RESUMO
INTRODUCTION: Cisternal and ventricular blood predisposes to hydrocephalus and cerebral ischemia after high-grade aneurysmal subarachnoid hemorrhage (HGSAH). We studied the role of lamina terminalis fenestration combined with cisternal blood evacuation in HGSAH. PATIENTS/MATERIALS AND METHODS: A clinical, prospective, non-randomized study of a series of HGSAH patients (Modified Fisher>or=3) treated in the acute phase was carried out. The microsurgical treatment included aneurysm clipping, cisternal blood evacuation, and fenestration of the lamina terminalis. A comparable, non-blood-cleansed, endovascular-treated group, was included as a control. Clinical results were evaluated by the Glasgow Outcome Scale (GOS). RESULTS: During a period of 30 months, 95 patients who met the selection criteria were treated by microsurgical procedures and 28 by endovascular procedures. The distribution of GOS scores was superior for the microsurgical group: good results (GOS 4-5) were obtained in 85.3%, with a mortality rate of 5.9%. By contrast, 60.3% of patients in the endovascular group achieved GOS 4-5 scores, and 15.8% died. Good results for the endovascular group correlated inversely with delay of treatment. A permanent ventriculo-peritoneal shunt was necessary in 3.2% and 7.1% of the microsurgical and endovascular groups, respectively. The incidence of cerebral infarct was 3.1% and 14.3% for the microsurgical and endovascular groups, respectively. DISCUSSION: Microsurgical management reduces the usually poor outcome of patients with HGSAH. Lamina terminalis fenestration diminishes the incidence of shunt-dependent hydrocephalus and, combined with extensive cisternal blood cleansing, can lower the incidence of stroke. A procedure for cleansing blood and clots from the cisterns in HGSAH, based on the pathophysiology of vasospasm, is proposed.
Assuntos
Hipotálamo/cirurgia , Trombose Intracraniana/cirurgia , Microcirurgia/métodos , Hemorragia Subaracnóidea/cirurgia , Espaço Subaracnóideo/cirurgia , Ventriculostomia/métodos , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Artérias Cerebrais/fisiopatologia , Feminino , Humanos , Hidrocefalia/etiologia , Hipotálamo/anatomia & histologia , Hipotálamo/fisiologia , Trombose Intracraniana/etiologia , Trombose Intracraniana/fisiopatologia , Masculino , Estudos Prospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/fisiopatologia , Terceiro Ventrículo/anatomia & histologia , Terceiro Ventrículo/fisiologia , Terceiro Ventrículo/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/prevenção & controle , Vasoespasmo Intracraniano/cirurgiaRESUMO
For the purpose of measuring the extent to which the modern university accomplishes its purposes, the authors have devised an evaluation methodology inspired by the work of the most modern international specialists in the subject. They have applied their methodology first to the system for evaluating medical programs in general and then to a specific medical program regarded as representative of medical training in Chile. Surveys of faculty and students led them to the conclusion that in actual evaluative practice there have been wide deviations from the ideal model, and that the evaluation system could be improved to become an essential component of the process of informing and training the student and to provide feedback to th teaching-learning process.
Assuntos
Educação Médica/normas , Criança , Estudos de Avaliação como Assunto , HumanosRESUMO
Con el proposito de medir hasta que punto la universidad moderna logra sus objetivos, los autores desarrollaron una metodologia de evaluacion, inspirada en los trabajos sobre la materia de los especialistas internacionales mas modernos; la aplicaron primero al sistema de evaluacion de carreras de medicina en general y despues a una carrera concrecta de medicina, consideradas representativas del studio de la medicina en Chile. Las encuestas que realizaron a cabo entre profesores y alumnos les llevaron a concluir que existen desviaciones notorias entre la realidad de la practica evaluativa y el modelo ideal y que es posible mejorar el sistema de evaluacion de modo que forme parte esencial del proceso informativo y formativo del alumno y sirva para retroalimentar el proceso de ensenanza-aprendizaje
Assuntos
Educação Médica , Estudo de Avaliação , Medicina , ChileRESUMO
En Chile la historia del desarrollo de la atencion primaria es fundamentalmente la del consultorio urbano. A este respecto es sorprendente observar como la Declaracion de Alma Ata especifica la Atencion Primaria de Salud en terminos que coinciden total y absolutamente con el modelo y funcion del Consultorio Periferico Urbano desarrollado en Chile desde 1952 por el SNS y con especial enfasis a partir de la decada del 60. De este modo, puede verse un fenomeno de anticipacion historica en Chile dentro del devenir de la salud mundial orientada por la OMS. Esta anticipacion esta siendo evaluada por los autores del presente trabajo
Assuntos
Atenção Primária à Saúde , ChileRESUMO
En Chile la historia del desarrollo de la atencion primaria es fundamentalmente la del consultorio urbano. A este respecto es sorprendente observar como la Declaracion de Alma Ata especifica la Atencion Primaria de Salud en terminos que coinciden total y absolutamente con el modelo y funcion del Consultorio Periferico Urbano desarrollado en Chile desde 1952 por el SNS y con especial enfasis a partir de la decada del 60. De este modo, puede verse un fenomeno de anticipacion historica en Chile dentro del devenir de la salud mundial orientada por la OMS. Esta anticipacion esta siendo evaluada por los autores del presente trabajo