Orientador: Sergio Tadeu Martins Marba / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T01:41:15Z (GMT). No. of bitstreams: 1 Vinagre_LuisEduardodeFigueiredo_M.pdf: 699641 bytes, checksum: f53b941c432fcc025a8d30c2ff8a4493 (MD5) Previous issue date: 2009 / Resumo: O objetivo deste trabalho foi avaliar o efeito do uso antenatal do corticosteróide na incidência da hemorragia peri-intraventricular global e em seus graus, levando-se em consideração o efeito do número de doses e o intervalo entre a administração da primeira ou segunda dose e o parto, em recém-nascidos com peso de nascimento entre 500 e 1.500 g. Para tanto foi realizado um estudo analítico retrospectivo, no qual foram incluídos 176 recém-nascidos internados em um hospital terciário do Município de Campinas no período de janeiro de 2000 a dezembro de 2001. Os recém-nascidos foram divididos em dois grupos: um em que se fez uso antenatal do corticosteróide que incluiu 143 participantes e outro que não recebeu este tratamento que abrangeu 33 participantes. Os dados foram analisados inicialmente através de tabelas descritivas e também foram utilizados, quando indicado, o teste do quiquadrado, o teste exato de exato de Ficher, o teste t de Student, o teste de Mann-Whitney e odds ratio. O nível de significância aceito foi de p<0,05 (intervalo de confiança de 95%). Os grupos foram comparáveis na maioria das variáveis; entretanto, houve diferença estatística em relação à idade materna (p = 0,0313), na hipertensão arterial materna (p < 0,0001), no trabalho de parto (p = 0,0059), tipo de parto (p = 0,0152) e infecção neonatal (p = 0,0093). Não houve diferença estatisticamente significativa entre os grupos em relação à idade gestacional, peso de nascimento e escore de Apgar. A incidência global da hemorragia periintraventricular foi de 12,5%, sendo 11,2% para o grupo que fez uso antenatal do corticosteróide e 18,2% para o grupo que não fez uso do tratamento. Este resultado não alcançou significância estatística (OR: 0,57 com IC 95% = 0,19 - 1,80). Não foi observada significância estatística também, ao analisar o período de tempo entre a administração da dose de corticosteróide e o parto e em relação ao número de doses. Apesar da literatura demonstrar um efeito protetor do uso antenatal do corticosteróide na prevenção da hemorragia peri-intraventricular, este trabalho não evidenciou tal efeito. A baixa incidência global da hemorragia peri-intraventricular, juntamente com a elevada taxa de mães hipertensas e de recém-nascidos pequenos para idade gestacional podem ter interferido na análise do uso antenatal do corticosteróide na prevenção desta patologia, ou mais algum outro fator, não identificado, que contribuiu na redução da hemorragia peri-intraventricular, esteve associado ao uso do corticosteróide, ocultando o seu efeito protetor / Abstract: The aim of this study is to evaluate the effects of antenatal corticosteroid therapy on the incidence of intraventricular hemorrhage and in its grade, regarding the effect of number of doses and the timing between the application of the first or second dose and delivery, in newborn with birth weight between 500 and 1,500 grams. An analytic retrospective trial was carried out enrolling 176 newborn admitted at a tertiary center hospital in Campinas city, São Paulo, Brazil, from January 2000 to December 2001. The newborns have been divided into two groups: one received antenatal corticosteroid therapy (143/176) and another (33/176) who have not received the treatment. Data were analyzed through descriptive chart, also when indicated, quisquare test and Fisher exact test, Student's t-test, Mann-Whitney test and odds ratio. The groups were comparable in majority of the variables; nevertheless there was statistically significant difference in maternal age, (p = 0,0313), maternal hypertension (p < 0,0001), labor (p = 0,0059), method of delivery (p = 0,0152) and neonatal sepse (p = 0,0093). There was no statistically significant difference among the groups regarding the gestational age, birth weight and in 5 minutes Apgar score. The global incidence of intraventricular hemorrhage was 12,5%. The incidence for the group which had been treated with antenatal corticosteroid therapy was 11,2%, and the other group it was 18,2%. This outcome didn't reach statistic significance (OR: 0,57; CI 95% = 0,19 - 1,80). Also, there was no statistic significance in the time between the dose application and delivery, and in regarding the number of doses. Despite literature demonstrating a protective effect of the use of antenatal corticosteroid therapy for prevention of intraventricular hemorrhage, this study showed no such effect. The low overall incidence of intraventricular hemorrhage along with high rate of maternal hypertension and small-for-gestational-age infant may have interfered in the analysis of the antenatal corticosteroid therapy in the prevention of this disease, or some other factor that contributes to reduce intraventricular hemorrhage, that couldn't be predicted, was associated with antenatal corticosteroid, obscuring its protective effect / Mestrado / Pediatria / Mestre em Saude da Criança e do Adolescente

