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We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome.

Introduction: Fibrous dysplasia is a non-heritable, congenital disease involving the bones. Its diagnosis relies on image examination and pathology. Treatment is usually conservative, but in cases of cranial nerve impingement or extension to the condyles, surgery should be considered. In this paper, we describe a singular case of monostotic fibrous dysplasia of the clivus in a child., Case Report: A 14-year-old boy presented with chronic headache and diplopia. A neurological examination revealed palsy of the right VIth cranial nerve. The radiological findings were consistent with fibrous dysplasia, with a hypointense and isointense clival lesion on T (1)- and T (2)-weighted images, respectively. Surgical treatment was indicated by cranial nerve impairment. An endoscopic endonasal approach with an image-guided system was used. The patient was discharged four days after surgery and his diplopia improved postoperatively., Discussion: A variety of surgical approaches have been used in the treatment of midline extra-axial cranial base tumors. Fibrous dysplasia of the clivus without expansion to the condylus can be removed with a transsphenoidal endonasal endoscopic approach. Preoperative imaging reveals the individual patient's anatomy and improves the intraoperative orientation., Conclusion: Image-guided transsphenoidal endoscopic surgery is recommended for its safety and minimal invasiveness., ((c) Georg Thieme Verlag KG Stuttgart . New York.)

CD and EPR were used to characterize interactions of oxindole-Schiff base copper(II) complexes with human serum albumin (HSA). These imine ligands form very stable complexes with copper, and can efficiently compete for this metal ion towards the specific N-terminal binding site of the protein, consisting of the amino acid sequence Asp-Ala-His. Relative stability constants for the corresponding complexes were estimated from CD data, using the protein as competitive ligand, with values of log K(CuL) in the range 15.7-18.1, very close to that of [Cu(HSA)] itself, with log K(CuHSA) 16.2. Some of the complexes are also able to interfere in the alpha-helix structure of the protein, while others seem not to affect it. EPR spectra corroborate those results, indicating at least two different metal species in solution, depending on the imine ligand. Oxidative damage to the protein after incubation with these copper(II) complexes, particularly in the presence of hydrogen peroxide, was monitored by carbonyl groups formation, and was observed to be more severe when conformational features of the protein were modified. Complementary EPR spin-trapping data indicated significant formation of hydroxyl and carbon centered radicals, consistent with an oxidative mechanism. Theoretical calculations at density functional theory (DFT) level were employed to evaluate Cu(II)-L binding energies, L-->Cu(II) donation, and Cu(II)-->L back-donation, by considering the Schiff bases and the N-terminal site of HSA as ligands. These results complement previous studies on cytotoxicity, nuclease and pro-apoptotic properties of this kind of copper(II) complexes, providing additional information about their possibilities of transport and disposition in blood plasma.

Background: Agnathia is a rare malformation characterized by the absence of the mandible., Methods: A male rhesus monkey with malformations was found dead and studied by internal examination, radiographs and histopathology., Results: A case of a rare first branchial arch anomaly with agenesis of the mandible and tongue is presented. The animal also had visceral deformities. However, ears were normal in shape and only slightly low in position. The craniofacial malformations may reflect incomplete separation of the first branchial arch into its maxillary and mandibular processes., Conclusions: The association between the craniofacial and other corporal anomalies is unclear.

Carotid-cavernous fistulas (CCFs) are an uncommon pathology in current neurosurgical practice. Furthermore, they generally present a challenge to the neurosurgeon because of both their deep location and the major neurovascular structures that surround them. CCFs consist of a vascular anomaly in which blood flows from meningeal branches of the internal and external carotid arteries, or directly from the internal carotid artery, into the venous circulation around and in the cavernous sinus. Twelve patients with direct and indirect/dural CCFs who underwent examination and treatment between July 2003 and February 2006 are reported here. All patients of this retrospective evaluation were symptomatic at the time of diagnosis, which was confirmed by cerebral angiography. The patients were treated by endovascular approaches and the CCFs were occluded. From our evaluation, we concluded that the endovascular procedure is safe, effective and minimally invasive in patients with CCF.

