Dormindo era das piores companhias: no quarto do plantonista quando ele encostava à cama, beliche de madeira das mais simples, com um colchão mole, já usado há anos, já dormia. Eu na cama de cima presenciava um terremoto. A cama vibrava, parecia que funcionava uma serralheria no quarto, meu colega roncava, roncava, roncava, tinha pausas respiratórias tão prolongadas que não teve um plantão em que não pensei que teria que lhe reanimar. E se ele tivesse uma parada cardiorrespiratória no meio do plantão?
Zezão estava sempre cansado. Ar de desgosto. Já tinha passado pelos dois empregos e pelo consultório quando chegou atrasado ao PA. Esbaforido, creditava ao trânsito da cidade o seu atraso, xingava o prefeito que só sabia cobrar impostos. Ia para sua sala e começava os atendimentos. Dia sim, dia não estava de plantão. Eram muitas as despesas.
Naquela noite tinha jogo do Brasil, o PA estava anormalmente vazio. Conseguimos jantar juntos, ele fez questão de pedir pizza. Aceitei.
Acho que há tempos não encontrava um amigo, então servia eu mesmo. Primeiro contou de suas façanhas. Graças a ter dado tantos plantões já tinha comprado dois apartamentos, mas cada um estava com uma ex-mulher. Seus relacionamentos não duravam. Não sabia o porquê. Mas tinha lhe restado uma bela casa de praia. Fazia dois anos que não conseguia ir lá, mas era sua! Qualquer dia nós poderíamos ir lá, qualquer dia. Nos próximos seria difícil. Estava em crise com sua mulher atual. Eram brigas, desentendimentos, já não dormiam juntos havia dois meses. O jeito era passar numa casa de acompanhantes. Fazer o que? Lá naquele lugar, havia mulheres lindas, discretas, sempre elogiavam seu desempenho! Gostavam dele, de certo.
Chega mensagem do filho no celular. Esse só procura para pedir dinheiro. Tanto trabalho, ele teve tudo: viajou, fez intercâmbio e estudou línguas. Está na faculdade. Foram muitos plantões pra dar tudo a ele.  Só manda mensagem pedindo dinheiro.
Perguntou o que eu queria fazer de especialidade.
Não tinha certeza. Queria fazer alguma especialidade clínica em que pudesse trabalhar com saúde pública: pediatria, medicina de família, infectologia, clínica médica…
- Rapaz você é muito novo, ainda não sabe do mundo. Esse negócio todo é muito bonito, mas se você for mesmo trabalhar com saúde pública, você jamais será como eu. Assim: bem sucedido.

 

xxxxxx
1471736_10202264061263627_940202081_n

Dr. Gerson Salvador
Médico infectologista Universidade de São Paulo
Disciplina de propedeutica médica Faculdade de Medicina da USP
Médico da divisão de Clínica Médica Hospital Universitário da USP

Contatos:

Facebook: https://www.facebook.com/gerson.salvadordeoliveira

twitter @gersonsalvador

email:  gersonsalvador@gmail.com

 

Outros Contos de Gerson Salvador:

http://neurocirurgiabr.com/de-barquinho-para-o-ceu-contos-de-gerson-salvador/

http://neurocirurgiabr.com/o-pior-medico-do-mundo-contos-de-gerson-salvador/

http://neurocirurgiabr.com/descompensacao-contos-de-gerson-salvador/

http://neurocirurgiabr.com/gasometria-contos-de-gerson-salvador/

http://neurocirurgiabr.com/dor-toracica-contos-de-gerson-salvador/

The post O médico bem sucedido ( Contos de Gerson Salvador) appeared first on NEUROSURGERY BLOG.



Original Article: http://neurocirurgiabr.com/o-medico-bem-sucedido-contos-de-gerson-salvador/?utm_source=rss&utm_medium=rss&utm_campaign=o-medico-bem-sucedido-contos-de-gerson-salvador
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Wednesday, May 21, 2014

Which New Oral Anticoagulant for Stroke Prevention in AF?