Abstract Primary intracerebral hemorrhage (ICH) comprises 10–15% of all strokes. Arterial hypertension and warfarin use are well documented risk factors for ICH, but aspirin use also seems to predispose to ICH. The annual incidence of primary ICH in western populations is 12–31 / 100,000. Mortality is high: 14–52% during the first month and 14–80% during the first year after ICH. The size and location of the hemorrhage, a midline shift in head computed tomography, intraventricular spread of the hemorrhage, level of consciousness on admission, and high blood glucose independently predict mortality. For a risk factor study, 98 consecutive patients admitted into the Department of Neurology, Oulu University Hospital, because of ICH between January 1993 and September 1995 were compared with 206 control subjects drawn from a population register. Thromboxane and prostacyclin biosynthesis were measured from serial urine samples of 43 patients. For outcome studies, all subjects (n = 208) with incident ICH during the study period in the population of Northern Ostrobothnia, Finland, were identified. Untreated hypertension was the main modifiable risk factor for ICH. Use of aspirin appeared to be a significant risk factor for ICH in the subjects with a history of epistaxis. Enhanced thromboxane and prostacyclin biosynthesis were observed in the acute phase and 3 months after ICH. Regular use of aspirin preceding ICH doubled the 3-month mortality rate compared with nonusers of aspirin/warfarin. Aspirin use also associated with early hematoma growth. Patients with ICH showed increased long-term mortality up to 7 years after ICH compared to controls. No excess mortality was observed among those with good recovery at 3 months, but those who were severely disabled at 3 months after ICH showed marked excess mortality.

Orientador: Yvens Barbosa Fernandes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T09:26:09Z (GMT). No. of bitstreams: 1 Zullo_JoaoFlavioDaniel_M.pdf: 4994617 bytes, checksum: 7f874ff0599b4cec270f92a8010dc856 (MD5) Previous issue date: 2014 / Resumo: As hemorragias intracerebrais supratentoriais espontâneas, correspondem a cerca de 10 a 20% de todos os acidentes vasculares cerebrais (AVC), acometendo mais de 4 milhões de pessoas por ano em todo o mundo(13). Apresenta as mais altas taxas de morbi-mortalidade dentre os diferentes tipos de AVC, sendo que a mortalidade desta patologia alcança índices ao redor de 30-40% dos doentes, além de grande número de pacientes com seqüelas graves, sendo que seu principal fator de risco é a hipertensão arterial sistêmica (HAS). Desde o trabalho de McKissock(1) at al em 1961, vem se tentando descobrir qual a melhor maneira para tratar pacientes que apresentam tais hemorragias. Com esse intuito, avaliamos 67 pacientes atendidos no HC/Unicamp e no Hospital Estadual de Sumaré/Unicamp (HES) entre os anos de 2007 e 2012, sendo 41 com hemorragias de núcleos da base e 26 com hematomas lobares. Estudamos a influência de vários fatores no prognóstico dos pacientes com hemorragias intracerebrais supratentoriais espontâneas, como idade, nível de consciência à admissão hospitalar (usando-se a escala de coma de Glasgow), profundidade do hematoma em relação à superfície cerebral, volume do hematoma, presença de hemorragia intraventricular, desvio de linha média, tempo entre ictus hemorrágico e cirurgia e tipo de tratamento (craniotomia ou conservador). O nível de consciência na chegada ao hospital é fator determinante com relação ao prognóstico funcional avaliado em 30 dias após o ictus, independente da modalidade de tratamento adotada, porém com diferentes nuances dependendo da localização da lesão (núcleos da base ou lobar). Algumas particularidades, como tamanho do hematoma, podem determinar o resultado prognóstico funcional, assim como o tratamento cirúrgico, hemoventrículo e desvio de linha média (DLM) tendem a influenciar o prognóstico / Abstract: Spontaneous supratentorial intracerebral hemorrhages correspond to 10 to 20% of all stroke cases, affecting more than 4.000.000 people/year worldwide(13). It shows the highest rates of morbidity and mortality among the different types of stroke. The mortality of this disease achieves around 30- 40% of all patients, besides a large number of pacientes with severe sequels. Its main risk factor is high blood pressure. Since McKissock(1) at al published his work in 1961, researchers are trying to figure out the best way to treat patients with this type of hemorrhage. Aiming this situation, we evaluated 67 patients treated at HC/Unicamp and State Hospital of Sumaré (HES)/Unicamp between 2007 and 2012, with 41 basal ganglia and 26 lobar hematomas. We studied the influence of several factors on the prognosis