This article reports on the methodology used by the research team of the State University in Maringá in the Baseline Study in 20 municipalities in the States of Paraná and Santa Catarina, Brazil, with more than 100,000 inhabitants each, in the implementation of the Project for Expansion and Consolidation of the Family Health Strategy. Workshops to discuss the evaluation of programs, construction and application of research instruments, site visits to supervise activities in disseminating the program, and development of a database with the local and regional scientific output were carried out. There was an obvious sense of responsibility and commitment on the part of municipal and State representatives, the majority of whom immediately agreed to the activities. They also showed interest in both the learning process and institutionalization of the evaluation. Fourteen municipalities incorporated other actors to build a support network for the evaluation of the primary health care system. The strategies contributed to the incorporation of evaluation into the planning process, indicating that training can be a constructive and powerful mechanism for institutionalizing evaluation.

The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach are 1) the impinging bony pathology and granulation tissue are accessible only via the ventral route; 2) the head is placed in the extended position, thus decreasing the angulation of the brainstem during the surgery; and 3) surgery is done through the avascular median pharyngeal raphe and clivus. We analyzed the clinical effects of odontoidectomy after treating 38 patients with basilar invagination. The anterior transoral operation to treat irreducible ventral compression in patients with basilar invagination was performed in 38 patients. The patients ages ranged from 34 to 67 years. Fourteen patients had associated Chiari malformation and eight had previously undergone posterior decompressive surgery. The main indication for surgery was significant neurological deterioration. Symptoms and signs included neck pain, myelopathy, lower cranial nerve dysfunction, nystagmus and gait disturbance. Extended exposure was performed in 24 patients. The surgery was beneficial to the majority of patients. There was one death within 10 days of surgery, due to pulmonary embolism. Postoperative complications included two cases of pneumonia, three cases of oronasal fistula with regurgitation and one cerebrospinal fluid leak. In patients with marked ventral compression, the transoral approach provides direct access to the anterior face of the craniovertebral junction and effective means for odontoidectomy.

The aims of this study were to evaluate aging factors associated with work stressors, work ability, and the quality of living conditions, among health care personnel. A cross-sectional study was conducted among 176 health care shiftworkers. Two health survey questionnaires (Tuomi et al., 1997, Scandinavian Journal of Work, Environment and Health, 17(Suppl 1), 67-74; and Tepas, 1996, unpublished instrument) were completed and ergonomic work analyses (Rohmert & Landau, 1983, A new technique for job analysis, London and New York: Taylor & Francis) were carried out at the emergency wards. Main concerns about exposure at the workplace were changes in equipment and technology, transportation, and changes in employer policies. Main concerns about off-the-job conditions were personal safety, increases in the cost of living, food safety, and water and air quality. 81.7% scored adequate (> 36.5 points) in the Work Ability Index, and considered themselves having adequate current work ability to cope with physical, mental, and social demands. The most frequently reported diseases were musculoskeletal disorders and minor emotional problems.

Musculoskeletal and emotional disorders are important causes of reported diseases, causing medical absences, and eventually earlier decrease of work ability. This paper reports the results of a study carried out among practical nurses working at the Orthopedics and Trauma Institute. The objectives of the study were: (a) to describe the routine activities performed during day and night shifts, and (b) to compare the work activities performed in different wards during these shifts. A Brazilian version of the Work Ability Index--WAI (TUOMI et al., 1994) was answered by 83 practical nurses. Forty-three of them (52%) reported pains or musculoskeletal diseases, either based on their own opinion or diagnosed by a physician. These nurses were invited to join the second phase of the study and twenty-nine accepted it. All work activities performed in 29 shifts were observed and recorded. The results showed that day shifts were far more demanding in terms of the number of activities related to patients' care than afternoon and night shifts. Also, body postures associated with day work activities demanded important physical efforts. The number of nurses in charge during night shifts was substantially lower than during day shifts. This could lead to an overload and affect the health of the nurses.