Which New Oral Anticoagulant for Stroke Prevention in AF?
Medscape Today- Medscape

Researchers compared safety and efficacy outcomes in the large phase 3 trials of four NOACs and identified knowledge gaps in translating these trials into clinical practice.
Heartwire

Original Article: http://www.medscape.com/viewarticle/825293?src=rss
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Surgical Infections Fly under the Radar at Outpatient Clinics

Surgical Infections Fly under the Radar at Outpatient Clinics
Scientific American: Mind and Brain

Outpatient surgeries at freestanding medical centers are growing in popularity, but for all their promise, gaps in tracking superbugs and other infections fuel concern

-- Read more on ScientificAmerican.com


Original Article: http://www.scientificamerican.com/article/under-the-knife-where-infections-fly-under-the-radar/
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Brain Abscess as a Cause of Macrocephaly in a Newborn

Brain Abscess as a Cause of Macrocephaly in a Newborn
Pediatric Neurology

The authors thank Drs. Gelabert and Aran-Echabe for their interest in our report. We agree that empiric, broad-spectrum antibiotics, followed by culture-directed therapy, is the mainstay of intracranial infection management. In answer to their question, our institution has a protocol to guide such management as we believe this constitutes standard practice. In patients with brain abscess, we use a combination of vancomycin, metronidazole, and ceftazidime, although other intracranial infections are treated with vancomycin and meropenem. Like Drs. Gelabert and Aran-Echabe, we considered that empiric therapy represents a broad-spectrum regimen, fully justified in most clinical settings. Regarding instillation of antibiotics into the abscess cavity, although no systematic approach has been studied in the literature (as far as we know), we empirically use gentamicin, again complying with institutional protocol. Finally, we agree that craniotomy is probably the surgical approach with the lowest recurrence rate, but we believe that certain clinical circumstances make less invasive approaches equally or more adequate. Discussion regarding different surgical options and optimal management is beyond the scope of our article. In the individual we described, our intention was to emphasize his particular clinical presentation, initially managed as an asymptomatic macrocephaly. Our aim was to illustrate an apparent disproportion between lesion size and alarming signs and between mass effect and neurological status. Obviously, the child was managed as an emergency as soon as he was referred to us. Neurosurgical intervention and intensive care surveillance were implemented immediately. The particular clinical setting of this patient gave us the impression that craniostomy allowed immediate relief of mass effect with less risk of complications. The safe resection of the abscess capsule was felt to be hampered by the size, extension, and chronology of the lesion. We hope that Drs. Gelabert and Aran-Echabe will agree with us that sometimes the optimal surgical approach has to be decided on an individual basis. Once again, we thank them for their kind comments about our article.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00088-5/abstract?rss=yes
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Hydrocephalus in neuromyelitis optica

Hydrocephalus in neuromyelitis optica
Neurology recent issues

A majority of patients with neuromyelitis optica (NMO) spectrum disorders (NMOSD) have MRI brain abnormalities, some of which are "NMO-typical" with localization in aquaporin 4 (AQP4)–rich circumventricular and periaqueductal regions.1 Although uncommon in adult patients, symptomatic brain involvement occurs in approximately 50% of NMO–immunoglobulin G (IgG) seropositive children. Here we report the clinical characteristics, type, and frequency of hydrocephalus in NMOSD.



Original Article: http://www.neurology.org/cgi/content/short/82/20/1841?rss=1
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Neuronal activation by acupuncture at Yongquan and sham acupoints for DOC: A PET study

Neuronal activation by acupuncture at Yongquan and sham acupoints for DOC: A PET study
Neurology News & Neuroscience News from Medical News Today

Acupuncture is a traditional Chinese medicine technique that is often used to help improve the level of consciousness in patients with disorder of consciousness (DOC).

Original Article: http://www.medicalnewstoday.com/releases/276971.php
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Use of Cone-Beam Computed Tomography Angiography in Planning for Gamma Knife Radiosurgery for Arteriovenous Malformations: A Case Series and Early Report

Use of Cone-Beam Computed Tomography Angiography in Planning for Gamma Knife Radiosurgery for Arteriovenous Malformations: A Case Series and Early Report
Neurosurgery - Current Issue

imageBACKGROUND: The effectiveness of Gamma Knife radiosurgery (GKR) for cerebral arteriovenous malformations (AVMs) is predicated on inclusion of the entire nidus while excluding normal tissue. As such, GKR may be limited by the resolution and accuracy of the imaging modality used in targeting. OBJECTIVE: We present the first case series to demonstrate the feasibility of using ultrahigh-resolution C-arm cone-beam computed tomography angiography (CBCT-A) in AVM targeting. METHODS: From June 2009 to June 2013, CBCT-A was used for targeting of all patients with AVMs treated with GKR at our institution. Patients underwent Leksell stereotactic head frame placement followed by catheter-based biplane 2-dimensional digital subtraction angiography, 3-dimensional rotational angiography, as well as CBCT-A. The CBCT-A dataset was used for stereotactic planning for GKR. Patients were followed at 1, 3, 6, and 12 months and then annually thereafter. RESULTS: CBCT-A–based targeting was used in 22 consecutive patients. CBCT-A provided detailed spatial resolution and sensitivity of nidal angioarchitecture enabling treatment. The average radiation dose to the margin of the AVM nidus corresponding to the 50% isodose line was 15.6 Gy. No patient had treatment-associated hemorrhage. At early follow-up (mean, 16 months), 84% of patients had a decreasing or obliterated AVM nidus. CONCLUSION: CBCT-A–guided radiosurgery is feasible and useful because it provides sufficient detailed resolution and sensitivity for imaging brain AVMs. ABBREVIATIONS: AVM, arteriovenous malformation CBCT-A, cone-beam computed tomography angiography CTA, computed tomography angiography DSA, digital subtraction angiography GKR, Gamma Knife radiosurgery MRA, magnetic resonance angiography RA, rotational angiography SRS, stereotactic radiosurgery

