Update on lumbar spinal stenosis. Retrospective study of 62 patients and review of the literature.

PURPOSE AND METHODS: Although lumbar spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis, and treatment. We retrospectively reviewed the medical charts of 62 patients admitted for lumbar spinal stenosis syndrome, and we compared our findings to those in the literature. There were 31 women and 31 men. Mean age was 71.8 years. The most common symptoms were positional radiculopathy (92%) and low back pain (95%). The more suggestive sign of pseudoclaudication was observed in only 75% of cases, in keeping with earlier studies. Neurologic symptoms consisting primarily in mild motor loss were present in 15 patients. RESULTS: The most common physical finding was pain during spinal extension (70%). Adopting a bent forward position during walking, a very suggestive manifestation, was seen in 15 patients. Imaging study findings included extensive changes in the discs and facet joints, disc protrusion, scoliosis, and degenerative spondylolisthesis. Myelography was rarely needed. There are no criteria sets for lumbar spinal stenosis syndrome. The diagnosis rests on clinical grounds, and extensive imaging studies are usually unnecessary. Our patients were treated with repeated corticosteroid injections into the thecal sac or epidural space and/or into the facet joints. Only eight patients required surgery. CONCLUSION: Our study supports the view that most cases of lumbar spinal stenosis can be managed conservatively.

[Comparison between immunofluorescence techniques and ELISA, using whole neutrophil extract and primary granules, for the detection of antineutrophil cytoplasma antibodies (ANCA)]. / Comparação entre as técnicas de imunofluorescência e ELISA com extrato total de neutrófilos e com grânulos primários para a detecção de anticorpos contra o citoplasma de neutrófilos (ANCA).

The detection of antineutrophil cytoplasmic antibodies is a very important tool for the diagnosis of systemic vasculitis. The specificity and sensitivity of these antibodies depends on the assay utilized for their detection. Therefore we have compared the immunofluorescence test (IF) with the ELISA using two different antigens: total neutrophil extract and isolated primary granules. Two patterns of fluorescence were detected by IF: the classic pattern was highly specific for Wegener's granulomatosis. In contrast the perinuclear staining correlated with renal vasculitis but was also observed in other diseases. However the IF test was unable to differentiate low-positive from atypical patterns. Such distinction could be achieved by ELISA. The use of ELISA with isolated primary granules is a good alternative for if since it has a good specificity, sensitivity and reproducibility, moreover it is a quantitative method.

[Antineutrophil cytoplasmic antibodies in systemic vasculitis]. / Anticorpos contra o citoplasma de neutrófilos nas vasculites sistêmicas.

The term systemic vasculitis concerns a group of diseases characterized by inflammation of vessels. The diagnosis and follow-up of these conditions is a serious challenge since their classification is difficult and the therapy is usually empiric. Perhaps the greatest breakthrough in the management of these diseases is the recent discovery of serological markers for some vasculitic syndromes. Wishing to determine how far the tests for detection of these antibodies are specific, sera from 63 patients with systemic vasculitides were tested by immunofluorescence of ethanol fixed neutrophils. Two different staining patterns were observed. The cytoplasmic staining (classic pattern) was very specific for Wegener's granulomatosis. In contrast, the perinuclear staining was also present in many vasculitic syndromes such as microscopic polyarteritis and poliarteritis nodosa. In addition, the sera were tested by ELISA, using whole neutrophil cell extract. Although the assay was less specific than the immunofluorescence, the test was helpful in discriminating between true ANCA and atypical fluorescence patterns. Moreover, high levels of antimieloperoxidase antibodies detected by ELISA in a limited number of patients were exclusively associated with the diagnosis of microscopic polyarteritis or Wegener's granulomatosis with renal involvement. Our data confirm the remarkable association of antineutrophil cytoplasmic antibodies with vasculitic syndromes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Alterations of hemostasis in systemic vasculitis]. / Alterações da hemostasia nas vasculites sistêmicas.

The authors revised the published data on coagulation abnormalities observed in patients suffering from primary vascular diseases or vasculitides associated with systemic diseases of the connective tissue. These patients present a tendency toward thrombosis as a result from platelet activation and endothelial cell injury, together with altered fibrinolytic activity. The proliferative events secondary to platelet activation and endothelial injury remain present after cessation of the inflammatory process and may play a role at the end stage obstruction of the vascular lumen always seen in these diseases.