of patients with spontaneous supratentorial intracerebral hemorrhage, such as age, consciousness at hospital admision (using the Glasgow Coma Scale), hematoma depth, hematoma volume, intraventricular hemorrhage, midline shift, time between bleeding and surgery and treatment option (craniotomy or conservative). The consciousness on arrival at the hospital is a determinant factor relative to functional outcome in 30 days after bleeding, regardless of treatment modality adopted, but with different nuances depending on the lesion location (basal ganglia or lobar). Some special features, like the size of the hematoma, can determine the funcional outcome, as well as surgery, ventricular hemorrhage and midline shift have a trend to influence prognosis / Mestrado / Neurologia / Mestre em Ciências Médicas

A derivação ventricular externa (DVE) é usada em neurocirurgia para drenagem de liquor em pacientes com aumento da pressão intracraniana (PIC) em várias patologias (tumores, trauma, meningite e hemorragias intracranianas espontâneas), podendo servir como tratamento ou como forma de monitorização da variação da PIC. A principal complicação desse procedimento é a infecção (meningite e/ou ventriculite). Fatores de risco para o aumento da taxa de infecção em DVE incluem hemorragias intracranianas espontâneas. Neste estudo, analisamos as taxas de infecção em uma série de pacientes com hemorragia intracraniana espontânea que necessitaram de procedimento cirúrgico com DVE. Estudamos prospectivamente todos os 94 casos consecutivos de pacientes que necessitaram de DVE devido a hemorragia cerebral espontânea entre 2010 e julho de 2011 no Serviço de Neurocirurgia do Hospital Cristo Redentor, pertencente ao Grupo Hospitalar Conceição, localizado em Porto Alegre, Rio Grande do Sul, Brasil. A nossa série foi composta de 43 homens (45,7%) e 51 mulheres (54,3%). A média de idade de toda a amostra foi de 56,1 anos. O tempo médio de permanência com DVE foi de 7 dias. Foi observada uma taxa de mortalidade de 45% e uma taxa de infecção geral de 36%. Quando avaliamos a variável “Dias de DVE >10”, encontramos diferença significativa entre os grupos, ou seja, os pacientes que utilizaram DVE por mais de 10 dias apresentaram uma chance maior de infecção do que os pacientes que utilizaram DVE por um tempo menor ou igual a 10 dias (odds ratio = 3,1; IC 95%: 1,1–8,7). As demais variáveis avaliadas se mostraram sem significância estatística para esta amostra. Encontramos uma taxa de cultura positiva de 5,3%. Os dados do presente trabalho sugerem que a infecção relacionada à DVE foi uma complicação muito frequente, ocorrendo em 36,2 % dos casos. Porém, adotamos ventriculite como padrão de diagnóstico, conforme preconiza o Centers for Disease Control and Prevention (CDC). Considerando a alta mortalidade associada a hemorragias intracranianas espontâneas, talvez a adoção de um protocolo mais agressivo para essa população de pacientes possa melhorar as taxas de morbimortalidade desse tipo de doença. / External ventricular drainage (EVD) is used in neurosurgery to drain cerebrospinal fluid from patients with increased intracranial pressure (ICP) in a variety of conditions (tumors, trauma, meningitis, spontaneous intracranial hemorrhage). EVD can serve both as a therapeutic measure and as a tool for ICP monitoring. The major complication of this procedure is infection (meningitis and/or ventriculitis). Risk factors for EVD infection include spontaneous intracranial hemorrhage. This Study analyze infection rates in a series of patients with spontaneous intracranial hemorrhage who underwent surgical EVD placement. This prospective study included all patients who required EVD for spontaneous intracranial hemorrhage from January 2010 to July 2011 at the Neurosurgery Department of Hospital Cristo Redentor (HCR), Porto Alegre, Rio Grande do Sul, Brazil. Overall, 94 consecutive patients were included. The series comprised 43 men (45.7%) and 51 women (54.3%). Mean age across the sample was 56.1 years. The mean duration of EVD use was7 days. Overall sample mortality was 45%, and the overall infection rate was 36%. Assessment of the variable “EVD days >10” revealed a significant difference between groups: patients who had an EVD in place for longer than 10 days had higher odds of infection than patients in whom EVD was used for 10 days or fewer (odds ratio = 3.1; 95%CI 1.1–8.7) The other variables of interest were not statistically significant in this sample. We found a culture positivity rate of 5.3%. The findings of this study suggest that EVD infection was a very common complication, occurring in 36.2% of cases. However, we adopted ventriculitis as the standard diagnosis, as advocated by the Centers for Disease Control and Prevention. Considering the high lethality associated with intracranial hemorrhage, the adoption of a more aggressive treatment protocol for this patient population might improve morbidity and mortality rates.