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/06000/Use_of_Cone_Beam_Computed_Tomography_Angiography.18.aspx
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Targeting the Affective Component of Chronic Pain: A Case Series of Deep Brain Stimulation of the Anterior Cingulate Cortex

Targeting the Affective Component of Chronic Pain: A Case Series of Deep Brain Stimulation of the Anterior Cingulate Cortex
Neurosurgery - Current Issue

imageBACKGROUND: Deep brain stimulation (DBS) has shown considerable promise for relieving nociceptive and neuropathic symptoms of refractory chronic pain. Nevertheless, for some patients, standard DBS for pain remains poorly efficacious. Pain is a multidimensional experience with an affective component: the unpleasantness. The anterior cingulate cortex (ACC) is a structure involved in this affective component, and targeting it may relieve patients' pain. OBJECTIVE: To describe the first case series of ACC DBS to relieve the affective component of chronic neuropathic pain. METHODS: Sixteen patients (13 male and 3 female patients) with neuropathic pain underwent bilateral ACC DBS. The mean age at surgery was 48.7 years (range, 33-63 years). Patient-reported outcome measures were collected before and after surgery using a Visual Analog Scale, SF-36 quality of life survey, McGill Pain Questionnaire, and EQ-5D (EQ-5D and EQ-5D Health State) questionnaires. RESULTS: Fifteen patients (93.3%) transitioned from externalized to fully internalized systems. Eleven patients had data to be analyzed with a mean follow-up of 13.2 months. Post-surgery, the Visual Analog Scale score dropped below 4 for 5 of the patients, with 1 patient free of pain. Highly significant improvement on the EQ-5D was observed (mean, +20.3%; range, +0%-+83%; P = .008). Moreover, statistically significant improvements were observed for the physical functioning and bodily pain domains of the SF-36 quality-of-life survey: mean, +64.7% (range, −8.9%-+276%; P = .015) and mean +39.0% (range, −33.8%-+159%; P = .050), respectively. CONCLUSION: Affective ACC DBS can relieve chronic neuropathic pain refractory to pharmacotherapy and restore quality of life. ABBREVIATIONS: ACC, anterior cingulate cortex DBS, deep brain stimulation PAG, periventricular/periaqueductal gray area VP, ventral posterior medial and lateral nuclei of the sensory thalamus

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/06000/Targeting_the_Affective_Component_of_Chronic_Pain_.13.aspx
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Epilepsy Surgery for Glioneuronal Tumors in Childhood: Avoid Loss of Time

Epilepsy Surgery for Glioneuronal Tumors in Childhood: Avoid Loss of Time
Neurosurgery - Current Issue

imageBACKGROUND: In contrast to the abundance of seizure outcome reports in epilepsy surgery for glioneuronal tumors in childhood and adolescence, there is a dearth of information regarding cognitive outcomes. OBJECTIVE: To investigate the seizure and cognitive outcome of children and adolescents that underwent resective surgery for glioneuronal tumor-associated refractory epilepsy and determine their predictive factors. METHODS: We retrospectively analyzed the presurgical findings, resection types, and outcomes over 1.3 to 12.3 years (mean, 7.3) of 29 consecutive patients, who underwent resection in 2000 to 2011. The mean age at epilepsy onset was 7.9 years (range, 0-15.4), the mean age at surgery was 11.7 years (range, 2.6-17.3), and the mean epilepsy duration to surgery was 3.8 years (range, 0.3-15.3). Etiology comprised 13 dysembryoplastic neuroepithelial tumors and 16 gangliogliomas, with additional focal cortical dysplasia in 5 cases. RESULTS: Eighty-six percent of children were seizure free 12 months after surgery; at final follow-up, 76% remained seizure free and 62% had discontinued antiepileptic drugs. Gross total resection was related to significantly higher rates of seizure freedom. Higher presurgical cognitive functioning (full-scale IQ, verbal IQ) was related to shorter epilepsy duration to surgery independent of age at epilepsy onset, thus determining postsurgical functioning. Improvements in verbal IQ, performance IQ, and visual memory as well as a trend toward improvement in full-scale IQ were established after surgery. Despite individual losses in full-scale IQ, verbal or visual memory, no deterioration was noted in any cognitive variable on a group level. CONCLUSION: Completeness of resection predisposes to favorable outcomes regarding seizure alleviation. Whereas cognitive functioning deteriorates with time in glioneuronal tumor-related refractory epilepsy, surgery is linked to improvement rather than to deterioration on a group level. ABBREVIATIONS: AED, antiepileptic drugs DNET, dysembryoplastic neuroepithelial tumor ECoG, electrocorticography EEG, electroencephalography FCD, focal cortical dysplasia FSIQ, full-scale IQ MTS, mesial temporal structures PIQ, performance IQ SD, standard deviation VIQ, verbal IQ

