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The aim of the current article is to describe how to improve the quality of imaging with 123I-ioflupane SPECT and to serve as a teaching tool on this topic. The radiopharmaceutical 123I-ioflupane is used to visualize the nigrostriatal pathway. Parkinson disease and parkinsonian syndromes are movement disorders that exhibit nigrostriatal degeneration, with a decreased dopamine transporter level in the pathway and thus a decreased 123I-ioflupane distribution. Other nonparkinsonian movement disorders, such as essential tremor, will have intact dopaminergic neurons and exhibit a normal distribution of the radiopharmaceutical throughout the striata. Parkinsonian disorders are usually diagnosed clinically. However, 123I-ioflupane SPECT can be a valuable tool when the clinical features are not sufficiently clear. 123I-ioflupane SPECT image interpretation is not always straightforward. Many pitfalls, including biologic factors, technical factors, medications, and factors such as age, race, ethnicity, and body habitus, can make the interpretation challenging. The technologist and nuclear radiologist must identify the expected imaging findings to avoid the most common mistakes related to artifacts. This article reviews the usual pitfalls and artifacts of 123I-ioflupane SPECT that can compromise an accurate diagnosis and lead to misinterpretation of image findings.

A 20-year-old G1P0 patient at 38 weeks and 1 day of gestation was admitted for emergency cesarean delivery. Her past medical history was positive for cervicomedullary arteriovenous malformation (AVM) that ruptured three years before. Spontaneous vaginal delivery was contraindicated by neurosurgery. Aiming for cardiovascular stability and immediate reduction of sympathetic activity, a combined spinal epidural was successfully placed. An uneventful cesarean section was performed. The patient was transferred to the intensive care unit neurologically intact and discharged home after 8 days. This report describes an unusual anesthetic management of a patient with a large AVM in active labor.

Von Hippel-Lindau (VHL) disease is a complex genetic syndrome characterized by multisystemic vascular neoplastic disorder. The affected population tends to develop tumors mainly involving the central nervous system, adrenal glands, pancreas, and kidneys. We describe anesthetic management for the resection of a cerebellar mass compressing the brainstem in a recently diagnosed 25-year-old female patient with a history of von Hippel-Lindau (VHL) syndrome. An uneventful occipital craniectomy for cerebellar tumor resection was performed under total intravenous anesthesia, without complications. The patient was discharged home on postoperative day five. This case depicts a situation in which a brainstem compressing lesion needs to be addressed urgently, and the pharmacological neuroprotective technique utilized for this procedure.

The acquired hypopharyngeal diverticulum (Zenker’s) is characterized by a posterior wall outpouching of the pharyngeal mucosa and submucosa through the vulnerable points of the pharyngoesophageal junction. We describe the case of a 67-year-old male who was recently diagnosed with Zenker's diverticulum and had complaints of dysphagia and halitosis. An endoscopic treatment (diverticulotomy) was performed without difficulties. The anesthetic management included rapid sequence induction, avoiding succinylcholine, and intraoperative infusion of dexmedetomidine. The neuromuscular blockade was reversed using sugammadex, decreasing the risk of failed extubation and possible airway re-intervention. The patient was discharged home the following day without complications.

The aim of the current article is to describe how to improve the quality of imaging with

The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year-old male COVID-19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention. Resumo: A pandemia de 2020, causada pelo novo coronavírus, COVID-19, teve seu epicentro na China. Causa Síndrome Respiratória Aguda Grave pelo Coronavírus 2 (SARS-CoV-2) e apresenta um amplo espectro de manifestações clínicas, que vão desde nenhum sintoma a insuficiência respiratória aguda grave e óbito. Com a expectativa de um número significativo de pacientes dependentes de ventilador, várias instituições estrategicamente adiaram cirurgias eletivas. Esse é o caso principalmente de procedimentos envolvendo a mucosa nasal, como a via transesfenoidal para a hipófise, devido ao nível imenso de disseminação de material viral. Não obstante, casos críticos requerem resolução acelerada. Essas situações são grave apoplexia hipofisária, diminuição do nível de consciência ou risco de perda visual aguda. O presente caso relata o manejo perioperatório bem sucedido de urgência de paciente do sexo masculino de 47 anos de idade com COVID-19 que chegou ao Pronto Socorro com cefaléia frontal à esquerda que culminou com diplopia, ptose do olho esquerdo e perda de acuidade visual à esquerda após 5 dias. A hipofisectomia transesfenoidal ocorreu sem intercorrências e o paciente recebeu alta do hospital no quarto dia do pós-operatório. Adicionalmente, descrevemos em detalhe o algoritmo de manejo de via aérea da University of Mississippi Medical Center para pacientes infectados pelo novo coronavírus e que necessitam de atenção cirúrgica de emergência.

Resumo A pandemia de 2020 causada pelo novo coronavirus, COVID‐19, teve seu epicentro na China. Causa Sindrome Respiratoria Aguda Grave pelo Coronavirus 2 (SARS‐CoV‐2) e apresenta um amplo espectro de manifestacoes clinicas, que vao desde nenhum sintoma a insuficiencia respiratoria aguda grave e obito. Com a expectativa de um numero significativo de pacientes dependentes de ventilador, varias instituicoes estrategicamente adiaram cirurgias eletivas. Esse e o caso principalmente de procedimentos envolvendo a mucosa nasal, como a via transesfenoidal para a hipofise, devido ao nivel imenso de disseminacao de material viral. Nao obstante, casos criticos requerem resolucao acelerada. Essas situacoes sao grave apoplexia hipofisaria, diminuicao do nivel de consciencia ou risco de perda visual aguda. O presente caso relata o manejo perioperatorio bem sucedido de urgencia de paciente do sexo masculino de 47 anos de idade com COVID‐19 que chegou ao Pronto Socorro com cefaleia frontal a esquerda que culminou com diplopia, ptose do olho esquerdo e perda de acuidade visual a esquerda apos 5 dias. A hipofisectomia transesfenoidal ocorreu sem intercorrencias e o paciente recebeu alta do hospital no quarto dia do pos‐operatorio. Adicionalmente, descrevemos em detalhe o algoritmo de manejo de via aerea da University of Mississippi Medical Center para pacientes infectados pelo novo coronavirus e que necessitam de atencao cirurgica de emergencia.

AVANCOS NO ISOLAMENTO E CARACTERIZACAO BIOLOGICA E MOLECULAR DE Acanthamoeba spp (ACANTHAMOEBIDAE) – AMEBA DE VIDA LIVRE: DETERMINACAO EXPERIMENTAL DO POTENCIAL PATOGENICO INFECCAO PELO Trypanosoma cruzi EM DOADORES DE SANGUE: REVISAO SISTEMATICA DA LITERATURA E ESTUDO DE PREVALENCIA NO HEMOCENTRO DE GOIAS