Spontaneous intracerebral haemorrhage (ICH) is one of the most lethal forms of stroke and has a relatively higher morbidity in Asian people. The high disability rate of 50% in all survivors and lack of clinically effective regeneration medicine make ICH a major unanswered problem worldwide. Considerable preclinical evidence suggests that neuroprotective interventions are urgently needed to lessen the effects of this disease. To date, less preclinical researches with proven positive results have successfully translated to the clinical setting, mainly due to poor modelling, a lack of behavioural testing, inadequate experimental design and failure to consider white matter damage. According to the few previous studies, white matter is a key predictor of ICH outcomes and a potential target of recovery. The long-term axonal degeneration in rodent ICH has been ignored for decades, and almost every preclinical study has focused on mechanisms in the acute phase. Clinically ICH patients may suffer a permanent loss of brain function or long-term deficits that take years to recover from. If the preclinical researches target the long-term axon degeneration/regeneration in the chronic stage, it might help to develop successful clinical interventions for functional reconstruction and rehabilitation. / Thus, to obtain the evidence of axonal degeneration and regeneration in the chronic stage of experimental ICH, this study at first systematically assessed the histological and functional outcomes of axonal regeneration in experimental ICH from day 3 to day 56 and secondly find the effective markers and methods for investigation axons in experimental ICH models in vivo. The long-term gait disturbance of a computer-generated CatWalk system, the electrophysiological changes, axonal loss by PKC gamma (PKCγ) immunohistochemistry and axonal degeneration by Bielschowsky silver staining were examined in unilateral striatum lesioned ICH (ST-ICH) rats. As the ST-ICH model demonstrated a spontaneous functional recovery within one or two month, we further developed a modified internal capsule lesioned ICH (IC-ICH) rat model which mimic clinical conditions, and investigated whether an internal capsule lesion leads to long-term axonal damage and long lasting functional deficits. / The finding demonstrated that haematoma in striatum led to severe axonal degeneration/loss in ipsilateral medullary corticospinal tract (CST) and functional deficits in a long-term duration (1-2 months after ICH). PKCγ level was an effective marker to quantify the axonal loss in experimental ICH and it indicated a significant axonal loss on day 56 after ICH in ipsilateral CST. Bielschowsky silver staining was a useful method to illustrate the morphological changes of axonal degeneration and regeneration in longitudinal sections of CST and it clearly showed the process of axon swelling, disrupted and regenerated in 2 months’ duration after ICH. / Somatosensory evoked potentials (SSEPs) and gait analysis were valuable functional assessments to characterize the long-term behavioral deficits resulting from axonal degeneration/regeneration in experimental ICH. The decrease in electrophysiological parameter SSEP amplitudes was observed in experimental ICH. Multiple gait parameters changed after ICH and some of that such as paw print area, paw pressure, stand index, duty cycle can be used as long-term evaluating markers in chronic stage of experimental ICH. / Compared to ST-ICH, the modified IC-ICH model exhibited a relatively smaller lesion volume with consistent axonal loss/degeneration and long-lasting neurological dysfunction at 2 months after ICH. Functionally, the impairment of the mNSS, ratio of contralateral forelimb usage, four limb stand index, contralateral duty cycle and ipsilateral SSEPs amplitude remained significant in the IC-ICH model at 56 days compared with the sham group, and asymmetries in the hind paw print area of the IC-ICH model exhibited significant differences from the ST-ICH model at 56 days. Structurally, the significant loss of PKCγ in ipsilateral CST of IC-ICH and the consistent axonal degeneration with several axonal retraction bulbs and enlarged tubular space was observed at 56 days after ICH. / In summary, the data from this study systematically characterize the histological and functional outcomes (especially gait parameter and SSEPs changes) in the experimental ICH model. A modified internal capsule lesioned ICH model was developed for rats, and proved to have long lasting neurological deficits. A comprehensive understanding of the dynamic progression after experimental ICH should aid further successful clinic translation in animal ICH studies, and provide new insights into the potential biomarkers and therapeutic targets of ICH. / 原發性腦出血（ICH）是一種致死性較高的卒中類型。在亞洲人群眾發病率相對較高。高致殘率和臨床上缺乏有效的治療手段，使得腦出血成為世界範圍內的健康問題。因此需要大量的臨床前研究尋找有效的治療方法。然而，迄今為止，臨床前研究獲得的陽性結果中，只有少數被成功的轉化到臨床應用。臨床轉化存在的部分失敗，歸結於幾個主要的因素包括動物模型的不足，動物行為學實驗的不恰當使用，實驗設計的缺陷以及對白質損傷機制的忽略。