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/06000/Epilepsy_Surgery_for_Glioneuronal_Tumors_in.15.aspx
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Treatment of a Basilar Trunk Perforator Aneurysm With the Pipeline Embolization Device: Case Report

Treatment of a Basilar Trunk Perforator Aneurysm With the Pipeline Embolization Device: Case Report
Neurosurgery - Current Issue

imageBACKGROUND AND IMPORTANCE: Basilar trunk perforator (BTP) aneurysms are rare lesions that pose significant challenges to microsurgical clipping and endovascular coiling. We present the intriguing case of a ruptured BTP aneurysm that was successfully treated with the Pipeline Embolization Device (PED). CLINICAL PRESENTATION: An elderly woman presenting with subarachnoid hemorrhage was found to have a 1.5-mm aneurysm arising from the proximal portion of a thin midbasilar perforator. The decision was made to treat this aneurysm with flow diversion in an attempt to preserve the patency of the perforator and to avoid the hazards associated with parent vessel trapping. A 3 × 12-mm PED was successfully deployed in the basilar trunk across the neck of the aneurysm, causing stasis in the aneurysm, with continuous flow through the parent vessel. The procedure and postoperative course were uneventful. A follow-up angiogram 2 weeks later showed complete disappearance of the aneurysm with preservation of the patency of the perforator. At the 6-month follow-up, the patient was asymptomatic and remained neurologically intact. CONCLUSION: We present the first case of a BTP aneurysm treated with the PED. The aneurysm was successfully occluded, and the patency of the feeding vessel was preserved. In light of the limitations of coiling and the hazards associated with microsurgery and parent vessel trapping, the PED may be a valuable option for BTP aneurysms. ABBREVIATIONS: BTP, basilar trunk perforator PED, Pipeline Embolization Device

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/06000/Treatment_of_a_Basilar_Trunk_Perforator_Aneurysm.19.aspx
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Neuroimaging in dementias: An important diagnostic aid!

Neuroimaging in dementias: An important diagnostic aid!
JNNP blog

Althgally the diagnosis of dementias remains clinically based, neuroimaging techniques have been increasingly utilised as diagnostic aids.  While "older" or more conventional techniques have been implmenented to exclude "mimc" disorders, newer techniques have been implemented to identify patters of atrophy or metabolic abnormalites that could aid in the type of dementia.  In this issue of JNNP, an elegant review highlighting the currently utilised techniques identifying patterns of atrophy, T1 and T2 lesions etc, puts neuroimaging in specific focus.  Helpful alogartithms have been proposed to guide the reader.  A potential role for "metabolic" imaging (SPECT and PET) is also discussed.

You can read more at http://jnnp.bmj.com/content/85/6/692.full

 

An algorithmic approach to structural imaging in dementia

Editor's Choice

  1. Lorna Harper1,
  2. Frederik Barkhof2,
  3. Philip Scheltens3,
  4. Jonathan M Schott1,
  5. Nick C Fox1


Original Article: http://blogs.bmj.com/jnnp/2014/05/21/neuroimaging-in-dementias-an-important-diagnostic-aid/
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Friday, May 16, 2014

How to Make a Graph (Part 2)

How to Make a Graph (Part 2)
Scientific American: Mind and Brain

How do you turn a bunch of data into a super-handy graph? Keep on reading to learn the final 2 steps in Math Dude's easy 4-step method for making graphs 

-- Read more on ScientificAmerican.com


Original Article: http://www.scientificamerican.com/article/how-to-make-a-graph-part-2/
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