有研究認為，腦白質是卒中後功能恢復的關鍵指標和潛在治療靶點。腦出血慢性期的軸索變性在齧齒類動物模型中的研究被忽視了幾十年，而幾乎所有的臨床前研究都關注於急性期的機制。而臨床上倖存的腦出血病人大多罹患永久性的腦功能損傷，往往需要數年才能恢復或者難以恢復。如果臨床前轉化實驗以腦出血後慢性期的神經軸索損傷/再生作為研究目標，也許可以找到有助於卒中後功能重建和康復的治療手段。 / 為了尋找腦出血慢性期神經軸索損傷的證據，本研究首先從組織學和功能行為學兩個方面對對實驗性腦出血後的軸索再生進行了系統的評價。並建立了有效反應慢性期神經軸索再生的一系列方法和標誌物。本研究將步態分析，電生理評價， Bielschowsky銀染和PKCγ組織學染色結合起來對腦出血後的動物模型的軸索蛻變和再生進行長期觀察。結果顯示傳統的紋狀體損傷模型在1到2個月出現自發的功能恢復。本研究進一步假設內囊出血模型可能會獲得更加持久的功能損傷，也更為接近臨床患者的情況。因此，為了更好地研究腦出血慢性期的白質損傷和類比臨床情況，本研究建立了一種改進的內囊出血大鼠模型，並用組織學和行為學方法對其長期的功能損傷進行評價。 / 研究結果顯示，位於紋狀體的血腫可以引起同側的延髓皮質脊髓束(CST)出現嚴重的慢性期退化和變性，並同時伴有神經功能損傷。PKCγ是評價實驗性腦出血後神經軸索損傷程度的有效標誌物，資料表明同側皮質脊髓束PKCγ的表達水準在ICH損傷56天后仍有顯著降低。對延髓椎體CST的Bielschowsky銀染，可以從結構上有效的反應軸索變形和再生的過程，CST縱行切片染色清楚地顯示了腦出血損傷後2個月的時間內軸索水腫、斷裂和再生的過程。 / 體感誘發電位（SSEPs）和步態分析的方法可以從功能上對腦出血後神經軸索損傷進行較為全面的評價和定量分析。單側紋狀體腦出血可以引起同側皮層SSEP波幅的降低。多個步態分析參數在腦出血後也存在明顯的變化，其中前後掌爪印面積（paw print area），爪印壓力（paw pressure），站立指數（stand index），患側肢體站立百分比（duty cycle）都可作為觀察腦出血後慢性期功能損傷和恢復的評價指標。 / 改進後的內囊腦出血模型顯示病灶體積相比較小但神經軸索的損失和神經功能障礙較為持久。從神經功能方面評判，與假手術組相比，神經功能評分（mNSS），對側前肢使用率（cylinder test），四肢站立指數（stand index），患側肢體站立百分比（duty cycle）和患側體感誘發電位波幅（SSEPs amplitude）在出血後2個月仍然顯著降低。後掌的爪印面積（print area）與紋狀體腦出血的動物比較在出血後第56天后仍有顯著差異。從軸索結構評判，內囊出血模型顯示出更為嚴重的神經軸索退變和損傷，表現為在出血後56天PKCγ蛋白表達量的持續降低，軸索斷裂結節和管狀間隙的形成。 / 綜上所述，本研究系統地分析了實驗腦出血後的組織學和功能特點，建立了一個改進的內囊腦出血大鼠模型，並證明該模型存在更為持久的神經功能障礙和神經軸索損傷。 / Liu, Yao. / Thesis Ph.D. Chinese University of Hong Kong 2014. / Includes bibliographical references (leaves 168-200). / Abstracts also in Chinese. / Title from PDF title page (viewed on 18, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 5 uppsatser.

A derivação ventricular externa (DVE) é usada em neurocirurgia para drenagem de liquor em pacientes com aumento da pressão intracraniana (PIC) em várias patologias (tumores, trauma, meningite e hemorragias intracranianas espontâneas), podendo servir como tratamento ou como forma de monitorização da variação da PIC. A principal complicação desse procedimento é a infecção (meningite e/ou ventriculite). Fatores de risco para o aumento da taxa de infecção em DVE incluem hemorragias intracranianas espontâneas. Neste estudo, analisamos as taxas de infecção em uma série de pacientes com hemorragia intracraniana espontânea que necessitaram de procedimento cirúrgico com DVE. Estudamos prospectivamente todos os 94 casos consecutivos de pacientes que necessitaram de DVE devido a hemorragia cerebral espontânea entre 2010 e julho de 2011 no Serviço de Neurocirurgia do Hospital Cristo Redentor, pertencente ao Grupo Hospitalar Conceição, localizado em Porto Alegre, Rio Grande do Sul, Brasil. A nossa série foi composta de 43 homens (45,7%) e 51 mulheres (54,3%). A média de idade de toda a amostra foi de 56,1 anos. O tempo médio de permanência com DVE foi de 7 dias. Foi observada uma taxa de mortalidade de 45% e uma taxa de infecção geral de 36%. Quando avaliamos a variável “Dias de DVE >10”, encontramos diferença significativa entre os grupos, ou seja, os pacientes que utilizaram DVE por mais de 10 dias apresentaram uma chance maior de infecção do que os pacientes que utilizaram DVE por um tempo menor ou igual a 10 dias (odds ratio = 3,1; IC 95%: 1,1–8,7). As demais variáveis avaliadas se mostraram sem significância estatística para esta amostra. Encontramos uma taxa de cultura positiva de 5,3%. Os dados do presente trabalho sugerem que a infecção relacionada à DVE foi uma complicação muito frequente, ocorrendo em 36,2 % dos casos. Porém, adotamos ventriculite como padrão de diagnóstico, conforme preconiza o Centers for Disease Control and Prevention (CDC). Considerando a alta mortalidade associada a hemorragias intracranianas espontâneas, talvez a adoção de um protocolo mais agressivo para essa população de pacientes possa melhorar as taxas de morbimortalidade desse tipo de doença. / External ventricular drainage (EVD) is used in neurosurgery to drain cerebrospinal fluid from patients with increased intracranial pressure (ICP) in a variety of conditions (tumors, trauma, meningitis, spontaneous intracranial hemorrhage). EVD can serve both as a therapeutic measure and as a tool for ICP monitoring. The major complication of this procedure is infection (meningitis and/or ventriculitis). Risk factors for EVD infection include spontaneous intracranial hemorrhage. This Study analyze infection rates in a series of patients with spontaneous intracranial hemorrhage who underwent surgical EVD placement. This prospective study included all patients who required EVD for spontaneous intracranial hemorrhage from January 2010 to July 2011 at the Neurosurgery Department of Hospital Cristo Redentor (HCR), Porto Alegre, Rio Grande do Sul, Brazil. Overall, 94 consecutive patients were included. The series comprised 43 men (45.7%) and 51 women (54.3%). Mean age across the sample was 56.1 years. The mean duration of EVD use was7 days. Overall sample mortality was 45%, and the overall infection rate was 36%. Assessment of the variable “EVD days >10” revealed a significant difference between groups: patients who had an EVD in place for longer than 10 days had higher odds of infection than patients in whom EVD was used for 10 days or fewer (odds ratio = 3.1; 95%CI 1.1–8.7) The other variables of interest were not statistically significant in this sample. We found a culture positivity rate of 5.3%. The findings of this study suggest that EVD infection was a very common complication, occurring in 36.2% of cases. However, we adopted ventriculitis as the standard diagnosis, as advocated by the Centers for Disease Control and Prevention. Considering the high lethality associated with intracranial hemorrhage, the adoption of a more aggressive treatment protocol for this patient population might improve morbidity and mortality rates.

A derivação ventricular externa (DVE) é usada em neurocirurgia para drenagem de liquor em pacientes com aumento da pressão intracraniana (PIC) em várias patologias (tumores, trauma, meningite e hemorragias intracranianas espontâneas), podendo servir como tratamento ou como forma de monitorização da variação da PIC. A principal complicação desse procedimento é a infecção (meningite e/ou ventriculite). Fatores de risco para o aumento da taxa de infecção em DVE incluem hemorragias intracranianas espontâneas. Neste estudo, analisamos as taxas de infecção em uma série de pacientes com hemorragia intracraniana espontânea que necessitaram de procedimento cirúrgico com DVE. Estudamos prospectivamente todos os 94 casos consecutivos de pacientes que necessitaram de DVE devido a hemorragia cerebral espontânea entre 2010 e julho de 2011 no Serviço de Neurocirurgia do Hospital Cristo Redentor, pertencente ao Grupo Hospitalar Conceição, localizado em Porto Alegre, Rio Grande do Sul, Brasil. A nossa série foi composta de 43 homens (45,7%) e 51 mulheres (54,3%). A média de idade de toda a amostra foi de 56,1 anos. O tempo médio de permanência com DVE foi de 7 dias. Foi observada uma taxa de mortalidade de 45% e uma taxa de infecção geral de 36%. Quando avaliamos a variável “Dias de DVE >10”, encontramos diferença significativa entre os grupos, ou seja, os pacientes que utilizaram DVE por mais de 10 dias apresentaram uma chance maior de infecção do que os pacientes que utilizaram DVE por um tempo menor ou igual a 10 dias (odds ratio = 3,1; IC 95%: 1,1–8,7). As demais variáveis avaliadas se mostraram sem significância estatística para esta amostra. Encontramos uma taxa de cultura positiva de 5,3%. Os dados do presente trabalho sugerem que a infecção relacionada à DVE foi uma complicação muito frequente, ocorrendo em 36,2 % dos casos. Porém, adotamos ventriculite como padrão de diagnóstico, conforme preconiza o Centers for Disease Control and Prevention (CDC). Considerando a alta mortalidade associada a hemorragias intracranianas espontâneas, talvez a adoção de um protocolo mais agressivo para essa população de pacientes possa melhorar as taxas de morbimortalidade desse tipo de doença. / External ventricular drainage (EVD) is used in neurosurgery to drain cerebrospinal fluid from patients with increased intracranial pressure (ICP) in a variety of conditions (tumors, trauma, meningitis, spontaneous intracranial hemorrhage). EVD can serve both as a therapeutic measure and as a tool for ICP monitoring. The major complication of this procedure is infection (meningitis and/or ventriculitis). Risk factors for EVD infection include spontaneous intracranial hemorrhage. This Study analyze infection rates in a series of patients with spontaneous intracranial hemorrhage who underwent surgical EVD placement. This prospective study included all patients who required EVD for spontaneous intracranial hemorrhage from January 2010 to July 2011 at the Neurosurgery Department of Hospital Cristo Redentor (HCR), Porto Alegre, Rio Grande do Sul, Brazil. Overall, 94 consecutive patients were included. The series comprised 43 men (45.7%) and 51 women (54.3%). Mean age across the sample was 56.1 years. The mean duration of EVD use was7 days. Overall sample mortality was 45%, and the overall infection rate was 36%. Assessment of the variable “EVD days >10” revealed a significant difference between groups: patients who had an EVD in place for longer than 10 days had higher odds of infection than patients in whom EVD was used for 10 days or fewer (odds ratio = 3.1; 95%CI 1.1–8.7) The other variables of interest were not statistically significant in this sample. We found a culture positivity rate of 5.3%. The findings of this study suggest that EVD infection was a very common complication, occurring in 36.2% of cases. However, we adopted ventriculitis as the standard diagnosis, as advocated by the Centers for Disease Control and Prevention. Considering the high lethality associated with intracranial hemorrhage, the adoption of a more aggressive treatment protocol for this patient population might improve morbidity and mortality rates.

Orientador: Donizeti Cesar Honorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T16:07:34Z (GMT). No. of bitstreams: 1 Sousa_RodrigoDantasde_M.pdf: 829191 bytes, checksum: f4f90d29ed7eee8c9f1d2e15d741c0ef (MD5) Previous issue date: 2008 / Resumo: A terapia de restrição e indução de movimento estão entre as formas de tratamento que mais desponta no mundo, por apresentar ótimos resultados funcionais. A baixa aderêcia ao tratamento tem sido alvo de discussão, logo seu protocolo tem sido modificado para minimizar esta problemtica. Neste trabalho a ténica foi adaptada e feita a avaliação da funcionalidade de todo o hemicorpo paréico. Foram selecionados 15 pacientes, dos quais permaneceram 10, de um fluxo méio de 100 pacientes/mês do Serviço de Fisioterapia e Terapia Ocupacional (SFTO) do Hospital de Clínicas (HC) da Universidade Estadual de Campinas (UNICAMP). Foram acompanhados 7 homens e 3 mulheres que já estavam em fisioterapia 2 vezes/semana, não apresentavam restrição da Amplitude de Movimento (ADM) do membro superior e com um único episódio de Acidente Vascular Encefálico (AVE). A imobilização foi feita através de um splint de posicionamento de punho, de mão e de dedos, durante 5 horas diárias, por dois períodos de 15 dias cada, com intervalo entre eles de 30 dias. Os pacientes foram avaliados pelas escalas de Fugl-Meyer Motor Assessment (FMA) e de Medida de Independência Funcional (MIF), no início e no final de cada período de imobilização. A análise estatística foi realizada através de médias, de variações e de variâncias; os modelos foram ajustados para a idade e tempo de lesão; as comparações foram feitas pelo coeficiente de Spearman; o nível de significância assumido foi o de =5%. Observou-se melhora da funcionalidade do hemicorpo parético, com significância estatística nas comparações entre as 3ª avaliações da MIF e da FMA-MMII (Membros Inferiores) (p=0,04) e entre as da MIF e da FMA-MMSS (Membros Superiores) (p=0,05). Pode-se concluir que 2 sessões de fisioterapia por semana, de 1 hora cada, mostraram-se benéficas. Os ganhos funcionais ocorreram em todo o hemicorpo parético e não apenas em membro superior parético / Abstract: The Constraint-Induced movement therapy is enters the forms of treatment that more blunts in the world, for presenting excellent functional results. Low the tack to the treatment has been target of quarrel, then its protocol has been modified to minimize this problematic one. In this work the technique was adapted and made the evaluation of the hemiparetic body 15 patients had been selected, of which they had remained 10, of an average flow of 100 patients/month of the Service of Physiotherapy and Occupational Therapy of the Hospital of Clinics of the State University of Campinas (UNICAMP). 7 men and 3 women had been attended who already were in physiotherapy 2 times/week, didn¿t present restriction of the movement articulation (ADM) of the upper extremity and with one episode of stroke. Immobilization was made through one splint of positioning of fist, hand and fingers, during 5 daily hours, for two periods of 15 days each, with interval between them of 30 days. The patients had been evaluated by the scales of Fugl-Meyer Motor Assessment (FMA) and Functional Independence Measure (FIM), at the beginning and in the end of each period of immobilization. The analysis statistics was carried through averages, variations and variances; the models had been adjusted for the age and time of injury; the comparisons had been made by the coefficient of Spearman; the assumed level of significance was of =5%. Improvement of the functionality of hemiparetic body was observed, with significance statistics in the comparisons between 3ª evaluations of the FIM and FMA-LE (Lower Extremity) (p=0,04) and enters of the FIM and FMA-UE (Upper Extremity) (p=0,05). It can be concluded that 2 sessions/week of physiotherapy, of 1 hour each, had revealed beneficial. The functional profits had occurred all in hemiparetic body and not only in upper paretic extremity / Mestrado / Ciencias Biomedicas / Doutor em Ciências Médicas

Orientador: Maria Valeriana Leme de Moura-Ribeiro / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T13:23:03Z (GMT). No. of bitstreams: 1 Elias_KarlaMariaIbraimdaFreiria_D.pdf: 4108158 bytes, checksum: 2046ae2bbb7de3b3c5354d1752b098df (MD5) Previous issue date: 2008 / Resumo: Na infância e adolescência, a doença cerebrovascular (DCV) constitui condição rara, de etiologia variada, em que a evolução a curto e longo prazo tem merecido esclarecimentos. Em anos recentes, a clássica impressão de recuperação favorável após eventos vasculares nesta população tem sido esmaecida com a verificação de variáveis índices de alterações comportamentais, cognitivas, lingüísticas e de aprendizagem. No referente ao processamento das informações auditivas o conhecimento é ainda bastante restrito e, diante desta constatação, nos propusemos a realizar ampla investigação desta função, através da aplicação de testes de categorias diversas e estabelecer o grau de competência auditiva na dependência das características lesionais. Assim, o principal objetivo desde estudo, foi avaliar as habilidades de processamento auditivo (central) em crianças e adolescentes acometidos pela DCV, grupo propósito (GP), comparando-os, com grupo controle (GC), composto por crianças destras, de mesmo sexo, idade e nível sócio-econômico das crianças do GP. Na avaliação audiológica foram aplicados os seguintes testes: localização sonora em cinco direções, memória seqüencial verbal e não-verbal, na categoria de avaliação simplificada; teste de fala com ruído e de fala filtrada, na categoria dos monóticos de baixa redundância; dicótico não-verbal, consoante-vogal, dicótico de dígitos e dicótico de dissílabos alternados (staggered spondaic word test/SSW) na dos dicóticos; padrão de freqüência e de duração, na de testes de processamento temporal. Os dados foram analisados através de metodologia estatística pertinente - teste exato de Fisher e Wilcoxon - e revelaram que o desempenho dos grupos foi similar nos testes de localização sonora e fala com ruído. Nos demais testes, o GP apresentou desempenho significativamente inferior ao GC, com alterações nas habilidades auditivas de fechamento, memória, atenção seletiva e processamento temporal. Os testes de fala filtrada e de padrão de duração foram, respectivamente, mais sensíveis que os testes de fala com ruído e padrão de freqüência, na identificação de alterações nas habilidades de fechamento auditivo e de ordenação temporal. Adicionalmente, a presença da lesão e não suas características foram determinantes para a definição do grau da competência auditiva. Através do presente estudo, pudemos ampliar o conhecimento evolutivo da DCV infantil ao demonstrar comprometimento em habilidades específicas de processamento auditivo. / Abstract: In childhood and adolescence the cerebrovascular disease (CVD) is a rare condition, of varied etiology, where the clarification of short and long term disease progression has been sought. The classical idea of favorable recovery following vascular events in this population has been obscured by the demonstration of variable levels of behavioral, cognitive, linguistic and learning variables. There is scarce knowledge on the processing of auditory information, therefore we have decided to perform a thorough investigation on this function by conducting tests of several categories, and to establish the degree of audiological competence that depends on the lesion characteristics. Therefore, the main purpose of the present study was the assessment of the central auditory processing abilities in children and adolescents suffering from CVD, purpose group (PG), which was compared to the control group (CG) formed by right-handed children, of the same sex, age and socioeconomic level as of the children of the PG. In audiological assessment the following tests were applied: sound location in five directions, verbal and non-verbal sequential memory, in the simplified category evaluation; test of speech in noise and filtered speech in the category of low redundancy monotics; non-verbal dichotic, consonant-vowel, dichotic digit and staggered spondaic word test/SSW in the dichotic category; frequency and duration pattern, in the temporal processing tests. The data were analyzed through the pertinent statistical methodology - Wilcoxon and Fisher's exact test - and revealed that the GP's performance was similar to the GC's in the sound location and speech in noise tests. In the other tests, the CVD group showed a significantly lower performance than the normal children, with alterations in auditory closure abilities, memory, selective attention and temporal processing. The tests of filtered speech and duration pattern were respectively more sensitive than the tests of speech in noise and frequency pattern, in the identification of alterations in auditory closure and temporal ordering. In this study the presence of lesion rather than its characteristics was decisive for the definition of the degree of audiological competence. We have increased our knowledge of progression of CVD in children by demonstrating the implications of this condition in specific abilities of auditory processing. / Doutorado / Ciencias Biomedicas / Doutor em Ciências Médicas